When Coleaders Differ: Rupture and Repair in Group Psychotherapy

The nature and quality of coleader relationships in group psychotherapy have been the subjects of numerous investigations (1–4). For example, Yalom and Leszcz (5) hypothesized that the success or failure of a group depends largely on the cotherapists’ relationship and emphasized the importance of complementary personalities. Success is more likely to occur, they hypothesized, when coleaders believe that their effectiveness depends on the quality of their relationship and when “coleaders freely share honest feedback and are emotionally open and available for each other.” More recently, other authors (4, 6) have suggested that developing a reflective process and sharing a similar conceptualization of the group is critical to addressing the intrapersonal and interpersonal patterns and experiences that may impede development of effective coleader relationships.

Satisfaction with the coleader relationship is likely a complex phenomenon that waxes and wanes over time and contributes to a unique relationship system. How effectively group leaders manage ruptures in this system may also affect the coleader alliance. Coleader teams should not expect their group members to address conflict in the group if the coleaders do not address conflicts in their own interactions. Rosenbaum (7) long ago stated, “Often the resistances of patients entering group therapy are mirrored in the resistances of cotherapists to confronting their own problems in interaction.” Differences in personality, attachment style, and conflict resolution may affect both the group and the way the coleaders manage their relationship with each other.

An isomorphic relationship exists between coleaders and the group: challenges and stressors experienced in the coleader relationship are likely to be mirrored in the group (8–10). If factors such as mistrust, competition, power struggles, personal or theoretical disagreements, envy, or incompetence are not addressed, relationship dysfunction may manifest as coleader anxiety about interacting with each other and with group members (5). Problematic coleader dynamics may also impede effective use of group leadership skills and may negatively affect group outcomes (8) because the progress of the group is generally considered to be contingent on the maturation of the coleader team (10). Ultimately, a coleader team needs to have developed an understanding, intimate, and cohesive relationship that allows for challenging conversations to occur.

Rupture and repair in the coleader alliance have been understudied in the group psychotherapy literature. Awareness exists broadly that ruptures can damage the individual therapeutic alliance and that addressing such ruptures can bring therapeutic benefit (11, 12). The discussion of how coleaders may beneficially work with ruptures has been less precise. Ruptures can take many forms and may vary in intensity from relatively minor tensions, of which one or both group leaders may be only dimly aware, to major breakdowns in collaboration, understanding, or communication. A coleader relationship may include a mixture of ruptures unique to the leaders’ individual personalities, attachment styles, and relationships with group members and with the group as a whole. This article examines rupture and repair in the coleader relationship through the lens of attachment and interpersonal integrative group theory. Relevant contextual considerations (e.g., culture, ethnicity, and gender) are discussed, and an overview of the importance of rupture and repair in the group coleader alliance is provided. Disguised case material is presented to illustrate fundamentals of our approach.

Attachment Theory and Coleader Relationships

There has been increased interest in building links between attachment theory and group psychotherapy (13–17). Research on applying attachment theory to group work has focused on the relationship between attachment styles and group therapeutic factors, group attachment, and how group therapy facilitates changes in members’ attachment styles. Correspondingly, less attention has been paid to how group leaders’ attachment styles may influence group processes and treatment outcomes. Although clinical research has effectively demonstrated the importance of the therapist representing a secure base (14, 18), more work is needed to identify how group coleaders’ attachment styles influence the process of group psychotherapy. Increased understanding of how coleaders’ attachment styles may affect collaboration, group processes, and treatment outcomes appears to be relevant, given the importance of group leaders in fostering a secure base for group members.

Research (19–21) suggests that a secure attachment style promotes a strong therapeutic alliance between clients and therapists. Group coleaders with secure attachment styles may be more likely to self-disclose, demonstrate progroup behavior, and have greater empathy toward others. Coleaders with lower attachment security may find it harder to trust, engage, and disclose, because of fear of rejection, which may in turn contribute to diminished self-efficacy.

Diversity and the Coleader Alliance

In a study of competency concerns, Okech and Kline (22) noted that coleaders may experience ongoing internal reactions and questions about self, partner, and group interactions as a way of making sense of the group experience. It is likely that such internal reactions are shaped by ethnic, cultural, gender, religious, and socioeconomic differences. Cultural forces operate at largely unconscious levels and can contribute to polarization; they decrease our willingness to talk openly about such matters while simultaneously increasing their clinical relevance in group interactions (23). As viewed from an attachment perspective, the internal working models of group coleaders must also be influenced by culture and used as reference points to fully understand the nature of the attachments cocreated in the group.

Attachment paradigms can be used to promote engagement across social and cultural identities, promoting mutuality and diminishing projections. A secure base in the group is essential, because it creates a haven from which to explore and tolerate uncertainty, to forgive injury, and to understand the impact of privilege and oppression in society. Secure attachment in the coleader alliance can promote intercultural dialogue and enhance a group leader’s capacity to have a more accurate and accepting view of his or her coleader. To provide competent, culturally sensitive group leadership, coleaders must be able to conceptualize diversity issues, become aware of personal issues activated by the coleader alliance and group, and generate diversity-competent interventions at multiple levels of group interactions. This ability is especially crucial when cultural differences exist between coleaders or with group members (22). Useful interventions for groups with diverse members promote norms that allow for discussion, understanding, and acceptance of differing experiences, beliefs, values, and behaviors and invite group members to make implicit tensions explicit.

Coleader self-awareness is critical and strongly related to the capacity to effectively manage anxiety while conducting group therapy. Addressing diversity in group settings often results in heightened emotions as well as the self-exploration and reflection required to become more aware of oneself as a cultural being. Awareness of social identity development and experience as a privileged or nonprivileged person in society may also allow coleaders to better connect with individual group members.

Reactions to conflict, misunderstandings, and culturally related subgrouping (24) may all activate personal feelings in the coleader alliance. Group leader reactions at the group system level may also be highly relevant; a group leader may become aware of how stereotypes, assumptions, and implicit biases affect how he or she views group-wide processes. Absent such awareness, coleaders may unconsciously perpetuate gender and cultural biases, prejudices, or blind spots in the group (25). For example, White group therapists unaware of their privilege will be unlikely to recognize when White group members unintentionally marginalize a person from a racial-ethnic minority group. Unintentional marginalization may manifest itself if a group leader minimizes a person’s angry feelings related to oppression (26, 27), fails to challenge a group member’s internalized oppression, or pressures a group member from a racial-ethnic minority group into a role, such as representative of a race (28). A coleader’s silence may communicate tacit agreement and perpetuate marginalization of a group member or coleader. In turn, this silence may have an impact on the nature of the relationship between the coleader team and group members. Transference and countertransference, which emerge in relation to the interplay of gender and cultural dynamics within the coleader alliance, must therefore be resolved in the direction of equal power and status if norms of equity and social justice are to be embedded in the group.

The following case example illustrates how group leaders with differing attachment styles have navigated an ineffective coleader interaction, the necessity of managing gender role transference and countertransference, and the need to create a secure base in the coleader alliance to successfully manage interpersonal conflict between themselves and among group members.

Formosa, an experienced Asian group psychologist in her 40s, and Javed, an Iranian American psychology intern in his 20s, were coleading a 10-member group in a private-practice setting. Midway through the first group meeting, Nola, a White group member in her 40s, introduced herself by emphasizing that she was “older.” She stated that she frequently assumed the role of taking care of others and doubted group members would understand her concerns. Formosa reflected back Nola’s caution, highlighting her need to be taken care of by the group and her simultaneous expectation of being disappointed.

In a subsequent session, when Javed was absent, Nola spoke about how disappointed she felt when friends invalidated her feelings. Patrick, another group member, responded that he had learned early in life to have no expectations so that he never felt disappointed. This comment upset Nola. She accused Patrick of being “a typical American White sexist man” and elaborated on the differential treatment she had received as a first responder in training—her male colleagues always received more recognition. Patrick sought to clarify that he was simply sharing his own reactions. Formosa asked Nola to slow down and to say more about how she experienced Patrick in the here and now, what she heard, and how she was hurt. Nola angrily accused Formosa of “singling her out,” stating, “You are trying to focus on the humanity of a perpetrator instead of the fact he did something wrong. Patrick hurt me.” Formosa validated Nola’s feelings and invited group members to share their responses. Most seemed frightened by Nola’s anger and remained silent.

Over the next several sessions, Nola and Patrick revisited their initial conflict. Javed usually remained silent during their tense exchanges. Nonetheless, Nola appeared to perceive him as an ally. Javed, Nola, and Michael (a White group member) always sat next to each other, exchanging eye contact and nonverbal support. At one point during another emotional exchange with Patrick, Nola stated to Javed, “I wish you were there on that day.” In contrast, she appeared to view Formosa as responsible for singling her out and ignored times when Formosa provided validation. Nola seemed to be experiencing potent polarized feelings toward the coleader team: she projected exclusively positive feelings onto Javed and intensely negative feelings onto Formosa.

An isomorphic path in the coleader alliance emerged during their debriefing. Formosa stated that she felt dismissed, rejected, and unacknowledged by Nola. She reached out to Javed for perspective. He stated, “It’s much easier for me to address a client who is frustrated with me. I don’t really know how to challenge a client who has positive feelings toward me.” It was becoming clearer that Formosa and Javed had personal issues that were being activated by the group and perhaps by their coleader alliance.

Formosa continued speaking about their increasingly polarized relationship with Nola. Javed replied, “I understand that it’s harder for you to receive all the negative transference, but I don’t really care.” To Formosa, Javed’s response felt like a rupture in the coleader alliance, similar to how she felt in the group with Nola. Javed further suggested that Formosa and Nola were just competing for his attention. Formosa strongly disagreed and suggested Javed’s comments reflected his reluctance to address Nola’s positive transference. Furthermore, Formosa cautioned that Javed’s selective passivity might reinforce Nola’s anger.

The coleaders struggled to find common ground. Javed described himself as a private person comfortable with remaining distant and secretive. Formosa stated that it was hard to establish trust with Javed; his absence of emotional availability and responsiveness made it hard for her to feel he cared about their working relationship. Javed replied that he avoids confrontation and vulnerability, and he acknowledged having received similar feedback from others. At some point, the two therapists recognized they were speaking about attachment styles, and Formosa felt safer sharing her contribution to their strained connection. She felt vulnerable letting Javed in on the impact of his behavior and helpless about pursuing him. Furthermore, she was fearful that disclosing more would reinforce his sense of control. They acknowledged their respective difficulties trusting each other and discussed how their differing attachment styles contributed to a nonproductive repetitive cycle in which Formosa kept “going after Javed,” while he maintained his distance.

Javed clarified his role in their pattern. He felt comfortable with Nola’s transference and anxious about losing it. He described his favored male status in his Iranian family of origin—he was the only son with two sisters. As a child, although he could make mistakes with impunity, his sisters were frequently punished. He recognized a similar pattern in adulthood: he quickly gained favor with others (particularly women) and sometimes ignored or minimized the collateral damage his approval-seeking had on others. Similarly, Formosa reflected on contributions she might be making to Nola’s intense anger. She first considered Nola’s conflict with Patrick: did Nola perceive something about Patrick that Formosa, as a woman from a racial-ethnic minority group, overlooked? Formosa thought about how quick she was to support him in group. Nola’s perception of Patrick as a “sexist White man” might be meaningful for them to explore in the group. It might also be something Formosa minimized, because she was accustomed to giving a lot of space to dominant men in her life because of accumulated blind spots in her own cultural and gender identity.

Javed was more clearly able to see how his avoidance and distancing triggered Formosa’s fear of rejection and increasing mistrust. He acknowledged his determination to remain distant and protect himself by not allowing others to exert any influence. Thus, he remained “in control,” feeling indifferent to his coleader’s frustration and dismissive of her invitation for more authentic connection. Formosa found it easier to focus on feelings of frustration and resentment, blaming Javed for his lack of responsiveness, rather than to articulate her need for connection. Their shared disclosure created an opening for mutual understanding and the basis for more challenging coleader interactions to occur.

Interpersonal Theory and Coleaders

For group leaders, thinking in terms of cocreation is crucial to understanding their own role in the coleader alliance. Observation of how coleaders strive to connect with each other can reveal something about their internal working models of interaction. In essence, people see themselves through the eyes of others, particularly significant others from early in life, and interact accordingly. Group interactions are used to address a range of problematic behaviors resulting from faulty interpersonal learning (29). An integrative interpersonal approach strives to bring past relationships into the group experience and explore how those relationships affect current functioning and shape a group member’s present interpersonal worldview (30). When navigating this process, group leaders must pay attention to their own interpersonal pushes and pulls, using countertransference as interactive data that help inform the coleaders about the group members and themselves.

Coleaders are often perceived differently by different group members. Group members who have difficulty integrating love and hate may project such feelings onto group leaders and may split the cotherapy team, making one leader the focus of positive feelings and idealization and the other a focus of hateful feelings to be attacked or shunned. Racial and cultural transference and countertransference may play a powerful yet unconscious role in intensifying group processes. Divergent group member perceptions of coleaders must be noted and openly discussed in the group (5) to provide a measure of reality testing and to reduce the intensity of such transference distortions. Effective coleaders present a unified stance and discover ways to challenge group members’ all-or-nothing distortions pertaining to coleader behavior in the group.

The following case example illustrates coleader efforts to manage such a rupture in the group. In this example, Formosa invites Nola to directly share her critical feelings toward her as a group leader. Nola’s consequent disclosure deepens the group’s level of affective expression, increases their understanding of different group members’ perceptions of the coleaders, and clarifies the isomorphic rupture between Javed and Formosa. The coleaders are then able to take responsibility for their role in cocreating group tensions and to use the group to heal their respective attachment injuries.

Formosa sat quietly in the group, contemplating her ambivalence about addressing Nola’s anger. She gathered her courage and addressed Nola directly.

The group held its collective breath. Two members were gently nodding when Nola broke the silence.

Nola then described Formosa as not being aware of her power as the more senior group leader. Nola stated that she viewed Javed, although younger and less experienced, as more competent. She said she disliked Formosa’s intensity and directness and preferred Javed’s way of intellectually challenging her. She said she recalled Formosa asking, “What sort of marriage do Javed and I have as coleaders?” Nola strongly objected to such depictions implying that Formosa and Javed held equal status in the group.

Formosa listened nondefensively as she leaned into the circle.

Through tears, Nola shared a significant life event, that she had an abusive female supervisor during her professional training. Nola was constantly criticized and made to feel inadequate and incompetent. The situation spiraled out of control, with Nola receiving one poor evaluation after another. Eventually she was deemed not to be a good fit and was forced to leave the program. Nola was clearly traumatized by the experience; it had damaged her professional status and self-esteem and had nearly destroyed her confidence.

Some group members looked visibly softened by Nola’s disclosure. Several shared how moved they were; this was the first time Nola had shared something in group with a genuine sense of vulnerability. Formosa asked Nola to look at the faces of the members. Nola scanned the group.

Javed also looked moved, and he paused for a moment.

Javed returned to the earlier exchange between Manjari, Michael, and Nola. Manjari stated she felt dismissed and unsafe with Nola and Michael.

Michael again seemed to align with Nola.

Formosa gently intervened in a culturally sensitive manner by addressing multiple levels of group interaction.

Javed invited others to share. Group members agreed that there seemed to be a subgroup among Michael, Nola, and Javed. However, others agreed with Nola and Michael, sharing that they felt Manjari had taken up a lot of space in the group, and that the way she talked did not bring people closer to her. Manjari appeared wounded and began to emotionally withdraw.

Conclusions

Effective coleaders are able to identify and successfully repair ruptures in the coleader alliance. Coleader attachment style can influence the group psychotherapy process, responses of both clients and therapists, the quality of the coleader alliance, and the ultimate outcomes of treatment. Suggestions for strengthening the coleader alliance include understanding coleader attachment styles for important clues about how the coleader is likely to respond; developing an understanding, intimate, and cohesive relationship that allows for challenging conversations to occur; becoming aware of personal issues activated by the coleader alliance and by the group; and generating diversity-competent interventions at multiple levels of group interaction. Ruptures, if not identified and managed, can damage the coleader alliance. Successfully addressing ruptures can bring therapeutic benefit for the coleaders and for the group as a whole.