Current Fads and Modes in Adolescent Group

Treatment: Perspectives on Distinctions,

Common Elements and the Question
of Therapeutic Relevance
Doris Pfeffer

Nathan Ackerman once said that the family therapist of today is the
child of yesterday who attempted to play the role of healer in her or his
family of origin. I related this to a young group therapy supervisee
whose immediate retort was "and the group therapist of today is the
adolescent of yesterday who gave up on his family and turned to his
peers." Therein may lie the pitfalls, the challenges and the attractions
for practitioners leading adolescent groups. It is with these pitfalls and
possiblities that this paper will concern itself, making some attempts to
touch upon the variety of approaches which have correctly or incorrectly, in my judgment, been categorized as group treatment. Since the
titling of this paper preceeded the process of its writing, both its direction and substance have departed considerably, if not entirely, from my
initial formulation. This is in no way intended to represent a paradigm
for the process of group formation or leadership where goals and procedures need to be clearly established aforehand. It may, however, be
analogous to the therapist's difficulty in holding onto his therapeutic
moorings as he moves through the rough water of adolescent turbulence.
There is a commonly held assumption that since adolescence is a
phase in human development of turning away from primary love
objects toward peers, toward the external world and its ideological
representations, group therapy is both sought after by the adolescent
patient and efficacious in its results; the "natural" modality of treatment for the roughly twelve to nineteen year old. In actuality, the liter-

This paper was presented at the 56th Annual Meeting of the American OFthopsychiatric
Association on April 3, 1979. Requests for reprints should be direci~d to Doris Pfeffer,
295 Central Park West, New York, NY 70024.
G R O U P Volume 3, Number 4, Winter 1979
0362-4021/79/1600-0195500.95 9
Human SciencesPress

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ature which is remarkably sparse in this area, my personal experience

and discussion with a fairly wide spectrum of practitioners bears out the
fact that quite the contrary is the case. Most adolescents in outpatient
settings either refuse or enter groups reluctantly, the drop out rate is
high, groups are short-lived with ever changing membership and are a
rarity in private practice. In outpatient clinics and agencies their
formation is often a long arduous task for the prospective therapist.
This situation changes radically in schools, day treatment settings and
institutions but here, of course, the group member is essentially captive
though not necessarily unwilling.
The reason for this phenomenon seems to rest in the nature of the
adolescent experience itself as well as in the therapist's response to
that experience. Before expanding upon these themes, I would like to
say a few words about the range of group modalities and what they do
or don't represent to me.
Groups that are conducted as formless rap sessions or topic
oriented discussions are frequently labelled as treatment groups. This is
a stretching of the concept. They may be informative, comfortable,
exhilarating to both leader and participants but there is nothing that
makes group experience inherently therapeutic. Therapy carries with it
some expectation of personality alteration. On the other end of the
spectrum, there are many young people with poorly structured egos
who are not capable of participating in the relatively mature endeavor
of sitting on a chair for one and one half hours and verbalizing their
feelings. Many of them are, however, participating in structured group
experiences that lend an ear to the dynamics of interpersonal and intrapsychic processes.
Scheidlinger (1974) refers to the "mother-group," symbolic of the
need gratifying pre-oedipal mother as represented by the group-as-awhole rather than by its individual members or by the leader. Particular
problems are posed for the adolescent in this search as he struggles to
decathect from infantile, idealized love objects and achieve constancy
elsewhere. Today he lives in a society whose unpredictable historical
moment mirrors his own inner state as regressive pulls and chaotic
instinctual urges feel as if they threaten his equilibrium and sense of
wholeness. Some adolescents bound in and out of relationships, social
clubs, cliques much as they shift ego models and ideological positions.
"Best friends" are frequently here today and shunned tomorrow.
Others have sought refuge in the drug culture or simply "dropped out"
for awhile as did a young acquaintance of mine who forsook, as did
many of his most talented classmates, the halls of Harvard for the
beaches of California waiting for the waves to wash the mysterious
messages of the cosmos ashore. While the authoritarian, the charismatic leader has the power to endow a group with fantasies of his own

Doris Pfefier

omnipotence, the group therapist strives for a goal that is far less
enticing. He offers the freedom to choose, to be and to grow toward
autonomy. In that context he implicitly demands a level of commitment and constancy from the adolescent group member that is beyond
the developmental grasp of some and for others creates problems that
must be met with special skill.
The practitioner working with adolescents in individual treatment
has an easier task in this connection. Here, one is in a position to join
the resistance of the reluctant patient by forming a fluid contract, by
refraining from behavior that signifies over investment in the new
patient's willingness to enter treatment, by allowing him to ease into a
relationship where autonomy is respected while regression is accepted.
In a group, however, irregular attendance, drop outs, acting-out that
takes the form of group destructive resistances which are so prevalent
in adolescence have a contagious effect. In such cases the "mothergroup" has not lived up to its promise to its members. Fear of revealing
ones dependency cravings, the frequent breach of confidentiality,
labile emotions, rage reactions to disappointment and frustration,
deeply competitive feelings beneath the surface of early pseudocohesion, all threaten the group matrix and bring into question its survival. They may set off signals to the adolescent that the seeming
external propensity for disintegration parallels the internal one which
makes continuation in the group difficult or impossible for him.
Now let us turn our attention to the therapist. A fourteen year old
patient once related a conversation with her best friend to me. Friend
wonders why she has to see this shrink, Pfeffer, when after all she can
always come to her if she needs to discuss a problem. My patient corrected her friend. "1 don't go to see her to discuss my problems. I go
because she's the only person who doesn't get mad back when I get
mad at her. You see, she's not really my shrink at all. She's my hired
scapegoat." Redl, in a lecture several years ago, made the observation
that the adolescent never comes to treatment--even individual treatment--alone. "He's always got the gang under the couch there with
him." Well, in the adolescent group the therapist has the group
confronting him and they are all there on the couch, not under it.
Kaplan and Roman (1963) have given us a valuable and clearly
spelled out description of group phase development in adult groups.
They describe the group as relating initially to the therapist as if he were
an individual consultant, moving on to deification, gradual focus on
other group members, formation of subgroups, pairing, with an
emerging sense and use of power and authority as the group members
move away from their early stance of nearly total dependency upon the
leader.
The adolescent group shows no such consideration toward its
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leader's developmental processes and consequently creates difficuff

counter-transference problems for him. Just as the mother gives birth
to a dependent infant and must move with skill and emotional modulation through developmental phases of separation-individuation with
him, facing.the continued interplay between the child's needs and her
own readiness to nurture and to let go, the therapist's ability to allow
the patient to strive for autonomy raises similar issues.
The therapist of an adolescent group is not called upon, however,
to face first things first--developmentally speaking. He or she is frequently confronted first with a test of power and authority, by members who form early alliances and what looks like group cohesion to the
point of resembling, at least to the overwhelmed therapist, something
like a gang formation. There is often use of highly sexual and aggressively charged language and the therapist is usually far from being
sought out for his expertise by individual members; dismissed or .
ignored in some fashion instead. My first adolescent group kept me in
a state of utero for exactly nine months before any of them spoke
directly to me. They had plenty to say about me, however. Another
group of Russian immigrant girls spoke Russian throughout most of the
first year to a non Russian speaking worker except on those occasions
when they assaulted her with a barrage of personal questions.
That all of this masks a need for and a fear of contact, a search for
identification and ego modelling, does not necessarily help the therapist who is unable to tolerate feelings of rage and exclusion and
unconsciously wishes to kill off the group.
He therefore instead of dealing with the unfolding resistances,
faces the danger of getting into a counter-transferential bind. The
group will not allow him to be what feels like a "good," nurturing
parent and so unconsciously--not permitted to return the expression
of rage--he acts in such a way as to contribute to the group's demise
behind which is often a wish to lose the group and return to treating
individual patients or, if group therapy, then preferably with neurotic
adults or pre-school children.
There are several common forms which these counter-transference resistances take. One is to behave in a judgmental fashion most
commonly taking the form of expounding psychoanalytic theory by
making interpretations of group or individual behavior; this in a manner that it totally disembodied from the developmental and emotional
matrix from which the behavior is being extracted.
Another is for the therapist--particularly the young therapist who
is closer chronologically to the group members than he is to their
parents--to attempt to dilute the transference or feelings toward
archaic parental images, as the case may be, by joining the group. He
freely engages in a variety of attempts to disengage himself from the
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adult role with examples ranging from telling the group "you can do
anything you want to do here. This is your place" to approval of pot
smoking and indeed sharing the fact that he too smokes (even in one
case where he didn't). My classic illustration is that of a young man who
literally drove an adolescent girls group fleeing from the room after
repeatedly answering questions about his sexual life under the illusion
that he was being "straight'! with them, thus, totally miscomprehending
that what he was being asked for was not a revelation of past or present
intimacies, but the establishment of adult boundaries against the threat
of loss of his and the group members impulse controls.
A common form of interfering with the groups efforts at giving
psychological birth to itself--particularly on the part of individually
trained therapists--is to interfere with early attempts at group formation as the adolescents search for common themes, alliances, shared
past experiences and, most notably, adult objects at whom to vent their
anger and derision. The therapist correctly senses that he is next. I have
never yet taught a class where I have been heard when I stated that
group bonding around the theme of anger or emotional extrusion of
the leader is the earliest reassuring sign one often gets that the group
has arrived at a unifying theme, a beginning level of integration and
that this bodes well for its survival. The therapist, in such situations, too
often proceeds to focus upon individual members, the content of their
outside lives rather than on emerging group themes. There is much
greater tolerance, on the leader's part, for intragroup warfare or scapegoating as forms of aggressive expression, as they allow him to maintain
the feeling of being in control and in charge. Actually, such divisiveness
among group members before some identification with the group-asa-whole has taken place, frequently foreshadows its early demise.
The adolescent while disposing of and attacking the therapist, on
the one hand, engulfs him with adoration on the other. The emerging
adolescent searches for ego models and the therapist inevitably
becomes the object of such yearnings. Spruiell (1975), in his article on
adolescent narcissism, points out that in working with adolescents one
must allow oneself to be idealized and subsequently de-idealized.
There is a tremendous temptation to reap continued gratification from
this type of transference. The therapist doesn't let go particularly as he
realizes that the fluidity of the adolescent object and transferential
world is such that an ego model today may be a discarded or hated
object tomorrow. It is especially important to differentiate between
narcissistic transference in the adolescent as distinguished both from
the object transference of the neurotic adult or primitive attempts at
merging of the pre-oedipal patient of any age.
Precisely because we are concerned here with a phenomenon
which is developmentally appropriate and not necessarily pathogenic

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that difficulty arises. Since we deal with a broad range of adolescents

diagnostically--often within the same group--careful delineations
need to be made in the struggle to define the nature of the narcissism
displayed to us. Failure to accept normal narcissistic development of
the adolescent either within himself or in the transference is to deny
one of the central realities and necessities of the process of transition
from childhood to independence. On the other hand, refined judgments need to be made because many of the adolescents we see are
developmentally in a state of primary narcissism and have never even
approached completion of the first individuation stage of early childhood.
In turning to the adolescent groups that are so numerous in day
treatment facilities and institutions, an interesting phenomenon has
developed in my recent work with the staff of the Montague School, a
day academic and treatment facility of the Jewish Board of Family and
Children's Services in New York. We set up four groups along what
seemed to be developmental lines. All of these girls were functional and/or too disruptive to be contained in the public school
settings from which they had been referred. They were all considered
by our staff to have poorly structured egos but there were, nonetheless,
differences in functioning, in interest levels and what we thought to be
ability to verbalize thoughts and feelings. We set up two discussion
groups and two activity groups for the most primitive girls, all of whom
are in the Senior high school age range. Our talking groups were
assigned to the more experienced personnel--two social work staff
members--and were to be run on an adolescent group therapeutic
model adjusted to the realities of treatment within a milieu setting. The
other two groups were assigned to students and we envisioned that
they would be conducted on a model resembling the activity interview
groups more typically run for latency age children.
What emerged was a situation in which the members of the socalled discussion group clamoured for activities and at least one activity
group rejected the offer of available activities. In the process of
berating the leader and the school for not taking proper care of them,
the members of the activity group began to verbalize conflicts and
feelings around dependency, on the one hand, and their lack of trust in
all of the adults in their known world, on the other. The flabbergastered young student leader--after the first of such meetings--apologetically presented her group in supervision stating that "1 hardly did
anything." I don't always agree with Slavson's advice to me and a group
of beginning group therapy seminar participants many years ago
"when in doubt do nothing" but in this case it surely worked so as to
enhance the therapeutic process. The group members were enabled to
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develop a sense of shared demands, need and anger, directed against a

leader and the milieu which served as symbols for a world that had, in
many respects, cast them out upon entry. A group theme had developed; a commitment to its life and continuity begun.
The principle underlying these group experiences seems to be
one that illustrates the difficulty we find particularly among group
therapists leading adolescent groups, in dealing with initial resistances
and in weaving back and forth between their expectations of progress
and the regressive pulls of the group. An exasperated father once complained to me that his fifteen year old daughter is going on thirty-five
one day and acts like two the next. It is my contention that it is because
the girls in this group were expected and preparations made for them
to act like two, the infant within the adolescent thus understood and
accepted, that they felt safe enough to take this step forward. The
student's lack of technique and interpretive facility forced her to keep
her mouth shut and prevented her from interfering with this process.
This was, of course, aided by her knowledge that there was no expectation or investment in the group's ability to participate in the experience
of verbalizing feelings on the part of the supervisory or administrative
staff.
Quite obviously it is not being suggested that personality restructuring is forged or resistances resolved in a week or a month or a year,
in working with such disturbed patients. The experience of these
groups demonstrates, however, that the pathways toward growth can
be opened up and the process significantly enhanced by the special
advantages that finding commonality among fellows, with all its accompanying threats and strains, offers as a~ antidote to the troubled state of
aloneness.
In conclusion, let me reiterate that in my view, the adolescent
group raises a special set of counter-transferential problems for its
leader. In outpatient settings, particularly, it is also characterized by
the kind of upheaval inimitable to the adolescent world which makes
its formation difficult, its duration often short-lived. But these groups
have their great rewards for those of us who have turned to peers in
our own lives and are inclined to allow, to enjoy, and to enhance the
peer sharing experiences of others as they struggle with their volatile,
dramatic, certainly never dull sense of adolescent urgency in the reach
toward adulthood.

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REFERENCES
Kaplan, S. & Roman, M. S. Phases of Development in Adult Therapy
Groups. The International Journal of Group Psychotherapy, 1963,
13, 10-26.
Scheidlinger, S. On the Concept of the Mother-Group. The International Journal of Group Psychotherapy, 1974, 24, 417-428.
Spruiell, V. Adolescent Narcissism and Group Psychotherapy. The Adolescent in Group and Family Therapy, Max Sugar, ed. New York:
Brunner/Mazel, 1975.

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