The Theory and Practice of Group Psychotherapy (12 page)

Or, again, consider certain structural aspects of the group meeting: members have markedly different responses to sharing the group’s or the therapist’s attention, to disclosing themselves, to asking for help or helping others. Nowhere are such differences more apparent than in the transference—the members’ responses to the leader: the same therapist will be experienced by different members as warm, cold, rejecting, accepting, competent, or bumbling. This range of perspectives can be humbling and even overwhelming for therapists, particularly neophytes.

THE SOCIAL MICROCOSM—IS IT REAL?

I have often heard group members challenge the veracity of the social microcosm. Members may claim that their behavior in this particular group is atypical, not at all representative of their normal behavior. Or that this is a group of troubled individuals who have difficulty perceiving them accurately. Or even that group therapy is not real; it is an artificial, contrived experience that distorts rather than reflects one’s real behavior. To the neophyte therapist, these arguments may seem formidable, even persuasive, but they are in fact truth-distorting. In one sense, the group
is
artificial: members do not choose their friends from the group; they are not central to one another; they do not live, work, or eat together; although they relate in a personal manner, their entire relationship consists of meetings in a professional’s office once or twice a week; and the relationships are transient—the end of the relationship is built into the social contract at the very beginning.

When faced with these arguments, I often think of Earl and Marguerite, members in a group I led long ago. Earl had been in the group for four months when Marguerite was introduced. They both blushed to see the other, because, by chance, only a month earlier, they had gone on a Sierra Club camping trip together for a night and been “intimate.” Neither wanted to be in the group with the other. To Earl, Marguerite was a foolish, empty girl, “a mindless piece of ass,” as he was to put it later in the group. To Marguerite, Earl was a dull nonentity, whose penis she had made use of as a means of retaliation against her husband.

They worked together in the group once a week for about a year. During that time, they came to know each other intimately in a fuller sense of the word: they shared their deepest feelings; they weathered fierce, vicious battles; they helped each other through suicidal depressions; and, on more than one occasion, they wept for each other. Which was the real world and which the artificial?

One group member stated, “For the longest time I believed the group was a natural place for unnatural experiences. It was only later that I realized the opposite—it is an unnatural place for natural experiences.”
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One of the things that makes the therapy group real is that it eliminates social, sexual, and status games; members go through vital life experiences together, they shed reality-distorting facades and strive to be honest with one another. How many times have I heard a group member say, “This is the first time I have ever told this to anyone”? The group members are not strangers. Quite the contrary: they know one another deeply and fully. Yes, it is true that members spend only a small fraction of their lives together. But psychological reality is not equivalent to physical reality. Psychologically, group members spend infinitely more time together than the one or two meetings a week when they physically occupy the same office.

OVERVIEW

Let us now return to the primary task of this chapter: to define and describe the therapeutic factor of interpersonal learning. All the necessary premises have been posited and described in this discussion of:

1. The importance of interpersonal relationships

2. The corrective emotional experience

3. The group as a social microcosm

I have discussed these components separately. Now, if we recombine them into a logical sequence, the mechanism of interpersonal learning as a therapeutic factor becomes evident:

I. Psychological symptomatology emanates from disturbed interpersonal relationships. The task of psychotherapy is to help the client learn how to develop distortion-free, gratifying interpersonal relationships.

II. The psychotherapy group, provided its development is unhampered by severe structural restrictions, evolves into a social microcosm, a miniaturized representation of each member’s social universe.

III. The group members, through feedback from others, self-reflection, and self-observation, become aware of significant aspects of their interpersonal behavior: their strengths, their limitations, their interpersonal distortions, and the maladaptive behavior that elicits unwanted responses from other people. The client, who will often have had a series of disastrous relationships and subsequently suffered rejection, has failed to learn from these experiences because others, sensing the person’s general insecurity and abiding by the rules of etiquette governing normal social interaction, have not communicated the reasons for rejection. Therefore, and this is important, clients have never learned to discriminate between objectionable aspects of their behavior and a self-concept as a totally unacceptable person. The therapy group, with its encouragement of accurate feedback, makes such discrimination possible.

IV. In the therapy group, a regular interpersonal sequence occurs:

a. Pathology display: the member displays his or her behavior.

b. Through feedback and self-observation, clients

1. become better witnesses of their own behavior;

2. appreciate the impact of that behavior on

a. the feelings of others;

b. the opinions that others have of them;

c. the opinions they have of themselves.

V. The client who has become fully aware of this sequence also becomes aware of personal responsibility for it: each individual is the author of his or her own interpersonal world.

VI. Individuals who fully accept personal responsibility for the shaping of their interpersonal world may then begin to grapple with the corollary of this discovery: if they created their social-relational world, then they have the power to change it.

VII. The depth and meaningfulness of these understandings are directly proportional to the amount of affect associated with the sequence. The more real and the more emotional an experience, the more potent is its impact; the more distant and intellectualized the experience, the less effective is the learning.

VIII. As a result of this group therapy sequence, the client gradually changes by risking new ways of being with others. The likelihood that change will occur is a function of

a. The client’s motivation for change and the amount of personal discomfort and dissatisfaction with current modes of behavior;

b. The client’s involvement in the group—that is, how much the client allows the group to matter;

c. The rigidity of the client’s character structure and interpersonal style.

IX. Once change, even modest change, occurs, the client appreciates that some feared calamity, which had hitherto prevented such behavior, has been irrational and can be disconfirmed; the change in behavior has not resulted in such calamities as death, destruction, abandonment, derision, or engulfment.

X. The social microcosm concept is bidirectional: not only does outside behavior become manifest in the group, but behavior learned in the group is eventually carried over into the client’s social environment, and alterations appear in clients’ interpersonal behavior outside the group.

XI. Gradually an adaptive spiral is set in motion, at first inside and then outside the group. As a client’s interpersonal distortions diminish, his or her ability to form rewarding relationships is enhanced. Social anxiety decreases; self-esteem rises; the need for self-concealment diminishes. Behavior change is an essential component of effective group therapy, as even small changes elicit positive responses from others, who show more approval and acceptance of the client, which further increases self-esteem and encourages further change.
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Eventually the adaptive spiral achieves such autonomy and efficacy that professional therapy is no longer necessary.

Each of the steps of this sequence requires different and specific facilitation by the therapist. At various points, for example, the therapist must offer specific feedback, encourage self-observation, clarify the concept of responsibility, exhort the client into risk taking, disconfirm fantasized calamitous consequences, reinforce the transfer of learning, and so on. Each of these tasks and techniques will be fully discussed in chapters 5 and 6.

TRANSFERENCE AND INSIGHT

Before concluding the examination of interpersonal learning as a mediator of change, I wish to call attention to two concepts that deserve further discussion. Transference and insight play too central a role in most formulations of the therapeutic process to be passed over lightly. I rely heavily on both of these concepts in my therapeutic work and do not mean to slight them. What I have done in this chapter is to embed them both into the factor of interpersonal learning.

Transference
is a specific form of interpersonal perceptual distortion. In individual psychotherapy, the recognition and the working through of this distortion is of paramount importance. In group therapy, working through interpersonal distortions is, as we have seen, of no less importance; however, the range and variety of distortions are considerably greater. Working through the transference—that is, the distortion in the relationship to the therapist—now becomes only one of a series of distortions to be examined in the therapy process.

For many clients, perhaps for the majority, it is the most important relationship to work through, because the therapist is the personification of parental images, of teachers, of authority, of established tradition, of incorporated values. But most clients are also conflicted in other interpersonal domains: for example, power, assertiveness, anger, competitiveness with peers, intimacy, sexuality, generosity, greed, envy.

Considerable research emphasizes the importance many group members place on working through relationships with other members rather than with the leader.
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To take one example, a team of researchers asked members, in a twelve-month follow-up of a short-term crisis group, to indicate the source of the help each had received. Forty-two percent felt that the group members and not the therapist had been helpful, and 28 percent responded that both had been helpful. Only 5 percent said that the therapist alone was a major contributor to change.
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This body of research has important implications for the technique of the group therapist: rather than focusing exclusively on the client-therapist relationship, therapists must facilitate the development and working-through of interactions among members. I will have much more to say about these issues in chapters 6 and 7.

Insight
defies precise description; it is not a unitary concept. I prefer to employ it in the general sense of “sighting inward”—a process encompassing clarification, explanation, and derepression. Insight occurs when one discovers something important about oneself—about one’s behavior, one’s motivational system, or one’s unconscious.

In the group therapy process, clients may obtain insight on at least four different levels:

1. Clients may gain a more objective perspective on their interpersonal presentation. They may for the first time learn how they are seen by other people: as tense, warm, aloof, seductive, bitter, arrogant, pompous, obsequious, and so on.

2. Clients may gain some understanding into their more complex interactional patterns of behavior. Any of a vast number of patterns may become clear to them: for example, that they exploit others, court constant admiration, seduce and then reject or withdraw, compete relentlessly, plead for love, or relate only to the therapist or either the male or female members.

3. The third level may be termed motivational insight. Clients may learn why they do what they do to and with other people. A common form this type of insight assumes is learning that one behaves in certain ways because of the belief that different behavior would bring about some catastrophe: one might be humiliated, scorned, destroyed, or abandoned. Aloof, detached clients, for example, may understand that they shun closeness because of fears of being engulfed and losing themselves; competitive, vindictive, controlling clients may understand that they are frightened of their deep, insatiable cravings for nurturance; timid, obsequious individuals may dread the eruption of their repressed, destructive rage.

4. A fourth level of insight, genetic insight, attempts to help clients understand how they got to be the way they are. Through an exploration of the impact of early family and environmental experiences, the client understands the genesis of current patterns of behavior. The theoretical framework and the language in which the genetic explanation is couched are, of course, largely dependent on the therapist’s school of conviction.