The Challenging Group Member PDF

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... The Challenging Group Member W E HAVE YET TO ENCOUNTER A CLIENT WHO COASTS through the...

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... The Challenging Group Member W E HAVE YET TO ENCOUNTER A CLIENT WHO COASTS through therapy like a newly christened ship gliding smoothly into the water. Each group member must be a challenge: the success of therapy depends on the members encountering and then mastering fundamental life problems in the here-and-now of the group. Only in that way can therapy be helpful; the clinical challenge is in fact the therapeutic opportunity. Each client’s clinical concerns are overdetermined and unique. In light of this, our intent is not to provide a compendium of solutions to all possible problems. Instead we aim to describe a strategy and set of techniques that will enable a therapist to address challenges that arise in the group. The term “challenging group member” is itself problematic because it can narrow our focus and reduce our understanding. Keep in mind that the challenging group member rarely exists in a vacuum but is often an amalgam of several components: the client’s own traits and psychodynamics, the group’s dynamics, and the client’s interactions with co-members and the therapist. By overestimating the contributions of the client’s character and underestimating the role of the interpersonal context, we pathologize clients and place them at risk for scapegoating.1 At the same time, certain behavioral constellations merit particular attention because of 1 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... their common occurrence and their utility in explicating therapeutic principles for group leaders. Accordingly, in this chapter, we turn our attention to common problematic clients: the monopolist, the silent client, the boring client, the help-rejecting complainer, the acutely psychotic or bipolar client, the schizoid client, and the characterologically difficult client (the borderline client and the narcissistic client). Although diagnostic classifications and nomenclature evolve over time, these clinical prototypes seem to persist. These clients often cause serious difficulties when they engage interpersonally with fellow group members, and they will also likely cause therapists to experience strong countertransference reactions. Keep in mind that these group members often direct attention away from their core vulnerabilities as they enact their difficulties rather than explore them.2 THE MONOPOLIST The bête noire of many group therapists is the habitual monopolist, a person who seems compelled to chatter on incessantly. These individuals are anxious if they are silent; if others get the floor, they reinsert themselves through a variety of techniques: rushing in to fill the briefest silence, responding to every statement in the group, continually addressing the problems of other group members with a chorus of “I’m like that, too.” 2 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... The monopolist may persist in describing conversations with others in endless detail, gossiping, or presenting accounts of online or social media stories that are only slightly relevant to the group.3 Some monopolists hold the floor by assuming the role of interrogator. One member barraged the group members with so many questions and “observations” that it occluded any opportunity for other members to interact or reflect. Finally, when angrily confronted by co- members about her disruptive effect, she explained that she dreaded silence because it reminded her of the “calm before the storm”—the silence preceding her father’s explosive, violent rages. Some clients who have a dramatic flair monopolize the group by means of the crisis method: they regularly present the group with major life upheavals, which always seem to demand urgent and lengthy attention. The other members are cowed into silence, their problems seeming trivial in comparison. (“It’s not easy to interrupt Game of Thrones,” as one group member put it.) Although a group may welcome and even encourage the monopolist in the initial meetings, the effect on the group is quickly countertherapeutic. The mood soon turns to one of frustration and anger. Other group members are often disinclined to silence a member for fear that they will then be obliged to fill the silence; they anticipate the obvious rejoinder of, “All right, I’ll be quiet. You talk.” It is not possible to talk easily in a tense, guarded climate. Members who are not 3 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... particularly assertive may smolder quietly or make indirect hostile forays. Generally, oblique attacks on the monopolist will only aggravate the problem and fuel a vicious circle. If the monopolist’s compulsive speech is an attempt to deal with anxiety, and he or she begins to sense the growing tension and resentment in the group, his or her anxiety rises, and the compulsive tendency to speak only increases. Unresolved tension arising from this dynamic will eventually wear away at group cohesion and manifest in signs of group disruption such as absenteeism, dropouts, fighting, and divisive subgrouping. When the group does finally confront the monopolist, it often takes the form of an explosive, brutal outburst by a group spokesperson, who then usually receives unanimous support from the other members. We have even witnessed a group giving the spokesperson a round of applause—a sure sign that a problem has been addressed far too late. The monopolist may then sulk, be completely silent for a meeting or two (“See what they do without me?”), or leave the group. In any event, little that is therapeutic has been accomplished for anyone. How can the therapist interrupt the monopolist in a therapeutically effective fashion? Despite the strongest urge to shout the client down or to silence the client by edict, such an assault has little value (except as a temporary catharsis for the therapist). The client is not helped: no learning has accrued; the dynamics underlying the monopolist’s compulsive speech persist and will, without doubt, 4 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... erupt again in further monopolistic volleys or force the client out of the group. Neither is the group helped; regardless of the circumstances, the others are threatened by the fact that the therapist has silenced one of its members in such a heavy- handed manner. A seed of caution and fear is implanted in each member’s mind as they imagine a similar fate befalling them. Nevertheless, monopolistic behavior must be checked, and generally it is the therapist’s task to do so. Although therapists generally do well to wait for the group to handle many other group problems, the monopolistic member is one problem that groups, especially young groups, often cannot handle. Monopolistic clients pose a threat to the group’s procedural underpinnings; group members are encouraged to speak, yet this particular member must be silenced. The therapist must prevent the development of therapy- obstructing norms and at the same time prevent the monopolistic client from committing social suicide. A two-pronged approach is most effective: consider both the monopolizer and the group that has allowed itself to be monopolized. This approach reduces the hazard of scapegoating and illuminates the role played by the group in each member’s behavior. From the standpoint of the group, bear in mind that individual and group psychology are inextricably interwoven. No monopolistic client exists in a vacuum: the client always abides in a dynamic equilibrium with a group that permits or encourages such behavior.4 So the therapist may 5 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... inquire why the group permits or encourages one member to carry the burden of the entire meeting. This inquiry may startle the members, who have perceived themselves only as passive victims of the monopolist. Or we might inquire if others experience the desire to hold everyone’s attention by talking through the whole meeting.5 After the initial protestations are worked through, the group members may benefit from examining their use of the monopolist in avoiding their own disclosures. Part of the power of group therapy is the way a single group phenomenon may evoke many different reactions. Some group members may be relieved at not having to speak in the group. They may let the monopolist do all the self-disclosure, or appear foolish, or act as a lightning rod for the group members’ anger, while they themselves assume little responsibility for the group’s therapeutic tasks. Prompted to disclose and discuss their reasons for inactivity, group members’ personal commitment to the therapeutic process is often augmented. They may, for example, discuss their fear of asserting themselves, or of harming the monopolist, or of being attacked in retaliation by another member or by the therapist. Or they may wish to avoid seeking the group’s attention lest their own neediness or narcissism be exposed. Or they may secretly revel in the monopolist’s plight, and enjoy being a member of the victimized and disapproving majority. The disclosure of any of these issues by an uninvolved client signifies greater engagement in therapy. 6 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... > In one group a submissive, chronically depressed woman, Katie, exploded in an uncharacteristic expletive-filled rage at the monopolistic behavior of another member. As she explored her outburst, Katie quickly recognized that her rage was really inwardly directed, stemming from her own stifling of her own voice, her own passivity, her avoidance of her own emotions. “My outburst was twenty years in the making,” Katie added as she apologized and thanked her startled “antagonist” for crystallizing this awareness. In his initial interview, Matthew, who would later become a monopolist in the group, complained about his relationship with his wife, who, he claimed, often abruptly resorted to such sledgehammer tactics as publicly humiliating him or accusing him of being irresponsible and dishonest in front of 9 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... his adult children. Within the first few meetings of the group, a similar sequence unfolded in the social microcosm of the group: because of his monopolistic behavior, judgmental attitude, and inability to hear the members’ response to him, the group pounded harder and harder, until finally, when he was forced to listen, their sledgehammer message sounded cruel and humiliating. Walt, who had been in the group for seven weeks, launched into a familiar, lengthy tribute to the remarkable improvement he had undergone. He described in exquisite detail how he had not understood the damaging effects of his behavior on others, and how now, having 11 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... achieved such understanding, he was ready to leave the hospital. The therapist, alert to the group process, observed that some of the members were restless. One softly pounded his fist into his palm, while others slumped back in a posture of indifference and resignation. The therapist intervened by asking the group members about their response to Walt’s account. All agreed they had heard it at every meeting—in fact, they had heard Walt speak this way in the very first meeting. Furthermore, they had never heard him talk about anything else and knew him only as a story. The members discussed their irritation with Walt, their reluctance to confront him for fear of seriously injuring him, of losing control of themselves, or of painful retaliation. Some spoke of their hopelessness about ever reaching Walt, and of the fact that he related to them only as stick figures without flesh or depth. Still others noted their terror of speaking and revealing themselves in the group; therefore, they welcomed Walt’s monopolization. A few members expressed their total lack of interest or faith in therapy and therefore failed to intercept Walt because of apathy. Thus, the process was overdetermined: a host of interlocking factors resulted in a dynamic equilibrium of monopolization. By halting the runaway process, and 12 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... uncovering and working through the underlying factors, the therapist obtained maximum therapeutic benefit from a potentially crippling group phenomenon. Each member moved closer to group involvement. Walt was no longer enabled to participate in a fashion that could not possibly be helpful to him or the group. One client, Nora, drove the group to despair with her constant clichés and self- deprecatory remarks. After many months in the group, her outside life began to change for the better, but each report of success was accompanied by the inevitable self- derogation. She was accepted by an honorary professional society (“That is good,” she said, “because it is one club that can’t kick me out”); she received her graduate degree (“but I should have finished earlier”); she looked better physically (“shows you what a good sunlamp and make-up can do”); she had been asked out by several new men in her life (“must be slim pickings in the market”); she obtained a good job (“it fell into my lap”); she had had her first orgasm with a man (“give the credit 21 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... to marijuana”). The group tried to increase Nora’s awareness of her self-effacement. An engineer in the group suggested bringing an electric buzzer to ring each time she knocked herself. Another member, Ed, trying to shake Nora into a more spontaneous state, commented on her bra, which he felt could be improved. He said he would bring her a present, a new bra, next session. Sure enough, the following session he arrived with a huge box, which Nora said she would prefer to open at home. So, there it sat, looming in the group and, of course, inhibiting any other topic. She was finally prevailed upon to open the gift and did so laboriously and with enormous embarrassment. The box contained nothing but Styrofoam stuffing. Ed explained that this was his idea for Nora’s new bra: that she should wear no bra at all. Nora promptly thanked him for the trouble he had taken. The incident launched much work for both members. The group told Nora that, though Ed had humiliated and embarrassed her, she had responded by apologizing to him. She had politely thanked someone who had just given her a gift of precisely nothing! The incident created the first robust spark of self-observation in Nora. She began the next meeting with, “I’ve just set the world ingratiation record. Last night I received a scam call about money I 22 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... allegedly owed, and I apologized to the man. I said, ‘I’m sorry but you must have the wrong number.’” Sandy was a thirty-seven-year-old housewife who had once, several years before, suffered a major treatment-resistant depression requiring hospitalization and electroconvulsive therapy. She sought group therapy at the insistence of her individual therapist, who thought that an understanding of her interpersonal relationships would help her to improve her relationship with her husband and overcome her shame and isolation. 30 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... In the early meetings of the group, Sandy was an active member. She tended to reveal far more intimate details of her history than the other members. Occasionally, she expressed anger toward another member, and then she engaged in excessively profuse apologies coupled with self-deprecatory remarks. By the sixth meeting, her behavior was becoming quite inappropriate. She discoursed at great length on her son’s urinary problems, for example, describing in intricate detail the surgery that had been performed to relieve his urethral stricture. At the following meeting, she noted that the family cat had also developed a blockage of the urinary tract; she then urged the other members to describe their pets. By her eighth meeting, Sandy was becoming increasingly manic. She behaved irrationally, insulting other members of the group, openly flirting with the men, to the point of stroking their bodies, and finally lapsing into pressured speech, inappropriate laughter, and tears. One of the co-therapists finally escorted her from the group room and took her to the emergency room. She was hospitalized; remained in a manic, psychotic state for a month; and then gradually recovered on a new medication regimen. The members were obviously extremely uncomfortable during Sandy’s final meeting. Their feelings ranged from bafflement and 31 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... fright to annoyance. After she was escorted out, some expressed their feelings of guilt, worried that, in some unknown manner, they may have triggered her behavior. Others spoke of their fear of her. One member recalled someone he knew who had become threatening and brandished a gun following a psychotic breakdown. During the subsequent meeting, one member expressed his conviction that no one could be trusted: even though he had known Sandy for seven weeks, her behavior proved to be totally unpredictable. Others expressed their relief that they were, in comparison, psychologically healthy, and still others, in response to their fears of similarly losing control, employed considerable denial and veered away from discussing these problems. Some expressed a fear that if Sandy returned she would make a shambles of the group. Others expressed their diminished faith in group therapy; one member asked for transcranial magnetic stimulation treatment instead, and another brought in an article from a scientific journal claiming that psychotherapy was ineffective. A loss of faith in the co-therapists and their competence was expressed in one member’s dream, where one of the co- therapists was in the hospital and the client rescued him. Over the next few weeks, all these 32 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... themes went underground, and the meetings became listless, shallow, and intellectualized. Attendance dwindled, and the group seemed resigned to its own impotence. At the fourteenth meeting, the co-therapists announced that Sandy was improved and would return the following week. A vigorous, heated discussion ensued. The members feared that: They would upset Sandy. An intense meeting would make her ill again and, to avoid that, the group would be forced to move slowly and superficially. Sandy would be unpredictable. At any point she might lose control and display dangerous, frightening behavior. Sandy would, because of her lack of control, be untrustworthy. Nothing in the group would remain confidential. At the same time, the members expressed considerable anxiety and guilt for wishing to exclude Sandy from the group. Soon, tension and a heavy silence prevailed. The group’s extreme reaction persuaded the co-therapists to delay reintroducing Sandy (who continued in concurrent individual treatment) for a few weeks. When Sandy finally did reenter the group, she was treated as a fragile object, and the entire group interaction was guarded and 33 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... defensive. By the twentieth meeting, five of the seven members had dropped out of the group, leaving only Sandy and one other member. The co-therapists reconstituted the group by adding five new members. It is of interest that, despite the fact that only two of the old members and the co-therapists continued in the reconstituted group, the old group culture persisted—a powerful example of the staying power of norms even in the presence of a limited number of culture- bearers.31 The group dynamics had locked the group and Sandy into severely restricted roles and functions. Sandy was treated so delicately by even the new members that the group moved slowly, floundering in politeness and social conventionality. Finally, in one group meeting, the co- therapists confronted the issue openly. They discussed their own fears of upsetting Sandy and thrusting her into another psychological decompensation. Only then were the members themselves able to deal with their feelings and fears about her. At that point, the group moved ahead more quickly. Sandy remained in the reconstituted group for a year and made significant improvements in her ability to relate with others and in her self-concept. In the forty-fifth meeting of a group, Roberta, a forty-three-year-old divorced woman, arrived a few minutes late in a disheveled, tearful, and obviously disturbed state. Over the previous few weeks, she had gradually been sliding into a depression, but now the process had suddenly accelerated. During the early part of the meeting she wept continuously and expressed feelings of great loneliness and hopelessness as well as an inability to love, hate, or, for that matter, have any deeply felt emotion. She described feeling great detachment from everyone, including the group, and, when prompted, discussed suicidal ruminations. The group members responded to Roberta with great empathy and concern. They inquired about events during the prior week and helped her discuss two important occurrences that seemed related to the depressive crisis. First, for months she had been saving money for a summer trip to Europe, but she now feared she would not 36 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... be able to go. During the past week, her seventeen-year-old son had decided to decline a summer camp job, and he refused to search for other jobs. In Roberta’s eyes, this turn of events jeopardized her trip. Second, after months of hesitation, she had decided to attend a dance for divorced middle-aged people, and it proved to be a disaster. No one had asked her to dance, and she had ended the evening consumed with feelings of total worthlessness. The group helped Roberta explore her relationship with her son, and for the first time she expressed considerable anger at him for his lack of concern for her. With the group’s assistance, she attempted to explore and express the limits of her responsibility toward him. It was difficult for Roberta to discuss her experience at the dance because of the shame and humiliation she felt. Two other women in the group, one single and one divorced, empathized deeply with her and shared their experiences and reactions to the scarcity of suitable males. The group also reminded Roberta of the many times during sessions when she had interpreted every minor slight as a total rejection and condemnation. Finally, after much attention, care, and warmth had been offered her, one of the members pointed out to Roberta that the experience of the dance was being disconfirmed right in the group: several 37 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... people who knew her well were deeply concerned and involved with her. Roberta rejected this idea by claiming that the group, unlike the dance, was an artificial situation, in which people followed unnatural rules of conduct. The members quickly pointed out that quite the contrary was true: the dance— the contrived congregation of strangers, the attractions based on split-second, skin-deep impressions—was the artificial situation, and the group was the real one. It was in the group that she was more completely known. Roberta, suffused with feelings of worthlessness, then berated herself for her inability to feel reciprocal warmth and involvement with the group members. One of the members quickly intercepted this maneuver by pointing out that Roberta experienced considerable empathy for the other members, evidenced by her facial expressions and body postures. But then Roberta let her “shoulds” take over and insisted that she should feel more warmth and more love than anyone else. The net effect was that the real feeling she did have was rapidly extinguished by the winds of her impossible self-demands. In essence, what then transpired was Roberta’s gradual recognition of the discrepancy between her public and private esteem. Near the end of the meeting, Roberta burst into tears, and she wept for several minutes. The group members were 38 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... reluctant to leave but did so once they had convinced themselves that suicide was no longer a serious consideration. Throughout the next week, they maintained an informal vigil, each calling or texting Roberta at least once as she stabilized. The group therapist also followed up with Roberta to ensure that she received urgent care in the form of clinical support and medications. Julia, a thirty-eight-year-old woman, entered group therapy to address her social isolation and her sense of herself as defective because of her long-standing bipolar disorder. She had been doing well on mood stabilizers, but several months into the group she began to wean herself off her medications, believing that she no longer required them. She soon became progressively paranoid and agitated in the group, and her individual therapist arranged for her admission as an involuntary patient to an acute care psychiatric unit. I (ML) visited Julia during her month-long hospital admission. She exclaimed at how moved she was by my visiting her and how heartening it was to feel that she was remembered. My visit made her eventual return to the group easier. When she 41 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... returned, she expressed embarrassment about her behavior when she had been manic, but was grateful that the group had not rejected her. For several months following, Julia referred to the importance of my hospital visit. Gene, a twenty-eight-year-old man, arrived for his initial consultation for outpatient group therapy with his community caseworker. He had asked the caseworker to attend because he had previously experienced discrimination when pursuing mental health care, having been told he was not suitable for the treatment he sought. Gene conveyed a sense of social oddness and awkwardness: his eye contact was poor, and he wore a long bright yellow raincoat throughout the entire consultation. At the same time, he expressed an earnest wish to alleviate his loneliness. He felt that he would benefit from exposure to others interacting normally, rather than being with others who suffered impairments similar to his. Gene entered an interpersonal psychotherapy group that was time limited, meeting weekly for eight months, and proved to be a regular and reliable participant. He described a lifetime of people avoiding him because they saw him as odd or mentally ill. Now, he was eager to understand how he alienated others and was keen to improve his social skills. In his early group sessions, he disclosed excessively and indiscriminately about his isolation, his sexual frustration, and his disappointment that others did not 44 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... appreciate his special abilities. He missed social cues and, if not interrupted by the group leaders, would have talked throughout the entire meeting. Despite appropriate preparation for the group, he sought to meet members outside the meetings, and the leaders had to reinforce boundaries time and again. Gradually, Gene learned how to share time and to offer help to others. Although the group feedback at times was heavy handed, he listened, and over the course of the group sessions he began to make eye contact, pose more appropriate questions to others, and allow time for people to respond before jumping to the next question. He also assimilated feedback about how his intense gazing at women’s bodies made them feel sexually objectified and was “creepy.” The group members treated Gene firmly, respectfully, and affectionately, and ultimately expressed their pleasure in witnessing Gene’s interpersonal growth. In the concluding session, Gene told the group this was his first positive experience as a member of any type of group. He also brought in a list of all the lessons he had learned, expressing his deep appreciation to the group members and his intention to build upon what he had learned. Margie, forty-two, was referred to the group by her individual therapist, who had been unable to make headway with her. Margie’s feelings toward her therapist alternated between great rage at him and hunger for him. The intensity of these feelings was so great that little work could be done, and the therapist was on the verge of discontinuing therapy. Placing her in a therapy group was his last resort. Upon entry into the group, Margie refused to talk for several meetings because she wanted to determine how the group ran. After four meetings in silence, she suddenly unleashed a ferocious attack on one of the group co-leaders, labeling him as cold, powerful, and rejecting. She offered no reasons or data for her comments aside from her gut feeling about him. Furthermore, she expressed contempt for those members of the group who felt affection for him. Her feelings for the other leader were quite the opposite; she experienced him as soft, warm, and caring. Other members 57 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... were startled by her black-and-white view of the co-therapists and urged her, unsuccessfully, to work on her great propensity for judgment and anger. Her positive attachment to the one leader contained her sufficiently to permit her to continue in the group—and allowed her to tolerate her intense hostile feelings toward the other leader and to work on other issues in the group—though she continued to snipe intermittently at the hated leader. A notable change occurred with the “bad” therapist’s vacation. When Margie expressed a fantasy of wanting to kill him, or at least to see him suffer, members expressed astonishment at the degree of her rage. Perhaps, one member suggested, she hated him so much because she badly wanted to be closer to him and was convinced it would never happen. This feedback had a dramatic impact on Margie. It touched not only on her feelings about the therapist but also on deep, conflicted feelings about her mother. Gradually, her anger softened, and she described her longing for a different kind of relationship with the therapist. She expressed sadness also at her isolation in the group and described her wish for more closeness with other members. Some weeks after the return of the “bad” therapist, her anger had diminished sufficiently to work with him in a more productive manner. Vicky was highly critical of the group format and frequently expressed her 63 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... preference for the one-to-one therapy format. She often supported her position by citing psychoanalytic literature critical of the group therapy approach. She felt bitter at having to share time in the group. For example, three-fourths of the way through a meeting, the therapist remarked that he perceived Vicky and John to be under much pressure. John had begun in the preceding session to talk about his mounting feelings of worthlessness. They both admitted that they needed and wanted time in the meeting that day. After a moment’s awkwardness, John gave way, saying he thought his problem could wait until the next session. Vicky consumed the rest of the meeting, and at the following session she continued where she had left off. When it appeared that she had every intention of using the entire meeting again, one of the members commented that John had been left hanging in the last session. But there was no easy transition, since, as the therapist pointed out, only Vicky could entirely release the group, and she gave no sign of doing so graciously (she had lapsed into a sulking silence). Nonetheless, the group turned to John, who was in the midst of a major life crisis. John presented his situation, but no good work was done. At the very end of the meeting, Vicky began weeping silently. The group members, thinking that she was 64 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... weeping for John, turned to her. But she was weeping, she said, for all the time that was wasted on John—time that she could have used so much better. What Vicky could not appreciate for at least a year in the group was that this type of incident did not indicate that she would be better off in individual therapy. Quite the contrary: the fact that such difficulties arose in the group was precisely the reason that the group format was especially indicated for her. Sal, a narcissistic man, was insulting, unempathic, and highly sensitive to even the mildest criticism. In one meeting, he lamented at length that he never received support or compliments from anyone in the group, least of all from the therapists. In fact, he could remember only three positive comments to him in the many group meetings he had attended. One member responded immediately and straightforwardly: “Oh, come on, Sal, get off 68 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... it. Last week both of the therapists supported you a whole lot. In fact, you get more stroking in this group than anyone else.” Every other member of the group agreed, and they offered several examples of positive comments that had been given to Sal over the past few meetings. Later in the same meeting, Sal responded to two incidents in a highly maladaptive fashion. Two members were locked in a painful battle over control. Both were shaken and extremely threatened by the degree of anger expressed, both their own and their antagonist’s. Many of the other group members offered observations and support. Sal’s response was that he didn’t know what all the commotion was about; in his view, the two were “jerks” for getting themselves so upset about nothing at all. A few minutes later, Farrell, a member who had been very concealed and silent, was pressed to reveal more about herself. With considerable resolve, and for the first time, she disclosed intimate details about a relationship she had recently entered into with a man. She talked about her fear that the relationship would collapse. Moreover, she desperately wanted children, but she had once again started a relationship with a man who made it clear that he did not want children. Many members of the group responded empathically and supportively to her disclosure. Sal was silent, and when 69 of 72 12/16/2024, 3:45 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... called upon he stated that he could see Farrell was having a hard time talking about this, but couldn’t understand why, because “it didn’t seem like a big-deal revelation.” Farrell responded, “Thanks, Sal, that makes me feel great—it makes me want to have nothing to do with you. I’d like to put as much distance as possible between the two of us.” The group’s response to Sal in both of these incidents was immediate and direct. The two people he had accused of acting like jerks let him know that they felt demeaned by his remarks. One commented, “If people talk about some problem that you don’t have, then you dismiss it as being unimportant or jerky. Look, I don’t have the problems that you have about not getting enough compliments from the therapists or other members of the group. It simply is not an issue for me. How would you feel if I called you a jerk every time you complained about that?”