The Theory and Practice Of Group Psychotherapy PDF

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... Interpersonal Learning I NTERPERSONAL LEARNING, AS WE DEFINE IT, IS A BROAD...

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... Interpersonal Learning I NTERPERSONAL LEARNING, AS WE DEFINE IT, IS A BROAD AND complex therapeutic factor. It is the group therapy analogue of such important therapeutic factors in individual therapy as insight, working through transference, and the corrective emotional experience. But it also represents processes unique to the group setting that unfold only as a result of specific therapist action. Understanding interpersonal learning—its deep connection to the therapeutic relationship and to authentic, accurate empathy—centers the group therapist in the research on effective group leadership.1 To describe how interpersonal learning mediates therapeutic change in the individual, we first need to discuss three other concepts: 1. The importance of interpersonal relationships 2. The corrective emotional experience 3. The group as social microcosm THE IMPORTANCE OF INTERPERSONAL RELATIONSHIPS From whatever perspective we study human society—whether scanning humanity’s broad evolutionary history or following the development 1 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... of the single individual—we are obliged to consider the human being in the matrix of his or her interpersonal relationships. There is convincing data from the study of primitive human cultures and contemporary society that human beings have always lived in groups characterized by intense and persistent relationships among members and that the need to belong is a powerful and fundamental motivation.2 Attachments in early life have enduring impact: they shape the individual’s capacity to recognize and manage emotions and to build relationships across the life span. These conclusions emerge clearly from an eight-decade-long study that followed a cohort of eighty-one men across the generations.3 Early secure attachment promotes resilience, whereas significant early childhood adversity may confer lifelong vulnerability to a host of medical and psychological ailments.4 These effects, mediated by stress hormones and our body’s inflammatory reactions, take place at the most basic levels, altering gene expression and creating potentially lifelong risk factors.5 John Bowlby, from his studies of the early mother-child relationship, concluded that attachment behavior is necessary for survival and that humans are genetically, neurobiologically, “wired” for attachment.6 If mother and infant are separated, both experience marked anxiety concomitant with their search for the lost object. If the separation is prolonged, the consequences for the infant will be profound. D. W. Winnicott noted, 2 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... “There is no such thing as a baby. There exists a mother-infant pair.”7 We live in a “relational matrix,” according to the noted psychoanalyst Stephen Mitchell, who wrote that “the person is comprehensible only within this tapestry of relationships, past and present.”8 Bowlby and Winnicott anticipated the contemporary fields of relational neuroscience and interpersonal neurobiology.9 Both sought an integrative understanding of the psychology and biology of relatedness. Daniel Siegel expanded on these connections, referring to the interconnection of mind, brain, and our interpersonal relationships as the “triangle of health.” These three domains work in concert to process information in the interest of our sense of self-integration and self-regulation.10 Our relational processes are embedded in our neurobiology. Understanding the reverberation between the relational and the biological helps us attune to and engage our clients more effectively and to utilize verbal, paraverbal, and nonverbal communication to understand—and demonstrate that understanding to—our clients.11 Our clients’ experience of this understanding can help to normalize their basic emotional needs that have been silenced by shame and judgment. This deepens our therapeutic effectiveness and the creation of a healing therapeutic context.12 > In the first meeting after her return from vacation, Elena, a woman with bipolar disorder and obsessive-compulsive disorder, 3 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... updated the group. Prior to the trip, Elena had announced to the group that she planned to go away with her boyfriend, Juan, instead of visiting her mother as she typically did. She dreaded being with her mother, who always shamed and attacked her for her illness. Earlier in the group she had talked about how hard it was to feel safe and trusting with Juan, or with any loving man, because of her feelings of deep unworthiness. The idea of spending a night with him created so much anxiety she could not sleep, and that, in turn, compounded her feelings of being undeserving of his care. Group members had drawn out for her the link between the difficulty she had asking for the group’s time and support and her feeling that she was undeserving of Juan’s care. The group challenged her constructively at one point when she planned to end the relationship in order to reduce the disruptive stimulation in her life. It was in response to this that Elena had agreed to go on vacation with him. As anticipated, she had trouble sleeping in the new hotel and sharing the bed with Juan each night. But she had discussed it with Juan beforehand, and he had told her to wake him up if she had trouble sleeping. Elena had been reluctant to do so the first night, but she did awaken him the second night. He responded by lovingly and 4 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... soothingly rubbing her back, and she fell back to sleep. Although sleep continued to be somewhat challenging for her throughout the week, she was able to enjoy their time together. The group enthusiastically supported her openness, but Elena found it hard to accept praise; she was unaccustomed to such support. Over time, the more she worked with the group, the more she was able to relate openly and lovingly with Juan. On one occasion the group broke into applause when she reported that Juan had told her there was no one he enjoyed traveling with more than her. This was powerful confirmation to Elena that her needs for compassion, appreciation, and loving care were indeed legitimate and could be met. It is easy to fall prey to avoidance and tentativeness in communication. I (ML) recall that while I was leading groups for women with metastatic breast cancer, my mother was diagnosed with terminal pancreatic cancer. At the kitchen table one night, my mother raised the question of why no one in the family was talking about the bar mitzvah of my son, which was scheduled for eight months later. We endured a long, silent pause. My mother then added, “People are not talking about Benji’s bar mitzvah because everyone knows I will be 14 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... dead before then.” My normally gentle and self-restrained father became agitated and responded quickly, telling her that she was being too pessimistic, that she should be hopeful and not think such negative things. She looked crestfallen, and I determined that I would put into action what I had been encouraging my group members and their families to do. I reached over to her and said, “Mom, I hope that you are wrong about your illness, but you may be right, and I realize now that we were not talking about Benji’s bar mitzvah because we were avoiding having to think about the fact that you may not be there with us. I also realize that our avoidance is making you feel alone and disconnected. While we may not be able to change the outcome of your illness, we can certainly change your experience at this moment. I promise you we will tell you everything there is to know about our plans and include you as much as possible.” My mother smiled, thanked me, and said, “Now I know what kind of work you do.” My mother in fact did not survive to attend the bar mitzvah, but the last few months of her life were spent in a much more open, close, and communicative fashion—which was much better for her and for us all. Bonnie, a depressed young woman, vividly described her isolation and alienation and then turned to Alice, who had been silent. Bonnie and Alice had often 26 of 61 12/16/2024, 12:44 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... sparred because Bonnie would accuse Alice of ignoring and rejecting her. In this meeting, however, Bonnie used a gentler tone and asked Alice about the meaning of her silence. Alice responded that she was listening carefully and thinking about how much they had in common. She then added that Bonnie’s softer inquiry allowed her to give voice to her thoughts rather than defending herself against the charge of not caring, a sequence that had ended badly for them both in earlier sessions. The seemingly small but vitally important shift in Bonnie’s capacity to approach Alice empathically created an opportunity for repair rather than repetition.