The Theory and Practice of Group Psychotherapy (74 page)

Much research supports the crucial role of self-disclosure in successful therapy outcome.
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Successfully treated participants in group therapy made almost twice as many self-disclosing personal statements during the course of therapy as did unsuccessfully treated clients.
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Lieberman, Yalom, and Miles found that in encounter groups, individuals who had negative outcomes revealed less of themselves than did the other participants.
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The concept of transfer of learning is vital here:
not only are clients rewarded by the other group members for self-disclosure, but the behavior, thus reinforced, is integrated into their relationships outside the group, where it is similarly rewarded.
Often the first step toward revealing something to a spouse or a potential close friend is the first-time disclosure in the therapy group.

Hence, to a significant degree, the impact of self-disclosure is shaped by the relationship context in which the disclosure occurs. What is truly validating to the client is to reveal oneself and
then
to be accepted and supported. Once that happens, the client experiences a genuine sense of connection and of understanding.
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Keep in mind also that here-and-now disclosure in particular has a far greater effect on cohesion than then-and-there disclosure.
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Often clients manifest great resistance to self-disclosure. Frequently a client’s dread of rejection or ridicule from other members coexists with the hope of acceptance and understanding.
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Group members often entertain some calamitous fantasy about self-disclosure;
to disclose and to have that calamitous fantasy disconfirmed is highly therapeutic
.

In a bold undergraduate teaching experiment, students confidentially shared a deep secret with the class. Great care was taken to ensure anonymity. Secrets were written on uniform paper, read by the instructor in a darkened classroom so as to conceal blushing or other facial expressions of discomfort, and immediately destroyed. The secrets included various sexual preferences, illegal or immoral acts (including sexual abuse, cheating, stealing, drug sales), psychological disturbances, abuse suffered in alcoholic families, and so on. Immediately after the reading of the secrets, there was a powerful response in the classroom: “a heavy silence . . . the atmosphere is palpable . . . the air warm, heavy, and electric . . . you could cut the tension with a knife.” Students reported a sense of relief at hearing their secrets read—as though a weight had been lifted from them. But there was even greater relief in the subsequent class discussion, in which students shared their responses to hearing various secrets, exchanged similar experiences, and not uncommonly chose to identify which secret they wrote. The peer support was invariably positive and powerfully reassuring.
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Maladaptive Self-Disclosure

Self-disclosure is related to optimal psychological and social adjustment in a curvilinear fashion: too much or too little self-disclosure signifies maladaptive interpersonal behavior.

Too little self-disclosure
usually results in severely limited opportunity for reality testing. Those who fail to disclose themselves in a relationship generally forfeit the opportunity to obtain valid feedback. Furthermore, they prevent the relationship from developing further; without reciprocation, the other party will either desist from further self-disclosure or else rupture the relationship entirely.

Group members who do not disclose themselves have little chance of genuine acceptance by the other members and therefore little chance of experiencing a rise in self-esteem.
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If a member is accepted on the basis of a false image, no enduring boost in self-esteem occurs; moreover, that person will then be even less likely to engage in valid self-disclosure because of the added risk of losing the acceptance gained through the false presentation of self.
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Some individuals dread self-disclosure, not primarily because of shame or fear of nonacceptance but because they are heavily conflicted in the area of control. To them, self-disclosure is dangerous because it makes them vulnerable to the control of others. It is only when several other group members have made themselves vulnerable through self-disclosure that such a person is willing to reciprocate.

Self-disclosure blockages will impede individual members as well as entire groups. Members who have an important secret that they dare not reveal to the group may find participation on any but a superficial level very difficult, because they will have to conceal not only the secret
but all possible avenues to it
. In chapter 5, I discussed in detail how, in the early stages of therapy, the therapist might best approach the individual who has a big secret. To summarize, it is advisable for the therapist to counsel the client to share the secret with the group in order to benefit from therapy. The pace and timing are up to the client, but the therapist may offer to make the act easier in any way the client wishes. When the long-held secret is finally shared, it is often illuminating to learn what made it possible to come forward at this point in time. I will often make such statements as “You’ve been coming to this group for many weeks wanting to tell us about this secret. What has changed in you or in the group to make it possible to share it today? What has happened to allow you to trust us more today?”† See
The Schopenhauer Cure
for a graphic example.

Therapists sometimes unwittingly discourage self-disclosure. The most terrifying secret I have known a client to possess was in a newly formed group that I supervised, which was led by a neophyte therapist. One year earlier, this woman had murdered her two-year-old child and then attempted suicide. (The court ruled her insane and released her on the provision that she undergo therapy.) After fourteen weeks of therapy, not only had she told nothing of herself but by her militant promulgation of denial and suppressive strategies (such as invoking astrological tables and ancient mystical sects) had impeded the entire group. Despite his best efforts and much of my supervisory time, the therapist could find no method to help the client (or the group) move into therapy. I then observed several sessions of the group through the two-way mirror and noted, to my surprise, that the client provided the therapist with many opportunities to help her discuss the secret. A productive supervisory session was devoted to the therapist’s countertransference. His feelings about his own two-year-old child and his horror (despite himself) at the client’s act colluded with her guilt to silence her in the group. In the following meeting, the gentlest question by the therapist was sufficient to free the client’s tongue and to change the entire character of the group.

In some groups, self-disclosure is discouraged by a general climate of judgmentalism. Members are reluctant to disclose shameful aspects of themselves for fear that others will lose respect for them. In training or therapy groups of mental health professionals, this issue is even more pressing. Since our chief professional instrument is our own person, at risk is professional as well as personal loss of respect. In a group of psychiatric residents, for example, one member, Joe, discussed his lack of confidence as a physician and his panic whenever he was placed in a lifeor-death clinical situation. Ted, an outspoken, burly member, acknowledged that Joe’s fear of revealing this material was well founded, since Ted did lose respect for him and doubted whether he would, in the future, refer patients to Joe. The other members supported Joe and condemned Ted for his judgmentalism and suggested that they would be reluctant to refer patients to
him
. An infinite regress of judgmentalism can easily ensue, and it is incumbent on the therapist at these times to make a vigorous process intervention.

The therapist must differentiate, too, between a healthy need for privacy and neurotic compulsive secrecy.† Some people, who seldom find their way into groups, are private in an adaptive way: they share intimacies with only a few close friends and shudder at the thought of self-disclosure in a group. Moreover, they enjoy private self-contemplative activities. This is a very different thing from privacy based on fear, shame, or crippling social inhibitions. Men appear to have more difficulty in self-disclosure than women: they tend to view relationships from the perspective of competition and dominance rather from tenderness and connectedness.
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Too much self-disclosure
can be as maladaptive as too little. Indiscriminate self-disclosure is neither a goal of mental health nor a pathway to it. Some individuals make the grievous error of reasoning that if self-disclosure is desirable, then total and continuous self-disclosure must be a very good thing indeed. Urban life would become unbearably sticky if every contact between two people entailed sharing personal concerns and secrets. Obviously, the relationship that exists between discloser and receiver should be the major factor in determining the pattern of self-disclosure. Several studies have demonstrated this truth experimentally: individuals disclose different types and amounts of material depending on whether the receiver is a mother, father, best same-sex friend, opposite-sex friend, work associate, or spouse.
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However, some maladaptive disclosers disregard, and thus jeopardize, their relationship with the receiver. The self-disclosing individual who fails to discriminate between intimate friends and distant acquaintances perplexes associates. We have all, I am certain, experienced confusion or betrayal on learning that supposedly intimate material confided to us has been shared with many others. Furthermore, a great deal of self-disclosure may frighten off an unprepared recipient. In a rhythmic, flowing relationship, one party leads the other in self-disclosures, but never by too great a gap.

In group therapy, members who reveal early and promiscuously will often drop out soon in the course of therapy. Group members should be encouraged to take risks in the group; but if they reveal
too much too early
, they may feel so much shame that any interpersonal rewards are offset; furthermore, their overabundant self-disclosure may threaten others who would be willing to support them but are not yet prepared to reciprocate.
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High disclosers are then placed in a position of such great vulnerability in the group that they often choose to flee.

All of these observations suggest that self-disclosure is a complex social act that is situation and role bound. One does not self-disclose in solitude: time, place, and person must always be considered. Appropriate self-disclosure in a therapy group, for example, may be disastrously inappropriate in other situations, and appropriate self-disclosure for one stage of a therapy group may be inappropriate for another stage.

These points are particularly evident in the case of self-disclosure of feelings toward other members, or feedback. It is my belief that the therapist should help the members be guided as much by responsibility to others as by freedom of expression. I have seen vicious, destructive events occur in groups under the aegis of honesty and self-revelation: “You told us that we should be honest about expressing our feelings, didn’t you?”
But, in fact, we always selectively reveal our feelings
. There are always layers of reactions toward others that we rarely share—feelings about unchangeable attributes, physical characteristics, deformity, professional or intellectual mediocrity, social class, lack of charm, and so on.

For some individuals, disclosure of overt hostile feelings is “easy-honest.” But they find it more difficult to reveal underlying meta-hostile feelings—feelings of fear, envy, guilt, sadistic pleasure in vindictive triumph. And how many individuals find it easy to disclose negative feelings but avoid expressing positive feelings—feelings of admiration, concern, empathy, physical attraction, love?

A group member who has just disclosed a great deal faces a moment of vulnerability and requires support from the members and/or the therapist. Regardless of the circumstances, no client should be attacked for important self-disclosure. A clinical vignette illustrates this point.

• Five members were present at a meeting of a year-old group. (Two members were out of town, and one was ill.) Joe, the protagonist of this episode, began the meeting with a long, rambling statement about feeling uncomfortable in a smaller group. Since Joe had started the group, his style of speaking had turned members off. Everyone found it hard to listen to him and longed for him to stop. But no one had really dealt honestly with these vague, unpleasant feelings about Joe until this meeting, when, after several minutes, Betsy interrupted him: “I’m going to scream—or burst! I can’t contain myself any longer! Joe, I wish you’d stop talking. I can’t bear to listen to you. I don’t know who you’re talking to—maybe the ceiling, maybe the floor, but I know you’re not talking to me. I care about everyone else in this group. I think about them. They mean a lot to me. I hate to say this, but for some reason, Joe, you don’t matter to me.”

Stunned, Joe attempted to understand the reason behind Betsy’s feelings. Other members agreed with Betsy and suggested that Joe never said anything personal. It was all filler, all cotton candy—he never revealed anything important about himself; he never related personally to any of the members of the group. Spurred, and stung, Joe took it upon himself to go around the group and describe his personal feelings toward each of the members.

I thought that, even though Joe revealed more than he had before, he still remained in comfortable, safe territory. I asked, “Joe, if you were to think about revealing yourself on a ten-point scale, with “one” representing cocktail-party stuff and “ten” representing the most you could ever imagine revealing about yourself to another person, how would you rank what you did in the group over the last ten minutes?” He thought about it for a moment and said he guessed he would give himself “three” or “four.” I asked, “Joe, what would happen if you were to move it up a rung or two?”