Consultation, Please
December 2001/January 2002 

Dear Consultant:
I recently took over the presidency of an Affiliate Society. I see a number of other mental health practitioners for group therapy in my private practice. These individuals also run groups in their private practices. I recently announced my new office in the Affiliate Society to my groups and suggested that they might wish to join AGPA and the local society. I then realized that we would be in a different relationship if they joined these organizations. I would like some assistance from other Affiliate Presidents or Past Presidents who have had a similar experience. Hopefully they would be willing to disclose their resolution of this possible ethical dilemma.

Sincerely,
Concerned Dual Leader

Dear Concerned Dual Leader:
The problem you have is one that I have also faced, not as President but as an active member of NSGP. I had a group member who was a therapist and who led groups. He came to one of our conferences, which I also attended, and was so enthusiastic that he joined NSGP. While I was secretly delighted and had thought many times that he would be an excellent colleague in NSGP, I also, with the help of my supervision group, recognized that this was a situation loaded with countertransference. So he and I spent a considerable amount of time discussing the whole issue in group: what it meant to him to have a special relationship with me, what it meant for the other group members to not have that special relationship, and his desire to be my co-therapist. This discussion was an important part of his therapy. In supervision, I looked at my own similar wishes. He continued as a member of NSGP for some time before moving to another part of the country.

The problem you are facing is much more difficult if you are from a small Affiliate Society. You want both to expand your membership and continue to be a good therapist for your patients. For me, it was best to keep things simple, to remember that the first priority has to be the therapy and the patient, and that rigid rules about what is right and wrong don’t work. I would suggest that you keep talking in the group about how to work out the conflict and stay constantly aware of your own countertransference issues and desires.

Richard Tomb, MD
Worchester, Massachusetts

Dear Concerned Dual Leader:
Like you, I am fortunate in having in my practice many group therapists who are either members or potential members of NCGPS and AGPA. While I am eager to see as many group therapists as possible participating in these two organizations, I too have struggled with some challenging clinical and ethical dilemmas around my patients’ involvement.

In terms of the clinical challenges, I am aware of the increased opportunity for a miss that occurs whenever I’m interacting with a patient outside of the therapy environment. It’s an unfortunate fact that my attentiveness to my patients is not the same when I’m in an administrative role or a social situation as it is when I’m involved in a therapy interaction. I’m also aware of other ways in which my behavior is different in these non- clinical situations. While I would like to comfort myself by saying that it’s all grist for the mill, and that the transference modifications that may occur can be beneficial, I don’t believe that this is always the case. The best I can do to maximize the potential benefit and minimize the potential damage is to invite discussion both before (when anticipated) and after any of these outside of therapy interactions.

For me, the ethical challenges are more difficult than the clinical ones. Most of them involve the power differential between therapist and patient and our obligation as therapists to avoid using the power of that relationship to promote behavior that may be more in our own interest than that of the patient. Thus, as tempting as it is, I refrain from recruiting my patients to join NCGPS or AGPA and from actively encouraging participation in our events. For similar reasons (in combination with the clinical complications already described), I discourage patients who are already involved in the local organization from taking positions that would require our directly working together or our mutual participation in the monthly meetings. I see this as an uncomfortable restriction (both for the patient and for NCGPS) that I am happy to see lifted once the therapy has ended.

A related power problem occurs when recruiting supervisees, especially those who may be dependent on the supervisor for evaluations. While I see it as an appropriate part of the supervisory relationship to encourage participation in relevant learning opportunities and to assist with the supervisee’s developing professional identity, I refrain from inviting my current supervisees into the NCGPS work force. I am concerned that what is intended as an entirely non-obligatory invitation may be perceived by the supervisee as an offer that he may not really feel free to decline.

Geraldine Alpert, PhD, CGP, FAGPA
San Francisco, California

Dear Concerned Dual Leader:
Here in the West, Native Americans talk about “walking in two worlds” to express the difference between life with the tribe on the reservation and that of the dominant society. You are in the position of having to walk in two worlds: therapist and colleague/leader. The dilemma is that some of the same faces show up in both worlds making it difficult to remember which boots you put on that morning.

Your initial foray into the dual worlds seems to have gone well with your invitation to your group members as colleagues to join the Society. While it invites ambiguity, had you not invited them nor discussed the issue openly, they surely would have known of the omission and could easily have felt left out or snubbed, potentially igniting transferential wildfires. Assuredly they are also aware of the dilemma. Should they choose to join the Society, they, too, would be walking in two worlds with you which presents them with their own challenge.

There are factors that mitigate the dilemma and others that accentuate it. Some of your group members will not join the Society to avoid the ambiguity. Others, inspired by your obvious competence and recognized leadership may join. For group therapy members who are advanced in their work, the development of a collegial relationship could prove to be very helpful. On the dark side of the world, some members may transfer material from one world to the other. They will either act out therapeutic material in the Society or drag Society business into the therapy group. However, your own ambiguous situation provides the greatest danger.

The key to successful negotiation of the dilemma may be to make a conscious decision into which world you will plant both feet for any given interchange with the people involved. Then be clear with them and yourself, in which world you are operating and keep your feet planted in that world. Several examples illustrate this principle at work. Not discussing group work at Society functions or Society business at group even if the member initiates the conversation. Deferring the conversation to another point in time can keep you centered. If you have an inkling that issues from one world are being addressed in the other by a member, stick to the world you have chosen to represent at that point. When in doubt, ask yourself, “How would I field this issue if I didn’t know what I know from the other world?” Allow both of you to keep your other relationship private although obviously, there will be currents going in both directions.

Having the member choose to bridge the worlds overtly may be the greatest difficulty encountered. For example, in the therapy group, members may acknowledge the competitiveness they felt with you at a Society meeting. Because you are the therapist in this situation, you have the responsibility to deal with the therapeutic implications of the competition with you as the therapist of this group.

While there are a decided number of difficulties with having two roles in someone’s life, it can also be very informative in broadening your perspective on your group members. Therapy can highlight the brokenness that people bring in for healing; yet there are delightful sides of our group members that we may never see except in a different arena. I hope as you “walk in these two worlds” that you can continue to clarify who you are at any given time. I wish you the best.

Charles Pohl, MSW, CGP
Boise, Idaho

This Consultation, Please column was published in the December 2001/January 2002 issue of The Group Circle.