Consultation, Please
April/May 2001 

Dear Consultant:
I am a 45-year-old female therapist who runs a weekly mixed group that has been meeting for three years. I do not have a co-therapist with this particular group. Several of the original members have finished their work and left, and I have replaced them over the past two years. There are four women and four men in this group; most of the group has been together at least one year. One man is leaving after three years, and I am planning to add a new member in a month. I have just been diagnosed with breast cancer and am facing surgery, followed possibly by chemotherapy and radiation. I am terrified about the surgery and subsequent treatment but am attempting to handle my vulnerability and fears with my own therapist and group supervision. How and what do I tell the group? This is not a group in which I have made much self-disclosure, other than the non-verbal things they could observe, such as my wedding ring, clothes, and the office decoration. I don’t know how to tell the group about the cancer and am fearful that I won’t be able to handle their responses, especially as they may feel angry or abandoned. I feel so scared because I don’t know how best to approach the subject of my illness, and how to handle the departure of the group member who has already announced his intention to leave in two weeks and the addition of the new member.

Sincerely,
Scared and Vulnerable

Dear Scared and Vulnerable:
I believe that telling your patients that you are going to have surgery for breast cancer, combined with whatever treatment is recommended (i.e., chemotherapy and or radiation), is crucial. While the best way to approach the subject is directly, the amount of information that you share with the group is up to you as it is important that you feel as comfortable as possible with what you tell them. It is my experience that group therapists become more transparent over time, particularly in long-term process groups. Indeed, the group may already sense that something is going on with you.

Self-disclosure is an ongoing issue for therapists. How much to share, for what reason, and how this helps the patient are the questions we need to keep in mind. If your group members know when and where you will have surgery and how long you anticipate being gone, they will not be surprised when group does not meet at that time and can begin to deal with their feelings prior to your surgery. Telling your patients, being willing to answer their questions, and sharing your feelings at your own comfort level is excellent modeling for them for their own lives and their relationships. 

It is important for you to be aware that anger may surface in the group. Their feelings of anger and abandonment are grist for the therapy mill, and you will need to consider how you will handle that anger, as well as their care and concern. 

The group’s work will continue when the old member leaves in two weeks. Both his leaving and their ongoing focus on your illness and treatment may stir their feelings of past experiences of abandonment and fear of loss. I trust you will deal with their fears, caring, sadness, and anger and will be a better therapist for the experience. After the member’s departure and your surgery would be a more opportune time to bring in the new member. If that is not possible then he will rapidly become part of a group that will deal with his arrival as best they can. 

Henry Grunebaum, MD, wrote a very good chapter, “The VulnerableTherapist: On Being Ill or Injured,” in “Beyond Transference: When the Therapist’s Life Intrudes” (edited by Gold & Nemiah, ©1998, American Psychiatric Press, Inc.), where he presents actual situations, similar to yours, and talks about the way that each therapist handled them. I end with a quote from Louis Ormont, PhD, CGP, DFAGPA, in his book, “The Group Therapy Experience”, (©1992, St. Martin’s Press). “It need hardly be said that our feelings are the essential part of what we bring to every group; they are our humanity, our instruments of diagnosis and cure. Not just our feelings, of course, but the feelings of the group members, individually and collectively, are the stuff of which all interactions are made.”

Karen Travis, LCSW, CGP 
Baton Rouge, Louisiana

Dear Scared and Vulnerable:
Several practical questions come to mind, questions I am sure you are including in your considerations about your own health and your work with your group. Though it is hard to know, it is important to have some idea how long you will be away from your work due to your illness. I have found that being able to consult my physicians for a predicted time framework helps ground me as I decide how and what to tell the group.

You will need to share to some extent the truth of your health problems with as much specificity as you can handle. Not dealing with it is not an option, since if you do not say anything, the group members will consciously or unconsciously become aware that something is wrong. They will likely fantasize an explanation about their perceptions of your behavior and/or your absence that fits their own life script. They then may begin to relive old experiences, feeling past losses and times when they felt scared and abandoned. You then may represent become the secretive parent, or the abandoning mother or father they couldn’t trust as children. They may also have been the children who had to figure out what was wrong with the parent and “fix” it without any confirmation or validation from their family of origin.

The good news in the situation is that you do not have the power to spare group members from their pain and grief. The Chinese word for “crisis” is comprised of the symbols “danger” and “opportunity.” This event in the life of the group presents a dangerous opportunity for the group members. The danger will be the temptation to respond in old patterns that kept them stuck as they respond to you and your situation out of the unfinished events from their own lives. They may well feel a mixture of feelings, but now have the opportunty to deal with the issues from the past. Here is your opportunity to examine with them those old patterns and to help them grieve what they needed and did not get from their original caregivers. The group can provide the supportive environment for the members to learn that they do not have to look only to you to do their work, but can rely on one another as they have at other times in this group. 

As the old member leaves in two weeks, it will be important that the group have time to say good-bye and become aware of their loss. His leaving will also trigger feelings of their own vulnerability. These feelings coupled with their fear of potential abandonment by you through your illness will provide a profound opportunity to do some excellent therapeutic work. At the present time, I would not advise putting in the new member too quickly until after your surgery when you and the group have had time to work together again. If he is already coming on a definite date, then the group will have one additional element to process, and he will have to get “on board” as he is ready. A long-term process group will go ahead to do the work they came to do and will not be held back by a new member as they experience the loss of another member and deal with your illness through their own filters.

Robert Gibson, STM, CGP
Macon, Georgia

This Consultation, Please column was published in the April/May 2001 issue of The Group Circle.