The Healing Power in Group Psychotherapy with Dr. Dennis Kivlighan

Dan is joined by Dr. Dennis Kivlighan, an expert in group psychotherapy. In this conversation, Dr. Kivlighan discusses the profound impact of experiential learning in therapy, the complexities of group dynamics, and the importance of corrective experiences. Dr. Kivlighan emphasizes the role of group members in the therapeutic process and advocates for a training model that prioritizes real experiences and feedback. The conversation highlights the significance of understanding interpersonal relationships and the social microcosm within therapy.

Special Guest: Dr. Dennis Kivlighan

Additional Resources

Three important clinical processes in individual and group interpersonal psychotherapy sessions

From where is the group? To what is the group?: Contributions of actor−partner interdependence modeling

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Chapters

• 0:00 Introduction and Episode Overview
• 1:05 Guest Introduction: Dr. Dennis Kivlinghan
• 7:30 Journey into Group Psychotherapy
• 12:45 Group Therapy as a Social Microcosm
• 18:10 How Group Therapy Facilitates Change
• 24:00 Corrective Experiences and Trust in Groups
• 29:40 The Role of Peers in Group Dynamics
• 36:10 Effective Training Models for Group Therapy
• 42:20 Importance of Experiential Learning in Therapist Training
• 44:50 Closing Remarks and Next Episode Preview

Transcript

0:00

[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 31 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights pull back the curtain and hopefully have some fun along the way. You find our show helpful or interesting, be much appreciated if you could share it with someone you know who might enjoy it to, it's a great way to spread the word and keep the conversation going. Today I couldn't be more excited to welcome one of the world's authorities on group psychotherapy. My guest is a professor in the department of human development at the University of Maryland. He's been editor of the Journal of Counseling Psychology and Editor of Group Dynamics, Theory of Research and Practice. He's a fellow in many APA divisions including Division 17, the Society of Counseling Psychology, Division 49, Society of Group Psychology and Group Psychotherapy and Division 29, the Society for the Advancement of Psychotherapy. He's received many prestigious awards, including a group psychologist to the year award, a lifetime achievement award from the Society of Counseling Psychology and a lifetime mentoring award. You also notice that in the show description I have links to a couple of his articles that we discussed in this episode. In part one of our conversation we discussed several aspects of group psychotherapy, including the group as a social microcosm, group facilitating new ways of being, the power of peer interactions in group, how to train group therapists and much more. This episode starts with my guest responding to my question about if he couldn't be a psychologist or researcher what his dream job would be. So without further ado it's my pleasure to welcome my very special guest Dr. Dennis Kivlinghan. If I had the talent I'd be a drummer, really? I played drums in high school. I love music. I have a terrible voice. I love singing. There's no way to pursue that by a real love and life, but if I could I would be like a jazz drummer. Really? Jazz singer, yeah. Oh that's the best answer I've gotten so far. Well I always say it best, but it's certainly interesting. I love music. It's just I always have music going. If we weren't talking not be listening to jazz at the moment. Gotcha. So who are your favorites? I like a lot of the classic, you know, Frank Sinatra. I like Michael Booth, Boothway. I like why am I blanking her name? It'll come to me. Ella Fitzgerald. Oh yeah. I like mainly jazz singers. Okay. Great. Okay. So then that sort of pivoted what you actually do. I know. I got it. I got it. Got it. Got it. Got it. So then how did you get into studying group? So there were three sort of things that came together during my time in graduate school. One was we had a required group therapy class and my advisor, Tom Aguerva, talked that class. Tom was an amazing. You probably haven't heard Tom. Uh-oh. He didn't do a lot of, um, didn't do a lot of research, but he's probably the best teacher I've ever had in my life. And he's also an amazing therapist. So he taught a group therapy class in our program. And it was back in the days when it was very experiential. So we basically did a yalom. He basically led a yalom type group for us. And it was incredibly powerful. I learned a lot about myself. I learned a lot about doing group therapy. If I learned about relationships, it just was one of the best experiences I'd had to that point in my life. So that sort of cooked me on the emotional aspect of group. Just how powerful it could be in terms of making changes. At the same time, I was, I was at Virginia Commonwealth University. And at the same time that I was taking that class with Tom, the counseling center there got a new director, Jack Corzini. Jack is a pretty well-known, or was a pretty well-known group psychotherapy researcher. And I took a directed readings class with Jack. And we were looking at group development. And my dissertation came out of that work that I had done with Jack. And so that was a nice marriage of the more practical stuff that I got with Tom. And then the more theoretical group therapy stuff that I got with. Jack. And then Don Keesler was in the clinical program at VCU. And he taught an approach on basically doing interpersonal therapy. Interpersonal therapy is of course the theoretical foundation of group therapy and all the work. And just Keesler was like Tom. He was an incredible teacher. But also the theory, the interpersonal theory just made so much sense to me. And of course, that's so well with the group area. Those three things ended up sort of coming together, melding together for me. So it was, yes, it was here and now oriented. So we did a lot of work with the relationships among us in the group. A lot of focusing on understanding our strengths of weaknesses in terms of how we came across real emphasis on feedback, interpersonal feedback in terms of what we did that either would push people away from us or people towards us. And also less than emphasis, but some emphasis under trying to understand where those patterns came from, how we got to where we developed our own personal style. But I think the main thing was that here and now focus within the group. When you said earlier that you had like, it was very personally meaningful for you, could you give more specifics in terms of what that was like or what that was? I mean, I really learned a lot about me. I had gotten, I was not a good student in high school. My mother was always pleading with me to, "Could you just try a little bit?" No, can't. And I wanted to. Of course I didn't say that. I just was a bratty adolescent and ignoring her. But that sort of that message that I got from that was, you know, you're not doing enough. You need to. And when I got out of my bratty adolescent side, you know, sort of when I did sort of finally in graduate school beside that I needed to apply myself, it was like, you know, I never felt like I was enough that it was, you know, I wasn't good enough, I wasn't enough in any way. And I think that that was one of the things that I learned in that group, that sort of how that affected my relationships, how that, you know, how I wouldn't. You would not trust that I was doing enough in my relationship with people. How it felt I had never, how it would keep me from feeling sort of satisfied in those relationships. And then helping me connect where that had come from in my earlier life. That's one example of something I learned in the group. So because of what the process was happening in group, that that was able to sort of emerge and you were able to like recognize that. Yeah, because you, because you would see that in my relationships with my peers, that, you know, that I would not, you know, I'd always be trying to sort of do more, not not being able to just sort of accept that I was okay in the moment. So this leads into something else I wanted to ask about. So I remember being in graduate school. My memory is that Jim Lichtenberg, or you probably know Jim, I would guess. I remember him talking about psychotherapy as sort of a social microcosm of your life, right, that these dynamics and things play out. And I remember sitting in graduate school and sort of thinking like, is it, like, is it like this is a question that I have? Is it because it is contrived, right? It's not a real place. And then, and so then, but we sort of oftentimes psychotherapy sort of assume that it is. And you're, you've done some work on this in the group context. And when I, when I read it, preparing for this, I was like, oh, wow, somebody who actually did some empirical work on this. And, you know, has thought about it more so than just assuming it. So I guess so my question is so is group a social microcosm of your life? Yes. And it's more complicated than that. So it's, you know, one of the things that I love that Keesler said was that that the person you're working with doesn't have to tell you their problems. They'll show you their problems. That, and that's sort of the cloakier way of thinking about the social microcosm. It's going to be there whether you want it to be or not. It's, it's, it's, in some ways, it can't help what happened. But like an individual therapy, the con isn't in the room by themselves. They're in the room with you. Is it therapist? And so, so when you look at our interaction, it's partially what they, what they are bringing, the client is bringing to the interaction and how they behave in their past relationships. But their behavior is being influenced by me. What I'm bringing to the relationship and how that, how that influences how I'm with the client. So you get sort of a male, of both of our social microcosms in the individual therapy. And then you think how much more complicated that gets in the group. So it's, you know, yes, I bring in my, you know, that belief that I needed to do more that I wasn't good enough. I brought that into the group. But then other people brought their own social microcosm in the group. And the group becomes a maelting of those different social microcosms. So yeah, our, our research does show that if someone, we look at intimate behavior as a, as a vehicle for trying to understand the social microcosm. So if someone has problems being intimate in their outside relationships, you'll see that in the group. But you'll also see that if, for instance, that the other group members don't have problems being intimate in their outside relationships, that'll sort of pull that member who does have problems, pull them along. It will help them to be, help them to not have as many problems within them as they might if they were groupful of people who also have problems being intimate. Yeah, so when you say intimate behavior, what do you mean? So things, this, we use an instrument that was developed by William Shadish. It was for his dissertation. He actually started out as a group therapy researcher. And he, and he, he just developed a checklist of different types of what he called intimate behavior. So it would be like being vulnerable, revealing something vulnerable about yourself. It would be giving feedback to other people. The types of, types of behaviors that would deepen our relationship, make it more intimate of caring. So we, we just have, we just look at those, that behavioral checklist is a way of trying to understand how intimate or not not intimate of person is in the group. As I was preparing for this, I was thinking about how, I was thinking back to my group class in grad school. And I sort of have this had this experience to an extent of, I don't know, group being not, now let me say this a different way. Like I sort of feel like in reading and thinking about your work that you study group, but in an interesting way that, that, that, that, that even just listening to you talk in the last 10 minutes, that those processes, those things that are occurring, how you're talking, you know, just talking about intimate behaviors and clients being willing or not willing to and how other clients pull for those things that it's just, it's so sophisticated. And as a, you know, someone who's trained as a psychologist and really, you know, what I got, it's like, it's, it's exciting. You know, it's like, Oh, this is really cool. What you're talking about. And so I, I guess where I'm trying to go with this is to an extent, I guess I want you to explain a big picture of course, like how you've come to think about how groups are helpful, like how group psychotherapy is helpful for folks. I'll try to answer that, but I want to, but I want to, before I do that, I want to comment on what you said about, you know, that's what I love about doing, the thing I love about doing groups psychotherapy research is that it's so complex. It's, you know, there, there's so many moving pieces and that it's fun from a sort of an intellectual point of view trying to, trying to capture all that, but it's also fun from a statistical point of view trying to come up with models that can capture that complexity. You know, for years and years when we were studying group therapy, we were, we were basically just studying individuals who happened to be in a group and it's only within the past 10 to 15 years that we've started, that we had these models where we can actually study how people influence each other and what the being, what the group sort of brings to the process that is that it's, that you're different when you're in a group than you are in other settings. And we're starting to be able to capture those things. So that's, I think with the exciting things about really getting to do group therapy research is that it really, you do get to try to understand some of that complexity and we are, we're with the play, we're with, we're at the place now that we have statistical models that can help us to do that. And in fact, actually, I think some of our, yeah, I tell my, some of my, my students that actually we can do the group theories have to catch up with where we are. The group theories are too simple. They don't, you know, we, the, you know, take something like Yolum's curative factors, you know, everybody knows about Yolum's therapeutic factors. How, how, I am back in the back of the day, he, he first called him "curdive factors" and then he got more modest and changed it to therapeutic factors. He started reading him, he thought he could cure people and then he realized that he was lucky, he could help him a little bit. And so, but, you know, it was, we didn't, we didn't think about them. So, at, at, at the level of, even a simple question like, is, is this an individual factor or is it a group factor? What's, what's the, you know, like cohesion is that is cohesion, my sense of how, of whether or not I'm attracted to the group or is cohesion the group sense of whether or not people are attracted to the group or is cohesion the coming together. I mean, this is my preferred views that, that cohesion is something different than just feeling good about the group, it's that we are on the same page, we all see things in a similar manner. So, we can now start to ask questions about that, but, you know, Yolum doesn't really make this, makes distinctions about what is cohesion. Is it, is it an individual thing or group thing? Is it a, is it a sort of a matter process that had coming together? So, that was, that was my side tracking. So, I'll actually, remember you question, I'll get back to it. So, with those, whoa, getting better able to try to answer your question of what makes group helpful. I think part, I think part of what makes group helpful is that it, it gives you a, it is a place where you can try new ways of being in the world. And you can get feedback from, from other, from real, real people about the consequences of that, of those experiments that you're doing. It's, you know, if I, if I want to be, why I want to use therapeutic language, it's, it's, I think the core of the, of what makes group helpful is the corrective experiences that happen within that space. Yeah, that you, that you've learned that you've had the opportunity to try new ways of being in the world. So, it, you've said two things, which is new ways of being and corrective experiences that I think would be worth digging a little deeper on. Yeah, I think actually I'm equating those two. I think a corrective experience is a new, is, is a new way of being in the world. So, we, we get into our patterns of experiences that we, we've learned, for instance, that, that we made, you know, someone may have learned from their background that it's hard to, that they shouldn't trust other people. I, I had a group therapy member one time who was, who was talking about trust. And usually, you know, we learn these lessons not implicitly, but explicitly. We, we learn, for instance, someone learns not to trust. They, they learn that through observing, you know, important people in their life. They learn that through some experiences that they had. But this one group member, still makes me sad to think about it. She, she talked about how her dad would, she would be standing on some steps and her dad would say, "Jump to me." And she would jump to him and he wouldn't catch her. And he would say, "You have to learn, you can't trust anybody." Can you imagine? Yeah. And that's, I mean, when you said explicit, like that's as explicit as it gets. Yeah, I've never heard that. I've never heard that message of you can't trust anyone taught so explicitly as it hurts for me. But you, you, so you, you, you, you, you have these views of the world, or these ways of being in the world. So I'm not going to trust anybody. And then the new experience is taking the risk of trusting someone. And what makes it correct is that it, it counters that. So if you take the risk of trusting someone in that trust is, is, losing my words, if that trust is fulfilled, then that, that becomes the corrective experiences, because it's an experience counter to the messages that are getting, getting you in trouble. So the new experience is a, is a step towards what's possibly a corrective experience, depending on what, you know, what happens after, after the risk of the client's death. When I think about group, I think about that, and how you're talking about that, that one of the powers is that that relative to individual is that the corrective experience happens with a, with a peer, right, that if I'm the therapist, we, we, that, that corrective experience or a similar corrective experience can also occur. And, you know, there, there, there is something to be said for that corrective experience occurring with a peer, right? This person's not a professional, or that this, these other people in the group are not professionals, they're not being paid. In fact, they're paying typically. And, and that, that, so that that, that corrective experience could be, or has the opportunity to be particularly powerful, because these are just, you know, these are civilians, these are just, these aren't therapists, these are just regular people. And it also really speaks to the unique role of the therapist or therapists, but the therapist in group. Yes, it does. And, you know, I, you know, as therapists, we're always tainted, you know, it's always, oh, you're just saying that because you're, you know, you're just doing that because you're the therapist. And, you know, you fight against that, you know, I, you know, one of the phrases I use is that, you know, I'm not an emotional whore. You can, you know, you may be pegged me, but you can't buy my emotions. If I, if I care about you, that's a genuine care about you. It's not a, it's not a bought care. Right, it's not contrived. You're being real. Yeah, but it's, but you, no matter how much you fight against it, you are still a little bit tainted, but, but the other group members aren't, you're, you know, they, they aren't being paid to care about you. They, that's not their job to care. They're not in there to care about you. That if they end up caring about you, it's because they do. So, yeah, that's powerful. And that, you know, in the, in the, in the, in the, in the, yolums early research, what he finds is that, that, if you ask people what were the most important interactions that they had in the group that were at, they were interactions with other group members, out of the therapist, the, the group members. And I think this is where you're going. The group members actually do the therapy in the group. So then what's the therapist job? The therapist job is to set that in emotion to help them to be the, the therapist to be effective for each of them. So, I think I didn't really get group, like get what effective group process could look like until I was on internship. And I was a part of several groups, many groups before that. But it wasn't until I found, I happened to have, being a group with somebody who, who like, really got what you're talking about. And I was able to see it. And I was like, oh, this is what we're supposed to do. Now, this is, and it's just, anyway, so my question is about training, you know, how to do, and you talked about earlier, your personal experiences. But how have you come to think about, you know, if you're a czar of the training program at Maryland or wherever you happen to be, you know, what would effective group therapy training look like? So actually, I'm going to go back to my time at Missouri. So when I, when I was at Missouri, so I had never intended to be a faculty member. I just sort of happened to me. You know, I didn't think I was capable of doing something like that. So actually, my first, I've worked in counseling center to begin with. I was a staff psychologist at the University of Maryland Counseling Center. And it was fortunate to work with Charlie Jelso and Claret Hill. And they, they were the ones that encouraged me to think about going into academics. And so, when I left the counseling center and went to Missouri, I was actually in these old-fashioned joint positions. I was a third of the time in the counseling center at Missouri, two-thirds of the time in the academic department. So I was always doing that, balancing that practice, theories type of, type of thing, the science practice, type of balance. And it was an impossible situation because you, but it was, it was a wonderful situation. I mean, because you, you had to do them, if you had to, and you had to figure out ways to put them together. And so that's, I feel like we developed a really good group training model at Missouri, based on some of the things that Yolum does, but also based off of some of the work in family therapy. You know, in family and couples therapy, they do a lot more observation, typically than we do in the either individual therapy or group therapy. And they do a lot more active in the moment supervision. You know, it could be, like at the bug in the ear, it could be coming into the group. So what we did was we would have, for our interns in the counseling center, we would, you know, have three or four interns a year, and we would have one training group where we, it was an ongoing, open-ended therapy group that had been going on for years. And so, you know, clients would come in and out of that group. And there were two of us, therapists, PhD levels, psychologists, who sort of were the, the leaders of the group, but the interns also co-let the group with us. And what, what we meant by that was that we would, there would be two co-leaders in the group at any point in time, but it could be, but it would typically be one of us, one of us, PhD therapists in one of the interns or could be two of the interns. And the other of us would be behind, and the rest of us would be behind the mirror watching, watching what was going on in the room. And there was a lot of, I think that there was a lot of really good learning behind the mirror because you could talk about, you could talk with experienced therapists about, oh, what do you see? What's, what's, what are they doing? Well, what are they missing? How would you, what would you do if you were in there? And the piece that we added to that, it wasn't just, what would you do if you were in there? That's a great idea. Go in there and do that. So we would, how I would describe the training program to the people who did it was, it was like a permeable membrane between the observation room and the, in the group room. You would literally, you would literally walk out of like regularly, I mean, just you'd be in the back behind the one way, two way mirror, whatever it is. And then you'd walk in, sit down, and you would, yeah, you would say, but you know, I was noticing this. I wonder if you would want, I wonder if we could, you know, try this or I think this is going on. What do you, how does that sound to you? And so this group was just running sort of regularly, week after week as for years. And so it sort of became this, it was normalized like the, the clients knew what they were getting into. Probably some of them had been there for several years or for a couple of years, some of them were new, but then that's, that's fascinating. You know, what was so interesting then was that we would, you know, I started this model and loved it and thought, oh, wow, this is an incredible training experience. And at one point, the group member said, you all, you know, get to observe us. Why can't we watch you all debrief? Because they knew we debrief afterwards. So we said, sure, you can debrief. Yeah. And then after all, they would say, well, when you all see something that you think's not getting addressed in the group, you all come into the room. Can we come into the room? If we, you know, if we disagree with something you're saying, and they'd be breathing and so they started the client, the group member started coming into the room. So you did that regularly where you had the group members watching you all process after they would watch and they would come in and they would say, no, we don't agree this, you know, we don't think you've got this right. That's amazing. Isn't that amazing? Yeah. But I mean, that's sort of what you, I mean, you know, it's, it's tough, right? Because there's probably certain things you might not quite, just, you know, you're going to be a little gentler, right? And how you talked about it with your peers, you know, because you know that you're being watched by the group members, but that's kind of what you want, right? Which is I work conceptualizing what's happening, but then actually to get immediate or close to immediate feedback from the group that says, no, no, I wasn't struggling with that. No, no, I was, I was over here worried about this thing or I was worried, I was worried about her, I wasn't worried about me, right? So you get to reformulate your conceptualization based on their feedback. Yeah. Isn't that amazing? Yeah. And they, they helped. That's fantastic. We didn't go in with this model fully laid out. It was they, they, and you know, in it, in it, it, it, it, I've always tried to reduce the power dynamic in therapy. And it's, it's, it's, I think the closest that come to, to, to try to eliminate that power dynamic as much as possible. You have that open sort of thing. Well, so as you were talking, I was thinking about I had one of the, in the first, I don't know, maybe the fifth or sixth or fourth of these I did was with Scott Miller. And so, and so Scott was talking about how when he was first doing training or what he was getting into re, I remember where exactly in his, but that, you know, and he was, he was doing a lot of solution focus stuff at the outset. And he was in Wisconsin, I believe. And he was talking about how they would do so much live observation. And it was research and practice. And they're bringing people from the community. And I said to him, you know, I feel like that we, well, I would bring it into the present, which is, but there's echoes of it that I'm like feeling, which is like that, what you're describing. It just, to me, it's, that feels right to me. You know, it takes time and energy, but it's like, that's kind of like why we got into the business to begin with, the types of things that you're describing there. And it feels like to me that those types of experiences are less common than they used to be. Do you agree with that? Yes, I do agree with that. I, I, I, what I would say, I'm not sure how common they ever were. I mean, I think there were in, in some particular programs, they were common. And in some particular approaches like, you know, more family couples therapies for whatever reason that seem to evolve in a much more open way in terms of happening. But it's, it's, it's, I almost feel like it's cheating almost. I mean, so since the time I, since the time I've been in Missouri, I haven't ever done an individual session that's, or a group session that hasn't been observed. I'm, but they are, they are making me a better therapist because I, because I always, you know, want them to, if I'm missing something to come in to the group and will come into the individual session, and help me, help me be a better therapist. You know, I think they get a lot out of learning that, and they get a lot out of coming into the room and trying the things that they're talking about. I mean, it's easy to talk about, you know, it's easy to, you know, come up with a million ideas of, you know, what, what, what you could do or, or, it's easy to criticize, you know, I would never do that. Now, if I did this, everything would be different in there, but it's, you know, actually putting that, yeah, the rubber reading the road, you know, trying to put that into, into places just, I think it's, it's such a great learning experience. And it's immediate. It's not, you know, it's, it's not like most supervision that, well, this is what was happening then. You could, you know, you could have done this, it, but, you know, it's, that's what's happening the next week. And it's, it's, you've got to, you've got to, I think you have to bring the, the learning closer to when it's happening and that the way you do that is through the observation types of things. And I think it's good for learning the group, but it's also good for learning individual. But it reminds me of like the first one of these I did was with Terry Tracy and, you know, he talked, he talked so much about like testing your hypotheses, like clinicians should test their hypotheses, right? And like that's how you do it. I mean, oh, that's a way to do it, right? Which instead of our more typical way of doing supervision, which is the next week or whatever you're talking about the client who had last week or the group you were in, or whatever, right? It's, but you don't know, right? So the, the supervisor can sound very smart and say, oh, this is what was going on. You should have done this, but you don't know where in that case, what you're saying is, right? As trainees, I'm sitting back there. I get to develop a hypothesis, or, you know, and I get to go test it and see what happens. And then you're layering on top of that, which it sounds like the clients brought, you know, brought to the room, which is, hey, now we're going to watch you. So we're going to give you, so it's not just in the moment, but then also when you're processing what's happening, then the group is giving you more feedback, which again is testing your hypotheses, even if you didn't want them tested, the group's going to make it the test. Yep. Exactly. So you talked about earlier the, your experience in that, like that training process group, where as trainees, you all were in sort of doing a process group as trainees, what do you think about that model? I know that there are a lot of issues about, you know, door relationships, relationships with peers. But I don't think you can learn that stuff just by reading a book or just by doing role plays. I think that that it's really, I mean, having the experience of self-disclosing, and if you appreciate what it's like for learning to appreciate what it's like for clients to set up the slows in a setting with other people, trying things out in real time. I think the movement away from more experiential approaches to training has been a loss for the training of therapists. That it's, I think, without that experiential piece, training is less, meaningful, less impactful. So I mean, I think you have to build and safeguard, I think, you have to have to really help people to understand and you have to make sure, you know, sure like you, you said, well, you know, I'm going to make this safe for you because if you say something, you're not sure you want out in the world, just let me know and how edited out. That was a safe guard for me, that's a good thing. So you've built in those safe guards, but I really think that the experiential training is an important component of should be an important component to retrain. That's a wrap on the first part of our conversation about group psychotherapy. Join us in our next episode when we dive deeper into how group psychotherapy works, get really practical about how practitioners can overcome some of the hurdles to doing group work in the real world. As I noted at the top, it would be much appreciated if you could spread the word to anyone else who you think might enjoy the show. Until next time.[Music]