Article group

g p
analysis

Socio-Cultural Influence on Group Therapy

Leadership Style
Mohamed Taha, Refaat Mahfouz and Magdy Arafa

The main author of this article had the opportunity to witness, to observe
and to be trained in two different styles of group therapy leadership over
the past few years: A more directive, prescriptive and active style that
was developed in Egypt and is considered as the traditional Egyptian
style of conducting dynamic therapy groups (Egyptian Integrative
Dynamic Model) and a less directive, more descriptive and passive style
that was developed in the UK and is considered as the traditional style
of leading dynamic therapy groups within the British National Health
Service (British Group Analysis). The article tries to investigate the
socio-cultural factors that favoured adopting the more directive, pre-
scriptive and active format in the Egyptian model although it revolves
around the same object–relations theoretical core as the British one.
This might stimulate an interesting discussion on the relativity of psy-
chotherapy concepts, processes and aims among different cultures.
Key words: socio-cultural, Minia, group, psychotherapy, Egypt

Introduction
There are various factors that influence the success or failure of group
psychotherapy. Roback and Smith (1987) emphasized that multi-
person treatment outcomes result from a complex interaction between
therapist, group and patient factors. Despite its critical importance,
group therapy leadership styles, their effect on therapy outcome, their
comparative results and the socio-cultural influence upon them have
not been fully investigated.

Group Analysis. Copyright © 2008 The Group-Analytic Society (London), Vol 41(4):391–406.
DOI: 10.1177/0533316408098443 http://gaq.sagepub.com

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392 Group Analysis 41(4)

Many group leadership styles are described in literature. Examples

are:

1. Autocratic/Democratic/Laissez-faire – Transactional/Transfor-
mative.
2. Prescriptive/Descriptive – Active/ Passive.

However, all of the above styles may be located at various points

along one continuum that ranges from an extremely directive pole to
an extremely non-directive one.
Several factors might be responsible for favouring a certain lead-
ership style in a therapy group: the working theoretical model, the
therapist’s personality and the supervisory/training system traditions.
Socio-cultural factors might play a considerable role as well. What
follows is a comparative presentation of two different and maybe
opposing styles of group therapy leadership styles, each of which
stems from and is coloured by a different culture.

Egyptian Integrative Dynamic Model of Group Psychotherapy

versus British Group Analysis
Theoretical Constructs
The fundamental elements of the theory and practice of group analy-
sis can be traced to object relations theory as originally proposed
by Melanie Klein. Her work with individuals was directly applied to
working with groups by Foulkes, who focused on interpreting group
tension.
On the other hand, the traditional Egyptian model for conducting
groups would best be described as a synthesis between object rela-
tions theory, existential philosophy orientation, Gestalt techniques
and transactional analysis understanding (Ghoz, 1978). This was
developed by Professor Yehia Rakhawy in the 1970s. His theory
was developed in the context of the Arabic language, the Islamic
tradition, Egyptian folk traditions, and the importance of harmoniz-
ing with one’s ‘biorhythmic natural surroundings’ (Rakhawy, 1978,
1994).
Mahfouz (2000) developed and integrated more theoretical ele-
ments, practical techniques and socio-cultural orientations into
that model to form the Minia Integrative Dynamic Model of Group
Psychotherapy.

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 Taha et al.: Socio-Cultural Influence 393

Leadership Style
General Attitude The group leader in group analysis is known as
the conductor and maintains an attitude of non-intrusive interest
in both the individuals and the group as a whole. He or she takes
responsibility for pointing out unacknowledged sources of conflict
and encouraging the establishment of free-floating discussion. The
conductor is active in supporting the integration of the group and will
balance interpretations to individuals and to the group as a whole with
supportive, reflective comments. The holding or containing function
of the group conductor is at least as important as any interpretations
given (Foulkes, 1948).
The style of leadership in the Egyptian model is somehow diffe-
rent; it coincides with Earley’s (1999) description of his inter-
active approach as being both active and empowering for group
members. The group leader is interested not only in behavior and
its unconscious meaning, but also the quality of presence and con-
tact as group members explore themselves and interact with each
other.
The leader may ask questions to elicit patients’ awareness of their
experience in the moment and the deeper issues that underlie their
reactions. He or she sometimes makes suggestions about new beha-
vior or attitudes that clients can try experimentally. When necessary,
the leader actively intervenes to make sure that the group is safe
enough for members and is moving in a therapeutic direction. How-
ever, the details of the work are initiated by the group members, and
they are encouraged to be responsible for their own therapeutic direc-
tion (Earley, 1999).
Sometimes, the leader does not wait for the group work to emerge
gradually but actively encourages it. At other times, he makes an
internal shift in attitude moving from a leader-centred to a group-
centred mode (Earley, 1999).

Main Therapeutic Technique Interpretation is the main therapeutic

technique used in group analysis. Interpretations are statements made
by the therapist about the deeper meaning of what the group brings
into the session through their free-floating discussions.
Their aim is to help patients to increase their awareness and under-
standing of the group process and themselves (Molnos, 1998). In
interpreting group phenomena, all kinds of communication (whether
in words or gestures) are taken into account, as should the fact

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394 Group Analysis 41(4)

that any kind of communication coming from a single individual

represents, in a certain manner, communication with the group as a
whole (Guimon, 2002).
On the other hand, Gestalt Therapeutic Games is the main thera-
peutic technique used in the Egyptian model of group therapy. It was
modified both in structure and formulation to adapt a wide range of
therapeutic applications (Mahfouz et al., 2004).
The philosophy of use of Gestalt games is to provide an effec-
tive means of unifying thought with feeling. They are thought to
demonstrate to the patient the many and subtle ways in which he
prevents himself from a holistic experience of self and environment.
They help to dig out resistances, and promote a heightened aware-
ness (Levitsky and Perls, 1972). Four main categories of Gestalt
Therapeutic Games are used: Complete the Debate, Empty Chair,
Reversals and Repetition.

Major Therapeutic Interventions The Code of Analysis of the Ther-

apeutic Field Style (S.C.A.T.) (Pontalti et al., 1997, 1998) classifies
the therapist’s interventions in a psychotherapeutic setting into: an
Organizational Area, an Interpretative Area and a Connection Area.
The Organizational Area is composed of those interventions that are
directed towards the construction and safeguard of the therapeutic
field. The Interpretative Area (IA) includes interventions referring to
therapists’ and patients’ interpretation during the session work. The
Connection Area (CA) aims to facilitate a connection between group
members or communicational themes.
Accordingly, the leader in British Group Analysis can be described
as using more Organizational and Connective Interventions in the
early stages of group life, and more Interpretative Interventions in
later stages. However, the leader in the Egyptian model might be
described as using Organizational and Connective Interventions
more than the Interpretative Interventions throughout the whole
group course.

Clinical Examples British Group p Analysis

y : An excerpt from a semi-
open therapy group, consisting of seven members, the leader and one
trainee. Patients are of both sexes, heterogeneous diagnosis, aged
between 35 and 55 years.

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 Taha et al.: Socio-Cultural Influence 395

In this session, (Alis) was talking about her mother and how distant she was, as
she was busy raising her sisters and brothers. (Gerhard) followed the thread and
expressed his anger towards his mother who did not protect him from his father’s
humiliation:
Pitty: Last night, there was a nice TV show about how to bring up your baby. They
talked about people in the 50s, 60s and 70s and how they used to bring up their
babies. Did you see it? In the 50s, you did not cuddle any … you just fed every
four hours. In the 60s, the doctor spoke, the mother had more options, you could
breast feed, you could bottle feed and you could put the baby in a nice car and this
continued in the seventies. He also talked about some mothers and how they raised
their children in Latin America, and guess what, they carry their babies between
their arms, cuddle their babies for a year, just stick with the baby. The baby feeds,
sleeps and lives between her arms for a complete year, so he becomes so confident
and so happy. I think this feels very lovely, it was good, great … you know.

Therapist: I have an idea about what might be going on in the group in this
moment. You seem to ask me on behalf of the group: what kind of mothering is it
in this group? Is it of the 50s, or the 60s or the Latin America one? What kind of
holding is it in this group? What kind of nutrition am I offering here? You might
like to explore this more, if you want.

Egyptian
gyp Integrative
g Dynamic
y Model: An excerpt from an open
continuous therapy group, consisting of 30 members, the leader and
seven trainees. Patients are all adult females, of heterogeneous diag-
nosis, aged between 18 and 50 years. In this group, the concepts of
true and pseudo femininity have developed in terms similar (but not
restricted to) Winnicott’s (1971) assumptions.
Moshira: I need to renew my marital relation. I want to return back to my old
marital happiness.

Therapist: We do not return back. We move forwards to make things better than
before.
Moshira: Yes.

Therapist: I will tell you something, and you may validate whether it is true or
not. I assume that your old marital happiness was not so realistic; it was full of
unrealistic imaginations and expectations. It included only some love fantasies,
with no real contact.
[Moshira gets anxious, clenches her teeth and stretches her fingers.]

Therapist: Just tell me if it is true or not?

Moshira: Yes, it is true.

Therapist: Do you know which part of you is involved in making a real relation-
ship, Moshira? I think it is the true femininity that makes a real relationship. It
is the part that relates to your husband, to your children, to life, to God, to other

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396 Group Analysis 41(4)

people and to everything. It seems to me that now is the right time to see what we
have done to our very nature, and where we have buried our true femininity. Is
that okay?

Moshira: Okay.

Therapist: Now, reformulate your original speech into: ‘I need to feel my true
femininity, to accept it, and to be happy with it in order to …’ Direct your speech
to a group member and try this game.

Moshira: No, please no . . .

Therapist: Why not? We are enjoying good weather, it is the autumn (joking …).

Moshira: Okay, Dr. Amr, I need to feel my true femininity, which I buried long
time ago, to accept it, and to be happy with it, in order for my relationship with my
husband to be better.

Therapist: In order for me to make my relationship with my husband better.

Moshira: Yes, in order for me to make my relationship with my husband better.

Therapist: Continue … go on …
Moshira: (Dr. Maha), I need to feel my true femininity, which I buried a long time
ago, to accept it, and to be happy with it, in order to be happy with my husband.

Trainee (Maha): Yes, you need it, and you need to be happy within your heart.
And I love you.

[Moshira gets more and more anxious.]

Therapist: Your true femininity is trying to emerge and express itself, but you are
blocking it. All that it needs is to feel some safety, don’t resist so much, go on …
Moshira: Dr. (Ahmed), I need to feel my true femininity, which I buried a long
time ago, to accept it, and to be happy with it, in order to feel secure. (Amany),
I need to feel my true femininity, which I buried a long time ago, to accept it, and
to be happy with it, in order to have a new beginning.
Amany: You have the right to a new beginning.

Moshira: Dr. …

Therapist: May I reformulate it for you. Say: (Dr. Mohamed Ayman), I need to
permit my true femininity, which I buried a long time ago, to emerge, to feel it, to
accept it, and to be happy with it in order to …

Moshira: (Dr. Mohamed Ayman), I need to permit my true femininity, which I

buried a long time ago to emerge, to feel it, to accept it, and to be happy with it,
in order to see you … all of you … as you are … without reducing any parts, and
accepting the parts that I only like.

Trainee (Mohamed Ayman): Good, (Moshira).

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 Taha et al.: Socio-Cultural Influence 397

Therapist: Go on …

Moshira: (Hala), I need to permit my true femininity, which I buried a long time
ago, to emerge, to feel it, to accept it, and to be happy with it, in order to love life.

Moshira: Dr. (Ahmed), I need to permit my true femininity, which I buried a long
time ago to emerge, to feel it, to accept it, and to be happy with it, in order not to
be a ‘woman on demand’.
Therapist: Good (Moshira). Would you like to try (Yara)?

Yara: No. I cannot. Let it come by itself.

Therapist: Here, we do not wait things to come by their own volition. Nothing
comes by its own volition, we are the ones who bury things and we are the ones
who permit them to emerge, and to feel them … just as it is with true femininity.
Amany: I need to try this, please. Dr. (Mohamed Ayman), I need to feel my true
femininity, and to accept it in order to stop distorting myself.

Trainee (Mohamed Ayman): You deserve it, Amany.

Amany: Dr. (Salwa), I need to feel my true femininity, in order feel my real
happiness. (Dr. Wael), I need to feel my true femininity, in order to win myself.
(Moshira), I need to feel my true femininity, in order for my mind to be open and
bright. (Hala), I need to feel my true femininity, in order to integrate myself and
stop being deconstructed. (Shawkia), I need to feel my true femininity, in order to
feel my inner freedom. Dr (Ahmed), I need to feel my true femininity, in order to
feel my inner energies and make good use of them.

Discussion
As exemplified above, the group leader in the Egyptian model of group
therapy adopts an active, directive and somehow prescriptive leader-
ship stance (Hinshelwood, 1997, 2007; Andy and Walshe, 2007). In
the clinical example above, he clearly elaborates his ideas, makes
comparisons, highlights possible connections and continuously works
to initiate, facilitate and maintain the ongoing group work (Mahfouz
et al., 2008). However, he does not overly confront or pressure mem-
bers for immediate and highly personal self-disclosure or impose his
values on the participants (Roback, 2000).
On the contrary, the group leader in the British model adopts a
more passive, non-directive and descriptive leadership stance. He
makes an interesting interpretation that relates the emerging theme of
good and bad mothering to himself and to the group as a whole that
is perceived as a good/bad mother.
Let us imagine that the Egyptian group is an analytic one led by
a British conductor. In this case, and upon the emergence of the
theme of wishing to return to the old marital happiness, he would not

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398 Group Analysis 41(4)

express his thoughts about true femininity. Neither would he suggest

the exercise of complete the debate. He might ask group members for
more exploration of this issue or might make an interpretation that
relates this theme to his perceived position as a group father who fails
to make his children happy.
On the other hand, and if we imagine that the exemplified group
analytic transcript is led by the Egyptian group therapist, we could
expect that he would not make an interpretation of the group transfe-
rential phenomenon. But he might encourage members to engage in
a group exercise that tries to make them more aware of their need for
good mothering and the subtle methods they use to block that need
from being expressed or satisfied in a holistic experience (he might
ask a group member to put his/her mother on the empty chair and
start a genuine interaction with it or ask members to try ‘I want to be
loved but I am afraid of …’).
Several factors might be responsible for favouring a certain
leadership style in a therapy group. Corey (2004) believes that
it is important for the group leader to accept the challenge of
modifying his strategies to meet the unique needs of the socio-
cultural context he works in. It is his responsibility to integrate the
basic social and cultural values into his working theory. He thinks
that group leaders need to have a socio-cultural framework from
which to consider diverse values, interaction styles and cultural
expectations.
The following are some of the socio-cultural factors that might
have contributed to tailoring the British object relations theory and
practice to suit social and cultural needs, expectations and beliefs of
the completely different Egyptian Arabic-Islamic culture:

The Concept of Family and the Expected Role of the Group Father
One of the major socio-cultural differences between British and
Egyptian (Arabic-Islamic) cultures is that western psychological
thought emphasizes self-sufficiency, independence from family and
self-growth. Alexander Mittscherlich (1963) assumes that fatherless-
ness affects every level of the western society.
In contrast, Egyptian people (as part of the Middle Eastern culture)
value interdependence more than independence, social consciousness
more than individual freedom, and the welfare of the group more than
their own welfare. They, as well as Asians, emphasize the collective
good and make plans with the family in mind (Chu and Sue, 1984).

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 Taha et al.: Socio-Cultural Influence 399

Moreover, family roles tend to be highly structured and obligations

to parents are respected throughout one’s life. The roles of family
members are highly interdependent, and family structure is arranged
so that conflicts are minimized while harmony is maximized. The
family structure is traditionally patriarchal in that communication
and authority flow vertically from top to bottom (D. Sue and Sue,
1993).
Parents are afforded a great deal of respect that might reach some
grade of holiness, and this respect governs all interpersonal relation-
ships of the individuals.
Hence, certain characters of the traditional Egyptian father figure
are expected to be displayed by the group leaderr in a therapeutic
setting. Being present, interactive, dominant, directive, intellectually
and emotionally involved, interested in group members’ everyday
life details, and protective are among those characteristics.
The same rationale can be applied to the expected role of a British
group father/leader, that is a fatherless attitude; an attitude of non-
intrusive interest in both members and the group, no direct emotional
involvement, non-directiveness, and being missed – a very similar
picture of a western father.

The Socio-Cultural Archetype of ‘The Leader’

Long acknowledged as an integral part of the heritage of western
civilization, Egypt’s importance to world history cannot be exag-
gerated, especially in the context of religions. At least three of the
world’s major religions – Judaism, Christianity, and Islam – can trace
their roots and/or early dissemination to the land of the Nile. Most
of the known prophets have spent some parts of their life journeys in
Egypt, or at least left their footprints beneath its land.
The Arabian culture is mainly derived from three key factors:
family, language, and religion (Badalto, 1984). The role of religion
in the Egyptian society is often a pervasive force governing beha-
viour. Egyptians typically place a high value on spiritual matters and
religion.
In this context, a group leader in the Egyptian community
represents a certain archetype in group members’ (and communities’)
subconscious minds: that of a prophet/religious teacher, who teaches,
instructs, directs and prescribes besides providing care, acceptance,
understanding and unconditional love to his followers.

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400 Group Analysis 41(4)

On the contrary, a British patient might not have such a religious

archetype of a leader in his mind; a stance that coincides with the
current prevailing western view of religion as being split from many
other aspects of everyday life.

The Operational Concept and Aim of Psychotherapy

Psychotherapy should be framed in sociocultural terms, as patients
may vary tremendously as a function of their sociocultural develop-
ment, namely, in social skills, cognitive capabilities, social expecta-
tions, and role in the family. Sociocultural differences may influence
the format, and focus of psychotherapy.
Both the British group analysis and the Egyptian integrative models
of group therapy view psychotherapy as ‘the meaningful transforma-
tion in the client’s internal world, which modifies his modes of feel-
ing, thinking and acting, as well as his mode of relating to himself
and others’ (Hinshelwood, 2007).
However, the Egyptian model has another dimension of the thera-
peutic process and outcome that may have stemmed from its socio-
cultural context, and drawn the group leader to play a particular
directive, guiding and prescriptive role. It calls for the inclusion of
moral discourse in the practice of psychotherapy and the cultivation in
therapists of the virtues and skills needed to be moral consultants to their
clients in a pluralistic and morally opaque world (Doherty, 1995).
The issues of moral responsibility and community well-being are
always present in the described Egyptian model, and a carefully
balanced attention to these issues is believed to have the ability to
greatly expand the contribution of psychotherapy to the alleviation
of human problems. As the Egyptian culture supplants religion as
the accepted guide/reference for human conduct, the psychotherapist
becomes the de facto moral/religious teacherr as well.
On the other hand, most western concepts of psychotherapy (includ-
ing group analysis) emphasize individual self-interest, giving short shrift
to family and community responsibilities, without explicit inclusion of
moral responsibilities or community well being. This stance is reflected
in group therapy which does not encourage (and sometimes prohibits) the
inclusion of morals and moral views in the process of psychotherapy.

Emotional Nature of the Society

Social and cultural norms clearly affect how individuals experience
their emotions. Western civilization has deep intellectual roots and

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 Taha et al.: Socio-Cultural Influence 401

traditions. However, Egyptian people (as part of the Middle Eastern

culture) are somehow more emotional. They are deeply affected with
and stirred by emotions. They feel emotions often, and intensively
express their feelings such as anger, love, grief, jealousy etc.
I assume that some psychotherapy techniques might work better in
specific cultures or communities than others. The psyche of people in
Middle Eastern emotional culture might be better accessed by tech-
niques that involve emotional ventilation and stirring up for being
more in touch with oneself and others. On the other hand, the psyche
of people in western intellectual civilization might be better accessed
by techniques that involve intellectual mental work, for better under-
standing of self and others (e.g. interpretation).
Based on this, the group leader in the described Egyptian model
might have favoured using techniques that are in tune with the emo-
tional nature of his society (e.g. psychodrama), rather than other tech-
niques that might not be as suitable and effective as being applied to
a more intellectual culture (e.g. interpretation).

Population Density in Relation to the Introduced Psychotherapeutic

Service
In July 2007, the Egyptian population was about 80,335,036. 98 per-
cent of the population lives on only 4 percent of the country’s whole
area, around the river Nile (The World Fact book, 2007). Egypt has
about 1000 psychiatrists (one psychiatrist for approximately 70,000
citizens), more than 1,300 psychiatric nurses and about 200 clinical
psychologists, with hundreds of general psychologists working in
fields unrelated to mental health services. There are many social
workers practising in all psychiatric facilities, but unfortunately
they are general social workers with minimal graduate training in
psychiatric social work. Egypt has about 9,700 psychiatric beds, one
bed for every 7,000 citizens (i.e. 15 beds per 100,000 population)
(Okasha, 2004).
The psychotherapeutic service in Egypt is mostly provided by psy-
chiatrists (who are trained for psychotherapy). Of those, a small num-
ber are qualified group therapists and practice their work in big cities
(Cairo, Alexandria) and some urban areas.
This picture of the psychiatric and the psychotherapeutic field has
enforced the group therapist in the described Egypt model to work
in large groups (up to 40 patients) rather than small or medium sized

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402 Group Analysis 41(4)

ones in order to correlate the large number of patients to the few

number of qualified therapists.
Foulkes (1975) suggested:
large groups have different and more difficult dynamics than small groups. They
need more active and constructive efforts from the side of the leader in order for
their institutionalization and organization … The leader’s whole attitude and the
particular way in which he introduces the group to itself and to himself determines
very much as to what is set in motion. He should indeed not be rigid, but on the
contrary ready to react flexibly and to change together with the group. He must be
careful with interventions and interpretations; some of them should be out of place
in the large group. One of the decisions he must make is whether he wishes to
plunge the group into deep anxiety (by being missed and encouraging free floating
discussions) or act as a moderator – for constructive work. It is open to question if
the best answer to the group’s tendency for psychotic mechanisms to be active and
manifest is to interpret them or not.

De Maré (1975, cited in Weinberg, 2006), one of the pioneers of

large groups, pointed out that while the function of the small group
is to socialize the individual, the function of the large group is to
humanize society. Large groups might need some balance between
increasing awareness and introspection from one side and structuring
the group by a natural positive leader from the other side.
In that sense, the group leader in the described Egyptian model
is continuously and actively involved in initiating, facilitating
and maintaining the ongoing group work. He depends largely on
a technique (Gestalt Games) that involves direct, structured and
controlled interpersonal interactions between group members
serving the purpose of better organization, institutionalization and
cohesion.

General Awareness, Psychological Knowledge and Educational

Level
Only 58 percent of the total Egyptian population can read and write
(U.S. Bureau of Near Eastern Affairs, 2007). And about 71.4 percent
of the population over 15 years of age are literate. Of these, 83 per-
cent are males and only 59.4 percent are females (The World Fact
book, 2007). The Egyptian general public has a relatively low level
of general knowledge and awareness. Currently, many governmen-
tal and non-governmental organizations invest in efforts to increase
knowledge and awareness among the Egyptian general public.
Psychological knowledge and awareness are also low. And psycho-
logical language and terminology is not so common and familiar in

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 Taha et al.: Socio-Cultural Influence 403

the Egyptian culture as in the case with western societies. Traditional

and religious healers have a major role in primary psychiatric care
in Egypt. They deal with minor neurotic, psychosomatic and some
psychotic states using suggestion and other techniques.
The prevailing circumstances of illiteracy and low level of
general and psychological awareness might be considered as one
of the factors that favoured adopting an active leadership style in
the described Egyptian model of group therapy. The leader in that
style integrates the roles of teaching, directing, constructing and
prescribing, rather than the roles of non-directing, interpreting and
describing.

Other Factors
There might be some other socio-cultural factors that share in tai-
loring a certain group therapy leadership style, e.g. linguistic and
religious factors. These points may be discussed in more detail in a
later work.

The Directive Style and the Question of Creativity

Andy and Walshe (2007) wonder whether the directive trend in the
described Egyptian model of leading therapy groups might hinder the
therapeutic process’ creative potential.
An ongoing study (2008) carried out by the authors tries to inves-
tigate the creative aspect of the above described Egyptian model
of group psychotherapy through interpretative phenomenological
analysis of some of its transcribed interactions. It tries to see if this
psychotherapy model can follow the stages and micro-processes of a
well-known model of creativity.
Interestingly, the preliminary results of this study show that the
Egyptian model could follow the stages and micro-processes of
Barron’s (1988) model of creativity, which involves more conscious
workk and emphasizes the very characteristic painful experiences at
moments of change.
Barron (1988) suggests that creativity proceeds through four
phases. He suggests that creativity starts with conception (in a pre-
pared matrix). This is followed by a period of gestation through time,
in intricately coordinated forms and sequences. A stage of parturi-
tion must follow, that is characterized by the suffering to be born and
the emergence to light of the new. Then there is a great deal of work
still to be done to bring up the baby in a further stage of realization

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404 Group Analysis 41(4)

and responsibility following the birth of the new idea or image or

new self.
The British group analytic model was found to be creative as well,
but was found to follow a different model of the creativity process
(Wallas, 1926), that involves more unconscious work, with an empha-
sis on the sudden illumination of insight.
Wallas (1926) offered also a four-stage model of the creative
process:

1. preparation – the initial sensing and exploring of a problem;

2. incubation – the problem is not consciously pursued and uncon-
scious mental processes are involved;
3. illumination – the sudden flash of insight when a new idea,
solution, or relationship emerges; and
4. verification – the incomplete product of the illumination stage
is revised, refined, and corrected.

Detailed results and discussion of this work might have the oppor-
tunity to be published in the near future.

Acknowledgement
We would like to express our greatest and deepest thanks to Professor Bob
Hinshelwood, Professor of Psychoanalysis and founder of the British Journal of Psy-
chotherapy, for his whole hearted support, great encouragement and creative sug-
gestions. The inertia with which we could finish this work largely belongs to his
enthusiasm, constructive criticism and constant guidance. We would also like to pres-
ent our gratitude to Mr. Michael Scott, Honorary senior lecturer, centre for psychoana-
lytic studies, University of Essex, UK, for his unlimited and skillfull support.

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Mohamed Taha Siddik Mohamed MSc is an assistant lecturer of psychiatry

at Al-Minia Faculty of Medicine, Egypt. He works with a team of colleagues in
the area of group psychotherapy practice and research. They have been conduct-
ing the Minia Group Therapy Training Program since July, 2000. Mohamed
worked on his MD thesis in the UK under the supervision of Professor
R. D. Hinshelwood, Professor of Psychoanalysis, Essex. Psychiatry Depart-
ment, Hospital of University of Minia, Al-Minia, Egypt. Email: mohamedtsi-
dik@yahoo.com

Refaat Mahfouz Mahmoud MD is a senior professor of psychological medi-

cine at the Al-Minia Faculty of Medicine, Egypt. He is the founder of the Minia
Integrative Dynamic Model of Group Psychotherapy and one of the contributors
to the development and growth of group psychotherapy practice and research in
Egypt and the Middle East. Email: refaatmahfouz@hotmail.com

Magdy Mohamed Arafa MD is a senior professor of psychiatry at the Cairo

Faculty of Medicine, Egypt. He is the founder and head of the Integrative Psychi-
atry Training Unit, an approach that combines medication with psychotherapy.
Email: arafamagdy@yahoo.com

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