Wook se Cho
Gentling the bull: harnessing anti-group
forces in music therapy group work with
adults with learning disabilities
Wook se Cho, (2013) "Gentling the bull: harnessing anti-group forces in music therapy group work with
adults with learning disabilities" from British Journal of Music Therapy 27 (1) pp.6-15, London: British
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Gentling the Bull:" Harnessing Anti-Group Forces
in Music Therapy Group Work with Adults with
Learning Disabilities
Wookse Cho
Abstract
This paper aims to examine music therapy group work with adults with learning disabilities, with a particular focus on the musical manifestations
forces. Anti-group
is a concept formulated
describe the destructive
development.
of the 'anti-group'
(Nitsun 1996)
by the group analyst Morris Nitsun in order to
aspects of groups that threaten
To illustrate the working of anti-group
their integrity
and therapeutic
forces in a music therapy group set-
ting, I will also present a case study of a slow open music therapy group which I ran for 3
years in an NHS clinic for adults with learning disabilities.
recognising, confronting
and harnessing the forces of the anti-group
pist and then by the group members)
and creativity,
Finally I will try to illustrate how
(firstly by the thera-
provided the group with opportunities
for growth
in particular in the way the members related to each other musically.
Keywords: adults with learning disabilities, group work, anti-group
stand, process and work with the themes
Introduction
which emerge as the result of the dynam-
Music therapy group work with adults
ic interactions
(both musical and non-
with learning disabilities is a challenging
musical) between the group members, I
area of work, which requires the therapist
consider in this article the way in which it
to use many different sets of skills. On the
is important for the therapist to also have
one hand he or she needs to be aware of
a good working knowledge and under-
the nature of each person's disabilities
standing of the concepts of group work
and how that could impact on their ability
and of group analytic theory in particular.
From my experience of facilitating
to use the instruments. Some members of
the group, due to physical disability, may
music therapy
not be able to hold a beater or use it with
learning disabilities, I have found that alt-
enough control to make a strong sound
hough therapeutic groups are designed to
on a drum, whilst others may have no
help people with problems of relating,
problem
also
communicating and expression of feelings
needs to consider the varying levels of
and emotions, it is true that this same
ability to use verbal communication,
experience can also create problems and
doing so. The therapist
as
groups for
adults with
well as the emotional and psychological
difficulties for the people involved. I think
needs of each person. In order to under-
this is particularly the case with people
6
who have had negative experiences of
has been of particular interest and rele-
various group settings, something many
vance. Eleanor Richards and Hayley Hind
people with learning disabilities may have
describe their experiences of running a
had. Richards (2007) writes about how
music therapy group for adults with learn-
many adults with learning disabilities tend
ing disabilities. They write about how the
to have been in institutional
group survived the breaking down of the
care since
childhood, resulting in "a sudden and un-
"agreement
explained
... to sustain a bland, un-
separation
changing atmosphere" (Richards and Hind
from their family of origin, and been re-
2002: 128), to become more able to tol-
quired to live in an environment
(or
inexplicable)
full of
erate a chaotic and unpredictable atmos-
other people, but offering little chance of
phere. They also talk about how surviving
either
privacy"
this process enabled the group to find
(Richards 2007: 61). She added that the
new ways to play the instruments, take
internal working
more care of them and also to relate to
lasting
attachment
or
model of people with
such early experiences of family, home or
each other with a feeling of playfulness.
group settings could be characterised by
Although Richards and Hind do not men-
"pessimistic assumptions about their lim-
tion the "anti-group",
ited value to others, the likelihood of re-
describe is very similar to that described
curring separations, their perception by
in my clinical example.
the process they
others as a 'problem', and their own ina-
In her chapter "Music Therapy with
bility to be an agent of change" (Richards
Adults with Learning Disabilities: Sharing
2007: 61). For people with such experi-
Stories"
ences a therapy group could be a place
about how a music therapy group has a
where these negative experiences and
particular value for people who find it dif-
beliefs about themselves
ficult to work with words. Music used in
fulfilling
become self-
prophecies, laden with
(Watson 2007) Watson writes
the therapeutic context can allow the cli-
hostile
ent to be an equal member of the group
projections of the membership.
"Anti-group"
(Nitsun 1996) is a con-
through their musical contribution
with-
cept formulated
by the group analyst
out needing verbal fluency. This makes it
Morris Nitsun to describe this often over-
possible for them to explore different
looked aspect of therapeutic group work.
roles (for example, being a leader, sup-
Nitsun says that he developed the idea to
porter, listener or a soloist) and issues
"help to make it possible to understand
such as difficulty in maintaining good rela-
the destructive processes at work and the
tionships with peers or carers, unresolved
tendency for some groups to turn in on
bereavement,
themselves in self-destructive ways" (Nit-
emotions
sun 1996: 1).
ways. Watson also describes her experi-
in
or difficulty
healthy,
in expressing
non-destructive
ence of running a music therapy group for
Literature review
people with more severe and profound
learning disabilities. In particular she ex-
Recently there has been a growing body
of literature
plains the importance of looking out for
about music therapy group
signs of defensive behaviour when work-
work with adults with learning disabilities.
ing with this client group, such as the cli-
The work of UK-based music therapists
ent falling asleep, discarding or throwing
Richards (Richards and Hind 2002; Rich-
away instruments, self-stimulatory behav-
ards 2007) and Watson (Watson 2007)
7
iour, constant playing, and rocking of the
ing; indeed I refrained from producing the
body back and forth. Again Watson does
group's ideas, influencing them as little as
not mention the term "anti-group" to de-
I could, but I was nevertheless doing
scribe such behaviour, but I believe this is
something. I was not the composer who
one potential description of such phe-
wrote the music, but the conductor who
nomena. Later in this article I attempt to
interpreted it, the conductor who brought
illustrate how these kinds of behaviour
it to light" (Foulkes 1948: 282). In my
could be seen as manifestations of anti-
opinion this makes his thinking applicable
group processesin music therapy. Firstly, I
to a music therapy group setting, a theme
would like to explore the notion of the
which
aggression of the group towards itself,
"Group Analysis and Improvisation: A Mu-
something Richards, Hind and Watson
sical Perspective" (Towse 1997). She dis-
Towse explores in her article
have alluded to but not mentioned explic-
cusses similarities
itly. In order to do this I will examine the
fugue and conducting a group, in terms of
between
playing a
concept of anti-group in more detail.
the conductor's need to decide on the
balance of voices, sometimes allowing
The development
psychotherapy:
of group
one voice to sing through whilst at other
Foulkes and Bion
times holding back a voice so as not to
overpower the others (Towse 1997: 52).
Foulkes is regarded by many as the founding father of group analysis. Although
Foulkes believed it was in the nature
therapeutic groups did exist before Foulk-
of group work that what was concealed
es, he was the first person to describe his
and repressed in the individual became
group work as group analysis or group
expressed in the interactions and inter-
analytic psychotherapy (Behr and Hearst
communications within the group. Nitsun
2005: 22). At the centre of his vision of
has argued that Foulkes had a somewhat
the powerfully creative potential of group
idealistic and optimistic vision of group
analysis was the concept of the "group
work and overlooked the negative aspects
matrix" (Foulkes 1971). He saw this as an
of group functioning, such as the fear and
ever-expanding network of communica-
hostility of the group members towards
tion between the group members that
the group, their attacks on the group, and
enabled therapeutic work to take place.
other symptoms of group malfunctioning
The two levels of the matrix are described
such as dropouts and group disintegration
asthe foundation matrix (which is created
(Nitsun 1996: 29).
by the commonalities between members
The diametrically opposite point of
at the start of the group's life) and the
view about group work was represented
dynamic matrix (which refers to the con-
by the work of Wilfred Bion. In his theo-
tinuously changing themes in the group,
ries on groups, Bion emphasised regres-
which emerge and develop as the group
sion above everything else and thus he
progresses). Foulkes also saw the role of
felt that ultimately all group tasks were
the therapist in an analytical group very
undermined by the impact of primitive
much as that of a conductor, and used the
fantasies and behaviour in group settings
word in a musical sense. He explained his
(Nitsun 1996: 10-11).
choice of the term conductor thus: "I of-
commander in the First World War, Bion
ten felt that my contribution was similar
became involved in what came to be
to that of a conductor. I was not produc-
known as "the First Northfield
8
A former
tank
Experi-
ment" (Behr and Hearst 2005: 22), helping
between the two) (Nitsun 1996: 57-59).
soldier-patients
from the Second World
The task for the group when faced with
War to organise their daily lives by form-
these processes is to break the vicious
ing task groups which they themselves
cycle or at least to diminish its rigidity
ran. However, due to disagreements be-
and/or intensity.
Other direct and indirect expressions
tween Bion and the military top brass at
Northfield
Hospital with
of the anti-group include "scape-goating"
regard to the
need to maintain military codes in these
(Nitsun 1996: 62) (an investment or pro-
groups, the experiment
col-
jection of anti-group by the whole group
lapsed. In his contribution to group theo-
in or onto a particular member, to the
ry, Bion emphasised the need for the
point of making this member want to
group leader to address the unconsciously
withdraw in hurt and anger) and the phe-
determined attitudes of the group mem-
nomenon
bers, which could interfere with the task
SS), where people suddenly stop attend-
of the group. These became known as
ing and eventually leave the group. This
"basic assumptions"
can often
eventually
(Behr and Hearst
of "dropouts"
(Nitsun
1996:
lead to a chain reaction of
dropouts. According to Nitsun, anti-group
2005: 21), with each requiring a different
kind of leadership from the group leader.
processes can also evoke considerable
It is interesting to note that whilst Foulkes
feelings of despair and failure in the facili-
saw the role of the group leader as that of
tator/therapist
(Nitsun 1996: 56).
a conductor, Bion saw it in terms of the
Nitsun
leader, thus possibly putting less faith in
that contribute
the group members' own abilities to help
nomenon, as follows (Nitsun 1996: 108-
each other. After the Northfield
132):
experi-
described
five
phenomena
to the anti-group
phe-
1. Regression: a tendency for people
ment, although Bion continued for some
time to run groups at the Tavistock Centre
in groups to become more primi-
in London, he eventually stopped pursu-
tive,
impulsive
and
unreflective,
due to the weakening of ego func-
ing his practice as a group therapist.
In order to find a perspective on
tioning in the group. This is akin to
group work that integrates both optimis-
what is commonly known as herd
or mob mentality.
tic and pessimistic outlooks, Nitsun developed the concept of the anti-group. He
2. Survival anxiety: groups can cause
used this to describe destructive process-
both 'fear of physical attack' and
es at work in groups, including the notion
'psychological attack' on the self,
of a group's aggressive attacks towards
with corresponding fears of injury,
itself. In relation to this there are two
death or psychological annihilation.
types of anti-group processes: 1) the man-
The failure to contain these fears
ifest anti-group (where an individual or
can impregnate the group with a
subgroup
sense of dread and predispose it to
carries the anti-group
senti-
ments for the rest of the group); and 2)
anti-group processes.
the latent anti-group (a less overtly ex-
3. Failure of communication:
in most
pressed form than the Manifest type but
groups, individuals vary widely in
pervading the whole group and potential-
their ability to express themselves
ly feeding into the manifest anti-group,
verbally. Groups can also vary wide-
thus developing
ly in their ability to overcome the
a circular
relationship
9
impasse and alienation caused by
members, two female and three male pa-
failed communications.
tients, with learning disabilities and vary-
4. Projective
plural
ing levels of ability to use verbal commu-
membership makes groups condu-
nication. The three men - J, D and M -
cive to frequent and intense projec-
had been in the group since the begin-
tive
identification:
identification
between
the
ning. J was in his early thirties, in a wheel-
members. Groups can often be-
chair, and often
come a mirror to hostile projections
group's music using his very expressive
of their membership.
voice. D was in his late fifties, and alt-
contributed
to
the
5. Envy:groups are often rife with po-
hough, when not playing music he was
tential for envy between members,
usually very quiet, he liked to play very
and an anti-group can arise when
loudly using drums with a beater. M was
envy
the
in his late thirties, suffered from epileptic
group itself, as a symbolic contain-
becomes directed
at
seizures and for this reason his attend-
er.
ance was irregular. The two
Nitsun believed that the anti-group is un-
joined later:
women
e who was in her late thirties,
avoidable in any group work. He argued
had severe learning disabilities as well as
that anti-group processes have a devel-
very limited vision. Lastly H, who was in
opmental function in the life of a group, in
her mid-twenties, was the most verbally
terms of posing a challenge to its strength
able member. The general aims of the
and resilience in the face of adversities.
group included using freely improvised
He felt that if a group can survive the de-
music to promote interaction, communi-
structive threat of the anti-group, this in
cation and expression between the group
itself can be transformational in that it
members.
attests to the strength of the group. Fur-
In the beginning phase of their work,
thermore, Nitsun also believed that anti-
the group's music as a whole felt quite
group processes can have a complemen-
disparate and chaotic, and the members
tary relationship to the creative and gen-
seemed disconnected from each other.
erative processesin the group, although it
Members often struggled to relate to
is important to note that the creative po-
each other's different feelings of pulse
tential of the anti-group exists in a deli-
and some also showed difficulties in play-
cate balance with its destructive potential
ing in a sustained way. The two therapists
(Nitsun 1996: 44-45). I shall now use an
often tried to work closely together musi-
example of a music therapy group with
cally so as to contain and shape the dis-
adults with learning disabilities to explore
parate elements in the group's music. For
these ideas further.
example, the co-therapist often used her
flute or her voice to interact directly with,
Clinical example
as well as to draw out, each group mem-
The group whose work I am going to pre-
ber's sound. She did this by playing or
sent started in January 2007 and ran until
singing short melodic fragments that mir-
March 2010. It was run as a slow open
rored the rhythmic feel of each group
group and was facilitated initially by two
member's playing. This freed me up to
music therapists, myself and my music
create a containing and yet evolving mu-
therapy colleague (whom I shall refer to
sical structure for the group's sounds
as the co-therapist). It consisted of five
from the piano, using different harmonic
10
devices, such as a simple diatonic chord
therapist
used clapping and singing to
progression repeated, pedal points, mod-
draw out H's quiet playing, as well as to
al harmony using different intervals, osti-
match the insistent rhythmic playing of D.
nato patterns and at times more textural
Meanwhile I was playing a simple repeat-
atonal music to match the chaotic feeling
ed harmonic progression that could pro-
in the group's music. By October 2008 the
vide a feeling
group had been running for over a year
group's music and using changes in dy-
of containment
to the
and we had reached the point where
namics to match the singing of J, which
many of the members seemed quite com-
often
fortable
with
freely
improvised
had a wide
dynamic and tonal
range. Thus we worked closely together
group
playing. Each person had also established
to
provide
a musical framework
that
their own unique way of playing in the
could allow everyone to experience being
group. J tended to use his expressive
heard, as well as to hear each other's dif-
voice with a huge melodic and dynamic
ferent sounds.
In November 2008 the co-therapist
range. At times he would join in disruptively, but at other times in a more tem-
left the group to go on maternity
pered and measured way. D often played
and I decided to carryon
a drum or a xylophone using a beater. He
group on my own. Following her depar-
tended to play in waves of rhythm, usually
ture, perhaps not surprisingly, the group
in a fast tempo, followed by pauses in be-
then went through a difficult period. J be-
tween. M's playing was sporadic as his
gan to display destructive behaviour to-
energy and anxiety levels were very de-
wards some of the instruments,
pendent on whether or not he had re-
thing he used to do early on in the group's
e tended
leave
facilitating the
some-
to play quietly
life but had then ceased to do. He also
on the wind chime or hand-held shakers
started to disrupt the group's music, by
due to her difficulties in holding and con-
preventing other players or myself from
cently a seizure.
trolling the instruments. Lastly H played in
playing. He often seemed to want to wil-
a very measured and slow way, often tap-
fully sabotage the group's music, or even
ping on a tambourine or a tambour, and
at times the whole session. I also noticed
struggled to join in when the group's
a big change in behaviour in H. During
tempo was faster than the one that she
group improvisations, instead of sitting in
was comfortable with. In one of the ses-
the circle with the rest of the group, she
sions around this time
might choose to sit next to the therapist
the therapists
started a group improvised piece by play-
near the piano, at times seemingly using it
ing with each other, the co-therapist using
to hide from the rest of the group. There
her flute and myself the piano. Our hope
was a growing absenteeism in the group,
was to model for the group how we could
with many of the members often missing
play together
sessions. Furthermore, there was a grow-
listening closely to each
other's sounds and responding by mirror-
ing tension and conflict between Hand J.
ing each other's melodic phrases. Gradu-
H, who was the most verbally able mem-
ally other group members joined in, J us-
ber of the group, started to verbally at-
ing his expressive, 'operatic' vocal sound,
tack J whenever
D his repeated, hypnotic rhythm on the
sounds,
xylophone and H her quiet, slow, meas-
group's music. She often said "bad!" to
ured playing on the tambourine. The co-
him, as well as telling him to "stop that!".
11
both
he made loud vocal
during
and outside
the
I tried to remind her that I did not en-
sponding to the music individual contribu-
courage the use of such language in the
tions, rather than thinking in terms of
group but to no avail. I felt that there was
providing a musical structure for the
an element of H trying to scape-goat J as
whole group. This comports with what
the problem person. I myself started to
Nitsun has written, in terms of the effect
find the group very difficult to manage;
of anti-group being a fragmentary one,
some of this was doubtless due to my
about "splintering the connections be-
having to do so on my own after having
tween
had a co-therapist for over a year. But
thought and meaning, in a way that is
there was also a feeling of despair and a
captured in Bion's concept of 'attacks on
senseof being overwhelmed in the face of
linking" (Nitsun 1996: 177-178).
individual
and
group,
feeling,
the destructive and disruptive behaviour
This phase, which seemed so affect-
of some of the group members. I felt that
ed by "anti-group" forces, lasted about six
this was affecting my ability to think in the
months. Subsequently the group began a
group, especially in responding musically
period of renewed creativity. During this
to what the group members were playing.
there was an increase in the group mem-
Indeed, in one of the group pieces during
bers' level of engagement, and in general
this period, I found myself focusing pre-
everyone started to take more responsi-
dominantly on matching D's loud and fast
bility for the group's music. There was
rhythmic playing on the big drum, by play-
also more patience in same group mem-
ing a walking bass line on the piano and
bers and fewer attempts to disrupt the
struggling to hold the whole group in
music. More attention was paid to each
mind musically. This meant that those
other, as well as more direct interactions
group members who could not play at a
(both musical and otherwise) between
fast tempo, like Hand C, struggled to join
them without having to go through the
in with the music. looking back now, I feel
therapist. However, one of the group, H,
that my clinical supervisions were crucial
did not survive the anti-group phase and
in helping me to reflect on these anti-
chose to leave the group. Watching a rec-
group processes and in helping me to
orded extract of the group from this peri-
maintain connections between thinking
od, I could see that there was more pa-
about the individuals and thinking about
tient waiting shown by J and fewer at-
the group as a whole at a time when this
tempts to sabotage the group music. His
felt very difficult. With hindsight, I could
use of voice was more controlled and less
see that perhaps all the group members
overpowering. There was also more sus-
were displaying, to varying degrees, dis-
tained playing from M, who hadn't played
ruptive behaviour to expresstheir feelings
much at all during the anti-group phase.
of abandonment following the departure
There were signs of O paying more atten-
of one of the therapists. Musically this
tion to other members and timing his
feeling of being abandoned manifested
playing in response to what they were
itself in everyone trying to assert their
playing. C increasingly joined in, playing
own way of playing, individually, rather
small hand-held instruments such as a
than together as a group. It also affected
maracas or a cabasa. I felt that as the
the therapist's ability to "link" (Nitsun
therapist I started to create music for the
1996: 178) together the group members'
whole group, rather than just matching
playing, thus leading to hearing and re-
the playing of one individual. It seemed as
12
if having weathered the storm of anti-
therapists precipitated the period I have
group feelings, especially the feelings of
described as the "anti-group" phase. Ac-
despair and helplessnessfollowing the co-
cording to Nitsun, an event such as the
therapist's departure. I was able to be
departure of a valued person can often
much more robust in withstanding same
leave the group feeling empty and de-
of the group members' destructive behav-
prived, and lead to anti-group processes.
iour and could allow the strong musical
The fact that in this case it was one of the
voices to emerge whilst providing a strong
parent figures made the impact even
sense of musical containment. My feeling
stronger. The group members possibly felt
was that the group members also recog-
the fear of the survival of the group as a
nised this and were aware that, despite
containing environment, which paradoxi-
their best efforts, the group had not com-
cally led them to attack it.
pletely fallen apart and that we had
Having struggled through this period,
somehow all survived this difficult phase
I felt that the group came out stronger
together. Having done so, they had found
and transformed, with a greater sense of
a space which felt safe and containing
responsibility and ownership of the music,
enough to allow them to start to play and
as well as a higher level of interaction
in which they could once more be crea-
with each other. This mirrors what Nitsun
tive.
said about anti-group processes having a
The group came to a planned ending
transforming effect on the group, in terms
at the beginning of March 2010. In the
of its identity and creativity. It also has
last 6 months of the group, the four
parallels with Donald Winnicott's idea of
members who continued to attend regu-
the "use of the abject" (Winnicott 1968)
e,
made a good steady
and the idea that the capacity of an object
progress in their ability to use music to
to withstand the destructive attacks leads
interact with each other. J continued to
to a greater use of the object. Having sur-
develop his sensitivity and patience to-
vived the group's attack on itself, the
wards the others. D showed signs of being
group space had acquired the potential to
larly, J, D, M and
able to vary his playing, for example using
be a place where play was possible and
shorter phrases and at times playing more
thus also a space for therapeutic work.
softly. M started to take a much more
Conclusion
active part in the group's music and
e began
One criticism of "anti-group" concept is
to play more independently on bigger in-
that it can be seen as being too abstract,
struments (drums, metallophone) using
broad, vague and elusive, in that any neg-
beaters. Therefore, despite the fact that
ative phenomenon in group work can be
one member had dropped out, I felt that
attributed
we had managed to negotiate an ending
point
process that felt therapeutically holding
Stewart in his review of Nitsun's book. He
and restorative, rather than disruptive,
says lithe anti-group can become almost
abrupt and scarring.
too all-embracing as a concept. The result
played in a more sustained way.
to the anti-group. This is a
made by music therapist
David
is that, contrary to Nitsun's stated wish to
Discussion: anti-group
clarify the details of complex dynamics, I
Looking back on the events at a later date,
was left feeling I couldn't see the 'wood
I wondered if the departure of one of the
for the trees" (Stewart 1997: 57). There is
13
also the danger that people may be left
lei between the Buddhist idea of catching
with the impression that the concept of
and gentling the bull, and therefore our
anti-group seeks to devalue or undermine
untamed desire, with the idea of recognis-
group work in general and the therapy
ing and harnessing the anti-group forces
group in particular. Nitsun argued that the
for the creative and therapeutic benefit of
concept is "conceived in broad terms to
a music therapy group.
describe a wide range of manifestations
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15