An Interview with Molyn Leszcz, MD, FRCP (C), DFAGPA by Ann O’Malley, PhD

Dr. Ann O’Malley, a clinical psychologist in private practice in Fairfax, VA interviewed Dr. Leszcz to help us learn more about what we might expect from him and the upcoming conference in Solomon’s MD.

Ann: Tell me how you got involved in group therapy. Was it a large component of your graduate training? If not, who or what influenced you toward working with groups?

Molyn: When I was training at the University of Toronto, my then Chief of Psychiatry, Stan Greben, asked if I would be interested in pursuing group therapy more rigorously at the end of my training. He connected me with Irv Yalom and I spent a year with him at Stanford. I found that year to be life altering. Irv and I became good friends and colleagues and have done many things together over the last many years, not the least of which was co-authoring the 5th edition of The Theory and Practice of Group Psychotherapy. When I came back to Toronto after spending a year in Stanford, I took responsibility for developing programs in education, training, and scholarship in the area of group training at the University and that really has been my academic base for the last thirty years or so.* ////

Ann: Can you provide a brief overview of what participants will learn about the importance of the therapeutic relationship? …………___…………………………………………

Molyn: Sure. What I’m hoping to do—through a combination of presentations, including theory, interaction and clinical illustration, and through the use of demonstration groups in which people volunteer to participate—is to try to address issues that have to do with how we improve our effectiveness as group therapists (with information that is also relevant to our work as individual therapists). One of the things that I’ve been very interested in more recently is that, although the adage that “all therapies win prizes” may be true (going back to Luborsky’s work in the 70’s and then a few years ago), not all therapists are equally effective. What I hope to do in this workshop is to address factors that contribute to improving therapists’ effectiveness in leading groups. Some of these relate to working in the here and now, activation of interaction, the attribution of meaning to experience as well as with how the therapist uses himself or herself as a therapeutic tool. This relates to transparency and, once we understand something, how we communicate it in a way that maximizes the learning that can occur for our patients, maximizes their emotional engagement, and reduces unnecessary inflammation. I find that sometimes therapists use themselves less fully than they should because they are afraid of boundary issues, or because they are afraid to turn the therapy into something that it’s not supposed to be, or because it will stimulate regression, or unnecessary dependence. My experience is that when therapists use themselves effectively it expedites the therapy, it makes the therapy more alive, more genuine, more meaningful, and there’s little downside. In fact, I think sometimes the downside of not finding a way to address what’s happening constructively in the moment is that therapy goes on and on because things are not being spoken about in a way that’s useful to our patients. So that’s what I hope to address.

Ann:    What do you consider to be some of the essential skills that a group therapist must have compared to an individual therapist?

Molyn: Well, I think that it’s even more complicated as a group leader because doing what might be necessary or useful for one person in a group at a particular moment in time may trigger a whole different subjective response from another member. The tricky thing is how to be an advocate for everyone at the same time, while speaking to group forces that are influencing what you’re seeing at the moment. If anything, and residents tell me this all the time, learning how to do groups well improves effectiveness at doing individual treatment. This is because they gain a certain kind of confidence and a kind of therapeutic courage.

Ann:    In the conference description, you mention that you’ll talk some about therapeutic metacommunication. Can you give us an idea of what you are referring to?

Molyn:     Therapeutic metacommunication is how we as therapists engage our patients in the processing of what is occurring between them and others or between them and us in the moment. It’s a way to enliven the here and now. It’s contingent on finding palatable ways to say unpalatable things. It’s built upon the principles of genuineness and immediacy, and always focuses on how we may help remove a potential obstacle to the patient’s growth and development. The behavior or the communication that is problematic for the patient comes from some place that has been hard earned by the patient and it’s not a matter of us judging it, but it is a matter of us commenting on it, so that the patient can be liberated from repeating it. Therapeutic metacommunication is staying alive to what’s happening in the here and now, giving feedback that is timely, and involves a certain amount of risk on the part of the therapist, but healthy, constructive risk.

    Let me give you an example: In one of my groups there’s a gentleman who is quite narcissistic and is successful in many ways except in his intimate relationships. This man will often rail about how unresponsive his wife is when he’s disappointed and says she doesn’t provide him with adequate support. So how do we work with that? We try to find ways in the group to look at here and now manifestations of what it’s like to engage him or what it’s like to offer him support. So, in a particular session I’d made an announcement at the beginning of the group that I wanted to remember to tell everyone about some changes to our schedule and that I had some important logistical information. When I came back to that later in the group after everyone had settled in, the man was kind of mocking and said, “That’s important information? What are you going to tell us next week, that we should be wearing different colored shirts?” I felt annoyed and irritated and shut down. Afterward I was able to digest that a little bit internally, as he was talking again about his wife and monopolizing a bit of the session. I said to him, “I want to share something with you—I felt a bit shut down and withdrawn from you and it made me think that if I can feel that with you here, that I don’t want to engage with you, that you’ve made me feel ineffective, I’m wondering if that isn’t something that’s happening between you and your wife when you feel disappointed.” And that led to a really productive discussion and exploration.

So that’s an example of what I mean by therapeutic metacommunication. I’m talking about something that’s happening between him and me in the moment, I’m not talking about it in a way that reflects it being raw or unprocessed. I’m trying to separate out my own countertransference, and trying to word it in a way that makes it workable and useful for the patient within the context of the therapeutic alliance. How does this align with the goals of treatment? How does this align with the tasks of treatment as we understand them? And can I do this in a way that strengthens the relationship rather than damages it? A damaging way of saying it is, “Well geez, no wonder your wife doesn’t give you any support, you make it impossible for anyone to get close to you!” That’s one way of saying it. A way that I think is more productive is to say, “You know that in your disappointment you make people feel badly and you push them away at a time when what you really need is their interest and support. I think it’s creates a vicious circle for you and for them. And I think we just had an example of that in the session earlier today with your comment about my announcement.”

Ann: Tell us about your past experience presenting to MAGPS at Solomon’s.

Molyn:    It was a great experience. I enjoyed myself a lot. That was my first time with the Mid-Atlantic. But I’ve had a long relationship with colleagues from the Washington School. I know there’s a lot of overlap. I found it a very congenial group when I was there. If I remember correctly, John Dluhy, John Thomas, and Bob Schulte put together the play ART. It was a terrific. The use of that play led to fantastic discussion among the participants. And it was a nice setting. What I also remember was Bob told me this is a group that doesn’t like PowerPoint, so I had my whole presentation on one piece of paper. And you can only do that with a really engaged group who asks questions, and the questions become your guide to the next thing you want to talk about.

What do you hope we take away from this conference weekend?

Molyn:    What I hope people will take away is that they will think about how they work in a way that maximizes the use of themselves as therapeutic agents. I hope they will be guided both from the literature and from having learned in a way that is emotionally engaging and stimulating. I hope that I will similarly learn from the experience of the people in the audience, and from the demonstration groups, and that we’ll all come away from it better for having been together.

Thank you for your time, Molyn. We really look forward to having you here.

*Editor’s Note: Portions of Molyn’s response to Ann’s first question were taken from a recent interview by Hank Fallon on behalf of AGPA. ……………………………………………………………………………

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