Process-Oriented Group Psychotherapy: Dynamic Empathic Engagement For Self-Transformation

By Barbara Dewar

A psychodynamic process-focused group therapy differs from a psychoeducational group. In a psychoeducational group experience, the leader’s mandate is to give the members necessary information for a focused issue, symptom or psychopathology; the main discourse centres on the focused issue. These groups are usually short term and hold the goal of ameliorating the symptom. Psychodynamic process-focused groups use methods that support dialogue about the members’ interpersonal worlds. By articulating their interpersonal worlds, members are enriched by stronger self-identities that lead to expanding choices as to life options. The process model aims for self-transformation as constructed in relation to others. In process groups, the leader assumes the role of facilitator rather than educator. These groups often have an open-ended time commitment.

The group psychotherapy conducted by Mary Walton-Ball and Judy Bridges Farquharson follows a process model, where the interpersonal subtext springboards from the theories of psychoanalytic intersubjective literature. In the intersubjective model, the tools that lead to transformative change are the qualities of empathic listening and agreed-upon resonant attunement in the intersubjective field. Process, structure and content are redefined continually by the facilitator and members as new understandings of empathy are practiced, and in turn, as these new understandings result in transformative experiences. Empathic conceptions, as articulated by the authors of contemporary intersubjective psychoanalytic literature, emerge as a stance of listening rather than an empathy that can be described as feeling the subjective feelings of an other (Brandchaft, 1983; Beebe & Lachmann, 1992; Stolorow & Atwood, 1992; Buirski & Haglund, 2001). For intersubjective theorists, the empathic stance is introspective or self-reflective. The more encompassing, preferred term is empathic inquiry, “which includes comprehending a full range of contextual elements, such as emotional, historical, behavioral, and cognitive aspects of the patient’s unfolding experience” (Buirski & Haglund, 2001, p. 50). The goal of the present intersubjective movement is to illuminate the client’s experience and to feel the agreed-upon attunement for transformations of new meanings.

Therapists attached to Espritedu and the Esprit collective psychotherapy group, facilitated by Mary and Judy, are exploring the concept of empathy as engagement. The goal becomes a model of collaborative dialogue, which often involves holding massive amounts of tension until group members feel that they have discovered a part of themselves. With discovery, there is often a new understanding of themselves in relation to others, which can be experienced as a feeling of interconnectedness with the whole. The therapist may or may not feel a resonance with a member’s experience. If the therapist doesn’t experience a resonance, he or she may have to hold the tension until he or she understands the member’s subjective experience. A member can self-transform whether or not the facilitator experiences a resonance with the participant. What is needed is the intent by the facilitator to engage in whatever dialogue is necessary to help members discover their self-identities, often resulting in a feeling of belonging to life.

With new constructions of the concept of empathy, the role of the group facilitator changes. The intersubjective introspective empathic stance, “may involve countertransferential affects and fantasies, but the therapist deals with them reflectively (not reactively)” (Cohen, 2000, p. 97). The therapist’s affects and fantasies may not always be containable “without some felt challenge to the therapist’s relational warmth and humanity” (Cohen, 2000, p. 97). This is where the concept of empathy as engagement in the group context stretches the intersubjective notion of process, structure and content. The facilitator constructs process by mutually engaging in unclear collaborative dialogues, riding an uncertain line between reactive and reflective empathic engagement with subjective interpersonal dialogues. Being within the subjective dialogue may bring to light the vulnerabilities of the group facilitator. The content and structure are always guided by the therapeutic alliance where, unequivocally, the search is for the members’ discovery of parts of themselves that block connection with others and the whole, resulting in new life changes and choices.

Mary describes an early experience in learning the art of group facilitation: “I had to confront set ideas about the physical structure of a group space. I “expected” group members to sit on cushions on the floor. I did not think to engage in dialogue with members that experienced back problems and preferred chairs. I could say that I lacked empathy to some of the members’ needs. One hot summer day, the air conditioning broke down, making it necessary to move to a cooler location. There was not enough wall space for people to rest their backs, so we sat on chairs and, of course, felt more comfortable. Because I found it too hard to change my surroundings, as this would make me feel vulnerable, I was unable to engage these issues and I prevented a guided dialogue that was necessary for the forward movement of some group members. By admitting misattunements, I am learning to be more human and more comfortable with vulnerability. I am also learning from both the model of engagement and my mentor the deeper meaning of empathic engagement through dialogue with another, which sometimes necessitates holding tension or discomfort within groups to work through a feeling exchange. This exchange takes its own time and is always in process within groups.”

Barbara describes an experience of empathic engagement where she had to hold an error in her judgement toward a group member:

“I felt reactive in showing annoyance to a group member who wore wet boots into the group room. I suggested that he leave his boots outside and he did so, but was visibly upset and silent. Both the group participant and I were upset all week. I knew that I was misattuned and needed to hear what he had to communicate. The following week, he shared that his boots were very expensive and he had little means to buy another pair if they were stolen. I apologized for my annoyance and for not drawing out his feelings. He then suggested that he bring his boots in and put paper towel underneath them. Self-transformation happened for both of us, where the member found his voice and I confronted my arrogance.”

Unlike a psychoeducational group that discusses a single issue, a process group focuses on any given interpersonal issue that is at hand for its members. Intersubjective psychoanalytic literature introduced the notion of empathic inquiry as a stance that encouraged relational self-transformations. Although the intersubjective movement holds the goal of resonant attunement as necessary for change, empathy becomes less about the automatic and conscious sympathetic connection with the feelings of others and more about qualities attached to listening. Modelling empathy as engagement is now being explored as the goal for members to absorb. This modelling becomes the tool that can be used to achieve clearer communications with others. Empathic engagement between facilitator and group members then becomes a form of mentorship, where members can translate empathic collaborative dialogue for effective relational communications in their everyday lives. In process group therapy based on the empathic engagement model, all participants have to work through the tensions that are inherent in all relationships. Difficulties can ensue while trying to balance, when to comfort the pain of a struggle (sympathy), often based on reaction, and when to stay on the path of empathic engagement using reflection, so that group members can discover parts of their self-identities as they engage with others. The facilitator’s self-disclosures, either mutually participating in the subjective experience or staying in a reflective mode, is a delicate balance that is only broken as the process of empathic engagement dictates.

Kohut (1959, 1977), the founder of self psychology, describes the empathic therapist as one who shores up the archaic self-development of a client, who is defined as being in a state of developmental arrest. In the self psychology model, the therapist is an influence on the member and must admit any misattunements. Process by empathic engagement in group psychotherapy stretches beyond influence by empathic attunement to support a model of collaborative dialogue for continual self-discoveries in relation to others, encouraging a feeling of solid belonging to the processes of life.