The Intervention

The group intervention consists of five steps.

1. The therapist's self-exploration of his or her own feelings in the moment.

2. The therapist using that self-exploration to provide feedback to the patient on the issue of identification.

3. The therapist inviting the group to share feelings and thoughts about what the patient is saying.

4. The therapist inviting the group to share similar identifications.

5. The therapist inviting the group to confront the patient when he or she hears them speaking from that identification.

The first step of this intervention is for the group therapist to listen carefully to the patient to determine what identificatory role they are playing. The therapist can do this step in two ways. First, the therapist should try to be aware of his or her own feelings by simply asking himself or herself "How am I feeling about what the patient is saying?" Second, the therapist can also ask himself or herself what the group could be feeling in response to the patient. The feelings elicited by the patient in group therapy can provide a valuable clue to which identification the patient is speaking.

The second step of this intervention is giving the patient feedback about how he or she is presenting themselves to the group. This feedback should include information about what role the person might be playing and what reciprocal role is potentially being elicited in the group members. The purpose of this step is to give the patient an invitation to become mindful about how he or she is being perceived and how his or her presentation of themselves might be an identification with an important person from his or her past or present.

The third step is to invite the group to share with the patient what they are feeling and thinking in response to what the patient is communicating. The purpose of this step is multifaceted. It communicates to the patient that he or she is being listened to, which supports the patient's motivations in combating troublesome identifications. Second, this feedback from the group gives the patient a number of perspectives from which to examine this issue. Third, this feedback shows the patient that this particular issue or identification is observable to others and that if they look they too can see it, which helps the patient from sliding back into unawareness.

The fourth step is to have the other patients in the group relate to the patient about how they have or have had similar identifications. In every group there should be at least one or two other members who have or have had a similar identification to the one being worked on. This works to help both the patient who is working on the particular identification and also the rest of the group members. The group members who are sharing how they have or have had similar identifications should also include the unique ways that they are transcending their own negative identifications.

The fifth step is for the therapist to recruit the group to confront or counter this identification when they hear it from the patient. During this confrontation, the patient should be encouraged by the group to speak in his or her own voice. They should also be encouraged to try out a different way of seeing themselves and a different way of presenting themselves to others. Multiple interactions around this facet of the patient's personality help him or her continue to be mindful about the problematic identification and how to counteract it.

A Short Case Example

During the group session an adult female patient was discussing her impending divorce and the emotional impact it was having on her. Her husband was communicating to her that he saw her as a "loser" who could not make it without him and that she would never find another person to love her. She presented to the group that this was how she also felt about herself and she indicated to the group that this man was correct in his perception of her.

The first step in this process was for me to ask myself what was I feeling and then to ask what might the group be feeling in response to her stoiy The answer was that I felt angry with someone beating her up emotionally. I then realized that she was not expressing any anger about how this man was treating her. Her emotional presentation was incon-gruent with the story that she was communicating to the group. It became clear to the therapist that she was identifying with how her soon-to-be-ex-husband perceived her. She was "identifying with the aggressor."

The second step was communicating to her that I felt angry about how she was being treated and that most people who are treated this way feel angry. I added that I did not perceive any anger being expressed by her. I then invited her to look at how she might be identifying with her ex-husband in his assessment, of her, in order to deal with her feelings of fear and hatred of him.

The third step was inviting the group members to express their feelings and thoughts about what they were hearing from the patient. Fortunately, this was a group who was used to thinking in terms of identifications and who was also comfortable giving feedback to one another. They expressed to this woman their own anger at how she was being treated along with their irritation at her for accepting her ex-husband's assessment of her. The group communicated to the patient that she was identifying with him, but that she did not have to do that anymore. They expressed to her that she could choose differently.

The fourth step was inviting the group members to share with the patient how they too had or have similar negative identifications. Fortunately for the patient, another group member had gone through a painful divorce and communicated to the patient how she had tended to be passive with her husband and accepting of his view of her until she realized that he was treating her with hostility. This generated anger, in her, toward him which then helped her break her identification with him. Others in the group also gave examples from their experiences with bosses, siblings, and parents.

The fifth step was inviting the group to confront the patient when they observed her slipping back or regressing into her identification with her soon-to-be-ex-husband. This step allows the group to creatively respond to the patient in a way that reminds her of what she is doing. Their creative response to this patient consisted of responding to her with the term "bull crap" along with saying her ex-husband's name when she would tell the group that no one would ever want her again and that she was worthless.

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