Components Of The Intervention

The initial challenge in these situations is to explore one's own internal experience and locate a stance or space from which thinking is possible. This is not an effort to suppress (countertransference) feelings, but to work with them in a creative and flexible way. It is thus not only essential as a therapist, but also good modeling for members. From that stance, a number of important considerations may be examined to help the therapist decide what might be going on and in what direction the group needs to move.

As usual, the overall trajectory we have in mind includes helping the individual and the group develop an increasing tolerance for affect, developing a capacity for empathy and mutuality, and eventually moving toward self-observation and reflection and thus here-and-now learning. This sequence can be facilitated if the therapist can:

1. Lean in: The first objective is to protect the group while attempting to link up with the affect expressed. Aggression is a signal of frustration or threat, and here Sara is triggering something in Jane that is invisible as a source but terribly apparent as an effect. The therapist must "lean" toward Jane, identifying with her emotional state and providing an effective structuring (that is, empathic) response that conveys deep understanding and thus the capacity to tolerate the feeling evoked. In this case, I sat fully upright and moved physically forward toward both women, offering protection to Sara by getting into Jane's line of sight and containment for Jane by clearly being willing to engage with her no matter what her level of intensity.

2. Make room and jump in: As the most powerful individual and most important transference object in the group, I needed to be included in the situation and demand I be taken into account. Addressing Jane, I said very directly and forcefully: "Jane! I think right now you are having feelings about Sara that make you upset," a phrase that had to be repeated a second time in order to get Jane to address it and me. Her reply was a scornful "Well, yeah!" but it did force her to speak to me and I could now keep working at giving her something to think about. (This is a version of directing aggression toward the leader that others in this book have noted, but begins with affect rather than content.) Once I had Jane's attention, I could move on to saying "I think you are angry at Sara for her mother's interest because you're angry at Francis for bringing me into the group and paying no attention to your wishes." It is less relevant that this be insightful and accurate; it should carry the kind of emotional tension the member is expressing. Engaging and getting the patient's attention are the more basic objectives; accuracy will come later, when dialogue can be established. So, when Sara replied "That's stupid!" I did not take her retaliation personally but was ready to keep her mind engaged by saying "She not only left you and brought me in to cover for her, but she also brought a little sister into the family." There was a pause as she began to think, so I added "and you're upset with me because you're not getting enough from me, and it seems like Sara is getting so much from her caregiver." Again, accuracy is desirable, but affect matching or "pacing" is the true goal here.

3. Titrate, but do not defuse! The goal is to find a way for the entire group to remain engaged. Defenses will be aroused and titration may be necessary, but the whole group must work with the situation without anyone feeling their reaction is overwrought or meaningless. Too rapidly attempting an interpretation that moves away from the here-and-now of the interaction to archaic "explanations" tends to infanti-lize the group and implies the group is too immature to explore their own reactions. The experience of tolerating affect successfully helps develop what might be described as a tougher "skin" or insulation (Ormont, 1984), as well as increasing cohesion and trust in the group's ability to weather storms together. It should also be obvious that trying to defuse a situation by overpowering the angry member (especially through shame or humiliation) is a poor choice and will lead to mistrust of the leader even if the situation is "successfully" de-escalated. So once I had joined Jane and "paced" her affect, I noted how furious she was because "It makes you angry to see Sara get so much when you felt you got nothing," and then to the group "and I think everyone kept their hands off because they, too, were jealous of the one who seemed to get it all."

4. Pursue meaning: Following the expression of intense feeling, the central character as well as group members who pulled away may feel shame. Pursuing meaning thoughtfully and respectfully communicates a basic tolerance of and interest in emotional dynamics. One specific way to support the growth of "skin" is to investigate the affect (fear, anger, etc.), and see if members can imagine responding nonthreateningly in spite of it. Members who were "too scared to say anything" might be invited to imagine speaking anyway, despite their fear of retaliation.

There are many potential forms of meaning that could become available as members finally contemplate their experience together. In this case, members eventually admitted to fearing retaliation from Jane if they were to object to her treatment of Sara (or even note that she's acted this way before), and envy of Sara (e.g., identification with Jane), which made them collude to have Jane attack and demolish the "fortunate" new member.

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