The Healing Crowd

All about group therapy: what it is, why it works, and which group is right for you.

The Peak-End Rule And Premature Termination In Group Therapy

What happens at the end can nearly undo all the good.

Even after a significant time in group therapy some members just stop coming. What happens to them when they end like this? What happens to the other members?

Endings are very important in how they color our memory. Barbara Fredrickson and Nobel Prize Winner Daniel Kahneman proposed a model of how experiences are remembered. The Snapshot Model suggests that we recall an event via a representational heuristic. Selected moments, like snapshots from a vacation, color our memory and give value to the experience.

But unlike our vacation photos these prototypical moments are hallmarked by their intensity, not their value as good or bad. The moments remembered are a type of averaging of our most intense affective experience during the event and what we felt at the end. This is where the Peak-End rule gets its name. The length of time of these events tends not to matter, only their strength.

In group therapy a member who has had good experiences in the group sometimes decides to stop coming. They may have had a positive peak during the group time, but their ending may have been less than ideal.

Termination in group therapy is a unique opportunity for correction. Many people who seek out treatment in group work have had very poor relationship endings, and the group process can be an opportunity to correct this.

This post is mostly about premature termination from an ongoing outpatient group. A group where members have been together for a while, perhaps a significant amount of time, and then one member simply does not come. He or she does not announce that they are no longer going to be part of the group and simply stop. This is not about an inpatient group. While some of the dynamics may be similar there are important differences. I will talk about that at another time.

While there are also come technical things the therapist may want to do to indicate that therapy has terminated (like sending a registered letter with information about other possible referrals and an effort to outreach to the client to call to discuss the departure) this discussion has to do with the dynamics of the group.

In preparing a client for group work I stress the corrective nature of group at many levels, but primarily the corrective recapitulation of the primary family. The group becomes a therapeutic agent of the corrective process by allowing the original dysfunctional patterns of thought and behavior to emerge, and then having members of the group interactive authentically different than the members in one’s family. The healing takes place when a group member recognizes that they distort the members in the group by projecting their sense of family onto them. The correction happens when the discrepancy between how a person is originally seen in the group is contrasted with how the person actually interacts. When you multiply this by several members in the group the effects can be powerfully therapeutic.

The overriding difficulty, however, is the fact that since a primary healing feature of group is the corrective recapitulation; the scars from the dynamics in the family of origin get carried within the psyche and are activated in and by the group process. This often includes the group member’s decision to leave. The group becomes a corrective assemblage of people and the original dynamics from the family get initiated, but members in the group learn to talk about these dynamics in such a way that they feel them, narrate them to the group, and then ultimately assimilate the projection they have had onto the group and use it as a learning opportunity. They see the group as activators of the same dynamics they experienced in their family, but then realize that this distortion can be corrected.

To give an example imagine a man in group who is told that his voice is too loud by a woman in the group and she reports being scared. The woman explains that this loud voice frightens and repulses her. The man or the facilitator asks other members in the group if they experience his voice as too loud, and, much to the woman who raised the issue’s surprise no one else in the group thinks his voice is loud at all. At this point, if there is to be a corrective recapitulation, the woman would talk about how this reminds her of her family, and perhaps even in a more transferential way her father. (See an example of transference here.) She explains to the group that when she told her mother that she was afraid of her father raising his voice because it was often followed with physical abuse, her mother said she was mistaken, that her father wasn’t being loud. The group would have mimicked her recall of the event, but by talking about the elements that activated her she becomes able to separate her sensitivity from her family of origin. She learns at an interactive level that the group is not her family.

But when a group member leaves without explanation there is no opportunity for the perception of the person leaving to be challenged. They are gone, and along with them the opportunity for a correction. It also often activates the feeling in the member’s left that they have done something wrong, are being abandoned, that the person is angry with them, or simply doesn’t care. This is all grist for the mill in the working through process of the group. Members can talk about how they arrived at their different conclusions, and the fact that the event of one person leaving can be viewed through so many different lenses can help each member see how their unique perspective has its roots in the family of origin.

So what happens to the member who left unannounced and doesn’t return? While they may have gotten something from the group process, in fact they may have gotten a great deal, a peak experience, their leaving in this manner is a therapeutic flop: How they cope with and end relationships not only remains unhealed, it is very likely to reinforce an old dysfunctional pattern. There are endless scenarios of why a person might choose to leave in this fashion. But lets focus on two examples: One positive and one negative.

On the positive one lets say woman has been in an ongoing group for six months and has felt she has gotten a lot out of the group. She’s understood the nature of the feedback she has received, been able to function well in the group, and thinks she has gotten from the group the most she can – so she leaves.

She has not considered the fact that others may need her to express this, that others may want to say goodbye, finish some unrealized encounter, or simply have the closure of being able to wish her well. She leaves only thinking about what she has gotten and has failed to recognize the needs of others. She may even justify this by believing she isn’t responsible for this.

But she would be wrong. Understanding the impact your behavior has on others, both positively and negatively is central to emotional growth. Not announcing it is an attempt to shield her from this responsibility. While she has ended group, she has not finished her work. Even though the peak experience during the group was good the end drags the average of the memory of the group down.

For the negative example imagine a man who gets angry and doesn’t want to bring this up in group. He becomes largely silent for few sessions, and then disappears. This is the neurotic paradox at its finest. He gets off the hook in the short run by no longer having to deal with the group, but in the long run has not learned to deal with his anger. He may have had a good experience in the group up until he got angry, but leaving in the way he did lowers his experience. The brevity of the ending experience can outweigh many months of positive.

The way to reduce this from happening is to make it clear when people join the group what the rules are for leaving. Specifically noting that the desire to leave is different from being ready to leave. Explain that a minimum of one session after their announcement is what would be needed. Talk in the group about endings on a regular basis and remind people that they need to talk about the desire to leave the group. When a member does it be sure to acknowledge this effort.

Talk to the group regularly about how relationships in their life have ended and how they might want to do an ending in the group. Explain that endings can be a time of celebrating progress and have the group elaborate on the changes they have witnessed over their time together. Ask what they will be taking from the group and how this might be brought into their lives. As a facilitator be sure to talk about being available for any follow up that might be necessary.

Often group members leave their family of origin in ways that are less than desirable and have difficulty with intimacies that result in poor endings. The significant progress a member has made in group can be enhanced significantly with a positive corrective ending. This can employ the best of both worlds by having their peak positive experiences during the group -- with a corrective experience at the end.

 

Daniel J. Tomasulo, Ph.D., TEP, MFA, is a licensed psychologist specializing in group psychotherapy and psychodrama.

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