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Group therapy is an essential tool in therapy, especially for clients who feel isolated. What are some of your common fears when it comes to running groups? What major differences did you see when observing session 1 and session 3 in the video? 4 sources
Psychotherapy.net | Part 2: Understanding Group Therapy–Volume I
YALOM:
You know, Dan, all through this meeting I have really been aware of your silence. I almost get the feeling like you
are miles away somewhere.
DAN:
Well, I came five, ten minutes late, and I’ve been having a hard time figuring out what’s going on. And so I guess
that’s why I haven’t had much input.
YALOM:
You mean, since you were late, you never could understand what was happening here in the group?
DAN:
Yeah. I didn’t want to say something and not know what I was talking about.
ALLEN:
Well you know, you’re usually late. I was just wondering why can’t you get here.
BETTY:
Did something specific happen to you? I mean, something that made you late today, or what?
CATHY:
He’s very often late. I make an effort to get here on time. I don’t know why you can’t.
DAN:
Well, it’s my practice. You know, I have got a waiting room full of patients, and I have got somebody in every
chair, and I am a dentist. I can’t just walk out and leave somebody with a half-filled tooth.
DARLENE:
Well how about just, you know, rescheduling your clients?
DAN:
Uh, I wish I could. The turnover of my staff is really, really high. It’s chaotic, and then there are people calling in
for emergencies, and everything’s always changing. You know, maybe that’s something I can work on in the
group. would be my attitude toward management. You know, I really try to get here. I mean, I really do try to get
here on time, but it’s just impossible.
DARLENE:
I don’t buy it.
ALICE:
Well, I just get upset when someone’s not here. You know, I feel like it’s something I said, like last week when I
said you were a dentist 24-hours a day. I thought maybe I might have hurt your feelings when I said that, and it’s
just really been hard for me to concentrate in this meeting today. Just, you know, maybe you could call next time.
You know, call Joan or Irv, and just let us know you are going to be late so we won’t have to worry about you.
JOAN:
I second that, Dan. Otherwise it keeps the group members guessing as to what’s happening.
CATHY:
There must be a way for Dan to get here on time. You made a commitment to the group, Dan, to be here on time.
We all make sacrifices. I drive an hour from San Francisco and I get here on time.
BETTY:
There’s really no sin in building a little bit of slack into your schedule, you know? I mean, even if you got here a
little bit early you could, you know, sit outside and talk with everybody. That wouldn’t be so bad, would it?
DAN:
You see, this is the kind of pressure I get at home. I mean, between my patients and my staff and my students. I
teach at dental school, you know, and then my wife and my kid and, you know, I just need to give myself a little
slack, you know? To have someplace I can have some peace and quiet, and that’s maybe why, that’s probably
why I don’t say much here, because it’s nice to have a place that I can come to where there are not a lot of
demands being made on me all the time.
BETTY:
Yeah, but what about the commitment to yourself? I mean, this group is for you, too. I mean, if you don’t put
anything in, you just sit there silent, how are you going to get anything out of it?
YALOM:
Yeah, that’s a good question Betty. You know, I am just aware of your situation in the group today as I sort of
think about Dan. You know, the idea that you come late, that you are forced into silence because you don’t feel
you’ve got the right to ask anyone any questions, and remain kind of uninvolved in the group for the entire
meeting. There’s got to be some other options for you.
DAN:
Well, I could not come.
JOAN:
Do you want someone to summarize the group for you, Dan?
DAN:
I mean, I walked in and Darlene was going through this, what was a very important thing for her, and I had made
enough of the disturbance already just by coming late. I didn’t want to interrupt anything more that Darlene had
to do.
JOAN:
Well, how long would it have taken for someone to summarize the group for Dan, just a couple of minutes?
Darlene, would you have been upset?
DARLENE:
No, I really would have preferred, Dan, if he had, you know, asked for a summary, you know, rather than being
quiet. I would have liked to have known what you were thinking, what you had to say about what I was saying.
DAN:
Yeah well, um, yeah, but then there’s probably other people who don’t feel that way, who wouldn’t say anything
because they want to be polite.
JOAN:
Who’d that be?
DAN:
Well, Bob.
BOB:
I wouldn’t mind, and I wouldn’t be polite about it, either. It’s not a matter of being polite. I think it would be good
for the group.
ALLEN:
Yeah, I don’t mind.
DAN:
And Cathy?
CATHY:
I don’t mind at all. I’m with Darlene. I’d much prefer it than you being silent.
YALOM:
Silent and then not being able to offer anything, say, to Darlene, because of your silence. You know, just imagine
the situation reversed. Imagine that you are talking in the group, Darlene comes in a few minutes late, and she
asks you, you know, what’s going on? Would you mind summarizing for me real quickly? Would you mind?
DAN:
No.
YALOM:
You wouldn’t mind?
DAN:
No.
YALOM:
So it’s okay for Darlene to do that to you, but not okay for you to do that to Darlene. How come?
DAN:
I guess it’s okay for other people to do things that it’s not okay for me to do.
YALOM:
That sounds important.
JOAN:
Dan, as Betty pointed out, you do have a commitment to yourself by being in group, and I am wondering if you
have trouble asking for time from the other group members, whether you are able to get what you need from the
group.
DAN:
Yeah, I don’t think I feel I get my share of time here. Attention.
ALICE:
Well, how are you getting help, you know? I am not sure what’s happening here for you, Dan. You’re so vague.
DAN:
Well, these things take time. I mean, it takes x amount of time to fill a cavity. You can’t rush these things. I think
I’ve learned quite a bit here, so far.
CATHY:
I am still uncertain as to why Dan is here.
DAN:
Well, um, being here wasn’t really my idea. I am in marriage therapy. We have a counselor. And he suggested
that it would speed up the process if I joined a group. And this is my third marriage, and so I figured that
anything else that might help it work out ? I have a 2-year-old ? and so I thought it would be a good idea, and my
wife really pushed me, insisted that I do this.
YALOM:
So it sounds like you’re here because the marriage counselor sent you here, or because your wife insisted that
you’re here, or you are here for the marriage, but that you’re not here for you yourself.
BOB:
Why are you in marriage therapy?
DAN:
You know, I come home and I’m looking, hoping, for a little peace and quiet, and as soon as I get in the door, the
wife is at me with this and she’s at me with that. You know, I just feel like I don’t have any time of my own, you
know? And it’s just like that at the office, and it’s all day long. People are making these demands and those
demands, and then she does the same thing. You know, like we went on a vacation last summer to get away and
have a little time, and the first thing that happens, I mean, we go into this hotel and then she starts arguing with
the clerk about the room. It didn’t have a good enough view. And then she gets mad at me because I’m not
arguing with the clerk. I mean I wasn’t, I didn’t go there for more stress, you know. I went there to get away from
some of this and she just wants to bring it everywhere that we go and create it when there isn’t any. She is just
irrational. all the time.
BOB:
Well, I have a suggestion. Why don’t you try for like a 30-minute buffer time when you get home to provide a
transition from work to your home situation?
DAN:
We’ve tried that. I mean, it’s a good idea. It’s just that she gets. you know. She thinks about things all day, and
when I come home, she wants to deal with them right away, and she expects me to answer, and there it goes. I
don’t want to have to always be telling her or reminding her what the rules are.
DARLENE:
Why is she so unhappy?
DAN:
Well, you know, it’s the old thing about she decides to become a mother and then she’s sorry she gave up her
work and now she resents it.
CATHY:
Is she in therapy?
DAN:
Yeah.
ALLEN:
If it’s her problem, then why are you in treatment?
DAN:
Well, you know, we have to live with each other. I mean, it’s our problem. It’s not just–
JOAN:
Dan, maybe we should stick to your part of it.
DAN:
Well yeah, I mean, you know, I’ve got some problems I guess. I mean, we all have, everybody’s got problems, it’s
okay. Yeah, I mean, we could go back to when I was a kid. My dad was an alcoholic, my folks were divorced, and
so, and I never really felt comfortable at school because I was a kid whose folks were divorced. And I wasn’t
much of one for sports and I wasn’t competitive with the other boys, and you know all this stuff. But, you know,
that’s all past. I, um, I’m a very successful dentist. I’ve got a professional career, I don’t think it’s a problem
anymore, and I–
BETTY:
I still don’t understand. I don’t know where you fit in. I’m really stuck. How are we going to be able to help you
here if it’s your wife who needs the therapy?
YALOM:
Do you feel stuck too, Dan?
DAN:
Well, I mean, as I. sometimes I wonder what good the group is going to do but, you know, it’s been really
interesting for me. I mean, I have really. I have enjoyed watching everybody, and feel like I’ve learned a lot from
being a part of this.
CATHY:
I feel a little uncomfortable saying this but, Dan, remember what you told me when we went out for coffee after
one of the meetings? It was, oh, a couple of weeks ago. You said you felt like you weren’t getting any help at all
and that this group was an imposition on your time.
DAN:
Well, I didn’t really mean it that way. No. well, you know I have, like I said, I have a hard time getting here, and I
have to usually rush the whole afternoon to get here, and sometimes I wish it wasn’t quite so hard to get here.
But I find it very interesting once I’m here. I mean, I really enjoy it.
ALLEN:
Well just schedule one less patient on Wednesdays. Just one.
DAN:
It’s not that easy. I mean, emergencies come up and patients are always calling in with this and, you know,
things are not in my control all the time.
YALOM:
You know Dan, I’d like you to go back just a few minutes, back to what Cathy was saying to you about your
conversation with her outside of the group. I think it’s so important for you to try to speak here spontaneously
because I think you have got some really strong feelings about the group that you were honest in expressing to
her, feelings about what you are not getting from the group. So I wonder if you could try expressing these. Tell us
exactly what you think about the group without quite being so tactful, without being so diplomatic, without
worrying quite so much about how we’re going to feel. Could you speak right from the heart? Speak straight?
DAN:
It’s the same thing. I mean, speaking from the heart, I have really found this group interesting, and I really have
learned a lot from being here and watching everybody and what they do, and being part of this group.
JOAN:
Notice what you’re feeling, Dan. Try this: All this time wasted, all this money wasted, all this rushing around, all
the stuff I’m doing, and it’s my wife’s problem, not mine. I am not getting a goddamn thing from all this.
DAN:
Well, you know, I never said that I felt that it was a waste of time being here, or that I. Well, the rushing around
it, it’s a little inconvenient. But I mean, it’s the price you pay for something like this, that’s all. That’s all. I really
find it interesting. It’s worth it to me.
YALOM:
Where are the rest of you on this? Could we give some feedback to Dan? What are you all feeling at this point?
DARLENE:
I feel like I don’t know what you feel.
BETTY:
I think he is a really nice guy.
CATHY:
Maybe too nice.
YALOM:
Listen, try this.Just try a thought experiment for a couple of minutes. You see Dan here, you live with him, in a
sense, for an hour-and-a-half once a week. Just imagine living with Dan, each of you, being married to Dan,
relating to him 24-hours a day. What kind of experience would that be like? You know, get yourself into that.
What feelings would get evoked by that experience?
ALICE:
To me, to me it would be like living alone. You know, this. Remember Dan, you said once that your wife accused
you of being absent? For me, that’s a perfect word for you: absent. You are never really here with me. I mean,
look at your chair. Even your chair is a couple of inches out of the circle.
CATHY:
Yeah, you know, I’ve noticed that too. I mean, it’s not enough to comment on, but it’s certainly enough to be
irritating. I don’t know, it would be so frustrating never being able to find Dan. Not knowing where he was.
DARLENE:
Yeah, I mean, it wouldn’t feel like a marriage. I mean, I really wouldn’t feel like I know who you are and, you
know, it would feel like you were trying to manage me, not relate to me.
BETTY:
You know, I think I’d be constantly saying, “Where are you?” You know, “I can’t find you.” I really think that I
would be getting angrier and angrier, too. I’d put a lot of demands on you. I’d probably even get shrill or
irrational just like your wife. I really think so.
YALOM:
You know, I’ve been aware, over the last few minutes, we’ve been sort of escalating the force of our comments to
you. I think I have been doing it. John’s been doing it. I think all the people here have been doing it, and I think
it’s an important phenomenon that’s been occurring. It’s almost as though that to kind of get through and help
you speak with your real voice, we’ve got to keep on getting more and more angry, or to use Betty’s words, more
and more shrill. It’s almost a replica, I wonder, of what might happen at home, you know, that your wife
somehow kind of increases the ante, increases the ante, keeps on knocking, in a way, to kind of help you talk in
your real voice.
DAN:
Hmm.
YALOM
This vignette illustrates many important issues for group therapy technique. First of all, early on there is a
COMMENTARY: mention of Dan’s coming in late and the fact that that tends to be disruptive to the group. Alice mentioned, for
example, that when he was late she began to have fantasies about whether it was something she had done in
the previous meeting. And so we set down a rule that I think is important for groups: that when people are going
to be late or when people are not going to be able to make it, that they call in advance just to quiet down a lot of
often wasted activity for that. But I think there is a very important issue that’s fairly clearly illustrated in this
vignette, and that had to do of course with the question of Dan and his relationship to his wife, but also his
relationship to the other group members. You know, at first Dan says, well, it’s not his fault, nothing is his fault,
not even his lateness is his fault. The group tends to give a lot of suggestions about things he might do about
that, but pretty soon they begin to see he has a ready rebuttal for each of these answers. And I think gradually
the group begins to discover that the reasons for his lateness are pretty deeply ingrained in the depths of his
personality structure.
Dan’s posture throughout this part of the meeting is that it’s not his responsibility, that these are things that his
wife does. That it’s not even his responsibility that he is in therapy; that he was sent, sent by other people, sent
by his marriage counselor, sent by his wife. The group starts to deal with this with some suggestions that are
offered, but suggestion and advice given by groups is almost invariably a fairly ineffective way to operate in a
group, and you begin to see how that operates. People say, well how about a 30-minute buffer zone when you get
home, how about filling one less cavity, scheduling one less patient, but each of these are rejected. Then the
group begins to suggest, well listen, if it’s your wife’s problem, what are you doing here? What is your role in
what goes on and what goes wrong in your relationship? That begins to move the things into a somewhat more
fruitful direction.
Then later, we begin to get some feedback for Dan, not about suggestions, not about ideas that they have about
his marital situation, but how they are feeling about his behavior toward them right here, in the here-and-now.
And then, in fact, when we begin to up the ante on that and sort of increase the leverage by getting feedback
about how people would feel, not by just living with him for an hour-and-a-half a week, as they do in this group,
but suppose they lived with him for 24-hours a day at home? Then the feedback became, I think, much more
pointed. People began to say, well, they’d feel they couldn’t find him, that he was absent, that even his chair
being outside of the circle was reflective of his being absent. Or that they’d feel that they were managed, they
weren’t really being cared for in a relationship. And so then, gradually, what begins to happen is that soon the
situation outside of Dan’s marriage begins to be recapitulated in the here-and-now of the group in a way that I
think is fairly self-evident on the tape. The tone begins to be more shrill, there is a sort of sledgehammer
approach, where people are becoming more and more forceful. In other words, to make Dan hear, to try to
understand and experience what his real feelings are because no one really knows what he feels. He is always
checking out the environment, saying what people want from him and then tending to give them that. So you
lose the person in there.
And that, of course, illustrates this extremely important aspect of group theory, which is the idea that I alluded to
in the previous tape, that the here-and-now, in the here-and-now, that the group operates as a social microcosm.
That behavior that people manifest toward others in their life soon begins to be manifested toward other people
in the group, provided you don’t structure the group too heavily. Sooner or later all these traits–of people are
arrogant, or people are obsequious, or people are vindictive, or people are self-effacing–all these traits begin to
be evident in the way that people respond toward others in the group. So there is no need to spend a great deal
of time on people giving you information about the past or even about their present life. It begins to transpire in
the living data that we begin to examine right in the group.
Now, that means that the focus on the here-and-now deemphasizes the past historical material, deemphasizes
even the current outside material that’s going on in your life right now. By deemphasizing, I am not saying that
we are negating the importance of these, but I am saying, from the standpoint of therapeutic power, we are
much better off by focusing on the immediate transactions that occur within the group.
Now, there is one other point that just is mentioned in a second but it’s worth taking a look at, and that’s the
issue of extra-group-socializing in a therapy group. That occurs in almost every group. I have long ago leaned
that it’s an error to say to members of the group that you don’t want members to see one another outside the
group. Because what happens then is it almost invariably does occur, and then members keep it secret. They
don’t tell you about it, or it becomes a whole issue of whether or not they are breaking your rules or not breaking
your rules. So I feel that it’s much more important to explain to members how extra-group socializing can get in
the way of therapy. And it usually gets in the way of therapy if members meet outside the group and form some
type of relationship that becomes very important to them and then they keep that secret. There is a conspiracy
of silence around that, so they don’t talk in the group about what they have talked about outside the group. And
then they cease to be of use to one another because they stop talking to one another in the group; they don’t
want to betray the friendship or betray what the other had said.
So extra-group socializing can be, in a sense, injurious to the group. But if, on the other hand, you have made it
very clear to the group members why it’s injurious to the group, and elicit some type of contract from them, that
if they do meet with others outside the group that they will take it as their responsibility to bring that material
back into the group, you know, then it can be quite facilitative of the group, and indeed that’s exactly what
happened in this group when Cathy mentioned that she had met with Dan outside the group and then related to
the group what Dan had told her about the fact that he had said to her that he had severe doubts about whether
or not this group was being useful.
Incidentally, when you have made it very clear to the group members about why extra-group socializing can in
fact get in the way of therapy, can sabotage the therapy, and then it happens you are in a much stronger position
to confront the patients, because you’re no longer confronting the patient with the issue of how come you are
breaking my rules, but you are confronting the patient with the much more powerful question of, well, how come
you are sabotaging your own therapy? I think you’ve got much more leverage when you are in that direction.
Okay, now let’s turn to our fourth and last vignette. This is an episode that occurs in the eighth meeting, toward
the end of the session.
ALLEN:
This is something I have been wanting to tell you. I’m bisexual. I guess I had to get that out, you know? Like, I
guess I wouldn’t be helped if I didn’t.
YALOM:
I’m glad you’re bringing it up.
DAN:
Um, is this, has this been something that’s always been the case?
ALLEN:
Well, I guess ever since I was around 13, I guess I felt that way.
BOB:
You know, I’ve always been, you know, I really don’t understand bisexuality. What’s. is there a predominant
preference?
ALLEN:
No, not really. I guess I’m pretty lucky. I have the best of both worlds.
JOAN:
Is this one of the reasons why you broke up with your girlfriend?
BETTY:
I’ve heard that bisexuality is related to families that don’t have a father, or the father is there but he’s not around
very much. Is that the case with you?
ALLEN:
No, I’ve never heard that before, you know. Our family was very supportive. My father was there. We’re the tight
knit group.
BETTY:
Doctor, do you find that to be the case?
YALOM:
No, I’m not sure about that, Betty. But you know, I am very much aware, though, of something else, and that is
that obviously it’s difficult for you to say this in a group. I am sort of thinking of what it’s been like for you to
come to the group for eight sessions and have this on your mind and be unable to say. What kind of experience
has that been for you?
ALLEN:
Well, you know, I’ve been wanting to tell you for some time, and last week I was going to come in and tell you,
last week, and when I got here, I guess I chickened out again.
YALOM:
What were your fears or fantasies of what would happen if you were to bring this up?
ALLEN:
Uh, well, you know, the usual. What people say behind your back, and, I mean, this is the first time I have ever
said it to anyone, you know, publicly, and I feel that, well, I felt from the beginning, I have a part that I play in this
group, and this is where I belong, I feel. I’m stuck between two different worlds.
CATHY:
Well, I feel you belong here very much. And I’ve always thought you were very forthright and refreshing.
ALICE:
Allen, I have gay friends, and I am sure the other group members know people who are gay. I really don’t think
you should feel that different.
ALLEN:
Well you know, it’s, I guess it was the. I guess it was the men, you know. It’s like, you know, if you tell them
you’re bisexual, they think you are trying to make a play for them or something. You know, there are so many
stereotypes, so many distortions about the “gay world.”
DAN:
You know, I don’t think that you have to worry about this group. I think the group is going to be very supportive
for you. And if you are worried about, I mean, not for myself, it’s not a problem.
DARLENE:
I don’t feel any differently about you. I mean, we may not be big buddies, old buddies in this group but, you
know, we have been together for eight sessions and, you know, we still care about you.
BETTY:
Oh sure, we’ve all gotten to know you in all the sessions and everyone has really appreciated what you have
contributed to the group. So I don’t think anyone’s going to change their opinion of you.
YALOM:
You know, I am so pleased you are able to bring this up. I am also curious as to what’s made it possible for you to
bring it up to the group today.
ALLEN:
Well, I guess the last few weeks I have felt more trust, and I just feel comfortable with the group.
YALOM:
And those fears you had about bringing today, you felt that you would lose face, you know. Before whom would
you lose face? Who is going to judge you? Who is the chief justice here?
ALLEN:
You, Joan. You know, I know I was supposed to tell the truth in the initial screening and I felt that, you know,
maybe I would probably be refused. I really hope you are not angry today.
YALOM:
You mean you thought that if you told Joan and me when we first saw you about your bisexuality that we would
have rejected you for the group?
ALLEN:
Basically, yeah.
YALOM:
Never would have entered my mind.
ALLEN:
No.
YALOM:
And the other judges. Who else, do you think?
ALLEN:
Well, Darlene and Bob. You know–
BOB:
Well, to be perfectly honest, Allen, I certainly wouldn’t be in judgment of you. Actually, I, when I was 11 or 12, I
had a homosexual experience with a really good friend of mine. And quite a few years after that I was really
conscious, worried, about my sexual, my sexual place in the world, I guess. Yeah.
ALLEN:
I don’t know. I tell you, it’s so difficult being a part of the gay community. You know, uh, I mean especially today,
you know, with all the AIDS thing, you know, and everyone is so frantic, you know. Almost every woman that I’ve
known, when I told her that was bi, she freaked out. And it seems that even after all of that, no matter how
difficult it is, I don’t see myself changing. Because I live a heterosexual life. I want a family. I deserve–
YALOM:
I want to just interrupt you for a minute, Allen, because I think something really important happened here just a
couple of minutes ago I want to just focus on, just a second. I am really interested in Bob, and what you just said
about your own gay experience when you were younger. Have you ever said that before to anyone else?
BOB:
Once, uh, 10 years ago, to my therapist.
YALOM:
And until this moment, this group, you have never told anyone else, never told peers?
BOB:
No, I have never told to any group of people that, no.
YALOM:
I have a hunch that that was a real gift to Allen.
ALLEN:
I don’t know, I guess I get so wrapped up in my own emotions I don’t think about other people’s feelings. I guess
that’s what Betty meant when she told me about it a couple of weeks ago.
DARLENE:
Allen, I don’t think you’re still acknowledging Bob’s gift to you.
ALLEN:
I guess you’re right. Uh, I don’t know why it is so difficult just to come out and say thank you. I mean, thank you
all, because you all have been supportive and you have all helped me. I appreciate it. I got it off my chest.
YALOM:
I’m glad you did, Allen. Do you feel, do you feel finished, or are there other parts that you want to work on today?
ALLEN:
Well I, well no, no, not, not, not today.
YALOM:
That’s as far as you want to go today?
CATHY:
Well, I am concerned about Betty. Earlier, Betty, you mentioned about your daughter’s drug problem. But I don’t
think you were finished.
ALICE:
Yeah, Betty, I feel like we all left you hanging, and now we are almost out of time.
BETTY:
No really, I feel fine. You know, we talked about it, I got it out and spoke with you, and no, I feel fine about it.
YALOM:
Betty, what did you get from the group today? I know you brought up the really significant problem. What do you
feel that we were able to give you?
BETTY:
Well, I don’t know, I think what I really wanted to do the most was bring everybody up-to-date, you know, on
what was going on in my life. That’s really about all I wanted to do. Yeah, I feel fine.
CATHY:
But I am still wondering exactly what you got from this today, Betty. I mean, she brought a problem to us, and
we were never able to solve it for her.
ALICE:
Yeah, what would be a solution to her problem?
DARLENE:
Can we ever really solve a problem in the group? I mean, it’s so complicated. I mean, what’s happening with you
and your husband and your daughter. I mean, we only know it from Betty’s point of view. And that’s just a small
part.
BOB:
Yeah, I know. Um, you might say I’m an engineer again, but how can we really deal with a problem when we’re
dealing with partial or inadequate data?
DAN:
Yeah, yeah. You know, you mentioned earlier that this was something that you brought up with your individual
therapist, and it seems to me like maybe that’s the more appropriate place to deal with it, that he is maybe able
to lead you to resolution, whereas the group really can’t.
YALOM:
So the issue, then, is if the group can’t deal with this problem, or that we are going to get inaccurate data, or it
should be dealt with in an individual therapy. It still leaves the question of what role this group can play, how this
group can be helpful.
JOAN:
What did you get today, Betty? What did you want when you came in the group today?
BETTY:
Well, as I said, I wanted to talk about it. I think that really helps me when I can just talk it over with you and kind
of bring you up on what’s going on. And that’s about all I really need, you know. Like you said, I had mentioned
that I talk about it to my therapist, but it’s not the same, you know. There is so much support here in the group.
When I can talk with all of you, I get that real supportive feeling.
ALICE:
Well, you got a lot of advice today,
BETTY:
see a lawyer, family meetings with your husband and daughter, and a drug rehab program for your daughter. Do
you think these suggestions are going to help?
BETTY:
Well, they’re all wonderful suggestions, they really are, you know, and I appreciate all of them. But the trouble is
I have to get others involved to go along with it, you know? Now, I did get a lawyer, but that hasn’t helped with
getting any support from my husband at all, you know–none. And as far as my daughter is concerned, I’ve been
trying to get her into a drug rehab center for a long time and she just will not go. And I can’t get her to go, no
matter what. And then I feel if I really push her in there, you know, or get her in there against her will, that’s not
going to do any good anyway. So I’m, you know, kind of at a standstill.
YALOM:
You know, I am aware that we seem to be kind of circling things, because I know this sounds very much like what
we were saying at the very beginning of the meeting. And, you know, on one hand you could think that, uh, Betty
says, well, she’s satisfied with what she got from the group today. But on the other hand, we can’t seem to let it
go. We keep on coming back, we keep on circling back, coming back, coming back to Betty even though she says
she is satisfied with what she got in the group. You know, the reason that, particularly, I think it’s important, is
because I think we have been doing something similar about the last three meetings. You know, somebody is
coming into the group with a real-life crisis, and we don’t seem to be able to find a way to solve that. And yet we
can’t let it go. So the whole meeting has been very much directed with all of us trying to do one-to-one work with
each person. So I guess the issue here is, are you satisfied with that? Is that what we want to be doing here? Is
that the best way to use the group? How did that pattern get started, you know? It wasn’t my idea or Joan’s.
DAN:
No, I. Speaking for myself, I think that, like, when you told this, that today, about your daughter, especially, I
mean, I felt so bad. I really wanted to be able to help you in some way. And you know, there’s something else
about it, too. I mean, I don’t really feel like you’ve gotten enough time in the group, and, like the time I had–a
few sessions ago–I mean, there was tremendous. it was tremendously helpful. And so, also, I guess it’s a way of,
of?
YALOM:
You mean the time you were talking about your problems with your wife?
DAN:
Yeah, yeah, the thing with the marital difficulties. Um, I guess it’s a way then, also, of repaying you, in a sense. I
mean, giving you your time, because I know how valuable that is.
YALOM:
Yeah, that’s a really good point, Dan. You know, I think that was a really good working meeting. You remember
that meeting? I wonder who has got some ideas about what was different about that meeting from what we’ve
said or been doing today or the last couple of weeks. Any ideas how we worked differently with Dan?
BOB:
Well, um, the one thing I noticed was, as a group, we started with Dan’s problem that was outside of the group.
We brought it down to what’s Dan’s role with his problem and his responsibilities with what is going on with his
marriage. And we brought it even further into the group with bringing that into what was his relationship with the
women in this group.
CATHY:
I think we seem to work much better when we stick to things, problems right here in this group.
DARLENE:
But it was different today with Betty. I mean, she was really hurting. I mean, what are we supposed to do? Say,
“We don’t deal with life’s emergencies,” you know? “You’re about to lose your kid,” but that’s not important
enough? I mean, I agree with you. You don’t get enough time, Betty.
YALOM:
You know, we all seem to agree here that when we focus on what’s happening right here between people, that’s
when we do the best. You know, that’s happened over and over again in the group, you know? But we’ve got a
real dilemma that’s come up today and the last couple of weeks. What happens when someone brings up some
sort of real outside important crisis in their life? You see, what’s been going on today is that we try to find some
way to solve that, and we’re generally, for lots of different reasons, pretty ineffective at that. And we sort of know
we are ineffective, and I am pretty sure that’s one of the reasons we are not able to let it go and we keep on
circling, coming back to it. But on the other hand, you know, like Darlene says, we can’t simply not pay attention
to that; that would be insensitive. So, you know, that’s a dilemma that we are facing. We have to find some way
to do something about that. And we’re going to have to stop today. Our time’s just about up. But I think one of
the things we have to work on is how we can find a way to offer you, Betty, something right here in the here-andnow; how we can help you more effectively.
ALLEN:
You know, I know we’re almost out of time, but I just wanted to add that I am having trouble finding something
for Betty. I mean, I know she is hurting, but I don’t know if or how or how much. Like, even today, it’s obvious
that she is in some sort of pain, but I’m just guessing, because it’s no pain that I can see.
CATHY:
Asking for help is certainly not Betty’s strong suit.
YALOM:
Yeah. You know, I think this is really important. I think this is a good, a good clue, because I’ve got very much the
same feeling. You know, my feeling is, Betty, that you are very good at giving help, very good at it, but you are
not good at finding ways to get help from other people. Yeah, speaking for myself, I find that I usually want to
find ways to be more helpful to you and I can’t find a way to do it, you know? And in fact, you settle for very little
in the group. Today, you settled for I-just-want-to-be-heard, and that’s all, and I feel there’s a lot more we could
give you, so that’s something we really need to look at in the future. Okay, we gotta go.
DARLENE:
No, no, no wait, wait. I’ve got something I want to say. My therapist told me to tell you, I am quitting my
individual therapy.
DAN:
Your therapist? I didn’t know you had an individual therapist.
DARLENE:
Well, I have. It’s this telephone therapy.
DAN:
Dial-a-Shrink. DARLENE: Well no, it’s this therapist that I had when I was in Atlanta before I moved out here, and
then we just stay in contact, and every couple of weeks, you know, I have been talking to her. Well, glad I told
you.
BOB:
Well, you certainly didn’t leave much time for us to discuss that in the group.
ALLEN:
Now what’s this business: Your therapist told you to say it? Does that mean you wouldn’t have said if she hadn’t
told you?
DARLENE:
Next time, Allen.
YALOM:
This vignette illustrates another aspect of norm setting. We talked about other norms that we want to set in a
therapy group. And in this segment we are looking at the issue and the norm of self-disclosure. I think every
therapist who leads a therapy group will agree that self-disclosure is important. It’s important that people
disclose. It’s important that people disclose very fully as they go ahead and go along through the therapy group. I
feel that I’d like members to do that. I’d also like them to feel, however, that the group is not a forced
confessional, that people can disclose when they’re ready, when they feel enough trust in the group. They can
disclose at their own pace.
But there is another issue of disclosure that I think we should look at in this vignette, and that’s the difference
between vertical disclosure and horizontal disclosure. And by that I mean that vertical disclosure is disclosure in
depth. Disclosure as you plunge into the type of material the person is talking and describing. Whereas horizontal
disclosure is disclosure about the disclosure, meta- disclosure. And in a group, I think that you are far better off
in the therapy process by encouraging horizontal disclosure rather than vertical disclosure. So in this vignette,
Allen discloses a big secret, and the tendency of the group, and the tendency of most groups, is to probe for
more vertical disclosure. People began to ask about more details about bisexuality: Well, when did it begin?
What’s it like? Who do you prefer? What sex do you prefer? Or they began intellectualizing by talking about, well,
about family patterns in bisexuality. So my stance and my response toward Allen was always in the direction of
asking for more horizontal disclosure. So that’s why I asked him about how hard it was for him to come to the
group all these weeks and not talk about this. That’s why I wondered to him about what made it possible for him
to talk about that in the group today, or had him take a look at why he was afraid, what some of his fantasies
had been about, what might happen were he to disclose that. Then I brought up material about his fears about
my response, or about my co-leader’s response, or his fears about the men’s response to him in the group.
Another important concept that comes up in this vignette, I think, is the fact that therapists in groups must make
use of process; we think in terms of process. Now, the word “process” has a lot of different definitions; people use
the word in different ways. When I use process, I mean it as almost an antonym, in contrast to content. Let’s say
some people are having a discussion. You ask, well, what’s the content of this discussion? It’s pretty obvious:
content is the actual words, actual issues being discussed. But suppose you ask the question, what’s the process
of this discussion? Well, the answer to that question is you ask the question, what do these words tell you about
the nature of the relationship of the people involved in the discussion? So when we ask a process question, or
when we maintain a process orientation, we are always looking at the nature of the relationship of each person
involved. And I think there were two incidents in this group that illustrated that.
One of them was when Bob said that he, too, had had a homosexual experience when he was quite young. And
notice what happened then, was that Allen, in a sense, didn’t acknowledge it; he simply went on talking about
another issue, without somehow acknowledging Bob. So then we began to comment on what the process of that
was; the process of that being that Bob had given Allen a gift, and Allen had refused to acknowledge it; that Allen
had some significant issues that came up many times in this group in many different ways around intimacy, both
with men and with females. He had a compulsive sexual pattern, a way of dealing with both men and women,
but shied away from deeper intimate levels, and the fact that he shied away from Bob’s really reaching out to
him in a very human way, finding it extremely difficult, very embarrassing to thank Bob for his gift.
I think the other example of a process issue came up in the very last minute of the group when Darlene
announced to the group that she was, at that point, finishing therapy, and that her therapist told her to say that
in the group. Now, she didn’t leave much time. We don’t find out much about that, about what the meaning of
that comment was. It wasn’t until a later meeting that we did. But if we, from the information that we were able
to accumulate later, it seemed like there were some interesting process issues. One, which was the idea that
Darlene had to almost convulsively break into the group, raise her hand to get some time, and that was a
reflection of her feeling that she didn’t have enough time in that group, or that the group was so busy with other
things that she had to almost burst in. I think the other thing was the fact that she was in essence saying to the
group that, because she was stopping therapy with her individual therapist in Atlanta, therefore she was going to
need a lot more support, a lot more attention in this group, and that was hard for her to say in any explicit way.
So she disguised that as, if you will, by saying, well, my therapist told me to say that. Or she left it at the very
last minute of the group so there wasn’t time for her to go ahead and discuss this openly. And the group caught
all this, I think, just the very end, the couple of times by the men in the group.
Now in this vignette, the group is also struggling with some procedural norms about how groups work, how this
group could work. One of the things that had happened was that in the previous three meetings, I felt the group
was having a difficult time with procedure because they had been crisis-oriented meetings. In other words, a
member came in, brought a crisis, a real-life crisis, the group had spent a lot of time trying to focus on that crisis,
and they had been fairly ineffective, meaning that is not a good way to use a therapy group. The idea of
someone bringing in an outside problem, members struggling to give suggestions about how to solve that
problem, is probably one of the worst ways to lead a group. So I was being fairly active here in trying to intercept
that process from continuing. So I had tended to, in a group, to identify that issue; say, look, this is what we’ve
been doing. I wanted to let them know that it was a procedure that had evolved from the group itself. It wasn’t
my idea. This is not my idea of how the group should proceed. I also wanted to let them know that it’s been
problematic; that we’ve not been able to solve problems in the way the group set about to do that for a number
of reasons. One of them was Bob’s, uh, as he put it, his engineer reason, that the data is inaccurate; we only had
partial data, and groups can’t come up with a very workable solution under that situation.
And then we went on to talk, as Dan said, “Well, I got a lot of help talking about the outside problem.” So I quite
intentionally asked the group by saying, “Well, what did we do differently with Dan in that last episode, that last
vignette?” And they could themselves say, well look, we went from the outside issue, the why he was relating in
the group, the way he was relating to the women in the group. And that was where the work was done. And so
then, at the very last part of that episode in this vignette, we then were struggling with the fact, well you know
we have got to find another way to offer her help, rather than talking about the crisis that she has outside. And
the group was just beginning to arrive at some ideas about that, and they began to notice, well, she doesn’t ask
for help very easily. That she is a very good help giver but not a very good help taker, or that she is satisfied with
very little, or that she doesn’t show her pain very much, so we don’t know how and which ways and when she is
hurting. So I think that the groundwork was already being laid at that point for future working groups with her in
the here-and-now, rather than with her around resolution, solving this outside crisis.
You notice in this vignette and also in the previous three, the therapists have been fairly active. You know, I have
felt that it’s part of my role to be quite active in shaping this group, shaping the norms, moving the group into the
here-and-now, reminding them of how the here-and-now was most active, finding ways to get them from the
outside material into the inside material, from impersonal material into personal material. As this group was to
continue in the future, those efforts would be far less necessary on my part. The norms had become integrated,
had become much more automatic on the part of the group members, the group members themselves were
aware that they work more effectively in certain ways and less effectively in other ways. So this group, by the
end of this eighth meeting, was poised at this point to enter into a state of a much more mature, hardworking
group.
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