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Chapter 2

INTERPERSONAL LEARNING

Interpersonal learning, as I define it, is a broad and complex therapeu­tic factor. It is the group therapy analogue of important therapeutic factors in individual therapy such as insight, working through the trans­ ference, and the corrective emotional experience. But it also represents processes unique to the group setting that unfold only as a result of spe­ cific work on the part of the therapist. To define the concept of interper­ sonal learning and to describe the mechanism whereby it mediates therapeutic change in the individual, I first need to discuss three other concepts:

1. The importance of interpersonal relationships 2. The corrective emotional experience 3. The group as social microcosm

THE IMPORTANCE OF INTERPERSONAL RELATIONSHIPS

From whatever perspective we study human society-whether we scan humanity's broad evolutionary history or scrutinize the development of the single individual-we are at all times obliged to consider the human being in the matrix of his or her interpersonal relationships. There is convincing data from the study of nonhuman primates, primitive human cultures, and contemporary society that human beings have always lived in groups that have been characterized by intense and persistent relarion­ ships among members and that the need to belong is a powerful, funda­ mental, and pervasive motivation.' Interpersonal relatedness has clearly been adaptive in an evolutionary sense: without deep, positive, reciprocal interpersonal bonds, neither individual nor species survival would have been possible.

19

20 INTERPERSONAL LEARNING

John Bowlby, from his studies of the early mother-child relationship, concludes not only that attachment behavior is necessary for survival but also that it is core, intrinsic, and genetically built in.2 If mother and infant are separated, both experience marked anxiety concomitant with their search for the lost object. If the separ:ltion is prolonged, the consequences for the infant will be profound. Winnicott similarly noted, "There is no such thing as a baby. There exists a mother-infant pair."3 We live in a "re­ lational matrix," according to Mitchell: "The person is comprehensible only within this tapestry of relationships, past and present."4

Similarly, a century ago the great American psychologist-philosopher William James said:

We are not only gregarious animals liking to be in sight of our fellows, but we have an innate propensity to get ourselves noticed, and noticed fa­ vorably, by our kind. No more fiendish punishment could be devised, were such a thing physically possible, than that one should be turned loose in society and remain absolutely unnoticed by all the members thereof.5

Indeed, James's speculations have been substantiated time and again by contemporary research that documents the pain and the adverse conse­ quences of loneliness. There is, for example, persuasive evidence that the rate for virtually every major cause of death is significantly higher for the lonely, the single, the divorced, and the widowed. 6 Social isolation is as much a risk factor for early mortality as obvious physical risk factors such as smoking and obesity.7 The inverse is also true: social connection and in­ tegration have a positive impact on the course of serious illnesses such as cancer and AIDS. 8

Recognizing the primacy of relatedness and attachment, contemporary models of dynamic psychotherapy have evolved from a drive-based, one­ person Freudian psychology to a two-person relational psychology that places the client's interpersonal experience at the center of effective psy­ chotherapy.t9 Contemporary psychotherapy employs "a relational model in which mind is envisioned as built out of interactional configurations of self in relation to others." 10

Building on the earlier contributions of Harry Stack Sullivan and his interpersonal theory of psychiatry, 11 interpersonal models of psychother­ apy have become prominent. 12 Although Sullivan's work was seminally important, contemporary generations of therapists rarely read him. For one thing, his language is often obscure (though there are excellent ren­ derings of his work into plain English); 13 for another, his work has so per­ vaded contemporary psychotherapeutic thought that his original writings seem overly familiar or obvious. However, with the recent focus on inte-

21 The Importance of Interpersonal Relationships

grating cognitive and interpersonal approaches in individual therapy and in group therapy, interest in his contributions has resurged. 14 Kiesler ar­ gues in fact that the interpersonal frame is the most appropriate model within which therapists can meaningfully synthesize cognitive, behav­ ioral, and psychodynamic approaches-it is the most comprehensive of the integrative psychotherapies.t15

Sullivan's formulations are exceedingly helpful for understanding the group therapeutic process. Although a comprehensive discussion of inter­ personal theory is beyond the scope of this book, I will describe a few key concepts here. Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings. The need to be closely related to others is as basic as any biological need and is, in the light of the prolonged period of helpless infancy, equally necessary to sur­ vival. The developing child, in the quest for security, tends to cultivate and to emphasize those traits and aspects of the self that meet with approval and to squelch or deny those that meet with disapproval. Eventually the individual develops a concept of the self based on these perceived ap­ praisals of significant others.

The self may be said to be made up of reflected appraisals. If these were chiefly derogatory, as in the case of an unwanted child who was never loved, of a child who has fallen into the hands of foster parents who have no real interest in him as a child; as I say, if the self-dynamism is made up of experience which is chiefly derogatory, it will facilitate hostile, dis­ paraging appraisals of other people and it will entertain disparaging and hostile appraisals of itself. 16

This process of constructing our self-regard on the basis of reflected appraisals that we read in the eyes of important others continues, of course, through the developmental cycle. Grunebaum and Solomon, in their study of adolescents, have stressed that satisfying peer relationships and self-esteem are inseparable concepts.17 The same is true for the el­ derly-we never outgrow the need for meaningful relatedness. 18

Sullivan used the term "parataxic distortions" to describe individuals' proclivity to distort their perceptions of others. A parataxic distortion oc­ curs in an interpersonal situation when one person relates to another not on the basis of the realistic attributes of the other but on the basis of a personification existing chiefly in the farmer's own fantasy. Although parataxic distortion. is similar to the concept of transference, it differs in two important ways. First, the scope is broader: it refers not only to an in­ dividual's distorted view of the therapist but to all interpersonal relation­ ships (including, of course, distorted relationships among group members). Second, the theory of origin is broader: parataxic distortion is

22 INTERPERSONAL LEARNING

constituted not only of the simple transferring onto contemporary rela­ tionships of attitudes toward real-life figures of the past but also of the distortion of interpersonal reality in response to intrapersonal needs. I will generally use the two terms interchangeably; despite the imputed dif­ ference in origins, transference and parataxic distortion may be consid­ ered operationally identical. Furthermore, many therapists today use the term transference to refer to all interpersonal distortions rather than con­ fining its use to the client-therapist relationship (see chapter 7).

The transference distortions emerge from a set of deeply stored memo­ ries of early interactional experiences. 19 These memories contribute to the construction of an internal working model that shapes the individual's at­ tachment patterns throughout life. 20 This internal working model also known as a schema21 consists of the individual's beliefs about himself, the way he makes sense of relationship cues, and the ensuing interpersonal behavior-not only his own but the type of behavior he draws from oth­ ers.22 For instance, a young woman who grows up with depressed and overburdened parents is likely to feel that if she is to stay connected and attached to others, she must make no demands, suppress her indepen­ dence, and subordinate herself to the emotional needs of others.t Psy­ chotherapy may present her first opportunity to disconfirm her rigid and limiting interpersonal road map.

Interpersonal (that is, parataxic) distortions tend to be self-perpetuat­ ing. For example, an individual with a derogatory, debased self-image may, through selective inattention or projection, incorrectly perceive an­ other to be harsh and rejecting. Moreover, the process compounds itself because that individual may then gradually develop mannerisms and be­ havioral traits-for example, servility, defensive antagonism, or conde­ scension-that eventually will cause others to become, in reality, harsh and rejecting. This sequence is commonly referred to as a "self-fulfilling prophecy"-the individual anticipates that others will respond in a cer­ tain manner and then unwittingly behaves in a manner that brings that to pass. In other words, causality in relationships is circular and not linear. Interpersonal research supports this thesis by demonstrating that one's in­ terpersonal beliefs express themselves in behaviors that have a predictable impact on others. 23

Interpersonal distortions, in Sullivan's view, are modifiable primarily through consensual validation-that is, through comparing one's inter­ personal evaluations with those of others. Consensual validation is a par­ ticularly important concept in group therapy. Not infrequently a group member alters distortions after checking out the other members' views of some important incident.

This brings us to Sullivan's view of the therapeutic process. He suggests that the proper focus of research in mental health is the study of processes

23 The Importance of Interpersonal Relationships

that involve or go on between people. 24 Mental disorder, or psychiatric symptomatology in all its varied manifestations, should be translated into interpersonal terms and treated accordingly.25 Current psychotherapies for many disorders emphasize this principle.t "Mental disorder" also consists of interpersonal processes that are either inadequate to the social situation or excessively complex because the individual is relating to oth­ ers not only as they are but also in terms of distorted images based on who they represent from the past. Maladaptive interpersonal behavior can be further defined by its rigidity, extremism, distortion, circularity, and its seeming inescapability. 26

Accordingly, psychiatric treatment should be directed toward the cor­ rection of interpersonal distortions, thus enabling the individual to lead a more abundant life, to participate collaboratively with others, to obtain interpersonal satisfactions in the context of realistic, mutually satisfying interpersonal relationships: "One achieves mental health to the extent that one becomes aware of one's interpersonal relationships. " 27 Psychi­ atric cure is the "expanding of the self to such final effect that the patient as known to himself is much the same person as the patient behaving to others." 28 Although core negative beliefs about oneself do not disappear totally with treatment, effective treatment generates a capacity for inter­ personal mastery29 such that the client can respond with a broadened, flexible, empathetic, and more adaptive repertoire of behaviors, replacing vicious cycles with constructive ones.

Improving interpersonal communication is the focus of a range of par­ ent and child group psychotherapy interventions that address childhood conduct disorders and antisocial behavior. Poor communication of chil­ dren's needs and of parental expectations generates feelings of personal helplessness and ineffectiveness in both children and parents. These lead to the children's acting-out behaviors as well as to parental responses that are often hostile, devaluing, and inadvertently inflammatory. 30 In these groups, parents and children learn to recognize and correct maladaptive interpersonal cycles through the use of psychoeducation, problem solv­ ing, interpersonal skills training, role-playing, and feedback.

These ideas-that therapy is broadly interpersonal, both in its goals and in its means-are exceedingly germane to group therapy. That does not mean that all, or even most, clients entering group therapy ask explic­ itly for help in their interpersonal relationships. Yet I have observed that the therapeutic goals of clients often undergo a shift after a number of ses­ sions. Their initial goal, relief of suffering, is modified and eventually re­ placed by new goals, usually interpersonal in nature. For example, goals may change from wanting relief from anxiety or depression to wanting to learn to communicate with others, to be more trusting and honest with others, to learn to love. In the brief group therapies, this translation of

24 INTERPERSONAL LEARNING

client concerns and aspirations into interpersonal ones may need to take place earlier, at the assessment and preparation phase (see chapter 10).3 l

The goal shift from relief of suffering to change in interpersonal func­ tioning is an essential early step in the dynamic therapeutic process. It is important in the thinking of the therapist as well. Therapists cannot, for example, treat depression per se: depression offers no effective therapeu­ tic handhold, no rationale for examining interpersonal relationships, which, as I hope to demonstrate, is the key to the therapeutic power of the therapy group. It is necessary, first, to translate depression into interper­ sonal terms and then to treat the underlying interpersonal pathology. Thus, the therapist translates depression into its interpersonal issues-for example, passive dependency, isolation, obsequiousness, inability to ex­ press anger, hypersensitivity to separation-and then addresses those in­ terpersonal issues in therapy.

Sullivan's statement of the overall process and goals of individual ther­ apy is deeply consistent with those of interactional group therapy. This interpersonal and relational focus is a defining strength of group therapy.t The emphasis on the client's understanding of the past, of the genetic de­ velopment of those maladaptive interpersonal stances, may be less crucial in group therapy than in the individual setting where Sullivan worked (see chapter 6).

The theory of interpersonal relationships has become so much an inte­ gral part of the fabric of psychiatric thought that it needs no further un­ derscoring. People need people-for initial and continued survival, for socialization, for the pursuit of satisfaction. No one-not the dying, not the outcast, not the mighty-transcends the need for human contact.

During my many years of leading groups of individuals who all had some advanced form of cancer, 32 I was repeatedly struck by the realization that, in the face of death, we dread not so much nonbeing or nothingness but the accompanying utter loneliness. Dying patients may be haunted by interpersonal concerns-about being abandoned, for example, even shunned, by the world of the living. One woman, for example, had planned to give a large evening social function and learned that very morning that her cancer, heretofore believed contained, had metastasized. She kept the information secret and gave the party, all the while dwelling on the horrible thought that the pain from her disease would eventually grow so unbearable that she would become less human and, finally, unac­ ceptable to others.

The isolation of the dying is often double-edged. Patients themselves often avoid those they most cherish, fearing that they will drag their fam­ ily and friends into the quagmire of their despair. Thus they avoid morbid talk, develop an airy, cheery facade, and keep their fears to themselves. Their friends and family contribute to the isolation by pulling back, by

25 The Impurtance of Interpersonal Relationships

not knowing how to speak to the dying, by not wanting to upset them or themselves. I agree with Elisabeth Kubler-Ross that the question is not whether but how to tell a patient openly and honestly about a fatal illness. The patient is always informed covertly that he or she is dying by the de­ meanor, by the shrinking away, of the living. 33

Physicians often add to the isolation by keeping patients with advanced cancer at a considerable psychological distance-perhaps to avoid their sense of failure and futility, perhaps also to avoid dread of their own death. They make the mistake of concluding that, after all, there is noth­ ing more they can do. Yet from the patient's standpoint, this is the very time when the physician is needed the most, not for technical aid but for sheer human presence. What the patient needs is to make contact, to be able to touch others, to voice concerns openly, to be reminded that he or she is not only apart from but also a part of. Psychotherapeutic ap­ proaches are beginning to address these specific concerns of the termi­ nally ill-their fear of isolation and their desire to retain dignity within their relationships.t Consider the outcasts-those individuals thought to be so inured to rejection that their interpersonal needs have become heav­ ily calloused. The outcasts, too, have compelling social needs. I once had an experience in a prison that provided me with a forceful reminder of the ubiquitous nature of this human need. An untrained psychiatric techni­ cian consulted me about his therapy group, composed of twelve inmates. The members of the group were all hardened recidivists, whose offenses ranged from aggressive sexual violation of a minor to murder. The group, he complained, was sluggish and persisted in focusing on extraneous, ex­ tragroup material. I agreed to observe his group and suggested that first he obtain some sociometric information by asking each member privately to rank-order everyone in the group for general popularity. (I had hoped that the discussion of this task would induce the group to turn its atten­ tion upon itself.) Although we had planned to discuss these results before the next group session, unexpected circumstances forced us to cancel our presession consultation.

During the next group meeting, the therapist, enthusiastic bur profes­ sionally inexperienced and insensitive to interpersonal needs, announced that he would read aloud the results of the popularity poll. Hearing this, the group members grew agitated and fearful. They made it clear that they did not wish to know the results. Several members spoke so vehe­ mently of the devastating possibility that they might appear at the bottom of the list that the therapist quickly and permanently abandoned his plan of reading the list aloud.

I suggested an alternative plan for the next meeting: each member would indicate whose vote he cared about most and then explain his choice. This device, also, was too threatening, and only one-third of the

26 INTERPERSONAL LEARNING

members ventured a choice. Nevertheless, the group shifted to an interac­ tional level and developed a degree of tension, involvement, and exhilara­ tion previously unknown. These men had received the ultimate message of rejection from society at large: they were imprisoned, segregated, and explicitly labeled as outcasts. To the casual observer, they seemed hard­ ened, indifferent to the subtleties of interpersonal approval and disap­ proval. Yet they cared, and cared deeply.

The need for acceptance by and interaction with others is no different among people at the opposite pole of human fortunes-those who occupy the ultimate realms of power, renown, or wealth. I once worked with an enormously wealthy client for three years. The major issues revolved about the wedge that money created between herself and others. Did anyone value her for herself rather than her money? Was she continually being ex­ ploited by others? To whom could she complain of the burdens of a ninety­ million-dollar fortune? The secret of her wealth kept her isolated from others. And gifts! How could she possibly give appropriate gifts without having others feel either disappointed or awed? There is no need to belabor the point; the loneliness of the very privileged is common knowledge. (Loneliness is, incidentally, not irrelevant to the group therapist; in chapter 7, I will discuss the loneliness inherent in the role of group leader.)

Every group therapist has, I am sure, encountered group members who profess indifference to or detachment from the group. They proclaim, "I don't care what they say or think or feel about me; they're nothing to me; I have no respect for the other members," or words to that effect. My ex­ perience has been that if I can keep such clients in the group long enough, their wishes for contact inevitably surface. They are concerned at a very deep level about the group. One member who maintained her indifferent posture for many months was once invited to ask the group her secret question, the one question she would like most of all to place before the group. To everyone's astonishment, this seemingly aloof, detached woman posed this question: "How can you put up with me?"

Many clients anticipate meetings with great eagerness or with anxiety; some feel too shaken afterward to drive home or to sleep that night; many have imaginary conversations with the group during the week. Moreover, this engagement with other members is often long-lived; I have known many clients who think and dream about the group members months, even years, after the group has ended.

In short, people do not feel indifferent toward others in their group for long. And clients do not quit the therapy group because of boredom. Be­ lieve scorn, contempt, fear, discouragement, shame, panic, hatred! Believe any of these! But never believe indifference!

In summary, then, I have reviewed some aspects of personality devel­ opment, mature functioning, psychopathology, and psychiatric treatment

27 The Correctiue Emotional Experience

from the point of view of interpersonal theory. Many of the issues that I have raised have a vital bearing on the therapeutic process in group ther­ apy: the concept that mental illness emanates from disturbed interper­ sonal relationships, the role of consensual validation in the modification of interpersonal distortions, the definition of the therapeutic process as an adaptive modification of interpersonal relationships, and the enduring nature and potency of the human being's social needs. Let us now turn to the corrective emotional experience, the second of the three concepts nec­ essary to understand the therapeutic factor of interpersonal learning.

THE CORRECTIVE EMOTIONAL EXPERIENCE

In 1946, Franz Alexander, when describing the mechanism of psychoana­ lytic cure, introduced the concept of the "corrective emotional experience." The basic principle of treatment, he stated, "is to expose the patient, under more favorable circumstances, to emotional situations that he could not handle in the past. The patient, in order to be helped, must undergo a cor­ rective emotional experience suitable to repair the traumatic influence of previous experience." 34 Alexander insisted that intellectual insight alone is insufficient: there must be an emotional component and systematic reality testing as well. Patients, while affectively interacting with their therapist in a distorted fashion because of transference, gradually must become aware of the fact that "these reactions are not appropriate to the analyst's reac­ tions, not only because he (the analyst) is objective, but also because he is what he is, a person in his own right. They are not suited to the situation be­ tween patient and therapist, and they are equally unsuited to the patient's current interpersonal relationships in his daily life."35

Although the idea of the corrective emotional experience was criticized over the years because it was misconstrued as contrived, inauthentic, or manipulative, contemporary psychotherapies view it as a cornerstone of therapeutic effectiveness. Change both at the behavioral level and at the deeper level of internalized images of past relationships does not occur primarily through interpretation and insight but through meaningful here­ and-now relational experience that disconfirms the client's pathogenic be­ liefs.36 When such discomfirmation occurs, change can be dramatic: clients express more emotion, recall more personally relevant and formative expe­ riences, and show evidence of more boldness and a greater sense of self.37

These basic principles-the importance of the emotional experience in therapy and the client's discovery, through reality testing, of the inappropri­ ateness of his or her interpersonal reactions-are as crucial in group ther­ apy as in individual therapy, and possibly more so because the group setting offers far more opportunities for the generation of corrective emotional ex­ periences. In the individual setting, the corrective emotional experience,

28 INTERPERSONAL LEARNING

valuable as it is, may be harder to come by, because the client-therapist rela­ tionship is more insular and the client is more able to dispute the spontane­ ity, scope, and authenticity of that relationship. (I believe Alexander was aware of that, because at one point he suggested that the analyst may have to be an actor, may have to play a role in order to create the desired emo­ tional atmosphere.) 38

No such simulation is necessary in the therapy group, which contains many built-in tensions-tensions whose roots reach deep into primeval layers: sibling rivalry, competition for leaders'/parents' attention, the struggle for dominance and status, sexual tensions, parataxic distortions, and differences in social class, education, and values among the members. But the evocation and expression of raw affect is not sufficient: it has to be transformed into a corrective emotional experience. For that to occur two conditions are required: (1) the members must experience the group as sufficiently safe and supportive so that these tensions may be openly expressed; (2) there must be sufficient engagement and honest feedback to permit effective reality testing.

Over many years of clinical work, I have made it a practice to interview clients after they have completed group therapy. I always inquire about some critical incident, a turning point, or the most helpful single event in therapy. Although "critical incident" is not synonymous with therapeutic factor, the two are not unrelated, and much may be learned from an ex­ amination of single important events. My clients almost invariably cite an incident that is highly laden emotionally and involves some other group member, rarely the therapist.

The most common type of incident my clients report (as did clients de­ scribed by Frank and Ascher) 39 involves a sudden expression of strong dis­ like or anger toward another member. In each instance, communication was maintained, the storm was weathered, and the client experienced a sense of liberation from inner restraints as well as an enhanced ability to explore more deeply his or her interpersonal relationships.

The important characteristics of such critical incidents were:

1. The client expressed strong negative affect. 2. This expression was a unique or novel experience for the client. 3. The client had always dreaded the expression of anger. Yet no cata­

strophe ensued: no one left or died; the roof did not collapse. 4. Reality testing ensued. The client realized either that the anger ex­

pressed was inappropriate in intensity or direction or that prior avoidance of affect expression had been irrational. The client may or may not have gained some insight, that is, learned the reasons ac­ counting either for the inappropriate affect or for the prior avoid­ ance of affect experience or expression.

29 The Corrective Emotional Experience

5. The client was enabled to interact more freely and to explore inter­ personal relationships more deeply.

Thus, when I see two group members in conflict with one another, I be­ lieve there is an excellent chance that they will be particularly important to one another in the course of therapy. In fact, if the conflict is particu­ larly uncomfortable, I may attempt to ameliorate some of the discomfort by expressing that hunch aloud.

The second most common type of critical incident my clients describe also involves strong affect-but, in these instances, positive affect. For ex­ ample, a schizoid client described an incident in which he ran after and comforted a distressed group member who had bolted from the room; later he spoke of how profoundly he was affected by learning that he could care for and help someone else. Others spoke of discovering their aliveness or of feeling in touch with themselves. These incidents had in common the following characteristics:

1. The client expressed strong positive affect-an unusual occurrence. 2. The feared catastrophe did not occur-derision, rejection, engulf­

ment, the destruction of others. 3. The client discovered a previously unknown part of the self and thus

was enabled to relate to others in a new fashion.

The third most common category of critical incident is similar to the second. Clients recall an incident, usually involving self-disclosure, that plunged them into greater involvement with the group. For example, a previously withdrawn, reticent man who had missed a couple of meetings disclosed to the group how desperately he wanted to hear the group mem­ bers say that they had missed him during his absence. Others, too, in one fashion or another, openly asked the group for help.

To summarize, the corrective emotional experience in group therapy has several components:

1. A strong expression of emotion, which is interpersonally directed and constitutes a risk taken by the client.

2. A group supportive enough to permit this risk taking. 3. Reality testing, which allows the individual to examine the incident

with the aid of consensual validation from the other members. 4. A recognition of the inappropriateness of certain interpersonal feel­

ings and behavior or of the inappropriateness of avoiding certain in­ terpersonal behavior.

5. The ultimate facilitation of the individual's ability to interact with others more deeply and honestly.

30 INTERPERSONAL LEARNING

Therapy is an emotional and a corrective experience. This dual nature of the therapeutic process is of elemental significance, and I will return to it again and again in this text. We must experience something strongly; but we must also, through our faculty of reason, understand the implica­ tions of that emotional experience.t Over time, the client's deeply held beliefs will change-and these changes will be reinforced if the client's new interpersonal behaviors evoke constructive interpersonal responses. Even subtle interpersonal shifts can reflect a profound change and need to be acknowledged and reinforced by the therapist and group members.

Barbara, a depressed young woman, vividly described her isolation and alienation to the group and then turned to Alice, who had been silent. Barbara and Alice had often sparred because R1rbarc1 would llccuse Alice of ignoring and rejecting her. In this meeting, howeue1; Barbara used a more gentle tone and asked Alice about the meaning of her si­ lence. Alice responded that she was listening carefully and thinking about how much they had in common. She then added that Barbllra's more gentle inquiry allowed her to give voice to her thoughts rather than defend herself against the charge of not caring, a sequence thllt had ended badly for them both in earlier sessions. The seemingly small but uitally important shift in Barbara's capacity to approach Alice em­ pathically created an opportunity for repair rather than repetition.

This formulation has direct relevance to a key concept of group ther- apy, the here-and-now, which I will discuss in depth in chapter 6. Here I will state only chis basic premise: When the therapy group focuses on the here-and-now, it increases in power and effectiueness.

But if the here-and-now focus (that is, a focus on what is happening in chis room in the immediate present) is to be therapeutic, it must have t,vo components: the group members must experience one another with as much spontaneity and honesty as possible, and they must also reflect back on chat experience. This reflecting back, chis self-reflectiue loop, is crucial if an emotional experience is to be transformed into a therapeutic one. As we shall see in the discussion of the therapist's tasks in chapter 5, most groups have little difficulty in entering the emotional stream of the here­ and-now; but generally it is the therapist's job to keep directing the group toward the self-reflective aspect of that process.

The mistaken assumption that a strong emotional experience is in itself a sufficient force for change is seductive as well as venerable ..Modern psy­ chotherapy was conceived in chat very error: the first description of dy­ namic psychotherapy (Freud and Breuer's 1895 Studies on Hysteria) 40

described a method of cathartic treatment based on the conviction that hysteria is caused by a traumatic event to which the individual has never

31 The Group as Social Microcosm

fully responded emotionally. Since illness was supposed to be caused by strangulated affect, treatment was directed toward giving a voice to the stillborn emotion. It was not long before Freud recognized the error: emo­ tional expression, though necessary, is not a sufficient condition for change. Freud's discarded ideas have refused to die and have been the seed for a continuous fringe of therapeutic ideologies. The Viennese fin-de-sie­ cle cathartic treatment still lives today in the approaches of primal scream, bioenergetics, and the many group leaders who place an exagger­ ated emphasis on emotional catharsis.

My colleagues and I conducted an intensive investigation of the process and outcome of many of the encounter techniques popular in the 1970s (see chapter 16), and our findings provide much support for the dual emo­ tional-intellectual components of the psychotherapeutic process. 41

We explored, in a number of ways, the relationship between each member's experience in the group and his or her outcome. For example, we asked the members after the conclusion of the group to reflect on those aspects of the group experience they deemed most pertinent to their change. We also asked them during the course of the group, at the end of each meeting, to describe which event at that meeting had the most personal significance. When we correlated the type of event with outcome, we obtained surprising results that disconfirmed many of the contemporary stereotypes about the prime ingredients of the successful encounter group experience. Although emotional experiences (expres­ sion and experiencing of strong affect, self-disclosure, giving and receiv­ ing feedback) were considered extremely important, they did not distinguish successful from unsuccessful group members. In other words, the members who were unchanged or even had a destructive ex­ perience were as likely as successful members to value highly the emo­ tional incidents of the group.

What types of experiences did differentiate the successful from the unsuccessful members? There was clear evidence that a cognitive com­ ponent was essential; some type of cognitive map was needed, some in­ tellectual system that framed the experience and made sense of the emotions evoked in the group. (See chapter 16 for a full discussion of this result.) That these findings occurred in groups led by leaders who did not attach much importance to the intellectual component speaks strongly for its being part of the foundation, not the facade, of the change process. 42

THE GROUP AS SOCIAL MICROCOSM

A freely interactive group, with few structural restrictions, will, in time, develop into a social microcosm of the participant members. Given

32 INTERPERSONAL LEARNING

enough time, group members wiH begin to be themselves: they will inter­ act with the group members as they interact with others in their social sphere, will create in the group the same interpersonal universe they have always inhabited. In other words, clients will, over time, automatically and inevitably begin to display their maladaptive interpersonal behavior in the therapy group. There is no need for them to describe or give a de­ tailed history of their pathology: they will sooner or later enact it before the other group members' eyes. Furthermore, their behavior serves as ac­ curate data and lacks the unwitting but inevitable blind spots of self-report. Character pathology is often hard for the individual to report because it is so well assimilated into the fabric of the self and outside of conscious and explicit awareness. As a result, group therapy, with its emphasis on feedback, is a particularly effective treatment for individuals with charac­ ter pathology. 43

This concept is of paramount importance in group therapy and is a keystone of the entire approach to group therapy. Each member's inter­ personal style will eventually appear in his or her transactions in the group. Some styles result in interpersonal friction that will be manifest early in the course of the group. Individuals who are, for example, angry, vindictive, harshly judgmental, self-effacing, or grandly coquettish will generate considerable interpersonal static even in the first few meetings. Their maladaptive social patterns will quickly elicit the group's attention. Others may require more time in therapy before their difficulties manifest themselves in the here-and-now of the group. This includes clients who may be equally or more severely troubled but whose interpersonal diffi­ culties are more subtle, such as individuals who quietly exploit others, those who achieve intimacy to a point but then, becoming frightened, dis­ engage themselves, or those who pseudo-engage, maintaining a subordi­ nate, compliant position.

The initial business of a group usually consists of dealing with the members whose pathology is most interpersonally blatant. Some inter­ personal styles become crystal-clear from a single transaction, some from a single group meeting, and others require many sessions of observation to understand. The development of the ability to identify and put to ther­ apeutic advantage maladaptive interpersonal behavior as seen in the so­ cial microcosm of the small group is one of the chief tasks of a training program for group psychotherapists. Some clinical examples may make these principles more graphic.•·

*In the following clinical examples, as elsewhere in this text, I have protected clients' privacy by altering certain facts, such as name, occupation, and age. Also, the interaction described in the text is not reproduced verbatim but has been reconstructed from detailed clinical notes taken after each therapy meeting.

33 The Group as Social Microcosm

The Grand Dame

Valerie, a twenty-seven-year-old musician, sought therapy with me pri­ marily because of severe marital discord of several years' standing. She had had considerable, unrewarding individual and hypnotic uncovering therapy. Her husband, she reported, was an alcoholic who was reluctant to engage her socially, intellectually, or sexually. Now the group could have, as some groups do, investigated her marriage interminably. The members might have taken a complete history of the courtship, of the evolution of the discord, of her husband's pathology, of her reasons for marrying him, of her role in the conflict. They might have followed up this collection of information with advice for changing the marital inter­ action or perhaps suggestions for a trial or permanent separation.

But all this historical, problem-solving activity would have been in vain: this entire line of inquiry not only disregards the unique potential of therapy groups but also is based on the highly questionable premise that a client's account of a marriage is even reasonably accurate. Groups that function in this manner fail to help the protagonist and also suffer de­ moralization because of the ineffectiveness of a problem-solving, histori­ cal group therapy approach. Let us instead observe Valerie's behavior as it unfolded in the here-and-now of the group.

Valerie's group behavior was flamboyant. First, there was her grand en­ trance, always five or ten minutes late. Bedecked in fashionable but flashy garb, she would sweep in, sometimes throwing kisses, and immediately begin talking, oblivious to whether another member was in the middle of a sentence. Here was narcissism in the raw! Her worldview was so solip­ sistic that it did not take in the possibility that life could have been going on in the group before her arrival.

After very few meetings, Valerie began to give gifts: to an obese female member, a copy of a new diet book; to a woman with strabismus, the name of a good ophthalmologist; to an effeminate gay client, a subscrip­ tion to Field and Stream magazine (intended, no doubt, to masculinize him); to a twenty-four-year-old virginal male, an introduction to a promiscuous divorced friend of hers. Gradually it became apparent that the gifts were not duty-free. For example, she pried into the relationship that developed between the young man and her divorced friend and in­ sisted on serving as confidante and go-between, thus exerting consider­ able control over both individuals.

Her efforts to dominate soon colored all of her interactions in the group. I became a challenge to her, and she made various efforts to control me. By sheer chance, a few months previously I had seen her sister in con­ sultation and referred her to a competent therapist, a clinical psychologist. In the group Valerie congratulated me for the brilliant tactic of sending her

34 INTERPERSONAL LEARNING

sister to a psychologist; I must have divined her deep-seated aversion to psychiatrists. Similarly, on another occasion, she responded to a comment from me, "How perceptive you were to have noticed my hands trembling."

The trap was set! In fact, I had neither "divined" her sister's alleged aversion to psychiatrists (I had simply referred her to the best therapist I knew) nor noted Valerie's trembling hands. If I silently accepted her un­ deserved tribute, then I would enter into a dishonest collusion with Va­ lerie; if, on the other hand, I admitted my insensitivity either to the trembling of the hands or to the sister's aversion, then, by acknowledging my lack of perceptivity, I would have also been bested. She would control me either way! In such situations, the therapist has only one real option: to change the frame and to comment on the process-the nature and the meaning of the entrapment. (I will have a great deal more to say about rel­ evant therapist technique in chapter 6.)

Valerie vied with me in many other ways. Intuitive and intellectually gifted, she became the group expert on dream and fantasy interpretation. On one occasion she saw me between group sessions to ask whether she could use my name to take a book out of the medical library. On one level the request was reasonable: the book (on music therapy) was related to her profession; furthermore, having no university affiliation, she was not permitted to use the library. However, in the context of the group process, the request was complex in that she was testing limits; granting her request would have signaled to the group that she had a special and unique relationship with me. I clarified these considerations to her and suggested further discussion in the next session. Following this perceived rebuttal, however, she called the three male members of the group at home and, after swearing them to secrecy, arranged to see them. She en­ gaged in sexual relations with two; the third, a gay man, was not inter­ ested in her sexual advances but she launched a formidable seduction attempt nonetheless.

The following group meeting was horrific. Extraordinarily tense and unproductive, it demonstrated the axiom (to be discussed later) that if something important in the group is being actively avoided, then nothing else of import gets talked about either. Two days later Valerie, overcome with anxiety and guilt, asked for an individual session with me and made a full confession. It was agreed that the whole matter should be discussed in the next group meeting.

Valerie opened the next meeting with the words: "This is confession day! Go ahead, Charles!" and then later, "Your turn, Louis," deftly manip­ ulating the situation so that the confessed transgressions became the sole responsibilities of the men in question, and not herself. Each man per­ formed as she bade him and, later in the meeting, received from her a crit­ ical evaluation of his sexual performance. A few weeks later, Valerie let her

35 The Group as Social Microcosm

estranged husband know what had happened, and he sent threatening messages to all three men. That was the last straw! The members decided they could no longer trust her and, in the only such instance I have known, voted her out of the group. (She continued her therapy by joining another group.) The saga does not end here, but perhaps I have recounted enough to illustrate the concept of the group as social microcosm.

Let me summarize. The first step was that Valerie clearly displayed her interpersonal pathology in the group. Her narcissism, her need for adula­ tion, her need to control, her sadistic relationship with men-the entire tragic behavioral scroll-unrolled in the here-and-now of therapy. The next step was reaction and feedback. The men expressed their deep hu­ miliation and anger at having to "jump through a hoop" for her and at re­ ceiving "grades" for their sexual performance. They drew away from her. They began to reflect: "I don't want a report card every time I have sex. It's controlling, like sleeping with my mother! I'm beginning to under­ stand more about your husband moving out!" and so on. The others in the group, the female members and the therapists, shared the men's feel­ ings about the wantonly destructive course of Valerie's behavior-de­ structive for the group as well as for herself.

Most important of all, she had to deal with this fact: she had joined a group of troubled individuals who were eager to help each other and whom she grew to like and respect; yet, in the course of several weeks, she had so poisoned her own environment that, against her conscious wishes, she became a pariah, an outcast from a group that could have been very helpful to her. Facing and working through these issues in her subsequent therapy group enabled her to make substantial personal changes and to employ much of her considerable potential constructively in her later re­ lationships and endeavors.

The Man Who Liked Robin Hood Ron, a forty-eight-year-old attorney who was separated from his wife, en­ tered therapy because of depression, anxiety, and intense feelings of lone­ liness. His relationships with both men and women were highly problematic. He yearned for a close male friend but had not had one since high school. His current relationships with men assumed one of two forms: either he and the other man related in a highly competitive, antag­ onistic fashion, which veered dangerously close to combativeness, or he assumed an exceedingly dominant role and soon found the relationship empty and dull.

His relationships with women had always followed a predictable se­ quence: instant attraction, a crescendo of passion, a rapid loss of interest. His love for his wife had withered years ago and he was currently in the midst of a painful divorce.

36 INTERPERSONAL LEARNING

Intelligent and highly articulate, Ron immediately assumed a position of great influence in the group. He offered a continuous stream of useful and thoughtful observations to the other members, yet kept his own pain and his own needs well concealed. He requested nothing and accepted nothing from me or my co-therapist. In fact, each time I set out to inter­ act with Ron, I felt myself bracing for battle. His antagonistic resistance was so great that for months my major interaction with him consisted of repeatedly requesting him to examine his reluctance to experience me as someone who could offer help.

"Ron," I suggested, giving it my best shot, "let's understand what's happening. You have many areas of unhappiness in your life. I'm an ex­ perienced therapist, and you come to me for help. You come regularly, you never miss a meeting, you pay me for my services, yet you systematically prevent me from helping you. Either you so hide your pain that I find lit­ tle to offer you, or when I do extend some help, you reject it in one fash­ ion or another. Reason dictates that we should be allies. Shouldn't we be working together to help you? Tell me, how does it come about that we are adversaries?"

But even that failed to alter our relationship. Ron seemed bemused and skillfully and convincingly speculated that I might be identifying one of my problems rather than his. His relationship with the other group mem­ bers was characterized by his insistence on seeing them outside the group. He systematically arranged for some extragroup activity with each of the members. He was a pilot and took some members flying, others sailing, others to lavish dinners; he gave legal advice to some and became romanti­ cally involved with one of the female members; and (the final straw) he in­ vited my co-therapist, a female psychiatric resident, for a skiing weekend.

Furthermore, he refused to examine his behavior or to discuss these ex­ tragroup meetings in the group, even though the pregroup preparation (see chapter 12) had emphasized to all the members that such unexam­ ined, undiscussed extragroup meetings generally sabotage therapy.

After one meeting when we pressured him unbearably to examine the meaning of the extragroup invitations, especially the skiing invitation to my co-therapist, he left the session confused and shaken. On his way home, Ron unaccountably began to think of Robin Hood, his favorite childhood story but something he had not thought about for decades.

Following an impulse, he went directly to the children's section of the nearest public library to sit in a small child's chair and read the story one more time. In a flash, the meaning of his behavior was illuminated! Why had the Robin Hood legend always fascinated and delighted him? Because Robin Hood rescued people, especially women, from tyrants!

That motif had played a powerful role in his interior life, beginning with the Oedipal struggles in his own family. Later, in early adulthood, he

37 The Group as Social Microcosm

built up a successful law firm by first assisting in a partnership and then enticing his boss's employees to work for him. He had often been most at­ tracted to women who were attached to some powerful man. Even his mo­ tives for marrying were blurred: he could not distinguish between love for his wife and desire to rescue her from a tyrannical father.

The first stage of interpersonal learning is pathology display. Ron's characteristic modes of relating to both men and women unfolded vividly in the microcosm of the group. His major interpersonal motif was to struggle with and to vanquish other men. He competed openly and, be­ cause of his intelligence and his great verbal skills, soon procured the dominant role in the group. He then began to mobilize the other members in the final conspiracy: the unseating of the therapist. He formed close al­ liances through extragroup meetings and by placing other members in his debt by offering favors. Next he endeavored to capture "my women"­ first the most attractive female member and then my co-therapist.

Not only was Ron's interpersonal pathology displayed in the group, but so were its adverse, self-defeating consequences. His struggles with men re­ sulted in the undermining of the very reason he had come to therapy: to ob­ tain help. In fact, the competitive struggle was so powerful that any help I extended him was experienced not as help but as defeat, a sign of weakness.

Furthermore, the microcosm of the group revealed the consequences of his actions on the texture of his relationships with his peers. In time the other members became aware that Ron did not really relate to them. He only appeared to relate but, in actuality, was using them as a way of relating to me, the powerful and feared male in the group. The others soon felt used, felt the absence of a genuine desire in Ron to know them, and gradually began to distance themselves from him. Only after Ron was able to understand and to alter his intense and distorted ways of re­ lating to me was he able to turn to and relate in good faith to the other members of the group.

"Those Damn Men"

Linda, forty-six years old and thrice divorced, entered the group because of anxiety and severe functional gastrointestinal distress. Her major in­ terpersonal issue was her tormented, self-destructive relationship with her current boyfriend. In fact, throughout her life she had encountered a long series of men (father, brothers, bosses, lovers, and husbands) who had abused her both physically and psychologically. Her account of the abuse that she had suffered, and suffered still, at the hands of men was harrowing.

The group could do little to help her, aside from applying balm to her wounds and listening empathically to her accounts of continuing mistreat­ ment by her current boss and boyfriend. Then one day an unusual incident

38 INTERPERSONAL LEARNING

occurred that graphically illuminated her dynamics. She called me one morning in great distress. She had had an extremely unsettling altercation with her boyfriend and felt panicky and suicidal. She felt she could not possibly wait for the next group meeting, still four days off, and pleaded for an immediate individual session. Although it was greatly inconvenient, I rearranged my appointments that afternoon and scheduled time to meet her. Approximately thirty minutes before our meeting, she called and left word with my secretary that she would not be coming in after all.

In the next group meeting, when I inquired what had happened, Linda said that she had decided to cancel the emergency session because she was feeling slightly better by the afternoon, and that she knew I had a rnle that I would see a client only one time in an emergency during the whole course of group therapy. She therefore thought it might be best to save that option for a time when she might be even more in crisis.

I found her response bewildering. I had never made such a rule; I never refuse to see someone in real crisis. Nor did any of the other members of the group recall my having issued such a dictum. But Linda stuck to her guns: she insisted that she had heard me say it, and she was dissuaded nei­ ther by my denial nor by the unanimous consensus of the other group members. Nor did she seem concerned in any way about the inconve­ nience she had caused me. In the group discussion she grew defensive and acnmon10us.

This incident, unfolding in the social microcosm of the group, was highly informative and allowed us to obtain an important perspective on Linda's responsibility for some of her problematic relationships with men. Up until that point, the group had to rely entirely on her portrayal of these relationships. Linda's accounts were convincing, and the group had come to accept her vision of herself as victim of "all those damn men out there." An examination of the here-and-now incident indicated that Linda had distorted her perceptions of at least one important man in her life: her therapist. Moreover-and this is extremely important-she had distorted the incident in a highly predictable fashion: she experienced me as far more uncaring, insensitive, and authoritarian than I really was.

This was new data, and it was convincing data-and it was displayed before the eyes of all the members. For the first time, the group began to wonder about the accuracy of Linda's accounts of her relationships with men. Undoubtedly, she faithfully portrayed her feelings, but it became ap­ parent that there were perceptual distortions at work: because of her ex­ pectations of men and her highly conflicted relationships with them, she misperceived their actions toward her.

But there was more yet to be learned from the social microcosm. An important piece of data was the tone of the discussion: the defensiveness, the irritation, the anger. In time I, too, became irritated by the thankless

39 The Group as Social Microcosm

inconvenience I had suffered by changing my schedule to meet with Linda. I was further irritated by her insistence that I had proclaimed a certain in­ sensitive rule when I (and the rest of the group) knew I had not. I fell into a reverie in which I asked myself, "What would it be like to live with Linda all the time instead of an hour and a half a week?" If there were many such incidents, I could imagine myself often becoming angry, exasper­ ated, and uncaring toward her. This is a particularly clear example of the concept of the self-fulfilling prophecy described on page 22. Linda pre­ dicted that men would behave toward her in a certain way and then, un­ consciously, operated so as to bring this prediction to pass.

Men Who Could Not Feel

Allen, a thirty-year-old unmarried scientist, sought therapy for a single, sharply delineated problem: he wanted to be able to feel sexually stimu­ lated by a woman. Intrigued by this conundrum, the group searched for an answer. They investigated his early life, sexual habits, and fantasies. Fi­ nally, baffled, they turned to other issues in the group. As the sessions con­ tinued, Allen seemed impassive and insensitive to his own and others' pain. On one occasion, for example, an unmarried member in great dis­ tress announced in sobs that she was pregnant and was planning to have an abortion. During her account she also mentioned that she had had a bad PCP trip. Allen, seemingly unmoved by her tears, persisted in posing intellectual questions about the effects of "angel dust" and was puzzled when the group commented on his insensitivity.

So many similar incidents occurred that the group came to expect no emotion from him. When directly queried about his feelings, he re­ sponded as if he had been addressed in Sanskrit or Aramaic. After some months the group formulated an answer to his oft-repeated question, "Why can't I have sexual feelings toward a woman?" They asked him to consider instead why he couldn't have any feelings toward anybody.

Changes in his behavior occurred very gradually. He learned to spot and identify feelings by pursuing telltale autonomic signs: facial flushing, gastric tightness, sweating palms. On one occasion a volatile woman in the group threatened to leave the group because she was exasperated try­ ing to relate to "a psychologically deaf and dumb goddamned robot." Allen again remained impassive, responding only, "I'm not going to get down to your level."

However, the next week when he was asked about the feelings he had taken home from the group, he said that after the meeting he had gone home and cried like a baby. (When he left the group a year later and looked back at the course of his therapy, he identified this incident as a critical turning point.) Over the ensuing months he was more able to feel and to express his feelings to the other members. His role within the

40 INTERPERSONAL LEARNING

group changed from that of tolerated mascot to that of accepted com­ peer, and his self-esteem rose in accordance with his awareness of the members' increased respect for him.

In another group Ed, a forty-seven-year-old engineer, sought therapy be­ cause of loneliness and his inability to find a suitable mate. Ed's pattern of social relationships was barren: he had never had close male friends and had only sexualized, unsatisfying, short-lived relationships with women who ultimately and invariably rejected him. His good social skills and lively sense of humor resulted in his being highly valued by other members in the early stages of the group.

As time went on and members deepened their relationships with one another, however, Ed was left behind: soon his experience in the group re­ sembled closely his social life outside the group. The most obvious aspect of his behavior was his limited and offensive approach to women. His gaze was directed primarily toward their breasts or crotch; his attention was voyeuristically directed toward their sexual lives; his comments to them were typically simplistic and sexual in nature. Ed considered the men in the group unwelcome competitors; for months he did not initiate a single transaction with a man.

With so little appreciation for attachments, he, for the most part, con­ sidered people interchangeable. For example, when a member described her obsessive fantasy that her boyfriend, who was often late, would be killed in an automobile accident, Ed's response was to assure her that she was young, charming, and attractive and would have little trouble finding another man of at least equal quality. To take another example, Ed was always puzzled when other members appeared troubled by the temporary absence of one of the co-therapists or, later, by the impend­ ing permanent departure of a therapist. Doubtless, he suggested, there was, even among the students, a therapist of equal competence. (In fact, he had seen in the hall a bosomy psychologist whom he .would particu­ larly welcome as therapist.)

He put it most succinctly when he described his MDR (minimum daily requirement) for affection; in time it became clear to the group that the identity of the MDR supplier was incidental to Ed-far less relevant than its dependability.

Thus evolved the first phase of the group therapy process: the display of interpersonal pathology. Ed did not relate to others so much a-s he used them as equipment, as objects to supply his life needs. It was not long be­ fore he had re-created in the group his habitual-and desolate--interper­ sonal universe: he was cut off from everyone. Men reciprocated his total indifference; women, in general, were disinclined to service his MDR, and those women he especially craved were repulsed by his narrowly sexual-

41 The Social Microcosm: A Dynamic Interaction

ized attentions. The subsequent course of Ed's group therapy was greatly informed by his displaying his interpersonal pathology inside the group, and his therapy profited enormously from focusing exhaustively on his re­ lationships with the other group members.

THE SOCIAL MICROCOSM: A DYNAMIC INTERACTION

There is a rich and subtle dynamic interplay between the group member and the group environment. Members shape their own microcosm, which in turn pulls characteristic defensive behavior from each. The more spon­ taneous interaction there is, the more rapid and authentic will be the de­ velopment of the social microcosm. And that in turn increases the likelihood that the central problematic issues of all the members will be evoked and addressed.

For example, Nancy, a young woman with borderline personality dis­ order, entered the group because of a disabling depression, a subjective state of disintegration, and a tendency to develop panic when left alone. All of Nancy's symptoms had been intensified by the threatened breakup of the small commune in which she lived. She had long been sensitized to the breakup of nuclear units; as a child she had felt it was her task to keep her volatile family together, and now as an adult she nurtured the fantasy that when she married, the various factions among her relatives would be permanently reconciled.

How were Nancy's dynamics evoked and worked through in the social microcosm of the group? Slowly! It took time for these concerns to man­ ifest themselves. At first, sometimes for weeks on end, Nancy would work comfortably on important but minor conflict areas. But then certain events in the group would fan her major, smoldering concerns into anx­ ious conflagration. For example, the absence of a member would unsettle her. In fact, much later, in a debriefing interview at the termination of therapy, Nancy remarked that she often felt so stunned by the absence of any member that she was unable to participate for the entire session.

Even tardiness troubled her and she would chide members who were not punctual. When a member thought about leaving the group, Nancy grew deeply concerned and could be counted on to exert maximal pres­ sure on the member to continue, regardless of the person's best interests. When members arranged contacts outside the group meeting, Nancy be­ came anxious at the threat to the integrity of the group. Sometimes mem­ bers felt smothered by Nancy. They drew away and expressed their objections to her phoning them at home to check on their absence or late­ ness. Their insistence that she lighten her demands on them simply ag­ gravated Nancy's anxiety, causing her to increase her protective efforts.

42 INTERPERSONAL LEARNING

Although she longed for comfort and safety in the group, it was, in fact, the very appearance of these unsettling vicissitudes that made it pos­ sible for her major conflict areas to become exposed and to enter the stream of the therapeutic work.

Not only does the small group provide a social microcosm in which the maladaptive behavior of members is clearly displayed, but it also becomes a laboratory in which is demonstrated, often with great clarity, the mean­ ing and the dynamics of the behavior. The therapist sees not only the be­ havior but also the events triggering it and sometimes, more important, the anticipated and real responses of others.

The group interaction is so rich that each member's maladaptive transac­ tion cycle is repeated many times, and members have multiple opportunities for reflection and understanding. But if pathogenic beliefs are to be altered, the group members must receive feedback that is clear and usable. If the style of feedback delivery is too stressful or provocative, members may be unable to process what the other members offer them. Sometimes the feed­ back may be premature-that is, delivered before sufficient trust is present to soften its edge. At other times feedback can be experienced as devaluing, coercive, or injurious. 44 How can we avoid unhelpful or harmful feedback? Members are less likely to attack and blame one another if they can look be­ yond surface behavior and become sensitive to one another's internal expe­ riences and underlying intentions.t Thus empathy is a critical element in the successful group. But empathy, particularly with provocative or aggressive clients, can be a tall order for group members and therapists alike. t

The recent contributions of the intersubjective model are relevant and helpful here. 45 This model poses members and therapists such questions as: "How am I implicated in what I construe as your provocativeness? What is my part in it?" In other words, the group members and the therapist con­ tinuously affect one another. Their relationships, their meaning, patterns, and nature, are not fixed or mandated by external influences, but jointly constructed. A traditional view of members' behavior sees the distortion with which members relate events---either in their past or within the group interaction-as solely the creation and responsibility of that member. An intersubjective perspective acknowledges the group leader's and other mem­ bers' contributions to each member's here-and-now experience-as well as to the texture of their entire experience in the group.

Consider the client who repeatedly arrives late to the group meeting. This is always an irritating event, and group members will inevitably ex­ press their annoyance. But the therapist should also encourage the group to explore the meaning of that particular client's behavior. Coming late may mean "I don't really care about the group," but it may also have many other, more complex interpersonal meanings: "Nothing happens

43 The Social Microcosm: A Dynamic Interaction

without me, so why should I rush?" or "I bet no one will even notice my absence-they don't seem to notice me while I'm there," or "These rules are meant for others, not me."

Both the underlying meaning of the individual's behavior and the im­ pact of that behavior on others need to be revealed and processed if the members are to arrive at an empathic understanding of one another. Em­ pathic capacity is a key component of emotional intelligence46 and facili­ tates transfer of learning from the therapy group to the client's larger world. Without a sense of the internal world of others, relationships are confusing, frustrating, and repetitive as we mindlessly enlist others as players with predetermined roles in our own stories, without regard to their actual motivations and aspirations.

Leonard, for example, entered the group with a major problem of pro­ crastination. In Leonard's view, procrastination was not only a problem but also an explanation. It explained his failures, both professionally and socially; it explained his discouragement, depression, and alcoholism. And yet it was an explanation that obscured meaningful insight and more accurate explanations.

In the group we became well acquainted and often irritated or frus­ trated with Leonard's procrastination. It served as his supreme mode of resistance to therapy when all other resistance had failed. When members worked hard with Leonard, and when it appeared that part of his neurotic character was about to be uprooted, he found ways to delay the group work. "I don't want to be upset by the group today," he would say, or "This new job is make or break for me"; "I'm just hanging on by my finger­ nails"; "Give me a break-don't rock the boat"; "I'd been sober for three months until the last meeting caused me to stop at the bar on my way home." The variations were many, but the theme was consistent.

One day Leonard announced a major development, one for which he had long labored: he had quit his job and obtained a position as a teacher. Only a single step remained: getting a teaching certificate, a matter of fill­ ing out an application requiring approximately two hours' labor.

Only two hours and yet he could not do it! He delayed until the allowed time had practically expired and, with only one day remaining, informed the group about the deadline and lamented the cruelty of his personal demon, procrastination. Everyone in the group, including the therapists, experienced a strong desire to sit Leonard down, possibly even in one's lap, place a pen between his fingers, and guide his hand along the appli­ cation form. One client, the most mothering member of the group, did exactly that: she took him home, fed him, and schoolmarmed him through the application form.

As we began to review what had happened, we could now see his pro­ crastination for what it was: a plaintive, anachronistic plea for a lost

44 INTERPERSONAL LEARNING

mother. Many things then fell into place, including the dynamics behind Leonard's depressions (which were also desperate pleas for love), alco­ holism, and compulsive overeating.

The idea of the social microcosm is, I believe, sufficiently clear: if the group is conducted such that the members can behave in an unguarded, unselfconscious manner, they will, most vividly, re-create and display their pathology in the group. Thus in this living drama of the group meet­ ing, the trained observer has a unique opportunity to understand the dy­ namics of each client's behavior.

RECOGNITION OF BEHAVIORAL PATTERNS IN THE SOCIAL MICROCOSM

If therapists are to turn the social microcosm to therapeutic use, they must first learn to identify the group members' recurrent maladaptive in­ terpersonal patterns. In the incident involving Leonard, the therapist's vital clue was the emotional response of members and leaders to Leonard's behavior. These emotional responses are valid and indispens­ able data: they should not be overlooked or underestimated. The therapist or other group members may feel angry toward a member, or exploited, or sucked dry, or steamrollered, or intimidated, or bored, or tearful, or any of the infinite number of ways one person can feel toward another.

These feelings represent data-a bit of the truth about the other per­ son-and should be taken seriously by the therapist. If the feelings elicited in others are highly discordant with the feelings that the client would like to engender in others, or if the feelings aroused are desired, yet inhibit growth (as in the case of Leonard), then therein lies a crucial part of the client's problem. Of course there are many complications inherent in this thesis. Some critics might say that a strong emotional response is often due to pathology not of the subject but of the respondent. If, for ex­ ample, a self-confident, assertive man evokes strong feelings of fear, in­ tense envy, or bitter resentment in another man, we can hardly conclude that the response is reflective of the farmer's pathology. There is a distinct advantage in the therapy group format: because the group contains multi­ ple observers, it is easier to differentiate idiosyncratic and highly subjec­ tive responses from more objective ones.

The emotional response of any single member is not sufficient; thera­ pists need confirmatory evidence. They look for repetitive patterns over time and for multiple responses-that is, the reactions of several other members (referred to as consensual validation) to the individual. Ulti­ mately therapists rely on the most valuable evidence of all: their own emotional responses. Therapists must be able to attend to their own reac-

45 Recognition of Behavioral Patterns in the Social Microcosm

tions to the client, an essential skill in all relational models. If, as Kiesler states, we are "hooked" by the interpersonal behavior of a member, our own reactions are our best interpersonal information about the client's impact on others. 47

Therapeutic value follows, however, only if we are able to get "un­ hooked"-that is, to resist engaging in the usual behavior the client elicits from others, which only reinforces the usual interpersonal cycles. This process of retaining or regaining our objectivity provides us with mean­ ingful feedback about the interpersonal transaction. From this perspec­ tive, the thoughts, fantasies, and actual behavior elicited in the therapist by each group member should be treated as gold. Our reactions are in­ valuable data, not failings. It is impossible not to get hooked by our clients, except by staying so far removed from the client's experience that we are untouched by it-an impersonal distance that reduces our thera­ peutic effectiveness.

A critic might ask, "How can we be certain that therapists' reactions are 'objective'?" Co-therapy provides one answer to that question. Co­ therapists are exposed together to the same clinical situation. Comparing their reactions permits a clearer discrimination between their own subjec­ tive responses and objective assessments of the interactions. Furthermore, group therapists may have a calm and privileged vantage point, since, un­ like individual therapists, they witness countless compelling maladaptive interpersonal dramas unfold without themselves being at the center of all these interactions.

Still, therapists do have their blind spots, their own areas of interper­ sonal conflict and distortion. How can we be certain these are not cloud­ ing their observations in the course of group therapy? I will address this issue fully in later chapters on training and on the therapist's tasks and techniques, but for now note only that this argument is a powerful reason for therapists to know themselves as fully as possible. Thus it is incumbent upon the neophyte group therapist to embark on a lifelong journey of self­ exploration, a journey that includes both individual and group therapy.

None of this is meant to imply that therapists should not take seriously the responses and feedback of all clients, including those who are highly disturbed. Even the most exaggerated, irrational responses contain a core of reality. Furthermore, the disturbed client may be a valuable, accurate source of feedback at other times: no individual is highly conflicted in every area. And, of course, an idiosyncratic response may contain much information about the respondent.

This final point constitutes a basic axiom for the group therapist. Not infrequently, members of a group respond very differently to the same stimulus. An incident may occur in the group that each of seven or

46 INTERPERSONAL LEARNING

eight members perceives, observes, and interprets differently. One com­ mon stimulus and eight different responses-how can that be? There seems to be only one plausible explanation: there are eight different inner worlds. Splendid! After all, the aim of therapy is to help clients understand and alter their inner worlds. Thus, analysis of these differ­ ing responses is a royal road-a via regia-into the inner world of the group member.

For example, consider the first illustration offered in this chapter, the group containing Valerie, a flamboyant, controlling member. In accord with their inner world, each of the group members responded very differ­ ently to her, ranging from obsequious acquiescence to lust and gratitude to impotent fury or effective confrontation.

Or, again, consider certain structural aspects of the group meeting: members have markedly different responses to sharing the group's or the therapist's attention, to disclosing themselves, to asking for help or help­ ing others. Nowhere are such differences more apparent than in the trans­ ference-the members' responses to the leader: the same therapist will be experienced by different members as warm, cold, rejecting, accepting, competent, or bumbling. This range of perspectives can be humbling and even overwhelming for therapists, particularly neophytes.

THE SOCIAL MICROCOSM-IS IT REAL?

I have often heard group members challenge the veracity of the social mi­ crocosm. Members may claim that their behavior in this particular group is atypical, not at all representative of their normal behavior. Or that this is a group of troubled individuals who have difficulty perceiving them ac­ curately. Or even that group therapy is not real; it is an artificial, contrived experience that distorts rather than reflects one's real behavior. To the neophyte therapist, these arguments may seem formidable, even persua­ sive, but they are in fact truth-distorting. In one sense, the group is artifi­ cial: members do not choose their friends from the group; they are not central to one another; they do not live, work, or eat together; although they relate in a personal manner, their entire relationship consists of meetings in a professional's office once or twice a week; and the relation­ ships are transient-the end of the relationship is built into the social con­ tract at the very beginning.

When faced with these arguments, I often think of Earl and Mar­ guerite, members in a group I led long ago. Earl had been in the group for four months when Marguerite was introduced. They both blushed to see the other, because, by chance, only a month earlier, they had gone on a Sierra Club camping trip together for a night and been "intimate." Nei-

47 Oueruiew

ther wanted to be in the group with the other. To Earl, Marguerite was a foolish, empty girl, "a mindless piece of ass," as he was to put it later in the group. To Marguerite, Earl was a dull nonentity, whose penis she had made use of as a means of retaliation against her husband.

They worked together in the group once a week for about a year. Dur­ ing that time, they came to know each other intimately in a fuller sense of the word: they shared their deepest feelings; they weathered fierce, vicious battles; they helped each other through suicidal depressions; and, on more than one occasion, they wept for each other. Which was the real world and which the artificial?

One group member stated, "For the longest time I believed the group was a natural place for unnatural experiences. It was only later that I re­ alized the opposite-it is an unnatural place for natural experiences." 48

One of the things that makes the therapy group real is that it eliminates social, sexual, and status games; members go through vital life experi­ ences together, they shed reality-distorting facades and strive to be honest with one another. How many times have I heard a group member say, "This is the first time I have ever told this to anyone"? The group mem­ bers are not strangers. Quite the contrary: they know one another deeply and fully. Yes, it is true that members spend only a small fraction of their lives together. But psychological reality is not equivalent to physical real­ ity. Psychologically, group members spend infinitely more time together than the one or two meetings a week when they physically occupy the same office.

OVERVIEW

Let us now return to the primary task of this chapter: to define and de­ scribe the therapeutic factor of interpersonal learning. All the necessary premises have been posited and described in this discussion of:

1. The importance of interpersonal relationships 2. The corrective emotional experience 3. The group as a social microcosm

I have discussed these components separately. Now, if we recombine them into a logical sequence, the mechanism of interpersonal learning as a therapeutic factor becomes evident:

I. Psychological symptomatology emanates from disturbed interpersonal relationships. The task of psychotherapy is to help the client learn how to develop distortion-free, gratifying interpersonal relationships.

48 INTERPERSONAL LEARNING

II. The psychotherapy group, provided its development is unhampered by severe structural restrictions, evolves into a social microcosm, a miniaturized representation of each member's social universe.

III. The group members, through feedback from others, self-reflection, and self-observation, become aware of significant aspects of their in­ terpersonal behavior: their strengths, their limitations, their inter­ personal distortions, and the maladaptive behavior that elicits unwanted responses from other people. The client, who will often have had a series of disastrous relationships and subsequently suf­ fered rejection, has failed to learn from these experiences because others, sensing the person's general insecurity and abiding by the rules of etiquette governing normal social interaction, have not com­ municated the reasons for rejection. Therefore, and this is impor­ tant, clients have never learned to discriminate between objectionable aspects of their behavior and a self-concept as a to­ tally unacceptable person. The therapy group, with its encourage­ ment of accurate feedback, makes such discrimination possible.

IV. In the therapy group, a regular interpersonal sequence occurs: A. Pathology display: the member displays his or her behavior. B. Through feedback and self-observation, clients

1. become better witnesses of their own behavior; 2. appreciate the impact of that behavior on

a. the feelings of others; b. the opinions that others have of them; c. the opinions they have of themselves.

V. The client who has become fully aware of this sequence also be­ comes aware of personal responsibility for it: each individual is the author of his or her own interpersonal world.

VI. Individuals who fully accept personal responsibility for the shaping of their interpersonal world may then begin to grapple with the corollary of this discovery: if they created their social-relational world, then they have the power to change it.

VII. The depth and meaningfulness of these understandings are directly proportional to the amount of affect associated with the sequence. The more real and the more emotional an experience, the more po­ tent is its impact; the more distant and intellectualized the experi­ ence, the less effective is the learning.

VIII. As a result of this group therapy sequence, the client gradually changes by risking new ways of being with others. The likelihood that change will occur is a function of A. The client's motivation for change and the amount of personal

discomfort and dissatisfaction with current modes of behavior;

49 Transference and Insight

B. The client's involvement in the group-that is, how much the client allows the group to matter;

C. The rigidity of the client's character structure and interpersonal style.

IX. Once change, even modest change, occurs, the client appreciates that some feared calamity, which had hitherto prevented such behavior, has been irrational and can be disconfirmed; the change in behavior has not resulted in such calamities as death, destruction, abandon­ ment, derision, or engulfment.

X. The social microcosm concept is bidirectional: not only does outside behavior become manifest in the group, but behavior learned in the group is eventually carried over into the client's social environment, and alterations appear in clients' interpersonal behavior outside the group.

XI. Gradually an adaptive spiral is set in motion, at first inside and then outside the group. As a client's interpersonal distortions diminish, his or her ability to form rewarding relationships is enhanced. Social anxiety decreases; self-esteem rises; the need for self-concealment di­ minishes. Behavior change is an essential component of effective group therapy, as even small changes elicit positive responses from others, who show more approval and acceptance of the client, which further increases self-esteem and encourages further change. 49 Even­ tually the adaptive spiral achieves such autonomy and efficacy that professional therapy is no longer necessary.

Each of the steps of this sequence requires different and specific facili­ tation by the therapist. At various points, for example, the therapist must offer specific feedback, encourage self-observation, clarify the concept of responsibility, exhort the client into risk taking, disconfirm fantasized calamitous consequences, reinforce the transfer of learning, and so on. Each of these tasks and techniques will be fully discussed in chapters 5 and 6.

TRANSFERENCE AND INSIGHT

Before concluding the examination of interpersonal learning as a media­ tor of change, I wish to call attention to two concepts that deserve further discussion. Transference and insight play too central a role in most for­ mulations of the therapeutic process to be passed over lightly. I rely heav­ ily on both of these concepts in my therapeutic work and do not mean to slight them. What I have done in this chapter is to embed them both into the factor of interpersonal learning.

50 INTERPERSONAL LEARNING

Transference is a specific form of interpersonal perceptual distortion. In individual psychotherapy, the recognition and the working through of this distortion is of paramount importance. In group therapy, working through interpersonal distortions is, as we have seen, of no less impor­ tance; however, the range and variety of distortions are considerably greater. Working through the transference-that is, the distortion in the relationship to the therapist-now becomes only one of a series of dis­ tortions to be examined in the therapy process.

For many clients, perhaps for the majority, it is the most important re­ lationship to work through, because the therapist is the personification of parental images, of teachers, of authority, of established tradition, of in­ corporated values. But most clients are also conflicted in other interper­ sonal domains: for example, power, assertiveness, anger, competitiveness with peers, intimacy, sexuality, generosity, greed, envy.

Considerable research emphasizes the importance many group mem­ bers place on working through relationships with other members rather than with the leader. 50 To take one example, a team of researchers asked members, in a twelve-month follow-up of a short-term crisis group, to in­ dicate the source of the help each had received. Forty-two percent felt that the group members and not the therapist had been helpful, and 28 percent responded that both had been helpful. Only 5 percent said that the thera­ pist alone was a major contributor to change. 51

This body of research has important implications for the technique of the group therapist: rather than focusing exclusively on the client-therapist relationship, therapists must facilitate the development and working­ through of interactions among members. I will have much more to say about these issues in chapters 6 and 7.

Insight defies precise description; it is not a unitary concept. I prefer to employ it in the general sense of "sighting inward"-a process encom­ passing clarification, explanation, and derepression. Insight occurs when one discovers something important about oneself-about one's behavior, one's motivational system, or one's unconscious.

In the group therapy process, clients may obtain insight on at least four different levels:

1. Clients may gain a more objective perspective on their interpersonal presentation. They may for the first time learn how they are seen by other people: as tense, warm, aloof, seductive, bitter, arrogant, pompous, obse­ quious, and so on.

2. Clients may gain some understanding into their more complex interac­ tional patterns of behavior. Any of a vast number of patterns may become clear to them: for example, that they exploit others, court constant admira­ tion, seduce and then reject or withdraw, compete relentlessly, plead for love, or relate only to the therapist or either the male or female members.

51 Transference and Insight

3. The third level may be termed motivational insight. Clients may learn why they do what they do to and with other people. A common form this type of insight assumes is learning that one behaves in certain ways be­ cause of the belief that different behavior would bring about some cata­ strophe: one might be humiliated, scorned, destroyed, or abandoned. Aloof, detached clients, for example, may understand that they shun close­ ness because of fears of being engulfed and losing themselves; competitive, vindictive, controlling clients may understand that they are frightened of their deep, insatiable cravings for nurturance; timid, obsequious individu­ als may dread the eruption of their repressed, destructive rage.

4. A fourth level of insight, genetic insight, attempts to help clients un­ derstand how they got to be the way they are. Through an exploration of the impact of early family and environmental experiences, the client un­ derstands the genesis of current patterns of behavior. The theoretical framework and the language in which the genetic explanation is couched are, of course, largely dependent on the therapist's school of conviction.

I have listed these four levels in the order of degree of inference. An unfortunate and long-standing conceptual error has resulted, in part, from the tendency to equate a "superficial-deep" sequence with this "de­ gree of inference" sequence. Furthermore, "deep" has become equated with "profound" or "good," and superficial with "trivial," "obvious," or "inconsequential." Psychoanalysts have, in the past, disseminated the be­ fief that the more profound the therapist, the deeper the interpretation (from the perspective of early life events) and thus the more complete the treatment. There is, however, not a single shred of evidence to support this conclusion.

Every therapist has encountered clients who have achieved considerable genetic insight based on some accepted theory of child development or psychopathology-be it that of Freud, Klein, Winnicott, Kernberg, or Kohut-and yet made no therapeutic progress. On the other hand, it is commonplace for significant clinical change to occur in the absence of ge­ netic insight. Nor is there a demonstrated relationship between the acqui­ sition of genetic insight and the persistence of change. In fact, there is much reason to question the validity of our most revered assumptions about the relationship between types of early experience and adult behav­ ior and character structure. 52

For one thing, we must take into account recent neurobiological re­ search into the storage of memory. Memory is currently understood to consist of at least two forms, with two distinct brain pathways. 53 We are most familiar with the form of memory known as "explicit memory." This memory consists of recalled details, events, and the autobiographical rec­ ollections of one's life, and it has historically been the focus of exploration and interpretation in the psychodynamic therapies. A second form of

52 INTERPERSONAL LEARNING

memory, "implicit memory," houses our earliest relational experiences, many of which precede our use of language or symbols. This memory (also referred to as "procedural memory") shapes our beliefs about how to proceed in our relational world. Unlike explicit memory, implicit memory is not fully reached through the usual psychotherapeutic dialogue but, in­ stead, through the relational and emotional component of therapy.

Psychoanalytic theory is changing as a result of this new understanding of memory. Fonagy, a prominent analytic theorist and researcher, con­ ducted an exhaustive review of the psychoanalytic process and outcome literature. His conclusion: "The recovery of past experience may be help­ ful, but the understanding of current ways of being with the other is the key to change. For this, both self and other representations may need to alter and this can only be done effectively in the here and now. "54 In other words, the actual moment-to-moment experience of the client and thera­ pist in the therapy relationship is the engine of change.

A fuller discussion of causality would take us too far afield from inter­ personal learning, but I will return to the issue in chapters 5 and 6. For now, it is sufficient to emphasize that there is little doubt that intellectual understanding lubricates the machinery of change. It is important that in­ sight-"sighting in"---occur, but in its generic, not its genetic, sense. And psychotherapists need to disengage the concept of "profound" or "signif­ icant" intellectual understanding from temporal considerations. Some­ thing that is deeply felt or has deep meaning for a client may or-as is usually the case---may not be related to the unraveling of the early gene­ sis of behavior.