You are leading a long-term cognitive behavioral therapy group for adults with a diagnosis of depression. The group has been meeting for six months on Tuesdays evenings. Attendance has been good: everyone has come to more than 95% of the group sessions. The group is moving into the working phase/stage of group therapy.
Before tonight’s meeting, you review your notes on each group member.
Alejandro Escobar-Vega
Alejandro is a 34-year-old man with a history of depression. Alejandro is a regular patient of yours who you first saw in clinic and then at the ER for a suicide attempt prior to the forming of this group. He was recently discharged from a two-week hospital stay after a second suicide attempt. He resisted joining the group, but has become a regular attendee, because his wife Dani insisted on it. His son Dario attends West High School, where Lucy Edwards teaches.
Lucy Edwards
Lucy is a 57-year-old married woman who has twin daughters who are 20 and attend college in another state. Lucy was recently diagnosed with breast cancer. She has a 15-year history of depression. She has been on medication and involved in individual therapy for several years but due to social isolation her therapist recommended she join this therapy group. Lucy teaches at West High School, where Barry’s and Alejandro’s sons attend.
Barry Van Dyke
Barry is a 43-year-old divorced man who has a son who is a junior at West High School. Barry has suffered with depression for three years, ever since his parents were killed in a motor vehicle accident. They were hit head-on by a drunk driver and were killed instantly. Barry is an only child.
Sung Park
Sung is a 38-year-old single woman. Sung is social worker at a local Korean service agency where she provides community support services to Korean families. The community is home to a large Korean population. Sung has had depression since high school and has been in treatment for more than eight years. She takes medication as well as being in individual and group therapy.
Jennifer Jones
Jennifer is a 49-year-old African American woman and the mother of three children, aged 11, 12, and 15. Her long-term partner is their father. Jennifer has a history of depression, which began when she was 13, and sexual trauma. She has been in treatment since her late teenage years. She attempted suicide once at the age 18 after being sexually assaulted.
L’Antonee “Monty” Montgomery
Monty is a 40-year-old single gay man who has major depression. He has been hospitalized four times in the last two years for suicidal ideation. He works at the local day care center for seniors.
This week’s meeting begins even before everyone is seated.
Alejandro and Lucy
I’ve gotta talk first tonight. Lucy! You talked about stuff from this group with your husband! And then he saw my wife at the grocery store last week and he told her he was sorry to hear I tried to kill myself. My son Dario was there with Dani. And my son DIDN’T KNOW WHY I WAS IN THE HOSPITAL!
Calm down! My husband was just worried about you.
But he shouldn’t even know anything about me!
I was just trying to get a little help thinking through whether I should reach out to Dario at school or not. You know I teach at West.
That’s not your job!
But it is! As a teacher, every kid is my “job!”
What do you do now?
Group leaders face a balancing act between speaking and letting the group members talk without interruption. At this point, it is okay to be quiet, but you want to be sure that the conversation does not turn into an argument.
Although this may be a way to gain control of your group, if group members do leave, it does not allow for the issues to be processed. It also does not foster the development of empathy among members.
Focusing on those who are not arguing can be a good tactic in a group, but it does not resolve the issue between Alejandro and Lucy.
This is the best response if you want to help your group members become more self-aware and aware of others’ needs in the group. Acknowledge (privately) the disruptive behavior, yet keep the focus on the sharer’s comment—all without going to a place of rules or shaming.
Sung, Lucy, Barry, and Alejandro
Lucy, I’m so disappointed about you breaking our confidentiality. Now I don’t trust that you won’t talk about me to people outside of the group. I have not told anyone about having depression, much less that I am seeking help through therapy. I would lose face in the community! And I’ll never get a boyfriend!
Oh, geez, it’s not like we signed something legally binding. And it’s my husband! Who keeps secrets from their husband? Not me! Gerald knows everything I know.
WAIT, Lucy!
Then you should have said so right away. What we say isn’t a secret, it’s our personal information. You have no right to share it with ANYONE. I don’t tell Dani anything about this group. She didn’t even know you were in it.
WAIT! Lucy, my son goes to West, too! Have you told Gerald anything about me being in this group? Or anyone else? Aren’t we supposed to keep everything confidential?
What do you do now?
It is a good idea to remind the group about the ground rules established when the group began. You can remind the group that they all agreed to confidentiality when they began the group. Group members agreed to only speak about their own personal experience outside of the group and not to talk to anyone outside of the group about what another group member has done or shared.
Group leaders face a balancing act between speaking and letting the group members talk without interruption. At this point, the conversation is turning into a shouting match and your invention is likely required to refocus the members.
This response comes across as shaming, and doesn’t include the group.
Although this may be a way to gain control of your group, it does not allow for the issues to be processed, and it does not foster the development of empathy among group members.
Jennifer
Lucy, I think you did the right thing. I know you’re worried about Alejandro’s son, Dario, since you are one of his teachers. And Alejandro, you should have told your son what happened already. He’s old enough to see what’s going on around him. Keeping secrets isn’t good. My children know all about what’s happened to me.
What do you do now?
This is not a good response, as it focuses on further division among group members.
This is not the best response, as it takes the group away from addressing the issue of trust among group members and how to maintain confidentiality within the group, which can be a part of the pre-working phase of group process.
While this question forces all group members to think about the ground rules and examine the rationale for ground rules about confidentiality, this is early in the group process to be confrontational with group members who are learning to trust you as a group leader and trust the other members of the group. Being this confrontational could lead to group members feeling further threatened and even berated, and could cause members to start coming late or even to stop attending.
This is the best response, because it brings the group back to the core issues of developing trust among members and maintaining confidentiality within the group. Trust is important because it allows members to share openly and to feel safe that other group members will respect the boundaries of the group and experiences of other group members.
Monty
I can’t believe this is happening! Oh my God! I could lose my job! You know I work hourly at the senior day care center. If my boss finds out why I took all that time off last year, he could fire me completely. I don’t have any protection against that. I told him my Mom needed some extra care, which they totally understood, of course. What the hell are you thinking, Lucy? I don’t feel safe sharing in this group and I don’t know if I want to come back anymore!
What do you do now?
This response acknowledges Monty’s concerns and shows that you are empathetic about Monty’s issues. You are also allowing group members to reflect about the meaning of trust and the value of being able to trust the group to maintain confidentiality in order for each group member to feel safe about what they are sharing. This also provides a platform for the group members to process the conflict relative to trust and confidentiality. This process gives members the experience resolving conflict while maintaining their relationships with other group members, providing them an emotionally corrective experience about resolving conflict and learning to working through difficult issues and still being able to maintain a relationship.
This response is both shaming and punitive. This early in the group, this type of response could cause group members to not trust you. Or it could cause group members to be fearful to share how they feel for fear they will also be reprimanded by you.
While does bring the focus back to Alejandro’s concerns about confidentiality, the response shuts Monty down. Your comments do not take into consideration how vulnerable Monty is feeling and it belittles Monty in front of other group members. When you discount a group member’s experience early in the developmental stages of the group, group members learn to be guarded and not to be honest about their feelings for fear they will also be belittled or discounted.
Monty, Alejandro, and Lucy
Thank you all. I do feel a little better about trusting you. But I don’t think Alejandro and Lucy have resolved anything yet. How can we move on?
I still think Lucy should apologize for talking to her husband outside the group. You know what Dario thinks of me now? I used to be his hero and now he knows that my life sucks and I don’t really want to be here. I also think she needs to tell the group that she will respect our confidentiality. And mean it.
I am sorry my husband talked to your wife in front of your son. That was wrong. But I am still concerned about how your suicide attempt is affecting your son.
What do you do now?
This responses closes down the interaction between Lucy and Alejandro and allows you to control what happens between group members. This might be an issue that you want to process during clinical supervision because the conflict occurring within the group might be triggering you to have the need to stop the conflict rather than allowing group members the time to process their feelings and resolve the conflict themselves.
This response gives Lucy the opportunity to process what she heard Alejandro say without criticizing her or embarrassing her. It also roleplays for other group members how one can interact with someone who doesn’t seem to be hearing what you are saying. It does this in a way that doesn’t put the person on the defensive.
This interaction allows group members to process as a whole the issues of confidentiality, feeling safe, addressing conflict, and building cohesion as a group. Allowing all members to participate improves communication among members and reduces the chances that members will attack one another. It also helps the group to move toward the next phase of group process, the working phase.
Ending
How will you help Lucy and Alejandro resolve their conflict? Do Jennifer, Monty, Barry, and Sung have more to say? Now it’s your turn to decide! Please return to the course to participate in the discussion.