Abstract
This paper describes a specific approach to group therapy that is carried out within the context of a Gestalt orientation. It begins with a brief history of how the particular approach described here evolved. Then comes a description of elements to pay attention to in the composition such a group, followed by a brief statement of the orientation given to each new member. Then five ground rules for the group process are presented. A central distinguishing principle of this kind of group is that participants agree to devote their attention and efforts to experiences that directly pertain to this group. Conversations about events in other times and places are largely off limits. After the “Ground Rules,” a section called “Some Tweaking I’ve Done” presents changes in the process the author has gradually made that contribute to a more effective process. Three thumbnail sketches of typical work follow.
Gestalt Group Therapy [GGT] takes several forms. A recent survey by Feder & Frew reported in the Gestalt Review (2005]) asked respondents which approach they use and reported the following: the original ‘Hot Seat’ work –19%; inter-personal –24%;group/systems focus –3%; a mixture of all or two of the above – 54%. This paper discusses my preferred approach for weekly group therapy, which fits into the interpersonal category, yet which I prefer to call Interactive Gestalt Group Therapy [IGGT] or sometimes loosely ‘Here-and-now GGT’. This will be more of a practical guide than a highly theoretical one.
Background
I formed my first group in 1940 when I was about ten. It met in my basement every Friday night during the school year, and featured ping-pong, arguments and refreshments. We called it ‘The Philly Humbugs.’ This was in Northern New Jersey about two hours from Philadelphia. Although the basis for the name may have been clear then, it is a major unsolved mystery now.
My interest resurfaced in graduate school. My doctoral thesis in 1961 dealt with the effect of group therapy on the therapeutic readiness of institutionalized delinquent adolescent boys. These early groups were ‘Gestalt’ only to the degree to which Gestalt is in my genes, since in 1940 Gestalt Therapy had not yet been officially invented and I hadn’t paid attention to it when I was doing my thesis in 1960.
Later, 1963, I joined an analytic group and quit after a year, rather unimpressed. In 1971 I joined a training group run by Laura Perls and was a member of one group or another for about 15 years, the last few being peer supervision style, with a good deal of personal work included.
After I started my private practice I formed a group and have had at least one ever since. During the heyday of groups in the 1980’s I had five every week. Some of these were adult groups, and some were kids’ groups–not to mention monthly marathons – the good ole days. By 1985 or so I was getting bored with all the story-telling in my two adult groups and decided to offer something different which I have been refining ever since. I called it a ‘here-and-now’ or interactive group.
It was structured like this: Each participant agreed in writing to abide by the rule that all group attention would be directed to matters pertaining to the group There would be no discussion of job problems, family problems, etc.—not even health problems, except as they directly pertained to the group experience.
I offered this to the 16 or so participants in the two groups then running and figured about half would opt for it and half would decide to stay with the style they were familiar with, which was much less restrictive as to content. To my great surprise everyone chose the interactive mode, and that’s what I’ve been leading ever since.
Group Composition
Over the years I have learned that an interactive group, which is quite intense and demanding, requires some extra care in selecting members. The main caution is, if at all possible, to avoid having two [or more] very volatile rigid persons in the same group. Otherwise the result can be protracted fighting that goes nowhere. A group can usually manage one such person and that person can benefit over time because s/he is not caught up in protracted antagonism with a person like her/himself, with neither party self-reflecting and both continually pointing fingers. If that kind of conflict goes on too long, too loud, and perhaps too abusively, it can cause other members to quit in dissatisfaction, pain and/or disgust.
It is also helpful, if possible, to avoid overloading the group with too many very passive persons, certainly not more than half the group. And it is particularly valuable to have a very active, even hypermanic, member since such a person stimulates a lot of interaction.
My preferred size for a 2-hour group is eight people, ideally mixed with regard to gender. This allows many opportunities for core issues to emerge and for fixed patterns with certain types of people to show up [some call this transference]. It also allows for sufficient attendance when people miss sessions for any reason. Interactive groups can bog down if there are only three or four members.
Preparation of Members
Most of my members come out of my individual therapy practice; occasionally I get a referral specifically for this type of group. Once a potential member has been identified, serious preparation is important. Once a client has responded favorably to my recommendation that she/he join such a group, I give the client a fairly lengthy handout, about twelve pages long, that describes the group and goes into some detail regarding its benefits. That is, it talks about how such a group, which focuses on relationships with others, can promote growth in such areas as intimacy, expressiveness, openness, assertiveness, sexual embarrassment, conflict-resolution, etc. I ask the prospective member to pay particular attention to the format described in the handout. The client is asked to take this home and read it; we then discuss it at the next session. If, after this exploration, the client wants to join, I have prepared an ‘Interactive Group Therapy Agreement’ which I ask the client to read and sign. The essence of it is that the client understands the nature of the group and agrees to abide by its basic ground rules [which follow in the next section].
The Ground Rules. There are only a few.
1. The basic principle one that defines the approach is this: participants agree to devote their attention and efforts to their experiences which directly pertain to this group. This includes past experiences in the group and also, to a lesser degree, concerns about future experiences in the group. Typical subjects for attention, then, are both general feelings about being in the group as well as specific feelings or conflicts or problems with other group members. For instance, there might be an awareness of feeling basic difficulty in expressing emotions or certain emotions, or even a specific emotion with a specific member, such as a problem expressing anger at one person only. Once an issue or concern is identified, then we work on it in the group [see examples of such work below].
The rationale for this approach is this: Within the group experiences, members will become aware of fixed patterns, self-interruptions and other hindrances to better living. Within the group they can explore them to achieve fuller awareness and then risk experiments to develop new patterns. Sometimes I characterize the group as an interpersonal relations laboratory, where the emphasis is on the immediacy of discovery and of experimentation
2. A second ground rule I offer pertains to contact between and among members outside of group. Members are neither encouraged nor discouraged from having contact outside the group. If they do it is understood that anything of significance is grist for the mill during group and one member may not ‘legitimately’ request another member to keep it secret. This, of course, is in contrast to a typical psychoanalytic group in which members are discouraged or sometimes even forbidden, from having any contact with one another outside of group. Since in my experience this rule is noteworthy for how much it is violated, I prefer my variation. Much good work arises out of this.
3. Regarding confidentiality, my rule is: members are responsible to keep confidential everything concerning all other members. They are welcome to discuss their own stuff with outsiders as long as they don’t reveal anything about other members.
4. A fourth, more minor rule is: if a member knows that s/he will miss a session, it is the member’s responsibility to let someone, preferably me, know. This contributes to the development of group cohesion, frees us from wondering why an absent member isn’t here, and lets us move on to the work with those present.
5. Finally, almost obviously: no physical violence is condoned and violation of this may be cause for removal from the group. Actually, in my groups, there has occasionally been some minor physical violence — though not to the point that I have ever asked anyone to leave the group on that account. Instead we have been able to use it as workable material. I feel better, though, having the rule.
Some Tweaking I’ve Done
Over the years I have made a few adjustments to the basic approach. These include the following.
Schmoozing. Clients in these kind of groups sometimes complain that they don’t know enough about each other. At the suggestion of one client, we experimented with the first ten minutes of each session being open time where members, as they arrived, could talk about anything at all. Sometimes I join in, sometimes I do paper work, and sometimes I’m not even in the room.
Meditation. Although schmoozing caught on quickly, it was a little hard to switch gears and go from chatting to working. So I suggested five minutes of guided meditation, which has also caught on. After the ten minutes of schmoozing, I ring a little chime and minimally guide people to close their eyes and pay attention to their breath. After five minutes, I ring it again and ask members to keep their eyes closed for one more minute and consider what they might want to work on during this session. Then I ring it again and we go to work.
Logs. At the end of each session each client is asked to spend about five minutes filling out a simple log. The log asks what they worked on this session, how far they got, how they might work on this issue between sessions, comments, suggestions, etc. Each member is provided a clipboard for this purpose with her/his name on the back of it. I collect them and before the next session made any comment or suggestion I think might be useful, stimulating, supportive, etc. These clipboards are placed on the floor before clients enter, face down with the name on the back, so they can pick them up and glance at what they wrote the previous week and what I said about it. Most clients fill these logs out assiduously and make very favorable comments about this activity.
Handouts. From time to time I hand out some simple guides. For instance, one that I recall right now has one on side the word AVOID and gives some reminders such as ‘avoid advice-giving’ or ‘generalizing’ or “minimizing” words like ‘just’ or maybe’ or ‘sometimes’ [especially this last which inevitably leads to story-telling]. On the other side is the word EMBRACE with suggestions such as ‘make statements rather than ask questions’ ‘pay attention to your body’ or ‘notice how you are interrupting yourself’ etc. [NOTE: These handouts are available from the author on request].
Some Typical Work
In the vignettes below I will give some examples of the work. Keep in mind that throughout the sessions, members are [theoretically at least] paying attention to the immediate experience. No wandering off to story-telling or history.
1. Debra, a relatively new member with a history of deep depression and two recent suicide attempts, comes in to her fifth session and immediately lashes out at Kevin in a furious and crude way. Something he said to her last week about her appearance had infuriated her and she had characteristically accepted it in silence [a fixed Gestalt]. Tonight she experiments with expressing herself in a polarized way. Later in the year she apologizes to Kevin for brutalizing him, yet is also glad she did it, as a step toward a more balanced way of responding to insult and injury. Eventually they became good friends.
2. Kevin–the same Kevin in the paragraph above—is a hotshot businessman consumed by money and fame. He introduces himself to the group early on by telling of his connections with some famous people [for instance the sitting US President]. When the group gets tired of this and calls him on this pattern [a fixed Gestalt] he becomes more sharply aware of doing it. In a later session he experiments with telling each group member something ordinary about himself, adding “I hope you can like me when I’m ordinary too”.
3. Bob, a quiet, sensitive mental health professional who suffers from panic attacks and phobias, becomes keenly aware that he is very quietly hiding [a self-interruptive fixed Gestalt]. He does a round in which he tells each member some immediate secret about himself, such as ‘my heart is pounding now” or “I’m scared a lot in here’, etc.
Sometimes these events between people are brief, while other times they play out over long periods of time. Sometimes the awarenesses are of minor patterns, and other times they are of major core issues. Whatever the case, this interpersonal laboratory provides an opportunity to develop the necessary awareness, muster the necessary courage, make the fatal decision – and then risk– that is, to experiment with something new. A cautionary note is that one ‘successful’ effort doesn’t mean the death of the old pattern. Usually many repetitions are necessary to erase the old pathways and develop firmly established new ones. In addition, I emphasize to my clients that any new skills or ways of being that they have developed in the group can only be imprinted by diligent experimentation along the same lines outside of group in their everyday environments.
The Therapist’s Burden, and the “Magic” of the Work
The work described above is not easy. The main difficulty is keeping members on course. The temptation and the urge to fall into telling stories about other times and places is very strong for many people. Usually at least two or three in each group succumb to it. Even when everyone else is faithful to the here-and-now agreement, violation of it by only one or two can get the group off track. Of course this in itself can prove to be a core issue [such as opposing authority], yet often it is just a habit and a mistaken belief that telling a story–about childhood, for instance, is therapeutic. In my view it is only of limited value, certainly of much less value than the method described above. And at the end of a day, when the therapist is tired, keeping the group on track can be difficult. Similarly discouraging advice-giving or psychobabbling, (that is, intellectualizing about what’s going on with other group members) etc can be onerous. Some of my tiresome phrases are “Please let’s come back to now (or “the group”) “How is this true here-and-now? etc.
The immediacy of events in an IGGT often results in segments which are intense, dramatic, carry a strong quality of importance for the individual(s) involved. For me these moments have an exhilarating, exciting, inspiring effect. Often my most creative work — experiments which I never planned –arises at these times, emerging organically from the live situation. This fuels my energy to stay with the approach as purely as possible. Although the work can be taxing, the rewards are great.
References
Feder, B. and J. Frew. “Another survey of gestalt group therapy.” Gestalt Review, 2005, in Press.
© Copyright 2007 by By Bud Feder. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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