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Voting to expel a group member — A reply to Breeskin from Ray Naar, PhD

Ray Naar counters John Breeskin's views on group psychotherapy and Breeskin responds

I can easily understand the frustration experienced by Dr. Breeskin and his group members (Breeskin, 2012). I must, however, respectfully and vehemently disagree with his suggestions. A group milieu should not be one of “conditional acceptance” where members are not allowed to march to their own drumbeat when it goes against the advice of the group. Well-meaning as that advice may be, the group must provide an atmosphere of trust and utmost respect for each member’s freedom and right to be oneself without fear of being rejected or ostracized (Naar, 1982). We grow at our own rate.

Lest my comments be construed as the vagaries of a young, idealistic and inexperienced group leader (don’t I wish) and, at the risk of sounding self-aggrandizing, I will introduce myself. I am almost 85 years old and started leading groups in 1968. At the apex of my career, I was leading six weekly groups, i.e., five groups of patients and one group of professional trainees. I have authored a textbook in group psychotherapy and I am CGP and a TEP.

Dr. Breeskin’s characterization of his article as lacking in elegance and empirical data is being too modest. It is clinical, anecdotal material that provides the impetus for research. I will commit the same sin and share some anecdotal material. I will preface it by stating two profoundly held beliefs. The first is that changing a specific targeted behavior is by no means a group’s sole purpose. The second is that we cannot accurately judge the rate of a person’s growth. With this in mind, I will talk about Jane, a morbidly obese young woman who always promised to follow her doctor’s and the group’s advice but never did. After a while, unless she chose to bring it up, the group only sporadically dealt with her obesity. Almost 3 years into the group, she requested a 6-month leave of absence. Six months later, almost to the day, this Greek goddess, tanned and athletic looking, entered the room. That was the new Jane, who explained that she had taken a leave of absence from her work and used part of her savings to attend a “fat farm” in California. I had never heard the term before. She then made the following statement, which I remember so well because I wrote it down immediately after the session ended:

You thought that I was not paying attention to what you were saying. But I knew you liked me and accepted me even though I seemed to make no efforts. But I wasn’t ready and you knew it and stopped bugging me. And, then, I was ready and here I am. Thank you.

During my 45 years of group practice, I have established and tried to adhere to a ritual whenever a new member joins a group. I suggest that h/she ask two questions from the old members. The questions more often asked are “What do you like most about the group?” and “Why did you join the group?” The answers most often given are “I can let my hair down and say what I want and I know that I am not judged even when people disagree with me” and, to the second question, “I don’t remember. All I know is that every time I come to group, I feel like a better person.”

As far as I am concerned, only one behavior warrants expulsion from the group and that is part of the “informed consent” process whenever we have a new member. This is a “breach of confidentiality” and, to my knowledge, it has never happened.

Letter by Dr. John Breeskin

Dear Ray,

I was delighted to read your comment on my article. You and I are creating a dialogue based upon honest differences and I always enjoy exchanges where people share their biases and defend their positions. Please feel free to “respectfully and vehemently” disagree with my suggestions. I do not agree that what I offered Eric was “conditional acceptance” because I worked with him after he left the group in individual therapy until he completed his desired task. If I had not offered him continuing support to reach his stated goal, then, indeed, I would be delinquent in my responsibility toward him. I am not a believer in Carl Rodger’s unconditional positive regard. I think that trust must be worked at and maintained but there are always consequences lurking in the shadows. I understand that I am taking on an icon in our field, but as a contrarian, I can do no less. Thank you for acknowledging the relevance of my clinical anecdotal material. Although I was trained as an empiricist, I do not find that point of view very helpful to me at this point in my career.

Your point about not being able to judge an individual’s progress is very well-taken and your case study clearly supports your point of view.

If you wish to continue this discussion, I would only be too happy to send you a paper that I wrote more fully explaining my view of group therapy. Thank you for your respectful contribution to my awareness.

Your scholar in arms,
Dr. John Breeskin aka Sparky

References

  • Breeskin, J. (2012). Voting to expel a group member. The Group Psychologist, 22(1), pp. 8-9.

  • Naar, R. (1982). A primer of group psychotherapy. New York: Human Sciences Press.