AGPA History
The American Group Psychotherapy Association (AGPA) was founded in 1943 and has grown to be the most important professional society for group psychotherapy. Read more about the development of group therapy and of AGPA below.
25 Year History
A Brief History of the American Group Psychotherapy Association 1943-1968
By the Comittee on History
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY
Volume XXI October, 1971 Number 4
I. THE ANTECEDENTS AND PIONEERS OF GROUP PSYCHOTHERAPY
DESPITE SOME COLLATERAL DEVELOPMENT in other countries, the roots of group therapy are primarily American. Joseph Hersey Pratt, a Boston internist, worked with tubercular patients at the Boston Dispensary and observed that patients’ emotional reactions, their feelings of shame and discouragement because of their illness, often interfered with their capacity to adhere to self-care regimens. Pratt, therefore, visited patients in their homes at first, but then conceived the idea of having large numbers of patients meet at the hospital to discuss their attitudes, report on their efforts at self-help in dealing with their ailments, and receive instruction from him.
The goal of these groups, initiated July 1, 1905, was to help patients understand the nature of their illness, to teach them how they could contribute to their own recovery, and to inspire them to sustain their courage in living with a chronic ailment. Dr. Pratt’s talks were essentially
• Helen E. Durkin, Chairman, Nathan Cooper, Albert L. Deutsch, Benjamin Fielding, Hannah Grunwald, Jack D. Krasner, Helen Langner, Charles McCormick. Max Rosenbaum. Edgar Ross, and Robert Thorne. Consultants: Milton M. Berger. Aaron Stein, Saul Scheidlinger, Harris B. Peck, and Emanuel Hallowitz.
The Committee gratefully acknowledges the contribution of E. Mansell Pattison in formulating a number of the interpretive components and the concluding reflections that have been incorporated in this summary of the history of the AGPA of an inspirational nature and included readings from secular writers and from the Bible designed to inculcate more wholesome attitudes and an “optimistic view of life.”
His groups were large, consisting of as many as 80 to 100 patients who sat in rows in classroom fashion facing the speaker on the platform. Patients with the best attendance record were moved toward the front. The “star” patients sat on a bench facing the audience next to the doctor. These “Thought Control Clinics” were the beginning of the “Class Method.”
Pratt and his co-workers were impressed by the results of this work, and as a consequence of their experience became increasingly aware of the influence of emotional factors in the treatment of their patients. By 1922, Pratt had extended the Thought Control Class Method to the treatment of diabetic and cardiac patients. Soon, others took up Dr. Pratt’s work. W. R. Emerson working with undernourished children, R. W. Buck with hypertensives, and Chappell with peptic ulcer patients were the most prominent of Pratt’s followers, as well as E. W. Lazell, who, in 1919, applied Pratt’s group lecture methods in the hospital treatment of purely mental disorders. With the support of William Alanson White, then Superintendent of St. Elizabeth’s Hospital in Washington, DC, Lazell, in 1921, began his group “lecture method” of treating chronic schizophrenics on the wards of that hospital. In addition to the ‘exhortation, inspiration, and general supportive techniques used by Pratt, Lazell included frank discussion of patients’ dynamics interpreted along Freudian psychoanalytic lines. This was an early attempt to combine intellectual insights with emotional support in a mental hospital setting. Later, Lazell discontinued the psychoanalytic discussions.
In the same tradition, Cody Marsh, a minister who later became a psychiatrist, carried Pratt’s medical discussion methods to an extreme by de-emphasizing rational understanding and relying on inspiration and exhortation. In 1931, he described his work in the treatment of psychoses in a paper entitled “The Psychological Equivalent of Revival.” He also conducted discussions with hospital personnel at all levels to help them acquire therapeutic attitudes toward their patients, and emphasized what became known as the “total push.” He organized social groups, work groups, and committees, and utilized every possible group activity to involve patients in the realities of living and to encourage them to discuss their problems and render one another mutual assistance.
Marsh also “taught” groups in the general community in which he included hospital patients along with “normal” members of the community. His motto, often quoted, was: “By the crowd they have been broken; by the crowd they shall be healed.”
The authoritarian style of Dr. Pratt was even more prominent in the work of Dr. A. A. Low. He organized “Recovery Inc…. an organization of post-hospitalized psychotic patients. Its purpose was to enable former mental patients to offer each other support in managing their lives in the ordinary community. Each chapter was under the direction and discipline of a patient and his lieutenants who had risen from the ranks. The rank and-file patients were required to have approval of the head of their “chapter” before they could arrive at any decision about their lives or make any move in carrying out their plans. Members of the upper echelon in a rigid hierarchical officialdom were not available to a member involved, except in cases of appeal. Only in extreme instances when all the other officials could not resolve a matter, could the case come before Dr. Low for a final decision. “Recovery” chapters were initiated in Chicago, and the organization has since spread to several Mid-Western states and beyond and are still in operation.
One can characterize both Dr. Pratt’s and Dr. Low’s techniques as “authoritarian,” except that, in the case of Pratt, the approach was inspirational and in Dr. Low’s. repressive. The first employed the image of a father figure to be pleased and rewarded; the other, quite correctly in view of the type of patients dealt with, supplied “ego controls.” Slavson (1959) characterized them as “authoritarian-inspirational” and “authoritarian-repressive,” respectively.
In the early 1930’s, Louis Wender held regularly scheduled meetings with the total patient population of a sanitarium in Hastings-on-Hudson, N.Y. the Hillside Hospital. The pattern of the sessions consisted of all informal talk on Freudian concepts of mental health and pathology, followed by an anonymous case presentation which the patients discussed. He pursued this didactic approach for some years, eventually modifying it somewhat under the impact of the developing practice of small-group psychotherapy. Many years later, convinced that the chief advantage of the group situation lay in its resemblance to the family, he included two and three generations of the same family in outpatient groups he conducted at Beth Israel Hospital in New York City.
Paul Schilder, whose work started in 1936, also adhered to the psychoanalytic frame of reference in his work with several groups at Bellevue Hospital in New York. He emphasized discussions of “body image,” “ideologies,” and attitudes toward self, possession, expulsion, aggression, cooperation, and the like. Dream analysis was also part of the process in his groups.
Another pioneer who needs to be noted is Trigant Burrow, who, having been analyzed by both Freud and Jung, introduced in 1920 what he first named “group analysis” and later called “phyloanalysis.” His groups were predominantly residential. Doctors and patients lived together, and the tensions that inevitably arose from this were reacted to and analyzed or discussed by the group. The terms “group analysis,” “here and now,” and “analysis of group tensions,” now in common use were originated by Dr. Burrow.
In 1934, S. R. Slavson introduced at the New York City Jewish Board of Guardians, a child-guidance clinic, a “creative recreational program” for small groups of socially maladjusted girls. Slavson came from the field of progressive education, an area in which he had made distinct and innovative contributions that brought him to international attention and led to his being invited to join the staff of the noted Malting House School in Cambridge, England. He had also had distinctive experience in social group work in which he had become interested in 1911 when he organized groups on his own in the neighborhood where he lived. In addition to his association with Malting House, he had also been associated with the noted Walden School, the Madison House, and the 92nd Street YMHA in New York, and provided leadership to the Socialist Sunday Schools of Greater New York. Slavson published four books dealing with his work in these areas.
Following his educational convictions, he structured the activities of “the J.B.G. groups along the same lines-use of arts and crafts materials to allow complete freedom of self-expression devoid of any didactic or judgmental elements-clinging to the conviction that self-expression and creativity are the key to human happiness and constructive social adjustment. This seemed to be confirmed by the first group, as the Big Sisters who had contact with the girls reported distinct improvement in the girls’ conduct. The girls grew more outgoing, friendly, and open. As a result, a few more groups were organized, but an exhibit of the girls’ works caused him to doubt that it was the creative element that brought about these results. He then undertook an exhaustive study of the detailed protocol reports of the sessions of one of the groups and came to the conclusion that it was the group interactions (of which he identified eight types) and relations in the permissive environment and the neutrality of the leader-therapist that rendered the salutary results. The suggestion that the project, which was first known as “Therapeutics of Creative Activity,” be called “Group Psychotherapy” was rejected by the Director of the Agency for public relations considerations, and the name “Group Therapy” was adopted.
The project was greatly expanded in numbers of groups and included boys as well as girls, who were treated separately. Because of the non verbal nature of the process, the groups were limited to children in latency, i.e., 8 to 12 years of age, and to eight members.
Betty Gabriel, a social caseworker at the J.B.G., observing the spontaneous play interaction of children. in latency in the waiting room, conceived the idea of having them meet together in her treatment room after supplying them with some of the materials used in the groups inaugurated by Slavson. Mrs. Gabriel (1939) published a significant paper on her observations. Later, this project, greatly expanded, was incorporated with the other groups as a special “Group Therapy Department” under Slavson’s direction, as was also the pioneering work of Fanny Amster, another caseworker at the agency, who reported on her work in “Collective Psychotherapy of Mothers of Emotionally Disturbed Children” (Amster, 1944). The department was later extended to include the treatment of preschool children and adolescents and their fathers and mothers. There were usually between 18 and 24 groups under treatment at any one time.
Among the early workers with small groups along “relationship therapy” lines were Helen E. Durkin and Henriette F. Glatzer at the BrookIyn Juvenile Protective Association, the name of which was later changed to Brooklyn Psychiatric Centers. Their work with children began in 1937 and with mothers in 1938. They were joined by another psychologist, Jeanette Hirsh, in 1944. Dr. John Levy was the Director of the Clinic and later was succeeded by Dr. Lawson Lowrey in 1938 after the former’s untimely death. The Brooklyn Juvenile Protective Association is credited with being the first to utilize group methods to treat parents of disturbed children in their own right, rather than individually as an adjunct to the therapy of their offspring.
In 1938, Dr. Alexander Wolf started a group of ten of his own analysands. He closely adhered to psychoanalytic principles but added to the regular sessions with him what he termed “alternate sessions,” i.e., meetings of patients in his absence. He labeled his method “The Psychoanalysis of Groups,” reviving Dr. Burrow’s original term for his groups. Dr. Wolf was acquainted with the work of Burrow, Shilder, and Wender and had incorporated some of their principles in his technique while departing from them on some grounds. One of the innovations he originated was the method of “going around” in which each patient in the circle was asked to speak about whatever bothered him. By 1942, Dr. Wolf had five groups of patients, one of which consisted of marital couples. Thus, he was a pioneer also in this latter regard.
Samuel B. Hadden was an ardent admirer and pupil of Dr. Pratt. His first acquaintance with his work came while he was still a resident in White Haven Sanitarium through observing, in 1923, the work of Dr. Joseph Walsh. In the course of practice of psychiatry, Hadden became aware of the need of his patients for the type of experience he had observed in White Haven to help them overcome their feelings of being misunderstood and of hopelessness. He delayed inauguration of work with groups until a propitious circumstance arose at the Presbyterian Hospital in Philadelphia, where he was asked to deal with a large group. This was the beginning of Hadden’s distinguished career, not only in group therapy, but in other fields of psychiatric practice. Not having been acquainted with the group developments in New York and a few other centers, his first paper on the subject was entitled “Treatment of Neuroses by the Class Method” (Hadden, 1942). However, two years later in 1944, a paper of his in the American Journal of Psychiatry bore the title “Group Psychotherapy.” Dr. Hadden remains an enthusiastic and leading figure in the promotion of small-group psychotherapy to this day.
II. THE FOUNDING OF THE ASSOCIATION
During the nine-year interval between the inauguration of Activity Group Therapy project and the founding of the Association, Slavson conducted investigations to establish criteria for selection of patients and to analyze the group therapeutic dynamics. He refrained from publishing anything on his work until he could establish sound information adequately validated. In 1938, Dr. Lawson Lowrey, founder of the American Orthopsychiatric Association and editor of its Journal, was engaged by the J.B.G. to evaluate Slavson’s work. Lowrey brought in a very favor able report; and Lowrey and Slavson became important persons in the informal channels of communication between the small number of group therapists and the professional community. Lowrey became a major sponsor of group therapy, and as editor of the American Journal of Orthopsychiatry, he opened its pages to the new movement.
The American Orthopsychiatric Association conference of February 1943 devoted two sessions to group therapy. With Lowrey’s approval, Slavson chalked a note on the blackboard at the conference registration desk inviting those specifically interested in group therapy to attend a luncheon at the Hotel New Yorker where the conference was held. About 50 people attended. Another luncheon meeting, similarly announced at the A.O.A. conference in Chicago, attracted 100 persons. It was decided at the New York meeting in 1943 to create a group therapy organization.
The first meeting took place on June 16, 1943 at the J.B.G. The general aims and purposes of the new organization were decided upon, and the following steering committee was elected to draw up a constitution and make plans for a formal organization: Dr. Nathan W. Ackerman, Mr. Saul Bernstein, Miss Elizabeth Hobbie (representing Dr. Lowrey), George Holland, Dr. G. Pederson-Krag, Dr. Harris B. Peck, and S. R. Slavson. The latter was asked to prepare a draft for a constitution.
On November 16, 1943, a second organizational meeting was held. About 20 people attended, approximately half of whom were on the J.B.G. staff. The hard-core group of original founders consisted of 20 to 25 interested individuals. Most of them were at the meeting. The Steering Committee presented its constitution, which was discussed point by point, revised accordingly, and adopted. In brief, this constitution specified the following: the purpose was to promote interest in group therapy and coordinate and clarify the efforts of those involved in its practice and theory; dues were to be $3.00 a year; the membership was to make all decisions; officers were to be a president, a vice-president, secretary and treasurer (these latter two offices could be held by one person); each officer was to be elected for a two-year term by a majority mail vote; a Nominating Committee was to be elected at the annual membership meeting to draw up a roster of candidates for officers and an Executive Committee, said Committee to be elected to carry out the policies and business of the Association. The constitution further provided for four standing committees to be appointed by the Executive Committee: (I) Membership and Publicity, (2) Research, (3) Publication, (4) Education. Constitutional amendments were to be voted upon by mail and required two-thirds of the votes for ratification.
The constitution also specified the qualifications for membership. Since these qualifications were under constant scrutiny and gave rise to many heated discussions, they are quoted here exactly as set forth in the original ‘constitution: (a) Psychiatrists who, in addition to meeting the requirements of their profession, have had three years’ experience in psychotherapy. (b) Psychologists and psychiatric caseworkers who, after graduation from a recognized school in their respective fields, have had at least three years’ experience in psychotherapy under approved supervision, with psychiatrists participating. (c) Persons who have not had the above specified educational training but who have had five years’ experience in psychotherapy, some of which must be in the actual practice of group therapy, under approved supervision with psychiatrists participating. (d) Persons with unusual gifts, knowledge, or experience who have made a distinct contribution to the practice or theory of group therapy.
The inclusion of persons other than practicing group therapists was essential to the formation of an association, since so few had practiced it at that time. However, care was taken to open membership only to persons who by training and experience in psychotherapy would be qualified to add group therapy to their practice. Opening to them the opportunity for exposure to the theory and reports of experiences by practitioners, it was hoped, would induce them to do so. Qualification (c) applied to a number of practitioners drawn from other professions many of whom worked as volunteers, as was the Case at J.B.G.; (d) was intended for a small number of individuals who fitted this description, because of the newness of group therapy at the time the qualifications were formulated. Later, a fifth category, (e) was added, “associate membership:’ for persons who, because of their position “can help the development and spread of group therapy.” This category was designed for professional persons in administrative capacities such as heads of social service agencies, clinics, hospitals, and institutions who had the power to include group therapy in their services. In a sense, then, the A.G.T.A. was a combination of professional competence and professional interest, a policy that was necessitated because of the prematurity of the Association’s founding. In time, however, as the number of practitioners grew, categories (c), (d) and (e) were eliminated.
With the constitution accepted, the group authorized the Steering Committee to carry out all the immediate business; to continue as Executive and Membership Committees until the first annual meeting; to appoint a Nominating Committee to prepare a slate for the January meeting; and to develop a program for the first Annual Conference to be held in conjunction with that meeting, January 14 and 15, 1944.
The Steering Committee did as directed. They elected a Nominating Committee, established a mailing list, sent out invitations to those eligible for charter membership, and planned the Conference to be held at the Russell Sage Foundation, January 14 and 15, 1944.
The first Annual Conference dealt with various practices of group therapy and consisted of two sessions: Friday evening, 8 to 10 P.M., a general session, and Saturday morning, 10 to 12 noon, three round tables, with summary reports given from 12 to 12:30 P.M. More than 170 people attended the Friday session, an encouraging omen for an association which did not even officially exist as yet. Only three New York child-guidance centers and one from New Rochelle were represented. Dr. George S. Stevenson, Medical Director, National Committee on Mental Hygiene, was chairman. Among the other participants who acted as chairmen and discussants were Drs. Lawson Lowrey, Nathan Ackerman, Johann Van Ophuijsen, Louis Wender, Giles Thomas, Temple Burling, Alexander Wolf, and Louis R. Wolberg.
The first annual membership meeting was a luncheon on Saturday, 1 to 3 P.M., January 15, 1944. Of the membership of 60-41 actual members and 19 pending-about 20 attended. Most of the 20 had also attended the November organizational meeting. The constitution was presented and accepted. Mrs. Glatzer then presented the slate prepared by the Nominating Committee: (1) Officers: President, S. R. Slavson; Vice-President, Dr. Lawson Lowrey; Secretary-Treasurer, George Holland; (2) additional elected members of the Executive Committee were Dr. Temple Burling, Dr. Kenneth Wollan, Dr. Caroline Zachary, and Fern Lowrey of the New York School of Social Work. The slate was later unanimously approved by mail vote. The Steering Committee was dissolved, and the officers and the other members of the Executive Committee took over the directorship of the Association. The organization did not change its name to the American Group Psychotherapy Association for some years.
III. THE EARLY YEARS, 1944-1947
The Executive Committee decided to meet four times a year and appointed an Administrative Committee to act during the interim periods. In effect, the Executive Committee began to function as a Board of Directors, i.e., it formulated policy but delegated to the Administrative Committee responsibility for the day-to-day conduct of the affairs of the Association and for identifying policy issues and recommending specific policies and programs. The Administrative Committee consisted of Pres. Slavson, Vice-Pres. Lowrey, and Sec.-Treas., Holland. However, in 1946, on the day that Dr. Temple Burling took over as the second president, the Executive Committee appointed a new Administrative Committee: Ex- President Slavson was renamed Chairman and Burling became a member ex-officio, Throughout the first decade, each succeeding president was on the Administrative Committee, but Slavson continued to be re-elected chairman.
This Committee conducted the business of the Association on a day- to-day basis during the early years of the organization. That Slavson was retained in the chairmanship of the Administrative Committee was in recognition of his enormous stake in the development of small-group psychotherapy and his ceaseless efforts to promote the work of the Association. Between 1943 and 1956, the A.G.T.A. operated from his personal office at J.B.G. He handled all the domestic correspondence and, after the war, the correspondence with almost 50 foreign countries. George Holland was assigned the bookkeeping chore, handling the finances and physical arrangements for the conferences. A glance at the Association’s early financial reports indicates that the paltry sums from dues, conference registration fees of $1 inaugurated in 1947, and the sale of publications could not have covered office rental or staff salaries. Slavson has said: “Without the generosity of the Jewish Board of Guardians in supplying the Association with office facilities, secretarial service, and actual costs of mailing, our small band of members would have been hard put to get off the ground with our projects during those early years.”
In March 1946, dues were raised to $5.00, and the Administrative Committee was increased from four to six members.
The Educational Committee, under its first Chairman, Dr. Nathan W. Ackerman, arranged a series of monthly discussions for members only which met at the J-B.G. headquarters. In fact, all meetings of the Board and Committees met at these premises gratis. The topics explored included various methods of group treatment, the role of the leader or therapist; etc. While these discussions were no doubt valuable to those participating, attendance was very low and the meetings were soon dropped.
The Committee also arranged the program for the second Conference, which was held January 12th and 13th, 1945, and dealt with the process of treatment in group therapy. This Conference attracted an attendance of about 400 persons, an impressive increase over the preceding year. The program consisted of two sessions. Since there were so few group psychotherapists available, the Friday evening session was devoted to group treatment of preschool children, group treatment of adolescents, and group treatment of combat neurosis. Saturday morning was given over entirely to one case treated in activity group therapy and discussed from the points of view of group therapy, psychiatry, and casework. The meeting was followed by a business luncheon for members at a nearby hotel.
The fourth page of this four-page program carried announcements of the publication by the Association of three symposia, each of about 40 pages, selling at fifty cents, and reprints of shorter separate articles by Ackerman and Slavson. Charles G. McCormick, one of the earliest members of the Association and a part-time group therapist at the J.B.G., had published a short paper on “Group Work versus Group Therapy” which was reprinted and widely circulated at ten cents a copy. This was done in anticipation of a possible invasion of the Association by social group workers or club leaders. A conflict on this score later broke out.
It is clear from the nature of the Conference and the publications that the task of those early years was to educate members of the related professions as to what group psychotherapy was and point up some of its elements and dynamics. No sound basic body of knowledge was then in existence. Those few who practiced it did so on the basis of their own hunches, as it were. The Conference programs, therefore, had to have the best available people invited to present papers. To prevent misunderstanding and misconceptions, each paper was discussed by an acknowledged leader in the psychotherapy field, and long periods for audience participation were provided.
The third Annual Conference, on clinical applications, was equally successful. It was held on January 4th and 5th, 1946. The registrants came from twelve states. A number of agencies, especially from the Middle West, underwrote the travel and Conference expenses of their staff who attended. The membership of the Association having been increased as a result of the preceding Conferences and the wide publicity they had received by mail and in the press, the Conference locale was accordingly altered. It was now moved to the prestigious Commodore Hotel. (No rent for meeting rooms was involved; the price of the luncheon seemed to cover it in those days.) The Friday evening and Saturday morning plenary sessions dealt with the specifics of group psychotherapy with preschool children, character disorders, speech disorders, social maladjustments, neurotics, psychopathic personalities, delinquents, and psychotics.
The afternoon was given over to two presentations of cases, one in Relationship Therapy by Durkin and Glatzer, the other in Interview Group Therapy. (The term “Interview Group Therapy” was introduced by Slavson to distinguish it from his original technique, which he now dubbed “Activity Group Therapy.” Later, he discarded this term as well and substituted “Analytic Group Psychotherapy,” which became the title of one of his books published by Columbia University Press in 1950.) All the papers and case presentations were by caseworkers and psychologists, with psychoanalysts serving as discussants. A third round table chaired by Lt. Comm. Howard Rome, “Group Psychotherapy with Military and Post-military Problems:’ had five psychiatrists as discussants. The number of participants in the program almost quadrupled to 20, of whom six were members of psychoanalytic societies.
The fourth Annual Conference in 1947 was held at the Hotel New Yorker, with papers presented on a variety of subjects, including group treatment of mothers, of adolescents, of sibling rivalry, and of allergies, the private practice of group treatment, and the training of group therapists. Again, the basic material was presented by nonmedical therapists while the discussions remained in the hands of medical men. This time not only were several states represented but, in addition, a number of individuals from foreign countries–Turkey, England, Belgium, Holland, and others–attended.
In 1946, Slavson and his secretary prepared the first bibliography on group therapy, which was published by the Association. It included 140 listings, of which 105 had been published during the preceding five years, a clear indication of the burst of interest in group therapy during 1940-45. It is interesting that there was not one listing bearing the title “Group Therapy” or “Group Psychotherapy” before 1934. There were titles such as “The Group Treatment of Dementia Praecox” (Lazell. 1921); “The Group Method of Analysis” (Burrow, 1927); “Brief Study in Trigant Burrow’s Group on Phyletic Method of Behavior Analysis” (Gait, 1933). In 1931, Marsh published a paper entitled “Group Treatment of the Psychoses by the Psychological Equivalent of the Revival,” but in 1935 his paper was entitled “Group Therapy and the Psychiatric Clinic.”
Seventeen of the 105 papers listed in this early bibliography had been authored by Slavson. The next largest contributor was the late Paul Schilder with four papers, followed by Joshua Bierer of England, and Lawson G. Lowery with three papers each. The only book on the subject of group psychotherapy was Slavson’s An Introduction to Group Therapy, published in 1942 and dealing with what later became known as “Activity Group Therapy.”
In all, the A.G.T.A. issued 36 brochures. The second bibliography was prepared by Slavson, Emanuel Hallowitz, and the office secretary, No. 32 in the series of brochures, and was issued in 1950. An additional volume was compiled by Dr. Norman Locke. No further bibliographies have been issued since; instead, publications have been listed annually in the Journal.
In 1947 International Universities Press published The Practice of Group Therapy. This book, edited by Slavson and consisting mostly of papers delivered at the Conferences of the Association, was in three parts: “General Principles,” “Activity Group Therapy,” and “Interview Group Therapy.” Dr. Nolan D. C. Lewis contributed an introduction, and the late noted psychoanalyst, J. H. W. Van Uphuijsen, wrote the last chapter, “Plan and Phantasy in Group Therapy.” The book was available for purchase at a reduced price to A.G.T.A. members.
Beginning in January 1945, a “Bulletin,” written, mimeographed, and mailed by Slavson, was issued periodically to the membership. The content was largely drawn from his vast correspondence and detailed activities in the field of group therapy in the United States and abroad, which were presented in a breezy style designed to keep interest going until a formal professional journal could be established.
The issue of membership qualifications created a minor crisis in the organization in the second year of its existence. One faction felt that requirements should be relaxed to include social group workers without psychiatric training, while another faction held that formal training in psychotherapy was a prerequisite to the practice of group therapy. At the second annual business meeting, after intense discussion the matter was tabled. The issue again arose at the annual meeting in 1947. Dr. Burling, the incumbent president, strongly supported relaxation of standards, and the issue was referred to a committee which brought in a negative motion.
During the heated discussions on the floor of the annual meeting which ensued, Dr. Burling scribbled his resignation on a piece of Hotel New Yorker stationery and left the podium. The resignation, which he failed to sign in his haste and probably also anger, can be found in the book of minutes, along with an amplifying statement of his position. In the latter, he says: “… Last night the Dean of this Association told us there is no such thing as Group Therapy-there is only psychotherapy. If that is the majority opinion of the membership, it is dishonest to continue to use the present name of this Association. It should be named ‘The Association for Multiple or Simultaneous Psychotherapy’….” Dr. William M. Doody was elected by the Board, as was provided in the bylaws, to fill Burling’s unexpired term.
Lawson Lowrey supported Burling, while Slavson, McCormick, Ackerman, Friend, and others were strongly against relaxation of standards. The latter prevailed, and the A.G.T.A. was more firmly committed than ever to its original membership qualifications, which included training in psychotherapy as a requisite.
The development of a training facility for group therapy was another issue of early concern to the organization. In January 1945, the membership confirmed the Executive Committee’s decision to proceed with a training program. Because of postwar pressures, many agencies in the New York area could not release their staff for such training, however, and later it was decided that it was improper for a professional organization to conduct training of personnel. Slavson then formed a committee of agency executives and announced an extensive training seminar in Activity Group Therapy. Agencies from three states responded, New York, New Jersey, and Connecticut, and in 1945 he gave the seminar at the New York School of Social Work. The A.G.T.A. endorsed the seminar but did not sponsor it.
By 1947 enough money was available to vote the Secretary an honorarium of $25.00 a month and to allocate $500.00 for publication and mailing costs. Membership growth was steady. On December 1, 1947, there were 187 members, with 16 applications pending. The Association had started four years earlier with 41 members and 19 pending applications.
IV. THE YEARS OF EXPANSION, 1948-1960
The cumulative effect of the preceding five years’ activities became tangibly apparent in 1948 when an era of accelerated expansion set in which required administrative reorganization. This period saw also a sizable increase in membership, in activities, and in noteworthy accomplishments. Slavson’s suggestion for setting up local study groups of practitioners to advance their knowledge and improve practice turned into regional and local affiliate societies. The first of these was the New York City group, which called itself “The Eastern Group Psychotherapy Society,” with Dr. Max Rosenbaum as its president. By 1968, the affiliate societies numbered 15, in addition to five Latin American national societies and one Canadian society.
Regional and local representatives were added to the Membership Committee, and several years later, under the leadership of Dr. Milton M. Berger, they were added to the Board. The position of secretary was separated from that of treasurer in 1948, and a standing committee on Public Relations was formed. In 1949, several other committees were added to deal with the expanding affairs of the Association. Most were exploratory and ad hoc, not requiring constitutional changes. When a committee’s work proved fruitful, the constitution was amended to make it a permanent standing committee.
The growth of the Association was reflected also in its professional sector. The 1948 Conference, for example, was extended to two full days. One day, Friday, was devoted to group psychotherapy in various institutions. Registration was limited to institutional staff only. Thirteen papers were presented during the morning and afternoon sessions. Friday evening and all day Saturday were given over to a general conference open to all professionals. Dr. S. H. Foulkes of London, England, whose visit to the United States was arranged by Slavson, opened the discussion at the Friday morning session and presented a paper at the evening session. Twenty-five presenters, chairmen, and discussants took part in the general sessions, among whom were Drs. Thomas A. C. Rennie, John A. Millet, Nolan D. C. Lewis, and S. Bernard Wortis.
Mr. Slavson, in his efforts to involve the psychoanalytic profession in group therapy, arranged for Dr. Foulkes to address psychoanalytic societies in four cities on the eastern seaboard, including the New York Psychoanalytic Society. Because Dr. Foulkes was a training analyst of the London Society, he was granted the courtesy of appearing before these American groups.
The late Dr. Wilfred C. Hulse and Mr. Slavson attended the First World Conference on Mental Health held in London, also in 1948. The interest shown in group therapy there encouraged them to suggest a regular publication for the Association. Thus, the first suggestion for a journal was made that year. The suggestion was repeated twice more with no action taken until an ad hoc committee was appointed by President Loeser in 1949, consisting of Drs. Hulse and Peck and Mr. Slavson. After more than a year’s inactivity of the Committee, Slavson single-handedly went to Prof. A. Kagan of the International Universities Press and consummated a five-year contract with the assistance of a lawyer, Joseph A. Levine, a former pupil of Slavson who donated his services.
The journal, a quarterly which was named with the approval of the Editorial Committee, The International Journal of Group Psychotherapy, was to consist of 112 pages, later it increased to 124 pages. The membership ratified the contract at its general meeting in January 1951, and advanced the dues from $5.00 to $10.00 in partial defrayment of the cost of the annual subscription of $6.00 to members. A ballot with a statement of the decision was mailed to the members as provided in the by-laws. A majority voted in favor. In a paper on the history of group psychotherapy presented at the Annual Conference in 1965, Slavson, speaking of the prematurity of organizing an association in 1943 and the inchoate nature of its membership, said in part:
The secondary gain from the publication of the Journal was the separation of the sheep from the goats. Although the various membership committees had been meticulous in rigidly applying membership qualifications to applicants seeking to join the Association, these qualifications of necessity could have been specific only as regards education and training. There were very few actual practitioners extant at the time to form an association of any effectiveness and the qualifications were limited to professional education in related professions, for it was not until 1964 that actual experience in group psychotherapy as a requirement for membership was imposed. Because of the earlier insufficiency of practice qualifications, the membership committees in preceding years had approved 450 members. However, when the membership fee was raised from $5.00 to $10.00 to cover the cost of the Journal, no less than 193 individuals did not renew their affiliation. There was thus a loss of 41% of our then current membership.
The first issue of the Journal appeared in April of 1951. Dr. Charles G. McCormick was to be editor, but finding himself unable to undertake the task, withdrew his acceptance. Mr. Slavson stepped into the breach and prepared the first issue. He was then asked to continue the editorship of the publication and did so for ten years.
In 1953, a list of contributing editors from the U.S., and eight European countries, and Brazil was added. In 1959, after Slavson’s 16 weeks of lecturing and teaching in seven European countries and the second International Congress on Group Psychotherapy in Zurich in 1957, 25 “corresponding editors” were added from as many countries on four continents. In most instances, they were the leading psychiatrists and psychotherapists in their respective countries. In 1961, Dr. Harris B. Peck succeeded Mr. Slavson as editor, the latter continuing in the capacity of “Consulting Editor.” Between 1951 and 1960, Samuel B. Hadden served as chairman of the Editorial Board and later as “Advisory Editor,”
The publication of the Journal and the change in the J.B.G. administration which deprived the Association of such services as meeting mailing costs brought financial strain to the Association. (Also, due to the increased work in connection with the Journal, the honorarium of the Association’s secretary was raised to $50 a month.) Some years before, unspent money had been deposited in a special “publications fund,” which now consisted of $500, and this sum was made available. Nonetheless, the fiscal needs were not completely met by this, and several members of the Board, including President Loeser, contributed $100 each. This was repeated the second year of publication as well.
By 1954, the Journal was widely read. Its circulation increased, and it received professional acceptance as a scientific publication of high quality. It also attracted applicants for membership. The Journal seemed to give the Association a distinct identity and lift.
The year 1952 brought other changes. A constitutional amendment provided for a President-Elect, who would automatically assume the office of President upon the expiration of the incumbent’s term; said President- Elect was to serve as a member ex-officio of all standing committees. Before the end of 1952, incorporation was completed under the membership incorporation laws of the State of New York. At Hadden’s suggestion the name was changed from the American Group Therapy Association to the American Group Psychotherapy Association, thus definitively acknowledging the Association’s commitment to psychotherapy as contrasted to other uses of groups for helping people, which the previous title may have suggested, though not intended.
At the annual meeting in 1953, modifications in membership qualifications were recommended and approved; they became official constitutional amendments by subsequent mail vote. Principally, a category of “Associate Membership” without franchise was established. The issue of Associate Membership had been under consideration from the beginning. The question had been brought up again and again, referred to the Membership Committee, etc. Now, finally, the question was resolved. The dues were $10.00 a year for both Full Members and Associates. The latter could be advanced later to full membership when they had met the requirements. Consequently, the new category provided an immediate source of additional income and a potential pool of additional Full Members. A “Fellowship Class” was added the following year to give recognition to those members who had made distinctive contributions to the field of group psychotherapy and to the Association.
Though there had been a Committee on Standards and Training as early as 1947, it was not until 1952, when Helen Durkin became Chairman, that the Committee really began to function. In October 1953, Dr. Durkin’s Committee submitted a report which made the point that A.G.P.A. was neither a certifying nor qualifying association, but rather a membership association designed to advance the application of group psychotherapy. The Committee “recommends the adoption of these ‘standards’ for anybody interested in adequate training and for any organization that wants to provide a training program in group psychotherapy.” The report then specifically outlined: “I. Qualifications for candidates for training, and II. Standards for training, including facilities, curricula, and supervision.” However, after careful study and debate Item I of the Standards and Training report was adopted and Item II was tabled.
In the fall of 1954, a subcommittee of the Executive Committee, under the chairmanship of President-Elect Hugh Mullan, presented recommendations for the revision of the administrative structure of the Association, including an overhaul of the constitution. These recommendations were designed to create a more effective organization, but they also seemed to reflect an attempt to open the Association to therapeutic ideologies markedly different from those (essentially of psychoanalytic orientation) that had guided the Association from its inception and that reflected the prevailing practices in the field in the U.S. and abroad. A comparatively small, highly vocal group of members which included President Mullan and Drs. Berger, Beukencamp, and Rosenbaum, were inclined to existentialist and “non-transferential” therapy. This schism in basic ideology of therapy generated extreme tension among those who carried the responsibility for guiding the Association. Although they continued to work together, this created many problems which came to a head some five years later.
The Conference programs kept pace with the growth of the membership and the prestige of the Association. The listing of the activities of the 1955 program, for example, filled six pages instead of three as in previous years. It was in 1955 that “Workshops” were introduced at the Annual Conferences. Four were held that year, dealing with “multiple therapists,” “first session,” “private practice,” and “resistance.”
The 1957 program grew to eight pages and three full days, January 10, II, and 12, and was preceded by the “First Training Institute,” an all-day small-group intensive educational experience. This proved a pivotal event in the life and growth of the Association. From modest beginnings the Institute has steadily grown under the ardent devotion to the project of Drs. Jay W. Fidler, Maurice E. Linden, and especially Milton M. Berger, who carried the full responsibility for the project. From an academic staff of 16 that first year, it grew to 44 in 1968. There were demurrals voiced at the name of “Training Institute” as misleading, and it was decided to omit the term “training.” Thus, the Institute became known merely by the single word title.
With the years, an increasing number of medically trained psychotherapists presented original papers instead of serving as chairmen and discussants. In 1955, for example, of the 42 persons who led workshops and presented papers, 31 had the insignia of M.D. after their names. A similar number, 32, were among the presenters and leaders in 1956. The increase in the medical profession’s interest in group psychotherapy, as well as much of the proliferation of the field, can be laid to the war years. Many physicians, as well as psychologists and social workers, in the armed forces were pressed into working with “battle fatigue” soldiers under the supervision of trained psychiatrists. Many of them continued group practice upon their return to their home bases, becoming professional heads in social service agencies, child-guidance clinics, and hospitals, especially those that served war veterans, and thus expanding the operational field for group psychotherapy and enhancing community mental health.
In 1958, several new features were added to the pattern of the Conferences. The Institute was extended to two days; the first research seminar was held under the leadership of Dr. Frank; a dinner dance was held; and a panel discussion; led by Dr. Carmichael, Chairman of the Committee on Affiliate Societies, on the development, growth and programs of the affiliate AG.P.A organizations, was held. There were at that time six domestic affiliate societies and seven in the process of formation. The Argentine Association of Psychology and Group Psychotherapy was the lone foreign affiliate at that time and was the outgrowth of a series of meetings by Slavson with Latin American delegates to the First International Conference on Group Psychotherapy in 1954 in Toronto, with Dr. Seguin of Peru acting as interpreter.
If 1948 was the beginning of expansion of the Association, 1957 marked a period of explosiveness. There were a number of contributing circumstances and events. First and foremost was the fact that due to Mr. Slavson’s retirement in 1956 from the J.B.G. after 22 years of affiliation, the Association was forced out of its material dependence on it. New quarters and new office staff had to be found. The records of that time show that Slavson approached several social service agencies and mental health clinics with no success. Quarters were then acquired at the Carnegie International Center as a subtenant of a mental health agency, and a part-time secretary was engaged. This greatly strained the resources of the Association. At the 1956 Conference dinner, Slavson privately left a check with Dr. Linden for $250 on condition that it be matched by donations from the diners. Linden, in his inimitable manner, did better than that. He raised enough from the floor to make up a stake of more than $1,100. The deficit for 1957 was estimated to be $2,000 of a budget of $4,500.
When the landlord-agency found it needed the space occupied by the A.G.P .A, President Mullan rented an office in the New York Academy of Medicine building in which the Association was quartered for a brief time. Finally, offices were located at the present location, 1790 Broadway, in one small room, and after finding part-time secretarial help unsuitable, a full-time administrative secretary was engaged.
Having a separate office and especially the full-time services of staff made possible many activities that could not be undertaken as a sideline in a very busy office with only one secretary as was the case at the Jewish Board of Guardians. This was the main reason why the participation in the Conferences had remained invitational and the number of committees were held to a minimum, as were also their meetings. The functions of the committees were predominantly policy-making and project-planning, with implementation carried out by the J.B.G. staff. Certainly, an enterprise like the Institute with the vast amount of details involved for. Dr. Berger and Dr. Fidler made full-time help essential. However, one cannot overlook the spirit of enterprise and originality in the promoters of this and other new projects that were instituted by the then new administration under the leadership of Dr. Hugh Mullan.
Dr. Max Rosenbaum, chairman of the Membership Committee, had succeeded in notably increasing the number who joined the Association largely, though not entirely, from the psychological profession. The popularity of the Institute, the more extensive promotional efforts, and the greater involvement of the committees, as well as the activities of the local and regional societies between the national Conferences, played a part in the numerical growth of the Association and its activities. All of this could not have been managed as an aside in the J.B.G. setting. Thus, the loss of the J.B.G. hospitality, which seemed at first a calamity, proved to be a boon. The Journal, as well, was of a significant value in attracting membership. Not only did its content bring to attention the scope and value of the practice, but it created an image of the Association of worthwhileness, solidity, and permanence.
As a result of the many contacts Dr. Hulse and Mr. Slavson had made in Europe and South America and the almost 12,000 pieces of the Association’s publications mailed free of charge to almost 49 countries in the past years, Hulse and Slavson, with the cooperation of Dr. Stevenson; made plans for an International Conference on Group Psychotherapy for 1954 in association with the Third International Conference of the World Mental Health Association in Toronto, Canada. The program for it was published in the International Journal of Group Psychotherapy and included a printed announcement, but conflicts arose with the American Society for Psychotherapy and Psychodrama, which subverted the plans, and to spare the W.M.H.A. embarrassment, a unified conference was arranged.
The events in 1954 presaged continuing difficulties in developing an international body representing group psychotherapy. There have continued to be conflicting theoretical ideologies as well as professional, organizational, and personal divergencies. Thus, although there are now group psychotherapy associations in many European and South American countries, they remain relatively out of touch with each other. The natural problems of communication have been compounded by the rapid growth of group methods and techniques in the United States which have developed with different emphases from some other countries;
In 1956, a revised set of by-laws were approved by mail vote and became effective March 1, 1956. These included five classes of membership (a) Members, (b) Fellows; (c) Associate Members, (d) Life Fellows and Life Members, (e) Honorary’ Fellows and Honorary Members. The governing body now became a Board of Directors with the following officers: President, President-Elect, Secretary, and Treasurer. The Vice-Presidency was dropped. Also on the Board were: the chairmen of standing committees, the retiring president for a two-year term,’ and elected members, ‘the latter to exceed by four the number of nonelected members. The Executive Committee- consisting of the President, President-Elect, Secretary, Treasurer and any other members of the Association as designated by the Board- was to act for the Board between meetings.
In addition to the Executive Committee, the original four standing committees had been expanded into the following nine: Membership, Program, Institute, Budget and Finances, Publications, Research, Public Relations, International Aspects of Group Psychotherapy, Affiliate Local and Regional Societies and Affiliate Associations from countries in the Western Hemisphere other than the U.S. The Program Committee was to be responsible for the annual Conferences.
When the A.G.P.A. embarked upon the year 1960, it had its fourth paid Administrative Secretary in three years and was located in its third office since leaving J.B.G. and had evolved a somewhat overwhelming structure of many committees, paid personnel, and a publication of its own. All this required money and space to function, and coordination of its various activities. By 1960, the budget was ten times that of 1948 and was still in the process of trying to catch up with itself. Much work remained to be done in solving the deficit problem and in putting the administrative pieces together so that the machinery would run smoothly and easily. That the organization survived and flourished was a tribute to the integrity of the founders of the Association in preserving the professional character of the still new method they had sponsored.
V. THE MATURING YEARS, 1960-1968
Only as a profession acquires some stable maturity can it tolerate and then actively promote the ferment of ideas. In fact, maturity of a profession may be roughly assessed by the degree of responsible interprofessional debate active in a profession. The years since 1960 reflect such growing maturity,
There has been a significant shift in the Association which perhaps is not unique to it but part of the larger ideological shift that has been occurring in the entire mental health field. Thus, in the early years of the Association, the discussion and writings of the leaders were concerned with the application of knowledge of human behavior gained from individual therapy to group settings. Much of the early disagreement focused on the priorities of attention to be given to the individual and to the group. Such debate has given way to larger concerns which involve the awareness of social systems and the interpersonal variables involved in mental health and mental illness. The early dichotomies between group therapy and individual therapy have yielded to new conceptual systems that embrace the whole social process of illness and treatment and the system of mental health care.
The early concerns of the pioneers in group therapy. which stressed the unique contributions of group therapy, have been replaced by a concern for the role and function of a variety of group treatment approaches that can be fitted into their appropriate place in the entire mental health enterprise and are suited to the specific pathological syndrome of each patient. This is not to say, however, that these facets were not recognized long before, almost in the early years of the movement. It was this recognition that was epitomized in the gradation and typing of groups as counselling, guidance, and psychotherapy. It was also early discovered that groups for particular patients can be total, parallel with individual treatment, or designed to taper off treatment. The bone of contention was, however, what constitutes the essence of psychotherapy.
The widening vistas of group psychotherapy, encompassing areas beyond clinical frontiers, were reflected in 1968 when the incumbent President, Clifford J. Sager, in an address to the Association, called attention to the social and political relevance of the lessons to be derived from group experiences and group theories. Further, Sager and the Board of Directors formally moved to set committees to work on relating the activities of the A.G.P.A. to related group methods and professional groups involved in group enterprises. In this connection, attention needs to be called to the symposium at the 1955 Conference on “Application of Principles of Group Psychotherapy to Education, Industry and Government,” and to Slavson’s (1956) chapter in The Fields of Group Psychotherapy entitled “(Group Psychotherapy) in Community Mental Health.” During the 1950’s both the Annual Institutes and Conferences have grown in attendance and influence. Combined attendance now surpasses 1000 persons each year, with many non·A.G.P.A. members in attendance.” After successful trials in Washington, San Francisco. and Chicago, a significant decision was reached in 1968 to hold two out of every three meetings outside New York.
Membership has grown steadily, with just about 2,200 members in 1970, an increase of nearly 900 in an eight-year period. In 1958 there were seven affiliate societies, ten in 1961, and 16 by 1970, plus six foreign affiliate associations. The affiliate societies have grown in strength and influence in the 1960’s. Most of them are strong professional groups, conducting extensive training programs.
The affiliate societies have increasingly sought a voice in the executive affairs of the Association. Maurice Linden, President in 1960-61, invited the affiliate societies to participate in meetings of the Board of Directors with voice but not vote. A by-laws revision in 1961 established the policy that affiliate presidents would be “privileged to take part in discussion, serve as consultants, function in an advisory capacity, offer debate and information, and communicate the wishes of the local organizations.”
Under the chairmanship of Milton M. Berger, the affiliate societies have come to play an important role in helping to decentralize the northeast hegemony of the Association and bring new national leadership to the fore. Each affiliate society now names a representative to the Affiliate Societies Committee; each affiliate society may also send its president to the regular meetings of the Board of Directors. The Association, by partial reimbursement of travel expenses, has encouraged this wide geographic representational voice in the affairs of the Association.
From the beginning, local and regional societies have struggled with the problem of membership. At times, they have pressed for the right to admit to membership colleagues not fully able to meet the requirements for membership of the parent Association, needing such members to have organizational strength and resources locally, they claimed, as well as wishing to share officially with local colleagues mutually useful knowledge. In a field proliferating in as wide and rapid a fashion as that of group therapy, the leaders of the Association felt it necessary to maintain a strong stand to block such efforts to weaken or undermine the basic requirements for membership in the Association.
The Board of Directors was constantly concerned throughout the years with the need to heighten the requirements for qualifications for membership in AG.P.A and its local and regional societies rather than to lower them. It was also engaged in encouraging the development of an increasing number of societies and centers which could offer adequate training in group psychotherapy to interested colleagues clamoring for such postgraduate training to meet the increasing demand for mental health services of all kinds on all levels in their communities.
On October 6, 1963, the AG.P.A. Board of Directors at its regular meeting- attempted to deal officially with this problem by communicating that only qualified members, associates, and fellows of the A.G.P.A. could be accepted as members of the local and regional societies but that “this does not preclude local and regional societies from developing auxiliaries, friends, or supporters.” It was hoped that this suggestion, which had, in fact, been developed by some local groups, would allow nonqualified professionals to remain involved with an affiliate society and to be invited to attend some of the affiliate’s professional meetings and training experiences while not being members or having voice or vote in the affairs of any official A.G.P.A local or regional society. This statement was officially made after years of difficulties arising from the fact that locals and regionals, either knowingly or unknowingly, wittingly or unwittingly, had somehow managed to have on their roster of membership people who were not members of the A.G.P.A
The question of membership has been complicated by the fact that increasing numbers of professionals are using group skills, such as educators, nurses, ministers, probation and parole workers, etc., not directly related to treatment per se. Further, the development of community mental health programs has spawned utilization of nonprofessionals and indigenous .mental health and social rehabilitation workers. These persons are frequently being trained in group skills and techniques, just as nonprofessional mental hospital aides are now assuming responsibility for conducting groups in many hospital settings. The A.G.P.A. began as an interest group for persons who, by training and profession, were potentially equipped to practice group psychotherapy, but as professionalization has accrued, it has moved conspicuously toward becoming a competency organization. This was a matter of much debate over the years. But in 1968 the matter was finally brought to a forthright decision that, thereafter, the A.G.P.A. would define itself as a professional competency organization.
Another significant development in the 1960’s was the recognition of the importance of sophisticated research. The work of the Association up to this point had been almost entirely clinical. The gap was large between the clinical level of reporting, typical of group therapy literature, and the sophisticated methodological designs and statistics that the academic disciplines studying groups had developed. In the 1960’s, a Research Committee was appointed, and it assumed an active interest in both sponsoring and stimulating research interest among the membership. In 1965, a research section was inaugurated at the annual Institute, which has been a regular feature of the Institute since. Many younger group therapists have received training in research, and with the development of ideological openness, there is increasing research interest and support from within the A.G.P.A. The Journal and the scientific meetings have been the forum for the critical examination of research problems and applications necessary to move the clinical procedures of group therapy into the arena of a scientific profession.
The history of a movement is the history of ideas, of men, and of organizations. Group psychotherapy, as a movement, is part of a larger intellectual and social development: the growing awareness, interest, and concern for the nature and function of human groups. As such, not all of the intellectual and social concerns of the “group movement” have been of concern to the clinicians who have developed group therapy. Hence, there has been a’ not unexpected gap between the conceptual base used by group therapists and the conceptual base used by researchers and theoreticians of group behavior. The conceptual interests of the pioneers of group therapy were naturally toward the establishment of a sound theoretical basis for the practice of group therapy, and there was little time, or impetus, to relate developing theories of group therapy to other scientific theories of group behavior. However, now that group therapy has become well established, conceptual interests appear to be shifting in the direction of building bridges toward related scientific group theories and data.
Among the early founders of A.G.P.A., some sought a broader base of theory and practice, some sought a narrower base. The latter carried the day in the early days of the organization. This may have provided strength then, but it also became an issue of contention among some of the members. In the end, the proponents of conceptual openness and more eclectic approaches to the theory and practice of group treatment appear to have obtained the support of the membership and administrative leadership without imperiling the basic clinical foundation and services of group psychotherapy as therapy.
Although the A.G.P.A. was steered in its early years by a group of professionals with strong feelings and ideological commitments, the strength and influence of the organization has come from its capacity to grow into an organization involving group therapists of diverse persuasion. It is a reflection of professional growth that the A.G.P.A. has moved in the direction of becoming an organization that looks toward being representative of all those professionals working in mental health disciplines related to group therapy and practice.
As an organization, the AG.P.A. is a relatively young professional group. One of its organizational strains has been its, for a time, interdisciplinary nature. Of course, this has also been one of its strengths and a major contribution to professional dialogue and development. As an interest group, the organization could have opted for expanding its base in terms of interest rather than competency. However, the concern for competency was present from the inception of the organization and has influenced all discussions regarding membership. Although the decision has been made to define the A.G.P.A. as a competency organization solely, there will be further issues of professional jurisdiction, certification, etc., which will have to be resolved.
As an organization, the A.G.P.A. and its Journal currently represent the major professional identification of group therapeutic practice in the world. It has moved toward a position of leadership in the field. However, the Association faces a number of organizational, professional, and scientific issues to be dealt with in the future. Among these are:
1. The problems of membership. Can all mental health professionals concerned with group treatment methods find adequate representation in one professional organization?
2. The method, content, and context of training. How can training standards be established and incorporated by the various mental health professions? The A.G.P.A. is just now publishing a suggested set of standards that could be basic for all disciplines.
3. Can an adequate research base be established for the investigation of clinical group treatment and for laboratory related research on groups? Is group psychotherapy, in its very nature, susceptible to any research techniques in view of the numerous personality and unrational factors involved?
4. How can a broader theoretical base for group treatment be established? In part, this issue relates to the broader issues of the theory of psychotherapy, but there are also widely divergent theoretical approaches to group treatment at the present time.
5. How can an interdisciplinary organization develop a flexible base for its function as a competency certifying organization that relates to several different mental health professions, each with its own ongoing changes in standards and practice?
Looking back over twenty-five years of development, the A.G.P.A. has grown into a major professional organization. It bears the responsibility in the United States, and to a considerable degree worldwide, as the particular organizational representative of group psychotherapy theory and practice. The organization has grown from a small interest group to a major professional body which is now faced with the establishment of liaisons with other major mental health professional bodies. The process of professionalization of group psychotherapy as a professional identity has marked the sociological development of the organization. This professionalization has not been total or complete, nor may it become so.
However, one of the interesting questions for the future will be the consequences of professionalization of group therapy.
In conclusion, the inception, growth, and current status of the A.G.P.A. may be seen as a reflection of the whole field of group psychotherapy. As an organization, the A.G.P.A. has played a major role in the clinical and theoretical development of group psychotherapy.
1945-46 1947 1948 1949-50 1951-52 1953-54 1955-56
1957-58 1959-60 1961-62 1963-64 1965-66 1967-68
President
S. R. Slavson
Temple Burling, M.D. William M. Moody, M.D.
Samuel B. Hadden, M.D. Lewis H. Loeser, M.D.
Lewis H. Loeser, M.D. Donald M. Carmichael, M.D.
Hugh Mullan, M.D. Nathan Beckenstein, M.D. Maurice E. Linden, M.D. Milton M. Berger, M.D. Donald A. Shaskan, M.D. Aaron Stein, M.D.
OFFICERS of the A.G.P.A.: /9-13-68 V ice-President
Lawson G. Lowrey, M.D. Anna Kempshall
Anna Kempshall
Helen E. Durkin, Ph.D. Margaret Naumberg Grace M. Abbate, M.D.
President-Elect
Hugh Mullan, M.D. Nathan Beckenstein, M.D. Maurice E. Linden Milton M. Berger, M.D. Donald A. Shaskan, M.D. Aaron Stein, M.D. Clifford 1- Sager, M.D.
Secretary
George Holland George Holland George Holland George Holland George Holland George Holland James E. Shea, M.D.
Arlene Wolberg, Ph.D. Glen Bowles, Ph.D.
Helen Papanek, M.D. Emanuel Hallowitz Emanuel Hallowitz
Jean Munzer, M.D.• Ph.D.
50 Year History
Fifty Years of AGPA 1942-1992: An Overview
SAUL SCHEIDLINGER, PH.D.
Albert Einstein College of Medicine, Bronx, NY
GERALD SCHAMESS, M.S.S.
Smith College of Social Work, Northampton, MA
A history of the first 50 years of the American Group Psychotherapy Association must be seen in the light of the growth of group psychotherapy as well as the social context in which this occurred. In his 25-year history of our Association, Pattison (1970) concluded that “The story of the AGPA is not the story of group psychotherapy, but each has been a large part of the other” (p. 21). Given the perspectives of an additional 25 years, we would add that the AGPA has also been a part of a broader post-World War II world as reflected in the human services in general and those in mental health in particular.
The Beginnings (1942-1952)
The logo with its emblazoned year 1942 notwithstanding, available evidence suggests that the first two meetings preceding the AGPA’s founding actually occurred in 1943. These were held in conjunction with two sessions on group therapy, featured at the annual meeting of the American Orthopsychiatric Association in February of 1943 in New York. This Special Section on Group Therapy was chaired by Dr. Lawson G. Lowrey, the then Editor of the American Journal of Orthopsychiatry. Mr. Samuel R. Slavsori, Dr. Nathan W. Ackerman, Dr. Harris B. Peck, and two clinical social workers, Helen Glauber and Dorothy Spiker, participated. In his Introduction to the Section, Lowrey (1943) referred to his Jewish Board of Guardians’ study of over 100 children treated by activity group therapy stating “…it is obvious that here is a technique which is as effective as individual therapy” (p. 650).”
Following these sessions, S.R. Slavson convened an informal luncheon of people interested in this new modality. At a follow-up meeting held at New York’s Jewish Board of Guardians where Slavson worked, he was asked to head a Steering Committee of five, charged to draft a provisional constitution for the ‘new organization. As described below, the composition of that Steering Committee foreshadowed the ideological differences that would soon shake the foundations of the young organization. Four of the members were psychiatrists, among them Nathan Ackerman, the subsequent founder of family therapy and Harris Peck, a future Editor of the International Journal of Group Psychotherapy. Only one, Saul Bernstein, was a social group worker.
At the next meeting in November of the same year, also held at Slavson’s office, about one-half of the 20 participants were from the Jewish Board of Guardians. The enacted constitution delineated the mission of the then-named American Group Therapy Association, it became the American Group Psychotherapy Association in 195?, as being designed to “…promote interest in group therapy and coordinate and clarify the efforts of those involved in its practice and theory” (Durkin et al., 1971, p. 412). Membership was restricted to psychiatrists, psychologists, and psychiatric case workers who had at least three years of postgraduate supervised practice in psychotherapy. Persons without these educational credentials had to have five years of psychotherapy experience “…under approved supervision with psychiatrists participating” (Pattison, 1968, pp. 10-11). Slavson was elected the first President of AGPA, but the subsequent 12 Presidents were all psychiatrists. This stress on psychiatric dominance is significant and reflects, in our view, Slavson’s desire to associate this new interdisciplinary organization with what he perceived as the prestige of psychiatry. In this connection, a special invitation to join the AGPA was sent to all members of the American Psychiatric Association. History must be repeating itself; AGPA today is once more seeking to attract more psychiatrists to the Association.
Slavson’s insistence that AGPA membership be restricted to clinicians trained in psychotherapy precipitated a number of organizational conflicts during the 1945 and 1946 annual meetings. These culminated in the precipitous 1947 resignation of Dr. Temple Burling, a psychiatrist and AGPA President who believed that all people working with groups should be included. In his hastily drawn resignation note he said: “It is the group dynamics that does the therapy- not the skilled use of psychotherapy” (Durkin, 1949). This issue, which he perceived as a dichotomy of group dynamics versus group psychotherapy was to haunt Slavson throughout his career and will be discussed later.
When the AGPA was founded, America was embroiled in an all-out global war and its economy had been converted to a war basis. At the 1942 annual meeting of the American Orthopsychiatric Association, “…the ominous shadow of a world in a struggle to avoid an all-embracing eclipse hung more heavily… than was anticipated” (American Journal of Orthopsychiatry, 1942, p. 175). That meeting carried many programs devoted to the war effort.
The contributions of group therapy to military psychiatry were also referred to at meetings of the AGPA, particularly the fact that many of the group field’s leaders (and later AGPA members) were experimenting with group methods while in the armed forces. Among these leaders were S. H. Foulkes and W. R. Bion in England as well as Samuel Hadden, Alexander Wolf, Irving Berger, and Donald Shaskan in the United States (Berger, 1978; Shaskan, 1978). It is noteworthy here that W. C. Menninger, America’s chief of Military Psychiatry, considered the use of group therapy during the war as one of the three major contributions to civilian psychiatry (Menninger, 1946). Following the war’s end, the AGPA approached the American Red Cross offering its services in helping veterans to obtain group therapy.
The AGPA’s beginnings were unquestionably the product of Slavson’s untiring and zealous efforts. He was aided at first by a few loyal associates at the Jewish Board of Guardians, among them George Holland, the organization’s first Secretary-Treasurer, Charles G. McCormick, Mortimer Schiffer, and later Hyman Spotnitz. After his term as President, Slavson continued in 1944 as chairman of the influential Administrative Committee for 10 years and edited a Bulletin until the founding of the International Journal of Group Psychotherapy in 1951. He continued as its de facto Editor until 1961. Furthermore, Slavson’s Jewish Board of Guardians office served as the Association’s headquarters until his retirement in 1955. The move to new offices enabled the first step toward the founder’s relinquishing some of his earlier control of the organization.
Slavson never disguised his strong preference for a group therapy rooted in Freudian psychoanalysis. This held true for his children’s activity therapy begun in 1934 as well as for activity-interview groups initiated by Betty Gabriel In 1937, and for therapy groups designed for adults. For more than two decades, his strict guardianship of the Association’s psychiatric-psychoanalytic identity served to isolate AGPA from alternative group treatment models.
Years of Expansion and Conflict (1952-1962)
In 1952, the organization was incorporated under the laws of the State of New York and its name changed to the American Group Psychotherapy Association. This followed the initial publication of the International Journal of Group Psychotherapy in April 1951 under the editorship of Lewis Loeser. In the Journal’s first issue, the AGPA was described as an interest group comprising”… professional persons in a cooperative effort to study, Interpret and encourage sound practices and training in the field of group psychotherapy. Its membership comprises practitioners in the fields of psychiatry, psychiatric casework and clinical psychology.” The quest to become a competency organization was to emerge later.
Meanwhile, the AGPA had grown by 1952 to 318 members from a mere 60 members in 1944. The Journal began with 300 paid subscribers. In his continuing effort to attract more psychiatrists to the organization, Slavson persuaded the Board of Directors in 1953 to make psychiatrists eligible for membership without the requirement for supervised experience expected of psychologists and of social workers (Durkin; 1949).
The years following AGPA’s move in 1955 to new headquarters, with a paid Executive Secretary, were marked by much internal dissent. The conflicts arose as younger more autonomy-minded new Presidents refused to follow Slavson’s dictates. Personality and ideological clashes pervaded the Board meetings; democratic procedures were frequently violated. Durkin (1949) observed: “As the younger members began to become of age and aspire to leadership, they espoused some new views, and rebelled against the conservatism and control of the founders” (p. 7).
Despite Slavson’s initial qualms lest standards be, compromised, a separate training institute, attended by 200 registrants, was added to the 1957 annual conference under the direction of Milton Berger and Maurice Linden. Over the years, these institutes have grown in quality, diversity, and, especially, prestige. Experienced professionals began to compete so vigorously for the small number of voluntary instructor positions that these assignments had to be apportioned (Christ, 1977). At present, the institute has come to be generally considered as the high point of the annual conferences.
Another source of conflict during the late 1950s pertained to the quest of the local affiliate and regional societies for greater autonomy and power. In 1956, the newly formed Affiliate Local and Regional Society Committee recognized the Delaware Valley, Eastern, Louisiana, New Jersey, and Tristate Societies and by January of 1959 those in Maine, Northern California, and the South-West. In a special memorandum addressed to the AGPA Board of Directors, Slavson (1959) called for increased scrutiny of the activities of these societies, including an examination of their constitutions so as to assure their conformity with the national By-Laws. This memorandum also called for an evaluation of the institutes, which Slavson still distrusted. Slavson’s influence, though diminished, was still formidable. The Board voted him ”. . . life membership . . . with full powers and privileges, including voting” (Durkin, 1949, p. 21).
With AGPA’s increasingly popular publications and training endeavors came the wish to extend this recognition to the international sphere. Slavson had already lectured in a number of foreign countries and maintained an active correspondence with professionals abroad. Not to be outdone by J. L. Moreno’s far flung international activities, Slavson had already named the AGPA’s national organ, the International Journal of Group Psychotherapy. He and Wilfred Hulse arranged in 1953 to have the Association join the World Federation of Mental Health. A planned International Conference of Group Psychotherapy in conjunction with the World Mental Health Congress in Toronto in 1954 failed to materialize because of irreconcilable differences between Slavson and Moreno. In 1954, AGPA established a new Committee on the International Aspects of Group Psychotherapy which served as a liaison with the growing number of foreign affiliate societies. The Journal also began to carry news items about group therapy abroad including special reports from France (Lebovici, 1958) and Holland (Spanjaard, 1958).
The 1952-1962 decade of AGPA’s “growing pains” coincided with the years of Eisenhower’s presidency (1953-1961) also fraught with many conflicts: the Korean War, the McCarthy hearings, desegregation struggles, and political scandals. The 1950’s have also been termed the years of conformity, with America categorized as “a case of the bland leading the bland.” It was the land of The Lonely Crowd (Riesman et al., 1953), The Man in the Grey Flannel Suit (Wilson, 1955), and of The Organization Man (Whyte, 1956).
During that same period the mental health field was beset by unprecedented squabbles between competing schools of thought and claims for hegemony which held true for group therapy as well. In the words of Newell (1951), “By defending hypotheses with a dogmatic, almost religious zeal, by resisting demonstration and investigation, and by clothing our thoughts in jargon, we retard the progress of science and knowledge in our field” (p. 449). Within the AGPA these ideological struggles revolved around two basic camps: (1) adherents of the orthodox Freudian position championed by Slavson, and (2) practitioners of neo-Freudian, Existentialist, and Transactional Analysis, some of whom managed to attain positions as officers of the association. Such questions as whether the group therapist should disclose anything about his/her own feelings to the group, or whether one should ever couch a patient physically caused vituperative debates.
The Years of New Visions and of Maturation (1962-1972)
This decade encompassed the Kennedy years of new hope too soon overshadowed by the dark experiences of Vietnam and Watergate. In the early 1960’s the Kennedy brothers managed, not unlike F.D.R., to capture the attention of America’s young, reflecting an image of courage and of concern for the poor and for Blacks. The New Frontier and Great Society legislation which included Medicare and Medicaid, as well as the Community Mental Health Center Act of 1963, had profound influences on the human services.
The new Comprehensive Community Mental Health Center model was so boldly innovative in theory, practice, and scope that it was at times connoted as a “Third Mental Health Revolution,” purporting to supplant the one initiated by Freud. This program called for hundreds of federally funded community-based mental health services all over America to meet the needs of all citizens, young and old. Not unlike the public health model, emphasis was divided among prevention, treatment of pathology, and maintenance of positive mental health.
The profound effect of these developments on the group field in general and on the AGPA in particular is evident when one realizes that most of the Community Mental Health Center’s services had to rely heavily on group therapy and on allied group techniques. The accumulated knowledge and experience of group therapists in outpatient, day hospital, inpatient, and even preventive contexts was now in great demand. In the absence of the urgently needed cadres of skilled group practitioners, harassed administrators began to resort to rash and risky solutions, among them the assignment of individual therapists and auxiliary professionals to work with groups. Moreover, an earlier trend to employ paraprofessionals in the mental health services was extended as well to the group field.
As might be expected, these rapid developments in a sphere already beset by professional role conflicts and confusing terminology refueled the fiery issues of boundaries, of methodologies, and of differential treatment goals. Many workers began to demand that the traditional aims of uncovering unconscious conflicts and of character reconstruction be replaced with less ambitious expectations focused on enhanced ego functioning, social competence, and symptom removal. The AGPA’s annual conferences and the Journal reflected this marked ferment. But the agenda of the conferences, especially, broadened to provide additional training opportunities for beginning group practitioners. The training programs of the affiliate societies responded in tandem.
During this period, clinical group therapy practice issues were also consolidated. For example, combined therapy (Aronson, 1964) was delineated with considerable clarity as were group approaches geared to the “hard-to-reach,” namely, substance abusers, delinquents, and the chronically ill. Modified ways in which group modalities could be employed with socially disadvantaged minorities who populated urban ghettos were also included (Peck.& Scheidlinger, 1968).
Efforts to solidify theories of group therapy continued during the 1960’s. Slavson’s Textbook in Analytic Group Psychotherapy (1964) distilled 50 years of his work. Other significant works also appeared, e.g., by Wolf and Schwartz (1962) and by Foulkes (1964). Interestingly, the first two volumes, though espousing differing technical ways of treatment, share an underlying belief in the primacy of the individual-focused approach in group therapy. Foulkes, in contrast, espoused a more group-centered position reflecting an earlier assertion of his: “Take care of the group and the individual will take care of himself.” Beyond this issue there lay more complex questions under dispute such as, “Are there group dynamics in therapy groups?” Or even, “Are group dynamic manifestations anti-therapeutic?” The more extreme positions of such British “Object Relations” practitioners as Ezriel (1950) and Bion (1959), who asserted that the group therapist’s task resides essentially in confronting the group-as-a-whole with its shared unconscious fantasy themes, evoked much controversy among some American group therapists.
Given the relative newness of group psychotherapy and the complexity of the task of theory-building, some theoreticians, among them Arsenian, Semrad, and Shapiro (1962), Durkin (1964), and Scheidlinger (1968), considered any broad generalizations or fixed dichotomies as premature. While allowing for the presence of certain generic elements characteristic of all psychotherapy, they advocated instead a continued objective scrutiny of how these cardinal factors appear in the therapy group with its multipersonal character and group dynamic processes.
Under the 1968 leadership of its new President, Clifford Sager, a family and community psychiatrist, AGPA became more energetic in altering its earlier exclusionary stance moving to an active interchange with the broader human services in the community, By this time the organization had experienced a further impressive expansion in numbers and in prestige. With a membership of about 2000 people and annual meeting attendance of about 1000 registrants, it became a force to be reckoned with, inviting the increased interest of many allied professionals.
‘These conferences, formerly held in New York City only, were now rotating among a number of U.S, cities with the large affiliate societies serving as hosts.
In 1970, Emanuel Hallowitz, a social worker, became AGPA’s first nonmedical President since Slavson. His election served to reinforce the interdisciplinary character of the organization. An expert in organizational dynamics, he also became the permanent architect of AGPA’s modernized By-Laws. He had earlier served as a peacemaker in the factional disputes during the 1960’s.
As they acquired strength and influence, the presidents of the local societies were encouraged in the early 1960’s to participate in the meetings of the Board of Directors “with voice but no vote.” Their power was enhanced further via the creation of an Affiliate Societies’ Committee which met annually with the national Association’s President. After many heated debates, the Board of Directors decreed in 1963 that only people with qualifications for national AGPA membership could be members of local societies. This move served to assure the protection of quality requirements for membership, and led to AGPA’s defining itself officially in 1968 as a competency organization.
While there had been a token Research Committee since its founding, it was not until the 1960’s that truly sophisticated research, including statistical designs, became a part of the Committee’s concerns (Dies, 1979). In addition, the annual institute inaugurated a Research Section whose findings appeared in the pages of the Journal.
Unlike the meetings of other professional organizations in mental health, AGPA’s conferences escaped the open expression of youth revolts spawned by the Vietnam War and the sense of alienation and helplessness following the assassinations of Martin Luther King, Jr. and of Robert Kennedy. In this connection, even the 1969 annual meeting of the American Orthopsychiatric Association, which was known for its liberal stance on social issues, suffered disruption by a group of radical young mental health professionals.
The so-called Encounter Group Movement which attracted much public and media attention, even producing a best seller by one of the movement’s proponents (Schutz, 1967), both challenged and embarrassed the AGPA because many people began to equate these controversial group enterprises with group therapy. That they did so was not surprising since a senior psychologist and clinician, Carl Rogers, had gone so far as to claim that the intensive encounter group was “… perhaps the most significant social invention of this century” (1968, p. 268). It is to AGPA’s credit that it approached this sensitive issue in an open and responsible fashion. Relevant symposia at its annual conferences and its publications began to place encounter groups in proper perspective within the human services, stressing their being affective-educational endeavors designed for the general public, and not for the treatment of the sick. Furthermore, in a seminal paper by Parloff (1970), group therapists were asked to warn against “. . . the dangers of indiscriminate application of these procedures by undisciplined leaders to the psychologically unstable” (p. 301). Soon, other professional organizations spoke out as well, enjoining the sponsors of encounter groups to apply a series of safeguards in their operations, including the screening of participants, the employment of informed consent, and, above all, the use of trained leaders.
Elitism, Differentiation, and Competency (1972-1982)
With the morale of the country weakened by the Vietnam War and by Nixon’s resignation, there ensued in the United States an era of self-questioning aggravated by President Carter’s uncertain leadership and a distraught economy. The quickening pace of technological and of societal change spawned the Women’s Movement in the early 1970s, together with a dawning ecological crisis. Social and moral confusion, frustration, fear, and violence all made Ronald Reagan’s presidential victory a virtual certainty.
Within the AGPA, the Encounter Group Movement and the multiplicity of groups operating under trained and untrained leadership in the many Community Mental Health Centers (763 in 1982) made urgent the need for some kind of differentiation among “people helping groups” and for the careful surveillance and training of group practitioners. What soon emerged was a general consensus that clinical psychotherapy groups with their primary focus on the “repair” of personality pathology differed from “therapeutic” group modalities in mental health, as well as from the varied personal growth, training, and support-self-help groups in the community (Scheidlinger, 1982). As for training, a suggested Guidelines for the Training of Group Psychotherapists was developed in 1970, seeking to standardize the mushrooming training programs sponsored by the affiliate societies. A few years later, the Board of Directors decided in principle that AGPA accreditation be made available to all group therapy training institutions. In addition, the 1974 annual conference was the first interdisciplinary program approved to offer Continuing Education credits for physicians, a procedure which has by now been standardized at our conferences for other professions as well.
Echoing the call from the universal Women’s Movement, a “grass roots” group of AGPA women members demanded the creation of a Women’s Issues Task Force to foster a greater recognition of women’s contributions to the organization and to facilitate their obtaining more influential roles in governance. While Henriette Glatzer had been elected the first woman President of AGPA in 1976, her contributions to the organization and to group therapy had long since received deserved recognition. More than the appreciation of one woman’s worth was needed and demanded. Alonso and Rutan’s article, “Women in Group Therapy” (1979), stood as part of this new Zeitgeist which also served to enhance a tangible increase in “power roles” for women in both the educational and “political” areas of the AGPA.
An “Umbrella” Organization in Pursuit of Excellence (1982-1992)
Despite the economic reverses in the United States during the late 1970s, which resulted in a substantial loss of paid AGPA memberships, the organization had by now become an effective functioning body with a sophisticated internal structure, newly purchased headquarters, and skilled administrative leadership. At a time when some other professional mental health organizations floundered in the weakened national economy and diminished funding for the human services, AGPA’s cadre of dedicated leaders managed to maintain a flexible stance, prepared to adapt imaginatively to the recurring external challenges. Thus, when membership declined sharply, AGPA restructured its base, during Norman Neiberg’s presidency, along pluralistic lines. After decades of being a predominantly elite, psychoanalytic movement, the Association opened its doors to all responsible mental health professionals who worked with groups. Needless to say, an equally compelling factor in this expansion was the realization that the earlier, counterproductive ideological parochialism had gone out of date. As was noted in another context (Scheidlinger, 1991), there was a growing awareness among the senior practitioners of all the major therapeutic models that: 1) single system ideologies and techniques had distinct clinical limitations; (2) research had shown that experienced workers from divergent theoretical camps tended to get similar outcomes; (3) the commonalities in all forms of psychotherapy were more impressive than was generally acknowledged; and (4) most seasoned American psychotherapists had come to view themselves as eclectics.
With all major systems of group therapy enjoying equal status, the organization’s programs and publications have begun to reflect this new diversity. A variety of ideologies, intervention measures, contexts, and patient populations, featured at the recent AGPA conferences under strict quality controls, have served to draw ever-increasing numbers of human services’ professionals to these events. Another example of the new flexibility and openness resides in markedly streamlined membership application procedures. Student and associate membership levels allowing for early entry are a part of this new system.
In the mid-1980s, Leonard Horwitz, AGPA President, spearheaded a novel, individualized, intra-organizational training program to encompass those practitioners lacking access to training sites which are usually located in large cities. This program combined didactic input from annual conference offerings with supervised clinical practice in the “home” communities, under the guidance of AGPA mentors.
As for publications, aside from the phenomenal growth of the International Journal of Group Psychotherapy, to be covered separately, the Association produced a series of highly regarded monographs dealing with research (Dies & MacKenzie, 1983), bibliography (Lubin & Lubin, 1986), the group treatment of children (Riester & Kraft, 1986), of adolescents (Azima & Richmond, 1989), of the elderly (MacLennan et al. 1987), of difficult patients (Roth et al. 1989), and with psychoanalytic group theory and therapy (Tuttman, 1991)–a total of seven monographs to date.
The Influence of Group Therapy’s Pioneers
The history of group psychotherapy as a treatment modality which includes its precursors and pioneers lies outside the scope of this chapter, devoted as it is to the history of the AGPA. The broader history of the field is available elsewhere (Rosenbaum & Berger, 1963; Anthony, 1971; Sadock & Kaplan, 1983).
What is of relevance here is the extent to which AGPA’s founders had been influenced by these historical figures. To begin with, Slavson, except for some brief references to Joseph H. Pratt as the first practitioner of modern group treatment in 1905, and to Trigant Burrow as the first person to use the term “group analysis,” had’ little to say about his predecessors other than Freud (Slavson, 1951). This is somewhat surprising since he had known about the work of Paul Schilder (1936) and Louis Wender in New York. As for the latter, Slavson served as a Discussant (together with Alexander Wolf and Jacob Moreno) of a major paper presented by Wender at the 1951 meeting of the Association for the Advancement of Psychotherapy (Wender, 1951).
Alexander Wolf, in contrast, credited his reading of Schilder and of Wender’s works as having encouraged him to try group treatment in his private practice. While Jacob Moreno’s prolific writings, beginning in 1910, dealt with important themes in group psychology such as spontaneity, role-play, and sociometry, followed by his writing on psychodrama in the 1920s, his direct influence on the early members of the AGPA was minimal. In part this was probably due to Moreno’s (1953) disdain for psychoanalysis. More significant, perhaps, was the extreme personal competitiveness and animosity between Slavson and Moreno throughout their lives. Besides Slavson, Moreno was personally known to Wilfred Hulse, Samuel Hadden, and Saul Scheidlinger through contacts at professional meetings. Hadden, an early collaborator of Slavson’s, contributed a chapter to a book which Moreno had edited in 1945. At a later point, Hadden (1955) wrote about having been influenced in his early group work by Pratt (1922), a personal acquaintance of his, as well as by Marsh (1935) and Lazell (1921), two other group pioneers.
In their original work designed to study the process of group psychotherapy, Powdermaker and Frank (1953) utilized an eclectic psychoanalytic approach, borrowing from what they considered to be the most desirable aspects of the various contemporary models of group psychotherapy. To quote them: “Our approach to group therapy with neurotic patients had points in common with that of Foulkes, Ackerman, Slavson, and Wolf, and we were influenced in our thinking by Schilder’s analytic concept and Trigant Burrow’s emphasis on the study of group interaction” (p. 4).
During the 1950s and 1960s there was a cohesive subgroup of Adlerian group therapists active in the AGPA, among them Helene Papanek (1954). They spoke and wrote frequently about Alfred Adler’s and Rudolf Dreikurs’ pioneering group work in Vienna with children and with groups of parents. This program, begun in 1921, was termed “collective therapy.” According to Dreikurs (1959), this collective therapy was a mere by-product of the general group-centered orientation which characterized these early child guidance clinics. After his emigration to the United States, Dreikurs became well-known for his group work in the Chicago school system.
Pinney (1978) visited Boston’s Emanuel Church and reviewed the 1905 records of Dr. Pratt’s and the Rev. Worcester’s groups with medical patients. Pinney (1978) also delved into Schilder’s early work with groups at New York’s Bellevue Hospital, concluding that Schilder’s reliance on transference manifestations and on the interpretation of dreams entitled him to be considered the first analytic group therapist. Donald Shaskan, an early AGPA President, had been a student of Schilder’s and wrote a book about him (Shaskan & Roller, 1985).
Aaron Stein, another former AGPA President, who had trained a generation of psychiatrists at New York’s Mount Sinai Hospital, was a student of Wender’s. He had worked under Wender at Hillside Hospital in New York where Stein subsequently became the Director of Group Therapy. Stein co-authored some papers with Wender, in which they proposed a parallel between Freud’s group psychology and the dynamics of group psychotherapy (Kibel, 1989).
The Journal
The International Journal of Group Psychotherapy is the official organ of the AGPA. Founded in April 1951, it represents, in a sense, the Association’s window to the group world outside, insofar as contributors do not have to be members of the AGPA. The editor, whose tenure cannot exceed two consecutive five-year terms, is appointed by the Board of Directors of the Association. He wields almost complete autonomy in the selection of his Editorial Board and in the designing of the Journal’s contents.
In the formative years of the AGPA, a number of basic themes characterized the journal’s content. The first of these centered on the applicability and clinical efficacy of group therapy as a treatment modality. A large number of practitioners reported on their creative and energetic efforts to establish group programs in a wide range of practice settings including mental hospitals, outpatient clinics, general hospitals, rehabilitation programs, as well as correctional institutions. The patient populations were far-ranging: from children and adolescents to adults with varied psychiatric disturbances, to patients with psychosomatic problems, to homosexuals, and to the mentally retarded and sexual offenders. These <contributions demonstrated the wide applicability of group treatment and the enthusiasm of the practitioners in this relatively new field.
The second theme reflected the need to establish the efficacy of group psychotherapy as a valid form of treatment, consonant with the basic tenets of psychoanalysis. This was especially important since Freudian psychoanalysts of the day were generally intolerant of any approach which was at variance with the dyadic treatment situation with its focus on the probing of intrapsychic conflicts. The issue was formally joined in the Journal in 1958 when Lawrence Kubie, a liberal among the Freudian analysts, questioned whether group psychotherapy could engender as profound are insight into unconscious processes as individual psychoanalysis. He suggested that group treatment might best serve as a “vitalizing antechamber” to the deeper individual analysis. In responding to this article, Foulkes (958) asserted that the group therapy verbalizations were equivalent to free associations and subject to appropriate individual and group level interpretations. Slavson (1958) believed that while group treatment might well be less “intensive” than psychoanalysis, it was uniquely suited to patients with problems in ego functioning. Kubie (1958) was troubled by these discussions, saying in a Rejoinder “… that my questions have been taken up in a, defensive and resentful spirit .. .” (p. 361). A few years later, Fried (1961) demonstrated group therapy’s potential to go “beyond insight” in repairing ego-related pathologies. It IS ironic that these apologetic-sounding discussions have given way in recent years to a plethora of papers in the Journal devoted to the unique value of the “here and now” experiential aspects of group therapy 10 reaching “preoedipal” levels of narcissistic and borderline disturbances of patients with arrested emotional development. Glatzer (1962) was among the earliest workers to employ group therapy with narcissistic patients.
Another theme articulated in the Journal during the 1960’s pertained to the adaptation of core psychoanalytic concepts to the group psychotherapy situation. The titles, too many for listing, ranged from transference and countertransference, resistance, acting-out, working through to identification and regression. Hand-in-hand with such theoretical productions went other articles dealing with the “how-to” aspects of group therapy: differential criteria for suitability; homogeneous versus heterogeneous groups; the handling of absences, and of dropouts as well as combined and conjoint treatment.
As might be expected, the newly emerging contributions from the so-called British School of Object Relations comprising such group therapy writers as Ezriel (1950), Bion (1959), and Foulkes (1975) found resonance in the pages of the Journal beginning with the 1960s and continuing to the present. They promoted renewed discussions of theoretical issues pertaining to the focus on the group-as-a-whole as well as clinical considerations of the earlier-noted treatment of patients with preoedipal pathology.
As AGPA moved toward enhancing competency and consistency in the training of group practitioners, the International Journal of Group Psychotherapy also showed impressive growth in quality and in the quantity of its readership. By 1975 the Journal boasted 5000 subscribers.
The Journal’s 25th Anniversary issue of April 1975 constituted a high point in the transition from its beginning as a provincial publication in April 1951 to a journal recognized internationally for the most sophisticated reporting of the major developments in group therapy theory, practice, and research. In his “Reflections upon the Anniversary,” Foulkes (1975) lauded the Journal’s”… leading position internationally” (p. 171).
In the same Anniversary issue, Peck (1975), a former Editor, identified two major challenges facing the group psychotherapy movement in the future. The first foresaw a role for group therapy in the promotion of social and institutional changes in the community in conjunction with the community mental health center model and with the therapists’ need to help the patient adapt to his institutions. The second challenge concerned the expansion of group therapy’s theoretical frame work to make place for the newly emerging group intervention modalities such as family therapy, as well as Gestalt and Transactional Analysis. In line with general systems theory he proposed: “When a patient changes his characteristic mode of behavior in the group, it almost inevitably alters the group’s shape and character … involving the individual members, the group leader and the group as a whole in a circular process wherein change in any part of the system affects every other part, as well as every other group in which each individual participates” (p, 156).
Peck’s first challenge disappeared with the early demise of the community mental health center movement. What survived from it in the Journal was a body of theory which tries to integrate psychoanalytic concepts with those of organizational dynamics (Kernberg, 1978, 1984).
These formulations highlighted the personality problems of organizational leaders (i.e., narcissistic and paranoid) as they attempt to provide “rational” leadership.
As for Peck’s prediction about the need to open AGPA’s boundaries to neo-analytic and non-analytic contributions, he proved to be right on the mark. As we noted earlier, a broadening of ideological perspectives and a loosening of earlier rigidities occurred not only via more diverse publications in the Journal but also at the organization’s scientific meetings and in its monographs. While most articles in the Journal still reflected the predominant psychoanalytical model of practice, contributions from the perspectives of transactional, existential, behavioral, and Gestalt groups were included as well.
Despite the field’s original reliance on traditional drive theory and ego psychology, group therapists’ sights have shifted to include considerations of object relations theory and of self-psychology. This is reflected in the Journal’s recent symposia dealing with such themes as Group Treatment of Borderline and Narcissistic Patients, The Group-as-a-Whole Approach, as well as Therapeutic Ingredients-of-Change in Group Psychotherapy. As might be expected, there are still some honest areas of basic disagreement among group therapy practitioners. An example is Scheidlinger’s (1987) contention that, given the complex and sensitive function of interpretation in group psychotherapy, it best be reserved for the experienced and trained professional group therapist. Napolitani (1987), in contrast, believes in an egalitarian approach in which the group therapist helps the patients and the group to take over all therapeutic functions including those of interpretation.
In addition to psychoanalytically oriented discussions, the Journal contained a number of articles which were an outgrowth of AGPA s Task Force on General Systems Theory. Thus, Durkin (1981) presented systems theory as a “superordinate” framework for group therapy practice. Within this framework, systems theory is believed to address in a more satisfactory manner the complex, circular interrelationships which encompass the group’s effect on individuals, on subgroups, and on the therapist. The individual’s effect on the group-as-a-whole and on the therapist as well as the latter’s effect on each individual and on the group. Other contributions with a general system’s perspective were Beck’s and Peter’s on leadership roles, MacKenzie’s (1979) on group norms, and Slife and Lanyon’s (1991) on the power of the “here and now” in group therapy.
In a series of three articles (1982, 1987, and 1990) Grunebaum and Solomon reviewed the relevant literature pertaining to the role of peer relationships throughout the life cycle. They offered cogent ideas about the usefulness of a peer group “history” in evaluating prospective patients for group treatment as well as in the viewing of group therapy as a corrective peer group experience.
As might be expected, since its beginning, the Journal has been a prime medium for the elaboration of Slavson’s activity group therapy for children stressing its application to different patient populations and to different settings. In the 1960s and 1970s a growing number of publications began to question the primacy of the original nonverbal, action-oriented approach and introduced treatment models emphasizing verbal therapist interventions and planned group discussions (Epstein & Altman, 1972). Some of these new models were adapted to the unique needs of the growing numbers of children with socially and emotionally deprived backgrounds including impulse-ridden and psychotic ones (Maclennan, 1977). A comprehensive overview of the theory and practice of child group therapy was published by Schamess in 1976.
As for the group treatment, of adolescents- often considered the treatment of choice for this age group-there appeared a similar overview paper by Kraft (1968). Prior to that, Ackerman (1957) had described a successful experience with a co-educational group of adolescents. This paper represented a kind of technical “breakthrough” insofar as group practitioners had heretofore worked with separate gender groups, in the fear that mixed groups would promote excessive sexual acting out.
Many of the early writings in the Journal dealt with therapy groups for delinquent adolescents, who were especially hard to reach in one-to-one treatment encounters. One of these papers was co-authored by Slavson (Altman & Slavson, 1962). In the same year, Feder (1962) wrote about short-term groups for delinquent boys in a residential setting. Most of the authors stressed the need for structure in all group work with adolescents, lest too much anxiety render these groups as unworkable. As might he expected, the papers on work with adolescents almost invariably touched on issues of countertransference, an ever-present phenomenon, because adolescents tend to turn their therapists into allies against their parents and other authority figures. In addition, the adolescent’s characteristic openly provocative and “testing” behavior is bound to abrade adult sensitivities and to evoke emotional reactions. For this reason, some otherwise competent group therapists were found to be simply unsuited to working with adolescent groups.
The Legacy of S. R. Slavson
On the occasion of Slavson’s 80th birthday, the October 1971 issue of the International Journal a/Group Psychotherapy was dedicated to him, including a special Tribute by Hyman Spotnitz (1971). Having ceased to be involved in AGPA’s governance, Slavson had by that time become President Emeritus and Consulting Editor of the Journal, for life. During his rare appearances at major organizational functions he seemed to relish his role of elder statesman.
Slavson died at the ripe age of 90 on August 5, 1981 and was appropriately memorialized by his disciple and long-time collaborator, Schiffer (1983). We believe that there probably would not have been an AGPA without this man’s evangelical zeal, drive, and persistence. In the words of Anthony (1971) “… he has instigated group therapy’s development as a profession, its recognition as a scientific discipline, and its acceptance as an arena of worthwhile research by behavioral scientists” (p. 24). His tight control of AGPA’s direction during its beginning years assured its location in the psychiatric-psychoanalytic realm with stress on solid educational “and clinical requirements for membership. His seminal contributions to the development of group therapy for children and to the group guidance of parents (Slavson, 1950) are unquestioned.
There is disagreement, however, regarding Slavson’s lasting contributions to the general theory of group psychotherapy, his prolific writings on the subject notwithstanding. Anthony (1971) for example, thought that”… as a theoretician he is more categorical than creative and there is a positiveness about his position that the state of the art hardly merits” (p. 24).
In our view, Slavson lost credibility because of his tenacious, lifelong denial of any connection between group dynamics and group psychotherapy. It is truly puzzling that this brilliant man and astute clinician, while describing a variety of group processes in therapy groups (using his own terminology), failed to see that many of these processes can occur in all small groups. One wonders here whether his “missing of the boat” (Anthony, 1975) might have been related to more subjective factors. It seems paradoxical that prior to his discovery of the therapeutic potential in children’s groups, Slavson was a progressive educator and social group worker, had written a number of books in these fields (1937, 1939), and had even edited a group work journal! Might it be that his excessively emphatic repudiation of these professional roots in group dynamics was essential to protect and insulate his later hard-earned and self-taught role as psychoanalyst-clinician-therapist?
Thus, when Lawson Lowrey (943) referred in public to Slavson’s new activity group method as being rooted in “… group work, progressive education and psychoanalysis” (p. 650), he might unwittingly have touched on an issue uniquely sensitive to S.R. Slavson whose covert task might have been to deny the first two of these roots. Interestingly, the above-noted comment of Lowrey’s occurred at the very same Special Section on Group Therapy at the 1943 meeting of the American Orthopsychiatric Association, which gave rise to Slavson’s convening of AGPA’s “founding” luncheon.
A Glimpse at the Future
At a time when other interdisciplinary organizations in mental health are in trouble, it is gratifying to report that AGPA has managed to reach its 50th Anniversary in fine health, with a stable membership and with uniquely successful annual conferences and publications. Its next immediate objectives are within reach: to develop a credentialing system for trained group practitioners and perhaps also to establish a much needed set of Guidelines for the Training of Child and Adolescent Group Therapists to parallel the existing Guidelines for the Group Therapy of Adults.
Given the continued unprecedented expansion of the broader “Group Helping Field,” the need for trained group practitioners is bound to grow. Contemporary trends point to an emphasis on homogeneous, short-term, and open-ended groups for people who share similar symptoms or handicaps as in substance abuse, eating disorders, phobias, and chronic disabilities. AGPA members might also find roles, perhaps as consultants and trainers, in the mushrooming area of indigenous self-help and support groups operative all over America. Lieberman (1990) estimated that from 9 to 12 million people regularly rely on some kind of support group.
As for existing paths, the intensive outpatient and inpatient group treatment of patients with impaired early development (i.e., borderline and narcissistic disorders) including schizophrenia, is bound to continue. Renewed focus will be required on the increased need of group modalities for children and adolescents, especially in schools, for medical patients and for the elderly.
As noted by Dies (1992), given the economic realities of our times, calls for pragmatism, integration, and clarification will be the order of the day. Reimbursable clinical practice will move toward greater professional specialization, codification, specificity, cost-effectiveness, and employment of combined therapies, including pharmacology. Long-term group therapy will be reserved for patients in the more affluent private sector, with emphasis on character reorganization, problems of living, and existential concerns. Spurred by the anxieties and alienations of a society caught up in an unprecedented rate of social change, the AGPA and its members will be productively occupied–and preoccupied for at least the next fifty years.
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75 Year History
Reaching our 75th Anniversary: A History of AGPA 1992-2016
ROBERT H. KLEIN, PH.D., ABPP, CGP, DLFAGPA
BONNIE J. BUCHELE, PH.D., ABPP, CGP, DLFAGPA
The American Group Psychotherapy Association (AGPA) experienced remarkable change and growth between 1992 and 2017, a reflection of a rapidly changing world. AGPA’s capacity to adapt and advance simultaneously was impacted by changes in various complex, interrelated systems: economic, social, academic, political, technological, and professional.
Economically, we saw the dot.com bubble burst, the stock market crash and recover, employment fluctuate, and globalization increase. Socially, we experienced involvement in several wars, affecting large populations of veterans and their families. Domestically we struggled with racism, sexism, classism, and ageism. Academically, we addressed healthcare issues of equal access, quality, accountability, and costs. Politically, we’ve seen alternating shifts in power from from one party to another, with wide changes in legislation along the way. Technologically, we faced vastly expanded automation; development of sophisticated computer systems and artificial intelligence, increasing concerns about privacy, security, and cybercrime, and the explosion of the Internet and social media.
Professionally, we witnessed the rise of managed care and the call for evidence-based treatment; recognition of the importance of treating the psychological consequences of disaster and trauma; and more active support in response to public health crises.
Many of these broad systemic changes found expression within AGPA. If one were to identify the most important change for AGPA during this period, it might be that AGPA has become less internally focused and is more aware of and responsive to this rapidly changing external world. Throughout this whirlwind timeframe, however, AGPA maintained its fundamental commitment to support the growth and development of high-quality, clinically effective group psychotherapy.
Early in this period, AGPA found itself increasingly concerned about survival. Its leadership, standing on the boundary between the organization and the outside world, realized, that to remain viable, AGPA must operate as an open system (vonBertalonffy, 1972). Functioning as a relatively closed system meant heightening the risks that AGPA and group psychotherapy might become irrelevant to the world of mental health care and continue to decrease in size, atrophy, and even die. On the other hand, to function as an excessively open system without necessary boundaries and controls could lead to dilution of the effectiveness of the modality and the organization, especially if it meant lowering training and practice standards. Pressure exerted about external needs, demands for accountability, goals for the profession itself, and concomitant necessary organizational structures could have been at odds with one another.
It had become apparent to the leadership that a balance must be struck. AGPA must be flexible and permeable, allowing transactions across boundaries to enable adaptation, growth, and change. But the effects of those transactions would need monitoring to preserve the field of group psychotherapy and provide sustenance for those practicing it.
In our opinion, AGPA’s evolution can be characterized best by looking at it through three naturally occurring eras: pre-9/11, 9/11, and post-9/11. We will take a look at the organization during those eras by focusing on seven critical facets/dimensions: (1) mission(s); (2) structure and administration; (3) jewels in the crown; (4) membership; (5) financial health; (6) organizational tensions and family dynamics; and (7) relationships with the outside world.
The Era of Pre-9/11: 1992-9/11/2001
1. Mission(s)
Early in this period, AGPA was primarily focused internally on the implementation of its mission by establishing and maintaining a place for group therapy as a treatment modality in the world of mental health. Its aim was to: (1) provide a forum for the exchange of ideas and publishing opportunities for members, and make publications and information available to them; (2) provide training, and establish and maintain high standards for ethical and professional practice; and (3) encourage research in group psychotherapy. The organization was healthy and stable, although the healthcare industry and the delivery of its services had already begun to undergo change, and AGPA, feeling the nudges, was attempting to be proactive in a variety of ways. As the rate of change in the external world was accelerating, awareness of the importance of remaining attuned and relevant regarding the outside world grew.
2. Structure and Administration
The AGPA community evolved into a tripartite structure, each with its own leadership and Board of Directors (see Table 1). Together they comprised the Tri-Organizational Board of Directors and were collectively known as AGPA. Two segments of the organization, AGPA and the Group Psychotherapy Foundation (now known as the Group Foundation for Advancing Mental Health), were already in existence in 1992. The National Registry of Certified Group Psychotherapists (the Registry, now known as the International Board for Certification of Group Psychotherapists), the third segment, was created in 1993. External conditions evoked growing concerns about the need for articulated practice standards, dialogue with third-party payers about reimbursement, and the need for regulation. The leadership believed that if AGPA did not do this regulation ourselves, then managed care, the insurance industry, the government or consumer groups would do it for us.
The Registry’s mission was to advance group psychotherapy by establishing and promoting standards for professional group practice to benefit the public. This involved defining a basic minimal standard of training for group psychotherapists, while simultaneously providing a credential (the Certified Group Psychotherapist [CGP]) that would define the qualified group therapist. The Founder’s Edition (1995) defined and showcased CGPs as clinical mental health professionals who had met nationally accepted criteria of education, training, and experience in group psychotherapy. Many large third-party payers endorsed the Registry and used its CGP credential as a criterion for reimbursement, thereby facilitating group therapists receiving payment for their services. This was timely as the field of mental health was undergoing a change with fewer individuals privately paying group therapists who were largely in private practice juxtaposed against the concurrent entry and ascendancy of managed care and the insurance industry as third-party payers. This shift enhanced a decrease in the numbers of clinicians going into private practice and an increase in those employed by agencies.
In 1993, as AGPA began to computerize, Board meetings were held in person two or three times a year, preceded by distribution of preparatory materials via Federal Express.2 Remaining technologically abreast of developments, staff and members started using email (the CEO report was first written on a personal computer [PC] during this time). Talk and planning of a website got underway, with an eventual launch of www.agpa.org in the late 1990s. The processing of continuing education (CE) by staff in the office was growing laborious because each discipline and a growing number of states had differing CE requirements. It was essential that AGPA provide CE credits for all its members, who came from a wide variety of disciplines and geographical locations. Without this benefit, membership numbers and participation in the Annual Meeting would likely decrease. Members needed continuing education with accompanying credit for training and credentialing purposes so that they could continue to make a living as licensed practitioners. Likewise, decreasing AGPA’s two largest income sources (membership dues and Annual Meeting revenues) would have a huge impact on AGPA’s financial well-being.
Change did not come easily, and organizational tensions mounted as AGPA attempted to respond to a changing world while maintaining its identity. Some felt that establishing a minimal basic standard for training in the practice of group psychotherapy via the Registry would have an overall effect of lowering training standards, while others promoted establishing a generally accepted and minimal training standard as a way to fight the age-old myth that “anyone can run a group.” Organizational financial viability became a more pressing issue as trends of diminishing membership and somewhat unpredictable Annual Meeting attendance gradually emerged.
In the midst of these pressures, AGPA proactively decided to initiate a Strategic Planning process, which was first undertaken in 1990. At a later date (1997), AGPA started using an outside facilitator to help with the process. Thus Strategic Planning became an integral part of the governance structure and culture and provided a mechanism wherein change could be anticipated and plans then could be made to deal with it.3
3. Jewels in the Crown
AGPA has two esteemed, established endeavors that are subject to very little controversy regarding their high value by the membership—the AGPA Annual Meeting and (our publications, particularly) the International Journal of Group Psychotherapy (IJGP).
For this reason, we decided to call them the jewels in the crown. Consensus was that these two activities represent the best of AGPA. Another AGPA publication, The Group Circle, AGPA’s quarterly newsletter, was also regarded as a valued membership benefit. The Annual Meeting is often referred to as the “best” of all mental health professional meetings with its special mix of experiential (especially within the two-day Institute but also found sprinkled liberally throughout the entire meeting) and didactic learning, as well as a carefully crafted program with a wide variety of the best presenters.
The AGPA Annual Meeting continued to be a jewel in the crown, with meetings held during this time in New York City, San Diego, Washington, D.C., Atlanta, San Francisco, Chicago, Houston, Los Angeles, and Boston. The introduction of several format innovations, including poster presentations and early morning one-hour presentations, enabled more members to participate as presenters in the program. The Large Group (introduced in 1996) and the Masters’ Circle (introduced in 1997) have become standard features of the Annual Meeting. The variety of program offerings increased during this time, reflecting the broadening of AGPA’s purview and interest in various theoretical orientations. Pluralism, not dogma, was the order of the day.4
The difficulty in accurately predicting attendance at Annual Meetings seemed to be a function of different variables, including the particular site of the meeting, the number of AGPA members, the attractiveness and relevance of the program, the increased availability of online professional training and CE credits, and the broader state of the national economy which, at times, left mental health professionals with limited discretionary income.
The IJGP is the most respected of group journals; its early articles were primarily clinical, but in recent times research articles have been increasingly included. This scholarly publication draws authors from a wide variety of backgrounds and countries.
The International Journal for Group Psychotherapy continued to be treasured by the AGPA membership. Journal content included discussions of combined psychopharmacology and group psychotherapy, treating different disorders in groups, stages of group development, community meetings, and various theoretical models for conducting group psychotherapy. Special sections focused on topics such as anger and aggression in groups, the group-as-a-whole, group therapy and managed care, treating “difficult patients” in group, and group supervision of group psychotherapists.
4. Membership
Membership of AGPA reached an all-time high in 1996, totaling 4,298 individuals and 30 Affiliate Societies as members in the Affiliate Societies Assembly. Special Interest Groups (SIGs), begun in 1989, were becoming increasingly active and visible within the organization. But, as noted, a declining membership trend began to be apparent during the late 1990s. Despite consistent positive reviews from attendees, the attendance at Annual Meetings also seemed to be declining, except when we met in a popular location. Much discussion ensued about the need to raise awareness regarding member benefits and the value of belonging to a professional organization. AGPA, like other mental health organizations, was feeling the effects of a trend among younger people who preferred participating online rather than joining organizations. In 2001 the GPF initiated a Donated Scholarship Program by awarding eight of them for attendance at the Annual Meeting, complimenting the Endowed Scholarship Program begun in 1985. Thus, the GPF proactively introduced young professionals from a range of diverse backgrounds to the Annual Meeting, managing the impact of a decreasing membership base of graying Baby Boomers.
5. Financial Health
Under the guidance of CEO, Marsha Block, CAE, CFRE, development of formal investment planning policies and procedures was undertaken. A financial consultant was hired by the GPF in 1993 and, subsequently, an investment house in 1994. In 1993, financial health prevailed with an AGPA yearly budget of $900,000, but later in the 1990s, budgetary concerns had arisen associated with the decrease in revenue from membership dues and the unpredictable Annual Meeting registration, as noted earlier.
The levels of growth and complexity in the organization from 1992 to 2015 are clear. Both our revenue and expenses have more than doubled over the years, while our net assets have grown even more impressively: a whopping 266%, without even including our $4M+ condominium.
6. Organizational Tensions and Family Dynamics
Tensions mounted from 1993-1995 with the creation of the Registry and with a growing impetus to have AGPA become a broader membership organization, a proposal that was controversial. In August 1995, a special Board meeting was called with a parliamentarian present to help contain the heated debates and allow for discussion to be constructive rather than divisive. Tensions continued, however, through the election of 1996 with an eventual resolution: AGPA became a membership organization, and the Registry more solidly established itself as a certifying body. Much of the underlying tension appeared to be political in nature, not mission-based. In fact, members often referred to AGPA as their “professional family,” having established longstanding friendships with one another and a strong allegiance to the organization as a whole. The strife was experienced as similar to the tensions that can arise in a family. The Waldorf-Astoria was experienced as a symbolic organizational home by many but, sadly, AGPA’s final Annual Meeting at the Waldorf took place in 1997, underscoring that “the times, they are a’changin’” (Dylan, 1964). On the other hand, this development was experienced by some as helpful in countering what they believed to be an “east coast-centric” and/or “elitist” attitude (meeting at the Waldorf) within the organization.
7. Relationship with the External World
As the 1990s progressed, AGPA began looking externally. The Registry, formed in 1993, became our mechanism to look outward and influence practice. The inevitable conflicts that came with the need for change imposed by the external world, including the insurance industry and an increasing regulatory climate, led to the question: How could we successfully chart our own course and maintain allegiance to our own values, yet remain attuned to changes in the world around us that might well affect our very form and existence?
AGPA served as a helpful container. Divisiveness was kept at a minimum, and collaboration regarding our differences was constructive. Gradually, AGPA had become an umbrella organization representing increasing diversity. Our theoretical orientations broadened, and the general membership began to be comprised of more psychologists, social workers, marriage and family therapists, nurses, and creative arts therapists, as we continued to welcome MDs. The number of women in leadership positions increased (see Table 1). The Gay and Lesbian Special Interest Group was established in 1997-1998, another explicit statement that inclusiveness, rather than exclusivity, was an important AGPA value. (This SIG was later expanded and renamed the Gay, Lesbian, Bisexual and Transgender Issues SIG.)
In retrospect it could be said that AGPA was able to use its own knowledge of group dynamics to manage its own struggles rather well.
AGPA became a member of the Mental Health Liaison Group in Washington, D.C., joining forces with other mental health organizations in attempting to influence Congress and other parts of the government.
Then, abruptly, AGPA turned outward with intensity. The events of 9/11 rushed us into the world as we responded to the needs of victims of the terrorist attacks in New York City, Pennsylvania, and Washington, D.C., their families, and the country as a whole. One of the authors (BJB), was just ending her AGPA presidency, but quickly reversed her direction from slowing down to re-immersing herself in the affairs of the organization so that, via a powerful collaborative effort on the part of many people, a comprehensive plan quickly emerged to shape AGPA’s involvement.
The 9/11 Era (2001-2008)
The potential value of conducting group interventions to address problems of trauma, loss, grief, and community crisis for thousands of survivors and their families was readily apparent. AGPA recognized that as an organization of experts who worked with groups, we had a unique and significant contribution to make. Almost overnight, we moved from being a guild to becoming a public health resource. Individual members, local Affiliate Societies, particularly the Eastern Group Psychotherapy Society (EGPS), and AGPA quickly began to work together.
Within the first six months following 9/11, AGPA became deeply involved on many different levels in the treatment and recovery effort: We participated in direct service delivery; developed support systems for the helpers; and initiated a broad array of training programs for clinicians to learn about treating trauma. These initial steps taken by the organization have taken us on a journey that has lasted to this day.
1. Mission(s)
The mission of AGPA was suddenly and dramatically expanded beyond our traditional aims as we identified ourselves as a public health resource that could be called upon following large-scale disasters and trauma.
2. Structure and Administration
It soon became clear that broadening our mission would require modifications in our structure and administration.
We quickly established the Disaster Outreach Task Force (which later became the Community Outreach Task Force) to conduct and monitor this new area of involvement. The Task Force was charged with determining points of delivery to the relief effort, monitoring credentials of group leaders, determining what training was needed, as well as what ongoing support services would be necessary for those doing frontline clinical work, education and training, and/or consultation. AGPA staff integrated and coordinated our efforts with those of other contributing individuals and organizations, while managing the practical, financial, and logistical operations.
A. Direct Service Delivery
Treatment of trauma in groups was new to the mental health community at that point. Most clinicians were relatively uninformed about large-scale trauma treatment, but there were experts among us who put their heads together to craft a response. Fortunately, each of us had some familiarity with the treatment of traumatized individuals in group (Buchele & Buchele, 1985; Ganzarain & Buchele, 1988; Klein & Schermer, 2000). Direct service delivery required that group leaders, operating as private contractors, be licensed and insured mental health providers. Licensure and insurance in one’s own discipline were CGP requirements. With assistance from EGPS and other Affiliate Societies, AGPA compiled an extensive list of CGPs in the New York, Boston, and Washington, D.C. areas, eager to be involved. All clinicians were provided consultation in their work. Co-leadership was encouraged. Finally, the leadership decided that this was far more than a volunteer effort in that it was a serious commitment to complete a complicated and demanding task to facilitate recovery by providing a service. Initially, a New York Times Company Foundation Grant provided funding so that group leaders could afford to leave their private offices to support the recovery initiative and be paid for their work. AGPA then sought additional grants to support these efforts.
AGPA began its work in the New York City area. A comprehensive three-tiered intervention approach was designed to: (1) address the immediate mental health needs of survivors, witnesses, and first-responders and their families; (2) reach out to assist businesses, school systems, and religious and community organizations in the immediate geographic area; (3) identify and begin working with those likely to suffer from the longer-range, disguised, or delayed effects of trauma.
During a seven-year period, AGPA conducted more than 500 group interventions (significantly more than originally promised) that touched the lives of thousands of people. They included both large and small group interventions, as well as individual sessions as needed. They ranged from single-session psychoeducational groups, to time-limited support groups, to ongoing time-extended service groups that continued for as long as five years. Participants included individuals and family members of survivors, witnesses, firemen, police officers, businesses, religious and community organizations, and school systems. AGPA was designated a First-Tier responder by the Office of the Mayor of New York City for its work following 9/11. AGPA was also recognized by the American Society of Association Executives with their 2005 Award of Excellence for its innovative work in citizenship and community service.
In the years immediately following 9/11, as disaster and trauma struck different areas of our country and the world around us, AGPA became involved in more relief and recovery efforts, including working with victims of school shootings, Hurricane Katrina, a tsunami in Southeast Asia, earthquakes in China, terrorist attacks in India, and traumatized combat veterans and their families. AGPA’s voice was heard in discussions at the Rosalynn Carter Symposia for Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) meetings, and subsequently in testimony before Congress on the treatment of returning veterans and their families. We chaired a coalition of New York City non-governmental organizations (NGOs) to address recovery from trauma, and explored further collaborations with other organizations, including the Red Cross, the Salvation Army, the Peter C. Alderman Foundation, the Robin Hood Foundation, and Voices of 9/11 among others. Over the years, we have maintained many of these collaborations.
B. Training for Mental Health Professionals
Providing training that ensures we do no harm and offers the highest quality of care is an important component of our organizational mission. To augment the basic training that our CGPs already had in group psychotherapy, trauma training was provided so that all leaders would have at least minimal training in group trauma treatment. Eventually, AGPA conducted a more extensive series of free online trauma training seminars during 2002-2004 that proved to be extremely well subscribed, attracting more than 2,500 participants. This marked the first time that AGPA made successful use of distance learning as a large-scale off-site training modality.
C. Support System to Help the Helpers
AGPA recognized that, in addition to our own members, many frontline community agencies located throughout the New York and Washington, D.C. areas would be called upon to deliver direct clinical service to 9/11 survivors. This led AGPA to prioritize “helping the helpers,” since conducting trauma work would expose clinical practitioners to considerable emotional stress, including compassion fatigue, secondary traumatization, and vicarious traumatization (Herman, 1992; Pearlman & Saakvitne, 1995; Allen, 2005). Hence, we provided both consultation and ongoing support groups for our own members, as well as for the clinical staffs of various public and private community agencies.
D. Further Development of Specialized Group Treatment of Trauma
Subsequent AGPA Annual Meetings featured numerous events and Special Institutes focusing on the diagnosis and treatment of trauma. In May 2003, together with EGPS, AGPA co-sponsored a Training Conference on “Group Approaches for the Psychological Effects of Terrorist Disasters” devoted to evidence-based approaches.
The cornerstone for the training efforts was the compilation of an AGPA book that consisted of 10 training modules commissioned by the September 11th Fund, Group Interventions for the Treatment of Psychological Trauma (Buchele & Spitz, 2004), which addressed group interventions for adults, adolescents and children following trauma. Evidence-based approaches were reviewed, along with the unique aspects of groups in the treatment of trauma, countertransference effects, longer-term follow up work, masked trauma reactions, and bereavement. These training modules were also incorporated into the Annual Meeting programs and subsequently were made available for staff training in community agencies.
The 2004 AGPA Annual Meeting featured a special “conference within a conference,” which featured initial protocols for group interventions following disaster for specific populations, including children, adolescents and families, uniform service personnel, survivors and witnesses, helpers and service delivery workers, those working with school systems, or those providing crisis intervention for organizations. Over the next several years, these protocols were reviewed by population-specific experts in the field and broadened for use with other similar populations. Plans were implemented for their use in training and dissemination. A final version of these population-specific protocols, Group Interventions for Disaster Preparedness and Response, was published in 2008 (Klein & Phillips, 2008).
In 2006, AGPA hosted a commemorative event for the fifth anniversary of 9/11, attended by people representing foundations, social service agencies, school programs, hospitals, interfaith organizations, various New York City programs, plus those AGPA members who had participated in disaster relief and recovery work. A group discussion on lessons learned and their implications for the future was moderated by Jack Rosenthal, President of The New York Times Company Foundation, the very same foundation that had awarded AGPA its first grant to support our initial efforts following 9/11.
Strategic Planning during the 9/11 era assumed increasing importance for AGPA. Maintaining our balance and overall priorities was essential. This process helped insure that the tail did not wag the dog. Our commitment of time, energy, and resources to trauma work, plus our success in obtaining substantial external funding early in this era, needed to be kept in perspective. It constituted only one part of our mission. Most importantly, we continued to be a membership organization with fundamental commitments to education, training, and research in group psychotherapy.
3. Jewels in the Crown
Both the AGPA Annual Meeting and the International Journal of Group Psychotherapy remained the “jewels in the crown” of our organization.
AGPA Annual Meetings remained the pre-eminent education and training sessions for group psychotherapists. By attending Annual Meetings one could learn about the latest developments in the field of group psychotherapy, network and share experiences with interested colleagues, and continue to expand one’s skills and expertise as a practitioner. Annual Meetings during the 9/11 era clearly reflected our extensive involvement with trauma work following disasters, although the bulk of the sessions continued to be devoted to our more traditional aims. Programming featured an outstanding array of invited speakers, institutes, workshops, and open sessions. Content areas included new theoretical developments, cutting-edge research, explorations of technique, different group leadership models, and applications of group approaches with different patient populations. Explorations of psychodynamic, as well as systems-centered, cognitive-behavioral, and relational, approaches could all be found in the program.5
During this period two important format changes were made in the Annual Meeting. First, the Community Meeting began to recognize efforts and achievements from all sectors of the organization. Second, a formal Memorial Service was introduced in 2004, becoming a standard feature to remember and honor those AGPA members who have died during the past year. Both events continue to evoke a deep, shared sense of connection and community.
As noted earlier, Annual Meeting attendance remained variable and somewhat unpredictable. Attendance in New Orleans in 2003 was 727 (our second year in a row meeting in that city to minimize administrative work during the immediate 9/11 recovery effort), but reached a 25-year high of 1,141 in New York just one year later. If generating a robust income stream were the sole concern then selection of a conference site would be relatively easy and straightforward. But other factors entered into consideration, especially with regard to our collective wish to be perceived and function as a national organization. By varying the site each year, the cost and convenience of attendance for members living in different areas was shared. Also, Affiliate Societies in different parts of the country were given a chance to host our Annual Meetings on a rotating basis.
In addition, AGPA began to move toward a model of year-round learning where opportunities expanded beyond the boundaries of the Annual Meeting. Not only did audiotapes of Annual Meeting events continue to be available after the meetings, but follow-up sessions were becoming a formal part of Annual Meeting presentations. Most importantly, with encouragement from the National Registry for Certified Group Psychotherapists, AGPA was making more extensive use of online learning. Seminars, panel discussions, and online group experiences were becoming available throughout the year. These offerings, often free or of minimal cost, were open to both AGPA members and non-members. The ready availability of continuing education credits for participation made them an even more desirable bargain.
The expansion of learning opportunities paved the way for AGPA to develop an Educational Product Line that featured a variety of specialized curricula. The Registry offered curricula for courses on: Ethics (MacNair-Semands, 2005); Principles of Group Psychotherapy (Weber, 2006); Training in Group Psychotherapy Supervision (Bernard & Spitz, 2006); CORE Battery Revisited (Burlingame et al., 2006); Psychoeducational Group Interventions (Brown, 2007); and Group Psychotherapy for Children (Sheppard, 2008). The trauma training modules (Buchele & Spitz, 2004) and population-specific intervention models (Klein & Phillips, 2008) also were published by AGPA during this period.
The International Journal of Group Psychotherapy remained the premier journal in the field throughout the 9/11 era. Quarterly issues focused on topics such as contemporary group psychotherapy and research, women in groups, eroticism and passion in group psychotherapy, group therapists’ shame, treating Post Traumatic Stress Disorder, grief and bereavement in groups, the relative efficacy of individual versus group psychotherapy, and working with children. Special issues appeared on a variety of topics, including termination, group therapist countertransference to trauma and traumatogenic situations, and ethical considerations in group psychotherapy. The size and diversity of the Editorial Committee was expanded. One excellent editor ended his term and another began. The Group Circle, expanded to include a Group Assets section about the Foundation, enjoyed continuing popularity as the organizational newsletter.
4. Membership
Membership numbers during the 9/11 era continued to decline. Membership reached a high of 4,298 in 1995-1996, but dropped 15 years later to a low of 2,131 in 2010-2011. The dream of establishing a membership base of 6,000 seemed unobtainable.
These data trends were consistent with those reported by other professional organizations. Most reported declining membership during this period. Were younger generations simply not joining organizations? Some sociologists suggested that we were beginning to experience the impact of the Gen-Xers, who have often been described as non-joiners (Putnam, 2000).
A variety of important questions about membership began to emerge during this time period. Does paying membership dues give one access to valued services and benefits that are not available to non-members? Can we maintain a roster of paid members or will we become an educational organization on a fee-for-service basis? Were the costs of membership outweighing the benefits? Were membership-based organizations still viable?
AGPA was also becoming increasingly aware that our members tended to represent an aging, white, middle-class population. Could we find ways to engage our most senior members when they were no longer conducting groups, or when they retired? Could we maintain diversity and attract younger populations? These and related important questions were being actively debated. In 2008, AGPA conducted a Joint Board Leadership Training Session on cultural diversity to try to determine how to expand our constituency base and create a home in AGPA for a wider variety of mental health professionals.
During this period, there was yearly and substantial growth in the Group Psychotherapy Foundation’s Scholarship Program, which successfully introduced and educated many students to the value and importance of group psychotherapy. Scholarships to AGPA’s Annual Meeting were awarded to deserving participants on the basis of interest and need. By 2006, the Scholarship Program numbers were soaring. Soon there were more than 100 scholarship recipients each year. These new attendees brought considerable excitement, exuberance, enthusiasm and energy, along with lots of new ideas, challenges and dilemmas to our ranks.
The injection of new blood through the Group Foundation scholarships has proven to be quite valuable. Each year AGPA receives many letters of gratitude acknowledging how important and meaningful recipients have found their experiences with us to be. While this has added to our meetings’ diversity, energy, and numbers, it has also required increasing fund raising activities. Donations to support the scholarship program have come primarily from AGPA members.
5. Financial Health
Throughout this era, achieving a balanced budget for AGPA and the Foundation remained a major priority. Decreasing membership had a significant impact on AGPA’s financial well-being. We were facing reduced revenue from dues and rising operating costs. But we were also embarking upon a new, expanded mission, involving increased activities as a public mental health resource. Fortunately, we secured external grant support in the form of foundation grants for most of our 9/11 efforts. AGPA received its first grant from the New York Times Company Foundation for $2 million in 2002. This led to our applying for and receiving additional grants. In 2004, with our expanded mission, we balanced our budget with grant acquisitions.
Our disaster outreach work was supported by, among others, The New York Times Company Foundation 9/11 Neediest Fund, the Time Warner Foundation, The Robin Hood Foundation, Project Liberty, The September 11th Fund, The September 11th Children’s Fund, The American Red Cross, Liberty Disaster Relief Fund, The Chevron Texaco Foundation, and the Langeloth Foundation. AGPA assembled a team of people to identify and contact potential funding sources, selecting only those funding organizations whose mission statements seemed compatible with our own. We developed and submitted a number of successful grant proposals, AGPA obtained 19 external grants totaling $5.7 million (Klein, Bernard, Thomas, Block, & Feirman, 2007), plus four Group Foundation Grants for more than $200,000 for a total of 23 grants for $5.9 million—no small feat, particularly given our level of organizational inexperience in such matters!
As we reached the close of the 9/11 era (2005-2008), new grant funding was largely unavailable. Efforts made to develop additional revenue streams met with limited success. Ultimately, AGPA had to reduce its commitment to serving as a direct public health service provider, and instead focus on disseminating and applying the trauma training modules and population-specific intervention protocols. The last grant we obtained from the Langeloth Foundation in 2004 supported these efforts through 2008. The Red Cross Disaster Relief Grant for our school program formally closed in 2007. To a significant extent, our contributions to other disaster relief and recovery work such as the aftermath of Hurricane Katrina, school shootings, and the earthquakes in China were underwritten by AGPA and its individual members, without external grant support.
It is important to note that, especially during the latter part of this period, AGPA had to make many difficult financial decisions. Pursuing multiple important objectives while simultaneously experiencing declines in our investment portfolio almost led us to the brink of financial disaster. When one of us (RHK) became AGPA President in 2004, the organization was facing a nearly $300,000 potential deficit for that year. Furthermore, between accomplishing our goals and an economic recession, we had been depleting our reserves at a rate of approximately $200,000 per year. If things did not change, the leadership agreed we could be completely out of business in just a few short years! Fortunately, cooler heads prevailed, and a satisfactory plan was constructed that restored financial order.
During the 9/11 era, AGPA, in collaboration with the Group Psychotherapy Foundation, made another important financial decision. Namely, the GPF agreed to pay down the mortgage principal on the AGPA headquarters. This decision was reached in 2003 after carefully considering the mortgage and maintenance costs associated with the New York City headquarters versus the costs and desirability of moving elsewhere. At that time, the remaining mortgage was $630,000. Eliminating the mortgage would significantly reduce AGPA’s yearly operating expenses.
The Capital Campaign, begun by GPF in 2003, raised $1.3 million with the dream of paying off the mortgage on the headquarters. The campaign was successfully completed and the mortgage was retired in 2005. In addition, the campaign also generated additional funding to help underwrite the costs of the Annual Meetings, thereby relieving an underlying source of budget deficits.
6. Organizational Tensions and Family Dynamics
Throughout the 9/11 era, organizational tensions centered around the expansion of our mission to include our role as a public mental health resource. Managing and paying for that enterprise without losing sight of our traditional focus remained crucial. Discussions often hinged on whether AGPA leadership should be looking more inside or more outside. Was our responsibility to attend more fully to the needs and interests of our members, or was it to engage the larger society where we might make a substantial contribution? Could we do both well and sustain the effort required? By 2007, AGPA office staff were being stretched to the limit with the convergence of too many activities with too few resources. Preserving an acceptable balance was complicated by the fact that much of the post-disaster trauma work was occurring on the east coast, inadvertently reinforcing the impression, as noted earlier, of some AGPA members that AGPA was east coast-centric.
Simultaneously, the field of psychotherapy was coming under fire. Questions were being raised at a national level by the federal government, consumers, and insurance companies as to whether psychotherapy was evidence-based (e.g., Anderson, 2006; Goodheart, Kazdin & Sternberg, 2006; Norcross & Wampold, 2011). Demands were being expressed for increased accountability (Burlingame, Straus & Joyce, 2013). Our professional identity and financial livelihood were being threatened. Even though few people could accurately define what evidence-based treatment actually meant or what counted as legitimate evidence, it became clear during this period that providing clinical services that were not evidence-based was not acceptable. Much of the accepted research demonstrating therapeutic efficacy had relied upon randomized controlled trials with diagnostically homogeneous groups using cognitive-behavioral and/or manualized short-term treatment interventions. For the most part, this was not what AGPA members were doing clinically. Most of our members conducted longer-term, heterogeneous, psychodynamically oriented groups. Few controlled studies, however, demonstrated the therapeutic efficacy of long-term, psychodynamically oriented group psychotherapy. Hence, many of our members were understandably anxious about the implications of these discussions.
In response to this growing level of concern, AGPA established the Science to Service Task Force in 2005 as an effort to bridge the gap between clinical practice and research (Klein, 2008). A blue-ribbon panel was created to review and synthesize the literature. By 2008, this Task Force provided a comprehensive, integrated set of widely heralded Clinical Practice Guidelines (Bernard et al., 2008) for group psychotherapy. Subsequent translation into multiple languages permitted their international use and attested to their popularity and efficacy. A more complete review of this effort can be found in a special issue of the International Journal of Group Psychotherapy (2008) and elsewhere (Leszcz & Kobos, 2010), as well as on the AGPA website.
7. Relationships with the Outside World
AGPA’s relationships with the outside world during the 9/11 era increased dramatically as we entered into the public mental health arena and responded to the changing climate of healthcare accountability. Efforts of AGPA’s Affiliate Societies were critical in this regard. We collaborated with other organizations and contacted funding sources to support our disaster relief and recovery work. Our trauma training modules and population-specific group intervention models were used by multiple agencies and branches of local and state government. Significant contacts were made with SAMHSA in New Orleans and with State Mental Health Departments in Louisiana, New Hampshire, Vermont, Rhode Island, and Maine. We invited other individuals and organizations doing disaster and recovery work to attend our Annual Meetings. In addition, we co-sponsored conferences and anniversary events in New York City, worked with the Veterans’ Administration and testified before Congress about the need for treatment of returning veterans. In 2008, AGPA joined the Human Services Council in New York City to network with local agencies, remain a visible resource, and identify potential opportunities to provide training, consultation, and supplemental service where needed.
Also in 2008, AGPA obtained its first training contract with a group of 14 Methadone Maintenance Clinics in New England. This contract resulted in a series of both in-person and online in-service training events. These activities began to expand the visibility and range of AGPA as a training/consultation resource within the mental health community.
On an international level, our trauma work led to developing relationships with survivors in Southeast Asia after a tsunami and with indigenous mental health workers in India following terrorist attacks. We also maintained extended contact with psychologists in China following earthquakes there. Multiple training sessions, lectures, seminars, group experiences, and consultations were provided by AGPA and individual AGPA members.
The Post-9/11 Era (2009-2016)
1. Mission(s)
Early in the post-9/11 era, AGPA continued to pursue its expanded education and training mission. Online education, development of new curricula, and community outreach continued to flourish. Opening the Online Continuing Education Center in 2009 took center stage. An online learning library was established with hundreds of hours of continuing education (CE) events. New telephonic CE events were offered and stored on the website. Development of new curricula continued with production of Adolescent Group Psychotherapy (Pojman, 2009), Substance Abuse and Addictions (Flores & Brook, 2011), and A Group Therapist’s Guide to Process Addictions (Korshak, Nickow, & Straus, 2015). The goal of year-round learning opportunities was fast becoming a reality.
Training contracts became a primary feature of Community Outreach Task Force activities. Work with the international community and at home continued. AGPA provided group training using Skype for mental health workers in Mumbai following terrorist attacks. Group training based upon the Principles of Group Psychotherapy course continued in China with follow-up supervision. A trauma training event was co-sponsored at an International Association for Group Psychotherapy and Group Processes (IAGP) Congress in Rome for survivors of the earthquake in Italy. Assistance efforts were directed toward the Haitian community after it was hit by a hurricane.
At home, Community Outreach responded to Hurricane Sandy, the Sandy Hook shootings, fires in Colorado, the Boston Marathon bombings, a Denver movie shooting, a Sikh temple attack in Illinois, the Virginia Navy Yard shootings, Austin and Colorado floods, and Oklahoma tornadoes. Through the Mental Health Liaison Group, AGPA provided input to legislative bodies on proactive mental health actions to reduce instances of violence.
Agency training contracts were also increasing. Additional in-service training was provided to several clinics in New Jersey, Methadone Maintenance Agencies in Boston, the DeBakey VA Medical Center in Houston, Georgia Department of Behavioral Health, a Bergen County (New Jersey) School District, and Kaiser Walnut Creek in California. AGPA partnered with the New York State Psychological Association to provide another disaster training event.
Camp Galaxy, begun in 2008, provided much needed recovery services building resilience each year for military families who had to deal with deployment or loss of a family member. This annual program, provided in collaboration with the Department of Defense, has proved to be extremely well-regarded and successful. In 2012, AGPA received the New York Society of Association Executives Social Responsibility Award for the Camp Galaxy program.
AGPA’s ongoing commitment to promoting increased diversity and cultural sensitivity was underscored throughout this period. Leadership assumed an active role in this process. Not only were these values broadly embraced by the organization, but participation in diversity training was required for Institute faculty as of 2015, and for all Annual Meeting faculty, the AGPA Board of Director members, and AGPA Staff as of 2016 (Klein, 2016).
2. Structure and Administration
Early in the post-9/11 era, it became clear that AGPA was ready for reappraisal and refocusing. Too many activities with too few AGPA staff had been underway. Funding for existing programs remained an important issue. We were feeling spread too thin and were experiencing an identity crisis. Examining our tri-organizational names, clarifying our priorities, redefining our missions, and revisiting our organizational structure were all perceived as important and necessary activities. Each component of our organizational identity needed to be scrutinized.
Through Strategic Planning initiated in 2010, AGPA retained its name but adopted a new tagline, “Groups at Work: Connection, Education, Leadership.” The GPF changed its name to the Group Foundation for Advancing Mental Health, with the tagline, “Together We Can Change Lives.” The Registry became the International Board for Certification of Group Psychotherapists. The mission statements and purposes of each tri-organizational component underwent revision. The organizations changed its logos, and in 2012, a consultant was engaged to guide AGPA through a massive website redevelopment project.
Planning for AGPA’s 75th Anniversary in 2017 became yet another important priority. By 2015, the process was well underway. Members were asked to record anniversary messages, commemorative publications were scheduled (including this history), and special event plans were made.
It is important to note here that a large part of AGPA’s success as an organization has been its capacity for self-examination, ability to adapt to changes in the environment, and its extraordinary potential for continuing growth and development. Strategic Planning has played a vital role in our success. But, beyond all else, we have been able to rely upon a steady and creative hand at the helm. Our CEO, Marsha Block, has provided that. In 2014, she celebrated her 40th year as CEO of AGPA. The continuity and guidance that she has provided is unparalleled in the world of not-for-profit corporations. Her dedicated and sustained tenure in this leadership role far exceeds that of any other CEO in the field. Few situations arise now that she has not seen before. Her management and financial skills are exceptional. Her ability to think strategically and creatively, her depth of knowledge about our organization and its history, and her talent at forming seamless and effective working partnerships with a constant cascade of volunteer leaders from within the organization, are all remarkable.
Indeed, Marsha Block, together with Angela Stephens (over 35 years with AGPA) and Diane Feirman (25 years with AGPA by the time of our 75th), have functioned as AGPA’s renewable energy sources for decades.
3. Jewels in the Crown
During the post-9/11 era, AGPA’s Annual Meeting continued to maintain its standard of excellence. Efforts were made to integrate the latest developments in theory and practice into the program, including advances in neurobiology, and attachment and relational models for group psychotherapy. More events focusing on evidence-based approaches to group psychotherapy were featured on the program as well. In 2010, a military track was created for the Annual Meeting, with invited presentations from the Department of Defense and the Veterans Administration.
The Scholarship Program flourished with more than 125 recipients in 2010, over 160 in 2013 and in excess of 200 in 2014.
Year-round learning was augmented through provision of 15 distance learning conferences in 2009. Our first online process group was introduced in 2010. However, it was becoming clear that the distance learning effort was encountering difficulties in the form of low participation numbers. In addition, the constant flow of marketing emails was annoying for some members. Increasing attention was required to try to find the right balance between topics, faculty, numbers of events, marketing, and audience interest. Some scaling back seemed to be in order and has been accomplished. Participation is now excellent, maxing out our teleconference capacity at almost every event.
By 2010, the International Journal of Group Psychotherapy was fully online. In 2013, an editorial shift took place. The arrival of another talented new Editor-in-Chief, plus the addition of new members to the Editorial Committee, again broadened our diversity and brought better balance with more researchers to review submissions. In 2015, the Journal’s contract with our former publisher, Guilford Press, expired. A new publisher, Taylor and Francis, was retained. Skillful negotiation of the new contract resulted in a $100,000 signing bonus, plus a nearly tripled annual income for AGPA. IJGP content continued to be broad and pan-theoretical. Special issues/sections, focusing on such topics as clinical practice guidelines, group interventions in college counseling centers, neurobiology and building interpersonal systems, and violence in America, remained an important bonus feature. Thus, the Journal continued to maintain its preeminence as the leading source of information for group psychotherapists. The Group Circle’s Editor pursued its carefully crafted format that touched upon timely issues in the field and featured both clinical and research matters, along with sections on consultation and Affiliate Society news.
However, while the Journal remained a vibrant jewel in the crown, and was now online as an income generating asset, there was increasing concern about its impact factor (Saha, Saint, & Christakis, 2003), a measure of how often articles published in the Journal are cited by others. In part, it was thought that our relatively low impact factor might be reflecting our tendency to publish more clinically relevant material as compared with more methodologically rigorous experimental work. More prominent, as well as younger aspiring authors might, therefore, be reluctant to publish with us unless their work reached a wider audience. The Editorial Committee is currently addressing this problem.
4. Membership
Concerns about shrinking membership have remained in the forefront during the post-9/11 era. This has been the case even though membership numbers had risen to their highest point in several years in 2014-2015. We have continued our attempts to broaden and diversify the membership base by promoting AGPA’s visibility in the field, strengthening recruiting efforts, making it easier and more attractive to join, and augmenting member benefits. All these efforts, however, have yielded limited success with much time and energy expended for meager returns. The downward trend in membership numbers has continued during this period despite the development over the years of multiple Special Interest Groups (SIGs) that have provided opportunities for members to pursue their particular interests at a grassroots level throughout the year. Discussion is underway about the longer-term implications of these trends for AGPA and whether we can remain a membership-based organization going forward.
5. Financial Health
As we entered into the post 9/11 period, our existing grants had expired and new grant opportunities were no longer available to support our outreach activities. On the other hand, we were moving forward with training contracts. In addition, attendance at Annual Meetings had remained relatively robust, and the Journal had become income-producing.
Two other important developments also occurred during this period and both had significant financial implications for AGPA. First, our investment portfolio recovered from the lows of 2007. In 2007, our investment portfolio, like that of many other organizations and individuals, had sustained major losses. The bubble burst and the stock market continued to fall as the banking and mortgage scandals broke across the United States. By 2013, however, our investment portfolio had fully recovered.
Second, the Foundation assumed an increasingly important role in supporting AGPA’s operations. To offset both grant and market losses during this period, the Foundation began to provide additional financial support for AGPA. The Scholarship Program continued to grow, reaching more than 200 recipients in 2015. More importantly, the Foundation raised $375,000 in 2014, a 25% increase from just three years prior. The Foundation had clearly become a major financial contributor to AGPA. Its role and importance to the organization grew significantly during this period.
6. Organizational Tensions and Family Dynamics
During the post-9/11 period, organizational tensions continued to surface in relation to the extent to which AGPA was focused on our role in the broader community versus our allegiance to the needs of our own members. Transitioning from our enormous reliance on outside grant funding while returning to our primary mission as an education/training/practice/research organization was managed well by the leadership. We remained actively involved in community outreach work but restored better balance to our operations. This was accomplished in large part through the process of an organizational makeover and modernization.
The goal of creating year-round learning opportunities was becoming a reality. But so, too, were the inherent problems that accompanied that process. In addition, we were unable to make any meaningful inroads with third party payers. It was becoming clear that, without employing a lobbyist to effectively represent our interests, we would continue to have limited influence in Washington, D.C. Even if we were able to increase our lobbying efforts, we might well find that, like most other mental health professional organizations, we are being marginalized.
In the external world, emphasis on evidence-based care continued so that the accompanying tensions required attention. The Science to Service Task Force continued to pursue the mission of promoting better integration between clinical practice and research and bridging the gap between the two. Following publication of the Group Psychotherapy Clinical Practice Guidelines (Bernard et al., 2008), the Task Force mobilized its internal resources to address the evidentiary base for group psychotherapy. Its summary and synthesis of the available literature in the field supporting the fact that group psychotherapy is evidence-based can be found on the AGPA website (Barlow et al., 2015). The important role played by this Task Force was further underscored when it was asked to take responsibility for updating and developing new training curricula, a task formerly managed by the Certification Board.
7. Relationships with the Outside World
During this era, our strengthened relationships with the outside world were sustained except for our drastically reduced reliance on external grant funding. Many of the relationships and partnerships established during the 9/11 era persisted. Responding to disasters and trauma, marketing and disseminating our training materials, providing in-service trainings and maintaining outreach efforts with agency staffs, expanding our Scholarship Program, pushing for greater diversity, and broadening our efforts at membership recruitment, all continually took us outside of our own membership boundaries.
Also important to note has been our collaboration with the American Psychological Association (APA) Division 49 and with the American Board of Professional Psychology to have group psychotherapy approved as an APA specialty. This considerable effort by psychologists, if successful, will constitute a major victory in our attempts to be recognized as a specific type of therapy requiring specialized training. In many ways, it constitutes a continuation of the work initiated by the Registry years ago when it introduced the idea of standards and levels of expertise in working with groups.
Unfortunately, our sphere of influence with some aspects of the external world, as measured by our relationships with managed care and Washington, D.C., has remained rather limited.
Of interest in this regard is the increased tension between AGPA and IAGP. This seems to be directly attributable to the Registry changing its name from the National Registry of Certified Group Psychotherapists to the International Board for Certification of Group Psychotherapists. This expansion of its scope and domain largely in reaction to community outreach work and the need for educational standards in emerging countries would elicit a strong reaction from our international colleagues. The Certification Board and AGPA are continuing to work on strengthening our relationships with IAGP as well as with other national and international organizations.
The Future: Dilemmas, Dreams and Desires
In the course of this discussion of AGPA’s history from 1992-2016, we have touched upon a number of important concerns that will require further attention going forward. In the authors’ opinion, we view these as opportunities as we move into our future.
There is little doubt, for example, that AGPA will continue to operate in the world of insurance companies placing increasing demands upon professionals and professional organizations to research, develop, and provide evidence-based treatments. Where we go with our Community Outreach and Distance Learning programs, how we resolve tensions with international group organizations, what we do to increase the impact factor of our Journal, and determining how we can expand our influence with third party payers, consumers, the government, and the professional mental health community, including staff in agencies, hospitals, and public practice settings, all remain important issues to be addressed.
Of course, to address any of these issues will require us to sustain financial viability and continue to grow and adapt to the world in which we live. Here we want to highlight the importance of three critical issues: maintaining a balance between our internally and externally focused activities; attending to membership needs; and ensuring leadership succession and stability.
1. Maintaining Our Balance
Earlier we noted that to survive and prosper, AGPA, like all organizations, needs to remain an open system, with its leadership standing on the boundary between the organization and the world around it, able to look both inside at the needs and desires of its members and outside at the interests, opportunities, and demands of the external environment. Thus, AGPA needs to remain flexible and attuned to both internal and external changes. It must also preserve a balance in allocating its resources (time, money, energy). Arriving at a balance is an ongoing process, requiring continuous assessment and adjustment. Strategic Planning has provided a vehicle for us to do that and needs to be maintained going forward.
During the past 25 years, largely because of 9/11, we have witnessed that pendulum swinging in the direction of responding to the opportunities and demands of the world in which we live. Both the needs and funding were available. Going forward, it is important to remind ourselves of our fundamental mission, which is to make AGPA the primary source for education, learning, and research in the field of group psychotherapy. Whatever we choose to do in the future, it should be consistent with and guided by our core values (Klein, 2004). By maintaining this allegiance, we feel confident that AGPA will be able to continue to raise awareness about the value of group psychotherapy and solidify our reputation as a leader in this field, dedicated to healing patients and improving lives. We believe that AGPA should remain a diverse organization with recognized authority on all forms of group process and functioning. We need to remain the standard bearer for the field, the organization that strives to ensure that all group therapists are highly educated and trained throughout their careers. In addition to providing opportunities for lifelong learning, AGPA can also continue to create lifetime bonds. Connecting with others and recharging one’s batteries are essential for all of us.
2. Membership
Throughout this entire 25-year period, AGPA, as other not-for-profit organizations, has witnessed a slow, but steady decrease in the number of members. The leadership continues to struggle with this challenge, though two developments have occurred that affect our situation in a positive way.
First, membership dues had always been one of the two primary income streams for the organization. Dues were critical in covering our direct and indirect program expenses, including payment of our mortgage. During the last 25 years, the Foundation has raised considerable monies leading to the retiring of AGPA’s mortgage on its headquarters. Those fundraising efforts have also supported AGPA in many different ways, including endowing specific events at the Annual Meeting, providing extensive scholarships which have increased the presence of younger people in AGPA, and funding research and other activities. Thus, the dependence on dues is somewhat less than earlier.
Second, membership is about community. That spirit of community is very important within AGPA’s culture to the point that it can even be considered a primary membership benefit. How a community is constructed and the concept of what a community is has undergone change with the impact of technology. Our growing SIGs, our Distance Learning opportunities, and our increasingly used listserv provide that community connection in between Annual Meetings.
As the leadership continues to wrestle with the diminishing numbers, consideration of how to incorporate the online aspects of community-building, maintenance, and growth will play a major role. Traditionally, we have depended heavily on face-to-face contact, but younger generations generally prefer connecting through their mobile devices and other online methods. As group therapists, we know that elimination of all in-person contact, that is, relying totally on technology, is unsatisfactory. However, since technology plays a significant role in how we relate to one another today, we will need to plan how the community can best blend these ways of being together, while sustaining the necessary revenue that comes from our Annual (face-to-face) Meeting.
3. Succession
We have been very fortunate as an organization to have our CEO, Marsha Block, CAE, CFRE, with us for over 40 years. The longevity of our time with Angela Stephens, CAE, and Diane Feirman, CAE, is also noteworthy and a big asset. No one wants to think about what AGPA would be like without Marsha, or Angela, or Diane. To the leadership’s credit, much thinking and planning about succession is well underway. A comprehensive plan has been outlined to insure that smooth, thoughtful transitions can occur.
As we move into our next 25 years, our incorporation of Strategic Planning into AGPA culture will continue to afford us a tool for further additional planning to occur, and, given AGPA’s capacity to cope with reality, we know it will happen.
AGPA is about to celebrate its 75th Anniversary, a significant milestone for a not-for-profit organization. On the other hand, it may seem like a single grain in the sand of time when considered from the perspective of the Big Bang theory of the origin of the universe about 13.7 billion years ago. But for many of us, AGPA has been a tree of life, providing sustenance and renewal. As the old leaves drop away, may it continue to produce countless new vibrant ones.
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Table 1. Tri-Partite Organizational Leadership
Year | AGPA | IBCGP | Group Foundation |
| 1992-1994 | Anne Alonso, PhD, CGP, DLFAGPA | Sharon Cheeseman, LICSW, CGP, LFAGPA (1993-1996) | Ruth Hochberg, PhD, CGP, DLFAGPA (1989-1993) |
| 1994-1996 | K. Roy McKenzie, MD, CGP, DFAGPA | John Price, PhD, LFAGPA (1993-1996) | |
| 1996-1998 | Saul Tuttman, MD, PhD, DFAGPA | Barry Helfmann, PsyD, CGP, DFAGPA (1996-2000) | Anne Alonso, PhD, CGP, DLFAGPA (1996-1998) |
| 1998-2000 | David Hawkins, MD, CGP, DLFAGPA | Albert Reister, EdD, FAGPA (1998-2000) | |
| 2000-2002 | Bonnie Buchele, PhD, CGP, DLFAGPA | Jeanne Pasternak, LCSW, CGP, FAGPA (2000-2006) | Isaiah Zimmerman, PhD, LFAGPA (2000) |
| 2002-2004 | Harold Bernard, PhD, ABPP, CGP, DLFAGPA | Patricia Barth, PhD, CGP, DLFAGPA (2000-2008) | |
| 2004-2006 | Robert Klein, PhD, ABPP, CGP, DLFAGPA | ||
| 2006-2008 | Elizabeth Knight, MSW, CGP, DFAGPA | Sherrie Smith, LCSW-R, CGP, FAGPA (2006-2014) | |
| 2008-2010 | Connie Concannon, LCSW, CGP, DFAGPA | Lisa Magon, PhD, CGP, FAGPA (2008-2014) | |
| 2010-2012 | Jeffrey Kleinberg, PhD, CGP, DFAGPA | ||
| 2012-2014 | Kathleen Ulman, PhD, CGP, FAGPA | ||
| 2014-2016 | Les Greene, PhD, CGP, LFAGPA | Tony Sheppard, PsyD, CGP, FAGPA (2014-Present) | Phyllis Cohen, PhD, PsyD, CGP, LFAGPA (2014-2016) |
| 2016-2018 | Eleanor Counselman, EdD, CGP, LFAGPA | Karen Travis, LCSW, BCD, CGP, FAGPA (2016-Present) |