Sunday, October 9, 2016

Group Therapy and Supervision

I find myself in the peculiar position of supervising a candidate who is conducting group therapy. The candidate, having previously been trained in Object Relations, has a penchant for confrontation of behavior and for going straight to the unconscious. I, on the other hand, prefer a more ginger approach, trying to keep in mind the useful purposes that otherwise untoward behaviors serve to protect the self from painful affect and from fragmentation. So I find myself in a dilemma about confrontation. On the one hand I wish to discourage its use in the candidate; on the other, I find myself confronting the candidate’s behavior of using confrontation. Because the medium is the message, here I am at crossed purposes with myself.

Webster says confrontation is to fight or oppose with anger; the candidate himself said confrontation serves to put the other in a difficult position. So is this what we therapists hope for our patients, that they will find themselves in a difficult position with us? While patients do need to experience some discomfort as motivation to come to treatment, I do not think we want to purposefully generate discomfort as a therapeutic tool.  We certainly do not wish a patient to feel shamed and unable to stay in treatment. Yes, we want an opportunity to be the old object so as to bring to the table and make available for exploration past shames, but we also need to be the new object who provides a corrective emotional experience (and gives the brain the opportunity to lay down new dendritic branchings and prune old ones). It is not our job to get a patient or group member to cease a certain unwelcome behavior, but rather it is our job to help identify the purpose served by such behaviors as well as what triggered such behaviors and our part or the group’s part in that trigger. But how to convey that to a candidate in a non-shaming way?

The continuing case course’s class itself forms a group, a group participating in the peer supervision, with the instructor as facilitator or group leader. Do I then address the entire group to inquire about what happened when X said this and Y said that? Do I ask how did it feel when candidate-group leader said this or that? It is interesting how the parallel process shows itself. The group as a class forms its alliances and subgroups just as the therapeutic group, led by the candidate, does. The class, too, as the therapeutic group does, seeks understanding and a sense of responsibility for our interpersonal interactions, hopes for knowledge and a universality of experience where belonging and sameness can coexist with an appreciation of uniqueness. The tricky dual role of course instructor and group facilitator becomes more evident as the course unfolds.

1 comment:

Lycia Alexander-Guerra, M.D. said...

Hi Lycia,
I just read your blog post on group supervision and confrontation. It’s such an interesting dynamic and tension that you describe. Because based on my own experience in supervision with you, I have to tell you that I really like both sides of what you are saying. First I love how you’ve taught me how to be non-shaming in calling attention to someone’s defensive behavior but framing the behavior in a way that makes sense of it in light of their history and trying their best to deal with their history. And yet I have appreciated over and over how you have confronted me in very caring ways as to where I may be headed in a direction that I may not want to continue in. I don’t know if it’s confrontation, or just sharing with me your perspective, and the reasons why you hold your perspective, it’s confrontation that is caring yet lending in expanding my perspective. I treasure that. I see it as generously helping another person grow in perspective. Rose Zayco, PhD