Abstract
Gans reminds us as therapists and group members, of our vulnerability and hence our courage, in embarking on the intimate and challenging process of group psychotherapy. He explores aspects of the experience that are complex, and even shameful, to discuss, but necessary to be tackled for group psychotherapy to be sufficiently stable and productive. In so doing, he addresses subjects such as shame, hostility, money, silence, the missed session, the ‘difficult’ patient, in a collection of papers written over the period from 1989 to 2008.
Taking an intersubjective perspective, the core task that Gans identifies is that of making space for each group member’s subjectivity, including that of the therapist, reminding us that much of the learning that one does as a leader of a group is about oneself (Mitchell, 2000; Benjamin, 2004). The co-existence of subjectivities invites and constructs tension when all are seeking recognition and understanding, while often avoiding and rejecting it.
His own personal stories reveal and illuminate the significance, complexity and dilemma of the core themes. They also facilitate a deep appreciation that as group psychotherapists, we can find courage in our shame, and strength in our limitations. He reminds us how difficult it can be to think, when faced with hostility, and goes on to provide an extraordinary example about his own experience of therapist hostility, and its therapeutic use in a group. He asks whether it is ever useful to express hostility from the therapist position, whether it can help in some contexts for the patient to experience the therapist as ‘real’ or whether it is always a counter transference ‘mistake’. In this personal story, he speaks passionately, to group members, of his distress about group behaviour, saying ‘I don’t think I have ever been this upset as a professional’ (p43), commenting that it was a human need at times to seek a container to pour hateful feelings into. In linking his own feelings explicitly with the projective process in the group, I, for one, was persuaded that there was a helpful outcome, the group enabled to face, make sense of and own their difficult feelings.
He provides specific and grounded guidance that acts as a useful reminder for experienced therapists and is also invaluable for those in training, including: acting as a ‘lightening rod’ for ‘negative’ feelings; sustaining feelings and expressions of empathy when experiencing attack; taking a position of ‘approximate knowing’ rather than objective authority.
He highlights the power of shame, derived from its origins in early experience, provoking defence when unmetabolized. He promotes an interesting discussion of the ways that the group context can generate unconscious defences to avoid the feeling of shame, enabling it to stay hidden through disguise. For instance, even discussions of loss can be defensive. As Gans points out ‘anything can be used for anything’ (p7).
As a systemic psychotherapist (and group analyst) I was drawn to the attention Gans gives to the significance of meta-communication of the therapist, either through their verbal or non-verbal behaviour. For instance, by addressing and not avoiding hostility, communicating . . . this is a group which can express and work with hostility.
He regularly asserts that there are ‘no innocent bystanders’ emphasizing the value of the group’s capacity to contain, more than the value of the individual therapist to interpret. He stresses the value of forms of indirect communication such as paradox, reframing and metaphor.
He explores the phenomenon of the so-called ‘difficult patient’. While he acknowledges that there are characteristics of individual group members which can be provocative, be challenging to respond to and contain, and from which therapists may even need protection, he stresses how important it is to think of the ‘difficult patient’ more in terms of a difficult ‘dynamic’ in relationship, rather than in terms of objective qualities within a person. His view is that a ‘difficult patient’ can often be thought of as a failure in understanding or a failure in finding language that enables sense making.
He describes a movement from an ‘illusory protective bubble of my sterile objectivity’ (p127) to a more systemic intersubjective approach. He talks in terms of ‘the co-constructed product of the patient in question, the group as a whole and the leader’ (p128). He suggests that most of us prefer loving rather than hating group members, our own narcissistic needs to be all knowing, all healing and all loving potentially undermining our ability to hold and learn from apparently destructive communications but that ‘members need to feel safe enough to be troublesome’ (p136). People who come to group therapy have often internalized what he calls ‘devastating imperatives’ e.g. make yourself invisible. The road to growth involves defying those imperatives and taking a leap of faith in going beyond the life script provided by family culture.
In facilitating this movement, he places great emphasis on valuing our own life experiences as therapists, appreciating the gifts experience brings us. He offers a great deal to us in sharing personal, painful experience, which has helped his own subjectivity to co-exist with other subjectivities. For me, the central message of the book is the challenge of intersubjective co-existence. He offers, through his efforts in bringing difficult topics alive, theoretically and practically, a group therapist’s mind rich with humility and courage and open to that challenge.