Sea Turtles Don’t Need Group Psychotherapy
By Robert S. Pepper, LCSW, Ph.D., CGP, F-AGPA
Group therapy is for people seeking help with relationships. It helps repair the damaged child ego and replace it with a healthier one through the interactions between group members, strangers known to each other only by first names. Relationships between members are “as if” in nature; the feelings that members have for each other are genuine and real, both positive and negative ones.
Group therapy helps people with maladaptive ways of relating to others by examining their resistance to change, even if the change is for the best. Some therapists and researchers have called group psychotherapy a form of reeducation for the healing of the soul.
The sociologist, Charles Cooley, called the phenomena of seeing ourselves through the eyes of significant others as the looking glass self. We get our identities, in part, from the way other people perceive us, incorporating those perceptions into our own self-image. The most influential self–image develops in the formative years (or the deformative years, as Dr. Jamie Turndoff, my friend and colleague, refers to them) through interactions with those we are closest to, our families.
Our family of origin provides our earliest group experiences. It is where we learn to be fully human, able to take our place in society. But families are not always benign forces in our lives. As children, a negative self-image develops when we are consistently told that we are not __X__ enough (fill in the blank: good-looking, thin, athletic, coordinated, organized, likable, religious, etc.) Unfavorable comparisons are sometimes made: Why can’t you be more like your __X__ (sister, brother, cousin, friend)?
As a thought experiment, consider the lives of sea turtles, one of the most asocial creatures on earth. Every year, the female sea turtle digs her nest on shore, lays her eggs, and returns to the sea. Weeks later, the hatchlings break out of the eggs and make their way to the sea without guidance, all on their own. Except during brief mating seasons, sea turtles have no family relationships at all.
If sea turtles were like humans, what effect would this have “psychologically?”
For one thing, unlike humans, sea turtles would have no destructive or self-destructive interactions with one another. Unlike us, they would be unencumbered by toxic introjects, those harmful voices of the past that live in our heads and influence how we see ourselves throughout our lives. Without an observing ego, the turtles wouldn’t form the neurotic patterns of relating that we humans do.
Sea turtles would not need group psychotherapy. But people often do!
Freud said that the unconscious mind is timeless, and I believe him. And so, I am led to conclude that anyone who has had parents is a good candidate for spending some time in group psychotherapy, where they can participate in a process known as progressive emotional communication.
Progressive emotional communication
Progressive emotional communication is the method some analytic group therapists employ. It is a progressive process that moves people toward more authentic ways of relating. It is emotional in that the exchanges are infused with genuine feelings. And it is communication because it’s interactive; there is give-and-take between the group members.
In my groups, a “contract” is made between members. They agree to: Say how you feel toward others and why you feel that way. In committing to this principle in our sessions, they begin to reveal their unique patterns of mismanaging relationships in their real lives.
The group leader’s role is to study members’ interactions, seeking to understand their unconscious motivations and the underlying feelings behind their actions. After months, sometimes years, of repeating the same behaviors during group interactions, members may learn about their unconscious investment in maintaining destructive patterns. The leader can facilitate this with the help of pointed questions: What are you getting out of the situation just as it is? or What is your part in maintaining the status quo? Group members’ objections to personality change, in other words, their own resistances to achieving the very things that they say they want in life, are slowly revealed.
It is only then that group members are in a conscious position to learn how to turn their behavior around and in doing so lead healthier lives, using more adaptive ways of having emotionally intimate relationships.
When group members ask me, When will I be ready to leave group therapy? I answer, The more you put into it, the more you get out of it. You’re ready to leave the group when you can do for yourself what the group does for you.
Oliver Burkeman’s article, “Therapy Wars: the Revenge of Freud” (Guardian, 2016) presents research which has shown that cognitive interventions alone are rather limited in their capacity to affect long-term personality change. Further, while gains made through cognitive means tend to dissipate over time, gains through analytic treatment tend to last.
Common Misconceptions
One common misconception is that group therapy is only for “crazy people.” While group therapy has been successfully used for the treatment of the mentally ill in the confined settings of hospitals and clinics, it has also been shown to be successful for “normal crazy people,” if you will, who seek help with relationship problems.
Another misconception is that group therapy is only for people who cannot afford individual psychotherapy. While group therapy is generally less costly, research has shown that it is an effective complement to individual therapy in helping people resolve issues around dependency in relationships.
Some research seems to imply, mistakenly, that good friends and family relationships alone can heal mental disorders. In Oprah Winfrey’s book with Bruce D. Perry, What Happened to You?, the authors acknowledge the importance of the love and support of family and community in maintaining mental health. They suggest that an individual therapist may also be helpful in this regard, for those who can afford it. They never mention the healing power of group therapy as a possible avenue to achieving healthy relationships.
Similarly, the famous Harvard longitudinal study (Waldinger and Schulz, 2023) shows that people with healthy relationships tend to be physically healthier than those without them.
Neither the Harvard study nor Oprah’s book consider the complicated road to attaining healthy relationships. Both offer simple-minded bromides like, stay positive, or surround yourself with happy people, without addressing the stressfulness, complexity, and the duality of all emotions and attitudes toward change.
However, personal relationships are not designed to absorb the full impact of our more powerful feelings. In group therapy, the directive to members is to say everything. That is clearly not a wise thing to do in non-therapy relationships. Some powerful, “dark” feelings are better left unsaid in close, intense, personal relationships. They are better expressed in the safe context of a secure group. To share every thought and feeling with a loved one can be hurtful and damaging to the relationship.
One group member’s experience provides a cautionary tale. He reported to the group that he told his wife about his murderous feelings and maniacal dreams of mass murder of a hated co-worker’s family. Even though he had enough ego strength to say to her that he would never act on those feelings, the results of his “sharing” were disastrous for his marriage. He scared his poor wife half to death! She called him a psychopath and threatened him with divorce.
If he had presented these intense feelings in the safety of a secure group therapy environment, they would have been tolerated, no matter how dark. In fact, the ability to make oneself vulnerable through the verbalization of negative but genuine emotion in group therapy is valued and respected for its honesty.
The restrictions prohibiting outside contact and physical contact among members help prevent adverse real-life consequences to group interactions. The group is a safe place where members’ words can’t come back to haunt them in their personal or professional relationships.
Some prospective group members claim to be “private people,” that is, they don’t want to share too much of their personal lives. Ironically, sharing one’s life with strangers is often the safest way to do it, but under the condition that members don’t have outside contact. Group members are known by their first names only in order to maintain anonymity.
Within secure boundaries nothing leaves the room. Under these conditions, members naturally and organically share their outside lives, even if they were reluctant to do so at the start of the group therapy treatment. They provide support and understanding for the normalization of all feelings. The “kindness of strangers” goes a long way in resolving resistances to emotional intimacy in members’ personal lives.
Transference Groups
My groups are known as transference groups in which members develop “as if” relationships. This means that members see each other as significant people in their lives and react as they would toward the actual people in their lives. Their perceptions of each other are often distorted, skewed by past emotional history.
They transfer feelings from their real-life relationships to other group members and to the group leader. The nature of the transference isn’t necessarily determined by any physical resemblance between the actual person and the “chosen” group member. Similarly, demographic variables such as age, status in life and gender are not necessarily part of the equation.
There are both positive and negative transferences. In the early stages of group treatment, the honeymoon phase of therapy, the transference is often positive; but over time, the negative transference emerges. This is actually a good thing. It allows the leader, other members, and the individual to see in vivo how they come across in their emotionally intimate relationships.
At first, usually the “acting-in” phase (in the sense that members’ behavior is taking place in the group rather than acting-out in their real lives), members do not see the impact of their behavior on others. When the negative transference plays out often enough, and the leader is skilled enough to maintain a safe environment of progressive emotional communication, the acting-in member can use the group as a laboratory to explore new ways of managing negative feelings. This can have a positive and constructive impact on the person’s relationships with group members which in turn can translate into improvements in their outside relationships.
The rule of thumb in analytic group psychotherapy is that if the transference is positive, it is not analyzed, unless it goes on for too long. If the transference is negative, however, unless it is analyzed promptly, there is a good chance the group member will quit.
The following vignette describes this work with Melinda, a group member who announced that she was leaving for good because I was a “cold and uncaring person.”
Melinda: A Case of Mistaken Identity
Melinda’s individual therapist had referred her to a group because she spent nearly all of her time alone. Unemployed, with no family, children, significant others, or friends to speak of, or even pets, Melinda was an isolate; her life was emotionally impoverished.
When she came for a consultation, my first impression was how much older she appeared than she actually was. Although Melinda was in her mid-40s, bright and articulate, she looked worn and haggard. With hair unkempt, clothes disheveled, she shuffled into the room. It was as if she wore her chronic depression as a mask.
“How do you spend your days?” I asked. Melinda gave me a blank stare and shrugged her shoulders.
“Is there anything in your life that you look forward to?” I asked.
“No. My life is so empty,” she said. “I have no reason to wake up in the morning.”
Her answer alarmed me. The prognosis was poor. But there was something strong that I sensed in her. As depressed as she was, she wasn’t suicidal, and she clung to life. I agreed to see her in a group.
To my pleasant surprise, she seemed to enjoy the company of the group members. She liked them, and the feeling was clearly mutual. Melinda seemed to relish the contact; she was more often than not focused on the give-and-take, even as an observer. Like a starving person, she devoured the group interactions. Just the same, she was very guarded, angry, and suspicious, particularly of me, which would have been all right had she been willing to talk about it. She wasn’t. Attempts to engage her in a discussion of her feelings toward me were met with a back-handed wave.
I asked Marilyn, another group member, “What’s the unspoken message to me when Melinda gives me that wave?”
She replied, “It’s a brush-off. You’re being dismissed.”
After several months of keeping me at arm’s length, Melinda complained bitterly at the end of one group meeting.
“You care about the others, but you don’t care at all about me. If you really cared you wouldn’t charge me for these sessions.”
I turned to the group and asked, “What feeling does Melinda want me to have right now?”
Sherry said, “She wants you to feel guilty.”
Sherry turned to Melinda and said, “You’re being totally unrealistic. This is Dr. Pepper’s livelihood.”
I asked Sherry, “Why can’t Melinda have her distortions?”
Then I turned to Melinda and said, “Let’s talk about that first thing next time.”
At the start of the next group meeting, Melinda said to me, “I’m considering leaving the group because of you.”
“How come?”
“Because you’re cold and uncaring,” she said.
“What’s your feeling toward me?”
“I’m indifferent to you,” she said.
“In what way am I cold and uncaring?”
“When I talk about my problems, you just don’t seem at all interested. You seem bored with me,” Melinda said.
“Are you a boring person?”
“I worry that am I. You never ask me questions; maybe that’s because I’m boring,” she said. At this point Steve chimed in.
“You’re not at all boring,” Steve said. “I thoroughly enjoy your insight and intellect. I would miss you terribly if you left the group. I look forward to seeing you every week. I’ve grown to like you very much. You’re the only one here who really understands me. Please don’t leave me.”
Melinda turned away from him, not responding, and said to me, “You never ask me a question.”
“Here’s a question,” I said. “Why do you ignore Steve, who clearly cares for you, and turn to me, who you claim gives you nothing?”
Melinda looked confused; she didn’t seem to understand my question.
She said, “What are you talking about?”
I turned to the group and asked, “Can someone else explain it? Perhaps I’m not being clear.”
Barney said, “Steve was wonderfully warm and supportive of you. You could see it in his eyes and hear it in his voice, but you dismissed him and went back to Dr. Pepper. You often speak about your problems here but never really ask for anything. I don’t know what you want from us.”
I asked the group, “What does Melinda need from the group, and is she getting it?”
Carol said, “She needs to feel loved.”
I asked Melinda, “Is Carol right?”
Melinda nodded her head in agreement, looked at Steve and said, “I felt your positivity.”
I asked Steve, “When was the last time you had your positivity felt?”
He smiled and said, “It’s been quite a while.”
Everyone, including Melinda, laughed.
I said to her, “Steve loves you.” But this was too much for Steve to admit, even to himself. Admitting he loved her would have made him feel too vulnerable.
He squirmed around a bit. “Let’s just say that I’m very fond of her,” Steve said.
It occurred to me that Melinda was capable of engendering loving feelings toward her, so I asked her a pointed question.
“Who in your life loved you?”
She smiled and responded immediately. “My grandmother. She loved me unconditionally. She lived upstairs from us. When my mother was mean to me, I’d run to her apartment, and she could comfort me and tell me that she loved me. I know it sounds dramatic, but I believe my grandmother saved my life.”
The other group members shared memories of a loving relative who they could run to when their home life was intolerable. Melinda had created a warm, peaceful feeling in the room, but she couldn’t sustain it. Her mood and tone suddenly shifted back to anger and hostility. She looked sternly at me and resumed her diatribe.
“I don’t ask for anything because I don’t expect you to respond to me,” Melinda said.
“Why not check out your perception of me?” I said. “I can’t read your mind. If you want something from me, ask.”
Melinda turned to the group. “See what I mean? He gives me that psychobabble double-talk. Talking to him is like talking to a wall. I might as well talk to the wall!”
Feeling pushed away and beginning to question my own resolve to help her, I turned to the group. “What feeling does Melinda want me to have right now?” I asked them.
“She wants you to feel guilty,” was the resounding group response.
Melinda was livid. She turned to the group again and said, “See! He’s a wise guy, mocking me….I want to feel loved, not hated.”
Turning to me she yelled, “I know you hate me.”
“Why would I hate you? … Why wouldn’t I care about you?” I asked.
“How the hell should I know? I’m not inside your head,” Melinda said.
“I know you don’t know. Speculate. You’re cordially invited to enter my unconscious,” I said.
“Maybe you’re cold and uncaring because our mother breast fed you on falsies.”
Everyone laughed.
Ali said, “That’s an old Woody Allen line.”
After the laughter died down, Greg said to Melinda, “Did you hear what you said?”
“No, what did I say?” she asked.
Dora answered for Greg, “You made a Freudian slip and said, ‘our mother’ instead of your mother.”
“I don’t know if you’re right, but I like the way you’re thinking,” I said to Greg and Dora,
“Don’t give me any of that Freudian crap,” Melinda said.
Then I turned to Melinda and asked directly, “Who in your family do I remind you of?”
“You’re just like my younger brother,” Melinda said. “My mother babied him. He was her favorite and he was cold and uncaring to me. But so, what of it? You are cold and uncaring; I feel so unloved in your group. You never pay any attention to me.”
I said softly, intently, looking her in the eye, “You have my full attention right now.”
Melinda said, “Yeah, but how do I know you’re sincerely concerned about me?”
Janice spoke up. “Could you talk to your brother this way? Would Dr. Pepper devote all this attention to you if he didn’t care?”
Melinda gave a faint smile and said, “Hmmm. Maybe.”
I said, “Ok, you hate me, but why take it out on the others in the group that you like, and they like you? You’re not just leaving me.”
It was as if she had an epiphany. “I’ll think about it,” she said.
And indeed, she did think about it. I had given her permission to hate me and still maintain a relationship with the group, in a way that did not happen for her in her family. For Melinda, her group experience was an emotionally corrective one and it made all the difference.
At the next meeting, Melinda bounced into the room like a changed person. Even before she spoke, there was something about her countenance that signaled a transformation. As soon as she began speaking, there was positive energy and a willingness to see me differently.
When Jason asked her about this “new” Melinda, she said that the cloud had lifted. After the last group, she went home and thought about the discussion. The memory of her grandmother reminded her that someone in her life loved her. It seemed so simple to her now. That exchange gave her a new perspective on our relationship.
Equally important, the kindness of a stranger had rekindled a loving memory of her
grandmother. She put the two experiences together, and that seemed to have given her the emotional freedom she needed to turn things around.
Conjoint therapy
When I work with people in group therapy who have individual therapists, I get permission to talk with the therapists on a regular basis. Quite often, a therapist will refer a patient to me for a group therapy screening when the treatment has reached an impasse and the patient has become stalled in the effort to achieve the primary goals of treatment: to love and be loved, to work and to play.
This collaboration is called conjoint therapy, in which the individual therapist and the group therapist can compare notes, so to speak, and coordinate the treatment. In group, the patient acts-in their ambivalence about relationships and then has the opportunity to debrief that experience with their individual therapist. To my mind, that’s psychotherapy at its best.
