The Theory and Practice of Group Psychotherapy (72 page)

J. Frank described a reverberating double-mirror reaction:

• In one group, a prolonged feud developed between two Jews, one of whom flaunted his Jewishness while the other tried to conceal it. Each finally realized that he was combating in the other an attitude he repressed in himself. The militant Jew finally understood that he was disturbed by the many disadvantages of being Jewish, and the man who hid his background confessed that he secretly nurtured a certain pride in it.
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Another source of conflict in groups arises from
projective identification
, an unconscious process which consists of projecting some of one’s own (but disavowed) internal attributes into another, toward whom one subsequently feels an uncanny attraction-repulsion. A stark literary example of projective identification occurs in Dostoevsky’s nightmarish tale “The Double,” in which the protagonist encounters a man who is his physical double and yet a personification of all the dimly perceived, hated aspects of himself.
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The tale depicts with astonishing vividness both the powerful attraction and the horror and hatred that develop between the protagonist and his double.

Projective identification has intrapsychic and interpersonal components.
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It is both a defense (primitive in nature because it polarizes, distorts, and fragments reality), and a form of interpersonal relationship.†
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Elements of one’s disowned self are put not only
onto
another and shunned, as in simple projection, but
into
another. The behavior of the other actually changes within the ongoing relationship because the overt and covert communication of the projector influences the recipient’s psychological experience and behavior. Projective identification resembles two distorting mirrors facing each other producing increasing distortions as the reflected images bounce back and forth.
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There are many other sources of anger in group therapy. Individuals with a fragile sense of self can respond with rage to experiences of shame, dismissal, empathic failure, or rejection and seek to bolster their personal stature by retaliation or interpersonal coercion. At times anger can be a desperate reaction to one’s sense of fragmentation in the face of interpersonal rejection and may represent the client’s best effort at avoiding total emotional collapse.
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Rivalry and envy may also fuel conflict. Group members may compete with one another in the group for the largest share of the therapist’s attention or for some particular role: for example, the most powerful, respected, sensitive, disturbed, or needy person in the group. Members (fueled perhaps by unconscious remnants of sibling rivalry) search for signs that the therapist may favor one or another of the members. In one group, for example, one member asked the therapist where he was going on vacation and he answered with uncharacteristic candor. This elicited a bitter response from another member, who recalled how her sister had always received things from her parents that she had been denied.†
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The addition of new members often ignites rivalrous feelings:

• In the fiftieth meeting of one group, a new member, Ginny,
^ac
was added. In many aspects she was similar to Douglas, one of the original members: they were both artists, mystical in their approach to life, often steeped in fantasy, and all too familiar with their unconscious. It
was not affinity, however, but antagonism that soon developed between the two. Ginny immediately established her characteristic role by behaving in a spiritlike, irrational, and disorganized fashion in the group. Douglas, who saw his role as the sickest and most disorganized member being usurped, reacted to her with intolerance and irritation. Only after active interpretation of the role conflict and Douglas’s assumption of a new role (“most improved member”) was an entente between the two members achieved.

As the group progresses, the members may grow increasingly impatient and angry with those who have not adopted the group’s norms of behavior. If someone, for example, continues to hide behind a facade, the group may coax her and attempt to persuade her to participate. After some time patience gives out and the members may angrily demand that she be more honest with herself and the others.

Certain members, because of their character structure, will invariably be involved in conflict and will engender conflict in any group. Consider a man with a paranoid personality disorder whose assumptive world is that there is danger in the environment. He is eternally suspicious and vigilant. He examines all experience with an extraordinary bias as he searches for clues and signs of danger. He is tight, ready for an emergency. He is never playful and looks suspiciously upon such behavior in others, anticipating their efforts to exploit him. Obviously, these traits will not endear that individual to the other group members. Sooner or later, anger will erupt all around him; and the more severe and rigid his character structure, the more extreme will be the conflict. Eventually, if therapy is to succeed, the client must access and explore the feelings of vulnerability that reside beneath the hostile mistrust.

In chapter 11, I discussed yet another source of hostility in the group: members become disenchanted and disappointed with the therapist for frustrating their (unrealistic) expectations.† If the group is unable to confront the therapist directly, it may create a scapegoat—a highly unsatisfactory solution for both victim and group. In fact, scapegoating is a method by which the group can discharge anger arising from threats to the group’s integrity and function, and it is a common phenomenon in any therapy group. The choice of a scapegoat generally is not arbitrary. Some people repeatedly find themselves in a scapegoat role, in a variety of social situations. It is useful for therapists to view scapegoating as created jointly by the group members and the scapegoat.
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Hostility in the group can also be understood from the perspective of stages of group development. In the early phase, the group fosters regression and the emergence of irrational, uncivilized parts of individuals. The young group is also beset with anxiety (from fear of exposure, shame, stranger anxiety, powerlessness) that may be expressed as hostility. Prejudice (which is a way of reducing anxiety through a false belief that one knows the other) may make an early appearance in the group and, of course, elicits reciprocal anger from others. Throughout the course of the group, narcissistic injury (wounds to self-esteem from feedback or being overlooked, unappreciated, excluded, or misunderstood) is often suffered and is often expressed by angry retaliation. Still later in the course of the group, anger may stem from other sources: projective tendencies, sibling rivalry, transference, or the premature termination of some members.†

Management of Hostility

Regardless of its source, the discord, once begun, follows a predictable sequence. The antagonists develop the belief that they are right and the others are wrong, that they are good and the others bad. Moreover, although it is not recognized at the time, these beliefs are characteristically held with equal conviction and certitude by each of the two opposing parties. Where such a situation of opposing beliefs exists, we have all the ingredients for a deep and continuing tension, even to the point of impasse.

Generally, a breakdown in communication ensues. The two parties cease to listen to each other with any understanding. If they were in a social situation, the two opponents would most likely completely rupture their relationship at this point and never be able to correct their misunderstandings.

Not only do the opponents stop listening, but they may also unwittingly distort their perceptions of one another. Perceptions are filtered through a screen of stereotype. The opponent’s words and behavior are distorted to fit a preconceived view. Contrary evidence is ignored; conciliatory gestures may be perceived as deceitful tricks. (The analogy to international relations is all too obvious.) In short, there is a greater investment in verification of one’s beliefs than in understanding the other.
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Distrust is the basis for this sequence. Opponents view their own actions as honorable and reasonable, and the behavior of others as scheming and evil. If this sequence, so common in human events, were permitted to unfold in therapy groups, the group members would have little opportunity for change or learning. A group climate and group norms that preclude such a sequence must be established early in the life of the group.

Cohesiveness is the primary prerequisite for the successful management of conflict. Members must develop a feeling of mutual trust and respect and come to value the group as an important means of meeting their personal needs. They must understand the importance of maintaining communication if the group is to survive; all parties must continue to deal directly with one another, no matter how angry they become. Furthermore, everyone is to be taken seriously. When a group treats one member as a “mascot,” someone whose opinions and anger are lightly regarded, the hope of effective treatment for that individual has all but officially been abandoned. Covert exchanges between members, sometimes bordering on the “rolling of one’s eyes” in reaction to the mascotted member’s participation is an ominous sign. Mascotting jeopardizes group cohesiveness: no one is safe, particularly the next most peripheral member, who will have reason to fear similar treatment.

The cohesive group in which everyone is taken seriously soon elaborates norms that obligate members to go beyond name calling. Members must pursue and explore derogatory labels and be willing to search more deeply within themselves to understand their antagonism and to make explicit those aspects of others that anger them. Norms must be established that make it clear that group members are there to understand themselves, not to defeat or ridicule others. It is particularly useful if members try to reach within themselves to identify similar trends and impulses. Terence (a second-century B.C. Roman dramatist) gave us a valuable perspective when he said, “I am human and nothing human is alien to me.”
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A member who realizes that others accept and are trying to understand finds it less necessary to hold rigidly to beliefs and may be more willing to explore previously denied aspects of self. Gradually, such members may recognize that not all of their motives are as they have proclaimed, and that some of their attitudes and behavior are not so fully justified as they have been proclaiming. When this breakthrough step has been achieved, individuals reappraise the situation and realize that the problem can be viewed in more than one way.

Empathy
is an important element in conflict resolution and facilitates humanization of the struggle. Often, understanding the past plays an important role in the development of empathy: Once an individual appreciates how aspects of an opponent’s earlier life have contributed to the current stance, then the opponent’s position not only makes sense but may even appear right.
Tout comprendre, c’est tout pardonner.

Conflict resolution is often impossible in the presence of off-target or oblique hostility:

• Maria began a group session by requesting and obtaining the therapist’s permission to read a letter she was writing in conjunction with a court hearing on her impending divorce, which involved complex issues of property settlement and child custody. The letter reading consumed considerable time and was often interrupted by the other members, who disputed the contents of the letter. The sniping by the group and defensive counterattacks by the protagonist continued until the group atmosphere crackled with irritability. The group made no constructive headway until the therapist explored with the members the process of the meeting. The therapist was annoyed with himself for having permitted the letter to be read and with Maria for having put him in that position. The group members were angry at the therapist for having given permission and at Maria both for consuming so much time and for relating to them in the frustrating, impersonal manner of letter reading. Once the anger had been directed away from the oblique target of the letter’s contents onto the appropriate targets—the therapist and Maria—steps toward conflict resolution could begin.

Permanent conflict abolition, let me note, is
not
the final goal of the therapy group. Conflict will continually recur in the group despite successful resolution of past conflicts and despite the presence of considerable mutual respect and warmth. However, unrestrained expression of rage is not a goal of the therapy group either.

Although some people relish conflict, the vast majority of group members (and therapists) are highly uncomfortable when expressing or receiving anger. The therapist’s task is to harness conflict and use it in the service of growth. One important principle is to find the right level: too much or too little conflict is counterproductive. The leader is always finetuning the dial of conflict. When there is persistent conflict, when the group cannot agree on anything, the leader searches for resolution and wonders why the group denies any commonality; on the other hand, when the group consistently agrees on everything, the leader searches for diversity and differentiation. Thus, you need to titrate conflict carefully. Generally, it is unnecessary to evoke conflict deliberately; if the group members are interacting with one another openly and honestly, conflict will emerge. More often, the therapist must intervene to keep conflict within constructive bounds.†

Keep in mind that the therapeutic use of conflict, like all other behavior in the here-and-now, is a two-step process: experience (affect expression) and reflection upon that experience. You may control conflict by switching the group from the first to the second stage. Often a simple, direct appeal is effective: for example, “We’ve been expressing some intense negative feelings here today as well as last week. To protect us from overload, it might be valuable to stop what we’re doing and try together to understand what’s been happening and where all these powerful feelings come from.” Group members will have different capacities to tolerate conflict. One client responded to the therapist’s “freezing the frame” (shifting the group to a reflective position) by criticizing the therapist for cooling things off just when things were getting interesting. A comember immediately commented that she could barely tolerate more tension and was grateful for a chance to regroup. It may be useful to think of the shift to process as creating a space for reflection—a space in which members may explore their
mutual
contributions to the conflict. The creation of this space for thoughtful reflection may be of great import—indeed, it may make the difference between therapeutic impasse and therapeutic growth.
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