The Theory and Practice of Group Psychotherapy (37 page)

4.
Here is how your behavior influences your opinion of yourself.
Building on the information gathered in the first three steps, clients formulate self-evaluations; they make judgments about their self-worth and their lovability. (Recall Sullivan’s aphorism that the self-concept is largely constructed from reflected self-appraisals.)

Once this sequence has been developed and is fully understood by the individual, once clients have a deep understanding that their behavior is not in their own best interests, that the texture of relationships to others and to themselves is
fashioned by their own actions
, then they have come to a crucial point in therapy: they have entered the antechamber of change.

The therapist is now in a position to pose a question that initiates the real crunch of therapy. The question, presented in a number of ways by the therapist but rarely in direct form, is:
Are you satisfied with the world you have created?
This is what you do to others, to others’ opinion of you, and to your opinion of yourself—are you satisfied with your actions?
^n
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When the inevitable negative answer arrives (“No I am not satisfied with my actions”) the therapist embarks on a many-layered effort to transform a sense of personal dissatisfaction into a decision to change and then into the act of change. In one way or another, the therapist’s interpretive remarks are designed to encourage the act of change. Only a few psychotherapy theoreticians (for example, Otto Rank, Rollo May, Silvano Arieti, Leslie Farber, Allen Wheelis, and Irvin Yalom
²⁴
) include the concept of will in their formulations, yet it is, I believe, implicit in most interpretive systems. I offer a detailed discussion of the role of will in psychotherapy in my text
Existential Psychotherapy
.
²⁵
For now, broad brush strokes are sufficient.

The intrapsychic agency that initiates an act, that transforms intention and decision into action, is will. Will is the primary responsible mover within the individual. Although analytic metapsychology has chosen to emphasize the irresponsible movers of our behavior (that is, unconscious motivations and drives), it is difficult to do without the idea of will in our understanding of change.
²⁶
We cannot bypass it under the assumption that it is too nebulous and too elusive and, consequently, consign it to the black box of the mental apparatus, to which the therapist has no access.

Knowingly or unknowingly, every therapist assumes that each client possesses the capacity to change through willful choice. Using a variety of strategies and tactics, the therapist attempts to escort the client to a crossroads where he or she can choose, willfully, in the best interests of his or her own integrity. The therapist’s task is not to create will or to infuse it into the client. That, of course, you cannot do.
What you can do is to help remove encumbrances from the bound or stifled will of the client.
²⁷

The concept of will provides a useful construct for understanding the procedure of process illumination. The interpretive remarks of the therapist can all be viewed in terms of how they bear on the client’s will. The most common and simplistic therapeutic approach is
exhortative
: “Your behavior is, as you yourself now know, counter to your best interests. You are not satisfied. This is not what you want for yourself. Damn it, change!”

The expectation that the client will change is simply an extension of the moral philosophical belief that if one knows the good (that is, what is, in the deepest sense, in one’s best interest), one will act accordingly. In the words of St. Thomas Aquinas: “Man, insofar as he acts willfully, acts according to some imagined good.”
²⁸
And, indeed, for some individuals this knowledge and this exhortation are sufficient to produce therapeutic change.

However, clients with significant and well-entrenched psychopathology will need much more than sheer exhortation. The therapist, through interpretative comments, then proceeds to exercise one of several other options that help clients disencumber their will. The therapist’s goal is to guide clients to a point where they accept one, several, or all of the following basic premises:

1. Only I can change the world I have created for myself.

2. There is no danger in change.

3. To attain what I really want, I must change.

4. I can change; I am potent.

Each of these premises, if fully accepted by a client, can be a powerful stimulant to willful action. Each exerts its influence in a different way. Though I will discuss each in turn, I do not wish to imply a sequential pattern. Each, depending on the need of the client and the style of the therapist, may be effective independently of the others.

“Only I can change the world I have created for myself.”

Behind the simple group therapy sequence I have described (seeing one’s own behavior and appreciating its impact on others and on oneself), there is a mighty overarching concept, one whose shadow touches every part of the therapeutic process. That concept is
responsibility.
Although it is rarely discussed explicitly, it is woven into the fabric of most psychotherapeutic systems. Responsibility has many meanings—legal, religious, ethical. I use it in the sense that a person is “responsible for” by being the “basis of,” the “cause of,” the “author of” something.

One of the most fascinating aspects of group therapy is that
everyone is born again, born together in the group
. In other words, each member starts off on an equal footing. In the view of the others (and, if the therapist does a good job, in the view of oneself), each gradually scoops out and shapes a life space in the group. Each member, in the deepest sense of the concept, is
responsible for this space and for the sequence of events that will occur to him or her in the group
.

The client, having truly come to appreciate this responsibility, must then accept, too, that there is no hope for change
unless he or she changes
. Others cannot bring change, nor can change bring itself. One is responsible for one’s past and present life in the group (as well as in the outside world) and totally responsible for one’s future.

Thus, the therapist helps the client understand that the interpersonal world is arranged in a generally predictable and orderly fashion, that it is not that the client
cannot
change but that he or she
will not
change, that the client bears the responsibility for the creation of his or her world and therefore the responsibility for its transmutation. The client must regain or develop anew a sense of his or her own interpersonal agency in the world.

“There is no danger in change.”

These well-intentioned efforts may not be enough. The therapist may tug and tug at the therapeutic cord and learn that individuals, even after being thus enlightened, still make no significant therapeutic movement. In this case, therapists apply additional therapeutic leverage by helping clients face the paradox of continuing to act contrary to their basic interests. In a number of ways therapists must pose the question, “How come? Why do you continue to defeat yourself?”

A common method of explaining “How come?” is to assume that there are formidable obstacles to the client’s exercising willful choice, obstacles that prevent clients from seriously considering altering their behavior. The presence of the obstacle is generally inferred; the therapist makes an “as if” assumption: “You behave
as if
you feel some considerable danger would befall you if you were to change. You fear to act otherwise for fear that some calamity will befall you.” The therapist helps the client clarify the nature of the imagined danger and then proceeds, in several ways, to detoxify, to disconfirm the reality of this danger.

The client’s reason may be enlisted as an ally. The process of identifying and naming the fantasized danger may, in itself, enable one to understand how far removed one’s fears are from reality. Another approach is to encourage the client, in carefully calibrated doses,
to commit the dreaded act in the group
. The fantasized calamity does not, of course, ensue, and the dread is gradually extinguished. This is often the pivotal piece of effective therapy. Change is probably not possible, let alone enduring, without the client’s having a lived experience of direct disconfirmation of pathogenic beliefs. Insight alone is unlikely to be effective. This principle cuts powerfully across different schools of therapy.†

For example, suppose a client avoids any aggressive behavior because at a deep level he fears that he has a dammed-up reservoir of homicidal fury and must be constantly vigilant lest he unleash it and eventually face retribution from others. An appropriate therapeutic strategy is to help the client express aggression in
small doses
in the group: pique at being interrupted, irritation at members who are habitually late, anger at the therapist for charging him money, and so on. Gradually, the client is helped to relate openly to the other members and to demythologize himself as a homicidal being. Although the language and the view of human nature are different, this is precisely the same approach to change used in systematic desensitization—a major technique of behavior therapy.

“To attain what I really want, I must change.”

Another explanatory approach used by many therapists to deal with a client who persists in behaving counter to his or her best interests is to consider the
payoffs
of that individual’s behavior. Although the person’s behavior sabotages many of his or her mature needs and goals, at the same time
it satisfies another set of needs and goals
. In other words, the client has conflicting motivations that cannot be simultaneously satisfied. For example, a male client may wish to establish mature heterosexual relationships; but at another, often unconscious, level, he may wish to be nurtured, to be cradled endlessly, to avoid the abandonment that he anticipates as the punishment for his adult strivings or, to use an existential vocabulary, to be sheltered from the terrifying freedom of adulthood. Obviously, the client cannot satisfy both sets of wishes: he cannot establish an adult heterosexual relationship with a woman if he also says (and much more loudly), “Take care of me, protect me, nurse me, let me be a part of you.”

It is important to clarify this paradox for the client. We might, for example, point out: “Your behavior makes sense if we assume that you wish to satisfy the deeper, earlier, more primitive need.” We try to help the client understand the nature of his conflicting desires, to choose between them, to relinquish those that cannot be fulfilled except at enormous cost to his integrity and autonomy. Once the client realizes what he really wants (as an adult) and that his behavior is designed to fulfill opposing growth-retarding needs, he gradually concludes:
To attain what I really want, I must change.

“I can change; I am potent.”

Perhaps the major therapeutic approach to the question “How come you act in ways counter to your best interests?” is to offer
explanation
. The therapist says, in effect, “You behave in certain fashions
because . . . ,
” and the “because” clause generally involves motivational factors outside the client’s awareness. It is true that the previous two options I have discussed also proffer explanation but—and I will clarify this shortly—the purpose of the explanation (the nature of the leverage exerted on will) is quite different in the two approaches.

What
type
of explanation does the therapist offer the client? And which explanations are correct, and which incorrect? Which “deep”? Which “superficial”? It is at this juncture that the great metapsychological controversies of the field arise, since the nature of therapists’ explanations are a function of the ideological school to which they belong.

I think we can sidestep the ideological struggle by keeping a fixed gaze on the
function
of the interpretation, on the relationship between explanation and the final product: change. After all, our goal is change. Self-knowledge, derepression, analysis of transference, and self-actualization—all are worthwhile, enlightened pursuits, all are related to change, preludes to change, cousins and companions to change; and yet they are not synonymous with change.

Explanation provides a system by which we can order the events in our lives into some coherent and predictable pattern. To name something and to place it into a causal sequence is to experience it as being under our control. No longer is our behavior or our internal experience frightening, inchoate, out of control; instead, we behave (or have a particular inner experience)
because . . . .
The “because” offers us mastery (or a sense of mastery that, phenomenologically, is tantamount to mastery). It offers us freedom and self-efficacy.† As we move from a position of being motivated by unknown forces to a position of identifying and controlling those forces, we move from a passive, reactive posture to an active, acting, changing posture.

If we accept this basic premise—that a major function of explanation in psychotherapy is to provide the client with a sense of personal mastery—it follows that the value of an explanation should be measured by this criterion. To the extent that it offers a sense of potency, a causal explanation is valid, correct, or “true.” Such a definition of truth is completely relativistic and pragmatic. It argues that no explanatory system has hegemony or exclusive rights, that no system is the correct, fundamental one or the “deeper” (and therefore better) one.