The Theory and Practice of Group Psychotherapy (63 page)

The therapists of the second group had forestalled an attack in a different fashion: they remained aloof, Olympian figures whose infrequent, ostensibly profound interventions were delivered in an authoritarian manner. At the end of each meeting, they summarized, often in unnecessarily complex language, the predominant themes and each member’s contributions. To attack these therapists would have been both impious and perilous.

Therapist countertransference in these two instances obstructed the group’s work. Placing one’s own emotional needs ahead of the group’s needs is a recipe for failure.
²³
Either of these two leadership styles tends to inhibit a group; suppression of important ambivalent feelings about the therapist results in a counterproductive taboo that opposes the desired norm of interpersonal honesty and emotional expression. Furthermore, an important model-setting opportunity is lost. The therapist who withstands an attack without being either destroyed or vindictive but instead responds by attempting to understand and work through the sources and effects of the attack demonstrates to the group that aggression need not be lethal and that it can be expressed and understood in the group.

One of the consequences of suppression of therapist-directed anger for the two groups in question, and for most groups, is the emergence of displaced, off-target aggression. For example, one group persisted for several weeks in attacking doctors. Previous unfortunate experiences with doctors, hospitals, and individual therapists were described in detail, often with considerable group consensus on the injustices and inhumanity of the medical profession. In one group, a member attacked the field of psychotherapy by bringing in a
Psychology Today
article that purported to prove that psychotherapy is ineffective. At other times, police, teachers, and other representatives of authority are awarded similar treatment.

Scapegoating of other members is another off-target manifestation. It is highly improbable for scapegoating to persist in a group in the absence of the therapist’s collusion. The leader who cannot be criticized openly generally is the source of scapegoating. Peer attack is a safer way of expressing aggression and rivalry or of elevating one’s status in the group. Added to this dynamic is the group members’ unconscious need to project unacceptable aspects of self onto a group member in an attempt to reduce the risk of personal rejection by the group. At its worst, this scapegoated member can be sacrificed by the group under the covert and misguided belief that if only it were not for this one member, the group would become a utopia.
²⁴

Yet another source of group conflict originates in the intrinsic process of change. Rigidly entrenched attitudes and behavioral patterns are challenged by other members, and each individual is faced with the discomfort of letting go of old patterns. A useful paradigm of change in group work consists of the sequence of unfreezing, change, and refreezing.
²⁵
The stage of “unfreezing” naturally entails a degree of challenge and conflict. Individuals adhere to their beliefs about relationships and cling to what is familiar to them. At first many clients lack the ability to examine themselves and to accept feedback. Gradually clients acquire the capacity to participate, feel emotion, and then reflect on that experience. Once that is possible, harmful, habitual patterns of behavior can be altered.
²⁶

The Third Stage: Development of Cohesiveness

A third commonly recognized formative phase of a group is the development of mature group cohesiveness. After the previous period of conflict, the group gradually develops into a cohesive unit. Many varied phrases with similar connotations have been used to describe this phase: in-group consciousness;
²⁷
common goal and group spirit;
²⁸
consensual group action, cooperation, and mutual support;
²⁹
group integration and mutuality;
³⁰
we-consciousness unity;
³¹
support and freedom of communication;
³²
and establishment of intimacy and trust between peers.

In this phase the interpersonal world of the group is one of balance, resonance, safety, increased morale, trust, and self-disclosure.
³³
Some members reveal the real reason they have come for treatment: sexual secrets and long-buried transgressions are shared. Postgroup coffee meetings may be arranged. Attendance improves, and clients evince considerable concern about missing members.

The chief concern of the group is with intimacy and closeness. If we characterize clients’ concerns in the first phase as “in or out” and the second as “top or bottom,” then we can think of the third phase as “near or far.” The members’ primary anxieties have to do with not being liked, not being close enough to others, or being too close to others.
³⁴

Although there may be greater freedom of self-disclosure in this phase, there may also be communicational restrictions of another sort: often the group suppresses all expression of negative affect in the service of cohesion. Compared with the previous stage of group conflict, all is sweetness and light, and the group basks in the glow of its newly discovered unity.
³⁵
Eventually, however, the glow will pale and the group embrace will seem ritualistic unless differentiation and conflict in the group are permitted to emerge. Only when all affects can be expressed and constructively worked through in a cohesive group does the group become a mature work group—a state lasting for the remainder of the group’s life, with periodic short-lived recrudescences of each of the earlier phases. Thus one may think of the stage of growing cohesiveness as consisting of two phases: an early stage of great mutual support (group against external world) and a more advanced stage of group work or true teamwork in which tension emerges not out of the struggle for dominance but out of each member’s struggle with his or her own resistances.

Overview

Now that I have outlined the early stages of group development, let me qualify my statements lest the novice take the proposed developmental sequence too literally. The developmental phases are in essence constructs—entities that exist for the group leaders’ semantic and conceptual convenience. Although the research shows persuasively, using different measures, client populations, and formal change theories, that group development occurs, the evidence is less clear on whether there is a precise, inviolate sequence of development. At times the development appears linear; at other times it is cyclical with a reiterative nature.
³⁶
It is also apparent that
the boundaries between phases are not clearly demarcated and that a group does not permanently graduate from one phase.

Another approach to group development research is to track the course of particular variables such as cohesion,
³⁷
emotionality,
³⁸
or intimacy
³⁹
through the course of the group. No linear course exists. In considering group development, think of replacing an automobile wheel: one tightens the bolts one after another just enough so that the wheel is in place; then the process is repeated, each bolt being tightened in turn, until the wheel is entirely secure. In the same way, phases of a group emerge, become dominant, and then recede, only to have the group return to the same issues with greater thoroughness later. Thus, it is more accurate to speak of developmental tasks rather than developmental phases or a predictable developmental sequence. We may, for example, see a sequence of high engagement and low conflict, followed by lower engagement and higher conflict, followed by a return to higher engagement.
⁴⁰
Hamburg suggests the term
cyclotherapy
to refer to this process of returning to the same issues but from a different perspective and each time in greater depth.
⁴¹
Often a therapy group will spend considerable time dealing with dominance, trust, intimacy, fears, the relationship between the co-therapists, and then, months later, return to the same topic from an entirely different perspective.

The group leader is well advised to consider not only the forces that promote the group’s development, but also those that have been identified as antigroup.
⁴²
These common forces encompass individual and societal resistance to joining—the fear of merging; the fear of loss of one’s sense of independence; the loss of one’s fantasy of specialness; the fear of seeking but being turned away.

THE IMPACT OF CLIENTS ON GROUP DEVELOPMENT

The developmental sequence I have described perhaps accurately portrays the unfolding of events in a theoretical, unpeopled therapy group and is much like the major theme of an ultramodern symphony that is unintelligible to the untrained ear. In the group, obfuscation derives from the richness and unpredictability of human interaction, which complicates the course of treatment and yet contributes to its excitement and challenge.

My experience is that the development of therapy groups is heavily and invariably influenced by chance—by the particular and unique composition of the group. Often the course of the group is set by a single member, generally the one with the loudest interpersonal pathology. By
loudest
I refer not to severity of pathology but to pathology that is most immediately manifest in the group. For example, in the first meeting of a group of incest victims, a member made a number of comments to the effect that she was disappointed that so many members were present whose healing was at such an earlier state than hers. Naturally, this evoked considerable anger from the others, who attacked her for her condescending remarks. Before long this group developed into the angriest, and least caring, group I’d ever encountered. We cannot claim that this one member put anger into the group. It would be more accurate to say that she acted as a lightning rod to release anger that was already present in each of the participants. But had she not been in the group, it is likely that the anger may have unfolded more slowly, perhaps in a context of more safety, trust, and cohesiveness. Groups that do not start well face a far more difficult challenge than ones that follow the kind of developmental sequence described in this chapter.

Many of the very individuals who seek group therapy struggle with relating and engaging. That is often why they seek therapy. Many say of themselves, “I am not a group person.”
⁴³
A group composed of several such individuals will doubtless struggle with the group tasks more than a group containing several members who have had constructive and effective experience with groups.
⁴⁴

Other individuals who may alter typical group developmental trends include those with monopolistic proclivities, exhibitionism, promiscuous self-disclosure, or an unbridled inclination to exert control. Not infrequently, such individuals receive covert encouragement from the therapist and other group members. Therapists value these clients because they provide a focus of irritation in the group, stimulate the expression of affect, and enhance the interest and excitement of a meeting. The other members often initially welcome the opportunity to hide behind the protagonist as they themselves hesitantly examine the terrain.

In a study of the dropouts of nine therapy groups, I found that in five of them, a client with a characteristic pattern of behavior fled the therapy group within the first dozen meetings.
⁴⁵
These clients (“early provocateurs”) differed from one another dynamically but assumed a similar role in the group: They stormed in, furiously activated the group, and then vanished. The therapists described their role in the group in such terms as “catalysts,” “targets,” “hostile interpreters,” or “the only honest one.” Some of these early provocateurs were active counterdependents and challenged the therapist early in the group. One, for example, challenged the leader in the third meeting in several ways: he suggested that the members hold longer meetings and regular leaderless meetings, and, only half jokingly, tried to launch an investigation into the leader’s personal problems. Other provocateurs prided themselves on their honesty and bluntness, mincing no words in giving the other members candid feedback. Still others, heavily conflicted in intimacy, both seeking it and fearing it, engaged in considerable self-disclosure and exhorted the group to reciprocate, often at a reckless pace. Although the early provocateurs usually claimed that they were impervious to the opinions and evaluations of others, in fact they cared very much and, in each instance, deeply regretted the nonviable role they had created for themselves in the group.
⁴⁶

Therapists must recognize this phenomenon early in the group and, through clarification and interpretation of their role, help prevent these individuals from committing social suicide. Perhaps even more important, therapists must recognize and discontinue their own covert encouragement of the early provocateur’s behavior. It is not uncommon for therapists to be stunned when the early provocateur drops out. They may so welcome the behavior of these clients that they fail to appreciate the client’s distress as well as their own dependence on these individuals for keeping the group energized.