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5-Minute Lessons #1

Within 300 seconds or less I invite the reader to learn something new, or re-learn something old, about group psychotherapy.

PROBLEM

In a recent group, the newest member (approximately 3 months) suddenly decided to re-locate to anther state. Her decision was finalized while she was on a 4-week absence from group to her newly chosen city. As she had been expected to return to group after only one week away, the group became anxious and suspicious that her absence indicated her intention to leave group. In a regularly scheduled individual session with this patient, she asked me to inform the group she would be moving out of town, but intended to return to say goodbye in person. I informed the group about both of her intentions.

The group reacted with a mixture of disappointment that she was leaving before they got to know her, and annoyance they had made any emotional investment in the relationship at all. They vehemently protested her intention to return in person. Many valid arguments were presented to bolster the case for the waste of time it would be to see her again. While there was underlying disappointment with me that I had chosen such a temporary member (her decision to re-locate was news to me as well!) the group clearly had a much easier time being angry with this patient than with me.

My re-locating patient, on the other hand, was excited about sharing her decision with the group. She considered this decision to made from a position of growth and only imagined that the group would share in her delight. She intended to tell the group what an instrumental part they had played in assisting her in accomplishing a crucial developmental milestone.   I had a problem, should I allow her to come back and “disrupt” the group? If she did return it is likely she would be blindsided by anger and resentments. This would hardly be the celebration of a developmental milestone she had envisioned for herself.

INTERVENTION

I encouraged the discussion of her return. A good deaI of frustration was expressed which extended to previous members that had left and a slew of other gripes. I inquired as to my contribution to these problems.  Apparently, I had significant culpability for many of them. While I was not specifically asked to make a decision regarding the return of the re-locating patient, the discussion was heated and exciting. The group eventually moved on to other emotionally relevant issues.

Theoretically, I could make a case for any number of decisions regarding the return of the re-locating member. In the end I chose to honor the group contract regarding termination. However, I was concerned the re-locating patient was walking into an emotional ambush. I decided to tell her about the groups reactions prior to her return.

RESULT

The patient made an informed decision and returned to the group. After some initial resistance to directly approach the issue, members of the group talked about what they had discussed about her during her absence.  Being emotionally prepared, the re-locating patient was very understanding of the feelings of the group members. Hostility was thus diffused and the re-locating patient was now seen as courageous for returning. The group heard directly from her the meaning and constructive value they had had for her. A group situation that was hurtling towards an emotional disaster became an unexpectedly moving experience.

REFLECTIONS

I am pleased with the decisions I made to allow the group to express their upset with me and hold to the contract. Likewise I am pleased I told this patient in advance what she would be walking into. I believe I relied less on a theory to guide me and more on the basis of what seemed most kind and thoughtful. What would be the point of being theoretically correct but risking a disruption that could not be repaired? In hindsight, I believe all would have been better served if I had openly told the group I was considering discussing with the re-locating patient the group’s reactions to her leaving prior to her attending the group. However, when I left the final group session before her return, I had no idea I would do anything different that I usually do. I just left that session with an uneasy feeling that demanded attention, and fortunately, received it.

Gil Spielberg, Ph.d, ABPP

Los angeles,Ca.

Oct. 3, 2014