International Journal of Group Psychotherapy ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20 An Analysis of Behavior in the First Meeting of a Therapy Group Edwin C. Severinghaus & Walter W. Igersheimer To cite this article: Edwin C. Severinghaus & Walter W. Igersheimer (1964) An Analysis of Behavior in the First Meeting of a Therapy Group, International Journal of Group Psychotherapy, 14:1, 49-59, DOI: 10.1080/00207284.1964.11642721 To link to this article: http://dx.doi.org/10.1080/00207284.1964.11642721 Published online: 29 Oct 2015. Submit your article to this journal View related articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20 Download by: [Florida State University] Date: 28 October 2017, At: 10:12 AN ANALYSIS OF BEHAVIOR IN THE FIRST MEETING OF A THERAPY GROUP EDWIN C. SEVERINGHAUS, M.D., AND Downloaded by [Florida State University] at 10:12 28 October 2017 WALTER W. IGERSHEIMER, M.D.l In a psychotherapy group the subject matter under discussion may range over virtually unlimited fields far removed in time and space from the group, but always in the background-and intermittently in the foreground-is the emotional reality of the current on-going interaction of members with each other and the leader. In relation to the "here and now" of the group, the members continually enact their individual needs, expectations, defenses, and conflicts in personal relationships, which thereby become accessible to therapeutic work as an immediate, tangible reality. For each individual these needs, defenses, etc., are expressed with a consistency that forms a pattern, or what might be called a style, which is characteristic of him. While this style is obviously based on the character structure of the person, it is also influenced by the need to adapt to and interact with the other group members and the leader. Under ordinary circumstances the group leader only gradually develops a clear awareness of this style, after its subtle and complex forms have been expressed repeatedly. The effectiveness of the group leader depends in part upon his understanding and appreciation of the neurotic elements in each member's style of relating; and, presumably, the sooner the better for all concerned. The hypothesis we have explored is that the typical style of each member's relation to the specific group at hand is expressed and foreshadowed to a very significant degree in the first group meeting in the form of subtle and condensed behavioral cues which can be discovered on close retrospective scrutiny of the session. We have reasoned that if this can be shown to be so, then further study of the methods and difficulties of extracting this kind of information from the first session would be of clinical and theoretical value. We believe that the first group meeting is a particularly valuable source of such observations, not only because it is the earliest opportunity but because the situation is more unfamiliar and unstructured than it will ever be again and is therefore open to the efforts of the members to structure it in the style and pattern typical of each. 1 Department of University Health, Yale University, New Haven, Conn. 49 50 E. C. SEVERINGHAUS-W. W. IGERSHEIMER Downloaded by [Florida State University] at 10:12 28 October 2017 METHOD OF STUDY A group of six men composed of five undergraduates and one graduate student at Yale University, all of whom had applied to the Department of Mental Hygiene for psychotherapy, met once weekly for one and a half hours throughout most of the academic year, a total of 23 sessions. In addition to the therapist (W.I.), an observer was present (E.S.) who was silent but occasionally made notes. Sessions were tape-recorded with apparatus that was visibly present in the room. Approximately six months after the termination of the group, a follow-up study was conducted by interviewing each member individually. In these interviews we explored the student's emotional state at the time and in the interval, the fate of major problems that had been stated in the group, and retrospective impressions of the group therapy experience. The sources of material for this study are the following: 1. The tape recording of the first session, to which we have listened repeatedly. 2. An extensive summary of the session dictated immediately afterwards, describing the group as a whole and each individual's behavior, and also recording our impressions, visual observations, speculations, formulations, and predictions. This record provides a description of the session uncontaminated by any knowledge of subsequent events (in contrast to our retrospective examination of the tape recording). 3. The "General Descriptions" (below) of each individual's over-all relationship to the group throughout therapy are based on (a) recordings and summaries of the subsequent sessions, (b) recordings of followup interviews, and (c) on our general familiarity with each member as we came to know him in the treatment process. We shall give detailed examples of the behavior of three of the members of the group, hoping that this will be an adequate sample to illustrate the value of such observations. The material on each individual is arranged as follows: (1) A very condensed summary of the member's personality and typical style of relating in the group. This will give the reader a background against which to view the first session behavior, analogous to our situation when we studied the session retrospectively; (2) A description of his behavior in the first session; (3) A comment on the relationship between these two kinds of observations. We shall not describe the first session as a whole in any detail. The therapist's approach was that of short-term, expressive-analytic group psychotherapy. He opened the meeting with an invitation for the members to express their thoughts and feelings freely. His activity in the first session was limited; he occasionally invited silent members to speak, and toward BEHAVIOR IN FIRST GROUP THERAPY MEETING 51 Downloaded by [Florida State University] at 10:12 28 October 2017 the end of the session he brought up the matter of the fee, which was to be between $3.00 and nothing, it being left up to each member to decide what he could afford. Interaction in the group began easily and quickly and continued without significant lag throughout the session. By the end of the session each member had presented at least a brief statement of his main reasons for seeking therapy. The content of the discussion had included anxiety over exposure and criticism, difficulties with girls, concerns about assertiveness and rejection, and conflicts in relation to authority figures. The general tone was one of easy interaction and establishment of familiarity with each other. Ned General Description. This 18-year-old sophomore came to the clinic with complaints of being nervous and fidgety for several years. He was referred by his girl friend who was made nervous by his nervousness. He was also bothered by uneasiness in social situations and by feeling competitive and inferior in relation to peers. He was a good-looking and obviously intelligent boy, and in the group would typically discuss problems in a lengthy, intellectualized manner that anticipated any kind of intervention, the effect of which was to cut off access to him. He seemed to be trying to communicate to the group that he understood himself and did not really need their help. Occasionally he would ask for advice but then would reject it as unsatisfactory. He conveyed an air of self-centered superiority and showed very little capacity to extend himself and become concerned with other members' problems. Frustration of his need to have the group's attention and admiration focused on him led typically to sulking and petulant withdrawal and various passive aggressive maneuvers. As the prospect for narcissistic gratification from the group diminished, he increasingly deprecated the value of the group experience and tended to identify most with another member who was extremely afraid of opening himself up to the group. His dependency conflict was very well illustrated in the follow-up interview in which he explained that his nervousness (his presenting symptom) was bothersome chiefly because it made him look to others like "a nervous little withdrawn guy," a concise description of the opposite of the image he tried to present to the group. First Session Behavior. In presenting his problem Ned said, "I don't know, my problem is not that easy to pinpoint. I have a nervousness ... I'd like to figure out why I've always been so nervous." He talked about difficulties in close relationships, saying, "I very often feel that I'm not making contact with the world. Somehow when I'm with other people, this nervousness makes me seem to be, somehow appear to be aloof or backward." He wanted to get a "uni- Downloaded by [Florida State University] at 10:12 28 October 2017 52 E. C. SEVERINGHAUS-W. W. IGERSHEIMER fying answer' to his problems. He described quite clearly his difficulties with girls, saying that he gets physical chills in their presence and that he is very sensitive to rejection from girls, yet fears close involvement. He has a habit of showing off his intellectual profundity to girls, ''Yet I get very indignant when a girl indicates that she thinks that she understands me." (In response to this, another member inquired whether Ned thinks that he understands himself, and a third asked whether he really wants to find out about himself, to which Ned replied weakly, "I think I do.") It annoys and irritates him that he cannot solve this problem (of girls) "in the most crucial area of my life," and states that this is the only area in which he has problems. On two separate occasions he took the opportunity to challenge the value and process of therapy, saying that he does not see "how just talking is going to stop me from shivering when I'm with girls." The general impression he gave in the session was of an intelligent, rational, rather suave, very verbal, psychologically minded young man. His manner had at times a boastful, egocentric, and competitive quality, and he occasionally stammered. While he elaborated his problems with considerable clarity, these descriptions of his distress were in great contrast to his manner, which seemed to say: I am normal, self-sufficient, all-American boy who is very much in control of things. While initially describing his problem, his voice was low-pitched, dry, choked, and sounded as if he were trying to conceal anxiety; later on he talked in large blocks of time during which he paid little attention to others except as a further stimulus to his own talking. Comment. All of the major outlines of the way Ned was to relate to the group, which seemed to have as its core a demanding, orally aggressive position, can be seen even in these small fragments of his behavior. His description of his narcissistic exhibitionism to girls followed by indignation if they pretended to understand him seems directly translatable as a warning and a somewhat haughty challenge to the group, and was even responded to as such by two members. His self-centered and lengthy manner of speaking foreshadowed a definite monopolistic tendency which appeared later, and the reference to "indignation," "annoyance," and "irritation" were little hints of the petulant way that he was to react when his narcissistic needs were not gratified by the group. We speculate that his saying his problem "is not that easy to pinpoint" can be read both as "it is very complex and probably beyond your limited understanding" and "I am not very willing to reveal myself." He quite arbitrarily limited the scope of his work in the group to the problem of girls, thereby reflecting his need for control. Indeed, his major defensive pattern in presenting himself as normal, in control, and not really in need of anybody was presented so effectively that it was only in retrospect that we were able to realize we had been "taken in," to the BEHAVIOR IN FIRST GROUP THERAPY MEETING 53 extent of being caused to wonder whether he really needed treatment. His challenge to the value of "just talking" foreshadowed a major source of resistance which was expressed repeatedly throughout treatment, and, in fact, the very act of challenging, not only once but twice, was a sample of the conflicts later to be expressed and acted out over issues of dominance, submission, rebelliousness, and negativism. The choice of language, such as wanting to "figure out" his problems and get a "unifying answer," was a subtle indication of his intellectual approach to psychotherapy. Downloaded by [Florida State University] at 10:12 28 October 2017 Lyle General Description. This 24-year-old Divinity School student was the only graduate student in the group, and the only one married at the beginning of the year. He presented at intake a variety of rather diffuse complaints of relatively long duration, including tension, indecision, feeling isolated and unable to commit himself in his marriage and his work, and the feeling that he communicated poorly with everyone. His motive for seeking treatment was unclear, but apparently was related to the fact that he would soon have to make a' choice between an academic and parish career in the ministry. In the group he was retiring, guarded, defensive, spoke in a rather unemotional, arid, and obsessional way, and had a curious ability to obscure the meaning, or at least the feeling, in his statements, so much so that it was literally difficult to sustain interest and attention in what he was saying. He maintained a kind of enigmatic separation from involvement with the others and would characteristically not speak much about what the rest of the group was discussing, but would intrude after a suitable lapse in the discussion with some private chain of thought unrelated to what had been going on, to which the others found it hard or perhaps undesirable to respond. Several group members reported, in the follow-up interviews, seeing him as a distant and unknown quantity, and in general they had very little identifiable feeling toward him. It was striking that at the follow-up interview, six months after the termination of the group, Lyle was unable to remember the names of the members. His avoidance of emotional issues was exemplified by the fact that he barely mentioned his wife, let alone discussed any marital difficulties, until almost the end of the year. Toward the therapist he was resistant and argumentative in covert and subtle ways; we soon learned that asking direct questions was precisely the wrong way of eliciting material from him. First Session Behavior. Lyle was dressed in a pedantic fashion, with a choice of clothes quite atypical for the Ivy League. He sat stiffly and symmetrically with his hands in his lap and fingers entwined, occasionally pressing a hand to his face. He was the last of Downloaded by [Florida State University] at 10:12 28 October 2017 54 E. C. SEVERINGHAUS-W. W. IGERSHEIMER the group to give his name and to identify his academic position in the round of initial introductions. After that he sat silent and apparently watchfully waiting until more than forty minutes had elapsed. Then, after a group silence (the first of any duration in the meeting so far), he said, "Guess I'm the only one that hasn't expressed . . . why I'm here. Dh . . it . . uh . . seems to be . . . I mean I can present it pretty logically and systematically but it seems to be more complicated than it is to express. One is the area of personal relations ... difficulty in relating to people, and forming ... solid (sigh) . . . relationships . . . personal relationships . . . this is one aspect of a ... uh ... a bigger problem. The second is probably the element of not being able ... and this is part of that ... to commit myself wholly to ... uh ... things, either personal relationships . . . I'm a married man, to my wife, uh ... my work, to my vocation ... perhaps a fear ... a hes ... a hesitancy to completely dedicate myself, my time, energy, efforts, etc., to a ... a project, to a personal relationship." His voice was halting, low in pitch, although with unpredictable and unexpected variations in volume and stress, and essentially flat in affect, with a quality of tiredness and fatigue and a forced, grinding tone which made us feel frustrated and impatient. Some of his responses were subtly negativistic or challenging, so that the therapist felt him as something of an antagonist. For example, in response to the therapist asking for his thoughts toward the end of the session, he haltingly complained that he was trying to figure out how we could "get deeper because just talking on this superficial level won't help." On another occasion, in the setting of mild group resistance in response to which the therapist was encouraging the group to come out with thoughts and feelings and to notice their reactions to each other, Lyle asked, "Do you mean that we will have to react to each other personally here and then examine it?" Toward the end of the session the therapist raised the question of the fee and invited each member to state how much he could afford. At this Lyle came dramatically to life and put a remarkable amount of energy into objecting to the idea of discussing this in the group. He said, "It could be conceivable that certain financial situations don't have a bearing on the psychological problems involved," and continued at some length to protest that this might not be an appropriate place to discuss such matters. When the therapist explored this attitude with him, he ultimately denied that he meant what he had said and claimed that he only meant that he did not know his financial position well enough to make a decision. Comment. Lyle's behavior both in the first session and throughout therapy was almost monotonously consistent. It was plain from the first session that he was, characterologically, obsessive compulsive, and these traits continued to be prominent throughout the treatment, although there was some increase in freedom and responsive- Downloaded by [Florida State University] at 10:12 28 October 2017 BEHAVIOR IN FIRST GROUP THERAPY MEETING 55 ness. The impact of his obsessive compulsiveness on his relationship to the group was dramatically clear even in the first session where he delayed activity as long as possible, was stiff, formal, and rather colorless, subtly antagonistic toward the therapist, and jealously protective of his private life as seen in the response to the question of the fee. He waited until everyone else had presented his problem, and then began with a statement which seemed almost to say: "Well, it looks like it's my tum and I guess there's nothing I can do but say something about myself." Both of his interactions with the therapist had a quality of complaint, impatience, and stubbornness. Since he could not decide the fee question in the first session, he was asked to let the therapist know in the next session what his decision would be, at which time, meaning to say that he would not be able to afford any fee, he said. "I won't be able to contribute." This was an accurate unconscious expression of a central conflict in his relationship with the group. Gary General Description. This IS-year-old freshman was referred by a student health nurse to whom, in a routine health interview, he mentioned his chronic nervousness. He had for years experienced various forms of anxiety and somatic tension and had developed ritualistic means of trying to control them. He felt easily criticized and unliked by his colleagues and had many hostile and competitive conflicts with his father and brother. We have found it particularly difcult to characterize his general relationship and problems in the group because he leaves an impression of unusual complexity in his personality and ways of responding. His behavior in the group was, in a sense, a personification of contrasts and contradictions. Speech was at times loud, assertive, and rapid, and at other times so extraordinarily hushed and low in pitch as to be barely audible. His moods were variously depression, anxiety, paranoid suspiciousness, remote boredom, and mild elation with good humor. In relation to the others, he was typically a little aloof and acted something of a "big shot," sometimes even supercilious and often exhibitionistically boastful, tending to deny any dependency needs and rarely putting himself in the position of asking for anything from the group. Occasionally, however, he would seem quite upset and confused and would rather uncomfortably ask for help. More than any other member he was preoccupied with keeping a watchful and suspicious eye on the comer of the room occupied by the therapist, observer, and tape recorder, and several times revealed his fear of harm from these sources. Our clinical assessment was similarly fluctuating; at times we saw him as "very sick," functioning in a borderline psychotic way, while at other times we were very impressed with the inner resources he could mus- Downloaded by [Florida State University] at 10:12 28 October 2017 56 E. C. SEVERINGHAUS-W. W. IGERSHEIMER ter. We often felt that he had "lived" more than the other members. There seemed to be strong unconscious homosexual impulses that made him, more than the other members, vulnerable to the threat of intimacy in this all-male group, and these very likely were a determinant in his precipitous and unplanned marriage before the middle of the school year. From that time on, his relationship to the group changed markedly; he then seemed mostly remote and uninvolved, occasionally haughty or bored, and acted as though he had to come to the meetings but did not need or want anything from the group. First Session Behavior. Gary's activity early in the first meeting was a complex interplay between approaching and avoiding a disturbing situation. It was he who started the round of introductions at the beginning and, that accomplished, he then suggested that each member mention his class (senior, sophomore, etc.). In the first few minutes of the meeting when everyone was feeling out the situation, Gary said: "Probably we're all a little bit scared," but a little later supposed "that the fear will eventually leave us." He referred anxiously to the tape recorder, saying, "It frightens me to have something like that recording everything that I say, makes me want to watch out and make sure I don't say the wrong thing." He took the initiative by asking the therapist, "Should we start by asking people why they came?", and after a short pause said: "I came because of an exceptionally nervous condition. It makes it hard for me to work or anything else. I have trouble writing. I was just keeping myself together." Later, several members expressed their fear and avoidance of girls but Gary said, "I'm exactly the opposite. Mine is practically perverted sexual activity. I just can't leave it alone. I have a drive to go out and screw 'em all. Eventually I get scared of it ... and quit." With his current girl friend he felt caught between a fear of losing her and feeling too close: "She has all the dope on me." While describing wanting to push her and force her to do things she did not want to do, he got confused about whether this made him a "sadist" or "masochist." Still another piece of paradoxical behavior occurred later in the session in which he seemed to compete with Ned over the issue of which one of them felt the more "inadequate," but he did so in a very adequate way. In response to the fee question, he tossed off his offer of "a buck fifty" in a very cavalier fashion, saying that he was "splitting it," referring to the $1.00 and $2.00 the previous two members respectively had offered. During the session his eyes constantly returned to the therapist, the observer, and the tape recorder. He spoke about himself in a very low voice and with a curious, self-critical and ironic tone as if laughing derisively at himself. Comment. The contradictory, conflicting, and shifting elements of behavior which were so prominent in Gary's activity throughout Downloaded by [Florida State University] at 10:12 28 October 2017 BEHAVIOR IN FIRST GROUP THERAPY MEETING therapy were already striking in the first session. His initial anxiety was clearly expressed in content, tone of voice, and in his manner of approach but he also displayed a quite adaptive and assertive way of dealing with this. He took the bull by the horns in what might be called a counterphobic effort to control the situation, and initiated both the introductions and the discussion of presenting problems. Samples of contrasting modes of behavior were seen in the range of voice from very soft to loud; in an assertive argument about being inadequate; in the ironic or mocking tone in describing himself which left the listener puzzled about what his attitude toward himself really was; in his expressed conflict between fears of losing and being too close to girls, which quite accurately described his relationship to the group throughout therapy; in his confusion about whether he was "sadistic" or "masochistic" (he demonstrated both tendencies at different times in the group); and in the contrast between presenting himself as nervous and inadequate and his almost bragging description of "perverted sexual activity" (we later learned that he had never had intercourse, contrary to the implication of those remarks). His very evident suspiciousness and distrust of the recording machine forecast a continuing problem for him; in fact, at the time of the follow-up interviews he was the only one to express the feeling that this had actually inhibited him. During the course of therapy it became clear that this was related to an almost paranoid attitude toward authorities, apparently deriving from the relationship with his rather sadistic father. His subsequent emotional withdrawal from the group does not seem particularly predictable from his first session behavior except inasmuch as he gives considerable evidence of conflicts over close involvement with others, and perhaps particularly with men. DISCUSSION We feel that this material demonstrates that a careful, retrospective study of individual behavior in the first session of this therapy group reveals the existence of cues in concise, condensed, and often subtle form that foreshadow to a remarkable degree the dominant trends of each member's relationship to the group as it subsequently developed throughout the course of treatment (23 sessions). We would like to emphasize that we are not pursuing a general over-all description of each personality, but rather an understanding of the major patterns and problems in relationships as they were expressed and experienced in the actual existing group. The behavior we have studied is not only the verbal content but the whole range of observable behavior which expresses the individual's immediate experience and his efforts to adapt to the "here and now" situation. It will be noted that many of the items of behavior on which we Downloaded by [Florida State University] at 10:12 28 October 2017 58 E. C. SEVERINGHAUS-W. W. IGERSHEIMER have focused our attention occur in relation to events typical of any first meeting of a therapy group, including tension around initial awkwardness, problems of introduction, patterning and timing of participation, efforts to find ways of relating to other strangers including the therapist, and the question of the fee. While only three of the members have been presented in detail in this paper, we have studied all six in the same way and find these observations to be equally true of all of them. We should like to point out some of the limitations of this study and the problems involved in a more systematic investigation of this hypothesis. While we have shown that the first group meeting contains a great deal of information about future group behavior, we have studied this retrospectively in the light of our familiarity with the total group experience. We have not demonstrated that a leader who has just finished the first session could Similarly benefit from a study of it, nor have we dealt with the problems he would run into in such an effort. It is very possible that at that point in time much of the behavior we have described might seem mystifying, irrelevant, ambiguous, or simply unimportant. On what basis would one, at that point, select behaviorial items for particular emphasis? In our study the items were selected on a rather global impressionistic basis Simply according to what caught our attention as we studied the first session. With this method there is the possibility, which we have not tried to investigate, that a circular process takes place in which we see in the first session what we are looking for on the basis of our knowledge of the individuals, and fail to notice the existence of possibly contradictory or concealing types of behavior or behavior that has the effect of confusing or misleading the observer. These problems should be studied by presenting tapes and descriptions of the first session to raters who have no familiarity with subsequent events. We feel ideally the rater should be physically present as an observer in the first session, but if this is not possible at least he should have access to a careful description of nonverbal behavior, which contributes such an important added dimension to what can be recorded on tape. Although the emphasis here has been on the individual member and his dynamic relationship to the group, this is an arbitrarily limited focus for the purpose of this study; we do not intend in any way to deny the value of a concurrent focus of attention on the process of the group as a whole. SUMMARY We have reported a detailed retrospective study of the first session of one therapy group. The group was composed of six college students, Downloaded by [Florida State University] at 10:12 28 October 2017 BEHAVIOR IN FIRST GROUP THERAPY MEETING 59 a therapist, and a silent observer, and met for twenty-three sessions in the setting of a college mental hygiene clinic. We hypothesized that the major patterns and conflicts of each member's relationship to the group throughout treatment are foreshadowed to a significant degree in the first group session in the form of subtle behavioral cues which can be discovered on close examination. The behavior of each member in the first session was scrutinized by an examination of our written observations and a tape recording of the session. These data were then compared with a characterization of each member's overall relationship to the group throughout treatment. In this paper we have illustrated the procedure and findings by reporting some of the details from the study of three of the group members, The unique value of the first group meeting for such observations is discussed, and attention is called to the importance of observing behavior in relation to certain typical group events as an aid to understanding each member's individual style and problems in relationship to the group. Methodological problems and areas requiring further study are described. Senior author's address: 65 Trumbull Street New Haven 10, Conn.