Group Observation the Breaking Down

Group Observation

The Breaking Down Borders Group meets twice a week at the Ambrose Psychological Clinic. Led by two counselors, one male and one female, the group serves persons diagnosed with borderline personality disorder (BPD). Eight out of the ten members were recently diagnosed with BPD and this was their first group therapy experience. The other two had undergone group therapy but for related disorders. By the time I arrived for observation, the group had met for seven sessions, over the course of almost one month.

The formally stated goals of the group include the following. First, the group will offer members a supportive, safe, secure environment for healing. Second, the group will encourage the development of trust and security, allowing members a safe forum for personal expression. Moreover, the group setting will encourage members to form meaningful bonds with leaders and other members. Third, group members will practice developing interpersonal skills and relationship building skills within the safe environment. Fourth, the group therapy will encourage members to build self-reliance, self-confidence, and self-esteem. Fifth, the group will serve as a mirror for all members, to stimulate self-reflection, self-awareness, and honesty. Sixth, the group will be one facet of a holistic program of care and group leaders will consult with counseling team members about the progress of each participant. In addition to the express goals of the group, leaders noted that while healing remains the main objective of the group all members will cultivate realistic expectations. Mental illnesses are not like broken legs: they do not always heal thoroughly and often clients need to accept their quirks, differences, and scars in order to live happy, fulfilling lives.

Having two leaders balanced the group dynamic and helped members to not feel as outnumbered by their counselors. The balance of power between leader and member was therefore moderated. Moreover, one leader was an African-American female and the other was a multiethnic (Asian and Caucasian) male. Leaders represented diversity and engendered an atmosphere of trust and support for all members. Having one leader from each gender helps all clients because regardless of the member's gender, he or she will respond differently to male and female leaders. Leaders often inadvertently unearth feelings about gender and sexuality. Similarly, a leader could evoke the persona of a parent, causing some individuals to engage in meaningful, potentially productive dialogue.

The leaders served more as facilitators than as authority figures. Group members were encouraged to set the pace and timing of the discussions. At the same time, leaders initiated each session and punctuated the session with questions and mediation. Because I arrived seven sessions into the course of the group, Breaking Down Borders was transitioning between the second and third stages. Some of the members still demonstrated the rebellious, anxious traits characterized by the second stage. One man continually interrupted others and argued; one woman refused to speak and seemed hardened. Each leader took a different approach to encourage the woman to talk. The male leader reiterated questions to her, and the female leader took the opposite approach and affirmed the woman's decision not to talk. Having two group leaders therefore ensures that various approaches can be used within the same session and even on the same person. During the third session, the woman was talking more. She responded to both the male and the female leader. In fact, the opposing approaches somehow blended in her psyche so that she could equally accept her hesitancy and at the same time capitalize on the sense of pressure she felt in needing to open up. More than any other member, she made the most noticeable breakthrough over the course of the three sessions I observed.

A few of the members responded to the problems that arose during the second stage of the group. For example, one member had argued with another, by putting down the antagonism she admitted feeling toward her father during the first session I observed. At the third session, the same member expressed sympathy for the same woman and both of them shed some tears. By the third session I observed it became apparent that the group was solidly within the third stage, developing the cohesiveness necessary to meet the group goals. When any group member exhibited resistance or antagonism, another member would point it out before a leader had to say anything. I also noticed that the leaders intervened less during the third session than at either of the first two. Group members seemed to have gotten into a rhythm within the format of the group so that strong leadership was not as necessary as it might have been during the first two stages. When leaders did intervene they did so sensitively and carefully, not patronizing the members but assuming they knew why they were in the group and also how the group would help them achieve their personal goals.

Another unspoken group goal appeared to be individuated support. Group leaders and group members both seemed aware that each person had traversed a different life path; that members came from various cultural, religious, and ethnic backgrounds and also that members were of different ages, genders, and sexual orientations. Moreover, each member's experience with borderline personality disorder differed. Some were diagnosed in their late teens and had relatively intensive histories of dealing with the illness via individual counseling and medication. Many of the members were co-morbid with problems ranging from substance abuse to depression. Not all members could be expected to discharge from the group without needing ancillary support, while others could. The diversity exhibited at the group did not overwhelm the leaders at any point and no ethnic or racial conflict ever arose during the three sessions I observed. Substantial gender conflict and communication problems did surface, however, which the leaders had to address spontaneously. For instance, a lesbian woman in the group frequently and vocally disagreed with a male member discussion his relationship with his wife.