The Interventions

When group therapists feel the need to direct the attention of the group, they have a choice of only four directions in which to go. They can either incorporate all four directions, a combination of three directions, or utilize one direction as the intervention of choice. These four directions are as follows:

1. Draw the attention to the member making a comment.

2. Focus on the person responding to the comment.

3. Elicit the responses of another member of the group to the comment.

4. Involve the group as a whole in examining their feelings about the comment.

These four interventions are accomplished with therapist-posed questions. It is essential when such an intervention is used, that the group has been educated to the fact that the therapist will never use rhetorical questions. Most people in our society have been accultur-ated to expect that many questions are really commands. "Why did you do that?" often can be interpreted as "You should not do that." The therapist must emphasize repeatedly that his or her questions are real questions, aimed at exploring "reasons for behavior."

In this case, in order to protect the new patient, my interventions were meant to direct the group in only three of the four directions for the entire session:

1. Toward a group member subjected to an attack.

2. Toward another group member.

3. Toward the group as a whole.

When the target of an attack retaliated against the attacker, I turned the attention to the retaliator by asking, "If someone had used the words that you used to retaliate, what effect would it have had on you?" This question must be asked very carefully, because in spite of careful preparation for the meaning of questions, it is easy for the patient to experience the question as reproof thus the patient experiences a narcissistic injury. The patient's established trusting relationship with the therapist and the therapist's tone of voice forestalled that misinterpretation. That allowed the therapist to proceed to: "What do you think your purpose was?" and "How would the rest of you have experienced that remark?" This again has completely removed the focus from the new patient.

In directing or eliciting a response from a group member toward the victim of an attack, I used questions like, "How did that make you feel?" If I had wanted to direct attention toward the attacker, I could have asked if producing that emotion was his or her goal, but in this case, since I wanted to direct away from the attacker, I would follow this with, "When have you felt a feeling like this before?" From there it was easy to go to "How have you handled situations like this in the past?" which has completely removed the focus from the new patient. After that, I was able to involve other patients with questions like, "You have talked of similar experiences, how does the one just described compare to yours?" By this point, the group had once more been directed away from the attacker.

Finally, to direct the spotlight onto the group as a whole, I would ask such questions as: "What seems to be happening here?" and "How do you feel about it?" Gradually, as the center of attention was kept away from the deeply troubled patient, he could calm down somewhat. I needed only a brief session with him following the group to satisfy myself that he was sufficiently composed to return home safely. In a subsequent discussion with his individual therapist, it was decided that this kind of group experience was too dangerous for this patient, and no effort would be made to encourage him to return.

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