When Coleaders Differ: Rupture and Repair in Group Psychotherapy
Publication: American Journal of Psychotherapy
Abstract
The nature and quality of coleader relationships in group psychotherapy have been the subjects of numerous investigations. Coleader rupture and repair, however, remain understudied in the group psychotherapy literature. Coleader ruptures vary in intensity, from relatively minor tensions, of which one or both group leaders may be only dimly aware, to major breakdowns in collaboration, understanding, or communication. Effective coleaders are able to identify and repair ruptures in the coleader alliance. This article examines rupture and repair in the coleader relationship through the lens of attachment and interpersonal integrative group theory. Case examples are used to illustrate the application of the principles discussed, and suggestions are provided for strengthening the coleader alliance.
Highlights
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Rupture and repair in the coleader relationship can be viewed through the lens of attachment and interpersonal integrative group theory.
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Coleader attachment styles can influence the group psychotherapy process, the quality of the coleader alliance, and group member outcomes.
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Attachment styles can provide clues about how to heal ruptures in the coleader alliance.
Editor’s Note: This article is part of a special issue on group psychotherapy with Guest Editor Fran Weiss, L.C.S.W.-R., B.C.D. Although authors were invited to submit manuscripts for the themed issue, all articles underwent peer review as per journal policies.
The nature and quality of coleader relationships in group psychotherapy have been the subjects of numerous investigations (1–4). For example, Yalom and Leszcz (5) hypothesized that the success or failure of a group depends largely on the cotherapists’ relationship and emphasized the importance of complementary personalities. Success is more likely to occur, they hypothesized, when coleaders believe that their effectiveness depends on the quality of their relationship and when “coleaders freely share honest feedback and are emotionally open and available for each other.” More recently, other authors (4, 6) have suggested that developing a reflective process and sharing a similar conceptualization of the group is critical to addressing the intrapersonal and interpersonal patterns and experiences that may impede development of effective coleader relationships.
Satisfaction with the coleader relationship is likely a complex phenomenon that waxes and wanes over time and contributes to a unique relationship system. How effectively group leaders manage ruptures in this system may also affect the coleader alliance. Coleader teams should not expect their group members to address conflict in the group if the coleaders do not address conflicts in their own interactions. Rosenbaum (7) long ago stated, “Often the resistances of patients entering group therapy are mirrored in the resistances of cotherapists to confronting their own problems in interaction.” Differences in personality, attachment style, and conflict resolution may affect both the group and the way the coleaders manage their relationship with each other.
An isomorphic relationship exists between coleaders and the group: challenges and stressors experienced in the coleader relationship are likely to be mirrored in the group (8–10). If factors such as mistrust, competition, power struggles, personal or theoretical disagreements, envy, or incompetence are not addressed, relationship dysfunction may manifest as coleader anxiety about interacting with each other and with group members (5). Problematic coleader dynamics may also impede effective use of group leadership skills and may negatively affect group outcomes (8) because the progress of the group is generally considered to be contingent on the maturation of the coleader team (10). Ultimately, a coleader team needs to have developed an understanding, intimate, and cohesive relationship that allows for challenging conversations to occur.
Rupture and repair in the coleader alliance have been understudied in the group psychotherapy literature. Awareness exists broadly that ruptures can damage the individual therapeutic alliance and that addressing such ruptures can bring therapeutic benefit (11, 12). The discussion of how coleaders may beneficially work with ruptures has been less precise. Ruptures can take many forms and may vary in intensity from relatively minor tensions, of which one or both group leaders may be only dimly aware, to major breakdowns in collaboration, understanding, or communication. A coleader relationship may include a mixture of ruptures unique to the leaders’ individual personalities, attachment styles, and relationships with group members and with the group as a whole. This article examines rupture and repair in the coleader relationship through the lens of attachment and interpersonal integrative group theory. Relevant contextual considerations (e.g., culture, ethnicity, and gender) are discussed, and an overview of the importance of rupture and repair in the group coleader alliance is provided. Disguised case material is presented to illustrate fundamentals of our approach.
Attachment Theory and Coleader Relationships
There has been increased interest in building links between attachment theory and group psychotherapy (13–17). Research on applying attachment theory to group work has focused on the relationship between attachment styles and group therapeutic factors, group attachment, and how group therapy facilitates changes in members’ attachment styles. Correspondingly, less attention has been paid to how group leaders’ attachment styles may influence group processes and treatment outcomes. Although clinical research has effectively demonstrated the importance of the therapist representing a secure base (14, 18), more work is needed to identify how group coleaders’ attachment styles influence the process of group psychotherapy. Increased understanding of how coleaders’ attachment styles may affect collaboration, group processes, and treatment outcomes appears to be relevant, given the importance of group leaders in fostering a secure base for group members.
Research (19–21) suggests that a secure attachment style promotes a strong therapeutic alliance between clients and therapists. Group coleaders with secure attachment styles may be more likely to self-disclose, demonstrate progroup behavior, and have greater empathy toward others. Coleaders with lower attachment security may find it harder to trust, engage, and disclose, because of fear of rejection, which may in turn contribute to diminished self-efficacy.
Diversity and the Coleader Alliance
In a study of competency concerns, Okech and Kline (22) noted that coleaders may experience ongoing internal reactions and questions about self, partner, and group interactions as a way of making sense of the group experience. It is likely that such internal reactions are shaped by ethnic, cultural, gender, religious, and socioeconomic differences. Cultural forces operate at largely unconscious levels and can contribute to polarization; they decrease our willingness to talk openly about such matters while simultaneously increasing their clinical relevance in group interactions (23). As viewed from an attachment perspective, the internal working models of group coleaders must also be influenced by culture and used as reference points to fully understand the nature of the attachments cocreated in the group.
Attachment paradigms can be used to promote engagement across social and cultural identities, promoting mutuality and diminishing projections. A secure base in the group is essential, because it creates a haven from which to explore and tolerate uncertainty, to forgive injury, and to understand the impact of privilege and oppression in society. Secure attachment in the coleader alliance can promote intercultural dialogue and enhance a group leader’s capacity to have a more accurate and accepting view of his or her coleader. To provide competent, culturally sensitive group leadership, coleaders must be able to conceptualize diversity issues, become aware of personal issues activated by the coleader alliance and group, and generate diversity-competent interventions at multiple levels of group interactions. This ability is especially crucial when cultural differences exist between coleaders or with group members (22). Useful interventions for groups with diverse members promote norms that allow for discussion, understanding, and acceptance of differing experiences, beliefs, values, and behaviors and invite group members to make implicit tensions explicit.
Coleader self-awareness is critical and strongly related to the capacity to effectively manage anxiety while conducting group therapy. Addressing diversity in group settings often results in heightened emotions as well as the self-exploration and reflection required to become more aware of oneself as a cultural being. Awareness of social identity development and experience as a privileged or nonprivileged person in society may also allow coleaders to better connect with individual group members.
Reactions to conflict, misunderstandings, and culturally related subgrouping (24) may all activate personal feelings in the coleader alliance. Group leader reactions at the group system level may also be highly relevant; a group leader may become aware of how stereotypes, assumptions, and implicit biases affect how he or she views group-wide processes. Absent such awareness, coleaders may unconsciously perpetuate gender and cultural biases, prejudices, or blind spots in the group (25). For example, White group therapists unaware of their privilege will be unlikely to recognize when White group members unintentionally marginalize a person from a racial-ethnic minority group. Unintentional marginalization may manifest itself if a group leader minimizes a person’s angry feelings related to oppression (26, 27), fails to challenge a group member’s internalized oppression, or pressures a group member from a racial-ethnic minority group into a role, such as representative of a race (28). A coleader’s silence may communicate tacit agreement and perpetuate marginalization of a group member or coleader. In turn, this silence may have an impact on the nature of the relationship between the coleader team and group members. Transference and countertransference, which emerge in relation to the interplay of gender and cultural dynamics within the coleader alliance, must therefore be resolved in the direction of equal power and status if norms of equity and social justice are to be embedded in the group.
The following case example illustrates how group leaders with differing attachment styles have navigated an ineffective coleader interaction, the necessity of managing gender role transference and countertransference, and the need to create a secure base in the coleader alliance to successfully manage interpersonal conflict between themselves and among group members.
Formosa, an experienced Asian group psychologist in her 40s, and Javed, an Iranian American psychology intern in his 20s, were coleading a 10-member group in a private-practice setting. Midway through the first group meeting, Nola, a White group member in her 40s, introduced herself by emphasizing that she was “older.” She stated that she frequently assumed the role of taking care of others and doubted group members would understand her concerns. Formosa reflected back Nola’s caution, highlighting her need to be taken care of by the group and her simultaneous expectation of being disappointed.
In a subsequent session, when Javed was absent, Nola spoke about how disappointed she felt when friends invalidated her feelings. Patrick, another group member, responded that he had learned early in life to have no expectations so that he never felt disappointed. This comment upset Nola. She accused Patrick of being “a typical American White sexist man” and elaborated on the differential treatment she had received as a first responder in training—her male colleagues always received more recognition. Patrick sought to clarify that he was simply sharing his own reactions. Formosa asked Nola to slow down and to say more about how she experienced Patrick in the here and now, what she heard, and how she was hurt. Nola angrily accused Formosa of “singling her out,” stating, “You are trying to focus on the humanity of a perpetrator instead of the fact he did something wrong. Patrick hurt me.” Formosa validated Nola’s feelings and invited group members to share their responses. Most seemed frightened by Nola’s anger and remained silent.
Over the next several sessions, Nola and Patrick revisited their initial conflict. Javed usually remained silent during their tense exchanges. Nonetheless, Nola appeared to perceive him as an ally. Javed, Nola, and Michael (a White group member) always sat next to each other, exchanging eye contact and nonverbal support. At one point during another emotional exchange with Patrick, Nola stated to Javed, “I wish you were there on that day.” In contrast, she appeared to view Formosa as responsible for singling her out and ignored times when Formosa provided validation. Nola seemed to be experiencing potent polarized feelings toward the coleader team: she projected exclusively positive feelings onto Javed and intensely negative feelings onto Formosa.
An isomorphic path in the coleader alliance emerged during their debriefing. Formosa stated that she felt dismissed, rejected, and unacknowledged by Nola. She reached out to Javed for perspective. He stated, “It’s much easier for me to address a client who is frustrated with me. I don’t really know how to challenge a client who has positive feelings toward me.” It was becoming clearer that Formosa and Javed had personal issues that were being activated by the group and perhaps by their coleader alliance.
Formosa continued speaking about their increasingly polarized relationship with Nola. Javed replied, “I understand that it’s harder for you to receive all the negative transference, but I don’t really care.” To Formosa, Javed’s response felt like a rupture in the coleader alliance, similar to how she felt in the group with Nola. Javed further suggested that Formosa and Nola were just competing for his attention. Formosa strongly disagreed and suggested Javed’s comments reflected his reluctance to address Nola’s positive transference. Furthermore, Formosa cautioned that Javed’s selective passivity might reinforce Nola’s anger.
The coleaders struggled to find common ground. Javed described himself as a private person comfortable with remaining distant and secretive. Formosa stated that it was hard to establish trust with Javed; his absence of emotional availability and responsiveness made it hard for her to feel he cared about their working relationship. Javed replied that he avoids confrontation and vulnerability, and he acknowledged having received similar feedback from others. At some point, the two therapists recognized they were speaking about attachment styles, and Formosa felt safer sharing her contribution to their strained connection. She felt vulnerable letting Javed in on the impact of his behavior and helpless about pursuing him. Furthermore, she was fearful that disclosing more would reinforce his sense of control. They acknowledged their respective difficulties trusting each other and discussed how their differing attachment styles contributed to a nonproductive repetitive cycle in which Formosa kept “going after Javed,” while he maintained his distance.
Javed clarified his role in their pattern. He felt comfortable with Nola’s transference and anxious about losing it. He described his favored male status in his Iranian family of origin—he was the only son with two sisters. As a child, although he could make mistakes with impunity, his sisters were frequently punished. He recognized a similar pattern in adulthood: he quickly gained favor with others (particularly women) and sometimes ignored or minimized the collateral damage his approval-seeking had on others. Similarly, Formosa reflected on contributions she might be making to Nola’s intense anger. She first considered Nola’s conflict with Patrick: did Nola perceive something about Patrick that Formosa, as a woman from a racial-ethnic minority group, overlooked? Formosa thought about how quick she was to support him in group. Nola’s perception of Patrick as a “sexist White man” might be meaningful for them to explore in the group. It might also be something Formosa minimized, because she was accustomed to giving a lot of space to dominant men in her life because of accumulated blind spots in her own cultural and gender identity.
Javed was more clearly able to see how his avoidance and distancing triggered Formosa’s fear of rejection and increasing mistrust. He acknowledged his determination to remain distant and protect himself by not allowing others to exert any influence. Thus, he remained “in control,” feeling indifferent to his coleader’s frustration and dismissive of her invitation for more authentic connection. Formosa found it easier to focus on feelings of frustration and resentment, blaming Javed for his lack of responsiveness, rather than to articulate her need for connection. Their shared disclosure created an opening for mutual understanding and the basis for more challenging coleader interactions to occur.
Interpersonal Theory and Coleaders
For group leaders, thinking in terms of cocreation is crucial to understanding their own role in the coleader alliance. Observation of how coleaders strive to connect with each other can reveal something about their internal working models of interaction. In essence, people see themselves through the eyes of others, particularly significant others from early in life, and interact accordingly. Group interactions are used to address a range of problematic behaviors resulting from faulty interpersonal learning (29). An integrative interpersonal approach strives to bring past relationships into the group experience and explore how those relationships affect current functioning and shape a group member’s present interpersonal worldview (30). When navigating this process, group leaders must pay attention to their own interpersonal pushes and pulls, using countertransference as interactive data that help inform the coleaders about the group members and themselves.
Coleaders are often perceived differently by different group members. Group members who have difficulty integrating love and hate may project such feelings onto group leaders and may split the cotherapy team, making one leader the focus of positive feelings and idealization and the other a focus of hateful feelings to be attacked or shunned. Racial and cultural transference and countertransference may play a powerful yet unconscious role in intensifying group processes. Divergent group member perceptions of coleaders must be noted and openly discussed in the group (5) to provide a measure of reality testing and to reduce the intensity of such transference distortions. Effective coleaders present a unified stance and discover ways to challenge group members’ all-or-nothing distortions pertaining to coleader behavior in the group.
The following case example illustrates coleader efforts to manage such a rupture in the group. In this example, Formosa invites Nola to directly share her critical feelings toward her as a group leader. Nola’s consequent disclosure deepens the group’s level of affective expression, increases their understanding of different group members’ perceptions of the coleaders, and clarifies the isomorphic rupture between Javed and Formosa. The coleaders are then able to take responsibility for their role in cocreating group tensions and to use the group to heal their respective attachment injuries.
Formosa sat quietly in the group, contemplating her ambivalence about addressing Nola’s anger. She gathered her courage and addressed Nola directly.
Formosa: Nola, I notice you have been working hard to support every group member, validate their feelings, and challenge and help them grow. But you have never asked for anything in return. I am wondering if you are getting enough from the group.Nola: I have zero expectations [for] the group.[Manjari, a South Asian group member, interrupts.]Manjari: I don’t know if that’s true. You come back session after session, so it’s hard for me to imagine that you don’t have any expectations.Nola [turns to Javed]: When I talked about my lack of expectations in our first group, I got a lot of validation from you. You highlighted my need to be taken care of rather than always taking care of others. You gave me permission to own my needs.Formosa [stops Nola]: Nola, you are doing it again.Nola: What?Formosa: This is not the first time you attributed credit to Javed for something he actually did not do. I was the one who spoke to you in the first session about your need to be taken care of by the group.Nola [looks surprised and raises her voice]: OK, Formosa—if you want credit, I can give you all the credit.Formosa [looks at Nola directly]: This is not about credit. It’s about how you have been treating Javed and me differently. I experience you as having very positive feelings for Javed and very negative feelings for me. I feel like I can never do anything helpful for you.
The group held its collective breath. Two members were gently nodding when Nola broke the silence.
Nola: I have to think about it. For some reason it is always easier for me to resonate with whatever Javed says. I am not sure why. Are you trying to imply it has something to do with gender?Formosa: Maybe it’s a combination of things: racial background, age, status, or who I represent. You talked about hating people who treat you with less respect because you’re a woman. There have been times in group when I think I have actually experienced what you are talking about—with you. I’ve wondered if our struggles have to do with my being a woman and a group leader.Nola: I don’t know. You are probably right about the gender issue, but I haven’t liked you since the beginning.Manjari: I noticed you criticize Formosa all the time.Nola: Manjari, please do not interrupt me. I need to have this conversation with Formosa. I am very annoyed by you. You take up too much space, and all you want to talk about is racism!Michael [joins with Nola]: I don’t always experience this group as helpful—sometimes I think people are just playing the “pain game” to get more attention from the group.Formosa: OK, you both clearly have important feelings associated with Manjari, and we can address those in a minute. Maybe they are related. For now, Nola, please say more about not liking me.
Nola then described Formosa as not being aware of her power as the more senior group leader. Nola stated that she viewed Javed, although younger and less experienced, as more competent. She said she disliked Formosa’s intensity and directness and preferred Javed’s way of intellectually challenging her. She said she recalled Formosa asking, “What sort of marriage do Javed and I have as coleaders?” Nola strongly objected to such depictions implying that Formosa and Javed held equal status in the group.
Formosa listened nondefensively as she leaned into the circle.
Formosa: I don’t know how to navigate our relationship, Nola. When I say something in the group, you disagree, correct me, and tell me that I am not getting you right. When I don’t say anything, you blame me for not being active and helpful enough. I have sensed your hostility since the beginning. I hear that you don’t like me, and that’s OK. I don’t want to be your enemy in this group, but I also don’t want to be so unimportant that you believe you can dismiss me.
Through tears, Nola shared a significant life event, that she had an abusive female supervisor during her professional training. Nola was constantly criticized and made to feel inadequate and incompetent. The situation spiraled out of control, with Nola receiving one poor evaluation after another. Eventually she was deemed not to be a good fit and was forced to leave the program. Nola was clearly traumatized by the experience; it had damaged her professional status and self-esteem and had nearly destroyed her confidence.
Some group members looked visibly softened by Nola’s disclosure. Several shared how moved they were; this was the first time Nola had shared something in group with a genuine sense of vulnerability. Formosa asked Nola to look at the faces of the members. Nola scanned the group.
Nola: I feel protective of Javed right now. I think I identify with his junior status as a group leader.
Javed also looked moved, and he paused for a moment.
Javed: Nola, thank you for sharing today. It helped me understand what Formosa and I represent for you. You identify with and want to protect me. And Formosa, I know how hard it has been for you to be on the receiving end of this. I feel bad that I was not able to address this dynamic between the two of you. To be honest, I didn’t know how to respond. Formosa, I wanted to more actively support you, but did not want to risk becoming a target of Nola’s anger. I couldn't figure out a way to support you without losing the good feelings of being the favored one.Nola [nods]: This conversation was very powerful. I realize that I still have a lot of feelings about what happened to me and a lot of anger toward women in authority. Formosa, I never understood why I would go home from group each week and be so angry with you. Now you look different to me, strong but also caring.
Javed returned to the earlier exchange between Manjari, Michael, and Nola. Manjari stated she felt dismissed and unsafe with Nola and Michael.
Manjari: What did you mean when you said I took up all the space to talk about racism?Nola: You always talk about your childhood and immigration and blame this country for what you have been through. But you don’t seem to be aware of your power in group. For example, your power to interrupt me or make the group all about you.
Michael again seemed to align with Nola.
Michael: Manjari, you actively participate, but it feels like a lot of times you just say things because you need to talk. I don’t understand why you shared those things. It feels like you have a lack of purpose sometimes.Manjari [angrily]: You may be tired of hearing me talk about racism, but I am living it every day! I don’t think you understand how privileged you are as a White man. You blame me for fighting for my space in the group and accuse me of playing the “pain game.” However, you just sit there and effortlessly get people’s attention without even trying. You have never been as vulnerable as me in group, but people are always willing to give you space because you are a White man. I am offended when you say, “Playing the pain game.” How come I have to advocate for myself to get what I want, but you get it by just sitting there?
Formosa gently intervened in a culturally sensitive manner by addressing multiple levels of group interaction.
Formosa: There are a lot of feelings being expressed right now. That means our group is feeling strong enough and people are feeling brave enough to do this work. I just want to remind everyone to stay focused on your feelings and try to avoid blaming or shaming anyone.Manjari: I am sorry. I am just deeply frustrated with the “privileged club” in our group. I am feeling tired of advocating for myself and not getting enough support.Patrick: I am glad you are calling that out. Apparently, I don’t belong to that club, because Nola thought I was a sexist.Formosa: Manjari, perhaps you are trying to communicate with me and Javed that you are not getting enough support from us as coleaders?Manjari: Javed is part of the club, but you aren’t. As a person of color, I hoped Javed could be a little more sensitive and supportive about my suffering, but I guess we are still too different from each other.Javed: Manjari, I am surprised to hear that I did not come across as supportive to you. I am sorry I disappointed you. I am wondering how I’ve become a member of the “club”?Manjari: Nola figured out earlier why she identifies with you more than [with] Formosa. But I think it’s mutual—somehow you also identify with her and Michael more than [with] me and Formosa.Formosa: Nola, I am thinking that maybe some of your anger toward Manjari might actually also be meant for me. Is it OK if I invite the group in to help us figure this out?Nola [tentatively]: OK.
Javed invited others to share. Group members agreed that there seemed to be a subgroup among Michael, Nola, and Javed. However, others agreed with Nola and Michael, sharing that they felt Manjari had taken up a lot of space in the group, and that the way she talked did not bring people closer to her. Manjari appeared wounded and began to emotionally withdraw.
Manjari: I feel like the scapegoat in here. Everybody seems to think I talk too much, and maybe I do. I grew up in a culture where people, especially men, were constantly trying to shut me out, so I fought my whole life against being silenced. Maybe sometimes I overcompensate. I also get anxious when talking in group—but the thing is, I do want to connect.Nola: It’s interesting you use the term scapegoat. I feel more like the scapegoat in this group. I am always having conflict in here, first Patrick, then Formosa, and now, with you. I imagine people perceive me as an angry, aggressive woman who likes to fight. I am also tired of feeling like a scapegoat in this group.Javed: So, Nola it sounds like you join with Manjari around feeling like the scapegoat in this group.Nola: Yes, I join you in feeling like the scapegoat in the group. And I also agree with you, as a woman, that we work too hard on resolving conflicts and fighting for space.Formosa: [summarizes]: We cocreated a dynamic as a group that led to Nola and Manjari feeling scapegoated by remaining passive, avoiding confrontation and negative feelings, and not taking up necessary space. I am glad we are no longer willing to settle for that as a group.
Conclusions
Effective coleaders are able to identify and successfully repair ruptures in the coleader alliance. Coleader attachment style can influence the group psychotherapy process, responses of both clients and therapists, the quality of the coleader alliance, and the ultimate outcomes of treatment. Suggestions for strengthening the coleader alliance include understanding coleader attachment styles for important clues about how the coleader is likely to respond; developing an understanding, intimate, and cohesive relationship that allows for challenging conversations to occur; becoming aware of personal issues activated by the coleader alliance and by the group; and generating diversity-competent interventions at multiple levels of group interaction. Ruptures, if not identified and managed, can damage the coleader alliance. Successfully addressing ruptures can bring therapeutic benefit for the coleaders and for the group as a whole.
Footnote
The authors report no financial relationships with commercial interests.
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Received: 13 July 2020
Revision received: 18 October 2020
Accepted: 11 December 2020
Published online: 8 February 2021
Published in print: June 01, 2021
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The author has confirmed that details of these cases have been disguised to protect the privacy of the clients described.
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