The Theory and Practice Of Group Psychotherapy PDF

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... The Therapist Working in the Here-and-Now A MAJOR DIFF...

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... The Therapist Working in the Here-and-Now A MAJOR DIFFERENCE BETWEEN A PSYCHOTHERAPY GROUP that hopes to effect extensive and enduring behavioral and characterological change and other kinds of groups—twelve-step groups, psychoeducational groups, social skills training groups, and cancer support groups—is that the psychotherapy group strongly emphasizes the importance of the here-and-now experience. Yet all group approaches, including highly structured groups that use the group only as a setting to deliver an intervention, benefit from the group therapist’s capacity to recognize, understand, and utilize the here-and-now. Therapists who are aware of group dynamics and the nuances of the relationships between all the members of the group are more adept at working on the group task even when deeper group and interpersonal exploration or interpretation is not the therapy focus.1 In Chapter 2, we presented some of the theoretical underpinnings of the use of the here- and-now. Now it is time to focus on the clinical application of the here-and-now in group therapy. First, keep in mind this important principle— perhaps the single most important point we make in this entire book: The here-and-now focus, to be effective, consists of two symbiotic tiers, neither of 1 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... which has full therapeutic power without the other. The first tier is an experiencing one: the members live in the here-and-now, and they develop strong feelings toward the other group members, the therapist, and the group. These here- and-now feelings become the major discourse of the group. The thrust is ahistorical: The immediate events of the meeting take precedence over events both in the current outside life and in the distant past of the members. This focus greatly facilitates the development and emergence of each member’s social microcosm. It facilitates feedback, catharsis, meaningful self-disclosure, and acquisition of socializing techniques. The group becomes more vital, and all of the members (not only the ones directly working in that session) become intensely involved in the meeting. But the here-and-now focus rapidly reaches the limits of its usefulness without the second tier, which is the illumination of process. If the powerful therapeutic factor of interpersonal learning is to be set in motion, the group must recognize, examine, and understand process. It must examine itself; it must study its own transactions; it must transcend pure experience and apply itself to the meaningful integration—the making-sense aspect—of that experience. Thus, the effective use of the here-and-now requires two steps: the group lives in the here-and- now, and it also doubles back on itself and examines the here-and-now behavior that has just occurred. If only the first—the experiencing of the here- 2 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... and-now—is present, the group experience will still be intense, members will feel deeply involved, emotional expression may be high, and members will finish the group agreeing, “Wow, that was a powerful experience!” Yet it will also prove to be an evanescent experience. Members will have no cognitive framework permitting them to retain the group experience, to generalize from it, to identify and alter their interpersonal behavior, and to transfer their learning from the group to situations beyond the group. This is precisely the error made by many group leaders during the encounter group era. If, on the other hand, only the second part of the here-and-now—the examination of process—is present, then the group loses its liveliness and meaningfulness. It devolves into a sterile intellectual exercise. This is the error made by overly formal, aloof, rigid therapists. Accordingly, the therapist has two discrete functions in the here-and-now: to steer the group into the here-and-now and to facilitate the self- reflective loop (or process commentary). Much of the here-and-now steering function can be shared by the group members, but for reasons we will discuss later, process commentary remains largely the task of the therapist. The majority of group therapists understand that their emphasis must be on the here-and-now. Though it is challenging to maintain that focus, it is an essential component of effective group therapy and correlates with improved clinical outcomes.2 A large survey of seasoned group 3 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... therapists underscored activation of the here-and- now as a core skill of the contemporary group therapist.3 A smaller but careful study codified group therapists’ interpretations and found that over 60 percent of interpretations focused on the here-and-now (either behavioral patterns or impact of behavior), while approximately 20 percent focused on historical causes and 20 percent on motivation.4 DEFINITION OF PROCESS The term process, used liberally throughout this text, has a highly specialized meaning in many fields, including law, anatomy, sociology, anthropology, psychoanalysis, and descriptive psychiatry. In interactional psychotherapy, too, process has a specific technical meaning. It refers to the nature of the relationships between interacting individuals—members and therapists.5 Moreover, as we shall see, a full understanding of process must take into account a large number of factors, including the internal psychological worlds of each member, interpersonal interactions, group-as-a-whole forces, the clinical setting of the group, and the larger sociocultural or political environment in which the group is embedded.6 It is useful to contrast process with content. Imagine two individuals in a discussion. The content of that discussion consists of the explicit words spoken, the substantive issues, the arguments advanced. The process is an altogether 4 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... different matter. When we ask about process, we ask, “What do these explicit words and the style of the participants reveal about the interpersonal relationship of the participants?” Therapists who are process-oriented are concerned not primarily with the verbal content of a client’s statement, but with the “how” and the “why” of that statement, especially insofar as the how and the why illuminate aspects of the client’s interpersonal relationships. Thus, therapists focus on the metacommunicationali aspects of the message and wonder why, from the relationship aspect, an individual makes a statement at a certain time in a certain manner to a certain person. Some of the message is conveyed verbally and directly; some of the message is expressed paraverbally (by nuance, inflection, pitch, and tone); and some of the message is expressed behaviorally, and even somatically, through one’s posture and physical presence.7 Identifying the connection between the intent and the actual impact of the communication is at the heart of the therapy process. Such an exploration illuminates, within the social microcosm of the group, the individual’s interpersonal patterns, beliefs, fears, and wishes. Consider, for example, this transaction: During a lecture, a student raised her hand and asked when the American Psychiatric Association had stopped labeling homosexuality as a mental disorder. The lecturer replied, “1974,” only to have the student inquire, “But wasn’t it earlier, in 1973?” Since the student already knew the answer to her question, her motivation was obviously not a quest for 5 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... information. (A question ain’t a question if you know the answer.) The process of this transaction? Most likely, the student wished to demonstrate her knowledge, or to humiliate or defeat the lecturer! Frequently, the understanding of process in a group is more complex than in a two-person interaction. We must search for the process not only behind individual statements but behind a sequence of statements made by several group members. The group therapist must endeavor to understand what a particular sequence reveals about the relationship between one client and the other group members, or between clusters or cliques of members, or between the members and the leader, or, finally, between the group as a whole and its primary task. John Schlapobersky, a prominent group analyst, encourages group leaders to reflect regularly on the following as a way to examine group process: Who is speaking? Who is being spoken to? What is being said and what is not being said?8 A clinical vignette may further clarify the concept: > Early in the course of a group therapy meeting, Burt, a tenacious, intense graduate student, exclaimed to the group in general, and to Rose (an unsophisticated mother of four), in particular, “Parenthood is degrading!” This provocative statement elicited considerable response from the group members, all of whom had parents and many of whom were parents. The free- 6 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... for-all that followed consumed the remainder of the group session. In another group, a member, Saul, sought therapy because of his deep sense of isolation. He was particularly interested in a group therapeutic experience because he had never before been a part of a primary group. Even in his primary family, he had felt himself an outsider. He had been a spectator all his life, pressing his nose against cold windowpanes, gazing longingly at warm, convivial groups within. At Saul’s fourth therapy meeting, another member, Barbara, began the meeting by announcing that she had just broken up with a man who had been very important to her. Barbara’s major reason for being in therapy had been her inability to sustain a relationship with a man, and she was now profoundly distressed. Barbara had an extremely poignant way of describing her pain, and the group was swept along with her feelings. Everyone in the group was very moved; I (IY) noted silently that Saul, too, had tears in his eyes. The group members (with the exception 11 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... of Saul) did everything in their power to offer Barbara support. They passed Kleenex; they reminded her of all her good qualities and assets; they reassured her that she had made the right choice, that the man was not good enough for her, that she was “lucky to be rid of that jerk.” Suddenly, Saul interjected: “I don’t like what’s going on here in the group today, and I don’t like the way it’s being led” (an obvious allusion to me). He went on to explain that the group members had no justification for their criticism of Barbara’s ex-boyfriend. They didn’t really know what he was like. They could see him only through Barbara’s eyes, and probably she was presenting him in a distorted way. (Saul had a personal ax to grind on this matter, having gone through a divorce a couple of years earlier. His wife had attended a women’s support group, and he imagined he had been the “jerk” of that group.) Saul’s comments, of course, changed the entire tone of the meeting. The softness and support disappeared. The room felt cold; the warm bond among the members was broken. Everyone was on edge. I felt justifiably reprimanded. Saul’s position was technically correct: the group was wrong to condemn Barbara’s ex-boyfriend in such a sweeping and uncritical manner. So much for the content. Now let’s examine the process of this interaction. 12 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... First, note that Saul’s comment had the effect of putting him outside the group. The rest of the group was caught up in a warm, supportive atmosphere from which he excluded himself. Recall his chief complaint that he was never a member of a group, but always the outsider. The meeting provided an in vivo demonstration of how that came to pass. In his fourth group meeting, Saul had, kamikaze-style, attacked and voluntarily ejected himself from a group he wished to join. A second issue had to do not with what Saul said but what he did not say. In the early part of the meeting, everyone except Saul had made warm, supportive statements to Barbara. I had no doubt that Saul felt supportive of her; the tears in his eyes indicated that. But why had he chosen to be silent? Why did he always choose to respond from his critical self and not from his warmer, more supportive self? The examination of this aspect of the process led to some very important issues for Saul. Obviously, it was difficult for him to express the softer, affectionate part of himself. He feared being vulnerable and exposing his dependent cravings. He feared losing himself and his own uniqueness by getting too close to another or becoming a member of a group. Behind the aggressive, ever-vigilant, hard-nosed defender of honesty (but a selective honesty: honesty of 13 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... expression of negative but not positive sentiments), there is often the softer, submissive child thirsting for acceptance and love. In a T-group (an experiential training group) of clinical psychology interns, one of the members, Robert, commented that he genuinely missed the contributions of some of the members who had been generally very silent. He turned to two of these members and asked if there was anything he or others could do that would help them participate more. The two members and the rest of the group responded by launching a withering attack on Robert. He was reminded that his own contributions had not been substantial, that he was often silent for entire meetings himself, that he had never really expressed his emotions in the group, and so forth. Viewed at the content level, this transaction is bewildering. Robert expressed genuine concern for the silent members, and for his solicitude he was soundly buffeted. Viewed at the process—that is, relationship—level, however, it makes perfectly good sense: the group members were involved in a struggle for dominance, and their inner response to Robert’s statement was, “Who are you to issue an invitation to speak? Are you the host or leader here? If we allow you to comment on 14 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... our silence and suggest solutions, then we acknowledge your dominion over us.” In another group, Kevin, an overbearing business executive, opened the meeting by asking the other members—housewives, teachers, clerical workers, freelance software developers, and store owners—for help with a problem: he had received “downsizing” orders. He had to cut his staff immediately by 50 percent—to fire twenty of his staff of forty. The content of the problem was intriguing but impersonal. The group spent forty-five minutes discussing such aspects as justice versus mercy: that is, whether one retains the most competent workers or workers with the largest families or those who would have the greatest difficulty in finding other jobs. Despite the fact that most of the members engaged animatedly in the discussion, which involved important problems in human relations, the co-therapists regarded the session as unproductive: the discussion could have appropriately occurred at a dinner party or any other social gathering. Furthermore, as time passed, it became abundantly clear that Kevin had already spent considerable time thinking through every aspect of the problem, and no one was able to provide him with novel approaches or suggestions. The session was not truly a work session: instead it was 15 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... a flight-from-work session. Such a dedicated focus on content is inevitably frustrating for the group, and the therapists began to wonder about process— that is, what this content revealed about the nature of Kevin’s relationship to the other members. As the meeting progressed, Kevin, on two occasions, let slip the amount of his salary (which was more than double that of any other member). In fact, the overall interpersonal effect of Kevin’s presentation was to make others aware of his affluence and power. The process became even more clear when the therapists recalled previous meetings in which Kevin had been soundly attacked by the group for his evangelical religious convictions, which he used to criticize others’ behavior but never his own —which included extramarital affairs and compulsive lying. At a recent meeting, he had been termed “thick-skinned” because of his apparent insensitivity to others. However, despite the criticism he had received, Kevin was a dominant member: he was the most active and central figure in almost every meeting. With this information about process, let’s examine the alternatives available to consider. The therapists might have focused on Kevin’s bid for prestige, especially after the attack on him and his loss of face in the previous meeting. Phrased in a 16 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... nonaccusatory manner, a clarification of this sequence might have helped Kevin become aware of his desperate need for the group members to respect and admire him. At the same time, the self-defeating aspects of his behavior could have been pointed out. Despite his yearning for respect, the group had come to resent and at times even to scorn him. Perhaps, too, Kevin was attempting to repudiate the charge of being thick-skinned by sharing his personal agony over the staffing issue in such a melodramatic fashion. There are many therapist options. The style of the therapists’ intervention would depend on Kevin’s degree of defensiveness: if he had seemed particularly brittle or prickly, then the therapists might have underscored how hurt he must have been at the previous meeting. If he had been more open, they might have asked him directly what type of response he would have liked from the others. Other therapists might have preferred to interrupt the content discussion and simply ask the group members what Kevin’s question had to do with last week’s session. Still another alternative would be to call attention to an entirely different type of process by reflecting on the group’s apparent willingness to permit Kevin to occupy center stage in the group week after week. By encouraging the members to 17 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... discuss their response to his monopolization, the therapist could have helped the group initiate an exploration of their relationship with Kevin. As chief of psychiatry in a university teaching hospital, I (ML) was involved in planning meetings regarding the impending COVID-19 pandemic. Several years previously, our hospital and surrounding community had been severely impacted by the severe acute respiratory syndrome pandemic (SARS).10 Many of our staff members had been quarantined; some became gravely ill and required ICU care; and a number of nurses and doctors in our surrounding community had succumbed to SARS. In this planning meeting involving all of the hospital’s department chiefs and our senior administrative leadership, the discussion became progressively more polarized and more heated. One senior member felt that we were heading for a catastrophe of epic proportion. Another senior member responded that that was a grossly exaggerated and dramatic response and that we would weather it without much impact. Emotional tensions grew, the polarization deepened, and we were approaching an impasse. At that point I commented that it would be helpful to look at this discussion from a psychological perspective. “It is human nature, after our SARS trauma, that our reactions in the face of a potential new threat range from feelings of powerful reexperiencing and deep dread, on the one 19 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... hand, and avoidance, minimization, or denial, on the other hand. Both polarized reactions carry some elements of truth; both need to be integrated into meaningful planning for the hospital, our patients and staff.” That process intervention identified and defused our mounting tensions and we were able to resume our task and planning process with greater mutual understanding. Two group members, Tim and Marjorie, had a sexual affair that eventually came to light in the group. The other members reacted in various ways, but none so condemnatory or so vehemently as Diana, a harsh forty-five-year-old moralist who criticized them for breaking group rules: Tim, for “being too intelligent to act like such a fool,” Marjorie for her “irresponsible disregard for her husband and child,” and the libertine therapist (IY) who “just sat there and let it happen.” I eventually pointed out that, in her formidable moralistic broadside, some individuals had been obliterated, that the Marjorie and Tim whom Diana had known for so long, with all their struggles 26 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... and doubts and fears, had suddenly been replaced by faceless one-dimensional stereotypes. Furthermore, I was the only one to recall, and to remind the group of, the reasons (expressed at the first group meeting) why Diana had sought therapy: namely, that she needed help in dealing with her rage toward a rebellious nineteen-year- old daughter who was in the midst of a sexual awakening and searching for her identity and autonomy! From there it was but a short step for the group, and then for Diana herself, to understand that her conflict with her daughter was being played out in the here-and-now of the group. One neophyte leader facilitating an experiential group of pediatric oncology nurses (a support group intended to help members decrease the stress experienced in their work) inferred through the collusive glances between members in the first meeting that there was considerable unspoken tension between the young, progressive nurses and the older, conservative charge nurses in the group. The leader felt that the issue, reaching deep into taboo regions of authority and tradition, was too sensitive and potentially explosive to touch. Her supervisor assured her that it was too important an issue to leave unexplored and that she should broach it, since it was highly unlikely that anyone else in the group could do what she dared not. In the next meeting, she raised the issue in a manner that is almost invariably effective in minimizing defensiveness: she described her own dilemma about the issue. She told the group that she sensed a hierarchical struggle between the junior nurses and the powerful senior nurses, but that she was hesitant to bring it up lest the younger nurses either deny it or attack their supervisors, who might be so wounded that they would decide to scuttle the group. Her comment was enormously helpful and plunged the group into an open and constructive exploration of a vital issue. Members of a group of elderly clients attending a psychiatric day hospital for treatment of depression groaned with feelings of disconnection and despair. The initial focus of the meeting was Sara—an eighty-seven-year-old Holocaust survivor. Sara lamented the persistent prejudice, hatred, and racism so prominent in the news headlines. Feeling scared and helpless, she discussed her wartime memories of being dehumanized by those who hated her without knowing anything about her as a real person. Group members, including other Holocaust survivors, also shared their tortured memories. I (ML) attempted to break into the group’s intense preoccupation with the painful past by shifting into the here-and-now. What did Sara experience in sharing these memories with the group today? Did she feel that the group members were engaging her as a real person? Why had she chosen to be different 38 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... today—to speak out rather than silence herself as she has done so often before? Could she take credit for that? How did others feel about Sara speaking out in this meeting? Gradually the meeting’s focus shifted from the recounting of despairing memories to lively interaction, support for Sara, and strong feelings of member connection. Claudia resisted participation on a here- and-now level for many sessions. Typically, she brought to the group some 42 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... pressing current life problem, often one of such crisis proportions that the group members felt trapped. First, they felt compelled to deal immediately with the precise problem Claudia presented; second, they had to tread cautiously, because she explicitly informed them that she needed all her resources to cope with the crisis and could not afford to be shaken up by interpersonal confrontation. “Don’t push me right now,” she might say. “I’m just barely hanging on.” Efforts to alter this pattern were unsuccessful, and the group members felt discouraged in dealing with Claudia. They cringed when she brought problems into the meeting. One day she opened the group with a typical gambit. After weeks of searching she had obtained a new job, but she was convinced that she was going to fail and be dismissed. The group dutifully but warily investigated the situation. The investigation met with many of the familiar, treacherous obstacles that generally block the path of work on outside problems. There seemed to be no objective evidence that Claudia was failing at work. She seemed, if anything, to be trying too hard, working eighty hours a week. The evidence, Claudia insisted, simply could not be appreciated by anyone not there at work with her: the glances of her supervisor, the subtle innuendos, the air of dissatisfaction toward her, the general 43 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... ambiance in the office, the failure to live up to her (self-imposed and unrealistic) sales goals. It was difficult to evaluate what she was saying because she was a highly unreliable observer. She typically downgraded herself and minimized her accomplishments. I (IY) moved the entire transaction into the here-and-now by asking a question. “Claudia, it’s hard for us to determine whether you are, in fact, failing at your job. But let me ask you another question: What grade do you think you deserve for your work in the group, and what do each of the others get?” Claudia, not unexpectedly, awarded herself a “D–” and staked her claim for at least eight more years in the group. She awarded all the other members substantially higher grades. I replied by awarding Claudia a “B” for her work in the group and then went on to point out the reasons: her commitment to the group, perfect attendance, willingness to help others, great efforts to work despite anxiety and often disabling depression. Claudia laughed it off, trying to brush off this exchange as a gag or a therapeutic ploy, but I insisted that I was entirely serious. Claudia then insisted that I was wrong and pointed out her many failings in the group (one of which was the avoidance of the here-and-now). However, Claudia’s 44 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... disagreement with me created dissonance for her, since it was incompatible with her long-held, frequently voiced, total confidence in me. (Claudia had often invalidated the feedback of other members in the group by claiming that she trusted no one’s judgment except mine.) Political issues loomed large during this particular period of time, and understandably made their way into the group. There was a particularly intense reaction to the extant policy of separating children from their families as they crossed the border from Mexico to the United States. Group themes of “the bad guys win and get away with it,” as well as feelings of hopelessness and helpless rage, were prominent. The morale in the group was somber, almost despairing. I (ML) encouraged the members of the group to reflect on their feelings, and Nate, a depressed man in his mid-seventies, recalled a traumatic echo from his childhood. The recent forced separations reminded him of his own parents telling him, during the McCarthy era, that they might be arrested, because they were communists 48 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... and would be separated from him. He added that the anxiety provoked led to a mistrust of others and a lifelong fear of losing important relationships. We then turned our attention to his experience with us—how did he experience the group? Was he drawing closer or distancing himself? Were there times when he felt helpless in the group? How could we best comfort and support him? How did others feel about Nate’s personal disclosure? How well were we providing what he needed from us? At one meeting, Elena disclosed much deep personal material. The group was moved by her account and devoted much time to listening, to helping her elaborate more fully, and to offering support. The therapist shared in these activities but entertained many other thoughts as well. For example, the therapist wondered why, of all the members, it was invariably Elena who revealed first and most. Why did Elena so often put herself in the role of the group member whom all the members must nurse? Why must she always display herself as vulnerable? And why today? And that last meeting! So much conflict! After such a 54 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... meeting, one might have expected Elena to be angry. Instead, she showed her throat. Was she avoiding giving expression to her rage? At the end of a session in another group, Jay, a young, rather fragile young man who had been inactive in the group, revealed that he was gay and HIV positive— his first deep personal disclosure in the group. At the next meeting the group urged him to continue to describe his feelings. He attempted to do so, but, overcome with emotion, blocked and hesitated. Just then, with indecent alacrity, Vicky filled the gap, saying, “Well, if no one else is going to talk, I have a problem.” Vicky, an aggressive forty- year-old single woman who sought therapy because of social isolation and bitterness, proceeded to discuss in endless detail a complex situation involving an unwelcome visiting aunt. For the experienced, process- oriented therapist, the phrase “I have a problem” is a double entendre. Far more trenchantly than her words, Vicky’s behavior declares, “I have a problem,” and her problem is manifest in her insensitivity to Jay, who, after months of silence, had finally mustered the courage to speak. In one group, for example, Sonia stated that she felt others disliked her. When asked who in particular disliked her, she selected Eric, a detached, aloof man who habitually related only to those who could be of use to him. Eric bristled, “Why me? Tell me one thing I’ve said to you that makes you pick me.” Sonia stated, “That’s exactly the point. You’ve never said anything to me. Not a question, not a greeting. Nothing. I just don’t exist for you. You have no use for me.” Eric, later, at a debriefing session after completing therapy, cited this incident as a particularly powerful and illuminating experience. One leader led an experiential training group of mental health professionals composed of one woman and twelve men. The woman habitually took the chair closest to the door, but she felt reasonably comfortable in the group until a leaderless meeting was scheduled when the therapist was out of town. At that meeting the group discussed sexual feelings and experiences far more blatantly than ever before, and the woman had terrifying fantasies of the group locking the door and raping her. She 59 of 117 12/16/2024, 3:26 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... realized how the therapist’s presence had offered her safety against fears of unrestrained sexual behavior by the other members and against the emergence of her own sexual fantasies. (She realized, too, the meaning of her occupying the seat nearest the door!) In another experiential group of mental health professionals at several levels of training, the leader was much impressed by the group skills of Stewart, one of the youngest and least experienced members. The leader expressed his fantasy that Stewart was a plant—that he could not possibly be just beginning his training, since he conducted himself like a veteran with ten years’ group experience. The comment evoked a flood of tensions. It was not easily forgotten by the group and, for sessions to come, was periodically revived and angrily discussed. With his comment, the therapist placed the kiss of death on Stewart’s brow, since thereafter the group systematically challenged and undermined him. It is to be expected that the therapist’s positive evaluation of one member will evoke feelings of sibling rivalry among the others. Every step the group leader makes will be scrutinized by each member