The Theory and Practice of Group Psychotherapy (10 page)

Intelligent and highly articulate, Ron immediately assumed a position of great influence in the group. He offered a continuous stream of useful and thoughtful observations to the other members, yet kept his own pain and his own needs well concealed. He requested nothing and accepted nothing from me or my co-therapist. In fact, each time I set out to interact with Ron, I felt myself bracing for battle. His antagonistic resistance was so great that for months my major interaction with him consisted of repeatedly requesting him to examine his reluctance to experience me as someone who could offer help.

“Ron,” I suggested, giving it my best shot, “let’s understand what’s happening. You have many areas of unhappiness in your life. I’m an experienced therapist, and you come to me for help. You come regularly, you never miss a meeting, you pay me for my services, yet you systematically prevent me from helping you. Either you so hide your pain that I find little to offer you, or when I do extend some help, you reject it in one fashion or another. Reason dictates that we should be allies. Shouldn’t we be working together to help you? Tell me, how does it come about that we are adversaries?”

But even that failed to alter our relationship. Ron seemed bemused and skillfully and convincingly speculated that I might be identifying one of my problems rather than his. His relationship with the other group members was characterized by his insistence on seeing them outside the group. He systematically arranged for some extragroup activity with each of the members. He was a pilot and took some members flying, others sailing, others to lavish dinners; he gave legal advice to some and became romantically involved with one of the female members; and (the final straw) he invited my co-therapist, a female psychiatric resident, for a skiing weekend.

Furthermore, he refused to examine his behavior or to discuss these extragroup meetings in the group, even though the pregroup preparation (see chapter 12) had emphasized to all the members that such unexamined, undiscussed extragroup meetings generally sabotage therapy.

After one meeting when we pressured him unbearably to examine the meaning of the extragroup invitations, especially the skiing invitation to my co-therapist, he left the session confused and shaken. On his way home, Ron unaccountably began to think of Robin Hood, his favorite childhood story but something he had not thought about for decades.

Following an impulse, he went directly to the children’s section of the nearest public library to sit in a small child’s chair and read the story one more time. In a flash, the meaning of his behavior was illuminated! Why had the Robin Hood legend always fascinated and delighted him? Because Robin Hood rescued people, especially women, from tyrants!

That motif had played a powerful role in his interior life, beginning with the Oedipal struggles in his own family. Later, in early adulthood, he built up a successful law firm by first assisting in a partnership and then enticing his boss’s employees to work for him. He had often been most attracted to women who were attached to some powerful man. Even his motives for marrying were blurred: he could not distinguish between love for his wife and desire to rescue her from a tyrannical father.

The first stage of interpersonal learning is pathology display. Ron’s characteristic modes of relating to both men and women unfolded vividly in the microcosm of the group. His major interpersonal motif was to struggle with and to vanquish other men. He competed openly and, because of his intelligence and his great verbal skills, soon procured the dominant role in the group. He then began to mobilize the other members in the final conspiracy: the unseating of the therapist. He formed close alliances through extragroup meetings and by placing other members in his debt by offering favors. Next he endeavored to capture “my women”—first the most attractive female member and then my co-therapist.

Not only was Ron’s interpersonal pathology displayed in the group, but so were its adverse, self-defeating consequences. His struggles with men resulted in the undermining of the very reason he had come to therapy: to obtain help. In fact, the competitive struggle was so powerful that any help I extended him was experienced not as help but as defeat, a sign of weakness.

Furthermore, the microcosm of the group revealed the consequences of his actions on the texture of his relationships with his peers. In time the other members became aware that Ron did not really relate to them. He only appeared to relate but, in actuality, was using them as a way of relating to me, the powerful and feared male in the group. The others soon felt used, felt the absence of a genuine desire in Ron to know them, and gradually began to distance themselves from him. Only after Ron was able to understand and to alter his intense and distorted ways of relating to me was he able to turn to and relate in good faith to the other members of the group.

“Those Damn Men”

Linda, forty-six years old and thrice divorced, entered the group because of anxiety and severe functional gastrointestinal distress. Her major interpersonal issue was her tormented, self-destructive relationship with her current boyfriend. In fact, throughout her life she had encountered a long series of men (father, brothers, bosses, lovers, and husbands) who had abused her both physically and psychologically. Her account of the abuse that she had suffered, and suffered still, at the hands of men was harrowing.

The group could do little to help her, aside from applying balm to her wounds and listening empathically to her accounts of continuing mistreatment by her current boss and boyfriend. Then one day an unusual incident occurred that graphically illuminated her dynamics. She called me one morning in great distress. She had had an extremely unsettling altercation with her boyfriend and felt panicky and suicidal. She felt she could not possibly wait for the next group meeting, still four days off, and pleaded for an immediate individual session. Although it was greatly inconvenient, I rearranged my appointments that afternoon and scheduled time to meet her. Approximately thirty minutes before our meeting, she called and left word with my secretary that she would not be coming in after all.

In the next group meeting, when I inquired what had happened, Linda said that she had decided to cancel the emergency session because she was feeling slightly better by the afternoon, and that she knew I had a rule that I would see a client only one time in an emergency during the whole course of group therapy. She therefore thought it might be best to save that option for a time when she might be even more in crisis.

I found her response bewildering. I had never made such a rule; I never refuse to see someone in real crisis. Nor did any of the other members of the group recall my having issued such a dictum. But Linda stuck to her guns: she insisted that she had heard me say it, and she was dissuaded neither by my denial nor by the unanimous consensus of the other group members. Nor did she seem concerned in any way about the inconvenience she had caused me. In the group discussion she grew defensive and acrimonious.

This incident, unfolding in the social microcosm of the group, was highly informative and allowed us to obtain an important perspective on Linda’s responsibility for some of her problematic relationships with men. Up until that point, the group had to rely entirely on her portrayal of these relationships. Linda’s accounts were convincing, and the group had come to accept her vision of herself as victim of “all those damn men out there.” An examination of the here-and-now incident indicated that Linda had distorted her perceptions of at least one important man in her life: her therapist. Moreover—and this is extremely important—she had distorted the incident in a highly predictable fashion: she experienced me as far more uncaring, insensitive, and authoritarian than I really was.

This was new data, and it was convincing data—and it was displayed before the eyes of all the members. For the first time, the group began to wonder about the accuracy of Linda’s accounts of her relationships with men. Undoubtedly, she faithfully portrayed her feelings, but it became apparent that there were perceptual distortions at work: because of her expectations of men and her highly conflicted relationships with them, she misperceived their actions toward her.

But there was more yet to be learned from the social microcosm. An important piece of data was the tone of the discussion: the defensiveness, the irritation, the anger. In time I, too, became irritated by the thankless inconvenience I had suffered by changing my schedule to meet with Linda. I was further irritated by her insistence that I had proclaimed a certain insensitive rule when I (and the rest of the group) knew I had not. I fell into a reverie in which I asked myself, “What would it be like to live with Linda all the time instead of an hour and a half a week?” If there were many such incidents, I could imagine myself often becoming angry, exasperated, and uncaring toward her. This is a particularly clear example of the concept of the self-fulfilling prophecy described on page 22. Linda predicted that men would behave toward her in a certain way and then, unconsciously, operated so as to bring this prediction to pass.

Men Who Could Not Feel

Allen, a thirty-year-old unmarried scientist, sought therapy for a single, sharply delineated problem: he wanted to be able to feel sexually stimulated by a woman. Intrigued by this conundrum, the group searched for an answer. They investigated his early life, sexual habits, and fantasies. Finally, baffled, they turned to other issues in the group. As the sessions continued, Allen seemed impassive and insensitive to his own and others’ pain. On one occasion, for example, an unmarried member in great distress announced in sobs that she was pregnant and was planning to have an abortion. During her account she also mentioned that she had had a bad PCP trip. Allen, seemingly unmoved by her tears, persisted in posing intellectual questions about the effects of “angel dust” and was puzzled when the group commented on his insensitivity.

So many similar incidents occurred that the group came to expect no emotion from him. When directly queried about his feelings, he responded as if he had been addressed in Sanskrit or Aramaic. After some months the group formulated an answer to his oft-repeated question, “Why can’t I have sexual feelings toward a woman?” They asked him to consider instead why he couldn’t have any feelings toward anybody.

Changes in his behavior occurred very gradually. He learned to spot and identify feelings by pursuing telltale autonomic signs: facial flushing, gastric tightness, sweating palms. On one occasion a volatile woman in the group threatened to leave the group because she was exasperated trying to relate to “a psychologically deaf and dumb goddamned robot.” Allen again remained impassive, responding only, “I’m not going to get down to your level.”

However, the next week when he was asked about the feelings he had taken home from the group, he said that after the meeting he had gone home and cried like a baby. (When he left the group a year later and looked back at the course of his therapy, he identified this incident as a critical turning point.) Over the ensuing months he was more able to feel and to express his feelings to the other members. His role within the group changed from that of tolerated mascot to that of accepted compeer, and his self-esteem rose in accordance with his awareness of the members’ increased respect for him.

In another group Ed, a forty-seven-year-old engineer, sought therapy because of loneliness and his inability to find a suitable mate. Ed’s pattern of social relationships was barren: he had never had close male friends and had only sexualized, unsatisfying, short-lived relationships with women who ultimately and invariably rejected him. His good social skills and lively sense of humor resulted in his being highly valued by other members in the early stages of the group.

As time went on and members deepened their relationships with one another, however, Ed was left behind: soon his experience in the group resembled closely his social life outside the group. The most obvious aspect of his behavior was his limited and offensive approach to women. His gaze was directed primarily toward their breasts or crotch; his attention was voyeuristically directed toward their sexual lives; his comments to them were typically simplistic and sexual in nature. Ed considered the men in the group unwelcome competitors; for months he did not initiate a single transaction with a man.

With so little appreciation for attachments, he, for the most part, considered people interchangeable. For example, when a member described her obsessive fantasy that her boyfriend, who was often late, would be killed in an automobile accident, Ed’s response was to assure her that she was young, charming, and attractive and would have little trouble finding another man of at least equal quality. To take another example, Ed was always puzzled when other members appeared troubled by the temporary absence of one of the co-therapists or, later, by the impending permanent departure of a therapist. Doubtless, he suggested, there was, even among the students, a therapist of equal competence. (In fact, he had seen in the hall a bosomy psychologist whom he would particularly welcome as therapist.)

He put it most succinctly when he described his MDR (minimum daily requirement) for affection; in time it became clear to the group that the identity of the MDR supplier was incidental to Ed—far less relevant than its dependability.

Thus evolved the first phase of the group therapy process: the display of interpersonal pathology. Ed did not relate to others so much as he used them as equipment, as objects to supply his life needs. It was not long before he had re-created in the group his habitual—and desolate—interpersonal universe: he was cut off from everyone. Men reciprocated his total indifference; women, in general, were disinclined to service his MDR, and those women he especially craved were repulsed by his narrowly sexualized attentions. The subsequent course of Ed’s group therapy was greatly informed by his displaying his interpersonal pathology inside the group, and his therapy profited enormously from focusing exhaustively on his relationships with the other group members.