The Theory and Practice of Group Psychotherapy (38 page)

Therapists may offer the client any of several interpretations to clarify the same issue; each may be made from a different frame of reference, and each may be “true.” Freudian, interpersonal, object relations, self psychology, attachment theory, existential, transactional analytic, Jungian, gestalt, transpersonal, cognitive, behavioral explanations—all of these may be true simultaneously. None, despite vehement claims to the contrary, have sole rights to the truth. After all, they are all based on imaginary,
as if
structures. They all say, “You are behaving (or feeling)
as if
such and such a thing were true.” The superego, the id, the ego; the archetypes; the masculine protest; the internalized objects; the selfobject; the grandiose self and the omnipotent object; the parent, child, and adult ego state—
none of these really exists
. They are all fictions, all psychological constructs created for semantic convenience.
They justify their existence only by virtue of their explanatory powers
.
²⁹

Do we therefore abandon our attempts to make precise, thoughtful interpretations? Not at all. We only recognize the purpose and function of the interpretation. Some may be superior to others, not because they are deeper but because they have more explanatory power, are more credible, provide more mastery, and are therefore more useful. Obviously, interpretations must be tailored to the recipient. In general, therapeutic interventions are more effective if they make sense, if they are logically consistent with sound supporting arguments, if they are bolstered by empirical observation, if they “feel” right or are congruent and “click” with a client’s frame of reference and internal world, and if they can be generalized and applied to many analogous situations in the client’s life.

Higher-order interpretations generally offer a novel explanation to the client for some large pattern of behavior (as opposed to a single trait or act). The novelty of the therapist’s explanation stems from his or her objective vantage point and unusual frame of reference, which permits an original synthesis of data. Indeed, often the data is material that the client has generally overlooked or that is outside his or her awareness.

If pushed, to what extent am I willing to defend this relativistic thesis? When I present this position to students, they respond with such questions as: Does that mean that an astrological explanation is also valid in psychotherapy? Such questions make me uneasy, but I have to respond affirmatively. If an astrological or shamanistic or magical explanation enhances a sense of mastery and leads to inner, personal change, then it is a valid explanation. There is much evidence from cross-cultural psychiatric research to support this position; the explanation must be consistent with the values and with the frame of reference of the human community in which the client dwells. In most primitive cultures, it is often
only
the magical or the religious explanation that is acceptable, and hence valid and effective.
³⁰

Psychoanalytic revisionists make an analogous point and argue that reconstructive attempts to capture historical “truth” are futile; it is far more important to the process of change to construct plausible, meaningful, personal narratives.
³¹
The past is not static: every experienced therapist knows that the process of exploration and understanding alters the recollection of the past. In fact, current neurobiological research tells us that every time we access an old memory we automatically alter it according to our current context, and the revised memory is then returned to long-term storage in place of the original memory.
³²

An interpretation, even the most elegant one, has no benefit if the client does not hear it. Therapists should take pains to review their evidence with the client and present the explanation clearly. (Be clear: if you cannot be crystal-clear, it is likely that the explanation is rickety or that you yourself do not understand it. The reason is not, as often has been claimed, that you are speaking directly to the client’s unconscious.)

Do not always expect the client to accept an interpretation. Sometimes the client hears the same interpretation many times until one day it seems to “click.” Why does it click that one day? Perhaps the client just came across some corroborating data from new events in the environment or from the surfacing in fantasy or dreams of some previously unconscious material. Note also that
the interpretation will not click until the client’s relationship with the therapist is just right.
For example, a group member who feels threatened and competitive with the therapist is unlikely to be helped by any interpretation (except one that clarifies the transference). Even the most thoughtful interpretation will fail because the client may feel defeated or humiliated by the proof of the therapist’s superior perceptivity. An interpretation becomes maximally effective only when it is delivered in a context of acceptance and trust.

Sometimes a client will accept from another member an interpretation that he or she would not accept from the therapist. (Remember, group members are entirely capable of making interpretations as useful as those of the therapists, and members will be receptive to these interpretations
provided the other member has accepted the client role and does not offer interpretations to acquire prestige, power, or a favored position with the leader.
)

A comprehensive discussion of the types of effective interpretations would require describing the vast number of explanatory schools and group therapy models—a task well beyond the scope of this book.
³³
However, three venerable concepts are so deeply associated with interpretation that they deserve coverage here:

1. The use of the past

2. Group-as-a-whole process commentary

3. Transference

I will discuss the first two in the remainder of this chapter. So many interpretative systems involve transference (indeed, traditional analytic theory decrees that
only
the transference interpretation can be effective) that I have devoted the next chapter entirely to the issue of transference and transparency.

THE USE OF THE PAST

Too often, explanation is confused with “originology” (the study of origins). Although, as I have discussed, an explanatory system may effectively postulate a “cause” of behavior from any of a large number of perspectives, many therapists continue to believe that the “real,” the “deepest,” causes of behavior are only to be found in the past. This position was staunchly defended by Freud, a committed psychosocial archaeologist. To the very end of his life, he relinquished neither his search for the primordial (that is, the earliest) explanation nor his tenacious insistence that successful therapy hinges on the excavation of the earliest layers of life’s memories. The idea that the
present
is only a small fraction of the individual’s life and that contemporary life is shaped by the overwhelmingly large contributions made by the past is powerfully embedded in the Western world’s view of time.
³⁴
This view understandably results in an emphasis on the past in traditional psychodynamic textbooks
³⁵
of group therapy.

However, the powerful and unconscious factors that influence human behavior are
by no means
limited to the past. Current analytic theory makes a distinction between the
past unconscious
(the child within the adult) and the
present unconscious
(the currently existing unconscious thoughts, fantasies, and impulses that influence our feelings and actions).
³⁶
Furthermore, as I shall discuss, the future, as well as the past and the present, is also a significant determinant of behavior.

The past may affect our behavior through pathways fully described by traditional psychoanalytic theorists and by learning theorists (strange bedfellows). However, the “not yet,” the future, is a no less powerful determinant of behavior, and the concept of future determinism is fully defensible. We have at all times within us a sense of purpose, an idealized self, a series of goals for which we strive, a death toward which we veer. These factors, both conscious and unconscious, all arch into the future and profoundly influence our behavior. Certainly the knowledge of our isolation, our destiny, and our ultimate death deeply influences our conduct and our inner experience. Though we generally keep them out of awareness, the terrifying contingencies of our existence play upon us without end. We either strive to dismiss them by enveloping ourselves in life’s many diversions, or we attempt to vanquish death by faith in an afterlife or by striving for symbolic immortality in the form of children, material monuments, and creative expression. In addition to the explanatory potency of the past and the future, there is a third temporal concept that attempts to explain behavior: the Galilean concept of causality, which focuses on the present—on the impact of
current forces
.

In summary, explanations ensue from the exploration of the concentric rings of conscious and unconscious current motivations that envelop our clients. Take one example: clients may have a need to attack, which covers a layer of dependency wishes that they do not express for fear of rejection. Note that
we need not ask how they got to be so dependent.
In fact, the future (a person’s anticipation of rejection) plays a more central role in the interpretation. Thus, as we hurtle through space, our behavioral trajectory may be thought of as triply influenced: by the past—the nature and direction of the original push; by the future—the goal that beckons us; and by the present—the current field forces operating upon it. Consider this clinical example:

• Two clients, Ellen and Carol, expressed strong sexual feelings toward the male therapist of the group. (Both women, incidentally, had histories—indeed, chief complaints—of masochistic sexual gratification.) At one meeting, they discussed the explicit content of their sexual fantasies about the therapist. Ellen fantasized her husband being killed; herself having a psychotic breakdown; the therapist hospitalizing her and personally nurturing her, rocking her, and caring for all her bodily needs. Carol had a different set of fantasies. She wondered whether the therapist was well cared for at home. She frequently fantasized that something happened to his wife and that she would care for him by cleaning his house and cooking his meals.

The shared sexual attraction (which, as the fantasies indicate, was not genital-sexual) had for Ellen and Carol very different explanations. The therapist pointed out to Ellen that throughout the course of the group, she had suffered frequent physical illness or severe psychological relapses. He wondered whether, at a deep level, she felt as though she could get his love and that of the other members only by a form of selfimmolation. If this was the case, however, it never worked. More often than not, she discouraged and frustrated others. Even more important was the fact that as long as she behaved in ways that caused her so much shame, she could not love herself. He emphasized that it was crucial for her to change the pattern, because it defeated her in her therapy: she was afraid to get better, since she felt that to do so would entail an inevitable loss of love and nurturance.

In his comments to Carol, the therapist juxtaposed several aspects of her behavior: her self-derogation, her refusal to assume her rights, her inability to get men interested in her. Her fantasy of taking care of the therapist was illustrative of her motivations: she believed that if she could be self-sacrificing enough, if she could put the therapist deeply into her debt, then she should, in reciprocal fashion, receive the love she sought. However, Carol’s search for love, like Ellen’s, always failed. Her eternal ingratiation, her dread of self-assertion, her continued self-devaluation succeeded only in making her appear dull and spiritless to those whose regard she most desired. Carol, like Ellen, whirled about in a vicious circle of her own creation: the more she failed to obtain love, the more frantically she repeated the same self-destructive pattern—the only course of behavior she knew or dared to enact. It was a neatly contained, self-reinforcing, and self-defeating cycle.

So here we have two clients with a similar behavioral pattern: “sexual” infatuation with the therapist. Yet the therapist offered two different interpretations reflecting two different dynamic pathways to psychological masochism. In each, the therapist assembled several aspects of the client’s behavior in the group as well as fantasy material and suggested that, if certain “as if” assumptions were made (for example, that Ellen acted as if she could obtain the therapist’s love only by offering herself as severely damaged, and that Carol acted as if she could obtain his love only by so serving him and thus place him in her debt), then the rest of the behavior “made sense.”

Both interpretations were potent and had a significant impact on future behavior. Yet neither broached the question “
How did you get to be that way?
What happened in your earlier life to create such a pattern?” Both dealt instead with currently existing patterns: the desire for love, the conviction that it could be obtained only in certain ways, the sacrifice of autonomy, the resulting shame, the ensuing increased need for a sign of love, and so on.

One formidable problem with explanations based on the distant past is that they contain within them the seeds of therapeutic despair. Thus the paradox: if we are fully determined by the past, whence comes the ability to change? As is evident in such later works as
Analysis Terminable and Interminable
, Freud’s uncompromising deterministic view led him to, but never through, this Gordian knot.