It seems to me odd that there is very little mentioned about siblings in the indexes of group therapy texts, because to my mind: Group therapy is sibling relationships.  That is, as they exist in the form of the ‘as if’ sibling relationships between members.  In the treatment process, members regress and re-create the dynamics of their families of origin in the group.  

Some prospective group members are quite hesitant to begin treatment for this reason. They are convinced that the group experience will be stressful and damaging, like their first group experience. And who wants to repeat that? But they actually may be right but for the wrong reason, as we shall see shortly.                                                                 

 I strongly agree with Stone and Bodansky’s assessment that members’ relationships to their ‘real-life’ siblings during childhood have a profound impact on the course and the outcome of group treatment. Stone suggests leaders wait for the patient’s spontaneous sharing of their sibling histories; but I take it a step further, I don’t wait.  I ask directly.                                                

 Those relationships are so important that I include questions about them in the screening interview of prospective group candidates.  I always want to know about the nature of their relationship with siblings. How many?  Where are you in the birth order?  How many years apart? Are you close? If there are more than one, who are you closest with? Brothers ,sisters?  Not so close with?  Why and why not?                                                                                               

These questions are often an accurate indicator of the newcomer’s adaptation to group: The better the relationships with real-life siblings the better the relationships with the ‘as if’ siblings in group. While nothing is 100%, the answer to these questions tells me a lot about the role the newcomer will most likely play out in the group.  Alfred Adler (1964) was one of the first to notice that personality was linked to birth order, the oldest as caretaker, the middle-child syndrome, and the youngest as the baby and so on.

I also agree that a good sibling relationship has the power to compensate for parental neglect. However, it is not necessarily true that members with unhealthy sibling relationships are doomed.  Even members’, whose childhood relationships with siblings were less than ideal, have an advantage in group treatment that the patient in individual treatment doesn’t— the group is the healing agent (Ormont, 2001).    I have seen many such group members resolve closeness issues by building strong bonds with their group siblings even when the transference was initially negative.    The negative transference is just important as the positive transference in the healing process; that is one way in which group therapy helps. It has been my experience that resolving the negative transference has a stabilizing effect on members’ outside the group functioning.                                                                                               

In the groups that I run, the contract is that members are to say how they feel toward each other and why they feel that way.  This creates an emotional immediacy and intimacy that is not possible in individual treatment; one that can compensate for the ‘damage’ done in childhood.  I see my role in this process as fostering an atmosphere in which members seek out each other for comfort and support rather looking to me for it first.                                                                                                                                             

If a member asks for feedback from me before everyone else has spoken, I point this out and wait until all the others have responded before addressing the member in need. This is particularly important in instances where their experience with real-life siblings has been unsatisfactory. It has been my experience that negative real life relationships between siblings is a screen for tension that existed between the parents which has spilt over onto the children. In group that often translates into an overheated attachment to the leader. The leader’s reaction may be too important.  Consequently, the focus in group should be away from the leader to-member interaction and more toward member-member where the power valence is more balanced. The leader’s role in such cases is to act as mediator, working through the reconciliation of the conflict between siblings.

In an instance from my own personal experience, I was the first member to arrive on time to my initial session of an ongoing group. When the others filed in, before any interactions took place, I was verbally attacked by a latecomer. She was furious that I was sitting in her seat. She demanded that I change seats. The leader reminded her that there was no assigned seating. However, his remark only further inflamed her. She hated that he protected me.

After she calmed down, she revealed that she had taken an immediate dislike to me. I reminded her of her younger brother, whom her parents favored. It should be noted that the woman was herself a seasoned professional group therapist, hence an example of the regressive power of group. To her credit, she stayed with it and talked the conflict through, thereby allowing the process to unfold. Not all cases of an immediate negative transference are as sanguine.

For example, a female borderline patient in individual therapy with me complained bitterly about the mistreatment she suffered at the hands of her sisters. She presented herself as a helpless victim of her sisters’ meanness. I suspected that her insistence on being seen as a victim was her defense against feeling guilty, but about what I did not know. Victims are people with guilty consciences. After a year of individual treatment in which I attempted to help this woman to understand her need to be the victim, but to no avail, I invited her to join a treatment group. The woman was leery of group. She couldn’t see how group would help, but she trusted my judgment enough to give it a try. She agreed to test it out.

But during her first meeting, she verbally assaulted all the women in the group, sarcastically finding fault with everything from their personalities to their choices of attire. The group took an immediate loathing to her.  I had to caution her to stop lest she be expelled from group after the initial session. In this one session, the patient unwittingly revealed a side of her that did not appear in a year’s worth of individual treatment. This gave me valuable leverage in helping the patient take back some control of her family relationships by understanding her role in her own sense of victimization. She saw herself as a “Cinderella” who had to contend with wicked step-sisters.                                                                                                                                         

This was not something that she had conscious control of, although to her it felt like it was happening all over again. In her real family she sensed that she was not her parents’ favorite. In the treatment milieu, she wanted to kill off her rivals with words. It took her several months for her to be able to put these feelings into words and say that she felt jealous, rather than act out that feeling in the group (Pepper, 2015).  It worked for a while.                                                                                                                       

But unfortunately for her, she had been so damaged by that original experience that she was unable to resolve the revengeful rage fantasies of her childhood. Her unconscious agenda was to destroy any semblance of a happy family and she could not tolerate the thought of living in peace in a communal environment. Eventually, she dropped out of group only to lead a sad, isolated and lonely life.

I’d like to add one final note.  All of the above remarks about the impact of sibling relationships come with a disclaimer: the manner in which group members know each other and what they know all have a significant impact on the course and outcome of the treatment (Pepper, 2015).   In order for the leader to legitimately differentiate transference from reality in a psychoanalytic group setting, members must be known to each other only in their roles as members.  When members are in dual relationships, that is when they have social contact outside the group, the leader is unable to clearly discern how much of the sibling relationship is based on real life interactions and how much of it is distortion, as transference implies.