Fostering Interpersonal Norms in a Gestalt Group

By Jay Earley, Ph.D.

Posted by permission. Retrieved from http://www.earley.org/GroupTherapy/fostering_interpersonal_norms.htm

 

Abstract

One form of Gestalt therapy group focuses on theinterpersonal interactions and relationships among group members. This is an effective andexciting way to make therapeutic use of the group setting. This practical articlediscusses how to foster group norms that intensify and maximize the interpersonal aspectof a Gestalt group. We examine pre-group hand-outs and interviews, defining appropriatenorms, how group members initiate interpersonal work, encouraging interpersonal norms, andhow to move work in an interpersonal direction.

Increasingly Gestalt therapists are usingapproaches to group therapy that go beyond individual work in the group to includeinterpersonal interactions or the group-as-a-whole (Feder & Ronall 1980; Harman 1984;Melnick 1980; Zinker 1977, Chap. 7, Handlon & Frederickson, 1998; Earley, 1996). Ibelieve that the interpersonal learning and healing which takes place in the interactionsamong the group members is very valuable therapeutically, and therefore my approach toGestalt group therapy emphasizes this.

My Gestalt groups are designed to intensify and maximize interpersonalcontact and the work that emerges from this. Much of the work is in pairs, as peopleexplore their feelings towards each other, work on their relationships, and experimentwith new ways of interacting. Some of the work involves one person working on hisrelationship with the group-as-a-whole. This approach embodies Gestalt therapy in itsemphasis on contact, awareness, dialogue, and experimentation.

This group work is similar in some ways to the interpersonal groupmethod of Yalom (1995). However, unlike Yalom, I emphasize awareness and the experientialexploration of underlying intrapsychic issues. I also pay attention to contact andintimacy issues and use an active leadership style. All these differences arecharacteristic of Gestalt therapy.

In my years of training Gestalt therapists in this method, it has beenespecially important for them to learn how to focus a group in an interpersonal direction.Therefore, this article discusses the practicalities of developing group norms thatemphasize interpersonal work. This approach to group therapy is discussed in detail in myforthcoming book Interactive Group Therapy.

Levels of Dynamics

First let’s discuss the three primary levels of dynamics operatingin groups:

1. Intrapsychic. The usual psychological dynamics therapists normallyexplore in individual therapy, including motivation, emotions, defenses, projections, etc.

2. Interpersonal. The dynamics that go on in the relationship betweenany two or more people in the group, including emotional reactions, closeness,assertiveness, boundaries, etc.

3. Group-as-a-whole. The dynamics of the group taken as a unit,including stages of development, group norms, group roles, emergent leadership,scapegoating, group-level resistance, etc.

Let’s look at an example: Jill returned to group after missing asession. Though she gave a somewhat plausible, she clearly could have chosen to come togroup. Jeff was angry at her because she had missed a number of sessions recently, and hewondered about her commitment to group. Jill felt hurt but didn’t show it; she triedto placate him by apologizing without really dealing with what was upsetting him. (1) Atthe intrapsychic level, Jeff was emotionally abandoned by his mother, and the intensity ofhis reaction to Jill came from this transference. (2) At the interpersonal level, Jill hasa pattern of dealing with hurt by trying to placate people in a superficial way, ratherthan showing her hurt, or standing up for herself, or dealing directly with the content ofthe confrontation. (3) At the group-as-a-whole level, there had been too much absence andlateness in group, which was probably due to hidden hostility that was poisoning the groupatmosphere.

At any given moment, the leader can choose to address a particularlevel. For example, if you felt that absences and lateness were seriously hampering thegroup, you might focus on that group level problem. You might choose instead to focus onJill’s communication pattern or Jeff’s transference.

The Value of Various Levels.

I believe that the interpersonalinteractions among the members provide the greatest therapeutic leverage in a groupsetting. In a group setting, the interpersonal level is often the place which is figuralfor group members because of their needs for connection, acknowledgment, and safety, andbecause of their emotional responses to other group members. This provides a natural wayto use the Gestalt focus on the present moment and contact. The interpersonal focusstimulates and brings out the emotional reactions and transferences that are the lifebloodof therapy and also provides an ideal venue for clients to experiment with new behaviorand receive healing responses from other group members.

The intrapsychic level is important because it is the domain in whichmembers become aware of their experience, access deeper feelings, and engage in otherprocesses that are directly related to therapeutic change.

Group-as-a-whole dynamics provide the context for the interpersonal andintrapsychic levels. The leader must monitor this level in order to prevent or remedyproblems in the overall operation of the group. In the early stages of a group, the leadermust pay attention to the development of appropriate group norms, as discussed in thisarticle. I prefer to use group level interventions only when they are needed to helpresolve a difficulty at the group level. Otherwise I focus directly on the intrapsychicand interpersonal levels which have the greatest potential for therapeutic change. Thisattitude is similar to Yalom’s (1995).

Group Norms

Group normsspecify those ways of being that arepreferred or expected in the group and those that are frowned on or prohibited. Groupnorms can be explicit or implicit, consciously chosen by the leader or the group, orunconsciously arrived at without any explicit discussion. (Yalom, 1995, p. 109-128)

Rules and Norms.Group norms are different from group rules. Group rules are explicit and are not to be broken without goodreason. Examples would be rules that prohibit violence or coming to groupintoxicated. Group norms, on the other hand, are looser because they constitutegeneral behavioral guidelines. For example, a common norm stipulates that one shouldspeak directly to other group members rather than about them.

How Norms Develop.Some norms are promulgated by the group leader,some come from the group, and some involve negotiation between the leader and group. Aleader will need to establish certain therapeutic norms for the group to be effective infostering healing and change. For example, it is important that members talk abouttheir feelings and explore their psychological issues. Without this norm, a groupcan easily lapse into idle chatter. The leader should be conscious of therapeuticnorms, so you can promote them, both explicitly and implicitly. It’s best if theygrow out of give and take between the leader and the group. If the group exerts too muchinfluence, the norms may not be therapeutic. If the leader simply imposes norms, however,group members may feel powerless or resentful.

Many group norms come primarily from the group members, and as long asthese norms aren’t anti-therapeutic, the leader can allow each group to establish itsown. For example, some groups prefer longer and deeper pieces of work focused on one ortwo people at a time. Other groups prefer more open and spontaneous group interactions,which allow members to interrupt more frequently to express their feelings or opinions. Aslong as a group doesn’t go too far in either direction, the leader can allow thegroup to develop its own balance.

Interactive Work

Because of the potency of the interpersonal level, I recommend thatearly in a group leaders establish the norm that work will focus on the relationshipsamong group members and their interpersonal interactions. The leader can use a variety ofmeans, described in this article, to establish this norm. If you are leading a group thatcombines interpersonal work with another group modality (such as individual work in thegroup), it is especially important to establish interpersonal norms, even though theyaren’t the only norms for the group. Since interpersonal work is the most threateningmodality for most people, group members may give it short shrift in favor of safer ways ofworking unless the leader vigorously promotes the norm.

Defining Interactive Work.Therefore, it ishelpful to give beginning group members as much guidance as possible on the purpose andstyle of interpersonal group work. This is especially valuable in limited-time groupsbecause it moves the group quickly into the most productive work. However, I find ituseful in long-term groups as well. I explain to prospective members ahead of time thatthe group will be “interactive” (my colloquial word for interpersonal) anddiscuss what this means, making a clear distinction between interactive work and outsideissues. Interactive work involves “Talking to someone in group about yourfeelings toward each other or about your relationship, or bringing up what you feel in thegroup or in the moment.” Outside issues mean”Bringing up issues from your current life outside group or your past, or discussingyour psychological issues in general or other topics.” I explain this in thepre-group interview and in written material given to members before they join. I emphasizethis distinction whenever necessary during the formative stages of a new group. No matterhow much you explain beforehand what interactive work is, some people won’t reallyget it until they have seen it in vivo a number of times and initiated interactive workthemselves.

The Value of Outside Issues

Though interactive work is the focus of the group, work on outsideissues should not be ruled out. After all, if the group members are to develop closerelationships, they must get to know each other’s lives. Under some circumstances, itis helpful to actually encourage work on outside issues:

1. If a client has strong feelings about an issue, especially if he isso caught in it that he can’t be present in group on a particular day. Talking aboutthe issue may relieve the emotional pressure and include the group in the person’sstruggle. Then he can let go of it for the evening and get involved in the group.

2. If sharing the issue will help the group to know the person at adeeper level. This is especially important for new members or a new group.

3. If the outside issue is related to something happening in group. Forexample, if a man is having difficulty with intimacy in the group, he might discussintimacy issues in his marriage.

4. If sharing the issue with the group constitutes an interpersonalchallenge for the person, so it is really interactive work. For example, suppose awoman has difficulty asking for emotional support, and she needs help with an outsideissue. Then talking to the group about this issue will bring up her difficulty withsupport so it can be worked on interactively.

Initiating Interactive Work

In keeping with the Gestalt emphasis on responsibility, encourage groupmembers to initiate interactive work themselves. There are two general ways for a clientto do this:

(1) Express her reactions in the moment to an event in group orto something another group member said or did.

(2) Bring up work that relates to previous meetings or longer termissues, especially feelings toward another member, or concerns about theirrelationship, or issues with the group-as-a-whole. Encourage clients to reflect on whatwork needs to be done on a given night, and come to group with an idea of what toinitiate.

Ways of Initiating.To be more specific, there are five useful waysto begin interactive work. A group member can:

1. Talk about what he is experiencing in the moment. This providespractice in awareness and can lead to any of the other possibilities below.

2. Bring up an issue with someone in group or with the leader–areaction or feeling toward that person. This typically leads to a dialogue between the twopeople.

3. Reach out to someone in group or to the leader–to get to know herbetter or to become closer to her. Emphasize that clients don’t need to have an”issue” with someone to initiate work on the relationship. Group memberssometimes think they can initiate interactive work only when they have a problem withsomeone. In fact, they can also initiate work with people they like as a way of becomingcloser. This often brings up issues people have about contact, intimacy, or reaching outto others. A good way to begin such work is for one person to tell the other what he likesabout her.

4. Bring up an issue with the group-as-a-whole. This could be somethinghappening in the moment, such as feeling close to the group or angry at the group. Itcould also be a longer standing issue, such as feeling left out of the group or perceivingcliques in the group.

5. Ask for feedback from someone or from the group as a whole. Thisfeedback could revolve around a specific issue, such as a member wanting to know if peoplefeel intimidated by him. Or it could concern something general such as a client wanting toknow how other members are responding to him. This is a common question for new members.

It helps to spell out these possibilities so members can takeresponsibility for initiating interactive work.

Ways of Relating

To further clarify the interpersonal norm, let’s look at fourdifferent ways that one group member can relate to another.

1. Facilitation. A client attempts to help another group member(without becoming personally involved, as a group leader might) by asking questions,making interpretations, giving advice, and making suggestions.

Facilitating can occasionally be useful in a group if the personreceiving it really wants it at the time. Group members with low self-esteem can benefitfrom discovering that their facilitations are really helpful to others. Facilitation canalso be valuable when it is experienced as a sign of caring; this is often more importantthan the content of the help. However, if the client doesn’t want facilitation ordoesn’t find it helpful, it can be experienced as intrusive, controlling, orinsensitive. Especially if the person offering it can’t let go when it isn’treceived. In this case, you may want to work with the person offering the facilitation onhis reason for needing to give it or his lack of sensitivity to other people’s needs.

The danger of a facilitation is that it can hide the real feelings ofthe person offering the help. Sometimes a facilitation simply comes from a desire to help,but other feelings or agendas may also be at work. For example, Stan makes aninterpretation about a woman’s anger that sounds plausible, but she is put off by it.On further exploration it turns out that Stan has felt hurt by her anger in the past, andhis interpretation was an attempt to get back at her. It is especially important toprevent a client from regularly using facilitations to avoid dealing with his own feelingsand issues. In this case, you can turn a facilitation back to the person by asking,

“What are you feeling toward (member) right now?” or

“Is there anything coming up for you that prompted you to offerthat interpretation (question, etc.)?”

Some methods of group therapy encourage facilitations in the form ofinterpretations. Ormont (1992) calls this “bridging” and values the fact thatgroup members become more involved with each other than if interpretations come only fromthe therapist. While this is certainly true, I think it is more valuable to encouragegroup members to get directly involved with each other through giving feeling responses.Otherwise they can hide their own feelings behind interpretations of others.

2. Empathy and Identification. These are ways of responding in aparallel way to another person, resonating with the person. For example, suppose Marysays, “I feel sad because it seems that I don’t belong in this group.” (a)Empathy means feeling some of Mary’s sadness in resonance with her. This might beexpressed as follows: “I really feel what you’re going through.” (b)Identification means knowing what it is like to feel what Mary is feeling you have had asimilar experience or struggled with the same issue. This might be expressed as: “Ifeel that way at work sometimes. It’s a real bummer.”

Empathy and identification play an important role in promoting caring,vulnerability, and group cohesiveness. They help connect people with each other andpromote a sense of safety in the group. People also learn from each other’s issuesthrough identification. As one person is working on an issue, others should be encouragedto notice how the work resonates with them. They can gain valuable insight into themselvesby paying attention to their reactions. In addition, if one person has a powerfulexperience of access, this may trigger other group members into accessing their own deepermaterial. Then they can each work on accessing the feelings that were brought up. However,if you are working with a group of more disturbed clients with fragile defenses, thisprocess of contagion can be dangerous and chaotic because they may not be able to holdtheir feelings until they can get the leader’s attention. Then you must help themlearn more effective defenses and ways to contain their feelings so that the groupdoesn’t get out of hand.

Empathy and identification can also be used to avoid confrontation ordifferences. Watch for clients relating to others only through resonating with theirfeelings and never by expressing their own direct feeling responses.

3. Perception. This means talking about one’s view orunderstanding of another person. For example, as a response to Mary, “It seemslike you keep yourself from being part of the group.” A perception containselements of both facilitation and feeling response. It can be useful as feedback, but makesure the person giving the perception isn’t using it to avoid a feeling response.People often state perceptions as if they were feelings. For example, “I feel likeyou keep yourself from being part of the group.” Make a clear distinction betweenperceptions and feelings, and ask for the person’s feeling response when that iscalled for. For example, you might say: “That’s your perception about Mary.How do you feel toward her?” For the most part, clients should be talking aboutthemselves, not the other person. Feedback in the form of perceptions of others iscertainly a valid way of responding, but not if it is used to avoid expressing one’sown reactions. When you sense that there is something peculiar about the way a personexpresses a perception, ask him to explore his feeling response to the other. Ofteninstead of just a neutral observation, there is a hidden feeling response.

4. Feeling Response. This means expressing an emotional reactionto the other person. This could be a positive reaction, such as caring, appreciation, orsupport. For example, as a response to Mary, “I want you to belong here. I careabout you.” Notice that this is not the same as empathy or identification. Herethe person is expressing his emotional response to Mary, not how he feels similar to her.Alternatively, it could be a negative reaction such as anger or judgment. For example,to Mary: “I’m annoyed. There you go again feeling sorry for yourself.”It also could involve wide variety of other emotions, including envy, fear, shock,amusement, admiration, etc. In an interactive group, I emphasize feeling responses becausethey lead directly to interactive work.

Fostering Interactive Work

Interactive work tends to build on itself. As group members begin totalk about their emotional reactions to each other, this generates additional emotionalreactions and therefore provides more interpersonal material to work with. This positivesnowball effect leads the group members more and more deeply into interpersonal work witheach other. On the other hand, if group members emphasize individual work on outsideissues and ignore their feelings toward each other, then over time, they have fewerfeeling reactions to work with because the focus of the group has shifted elsewhere. Ifthis happens, encourage the group members to return to interacting with each other. Ifthey claim that they don’t have many feelings toward each other to work with, this isboth because they are ignoring their feelings toward each other because of the shift awayfrom interaction. There are always some feelings among group members to work with, andonce the group shifts back to interactive work, the interpersonal material will graduallyincrease.

Here are some suggestions for encouraging group members to dointeractive work:

1. Ask for it explicitly. When a group has focused on outside issuesfor a while, it can be helpful to point this out and suggest that the next work beinteractive. In the early stages of a group, you can teach group members about initiatinginteractive work using a simple exercise as follows: Suggest that each member think of oneother person in the group toward whom she has feelings which haven’t yet beenexpressed. Then ask someone to volunteer to begin by expressing these feelings to theperson she picked. If appropriate, allow this to expand into an interaction between thetwo people. Then ask for another volunteer, and so on.

2. Set up interactive work in individual sessions (if you are seeing aclient in individual therapy as well). This is especially useful during the first fewmonths of a person’s being in group. In the safe setting of an individual sessionwhere only you will hear them, clients are often able to access feelings towards others inthe group that don’t come up in the more threatening group setting. In the session,ask the client to consider each group member in turn and tell you her initial impressionsor feelings towards that member. After she has described her feelings, explain that shecould bring out these feelings in group as a way of initiating interactive work. If she istoo frightened to do this, you can work with her on her fears to help prepare her to dothe work. In any case, the client should be allowed to choose when she is ready to tacklethis work.

3. Encourage people to explore their blocks. If you notice that peopleseem to be avoiding interactive work, you can ask them to explore what’s behind theirreluctance. They might discover that they are afraid of stirring up conflict or beingjudged or dealing with intimacy issues. Make it clear that they can do this explorationwithout having to initiate the work that they are afraid of. They don’t even have todivulge what it is. If this provides enough freedom for them to explore what is stoppingthem, they are usually quite willing to initiate the work.

4. Point out emotional reactions. Be on the lookout for signs of anysubtle emotional reaction that one member may be having toward another or toward thegroup. If you point it out at the moment and ask him about what he is feeling, this oftengets things rolling. For example, suppose the group is discussing a topic and younotice that someone rolls her eyes in response to Mary’s comment. You can say,”I noticed you had a reaction just then to what Mary was saying. What was it?”

Moving from Outside to Interactive Work

In most cases, even when it is appropriate for a client to bring up anoutside issue, it is helpful to focus your facilitation on how the client is relating tothe group (and they to him) rather than on the issue itself. It is surprising how oftenwhat looks like purely outside work has important interpersonal ramifications. When aperson is sharing an outside issue, there are a number of interventions that can move thework in a more interactive direction:

1. Ask the group member if he has that issue with anyone in group. Forexample, suppose Hank is saying that he gets intimidated by certain kinds of women. Youcan ask him if he has felt intimidated by any of the women in the group. Or if youhave noticed this issue in group, point it out. For example, you could mention thatHank seemed to be intimidated by a certain woman in an earlier group meeting.

2. Ask the person to notice when he has that reaction in group andbring it up right away. For example, ask Hank to pay attention to his interactions withthe women in the group and notice if he feels intimidated at any point.

3. If the issue involves difficulties in reaching out or connectingwith others, suggest that the member pick someone in group that he would like to connectwith. For example, a man talks about how isolated and lonely he feels and how difficultit is for him to make friends. In exploring this, it emerges that he is frightened toinitiate connections with people for fear they won’t be interested in him. You couldsuggest that he pick someone in the group that he would like to get to know better (orbecome closer to) and experiment with connecting with that person. Of course, even pickingsomeone and revealing this to the group may be terrifying, but he doesn’t actuallyhave to do this in order to benefit from this work. Even if he only gets as far as feelingthe fear, you can then work with him on accessing the fear and learning more about it. Ifhe is then able to reach out to the person, you can work with him on the way he expresseshimself or the way he reacts to the person’s response.

4. While a client is sharing an outside issue, it is often useful towork with him on becoming more present while talking about it. If someone talks about anemotional issue in a matter-of-fact voice or as an entertaining story, you can help him toidentify the underlying feelings and to express them to the group. Once this brings himmore into contact with himself and the group, he is likely to explore the issue moredeeply or interact with someone.

5. Ask how it feels to be sharing this issue with the group. How is theclient feeling about the way the group is responding to him? Is it meeting his needs? Thisfocuses the person on his interactive process with the group rather than only on thecontent of the outside issue. For example, the client might say, “Oh, it’s agreat relief to be saying this, because I can see that people don’t think I’mridiculous.” This reveals a fear he was struggling with. On the other hand, if theclient’s response indicates that he is self-absorbed and out of contact with thegroup, you can explore this with him.

6. Ask what the group member needs or wants from the group in sharingthe issue. Typically a person will need caring of some kind—empathy, compassion,identification, appreciation, acceptance, or understanding. He may also need advice,permission, or encouragement. Often people have a hard time identifying what they need, soyou may need to suggest possible alternatives. The process of struggling to identify needscan be very helpful. It also prevents the person from just telling stories without makingcontact with the group. For example, Melissa shared with the group that her daughterwas having a baby as a single mother and Melissa was excited about helping her butdidn’t want to be too intrusive. When I asked Melissa what she wanted from the groupin sharing this, she realized that it was very important for her to tell the group thatshe was excited and proud. The group knew that Melissa had been born out of wedlock andwas made to feel tremendous shame about this as a child. She knew that the group wouldunderstand how important it was that she didn’t feel any shame about herdaughter’s plans.

Once the person’s needs are identified, you can explore thedynamics between the person and the group: (a) Is the group meeting the person’sneeds? (b) If so, is she taking it in? (c) Is she sharing in such a way as to keep thegroup from meeting her needs? She may be boring, out of contact, playing victim, etc. (d)Is she afraid to let the group know what she needs? Does she think she doesn’tdeserve it, or that she will be shamed for having needs?

7. Have the client pick one group member to share the outside issuewith, and explore the emotional contact between them. This is another way to explore thedynamics of the sharing, but in this case, there is a greater opportunity for the other torespond (since it isn’t a whole group), and this makes the dynamics clearer andeasier to work with. For example, it highlights the degree to which the client actuallymakes himself vulnerable to the other. And if the other person responds in a caring way,how does the client deal with that?

Conclusions

The interpersonal level of group work provides a powerful medium fortherapeutic change. This article discusses various ways of fostering interpersonal groupnorms and moving work in an interpersonal direction.

References

Earley, J. (1996). Healing through relationship in an interactive Gestalt group. InFeder, B. and R. Ronall ed. A Living Legacy of Fritz and Laura Perls: Contemporary CaseStudies.

Feder, B. and R. Ronall ed. (1980). Beyond the Hot Seat: Gestalt Approaches to Group.New York: Brunner/Mazel.

Handlon, J. H. and Fredericson, I. (1998). What changes the individual in Gestaltgroups? Gestalt Review, 2: 275-294.

Harman, R. (1984). Recent developments in Gestalt group therapy. InternationalJournal of Group Psychotherapy. 34: 473-483.

Melnick, J. (1980). Gestalt group process therapy. Gestalt Journal. 3:86-96.

Ormont, L. (1990). The Group Therapy Experience. New York: St.Martin’s.

Zinker, J. (1977). Creative Process in Gestalt Therapy. New York: Brunner/Mazel.

Yalom, I. (1995). The Theory and Practice of Group Psychotherapy, Fourth ed. NewYork: Basic Books.