Anne M. Slocum McEneaney
A TEACHING TALE
Although the interpersonal learning that can result from psycho- dynamic psychotherapy groups has been shown by both patients and therapists as among the most significant benefits they derive from group treatment (Yalom, 1995), many patients present for a group screening without having a clear understanding of how this learning will take place. Once it has been explained that this occurs by sharing one’s own experience of being in the group, including one’s impres- sions of and reactions to others, and by being as open as possible to hearing others’ impressions of and reactions to themselves, most pa- tients are intrigued, but wary. Many, even if interested in this idea, are unclear how being open might impact on themselves or others, and how exactly this would translate into learning something new about oneself that might change future behavior and the quality of one’s re- lationships. This intervention provides an example of a “teaching tale” that can be used to illustrate an incident of conflict, which led to interpersonal learning and growth for both primary participants and for other group members. It is useful to educate patients about inter- personal process, to demystify group psychotherapy (Rutan & Stone,
1993), and to serve as a model of growth-producing group behavior.
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SLOW-OPEN AND TIME-LIMITED GROUP POPULATIONS
This intervention can be useful in any psychotherapy group in which members focus on their interpersonal interactions in the “here and now,” so as to better understand and derive more from their rela- tionships with others. It has been successfully used in both “slow- open” and time-limited groups, with both adults and teenagers.
A PSYCHOEDUCATIONAL INTERVENTION TALE
Once group process has been explained in conceptual terms, the leader then says, “Let me give you an example of what I mean” and shares the following:
This happened many years ago, in a group of women with eating problems1. The members had met for five sessions and had
bonded quickly around their similarities and the relief they felt at being understood and not judged. By this session, however, several had begun to wonder, “Where do we go from here? Can I talk about the things that I am not sure everyone does share and will understand? Is it safe to go deeper?”
Naturally, people became anxious as they had these thoughts, and there were two members in particular who had very differ- ent ways of trying to manage their anxiety. One became very quiet and withdrawn, sitting all the way back in her chair; she was clearly paying attention to what others were saying, but just as clearly did not want to engage with others. Another member, very outgoing, became focused on wanting to connect to the others. She began to ask a lot of questions of the person to whom she felt least connected—who was, of course, the very quiet person.
So began the interplay in which one member peppered the other with questions about everything the second had ever previously said in group. The second, at first, gave brief answers, then monosyllabic ones, then said “leave me alone.” The interrogator would or could not, and the tension in the room rose, as these two became increasingly angry, and other members increasingly uncomfortable. After a few more minutes, I asked each of the primary participants to stop and tell
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the group what they had been experiencing, thinking, and feeling in this interchange.
Each said essentially the same thing: “I was anxious and when I get anxious, I get (quiet/try to connect). And I guess she doesn’t like that, and I guess she doesn’t like me, and I don’t like her either.” But, by hearing each other say this, each learned several significant things about themselves.
RESPONSES TO THE INTERPERSONAL EXCHANGE
First, each realized that she had been assuming that the other was acting as she was because the other did not like her. By hearing this, they each “got it” that the other simply acts in this way when she is anxious, and it really had nothing to do with her personally.
Second, each was able to see and acknowledge that this way of dealing with anxiety had consequences that they did not necessarily like or want, and that it had led to negative consequences for each in the past. Each had had prior experiences of being left out of social groups they wanted to join because they became anxious and so with- drawn or intrusive that others chose to leave them out.
Last, each member returned the next week and spontaneously said that if she had left last week feeling the way she felt during that angry interaction, she would have acted out her feelings in eating-disordered behavior over the next several days. But, because each was able to talk about the feelings generated and gain this new understanding of herself and the other person, they had not felt the urge to use the eat- ing disordered behavior. The feelings had been processed on the feel- ing level and did not need to be acted on behaviorally.
Other members talked about this experience as being powerful for them both in terms of vicarious learning and in helping them address their own fear and avoidance of conflict (also discussed in the group, after the primary participants had spoken)
CONCLUSION AND CONTRAINDICATIONS
This sort of psychoeducational modeling of interpersonal group process can be very useful to help potential group members who have the necessary skills in abstraction and introspection, but may not be
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familiar or comfortable with the (culturally incongruent) idea of shar- ing reactions and impressions (especially affective ones) with others, and may not understand the interpersonal benefit that may result from doing so in a psychotherapy group.
Such a therapy group may be contraindicated for people without these cognitive abilities. A person’s inability to understand this story, and its interpersonal implications, may be useful in making such a determination.
NOTE
1. This example is relevant, however, to any psychodynamic psychotherapy group.
REFERENCES
Rutan, J.S. & Stone, W. (1993). Psychodynamic group psychotherapy (Second edi- tion). New York: The Guilford Press.
Yalom, I, (1995). The theory and practice of group psychotherapy (Fourth edition). New York: Basic Books.