Changes in Group Membership

Most groups will eventually face the challenge of changing membership. In open groups, people may be joining or leaving the group at any time. Closed groups may have a longer period of stable membership (though people do sometimes drop out), though these groups typically do accept new members at predetermined intervals. The only kind of group that never has to integrate newcomers is a truly time-limited group where members terminate at the end, rather than rolling over into a "new" time-limited group.

Changing group composition through the addition and subtraction of members can be disruptive and distressing. How many clients - perhaps especially those referred for group therapy - have issues with relationships, attachment, abandonment, etc.? And while group work in general is likely to bring out all of these issues, they are most strongly present during hellos and goodbyes.

Goodbyes are hard because they obviously signify a loss. People who are staying in the group may feel abandoned by those leaving (especially if they have abandonment issues). If someone is leaving because they no longer need the group, remaining members may compare and feel bad about their own level of functioning, feel jealous, etc. If someone has had to leave the group because they were not a good fit or unable to participate appropriately, or needed a different level of care, people may worry that they may somehow "mess up" and get "kicked out." Whatever the reason someone leaves, everyone is likely to think about the nature of the connection between them, and what happens to that bond if they are no longer together. Some may wonder whether the ending of the relationship negates its value from the beginning. Then, the remaining members may worry about how the loss will affect group dynamics. Who will take on the roles played by the person who left? Will the group function as effectively? And so on.

Hellos are hard because they can trigger fears of the unknown, as well as personal insecurities (which may, again, be particularly present in those referred for group therapy). People may wonder whether the new person will like them, and whether other group members may like the new person better. They worry how their role in the group will change, and how the overall group dynamic will change. Often, people assume the worst, and may even act as if it were true, disrupting the whole group dynamic. Some people may make assumptions about, or even judge the new person as well. And, of course, the new person is coming in with their own fears about what type of people will be in the group, whether they will fit in, be liked, etc. The group may revert to an earlier stage of group development as it tries to find a new equilibrium with this change in membership.

While both hellos and goodbyes are hard, potentially emotional transitions, they are also incredibly rich opportunities for therapeutic growth, if the group can tolerate them enough to continue doing the work at hand. Sometimes simply naming the fact that it is hard and emotional can allow the work to proceed. Other times, hello and goodbye rituals may facilitate the process (and processing).

Also bear in mind that these issue come up not only for therapy groups, but for all kinds of groups - classes, clubs, teams...even treatment teams. While the challenges may not become a manifest topic addressed by these groups, it helps to consider what members may be experiencing when membership changes. Expect some bumps in the road, and perhaps a period reduced cohesion and productivity as the group tries to sort out everything going on under the surface. However, just as the original group established itself as a unit, we trust that the same thing will happen again.

Do you have any hello or goodbye rituals that you use to ease the way during membership transitions, in any kind of group?

Olympic Gymnastics: An Illustration of the Double-Bind

Olympic gymnastics has apparently had a rule change in recent years, about who qualifies for the individual all-around competition. You've probably heard all about it, because it caused no small amount of angst at this week's qualification rounds. The rule states that the top 24 scoring athletes qualify for finals BUT only two can qualify from each country.
This quota system caused heart-break when American women scored 2nd, 3rd, and 4th overall - but the 4th-place finisher, world champion Jordyn Wieber, did not qualify for the finals, because two of her teammates scored higher. And, while the US team was the highest scoring, and closest scoring group of teammates this happened to, it was by no means the only team who would had three of the top 24 scores: Russia's Anastasia Grishina, Great Britain's Jennifer Pinches, and China's Jinnan Yao were similarly disqualified.

Plenty of pundit are talking about the injustice of this rule, arguing that the top 24 scores should advance, regardless of country. I don't need to say what's already being said. What interests me more (as a therapist), is the position the social dynamics the rule creates for the women on a given team. Think about it: You're going through the qualifying round, and as a member of a 5-person team, you obviously want your teammates to do well - after all, qualification is based on total team score. However, as an individual with aspirations for the individual all-around competition, you can't want your teammates to do that well. You need them to do pretty well, but not better than you do (or, at least, have no more than one of them perform better than you!).

This is what psychological theorists might call a double bind: technically speaking, a situation in which someone faces two conflicting demands, such that, by meeting one demand, the person automatically fails at meeting the other.
Here's how I see it at work in women's gymnastics. Each country can choose only 5 women for its squad, to compete in the team all-around, the individual all-around, and the individual competitions for each apparatus (there are 4 for women). Since 4 of the 5 women have to compete for the team on each apparatus, the vast majority have to be all-around athletes, rather than "specialists" (e.g., the US has one specialist, a vaulter). As all of these all-around athletes are competing on each apparatus in the qualifying round, they are each trying to do their best (1) to get their team into the team finals, (2) to get into the individual all-around finals, and (3) to get into the event finals for each apparatus they're strong on. For the most part, these goals are consistent with one another: if every teammate does her best on each routine, both team and individual qualifying goals are met. The bind comes in when you pit teammates against each other for two slots in the individual all-around. Now gymnasts on strong teams are caught between wanting their teammates to do their best (to reach the team goal, and, well, because they're teammates and should want the best for each other), and needing their teammates to make mistakes, as a criterion for individual advancement. Doing your best may not matter unless your teammate messes up.

That's an icky situation to be in (and even worse when the "women" in question are really just teenage girls, thrown out onto a world stage and weighed down by the pressure and expectations of an entire country - not to mention their own drive and ambition, and the umpteen years they and their families have devoted to the dream of olympic victory). It has to create strain, intrapsychically, and interpersonally on the team. It takes great strength of character to weather that kind of strain and manage not to hate each other by the end. My heart goes out to all of them.
Let's do our best to do away with this kind of double-bind, wherever it appears. Life is hard enough. Let's try not to make it impossible.

In(ter)dependence Day

Today is Independence Day in the United States. It celebrates the country's separation from Britain - its existance as an "independent" nation. Many countries have similar holidays, at various times during the year, because many people and cultures see independence as something to celebrate (and yes, also because of widespread colonialism that preceded independence). We like getting to decide for ourselves how we want to structure and govern our countries, to feel like we at least have a say in decisions that affect us. Nobody likes "taxation without representation!"

Independence is also something that is important to many people on a personal level. Particularly in the Western world, independence - both emotional and financial - is held up as an ideal toward which we are encouraged to strive. Unfortunately, striving for the elusive ideal of independence can cause dissatisfaction and unhappiness for too many people, who feel worse about themselves because of their (normal) perceived dependence on others for emotional or material support. As a result, independence and dependence are often themes in therapy - for example, as a motivation for change, as a loss associated with symptoms, as a contributor to stress or (low) self-esteem.

Now don't get me wrong - there is certainly some benefit to feeling independent. It provides a sense of competence and mastery that contribute to ego strength, and a sense of agency and engagement with life that keeps us alert and motivated. It facilitates child development, and improves functioning in old age. However, that beneficial feeling of independence can occur without ever meeting the independent ideal - the expectation that we will be able to function independently in every facet of life.

In fact, our inability to reach to ideal, even when we're feeling independent, can detract from our experience of independence - we minimize or dismiss our achievements because we are still short of the ideal. The solution? It's not, as many clients suppose, to redouble our efforts toward the ideal. Instead, the solution is to change our ideal.

Humans were not created to be "independent." We are social animals, and it's normal to turn to other humans for help and support. In fact, relying on each other is healthier than striving for complete and total independence. We are designed to be interdependent. That means that we depend upon each other in a social group, and wider society, to share both responsibilities and benefits. After all, most of us have areas of life that are a struggle, and/or go through periods of struggle in our lives. However, "depending" on others in this way is not "dependence" because it is mutual - we also help sustain others in areas and times that are not a struggle for us. We enrich each other's lives, and that is as it should be.

I had this conversation with a group I was running last week. They were adament that they should not "burden" anyone in their lives with their problems, and that the best thing they could do for loved ones would be to pretend everything is fine. I suggested that this was unfair to others - and not selfless, as they imagined. I encouraged them to consider the possibility that other people they care about actually want to care about and support them in return...and that by refusing to accept support, they were depriving their loved ones of the chance to do so.

Yes, relying on others can feel vulnerable, and sometimes lead to disappointment. However, I contend that we also feel vulnerable and disappointed when we're striving for an unreachable ideal. If we choose to strive for interdependence rather than independence, we may just discover that the vulnerability and disappointment are fleeting, the sense of connection sustains us, and the mutual support and "dependence" enriches our lives.

After all, when it comes down to it, even our countries are not truly "independent" - for example, look how strongly our economies have turned out to depend upon other countries' financial condition! Therefore, given our reliance on one another, let's forego Independence Day, and celebrate Interdependence Day instead. Any takers?

Talk It Out, Don't Act It Out

Emotions, both positive and negative, are an inevitable part of life. We all have them, for a very good reason: emotions give us information about things that are important to us. For example, fear is supposed to warn us of danger; anger tells us our needs, rights or preferences have been violated; and sadness indicates loss. Unfortunately, many people have learned to tune out, turn off, or otherwise ignore their feelings. As a result, their feelings may end up coming out in less helpful ways, either internal (anxiety, depression), or external (maladaptive behavior). 

There are several reasons clients may "act out" their feelings instead of acknowledging, expressing, and processing them. Most either haven't learned how to recognize and identify emotions (this is called alexithymia), or have been learned/been taught that emotions (especially negative emotions) are bad or dangerous. However, acting feelings out tends to be dissatisfying for the client and whomever they're communicating with through their behavior: behavior is an imprecise way of communicating feelings that causes misunderstandings and doesn't move toward any form of resolution.

The solution, of course, is to learn how to identify and express one's emotions more directly. (Easier said than done, of course). Here are some steps for dealing with emotions when they happen in a relational context (i.e., when you might otherwise act out your feelings, leaving the other person to translate your meaning).

Step 1 is to identify what you're feeling - everything you're feeling, because most of the time, emotions come layered or mixed together. I will write other posts on identifying emotions. Suffice it to say that it involves scanning physical sensations, thoughts, and impulses, and connecting them with feeling words based on category and intensity (e.g., anger vs. sadness, rage vs. irritation). 

 

Step 2 is to balance or regulate any emotions that are out of proportion to the situation at hand (e.g., to reevaluate our assumptions about someone else's motives to avoid overreacting). It's important to remember that feelings are not facts - for example, just because we feel anxious doesn't mean there is danger. It's important to sort the two out before we try to communicate our feelings.

Step 3 is to describe the full spectrum of emotions accurately, and without adding judgments, blaming, or assuming anything about the other person's feelings or intentions, or presenting our feelings as facts. If you need to reference someone else's behavior, stick to the facts. For example: "I felt frustrated and confused when you didn't call, and those feelings made me anxious about our relationship." (This is what is often called an "I statement" because you're focusing on your own experience, and beginning with "I feel..."). 

Step 4 is to make room for the other person's feelings - yes, they are entitled to whatever emotions they have as well. This can be especially challenging if the other person takes on a defensive or blaming posture, or isn't as skilled in emotional expression. 

Step 5 is to request the response you would like from the other person. If you just want to be heard, tell them you want them to understand (rather than change) how you feel. If you want them to change their behavior in some way, be specific, direct, and concrete (again, leaving out judgments and assumptions about intent). If there is something you want them to do to "fix" your feelings, be clear about that, too. 

Step 6 is to thank them for listening, or responding as you've requested, and (if/when you're ready) see if there is something they need you to do, hear, or say.

Are there other strategies you use to identify and express emotions? What makes this process difficult?

Systems at Work

A dominant theoretical foundation of social work is Systems Theory, which uses biological or ecological systems as a metaphor for understanding human behavior. As you may remember (from biology, or from human behavior courses), a system is made up of interdependent parts that adapt to each other in order to maintain equilibrium - a state of balance, or the status quo.

We can gain insight into human behavior by considering how this concept applies to different levels of human functioning:

• An individual person functions as a system, with biological, psychological, emotional, cognitive, and spiritual "parts" of the self interact to maintain a stable ego state.
• Families (of all shapes and sizes) function as systems, with each member influencing and influenced by the others, functioning interdependently to maintain the family's identity, meet its material needs, and function in relation to the outside world.
• Other small groups also function as systems, including therapy groups, clubs, committees, etc. The members function interdependently and adapt to one another in order to effectively carry out the group's purpose.
• Organizations function as systems, with interplay between individual staff, between different teams and departments, between management and employees, with funding sources and outside constituents, all in the service of fulfilling the organization's mission.
• Communities function as systems, with each of the previous levels of systems existing within communities as parts that interact to maintain the overall functioning of the community.
• Societies, cultures, states and nations are also systems, with each of the preceding levels of systems functioning as pieces thereof.

We are most likely to intentionally draw on systems theory if we're practicing macro social work, focusing on the systemic functioning of the community, society, state, or nation; doing family therapy, focusing on the functioning of a family system; or doing group therapy, establishing and maintaining the group as a functioning system. We're also likely to notice how we fit into our organizations as systems. In contrast, it can be easy to forget about systems when we're doing individual therapy.

However, perhaps especially in individual therapy, it's a mistake not to think about systems. In the macro, family, or group work, we intervene with an entire system. However, with individual work, we intervene with one person, as both an individual system, and part of larger systems (family, group, organization, community). It behooves us to remember that systems strive to maintain equilibrium, and therapy often functions to destabilize the system's balance. When we work with someone to change their thinking, there are going to be ripple effects in their emotions and behavior. When our work with a client changes their behavior, it's going to effect the other systems of which they are a part. Sometimes these ripples facilitate and expand the changes clients are trying to make. Sometimes, however, there is a push-back from other parts of a system as the system seeks balance through the status quo. Therefore, when our efforts in individual therapy aren't leading to the desired effects, we have to consider what other forces might be operating to maintain our client's existing role in the functioning of a system.

How do you think about systems and their role in your work? What level(s) of systems do you work with?

Football as Metaphor

Here in the U.S., we're in the midst of football playoffs, with the Super Bowl only a few weeks away. Even people who aren't that interested in football are beginning to pay attention (especially if their city's team is still playing). Come Super Bowl Sunday, betting pools will have been set up at offices across the country, and everyone will be talking about the game...or the commercials!

So, what's with our obsession with football? 

Freud would have a field day with football. Think about it: it's basically socially-sanctioned aggression governed by (somewhat arbitrary and hard to follow) rules. Thus, football can be seen as a vivid illustration of the ego's management of the id's aggressive drive via the superego's code of conduct....

But that may be a reach. Perhaps it just boils down to the emphasis our culture places on competition. From an early age, we learn to compare ourselves to one another. Initially, comparison focuses only on how we are the same as or different from each other (peer pressure usually encourages sameness, and creates distress over difference). However, it's not long before comparison becomes more about ranking who is better - smarter, stronger, taller, faster. In other words, comparison becomes competition. 

Childhood is full of opportunities for competition (e.g., grades, school sports, etc.), but competition is more oblique in adulthood. We struggle to measure our worth in comparison to each other using things like money, cars, and other status symbols, or clubs, activities, and good deeds. However, none of these things can clearly determine who is "best." That lack of clarity may be unsatisfying, or even anxiety-provoking. 

Enter professional sports, where adult competition results in clear winners and losers. However, football is different from other sports, at least in the U.S., in that the other sports structure their play-offs around multi-game series, while football is single-elimination. A multi-game series, where the title goes to whichever team wins the more games overall, rather than to the winner of a single game, acknowledges the reality that people have good days and bad days, and that being "best" is more about an average over time rather than a single performance. That seems more like reality to me (life is messy, we all vary in how well we do things, and success is more about consistency over time), but also more anxiety-provoking and less satisfying than the illusion of a clear winner arising from a single contest.

Really, neither system of determining a "winner" tends to be satisfying in the long run: the next season arrives before you know it, and everyone has to prove themselves all over again. I think that is a good parallel for real life - if we structure our lives around competition, we never get to our desired end-point, because there's always another opponent, and there's usually someone who's better that we are in some way. 

Instead, life tends to be more satisfying when we structure it around connection rather than competition. It is relationships rather than comparisons with one another that make life meaningful. After all, while you can never rest on your laurels as the best ____, you can rest in the knowledge that you are cared for and about. 

So, come Super Bowl Sunday, regardless of which team you're rooting for, I'd encourage you to focus at least as much on the people around you as the ones on the television screen. Whatever the game's outcome, if you have connection and companionship, you've won!

Sticks and Stones, or 3 Strategies for Facing Judgment

Most people have a tendency to (1) judge each other (and themselves), and (2) be sensitive to the judgments of others. Our struggle to maintain a positive self-image in the face of judgment is captured in childhood rhymes: "Sticks and stones can break my bones, but words can never hurt me" or "I'm rubber and you're glue. Whatever you say bounces off me and sticks to you."

Most of us know that saying these things doesn't stop judgmental comments from hurting. We all have areas of insecurity, where judgments play into our fears of inadequacy - emotional Achilles' heels. There are also often specific people whose judgments hit us harder, because we care more about their opinions and approval. Sometimes these are key peers, but often they are family members. Commonly, the people whose opinions matter most to us make, or have made, judgments that contribute to/hit upon areas of insecurity...a pattern that makes these judgments hurt more, and exacerbates existing insecurities.

This pattern is also another reason why family holiday gatherings can be triggering for clients (and perhaps a few of us as well). "Well-meaning" family members may ask loaded question, make subtle (or not-so-subtle) criticisms or "suggestions" that leave a person feeling flawed, inadequate, and exposed. Therapists everywhere lament the set-backs clients may experience as a result. 

Instead of repairing the damage after the fact, it behooves us and our clients to prepare them as much as possible ahead of time if/when they're likely to face criticism from important people (e.g., their families). 

One strategy is inoculation - basically, reducing the impact of criticism/judgment by exposing oneself to the likely content ahead of time. Through repetition, the criticism starts to lose its impact and become "just words." Thus, if you know that your mother is going to ask questions and make comments about your relationship status, you can prepare by rehearsing, visualizing, or writing about the possible things she may say. While it's impossible to predict and prepare for all possible criticisms, many of our areas of insecurity are criticisms we have faced in the past, and are therefore quite likely to face again.

While inoculation allows you to prepare ahead of time to reduce the emotional impact of criticism, a second strategy is useful for responding to criticism in the moment. It's called fogging, though I find that name a bit...obscure. The idea is that the ways we tend to try to defend ourselves in the face of criticism may make the situation worse instead of better, because in the process we engage with the other person around the criticism, making it stronger and longer lasting than a single comment. Instead, fogging involves not engaging in defensiveness or debate around the criticism, thereby keeping it short and hopefully discouraging further criticism. How? Some strategies include: Acknowledging the other person's perspective ("I see how you might think that"); Agreeing in principle ("You may be right"); Thanking the person for the feedback without responding to its content ("Thank you for the suggestion"); or Delaying ("I'll be sure to think about that").

Another strategy that can be used during and immediately after the criticism comes from CBT: identifying cognitive distortions in the criticism (e.g., black and white thinking - "You always/never_____"), and in our response to it (e.g., magnifying or catastrophizing), and repeating to ourselves more balanced thinking and/or affirmations (e.g., "One person's opinion doesn't have to become my reality").

What strategies do you suggest to clients (or use yourself) to prepare for and face criticism or judgment from others?