+ Contrast Between Individual and Group Session Process
Individual Session
The following is a description of an ‘Individual Session’ wherein the client, Todd, starts to discuss the loss of his dog, the stress encountered with the loss, and the long-held difficulty in approaching his own vulnerability. In the way in which I work, I maintain ‘individual sessions’ with a client while she/he is also working in group psychotherapy. In this case, the client Todd, is also in a weekly therapy group. Note the overlay of the clinical issue and how it is worked through during the ‘individual session’ and how, in contrast, it is worked through during the ‘group session’.
Therapist: (Saying to his 38-year old male, father of two after the death of his dog to cancer)....”You look pretty beat up today.”
Todd: “Exhausting night! We went to the vet to put our 12-year old Shepard, Lilly, down. She had cancer and was not eating, very frail, and her body was ravaged. My oldest son, Clay came along (Clay is 8) and insisted even though I wasn’t sure it was a good idea. My wife was there too and I had my sister sit with my little girl. It was pretty sad.
Therapist: So sorry to hear that Todd. Lilly had been with you when you and your wife first met at the dog park.
Todd: Absolutely. Kate (Todd’s wife) was more smitten with Lilly than me. Lilly was boundless play and friendly, much to many peoples’ surprise and delight. (Todd shows some mist in his eyes as he reminisces).
Therapist: How hard that must have been for you, Kate and Clay.
Todd: It was a tear-fest and we had to hold Clay for a long while before driving home. He did not want to leave Lilly at the vets. He wanted to bury her in the back yard....he was inconsolable for a good 30-minutes. Kate was holding it together very well until the end, and then she broke down about all the memories and then her and Clay were holding each other for a long while in the room with Lilly just laying there. It was so sad.
Therapist: I’m glad to hear you express your sadness Todd. Lilly was a bunch of work early on with her testiness, but you and Kate, and then the kids made her more of a family dog. I remember your pride when you brought her in for a visit after Clay was born (Todd and the therapist have been working together for 9-years).
Todd: (Nods but more stoically)...I am pretty sad, but I can’t get to it. I feel more stuck and just dead tired. And to be frank, I am relieved that Lilly is not suffering any more. She was a ton of work and expense at the end. We could not get into an extended chemo treatment and the vet was kind enough to say she wouldn’t recommend it.
Therapist: Anger and kidding have always been easier for you than the sadness Todd. It may be stuck for a bit but I trust that you will find it if you want.
Todd:Yeah! Kate and I got into a bit of snit this morning when we were dropping the kids at school. We were able to pull it in quickly as we realized we were both pretty raw, as was Clay and Maria (their 5-year old).
Therapist: You might want to share this with the group tomorrow (Todd was involved in a weekly group and once a month individual therapy. Todd was a well accepted and liked member of a 5-year old, co-ed, 75-minute weekly group with 7 other client members).
Group Session (6 of 8 members attending, 2 away on travel)
The thematic issue that Todd raised in Individual Therapy can be addressed in Group Therapy with a slightly different approach. In this the case, the ‘members’ of the group work to express and support and challenge Todd. This group has convened for several years. In this instance, Todd was an original member of the group and there are a myriad of overlapping relationships just like in ‘real life.’ See what your own reaction and understanding is of the contrast between group and individual session work.
Client 2: “I need some time today as my anxiety is through the roof about work.
Client 3: “ I would like some time too to check in”.
Todd: “I guess if there is time remaining I would like to check in too”
{Client 2 and 3 do their pieces of work with about 20-minutes remaining for Todd to come forward with his request}.
Todd: “Brian (the therapist) thought it would be good for me to talk about the loss of Lilly. We had to put her down on Sunday after a short fight with an aggressive cancer”.
Client 4: “Say it ain’t so Todd. So sorry, Lilly was a great dog! What a character....so sorry to hear Todd.”
Client 2, 3, and 5 similarly say....something like...”so sorry to hear Todd."
Client 6: {after a brief pause.. She and Todd routinely cross swords with one another ...sometimes playfully and sometimes not....} ...”So ‘Brian’ thought it would be good idea for you talk about Lilly passing?”
Todd:“Yeah, I get your meaning...Hillary/Client 6”.
Client 3: “Can you decode this please?”
Hillary: {to Todd..} “Do wish to unpack this or not?”
Todd: {towards Client 3/newer member} “Hillary knows from years of clashes, skirmishes, tweaks, and such that I much rather joke but am almost always ready to fight. {towards Hillary....} “How’s that?”
Hillary: {looks at Todd..but remains silent}
Client 2: “Todd....’Brian’ suggested? Made? Coerced? You to bring this in?”
Todd: {flippantly}...”Practically held a gun to my head!” {few chuckles}
Brian/therapist:: “Water gun full of tears”...{Todd winces}
Hillary: {towards no one in particular but directed at Todd}...”Apple doesn’t fall far from the tree.”
Todd: “Ouch”.
Client 3: “I’m lost’”
Client 5/ Tony: { who has a very solid and openly friendly relationship with Todd in the group as they have been adoptive group brothers for about 5 years....towards Client 3..} “Todd comes from a long, long line of combative but affable men who typically steer clear of any vulnerable feelings like sadness, tenderness, sickness, death, etc.. We have been at this with Todd for a number of years but most recently when his wife Kate and he got into an extended fight about how sad she was with her sister’s cancer. Todd does not like to linger in this territory for himself as well as others, including his wife Kate. Todd’s ‘dad’ would never had been in a therapist’s office let alone a group....so Todd is trying to roll a bit away from the tree.”
Todd: “That was excellent Tony.”
Brian/therapist: {towards Todd...} “Maybe you might benefit from talking aloud about what happened on Sunday night?”
Todd: {towards Brian/Therapist}...”What do you mean?”
Client 3: “Like what happened on Sunday? {...gently..}..How did you handle putting your dog down?”
Todd: {..somewhat sharply toward client 3..}...”Lilly!”
Hillary: {....towards Client 3} ..”If he starts up with you I’ll help out”.
Tony: “Todd....?...stay with yourself.....How did she pass?”
Todd: { to the whole group with his head mostly down....recounts the story that he told Brian/Therapist a few days earlier about how Lilly passed, how hard it was for Kate and Clay, how sa-a-a-a-d...many of the clients in the group listen attentively... a few clients grab for a box of tissue and are tearing up, Tony is openly crying..}
Tony: “Jesus Christ that is so fucking sad man....{crying a bit....Tony had put his dog down a year earlier}
Todd: {with a bit of ‘mist’ in his eyes} “I hated seeing my son hurt so badly and Kate was wailing by the end. I was a wreck but I kept it mostly together.”
Hillary: {toward Todd and soothingly}...”But just now it looks like you are ‘feeling’ some sadness?”
{the group is silent for a long minute...everyone is attuned to Todd, a few group members steal glances of him and make eye contact}
Brian/therapist: {towards Todd...subtlely} “Is there more there?”
Todd: {shakes his head ‘no’ but is looking down}
Tony: {...blowing his nose..}..”I hated losing my dog! I can’t imagine trying to be ‘strong’ for a son who was witnessing it”.
Todd: “My dad had to put down our family dog when I was 14. That was the last dog we owned as a family. My father did not wince at all when we were at the vets. I was a tornado of tears inside but had already learned NOT to show that in his presence. When I went home after we put our dog down I went straight to my room and curled up in bed. My brother knew I was crying but no one else.....{Todd starts to shed a few tears down his cheeks, definitely not sobbing, but these are tears of sadness and relief. The room is quiet. Todd reaches for tissue and blows his nose a bit}.
Brian/therapist: “Todd...perhaps you can look around the room and make eye contact with a few people who you trust?”
Todd: {first looking at Tony....makes eye contact, sweetly, holds his gaze for a few seconds. Then Todd looks at Hillary.....again sweetly and looks to the ground}....”Thanks Hill for egging me on. I can count on you to push when necessary. I know how important this is for me, my marriage and my kids.”
Hillary: “Glad to be with you Todd. You are so much more approachable for me when you show your vulnerability. You know I can’t stand stoic men! Emotionally available men....’lovely”.
END OF SESSION:
This is a snippet of how a group interaction can go with a delicate issue. People work mostly cooperatively, hardly flawlessly, to move through their own character and defense issues to grow. In this example, many members had worked with each other for several years and had a basis of trust, shared history, earned through a lot of defensiveness and some conflicts (Todd and Hillary were primary adversaries for several years...but good teachers to one another). Todd’s individual work was stretched and voluntarily extended to the group work. He is trying to undo his own ‘stoicism’ and lack of connection to his own feelings and those of his primary family (Kate, his son and daughter) via the family of the group. To understand understand more about the benefits of group please read the summary below.
+ Read more about the Benefits of Group Psychotherapy
A group psychotherapist once said somewhat glibly that if a client joins a psychotherapy group, then s/he will benefit (simply by being a member). I would tend to agree if several caveats are met. First; that each member willingly enters the group and has had a requisite amount of individual therapy. (What is ‘requisite’ is hard to define and is determined on a case by case basis). And second, the initial commitment to the group is at least 6-months, but preferably a year in duration before any discussion about terminating a group is considered. It is a contract of ‘consideration’ between the client, therapist, and ‘the group’ that the complexity of joining and understanding the functioning of a psychotherapy group, even for a sophisticated client, requires thoughtfulness, attunement, curiosity, risk, and time.
Group Psychotherapy can be a simple forum and experiential container to nurture the client’s own intuitive sense about what is ailing him/her in their life. This simple speaking, interacting, and listening can enhance sense of self; can be a solid ground from which to articulate one’s own voice; and can be a place to observe and use the collective wisdom of the group to address the darker and playful aspects of life. At it’s best a group can provide entrance of an individual with their unique relational style into a myriad of relations that are both reflective and reparative in the here and now. When a group, led by a ‘good enough’ therapist, travels along week by week, the intimate conversations provide insight, ‘outsight’ ( a term used to identify how what we recognize in the other gives access to what could not be easily seen with the self), relief from pain, isolation and stress and allows for a sense of deep connection to self and others which includes loving and supportive feelings.
+ Read More on the Concepts/Components of Group Psychotherapy:
Whether we are talking about individual psychotherapy, couples work, consultation in the workplace, or group psychotherapy, therapists typically differentiate between ‘content’ (a specific subject discussed) and ‘process’ (the manner, tone, affect, word choice, symbolism, participants responses, meaning, etc). ‘Process dynamics’ is described by Schlapobersky (2016) as the way in which group members speak and relate with one another where change is possible to occur. This is a psychoanalytic group conceptualization that I fine approachable and understandable for teaching clients and supervisees about group psychotherapy. It is by no means the only way in which to understand group functioning but a frame I find helpful. The author provides a list of these key elements which include: resonance; mirroring; reciprocity; application; condensation; and, valency. In the space below I will try to convey in plain language what each of these mean to help potential group clients appreciate the process that they are undertaking in a conscious, informed manner.
RESONANCE: Resonance can be defined as ‘the elementary conveyor of emotions’(Schlapobersky, 2016). This refers to all emotions in all social relations. How you or I express to a friend, “I love, hate, fear, am annoyed, need, desire, am sad, etc...”) and how it is ‘received’ sums it all up. The concept of resonance is tied necessarily to ‘valency’ or the characteristics of the receiver.
VALENCY: When talking of ‘valency’ we typically refer to two aspects of an individual’s character within the group; 1) her/his capacity to be affected by affect/emotional expression; and, 2) stylistic or habituated manner of relating to received expressions.
RECIPROCITY: This term simply refers to the idea of a positive action/ expression which elicits a generally positive response and conversely a negative expression evokes and angry or hostile response.
MIRRORING: Pines (1983) describes mirroring as when a person becomes aware of two facts: 1) that their internal view of self is incomplete or in process; and, 2) that it can be recognized more readily in other persons.
CONDENSER: Foulkes and Anthony (1965, p151) describe the ‘condensing’ or distillation of emotional individual or group interactions into an often highly charged, sometimes symbolic expression that is understood and shared by ‘most’ members.
AMPLIFICATION: Note above in the definition of condenser included is the caveat ‘most’. However manifest or clear an expression or symbolic meaning is made in a group, not all individuals will gather the meaning and/ or there are likely idiosyncratic/subjective differences in the meaning based on the ‘valency’ of the individuals involved.
To some extent, these are ‘heady’ concepts. You might even be thinking, ‘Why is Cross even trying to write about this theoretical stuff?” The group example below illustrates the joint interplay of these concepts. I hope it is informative and captures some of the beauty of groups in action. It is funny and true that your own ‘valence’ will determine how you understand, and in what particular way you view, the example below.
REFERENCES:
Foulkes, S. H., and Anthon, E. J., (1965), Group Psychotherapy: The Psychoanalytic Approach, London, Penguin. Reissued London, Karnac.
Pines, M. (1982, 1998), Reflections on Mirroring: Sixth Annual Folkestone Lecture, Group Analysis 15, Supplement: London.
Pines, M. (1983), The Evolution of Group Analysis. London, Routledge.
Schlapobersky, J.R. (2016), From the Couch to the Circle: Group Analytic Psychotherapy in Practice. Routledge: New York.
+ EXAMPLE OF GROUP PSYCHOTHERAPY COMPONENTS
GROUP EXAMPLE: For purposes of illustration let us say that this is an 8-member group with only 6-members in attendance during the present interaction. Space, time, and my own mental limitations require the example to be brief and poignant. The members of the group have been together for about 18-months with Jane being relatively new to the group in the past 6-months.
Group Members: Darnell (32-year old African American lawyer); Sonia (37-year Vietnamese American playwright); Steve (42-year old Caucasian electrician); Jane (31-year old Caucasian biology post-doc); Victor (28-year old, second generation Mexican American gay administrative assistant); and (YOU! - Yes...you. If you ever join a group, or not, you will still have your own ‘valence’ to what is expressed, what is not, and how you experience yourself and others. Try to imagine, really imagine, being part of this interaction).
The group commences with Victor and Darnell stating that they each wished for some time. Victor has just completed his work and there is approximately 30-minutes left in the session.
Darnell: {appearing more agitated than normal..} I’m feeling stuck with what we spoke about last week. I was really upset [RESONANCE, VALENCY] with the way I stated my attraction to you, Sonia, and how that went south so quickly. I felt Vickie, I wished she was here, ( Vickie is a member of the group who is not present) was disrespectful and off target when she accused me of ‘playing smooth’. I just don’t recognize myself there and felt misunderstood. I’m so NOT smooth and I don’t try to be {agitated}. [RESONANCE]
Jane: Remind me of what you remember Darnell.
Darnell: {...in his slow, measured, thoughtful and proper manner....with little voice inflection and lawyer-ly precision} “I remember at the start of the group that Sonia was late but then she entered after about 5 -minutes and I noted to myself that she looked attractive in her ‘yellow dress’. We were discussing things with Vickie and Steve, the similarity in the hurt they were experiencing in their couples. I recall saying/ stating that I could empathize with both of them. {..turning toward Steve..} Steve, I thought you were quite hurt by your wife’s comments about your earnings be off...{ still looking at Steve} [RECIPROCITY] And Vickie, well she is still at odds with her partner about the holidays and how to manage it, but I recall her being hurt that she did not feel understood by Tim (Vickie’s partner). [RESONANCE]
Jane: {...interrupting when Darnell takes a breath...and slightly impatient}...But what about what Vickie said got you upset? [CONDENSER]
Darnell: {...still measured and calm...with a slight smile..}...I’m getting there..”There was a moment when I said these things to Steve and Vickie that I felt connected....as I don’t always feel very understood by my wife. I mean, Stace, (Darnell’s wife of one year) can be very direct, mostly kind, but when she’s not, she’s NOT! And ....just then...things got silent for a few seconds and Sonia stated, “Sorry to have been late I got held up at the coffee shop again.”
Victor: {to Darnell but also to the group} “It felt like a very long pregnant pause before Sonia spoke...like 30-seconds....Seemed to be a connection between you and Vickie just then...” [RESONANCE]
Brian/Therapist: “Thanks Victor. I recall the pause....Darnell?”
Darnell: “Thank you both {to Victor and Brian}. Yeah, I felt a bit sad, but connected, more to Vickie at that moment than to you Steve.....even though you both were sharing similar items.”
Jane: “But what upset you Darnell?”
Steve: {...jumping in...} “Well, that’s what came next...you left both of us...when Sonia spoke about being late...in her pretty ‘yellow dress’ ”.
Darnell: “I agree.....that I sort of left both of you...but I thought the moment passed.”
Steve: “Sort of?” [AMPLIFICATION]
Victor: {..playfully....to Darnell} “Sort of?” [AMPLIFICATION]
Sonia: {...to Darnell..but to all..} “I didn’t mean to interrupt but I thought we were transitioning. And, I appreciated the compliment Darnell, and the attention. {said with a smile}. I do think though, ...my timing was a bit off. AND....you {..to Darnell} did leave Vickie and Steve. I mean, If I am honest, it did not feel finished. [CONDENSER]
Brian/Therapist: Darnell....what are you feeling? What are you aware of?
Darnell: {looking down..} I feel a bit ashamed and shouldn’t have said anything to Sonia at that point. Whenever I say things, I have to be more thoughtful [self-flagellating} . I’m sorry Steve {... somber}. [RESONANCE]
Steve: About what? I was enjoying the contact with you Darnell and was going to respond...But I was ‘hesitant.’ We share a lot with the similarity in our spouses......Then the ‘yellow dress’ comment ..I noticed Sonia too.... {said with a smile}. [RESONANCE, CONDENSER]
Jane: “I’m getting a ‘yellow dress’ exactly like yours! {to Sonia with a smile}. {laughter} [CONDENSER]
Victor: “Me too!....{laughter} [CONDENSER]
Brian/Therapist: “That’s three of us! {more raucous laughter including Darnell who was still feel ashamed} [CONDENSER]............{Brian quietly and leaning forward to make contact with Darnell...}......”The way I have seen it...You live, “tightly” within your skin.” You have come a long way from your impoverished, fatherless background to become a lawyer in a well regarded firm. You ‘were’ connecting with two group members over ‘dissonance’ in your primary relationship.....and a pretty woman in a very lovely ‘yellow dress’...also caught your attention {said warmly}. You are hardly ‘thoughtless’.....quite the opposite. And, you are hardly a ‘philanderer’ { ...like his father who abandoned him and his mother}.
Darnell: {poised, looking up and around to make contact}...Thanks everyone. “Tightly!”...yes... I’ve felt I had to get it so right to escape my roots and still have to guard against perceptions. {to Steve...} I wanted to connect with you as we share similar difficulties with our lovely wives...{said with a smile}. And with Vickie, I respect her and felt she has had my back for some time. I do think the moment was particularly close...intimate....and I think that I moved onto the ‘yellow dress’ just a tad too soon {...to Sonia with a warm smile}...I moved away. ......{Steve nods in agreement}............. ....{to Sonia....}....I do not want to dilute the compliment and how attractive I find you...my timing was bit off. I would like an occasional flirtation with you...but have been reluctant to say anything as a ‘flirtatious black man’ is a stigma I desperately have avoided.... [RESONANCE]
Brian/Therapist: But at a ‘cost’ Darnell....your sexuality, both for yourself and within your marriage, seems to suffer..[INTERPRETATION]
Darnell: ....{softly...}...Agreed. My wife is wanting more in the area of sexuality and I have such a difficult time opening up to her...I can use some attention to that here.
Jane: ...{after an appropriate pause...} We can all wear our ‘yellow dresses’ Darnell anytime you need...
Darnell: Thanks Jane....I think I will need to come back to Vickie down the road with this again....
END OF GROUPS SESSION EXAMPLE
As you can see, groups and the interactions between individuals are in process, like real life. It is a gift to be part of an ongoing group. Internal dialogue is expressed, meaning is made and adjusted, and the insights drawn are deeply personal. Not all groups are this connective. Some sway, tumble around, are disjointed, and threads and themes are hard to follow. That is then a part of the group ‘work’. People develop greater curiosity about themselves and others which serve to deepen connection and create jointly held meanings. Members become gifts to one another over time.