The Theory and Practice of Group Psychotherapy (88 page)

DREAMS

The number and types of dreams that group members bring to therapy are largely a function of the therapist’s attentiveness to dreams. The therapist’s response to the first dreams presented by clients will influence the choice of dreams subsequently presented. The intensive, detailed, personalized investigation of dreams practiced in analytically oriented individual therapy is hardly feasible in group therapy. For groups that meet once weekly, such a practice would require that a disproportionate amount of time be spent on one client; the process is, furthermore, minimally useful to the remaining members, who become mere bystanders.

What useful role, then, can dreams play in group therapy? In individual analysis or analytically oriented treatment, therapists are usually presented with many dreams and dream fragments. They never strive for complete analysis of all dreams (Freud held that a total dream analysis should be a research, not a therapeutic, endeavor) but, instead, elect to work on dreams or aspects of dreams that seem
pertinent to the current phase of therapy
. Therapists may ignore some dreams and ask for extensive associations to others.† For example, if a bereaved client brings in a dream full of anger toward her deceased husband as well as heavily disguised symbols relating to confusion about sexual identity, the therapist will generally select the former theme for work and ignore or postpone the second. Moreover, the process is self-reinforcing. It is well known that clients who are deeply involved in therapy dream or remember dreams compliantly: that is, they produce dreams that corroborate the current thrust of therapy and reinforce the theoretical framework of the therapist (“tag-along” dreams, Freud termed them).

Substitute “group work” for “individual work,” and the group therapist may use dreams in precisely the same fashion. The investigation of certain dreams accelerates group therapeutic work. Most valuable are group dreams—dreams that involve the group as an entity—or dreams that reflect the dreamer’s feelings toward one or more members of the group. Either of these types may elucidate not only the dreamer’s but other members’ concerns that until then have not become fully conscious. Some dreams may introduce, in disguised form, material that is conscious but that members have been reluctant to discuss in the group. Hence, inviting the group members to comment on the dream and associate to it or its impact on them is often productive. It is important also to explore the context of the disclosure of the dream: why dream or disclose this dream at this particular time?
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• In a meeting just preceding the entry of two new members to the group, one self-absorbed man, Jeff, reported his first dream to the group after several months of participation. “I am polishing my new BMW roadster to a high sheen. Then, just after I clean the car interior to perfection, seven people dressed as clowns arrive, get into my car carrying all sorts of food and mess it up. I just stand there watching and fuming.”

Both he and the group members presented associations to the dream around an old theme for Jeff—his frustrating pursuit of perfection and need to present a perfect image to the world. The leader’s inquiry about “why this dream now?” led to more significant insight. Jeff said that over the last few months he had begun to let the group into his less-than-perfect “interior” world. Perhaps, he said, the dream reflected his fear that the new members coming the next week would not take proper care of his interior. He was not alone in this anxiety: Other members also worried that the new members might spoil the group.

Some illustrative examples of members’ dreams in group therapy may clarify these points.

At the twentieth meeting, a woman related this dream:

• I am walking with my younger sister. As we walk, she grows smaller and smaller. Finally I have to carry her. We arrive at the group room, where the members are sitting around sipping tea. I have to show the group my sister. By this time she is so small she is in a package. I unwrap the package but all that is left of her is a tiny bronze head.

The investigation of this dream clarified several previously unconscious concerns of the client. The dreamer had been extraordinarily lonely and had immediately become deeply involved in the group—in fact, it was her only important social contact. At the same time, however, she feared her intense dependence on the group; it had become
too
important to her. She modified herself rapidly to meet group expectations and, in so doing, lost sight of her own needs and identity. The rapidly shrinking sister symbolized herself becoming more infantile, more undifferentiated, and finally inanimate, as she immolated herself in a frantic quest for the group’s approval. Perhaps there was anger in the image of the group “sipping tea.” Did they really care about her? The lifeless, diminutive bronzed head—was that what they wanted? Dreams may reflect the state of the dreamer’s sense of self. The dream needs to be treated with great care and respect as an expression of self and not as a secret message whose code must be aggressively cracked.
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Some of the manifest content of this dream becomes clearer through a consideration of the content of the meeting preceding the dream: the group had spent considerable time discussing her body (she was moderately obese). Finally, another woman had offered her a diet she had recently seen in a magazine. Thus, her concerns about losing her personal identity took the dream form of shrinking in size.

The following dream illustrates how the therapist may selectively focus on those aspects that further the group work:

• My husband locks me out of our grocery store. I am very concerned about the perishables spoiling. He gets a job in another store, where he is busy taking out the garbage. He is smiling and enjoying this, though it is clear he is being a fool. There is a young, attractive male clerk there who winks at me, and we go out dancing together.

This member was the middle-aged woman who was introduced into a group of younger members, two of whom, Jan and Bill, were involved in a sexual relationship (discussed in chapter 13). From the standpoint of her personal dynamics, the dream was highly meaningful. Her husband, distant and work-oriented, locked her out of his life. She had a strong feeling of her life slipping by unused (the perishables spoiling). Previously in the group, she had referred to her sexual fantasies as “garbage.” She felt considerable anger toward her husband, to which she could not give vent (in the dream, she made an absurd figure of him).

These were tempting dream morsels, yet the therapist instead chose to focus on the
group-relevant
themes. The client had many concerns about being excluded from the group: she felt older, less attractive, and very isolated from the other members. Accordingly, the therapist focused on the theme of being locked out and on her desire for more attention from others in the group, especially the men (one of whom resembled the winking clerk in the dream).

Dreams often reveal unexpressed group concerns or shed light on group blockages and impasses.
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The following dream illustrates how conscious but avoided group material may, through dreams, be brought into the group for examination.

• There are two rooms side by side with a mirror in my house. I feel there is a burglar in the next room. I think I can pull the curtain back and see a person in a black mask stealing my possessions.

This dream was brought in at the twentieth meeting of a therapy group that was observed through a one-way mirror by the therapist’s students. Aside from a few comments in the first meeting, the group members had never expressed their feelings about the observers. A discussion of the dream led the group into a valuable and much-needed conversation about the therapist’s relationship to the group and to his students. Were the observers “stealing” something from the group? Was the therapist’s primary allegiance toward his students, and were the group members merely a means of presenting a good show or demonstration for them?

AUDIOVISUAL TECHNOLOGY

The advent of audiovisual technology has elicited enormous interest among group therapists. Videotaping seems to offer enormous benefits for the practice, teaching, and understanding of group therapy. After all, do we not wish clients to obtain an accurate view of their behavior? Do we not search for methods to encourage self-observation and to make the self-reflective aspect of the here-and-now as salient as the experiencing aspect? Do we not wish to illuminate the blind spots of clients (and therapists, as well)?
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Audiovisual technology seemed a great boon to the practicing group clinician, and the professional group therapy literature of the late 1960s and 1970s reflected an initial wave of tremendous enthusiasm,
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but succeeding years have seen a steep decline in articles and books about the clinical use of audiovisual technology—and of those that have been published, the majority focused on populations that are particularly concerned by self-image issues: for example, adolescents and clients with eating disorders or speech disorders. The use of audiovisual techniques in teaching and in research, on the other hand, has been more enduring.

It is hard to explain the diminishing interest in the clinical application of audiovisual technology. Perhaps it is related to the ethos of efficiency and expediency: the clinical use of audiovisual equipment is often awkward and time-consuming. Nonetheless I feel that this technology still has much potential and, at the very least, merits a brief survey of how it has been used in group therapy.

Some clinicians taped each meeting and used immediate playback (“focused feedback”) during the session. Obviously, certain portions must be selected by the group members or by leaders for viewing.
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Some therapists used an auxiliary therapist whose chief task was to operate the camera and associated gadgetry and to select suitable portions for playback. Other therapists taped the meeting and devoted the following session to playback of certain key sections asking the member to react to it.
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Some therapists scheduled an extra playback meeting in which most of the previous tape is observed; others taped the first half of the meeting and observed the tape during the second half. Still other therapists used a serial-viewing technique: they videotaped every session and retained short representative segments of each, which they later played back to the group.
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Other therapists simply made the tapes available to clients who wished to come in between meetings to review some segment of the meeting. The tapes were also made available for absent members to view the meeting they missed.

Client response depends on the timing of the procedure. Clients will respond differently to the first playback session than to later sessions. In the first playback, clients attend primarily to their own image and are less attentive to their styles of interacting with others or to the process of the group. My own experience, and that of others, is that group members may have a keen interest in videotape viewing early in therapy but, once the group becomes cohesive and highly interactive, rapidly lose interest in the viewing and resent time taken away from the live group meeting.
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Thus, any viewing time may have to be scheduled outside of the regular group meeting.

Often a member’s long-cherished self-image is radically challenged by a first videotape playback and they may recall, and be more receptive to, previous feedback offered by other members. Self observation is powerful; nothing is as convincing as information one discovers for oneself.

Many initial playback reactions are concerned with physical attractiveness and mannerisms, whereas in subsequent playback sessions, clients note their interactions with others, withdrawal, self-preoccupation, hostility, or aloofness. They are much more able to be self-observant and objective than when actually involved in the group interaction.

I have on occasion found video recording to be of great value in crisis situations. For example, a man in a group for alcoholics arrived at a meeting intoxicated and proceeded to be monopolistic, insulting, and crude. Heavily intoxicated individuals obviously do not profit from meetings because they are not capable of retaining and integrating the events of the session. This meeting was videotaped, however, and a subsequent viewing was enormously helpful to the client. He had been told but never really apprehended how destructive his alcohol use was to himself and others.

On another occasion in an alcoholic group, a client arrived heavily intoxicated and soon lost consciousness and lay stretched out on the sofa while the group, encircling him, discussed various courses of action. Some time later, the client viewed the tape and was profoundly affected. People had often told him that he was he was killing himself with alcohol, but the sight of himself on videotape, laid out as if on a bier, brought to mind his twin brother, who died of alcoholism.

In another case, a periodically manic client who had never accepted that her behavior was unusual had an opportunity to view herself in a particularly frenetic, disorganized state.
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In each of these instances, the videotape provided a powerful self-observatory experience—a necessary first step in the therapeutic process.

Videotaping has also been used to prepare long-term patients for a transition out of the hospital. One team reports a structured twelve-session group in which the members engage in a series of nonthreatening exercises and view videotapes in order to improve their communicational and social skills.
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