The Theory and Practice of Group Psychotherapy (30 page)

3. Assuming that Burt’s chief intent was to attack Rose, why did he proceed so indirectly? Is this characteristic of Burt’s expression of aggression? Or is it characteristic of Rose that no one dares, for some unclear reason, to attack her directly?

4. Why did Burt, through an obviously provocative and indefensible statement, set himself up for a universal attack by the group? Although the lyrics were different, this was a familiar melody for the group and for Burt, who had on many previous occasions placed himself in this position. Why? Was it possible that Burt was most comfortable when relating to others in this fashion? He once stated that he had always loved a fight; indeed, he glowed with anticipation at the appearance of a quarrel in the group. His early family environment was distinctively a fighting one. Was fighting, then, a form (perhaps the only available form) of involvement for Burt?

5. The process may be considered from the even broader perspective of the entire group. Other relevant events in the life of the group must be considered. For the past two months, the session had been dominated by Kate, a deviant, disruptive, and partially deaf member who had, two weeks earlier, dropped out of the group with the face-saving proviso that she would return when she obtained a hearing aid. Was it possible that the group needed a Kate, and that Burt was merely filling the required role of scapegoat?

Through its continual climate of conflict, through its willingness to spend an entire session discussing in nonpersonal terms a single theme, was the group avoiding something—possibly an honest discussion of members’ feelings about Kate’s rejection by the group or their guilt or fear of a similar fate? Or were they perhaps avoiding the anticipated perils of self-disclosure and intimacy? Was the group saying something to the therapist through Burt (and through Kate)? For example, Burt may have been bearing the brunt of an attack really aimed at the co-therapists but displaced from them. The therapists—aloof figures with a proclivity for rabbinical pronouncements—had never been attacked or confronted by the group. Their cotherapy relationship had also escaped any comment to date. Surely there were strong, avoided feelings toward the therapists, which may have been further fanned by their failure to support Kate and by their complicity through inactivity in her departure from the group.

Which one of these many process observations is correct? Which one could the therapists have employed as an effective intervention? The answer is, of course,
that any and all may be correct
. They are not mutually exclusive; each views the transaction from a slightly different vantage point. What is critical, however, is that the focus on
process
begins with the therapist’s reflection on the host of factors that may underlie an interaction. By clarifying each of these in turn, the therapist could have focused the group on many different aspects of its life.
Which one, then, should the therapist have chosen
?

The therapist’s choice should be based on one primary consideration:
the immediate needs of the group.
Where was the group at that particular time? The therapist had many options. If he felt there had been too much focus on Burt of late, leaving the other members feeling bored, uninvolved, and excluded, then he might have wondered aloud what the group was avoiding. The therapist might have then reminded the group of previous sessions spent in similar discussions that left them dissatisfied, or might have helped one of the members verbalize this point by inquiring about the members’ inactivity or apparent uninvolvement in the discussion. If he felt that the indirectness of the group communication was a major issue he might have commented on the indirectness of Burt’s attacks or asked the group to help clarify, via feedback, what was happening between Burt and Rose. If he felt that an exceptionally important group event (Kate’s departure) was being strongly avoided, then he might have focused on that event and the conspiracy of silence around it.

In short, the therapist must determine what he or she thinks the group and its members need most at a particular time and help it move in that direction.

• In another group, Saul sought therapy because of his deep sense of isolation. He was particularly interested in a group therapeutic experience because he had never before been a part of a primary group. Even in his primary family, he had felt himself an outsider. He had been a spectator all his life, pressing his nose against cold windowpanes, gazing longingly at warm, convivial groups within.

At Saul’s fourth therapy meeting, another member, Barbara, began the meeting by announcing that she had just broken up with a man who had been very important to her. Barbara’s major reason for being in therapy had been her inability to sustain a relationship with a man, and she was profoundly distressed in the meeting. Barbara had an extremely poignant way of describing her pain, and the group was swept along with her feelings. Everyone in the group was very moved; I noted silently that Saul, too, had tears in his eyes.

The group members (with the exception of Saul) did everything in their power to offer Barbara support. They passed Kleenex; they reminded her of all her good qualities and assets; they reassured her that she had made a wrong choice, that the man was not good enough for her, that she was “lucky to be rid of that jerk.”

Suddenly Saul interjected, “I don’t like what’s going on here in the group today, and I don’t like the way it’s being led” (a thinly veiled allusion to me, I thought). He went on to explain that the group members had no justification for their criticism of Barbara’s ex-boyfriend. They didn’t really know what he was like. They could see him only through Barbara’s eyes, and probably she was presenting him in a distorted way. (Saul had a personal ax to grind on this matter, having gone through a divorce a couple of years earlier. His wife had attended a women’s support group, and he had been the “jerk” of that group.)

Saul’s comments, of course, changed the entire tone of the meeting. The softness and support disappeared. The room felt cold; the warm bond among the members was broken. Everyone was on edge. I felt justifiably reprimanded. Saul’s position was technically correct: the group was wrong to condemn Barbara’s ex-boyfriend in such a sweeping and uncritical manner.

So much for the content. Now let’s examine the process of this interaction. First, note that Saul’s comment had the effect of putting him outside the group. The rest of the group was caught up in a warm, supportive atmosphere from which he excluded himself. Recall his chief complaint that he was never a member of a group, but always the outsider. The meeting provided an in vivo demonstration of how that came to pass. In his fourth group meeting, Saul had, kamikaze-style, attacked and voluntarily ejected himself from a group he wished to join.

A second issue had to do not with what Saul said but what he did not say. In the early part of the meeting, everyone except Saul had made warm, supportive statements to Barbara. I had no doubt that Saul felt supportive of her; the tears in his eyes indicated that. Why had he chosen to be silent? Why did he always choose to respond from his critical self and not from his warmer, more supportive self?

The examination of this aspect of the process led to some very important issues for Saul. Obviously it was difficult for him to express the softer, affectionate part of himself. He feared being vulnerable and exposing his dependent cravings. He feared losing himself and his own uniqueness by getting too close to another and by becoming a member of a group. Behind the aggressive, ever-vigilant, hard-nosed defender of honesty (but a selective honesty: honesty of expression of negative but not positive sentiments), there is often the softer, submissive child thirsting for acceptance and love.

• In a T-group (an experiential training group) of clinical psychology interns, one of the members, Robert, commented that he genuinely missed the contributions of some of the members who had been generally very silent. He turned to two of these members and asked if there was anything he or others could do that would help them participate more. The two members and the rest of the group responded by launching a withering attack on Robert. He was reminded that his own contributions had not been substantial, that he was often silent for entire meetings himself, that he had never really expressed his emotions in the group, and so forth.

Viewed at the content level, this transaction is bewildering: Robert expressed genuine concern for the silent members and, for his solicitude, was soundly buffeted. Viewed at the process—that is, relationship—level, however, it makes perfectly good sense: the group members were much involved in a struggle for dominance, and their inner response to Robert’s statement was, “Who are you to issue an invitation to speak? Are you the host or leader here? If we allow you to comment on our silence and suggest solutions, then we acknowledge your dominion over us.”

• In another group, Kevin, an overbearing business executive, opened the meeting by asking the other members—housewives, teachers, clerical workers, and shopkeepers—for help with a problem: he had received “downsizing” orders. He had to cut his staff immediately by 50 percent—to fire twenty of his staff of forty.

The content of the problem was intriguing, and the group spent forty-five minutes discussing such aspects as justice versus mercy: that is, whether one retains the most competent workers or workers with the largest families or those who would have the greatest difficulty in finding other jobs. Despite the fact that most of the members engaged animatedly in the discussion, which involved important problems in human relations, the co-therapists regarded the session as unproductive: it was impersonal, the members remained in safe territory, and the discussion could have appropriately occurred at a dinner party or any other social gathering. Furthermore, as time passed, it became abundantly clear that Kevin had already spent considerable time thinking through all aspects of this problem, and no one was able to provide him with novel approaches or suggestions. The session was not truly a work session: instead it was a flight-from-work session.

Such a dedicated focus on content is inevitably frustrating for the group, and the therapists began to wonder about process—that is,
what this content revealed about the natur
e
of Kevin’s relationship to the other members
. As the meeting progressed, Kevin, on two occasions, let slip the amount of his salary (which was more than double that of any other member). In fact, the overall interpersonal effect of Kevin’s presentation was to make others aware of his affluence and power.

The process became even more clear when the therapists recalled the previous meetings in which Kevin had attempted, in vain, to establish a special kind of relationship with one of the therapists (he had sought some technical information on psychological testing for personnel). Furthermore, in the preceding meeting, Kevin had been soundly attacked by the group for his fundamentalist religious convictions, which he used to criticize others’ behavior but not his own propensity for extramarital affairs and compulsive lying. At that meeting, he had also been termed “thick-skinned” because of his apparent insensitivity to others. However, despite the criticism he had received, Kevin was a dominant member: he was the most active and central figure in almost every meeting.

With this information about process, let’s examine the alternatives available to consider. The therapists might have focused on Kevin’s bid for prestige, especially after the attack on him and his loss of face in the previous meeting. Phrased in a nonaccusatory manner, a clarification of this sequence might have helped Kevin become aware of his desperate need for the group members to respect and admire him. At the same time, the self-defeating aspects of his behavior could have been pointed out. Despite his yearning for respect, the group had come to resent and at times even to scorn him. Perhaps, too, Kevin was attempting to repudiate the charge of being thick-skinned by sharing with the group in melodramatic fashion the personal agony he experienced in deciding how to cut his staff.

The style of the therapists’ intervention would depend on Kevin’s degree of defensiveness: if he had seemed particularly brittle or prickly, then the therapists might have underscored how hurt he must have been at the previous meeting. If he had been more open, they might have asked him directly what type of response he would have liked from the others.

Other therapists might have preferred to interrupt the content discussion and simply ask the group what Kevin’s question had to do with last week’s session. Still another alternative would be to call attention to an entirely different type of process by reflecting on the group’s apparent willingness to permit Kevin to occupy center stage in the group week after week. By encouraging the members to discuss their response to his monopolization, the therapist could have helped the group initiate an exploration of their relationship with Kevin.

Keep in mind that therapists need not wait until they have all the answers before asking a process question. Therapists may begin the process inquiry by simply asking the members: “How are each of you experiencing the meeting so far?” Or they may use slightly more inference: “You look like you are having some reaction to this.” At other times, the therapist’s level of inference may be raised and interventions may be more precise and interpretive: “Kevin, I have a sense that you yearn for respect here in the group, and I wonder if the comment last week about you being ‘thick-skinned’ isn’t in some way related to your bringing in this work dilemma.”