Voice Of Experience: A Consultation Forum

Dear Voice of Experience,

My question relates to the presence of “secrets” in group. Pacing is important in therapy, and as therapists, we know that some details of our clients lives will remain hidden until safety has been established. We have this in mind as our work with them progresses, and we work to make room for these “secrets” over time. Similarly, clients often keep hidden from group some information that they have shared with us individually, especially those details that are likely to engender judgment. I wonder about how best to facilitate the evolution toward disclosure in the group process while attending to the needs of both the group as a whole and each individual member. With identifying details altered, I will provide an example of one case in which this question has arisen for me.

I lead a mixed gender process group comprised of five members, four of whom I also work with or have worked with individually. The group has been running for three years with some variations in membership. Amy, a longstanding member, is actively involved in an adulterous affair without her wife’s knowledge. In our individual work, she has only recently made this known to me, and she is working toward understanding and changing her behavior. She has not shared this information with the group, and currently does not wish to do so. Amy has a strong and confident presentation that belies a vulnerable and self-attacking part of herself.

Among the five other group members is Sarah, who joined the group 4 months ago. Sarah endured the traumatic dissolution of a marriage that included her husband cheating on her. She remains tender and angry about this experience in her recent past and often explores these feelings in group. Another group member, James, experienced the divorce of his parents when he was a young child, also the result of an infidelity; this aspect of his history is well-known to the group, and he is only just beginning to experience pain and anger about this part of his life.

What can I do to help the group talk about their feelings when they don’t understand what is being kept secret?

I feel that there is great potential for Amy and for the group to benefit and grow from the sharing of her secret, but I also fear that it could be destructive to the group process and dangerous for Amy depending on how the revelation is handled. I fear she may be attacked in a way that might lead her to leave the group or that relationships between her and other group members will be severely damaged.

I wonder whether the group senses the secret, and how I might know when questions about what Amy is holding back are bubbling up under the surface. What can I do to help the group talk about their feelings when they don’t understand what is being kept secret? How will I determine when or whether the group is ready for Amy to share? What advice do you have for me about how to facilitate this sharing in terms of timing, supporting Amy, and supporting the other group members? If I decide that the secret is becoming treatment-destructive and Amy is still unwilling to bring it in, how strongly should I push her to do so? Do you have any advice for me as I work to contain my own feelings of impatience during the process? Can the group be helpful with this holding?

Gratefully,

Holding Pattern in Austin  

 

Dear Holding Pattern in Austin,

What a wonderful topic — secrets! There are always secrets in therapy, regardless of the modality of individual, couples or group therapy. If everything were said, the treatment would be completed.

A few things jumped out at me as I read your inquiry. First, secrets are stimulating for therapists. Second, there seems to be an idea that you have to do something to make the secret come out and be worked with. Third, some of the language used makes me think of countertransference concerns.

The first two ideas are linked; the stimulating nature of secrets leads to an urge to take action. As therapists, we often want things out in the open and can be impatient for the process to get moving. Our own therapeutic zeal (or other countertransference concerns) can influence our approach to a myriad of topics, including secrets. We might be uncomfortable or anxious knowing something the rest of the group does not know. Or we might be influenced by our own or the group’s history regarding the secret. We have to tolerate and metabolize many different, difficult feelings. The majority of the time we need not do anything more than serve as the container for the split-off and often intolerable affect (projective identification), impulses and fantasies of group members. This might be the most challenging aspect of our job — to sit still in the midst of an internal maelstrom while metabolizing the affect of an entire room.

Your group situation seems to have an incredible mix of inductions and personal experiences charged around the idea of an extramarital relationship. The use of the words “adulterous” and “cheating” alerted me to possible countertransference concerns specific to the secret. We are constantly analyzing ourselves as therapists, tracking and sifting through subjective and objective countertransference. Objective

There are always secrets in therapy…If everything were said, the treatment would be completed.

countertransference has to do with all the feelings the therapist has towards a client that any reasonable person might have. The client (or group) elicits these feelings and thoughts. Subjective countertransference refers to the more idiosyncratic responses a specific therapist might have. These reactions might relate to past experiences, unresolved emotional conflict, or any other personal detail that is stimulated by the issue being worked in the room. We generally allocate the majority of the countertransference to the objective category, but that does not eliminate the need to understand the subjective components.

I’d also like to address your questions directly. The group likely does know on an unconscious level that something has occurred at least resembling an affair. I am often impressed at the accuracy of shared yet unspoken knowledge in my groups. I would encourage you to do the same thing you always do to help the group talk about their feelings — identify and work through resistances while respecting each individual’s process. The process may be lengthy, as it would be with other inaccessible material. It is not up to you to determine when or whether the group is ready for Amy to share. It is your work to stay present and open to what they tell you (verbally and non-verbally) so that you can follow the threads of resistance and understand the many forms it takes. There is a danger that Amy could be scapegoated once the secret is out. You will have to let the process unfold, but also draw the aggression towards yourself so that Amy has enough space to safely have her own experience without being murdered by the group. It is likely that when it comes out there will be ripples of reactions and feelings, but these reactions do not need to be treatment-destructive.

Regarding your process, I can only share what I’ve learned from my own process. I’ve been in my own treatment and consultation for the full time I’ve been practicing. It does not matter what level of clinician any of us is, there will always be more material to work with, whether from our own lives or from our work. The work in a consultation or training group is especially rich as the group can reveal further layers of a situation through parallel process.

I have learned to take my countertransference reactions to my own consultation and to therapy. While we like to think that countertransference is either subjective or objective, with emphasis on objective, the truth is murkier. Generally, objective countertransference can be more cleanly identified, but there is often a tinge of subjective. And subjective countertransference nearly always has a few kernels of objective. This is why I devote myself to my own process. I create space to feel, understand and talk about all of my countertransference experiences. Then, later, after I’ve done my work, I can bring it back to the group in tiny spoonfuls, just enough to stimulate their process without shocking the circuits. They are then able to work through their split-off feelings, integrating disowned affect with the conscious experience in and of the group.

Jeanne Bunker

Jeanne Bunker, LCSW, CGP is a psychotherapist in private practice in Austin TX, where she does clinical work and supervision. She leads therapy as well as training groups. She has mastered the art of group co-leadership and has mentored many younger colleagues. Her interest in international group issues has taken her to Russia and Romania as a teacher of group. She is experienced in the art of Pet-Assisted Therapy utilizing her dogs. Jeanne is a graduate of the Center for Group Studies in New York.

 

Dear Holding Pattern,

I think your question is largely about holding, but maybe in a different aspect of the word than in your title.  A “holding pattern” implies a kind of non-productive waiting, perhaps one filled with impatience, boredom, and a frustrated desire to land somewhere you want to be.

The way I see it, Sarah is holding a secret; you are holding Sarah and her secret while holding the group as whole. You are also holding your own fear about what might happen next as well as some very strong countertransference.

I don’t see this as a holding pattern—this is the work! You have landed and are  working very hard right now. Good for you for seeking consultation in this very stimulating group dilemma. I’ll do my best to answer some of your questions.

On safety and fear of destruction

A steady ability to hold group members in an accepting and non-judgmental way creates a space for disclosures, such as Amy’s, that might involve feeling shame. It seems you have established a sense of safety in the group, as members are talking about tender and painful subjects. In this instance, Amy and the group must also have confidence in your ability to protect a vulnerable member against attack.  If you are doubting your ability to provide protection and insulation for Amy in this group, it’s important to understand the source of your concern. Is this a group dynamic that needs to be explored, a leader issue, or are you feeling Amy’s fear?

On the group sensing the secret

As an attuned group leader, you will notice clues if the group is feeling discomfort related to a secret. If the process seems stalled, if the topic of secrets is raised, if you notice aggression toward Amy, or if people report feeling “spacey” or “confused”, you might become curious about whether the secret has permeated the group process. You might ask if other group members are having similar feelings and if anyone has an idea about what might be happening in the room.

And the rest of your questions

Amy’s secret is occupying a great deal of your attention and causing you a lot of worry. We don’t know yet if it’s a problem for the group, nor can we predict when Amy or the group will be ready for this disclosure.

I don’t see this as a holding pattern—this is the work!

I hope you will explore the feelings behind your urge to “push her” and your “impatience.” Are you angry with her for causing this problem for you or afraid she will damage your group? Is Amy angry with herself and inducing aggression in you? Do you have an experience in your past in which you were hurt by infidelity?

Your job is to be fully present with Amy and the group as this unfolds, not to force anything to happen. You will help Amy and the group resolve their resistances to having this information brought into group by being curious, holding the space for all of their feelings, and providing a sense of safety. In individual sessions with Amy, you might begin to explore her history with secrets and what dynamics she might be recreating by withholding her secret from the group.

As to your question of whether the group can help with the holding, that can’t happen until the process becomes conscious in the group. I hope you have a consultation or peer group who can help hold you in the meantime as you explore your rich countertransference. In that way you can learn much about yourself, Amy, and your group.  

Thank you for sharing your excellent questions!

Sincere best wishes,

Tammy Brown, LCSW, CGP

Tammy Brown is a psychotherapist in private practice in Austin with over 20 years of experience leading a variety of therapy groups. She offers process, consultation, and supervision groups and works with individuals and couples. She has presented workshops on group psychotherapy locally and nationally and served as AGPS president. Tammy enjoys incorporating creativity and nature into her work and will be presenting an Eco-Art Therapy workshop in October 2017.

 

Dear Holding Pattern,

Even though dealing with secrets is part of our job, keeping secrets can be very difficult on everyone involved – including the therapist. When treating only individual clients, secret keeping is part of our daily routine and we are careful to keep client information confidential. But you are challenged with Amy because you are in possession of a secret that she does not wish the group to know right now. So your question is how to help Amy, your group, and yourself deal with this difficult problem. I have a few ideas.

Given your orientation that secrets should be shared in individual therapy first and eventually in group, you will need to prepare Amy and the group for this disclosure. Over time, I would suggest working with Amy in her individual sessions to help her understand why it might be helpful for her to bring this secret into group and gradually work with her resistance to talking about the affair. Since she has recently disclosed this secret to you in individual, this may take weeks and probably many months before she is ready to talk about it in group. Given that she may want to disclose this affair to her wife at some point, she could probably use the practice in group. You’ll also want to prepare the group. You said that you are worried about group members attacking Amy if she discloses this affair, and I would take that fear seriously. At only three years old, your group is young, and one of the tasks as a leader of a newer group is to teach our group members not to attack each other but to put those impulses into words. This usually takes years of perseverance, and it is a major achievement when you hear a group member say “I really want to attack you right now” rather than insulting or berating a fellow group member. Amy’s secret may provide an opportunity to work with your group on putting their impulses to attack into words rather than acting on them, a valuable skill both inside and outside the group room.

Having to hold this secret is taking a toll on you. You are afraid that it might be affecting your group negatively, and managing your impatience sounds like a full-time job. I am curious about the emotions underlying your impatience. Are you angry at Amy for putting you in the position of having to keep this secret from the group? Are you hurt or angry at Amy for keeping this secret from you for so long in her individual? The most valuable tool we have as group leaders is feeling and identifying our deepest emotions inside ourselves and toward our clients. It is only by knowing what we are feeling that we can know what our patients are feeling and how best to guide our groups. But managing these feelings is the hard part, and you didn’t mention your own history with infidelity, betrayal, and secrets. I hope you have your own individual therapy, trusted colleagues, and a group where you can talk about your feelings toward Amy and how this might be stirring up issues from your history. The intersection of our clients’ issues and our own issues can be some of the most difficult and the most productive areas of inquiry for our growth, both personally and professionally. There is much to learn here about Amy and how it affects her to keep her affair secret from her wife and the group.

The role of group, as I see it, is to help our group members learn to get along with each other rather than to say everything.

Let me offer you one final idea. This one is probably the most challenging but may give you the most relief. I agree with you that we want people to reveal as much as they can in individual therapy. Over time, given a strong therapeutic alliance, our clients will tell us more and more with the aspiration to say everything in their individual sessions. But I would invite you to revisit your assumptions about secrets in group. The role of group, as I see it, is to help our group members learn to get along with each other rather than to say everything. In fact, there are some things that should go unsaid in group and this secret may be one of those
things. More than likely, any efforts you make to coax Amy into talking about this in group will undermine her willingness to say everything in individual. In group there will always be privacy and there will always be secrets. If you get the idea that someone might be having some feelings directed at Amy, the simple act of asking “what are you feeling toward Amy right now” can start the dialogue, and you never really know where that question is going to lead. Maybe Amy will talk about this affair in group at some point and maybe she won’t. Maybe Amy will elect to tell her wife about the affair at some point and maybe she won’t. What is important is that any disclosures happen on her timeline and that you help Amy understand herself better.

I use various combinations of individual, couples, and group work with my clients. In my work with couples, I have been struck by how difficult affairs are to work with because of the primitive responses and defenses that get stirred in the unfaithful partner, the betrayed partner, and the therapist. This is especially true for ongoing affairs such as this one. Amy is dealing with ambivalence around both her marriage and the affair, which is manifesting in the therapy. You are doing difficult and important work with Amy and the rest of your group, and I think you are asking the right questions. Best of luck!

Dave Kaplowitz, LMFT, CGP

Austin, TX

Dave Kaplowitz is a Licensed Marriage and Family Therapist and a Certified Group Psychotherapist. He has a private practice in Austin where he works with individuals, couples, and groups helping his clients have more satisfying interpersonal relationships. He leads three modern analytic process groups, two of which are co-led with Michelle Bohls, LMFT, CGP. Dave is active in the community having served on the board of the Austin Association for Marriage and Family Therapy and is the current President of the Austin Group Psychotherapy Society. He is dedicated to his personal and professional development and is a student at the Center for Group Studies in New York City.

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