The Theory and Practice of Group Psychotherapy (71 page)

Gradually, Jan and Bill’s relationship began to sour. She had always maintained that all she wanted from him was his sheer physical presence. One night every two weeks with him was what she required. Now she was forced to realize that she wanted much more. She felt pressured in life: she had lost her job and was beset by financial concerns; she had given up her promiscuity but felt sexual pressures and now began to say to herself, “Where is Bill when I really need him?” She grew depressed, but rather than work on the depression in the group, she minimized it. Once again, secondary considerations were given priority over primary, therapeutic ones, for she was reluctant to give Gina and the other members the satisfaction of seeing her depressed: They had warned her months ago that a relationship with Bill would ultimately be self-destructive.

And where, indeed, was Bill? That question plunged us into the core issue of Bill’s therapy: responsibility. As Jan grew more deeply depressed (a depression punctuated by accident proneness, including a car crash and a painful burn from a kitchen mishap), the group confronted Bill with the question:
Had he known in advance the outcome of the adventure, would he have done anything different?

Bill said, “No! I would have done nothing different! If I don’t look after my own pleasure, who will?” The other members of the group and now Jan, too, attacked him for his self-indulgence and his lack of responsibility to others. Bill pondered over this confrontation, only to advance a series of rationalizations at the subsequent meeting.

“Irresponsible? No, I am not irresponsible! I am high-spirited, impish, like Peer Gynt. Life contains little enough pleasure,” he said. “Why am I not entitled to take what I can? Who sets those rules?” He insisted that the group members and the therapist, guilefully dressed in the robes of responsibility, were, in fact, trying to rob him of his life force and freedom.

For many sessions, the group plunged into the issues of love, freedom, and responsibility. Jan, with increasing directness, confronted Bill. She jolted him by asking exactly how much he cared for her. He squirmed and alluded both to his love for her and to his unwillingness to establish an enduring relationship with any woman. In fact, he found himself “turned off” by any woman who wanted a long-term relationship.

I was reminded of a comparable attitude toward love in the novel
The Fall
, where Camus expresses Bill’s paradox with shattering clarity:

It is not true, after all, that I never loved. I conceived at least one great love in my life, of which I was always the object . . . sensuality alone dominated my love life.... In any case, my sensuality (to limit myself to it) was so real that even for a ten-minute adventure I’d have disowned father and mother, even were I to regret it bitterly. Indeed—especially for a ten-minute adventure and even more so if I were sure it was to have no sequel.
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The group therapist, if he were to help Bill, had to make certain that there was to be a sequel.

Bill did not want to be burdened with Jan’s depression. There were women all around the country who loved him (and whose love made him feel alive), yet for him these women did not have an independent existence. He preferred to think that his women came to life only when he appeared to them. Once again, Camus spoke for him:

I could live happily only on condition that all the individuals on earth, or the greatest possible number, were turned toward me, eternally in suspense, devoid of independent life and ready to answer my call at any moment, doomed in short to sterility until the day I should deign to favor them. In short, for me to live happily it was essential for the creatures I chose not to live at all. They must receive their life, sporadically, only at my bidding.
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Jan pressed Bill relentlessly. She told him that there was another man who was seriously interested in her, and she pleaded with Bill to level with her, to be honest about his feelings to her, to set her free. By now Bill was quite certain that he no longer desired Jan. (In fact, as we were to learn later, he had been gradually increasing his commitment to the woman with whom he lived.) Yet he could not allow the words to pass his lips—a strange type of freedom, then, as Bill himself gradually grew to understand: the freedom to take but not to relinquish. (Camus, again: “Believe me, for certain men at least, not taking what one doesn’t desire is the hardest thing in the world!”)
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He insisted that he be granted the freedom to choose his pleasures, yet, as he came to see, he did not have the freedom to choose for himself. His choice almost invariably resulted in his thinking less well of himself. And the greater his self-hatred, the more compulsive, the less free, was his mindless pursuit of sexual conquests that afforded him only an evanescent balm.

Jan’s pathology was equally patent. She ceded her freedom to Bill (a logical paradox); only he had the power to set her free. I confronted her with her pervasive refusal to accept her freedom: Why couldn’t she say no to a man? How could men use her sexually unless she allowed it? It was evident, too, that she punished Bill in an inefficient, self-destructive manner: she attempted to induce guilt through accidents, depression, and lamentations that she had trusted a man who had betrayed her and that now she would be ruined for life.

Bill and Jan circled these issues for months. From time to time they would reenter their old relationship but always with slightly more sobriety and slightly less self-deception. During a period of nonwork, I sensed that the timing was right and confronted them in a forcible manner. Jan arrived late at the meeting complaining about the disarray of her financial affairs. She and Bill giggled as he commented that her irresponsibility about money made her all the more adorable. I stunned the group by observing that Jan and Bill were doing so little therapeutic work that I wondered whether it made sense for them to continue in the group.

Jan and Bill accused me of hypermoralism. Jan said that for weeks she came to the group only to see Bill and to talk to him after the group; if he left, she did not think she would continue. I reminded her that the group was not a dating bureau: surely there were far more important tasks for her to pursue. Bill, I continued, would play no role in the long scheme of her life and would shortly fade from her memory. Bill had no commitment to her, and if he were at all honest he would tell her so. Jan rejoined that Bill was the only one in the group who truly cared for her. I disagreed and said that Bill’s caring for her was clearly not in her best interests.

Bill left the meeting furious at me (especially at my comment that he would soon fade from Jan’s mind). For a day, he fantasized marrying her to prove me wrong, but he returned to the group to plunge into serious work. As his honesty with himself deepened, as he faced a core feeling of emptiness that a woman’s love had always temporarily filled, he worked his way through painful feelings of depression that his acting out had kept at bay. Jan was deeply despondent for two days after the meeting, and then suddenly made far-reaching decisions about her work, money, men, and therapy.

The group then entered a phase of productive work, which was further deepened when I introduced a much older woman into the group who brought with her many neglected themes in the group: aging, death, physical deterioration. Jan and Bill fell out of love. They began to examine their relationships with others in the group, including the therapists. Bill stopped lying, first to Jan, then to Gina, then to the other members, and finally to himself. Jan continued in the group for six more months, and Bill for another year.

The outcome for both Jan and Bill was—judged by any outcome criteria—stunning. In interviews nine months after their termination, both showed impressive changes. Jan was no longer depressed, self-destructive, or promiscuous. She was involved in the most stable and satisfying relationship with a man she had ever had, and she had gone into a different and more rewarding career. Bill, once he understood that he had made his relationship with his girlfriend tenuous to allow him to seek what he really didn’t want, allowed himself to feel more deeply and married shortly before leaving the group. His anxious depressions, his tortured self-consciousness, his pervasive sense of emptiness had all been replaced by their respective, vital counterparts.

I am not able in these few pages to sum up all that was important in the therapy of Jan and Bill. There was much more to it, including many important interactions with other members and with me.
The development and working through of their extragroup relationship was, I believe, not a complication but an indispensable part of their therapy.
It is unlikely that Jan would have had the motivation to remain in therapy had Bill not been present in the group. It is unlikely that without Jan’s presence, Bill’s central problems would have surfaced clearly and become accessible for therapy.

The price paid by the group, however, was enormous. Vast amounts of group time and energy were consumed by Jan and Bill. Other members were neglected, and many important issues went untouched. Most often, such extragroup subgrouping would create a destructive therapy impasse. † It is most unlikely that a new group, or a group that met less frequently than twice a week, could have afforded the price. It is also unlikely that Jan and Bill would have been willing to persevere in their therapeutic work and to remain in the group had they not already been committed to the group before their love affair began.

CONFLICT IN THE THERAPY GROUP

Conflict cannot be eliminated from human groups, whether dyads, small groups, macrogroups, or such megagroups as nations and blocs of nations. If overt conflict is denied or suppressed, invariably it will manifest itself in oblique, corrosive, and often ugly ways. Although our immediate association with conflict is negative—destruction, bitterness, war, violence—a moment of reflection brings to mind positive associations: drama, excitement, change, and development. Therapy groups are no exception. Some groups become “too nice” and diligently avoid conflict and confrontation, often mirroring the therapist’s avoidance of aggression. Yet conflict is so inevitable in the course of a group’s development that its absence suggests some impairment of the developmental sequence. Furthermore, conflict can be exceeding valuable to the course of therapy, provided that its intensity does not exceed the members’ tolerance and that proper group norms have been established. Learning how to deal effectively with conflict is an important therapeutic step that contributes to individual maturation and emotional resilience.
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In this section, I consider conflict in the therapy group—its sources, its meaning, and its contribution to therapy.

Sources of Hostility

There are many sources of hostility in the therapy group and an equal number of relevant explanatory models and perspectives, ranging from ego psychology to object relations to self psychology.
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The group leader’s capacity to identify the individual, interpersonal, and group dynamic contributions to the hostility in the group is essential.
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Some antagonisms are projections of the client’s self-contempt. Indeed, often many sessions pass before some individuals really begin to hear and respect the opinions of other members. They have so little self-regard that it is at first inconceivable that others similar to themselves have something valuable to offer. Devaluation begets devaluation, and a destructive interpersonal loop can be readily launched.

Transference or parataxic distortions often generate hostility in the therapy group. One may respond to others not on the basis of reality but on the basis of an image of the other distorted by one’s own past relationships and current interpersonal needs and fears. Should the distortion be negatively charged, then a mutual antagonism may be easily initiated. The group may function as a “hall of mirrors,”†
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which may aggravate hostile and rejecting feelings and behaviors. Individuals may have long suppressed some traits or desires of which they are much ashamed; when they encounter another person who embodies these very traits, they generally shun the other or experience a strong but inexplicable antagonism toward the person. The process may be close to consciousness and recognized easily with guidance by others, or it may be deeply buried and understood only after many months of investigation.

• One patient, Vincent, a second-generation Italian-American who had grown up in the Boston slums and obtained a good education with great difficulty, had long since dissociated himself from his roots. Having invested his intellect with considerable pride, he spoke with great care in order to avoid betraying any nuance of his accent or background. In fact, he abhorred the thought of his lowly past and feared that he would be found out, that others would see through his front to his core, which he regarded as ugly, dirty, and repugnant. In the group, Vincent experienced extreme antagonism for another member, also of Italian descent, who had, in his values and in his facial and hand gestures, retained his identification with his ethnic group. Through his investigation of his antagonism toward this man, Vincent arrived at many important insights about himself.

• In a group of psychiatric residents, Pat agonized over whether to transfer to a more academically oriented residency. The group, with one member, Clem, as spokesman, resented the group time Pat took for this problem, rebuking him for his weakness and indecisiveness and insisting that he “crap or get off the pot.” When the therapist guided the group members into an exploration of the sources of their anger toward Pat, many dynamics became evident (several of which I will discuss in chapter 17). One of the strongest sources was uncovered by Clem, who discussed his own paralyzing indecisiveness. He had, a year earlier, faced the same decision as Pat and, unable to act decisively, had resolved the dilemma passively by suppressing it. Pat’s behavior reawakened that painful scenario for Clem, who resented the other man not only for disturbing his uneasy slumber but also for struggling with the issue more honestly and more courageously than he had.