The therapeutic relationship at its best can be a unique, powerful and transformational experience, carrying in its essence a particular flavour and quality we are unlikely to encounter anywhere else in our lives. I can share with a close friend the most intimate aspects of my being, the darkest areas of my soul and the most perplexing difficulties in my life, which is a great relief and brings much needed comfort and acceptance. However, when the same experiences are shared and explored in the therapy room, they take on a whole new meaning, feel quite different, and are experienced and processed at a different frequency, yielding a whole new set of insights, openings and new territories to discover and be acquainted with. Generally speaking, most people accept that whilst close friendships have great potential for healing to occur, they are different and can never take the place of the therapeutic relationship – and vice versa of course. We have all experienced to some degree or other, the relief, hope and healing supportive energy available through a one-to-one therapeutic relationship, and we would all more or less agree that whilst sometimes painful and frightening, overall it is a valuable life changing experience. This whole process is amplified and expanded when we enter the realms of group therapy, not instead of a one-to-one relationship, but more an extension, a broader aspect of personal growth and healing. So, the remainder of this article will focus on the therapeutic relationship as encountered in a therapy group, both from client and therapist’s perspective – as they are interchangeable and deeply interconnected. The therapeutic relationship is one in which the client is honoured, respected and met with nothing other than unconditional love and acceptance for who he or she really is, or is struggling to be. This can only take place when the therapist also allows his/her struggle for personhood to emerge into being.
There are many forms of group therapy, and each has its own unique quality an d identity, whether that be a short-term, task-oriented group, or an ongoing process style group. Within each group setting the group energy can be influenced by a therapist’s style, philosophy, personal belief system, and in my own experience, by the way you look, you wear, right down to accent and vernacular tendency. The point I’m getting at here is, that clients generally prefer their therapist to be qualified and have an acceptable level of accreditation: we all accept that, however, (and this is powerful in group work) clients are often more interested and fascinated by the kind of person you are, your preferences in life, strengths and weaknesses, if you really care etc. I am highlighting this point because in group work, the very nature of a group of human beings gathered together gives rise to otherness, comparison, checking other people out, measuring stuckness or progress via other people’s reactions and so on. The people who tend to be most scrutinised in a group situation are the therapists! This creates an extremely challenging opportunity to engage in a therapeutic relationship with a group of people and a co- therapist if you’re lucky enough or burdened to have one, as the case may be. I’ll say a little bit more about the co-therapist relationship later. As with one-to-one therapy, the group therapist must be a real person (this is more of a challenge in a group as it’s impossible to fool eight wounded people – that’s sixteen bullshit detecting eyes!). So, if you enter the group arena hiding behind professional cliches, offering sterile, patronising solutions, I’m sure you will be about to experience true humility and what it really means to learn about psychotherapy Irvin D. Yalom is considered by many to be the godfather of group therapy, this is what he has to say about genuineness in group therapy:
“underlying all considerations of technique there must be a consistent positive relationship between therapist and patient. The basic posture of a therapist to a patient must be one of concern, acceptance, genuineness and empathy. Nothing, no technical consideration, takes precedence over this attitude.”
So you see that everything we are learning about being a humanistic and integrative psychotherapist comes into direct focus when we are attempting to establish therapeutic relationships with individuals who have come together as a group to ease the suffering of life and somehow develop a more positive fulfilling lifestyle.
Group therapy has been likened to a microcosm of society, emulating all the struggles, powerplays, rituals and ways of being we are part of on a daily basis. The group therapist needs to maintain a strong awareness of this dynamic as he/she facilitates the flow of energy from one aspect to another. While all of this is going on, for obvious reasons, the group can also begin to mirror the family, both the individual client’s family with all of the unique background that may have, and also the formation of a new family, a place where new ways of being can be practised, a place (perhaps unlike my own family) where I can really be myself, have a strong opinion and notice that others actually can cope – they don’t die and neither do I. As you can see there are many different dynamics unfolding in the group process. Some obvious, some more subtle, some conscious, some unconscious. The therapist needs to remain aware of all this, while at the same time relating to each person with respect, uniqueness and care. It can be quite demanding to engage in a therapeutic relationship with each individual whilst at the same time being tuned into the overall group mind or energy. Yalom describes it this way:
”Sometimes I think of the therapy group as an enormous dynamo, often the therapist is deep in the interior, working, experiencing, interacting [and being personally influenced by the energy field), at other times the therapist dons mechanic’s clothes and tinkers with the exterior, lubricating, tightening nuts and bolts, replacing parts.”
The therapeutic relationship (which is a healing relationship) requires extra wisdom, sustenance and heart in the realms of group work. You are constantly being challenged, criticised, seduced, supported, rejected, idealised and ridiculed… just like most parents or guardians are. This dynamic can be assisted beautifully or complicated beyond description by the presence of a co-therapist, which I will talk about next.
There are many different views and opinions as to whether a group needs a co- therapist, some consider the notion superfluous, others think of it as a luxury. My own experience has been varied and interesting. Working in a residential treatment facility, it is a practicality to have two therapists per group; due to the intense nature of such groups, there is a need for one of the therapists to have time off etc., whilst the other attends to the group needs of that day. Having a co-therapist can enhance and augment the quality of care available in group therapy. This means being open to the various differences that may exist between you. Attending to issues such as: who does what, fear and jealousy if the other therapist seems to be competent and able, disagreements about basic therapeutic procedure, and much, much more. To engage in a co-therapist relationship requires open communication. If this is not clear and honest you are subject to all kinds of problems, and of course this affects the therapeutic relationship and the group sense it immediately (Mammy and Daddy aren’t getting on again). This will happen even if the therapists have a surface agreement – the group are highly sensitive and will tune in at a more subtle frequency, and inevitably, will begin to parent and guide the two therapists. So, honest communication between two therapists who are not threatened by each other’s skills, beliefs and philosophical frameworks is essential if the group is to benefit from the therapeutic alliance. If this is not in place many people end up getting hurt (including the therapists). Constant supervision, pre and post group meetings, and a sincere commitment to their own therapy, are pre requisites for a healthy co-therapist relationship – it can also be useful if they like one another!
Finally, I would like to say a little about the potential group therapy holds to support healing, transformative relationships. If the therapist or co-therapist as the case may be, are open minded, genuinely concerned individuals, who share experience, knowledge and understanding of the complex dynamics of group therapy, and who also believe that human beings share an insatiable desire to heal themselves and be okay and happy in the world, group therapy is an extraordinary setting for this to occur. Most people come to therapy to attain some kind of personal freedom and enlightenment. These natural god given rights have been thwarted by unhappy families, experiences of abuse, addiction, marginalisation, isolation, to name but a few of the various pains that motivate people into seeking help. If a person can begin to feel safe, accepted, supported and esteemed in the context of a group, then that person is well on the way to achieving a sense of meaning, purpose and value in the world. When an individual can learn to share their deepest, most shameful thoughts and feelings, and those thoughts and feeling s are supported by therapist and group alike, the individual is then in a more advantageous position to change self defeating behaviour or whatever it was that guided them into therapy initially. I have seen it time and time again, a person straggling for acceptance in a group, and the sheer joy and liberation that accompanies such disclosure and acceptance; the therapeutic relationship is definitely intensified in a group situation – therefore the possibilities for personal and group healing are boundless. I would like to finish with a quote from Judith Lewis Herman, author of Trauma and Recovery. In her brilliantly written book she captures something of what I am trying to say here:
”The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore is based upon the empowerment of the survivor and creation of new connections. Recovery can take place only within the context of relationships; it cannot occur within isolation. In her renewed connection with other people, the survivor recreates the psychological faculties that were damaged or deformed by the traumatic experience. These faculties include the basic capacity for trust, autonomy, initiative, competence, identity and intimacy. Just as these capabilities are originally formed in relationships with other people, they must be reformed in such relationships.”
As you can see from this quote, the therapeutic relationship in group work can provide a safe, loving environment, where people can learn to be re-empowered, and of course, learn to connect with other human beings. That in itself is a powerful healing process, and one worth all of the challenge and stamina required to be part of a therapeutic relationship.
Irvin D. Yalom, The Theory and Practice of Group Psychotherapy, p. 112, Basic Books Inc. Publishers, New York.
Judith Lewis Herman, Trauma and Recovery, p. 133, Pandora.
Jimmy Judge is a psychotherapist working in the New Day Counselling Centre and in the Rutland Centre.