Consultation, Please
April/May 2002 

Dear Consultant:
I am a male therapist in a small town private practice and have been running groups for 10 years. One of my long-term psychodynamic groups has been together weekly for nearly five years. There are five males and four females in this group. Over the five years, there have been no terminations; nor have I added new patients. The contract for the group requires that any out-of-group contact be brought into group at the next meeting. Recently, about 10 minutes before the end of the group, "Leslie," a 35-year-old divorced woman, began to cry hysterically as she announced to the group that she and "Bradley," another member of the group had been having an affair. He is married with three children. She further stated that she had just learned that she was pregnant with Bradley's child. Bradley looked stunned as he heard her announcement, but made no eye contact with any group member. This was the first time that the group had known of their intimate contact, as they had neither discussed their relationship nor had they ever expressed feelings for one another in the group. I felt torn because we were out of time, and I strictly adhere to time boundaries. The group ended on time without any comment from the other members. How do I handle this situation?

Sincerely,
Caught Off Guard

Dear Caught Off Guard:
I am not sure how I would have reacted in the moment, but I will make some guesses, based on some similar experiences of being caught off guard at the end of a session. First, as important as time boundaries are in my practice, I might have taken some extra time. Second, I might have pointedly asked Leslie about the trigger for her communicating her distress to the group and supported her including the group in her situation. I believe that Leslie may have been taking a significant step toward openness. In addition, I probably would have inquired about Leslie's plans to care for herself, assessed any danger, and looked at her support system. Third, I might have addressed Bradley and commented on his "stunned look." Based upon how he responded, I would follow his lead. With both Leslie and Bradley, I would not be that interested in the details of their relations, but only in the immediate affect and the support of their being able to be with the group.

I would also have addressed the other members by saying: "the rest of you are quiet. I am curious about your experience. Can you put it into a few words?" I also may have inquired about reactions to Leslie's emotional communication and Bradley's response.

I work under the assumption that all human experience is embedded in relational systems, one cannot escape the emotional impact of the group members and the therapist on one another. I would suggest that the group rules and contract be revisited. Since you live in a small town, it is likely that the members, as well as the therapist, run into one another outside of the group. I wonder how this has been handled in the past.

In addition, I was struck with the apparent stability of your group-five years without someone leaving seems unusual to me. I wondered if this might point to a compliant group, and refer you to Harwood's (1998) comments that "when there is compliance to the group's or another member's point of view, without recognition of understanding of a member's wishes or subjective experience, conflict re-emerges;" the conflict between the member's emerging self and the therapist's discomfort. Compliance would be the member's silence to preserve the relationship with the therapist in lieu of rage, fragmentation, or leaving. Understanding and validating the member's subjective experience provides the opportunity to build new psychic structure and further the evolution of an authentic self.

Finally, I would consider Shapiro's (1998) suggestion that while pairing can be interpreted as resistance, it can also reflect an attempt to find connections. Relating to these strivings as healthy might provide opportunity for the expression of additional thoughts and feelings.

Allen Gelber, PhD, CGP
Phoenix, Arizona

Harwood, I. (1998) Advances in Group Psychotherapy and Self Psychology, in Harwood, I. & Pines, M. (eds.) Self Experience in Group, London: Kingsley.

Shapiro, E. (1998) Intersubjectivity in Archaic and Mature Twinship in Group Therapy, In Harwood, I. & Pines, M. (eds) Self Experiences in Group, London: Kingsley.

Dear Caught Off Guard:
My first reaction upon reading your dilemma was "Oh ----!" (expletive deleted). The next association: your kid comes home and informs you she's pregnant. She confesses that she's been less than forthcoming about whom she's been seeing (not the cute teenage football player, but the married coach who is part of your extended family). The other siblings have no comment, and it is unclear whether they knew of their sister's tryst or felt as blind-sided as you. So how does a parent feel? And what does a parent do? In families, like groups, each member expresses the feelings of the others, and each plays a part in the ensuing interactions.

The challenges for the therapist are numerous. However, before you can deal with the impact this news has on the group or understand the meaning of the relationship between Leslie and Bradley, it is important to identify and understand your reactions and subjectivity as they intertwine with those of the patients. Upon hearing the news, what was your immediate reaction? (Shock, anger, dismay, or other emotions?) Were your feelings directed at the couple, the silent members of the group, your experience of the entire group, or your own clinical competence.

After this initial reaction, did you have feelings of betrayal, self-recrimination, self-doubt, and/or shame? As you reflected about the group and reviewed the manifest and covert themes, did you feel that you missed metaphors or emotions reverberating among the members including Leslie and Bradley, and in particular feelings towards you? Should you have known there was the possibility of a romance between members? Were there clues in their histories, individual and group discourse, transferences (parental and sibling), and/or the length and intensity of the group relationships? Did you fear the group might not survive or that your reputation would be affected in your small town? Were you feeling fearful that a call might come from a lawyer?

The group agreement provides a frame, defining boundaries, structures, and roles. It protects and safeguards both patient and therapist. Patients (and therapists) inevitably will test and cross boundaries. This provides an opportunity to understand the patients' inner world and how it impacts their emotional development and relationships. It also can help you understand your own subjectivity and enactments. Did you as a therapist collude with members' silences when other boundaries were crossed? Did you participate in some prior avoidance out of fear that you would not be admired or that you would be an object of anger? Does the members' silence also represent collusion with you?

As you process your subjectivity, vulnerabilities and insight, you must invite the entire group to explore their own and others' responses, including your own.

Esther Stone, MSSW, CGP, FAGPA
Cincinnati, Ohio

This Consultation, Please column was published in the April/May 2002 issue of The Group Circle.