The Theory and Practice of Group Psychotherapy (67 page)

In groups for women with metastatic breast cancer,
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the members were very clear about the timing of new members joining. If the group was dealing with a very ill, dying, or recently deceased member, the members preferred not to have new additions because they needed all of their energy and time to address their loss and grief.

Response of the Group.
A cartoon cited by a British group therapist portrays a harassed woman and her child trying to push their way into a crowded train compartment. The child looks up at his mother and says, “Don’t worry, Mother, at the next stop it will be our turn to hate!”
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The parallel to new members entering the group is trenchant. Hostility to the newcomer is evident even in the group that has beseeched the therapist to add new members, and it may reach potent levels. The extent of the antipathy has even been labeled “infanticide.”
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I have observed many times that when new members are slated to enter a meeting, the old members arrive late and may even remain for a few minutes talking together animatedly in the waiting room while the therapists and the new clients wait in the therapy room. A content analysis of the session in which a new member or members are introduced reveals several themes that are hardly consonant with benevolent hospitality. The group suddenly spends far more time than in previous meetings discussing the good old days. Long-departed group members and events of bygone meetings are avidly recalled, as new members are guilelessly reminded, lest they have forgotten, of their novitiate status. Old battles are reengaged to make the group as unpalatable as possible.

Similarly, members may remark on resemblances they perceive between the new member and some past member. The newcomer may get grilled. In a meeting I once observed in which two members were introduced, the group noted a similarity between one of them and a past member who (the newcomer shortly learned) had committed suicide a year before; the other client was compared to someone who had dropped out, discouraged and unimproved, after three months of therapy. These members, unaware of the invidiousness of their greetings, consciously felt that they were extending a welcome, whereas in fact they projected much unpleasant emotion onto the newcomers.

A group may also express its ambivalence by discussing, in a newcomer’s first meeting, threatening and confidence-shaking issues. For example, in its seventeenth session, in which two new members entered, one group discussed for the first time the therapists’ competence. The members noted that the therapists were listed in the hospital catalogue as resident-students and that they might be leading their first group. This issue—an important one that should be discussed—was nonetheless highly threatening to new members. It is of interest that this information was already known to several group members but had never until that meeting been broached in the group.

There can, of course, be strong feelings of welcome and support if the group has been searching for new members. The members may exercise great gentleness and patience in dealing with new members’ initial fear or defensiveness. The group, in fact, may collude in many ways to increase its attractiveness to the newcomer. Often members gratuitously offer testimonials and describe the various ways in which they have improved. In one such group, a newcomer asked a disgruntled, resistive woman member about her progress, and before she could reply, two other members, sensing that she would devalue the group, interrupted and described their own progress. Although groups may unconsciously wish to discourage newcomers, members are generally not willing to do so by devaluing their own group.

There are several reasons for a group’s ambivalent response to new members. Some members who highly prize the solidarity and cohesiveness of the group may be threatened by any proposed change to the status quo. Will the new members undermine the group? Powerful sibling rivalry issues may be evoked at the entrance of a new drain on the group’s supplies: members may envision newcomers as potential rivals for the therapist’s and the group’s attention and perceive their own fantasized role as favored child to be in jeopardy.
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Still other members, particularly those conflicted in the area of control and dominance, may regard the new member as a threat to their position in the hierarchy of power. In one group where a new attractive female client was being introduced, the two incumbent female members, desperately protecting their stake, employed many prestige-enhancing devices, including the recitation of poetry. When John Donne is quoted in a therapy group as part of the incoming ritual, it is hardly for an aesthetic end.

A common concern of a group is that, even though new members are needed, they will nonetheless slow the group down. The group fears that familiar material will have to be repeated for the newcomers and that the group must recycle and relive the tedious stages of gradual social introduction and ritualistic etiquette. This expectation fortunately proves to be unfounded: new clients introduced into an ongoing group generally move quickly into the prevailing level of group communication and bypass the early testing phases characteristic of members in a newly formed group. Another, less frequent, source of ambivalence issues from the threat posed to group members who have improved and who fear seeing themselves in the newcomer, as they were at the beginning of their own therapy. In order to avoid reexposure to painful past periods of life, they will frequently shun new clients who appear as reincarnations of their earlier selves.

Commonly, the new members of the group have a unique and constructive perspective on the group members. They see the older members as they are currently, reinforcing the reality of the changes achieved, often admiring the veteran members’ perceptiveness, social comfort, and interpersonal skills. This form of feedback can serve as a powerful reminder of the value of the therapeutic work done to date. The morale of both the new and the old members can be enhanced simultaneously.

Therapeutic Guidelines.
Clients entering an ongoing group require not only the standard preparation to group therapy I discussed in chapter 10 but also preparation to help them deal with the unique stresses accompanying entry into an established group. Entry into any established culture—a new living situation, job, school, hospital, and so on—produces anxiety and, as extensive research indicates, demands orientation and support.†
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A review of the new member’s prior experiences of joining can be instructive and identify potential challenges that may emerge.

I tell clients that they can expect feelings of exclusion and bewilderment on entering an unusual culture, and I reassure them that they will be allowed to enter and participate at their own rate. New clients entering established groups may be daunted by the sophistication, openness, interpersonal facility, and daring of more experienced members; they may also be frightened or fear contagion, since they are immediately confronted with members revealing more of their pathology than is revealed in the first meetings of a new group. These contingencies should be discussed with the client. It is generally helpful to describe to the incoming participant the major events of the past few meetings. If the group has been going through some particularly intense, tumultuous events, it is wise to provide an even more thorough briefing. If the group is being videotaped or the therapist uses a written summary technique (see chapter 14), then the new member, with the group’s permission, may be asked to view the tapes or read the summaries of the past few meetings.

I make an effort to engage the new client in the first meeting or two. Often it is sufficient merely to inquire about his or her experience of the meeting—something to the effect of: “Sara, this has been your first session. What has the meeting felt like for you? Does it seem like it will be difficult to get into the group? What concerns about your participation are you aware of so far?” It’s often useful to help new clients assume some control over their participation. For example, the therapist might say, “I note that several questions were asked of you earlier. How did that feel? Too much pressure? Or did you welcome them?” Or, “Sara, I’m aware that you were silent today. The group was deeply engaged in business left over from meetings when you were not present. How did that make you feel? Relieved? Or would you have welcomed questions directed at you?” Note that all of these questions are here-and-now centered.

Many therapists prefer to introduce two new members at a time, a practice that may have advantages for both the group and the new members. Occasionally, if one client is integrated into the group much more easily than the other, it may backfire and create even greater discomfort for a newcomer, who may feel that he is already lagging behind his cohort. Nevertheless, introduction in pairs has much to recommend it: the group conserves energy and time by assimilating two members at once; the new members may ally with each other and thereby feel less alien.

The number of new members introduced into the group distinctly influences the pace of absorption. A group of six or seven can generally absorb a new member with scarcely a ripple; the group continues work with only the briefest of pauses and rapidly pulls the new member along. On the other hand, a group of four confronted with three new members often comes to a screeching halt as all ongoing work ceases and the group devotes all its energy to the task of incorporating the new members. The old members will wonder how much they can trust the new ones. Dare they continue with the same degree of self-disclosure and risk taking? To what extent will their familiar, comfortable group be changed forever? The new members will be searching for guidelines to behavior. What is acceptable in this group? What is forbidden? If their reception by the established members is not gracious, they may seek the comfort inherent in an alliance of newcomers. The therapist who notes frequent use of “we” and “they,” or “old members” and “new members,” should heed these signs of schism. Until incorporation is complete, little further therapeutic work can be done.

A similar situation often arises when the therapist attempts to amalgamate two groups that have been reduced in number. This procedure is not easy. A clash of cultures and cliques formed along the lines of the previous groups can persist for a remarkably long time, and the therapist must actively prepare clients for the merger. It is best in this situation to end both groups and then resume as a totally new entity.

The introduction of new members may, if properly considered, enhance the therapeutic process of the old members, who may respond to a newcomer in highly idiosyncratic styles. An important principle of group therapy, which I have discussed, is that every major stimulus presented to the group elicits a variety of responses by the group members. The investigation of the reasons behind these different responses is generally rewarding and clarifies aspects of character structure. For members to observe others respond to a situation in ways remarkably different from the way they do is an arresting experience that can provide them with considerable insight into their behavior. Such an opportunity is unavailable in individual therapy but constitutes one of the chief strengths of the group therapeutic format. An illustrative clinical example may clarify this point.

• A new member, Alice—forty years old, attractive, divorced—was introduced at a group’s eighteenth meeting. The three men in the group greeted her in strikingly different fashions.

Peter arrived fifteen minutes late and missed the introduction. For the next hour, he was active in the group, discussing issues left over from the previous meeting as well as events occurring in his life during the past week. He totally ignored Alice, avoiding even glancing at her—a formidable feat in a group of six people in close physical proximity. Later in the meeting, as others attempted to help Alice participate, Peter, still without introducing himself, fired questions at her like a harsh prosecuting attorney. A twenty-eight-year-old devout Catholic father of four, Peter had sought therapy because he “loved women too much,” as he phrased it, and had had a series of extramarital affairs. In subsequent meetings, the group used the events of Alice’s first meeting to help Peter investigate the nature of his “love” for women. Gradually, he came to recognize how he used women, including his wife, as sex objects, valuing them for their genitals only and remaining insensitive to their feelings and experiential world.

The two other men in the group, Arthur and Brian, on the other hand, were preoccupied with Alice during her first meeting. Arthur, a twenty-four-year-old who sought therapy because of his massive sexual inhibition, reacted strongly to Alice and found that he could not look at her without experiencing an acute sense of embarrassment. His discomfort and blushing were apparent to the other members, who helped him explore far more deeply than he had previously his relationship with the women in the group. Arthur had desexualized the other two women in the group by establishing in his fantasy a brother-sister relationship with them. Alice, who was attractive and available and at the same time old enough to evoke in him affect-laden feelings about his mother, presented a special problem for Arthur, who had previously been settling into too comfortable a niche in the group.

Brian, on the other hand, transfixed Alice with his gaze and delivered an unwavering broad smile to her throughout the meeting. An extraordinarily dependent twenty-three-year-old, Brian had sought therapy for depression after the breakup of a love affair. Having lost his mother in infancy, he had been raised by a succession of nannies and had had only occasional contact with an aloof, powerful father of whom he was terrified. His romantic affairs, always with considerably older women, had invariably collapsed because of the insatiable demands he made on the relationship. The other women in the group in the past few meetings had similarly withdrawn from him and, with progressive candor, had confronted him with, as they termed it, his puppy-dog presentation of himself. Brian thus welcomed Alice, hoping to find in her a new source of succor. In subsequent meetings, Alice proved helpful to Brian as she revealed her feeling, during her first meeting, of extreme discomfort at his beseeching smile and her persistent sense that he was asking for something important from her. She said that although she was unsure of what he wanted, she knew it was more than she had to give.