Of the gifts that we offer recovering addicts in treatment, perhaps the most valuable is compassion. This gift is amplified when the compassion emerges from the therapy group, and is most powerful when the compassion is offered spontaneously, with honesty and immediacy. I suggest that to the extent that group therapists maintain a sense of humility, they need to be attuned to the group conscience as a reliable guide to offering compassion to group members.
Jeffrey D. Roth, MD
While compassion requires us to be able to identify with each member of our group, conflict may strain our capacity to identify. Such conflict may result from a judgment arising within us in response to what a group member shares, or we may find ourselves taking sides in a conflict between group members or factions of the group.
An example of a typical judgment would occur with the therapist's moral condemnation of a group member who speaks of abusing another person while intoxicated. Particularly if the therapist has had the experience of having been abused, the pressure to respond with outrage at the group member rather than compassion for the group may be enormous.
An example of the therapist taking sides might occur in a mixed-gender group where the men and women in the group line up on opposite sides of a conflict about a woman's decision to divorce her addict husband. The therapist who recently has experienced a bitter divorce may be hard pressed not to become embroiled in the debate.
Shared support role
One major advantage of group therapy for the treatment of addiction lies in the opportunity the group affords the therapist to rely on the group conscience for compassion, rather than the therapist being the sole support for each group member. The Second Tradition of 12-Step programs states, “For our group purpose, there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.” We may find this tradition useful in the therapy group, as well.
Let's begin with the first example of the group member who has abused another person. If the therapist abstains from carrying moral outrage on behalf of the victim (and the group), the therapist has an opportunity to listen to the group's response to the story. Response may range from identification from members who might have been involved in abuse as perpetrators to counter-identification from members who might have been abused themselves. The feelings involved will likely include shame, fear, anger, and hurt.
The therapist's ability to support the expression of all of these feelings from any group member who is willing to share the experience enhances the group's ability to offer authentic compassion, which I suggest includes the group's ability to identify with both the perpetrator and the victim.
Most importantly, the group conscience may include a response from a group member who is outraged about the abuse and intensely critical of the group member who shared the story. The group therapist may put this condemnation to effective use if he/she understands that the perpetrator inevitably harbors overwhelming self-condemnation, which is invariably projected outward in order to ward off the suicidal despair that accompanies the unsupported recognition of the abuse's enormity. Therefore, the willingness of a group member to hold this condemnation on behalf of the perpetrator may be explicitly interpreted to the group as an empathic response to the perpetrator's self-condemnation.
This principle would apply with equal importance if the group member speaks of having killed someone in an episode of drunk driving, and a member of the group had a family member who was killed in such an event.
In the second example, where the group divides into competing factions, the group therapist who is able to use “the group as a whole” is likewise able to use the split for creative purposes. How often do we attempt in vain to help the addict spouse come to terms with the embittered enabling partner's seething resentment? The experience of being blamed provides potent fuel for the next relapse. If the group is able to provide the addict members with other members who have the reciprocal experience, the therapist may be able to support the group members in listening to the resources that the group has compassionately made available.
Clearly the therapist needs to acknowledge powerlessness over the group's need to repeat the conflict rather than learn from it. On the other hand, if the therapist believes in the group's wisdom, the group is more likely to identify with the therapist's recognition of the healing possibility of listening to divergent points of view rather than fighting over them.
I see these repetitions of conflicts from outside the group as they occur in group therapy as therapeutic reenactments, and I call them “toxoids.” The analogy refers to the process of immunization, in which a harmful toxin is rendered inert in order to inject it into the patient to generate an immune response. What I find useful in the toxoid model is that it helps me find compassion in seemingly hostile interactions among group members.
I am continuing to offer a monthly consultation group online. Readers who are interested in attending may contact me at firstname.lastname@example.org. I also continue to welcome questions from readers for this column, directed to the same address.