International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
New Life Styles: Should They Influence Our Group Goals and Values? Elizabeth E. Mintz To cite this article: Elizabeth E. Mintz (1976) New Life Styles: Should They Influence Our Group Goals and Values?, International Journal of Group Psychotherapy, 26:2, 225-233, DOI: 10.1080/00207284.1976.11491934 To link to this article: https://doi.org/10.1080/00207284.1976.11491934
Published online: 29 Oct 2015.
Submit your article to this journal
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20
New Life Styles: Should They Influence Our Group Goals and Values? ELIZABETH E. MINTZ , PH.D.
NoT
MANY DECADES AGO, a group of psychoanalysts met to discuss the goals of psychoanalysis and the criteria for termination of treatment. They spoke of the redistribution of psychic energy, mitigation of the superiority of the superego, alleviation of castration anxiety in men and diminution of penis envy in women. But it is rumored that, at an informal gathering afterwards, one of the patriarchs declared: "Of course, the real test of a successful analysis is: Has the patient been able to double his income?" Legend does not state what criterion was offered for the successful analysis of a woman patient. One would presume, however, that it would be her marriage if she were unmarried ; if she were married, possibly the test would be the doubling of her husband's income. While this report may or may not be apocryphal, there is slight doubt that in past years it was the goal of psychotherapy, individual or group, to help the individual adjust, that is, conform> to his culture and his social surroundings. An implicit corollary would be the acceptance of prevalent social values as basically valid and not to be challenged. Let me give a few examples from my personal experience. Years ago, when I was searching for an analyst , it came out in a preliminary interview that I had very deep feelings about war; in those days, I called myself by the old-fashioned term of pacifist. The analyst, a very courteous European gentleman, said gently, "Oh, you are then so
Dr. Mintz is in private practice in New York City.
225
226
Elizabeth E . Mintz
fighting inside yourselfT' He could not see my anti-war stance as anything except the rejection of my own hostile impulses, projected outward. Another story, this one about the analyst with whom I finally worked, for whom I still feel great appreciation , but who on one occasion betrayed a value system which at the time I hardly thought to question. My car was parked on a New York street and blocked by a huge double-parked truck , and I was in a hurry. I climbed into the cab of the truck , found the ignition key in the lock, and moved the huge creature far enough ahead so that I could get my car out. For me this was a counterphobic action, and I bragged about it to my analyst. He commented softly, "But don't you feel that as a woman you lost something by being so aggressive?" Today I doubt if any psychotherapist-or maybe I should say most psychotherapists-would openly and unabashedly convey such attitudes to patients. Today, I believe, most of us, though with exceptions, have become more accepting of the right of an individual to challenge the accepted social institutions. Most of us have thought at least twice, some of us have thought many times, about the extent to which social conformity can or should be equated with emotional health. Today we deal with women who are seriously questioning whether or not they ever wish to assume the responsibilities of motherhood; with women who wish for motherhood but do not wish for marriage; with homosexual men and women who do not wish to change their preference and are insisting on acceptance by society; with couples who have agreed that the marriage contract can include sexual experience with other partners. We find various forms of communal living; families in which the traditional male-female domestic and economic roles have shifted; young men and women who are frankly and sometimes militantly rejecting the success orientation of our society. Some therapists, of course, openly or implicitly still treat these attitudes essentially as manifestations of the oedipal rebellion against paternal authority as vested in the social establishment. Other therapists seek , implicitly or openly, to encourage in their patients the challenging and perhaps the rejection of traditional social values, believing that only in this way can the patient's full emotional liberation be attained . All of us , if honest, cannot but agree that to a greater or lesser extent our personal values must inevitably affect our therapeutic activities.
New Life Styles
227
We who do group therapy are in a paradoxical position. On the one hand, each group member is protected by the fact that he must encounter not only the value system of his therapist but also the value systems of the other group participants. Thus there is, to a considerable extent, a built-in system of checks and balances. On the other hand, there is also a tendency for groups to be ideologically rather homogeneous. In communities where people can choose among several therapists, there is a tendency for them to gravitate toward one whose ideas and values are more or less harmonious with their own. Moreover, group participants are likely to pick up subtle cues from the therapist and, without being aware of it, modify their own value systems accordingly. Thus, perhaps without being fully aware of it, a group is likely to develop its own mystique. For example, a group may accept the model of the nuclear family as an ideal way to live, and may focus on trying to improve the family relationships of its married participants and on aiding the unmarried participants to find suitable partners. Another group may equate personal independence and carefree hedonism with emotional health, while still another may emphasize such goals as social recognition and financial achievement. These values may be so subtly entertained that neither therapist nor group are really aware of their existence. Occasionally, however, we find a situation in which a group member encounters a group-plus-therapist combination which differs from him sharply in terms of political convictions, personal life-style, or basic values. This may occur with a group member whose life-style is socially deviant, but it may also occur with a group member who is ultra-conservative personally or politically. Unless the therapist is aware of this situation and is skillful in handling it, the deviant member may experience the situation as a covert pressure to which he should at least pretend to yield, thereby losing identity rather than developing it. Alternatively, he may choose to fight the group-plustherapist combination, a way of expending psychological energy which would probably be better utilized for personal growth. On the other hand, especially if the therapist is genuinely neutral, such differences may lead to fruitful self-exploration and to an enhanced ability to accept individual differences. We certainly could not maintain that a group therapist should try to arrange groups with homogeneous values. And yet, at least once, I have turned down an applicant for group because of the uncongeniality of his values.
228
Elizabeth E. Mintz
This group was a marathon, and the patient was referred by a respected colleague . Ordinarily, under these circumstances, I would not have screened him, but something about his telephone manner made me suggest a ten-minute preliminary interview. Within a few moments of seating himself in my office, this young man inquired coolly, "Can you promise me there will be no Blacks in this marathon?" While I was recovering my breath, he added , "And no hippies, either?" The rest of the interview was quite fascinating in terms of noncommunication. He was trying to find out whether the marathon would be good enough for him (he was the son of a very wealthy family), and I was trying to explain to him that I did not think he was ready for a marathon. Here, contrary to my belief that the therapist should not identify his personal value systems with emotional health , I outrageously rejected a participant because I saw that his perspective on the world was markedly different from mine and, I assumed , from what the group's would be. Yet this young man very obviously needed all the therapy he could get. Why would I not accept him? Not because there was danger of his breaking down; he did indeed convey the impression of a borderline personality, but I think that I could have protected him from collapsing under the criticism and rejection which he probably would have encountered from the group. Such protection, however, would have involved a disproportionate amount of my time and energy and would have required the participants to sacrifice one of the primary group values-the provision of a situation in which all kinds of feelings can be openly expressed. This example is not clear-cut , since the young man's personal mannerisms would probably have made it hard for the group to accept him even in the absence of his blatant snobbism, but the combination , I felt, would have been too much for the group and perhaps for me also. Groups in general seem to be increasingly accepting of deviant lifestyles ; I do not know whether this is particularly characteristic of relatively sophisticated communities, such as my own New York City area, or whether it is a general phenomenon. If the therapist is able to avoid the expression of whatever preconceptions he himself may have, most groups seem able to evaluate the life-style of the individual participant in terms of the extent to which it meets his needs rather than in terms of conformity to social norms.
New Life Styles
229
For example, in a marathon group there was a couple in their late thirties, committed to their marriage and to the rearing of two children. Their life-style was fairly conventional. with one exception. Since their sexual enjoyment of one another had faded through the years, and since they wished to maintain the marriage, they found a solution in partner-swapping. They searched for other couples who were in a similar situation and spent many of their weekends exchanging partners. Fifteen years ago, or even 10 years ago, I am quite sure that the average group member would have been shocked by this arrangement. Also, I would guess that most therapists would take-or would have taken- the position that this search for sexual novelty and excitement represented an immature unwillingness to accept reality; possibly also a reluctance to develop a true marital intimacy and acceptance which, hopefully, might have restored satisfaction to the sexual relationship. In this marathon, which was fairly recent, only two of the rather sophisticated Easterners who attended were disapproving of the partner-swapping. As for me, having come a considerable distance from the Midwest conservatism in which I was raised, I believe that I was successful in allowing my reaction to be determined entirely by what I heard and saw rather than by any preconceptions about the merits or otherwise of this life style. (Perhaps I should say, parenthetically, that my marathons usually include about twelve people and are specifically therapeutic in their orientation, so that we can appropriately focus on individual problems rather than on group activities.) What I saw convinced me that, for this particular couple, it was a life-style which, for them and at this time, was working. Their behavior seemed to substantiate their claim that their new life-stylenow in existence for about two years-had redeemed their marriage from boredom. They displayed neither the tired indifference nor the antagonism nor the glued-together symbiosis which, for those who have worked with couples , are equally indicative of a pathological relationship. They were related, relaxed, friendly, and occasionally they touched hands. The marriage clearly wasn't romantic, but I certainly thought it was good . My task as a therapist was not to search for neurotic elements in their life-style but , rather , to keep the group from becoming a seminar on marital fidelity while we encouraged them to explore their feelings. A good deal of valuable material
230
Elizabeth E. Mintz
emerged, both on the participants' current marriage situations and on ways they had experienced their parents' marriages. Here is another example of a couple, a younger couple, in an ongoing group. She is a teacher; he is a painter. They have been married no more than a year, and before marriage they discussed and decided upon their mode of living. Although he had received some recognition for his work, he was not well enough established for his painting to be profitable; yet he was very serious and dedicated and was unwilling to be a "Sunday painter." She , by mutual agreement, supported the family while he put in every working day at his easel. Is she castrating him ; is he exploiting her; and can they really accept a way of living so alien to traditional family roles? Again, I did my best to reach an answer to these questions by listening and not by speculation. What came out, as the group continued, was that the wife was struggling against feelings of irritation toward her husband, which she was unwilling either to face or to express. As it emerged, her problem was that although consciously she was entirely willing to be the family breadwinner, she resented it at times when her husband disappointed her in other ways. After considerable discussion, this couple agreed that essentially they would maintain their financial arrangements but that their domestic arrangements, their division oflabor, would be modified so as to make the wife's life easier. This solution, which worked fairly well, could not in my opinion have been reached so readily if the group had begun by criticizing their unconventional one-sided arrangement. Homosexuality is one of the most interesting and challenging areas in which, I think, many therapists still find it difficult to make a distinction - or, indeed, to decide whether or not a decision should be made at all - between whether it is simply a valid , alternate life-style or a deeply rooted symptom of pathology. This is a distinction which, personally, I have never found it necessary to make in pragmatic terms. From the beginning of my practice some 20 years ago, I have taken the position that if a homosexual man or woman accepts the homosexual adjustment and wishes to maintain it, this way of life is not the clinical problem. The problem is anxiety, or depression, or work-block, or whatever the new patient wishes to present. If, on the other hand, my patient is dissatisfied with his or her homosexual adjustment and wishes to change it, then we can together accept this as the goal of treatment and work toward it.
New Life Styles
231
Yet the times they are achanging. Today-and this would not have been true for me 20 years ago-if a homosexual patient enters my office wishing to change his or her sexual orientation, I feel it is my responsibility to explore to what extent the wish to change is based on a need for social acceptance. And if this is the basis of the wish, then it seems to me my therapeutic duty to explore this very need for social acceptance. Is it , perhaps, rooted in a need to please and to conform? Does this individual want to change in order to be more in line with social mores, and is that valid in terms of his real identity? Or, which is also clinically possible, are we dealing with an individual whose strongest impulses are actually heterosexual but who is frightened by them? This question, of course, raises questions about the etiology of homosexuality which are much beyond the scope of this presentation. But I am very sure that we can no longer evaluate the adjustment of the homosexual in terms of its general social acceptability. It has always been my policy to work with homosexual men or women in mixed groups ; and it has never seemed to me that they have problems which are qualitatively different; like all of us, like you and me , they suffer from problems of how to handle hostility, dependency, and fear. This approach has, in general , worked out all right. But by all right, I do not necessarily mean a change from homosexuality to heterosexuality, though that has occasionally happened. I mean an increase in the personal happiness and self-fulfillment of the patient, not an alteration in terms of adjustment to accepted cultural values. For instance, I considered it a therapeutic triumph when a lonely, gifted, intellectual man of 30, who had never been able to make any kind of real emotional or sexual contact and had always been confined to the dreary routine of ephemeral sexual contacts in washrooms and Turkish baths, was able to form a tender, affectionate, responsible, long-lasting relationship with another homosexual man. In this particular example, the power of the group was especially noteworthy. It was a therapeutic experience of five years' duration; weekly group plus one or two individual sessions every week. Leaving out the depth experiences of the individual sessions, let me describe the progress of this patient in this group. In the beginning, he was terrified of group therapy. He felt that his homosexuality would make him be regarded as a pariah. (This began about ten years ago). In suggesting that he enter a group, I was
232
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concerned mainly with his social isolation and with helping him find out how to talk with other people and to be with them, since he was almost completely isolated except for professional contacts, at which he functioned very well. It took him perhaps half a year to share with the group his way of living. Contrary to his expectations, the group was not shocked at all. They told him that they had always felt that he was holding something back about himself and that they were delighted to find that he trusted them sufficiently to speak more frankly. One of the women and one of the men went over and embraced him, which was the first time he had ever experienced physical contact that did not imply a sexual demand or obligation. Gently and tenderly the group began to recognize and deal with this man's deepest reason to be dissatisfied with his homosexualitythat he would not be a father. We worked this through fairly well, I think, as evidenced by the fact that this patient was eventually able to give meaningful encouragement to a younger man in the group whose father had consistently ridiculed his intellectual aspirations. It strikes me as a sad commentary that separate therapeutic institutes have had to be formed for meeting the needs of women and for meeting the needs of homosexuals. In New York City alone there are several institutes, staffed by qualified professional psychotherapists, which hold themselves out as being able to meet the needs of people whose needs cannot be met by conventional group or individual psychotherapy. I think it is a tragedy that the self-assertive , selfactualizing woman is still often regarded by her therapist and by her group as having a problem in that she does not conform to social norms . I think it is a terrible indictment of our profession that the homosexual man or woman still sometimes confronts a group or therapist who insists upon regarding this adjustment as a crime, a vice, or a disease . In my own practice , I have seen a surprising number of women who have come to me from former therapists who insisted to them that the role of women is to submit (even one of my most delightful gurus, Theodor Reik, insisted that women should be passive) . I have seen a homosexu al man who , in a deep depression , had consulted another therapist and been told that therapy should focus exclusively upon his homosexu ality , which for this particular man at this time was the only alternative to a life of complete emotional isolation. I have seen
New Life Styles
233
patients with political convictions left of center to varying degrees who had worked with therapists who had insisted upon interpreting these social attitudes as oedipal rebellion. Nevertheless, it is also important for those of us who are striving to rid ourselves of prejudice and preconception to recognize that the social deviant may indeed, in fact , be motivated by anxiety rather than by genuine conviction, and that for some patients it is easier to complain about the unfairness of the establishment than to face their personal difficulties. One of my group members for some monthsone with whom I frankly did not do too well-was a gifted Lesbian who had lost job after job because of her excessive drinking and her excessive irritability. She worked in a field in which her homosexual adjustment was not relevant, but neither the group nor I could budge her from a paranoid conviction that she was continually being fired because her employers "suspected" her of being homosexual. It was easier for her to blame the intolerance of the establishment than to explore her need to drink and to have temper tantrums. The social changes which today are proliferating place a new burden upon the conscientious therapist. We must examine our own preconceptions and decide which of them are valid. I myself have tried to do this; I no longer think of marriage and child-rearing and upward economic mobility as the healthy norm to which all healthy people should aspire, though I still think it is a good way of life for people who want it. Also, I think there are some basic values which should survive all social , sexual , and economic changes, such as concern for the welfare of other people. It seems to me that we have the difficult task of listening even more carefully to our patients and trying hard to see when we are confusing our personal values with our perception of their problems. We must make every effort to disentangle when unconventional life-styles are a genuine expression of the needs and values of the individual and when they simply represent a confused rebellion against whatever the patient was taught. It is not an easy assignment. But whoever said that it was easy to be a group therapist? Dr. Mintz's address: 500 W est End Avenue
New York, N.Y. 10024
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
New Life Styles: Should They Influence Our Group Goals and Values? Elizabeth E. Mintz To cite this article: Elizabeth E. Mintz (1976) New Life Styles: Should They Influence Our Group Goals and Values?, International Journal of Group Psychotherapy, 26:2, 225-233, DOI: 10.1080/00207284.1976.11491934 To link to this article: https://doi.org/10.1080/00207284.1976.11491934
Published online: 29 Oct 2015.
Submit your article to this journal
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20
New Life Styles: Should They Influence Our Group Goals and Values? ELIZABETH E. MINTZ , PH.D.
NoT
MANY DECADES AGO, a group of psychoanalysts met to discuss the goals of psychoanalysis and the criteria for termination of treatment. They spoke of the redistribution of psychic energy, mitigation of the superiority of the superego, alleviation of castration anxiety in men and diminution of penis envy in women. But it is rumored that, at an informal gathering afterwards, one of the patriarchs declared: "Of course, the real test of a successful analysis is: Has the patient been able to double his income?" Legend does not state what criterion was offered for the successful analysis of a woman patient. One would presume, however, that it would be her marriage if she were unmarried ; if she were married, possibly the test would be the doubling of her husband's income. While this report may or may not be apocryphal, there is slight doubt that in past years it was the goal of psychotherapy, individual or group, to help the individual adjust, that is, conform> to his culture and his social surroundings. An implicit corollary would be the acceptance of prevalent social values as basically valid and not to be challenged. Let me give a few examples from my personal experience. Years ago, when I was searching for an analyst , it came out in a preliminary interview that I had very deep feelings about war; in those days, I called myself by the old-fashioned term of pacifist. The analyst, a very courteous European gentleman, said gently, "Oh, you are then so
Dr. Mintz is in private practice in New York City.
225
226
Elizabeth E . Mintz
fighting inside yourselfT' He could not see my anti-war stance as anything except the rejection of my own hostile impulses, projected outward. Another story, this one about the analyst with whom I finally worked, for whom I still feel great appreciation , but who on one occasion betrayed a value system which at the time I hardly thought to question. My car was parked on a New York street and blocked by a huge double-parked truck , and I was in a hurry. I climbed into the cab of the truck , found the ignition key in the lock, and moved the huge creature far enough ahead so that I could get my car out. For me this was a counterphobic action, and I bragged about it to my analyst. He commented softly, "But don't you feel that as a woman you lost something by being so aggressive?" Today I doubt if any psychotherapist-or maybe I should say most psychotherapists-would openly and unabashedly convey such attitudes to patients. Today, I believe, most of us, though with exceptions, have become more accepting of the right of an individual to challenge the accepted social institutions. Most of us have thought at least twice, some of us have thought many times, about the extent to which social conformity can or should be equated with emotional health. Today we deal with women who are seriously questioning whether or not they ever wish to assume the responsibilities of motherhood; with women who wish for motherhood but do not wish for marriage; with homosexual men and women who do not wish to change their preference and are insisting on acceptance by society; with couples who have agreed that the marriage contract can include sexual experience with other partners. We find various forms of communal living; families in which the traditional male-female domestic and economic roles have shifted; young men and women who are frankly and sometimes militantly rejecting the success orientation of our society. Some therapists, of course, openly or implicitly still treat these attitudes essentially as manifestations of the oedipal rebellion against paternal authority as vested in the social establishment. Other therapists seek , implicitly or openly, to encourage in their patients the challenging and perhaps the rejection of traditional social values, believing that only in this way can the patient's full emotional liberation be attained . All of us , if honest, cannot but agree that to a greater or lesser extent our personal values must inevitably affect our therapeutic activities.
New Life Styles
227
We who do group therapy are in a paradoxical position. On the one hand, each group member is protected by the fact that he must encounter not only the value system of his therapist but also the value systems of the other group participants. Thus there is, to a considerable extent, a built-in system of checks and balances. On the other hand, there is also a tendency for groups to be ideologically rather homogeneous. In communities where people can choose among several therapists, there is a tendency for them to gravitate toward one whose ideas and values are more or less harmonious with their own. Moreover, group participants are likely to pick up subtle cues from the therapist and, without being aware of it, modify their own value systems accordingly. Thus, perhaps without being fully aware of it, a group is likely to develop its own mystique. For example, a group may accept the model of the nuclear family as an ideal way to live, and may focus on trying to improve the family relationships of its married participants and on aiding the unmarried participants to find suitable partners. Another group may equate personal independence and carefree hedonism with emotional health, while still another may emphasize such goals as social recognition and financial achievement. These values may be so subtly entertained that neither therapist nor group are really aware of their existence. Occasionally, however, we find a situation in which a group member encounters a group-plus-therapist combination which differs from him sharply in terms of political convictions, personal life-style, or basic values. This may occur with a group member whose life-style is socially deviant, but it may also occur with a group member who is ultra-conservative personally or politically. Unless the therapist is aware of this situation and is skillful in handling it, the deviant member may experience the situation as a covert pressure to which he should at least pretend to yield, thereby losing identity rather than developing it. Alternatively, he may choose to fight the group-plustherapist combination, a way of expending psychological energy which would probably be better utilized for personal growth. On the other hand, especially if the therapist is genuinely neutral, such differences may lead to fruitful self-exploration and to an enhanced ability to accept individual differences. We certainly could not maintain that a group therapist should try to arrange groups with homogeneous values. And yet, at least once, I have turned down an applicant for group because of the uncongeniality of his values.
228
Elizabeth E. Mintz
This group was a marathon, and the patient was referred by a respected colleague . Ordinarily, under these circumstances, I would not have screened him, but something about his telephone manner made me suggest a ten-minute preliminary interview. Within a few moments of seating himself in my office, this young man inquired coolly, "Can you promise me there will be no Blacks in this marathon?" While I was recovering my breath, he added , "And no hippies, either?" The rest of the interview was quite fascinating in terms of noncommunication. He was trying to find out whether the marathon would be good enough for him (he was the son of a very wealthy family), and I was trying to explain to him that I did not think he was ready for a marathon. Here, contrary to my belief that the therapist should not identify his personal value systems with emotional health , I outrageously rejected a participant because I saw that his perspective on the world was markedly different from mine and, I assumed , from what the group's would be. Yet this young man very obviously needed all the therapy he could get. Why would I not accept him? Not because there was danger of his breaking down; he did indeed convey the impression of a borderline personality, but I think that I could have protected him from collapsing under the criticism and rejection which he probably would have encountered from the group. Such protection, however, would have involved a disproportionate amount of my time and energy and would have required the participants to sacrifice one of the primary group values-the provision of a situation in which all kinds of feelings can be openly expressed. This example is not clear-cut , since the young man's personal mannerisms would probably have made it hard for the group to accept him even in the absence of his blatant snobbism, but the combination , I felt, would have been too much for the group and perhaps for me also. Groups in general seem to be increasingly accepting of deviant lifestyles ; I do not know whether this is particularly characteristic of relatively sophisticated communities, such as my own New York City area, or whether it is a general phenomenon. If the therapist is able to avoid the expression of whatever preconceptions he himself may have, most groups seem able to evaluate the life-style of the individual participant in terms of the extent to which it meets his needs rather than in terms of conformity to social norms.
New Life Styles
229
For example, in a marathon group there was a couple in their late thirties, committed to their marriage and to the rearing of two children. Their life-style was fairly conventional. with one exception. Since their sexual enjoyment of one another had faded through the years, and since they wished to maintain the marriage, they found a solution in partner-swapping. They searched for other couples who were in a similar situation and spent many of their weekends exchanging partners. Fifteen years ago, or even 10 years ago, I am quite sure that the average group member would have been shocked by this arrangement. Also, I would guess that most therapists would take-or would have taken- the position that this search for sexual novelty and excitement represented an immature unwillingness to accept reality; possibly also a reluctance to develop a true marital intimacy and acceptance which, hopefully, might have restored satisfaction to the sexual relationship. In this marathon, which was fairly recent, only two of the rather sophisticated Easterners who attended were disapproving of the partner-swapping. As for me, having come a considerable distance from the Midwest conservatism in which I was raised, I believe that I was successful in allowing my reaction to be determined entirely by what I heard and saw rather than by any preconceptions about the merits or otherwise of this life style. (Perhaps I should say, parenthetically, that my marathons usually include about twelve people and are specifically therapeutic in their orientation, so that we can appropriately focus on individual problems rather than on group activities.) What I saw convinced me that, for this particular couple, it was a life-style which, for them and at this time, was working. Their behavior seemed to substantiate their claim that their new life-stylenow in existence for about two years-had redeemed their marriage from boredom. They displayed neither the tired indifference nor the antagonism nor the glued-together symbiosis which, for those who have worked with couples , are equally indicative of a pathological relationship. They were related, relaxed, friendly, and occasionally they touched hands. The marriage clearly wasn't romantic, but I certainly thought it was good . My task as a therapist was not to search for neurotic elements in their life-style but , rather , to keep the group from becoming a seminar on marital fidelity while we encouraged them to explore their feelings. A good deal of valuable material
230
Elizabeth E. Mintz
emerged, both on the participants' current marriage situations and on ways they had experienced their parents' marriages. Here is another example of a couple, a younger couple, in an ongoing group. She is a teacher; he is a painter. They have been married no more than a year, and before marriage they discussed and decided upon their mode of living. Although he had received some recognition for his work, he was not well enough established for his painting to be profitable; yet he was very serious and dedicated and was unwilling to be a "Sunday painter." She , by mutual agreement, supported the family while he put in every working day at his easel. Is she castrating him ; is he exploiting her; and can they really accept a way of living so alien to traditional family roles? Again, I did my best to reach an answer to these questions by listening and not by speculation. What came out, as the group continued, was that the wife was struggling against feelings of irritation toward her husband, which she was unwilling either to face or to express. As it emerged, her problem was that although consciously she was entirely willing to be the family breadwinner, she resented it at times when her husband disappointed her in other ways. After considerable discussion, this couple agreed that essentially they would maintain their financial arrangements but that their domestic arrangements, their division oflabor, would be modified so as to make the wife's life easier. This solution, which worked fairly well, could not in my opinion have been reached so readily if the group had begun by criticizing their unconventional one-sided arrangement. Homosexuality is one of the most interesting and challenging areas in which, I think, many therapists still find it difficult to make a distinction - or, indeed, to decide whether or not a decision should be made at all - between whether it is simply a valid , alternate life-style or a deeply rooted symptom of pathology. This is a distinction which, personally, I have never found it necessary to make in pragmatic terms. From the beginning of my practice some 20 years ago, I have taken the position that if a homosexual man or woman accepts the homosexual adjustment and wishes to maintain it, this way of life is not the clinical problem. The problem is anxiety, or depression, or work-block, or whatever the new patient wishes to present. If, on the other hand, my patient is dissatisfied with his or her homosexual adjustment and wishes to change it, then we can together accept this as the goal of treatment and work toward it.
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Yet the times they are achanging. Today-and this would not have been true for me 20 years ago-if a homosexual patient enters my office wishing to change his or her sexual orientation, I feel it is my responsibility to explore to what extent the wish to change is based on a need for social acceptance. And if this is the basis of the wish, then it seems to me my therapeutic duty to explore this very need for social acceptance. Is it , perhaps, rooted in a need to please and to conform? Does this individual want to change in order to be more in line with social mores, and is that valid in terms of his real identity? Or, which is also clinically possible, are we dealing with an individual whose strongest impulses are actually heterosexual but who is frightened by them? This question, of course, raises questions about the etiology of homosexuality which are much beyond the scope of this presentation. But I am very sure that we can no longer evaluate the adjustment of the homosexual in terms of its general social acceptability. It has always been my policy to work with homosexual men or women in mixed groups ; and it has never seemed to me that they have problems which are qualitatively different; like all of us, like you and me , they suffer from problems of how to handle hostility, dependency, and fear. This approach has, in general , worked out all right. But by all right, I do not necessarily mean a change from homosexuality to heterosexuality, though that has occasionally happened. I mean an increase in the personal happiness and self-fulfillment of the patient, not an alteration in terms of adjustment to accepted cultural values. For instance, I considered it a therapeutic triumph when a lonely, gifted, intellectual man of 30, who had never been able to make any kind of real emotional or sexual contact and had always been confined to the dreary routine of ephemeral sexual contacts in washrooms and Turkish baths, was able to form a tender, affectionate, responsible, long-lasting relationship with another homosexual man. In this particular example, the power of the group was especially noteworthy. It was a therapeutic experience of five years' duration; weekly group plus one or two individual sessions every week. Leaving out the depth experiences of the individual sessions, let me describe the progress of this patient in this group. In the beginning, he was terrified of group therapy. He felt that his homosexuality would make him be regarded as a pariah. (This began about ten years ago). In suggesting that he enter a group, I was
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concerned mainly with his social isolation and with helping him find out how to talk with other people and to be with them, since he was almost completely isolated except for professional contacts, at which he functioned very well. It took him perhaps half a year to share with the group his way of living. Contrary to his expectations, the group was not shocked at all. They told him that they had always felt that he was holding something back about himself and that they were delighted to find that he trusted them sufficiently to speak more frankly. One of the women and one of the men went over and embraced him, which was the first time he had ever experienced physical contact that did not imply a sexual demand or obligation. Gently and tenderly the group began to recognize and deal with this man's deepest reason to be dissatisfied with his homosexualitythat he would not be a father. We worked this through fairly well, I think, as evidenced by the fact that this patient was eventually able to give meaningful encouragement to a younger man in the group whose father had consistently ridiculed his intellectual aspirations. It strikes me as a sad commentary that separate therapeutic institutes have had to be formed for meeting the needs of women and for meeting the needs of homosexuals. In New York City alone there are several institutes, staffed by qualified professional psychotherapists, which hold themselves out as being able to meet the needs of people whose needs cannot be met by conventional group or individual psychotherapy. I think it is a tragedy that the self-assertive , selfactualizing woman is still often regarded by her therapist and by her group as having a problem in that she does not conform to social norms . I think it is a terrible indictment of our profession that the homosexual man or woman still sometimes confronts a group or therapist who insists upon regarding this adjustment as a crime, a vice, or a disease . In my own practice , I have seen a surprising number of women who have come to me from former therapists who insisted to them that the role of women is to submit (even one of my most delightful gurus, Theodor Reik, insisted that women should be passive) . I have seen a homosexu al man who , in a deep depression , had consulted another therapist and been told that therapy should focus exclusively upon his homosexu ality , which for this particular man at this time was the only alternative to a life of complete emotional isolation. I have seen
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patients with political convictions left of center to varying degrees who had worked with therapists who had insisted upon interpreting these social attitudes as oedipal rebellion. Nevertheless, it is also important for those of us who are striving to rid ourselves of prejudice and preconception to recognize that the social deviant may indeed, in fact , be motivated by anxiety rather than by genuine conviction, and that for some patients it is easier to complain about the unfairness of the establishment than to face their personal difficulties. One of my group members for some monthsone with whom I frankly did not do too well-was a gifted Lesbian who had lost job after job because of her excessive drinking and her excessive irritability. She worked in a field in which her homosexual adjustment was not relevant, but neither the group nor I could budge her from a paranoid conviction that she was continually being fired because her employers "suspected" her of being homosexual. It was easier for her to blame the intolerance of the establishment than to explore her need to drink and to have temper tantrums. The social changes which today are proliferating place a new burden upon the conscientious therapist. We must examine our own preconceptions and decide which of them are valid. I myself have tried to do this; I no longer think of marriage and child-rearing and upward economic mobility as the healthy norm to which all healthy people should aspire, though I still think it is a good way of life for people who want it. Also, I think there are some basic values which should survive all social , sexual , and economic changes, such as concern for the welfare of other people. It seems to me that we have the difficult task of listening even more carefully to our patients and trying hard to see when we are confusing our personal values with our perception of their problems. We must make every effort to disentangle when unconventional life-styles are a genuine expression of the needs and values of the individual and when they simply represent a confused rebellion against whatever the patient was taught. It is not an easy assignment. But whoever said that it was easy to be a group therapist? Dr. Mintz's address: 500 W est End Avenue
New York, N.Y. 10024
