Stacy Nakell Interviews Conference Presenter Molyn Leszcz

Stacy Nakell: I’m here with Molyn Leszcz and Molyn, we are really  looking forward to having you in Austin to facilitate our first 2 day conference, focused on developing and sustaining successful group leadership practices! I remember the last time you were in Austin, which was  twelve years ago. What was your experience with the Austin community and how do you feel about being our first 2 day conference presenter?

Molyn Leszcz: Thank you Stacy for doing the interview. I’m very happy to visit Austin in October! It’s hard to believe it’s been twelve years since my last visit to present a workshop at AGPS! I was very impressed with the Austin community — the way people work together as a community of practice and support one another’s professional development. I made some very valuable contacts with people then that have continued. I see people regularly at AGPA, and I am looking forward to coming back to Austin. To be the first presenter in a 2-day conference, I feel very honored.

SN: For those who don’t know you, please tell us about your interest in group therapy and how this interest has influenced your career path.

ML: Sure. Well, group therapy has been part of my academic career since I finished my training in psychiatry. I had the good fortune of doing a post-residency fellowship with Irv Yalom at Stanford University, which was the beginning of a long focus on group psychotherapy. I loved working with Irv and we continue to work together on various projects. I’ve been at the University of Toronto since 1981, and my work has always centered on psychotherapy and group psychotherapy in particular. Group psychotherapy is what I teach, supervise, and research. I’ve utilized group therapy with varying populations in various clinical settings ranging from people struggling with substance abuse, psychosis, metastatic cancer to geriatric populations and inpatient treatment groups. I find that the fundamentals of group work are useful and valuable in each clinical application. And for the last 12 years I’ve been the chief of Psychiatry at one of the University of Toronto’s teaching hospitals, Mt. Sinai Hospital, and I have also served as university vice chair and chair. My work in group therapy has been incredibly helpful and important to me. I’m glad that I’m going to be working again on the next edition of the group therapy textbook to be able to hone my focus in that area.

This is not really a new model, rather, a honed focus on the importance of being part of our patient’s solution rather than part of the problem.

SN: In your writings, I’ve really enjoyed your focus on the skilled group therapist and the importance of enabling new relationships, which you call “passing the transference test.” Can you explain how a therapist can recognize and “pass” this test when it arises in group, and how it can lead to a corrective emotional experience?

ML: This is not really a new model, rather, a honed focus on the importance of being part of our patient’s solution rather than part of the problem. Our patients come into treatment seeking opportunities for growth and for development that involve recognition and understanding of two things: one, the pathogenic beliefs that obstruct growth and development that take shape early in life and two, the ways those are expressed in relational and interpersonal terms. Groups are fantastic vehicles for the illumination of that sequence because we can see the beliefs and the behavior come alive in the group, often giving us a more accurate picture than a patient’s narrative alone. I can study how patients behave and interact differently with others depending on their age, level of attraction, or other features. It adds richness. Once the pattern is illuminated, then the task is try to help facilitate growth and development, which means disconfirming pathogenic beliefs and interrupting the negative loop that often arises when relational patterns emerge from those beliefs. This is the essence of group therapy. In order for us to do that, we need to have sturdy alliances with each member and a strongly cohesive group. We don’t want people to be on their best behavior, we want them to be as they genuinely are.

SN: So, as the therapist, it sounds like part of your job is to change the story or to create a different outcome for the client than what they were used to in their relationships. I wonder if you could tell us a little bit about that process.

ML: We don’t author a different course, but rather remove obstacles for our group members so that they can author a course for themselves that is more compatible with what they actually wish for. That means overcoming shame, overcoming fear, overcoming the reluctance to be vulnerable, and entering into a more reciprocal and mutual way of relating. Many of the people who seek group therapy don’t have innate experiences in which groups have been part of the solution. Groups have often been part of the problem. Never belonging, socially anxious, having been bullied, feeling that they don’t make the cut, that they have some deficiency or defect. Or they have blind spots and they think “I’m a nice guy” or “I’m a good woman, why am I not able to have more satisfaction in my life?”

SN: One thing I have noticed in your writing is that you encourage therapists to encourage client protest. I wonder what you mean by that and how we can encourage protest while maintaining our leadership role?

ML: Well I think we maintain leadership by virtue of encouraging protest. I want my patients to bring their genuine selves. We all have differing intersubjective experiences, and I want to know when I get it wrong and when I get it right. I place a great deal of value on people offering genuine endorsement and expressions of gratitude as well. So it’s not just the protest, it’s bringing the entirety of one’s experience into the therapeutic arena.

SN: Ok, so it sounds like you encourage people’s reactions to you and one another to come out in genuine ways, whether they are protest or something more filial.

ML: Exactly.

SN: Speaking of protest, we have all experienced clients who make provocative, hurtful and off-putting statements to us or to other group members. Can you describe your internal experience of this kind of tense group conflict and how you stay focused on not getting “hooked” when you are in the moment?”

ML: Getting hooked is not the problem. In fact, I appreciate the chemistry when group members get under my skin. The trick is not to not get hooked, but to recognize what is this person’s interpersonal message, what is this person’s interpersonal impact. Why are they doing what they are doing? How can I understand it in a way that furthers the treatment? If I am feeling really annoyed, or hurt, or ashamed, then it often is saying something important about the experience of the person who is engaged with me or engaged with others. As I said earlier, group interactions are always intersubjective, and we all bring our “stuff” into them. It’s not that I don’t get annoyed or angry, but I don’t act from a position of anger. I will look at that as an opportunity for some therapeutic meta-communication — processing the experience. When a person in the group, for example, takes a stridently anti-cohesive approach to the group and devalues and dismisses the work and other people in the group, but yet that person continues to come to the group, that’s a therapeutic opportunity. The patient is testing the safety of the environment to tolerate non-compliance. I see that often as an incredible therapeutic opportunity. Again, for me it pivots on the fact that people come. As long as people are coming, we can work with them.

SN: So it sounds like you stay in your therapeutic self and notice all of the feelings that arise for you without acting on them unless it is for the benefit of the client.

ML: Yes. I want my patients to strike while the iron is hot, but as therapist, we need to not act until we can metabolize our countertransference. We need to distinguish the countertransference that is elicited by the patient in a way that is fairly objective and that which is subjective. So countertransference is incredibly important data. I believe all therapies are generally equivalent, but the effectiveness of the therapist requires a deliberate focus on training, on supervision, on observed practice, so that each of us is the best version of ourselves as a treater. If you have surgery, you want to go to see the surgeon who has the best record with regard to good outcomes. We should have the same standards in mental health.

We don’t author a different course, but rather remove obstacles for our group members so that they can author a course for themselves that is more compatible with what they actually wish for.

SN: Ok, and you say one of the main keys to that is our ability to work with our countertransference, both the objective and the subjective.

ML: Exactly. Both are keys to maintaining an empathic connection to our patients.

SN: One of the experiences of the two-day group will be a demonstration group. When reflecting on what you’ve said about group cohesion and empathy as keys to successful group treatment, along with what you are saying about analyzing countertransference reactions, how might we see this show up in a demo group with you?

ML: Well, I hope you will see it show up! Demonstration groups are like a box of chocolates, you never know what you will get. In order for us to grow, we have to be observed. The concept of deliberate practice is key. I’m hoping that we will all learn something from the experience. I think that if we are aligned on that front it will be a good experience.

SN: Part of the structure of this particular conference includes interactions between you and the therapists who will be leading the small group experiences. What do you hope to impart to them regarding how to provide effective experiences for their groups?

ML: I’ll begin by recognizing that the people who are leading the small group experiential training opportunities are, in my experience, excellent group leaders. But themes will emerge, through the presentation, through the demonstration group, through our embeddedness in a larger society, that will weave their way through the experiential groups. I hope to provide a reflective space to explore these themes.

SN: OK, thank you. So I know this is a big question, but what do you most hope the therapists who attend your training learn or experience during these two days?

ML: I would hope  people will come away feeling heartened about doing the work. It’s both difficult and important work. If people feel reinforced and supported and encouraged in what they do, that will be good. If they learn something that allows them to expand their therapeutic repertoire, I think those would be good objectives for me.

SN: OK, I appreciate that! I wonder if there’s anything I haven’t asked about that you might think we should know about your work or what it looks like to create a successful and effective group psychotherapy practice.

ML: I don’t know that I have much more to say about that in a specific way, because the way in which we practice is different from community to community, it’s certainly different as a psychiatrist in Canada versus in the US. Canada has pretty close to universal health care. Not to say that mental health care is easy and everyone has access to it, but people can access care without concern about the cost. There are advantages to that and there are some disadvantages to that — sometimes there are long waits. The economics of health care are less concerning for most Canadians than they are for most Americans, based on my conversations with my American friends and colleagues. And I’m going to try to stay away from stuff that might be politically controversial.

SN: Good luck!

ML: I’m half joking when I say that. I think people who work with groups and understand group dynamics and understand group process can be an enormous resource to our communities and to the societies in which we live. We can see things that others don’t see because they are in an intensely reactive frame of mind. We can find ways to promote a safe environment rather than a polarizing and fragmenting one.

SN: OK, well, we certainly need that here in Texas! Thank you so much for your time!

ML: Stacy, thank you so much for doing the interview with me, I’ve really enjoyed it and you’ve been a terrific interviewer.

SN: Thank you! We really look forward to seeing you here in October!

Leszcz, M. & Malat, J. (2012). The interpersonal model of group psychotherapy. In J. Kleinberg (Ed.) The Wiley-Blackwell Handbook of Group Psychotherapy (pp. 22-58). West Sussex, UK: John Wiley and Sons, Ltd.

Leszcz, M. The effective group psychotherapist. Presented to the Dutch Group Psychotherapy Association, November 8, 2103.

Stacy Nakell, LCSW, CGP has been in private practice in Austin since 2007. She specializes in work with those struggling with Body Focused Repetitive Behaviors (BFRBs) such as hair-pulling and skin-picking. She has been a trailblazer in the use of psychodynamic techniques, including group therapy, for this population. Her article A healing herd: Benefits of a psychodynamic group approach in treating body-focused repetitive behaviors was published in 2015 in the International Journal of Group Psychotherapy. She is currently writing a book about her approach.

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1 reply
  1. Deborah Sharp
    Deborah Sharp says:

    I was excited to know that Molyn was coming to Austin and this interview reinforces what a rich experience this conference will be. A friend and I were talking about joining the consultation group and I’m planning to sign up.

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