The Theory and Practice of Group Psychotherapy (11 page)

THE SOCIAL MICROCOSM: A DYNAMIC INTERACTION

There is a rich and subtle dynamic interplay between the group member and the group environment. Members shape their own microcosm, which in turn pulls characteristic defensive behavior from each. The more spontaneous interaction there is, the more rapid and authentic will be the development of the social microcosm. And that in turn increases the likelihood that the central problematic issues of all the members will be evoked and addressed.

For example, Nancy, a young woman with borderline personality disorder, entered the group because of a disabling depression, a subjective state of disintegration, and a tendency to develop panic when left alone. All of Nancy’s symptoms had been intensified by the threatened breakup of the small commune in which she lived. She had long been sensitized to the breakup of nuclear units; as a child she had felt it was her task to keep her volatile family together, and now as an adult she nurtured the fantasy that when she married, the various factions among her relatives would be permanently reconciled.

How were Nancy’s dynamics evoked and worked through in the social microcosm of the group? Slowly! It took time for these concerns to manifest themselves. At first, sometimes for weeks on end, Nancy would work comfortably on important but minor conflict areas. But then certain events in the group would fan her major, smoldering concerns into anxious conflagration. For example, the absence of a member would unsettle her. In fact, much later, in a debriefing interview at the termination of therapy, Nancy remarked that she often felt so stunned by the absence of any member that she was unable to participate for the entire session.

Even tardiness troubled her and she would chide members who were not punctual. When a member thought about leaving the group, Nancy grew deeply concerned and could be counted on to exert maximal pressure on the member to continue, regardless of the person’s best interests. When members arranged contacts outside the group meeting, Nancy became anxious at the threat to the integrity of the group. Sometimes members felt smothered by Nancy. They drew away and expressed their objections to her phoning them at home to check on their absence or lateness. Their insistence that she lighten her demands on them simply aggravated Nancy’s anxiety, causing her to increase her protective efforts.

Although she longed for comfort and safety in the group, it was, in fact, the very appearance of these unsettling vicissitudes that made it possible for her major conflict areas to become exposed and to enter the stream of the therapeutic work.

Not only does the small group provide a social microcosm in which the maladaptive behavior of members is clearly displayed, but it also becomes a laboratory in which is demonstrated, often with great clarity, the meaning and the dynamics of the behavior. The therapist sees not only the behavior but also the events triggering it and sometimes, more important, the anticipated and real responses of others.

The group interaction is so rich that each member’s maladaptive transaction cycle is repeated many times, and members have multiple opportunities for reflection and understanding. But if pathogenic beliefs are to be altered, the group members must receive feedback that is clear and usable. If the style of feedback delivery is too stressful or provocative, members may be unable to process what the other members offer them. Sometimes the feedback may be premature—that is, delivered before sufficient trust is present to soften its edge. At other times feedback can be experienced as devaluing, coercive, or injurious.
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How can we avoid unhelpful or harmful feedback? Members are less likely to attack and blame one another if they can look beyond surface behavior and become sensitive to one another’s internal experiences and underlying intentions.† Thus empathy is a critical element in the successful group. But empathy, particularly with provocative or aggressive clients, can be a tall order for group members and therapists alike.†

The recent contributions of the intersubjective model are relevant and helpful here.
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This model poses members and therapists such questions as: “How am I implicated in what I construe as your provocativeness? What is my part in it?” In other words, the group members and the therapist continuously affect one another. Their relationships, their meaning, patterns, and nature, are not fixed or mandated by external influences, but jointly constructed. A traditional view of members’ behavior sees the distortion with which members relate events—either in their past or within the group interaction—as solely the creation and responsibility of that member. An intersubjective perspective acknowledges the group leader’s and other members’ contributions to each member’s here-and-now experience—as well as to the texture of their entire experience in the group.

Consider the client who repeatedly arrives late to the group meeting. This is always an irritating event, and group members will inevitably express their annoyance. But the therapist should also encourage the group to explore the meaning of that particular client’s behavior. Coming late may mean “I don’t really care about the group,” but it may also have many other, more complex interpersonal meanings: “Nothing happens without me, so why should I rush?” or “I bet no one will even notice my absence—they don’t seem to notice me while I’m there,” or “These rules are meant for others, not me.”

Both the underlying meaning of the individual’s behavior and the impact of that behavior on others need to be revealed and processed if the members are to arrive at an empathic understanding of one another. Empathic capacity is a key component of emotional intelligence
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and facilitates transfer of learning from the therapy group to the client’s larger world. Without a sense of the internal world of others, relationships are confusing, frustrating, and repetitive as we mindlessly enlist others as players with predetermined roles in our own stories, without regard to their actual motivations and aspirations.

Leonard, for example, entered the group with a major problem of procrastination. In Leonard’s view, procrastination was not only a problem but also an explanation. It explained his failures, both professionally and socially; it explained his discouragement, depression, and alcoholism. And yet it was an explanation that obscured meaningful insight and more accurate explanations.

In the group we became well acquainted and often irritated or frustrated with Leonard’s procrastination. It served as his supreme mode of resistance to therapy when all other resistance had failed. When members worked hard with Leonard, and when it appeared that part of his neurotic character was about to be uprooted, he found ways to delay the group work. “I don’t want to be upset by the group today,” he would say, or “This new job is make or break for me”; “I’m just hanging on by my fingernails”; “Give me a break—don’t rock the boat”; “I’d been sober for three months until the last meeting caused me to stop at the bar on my way home.” The variations were many, but the theme was consistent.

One day Leonard announced a major development, one for which he had long labored: he had quit his job and obtained a position as a teacher. Only a single step remained: getting a teaching certificate, a matter of filling out an application requiring approximately two hours’ labor.

Only two hours and yet he could not do it! He delayed until the allowed time had practically expired and, with only one day remaining, informed the group about the deadline and lamented the cruelty of his personal demon, procrastination. Everyone in the group, including the therapists, experienced a strong desire to sit Leonard down, possibly even in one’s lap, place a pen between his fingers, and guide his hand along the application form. One client, the most mothering member of the group, did exactly that: she took him home, fed him, and schoolmarmed him through the application form.

As we began to review what had happened, we could now see his procrastination for what it was: a plaintive, anachronistic plea for a lost mother. Many things then fell into place, including the dynamics behind Leonard’s depressions (which were also desperate pleas for love), alcoholism, and compulsive overeating.

The idea of the social microcosm is, I believe, sufficiently clear:
if the group is conducted such that the members can behave in an unguarded, unselfconscious manner, they will, most vividly, re-create and display their pathology in the group
. Thus in this living drama of the group meeting, the trained observer has a unique opportunity to understand the dynamics of each client’s behavior.

RECOGNITION OF BEHAVIORAL PATTERNS IN THE SOCIAL MICROCOSM

If therapists are to turn the social microcosm to therapeutic use, they must first learn to identify the group members’ recurrent maladaptive interpersonal patterns. In the incident involving Leonard, the therapist’s vital clue was the emotional response of members and leaders to Leonard’s behavior. These emotional responses are valid and indispensable data: they should not be overlooked or underestimated. The therapist or other group members may feel angry toward a member, or exploited, or sucked dry, or steamrollered, or intimidated, or bored, or tearful, or any of the infinite number of ways one person can feel toward another.

These feelings represent data—a bit of the truth about the other person—and should be taken seriously by the therapist. If the feelings elicited in others are highly discordant with the feelings that the client would like to engender in others, or if the feelings aroused are desired, yet inhibit growth (as in the case of Leonard), then therein lies a crucial part of the client’s problem. Of course there are many complications inherent in this thesis. Some critics might say that a strong emotional response is often due to pathology not of the subject but of the respondent. If, for example, a self-confident, assertive man evokes strong feelings of fear, intense envy, or bitter resentment in another man, we can hardly conclude that the response is reflective of the former’s pathology. There is a distinct advantage in the therapy group format: because the group contains multiple observers, it is easier to differentiate idiosyncratic and highly subjective responses from more objective ones.

The emotional response of any single member is not sufficient; therapists need confirmatory evidence. They look for repetitive patterns over time and for multiple responses—that is, the reactions of several other members (referred to as consensual validation) to the individual. Ultimately therapists rely on the most valuable evidence of all: their own emotional responses. Therapists must be able to attend to their own reactions to the client, an essential skill in all relational models. If, as Kiesler states, we are “hooked” by the interpersonal behavior of a member, our own reactions are our best interpersonal information about the client’s impact on others.
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Therapeutic value follows, however, only if we are able to get “unhooked”—that is, to resist engaging in the usual behavior the client elicits from others, which only reinforces the usual interpersonal cycles. This process of retaining or regaining our objectivity provides us with meaningful feedback about the interpersonal transaction. From this perspective, the thoughts, fantasies, and actual behavior elicited in the therapist by each group member should be treated as gold. Our reactions are invaluable data, not failings. It is impossible not to get hooked by our clients, except by staying so far removed from the client’s experience that we are untouched by it—an impersonal distance that reduces our therapeutic effectiveness.

A critic might ask, “How can we be certain that therapists’ reactions are ‘objective’?” Co-therapy provides one answer to that question. Co-therapists are exposed together to the same clinical situation. Comparing their reactions permits a clearer discrimination between their own subjective responses and objective assessments of the interactions. Furthermore, group therapists may have a calm and privileged vantage point, since, unlike individual therapists, they witness countless compelling maladaptive interpersonal dramas unfold without themselves being at the center of all these interactions.

Still, therapists do have their blind spots, their own areas of interpersonal conflict and distortion. How can we be certain these are not clouding their observations in the course of group therapy? I will address this issue fully in later chapters on training and on the therapist’s tasks and techniques, but for now note only that this argument is a powerful reason for therapists to know themselves as fully as possible. Thus it is incumbent upon the neophyte group therapist to embark on a lifelong journey of self-exploration, a journey that includes both individual and group therapy.

None of this is meant to imply that therapists should not take seriously the responses and feedback of all clients, including those who are highly disturbed. Even the most exaggerated, irrational responses contain a core of reality. Furthermore, the disturbed client may be a valuable, accurate source of feedback at other times: no individual is highly conflicted in every area. And, of course, an idiosyncratic response may contain much information about the respondent.

This final point constitutes a basic axiom for the group therapist. Not infrequently, members of a group respond very differently to the same stimulus. An incident may occur in the group that each of seven or eight members perceives, observes, and interprets differently.
One common stimulus and eight different responses—how can that be?
There seems to be only one plausible explanation: there are eight different inner worlds. Splendid! After all, the aim of therapy is to help clients understand and alter their inner worlds. Thus, analysis of these differing responses is a royal road—a via regia—into the inner world of the group member.

For example, consider the first illustration offered in this chapter, the group containing Valerie, a flamboyant, controlling member. In accord with their inner world, each of the group members responded very differently to her, ranging from obsequious acquiescence to lust and gratitude to impotent fury or effective confrontation.