Our mind is nothing but a bundle or collection of different
perceptions, which succeed each other
with an inconceivable rapidity, and are
in a perpetual flux and movement."
David Hume. A Treatise of Human Nature. Book I, Part 4,
Section 6 (“Of Personal Identity”) 1739
Modern society is facing a dilemma.
one hand statistics demonstrates a steady increase in stress-related
disorders (Sutton. 2007), on another hand, though there is a common
demand in quality of life improvement, society is not prepared to
corresponding investments in both time and financial resources due to
other prerogatives. Psychotherapy, which is one of the most
effective tools in coping with stress (Brody & Stuart, 1994; Jones
et al., 1999; Strain, 1995), has historically been transformed
into an attribute associated with people who are well off financially,
in some way not dissimilar to golf club or prestigious car (Austad,
1996). The wish to make psychotherapy more widespread, initiated
development of short-term psychotherapies such as psychodynamic
short-term treatments, cognitive-behavior therapy (CBT), interpersonal
therapy (IPT), and others. All of these therapies share a dichotomistic
view that distinguishes between an individual and his/her environment
not seeing them as one undividable unity.
As a result, the
problem that has been intrinsic with such therapies was an inevitable
compromise in goal setting and a reductionist approach in their
assessment of the human psyche. Social psychology with its emphasis on
social influence has always accepted the view that a person should not
be regarded outside the context of his/her social matrix (Myers, 2006).
Yet, its subject was in general the explanation of normative social
phenomena and not exploration of human psychopathology.
introduce here a newly conceptualized psychotherapeutic approach based
mostly on the elaborations of reference group theory and related
concepts of social psychology along with other conceptions such
as learning theory, attachment theory, object relation theory , and
others. The approach is intended for treatment of a Social
Influence Related Disturbance (SIRD).
SIRD is defined here as any
mental or psychosomatic disorder that was originated or co-contributed
by either external social influence mediated by individuals or groups
and / or their intrapsychic internalizations.
It’s apparent that
this category does not introduce any new nosological entity per se, its
purpose is solely the shifting of point of view into the direction of
the implied impact of social influence.
A patient, for that
purpose, is regarded as a member of a social group or a number of
groups. The disorder is seen in a context of functional and structural
group changes, the patient’s interactions with the group, as well as
interactions between the groups’ internal representations among
themselves and/or external groups.RGFT
As stated before, RGFT deals with a spectrum of disorders associated with social influence.
may be implied, that these disorders (SIRD) originate from a
psychological reaction to a stressor associated with influence caused
by external or internalized groups. This view is congruent with
Reference Group Theory (Hyman ,1942; Sherif, 1948; Merton
& Kitt, 1950; Deutsch & Gerhard, 1955) which looks at
psychosocial stressor and maladaptive response to it in context
of person’s reference groups (Hyman & Singer, 1968). We also
adapt here the concept of the internalized group firstly
introduced by Turner (Turner, 1987, 1991 ) which is analogous to the
object relations’ internal representation (Fairbairn, 1954; Guntrip,
1995). Additionally, we hypothesize that derivation of the RG’s
social influence is in the basic need for attachment similar to
understanding of attachment theorists (Ainsworth et al., 1978; Bowlby,
1999) and that this influence is mostly mediated by modeling as
stated by Bandura (Bandura et al., 1989, 1999). In our elaboration we
were influenced also by the conception of multiple selves (James, 1950;
Assagioli, 2000; Stone & Stone, 1983; Stone & Winkelman, 1993).
Before discussing the therapeutic approach, we introduce a number of theoretical elaborations.The RGFT basic assumptions are as follows:
Person’s behavior, emotions, and attitudes can be comprehended only
within the context of his/her present and historical social matrix.
2. The reference groups differ in their impact on a person in accordance to the importance that he/she ascribes to those groups.
Person can be regarded as comprised of a “Primary Self” - a personality
core that emerges prior to socialization (initiated by the begin of
speech acquirement), his/her internal groups (Secondary Selves), and
internalization of his/her subculture.
4. Social influence (mediated by the internal and external RGs) is partly conscious and partly unconscious.
Much of the psychopathology developed after the begin of person’s
socialization can be explained through the conflicts occurring among
person’s internal groups (Secondary Selves) as well as through
conflicts between the person’s internal (Secondary Selves) and external
RGs and/or personality core (Primary Self)
important theoretical elaboration is Trigger Event Analysis (TEA) that
has been described in details elsewhere (Salganik & Soifer, 2008).
TEA divides all triggers leading to some kind of mental breakdown
into 6 categories: Status, Norms, Attachment, Threat, Routine, Energy.
These triggers have either explicit or implicit social characteristics,
which means that they are associated with patients’ RGs (either
internal or external ones). The given context of mental deterioration
leads to the conclusion that these triggers have to be regarded as
negative triggers - events that precipitate deterioration in mental
TEA assumes that an individual reacts to all possible
triggers in a for him/her unique and specific way. The same trigger
that may have a profound impact upon one particular individual may
leave another one totally unaffected. The personal sensitivity to
specific triggers is categorized in exactly the same way as the
triggers themselves. That means that each person will exhibit
sensitivity (or lack of it) to such issues as changes in status, RG
norms, attachments, threats, routine, and energy resources in a for
him/her specific way. We call the corresponding personal sensitivities
– Sensitivity Channels. For example, if a person is sensitive to
changes in his /her status and the corresponding changes
are imposed on him/her by the social environment, there will be a high
probability for aversive mental response.Figure I summarizes the described theoretical model:Primary Self:
is a psychical structure that develops prior to socialization.
Socialization in the sense of RGFT overlaps greatly with the same term
in social psychology and thus does not include the first two years of
life prior to language acquisition and prior to the brain ability to
internalize integrative aspects of the other object (or him/herself),
including perception, cognition, emotion, and behavior. Secondary Self
is a psychical structure that develops in a process of socialization.
It represents the internal image and is a result of internalization of
the corresponding RG (that could be a single person or a group of
persons). Secondary Self comprises following characteristics (that in a
way resemble a blue print of a corresponding person/group):
perceptional, cognitional, emotional, and behavioral patterns. Dictator Self:
is a subtype of a Secondary Self which Reflective Self is tightly
identified with. It is thus the most dominant among the Secondary
Selves and influences greatly a person’s perceptional, emotional,
cognitive, and behavioral pattern.Reflective Self:
is a psychical structure that represents a person’s autonomic ability
to evaluate a given situation and to choose a corresponding adaptive
is a source of a social influence upon a person that can not be
inferred or deduced from any specific RG effect but is a result of an
integrative impact of a certain social environment as a whole. Defensive Shield:
is a variety of mostly unconscious adaptive mechanisms that a person
develops in order to diminish a negative impact on his/her Sensitivity
In addition, we summarize some novel aspects of our approach in comparison to other psychotherapies:
1. It takes into consideration an entirety of the patient’s RGs and not just their selected subgroup
2. Secondary Selves are typically associated with real persons or RGs which are charged with certain personal significance
Secondary Selves are interrelated in a hierarchical order where the
Dictator Self secures to itself the highest rank among the Secondary
4. Much of psychopathology is being interpreted through
the conflicts among Secondary Selves themselves and between
Secondary Selves and external RGs.
5. A new concept – Trigger
Event Analysis reflects the individual sensitivity regarding
the variety of possible psychosocial stresses.
RGFT (therapeutic aspects)Assumptions about the therapy:
1. Psychotherapy’s general goal is to facilitate patient’s adaptation to his/her specific societyTreatment GuidelinesPatient Selection Criteria
Individuation is an utmost goal of RGFT and can be achieved by
exploring person’s social influences and bringing them into
3. The treatment is client-centered, person is
advised from the very beginning that he/she is the only one that
actually knows and is in the position to cope with his/her problems and
not the therapist. Any attempt on patient’s side to invite social
influence from the therapist is explored and patient’s responsibility
for resolving of his/her problem emphasized
4. The focus of the
treatment is the investigation of “inversed” transference, e.g.
the impact of patient’s internal groups on his/her attitudes and
behavior – (“acting on behalf of internal groups”)
5. The treatment is “patient-driven”, the working topics and the termination of treatment are determined by a patient
An analysis of the patient’s problem makes it feasible that there is a
major issue associated with his external and/or internal RG’s which
comprises one or all of the following:
• Paucity of RG’s number
One or more of his/her RG’s has a pathogenic quality (exerts a
profound negative emotional impact -causes significant mental
distress upon a person. We assume, in the context of TEA, that
this negative impact will be upon one or more vulnerable Sensitivity
• One or more of his/her empathetic
RG’s has undergone recent functional or structural changes (empathetic
group is the one that exerts a profound positive emotional impact upon
a person. Again, this influence will be mediated through the one or
more Sensitivity Channels involved)
conflict(s) between internalized groups themselves, and/or between
internalized and external group(s), and/or any of the above with the
2. A patient has to be cooperative with the therapy and to be able to comprehend its goals.
3. At assessment stage, an analysis of the internal and external RGs, that are relevant for a person should be performed.
It is crucial to evaluate whether the patient’s RGs play an important role in initiation of the present mental crisis.
Event Analysis (TEA) is performed - typical triggers for a patient
identified. The triggers are evaluated against the relevant RGs. If
triggers are associated with only a limited number of specific external
RGs, then the problem is likely to be with those external groups – RGFT
for external groups (RGFT ext.) is advised. If triggers are more
or less evenly distributed among different external RGs – there
is probably a problem with the patient him/herself. In this case, RGFT
for internalized groups (RGFT int) is advised.
approach for the external RGs (RGFT ext) is handled elsewhere (Salganik
& Soifer, 2008). It should be mentioned that though described in
association with schizophrenic relapse, the paper conclusions may be as
well generalized for other mental disorders associated with SIRD.
In this paper we describe a therapeutic approach relevant for the
internal RGs (RGFT int).
4. Treatment stage in RGFT int.
is based on a proprietary theoretical model and aims at enhancement of
patient’s individuation and better awareness of social influences.The RGFT int. Session:
Step One: Deciding Which Secondary Self to Interview
• Identify the issue, distress, problem, or Secondary Self the patient wants to focus on.
• Moderator and person’s Reflective Self can co-decide which Secondary Self to begin with.
• At the beginning of the treatment, the relevant Secondary Self is usually the Dictator Self.
Step Two: De-identification (similar to [ Assagioli, 2000;, Stone & Winkelman, 1993) - interviewing the Secondary Self :
Have the person physically move over from the Reflecting
Self’s chair into the chair or space of the self to be interviewed
(usually the Secondary Self).
Moderator asks the Secondary Self questions that bring forth who
that SS is, its attitudes, scenarios, its reflection of a
patient, etc. Extensive use of Socratic questioning.