The Theory and Practice of Group Psychotherapy Read Online Free PDF Page A

dying, by not wanting to upset them or themselves. I agree with Elisabeth Kübler-Ross that the question is not whether but how to tell a patient openly and honestly about a fatal illness. The patient is always informed covertly that he or she is dying by the demeanor, by the shrinking away, of the living. 33
    Physicians often add to the isolation by keeping patients with advanced cancer at a considerable psychological distance—perhaps to avoid their sense of failure and futility, perhaps also to avoid dread of their own death. They make the mistake of concluding that, after all, there is nothing more they can do. Yet from the patient’s standpoint, this is the very time when the physician is needed the most, not for technical aid but for sheer human presence. What the patient needs is to make contact, to be able to touch others, to voice concerns openly, to be reminded that he or she is not only apart from but also a part of. Psychotherapeutic approaches are beginning to address these specific concerns of the terminally ill—their fear of isolation and their desire to retain dignity within their relationships.† Consider the outcasts—those individuals thought to be so inured to rejection that their interpersonal needs have become heavily calloused. The outcasts, too, have compelling social needs. I once had an experience in a prison that provided me with a forceful reminder of the ubiquitous nature of this human need. An untrained psychiatric technician consulted me about his therapy group, composed of twelve inmates. The members of the group were all hardened recidivists, whose offenses ranged from aggressive sexual violation of a minor to murder. The group, he complained, was sluggish and persisted in focusing on extraneous, extragroup material. I agreed to observe his group and suggested that first he obtain some sociometric information by asking each member privately to rank-order everyone in the group for general popularity. (I had hoped that the discussion of this task would induce the group to turn its attention upon itself.) Although we had planned to discuss these results before the next group session, unexpected circumstances forced us to cancel our presession consultation.
    During the next group meeting, the therapist, enthusiastic but professionally inexperienced and insensitive to interpersonal needs, announced that he would read aloud the results of the popularity poll. Hearing this, the group members grew agitated and fearful. They made it clear that they did not wish to know the results. Several members spoke so vehemently of the devastating possibility that they might appear at the bottom of the list that the therapist quickly and permanently abandoned his plan of reading the list aloud.
    I suggested an alternative plan for the next meeting: each member would indicate whose vote he cared about most and then explain his choice. This device, also, was too threatening, and only one-third of the members ventured a choice. Nevertheless, the group shifted to an interactional level and developed a degree of tension, involvement, and exhilaration previously unknown. These men had received the ultimate message of rejection from society at large: they were imprisoned, segregated, and explicitly labeled as outcasts. To the casual observer, they seemed hardened, indifferent to the subtleties of interpersonal approval and disapproval. Yet they cared, and cared deeply.
    The need for acceptance by and interaction with others is no different among people at the opposite pole of human fortunes—those who occupy the ultimate realms of power, renown, or wealth. I once worked with an enormously wealthy client for three years. The major issues revolved about the wedge that money created between herself and others. Did anyone value her for herself rather than her money? Was she continually being exploited by others? To whom could she complain of the burdens of a ninetymillion-dollar fortune? The secret of her wealth kept