The Society for the Psychological Study of Masculinity and Men, Division 51, American Psychological Association
volume 12
number 2
  
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  SPSMM Bulletin: Special Focus Section

Reflections on Group psychotherapy with men

 

Editor’s Note:  The following is a collection of responses to an open call for papers (scholarly, reflective, personal) about therapeutic work in men’s groups.  A variety of interesting responses were received.  Thank you to all who contributed.  - MWH

When a Men’s Group Cracks:
Beneficial Divergent Spontaneity in Group Leadership
Dan Quinn, Psy.D.

“Forget your perfect offering.  There is a crack, a crack in everything.  That’s where the light gets in.”  Leonard Cohen, Anthem

I’m ashamed to describe one of the more effective things I have done as leader of a men’s group.  Over the course of many weeks, one of our members kept dozing off during group.  For weeks we processed it, and we came to believe it had to do with his fear of conflict – every time he fell asleep we were able to track it back to something conflictual he had wanted to say, but hadn’t.  Despite the insights, the dozing continued.   One evening he nodded off again, and I looked at him as I unscrewed the cap from my water bottle and took a sip. We all watched him in silence. And then I tossed a big splash of water directly into his face.

I’ll say more about his reaction in a minute, but the moment had a profound impact on me.  I felt both excitement and guilt, and as I pondered this act over the weeks and months that followed.  Of course I wondered about my aggression.  This seemed directly at odds with the warmth, respect, thoughtfulness and client-directed focus of my humanistic and analytic orientation.  

But something larger seemed to be at work.  I became fascinated by the idea that some undeveloped potential for aliveness might lie just beneath the surface of my common therapeutic practice.  My long-time fascination with Carl Whitaker, Milton Erickson, R.D. Laing and other “cowboys” started to take shape, and I was led to conduct an interview study of 30 therapists about their moments of beneficial divergent spontaneity, which I came to regard as what Leonard Cohen refers to as, ’Cracks.’ Most therapists knew immediately what I was talking about when I asked about “beneficial, spontaneous, divergent interventions.”  Only 2 out of the 32 I interviewed were unable to think of a moment like this in their practice.  In the course of the study I heard some remarkable stories.  One therapist, for example, found himself dragging an obstinate boy out of his office at the end of their hour they started this with scowling seriousness but ended with playful laughter.  I heard from another therapist that he told an embattled, resistant couple, “I was hoping you wouldn’t come today … but I’m willing to stick it out if you are.”  (They stayed, and stayed married.) 

One therapist recalled one of his first clients fifty years prior who came to the first session sobbing histrionically like a character in a cartoon, actually saying, “Boo hoo hoo,” and rubbing her eyes with her fists.  The novice psychiatrist was horrified to find that he couldn’t keep himself from smiling.  When the patient caught his eye, he burst into laughter, and after a moment, she began to giggle too.  They laughed together for several minutes…before hardly a word had been spoken, and went on to have a highly successful therapy process lasting several years.

Themes emerged in the data, which were, of course, filtered through the lens of therapist perception and memory (and remember, I was only asking for stories that had a happy outcome).  Most of these ‘Cracks’ occurred when the work was at an impasse, or the patient was stuck in some way.  Most of the Cracks came out of a feeling of rebelliousness in the therapist, as if something or someone was so intolerably oppressive that the therapist was moved to act spontaneously, and about half of the therapists felt guilty after the intervention – despite its effectiveness.  These interventions could often be understood afterwards as enactments of an important and repetitious relationship dynamic from the client’s past, only this time the dynamic had a different, positive, outcome.  Every Crack led to an increase in intimacy between therapist and client.   Most of them occurred in a setting in which the connection between therapist and client felt reasonably well-established, although not necessarily over a long period of time.  This seemed an absolutely critical characteristic: that there was some sense of connection between the therapist and client that allowed the event to occur without harm to the client, and the intervention, while often aggressive, was understood by both parties as something designed to bring the two closer together.

The most careful theoretical consideration of these Cracks is found in the Relational Psychoanalytic literature, and many of the Relational Psychoanalytic authors display a fond fascination with them.  (If you’re still thinking of a psychoanalyst as a poker-faced note-taker behind a couch, in many cases you’re way out of date.)  Bass calls them “’Enactments’ with a capital ‘E’” (2003).  Stechler (2003) follows Russell (1998) in referring to these moments as “The crunch.”  Maroda (1999) considers them moments of “mutual surrender… a falling away of the analyst’s resistance to being known by the patient in the deepest way possible” (p. 58).  (See also Knoblauch, 2001, Meares, 2001, Ringstrom, 2001.)  Symington (1986) is so loathe to name this rather mysterious event that he guardedly refers to it as “the x-phenomenon…a phenomenon with which all analysts are familiar”, but he titles his paper on this topic, “The Analyst’s Act of Freedom” (p. 253).    

Ringstrom (2001) and Stechler (2003) theorize that these spontaneous interventions generate transitional moments in the patients’ lives and they emphasize their function as a kind of rebellion against oppressive implicit rules, an unspoken taboo, or unconsciously shared superego.  Maroda found herself Cracking under the strain of working with “borderline” patients, writing that, “Certain patients pushed me beyond the point where I was able to contain myself,” but she was surprised to find that these “accidents” in fact often had beneficial impact (1991, p. 3).  Symington sees them as moments of rebellion from a situation in which the analyst is “the prisoner of an illusion…” when the analyst has been “lassoed into the patient’s self-perception” (1986, p. 253), a situation which Bion described as one in which the patient has a “wish to limit my freedom of thought” (1978, p.16).

But I’ve been particularly interested in Cracks that occur in a group setting, like the water I impulsively tossed into the face of my sleeping men’s group client, and I’ve found myself working increasingly spontaneously in groups.  On one occasion, a fellow in one of my groups slipped once again into his agonized monologue of very real troubles, and once again the group seemed to wait, kindly, for him to stop, murmuring kindheartedly.  I broke into one of his long sentences and heard myself say, “I think Joe came here hoping someone would interrupt him.”  The group responded with confusion and outrage that I showed so little sympathy.

“What do you mean?” one member demanded. 

“I’m not sure what I mean,” I replied.  (I wasn’t.)  “I think I may be speaking in tongues.”

I know what he means” said Joe, quickly.  It emerged that Joe felt tyrannized by his own script, as did we all, and he had been using the group as an unwilling audience to the tortured self-talk playing incessantly in his skull. In the weeks that followed, the group began to bust him on ’that tape you run.’  He soon began to interrupt himself, and communicate more directly in group, and he also started taking action on problems in which he had been mired for many years.

Of course, sometimes in group the enactments are obvious after the fact, when I have unwittingly taken on the role of one of the important characters in a client’s life.  Last week, for example, I think I became somebody’s wife.  A group was sympathizing with one man whose wife had been “nagging” him to such an extent that he was considering divorce.  “What a controlling bitch,” one fellow chimed in.  “Tell us more about your anger,” another man asked helpfully.

But I recognized something in my own reaction surging up, and I sensed it was best not to contain it. “Let me tell you first about my anger,” I heard myself interject. “I want you guys to grow up!”  Shocked silence followedand I admit I was surprised, too but I slowly sorted out what I meant.  “If you’re not living up to your commitments and then you’re yelling at her when she protests, you’re not acting like an adult.” 

I looked around at the faces of nine silent men.  “What do you mean?” one man said.

“I guess I’m asking, how can you hope to have a relationship if you don’t do what you commit to doing?  I just don’t see how that could work.”

“I see what you’re saying,” said another.

The man considering divorce was able to begin talking about how ashamed and triggered he felt when his wife made perfectly reasonable requests, and he admitted, as well, to how inferior he often felt in his broader life, and with me and the rest of the group.  Afterwards, he was able to go home and talk constructively with his wife about the ways in which his shame activates his defensiveness.

The risk, of course, is that harm will be done in these sometimes aggressive moments, particularly when one may be acting purely out of self-interest.  One story goes, for example, that Fritz Perls was working with a man in a group who steadfastly held that he couldn’t feel anything, until Perls punched him in the face, knocking him down, and saying, “Can you feel that?”  It can be easy to cross over into sadism, bullying, especially in the excitement of group dynamics.

I find myself in these moments, in the split second before I act, testing my sense of the strength of the connection between me and the client to bear whatever is about to emerge.   There seems to be an instantaneous check – is this just for me?  Or is it for him, or us.  Alongside the aggression in the impulse there seems to be some implicit urge to increase the sense of connection between us, a wish in me to make an attempt at radical joining.  It’s aggression in the interest of connection.  I find that Cracks show up more readily in groups than in individual therapy, and I theorize that the warmth and support of the group provides the client with added protection from me and frees me to take on a potentially unsavory character in the unfolding drama.

What happened with my dozing conflict-avoidant client, whom I’d doused?  He blew up.  Conflict!  He told me in no uncertain terms how furious he was. 

I was able to talk about how frustrated and angry I was, because we were deprived of his involvement, and because I saw his avoidance crippling his life.  The impasse was broken, and over the weeks and months that followed, he and I grew closer.  He never fell asleep again.  He began experimenting with ‘throwing water’ at others, saying more directly what he was thinking and feeling.  He gradually began to assume a more influential role in all his relationships. And he was a lot less easy to live with.

References

Bass, A. (2001). It Takes One to Know One; or, Whose Unconscious Is It Anyway?. Psychoanalytic Dialogues, 11(5), 683.

Bass, A. (2003). "E" Enactments in Psychoanalysis. Psychoanalytic Dialogues, 13(5), 657-675.

Black, M. (2003). Enactment. Psychoanalytic Dialogues, 13(5), 633-655.

Chused, J. (2003). The Role of Enactments. Psychoanalytic Dialogues, 13(5), 677-687.

Coltart, N. (1986).  ‘Slouching towards Bethlehem’…or thinking the unthinkable in psychoanalysis.  In Kohon, G. (ed.)  The British school of psychoanalysis: The independent tradition.   New Haven and London: Yale University Press.

Ferro, A. (2002).  In the analyst’s consulting room.  New York: Taylor & Francis.

Guggenbuhl-Craig, A. (1982). Power and the helping professions. Dallas: Spring Publications.

 

Haley, J., Hoffman, L. (1967).  Techniques of family therapy: Five leading therapists reveal their working styles, strategies, and approaches.  New York: BasicBooks.

 

Haley, J.  (1986).  Uncommon therapy: The psychiatric techniques of Milton Erickson, M.D. New York: W.W. Norton.

 

Hoffman, I. (1998). Ritual and spontaneity in the psychoanalytic process: A dialectical-constructivist view. Hillsdale, N.J.: The Analytic Press.

 

Kottler, J., Carlson, J.  (2003a). Bad therapy: Master therapists share their worst failures.  New York: Burner-Routledge.

Maroda, K. (2002).  Seduction, surrender, and transformation: Emotional engagement in the analytic process.  Hillsdale, N.J.: The Analytic Press.

Maroda, K. (2004).  The power of counter-transference: Innovations in analytic technique.  Hillsdale, N.J.: The Analytic Press.

Mitchell, S.  (1993).  Hope and dread in psychoanalysis.  New York: BasicBooks.

Mitchell, S. (1988) Relational concepts in psychoanalysis : An integration. Boston: Harvard University Press.

Mitchell, S. & Aron, L.  (1999).  Relational psychoanalysis: The emergence of a tradition.  Hillsdale, NJ: The Analytic Press.

Mitchell, S. (2002).  Can love last?  New York: Norton.

Mitchell, S. & Black, M. (1995). Freud and Beyond. New York: BasicBooks.

Napier, G. & Whitaker, C. (1978)  The family crucible: the intense experience of family therapy.  New York: Harper & Row.

Rosen, Sy.  (1982).  My voice will go with you: Teaching tales of Milton Erickson.  New York: Norton.

Singer, M.T. & Lalich, J. (1996) Crazy therapies: What are they?  Do they work?  San Francisco: Jossey-Bass.

Symington, N. (1986).  The analyst’s act of freedom.  In Kohon, G. (ed.) (1986).  The British school of psychoanalysis: The independent tradition.   New Haven and London: Yale University Press.

Winnicott, D.W. (1949). Hate in the counter-transference.  The International Journal of Psycho-analysis. 30,2. 69-73.

Winnicott, D.W. (1958) The capacity to be alone.  International Journal of Psycho-Analysis, 39,416-420.

Winnicott, D.W. (1960). ‘Ego distortion in terms of the true and false self,’ in The Maturational Processes and the Facilitating Environment. London: Karnac Books.

Winnicott, D.W. (1971).  Playing and reality.  London: Tavistock.

Winnicott, D.W. (1974). Fear of breakdown., Int. Rev. Psychoanal., 1,03-107.

 

The ABC’s of What Happens in a Men’s Group
Fredric E. Rabinowitz, Ph.D.
University of Redlands

SPSMM Bulletin: What kinds of themes and topics do the men explore typically in your men’s groups?

a. What it means to trust other men?
b. How does our relationships with parents and siblings impact our current relationships? c. What does it mean to be a father? What do we feel we are doing well and not so well about this role? What were our relationships like with our own fathers?
d. What impact did childhood emotional/physical/sexual abuse have on us now?
e. How are the partners we have chosen in our lives reflect our own needs and family dynamics?
f. How have we dealt with betrayals from partners and/or parents?
g. What do we hide from ourselves and others when we are in our everyday work environments?
h. What don’t we express emotionally that is a significant facet of who we are?
i. How do we deal with the frustration of our emotional, physical, and sexual needs?
j. How do we deal with loss, depression and existential angst that accompanies aging and a decline in our physical prowess?
k. How do our bodies carry the weight of our unexpressed emotions and desires?
l. In what way do we use addiction to medicate ourselves?
m. What brings us shame? How do we handle this overwhelming feeling?
n. How does our inner judge keep us from being satisfied with our lives?  What kinds of judgments do we make?
o. Will we still be loved if we are vulnerable and not following traditional masculine roles?
p. How does fear of abandonment keep us from taking risks that might lead to growth?
q. What are healthy ways to deal with our frustration and anger?
r. How can we break the bonds of co-dependence and feel okay about being separate in our close relationships? What are our fears about doing this?
s. How do ancient stories and myths resonate with our own life experiences?
t. How might we use art, poetry or body expressiveness to share our playful side?
u. How do our “dark” or “disowned” parts of our personalities find expression? Within ourselves and in reaction to others?
v. How do we come to understand the paradox of feeling alone and avoiding intimacy with others?
w. What kinds of power do we project onto our female partners?  How does this benefit us and take from us?
x. How do we deal with same sex attraction?  How do we deal with homophobia?
y. How do the gay men in the group handle the heterosexual stories?  How can the straight men understand the gay man‚s reality?
z. What do we do when we feel stuck and in a rut? What keeps us there and how do we get out?
aa. How do we deal with fear and its hold on us? Why does it feel better sometimes not to change?
bb. What do we do about loss? How can we deal with the unfinished business in our relationships (especially with parents)?
cc. How do we as men protect against pain? How do we shield ourselves with our narcissism?
dd. How does it feel to be an outcast from the group? What prevents you from feeling belonging?
ee. Is it okay to express negativity toward other group members? What will happen to relationships in which we allow our dark sides to emerge?
ff. How do each of us express love?  What keeps us from being fully vulnerable with this emotion? How have we been damaged and betrayed by love?
gg. Control is such a large factor in men‚s lives. How do we use it to our advantage? How do we let go of it?
hh. How do we reconcile our more primitive animalistic passions from what is socially acceptable?
ii.   What keeps us from giving each other praise and appreciation? How come it is so hard to accept this from others?
jj. The value of interpersonal feedback from other men in the group about who we appear to be to them.

SPSMM Bulletin: What are the main outcomes for those who participate in these groups?
a. Increased comfort with emotion in general.
b. Willingness to reflect on life and take into account passion as a part of the decision making process.
c. Less tolerance for interpersonal situations which are abusive or one-sided.
d. More desire to take interpersonal and vocational risks to make life better.
e. Trust in male support.
f. More acceptance of life‚s changes, challenges, and obstacles.
g. Better care for whole person (body, mind, relationships)
h. More emphasis on being a good parent or partner.
i. More openness to feedback.
j. Less need to be in control of work and home environment.
k. More acceptance of deaths and losses.

SPSMM Bulletin: How have you changed your leadership in these groups from when you began to run them?.

a. More likely to trust men to bring in material and tolerate some initial discomfort.
b. Less reliance on exercises and didactic psychoeducational interventions.
c. More personal self-disclosure as a leader
d. Men who have been in group for more than a year act as guides, mentors, and leaders to newer members.
e. Less limitations on what can happen.  More trust of the group process.
f. Better able to screen who would best benefit from the group.
g. More comfort with individuals doing both individual and group.
h. More awareness of resistance and how to identify and help men get through it.
i. More possible interventions that include physical movement, touch, psychodrama, and identification of interpersonal dynamics within the group.
j. More comfort in acting in tandem with my co-leader.

k. Get many more referrals from men who have been in the group as well as female therapists who value what a men’s group can offer.  More visibility in the community has led to many more referrals as well.

For over 25 years, Dr. Rabinowitz has been leading men’s groups. He did his first men’s group with co-leader Sam Cochran in 1981 at the University of Missouri-Columbia Counseling Center while doing his pre-doctoral internship.  Since 1987, he has co-led on-going men’s groups in Redlands, California as a part of his private practice.  Dr. Rabinowitz has written numerous articles and co-written three books with Sam Cochran: Man Alive: A Primer of Men’s Issues (1994, Brooks/Cole); Men and Depression: Clinical and Empirical Perspectives (2000, Academic Press); and Deepening Psychotherapy with Men (2002, American Psychological Association).  Fredric Rabinowitz is a past president of SPSMM.

Relevant References

Andronico, M.P. (1996). Men in groups: Insights, interventions, and psychoeducational work.  Washington, D.C.: American Psychological Association.

Brooks, G.R. (1998).  Group therapy for traditional men. In W. Pollack & R. Levant (Eds.), New psychotherapy for men (pp. 83-96).  New York: Wiley.

Cochran, S.V. & Rabinowitz, F.E. (1996).  Men, loss, and psychotherapy.  Psychotherapy, 33, 593-600.

Cochran, S.V. & Rabinowitz, F.E. (2000). Men and depression: Clinical and empirical perspectives.  San Diego: Academic Press.

Rabinowitz, F.E. (1991).  The male-to-male embrace: Breaking the touch taboo in a men’s therapy group.   Journal of Counseling and Development,69, 574-576.

Rabinowitz, F.E. (2001).  Group therapy for men. In G. Brooks & G. Good (Eds.), The new handbook of psychotherapy and counseling with men (pp. 603-621).  San Francisco: Jossey-Bass.

Rabinowitz, F. E. & Cochran, S. V. (1994).  Man Alive: A Primer of Men’s Issues. Pacific Grove, CA:  Brooks/Cole.

Rabinowitz, F. E. & Cochran, S. V. (2002).  Deepening psychotherapy with men.  Washington, D.C.: American Psychological Association.

 

Man to My Therapist
Todd Fisher
Azusa Pacific University

 “There are some important things you need to know… 

I really don’t want to be here.  I would rather be doing anything else than being here.  Shopping with my wife and or doing my taxes sound pretty good about now.   

I don’t want to talk about the past.  I have moved on from that….  That’s just a waste of time to go back there.  Besides, I didn’t like my childhood.  Why should I go back there?  If I did, the hole seems too deep.  My fear is that I will never come back.  They will lock me up and put me in a straight jacket.  I can’t let my guard down.  I have too much to do.  There are too many people counting on me.  If I can figure out a way to make more money, that will change me and my family.  Besides, my situation is only temporary.  I have been through this before. 

Do you get me?  You can’t understand all that I have been through, so there is no use in telling you anything.  I don’t trust men or women.  Why should I trust you?  Relationships are tough.  I am even paying this relationship and you are in control.  What was I thinking? 

I have tried to seek the advice from other men, but they usually tend to try to fix me or tell me another way of doing what I am doing.  My wife says I am just ‘hopeless’.  How are you different than they are? 

I have done many things in my life that I am not proud of.  Will you be able to talk about what I have done without judging me?  Can I talk to you about sex without being judged?  Would you hold my fear, anger, anxiety?  Would you sit in the depths of my depression and not try to make it better?  You know I have rage inside of me that that would blow you away that if I showed you a part of it.  I try not to show it because it scares people away.    

Do you know what you are doing?  My problems are so different than men I know.   

I don’t know how to stop doing certain things in my life that I don’t want to do. 

I just feel there are so many areas in my life where I feel empty-handed.  No one was there to teach me.  I avoid what I don’t know how to do.  So if I don’t look at it then maybe it will go away.

I am tired.  I am tired of being tired.  I try so hard, yet my life doesn’t seem to change. 

My life is not how I imagined it.   I am caught in the corporate environment that tells me to do one thing, yet I know what is right to do.  I don’t say anything.  I feel trapped. 

I want out.  I want a break from this hell I have created called my life. 

You say it is possible that my life could be different? 

 Males in Transition and the Self-Help Group
Marty Wong

Editor’s Note: Marty was gracious in sending this article that appeared in The Counseling Psychologist in 1978.  Due to copyright issues, I cannot publish it here.  I encourage you to access the full article through PsycINFO or to contact Marty for reprints of the article.  The full citation reads:

Wong, M.R. (1978).  Males in transition and the self-help group.  The Counseling Psychologist, 7, 46-50

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  Edited by: Mitchell Hicks, PhD