Contactful Dialogue

Relational Group Psychotherapy:

the Healing of Stress, Neglect and Trauma
By Richard G !rs"ine, PhD
Abstract
This article is the Keynote Address given at the 4th International Integrative Psychotherapy
Association Conference, April 17, 200! In spea"ing to the conference the#e of $Ac%te Tra%#a,
C%#%lative &eglect, and Chronic 'tress( the article describes so#e of the principles of
)elational *ro%p Psychotherapy! The theory of #ethods is based on the concept that the healing
of tra%#a, neglect and stress occ%rs thro%gh a contactf%l therape%tic relationship! )elational
gro%p psychotherapy dra+s fro# several develop#ents in gro%p therapy, partic%larly the
cybernetic feedbac" and other,centered #odels! It e#phasi-es the healing po+er of relationships
bet+een gro%p #e#bers and the i#portance of pheno#enological in.%iry, affective att%ne#ent,
identification, and relational,needs! The leader/s tas"s are to sti#%late the flo+ of contactf%l
dialog%e and to teach abo%t h%#an needs and healthy relationships!
######
The healing of stress, neglect and trauma occurs through a contactful therapeutic relationship This
concept is $ased on the %ntegrati&e Psychotherapy theory of methods By 'contactful( )e mean the
capacity to $e attuned to another person*s affect, relational+needs, rhythm, cognition, and
de&elopmental le&el %t also means to $e respectfully present, authentic and congruent By 'therapeutic
relationship( )e mean the s"ill, commitment, intentionality and ethics of a professional
psychotherapist
The healing of stress and trauma may also occur through the multiple relationships in an effecti&e
group psychotherapy )here the group mem$ers are in&ol&ed and attuned to each other*s affect,
rhythm, relational+needs, cognition, and de&elopmental age of shame, neglect or trauma Such
in&ol&ement also includes each mem$er*s commitment to honesty, authenticity and the integrity of the
group*s therapeutic process
People )ho ha&e $een affected $y cumulati&e neglect, acute trauma or chronic stress re,uire
relationships that pro&ide respectful in,uiry into the person*s e-perience as )ell as an interpersonal
in&ol&ement that pro&ides consistency and dependa$ility through ac"no)ledgement, &alidation and
normali.ation %t is the interpersonal in&ol&ement that heals Trauma may $e the result of acute e&ents
such as physical or se-ual a$use, )ar or natural disaster, $ut it may also $e the result of mental a$use
that is caused $y prolonged ridicule and criticism Stress is often the result of li&ing )ith prolonged
shame, the accumulation of neglect, and unresol&ed trauma !ach of these e&ents threatens the
emotional and cogniti&e sta$ility as )ell as the physical security of a person
/ith acute trauma, cumulati&e neglect and chronic stress there is an increased need for protection,
nurturing, empathy and understanding /hen these needs are unmet people )ill de&elop self+protecti&e
strategies to maintain some mental and physical sta$ility and a sem$lance of relationship Such
strategies include forming Script Beliefs a$out self, others and the ,uality of life, disa&o)ing affect,
desensiti.ing physiologically, dissociating from the sense of self, or distancing in relationship )ith
others /hen used ha$itually o&er time, these strategies interrupt the person*s a$ility to $e contactful
$oth internally )ith self and e-ternally )ith others
Trauma and chronic stress often remain as fi-ated e-periences $ecause the important people in a
person*s life failed to pro&ide the necessary restorati&e and nurturing functions /hen an e-perience
remains traumati.ing it is often the result of a failure of a num$er of people to pro&ide a protecti&e,
understanding and healing relationship These failures may not only $e $y parents and may also
include teachers, other relati&es, si$lings, and other children 0ften an e-tended family, or e&en a
)hole community, is needed to pro&ide the healing of trauma 1ull interpersonal contact and honest
communication $et)een people is the means $y )hich trauma and stress can $e resol&ed
%t is in the ,uality of contact $et)een people ++ a series of authentic and sensiti&e encounters ++ that the
full a)areness of $oth one*s self and the other is possi$le
Models of Group Psychotherapy:
%t is $eyond the scope of this 2eynote 3ddress to co&er a detailed history of the contri$utions of
&arious models of group psychotherapy4 ho)e&er, % )ould li"e to descri$e three models of Group
psychotherapy that ha&e influenced my professional practice They may $e descri$ed as Therapy+$y+
the+Group, Therapy+$y+%nterpretation, and Therapy+in+the+Group
%nfluence from each of these forms of group therapy ha&e led to the de&elopment of an %ntegrati&e
Psychotherapy model of Therapy+through+the+Group Process4 a therapy that emphasi.es the
importance of human relationships and our interdependence on each other The healing of stress,
cumulati&e neglect and trauma is possi$le )ith contactful, caring relationships that attend to each
person*s phenomenological e-perience and relational+needs
%n the 5678*s 3lcoholics 3nonymous 933: $egan as a leaderless group 33 is $ased on the theory that
alcoholism is a disease and indi&iduals need the support of the group in order to stop drin"ing The
methods of the group are shaped $y the T)el&e Step program4 e&ery aspect of the group is determined
$y one of the t)el&e steps ;em$ers are encouraged to tell their story, often o&er and o&er again 33
emphasi.es honesty and responsi$ility as important elements in an indi&idual*s reha$ilitation
%n 56<=, non+directi&e Group Therapy )as de&eloped at the >ni&ersity of Chicago $y Carl Rogers and
Bo$ Ne&ille to treat /ar Neurosis This form of group therapy emphasi.ed a democratic process of
e,uality and the encouragement of group mem$ers to share their traumatic stories and feelings )ith
each other By telling each other their stories o&er and o&er again, )hile recei&ing an empathetic
response, the traumas of )ar )ere healed The leader*s role is to model empathy, congruence, and
unconditional positi&e regard for group mem$ers There is no interpretation from the leader The
therapy in a non+directi&e group is not determined $y a theory of moti&ation, personality or
psychopathology $ut $y the idea that people need to $e authentic )ith each other a$out their emotional
e-periences
Non+Directi&e groups and 3lcoholics 3nonymous groups represent )hat )e call Therapy+$y+the+
Group They are &ery different from the Psychoanalytic group therapies that emphasi.e the importance
of the therapist*s interpretation Se&eral types of Psychoanalytic Groups $egan in the 56=8*s under the
influence of the Ta&istoc" Clinic in !ngland The analyst*s tas" is to interpret group mem$ers*
$eha&ior according to psychoanalytic theorists, including Sigmund 1reud and ;elanie 2lein Group
mem$ers are encouraged to tal" to each other and, in the course of the group*s discussion, each
mem$er*s childhood transferences and psychopathology are $e re&ealed in their $eha&ior The leader
does not spea" until the end )hen he or she may ma"e authoritati&e interpretations of group mem$ers*
pathological moti&ations for their $eha&ior 1or e-ample, interpretations of an indi&idual*s $eha&ior
might $e attri$uted to unresol&ed aggression, en&y, se-ual attraction or infantile transference %n such
Psychoanalytic groups, the authority of theory appears to $e more important than the group mem$er*s
phenomenological e-perience The leader*s interpretations are often shaming and pro&o"e people to
either )ithdra) or conform
The 56?8*s )ere a rich time of de&elopment in group therapy Three trends emerged !ric Berne made
uses of a modified Psychoanalytic group to analy.e group mem$er*s transactions in order to determine
)hich )ere transferential and )hich )ere not transferential He )as primarily focused on the
transferences $et)een group mem$ers that resulted in psychological games and reinforced their @ife
Script He )as acti&e intermittently during the group*s discussions $y ma"ing interpretations and
e-planations during the process rather than )aiting till the end as in most psychoanalytic groups His
methods included e-planation and interpretation a$out the theory of ego states and the rules of
transactions, games and scripts He attempted to create a sense of e,uality $y engaging group mem$ers
in ma"ing contracts for $eha&ioral change 3lthough Berne did not ma"e psychoanalytic
interpretations a$out an indi&idual*s pathological moti&ations, ++ he focused instead on people*s
interactions )ith each other ++ $oth Berne*s Transactional 3nalysis groups and the Psychoanalytic
Groups can $e seen as a model of Therapy+through+%nterpretation
3lso during the 56?8*s 1rit. Perls de&eloped the concept of Therapy+%n+the+Group %n these groups the
psychotherapist did indi&idual psychotherapy )ithin the group )hile group mem$ers o$ser&ed the
indi&idual therapy Group mem$ers participated $oth &icariously and through their supporti&e
statements at the end of the )or" The psychotherapist )as highly directi&e of the indi&idual*s
psychotherapy $y encouraging the client to do psychological e-periments, to $e e-pressi&e, and to
e-plore unfinished emotional e-periences from the past The theory is $ased on the concept of
interruptions to contact: confluence, retroflection, proAection, and introAection Perl*s Gestalt Therapy
Groups pioneered the concept of TherapyBin+the+Group and had a large influence on ho)
Transactional 3nalysis and other forms of group therapy )ere conducted after the 56C8*s
The third trend of the 56?8*s )as the !ncounter Groups These groups $egan as a form of human
relations training The theory )as $ased on a Cy$ernetic ;odel that )e all affect each other in a
myriad of )ays, illustrated $y the concept that the $eha&ior of one person in the group is a direct
influence on the $eha&ior of the other people in the group /e are all constantly influencing each
other !ncounter groups focused on &arious group mem$ers descri$ing the $eha&ior of each of the
other group mem$ers and ho) that $eha&ior affected them !ach mem$er in the group )as encouraged
to gi&e feed$ac" to other group mem$ers and to $e highly confrontati&e, e&en aggressi&e, in descri$ing
the others* $eha&ior Direct confrontation )as seen as a form of authenticity Both an indi&idual*s
$eha&ior and their lac" of emotional e-pression )ere seen as his or her 'pro$lem( The theory is $ased
on the idea that people are often out of touch )ith themsel&es and needed an intense encounter )ith
others in order to $ecome authentic >nfortunately, the lac" of respect that often occurred and a hea&y
focus on $eha&ior change made these groups shaming and traumati.ing to some participants
By the 5668*s there )ere a num$er of therapists e-perimenting )ith different forms of group
psychotherapy ;any Group Psychotherapists )ere influenced in some )ay $y these pre&ious models
% too )as influenced and stimulated to de&elop a form of group psychotherapy that )as truly relational
and co+constructi&e $y ma"ing full use of the therapeutic potential in the group*s process )ith each
other
Today % )ill descri$e Aust t)o trends in Group Process and suggest ho) )e might integrate the t)o to
form a group psychotherapy that is effecti&e in pre&enting stress and healing the )ounds of trauma and
neglect The t)o trends in Relational Group are the 'cy$ernetic feed$ac"( model and the 'other+
centered( model
;any current psychotherapy groups ma"e use of a cy$ernetic feed$ac" model of group interaction
3lthough such a model is interpersonal, it stresses the &ie)+point of the spea"er, emphasi.ing one
person*s perspecti&e as more significant than listening to and learning the other person*s perspecti&e
1or e-ample, the spea"er may say to another, 'Dou are angry and )ithdra)n( 3 pronouncement is
made and the other is e-pected to respond The focus is on each mem$er*s perception and
interpretation of other group mem$er*s $eha&iors The feed$ac" is an e-pression of the spea"er*s
perspecti&e )hether or not it accurately descri$es the other person 3uthenticity is defined as spea"ing
in congruence )ith one*s o)n interpretation of the other*s $eha&ior The purpose of the group is to
influence each other*s $eha&ior and the message is, 'This is ho) you affect me(
Theoretically the therapy in the cy$ernetic model is in the continuous feed$ac" of one mem$er to
another Ho)e&er, a group that relies only on this mode of functioning often $ecomes shaming to
many participants and in&ites either compliance or )ithdra)al /hen used e-clusi&ely, this model of
group psychotherapy may increase people*s stress, shame or a sense of $eing misunderstood )ithin the
group
%n contrast, an 0ther+Centered psychotherapy group places its focus on the other*s phenomenological
e-perience and ho) each person*s su$Aecti&e e-perience is manifested in $eha&ior %n an 0ther+
Centered group one*s personal perspecti&e and interpretation is seen as inade,uate in understanding the
other person Therefore, there is an emphasis on attunement )ith the other*s inner e-perience ++ a
resonance )ith their affect, perspecti&e, and ho) they ma"e meaning %t is $ased on the assumption
that % "no) nothing a$out the other, that my o$ser&ation and interpretation are not enough to
understand them 0ne of the purposes of an 0ther+Centered group is to learn to see the other as he or
she sees him or herself Careful listening and in,uiring are seen as essential to "no) the other
!mpathy and attunement to the other*s affect, rhythm, and cognition is important /hen people
e-perience $eing truly "no)n, )ithout ridicule, their stress le&el decreases and they can more freely
e-press themsel&es
/hen using a Relational Group Process in %ntegrati&e Psychotherapy, )e com$ine the $est of $oth the
Cy$ernetic and 0ther+Centered modes of )or"ing The group mem$ers attend to each person*s
phenomenological e-perience and pro&ide respectful feed$ac" The therapy is through the relational
process of each mem$er $eing fully in&ol&ed )ith each other mem$er /hen group mem$ers are
attuned to the relational+needs of each other and respectful in their transactions )ith each other, the
feed$ac" they pro&ide $ecomes a &alua$le asset in promoting each person*s gro)th
% often $egin a Relational Group Process )ith a focus on teaching the importance of an intersu$Aecti&e
perspecti&e )ithin the group $y encouraging group mem$ers to $e empathetic, to listen, to in,uire and
to resonate )ith others Group mem$ers learn, and hopefully appreciate, the other*s perspecti&es and
feelings Det an effecti&e relational group )ill also include a feed$ac" model of 'This is ho) % see
you( %t is in integrating $oth the 0ther+Centered and Cy$ernetic models of )or"ing that )e create an
'>s( rather than Aust a 'Dou( or ';e( perspecti&e
/hen group mem$ers fully listen to each other and thin" a$out ho) the other indi&idual*s perceptions
compare and contrast )ith their o)n, then a ne) e-perience emerges ++ an e-perience that is uni,uely
different from )hat each indi&idual has pre&iously "no)n Ne) understandings emerge, old $eliefs
change, and ne) emotional e-periences occur %t is through shared affect and perceptions that old
emotional e-periences can $e integrated )ith current relationships that are uni,uely indi&idual and
simultaneously uni,uely relational %n doing so, )e create a place that $elongs solely to no one in
particular and yet it $elongs to each and all B a creati&e place of relationship
This reciprocal process of acti&e in&ol&ement )ith other group mem$er*s perspecti&es and respectful
reactions ena$les e&eryone in the group to $oth ela$orate and enrich their e-pressions of their o)n
e-periences Relational Group Psychotherapy pro&ides mem$ers )ith an opportunity to e-press one*s
self, to $e understood, to gro) in emotional attachment, and to de&elop one*s o)n identity The
therapist*s tas" is to introduce principles and practices that normali.e and &alidate each indi&idual
person and the multiple relationships in the group, to pro&ide a sense of cohesion, continuity and
sta$ility, and to encourage the group mem$ers to ,uestion and challenge their $eliefs, fantasies and
$eha&iors The therapy is in the honest and respectful dialogue
!ffecti&e relational group psychotherapy pro&ides a contrast $et)een an indi&idual*s internal
psychological processes of emotional memories, script $eliefs, e-pectations, and self regulation )ith
the &arious group mem$er*s sensiti&ity to relational+needs, the importance of phenomenological
in,uiry, and the reparati&e po)er of people*s genuine interest and in&ol&ement
The leader*s tas" is to teach and emphasi.e the importance of acti&e listening, &alidation and
normali.ation This is not a normali.ation that is placating or minimi.ing the significance of a
pro$lem, $ut a normali.ation that recogni.es the person*s affects, fantasies, self+protecti&e process,
script $eliefs and modes of coping as normal ++ normal )ithin a stressful, neglecting or traumati.ing
family or school conte-t
Relational Group Psychotherapy ta"es the psychotherapist out of the center of the group, out of the
tas" of interpreting, and out of the role of )or"ing indi&idually )ith each person, and puts the focus on
the relationships $et)een group mem$ers The leader is a teacher a$out human needs and
relationships, guiding and facilitating in&ol&ed relationships among group mem$ers The image % use
of a Relational Group Psychotherapist is that of an orchestra conductor )ho maintains the rhythm,
adAusts the &olume, gestures to the &arious musicians )hen to play their solos, and facilitates the
orchestra*s playing in harmony )ith each other
3 guiding principle of Relational Group psychotherapy is the respect for each person*s integrity and
phenomenological e-perience Through respect, "indness and compassion, each mem$er of the group
esta$lishes an interpersonal relationship that pro&ides affirmation of the other*s integrity Contact
$et)een group mem$ers is the therapeutic conte-t in )hich each person e-plores his or her feelings,
needs, memories, and perceptions This does not mean that a Relational Group Process is all a$out
$eing 'nice and superficial( )ith each other 0n the contrary, )hen )e truly engage in using the $est
of a cy$ernetic+feed$ac" model, )hether it $e through the use of self+definition, ma"ing an impact or
initiating )ith another, it may in&ol&e uncomforta$le discussions, challenges to the other person*s
perspecti&es, or confrontations of their $eha&iors Through the integration of the other+centered and
cy$ernetic models, discussion, challenge, or confrontation done )ith honesty and respect for the
other*s perspecti&e, in a non+humiliating )ay, often $uilds trust in the relationship
Healing relationships are $ased on caring in&ol&ement in the act of )or"ing together for a common
$enefit of each group mem$er*s )elfare 0ne of the tas"s of the group psychotherapist is to facilitate
the group mem$ers to in,uire a$out each other*s phenomenological e-perience and to dra) out other
group mem$ers )ho are not acti&ely participating or )ho may $e reluctant to tal" a$out )hat they are
feeling 3n illustration of this occurred in a group session )here Charles spo"e a$out the stress he felt
in the painfully protracted illness and e&entual death of a dear friend His grief )as intense He then
than"ed $oth the group mem$ers and the psychotherapist for their encouragement and support in
tal"ing a$out a topic in )hich he )as hesitant to spea" He descri$ed the relief he felt after tal"ing and
crying a$out his pain )ith the group He tal"ed )ith each of the group mem$ers a$out ho) his grief
had shifted to a sense of appreciation for ho) his life had $een enriched $ecause of the friendship
/ith the group leader*s encouragement he then in,uired a$out the e-periences of t)o others in the
group )ho had not spo"en and had recently e-perienced the death of lo&ed ones They $oth said that
they found it difficult to spea" a$out death and their lost relationships $ecause of the fear of $eing
o&er)helmed )ith intense sadness $ut, in )itnessing Charles* emotionally filled story, they )ere a$le
to e-press some of their o)n grief This led to the )hole group tal"ing a$out the importance of
interpersonal connections, loss, sadness, and ho) they each had a history of distracting themsel&es
from the intensity of their feelings
%n Relational Group Psychotherapy the therapist is not the only one to support, in,uire and encourage
group mem$ers to e-press themsel&es Group mem$er*s in,uiry and empathy )ith each other and their
encouragement for e&eryone to $e heard, may constitute the most psychologically supporti&e
transactions $ecause they may e-press a shared e-perience of similar loss, stress, neglect or trauma
Relational group psychotherapy often $egins )ith recognition of each person*s needs and feelings The
leader )ill often encourage the group to focus on each person*s need for security, the freedom to $e 'as
they are( )ithout criticism, ridicule, or putdo)n 0ne of the first steps in pre&enting and healing stress,
in the undoing of cumulati&e neglect, and in the resolution of trauma is for each person to ha&e an
assurance of freedom from $eing shamed in the group This is often accompanied $y encouraging
group mem$ers to tal" a$out past humiliating e-periences and ho) they )ere hurt, angry or remain
fearful in a group Sometimes group mem$ers are in&ited to remem$er specific scenes from family or
school e-periences and to tal" a$out their e-periences 0ften it is the implicit memories and archaic
)ays of relating that are reenacted )ithin the group The emphasis may then shift to )hat the person
needs differently from group mem$ers in order to feel secure Such con&ersation may mo&e from one
group mem$er to another )ith a focus on the type of security each needs from the other
%n a group that had met for a fe) sessions, the discussion among the mem$ers seemed to $ecome
superficial % $egan the ne-t session $y stating that no one had used the )ord 'shame( in our pre&ious
sessions The mention of 'shame( )as responded to )ith se&eral minutes of silence and then each of
the group mem$ers spo"e of their o)n shame and ho) they often felt de$ilitated $y their sense of
'something*s )rong )ith me( 0&er the ne-t se&eral sessions the entire group tal"ed a$out ho) they
)ere $lamed or humiliated in school, in pre&ious groups, and in their families These discussions led
group mem$ers to reali.e ho) each person needs safety in the group and they pledged to each other
that there )ould $e no shaming transactions
0ften the discussion of security leads to someone*s need for &alidation and affirmation $y other group
mem$ers 1or many people their $eha&ior or )ay of ma"ing meaning )as discounted, ignored, or in
some )ay not &alidated in pre&ious relationships The lac" of &alidation is often shaming and adds to
stress Ealidation is pro&ided )hen )e find &alue in )hat the other is saying 3n important tas" of
Relational Group Psychotherapy is to pro&ide each mem$er )ith a sense of &alidation 1or e-ample,
fre,uently in groups a mem$er )ill say something that is full of emotion and group mem$ers )ill
remain silent This is often $ecause group mem$ers thin" that they are $eing respectful Det, a silent
response is often e-perienced $y the spea"er as a lac" of &alidation of their affect The person may
$egin to dou$t themsel&es and )hat they are saying4 internal stress, shame and )ithdra)al may result
%t $ecomes the leader*s Ao$ to identify such moments in the group )hen there is a lac" of &alidation
and to encourage mem$ers to spea" a$out )hat they are feeling in response to the person Group
mem$ers are encouraged to in,uire a$out each other*s phenomenological e-perience and to pro&ide an
emotionally &alidating response
!ach of us needs to rely on others )ho are sta$le, dependa$le, and protecti&e The psychotherapy
group can fulfill this need )hen group mem$ers consistently respect each person*s affect, fantasies and
self+protecti&e process The group pro&ides a protecti&e function )hen there is a secure &enue and the
necessary attunement and in&ol&ement to understand the emotional e-pression or implicit memory that
a mem$er is e-periencing 1or e-ample, in some groups % emphasi.e the significance of the larger
unconscious story that a mem$er is enacting in his or her $eha&ior and the importance of patience and
acceptance as a )ay to pro&ide sta$ility and dependa$ility
3ll of us ha&e the need to ha&e our personal e-periences confirmed Confirmation occurs )hen )e are
in dialogue )ith someone )ho understands $ecause he or she has had a similar e-perience The group
leader )atches for and encourages mem$ers to tal" a$out ho) they identify )ith )hat a person may $e
saying that is similar to their o)n e-perience 1re,uently the con&ersation then flo)s $et)een se&eral
group mem$ers )ith each contri$uting the uni,ueness of their o)n e-perience %t is in the shared
e-periences that people do not feel alone or )orry that they are strange or cra.y Shared e-periences
are an important antidote to shame and an important reduction of stress
%n addition to shared e-periences and similarities, each person in the group is uni,uely different
People ha&e the need to "no) and e-press their o)n self+definition and uni,ueness and to recei&e
ac"no)ledgement and acceptance $y the others in the group Self+definition is the communication of
one*s self+chosen identity through the e-pression of preferences, interests, and ideas )ithout
humiliation or reAection The Relational Group Psychotherapist encourages each person*s e-pression of
identity and integrity and the group*s normali.ation of the need for self+definition %n some family and
school situations the child*s attempts at self+definition )ere ridiculed or punished /hen self+
definition is th)arted, internal stress increases 3n effecti&e group facilitates each indi&idual in
defining his or her self in relationship )ith others
0ne of the important tas"s of the group psychotherapist is to teach each of the group mem$ers ho) to
engage in a phenomenological in,uiry !ach response a person ma"es to a phenomenological in,uiry
is an e-pression of identity B another self+definition
3ll people ha&e the need to ma"e an impact on others )ith )hom they are in&ol&ed 3n indi&idual*s
sense of competency in relationship emerges from attracting the other*s attention and interest,
influencing )hat may $e tal"ed a$out, and effecting a change of emotion or $eha&ior in the others
3ttunement to a group mem$er*s need to ma"e an impact occurs )hen the other group mem$ers allo)
themsel&es to $e emotionally impacted $y the spea"er and to respond )ith compassion )hen the
spea"er is sad, to pro&ide an affect of security )hen the person is scared, to ta"e the other seriously
)hen he or she is angry, and to $e e-cited )hen he or she is Aoyful
;any people in group need the others to initiate contact, to ha&e the others reach out in a )ay that
ac"no)ledges their presence and demonstrates their importance in the relationship The group
psychotherapist models initiation, teaches a$out the importance of initiation and encourages mem$ers
to initiate )ith each other So often people are hesitant to initiate $ecause they imagine that they may
$e in&asi&e or they remem$er rules from school that prohi$ited children from tal"ing to each other
during class The initiation that group mem$ers do )ith each other often reduces stress in the group
1or e-ample, a group mem$er may say to another, '% noticed that you ha&e $een silent for a )hile %
)ould li"e to "no) )hat you are e-periencing( This initiation is an in&itation to $e fully in&ol&ed
The need to e-press than"fulness, gratitude or to gi&e affection is important in human relationships
/hen group mem$ers pro&ide a sense of security, &alidation, sta$ility and dependa$ility, a shared
e-perience, an opportunity for self+definition and impact, and sho) initiation )ith each other,
indi&iduals are often grateful and )ant to e-press their affection The effecti&e group leader facilitates
mem$ers in e-pressing their than"fulness and gratitude
%t is this trust, a shared relationship, &alidation, consistent relia$ility and security, and ongoing
responses to each indi&idual*s relational+needs that puts an end to shame, rectifies cumulati&e neglect,
dissol&es chronic stress and heals trauma

0ootnote1
This article )as presented as a 2eynote 3ddress at the <th %nternational %ntegrati&e Psychotherapy
3ssociation Conference, 3pril 5C, F886 in @a"e Bled, Slo&enia The theme of the conference )as
'3cute Trauma, Cumulati&e Neglect, and Chronic Stress(

A%thor1
Richard G !rs"ine, PhD is a licensed Psychoanalyst and Clinical Psychologist His $ac"ground
includes Client+Centered therapy, Gestalt therapy, Transactional 3nalysis, and Contemporary
Psychoanalysis )ith an %ntersu$Aecti&e perspecti&e He is the Training Director at the %nstitute for
%ntegrati&e Psychotherapy, =88 !ast G=th Street, Ne) Dor", ND, 588FG, >S3 Phone: F5F C7< =F65
!+mail: %ntegPsychHearthlin"net /e$ site: )))%ntegrati&eTherapycom
Copyright April 10, 2009 by Richard G. rs!i"e, Ph.#. a"d the $"stitute for $"tegrati%e
Psychotherapy, &e' (or!, &(.