CAT (Classroom Assessment Technique) OPTIONAL (For Participation) Read this e-Library resource as provided in your syllabus: Treating the Dismissive-Avoidant Group Member Read “Treating the Dismissive-Avoidant Group Member” by Marmarosh, Markin, & Spie

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CAT (Classroom Assessment Technique) OPTIONAL (For Participation)

Read this e-Library resource as provided in your syllabus:

Treating the Dismissive-Avoidant Group Member

Read “Treating the Dismissive-Avoidant Group Member” by Marmarosh, Markin, & Spiegel, from Attachment in Group Psychotherapy (2013).

See attached document

Tardiness is not indicative, necessarily, of a dismissive-avoidant group member but tardiness be one symptom of the fear and anxiety one has about attending groups. If this is the case, how would you approach the situation?

143

http://dx.doi.org/10.1037/14186-008
Attachment in Group Psychotherapy, by C. L. Marmarosh, R. D. Markin, and E. B. Spiegel
Copyright © 2013 by the American Psychological Association. All rights reserved.

This chapter focuses on more dismissing-avoidant group members—
those members with high attachment avoidance and low attachment anxiety.
We focus on how these members relate to others in the group and how group
therapy can facilitate changes for them by enacting past working models of
self and other in the group. The chapter is divided into three parts. First,
we discuss dynamics that are likely to unfold between group members with
a more dismissing-avoidant attachment and the group. Second, we describe
how the leader’s attachment influences the work with more dismissive group
members. Finally, we outline group therapy goals for more dismissing-avoidant
members and offer suggestions on how group therapy can facilitate the achieve-
ment of these goals. A case example is used to illustrate attachment-related
problems for more dismissing-avoidant group members as well as possible group
leader interventions.

7
TREATing ThE DiSMiSSing-AvoiDAnT

gRouP MEMBER

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144 attachment in group psychotherapy

ThE MoRE DiSMiSSivE MEMBERS AnD ThE gRouP

According to Wallin (2007), more dismissing-avoidant patients
often avoid emotions that stir up feelings of vulnerability, and they have
a particularly difficult time coping with these emotions when they are
stirred up in treatment. Rather than expressing their internal experiences
verbally, they often rely on subtle cues to express their underlying emo-
tions (guerrero, 1996; Wallin, 2007). These patients are more inclined to
say everything is fine while clenching their fists, averting eye contact, or
smiling during emotionally painful interactions. Dismissive adults prefer more
physical distance from others (Kaitz, Bar-him, Lehrer, & grossman, 2004)
and demonstrate less facial gazing, vocal and physical supportiveness, and
listening to their partners in videos interacting with a romantic partner
(guerrero, 1996).

in addition, these more dismissing-avoidant individuals often engage
in defensive self-enhancement, which means they suppress negative aspects
of themselves and instead focus on their strengths (Mikulincer & Shaver,
2007b). The simultaneous suppression of negative emotions and expression
of grandiosity further mask any aspect of a true self. The avoidance of emo-
tions and self-inflation are examples of the deactivation that characterizes
these individuals. They have learned to dismiss their needs for others,
including group members, leaders, and the group as a whole. Researchers
have shown that more dismissing-avoidant individuals tend to dismiss the
benefits of the group, focus on their personal goals versus group goals, and
have negative attitudes toward the groups that they belong to (Rom &
Mikulincer, 2003).

For example, Amy would minimize the importance of the leaders by
interrupting them while they were talking, devalue the members by rejecting
their feedback, and minimize the importance of the group by comparing the
group with other groups that were more desirable. over time, other members
started to confront Amy about her inability to value them. one member,
Frank, revealed that he believed Amy thought she was “too good for the group.”
Amy agreed and did not seem to mind the feedback. She often perceived the
group’s confronting her as evidence that they were envious of her. group
members eventually rejected Amy. When the leader explored her reactions
to being left out, she shared that this was not new for her. She was often
rejected as a child, although she did not reflect on this with any emotion.
it became evident that she had learned to reject others as a way of bolstering her
own self-esteem and protecting herself from inevitable rejection. Despite this
revelation, group therapy continued to be a challenging process for Amy, and
she eventually dropped out of the group.

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treating the dismissing-avoidant group member 145

Challenges to Cohesion

group therapy is challenging for more dismissive-avoidant individuals
because the act of seeking help challenges their internal working model
of themselves as strong and of others being weak. needing the group or
acknowledging their vulnerability in the group has the potential to rouse early
painful losses that originally led to deactivation (Beebe & Lachmann, 2002;
Schore, 1994). Rom and Mikulincer (2003) actually found that individuals
with more dismissing-avoidant attachments had greater group-specific anxiety
because the stress of joining a group inhibited their ability to deny anxiety.
unfortunately, continuing to defend against this vulnerability with self-
sufficiency and superiority leaves them lonely and rejected (Fosha, 2000).
Mikulincer and Shaver (2007b) stated that even though avoidant individuals
experience loneliness, they continue to deactivate and remove themselves
from social relationships. not surprisingly, Kirkpatrick and hazan (1994)
found that greater avoidance was correlated with an increased likelihood of
being single and alone.

The difficulties these members struggle with not only leads them to be
more inclined to struggle in the group process but can often lead to premature
termination from group treatment. Tasca and colleagues (2004) found that
women with more attachment avoidance were more likely to drop out of
group therapy. Because these group members are challenging in group and
at risk of premature termination, it is helpful for group leaders to keep their
avoidance of painful pasts in mind. Although they can often appear arrogant or
independent on the surface, they have turned off proximity-seeking behaviors
and are often seeking relationships but without the ability to accept intimacy
(Mikulincer & Shaver, 2007b).

Interactions With Other Group Members

Because dismissing-avoidant group members avoid the direct expression
of their true feelings or internal states or are completely unaware of them
(Fraley & Shaver, 2000), it is sometimes difficult to identify their under lying
emotions or presenting problems (Cassidy, 1994; Main & Weston, 1982;
Wallin, 2007). one way to understand how these individuals truly experience
themselves in the group is through the feelings and experiences they induce
in others they interact with via projective identification (Wallin, 2007).

Bion (1961) was the first to apply the concept of projective identification
to groups and defined projective identification as the process of a member
disowning unacceptable aspects of himself or herself and projecting them
onto the group as a whole, its leaders, or specific members. Yalom and Leszcz

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146 attachment in group psychotherapy

(2005) defined projective identification in group as the “process of projecting
some of one’s own (but disavowed) internal attributes into another, toward
whom one subsequently feels an uncanny attraction–repulsion” (pp. 365–366).
Rutan and Stone (1993) clarified that projective identification is a two-party
system because it requires one who projects the unwanted parts and another
or multiple others who accept the projections in the group. By exploring pro-
jective identification, we can learn what is going on inside of the dismissive
group member who may not have awareness of his or her underlying feelings
or needs, and we can see what is being activated in the group. A wonderful
example of projective identification in a group with a more dismissing-avoidant
member is depicted in Yalom’s (Yalom & gadban, 1990) video demonstrations
of group therapy, described next.

Case Example: Interactions With a More Dismissive Group Member

Dan, a more dismissing-avoidant group member, comes late to group
consistently and avoids participating fully in the sessions. Yalom is the first
to confront Dan about not participating in the group. At first, the members
express their desire to have Dan participate in the group, but his vacant
reactions lead them to question why he is even coming to group in the first
place. During the session, he blames his work for his lateness and his wife for
his problems, and he minimizes the members’ request to have him participate.
gradually, during the session, the members become more and more frustrated,
and eventually, they become aggressive in their attempts to get a reaction
from him. Yalom recruits all the female group members to “tell Dan what it
would be like to be with him 24/7 . . . to be married to him.” Dan continues
to look calm, cool, and collected while each female member tells him how
challenging it would be to be his wife. not surprisingly, he becomes more
defensive and appears to withdraw even more.

At some point in the session, a female member reveals that Dan had
told her in private that he was frustrated with the group and often felt that
it was a waste of his time. We also learn that as a child, Dan struggled with
his parent’s alcoholism and his own feelings of inadequacy and rejection.
We can imagine that Dan’s bids for emotional connection were often unmet,
and he learned to disavow his own needs, feelings of anger, or his experience
of disappointment in relationships. These disregarded parts of him appear to
be induced in the others through his passive-aggressive behaviors, which also
happens in his marriage. he denies having any needs or feeling angry while
those around him feel completely needy and enraged.

This example highlights how the more dismissing-avoidant member,
Dan, is not forthcoming about his true feelings of resentment and anger,
and he does not appear to be aware of how his own needs are easily dismissed.

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treating the dismissing-avoidant group member 147

he withdraws into his work and continues to struggle with relationship issues.
The group becomes a microcosm of his outside world (Yalom & Leszcz, 2005),
with Dan re-creating a similar dynamic in the group to his relationships with
his coworkers and wife. Those who interact with Dan find themselves angry and
alone. Projective identification is one significant way more dismissing-avoidant
individuals can express their underlying emotions in the group without
having to be weak or needy (Cassidy, 1994). if the group leader can process
this enactment in the session, the leader has a powerful tool to explore what
is happening in the group and within individual members.

group members, like Dan, who have dismissing-avoidant attachments
(high avoidance and low anxiety), often engender complex feelings in other
members. Alice, a more preoccupied group member, starts to blame herself
during the session and worries that something she said in group angered Dan
and made him come late. She swallows her own feelings of anger and instead
appears concerned that Dan is angry with her. it is not uncommon for more
preoccupied members to be activated by more dismissing-avoidant members
because the dismissing-avoidant member’s rejection and neglect activate the
more preoccupied person’s worst fears. More preoccupied individuals often doubt
themselves and personalize reactions in the group. When they are activated,
they tend also to increase pursuit of the more dismissing-avoidant individual
and can be intrusive in their attempt to increase intimacy (Lavy, 2006). This
pursuit often leads more dismissing-avoidant individuals to withdraw even
more (Bartholomew & Allison, 2006).

Secure members are critical to the group process because, like secure
individuals in a couple, they tend to buffer the effects of members with a more
dismissing-avoidant attachment (Ben-Ari & Lavee, 2005; Feeney, 2005).
Secure partners are more forgiving (Mikulincer, Shaver, & Slav, 2006), can
express vulnerable feelings (Feeney, 1995), can self-soothe (Mikulincer &
Shaver, 2007c), are more compassionate (Mikulincer & Shaver, 2007c), and
can model how to address conflict (Paley, Cox, Burchinal, & Payne, 1999).
Likewise, the leader’s attachment style is also critical to facilitating a secure
base in the group.

ThE gRouP LEADER’S ATTAChMEnT STYLE AnD
ThE DiSMiSSivE gRouP MEMBER

Wallin (2007) argued that how a therapist responds to the patient’s
projection and the enactments is influenced by his or her own attachment
orientation. A more dismissing-avoidant therapist may engage in deactivation,
avoiding the patient, whereas a more preoccupied therapist may engage
in hyperactivation, becoming overly obsequious or intrusive and pursuing.

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148 attachment in group psychotherapy

The secure group leader is able to regulate his or her emotions, facilitate
curiosity about his or her experience in the group, and help group mem-
bers observe their reactions in the here and now. Yalom and Leszcz (2005)
described this as the leader “retaining or regaining our objectivity” (p. 45).
in the video, Yalom does this by stepping back from the enactment to reflect on
the process that is evolving in the group. he wonders aloud what is happening
when Dan withdraws and the group becomes “louder and more shrill” as they
attempt to get Dan to speak more authentically. in attachment terms, Yalom
is exploring the deactivating behavior in one group member and how it is
pulling for hyperactivating behaviors in the others. At the same time, Yalom
is facilitating group members’ mentalization by having them step back and
reflect on the emotionally charged group process so that they can make sense
of what is happening within themselves and in the group.

gRouP ThERAPY goALS FoR MoRE DiSMiSSivE
gRouP MEMBERS

The major task of group therapy is to help a more dismissive member
move from an avoidant orientation to one that is more relational and secure.
This requires that the individual rework internal models of others as weak
and inferior and of the self as superior and self-sufficient. This is no easy task
and involves challenging these implicit patterns of relating as they occur in
the here and now of the group. Because dismissive members have learned to
disavow painful emotions such as shame and aloneness, they are excellent
at intellectualizing, but they often lack the capacity to access emotions and
experience them relationally (Fosha, 2000; holmes, 1996; Main & Weston,
1982; Wallin, 2007). here we discuss how empathy, insight, mentalization,
and emotional regulation are key treatment ingredients to helping a dismissive
group member move toward more attachment security.

Using Empathy to Experience Core Affect: Walking the Tightrope

one of the reasons dismissive individuals do not have access to certain
painful emotions is because of their defensive exclusion of attachment-based
memories and thoughts (Fraley & Shaver, 1997, 2000; Schore, 1994). When
it comes to more dismissing-avoidant group members, it is helpful to keep in
mind their struggle with vulnerability and experience of shame. Early in their
development, they were most likely met with indifference, disdain, or even dis-
gust when revealing vulnerable affective experiences (Main & Weston, 1982;
Schore, 1994). The group leader must balance the need to confront the member’s
avoidance while also remaining sensitive to his or her underlying humiliation.

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treating the dismissing-avoidant group member 149

in the early phases of group therapy, when the group is forming, more
dismissing-avoidant individuals tend to be more sensitive to the pressures of
belonging and struggling to determine how group can help them while also
maintaining their distance. This struggle is often typified by coming late,
missing sessions, giving advice, remaining silent, telling jokes, or talking about
outside events that are safe to talk about. it is important to keep in mind that
these individuals may not be able to identify how they are really feeling, let
alone be able to share what they are feeling with others.

An empathic leader holds back from challenging, too soon, the natural
defenses that these individuals have relied on over the course of their lifetimes.
it is helpful for the leaders to acknowledge these members’ self-sufficiency
and their independence in the group, which is at odds with opening up
and joining the group. These members struggle with a challenging dilemma:
If I want to stay strong and rely on myself, I will be alone; if I open up and depend
on the group, I will be weak and needy. in the face of this dilemma, the group
leader can admire the group member’s independence, which has gotten him
this far, but the leader can also comment on how this self-sufficiency has left
the member alone and feeling disconnected to people, the issue that most likely
brought him to group treatment in the first place. To change means they will
have to start feeling.

in addition, researchers (Mikulincer, Birnbaum, Woddis, & nachmias,
2000) have shown that more avoidant individuals easily suppress attachment-
based concerns if they are not under stress, but they lose this ability in certain
situations. group therapy, with its many ongoing processes, can function as
a stressful environment for these members and allow for more underlying
attachment-based processes to surface. The following case example demon-
strates how the group process activated Raj and facilitated his exploration of
his attachments in the group.

Case Example: Using Empathy to Elicit Core Affect

Raj was a 45-year-old, single, engineering professor with an obsessive
type personality. he was a workaholic who valued his career and academic
success. Although he was doing well in his professional life, his relationships
failed miserably. he was single and wanted to be married, but he was detached
and judgmental. he was also triggered by people’s demands on him and often
distanced himself from needing anything or anyone. one way he avoided
depending on others was focusing on his work and obsessing about the details
of his research. he often would fall silent in the group when others were
vulnerable, and he would give logical advice that always felt a bit patronizing.
it was as if he did not know how to connect or have social skills. Although
group members repeatedly gave him feedback, he never seemed to be able

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150 attachment in group psychotherapy

to change the way he engaged with the group. Raj intellectually understood
that he avoided his needs and feelings, but he could not help it or access more
vulnerable parts of himself. he would often say with a sense of annoyance,
“i just don’t understand what you want from me.”

During one session, Raj reacted to nancy, a group member who was
describing her dependence on her boyfriend.

Raj: Why do you care so much what your boyfriend thinks? You should
be more independent. i was independent since the age of 5.
[The group is again frustrated by Raj’s arrogance, superiority, or
lack of empathy, but this time, Raj leaves a clue that the leader
immediately follows. The leader knows the group could go down the
same “frustrated feedback track.”]

Leader: You have been independent for so long, since you were 5 years
old. What was going on at that time, Raj? [The leader imagines
that Raj is not trying to be difficult but is just unable to tolerate any
expression of neediness. She speaks in an open tone and thinks he
would feel safer if the leader acknowledges his strength and inde-
pendence. She hopes that this empathy will lessen his defensiveness
and allow him to explore what part of his childhood is related to his
self-sufficiency.]

Raj: [struggling at first] nothing. i was just an independent child.
That’s all.

Leader: Raj, this is important. Let’s think about it. What might have been
going on that made you feel you were strong and independent
since, as you said, the age of 5.

Raj: [without emotion] Well. one thing was being the one in my
family chosen to be sent to boarding school. i think when
i was 5. Why is this important, anyway? Why are you asking
me about this?

Leader: That’s a good question. it is my experience that we all bring our
past experiences into our current relationships and that what
happened when you were 5 might help us understand how you
feel in the group, why independence is so important to you, and
why you respond the way you do to members, like nancy, when
they reveal their needs. Does that make sense? [This intervention
is aimed not only at clarifying things for Raj but also at helping the
other group members empathize and mentalize as to the deeper roots
to Raj’s behaviors in the group.]

Raj: [seeming to appreciate how the information could be useful] i guess
it sounds logical. Although i don’t think that anything that
happened to me at 5 is impacting me in here.

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treating the dismissing-avoidant group member 151

Leader: i know. Maybe this may not be relevant, but let’s see where it
goes. i know others in here may benefit from getting to know
you better.

Raj: Well. You know i was born in india and moved here later in life
to go to college. it is very common in india to send children
to boarding school to learn English to get an education. i was
honored to be the one selected in my family. i did very well and
graduated at the top of my class. [Raj focuses on educating the
members and defensively showing off his success.]

Leader: You adapted so well and were extremely successful at such a
young age. You said that is when you became independent.
Can you say more about that—about the experience going to
boarding school. [The leader empathizes with Raj. She does not
immediately challenge his defenses at this time and instead explores
his success to help him open up more about his experience.]

Raj: [spoken without emotion] Well, i was told i would be going to school
and that this was a good thing for the family. Then we packed that
night, and we left in the morning. i saw them a year later.

Julie: WhAT?! You did not see them for a year?

Raj: Well, i didn’t know that it would be a year [said with slight
annoyance].

Mary: Still. That’s horrible. You were only 5 years old. You were so
young. i am a schoolteacher, and i think that is a young age to
be away from your family for a year.

Raj: [looking disgusted] You don’t seem to understand. it wasn’t horrible.
it made me who i am, and i owe my family so much for that
opportunity. [Raj feels misunderstood and leans back in his chair.
The leader, sensing the increasing defensiveness and wanting to respect
Raj’s cultural background, empathizes with his experience of not being
understood.]

Leader: Raj, i wonder if the group is not as familiar with indian culture,
and it is very important for us to appreciate the value of educa-
tion and being selected to attend school. You have something
important to share with us. Could you tell us what it was like
for you? [The leader attempts to empathize with Raj and repair the
rupture to continue to make space for him to express himself.]

Mary: i’m sorry, i jumped in. i would like to know more. i have strong
reactions when it comes to children. [Mary is more secure than
some of the other members and is able to acknowledge her own anxiety.
She expresses interest in bringing Raj into the group despite his hurtful
responses in the past.]

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152 attachment in group psychotherapy

nancy was silent during the interaction, and the leader was keeping
her in mind because Raj had judged nancy earlier in the session. The group
leader was also trying to facilitate Raj’s openness in the group. She felt her
way into his experience and empathized with his strength while facilitating
some curiosity about his experience of being independent at such a young
age. The leader was aware that exploring Raj’s memories of being 5 years old
would likely expose his more vulnerable emotions and possibly move toward
his affect. This would also be more challenging for Raj, whose attachment
needs were consistently denied.

Facilitating Emotional Insight Into Underlying Feelings and Defenses

Fosha (2000) described how more dismissing-avoidant individuals
have learned to deal without feeling, and the price they pay for not feeling
is “isolation, alienation, emotional impoverishment, and at the best, a brittle
consolidation of self” (p. 43). The group leaders must facilitate a secure base
within the therapy group for dismissive individuals to feel there is any value at
all to exploring their emotions within a relational context. group member–
leader interactions are likely to trigger these unwanted emotions immediately
and offer multiple opportunities to understand their instinctive avoidance.
For example, Raj was triggered in the group by a fellow group member’s open-
ness about her dependency on her boyfriend, and that is when he proudly
announced that he was independent since he was 5.

Researchers (Mikulincer, Shaver, gillath, & nitzberg, 2005) have found
that more dismissing-avoidant individuals are motivated by egoistic outcomes,
and the group leader may need to start with helping the dismissing-avoidant
member identify a selfish motive to open up in the group. The leader focuses
on Raj’s strength and independence, and she maintains Raj’s specialness in the
group by addressing his ethnic background and the lack of the group members’
knowledge of his diversity. he is the expert who can explain something to the
group. The leader also addressed the cultural diversity in the group to facilitate
safety for other members in the group who come from a different background to
promote an openness and respect to differences (DeLucia-Waack, 2011).

Clinicians (Fosha, 2000) and researchers (Main & Weston, 1982) have
described how dismissive group members, like Raj, are more likely to rely on
repression and avoidance when core affects surface because these core affects
were not welcomed in their earlier attachment relationships. in the following
example, we see how the group leader took note of Raj’s nonverbal reactions
and continued to explore his childhood in the group to increase his disclosure
of personal information that could lead to emotional expression.

The leader sensed Raj’s need to defend his cultural background and was
also aware that he might feel unique in being the only indian American in the

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treating the dismissing-avoidant group member 153

group. Raj seemed to appreciate the acknowledgment that he was different and
that he could educate the group about his ethnic group identity.

Raj: Well, i came from a large family in india. i am the oldest. i have
two younger brothers and two younger sisters.

Steve: Were you all close?

Raj: i guess that depends on how you define closeness. i was closest
to my grandparents, i suppose. Due to the limited space in the
house, i slept with my grandparents at night and spent the days
with my brothers and sisters. it was a busy house. [At this point,
Raj folds his arms around himself as if to contain himself.]

Leader: That must have been so different to suddenly go from sleeping
with your grandparents every night and having all of your family
around you to being on your own at school. [The leader considers
that for Raj, this may be an important memory of his grandparents
and has triggering feelings within him; however, at this point, she
focuses only on how different this experience was for him.]

Raj: [His expression has changed, and he avoids eye contact.] i never
really thought about it that way. it was very different from living
at home. i have a big family [pauses]. But i knew i was the lucky
one to have this opportunity. [Raj’s struggle to suppress his attach-
ment needs is profound. The group members have had a glimpse into
his experience of loss, and the leader continues to track his reactions
within the group, knowing that his experiences will lead to more
vulnerability.]

Increasing Mentalization

in addition to empathizing with underlying emotions, it is critical for
the group leader to help more dismissing-avoidant group members, like Raj,
find ways of reflecting on these emotions in the group. We suggest that the
group leader can help facilitate mentalization in dismissive members by ver-
balizing feelings slowly, facilitating group member insight into the feelings
that underlie behaviors, and encouraging interpersonal feedback within the
here and now of the group. These three processes help to interrupt dismis-
sive members’ avoidance of affect, which typically interferes with reflective
functioning (Tasca, Foot, et al., 2011).

Emotional Regulation: Verbalizing and Tolerating Feelings

one way the group leader can help more dismissing-avoidant individuals
put emotional experience into words is to reflect back the emotions that are

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154 attachment in group psychotherapy

nonverbally being expressed in a slow manner that is not experienced as
intrusive. The group members and leaders can also explore a memory that
comes to mind in the group that triggers more emotions. in the case of Raj,
the group leader felt that it would be important to help him identify some
feelings in the group given his resistance to the group’s interpersonal feedback
and was isolating himself more and more from the group process.

Raj: Come to think of it, i never knew i would not see them for a
year. i thought i would see them.

Mary: Was that customary in india? not to see your parents or family
for that long a time in boarding school? [This question reflects
more curiosity and openness to Raj’s cultural background and exposes
what is cultural vs. what is specific to Raj’s family.]

Raj: [paused] no. other parents did come to visit, but my family lived
too far away. They could not come each week. it makes sense,
and it would not be practical. They had to work and did not
have the money to visit. [Although Raj is still minimizing the
experience, it is clear this question has touched on his emotions.]

Steve: So they lived too far away to visit you. Wow. it must have been
hard to hear that they would not come to see you for a year.
[Again, a group member is curious about Raj’s experience and genuinely
interested. This is different from past group interactions.]

Raj: Well, they did not really tell me that. i figured it out over time.

Steve: how did you figure that out?

Raj: i guess i realized it when they didn’t come. i would go to the
front hall where all of us would go to see our families on the
weekend. i would go each weekend to wait, and they never came.
Eventually, i realized they were not coming, and i stopped
going. [Although Raj still speaks with the same matter-of-fact tone,
his feelings are palpable in the room. The group is silent.]

Nancy: [in a compassionate tone, reaching out] Wow. You waited and they
never came. You really must have been a strong kid to deal with
that and to do so well in school on your own.

Raj: [said in a slower tone] i know it sounds worse than it was. i mean
it was hard on me, but it was not so bad. [Raj again tries to protect
himself from the feelings that are starting to come to the surface.]

Leader: Raj, it may not have been so bad, but you said it was hard.
i imagine that 5-year-old must have been very disappointed and
had many feelings before he decided to give up. Am i correct?
Do your recall what that 5-year-old may have felt each week while
waiting? You know, before he decided it would best to move on.

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treating the dismissing-avoidant group member 155

Raj: [speaking even more slowly] i never thought about this. i have
never thought about what he was feeling each week. i don’t
know. he . . . well i mean i . . . i just waited. it was hard to wait
there. i am not sure this is that important. [Raj continues to hold
back, but he is more open than he has ever been in the group.]

Leader: it feels to me like this is an important time in your life, Raj.
This is when you learned to become so independent. Can you
recall one specific time when you were waiting to help us really
understand what it was like for you? What made it so hard? [The
leader honors Raj’s independence and then tries to help him explore a
memory that helps him identify his feelings as a child, which may be
more tolerable than his feelings as an adult.]

Raj: i don’t know. it was a long time ago. i guess there was this
one time.

With the help of the group members, who became intrigued by his past
and continued asking him questions, Raj eventually recounted one specific
day. he described going to the front room early to get a seat right across from
the front door, and he eagerly waited for his family to visit. Each time the
door opened, he imagined it would be his mother walking through. Each time,
it would be someone else’s family, and he would watch them reunite. it was
never his family, and it would happen more than a dozen times.

Raj: Eventually, i just stopped waiting for them to come. on the
weekends, i would stay in my room and focus on my school-
work. This ended up to be a good thing since i did so well.
[Although Raj is positive about the outcome of the experience, his
face becomes red, and he appears uncomfortable with the feelings
that are coming up. He looks sad. The group is present and engaged.]

Leader: Raj, for a moment i saw something in your eyes, and it looked
like you felt sad just now. is that how you felt?

Raj: i never really thought about this time in my life as sad. i was
sad. i have not really gone back there in a long time. [Pauses]
i just don’t want to focus on sadness now. i don’t see the point.
it doesn’t change anything.

Steve: i can really relate to that. i also ask myself, “What is the point?”
sometimes. “Why do i need to focus on feeling angry or sad?”

Leader: So what do you tell yourself, Steve, when you ask yourself that?

Steve: it has taken me a long time to realize that shutting off my feelings
from when i was growing up made sense when i was a kid, but
now it has pushed others away and kept me alone. it is hard
to believe that these feelings can have a purpose. i remember

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156 attachment in group psychotherapy

the first time in this group when i shared my experience of
my father’s alcoholism and how that triggered all of this anger
i had pent up for years. At the time, i could not see how that
anger was influencing all of my relationships especially with
my own kids. [Steve is a member who is also high in avoidance but
less so than Raj. He is able to empathize with Raj’s deactivation of
emotions, but he is also able to offer a different perspective on how
disavowal of painful feelings can have a negative impact on current
relationships.]

This clinical example highlights how group members can help each other
process and explore emotional reactions. Although Raj quickly moves away
from his sadness, he is able to acknowledge the sadness he felt as a child for the
first time in group. he also raises his experience as a child who is sitting with
painful emotions without a caregiver to comfort or soothe him. Raj indicated
that he learned to focus on schoolwork to avoid being overwhelmed with his
intense feelings of longing, disappointment, and anger. This was adaptive as
a 5-year-old struggling to survive repeated disappointments. This detachment
and withdrawal from emotions is not adaptive in his current life, however.
Steve, another more dismissing-avoidant group member, is able to empathize
with Raj and express his own struggles with identifying and tolerating emotions
and how this influences current relationships. More important, during this
session, Raj has moved from being judgmental toward nancy for expressing
emotional vulnerability and neediness to focusing on the root of his own
disavowal of needs. he also offers the group an opportunity to connect with
him and his struggles to avoid his feelings.

Encouraging Interpersonal Feedback

When working with dismissive group members, it is helpful to encourage
the group not only to challenge their avoidance but to recognize their risk
taking. As Raj revealed more in the session, group members seemed to be
more engaged with him. They appeared interested and thoughtful as he was
describing his experience. Raj’s disclosures had an important impact on the
members, who then started to share their painful experiences to connect with
him. The group members, like Steve, shared their own past that related to Raj
to demonstrate their understanding of the use of avoidance to manage more
painful emotions. Although members were able to relate, the experience of
increasing intimacy caused Raj to withdraw again. he felt the support group
members offered was not always helpful, and he was ambivalent about being
similar to the other group members. The compassion he was receiving felt
uncomfortable to him, and he did not want to be weak and needy. The leader
aimed to help Raj use the group feedback to foster some insight into how his

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treating the dismissing-avoidant group member 157

avoidance was perceived by other people and how this may have an impact
on him outside the group.

Leader: Raj, i wonder what your experience of the group has been like
today?

Raj: i don’t know. it is very different from what i expected. People
seem to like it when i talk about this side of me from the past,
but i’m not sure i see the point in the long run. if i were you,
i would want to hear how i can help address your problems, not
how i was feeling sad when i was young.

Nancy: To be honest, this is the first time i have ever felt like i knew
you. i think this is the only time that you have shared anything
about yourself. You always give advice, like a professor, and you
do it as though you have it all figured out. You have the answers.

Leader: nancy, how does that make you feel?

Nancy: it makes me feel worse. i feel like you think you’re better, and it
makes me feel angry. i’d much rather hear about your struggles,
too. hearing about your experience has made me feel like we’re
not so different after all.

Steve: Exactly. i really appreciated you sharing what you did even if
you don’t think it was helpful. i think i understand why you focus
on your work so much. i used to think you just didn’t care, but
i think you focus on solving problems because you learned as a kid
that feelings are not helpful. i also struggle with that, so i get it.

Raj: So you want me to talk more about my childhood?

Nancy: no, i guess what i am saying is i want you to talk more about
yourself and give less advice. Just be you in here.

Leader: nancy, can you share more with Raj about your experience
with him earlier in the session versus now?

Nancy: Sure. i guess i was annoyed when he said i should not be so
dependent on my boyfriend. [The leader motions for Nancy to
talk directly to Raj.] i should be more like you, independent.
Like you have been since you were 5 [talking to Raj]. i felt like
you were being critical of me. But now that i have gotten to
know more about you, i see that there is a reason why you don’t
want to depend on people. You don’t want to be disappointed.
i relate to that, and i don’t want to be disappointed either.

Leader: Raj, what do you hear nancy saying?

Raj: i didn’t know i came across as perfect. i don’t think i’m perfect.
[It is hard for Raj to take in the positive feedback.]

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158 attachment in group psychotherapy

Mary: i don’t think you realize that when you give only advice, you
come across as having all the answers. it feels like you’re perfect
or better than us.

Raj: Do others think that way? [Several group members nod their heads
in agreement.]

The intervention described was the first time Raj acknowledged any
feelings, described anything personal in the group, and was able to hear group
members’ feedback. This was a major and important step for Raj, who continued
to courageously struggle to take in the group’s feedback over time.

We can see the importance of using the past to enhance our understanding
of the here-and-now interactions in the room with a more dismissing-avoidant
group member (Bowlby, 1988). Before this session, the leaders and members
continually provided feedback to Raj, but the feedback was not penetrating
his defensiveness. he was not able to access his feelings with ease, and every
bone in his body was rejecting vulnerability. The group’s confrontations never
seemed to affect Raj, and this only served to frustrate the group members. To
foster a new pattern of interpersonal interaction and emotion regulation, the
leader engaged with Raj with more curiosity to foster a new experience.

The leader invited him to explore the roots of his deactivation and take
a closer look at his reaction and eventually his underlying feelings. once the
details of his childhood became more apparent to the leader and the other
members, the group became more accepting of him and could understand his
behaviors in the group. Eventually, the members’ reactions began to become
a more salient factor in the process as they expressed empathy for Raj and also
feedback as to how his vulnerability was more attractive to them compared
with his superiority. not surprisingly, Raj did not trust the positive feedback
he received from group members. This is consistent with work by Brennan
and Morris (1997), who described how more dismissing-avoidant individuals
tend to reject other’s feedback in general, especially positive feedback that
activates their dependency needs. Future group sessions focused on helping
Raj continue to gain insight into his ambivalence to emotional closeness in the
group and the way he came across to others. Although the interaction did not
alter Raj’s attachment behaviors immediately, it initiated a process in which
Raj could begin to develop a more cohesive narrative of himself, learn to slowly
tolerate emotions, and gain insight into how and why he pushed others away.

ConCLuSion

group therapy has the unique power to facilitate incredible growth for
members who come to the group with a long history of interpersonal avoid-
ance and emotional detachment. group therapy provides these patients with

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treating the dismissing-avoidant group member 159

interpersonal feedback that calls into question their devaluation of others
and idealization of themselves. The group members have the power to confront
these dismissing-avoidant interpersonal strategies if the leader helps them
explore the underlying motivation behind emotional detachment. For some
group members high in avoidance and low in anxiety, interpersonal feedback
with regard to their defensiveness can engender insight, but for some group
members within this avoidant dimension, receiving challenging interpersonal
feedback will only provoke more defensiveness. The group leader’s task is to
know when to allow the group to challenge the more dismissing-avoidant
group members and when to try a different strategy. These members are at
risk of being a scapegoat if the interpersonal feedback does not penetrate the
defensiveness. The leader must facilitate empathy and mentalization to foster
insight within the group. To do this, it is important for the leader to facili-
tate a different interpersonal experience by slowly making space for these
individuals to reveal the underlying motivation for their self-sufficiency.
Providing this window into the more dismissing-avoidant group member’s
feelings facilitates empathy in the group and connects this member with others,
facilitating cohesion.

As we look back on the case of Raj, we see how he was slowly able to gain
insight into the impact of his actions on others in the group when he was seen
in a different light. Raj was able to expose a different part of himself in the
group, and other members were able to see how he needed to protect himself
from the feelings he had as a child. only after the others really saw him were
they able to provide helpful feedback that could be digested by and meaning-
ful to Raj.

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