Consultation, Please
August/September 2002

A group member, whom I also see individually, has received a job assignment that will require him to be out of town for two-week periods, every six to eight weeks. This schedule will continue for six months, at which time he can resume regular attendance. He joined the group five months ago and after a period of ambivalence, had begun to open up in group when he got this job assignment. He wants to stay in the group, and is willing to pay for his missed sessions and to talk about the feelings connected with this schedule. He will continue in individual therapy with me when he is in town. The group, including the leader, was understandably unhappy with his news. Although the group has been stable in general, three members have left in the past nine months (one graduated, one moved away, and one left abruptly for a combination of reality factors and resistance). Additionally a longstanding member is facing the need for a three-month medical absence. Should I permit this member to stay under these conditions? It will no doubt strain the group, but it doesn’t feel right to insist he leave. Also, how should I handle bringing in new members during this period? 

Sincerely,
Revolving Door Therapist

Dear Revolving Door: 
Your question contains many interesting facets. As I was reading it, I found myself thinking of the phrase, “a group is a group is a group.” In our lives, we are parts of various group, whether school classes, work departments, sports teams, or therapy groups. Each of these is subject to various life changes and vicissitudes, such as additions of new members, lay-offs, firings, or relocations. Some of us have been fortunate to be part of an exciting, collaborative group, one that leaves us feeling connected with the others, and enhances our creativity. But, in time, even in the best of such groups, members depart. This leaves all members, including its leaders feeling sad and perhaps irritated at the factors that changed the group’s texture. We may also begin to notice tensions between remaining members and to reevaluate whether we’d want to continue to stay with the group.

In therapy groups, one of the leader’s key functions is to establish the helpful ‘safe atmosphere’ within which the group members can do their work. With such a role comes a sense of responsibility borne out of our earnestness to be helpful and to “do right” by our patients. It is hard work to help a therapy group move through its developmental stages, closely monitoring its boundaries, as a gatekeeper. You mention that your group was stable prior to the disruptions. With three departures from the group, inevitable a regression occurs. The group is now different, the existing alliances may be disrupted, and old losses are stimulated. Your group is now reconfiguring itself, and chances are good that tensions abound and feelings are running deep. It wouldn’t surprise me if you were at least a little chagrined as well, seeing all your hard work disrupted. You are also facing the probability that a member may take a medical leave soon, not to mention the request of the patient who is the focus of your question.

Regarding your question of whether or not to permit this member to continue, I’m assuming your group contract does not include a clause about attending a certain number of groups nor allowing only a certain number of absences before one is asked to leave. I think there is something to your sense that it is not right to insist that the member leave. In this instance then it could well be that this member will become a lightening rod for this issue. That is, as members struggle with their own feelings of loss and anger about the disruptions and whether they will stay or not, this member could become a scapegoat in the process and would need your protection. This may not necessarily be easy for you as you deal with your own feelings of disappointment with all the turbulence. It is your attention to the process and boundaries of the group that is important, whatever the group feelings are at any point. Hence, there is opportunity for exploration as a result of this change. 

Your question about the addition of new members is a tricky issue. It is hard for new members to come into a turbulent situation, more so when there is a sense that endings in the group do not feel productive. In such cases, the new members come into an already anxiety-provoking situation only to be met with a history that tells them there may not be hope for the help they are (ambivalently) seeking. You mention the group had at least one graduation, and another member who moved away, both of which are not necessarily bad endings. It may serve the group well to spend some sessions reflecting on endings and the differences between them before adding new members. In this way, the group can process the members’ feelings, their changes in roles and the ambivalence issues that have re-emerged. You may also find it worthwhile to simultaneously inform the group that you will be adding new members in the future. This can fit in nicely with the losses, and the sense of the sense of the circle of life (a revolving door concept). When bringing in new members, you may want to brief them about the status of the group and plan to bring in two of them at once, as this will afford each new member an ally in this turbulent time for the group. 

The issues you raise represent interesting changes in your group’s life. These changes happen for reasons over which we have no control. Sometimes we as leaders react to the changes as if we caused them despite our best efforts. These feelings have the potential to impact our decisions as we work to maintain the group environment. 

Mark Nickels, MD, CGP
Fairport, New York

Dear Revolving Door:
Concerning the member whose job assignment will require him to be out of town, I want to support your comment that “it doesn’t feel right to insist he leave” the group. Examine your group agreements for validation here. The group container has to have room to breathe and be a flexible support for you, the therapist, as well as for the members of the group. You may have an agreement that speaks to attendance “as much as humanly possible,” written loosely perhaps to help us cope with the unexpected. Just when I think that I know what to expect from a group, I rediscover that I don’t! The unexpected (and probably unforeseeable) enters in. Humans need jobs. Humans get sick and need medical attention, surgery, etc. So do therapists. In families people come and go with jobs and sickness, just as in life. Life is a revolving door.

As the leader, you may be having an internal dialogue, honoring the principles we have learned in training about group psychotherapy on the one hand, and, on the other, responding to the vicissitudes of your group members’ lives and changing needs. Your group may also undertake a parallel interpersonal dialogue, wrestling with their personal needs in the context of the others as your group member willingly shares his feelings about his dilemma. 

In the life of your group, I can foresee this situation as a medium for rich exploration centering on trust and commitment, sibling rivalry, rejection, and other competitive needs. Depending on the relative ego strengths of members, differing fears may be unearthed, such as fears of loss of self, of abandonment, loss of love, fears of expressing hostility and fears of intimacy or its loss.

How to bring in new members during this period? Just as you always do: judiciously, thoughtfully, and unapologetically. It seems to me that your group has a leader who is serious about providing a workable reasonably safe container for exploration even in the face of life’s revolving and unexpectedly changing doors.

Joan Seiffert, LCSW, CGP
Winston-Salem, NC

This article was published in the August/September 2002 issue of The Group Circle.