by Marc G. Schramm, Psy.D., C.G.P.
A correspondent recently provided a scenario and asked for my thoughts about it. He presents the case of an outpatient group psychotherapy practice that holds a Holiday Open House each year, to which it invites its present and former clients. This open house is clearly described to everyone as a social get-together, and significant others are also invited. My correspondent asks if I think this is a boundary violation, and what impact the open house would have on the therapeutic relationship. He also wonders what I would think if a limited amount of alcohol is served.
Since one function of the group therapist is to establish and maintain group boundaries, the therapist in question would only be guilty of a boundary violation if the open house flouts his/her rules. The therapist might argue that in having the open-house yearly, it is a built-in part of the groups' boundaries. If all new members are aware of this when they start group, the therapist would at least technically have a point. But the boundaries of individual members are another matter.
Therapeutic relationships can be affected by a number of factors. Does the therapist behave differently when at the open-house? Does he/she step out of the therapist role and adopt a different persona? Is there more self-revelation? Such changes can significantly alter therapeutic relationships. But lack of such changes may disappoint the expectations group members have of the social context.
Therapeutic relationships between group members are also at stake. In support groups, yearly social gatherings *might* enhance the supportive factors primary in such groups. But in psychotherapy groups, additional therapeutic factors are present. A therapy group provides a safe-space, a holding environment, where the standard rules of social engagement do not apply. A sense of safety is built up so that members can let down their guard.
The open-house that was described is bound to lead to anxiety for many group members over how to behave around others. The presence of former members creates imbalance. The presence of members from other groups can incite competitiveness and insecurity. And a group member could hardly help but wonder what the significant-others may have been told about him/her.
Safety and confidentiality may well be the factors at greatest risk. Perhaps the group leader instructed everyone to respect confidentiality. In the context of a social event, such strictures may well add to rather than reduce members' sense of awkwardness. And how does the group leader monitor (much less manage) interactions for inappropriate comments and queries by attendees?
Some members, sensing potential difficulties, may not want to attend. They must either attend unwillingly, or defy the group norm and risk being scapegoated. Variations of these risks do of course exist in any psychotherapy group, but within the context of a holding-environment where the process can be clearly observed and worked-through in the here-and-now of the group. Most people at the open house would not be together for any later working-through.
Serving alcohol runs the risk of putting substance abusing members in the path of temptation. Resisting the group is not easy, especially in a setting where the issue cannot be dealt with and resolved in the here-and-now. At least the alcohol is being limited, but I must admit to a lack of confidence in the therapist's ability to set limits.
I wonder about the reasons for the open house; was it first suggested by one particular group? Groups frequently test limits -- or, more accurately, the therapist. Many therapists experience pressure (sometimes more from internal than external sources) not to be a strict parent. Attempts at maintaining boundaries are often met with resistance by group members, with some therapists unable to tolerate the loss of approval they experience.
Maintaining appropriate boundaries is in fact one of the more difficult tasks facing less experienced therapists, many of whom confuse the exercise of authority with the exercise of authoritarianism. It is also worth recalling the work of Wilfred Bion: The Pairing Basic Assumption appears to be interfering with the therapeutic work group -- in this case through the intervention of the therapist.
Bion, W.R. (1955). Group dynamics -- a re-view. In: S. Scheidlinger (Ed.), Psychoanalytic Group Dynamics -- Basic Readings. New York: IUP.
Schramm, M.G. (1996). Basic Assumptions. SelfhelpMagazine.com
Schramm, M.G. (1996). No fine print-part one: The basics of a group contract. SelfhelpMagazine.com
Marc G. Schramm, Psy.D., is a Founding Certificant of the National Registry of Certified Group Psychotherapists, a clinical member of the American Group Psychotherapy Association, and President of the Tri-State Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222
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