The Theory and Practice of Group Psychotherapy (41 page)

Psychoanalysts disagree about the degree of permissible therapist disclosure—ranging from extensive disclosure
⁹
to complete opaqueness.
¹⁰
But they do agree that transference is “inappropriate, intense, ambivalent, capricious, and tenacious”
¹¹
and agree also about the centrality of the transference and the key role of the interpretation of transference in analytic treatment. The difference between analytic schools centers mainly on whether “transference is everything or almost everything.”
¹²

In group therapy the problem is not the importance of transference work; it is the
priority
of this work relative to other therapeutic factors in the treatment process. The therapist cannot focus solely on transference and at the same time perform the variety of tasks necessary to build a group that can make use of the important group therapeutic factors.

The difference between group therapists who consider the resolution of therapist-client transference as the paramount therapeutic factor
¹³
and those who attach equal importance to the interpersonal learning that ensues from relationships between members and from other therapeutic factors is more than theoretical: in practice, they use markedly different techniques. The following vignettes from a group led by a formal British analyst who made only transference interpretations illustrate this point:

• At the twentieth meeting, the members discussed at great length the fact that they did not know one another’s first names. They then dealt with the general problem of intimacy, discussing, for example, how difficult it was to meet and really know people today. How does one make a really close friend? Now, on two occasions during this discussion, a member had erred or forgotten the surname of another member. From this data the group leader made the transference interpretation that by forgetting the others’ names, the members were expressing a wish that all the other members would vanish so that each could have the therapist’s sole attention.

• In another session, two male members were absent, and four women members bitterly criticized the one male client present, who was gay, for his detachment and narcissism, which precluded any interest in the lives or problems of others. The therapist suggested that the women were attacking the male client because he did not desire them sexually. Moreover, he was an indirect target; the women really wanted to attack the therapist for his refusal to engage them sexually.

In each instance, the therapist selectively attended to the data and, from the vantage point of his particular conception of the paramount therapeutic factor—that is, transference resolution—made an interpretation that was pragmatically correct, since it focused the members’ attention on their relationship with the leader. However, in my view, these therapist-centered interpretations are incomplete, for they deny important intermember relationships. In fact, in the first vignette, the members, in addition to their wish for the therapist’s sole attention,
were
considerably conflicted about intimacy and about their desires and fears of engaging with one another. In the second vignette, the male client
had
in fact been self-absorbed and detached from the other members of the group, and it was exceedingly important for him to recognize and understand his behavior.

Any mandate that limits group therapists’ flexibility renders them less effective. I have seen some therapists hobbled by a conviction that they must at all times remain totally anonymous and neutral, others by their crusade to be at all times totally “honest” and transparent, and still others by the dictum that they must make interpretations only of transference or only of mass group phenomena, or, even more stringently, only of mass group transference.

The therapist’s approach to the group can amplify or moderate the expression of members’ transferences. If the therapist emphasizes his centrality, the group will become more regressive and dependent. In contrast, if the therapist values the peer interactions and peer transferences as primary expressions and not merely as displacements from the therapist, then the intensity of the transference experience in the group will be better modulated.
¹⁴

In this chapter I make the following points about transference:

1. Transference
does
occur in therapy groups; indeed, it is omnipresent and radically influences the nature of the group discourse.

2. Without an appreciation of transference and its manifestations, the therapist will often not be able to understand fully the process of the group.

3. Therapists who ignore transference considerations may seriously misunderstand some transactions and confuse rather than guide the group members; therapists who attend
only
to the transference aspects of their relationships with members may fail to relate authentically to them.

4. There are clients whose therapy hinges on the resolution of transference distortion; there are others whose improvement will depend on interpersonal learning stemming from work not with the therapist but with another member, around such issues as competition, exploitation, or sexual and intimacy conflicts; and there are many clients who choose alternative therapeutic pathways in the group and derive their primary benefit from other therapeutic factors entirely.

5. Transference distortions between group members can be worked with as effectively, and perhaps even more effectively, than transference reactions to the therapist.
¹⁵

6. Attitudes toward the therapist are not all transference based: many are reality based, and others are irrational but flow from other sources of irrationality inherent in the dynamics of the group. (As Freud recognized, not all group phenomena can be explained on the basis of individual psychology.)
¹⁶

7. By maintaining flexibility, you may make good therapeutic use of these irrational attitudes toward you, without at the same time neglecting your many other functions in the group.

TRANSFERENCE IN THE THERAPY GROUP

Every client, to a greater or lesser degree, perceives the therapist incorrectly because of transference distortions, sometimes even before beginning therapy. One psychiatrist tells the story of going out to meet a new client in the waiting room and having the client dispute that the therapist was who he said he was because he was so physically different from the client’s imaginings of him.
¹⁷
Few clients are entirely conflict free in their attitudes toward such issues as parental authority, dependency, God, autonomy, and rebellion—all of which are often personified in the person of the therapist. These distortions are continually at play under the surface of the group discourse. Indeed, hardly a meeting passes without some clear token of the powerful feelings evoked by the therapist.

Witness the difference in the group when the therapist enters. Often the group may have been engaged in animated conversation only to lapse into heavy silence at the sight of the therapist. (Someone once said that the group therapy meeting officially begins when suddenly nothing happens!) The therapist’s arrival not only reminds the group of its task but also evokes early constellations of feelings in each member about the adult, the teacher, the evaluator. Without the therapist, the group feels free to frolic; the therapist’s presence is experienced as a stern reminder of the responsibilities of adulthood.

Seating patterns often reveal some of the complex and powerful feelings toward the leader. Frequently, the members attempt to sit as far away from you as possible. As members filter into the meeting they usually occupy distant seats, leaving the seats on either side of the therapist as the penalty for late arrivals; a paranoid client often takes the seat directly opposite you, perhaps in order to watch you more closely; a dependent client generally sits close to you, often on your right. If co-therapists sit close to each other with only one vacant chair between them, you can bet it will be the last chair occupied. One member, after months of group therapy, still described a feeling of great oppression when seated between the therapists.

Over several years, for research purposes, I asked group members to fill out a questionnaire after each meeting. One of their tasks was to rank-order every member for activity (according to the total number of words each spoke). There was excellent intermember reliability in their ratings of the other group members
but exceedingly poor reliability in their ratings of the group therapist
. In the same meetings some clients rated the therapist as the
most
active member, whereas others considered him the
least
active. The powerful and unrealistic feelings of the members toward the therapist prevented an accurate appraisal, even on this relatively objective dimension.

One client, when asked to discuss his feelings toward me, stated that he disliked me greatly because I was cold and aloof. He reacted immediately to his disclosure with intense discomfort. He imagined possible repercussions: I might be too upset by his attack to be of any more help to the group; I might retaliate by kicking him out of the group; I might humiliate him by mocking him for some of the lurid sexual fantasies he had shared with the group; or I might use my psychiatric wizardry to harm him in the future.

On another occasion many years ago, a group noted that I was wearing a copper bracelet. When they learned it was for tennis elbow, their reaction was extreme. They felt angry that I should be superstitious or ascribe to any quack cures. (They had berated me for months for being too scientific and not human enough!) Some suggested that if I would spend more time with my clients and less time on the tennis court, everyone would be better off. One woman, who idealized me, said that she had seen copper bracelets advertised in a local magazine, but guessed that mine was more special—perhaps something I had bought in Switzerland.

Some members characteristically address all their remarks to the therapist, or speak to other members only to glance furtively at the therapist at the end of their statement. It is as though they speak to others in an attempt to reach the therapist, seeking the stamp of approval for all their thoughts and actions. They forget, as it were, their reasons for being in therapy: they continuously seek to gain conspiratorial eye contact; to be the last to leave the session; to be, in a multitude of ways, the therapist’s favorite child.

One middle-aged woman dreamed that the group therapy room was transformed into my living room, which was bare and unfurnished. The other group members were not there; instead, the room was crowded with my family, which consisted of several sons. I introduced her to them, and she felt intense warmth and pleasure. Her association to the dream was that she was overjoyed at the thought that there was a place for her in my home. Not only could she furnish and decorate my house (she was a professional interior designer) but, since I had only sons (in her dream), there was room for a daughter.

Transference is so powerful and so ubiquitous that the dictum “the leader shall have no favorites” seems to be essential for the stability of every working group. Freud suggested that group cohesiveness, curiously, derives from the universal wish to be the favorite of the leader and the mutual identifications the group members make with the idealized leader.
¹⁸
Consider the prototypic human group: the sibling group. It is rife with intense rivalrous feelings: each child wishes to be the favorite and resents all rivals for their claims to parental love. The older child wishes to rob the younger of privileges or to eliminate the child altogether.
And yet each realizes that the rival children are equally loved by their parents
and that therefore one cannot destroy one’s siblings without incurring parental wrath and thus destroying oneself.

There is only possible solution:
equality
. If one cannot be the favorite, then
there must be no favorite at all.
Everyone is granted an equal investment in the leader, and out of this demand for equality is born what we have come to know as group spirit. Freud is careful to remind us that the demand for equality applies only to the other members. They do not wish to be equal to the leader. Quite the contrary: they have a thirst for obedience—a “lust for submission,” as Erich Fromm put it.
¹⁹
I shall return to this shortly. We have regrettably often witnessed the marriage of weak, devitalized, and demoralized followers to charismatic, often malignantly narcissistic group leaders.
²⁰

Freud was very sensitive to the powerful and irrational manner in which group members view their leader, and he systematically analyzed this phenomenon and applied it to psychotherapy.
²¹
Obviously, however, the psychology of member and leader has existed since the earliest human groupings, and Freud was not the first to note it.† To cite only one example, Tolstoy in the nineteenth century was keenly aware of the subtle intricacies of the member-leader relationship in the two most important groups of his day: the church and the military. His insight into the overvaluation of the leader gives
War and Peace
much of its pathos and richness. Consider Rostov’s regard for the Tsar:

He was entirely absorbed in the feeling of happiness at the Tsar’s being near. His nearness alone made up to him by itself, he felt, for the loss of the whole day. He was happy, as a lover is happy when the moment of the longed-for meeting has come. Not daring to look around from the front line, by an ecstatic instance without looking around, he felt his approach. And he felt it not only from the sound of the tramping hoofs of the approaching cavalcade, he felt it because as the Tsar came nearer everything grew brighter, more joyful and significant, and more festive. Nearer and nearer moved this sun, as he seemed to Rostov, shedding around him rays of mild and majestic light, and now he felt himself enfolded in that radiance, he heard his voice—that voice caressing, calm, majestic, and yet so simple. And Rostov got up and went out to wander about among the campfires, dreaming of what happiness it would be to die—not saving the Emperor’s life (of that he did not dare to dream), but simply to die before the Emperor’s eyes. He really was in love with the Tsar and the glory of the Russian arms and the hope of coming victory. And he was not the only man who felt thus in those memorable days that preceded the battle of Austerlitz: nine-tenths of the men in the Russian army were at that moment in love, though less ecstatically, with their Tsar and the glory of the Russian arms.
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