The Challenge for Group Psychotherapy

Analytic Group Psychotherapy with the Aged, Part 4

Jack developed increased ego strength through his positive relationship in the group, complemented and reinforced by his expanding social relationships outside. He worked through his apprehensive feelings of anticipated isolation and was able to retire from his job with little anxiety. Following this action, he was able, for the first time, to leave the New York area and spend the winter in Florida. In the spring, he returned to the group with continued efforts towards working through his unresolved conflicts with the mother and related, hostile, aggressive, competitive feelings toward father and brother. It was also significant to note that during this time, he was able, on intermittent occasions, to attain and maintain erections, and, on occasion, attempted, with some relative success, to have sexual intercourse with some of the women he dated.

Bill was experienced by the other group members as “the helpless child of the family.” He was brought to the first session by his son. He usually sat in a dazed manner, appearing to be completely unaware of what was going on around him. His usual reaction to questioning was silence. On occasion, he spontaneously mumbled something to the effect that he had nothing to say or did not know what to say. These reactions were usually sudden and unexpected and had the effect of attracting attention and stopping whatever activity was going on at the time. The women adopted maternal roles, offering complete sympathy and support and encouraged him to talk about his problems. Somewhat incoherently, he described his first and second marriages and separations, blaming his business for all his difficulties. He had lived in the New York area for a number of years but pleaded an inability to get from one place to another. Later, he contradicted this by saying that he was able to travel but did not know where he wanted to go. He described being isolated in his room and unable to get out, unless his son came for him. With the group’s encouragement, he continued to discuss and clarify the reality of his situation. He revealed his ability to get about and the existence of people with whom he might socialize. His “inability” was a defense mechanism developed as a means of manipulating others to gratify his intense dependency needs. As the group became more aware of his restricted existence, they encouraged him to take a part-time job and, in so doing, experience some feeling of independence from his son. The women encouraged by cajoling and seducing. Jack pressured with an air of condescension. The other patients’ lack of acceptance of Bill’s passive role created a threatening feeling of losing the dependency relationship with his son, finally resulting in withdrawal from the group. The therapist’s initial lack of comprehensive understanding of Bill’s passive defense mechanism may also have aided his withdrawal.

Joan, as a result of attempts to act out her suicidal ideas, replaced Bill as the focus for emergency action. However, the therapist’s experience with Bill enabled him to cope with the situation more effectively, preventing an initial panic reaction by any of the group members or by Joan. The therapist’s intervention had a positive effect. Instead of badgering her with ideas that her suicidal attempts were “bad” or “foolish,” the group interacted emotionally, as well as analytically, and developed multiple transference relationships. Hilda and Henry identified with her; Agnes related to her as to “sister.” (Agnes blamed herself for her sister’s successful suicide.) Mabel adopted a supporting, maternal role; Jack assumed an objective, helpful role, which manifested his resentment toward the utilization of passive-aggressive behavior. The experiencing of emotional support from the group enabled Joan to interact and relate associative material. With the therapist’s focusing, the group helped Joan understand the use of her suicidal attempts as a method of preventing her son’s marriage. The suicidal attempts ceased and her behavior in, as well as outside, the group sessions changed. Joan’s sadness slowly was replaced by smiles, and she began to describe increased activity in household and social relationships. During the group’s summer holiday (the therapist was also on vacation), Joan began seeing an individual therapist near her home. She was able to establish a positive therapeutic relationship with the new therapist and decided to remain with him when the group reconvened in the fall.

Agnes entered the group with feelings of total helplessness and expressed an inability to relate to any member of the group. She eagerly told of incidents that contributed to existing feelings of “depression.” She attempted to monopolize the group by revealing a lifetime of frustration and sadness. She disclosed early rivalry relationships with an older sister. As Agnes was “prettier,” and the “brighter” of the two, the mother became overprotective of the sister. She also described experiences of intense feelings of rejection when sent from her homeland (Russia) to the U.S., thus separating her from the family. In an attempt to defend herself from the continuous experience of being thwarted and rejected in any dependency relationship, Agnes developed a role of “pseudo-independence.” Her efforts to attain this “independence” had taken two directions: attaining a job that would keep her financially secure, and at the same time rebelling against the mores and conventions of society (parents) and following what she termed a “Bohemian” life.
In the group, she continued to attract attention by describing anxiety-provoking incidents but was unable to reveal or discuss her sexual problems with her husband or her intense guilt resulting from the sister’s suicide. Joan’s suicidal attempts provoked her already intense anxiety, resulting in an inability to interact for the first few weeks. Joan provided an object for a sister-transference, and Agnes’ major concern became the prevention of Joan’s death. As Joan began to improve, Agnes’ anxiety diminished and she was able to relate to other members of the group. Although initially professing an inability to relate to others on a conversational level, the increased interaction of the group members resulted in Agnes’ allowing herself to respond more openly. During the interaction with the group members, she began to discuss her need to be independent. She recalled early parental conflicts and mother’s cry that financial dependency on the father was the only bond that kept the marriage together. The intense rivalry with sister during childhood was discussed, and the group aided her in bringing out and recognizing the meaning of her guilt over the sister’s suicide. Her interactions in the group brought out that although she shared her bed over the years, Agnes’ need to be independent postponed marriage for ten years. The marriage took place only after her husband threatened to commit suicide if she continued to refuse. The effectiveness of her denial of dependency on the husband completely deteriorated when she was confronted with the threat of losing him. Agnes made efforts to participate in the group, yet her conflicts regarding dependency needs continued to thwart any free interaction within the group session.

Agnes’ therapeutic progress in the group was very slow. Her demeanor was characteristic of a help-rejecting complainer. Her behavior in the group was usually that of a petulant, demanding child who sought and insisted upon the exclusive attention of mother (therapist). The multiple transference relationships with the other group members were to siblings and manifested continuous and intense rivalry. Reactions manifesting experiences of gratification occurred only when she was able to monopolize the therapist’s attention. When attention was paid to someone else, she experienced feelings of rejection and often reacted with intense hostility. These reactions were often accompanied by accusations of receiving no help from either the therapist or other group members and threatening to reject by leaving the group. Encouraged by the therapist, the other group members began to focus the transferential relationships manifested by Agnes’ reactions. Gaining awareness and some understanding of her experiences with the mother, Agnes was able to develop tolerance for frustration. The group’s reaction to her anxiety, rather than to her hostile reactions, precipitated a modification of her relationship in the group and permitted the development of a “childhood friendship relationship” with Mabel.

Although feelings of sibling rivalry with the group persisted, Agnes continued to experience acceptance by other group members. She began to discuss and describe her relationship with her husband, and said he had made every possible effort to satisfy her. His efforts, however, always appeared to be in vain. Sexually, he was experienced as inadequate and she had not been loath to let him know her feelings. Intellectually, he was considered to be her inferior and she insisted upon comparing him negatively with her “intellectual” friends. His only attribute, as she described it, was his physical strength as a young man. His occupation required lifting heavy objects and he had been able to lift well over 100 hundred pounds with little effort. With chronological aging, his physical strength had waned somewhat, resulting in his image becoming even more demeaned to her. Continuing to deny her dependency, she claimed that the relationship continued only because of recurrent illnesses during the last several years (a coronary condition) and that he was very dependent upon her. With the aid of the group, Agnes was able to see the similarity between the relationship with her husband and the relationship with her sister and that her own dependency needs and her inability to accept these, resulted in the development of relationships in which she could experience others as depending upon her. However, threatened loss of the other person provoked the underlying anxiety related to her own denied dependency needs. The awareness and partial understanding of her relationship with others, coupled with the support gained through the acceptance by the other group members, was most important for Agnes. A few months later, the husband had a coronary attack, resulting in his death. Although the trauma resulted in a negative depression, it was of relatively short duration and was not, as she anticipated, completely incapacitating.

Henry entered the group with an air of oppression, making his presence known by expressing the complete inability to function vocationally or socially. He continually sought out the therapist, pleading to be told what to do. When he received no prescription from the therapist, he turned to the group and asked continually for an evaluation of his problems and progress. He overtly identified with the helplessness of Joan and was successful in provoking the group’s anxiety relating to their own dependency needs. Reacting to their own respective anxieties, several group members took various defensive measures. Hilda encouraged him to look at childhood experiences and made some superficial suggestions with regard to vocational opportunities. Jack became extremely hostile to Henry. He suggested demeaning jobs that Henry might accept “in order to keep him occupied.” Mabel attempted to take him under her wing, as if he were a small, helpless child. She encouraged and supported, advised him as to job opportunities, and tried to protect him from Jack’s hostility.

Initially, Henry sought out and wallowed in the attention extended by the women in the group. He reacted to Jack’s hostility by sulking and expressing feelings of complete defeat. Also, in a passive, dependent manner, he looked to the therapist for support, expressing his need for protection from Jack. He continued to accept, and verbalized appreciation for, the attention and concern shown to him by other group members and continued to function in a self-defeating manner. Focusing on the relationship with the therapist, the latent meaning of his reactions became more significant. Although he overtly sought help, his repeated failures manifested an attempt to degrade and deny the effectiveness and adequacy of the father figure. When the group inquired about his activities, Henry was always ready to describe his inability to follow through and succeed in any endeavor. He described his frustration in marriage and his inability to ever experience sexual satisfaction. His wife dominated his actions, had always made the final decisions regarding any activity inside or outside the home. When the children came, he began to experience some feeling of worth – at least the children were dependent upon him and thus he was able to assume a temporary position of “power.” As the children matured and began to assume independent roles, Henry’s feeling of “power” started to dissipate. When the children married and had families of their own, Henry’s defense mechanism against his own dependency needs began to deteriorate, resulting in an anticipation of overwhelming anxiety. As the group focused on and explored Henry’s passivity, he was ready to grasp any source of relief. However, when an area of possible success was explored, he manifested intense irritation and began to withdraw. One day, Jack asked him how much money he had in the bank and he reacted with intense anxiety and abrupt hostility, saying, “I came here to get help with my problems—not to show my bankbooks!” Upon further inquiry, it was learned that Henry had been able to accumulate a relatively large sum of money but feared that if this became known, he would be asked to give and lose his dependency role in the community.

Following Henry’s “exposure” that he could succeed, the group began to focus on his passivity as a block toward developing a dominant, assertive role. His interactions with Jack began to change. Overt passivity was replaced by aggressive outbursts. He began to retaliate to Jack’s demanding remarks and thus lost his role of “baby” in the group.
Although intense dependency needs continued to be manifested in his behavior and dreams, Henry started to show initiative and active aggressiveness. After several years of unemployment, he obtained and successfully held a job for five months. He experienced success on the job and left only because the employer needed to cut expenses.

Henry’s acceptance and the support he experienced in the group, reinforced by successful activity in his environment, resulted in the development of increased ego strength, which permitted him to become a more active participant in the group, as well as outside activities. He began to assume a more dominant role in his marriage and was rewarded with experiences of satisfaction rather than a repetition of former frustrations.

Lila came to the group with a great deal of eagerness and anxiety. She anticipated obtaining a great deal of “learning” from others’ experiences but was very apprehensive about the acceptance of her problems by the other group members. She entered the group after an integrated, therapeutic working relationship had developed among the members. The multiple transference interactions at this time were of a positive nature, and Lila’s reaction to the experienced “openness” and “friendliness” of the group resulted in her feeling “completely at ease.”

During her second session, she was able to freely express her positive feelings toward all the group members, as well as negative reactions to specific behavior. She also expressed the feeling that she could relate her problems with little apprehension and felt that the other group members would offer her help. A resume of her life history was then related. She described childhood and adult experiences and conflicts. Her description of childhood experiences emphasized the need and attempt to comply with mother’s ideals and demands. Her only reservation was in disclosing that she was a college professor. Her desire to give and reach out to the group members resulted in Lila’s immediate inclusion within the group circle. After several more sessions, she began to express her specific needs for help from the group. The overt expression of needs and desires reinforced the group’s positive reactions. The therapist focused on this interaction and encouraged other members to express their wants overtly and more specifically.

Lila continued her active participation within the psychotherapeutic group process. Typically, as in any analytic psychotherapy group, the presence of other patient members afforded Lila an opportunity to develop multiple transference relationships. Interactions revealed the persistent over-protectiveness of a mother to an only child and the effective resolution of early dependency needs. Although she had been able to achieve educational and professional success, Lila had never experienced herself as an adequate individual who could effectively function in an interpersonal relationship. She sought out heterosexual relationships, but protected herself from any permanent involvement by holding onto the home situation. When her mother died, she used the need to care for an aging father as a defense against becoming involved in a marital relationship. With the death of the father and the loss of her dependency object, she reacted with intense anxiety and began to withdraw. As she worked within the multiple transferential relationships, Lila was able to work through her intense dependency needs and began to develop mutually satisfying relationships outside the group situation. After eighteen months in the group, she developed a relationship with a man. She felt that this relationship was mutually satisfying, and her relationship with colleagues became more meaningful. She also experienced a sense of achievement in her work. Soon after this, she left the group, expressing the feeling that she had obtained the goal for which she had entered the group. The other group members, although reluctant to have her leave, agreed that she could continue to grow and mature on her own. Her need to feed others as a defense against her own dependency needs had been resolved, and she was now in a position to establish interdependent, mutually satisfying relationships.