Rethinking Assumptions About Group Therapy

PART 2 TRANSCRIPT

Dan Well, I came five, ten minutes late, uhm, and I've ah, 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. (crosstalk)

Irvin Yalom You mean, you mean since, you mean, since you were late, you never could understand what was happening here in the group?

Dan Yeah. Yeah, and I didn't wanna say something and not know what I was talking about.

Allen Well you know, you're usually late. I, I was just wondering why can't you get here.

Betty Is, did something specific happen to you? I mean, something that made you late today, or what?

Cathy He's very often late. I mean(ph), I make an effort to get here on time. I, I don't know why you can't.

Dan Well, it's my practice. You know, I, I've got a, a waiting room full of patients, and I've got somebody in every chair, and you know, I'm a dentist. I can't just walk out and leave somebody with a half-filled tooth.

Darlene You know, how about ah, just, you know, rescheduling your clients?

Dan Oh, I wish I could. I've, the uhm, that's turnover in my, in my staff is really pretty high. Uhm, it's chaotic, and then there's people calling in for emergencies, and everything is always changing. You know, maybe that's something I can work on in the group, would be ah, my attitude towards, towards management. You know, I really try to get here. I mean, I really do try to get here on time, but, but it's just impossible.

Darlene I don't buy it.

Alice Well, oh, I just get upset when someone is not here. You know, I feel like it(ph) something I said, like last week when I said you were a dentist 24-hours a day. I thought maybe I might hurt your feelings when I said that, and it's just really been hard for me to concentrate in this meeting today. Just, ah, you know, maybe you could call next time. You know, call John or Irv, it's just to let us know that your gonna 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, there must be a way for Dan to get here on time. I mean, 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, 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 I can see it, this is the kind of pressure I get at home. I mean, I, you know, in bet, between my patients and, and, my staff and my students. I, I teach at dental school, you know, and then my, my, my wife and my kid and, you know, I just needs to give myself a little slack, you know? Uhm, to have some place I can, I can have some peace and quiet, for me that's maybe why, that's probably why I don't say much here, because it's, it's, it's nice to have a place that I can come to where, there's 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 gonna get anything out of it?

Irvin Yalom Yeah, that's, that's a good question Betty. You know, I'm, I'm just aware of, of your situation in the group today as I, as I saw. Think about it Dan. You know, the idea that you, you come late, that you are forced into silence because you don't feel you've got the right ah, to ask anyone any questions, uhm, and uhm, and remain kind of uninvolved in the group for the entire meeting. The, there's gotta be some other options for you.

Dan Well, yeah, yeah, I could not come.

Joan Do you want someone to summarize the group for you, Dan?

Dan I mean, when I walked in and Darlene was going through this, this ah, what was a very important thing for her, and I, I'd made enough of the disturbance already just by coming late. And I didn't wanna uhm, I mean, to interrupt anything more that Darlene had to, had to do.

Uh hmm.

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.

Joan With that?

Darlene No, I, I'm really what I preferred, Dan, if he'd, 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 You know, well, uhm, yeah, ah, but then there's, there's probably other people that, that, that don't feel that way, that couldn't say anything because they want to be polite.

Joan Who'd that be?

Dan Uhm, well, Bob.

Bob I wouldn't mind, and I wouldn't be polite about it, either. And 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.

Irvin 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 ah, you're 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.

Irvin Yalom You wouldn't mind?

Dan No.

Irvin Yalom So, 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 ah, I guess it's okay for, for other people to do things that it's not okay for me to do.

Irvin Yalom That sounds important.

Joan Dan, as Betty pointed out, you do have a commitment to yourself by being in group, and I'm 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, I don't think I affect you, I get my, my share of my time here and attention.

Joan Uh hmn.

Alice Well, how are you getting help, you know? I, I'm not sure what's happening here for you, Dan. Uhm, 'coz you're so vague.

Dan Well, these things take time. I mean, it takes x amount of time to fill a cavity. And you can, you can't rush these things. Uhm, uhm, I, I think I've learned quite a bit here, yeah, so far.

Cathy I'm still uncertain as to why Dan is here.

Dan Well, uhm, being here wasn't really my idea. I am, I'm in marriage therapy. Uhm, we have a counselor. And he suggested that it would be, it would speed up the process if, what if I joined the, a group. And ah, and this is my third marriage, and so I figured that anything else that ah, might help it work out and yeah I, I have a 2-year-old and ah, so I thought it would be a good idea, and, and my wife really ah, pushed me ah, insisted that I do this.

Irvin Yalom So it sounds like you're, you're here because the marriage counselor sent you here, or because your wife insisted that you're here, or you're here for the marriage, but that you're not here for you yourself.

Bob So, why are you in marriage therapy?

Dan You know, I come home and ah, and I've been 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. Uhm, you know, I just, 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 its all day long. People are making these demands and those demands, uhm, and then she does the same thing. You know, like we went on a vacation last summer to get away and then have a little time, and the first thing that happens, I mean, we go this, this hotel and then she starts arguing with the clerk about the room. You know, it didn't have a good enough view. Uhm, 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, I went there to get away from some of this and she just wants to bring it everywhere that we go and, and create it when there isn't any. She is just, too irrational all the time.

Bob Well, uhm, I have a suggestion. Why don't you, why don't try for like a, a 30-minute buffer time when you get home so that, provide a transition from work to your home situation?

Dan We, we'll try that. I mean, it's a good idea. It's, 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, you know.

Darlene Why is she so unhappy?

Dan Oh, you know, it's the, it's 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 you in treatment?

Dan No, you know, we, we have to live with each other. I mean, its our problem. It's not just.

Joan Dan, maybe we should stick to your part of it.

Dan Uh, 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. Uhm, yeah, I mean, we go back to when I was a kid. I, I, ah, my dad was an alcoholic, ah, my folks were divorced, and so, and I never really felt comfortable at school because I was a kid whose folks were divorced. And, and the, and I wasn't much want 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, uhm, I'm a very successful dentist. I've got a professional career, I don't think its a problem anymore, and I. (crosstalk)

Betty I still don't understand. I don't, I don't know where you fit in. I'm really stuck. How are we gonna be able to help you here if it's your wife who needs the therapy?

Irvin Yalom Do you feel stuck too, Dan?

Dan Uhm, well, I mean, as it's like sometimes I wonder what, what good the group is gonna do ahh, but, you know, it's been really interesting for me. I mean, I, I've really, I, Is've been enjoyed watching everybody, and, and feel like I'm learned a lot from, from being a part of this.

Cathy I feel a little uncomfortable saying this but, do you 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, I did, I didn't really mean it that way. No, I uhm, 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, 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 last patient on Wednesdays. Just one.

Dan It's not that easy. I mean, emergencies come up and ah, patients are always calling in with this and, you know, things are not in my control all the time.

Irvin Yalom You know Dan, I'd like you to go back just a few minutes, back to ah, back to what Cathy was saying to you about your conversation with her outside the group. Ah, I think, I think it's so important for you to try to speak here spontaneously ah, 'cause I think you've got some really strong feelings about the group that you were honest in expressing to her, the things, feelings about which you are not getting from the group. So I wonder if, 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 gonna feel. Could, could you speak right from the heart? Speak straight?

Dan Uhm, ah, 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, 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 of the stuff I'm doing, it's my wife's problem, not mine. I'm not getting a goddamn thing from all this.

Dan Well, you know, I never said that I, 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've, I've, I, I really find it interesting. It's worth it to me.

Irvin Yalom Where are the rest of you on this? Could, could ah, could we give some feedback to Dan? What have, what have, what do you all feeling at this point?

Darlene I just, I feel like I don't know what you feel.

Betty I think he's a really nice guy.

Cathy Maybe too nice.

Irvin Yalom Listen, try, try this, just try a thought experiment for a couple of minutes. You, you see Dan here, you, you live with him, in a sense, for an hour-and-a-half once a week. Just imagine ah, 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, by that experience?

Alice To me, to me it would be like, 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're 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 are 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 be getting angrier and angrier, too. I'd put a lot of demands on you, probably even get shrill or, or irrational just like your wife . I, I'm really think so.

Irvin 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've been doing it. John's been doing it. I think, all the people here have been doing it, and I think it's important phenomena that's been occurring. It's almost as though that to kinda get through and help you speak with your real voice, we've got to keep on getting more and more angry, or, 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 cant(ph), it's kind to talk, help you talk in your real voice.

Dan Huh.

COMMENTARY

Irvin Yalom This, this vignette ah, illustrates many important issues for, for group therapy technique. First of all, there's a, early on there is a mention of ah, 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 previous meeting. Ah, and so we, we set down a rule that I think it's important for groups it says 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, a lot of often wasted activity for that. But I think there's a very important issue that's fairly clearly ah, illustrated in this vignette, and that had to do of course with the, with the question of, of Dan and his relationship to the, to his wife , but also his relationship to the other group members. You know, at ah, 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 ah, discover that the reasons for his lateness are pretty deeply ingrained in, in the depths of his, of his personality structure. Dan's ah, 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 but he is in therapy; that he was sent, sent by other people, sent by his marriage counselor, ah, sent by his, his wife . Uhm, the group starts to deal with this with some suggestions that are offered, but suggestion and advice given by groups is, 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 ah, buffer zone when you get home, how about two in one less cavity, scheduling one less patient, but each of these are, are rejected. Then the group begins to suggest, well listen, ah, if your, it's your wife's problem, what are you doing here? Ah, what is your role in what goes on and what goes wrong in your relationship? Ah, that begins to move of the things into a somewhat more fruitful ah, direction. Then later, we begin to get some feedback ah, for Dan, not about suggestions, not about ideas that they have about his marital situation, but how their feeling about his behavior towards them right here, in the here-and-now. Uhm, and then, in fact, when we begin to up the ante on that and so 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, Uhm, 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 ah, cared for in a relationship. And so then, gradually, what begins to happen is that soon the situation outside in 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, 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 tend to, to give them that. So you, you lose the person in there. And that, of course, illustrates this ah, extremely ah, important aspect of, of, of group theory, ah, which is the idea that I alluded to in the previous tape, that the here and now, in the here-and-now, that, that the group operates as a social microcosm. That behavior that people manifest toward others in their life soon begins to be manifested towards 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, or people are vindictive, or people are self-effacing. All these traits begin to be evident in the way the people respond towards others in the group. So there's 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 de-emphasizing the past historical material, de-emphasizing even the current outside material that's going on in your life right now. By de-emphasizing, I'm not saying that we are negating the importance of these, but I am saying, from the standpoint of therapeutic power, we're much better off by focusing on the immediate transactions that occur within the group. Now, there's one other point that just is mentioned in a second but it's worth taking a look at, and that's the, the issue of, of extra group socializing in a, in a therapy group. Uhm, that occurs in almost every group. I've long ago learned 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 is almost invariably does occur, and then members are keep it secret. They don't tell you about it, or becomes a whole issue of whether or not they're breaking your rules or not breaking your rules. Uhm, so I feel, I feel that it's, it's much more important to explain to members how extra group socializing can get in the way of therapy. Ah, 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've 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 wana 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 ah, facilitative of the group, and indeed that's exactly what happened in this group when Cathy ah, 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 ah, said to her that he had severe doubts about whether or not this group was, was being useful. Incidentally, when you, when you've made it very clear to the group members about why extra group socializing can in fact get in the way of therapy, can, can sabotage the therapy, and then it happen to you in a much stronger position to confront the patients, because you're no longer confronting the patient with the issue of how come you're breaking my rules, but you're confronting the patient with the much more powerful question of, well, how come you are sabotaging your own, your own therapy? I think you've got much more leverage when you are in that direction. Okay, now ah, let's turn to our, our fourth and last vignette. This is an episode that occurs in the eighth meeting, towards the end of the session.

Allen This is, something ah, there's something I've been wanted to tell you ah, I, I'm bisexual. Oh, I guess I had to get that out, you know? I, I guess I wouldn't be helped if I didn't.

Irvin Yalom I'm glad you're bringing it up.

Dan Uhm, is this, this is been something that's always been the case?

Allen I don't know, well, I guess ever since I was around 13, I guess I felt that way.

Bob Alright, you know, I, I'm always been, you know, I really don't understand bisexuality. What's, is there a predominant preference?

Allen No, not really. I, 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 ah, bisexuality is related to ah, families that don't have a father , or, or the father is there but he's not around very much. Is, is that the case with you?

Allen No, I've never heard that before, you know, really, our family was very supportive. My father was there, leap(ph). We're the tight knit group.

Betty Doctor, do you find that to be the case?

Irvin Yalom No, I'm not sure about that ah, Betty. But you know, I, I'm very much aware, though, of something else, and that is obviously it's difficult for you to say this in a group. You know, 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, what kind of experience is that, 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.

Irvin Yalom What were your fears or fantasies of what would happen if you were to bring this up?

Allen Uh, well, well, you know, the usual. What, what people say behind your back, and, I mean, this is the first time I have ever said it to, to anyone, you know, publicly, and I feel that ah, well, I felt from the beginning, I, I have a part that I play in this group, and I've, 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. Uhm, 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, whenever you're telling you, you bisexual, they, they think you are trying like a play for them or something. Well, you know, there are so many stereotypes, so many distortions about the "gay world."

Dan You know, I, I don't think that you have to worry about this group. I think the group is going to be very supportive ah, for you. Ah, and if you are worried about, I mean, not for myself, I, 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, 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.

Irvin Yalom You know, I'm so pleased you are able to bring this up. I am also curious as, as to what's made it possible for you to bring it up to the group today.

Allen Well, I guess, you now, last few weeks I have felt more trust, and I just feel comfortable with the grouping.

Irvin Yalom And those, those fears you had about bringing today, you, you felt that you would lose face, you know. Before whom would you lose face? Who's gonna judge you? Who is the chief justice here?

Allen You and Joan. You know, I, I know I was supposed to tell the truth in the initial screening and I felt that, you know, maybe at the, I probably be refused. and I, I really hope you are not angry today.

Irvin Yalom You mean you, you thought if you told Joan and me when we first saw you ah, about your bisexuality we would have ah, rejected you from the group?

Allen Basically, yeah.

Irvin Yalom I never would, never would have entered in my, ah, and the other judges. Who, who else, do you think?

Allen Well, ah, Darlene and Bob. You know.

Bob Well, ah, to be perfectly honest, Allen, I certainly, I certainly wouldn't be in judgment with the act. Actually, ah, I am, when I was 11 or 12, uhm, I had a, a homosexual experience with a really a good friend of mine. And uhm, quite a few years after that I was really ah, conscious of, worried about my sexual, my sexual ah, ah, place in the world, I guess, you know.

Allen I know, I tell you it's, it's, it's so difficult being, being a part of the gay community. You know, ah, I mean especially today, you know, with all the AIDS thing, you know, and everyone is so frantic, you know and almost every woman that I, I, I've known, ah, that if I told her that I was bi, she, she freaked out. And it seems that even after all of that, no matter how, how difficult it is, I, I, I don't see myself changing. Because I, I live a heterosexual life. I, I want a family. I, I deserve. (crosstalk)

Irvin Yalom Just interrupt you for a minute, A, Allen, 'coz I think something really important happened here just a couple of minutes ago I wanna just focus on, just a second. I'm, I'm really interested Bob in, in what you just said about your own gay experience when you were younger. Have, have you ever said that before to anyone else?

Bob Uhm, uhm, once, ah, 10 years ago, to my, to my therapist.

Irvin Yalom And until this moment, this group, you've never told anyone else, never told peers?

Bob No, huh, no, we're, I would, I've never told to any group of people that, no.

Irvin Yalom I have a hunch that ah, that was a, a real gift to Allen.

Allen I don't know, I guess I get so I were wrapped up in my own emotions I don't think about other people's feelings. I, I guess that's what Betty meant when she told me about it a couple of weeks ago.

But Allen, I don't think you're still acknowledging Bob's gift to you.

Allen I guess you're right. Ah, I don't know why it is so difficult for me just to come out and say thank you. I mean, I mean thank you all, because, because you all have been supportive and you've all helped me. I appreciate it. I got it off my chest.

Irvin Yalom I'm glad you did, Allen. You feel, you feel finished or are there other parts that you wanna work on today?

Allen Well I, well, hum, no, nothin', no, no, not, not today.

Irvin Yalom That's as far as you wanna go today?

Cathy Well, I'm 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, and now we're almost out of time.

Betty No really, I feel fine. like, you know, we talked about it, I got it out and spoke with you, and that, no, I feel fine about it.

Irvin Yalom Betty, what, what did you get from the group today? I know you brought up a really significant problem. What do you feel that we were able to give you?

Betty Well, I don't, 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, I mean, we only know it from Betty's point of view. And that's just a small part.

Uh hmm.

Bob Yeah, you know, uhm, you might say I'm, I'm an engineer again, but uhm, how can we really deal with a problem when we're dealing with uhm, partial or inadequate data?

Dan Yeah, yeah. You know why(ph), you mentioned uhm, earlier that, that this was something that you brought up with your individual therapist, and ah, it seems to me like(ph) maybe that's, 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. You know.

Irvin Yalom So, some sort of the issue, then, is if, if the group can't deal with this problem, or that we're gonna get inaccurate data, or it should be dealt with in an individual therapy. It still leaves the question of, of how, what role this group can play and how this group can be helpful.

Joan What is that you get today, Betty? What did you want when you came in the group today?

Betty Well, you know, as I said, I, 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. Uhm, and, and that's, that's about all I really need, you know. Uhm, like you said, I had mentioned that I, 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. Uhm, see a lawyer, uhm, family meetings with your husband and daughter , and, and then a drug rehab program for your daughter . Do you think these suggestions are gonna 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 the, you know, others involved to, 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 in 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 gonna do any good anyway. So I'm, you know, kind of at a standstill.

Irvin Yalom You know, I'm, I'm aware that uhm, we seem to be kind of circling things, 'coz I know this sounds very much like what we're saying at the very beginning of the meeting. And, you know, on one hand you could think that, ah, you know, Betty says, well, she's satisfied with what she got from the group today. But on the other hand, you know, we can't seem to let it go. We keep on coming back, we keep on circling back, coming back, coming back to, 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 'coz 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 is ah, 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 got started, you know. It wasn't my idea or Joan's.

Dan No, I think, speaking for myself, I think that, like, when you told this, that today, about your, about your daughter , especially, I mean, I felt so bad. I really wanted to be able to help you in some way. Yeah, uhm, and you know, there's something, something else about it, too. I mean, I, 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, it's a way of, of. (crosstalk)

Irvin Yalom You mean the time you were talking about your problems with your wife ?

Dan Yeah, yeah, that the, the, the thing with tell the marital difficulties. Uhm, I, 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. You know.

Irvin Yalom Yeah, that's a really good point, Dan. You know, I think that was a really good working meeting. You won't, 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, with Dan?

Bob Well, uhm, the one thing I, I noticed was, as a group, we started with Dan's problem that was outside of the group. You know it, well, we brought it down to what's Dan's role with, with his problem and his responsibilities with what is going on with his marriage. And we brought it even further into the group with, with bringing that into what is, what was his relationship with the women in this group.

Cathy I think we seem to work much better when we, we stick to things ah, problems right here in this group.

Uh hmm, Uh hmm.

Darlene But there was a different today with Betty. I mean, she was really hurting. I mean, what are we supposed to do? Just say, "We don't deal with life's emergencies," you know, you're about to lose your kid, that's not important enough. I mean, I agree with you. You don't get enough time, Betty.

Irvin Yalom You know, we all seem to agree here that when we focus on what's happening right here between people, that's, 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, 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're facing. We have to find some way to do something about that. And we're gonna have to stop today. Our time is just about up. But I think one of the things we gotta work on is how we find a way to, to offer you, Betty, something right here and the hear(ph) it now; how we can help you more effectively.

Allen You know, I knew we're almost out of time, but I, I just want to add that I'm having trouble finding something for Betty. I mean, I, I, 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 there is, there is no pain that I can see.

Cathy Asking for help is certainly not Betty's strong suit.

Yeah. You know.

Irvin Yalom But you know, I think this is really important. I think this is a good, a good clue, exactly(ph) I've got very much the same feeling. You know, my, 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 wanna 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 a 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, we really need to look at in the future. Okay, we gotta go.

Darlene No, no, no wait, wait. I've got something I wanna 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 Friend, 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 in every couple of weeks, you know, I've been talking to her. Well, glad I told you.

Bob Well, you certainly didn't leave much time for us to discuss that in, in the group.

Allen Now what's his business, your therapist told you to say it? Does that mean you wouldn't have said it, if she hadn't told you?

Darlene Next time, Allen.

COMMENTARY

Irvin Yalom This vignette illustrates another aspect of, of norm setting. We talked about other norms that we want to set in a therapy group. And ah, in this segment we are, we're looking at the issue and the norm of self-disclosure. I think ah, every therapist who leads a therapy group will agree ah, that self-disclosure is important. It's important that people disclose. It's important that people disclose ah, very fully ah, as they go ahead and go along through the therapy group. Uhm, I feel that, that I, I'd like members ah, to do that. I'd also like them to feel, however, that ah, they ah, that the group is not a forced confessional, that people can disclose ah, when they're ready, when they feel enough trust in the group. They can disclose at their, at their own pace. But there is ah, another issue of disclosure that I think ah, that I think we should ah, were should look at in, in this vignette, and that's the, the difference between ah, vertical disclosure and horizontal disclosure. Ah, and by that I mean that ah, vertical disclosure is disclosure in depth. Ah, disclosure uhm, as you plunge into the type of material the person is, is talking and describing. Whereas horizontal disclosure is disclosure about the disclosure, meta disclosure. And in a group, I think that you're far ah, better off in the therapy process by encouraging ah, horizontal disclosure rather than vertical disclosure. So in this vignette, Allen discloses a, 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 ah, more details about bisexuality: Well, when did it begin? What's it like? Who do you prefer? Ah, what sex do you prefer? Or began intellectualizing in bed by talking about, well, about family patterns in bisexuality. So that, that my stance and my response towards Allen was always in the direction of asking for more horizontal disclosure. So that's why I asked him about ah, how hard it was for him to come to the group all these weeks and not talk about this. Ah, that's why I wondered ah, to him about what made it possible for him to talk about that in, 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 happened were to, were he to disclose that. Then I brought up material about ah, his fears about my response, about my co-leader's response or his fears about the, the men's response to him, that in the group. A, a, another important concept that comes up in this vignette, I think, is the, is the fact that therapists ah, in groups must make use of process; we think in terms of process. Uhm, 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, 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 or 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, you, you ask the question, what do these words tell you about the nature of the relationship of the people involved in the discussion? So we ask a process question or when we maintain a process orientation, we're always looking at the nature of the relationship of each people involved. And I think there were two incidents in this group that illustrated that. One of them was when ah, when Bob said that he, too, had had a homosexual experience when he was, when he was quite young. And notice ah, 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 is 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, and with females. He had a compulsive sexual pattern, a, 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 for him(ph), very embarrassing to thank, thank ah, Bob for his gift. I think the other example of a, 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 uhm, 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. It wasn't, it wasn't until a, a later meeting that we did. But, but if we, from the information that we were able to accumulate later, it seemed like there was, there's some interesting process issues. One on which was the idea that Darlene had to almost convulsively break into the group, raise her hand ah, 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 uhm, she was in essence saying to the group that, because she was stopping therapy with her individual therapist in, in Atlanta, therefore she was going to need a lot more support, a lot more attention from this group, and that was hard for her to say in any explicit way. So she disguised that ah, as if, if you will by, by saying, to them, "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, to ah, go ahead and discuss this openly. And the group caught on her 'coz I think, just the very end, the couple of times by the men in the group. Now in, in this ah, vignette, the group was also ah, 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 probe, problem, is a, is probably one of the worst ways to, to lead a group. So I was being fairly active here in trying to ah, intercept that process from continuing. So I intended to ah, 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. You know, one of them was Bob's, ah, as he put it, his engineer reason that the, the data is inaccurate; we only had partial data, ah, and groups can't come up with a very workable solution under, under that situation. And then we went on ah, 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 way 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 ah, part of that episode in, in this vignette, we then were struggling with the fact, well you know we've got to find a, 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 as well ah, 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 the, the ground work was already being laid at that point for future working group with her in the here-and-now, rather than with her around a resolution in solving this inside(ph) outside crisis. You notice in this vignette and also in the, in the, in the previous three, uhm, therapists have been fairly active. You know, I've just, I've felt that it's part of my role to be quite active in shaping this group, shaping the norms, ah, 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 ah, continue ah, in the future ah, those efforts would be far less necessary on my part. The, the norms had become integrated, had become much more automatic on the part of the group members, ah, the group members themselves were aware that they work more effectively in certain ways and less effectively in other ways. So this group, ah, by the end of this eighth meeting, was poised at this point ah, to, to enter into a, a, a state of a, of a much more mature, hardworking group.