(August 2001)

As our country becomes more racially and ethnically diverse, group clinicians will be increasingly challenged to work with multi-racial and multi-ethnic groups. To be effective we need to confront our discomfort with racial/ethnic feelings and to deepen our understanding of how race and ethnicity affect group process.

There is a dearth of literature on positive outcome of multi-racial group psychotherapy. From 1953 to 1972, the literature focused on limitations imposed and some recent authors maintained that multi-ethnic therapy groups present special challenges for the group worker. As this paper will show, interracial group therapy is workable.

Stimulating conscious and unconscious feelings and thoughts about race/ethnicity can elicit major resistance to a working alliance in both individual and group psychotherapy. The working through of this resistance however, can lead to a more rapid unfolding of core psychodynamic issues.

Given my experience doing combined therapy, I propose the following generalizations:

1. The group process elicits feelings about one's own racial/ethnic group and different groups with greater intensity than individual therapy. Patients anticipating entering a multi-ethnic group may produce more material about their ethnicity and that of others.
2. Repression and denial of racial/ethnic differences, often maintained in individual therapy, are harder to maintain in group therapy.
3. When someone enters or leaves the group, racial and ethnic differences seem to be elicited with greater intensity.
4. Two ways of measuring the cohesiveness of a multi-racial/ethnic group are:
   a.) the degree of freedom members experience to discuss feelings about one's group and others (including stereotypes); and
   b.) the degree of freedom that members feel to express aggressive and loving feelings toward each other.

In American society, feelings about racial/ethnic identifications may be more highly charged and defended against, and therefore are less likely to be expressed in the group. Thus, the comfort to express these feelings (including racial and ethnic stereotypes) and the freedom to express aggression and affection across racial/ethnic lines would be reasonable barometers of a cohesive group.

Case material from a multi-racial/multi-ethnic therapy group will illustrate these generalizations. This vignette is taken from the middle phase of the group.

The Group

The group has met for several years and has always been multi-racial/multi-ethnic; Wanda (black, Protestant), Mary (black/Latina, Catholic), Karen (black, Protestant), Diane (white/Jewish), Liza (black/Latina, Catholic), and Sarah (white/Protestant). Each member of the group has been in combined individual/group therapy with the group therapist.

Group Vignettes

At this session the affect of the group was sad and withdrawn; members were unresponsive to each other.

Therapist:

I wonder if what people are feeling now is related to last week's session. I think a number of people have a lot of unfinished business to discuss.

I feel sorry about what I said to you last week. I feel you are angry with me.

Yes, I am. You really stomped on me. You're insensitive and you always want so much attention in here. You know how hard it is for me to speak in here. You interrupted me in such a way I couldn't continue.

You were really unfair to Liza. And I often find you intimidating.

Diane: (to Wanda).

I know you have been abused by your family, but you abuse others, just like the adolescent kids I teach. WE have given you so much, but it doesn't seem to help. You intimidate me.

So now I'm a handicapped kid. I'm a kid, huh?

Diane:

I need to know that I am cared for in here before I can talk more about what is going on in my life now. (to Wanda) I don't like it that you can get angry with me for being white.

I know I've been angry with you for being white. But it's also because I feel you are so critical of me, and in such a flippant way, saying I'm a kid.

In the next session, one week later:

Wanda: (to Diane)

For the first time, I feel better about our relationship. For the first time, I don't see you or the other members as my family I had to say to myself, "These people in the group are not trying to hurt me, so let me look at what they're saying." My sisters intimidated me, so I felt that the only way to survive in this world was to intimidate people. In the beginning, I felt angry because you white women (Diane and Sarah) were here. I didn't want to share Judy with white women. Sometimes, I felt that I wanted to intimidate all of you, white and black, so that I could have Judy to myself I still see you as white--maybe in time, I'll be able to see you as individuals.

I feel better toward you now, freer to express my feelings. I won't be attacked.

Discussion

The clinical material illustrates how Wanda and Diane use the working-through process of combined therapy to move beyond racial stereotypes, transference distortions (sibling rivalry, often expressed first in racial and ethnic terms) to communicate honestly and fully. Before Wanda entered the group, she maintained an idealizing transference with the therapist. In group, however, she became intensely hostile. The transference was split: the therapist was the "good mother" in individual therapy, the "bad mother" in the group.

Wanda projected her feelings of self-hatred about being black onto the therapist, thus accepting the racial stereotype that whites are preferred. Her therapist-mother was not offering the breast to her, a black, but to white members. The therapist had become the depriving, frustrating mother who gave more to her siblings than to her. Unconsciously, she feared if she made progress, felt better about herself and more separate, the therapist would abandon her. Needy and helpless, she could remain dependent on the therapist.

Wanda's self-disclosure about her self-hatred was facilitated by the cohesiveness of the group. Her expression of more positive feelings about her ethnic identify paralleled her growing acceptance of sharing the therapist, and her experiencing herself as more separate. She developed more positive feelings about her ethnic identity, first by acknowledging her ambivalence about being black, and second by working through these feelings. The working-through process freed her to accept new objects of identification who had more positive feelings about blackness: her therapist and group members; both black and white.

Wanda's participation in the interracial group had a catalytic effect on the therapeutic process. The disruption of the therapeutic dyad, sibling rivalry, and multiple transferences were highlighted by racial issues. Group participation revived Wanda's experiencing of fighting her sisters for her mother's attention. Though her hostility and envy would have emerged in an all-black group, participating in an interracial group intensified and elicited her core problem: her need to be admired and loved by her mother, and her fear that she was too inadequate to win and sustain her mother's admiration and love.

At the beginning of therapy, Diane denied any feelings of discomfort about working with a black woman therapist. In fact, she experienced herself as free of prejudice As combined therapy progressed, Diane struggled to discuss feelings of self-hatred and ambivalence about her Jewish identity. Group helped her become more accepting of "not nice" feelings towards herself and others.

Diane's denying prejudicial feelings toward the therapist corresponded to the therapist's wish to perceive her as good and accepting of the therapist's blackness. The ethnic stereotype of Jews as being more accepting of blacks fostered a sense of false closeness with the therapist. To summarize, psychodynamics get attached to race/ethnicity; psychodynamics are manifested within the context of race/ethnicity. A clinical focus that includes ethnicity can help individuals resolve identity conflicts and move to a more secure and positive grounding in their own group and hence to healthier self-esteem. Therapists can facilitate individual growth and mutual understanding by appreciating the significance of race and ethnicity in the therapeutic process.

This excerpt has been adapted from an article which was first published in Group, Vol. 18, No. 2, Summer 1994.

Judith C. White, MSCSW, CGP, is a psychotherapist and psychoanalyst in private practice in New York City. A faculty member and supervisor in the Advanced Training Program for Group Practice at the Jewish Board for Family and children's Services and a supervisor in the Psychoanalytic Training Institute of the Postgraduate Center for Mental Health for both adult and group practice.