The Theory and Practice of Group Psychotherapy (73 page)

Receiving negative feedback is painful and yet, if accurate and sensitively delivered, helpful. The therapist can render it more palatable by making the benefits of feedback clear to the recipient and enlisting that client as an ally in the process. Often you can facilitate that sequence by remembering the original presenting interpersonal problems that brought the individual to therapy or by obtaining verbal contracts from group members early in therapy, which you can refer back to when the member obtains feedback.

For example, if at the onset of therapy a client comments that her fiancé accuses her of trying to tear him down, and that she wishes to work on that problem in the group, you may nail down a contract by a statement such as: “Carolyn, it sounds as though it would be helpful to you if we could identify similar trends in your relationships to others in the group. How would you feel if, from now on, we point this out to you as soon as we see it happen?” Once this contract has been agreed upon, store it in your mind and, when the occasion arises (for example when the client receives relevant similar feedback from men in the group), remind the client that, despite the discomfort, this precise feedback may be exceptionally useful in understanding her relationship with her fiancé.

Almost invariably, two group members who feel considerable mutual antagonism have the potential to be of great value to each other (see my novel
The Schopenhauer Cure
for a dramatic example of this phenomenon). † Each obviously cares about how he is viewed by the other. Generally, there is much envy or much mutual projection, which offers the opportunity to uncover hidden parts of themselves. In their anger, each will point out to the other important (though unpalatable) truths. The self-esteem of the antagonists may be increased by the conflict. When people become angry at one another, this in itself may be taken as an indication that they are important to one another and take one another seriously. Some have aptly referred to such angry relationships as “tough love” (a term originating in the Synanon groups for addicts). Individuals who truly care nothing for each other ignore each other. Individuals may learn another important lesson: that others may respond negatively to some trait, mannerism, or attitude but still value them.

For clients who have been unable to express anger, the group may serve as a testing ground for taking risks and learning that such behavior is neither dangerous nor necessarily destructive. In chapter 2, I described incidents cited by group members as turning points in their therapy. A majority of these critical incidents involved the expression, for the first time, of strong negative affect. It is also important for clients to learn that they can withstand attacks and pressure from others. Emotional resilience and healthy insulation can be products of work involving conflict.†

Overly aggressive individuals may learn some of the interpersonal consequences of blind outspokenness. Through feedback, they come to appreciate the impact they have on others and gradually come to terms with the self-defeating pattern of their behavior. For many, angry confrontations may provide valuable learning opportunities, since group members learn to remain in mutually useful contact despite their anger.

Clients may be helped to express anger more directly and more fairly. Even in all-out conflict, there are tacit rules of war, which, if violated, make satisfactory resolution all but impossible. For example, in therapy groups combatants will occasionally take information disclosed by the other in a previous spirit of trust and use it to scorn or humiliate that person. Or they may refuse to examine the conflict because they claim to have so little regard for the other that they do not wish to waste any further time. These postures require vigorous intervention by the therapist. When therapists belatedly realize that an earlier or different intervention would have been helpful, they should acknowledge that—as Winnicott once said—the difference between good parents and bad parents was not the number of mistakes made but what they did with them.
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Sometimes in unusually sustained and destructive situations the leader must forcefully assume control and set limits. The leader cannot leave such situations to the group alone if doing so gives license to an individual’s destructive behavior. Consider this description of limit-setting by Ormont:
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Gabriel crackled with ill will toward everybody. He would not let anyone talk without shouting them down. When the members demanded I get rid of him, I cut in on him sharply: “Look, Gabriel, I understand how you feel. I might say the same things, but with a lighter touch. The difference is that you’re out of control. You have a fertile imagination. But you’re not moving things along in the group—you’re simply finding fault and hurting feelings.

He seemed to be listening, so I ventured an interpretation. “You’re telling us Miriam is no good. I get the impression you’re saying you are no good—a no-good guy. Either you’re going to cooperate or you’re going to get out!” His reaction astonished us. Without saying a word to me he turned to Miriam and apologized to her. Later he told us how he felt my ability to set limits reassured him. Somebody was in control.

One of the most common indirect and self-defeating modes of fighting is the one used by Jan in the clinical illustration of subgrouping I described earlier in this chapter. This strategy calls for the client, in one form or another, to injure himself or herself in the hope of inducing guilt in the other—the “see what you’ve done to me” strategy. Usually, much therapeutic work is required to change this pattern. It is generally deeply ingrained, with roots stretching back to earliest childhood (as in the common childhood fantasy of watching at your own funeral as parents and other grief-stricken tormentors pound their breasts in guilt).

Group leaders must endeavor to turn the process of disagreeing into something positive—a learning situation that encourages members to evaluate the sources of their position and to relinquish those that are irrationally based. Clients must also be helped to understand that regardless of the source of their anger, their method of expressing it may be self-defeating. Feedback is instrumental in this process. For example, members may learn that, unbeknownst to themselves, they characteristically display scorn, irritation, or disapproval. Human sensitivity to facial gestures and nuances of expression far exceeds proprioceptive sensitivity.
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Only through feedback do we learn that we communicate something that is not intended or, for that matter, even consciously experienced. Focusing attention on the divergence between a client’s intent and actual impact can significantly enhance self-awareness.†
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The therapist should also attempt to help the conflicting members learn more about their opponent’s position. Therapists who feel comfortable using structured exercises may find that role-switching may be a useful intervention. Members are asked to take the part of their opponent for a few minutes in order to apprehend the other’s reasons and feelings. Focused anger-management groups have been applied effectively in a range of settings and clinical populations, stretching from burdened caregivers of family members with dementia to war veterans suffering posttraumatic stress disorder. These groups usually combine psychoeducation (focusing on the connections between thoughts, emotions, and behavior) and skill building.†

Many group members have the opposite problem of suppressing and avoiding angry feelings. In groups they learn that others in their situation would feel angry; they learn to read their own body language (“My fists are clenched so I must be angry”); they learn to magnify rather than suppress the first flickerings of anger; they learn that it is safe, permissible, and in their best interests to be direct and to feel and express anger. Most important, their fear of such behavior is extinguished: their fantasized catastrophe does not occur, their comments do not result in destruction, guilt, rejection, or escalation of anger.

Strong shared affect may enhance the importance of the relationship. In chapter 3, I described how group cohesiveness is increased when members of a group go through intense emotional experiences together, regardless of the nature of the emotion. In this manner, members of a successful therapy group are like members of a closely knit family, who may battle each other yet derive much support from their family allegiance. A dyadic relationship, too, that has weathered much stress is likely to be especially rewarding. A situation in which two individuals in group therapy experience an intense mutual hatred and then, through some of the mechanisms I have described, resolve the hatred and arrive at mutual understanding and respect is always of great therapeutic value.

SELF-DISCLOSURE

Self-disclosure, both feared and valued by participants, plays an integral part in all group therapies. Without exception, group therapists agree that it is important for clients to reveal personal material in the group—material that the client would rarely disclose to others. The self-disclosure may involve past or current events in one’s life, fantasy or dream material, hopes or aspirations, and current feelings toward other individuals. In group therapy, feelings toward other members often assume such major importance that the therapist must devote energy and time to creating the preconditions for disclosure: trust and cohesiveness.†

Risk

Every self-disclosure involves some risk on the part of the discloser—how much risk depends in part on the nature of what is disclosed. Disclosing material that has previously been kept secret or that is highly personal and emotionally charged obviously carries greater risk. First-time disclosure, that is, the first time one has shared certain information with anyone else, is felt to be particularly risky.

The amount of risk also depends on the audience. Disclosing members, wishing to avoid shame, humiliation, and rejection, feel safer if they know that the audience is sensitive and has also previously disclosed highly personal material.†
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Sequence of Self-Disclosure

Self-disclosure has a predictable sequence. If the receiver of the disclosure is involved in a meaningful relationship with the discloser (and not merely a casual acquaintance at a cocktail party) the receiver is likely to feel obligated to reciprocate with some personal disclosure. Now the receiver as well as the original discloser is vulnerable, and the relationship usually deepens, with the participants continuing to make slightly more open and intimate disclosures in turn until some optimal level of intimacy is reached
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Thus, in the cohesive group self-disclosure draws more disclosure, ultimately generating a constructive loop of trust, self-disclosure, feedback, and interpersonal learning.
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Here is an illustrative example:

• Halfway through a thirty-session course of group therapy, Cam, a thirty-year-old avoidant, socially isolated, engineer, opened a session by announcing that he wanted to share a secret with the group: for the past several years, he had frequented strip clubs, befriending the strippers. He had a fantasy that he would rescue a stripper, who would then, in gratitude, fall in love with him. Cam went on to describe how he had spent thousands of dollars on his “rescue missions.” The group members welcomed his disclosure, especially since it was the first substantially personal disclosure he had made in the group. Cam responded that time was running out and he wanted to relate to the others in a real way before the group ended. This encouraged Marie, a recovering alcoholic, to reciprocate with a major disclosure: many years ago she had worked as an exotic dancer and prostitute, and she assured Cam that he could expect nothing but disappointment and exploitation in that environment. She had never disclosed her past for fear of the group’s judgment, but felt compelled to respond to Cam: She hated to see such a decent man engaging in self-destructive relationships. The mutual disclosure, support, and caring accelerated the work in the subsequent meeting for all the members.

Adaptive Functions of Self-Disclosure

As disclosures proceed in a group, the entire membership gradually increases its involvement and responsibility to one another. If the timing is right, nothing will commit an individual to a group more than receiving or revealing some intimate secret material. There is nothing more exhilarating than for a member to disclose for the first time material that has been burdensome for years and to be genuinely understood and fully accepted. † Interpersonalists such as Sullivan and Rogers maintained that self-acceptance must be preceded by acceptance by others; in other words, to accept oneself, one must gradually permit others to know one as one really is.

Research evidence validates the importance of self-disclosure in group therapy.
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In chapter 3, I described the relationship between self-disclosure and popularity in the group. Popularity (as determined from sociometrics) correlates with therapy outcome.
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Group members who disclose extensively in the early meetings are often very popular in their groups.
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People reveal more to individuals they like; conversely, those who reveal themselves are more likely to be liked by others.
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Several research inquiries have demonstrated that high disclosure (either naturally occurring or experimentally induced) increases group cohesiveness.
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But the relationship between liking and self-disclosure is not linear. One who discloses too much arouses anxiety in others rather than affection.
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In other words, both the content and process of self-disclosure need to be considered. Self-disclosure should be viewed as a means and not an end in itself.
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