The Theory and Practice of Group Psychotherapy (39 page)

The past, moreover, no more determines the present and the future than it is determined by them. The past exists for each of us only as we constitute it in the present against the horizon of the future. Jerome Frank remind us that clients, even in prolonged therapy, recall only a minute fraction of their past experience and may selectively recall and synthesize the past so as to achieve consistency with their present view of themselves.
³⁷
In the same way that a client (as a result of therapy) alters her self-image, she may reconstitute the past. She may, for example, recall long-forgotten positive experiences with parents; she may humanize them and, rather than experiencing them solipsistically (as figures who existed by virtue of their service to herself), begin to understand them as harried, well-intentioned individuals struggling with the same overwhelming facts of the human condition that she faces herself. Once she reconstitutes the past, a new past can further influence her self-appraisal; however, it is the
reconstitution
, not simply the
excavation
, of the past that is crucial. Note an allied research finding: effective therapy generates further recollection of past memories, which in turn further modify the reconstitution of the past.
³⁸

If explanations are not to be sought from an originological perspective, and if the most potent focus of the group is the ahistorical here-and-now, does the past therefore play no role at all in the group therapeutic process? By no means! The past is an incessant visitor to the group and an even more incessant visitor to the inner world of each of the members during the course of therapy. Not infrequently, for example, a discussion of the past plays an important role in the development of group cohesiveness by increasing intermember understanding and acceptance.

The past is often invaluable in conflict resolution. Consider, for example, two members locked in a seemingly irreconcilable struggle, each of whom finds many aspects of the other repugnant. Often a full understanding of the developmental route whereby each arrived at his or her particular viewpoint can rehumanize the struggle. A man with a regal air of hauteur and condescension may suddenly seem understandable, even winsome, when we learn of his immigrant parents and his desperate struggle to transcend the degradation of a slum childhood. Individuals benefit through being fully known by others in the group and being fully accepted; knowing another’s process of becoming is a rich and often indispensable adjunct to knowing the person.

An ahistorical here-and-now interactional focus is never fully attainable. Discussions of future anticipations, both feared and desired, and of past and current experiences, are an inextricable part of human discourse. What is important in group therapy is the
accent
; the past is the servant, not the master. It is important in that it explicates the current reality of the client, who is in the process of unfolding in relation to the other group members. As Rycroft states, “It makes better sense to say that the analyst makes excursions into historical research in order to understand something which is interfering with his present communication with the patient (in the same way that a translator might turn to history to elucidate an obscure text) than to say that he makes contact with the patient in order to gain access to biographical data.”
³⁹

To employ the past in this manner involves an anamnestic technique differing from that often employed in individual therapy. Rather than a careful global historical survey, group therapists periodically attempt a sector analysis in which they explore the development of some particular interpersonal stance. Consequently, many other aspects of a client’s past remain undiscussed in group therapy. It is not uncommon, for example, for group therapists to conclude a course of successful therapy with a client and yet be unfamiliar with many significant aspects of the individual’s early life.

The lack of explicit discussion of the past in the ongoing therapy group does not accurately reflect the consideration of the past occurring
within
each client during therapy. The intensive focus on the here-and-now does not, of course, have as its final goal the formation of enduring relationships among group members. That is a way station, it is
a dress rehearsal
for the work that must be done with family and friends—the truly important individuals in a client’s life.

At the end of therapy, clients commonly report significant attitudinal improvements in relationships that have rarely been explicitly discussed in the group. Many of these involve family members with whom one has had a relationship stretching far back into the past. Many clients, in fact, change their feelings about family members who are long dead. So the past plays a role in the working-through process, and the therapist should be aware of this silent, important homework. Yet it is an implicit role. To make repetitive use of the group meeting for explicit discussion of the past would sacrifice the therapeutic potency of the here-and-now interactional focus.

GROUP - AS - A - WHOLE PROCESS COMMENTARY

Some group leaders choose to focus heavily on group-as-a-whole phenomena. In their comments, these leaders frequently refer to the “group” or “we” or “all of us.” They attempt to clarify the relationship between the group and its primary task, or between the group and the leader or one of its members, a subgroup, or some shared concern. Recall, for a moment, the “parenthood is degrading” incident described earlier in this chapter. In that incident the therapist had many process commentary options, some of which were group-as-a-whole explanations. He might, for example, have raised the issue of whether the “group” needed a scapegoat and whether, with Kate gone, Burt filled the scapegoat role; or whether the “group” was actively avoiding an important issue—that is, their guilty pleasure and fears about Kate’s departure.

Throughout this text I weave in comments related to group-as-a-whole phenomena: for example, norm setting, the role of the deviant, scapegoating, emotional contagion, role suction, subgroup formation, group cohesiveness, group pressure, the regressive dependency fostered by group membership, the group’s response to termination, to the addition of new members, to the absence of the leader, and so on. In addition to these common group phenomena, earlier editions of this book described some comprehensive group-as-a-whole approaches, particularly the work of Wilfred Bion, which offers an elaborate description of the psychology of groups and the unconscious forces that obstruct effective group functioning.
⁴⁰
His approach, also known as the Tavistock approach, persists as a useful model for understanding group-as-a-whole dynamics. Its emphasis, however, on an inscrutable, detached, leader who serves as “conductor” of the group and limits his participation solely to group-as-a-whole interpretations has resulted in the abandonment of the Tavistock approach for group psychotherapy. Tavistock conferences, however, are still used as an educational vehicle to inform participants about the nature of group forces, leadership, and authority. (See
www.yalom.com
for fourth edition discussion of Bion’s contributions.)

There is little question of the importance of group-as-a-whole phenomena.
All group leaders would agree that inherent forces in a group significantly influence behavior; individuals behave differently in a group than they do in dyads (a factor that, as I will discuss in chapter 9, confounds the selection of group therapy members). There is wide agreement that an individual’s behavior cannot be fully understood without an appreciation of his or her social and environmental context. But there remains the question of how best to apply this knowledge in the course of the therapy group. Examining the rationale of group-as-a-whole commentary provides some guidelines.

Rationale of Group-as-a-Whole Process Commentary

Group-as-a-whole phenomena influence the clinical course of the group in two significant ways: they can act in the service of the group, and they can impede effective group therapy.

Group-as-a-whole forces acting in the service of therapy
. I have, throughout this text, already considered many therapeutic uses of group-as-a-whole phenomena: for example, many of the major therapeutic factors, such as cohesiveness—the esprit de corps of the entire group—obviously relate to group-as-a-whole properties, and therapists are, in fact, harnessing group-as-a-whole forces when they facilitate the development of cohesiveness. However
, it does not follow that the leader must make explicit group-as-a-whole comments
.

Group-as-a-whole forces impeding therapy
. There are times when group-as-a-whole processes significantly impede therapy, and then commentary is necessary. In other words,
the purpose of a group-as-a-whole interpretation is to remove some obstacle that has arisen to obstruct the progress of the entire group.
⁴¹
The two common types of obstacle are
anxiety-laden issues and antitherapeutic group norms.

Anxiety-Laden Issues

O
ften some issue arises in the group that is so threatening that the members refuse to confront the problem and take some evasive action. This evasion takes many forms, all of which are commonly referred to as
group flight
—a regression from the group’s normal functions
.
Here is a clinical example of flight from an anxiety-laden issue:

• Six members were present at the twenty-fifth group meeting; one member, John, was absent. For the first time, and without previous mention, one of the members, Mary, brought her dog to the meeting. The group members, usually animated and active, were unusually subdued and nonproductive. Their speech was barely audible, and throughout the meeting they discussed safe topics on a level of impersonality appropriate to a large social gathering or cocktail party. Much of the content centered on study habits (three of the members were graduate students), examinations, and teachers (especially their untrustworthiness and defects). Moreover, the senior member of the group discussed former members who had long since departed from the group—the “good old days” phenomenon. Mary’s dog (a wretched, restless creature who spent most of the group session noisily licking its genitals) was never mentioned.

Finally, the therapist, thinking he was speaking for all the group members, brought up the issue of Mary’s having brought her dog to the meeting. Much to the therapist’s surprise, Mary—a highly unpopular, narcissistic member—was unanimously de fended. Everyone denied that the dog was in any way distracting, leaving the protesting therapist dangling in the wind.

The therapist considered the entire meeting as a “flight” meeting and, accordingly, made appropriate group-as-a-whole interpretations, which I will discuss shortly. But first, what is the evidence that such a meeting is in flight? And flight from what? First, consider the age of the group. In a young group, meeting, say, for the third time—such a session may be a manifestation not of resistance but of the group members’ uncertainty about their primary task and of their groping to establish procedural norms. However, this group had already met for many months and had consistently operated at a more mature level.

It becomes very evident that the group was in a flight mode when we examine the preceding group meeting. At that meeting, John, the member absent from the meeting under consideration, had been twenty minutes late and happened to walk down the corridor at the precise moment when a student opened the door of the adjoining observation room in order to enter it. For the few seconds while the door was open, John heard the voices of the other group members and saw a room full of observers viewing the group; moreover, the observers at that moment happened to be giggling at some private joke. John, like all the group members, had of course been told that the group was being observed by students. Nevertheless, this shocking and irreverent confirmation stunned him. When John, in the last moments of the meeting, was finally able to discuss it with the other members, they were equally stunned. John, as I mentioned, did not show up for the next session.

This event was a catastrophe of major proportions for the entire group—as it would be for any group. It raised serious questions in the minds of the members. Was the therapist to be trusted? Was he, like his colleagues in the observation room, inwardly giggling at them? Was anything he said genuine? Was the group, once perceived as a deeply human encounter, in fact a sterile, contrived, laboratory specimen being studied dispassionately by a therapist who probably felt closer allegiance to “them” (the others, the observers) than to the group members?

Despite—or, rather,
because
of—the magnitude of these painful group issues, the group declined to confront the matter. Instead, it engaged in flight behavior, which now begins to be understandable. Exposed to an outside threat, the group members banded tightly together for protection. They spoke softly about safe topics so as to avoid sharing anything with the outside menace (the observers and, through association, the therapist). The therapist was unsupported when he asked about the obviously distracting behavior of Mary’s dog. The “good old days” was a reference to and yearning for those bygone times when the group was pure and verdant and the therapist could be trusted. The discussion of examinations and untrustworthy teachers was also a thinly veiled expression of attitudes toward the therapist.

The precise nature and timing of the intervention is largely a matter of individual style. Some therapists, myself included, tend to intervene when they sense the presence of group flight even though they do not clearly understand its source. I may, for example, comment that I feel puzzled or uneasy about the meeting and inquire, “Is there something the group is not talking about today?” or “Is the group avoiding something?” or “I have a sense there’s a ‘hidden agenda’ today; could we talk about this?”