SYMPOSIUM: A DISCUSSION OF THE

VIDEOTAPES OF A DIFFICULT GROUP

Yvonne Agazarian, Ed. D. Louis R. Ormont, Ph.D.

Saul Tuttman, M.D., Ph.D.

Three conference participants (Drs. Yvonne Agazarian, Louis Ormont and Saul Tuttman), each an experienced group therapist employing distinctly different styles and theoretical frames, react to a videotape of a '~Difficult Group" and offer their respective critique and sugges- tions.

The material was originally presented before an audience at the Eastern Group Psychotherapy Association Annual Conference (1985) in New York City.* The audience first saw the videotape at the con- ference and then observed the interaction among panelists. This ma- terial was submitted for publication because: 1) issues of contrasting technique and theory are heightened by a concrete comparison of different clinicians' reactions to the same material; 2) the serious task of coping with a group of difficult patients is of concern to all group therapists who are faced with such challenges; 3) the circumstances, in which patients who feel needy and neglected chronically put pres- sure on the therapists, occur with frequency; at the same time, 4) the therapists are also under stress in that their supervisors and evalu- ators are scrutinizing their work. All of this makes for a fascinating and difficult dynamic situation. Finally, 5) examining this group material resulted in a lively exchange which was stimulating and interesting to both audience and participants.

Yvonne Agazarian, Ed.D., is in private practice in Philadelphia, Pennsylvania. Louis Ormont, Ph.D., is Clinical Professor, Gordon Derner Postgraduate Institute for Psychoanalysis, Adelphi University, Garden City, New York; Faculty of Philadelphia School of Psychoanalysis and Center for Modern Psychoanalytic Studies. Saul Tuttman, M.D., Ph.D., is Clinical Associate Professor of Psychiatry, New York University School of Medicine; Adjunct Associate Professor of Psychiatry at New York Medical College, Faculty Training and Supervising Analyst of the Division of Psy- choanalytic Training; and Director of the American Group Psychotherapy Association Training Program. *Edward L. Parsons, M.D., was the moderator of the conference. He provided the videotape, invited the group therapists to participate, and served as chairman and panelist. The authors are appre- ciative of his efforts as well as of the participation of the cotherapists of the videotaped group, Clifford Taylor, M.D., and Judith Fitzgerald, M.S.W.

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A BRIEF HISTORY

The videotaped group began in early 1977 in conjunction with a research project at a clinic in New York State. The original group* consisted of five of the six women viewed on the tape: Alice, Bess, Clara, Doris, Glenda, and Edna. These patients were known to the center's medical clinics for psychosomatic disorders and multiple chronic complaints.

Shortly after the group started, two men joined the group. One man dropped out and the second, Frank, was diagnosed as having a malignant, terminal carcinoma. Frank stated, on many occasions, that this group was his family and asked them to help him prepare for his death. The group responded initially with admiration and awe that he was so '~courageous" in talking about his own death and dying. However, over a period of time until his death, anger slowly surfaced toward him for having a ~special" illness and receiving justified ~spe- ciar' attention from the medical staff and the group therapists.

Much of the group session time, members were rather noncommunicative. They were absent on many occasions, made frequent clinic and emergency room visits, and some members were hospitalized quite often for various so- matic complaints.

The comments of the three presenters provide details of the incidents and interactions pertinent to group history. Among the main issues of concern to the group was the loneliness of the members relating to the emptiness of their lives. Somehow, the group leaders tended to minimize these aspects of group feeling; they endeavored, rather, to focus on resistances and underlying dy- namics. This led to further resentments among the group members, who were generally hesitant to confront their group leaders.

Predicaments of this type occur frequently since so many clinic patients continue in treatment for years while trainees (residents, interns, etc.) and relatively new staff therapists are assigned for brief periods to ~treat" the ongoing groups. In addition to the special problems of the patients, the ther- apists are confronted with group resentments, pressures from supervisors, and the intrapsychic tensions usually prevalent among those under complex pres- sures to learn and work effectively and deal with transferentially based im- possible demands from needy patients.

What follows are the presentations of the three discussants.

S.T.

*Names and identifying dates have been changed for purposes of protecting confidentiality