Group Therapy Training: A Group Therapy Primer

COURSE DESCRIPTION:

Through didactic, experiential, and small group discussion, we will examine the foun-

dational principles of related to Group Cohesion. The course material will be applica-

ble and relevant to groups of any length, theoretical or thematic orientation or set-

ting. We will cover issues of pre-group screening and preparation, and group com-

position. We will integrate the 4 perspectives— the Person, the Member, the

Container, and the Group-asa-whole lenses. We will reflect on when, and how, thera-

pists running groups should intervene; which perspective is most time-specific

depending upon which phase, or stage that a group has evolved to. And we will give

special attention to countertransference and how to prevent, manage, or resolve

potential group scapegoating. We will include a special section on short-term groups,

including maximizing the termination phase. Lastly, we will cover co-leadership

dynamics: compatibility issues; power dynamics; and communication.

***Santa Clara Behavioral Health Service Department (SCCHSD) is approved by

the CA Association of Marriage and Family Therapist to sponsor continuing

education for Santa Clara County LMFTs, LCSWs, LPCCs, and/or LEPs. SCCBHSD

maintains responsibility for this program/course and its content. This course

meets the qualifications for 6 hours of continuing education credit for LMFTs,

LCSWs, LPCCs, and /or LEPs, as required by the CA Board of Behavioral Sciences.

The CA Association of Marriage and Family Therapist is the BBS recognized

approval agency-Provider # 131775. SCCBHSD also is approved by CA Consor-

tium of Addiction Programs and Professionals (CCAPP) and CA Association of

Alcohol/Drug Educators (CAADE) and the Board of Registered Nursing to

provide CEUs. Lunch and scheduled breaks during the training do not count

towards CEU credit.

***Please contact Learning Partnership if you need accommodations for one of our trainings at 408-792-3900. ***You now can download/print our own CEU Certificates online at sccLearn 2 weeks after the training date. ***Do you have a Grievance? Please call Learning Partnership at 408-792-3900.

Target Audience: SCC BHSD staff and contracted agencies

COURSE OBJECTIVES-Participants will:

Create a multi-dimensional frame in which to view a group’s progress.

Identify which phase of a group’s development to which groups have evolved.

Predict when potential scapegoating may occur, and adopt a plan to intervene.

Examine and understand countertransference reactions.

Discuss in small groups, the application of “Person” and “Member” Perspectives.

and information about eating disorders.

Jim Fishman, LCSW, CGP (Certified Group

Psychotherapist) is in private practice in San

Francisco, where he works with individuals,

couples, and groups. He has presented and

trained clinicians locally and nationally. As a

faculty member and supervisor at The Psycho-

therapy Institute of Berkeley’s Group Therapy

Training Program, Jim has served on the board

of the Northern California Group Psychothera-

py Society, and has published on topics as

varied as Navigating the Co-Leader Relation-

ship Through Dreams (co-authored with Linda

Rose, LCSW) in The Group Circle, to AIDS,

Sexual Compulsivity, and Gay Men: A Group

Treatment Approach (Co-authored with

Michael Baum, MFT) in Therapists on the Front

Line (Cadwell, et al). Starting out his career in

Boston, Jim was one of the cofounders, in

l983, of the AIDS Action Committee and was

director of Men’s Clinical Services at Operation

Concern/New Leaf in San Francisco through

the late 1980’s. For over a decade, Jim studied

group phases and leader roles with his men-

tor, Ariadne P. Beck, M.A.. Having also studied

meditation intensively in India for over 2 years,

Jim is a now an avid meditator, and is also a

self-trained watercolor artist. Jim has a passion

for the search for wholeness through art, med-

itation, and depth psychotherapy.

Our Trainings are Free-

Register online at sccLearn

BHSD Learning Partnership Presents:

April 27, 2018 9:00 am-4:30 pm

Registration begins at 2:30 am

Scottish Rite Center 2455 Masonic Drive

San Jose, CA 95125

A GROUP THERAPY PRIMERby James Fishman, MSW, LCSW, CGPfor attendees of Group Therapy Training on April 27, 2018Santa Clara County Behavioral Health Services_____________________________________________________________________________________________________________________

Molyn Leszcz, MD, CGPCo Author with Irv Yalom, The Theory and Practice of Group PsychotherapyProfessor, Dept. of Psychiatry,University of TorontoMount Sinai Hospital, Toronto (11/11/17)

COHESION= The Group Equivalent of “The therapeutic alliance”:

The therapeutic relationship matters more than the group model. Beyond client’s characteristics, the therapist & the relationship most impacts outcome across all treatments, including pharmacotherapy.

Emphasize adaptation, first; pathology second: “You come by this behavior/conflict honestly, given your background.

Utilize the Here and Now— the group as “Social Microcosm.”

Attend to clients’ negative Schema— Pathogenic beliefs and the resultant maladaptive transaction cycle in group interactions.Welcome Countertransference as data.

Evidence based principles Related to Cohesion:(Bernard et al, 2008; Burlingame et al 2013)

1. Conduct pre-group preparation that formulates a plan, group goalssets treatment expectations, defines group rules & optimal risk-taking.

2. The group leader should establish clarity about group processes in early sessions— since higher levels of early structure are predictive of higher levels of disclosure and cohesion later.

3. Balancing attention to intrapersonal (individual) considerations vs. intra-group considerations. Too much similarity or too much difference can be too flattening or too tension-inducing.

4. The leader models real-time observations, serves as guide to effective interpersonal feedback; shows a moderate level of control and affiliation.

5. Timing of feedback: which developmental stage is the group at? challenging feedback is better received once group has achieved cohesiveness. Are members READY to receive feedback?

6. The leader’s management of his or her own emotional presence provides powerful role-modeling, especially how he or she handles interpersonal conflict.

7. ** The leader focuses on facilitation of members’ emotional expression, the responsiveness of others to that disclosure, and the shared meaning derived from each party’s epxressions.

____________________________________________________________

(Don Brown Model: The Group-as-System as summarized by Gordon Murray, MFT, San Francisco)

James Durkin’s “Living Groups”“System” A connection of objects or people that mutually influence each other, whereby patterns, generalizations, or even laws describe or predict the interactions of the individuals. Each system has a “boundary”= inside vs. outside. “Permeable” boundaries can mean flexibility, the ability to be accessed

or “known”; Too much permeability (totally random permeability) can dissolve its identity, its integrity.

Conversely, too impermeable, rigidly held boundaries can mean any new information or input is blocked ; and nothing is being given access to the outside world.

Systems have, at best, “semi-permeable” boundaries. And this pre-supposes someone who will decide and enforce the criteria for entering the system— someone wields power, authority, control.

Each larger system will have a number of subsystems, as well as a larger system called suprasystem. Isomorphic: a change in one system influences the other systems in the hierarchy. Therefore, influences such as a Mental health system, a county like Santa Clara County, a democratic Governor — all have some impact on other subsystems. Groups are embedded in other systems, and reflect cultural influences, such as racial injustice, homophobia, gender roles.

YVONNE AGAZARIAN: 4 perspectives: Person; Member; Container; Group-as-a-whole.The “Visible Group” Person and Member— most easily apparent to therapists and clients.The “Invisible Group” less obvious to therapist or client (Container and Group-as-a-whole.”

‘Person” Perspective: trying to describe the world inside an individual’s psyche based on “intrapsychic” perspective: “My temper gets in the way” ‘I have an Oedipal complex,” “I was traumatized by early abuse.”

The “Member” Perspective; How the above “person” perspective issues will play out in one’s outside life, but more importantly, as a member of this particular group. Yalom: members in a group unconsciously pattern their behavior after their actual familiar social world. THE GROUP AS SOCIAL MICROCOSM. Members select and organize their experiences around

familiar patterning. Working in the here-and-now in a safe environment allows members to become of aware of their patterning constructs and to change these.

ANN, PAM & BRUCE: THE “MEMBER” PERSPECTIVE(from Agazarian & Peters, The Visible and Invisible Group, pp.. 62-73)

The Member level Incident

In her first major interaction in the group, Ann talks about her fears of being rejected and says she feels like asking for reassurance. Bruce, another member, responds by being empathetic and reassuring.

Ann feels comforted by Bruce until she notices that Pam, who had been quite talkative prior to Ann’s sharing, now has a stoney, cold look on her face. Ann is taken aback, and her face drops.

Bruce, who has become very sensitive to Ann, sees what is going on and casts an angry look at Pam, and says sarcastically to her, “Well, you’re being might supportive.” Pam remains silent and Ann anxiously asks if she has offended her. Pam remains silent, turning slightly away from Ann in her chair. Bruce looks at Ann and shrugs.

The Theory

When Ann does enter the group… as a ‘member’ she will select those behaviors which seem appropriate to the group situation as she sees it…The situation as she sees it probably has more to do with the group that she has projected or displaced from her unconscious expectations than with the actual group that exists.

Ann-the-person will react (probably unconsciously) to several of the people in the group. Something about the way they look, sit, talk or speak will remind her of people that she knows. She will also tend to respond to these selected people more in terms of her expectations than in terms of the way they respond to her.

Behaving toward people ‘as if’ they are going to respond in a specific way is a powerful influence in eliciting the response that is expected. It is probable that at least some of the other people in the group will resonate with Ann’s behavior.

________________________

Based on these MEMBER interactions, make some hypotheses about PERSON-level dynamics that might be going on in Ann, Pam, and Bruce. What PERSON dynamics could account for this sort of manifestation at the MEMBER level?

THE INVISIBLE GROUP

Now, let’s look at the Group-as-a-system, not just a collection of individuals.

The group system expresses itself through nominating individuals who “contain” or “carry” or “hold” some important aspects of the group. Now, the person containing a given aspect probably has a “VALENCE” for that particular quality, from a childhood role, so he or she accepts the nomination.Much projection and projective identification is involved here. Members’ split off parts of the self are (unspokenly) projected into or onto other members, who then may feel a disproportional intensity of affect or role they are carrying (‘for the group.’) The elected role may be positive (idealized) or negative (scapegoated). Identifying the container phenomena can be a great relief to them, similar to when, in Family Therapy, the therapist calls out the “Identified Patient” role that the adolescent offspring may be thrust into, or, The Parentified Child, or The Family Hero.

So far, therapists may choose which level upon which to intervene: Intrapsychic (Person); Interpersonal (Member); Container (“projected or elected role).

Today, we will learn, in depth about the 4th dimension, most useful and least known to group therapists: The Group as a Whole.

*The group is an entity that evolves over time. *Developmental stages of any/all groups, regardless of topic or theoretical view. * The development of group NORMS, and STRUCTURES.You may have heard these catch-phrases:

Forming - Storming - Norming - Performing - Mourning

Groups gather for some purpose (Forming).They run into conflict (Storming)They develop rules to regulate and resolve conflicts (Norming)They get around to do the work they came to do: ((Performing)They will eventually have to cope with endings (Mourning).

* Developmental stages take place in an invariant sequence. * Not “perfectly” but “doing a good enough job” at each stage.

When a therapist gets “stuck” or overwhelmed, he or she can go to a higher level of abstract thinking: What phase are we in? What feeling-tone issues are arising? What norms are we trying to master? How to disagree? How to be close? When is it too early to disclose?

BECK’S EMERGENT LEADERSHIP ROLES & 9-Stage Sequence.

ARIADNE BECK, M.A. & the Chicago Group Therapy Research Team Phases of Group Development and the 4 “Leadership Roles”

*Applies to groups of any theoretical orientation * Phases are “sequential” invariant in their order. * As each group develops, the group evolves a living STRUCTURE. STRUCTURE includes: Norms for Interaction: how will the group manage conflicts? How do we deal with different relational styles? How fast istoo fast to open up?

The GROUP is a “CONTAINER”— The first 2 phases involve creating asolid, safe container to eventually be able to “HOLD” deeper material.There is a tendency to want to “rush” the intimacy process—But this is akin to a “getting engaged” on a First Date!

At each phase, the therapist must find a way to hear and encompass the range of needs of each of the members, while maintaining cohesion or relatedness within the group process.

4 Leader Roles assumed within the group:

TASK leaderEMOTIONAL leaderSCAPEGOAT leaderDEFIANT leader

A LEADER is defined as one of 4 members who HOLD, CONTAIN AND HELP a group clarify its direction and goals. They help make boundaries more EXPLICIT.If membership is stable (no one leaving or entering the group), these roles are consistent throughout the life of the group.Other members adopt and help with each function, however.And in groups with larger compositions, 2 members may take on any one of the leader roles.

TASK LEADER: The CONVENER of the group.The guide to the task of the group.

Has expertise relevant to the goal of the group.Influences the NORMS, goal clarification, and

stye of communication of group.The go-between who works with the Surrounding

Organization.EMOTIONAL LEADER:

Generally the “best liked” person in group.Assertive and self-aware. Important support to others Highly motivated & prepared to take part in task of

the group. Speaks for “we,” not just “I”: Australian Shephard of the group.

tSCAPEGOAT LEADER:

Makes room for “difference” within group.May seem out of step—Not always attuned to social cues, and can be

1 step “ahead” or “behind” group.Often the object of open criticism or attack.Often object of non-verbalized negative feelings.Helps crystallize many group issues about norms.His/her role is vehicle for clarifying many issues.

DEFIANT LEADER:Most ambivalent member about group participation.Models the struggle between “dependence” and

“independence”Fears “group MERGER,” similar to, in couples work,

(Pursuer/Distancer dynamic)— ike the Distancer.Defies the pressures to participate at the same pace

or to the same degree or depth as others.

The process of differentiation on a Member-level, leads to Integration on a structural, group-as-a-whole level.

* * * * * * * * * * * * * * *Jim Fishman: Walk each potential member through “the crunch,” “acting in,” the expectable impasse, the wish to flee group. “This is a likely way that your core interpersonal issues will emerge in group process.

“Here and Now” focus takes precedence over “Outside group problems” The importance of SCREENING for substance abuse, massive anxiety,intractable depression, suicidality. Can you listen to others and make space for others?

PRE-GROUP WORK (whether via phone call, in-person interview(s), or— with client permission— collaborating with a referring therapist—lays the ground work in assessing whether the client is ready orappropriate for group work and can be foundational and predictive of greater success in the group.

1. Does the client understand the group goals?2. Can he or she articulate how their needs match the group’s goals?3. Is he or she receptive to feedback?4. Can he or she listen, and grant air-time to others’ issues/needs?5. Can they self-reflect? Is he or she open to thinking ahead to what

might be predictive in upcoming challenges to face?6. Is he or she challenging the group therapist in a productive, open

way or trying to resist, de-skill, or reverse roles with the therapist?7. What group role or dynamic might the client “have a valence” for

adopting or co-creating, and how open is he or she to the “change process”?

* * * * * * * * * * * * * * * * * * BECK stages, Continued:

Phase One: (TL = Task Leader. EL = Emotional Leader. SL = Scapegoat Leader. DL = Defiant Leader.)

The initial contract to become a group.Sizing up the situation.Identifying individual and group goals (introductions).

What happens in Phase 1:The Task Leader (therapist) conveys his availability to each member.Look for and vocalize “Pair bonding,” i.e. shared commonalities.“How does it feel to be here today?” (exciting; scary…)Emotional Leader (EL) is “selected” in phase 1. EL is most ready to make use of group, ready for the Change Process.“Open-ended enrollment” creates stressful experience for members who are ready to settle in and move forward.

However, even groups with rapid member turnover (in-patient groups; day treatment programs) gain learning in; a “core group” can carry & further the group culture/norms.

BENEFITS OF STAGE ONE: - presenting one’s self in relevant way to rest of the group. - Pair bonding leads to: “I’m not the only one who…” Before session one ends, TL asks, “Is anyone feeling out-of-place, or thinking of not returning next time?” *** This is a very productive question, draws out “outliers” and brings forth others’ (unvocalized) identification with outlier, who then feels less alone.Make sure everyone has introduced themselves.

PHASE 2: HOW WILL WE WORK TOGETHER: COMPETITIVE URGES AND DIFFERENCES EMERGE

How will we hammer out differences in style?How will competitive feelings be handled?Is there enough space in this group to meet my needs? “Best known/Least Loved Phase of Group”!Each member, out of anxiety, pushes for what makes them feel their needs will be addressed.An almost irresistible “pull” into “POWER STRUGGLE with Winners and Losers.”

SCAPEGOATING:—A group “Defense mechanism” occurs— by focusing on one member who “does not fit into group” and is thus “scapegoated.”The Scapegoat Leader is the object of much projection.

Scapegoat Leader:The Scapegoat Leader is not necessarily disruptive or inappropriate, but may OPERATE FROM A DIFFERENT SET OF ASSUMPTIONS & timings from the rest of group. SL generally more self-disclosing at this phase, more spontaneous about expressing observations of others that areusually being denied by others.

The SL wants to engage in the groups task; he/she is invested, but may not pick up on social cues. & doesn’t know how to get “in.”

Instead, SL frequently becomes the object of transference projections of past parental or sibling figures. SL, in turn, finds it hard NOT to get defensive in face of group rejections.

THE GROUP’S RESPONSE:Fight/Flight tendencies emerge.Sub-group alliances can occur.Faulty belief: Differences can ONLY be managed through use of POWER or COERSION.

COUNTERTRANSFERENCETherapists often feel overwhelmed and de-skilled at this point in group. (Why did i ever think I could run a group?) Will group survive?**Remember: the Therapist (TL) cannot single-handedly get a group to resolve the phase 2 impasse. He/she has to enlist the group’s help.

SOLUTIONS TO PHASE 2 CRISIS:1. TL must offer support to the SL.2. TL must help group members process their own anxieties & explains how the group is mis-using the SL.3. “What would each of you need to focus on and feel, internally, if you weren’t trying to ‘fix’ or ‘change’ SL? “4. “If you take SL on, you’re taking ME on, too.”

NEVER ALLOW “ATTACKING”5. TL must never allow attack to go on. Must intervene. “This is not acceptable behavior.” TL needs to step back and remain the referee, and grasp the “group level” tensions causing this impasse.

UNEARTH THE CAN OF WORMS.6. If scapegoating is occurring non-verbally (members sigh, ignore, avoid SL) the TL must make the non verbal scapegoating/cues

overtly named.

7. “What’s going on when SL speaks? You all seem to look away…”(Scapegoating has occurred even in the Waiting Room or on their ways out the door).

THERAPIST PITFALLS:TL may feel drawn to place responsibility for problems/group tensions solely at the feet of the SL.(i.e. “why have you recreated your family trauma upon the group?”) TL may ignore the “invisible” group-level projections and pressures put upon SL. The scapegoat leader is at great risk of dropping out, only rendering the group less safe than before..

Unless the clinician has found a productive way to process his/her negative countertransference towards SL. the TL may scapegoat the scapegoat. As therapists, we must work on alignment with Scapegoat and protecting him or her.

THE EMOTIONAL LEADER’S ROLE: ** The Emotional Leader can give productive feedback and voice to the SL in an effective, non-scapegoating way. Research shows that The EL has NEVER led the attack on the SL. EL’s efforts act as a “bridge” between the SL and the rest of the group by honestly and respectfully addressing certain behaviors coming from the SL..

A dialogue ensues, and the SL becomes more understandable, de-escalating group tensions.

POSITIVE OUTCOMES OF STAGE 2:The group is challenged to communicate more explicit and verbally about non-verbal cues.

The SL goes on to become an integrated, engaged member of the group.

The group learns about projections and assumptions, and how taking back these projections leads to greater group safety.

The group learns that it is possible and doable to resolve conflicts in a non-coercive, more respectful way — many COUPLES do not learnhow to navigate out of Stage 2! Many FAMILIES have not mastered how to have conflict yet work it through productively.

The solution must arise between members themselves on basic norm/goals. This is how NORMS AND STRUCTURE are built.

STAGE 3: THE EXPLORATION OF INDIVIDUALS

— Stage 3 is the first phase where, having built a solid foundation, it’s time for each member to “drop in,” go deeper, into exploring his or her own personal conflicts and issues.

— Each member gets a chance to express and reveal his/her self and get feedback from the group and from therapist.

— At this phase, members feel “I can achieve as much or even more in group therapy than in individual therapy.

—The Emotional Leader does a great among of work, and EL’s changes are visible to other members.

— Greater warmth, depth and commonality emerge in group process.

Phase 3 is the longest phase of groups, and — if you have to end a group— phase 3 is good phase to end it in, once a group has achieved resolution in phase 2.

Questions for use by a group leader to identify the phase in which a group is functioning based on the Chicago Group Development Research Team’s* theory of group development *Ariadne P. Beck, Jo Ann Brusa, James M. Dugo, Albert M. Eng, Carol M. Lewis

� Phase I

1. Have all the members said who they are and why they are there in at least cryptic terms relevant to the particular group?

2. Is membership complete?

3. Do you as TL feel some empathic bond to each member of the group?

4. Have the members discussed and come to agreement about any normative issues?

5. Has the group expressed any topic on which they can connect with each other emotionally?

6. Has everyone found at least one other person that they can identify as having similar problems to their own?

7. Has everyone decided they want to be there?

�

Phase II

1. Is there a tension and/or discomfort in the group especially towards one or two individuals?

2. Is there pressure being put on one person to change their position or their style? Or is there one member who is expressing discomfort to you privately about their experience with the others in the group?

3. Do you sense a basic mis-communication or mis-trust in the group?

4. Do you fear a dissolution of the group; or a potential loss of a member?

5. Do you see sub-group alliances as a prominent feature in the group interaction?

6. Has the group worked out some ground rules and processed a long term goal?

7. Have members acknowledged their fear of disclosure or accepted responsibility for avoiding disclosure?

Phase III

1. Is there a change from an atmosphere of stress or tension to an atmosphere in which the members can listen to each other and can sustain a focus on a shared topic?

2. Have group members started exploring a variety of ways of being involved with each other and of communicating about issues?

3. Are the members taking turns at addressing the issues or the history of the issues that have brought them to the group? Has everyone taken a turn?

4. Has each member taken some degree of risk in self- exploration or interpersonal exploration in the group?

5. Is there an atmosphere in the group of respect for members' characteristics and for differences in styles?

6. Has the rest of the group (including therapists) responded to each individual in a helpful and/or supportive way (i.e. giving encouragement to work further)?

7. Have group members noticed the ways they are similar as well as different and expressed some degree of equanimity about both?

�

Phase IV

1. Is there a visible change in the mood towards lightness and humor especially at the beginning of sessions?

2. Is the Emotional Leader expressing (either verbally or non- verbally) positive or close feelings towards TL?

3. Do members want to plan out of group contacts?

4. Is the therapist participating in a more personally accessible way?

5. Is there evidence of pairing with positive feelings or sexual attraction dominating?

6. Do clients bring in issues regarding intimate relationships or sexual problems to work on?

7. Have there been feelings of tenderness or attraction expressed in the group?

8. Has everyone shared in the ‘good feeling’ in the group?

�

Phase V

1. Is there a new sense of tension or awkwardness in the group?

2. Is the group having a difficult time with some normative issue? Is a norm being challenged by a group member?

3. Are you feeling torn or pulled in the group?

4. Are group members concerned about but finding it hard to help a member (DL) who is expressing pain?

5. Are you feeling ambivalent in relation to DL?

6. Are members either exploring or acting out concerns about mutuality in their relationships in the group? Or in relationships outside of the group?

7. Have members negotiated the way they will handle their new bond of commitment to each other?

8. Are individual needs and differences being addressed in a caring and exploratory manner?

�

Phase VI

1. Has the mood lifted since the last phase?

2. Are you being addressed in a new way by group members, and especially by EL?

3. Do you feel more like “a part of the group” as a person? If not, are you finding it difficult to understand or to go along with the new mood in the group? Or to go along with the greater assertiveness of the members, especially the EL?

4. Are members expressing a more directly assertive ownership of the group, its direction and its management? Are they seeking your collaboration in this process?

5. Are new norms being worked out for the way group members will work together, including working with you?

Phase VII

1. Is the atmosphere serious and focused but one in which there is great sensitivity to individuals’ needs at the beginnings of sessions? Do group members negotiate about how the group time will be used?

2. Are individuals presenting their own problems fairly assertively and defining the way the group can be most helpful to them?

3. Are you experiencing less need to focus clients’ issues and observing more clarity on their part about what they need from you?

4. Are you feeling challenged by the multiplicity of core and/or primitive issues that are emerging in the group members’ work?

5. Is there a growing sense of dependability in member’s responses to each other?

6. Is there a growing excitement and eagerness to use group time for intensive work?

� Phase VIII

1. Has a group ending time been named? Is it related to organizational structure; to member(s) leaving or entering; to pre-planned termination?

2. Is there some resistance to addressing closure?

3. Do members find it useful and clarifying to review what they have accomplished, assess where they are now and plan how they will implement what they have learned?

4. Are members giving each other feedback on their observations about how they have changed, or worked on their change process?

5. Has each member taken a turn at the review and feedback process?

6. Has the atmosphere in the group lightened since the previous phase, as the disengagement process begins?

� Phase IX

1. Have individual members acknowledged the significance of others in the group to their own change process?

2. Have members given personal feedback on how they have perceived and experienced each other in the group?

3. Have you received feedback from the other members on your participation as therapist, fellow member and person in the group?

4. Has the group found a way to mark its ending meaningfully?

TIME LIMITED GROUP THERAPY

By definition, this kind of group defined by its time boundaries.James Mann— limits groups to 12 sessions the group brings to the forefront the human dilemma: a) How to be intimate and close, yet… b) Learn to deal with separation and eventual loss, in the most helpful way.

TIME LIMITED GROUPS & TERMINATION:Group termination issues powerfully stimulate issues of time.*Especially with those who feel “stuck,” the awareness of time and existential pressures elicits important work.

the very “clock ticking” is the needed impetus to “get down to work”.Countertransference and the “wish to extend” the group—

Validate negative thoughts but counterbalance with evidence of achieved goals.

— Distinguishing between Abandonment (no preparation, no “meeting” the loss) Vs. conscious, predicted Endingtrauma disrupts time:i.e. Premature deaths; Divorce; Early death of a child;Examples: Anger Management; Depression; Anxiety; Parenting skills.

SO MUCH OF OUR LIVES ARE ORGANIZED AROUND TIME BOUNDARIES Adolescence; The School Year; moving to new City/School system; college; Divorce; Biological time-clock (parenting); Retirement. Death & Dying process.

1) Make clear the time-limited nature of the group at the beginning.2) “Track” the mid-point (after 6 weeks).3) 12-weeks is optimal time for a successful time-limited group.4) Closed membership is optimal (vs. Open enrollment

membership.)

Termination: Systematic Go-roundEach member speaks to each of the other members**What’s been left unsaid (+ or -): unfinished business.Turning pointsDisappointmentsTake-aways: How to apply group learning afterwards.

CO-THERAPY: Selecting a Co-therapist is highly important process,and positive co-therapy team communication is crucial to the success of the group. A GROUP CANNOT PROGRESS IN ITS STAGES

BEYOND WHERE THE CO-THERAPY TEAM HAS PROGRESSED WITH ONE ANOTHER.Co-leading groups can be highly “exposing” and challenging, or a highly rewarding, connecting process. Many sides of our interpersonal and intra-personal “stuff” gets revealed, in real time, in front of the group. Therapists’ own “narcissistic needs or injuries” can and do emergeand need to be attended to.

Qualities That Therapist Desire in Co-therapists (adapted from a survey by Bill Roller & Vivian Nelson in The Art of Co-Therapy, pp 63-64): 1. The capacity to be equal in communicating and openness,

including comfort to ask questions of a partner to critique his or her attributes.

2. Willingness to agree or disagree outside the therapy session.3. Freedom to discuss theoretical and interpersonal issues toward

constructive management of differences.4. Willingness to share treatment objectives and develop common

goals.5. Qualities of being equal in power, noncompetitive and compatible.6. Similar/compatible theoretical orientations and values.

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A Therapist's Guide to Issues of Intimacyand Hostility Viewed as Group-Level

Phenomena

James M. Dugo, Ph.D.Ariadne P. Beck, M.A.

INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPYVolume 34, Number 1, 1984, 25-45.

James M. Dugo, Ph.D.2644 E. DempsterDes Plaines, IL. 60016

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Issues of Intimacy and hostility often raise the most difficult feelings for individuals tohandle and negotiate in human relationships. It is quite understandable, then, that these feelingsoften present difficulties in a group. Group members often evade expressing their feelings andoften evade constructive resolution of the problems, and leaders often have trouble knowingexactly how, when, and where to intervene to facilitate exploration and emotional resolution.

Issues relating to intimacy and hostility are usually interpreted as having intrapsychicorigins and often as being based in developmental problems in the early life of particular groupmembers. The focus of this paper, however, is on another systematic source for these issuesemerging in a group at a particular time and in turn causing problems for the members andleaders. This source is the evolution of group structure that proceeds in a systematic mannercharacterized by developmental phases. These phases in turn present the group with certaingroup-level problems that must be addresssed if the structure is to continue to evolve in anenabling manner. Typically, group members interpret these group-level issues as dyadic orpersonality issues and rarely see the group-level aspect of the phenomena. Therapists alsotend to be oriented in this way, generally having come to group therapy after working withindividuals and having had a much stronger training in theory related to individual processes thanin theory related to group processes.

The thesis of this paper is that a developmental framework for group processpresents the leader with some useful guidelines in relation to both intimacy and hostility. Thetopic will be developed within the context of Beck's nine-phase theory of group development(Beck, 1974; 1981a; 1981b), with special emphasis on the first, second, fourth, and fifth phasesin which issues of hostility and intimacy surface as group-level phenomena. Although it may notbe obvious that the structural development of a group is directly relevant to issues of intimacyand hostility, it is our belief that this relationship is powerful. We share the experience that a lackof awareness of a group's developmental process leads many leaders to misunderstand theimplications of the behavior manifested by group members. For example, some groups areunable to get beyond nonconstructive, competitive interactions that essentially cripple a group'spotential for effective work. If the leader does not undertand the group-level issues that arebeing worked out in what appear to be very personal conflicts, he will often respond in ways

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which maintain the conflict and therefore escalate the hostility, rather than resolve it. This oftenresults in crippling a group's potential for intimacy.

Beck's theory describes the nine phases in the development of group structure.Structure is defined as including the emerging leadership roles, the norms for functioning in thegroup, the limits and criteria for membership, the group level organizational issues, and thegroup-level identity. The group's structure emerges over time and is characterized by somepatterns of interaction that are consistent across groups. A group will evolve through all the ninephases provided that the membership remains stable, if the members are able to find solutionsto the group-level problems posed by each phase, and if the Task Leader does not preventtheir progress.

The phases of development differ in the group level issues that they are addressingas well as in the leaders who dominate the process of the phase. They are very similar,however, in a characteristic process of differentiation over group-level issues and integration ofthe members when their differences are bridged and the group-level issues are resolved. Eachphase poses a different set of group-level issues and is characterized by the emergence ofleaders who become essential in the group's dialectical processing of those issues (Beck andPeters, 1981; Peters and Beck, 1982).

The concept of leadership used here is one that applies to a number of persons in thegroup, not just to the therapist. A leader is defined as a person who has a great deal ofinfluence in determining the group's direction, timing, or content during its life, and usually in amanner that can be characterized as having a particular pattern or a style. In addition, theemergent leaders share the task of spokesman in the dialectical processing of group-levelissues. Four major leaderhsip roles have been identified as related to the development ofgroup structure. They are the Task Leader, the Emotional Leader, the Scapegoat Leader, andthe Defiant Leader. This concept is further elaborated as each phase of development isdisucessed in greater detail. The nine phases of development and their significance in thestructural development of the group have been diescussed in two other papers (Beck, 1974;1981a).

The four relevant phases in issues of intimacy and hostility are the first, second, fourth,and fifth. Brief descriptions of the third phase are also presented, in order to maintain a sense ofthe continuity of group process. The phases are viewed as contexts in which the individualmember has opportunities for bonding with others and differentiating the self both from others

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and intrapsychically. Several vantage points are presented in this description of each phase:first, from the vantage point of an observer looking at the process of the group as a whole in thedevelopmental framework; second, from the vantage point of an observer looking at the uniquecharacteristics of the persons in the group who take up the crucial functions of leading thedialectical process in each phase of group development; and third, from the subjectiveviewpoint of the Task Leader, who at times must rely on his own experiencing of and reactionsto the group, to determine the presence and meaning of the group-level phenomena at work.

PHASE I: MAKING A CONTRACT: THE AGREEMENTTO WORK ON BECOMING A FUNCTIONAL GROUP

The first phase of group development addresses basic issues of bonding between anew set of people or between an existing group and new members. The quality and style ofthis initial bond sets the stage for the developing relationships and for intimacy in later phases.

The first phase gives everyone a chance to size up the situation -- himself and theothers, including the therapist(s) -- and to decide whether or not he is prepared to participate in aprocess with this particular set of people. Some people decide they are not comfortableenough to stay. The finalization of membership is required before a group will move on to thenext phase.

Phase I has as its focus the creation of an initial contract to become a group, given thatit begins with a collection of individuals who are usually strangers to each other or who do notalready define themselves as a collectivity or a partial group to whom new members are beingintroduced. It also has as its task the intial clarification of both individual and group-level goals,and the identification of certain limits or expectations, thus beginning the norm-creation process.

As this phase nears its close, a strong impulse or pressure to exchange or sharesome emotionally meaningful content emerges in the group, as though there is a mutually feltneed to establish a bond in terms of experiences that are common to everyone there. The twomajor group level tasks of Phase I that are essential to the development of intimacy are (1) thateach member must successfully form at least one pair bonding with another member in thegroup, and (2) that the group as a whole must find an issue which allows a felt sense of sharing

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or commonness, thus forming a group-as-a-whole bond. At the close of this sharing themembers are ready to face the problems of organizing themselves into a functional group.

LEADERSHIP ROLES EMERGING IN PHASE I

The Task Leader is the initial important leadership role in Phase I. In a therapy groupthe members have usually come to get help from the professional input of a therapist. Often,the therapist has interviewed all the members prior to their entry to the group. The intitial andprimary bond, therefore, is usually between each member and the therapist(s). The inititalimportant task for the Task Leader is to convey his availability to each member.

We know that an important group level task for Phase I is for the members to assesseach other and their own abilities to work in the context of the particular composition of membersin the group. The Task Leader or therapist can facilitate or hinder this process by his awarenessor lack of awareness of what is necessary and by his basic willingness to allow members tobegin a process of bonding with each other. This leader uses his own bond with each memberto facilitate each person in his representation of self to the others. (The terms Task andEmotional Leaders are borrowed from Bales [1958].)

The Emotional Leader is very important to the group throughout the group's life. Inhis anlysis of this role in task-oriented groups, Bales (1958) identified the Emotional Leader as akind of manager of the Group's social-emotional life, helping to give expression to themembers' concerns and acting as an integrator of the Task Leader and the rest of the group.The emergence of the Emotional Leader during Phase I is a major structural event in a group.We know from our own research on therapy groups (Beck and Peters, 1981; Peters and Beck,1982) that everyone in a group likes the Emotional Leader, who tends to be the person in thegroup who is most ready to make use of what it offers. In a therapy group that means that theEmotional Leader is ready for a significant experience of personal growth, and is usually "turned-on" by the group process almost immediately. This person becomes an overseer of thebonding process in a group -- experiencing pain when another member feels that what he isgetting from the group is inadequate or when another member threatens to leave the group.The Emotional Leader plays a key role in the emergence of the felt sense of closeness and ofthe developing cohesion, partly by being the focus of positive feelings from all the members,

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which in itself pulls the group together, and partly by becoming the ongoing monitor of thequality of this aspect of group life.

During Phase I, The Task Leader's subjective experience is usually one of anxiety, oreven of apprehension regarding the group's formation. Therapists are usually aware that theirown behavior may either facilitate or hinder the process. From our viewpoint, therapists oftenrespond to this anxiety by either ignoring the important group-level issues or by trying to forcethem too quickly. Intermember bonding cannot be legislated, which means that the Task Leadermust be able to allow each member the space to make a choice freely and the group to chooseeach member freely.

In an exploratory study (Dugo, 1979), all the members of two therapy clinic outpatientgroups were asked to keep running journals of their reactions to the members of the groupduring the first four sessions of a new member's participation. Those who stayed were able tomake a "bridge" into the group during their first four sessions by identifying at least one otherperson in the group who they perceived as having similar problems or a similar life situation.They expressed a feeling of being able to connect to that person(s). Members who droppedout perceived the group as "alien" in some sense and did not identify any one person as havingsimilar issues to their own. There are times, therefore, when a new member or a whole groupmay not stay in therapy because the therapist does not recognize the importance of this initialtask of relationship buildng -- finding a common bond. This experience can be facilitated byfocusing on the issues explicitly if the group itself does not do so spontaneously.

In general, when the therapist is able to recognize the important group-level issues ofthis phase -- client self-representation, pair bonding, and group-as-a-whole bonding -- andfacilitates the group's work on them, a high level of resolution is achieved and energy generatedfor the members' participation in the next phase of group development.

PHASE II: ESTABLISHIMENT OF A GROUP IDENTITYAND DIRECTION

Phase II is the best known and least loved of all group phases. It is characterized bytension and ambiguity which often, though not always, lead to open hostility. Since thishappens so early in the group's experience together, it can be quite threatening or frightening to

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some members, and certainly requires a high level of energy from all members to process theissues.

The critical issues of Phase II are the basic and formal organizational issues. If a groupis to settle down to work, it must first arrive at a method or way of working together. In structuralterms, this means moving from the tentative commitment and identification of Phase I to a moreserious decision-making process regarding the purpose of the group, its norms and leadership,and most importantly, the management of competitive and even angry impulses.

Phase II involves the second major step in the bonding process. Having made acommitment to join together in an enterprise, the group members must now face the question ofwhether there will be sufficient space in the new set of relationships for their differences to existcomfortably and whether it is possible to offer mutual respect, given those differences.

There is a natural anxiety at this point in the group's process, and one way in which thisanxiety is expressed is that each member tends to push for the kind of order that will make himthe most comfortable. As a result, the predominant style of interaction is competitive duringPhase II. At this early phase in relationship building, there is an almost seductive and irresistibleurge to perceive the situation as a power struggle in which the risk to the individual is that hisneeds will not be met unless he is a winner. The competition tends to become focused ratherquickly into a distresss with one member in particular who is scapegoated by the rest of thegroup. In focusing their energies this way, the rest of the group members draw together. Theyhave established a kind of identity, not in knowing who they are as a group, but in agreeing thatone member does not fit in. This can be thought of as a group defense mechanism that isgenerated because of the anxiety level and the difficulty of the task facing the group.

In Phase I we described the initial step in building a relationship, i.e., the need to find abasis of commonality, sharing, or attraction. Phase II represents the second step in this process-- i.e., the need to create space for differences. If a basis is to be found for cooperative workrelationships in the next phase of group development, then the crucial issue of Phase II is theresolution of conflict and the clarification of the fact that competition as a group-level interactionalstyle is dysfunctional. In order to accomplish this, a group must experience the resolution ofconflict in the group from which a model is then drawn for future use.

LEADERSHIP ROLES IN PHASE IIScapegoat Leader

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As is already clear, Phase II is a period of some crisis for the Scapegoat Leader in thegroup, and therefore the time when this leader becomes quite clear to everyone else.Unfortunately, they are primarily aware of one aspect of his behavior at this time, and thatappears quite negative and defensive. In fact, it is very difficult to avoid being defensive. Thegroup exerts a powerful negative pressure on this individual, often conveying a good deal ofrejection. The group projects assumptions and images on this individual that are exaggerationsand often are even untrue. In the face of this experience, the Scapegoat Leader behavesdefensively and awkwardly, often becoming quite insensitive to subtle nonverbalcommunication in the group. He seems to be unable to tune in to it, or perhaps he tunes in to itbut does not agree with it. Despite the fact that he is not communicating accurately with thegroup, the Scapegoat Leader usually asserts himself, trying to exert leadership and influence onthe group's process and, more importantly, on the emerging norms and goals. Alternatively, hemay withdraw in a resentful silence, exerting pressure indirectly.

The Scapegoat Leader is generally more self-disclosing than the other groupmembers at this phase of group life, and usually more spontaneous in expressing hisobservations of others, especially those aspects that may be obvious to others but are beingdenied by them. In this way he is clearly modeling and mirroring the conflict in relationshipbuilding between self-assertion and conformity -- a struggle that peaks in Phase II for everyonein the group.

Probably the most critical issue in the relationship between the Scapegoat Leader andthe rest of the group is whether the conflict is allowed to deteriorate into a mutual stereotypingprocess, which then escalates the conflict and the distance between people. If this stereotypicinteraction is allowed to continue, a dysfunctional model of bonding becomes reinforced. In thismodel the belief is maintained that differences between persons can only be managed by theuse of power. This power is used to change the other person by any means available and isusually coercive. It is important in this conflict for the group members to experience constructiveforms of conflict resolution that lead to a deeper understanding of both the self and the otherperson, which, in turn, facilitates intimacy and closeness. Most clients have experienced difficultyin navigating this juncture in intimate relationships in their lives, making this one of the mostimportant learning experiences that group therapy can offer.Emotional Leader

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The Emotional Leader plays an important role in Phase II as the articulaterepresentative of a contrasting viewpoint to that of the Scapegoat Leader's. In an optimalgroup, both the Emotional Leader and the Scapegoat Leader work for the good of the group,even while competing about some critical normative and goal issues. The Emotional Leaderplays an important role in the acceptance and integration of the Scapegoat Leader into thegroup, during and after the conflict. In groups that we have observed, the Emotional Leader hasnever led the attack on a Scapegoat Leader. It is always someone else who does that.Therefore the Emotional Leader is free to enter the dialogue in a focused but much lessnegative way.

In forging a solution to the group-level issues of Phase II, the Emotional Leader andthe Scapegoat Leader begin to form an important bond. The quality and depth of that bond inmany ways model the peer group which will form and emerge in later stages of the group's life.Although they appear at the beginning to be very different from each other, these two leadersgo on to form a strong positive relationship. In a successful group, they model the relationshipthat builds trust in the face of differences.

The Task Leader is usually the only person who can intervene in the conflict unlessthere are members present who are experienced and highly constructive in handling thisproblem. Task Leaders have been known to join in the attack out of the belief that the group willcome together this way -- that if the Scapegoat Leader should leave, there would be lessconflict in the group. This belief represents a basic misunderstanding of the structural need for aScapegoat Leader in the group, and of the fact that if the first Scapegoat Leader left, he wouldbe replaced by another. Instead of participating in this attack, the Task Leader must help thegroup to understand its own behavior and, more importantly, its underlying anxieties. Just asimportant is the expresssion of support by the Task Leader to the Scapegoat Leader. Ifnecessary, the Task Leader must process his own negative feelings toward the ScapegoatLeader, because if he is unable to express support to this person, the chances are greatlyincreased that the Scapegoat Leader will drop out of the group.

The therapist's subjective experience of Phase II is often determined by his reactionto, and understanding of, the overt and covert levels of conflict, hostility, and scapegoating in thegroup. Overt levels of hostility are seen in the direct expression of anger, blaming, and dislikeof one group member by another or others. Covert hostility is experessed in an indirect,subtle, but equally powerful way. The same feelings are communicated nonverbally.

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The Task Leader inherently knows that a high level of hostility in the group could leadto its fragmentation. It seems obvious to him that people will not continue to come to a groupwhich feels unsafe and unproductive, unless the group members see some hope of resolutionof conflicts. This fear that the group could fail evokes powerful feelings for the therapist, who willoften feel that his self-esteem and competence are on the line. He feels responsible forbringing about some resolution of the conflict, but may feel helpless and unsure of what he is todo. Fearing that the group will fail -- and therefore that he will fail as well -- the Task Leader mayjoin in the scapegoating conspiracy (as forementioned), believing that if the Scapegoat Leaderleaves, the group will come together and the conflict will be over; or he may seek an equallydestructive but seemingly more caring solution by trying to change the Scapegoat Leader sothat he "fits into" the group better. The Task Leader must first understand that fragmentation isindeed a real possiblitiy, but that the overt and covert hostility and conflict are not simplypersonal issues between some of the members and the Scapegoat Leader caused by thepersonality of the Scapegoat Leader -- an issue which can be improved by magically alteringthat personality.

The Task Leader's first task is to help the group to identify the conflict and hostility ifthey are on a covert level. He must be willing to open up the "can of worms" before the subtledestructive forces quietly consume the group. If the hostility has escalated into overt destructiveblaming and projecting, the Task Leader must intervene, because group members arefrightened if their hostility gets out of control, and they will soon drop out rather than feel that theyhave severely harmed someone or that they themselves will be harmed. The Task Leadermust take on the role of referee, labeling foul play, uncovering the underlying issues that causethe anxiety, and helping members to establish more constructive communication patterns. Hisrole is crucial at this stage, but he cannot bring about the change alone. His competency is onthe line. So that he can be free to ask other members to take responsiblity for bringing about alistening, cooperative atmosphere, the Task Leader must have a realistic picture of his limits. Itmust be clear to this leader that the resolution of the conflict can come about only by themembers themselves reaching agreement on basic norms and goals. The group therapistmust, then, referee the destructive communication, elicit the client's efforts in changing thisdestructiveness, lend support to each side, not buy the scapegoating conspiracy, turn blamingin self-relfecting, and help to shape the norms necessary to establish effective listening andcooperation.

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PHASE III: THE EXPLORATION OF INDIVIDUALS IN THE GROUP

Since the intent of this article is to deal with hostility and intimacy in group levelprocess, Phase III will not be developed at any length here. Phase III is the first real workphase, and it becomes possible only when the competitive issues of Phase II are resolved. Inthis intensive work phase, each member has an opportunity to express and reveal himself andto get some feedback from both the group members and the therapist. A great deal of work oncommunication usually takes place in Phase III. The members become distinct from each otherand more clearly visible, building on the creation of space that was achieved in Phase II. Theytest out the potential for collaborative work during Phase III, joining together in variouscombinations to confront each member's problems and to draw on the variety of skills andexperiences brought by all the members. It is in this phase that members first discover thatthey can work as productively on their issues in the group context as they can in indivdualtherapy -- or even more productively. An important aspect of group level process in Phase IIIis the establishment of equality among members. This is the foundation for a bond amongpeers that in later phases will mature into a mutuality and interdependidence.

Phase III is a time when the Emotional Leader particularly is doing a great deal of workon his own issues, when his changes become visible both in the group and in otherrelationships in his life. He is already gaining a great deal from the group's support and from hisspecial relationship to the Task Leader. In this phase, the Defiant Leader begins to take a moresignificant role in the group, to some extent mirroring the therapist's behavior in relation to fellowgroup members. The Task Leader serves a very important function in Phase III. Not only doeshe perform as the primary therapist, often sounding much as he does in individual therapy, buthe also controls, that is, limits or facilitates, the growing therapistlike role of the other groupmembers.

Phase III ends with a reflective exchange among the members, in which they drawupon their new knowledge of each other and find some new basis for commonality or similaritythat solidifies the growing intimacy now based upon a deeper understanding of each other.

Although we are not dealing intensively with Phase III in this paper, it is important tonote that this is usually the longest phase of long-term groups and that in groups of clients whoare at very low levels of personality development, this phase may go on indefinitely.

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PHASE IV: THE ACKNOWLEDGEMENT OF INTIMACY

The more realistic base for cohesion in Phase III seems to free people to initiate thenext critical step in the intimacy bond. This phase of the group's communication focusesexplicitly on questions of closeness, sexuality, and intimacy. These are usually the most touchytopics for the members to deal with openly. Perhaps for this reason the fact that they can comeup and be dealt with reasonably has several important consequences Those members whofeel that their biggest problems are in this area are now freed to participate more fully in thegroup. Because these subjects are also important for everyone else, it is very meaningful to allmembers that there is a possiblity of communicating openly about them. A significant aspect ofthis phase is the expression of closeness or caring or attraction to the Task Leader in the group.In some groups this comes up very naturally and comfortably. In other groups it is a difficultpoint in the process to traverse and may first necessitate confronting or challenging the authorityof that leader. This latter event seems to be a function of the degree of distance maintained bythe Task Leader in relation to the group members, the degree of distance expressed betweencoleaders emotionally, the degree to which the Task Leader relates as an authority (professionalor otherwise), or the degree to which the Task Leader's leadership style tends towardauthoritatrian characteristics. The greater the degree of any or all of these characteristics in thegroup, the greater is the necessity to challenge the leader before it is posible to "embrace" himemotionally. Even a nonauthoritarian leader who was insensitive to the timing for relinquishingcontrol in the group would draw a confrontation at this time. Once all these initial factors of PhaseIV group-level issues are addressed, the result is a noticeable reduction of tension in the groupand an impulse to move toward each other more positively. This impulse raises a generalproblem for the group members. How will they relate to each other in terms of intimacy? Whatabout the sexual dimension of relationships within the group? Can tenderness be a part of theexperience within the group? The wave of good feeling usually carries the group rather quicklythrough an exchange of positive feelings via words and gestures that clearly acknowledgewarmth and attraction between the members, and also between the group and the therapists.This is a critical experience in the life of a group. Intimacy naturally follows when individuals havesuccessfully completed a struggle and established a cooperative relationship. At this point inthe bonding process, people need to validate with one another the importance of their

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cooperation. The recognition of these crucial aspects of what each person offers, and what eachmeans to the others, comes at precious moments for group members.

Often group members have rarely experienced these moments elsewhere. Manygroup members have seldom had close interpersonal relationships that have moved out of aPhase II competitive mode and, as a result, have found themselves generally moving awayfrom relationships in self-protection. It seems that many clients report -- and sometimesunconsciously foster -- a competitiveness in their relationships with their parents and peers,which simply continues to undermine their sense of self-esteem.

For some individuals Phases III and IV in the group become the first time they haveexperienced that being vulnerable can lead to constructive growth. Further, group memberswho have previously experienced constructive, cooperative working relationships may havehad impasses in relationships in which sexual feelings become confused with needs forcloseness and support.

Phase IV allows group members to identify and experience the obstacles in theirdevelopment that have prevented closeness and tenderness from becoming integrated intotheir personal relationships. It creates the opportunity to experience the value of openlyacknowledging their positive feelings for others and to explore the viable limits of therelationships in the group.

LEADERSHIP ROLES IN PHASE IV

Emotional LeaderBy Phase IV the general liking of the Emotional Leader by other members and the

therapists is solidified and expressed more openly. The Emotional Leader is modeling theconflict that all group members feel between the wish to form deep bonds with others and thewish to deny the need for deep bonds with others. During Phase III the Emotional Leaderentered a significant and usually dramatic growth spurt. Now, In IV, the Emotional Leaderseems to be asking for some recognition or acknowledgment of the special bond betweenhimself and the Task Leader. In doing so, the Emotional Leader is creating the opportunity forthe Task Leader to enter into a more deeply human relationship, not only with himself but

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eventually with the rest of the group as well. The Task and Emotional Leaders model theexpression of caring and affection for the group as a whole.Scapegoat Leader

The Scapeboat Leader also participates in some significant way in the Phase IVprocess and is often the person who can openly acknowledge caring or attraction for the TaskLeader during this time.Task Leader

Phase IV is a challenge for the Task Leader because it signifies a membership that ison its way to ownership of its own process and responsibility for its own issues -- a process thatcomes to fruition in Phase VI. An important part of this leader's role in this phase, then, has to dowith his openness to allowing or facilitating this development. The traditional individually orientedtherapist can comfortably keep a group in Phase III for a very long period of time. Phase IIImaintains a clear dependency of clients on therapists and often deals with parent/childrelationship issues. The Task Leader models the conflict for the group as a whole betweenexercising control in the group -- that is, taking and using his own power in the group -- andreleasing control -- that is, giving to or sharing power with the other group members. Eachphase offers opportunities for some aspect of this conflict to be expressed. Phase IV is thefirst of three phases in which the Task Leader is on the line and being watched closely regardingthese issues. If the Task Leader's behavior changes appropriately in Phase IV, the membersof the group begin to perceive him as a complex person, not only the authority figure, expert,healer, or manager on whom they are dependent.

It is sometimes difficult for a therapist to respond constructively to the challenge fromthe Emotional Leader, or to understand this leader's significance for the group. Therapists oftenfeel that they should experience and express the same feelings of specialness for each client ina group, and most particularly that they should never show "favoritism." Although there is somemerit to this viewpoint, it is important to recognize that at this point in the group's life a responseto the Emotional Leader would not only be appropriate, but would also facilitate the group as awhole. Group members seem to understand this quite well. Further, issues of rivalry orjealousy can be dealt with appropriately and openly at this time. Some therapists who havedifficulty with this phase fear the closeness or tenderness that they feel toward their EmotionalLeaders, while others simply have trouble sharing power, or they enjoy the kind of powerwhere they are seen as healers who are in control.

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At the other end of the spectrum of responses, it is possible for the Task Leader tooverreach. Leaders who use group experiences as a place to meet their own needs forcloseness will tend to flood their Emotional Leader with a deluge of feeling. Too much self-disclosure inhibits intimacy just as much as too much withholding. Too much self-disclosure fromthe therapist can erode the therapeutic contract of the group. Being a loving therapist involvesneither withdrawal from what feels special between himself and a client, nor the exploitation ofthat bond.

One of the barriers for the Task Leader at this point may be the sexual vibrations hesenses between members or between himself and the Emotional Leader. The Task Leadermay fear the potential of members to act out these impulses, which may be an issue with certainclients. To resolve this, the Task Leader must be clear within himself that sexual feelings canmark the beginning of members becoming closer, more emotionally intimate.

What is really happening on a group level at this period of development is that theEmotional Leader and the Task Leader are modeling the recognition of mutual, special feelings.They point to the importance of closeness and tenderness ( as opposed to sexuality) and tothe increased energy that this kind of relationship can produce. Rather than other membersfeeling destructive resentment in reponse to this, they begin to feel free to recognize andexpress their own special feeling toward one another. Rather than destroying the therapeuticcontract of the group, the exchange of close feelings between members creates energy andcommitment for deeper individual exploration and growth in later phases. Also, rather than losehis role as therapist, the Task Leader opens the door for other members to take a more activeleadership and therapeutic role in the group.

PHASE V: THE EXPLORATION OF MUTUALITY

Phase V is characterized by feelings of vulnerability. The open expression of liking inPhase IV implies a mutual commitment to create a deeper relationship. The natural next step inthe bonding process entails the question of how dependency needs will be handled in thecontext of that relationship and how frustration and hostility will be handled when needs areeither not met or are not understood. The natural direction to resolving these issues is the

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development of relationships based on equality and mutuality and the acceptance ofresonsibility toward one another. Of necessity, this implies a reduction of the dependency onthe Task Leader and the movement toward greater autonomy both individually and as a group.It also implies a recognition of personal limitations in oneself and in others, and the fact that noone, including the therapist, is going to meet all of anyone's needs.

As Phase V begins, members share anxiety regarding their vulnerability, and there isstrong pressure on everyone in the group to demonstrate his goodwill. The pressure tends toproduce defensiveness. This may be an intense phase for many groups. Group membershave experienced a sense of closeness and worth in Phase IV. Now in Phase V they aretesting the limits of each other's caring and the struggle that the establishment of mutualitynecessitates. The group must find a way to cope with the inevitable bonding issues regardingdependency and frustration in a way that establishes some reasonable expectations for all.

In this second phase of group-level tension that generates hostility, the possibilitiesexist for group members to experience and observe a number of aspects of relationshipbuilding which are crucial. Among these are (1) crisis situations often occur when the fulfillment ofdependency needs is threatened in some basic way (in this case, the Defiant Leader's need tomaintain dependency on the Task Leader); (2) individuals have difficulty in being articulate aboutbasic dependency needs (in this case, both the Defiant Leader and other members); (3)frustration and hostility are generated in situations in which you care about someone but areunable to help him to reduce his tension or fear (the Defiant Leader is usually very difficult tohelp at this time); (4) differentiation among needs that can and cannot be met, and among theabilities or limitations of others to meet any particular needs that one has; and (5) learning how towork out a mutuality or a balance in the caring process, and that caring does not mean theexchange of identical things but rather the exchange of concerns for what each one really needs ,wants, can use, or is able to enjoy.

The nature of the vulnerability that is experienced at this time creates a great problem,almost a trap, for anyone -- usually the Defiant Leader -- who may be experiencing deep fear,hostility, or ambivalence about participating in such mutuality in the group. As stated earlier inthe discussion on Phase II, the heart of destructive hostility is the demand that the other personchange in behalf of oneself. In Phase II the demand is made by the group on the ScapegoatLeader regarding his style of communication and his appropriateness for the group. In Phase V

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the demand is expressed by the Defiant Leader toward the group regarding trusting the peerbond and movement toward a more autonomous relationship to the Task Leader.

LEADERSHIP ROLES EMERGING IN PHASE V

Defiant LeaderThe person who fulfills this role is often in a period of psychological and social

alienation outside of the group. Often he has no particular community group, family, or set offriends outside the therapy group to whom he feels deeply related and from whom he feels astrong, meaningful support. This situation places the Defiant Leader in a position where thechildhood experience is reactivated in which he feels dependent on the family (in this case thegroup), while feeling threatened by the group's demands to grow up. The Defiant Leaderpresents the group with a stressful set of responses in this phase -- conveying an inability (orunwillingness) to participate in a mutual relationship with peers, as well as an inability to cut loosefrom the Task Leader's authority. In fact, this leader models the bonding conflict for the group asa whole between dependence and independence, between the ability to trust others and theability to take care of self.

As a group level, the Defiant Leader is mirroring the need of each member in thegroup to have a special contract for his indivdiual needs, and in this way, he provides a model ofthe asynchronous aspect of growth in close relationships. In particular, this critical event surfacesthe fantasies that can be generated in intimacy relationship regarding the other person's abilitiesto meet one's needs, and surfaces the fear and hostility that is generated when those fantasiesare frustrated. The lesson to be learned here is that flexibility and understanding are needed tobridge the gap that is created -- otherwise the bond will deteriorate. As the group and the TaskLeader come to accept the real meaning of the Defiant Leader's stance, the hostility subsides.There is something quite rewarding for the group members in coming to appreciate the real painand helplessness of the Defiant Leader and the limits of their own power and that of the TaskLeader to change him on their own time schedule. It is a "humaninzing" experience.The Task Leader

The Task Leader usually struggles a good deal during Phase V. The complexity ofthe Defiant Leader's messages to the group, but in particular to the Task Leader, creates a greatdeal of stress.

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The interventions of the Task Leader require his willingness to accept the DefiantLeader's need to scream, yell, kick, and undermine without punishing him. The therapist needsto accept the limits of his and the group's power to change someone who isn't ready and tohelp the group to accept the same. In a way the Task Leader helps the group membersunderstand that in negotiations for mutuality everyone asks for some special clause in thecontract because of his own particular vulnerability, dependence, and need for space.

Phase V sorely tests the Task Leader's impulse to control just at the moment beforehe needs to let go of the management reins. It is this aspect of the problem that most oftenstumps the Task Leader. Success in Phase V is difficult for all the parties involved, and in ourobservation is not often achieved.

Subjectively the Task Leader begins to feel either subtly or overtly attacked by theDefiant Leader, who will often complain, either that he is not getting any better or that he doesnot need the group anymore (despite the fact that he appears to be in more of a crisis or ingreater need than any other member). When the Task Leader tries to help him, in spite of thisthe Defiant Leader resists. He seems to cry out for the Task Leaders's help, yet resists anytherapeutic nurturance. It is easy for the Task Leader to feel either uncaring or impotent as atherapist in response to this dilemma. The major poblem for the therapist in dealing with theDefiant Leader is that the Defiant Leader is neither aware of these issues or his needs, nor is heresponsive to requests that he reflect upon himself and get in touch with his issues. It is notdifficult, therefore, to see why it is only a minority of groups that succeed in finding a solution tothis dilemma and succeed in keeping their Defiant Leaders. The net result of this is that the TaskLeader often has to face the experience of failure just as his group is moving to greater andmore visible maturity.

The true solution to Phase V requires helping the Defiant Leader to become morearticulate about his needs and accepting the Defiant Leader while he moves toward greaterclarity, reflecting on the norms of the group which are causing the bind, being willing to modifythe norms in an appropriate way, and having the Task Leader become open to his ownlimitations as a model for the entire group to explore their own limitations.

In the process of coping with the crisis of Phase V the group explores and clarifies itslimits for dealing with dependency. The possibility of expressing hostility and having that dealtwith without rejection is also demonstrated in those groups that successfully cope with thisphase. The resolution of these problems establishes a dominant norm of equality among

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peers and a new sense of cohesion develops. The special contract with one person will beseen in the next phase to be the model for all relationships in the group, in the sense that eachperson is unique and the group's needs change from meeting to meeting. Expectations mustbe flexible.

The achievement of mutuality, at least to a minimal degree, becomes the basis for areorganization of the group's structure. If the group does not settle the issue of mutuality in oneway or another, it can prevent this reorganization from taking place at all.

This paper has described the four phases of group development during which thephase specific group-level issues focus on hostility and intimacy in the group as a whole. Theimportant leadership roles that emerge during these phases have also been described, and theTask Leader's functions and experiences in particular have been elaborated, in order to help thetherapist to reflect upon and use his own experiences more effectively.

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REFERENCES

Bales, R. F. (1958), Task roles and social roles in problem-solving groups.In: Readings in Social Psychology, eds. E. E. Maccoby, T. M. Newcomb,and L. Hadley, New York: Holt, Rinehart and Winston, pp. 437-447.

Beck, A. P. (1974), Phases in the development of structure in therapy and encounter groups. In: Innovations in Client-Centered Therapy, eds. D. Wexler andL. N. Rice, New York: Wiley Interscience.

Beck, A. P. (1981a), Developmental characteristics of the system forming process.In: Living Groups: Group Psychotherapy and General System Theory, ed.J. Durikin. New York: Brunner/Mazel.

Beck, A. P. (1981b), The study of group phase development and emergentleadership. Group, Winter 5 (4): 48-54.

Beck, A. P. and Peters, L. N. (1981), The research evidence for distributed leadership in therapy groups. This Journal, 31 (1): 43-71.

Dugo, J. M. (1979), Exploratory study of dropo-outs from group psychotherapy. Unpublished.

Peters, L. N., and Beck, A. P. (1982), Identifying emergent leaders inpsychotherapy groups. Group, Spring, 6 (1): 35-40.