Intervention And Group Response

1. Assess the permeability of the insulation barrier. This technique requires understanding how and why a person uses certain defenses, and how he or she reacts to the group's attempts to penetrate the defenses.

2. Provide an external insulation barrier. If, as in this case, the person's ego is fragile (even if it is transient state of under insulation), we must step in to provide a temporary insulation barrier. I told the group that it seemed as if Dave was "against the ropes awaiting the knockout blow," when in fact what he might have craved most was "tenderness and understanding." The group became immediately defensive. They retorted that Dave is quite capable of hearing their input and integrating it as he had done on many occasions. I did not back down, however, and suggested that perhaps that has normally been the case, but that somehow it was different this time given his withdrawal and nonverbal, emotional reactivity.

3. Use bridging to someone with similar defenses. Find someone who is underinsulated, and employ the technique of bridging (Ormont, 1990), which is a method for helping one member establish emotional communication with another, around similarities as well as differences. In this case I consulted with "Daniela," who was more characterologically underinsulated, and asked if she understood Dave's withdrawal. I knew that she was experienced with feeling injured in the face of confrontation when all she wanted was "tenderness and understanding." She immediately empathized, and added that she felt hesitant to say anything because she did not want to be attacked like the group attacked Dave. She said that people in her life never understood how deeply their words and behavior could injure her. As she spoke, Dave welled up with tears, but at the same time nodded as if feeling understood for the first time in months.

4. Continue to help the group explore the impasse, its resolution, and emerging feelings. In this case Dave was eventually able to share how Daniela's empathy helped him rejoin the group. The group was surprised at the depth of Dave's feelings of being misunderstood and unrecognized. They shared their perception that Dave was quite capable relationally, and were taken aback by Dave's apparent neediness. What they did not know, until Dave shared it, was that recently in his life, he had been feeling similarly misunderstood by friends and family, who he felt had always underestimated his needs because he was so adept at putting up a front of "being together."

5. Be on the lookout for how a patient's past might contribute to a weakening of the insulation barrier. I asked Dave if he ever felt his needs went underappreciated in the past, and he poignantly shared how he always felt like he had to be strong for his single mother, who was struggling to raise him and his brother and sister. As a result of serving as a parentified child, Dave felt as if he always needed to be the "adult," which the group enacted with him in the present.

CONCLUSION AND CONTRAINDICATIONS

Although Ormont's (1994) treatment of under- and overinsulated patients was referring to those whose insulation barrier (i.e., ego strength or boundary) was characterologically flawed, the concept can also be useful in working with group members who might experience transient over- and underemotional insulation. The intervention in the latter case proved to help Dave and the group work through an impasse that had the potential to hurt Dave and cause him to flee the group. Working with Dave's transient experience of being emotionally underinsulated by using myself as a temporary insulation barrier, which required that I correct my initial assessment of his being overinsulated, and to bridge with another member who was more characteristically under insulated, allowed Dave to feel an empathic connection and understanding that allowed him to relinquish his defensive posture in the group. Until I made the necessary diagnostic correction, however, the group and I worked as if Dave's resistance needed to be penetrated, which only further threatened him, and created the mistaken impression of overinsulation. The key to understanding that this was an incorrect conceptualization and technique was being attuned to how the group's confrontations were in fact penetrating him on a deep, emotional level

With group members who are underinsulated characterologically, this kind of work would have to be repeated and worked through numerous times before the patient's insulation barrier was more firmly

How Can You Not See My Pain?

established internally. In the case of Dave, the intervention was more reparative than structure building, which was all that was required to bring him back into the fold of the group. What can be appreciated from the scenario, the use of the concept of emotional insulation, can be invaluable in crafting an appropriate intervention; however, its effectiveness depends upon an accurate assessment of the nature of the insulation flaw.

Although there are no contraindications to the intervention per se, it is imperative that the clinician accurately assess whether or not the member in question is under- or overinsulated emotionally. As was the case in this group, an initial misunderstanding of the nature of this patient's ego strength led to interventions that only strengthened the resistance. Once 1 was able to accurately discern the underlying insulation flaw, however, I was able to craft a more appropriate intervention.

REFERENCES

Kadis, A. L., Krasner, J. D.. Winick, C., & Foulkes, S. H. (1965). A practicum of group psychotherapy. NY: Harper and Row. Ormont, L. R. (1990). The craft of bridging. International Journal of Group Psychotherapy, 40(1), 3-17. Ormont, L. R. (1994). Developing emotional insulation. International Journal of

Group Psychotherapy, 44(3), 361-375. Rutan, J. S. & Stone, W. N. (1993). Psychodynamic group psychotherapy (Second edition). New York: The Guilford Press. Yalom, I. (1995). The theory and practice of group psychotherapy (Fourth edition). New York: Basic Books.

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