The Theory and Practice of Group Psychotherapy (62 page)

In young groups, the members’ fantasies play in concert to result in what Freud referred to as the group’s “need to be governed by unrestricted force, its extreme passion for authority, its thirst for obedience.”
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(Yet, who is God’s god? I have often thought that the higher suicide rate among psychiatrists relative to other specialists is one tragic commentary on this dilemma.
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Psychotherapists who are deeply depressed and who know that they must be their own superbeing, their own ultimate rescuer, are more likely than many of their clients to plunge into final despair.)

The content and communicational style of the initial phase tends to be relatively stereotyped and restricted, resembling the interaction occurring at a cocktail party or similar transient social encounters. Problems are approached rationally; the client suppresses irrational aspects of his concerns in the service of support, etiquette, and group tranquillity. Thus, at first, groups may endlessly discuss topics of apparently little substantive interest to any of the participants; these cocktail party issues, however, serve as a vehicle for the first interpersonal exploratory forays. Hence, the content of the discussion is less important than the unspoken process: members size up one another, they attend to such things as who responds favorably to them, who sees things the way they do, whom to fear, whom to respect.

In the beginning, therapy groups often spend time on symptom description, previous therapy experience, medications, and the like. The members often search for similarities. Members are fascinated by the notion that they are not unique in their misery, and most groups invest considerable energy in demonstrating how the members are similar. This process often offers considerable relief to members (see the discussion of universality in chapter 1) and provides part of the foundation for group cohesiveness. These first steps set the stage for the later deeper engagement that is a prerequisite for effective therapy.
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Giving and seeking advice is another characteristic of the early group: clients seek advice for problems with spouses, children, employers, and so on, and the group attempts to provide some practical solution. As discussed in chapter 1, this guidance is rarely of functional value but serves as a vehicle through which members can express mutual interest and caring. It is also a familiar mode of communication that can be employed before members understand how to work fully in the here-and-now.

In the beginning the group needs direction and structure. A silent leader will amplify anxiety and foster regression.† This phenomenon occurs even in groups of psychologically sophisticated members. For example, a training group of psychiatry residents led by a silent, nondirective leader grew anxious at their first meeting and expressed fears of what could happen in the group and who might become a casualty of the experience. One member spoke of a recent news report of a group of seemingly “normal” high school students who beat a homeless man to death. Their anxiety lessened when the leader commented that they were all concerned about the harmful forces that could be unleashed as a result of joining this group of seemingly “normal” residents.

The Second Stage: Conflict, Dominance, Rebellion

If the first core concern of a group is with “in or out,” then the next is with “top or bottom.”
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In this second, “storming” stage, the group shifts from preoccupation with acceptance, approval, commitment to the group, definitions of accepted behavior, and the search for orientation, structure, and meaning, to a preoccupation with dominance, control, and power. The conflict characteristic of this phase is among members or between members and leader. Each member attempts to establish his or her preferred amount of initiative and power. Gradually, a control hierarchy, a social pecking order, emerges.

Negative comments and intermember criticism are more frequent; members often appear to feel entitled to a one-way analysis and judgment of others. As in the first stage, advice is given but in the context of a different social code: social conventions are abandoned, and members feel free to make personal criticism about a complainer’s behavior or attitudes. Judgments are made of past and present life experiences and styles. It is a time of “oughts” and “shoulds” in the group, a time when the “peercourt”
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is in session. Members make suggestions or give advice, not as a manifestation of deep acceptance and understanding—sentiments yet to emerge in the group—but in the service of jockeying for position.

The struggle for control is part of the infrastructure of every group. It is always present, sometimes quiescent, sometimes smoldering, sometimes in full conflagration. If there are members with strong needs to dominate, control may be the major theme of the early meetings. A dormant struggle for control often becomes more overt when new members are added to the group, especially new members who do not “know their place” and, instead of making obeisance to the older members in accordance with their seniority, make strong early bids for dominance.

The emergence of hostility toward the therapist is inevitable in the development of a group. Many observers have emphasized an early stage of ambivalence to the therapist coupled with resistance to self-examination and self-disclosure. Hostility toward the leader has its source in the unrealistic, indeed magical, attributes with which clients secretly imbue the therapist. Their expectations are so limitless that they are bound to be disappointed by any therapist, however competent. Gradually, as they recognize the therapist’s limitations, reality sets in and hostility to the leader dissipates.

This is by no means a clearly conscious process. The members may intellectually advocate a democratic group that draws on its own resources but nevertheless may, on a deeper level, crave dependency and attempt first to create and then destroy an authority figure. Group therapists refuse to fill the traditional authority role: they do not lead in the ordinary manner; they do not provide answers and solutions; they urge the group to explore and to employ its own resources. The members’ wish lingers, however, and it is usually only after several sessions that the group members come to realize that the therapist will frustrate their yearning for the ideal leader.

Yet another source of resentment toward the leader lies in the gradual recognition by each member that he or she will not become the leader’s favorite child. During the pretherapy session, each member comes to harbor the fantasy that the therapist is his or her very own therapist, intensely interested in the minute details of that client’s past, present, and fantasy world. In the early meetings of the group, however, each member begins to realize that the therapist is no more interested in him or her than in the others; seeds are sown for the emergence of rivalrous, hostile feelings toward the other members. Each member feels, in some unclear manner, betrayed by the therapist. Echoes of prior issues with siblings may emerge and members begin to appreciate the importance of peer interactions in the work of the group.†

These unrealistic expectations of the leader and consequent disenchantment are by no means a function of childlike mentality or psychological naivete. The same phenomena occur, for example, in groups of professional psychotherapists. In fact, there is no better way for the trainee to appreciate the group’s proclivity both to elevate and to attack the leader than to be a member of a training or therapy group and to experience these powerful feelings firsthand. Some theorists
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take Freud’s
Totem and Taboo
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literally and regard the group’s pattern of relationship with the leader as a recapitulation of the primal horde patricide. Freud does indeed suggest at one point that modern group phenomena have their prehistoric analogues in the mist of ancient, primal horde events: “Thus the group appears to us as a revival of the primal horde. Just as primitive man survives potentially in every individual, so the primal horde may arise once more out of any random collection; insofar as men are habitually under the sway of group formation, we recognize in it the survival of the primal horde.”
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The primal horde is able to free itself from restrictive, growth-inhibiting bonds and progress to a more satisfying existence only after the awesome leader has been removed.

The members are never unanimous in their attack on the therapist. Invariably, some champions of the therapist will emerge from the group. The lineup of attackers and defenders may serve as a valuable guide for the understanding of characterological trends useful for future work in the group. Generally, the leaders of this phase, those members who are earliest and most vociferous in their attack, are heavily conflicted in the area of dependency and have dealt with intolerable dependency yearnings by reaction formation. These individuals, sometimes labeled counterdependents,
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are inclined to reject prima facie all statements by the therapist and to entertain the fantasy of unseating and replacing the leader.

For example, approximately three-fourths of the way through the first meeting of a group for clients with bulimia, I asked for the members’ reflections on the meeting: How had it gone for them? Disappointments? Surprises? One member, who was to control the direction of the group for the next several weeks, commented that it had gone precisely as she had expected; in fact, it had been almost disappointingly predictable. The strongest feeling that she had had thus far, she added, was anger toward me because I had asked one of the members a question that evoked a brief period of weeping. She had felt then, “They’ll never break me down like that!” Her first impressions were very predictive of her behavior for some time to come. She remained on guard and strove to be self-possessed and in control at all times. She regarded me not as an ally but as an adversary and was sufficiently forceful to lead the group into a major emphasis on control issues for the first several sessions.

If therapy is to be successful, counterdependent members must at some point experience their flip side and recognize and work through deep dependency cravings. The challenge in their therapy is first to understand that their counterdependent behavior often evokes rebuke and rejection from others before their wish to be nourished and protected can be experienced or expressed.

Other members invariably side with the therapist. They must be helped to investigate their need to defend the therapist at all costs, regardless of the issue involved. Occasionally, clients defend you because they have encountered a series of unreliable objects and misperceive you as extraordinarily frail; others need to preserve you because they fantasize an eventual alliance with you against other powerful members of the group. Beware that you do not unknowingly transmit covert signals of personal distress to which the rescuers appropriately respond.

Many of these conflicted feelings crystallize around the issue of the leader’s name. Are you to be referred to by professional title (Dr. Jones or, even more impersonally, the doctor or the counselor) or by first name? Some members will immediately use the therapist’s first name or even a diminutive of the name, before inquiring about the therapist’s preference. Others, even after the therapist has wholeheartedly agreed to proceeding on a first-name basis, still cannot bring themselves to mouth such irreverence and continue to bundle the therapist up in a professional title. One client, a successful businessman who had been consistently shamed and humiliated by a domineering father insisted on addressing the therapist as “Doctor” because he claimed this was a way to ensure that he was getting his money’s worth.

Although I have posited disenchantment and anger with the leader as a ubiquitous feature of small groups, by no means is the process constant across groups in form or degree. The therapist’s behavior may potentiate or mitigate both the experience and the expression of rebellion. Thus, one prominent sociologist, who has for many years led sensitivity-training groups of college students, reports that inevitably there is a powerful insurrection against the leader, culminating in the members removing him or her bodily from the group room.
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I, on the other hand, led similar groups for more than a decade and never encountered a rebellion so extreme that members physically ejected me from the room. Such a difference can be due only to differences in leader styles and behavior. What kind of leader evokes the most negative responses? Generally it is those who are ambiguous or deliberately enigmatic; those who are authoritative yet offer no structure or guidelines; or those who covertly make unrealistic promises to the group early in therapy.
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This stage is often difficult and personally unpleasant for group therapists. Let me remind neophyte therapists that you are essential to the survival of the group. The members cannot afford to liquidate you: you will always be defended. For your own comfort, however, you must learn to discriminate between an attack on your person and an attack on your role in the group. The group’s response to you is similar to transference distortion in individual therapy in that it is not directly related to your behavior, but its source in the group must be understood from both an individual psychodynamic and a group dynamic viewpoint.

Therapists who are particularly threatened by a group attack protect themselves in a variety of ways.†
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Once I was asked to act as a consultant for two therapy groups, each approximately twenty-five sessions old, that had developed similar problems: both groups seemed to have reached a plateau, no new ground appeared to have been broken for several weeks, and the members seemed to have withdrawn their interest in the groups. A study of current meetings and past protocols revealed that neither group had yet directly dealt with any negative feelings toward the therapists. However, the reasons for this inhibition were quite different in the two groups. In the first group, the two co-therapists (first-time leaders) had clearly exposed their throats, as it were, to the group and, through their obvious anxiety, uncertainty, and avoidance of hostility-laden issues, pleaded frailty. In addition, they both desired to be loved by all the members and had been at all times so benevolent and so solicitous that an attack by the group members would have appeared unseemly and ungrateful.