The Theory and Practice of Group Psychotherapy (33 page)

Resistance occurs in many forms. Often it appears in the cunning guise of total equality. Clients, especially in early meetings, often respond to the therapist’s here-and-now urgings by claiming that they feel exactly the same toward all the group members: that is, they say that they feel equally warm toward all the members, or no anger toward any, or equally influenced or threatened by all.
Do not be misled. Such claims are never true.
Guided by your sense of timing, push the inquiry farther and help members differentiate one another. Eventually they will disclose that they do have slight differences of feeling toward some of the members. These slight differences are important and are often the vestibule to full interactional participation. I explore the slight differences (no one ever said they had to be enormous); sometimes I suggest that the client hold up a magnifying glass to these differences and describe what he or she then sees and feels. Often resistance is deeply ingrained and the client is heavily invested in maintaining a position that is known and familiar even though it is undermining or personally destructive.

Resistance is not usually conscious obstinacy but more often stems from sources outside of awareness. Sometimes the here-and-now task is so unfamiliar and uncomfortable to the client that it is not unlike learning a new language; one has to attend with maximal concentration in order not to slip back into one’s habitual remoteness. Considerable ingenuity on the part of the therapist may be needed, as the following case study shows.

• Claudia resisted participation on a here-and-now level for many sessions. Typically she brought to the group some pressing current life problem, often one of such crisis proportions that the group members felt trapped. First, they felt compelled to deal immediately with the precise problem Claudia presented; second, they had to tread cautiously because she explicitly informed them that she needed all her resources to cope with the crisis and could not afford to be shaken up by interpersonal confrontation. “Don’t push me right now,” she might say, “I’m just barely hanging on.” Efforts to alter this pattern were unsuccessful, and the group members felt discouraged in dealing with Claudia. They cringed when she brought in problems to the meeting.

One day she opened the group with a typical gambit. After weeks of searching she had obtained a new job but was convinced that she was going to fail and be dismissed. The group dutifully but warily investigated the situation. The investigation met with many of the familiar, treacherous obstacles that generally block the path of work on outside problems. There seemed to be no objective evidence that Claudia was failing at work. She seemed, if anything, to be trying too hard, working eighty hours a week. The evidence, Claudia insisted, simply could not be appreciated by anyone not there at work with her: the glances of her supervisor, the subtle innuendos, the air of dissatisfaction toward her, the general ambiance in the office, the failure to live up to her (selfimposed and unrealistic) sales goals. It was difficult to evaluate what she said because she was not a highly unreliable observer and typically downgraded herself and minimized her accomplishments.

The therapist moved the entire transaction into the here-and-now by asking, “Claudia, it’s hard for us to determine whether you are, in fact, failing at your job. But let me ask you another question: What grade do you think you deserve for your work in the group, and what do each of the others get?”

Claudia, not unexpectedly, awarded herself a “D–” and staked her claim for at least eight more years in the group. She awarded all the other members substantially higher grades. The therapist replied by awarding Claudia a “B” for her work in the group and then went on to point out the reasons: her commitment to the group, perfect attendance, willingness to help others, great efforts to work despite anxiety and often disabling depression.

Claudia laughed it off, trying to brush off this exchange as a gag or a therapeutic ploy. But the therapist held firm and insisted that he was entirely serious. Claudia then insisted that the therapist was wrong, and pointed out her many failings in the group (one of which was the avoidance of the here-and-now). However, Claudia’s disagreement with the therapist created dissonance for her, since it was incompatible with her long-held, frequently voiced, total confidence in the therapist. (Claudia had often invalidated the feedback of other members in the group by claiming that she trusted no one’s judgment except the therapist’s.)

The intervention was enormously useful and transferred the process of Claudia’s evaluation of herself from a secret chamber lined with the distorting mirrors of her self-perception to the open, vital arena of the group. No longer was it necessary for the members to accept Claudia’s perception of her boss’s glares and subtle innuendoes. The boss (the therapist) was there in the group. The whole transaction was visible to the group. Finding the here-and-now
experiential
analogue of the untrustworthy “then-and-there”
reported
difficulties unlocked the therapeutic process for Claudia.

I never cease to be awed by the rich, subterranean lode of data that exists in every group and in every meeting. Beneath each sentiment expressed there are layers of invisible, unvoiced ones. But how to tap these riches? Sometimes after a long silence in a meeting, I express this very thought: “There is so much information that could be valuable to us all today if only we could excavate it. I wonder if we could, each of us, tell the group about some thoughts that occurred to us in this silence, which we thought of saying but didn’t.”

The exercise is more effective, incidentally, if you participate personally, even start it going. Substantial empirical evidence supports the principle that therapists who employ judicious and disciplined self-disclosure, centered in the here-and-now of the therapeutic relationship, increase their therapeutic effectiveness and facilitate clients’ exploration and openness.
⁹
For example, you might say, “I’ve been feeling on edge in this silence, wanting to break it, not wanting to waste time, but on the other hand feeling irritated that it always has to be me doing this work for the group.” Or, “I’ve been feeling uneasy about the struggle going on in the group between you and me, Mike. I’m uncomfortable with this much tension and anger, but I don’t know yet how to help understand and resolve it.”

When I feel there has been a particularly great deal unsaid in a meeting, I have often found the following technique useful: “It’s now six o’clock and we still have half an hour left, but I wonder if you each would imagine that the meeting has ended and that you’re on your way home. What disappointments would you have about the meeting today?”

Many of the inferences the therapist makes may be off-target. But objective accuracy is not the issue:
as long as you persistently direct the group from the nonrelevant, from the then-and-there, to the here-and-now, you are operationally correct.
For example, if a group spends time in an unproductive meeting discussing dull, boring parties, and the therapist wonders aloud if the members are indirectly referring to the present group session, there is no way of determining with any certainty whether that is an accurate statement. Correctness in this instance must be defined relativistically and pragmatically. By shifting the group’s attention from then-and-there to here-and-now material, the therapist performs a service to the group—a service that, consistently reinforced, will ultimately result in a cohesive, interactional atmosphere maximally conducive to therapy. Following this model, the effectiveness of an intervention should be gauged by its success in focusing the group on itself.

According to this principle, the therapist might ask a group that dwells at length on the subject of poor health or on a member’s sense of guilt over remaining in bed during times of sickness, “Is the group really wondering about my [the therapist’s] recent illness?” Or a group suddenly preoccupied with death and the losses each member has incurred might be asked whether they are also concerned with the group’s impending fourweek summer vacation. In these instances the leader attempts to make connections between the overt content and underlying unexpressed covert group-related issues.

Obviously, these interventions would be pointless if the group had already thoroughly worked through all the implications of the therapist’s recent absence or the impending summer break. The technical procedure is not unlike the sifting process in any traditional psychotherapy. Presented with voluminous data in considerable disarray, the therapist selects, reinforces, and interprets those aspects he deems most helpful to the client at that particular time. Not all dreams and not all parts of a dream are attended to by the therapist; however, a dream theme that elucidates a particular issue on which the client is currently working is vigorously pursued.

Implicit here is the assumption that the therapist knows the most propitious direction for the group at a specific moment. Again, this is not a precise matter. What is most important is that the therapist has formulated broad principles of ultimately helpful directions for the group and its members—this is precisely where a grasp of the therapeutic factors is essential.

Often, when activating the group, the therapist performs two simultaneous acts: steering the group into the here-and-now and, at the same time, interrupting the content flow in the group. Not infrequently, some members will resent the interruption, and the therapist must attend to these feelings, for they, too, are part of the here-and-now. Often it is difficult for the therapist to intervene. Early in our socialization process we learn not to interrupt, not to change the subject abruptly. Furthermore, there are often times in the group when everyone seems keenly interested in the topic under discussion. Even though the therapist is certain that the group is not working, it is not easy to buck the group current. As noted in chapter 3, social-psychological small-group research demonstrates the compelling power of group pressure. To take a stand opposite to the perceived consensus of the group requires considerable courage and conviction.

My experience is that the therapist faced with this as well as many other types of dilemmas can increase the clients’ receptivity by expressing both sets of feelings to the group. For example, “Lily, I feel very uncomfortable as you talk. I’m having a couple of strong feelings. One is that you’re into something that is very important and painful for you, and the other is that Jason [a new member] has been trying hard to get into the group for the last few meetings and the group seems unwelcoming. This didn’t happen when other new members entered the group. Why do you think it’s happening now?” Or, “Lenore, I’ve had two reactions as you started talking. The first is that I’m delighted you feel comfortable enough now in the group to participate, but the other is that it’s going to be hard for the group to respond to what you’re saying because it’s very abstract and far removed from you personally. I’d be much more interested in how you’ve been feeling about the group the last couple of meetings. Are there some incidents or interactions you’ve been especially tuned in to? What reactions have you had to other members here?”

There are, of course, many more such activating procedures. (In chapter 14, I describe some basic modifications in the group structure and procedure that facilitate here-and-now interaction in short-term specialty groups.) But my goal here is not to offer a compendium of techniques. Rather, I describe techniques only to illuminate the underlying principle of here-and-now activation. These group techniques, or gimmicks, are servants, not masters. To use them injudiciously, to fill voids, to jazz up the group, to acquiesce to the members’ demands that the leader lead, is seductive but not constructive for the group.
¹⁰

Overall, group leader activity correlates with outcome in a curvilinear fashion (too much or too little activity leads to unsuccessful outcomes). Too
little
leader activity results in a floundering group. Too
much
activation by a leader results in a dependent group that persists in looking to the leader to supply too much.

Remember that sheer acceleration of interaction is not the purpose of these techniques. The therapist who moves too quickly—using gimmicks to make interactions, emotional expression, and self-disclosure too easy—misses the whole point. Resistance, fear, guardedness, distrust—in short, everything that impedes the development of satisfying interpersonal relations—must be permitted expression. The goal is to create not a slick-functioning, streamlined social organization but one that functions well enough and engenders sufficient trust for the unfolding of each member’s social microcosm. Working through the resistances to change is the key to the production of change.

Thus, the therapist wants to go not
around
obstacles but
through
them. Ormont puts it nicely when he points out that though we urge clients to engage deeply in the here-and-now, we expect them to fail, to default on their contract. In fact, we
want
them to default because we hope, through the nature of their failure, to identify and ultimately dispel each member’s particular resistances to intimacy—including each member’s resistance style (for example, detachment, fighting, diverting, self-absorption, distrust) and each member’s underlying
fears of intimacy
(for example, impulsivity, abandonment, merger, vulnerability).
¹¹

TECHNIQUES OF PROCESS ILLUMINATION

As soon as clients have been successfully steered into a here-and-now interactional pattern, the group therapist must attend to turning this interaction to therapeutic advantage. This task is complex and consists of several stages: