Upon being accepted to grad school, I remember immediately mapping out my schedule for the next year and a half to start prepping for what was ahead (I’m a full blown nerd, I know). There were course titles that grabbed my attention, like Psychopathology and Human Development, and naturally some that did not, like Group Counseling. Truthfully, my disdain for Group was rooted in pure ignorance; though I’d interned in the field as an undergrad, I had never actually witnessed or participated in group sessions; any assumptions I made about its effectiveness (& fun-ness =P) were without basis.

      As it often turns out, Group ended up being one of the best classes I’ve ever taken. In addition to teaching me a ton, it was actually very therapeutic (I miss my T-Group!). I pitifully confess that my most dreaded course has even proven to be one of the most valuable in my current practice with Alzheimer’s patients. Like a puppy with its tail between its legs, I admit defeat and surrender to the pro-Group team – thank you Dr. Burkholder! 😉

      One of the concepts I am most grateful to have practiced in Group is that of embracing silence. As an outgoing, chatty, 20-something girl (not ready to admit I’m almost 30 and a “woman” :-O stick with “girl” for me please), this was painfully uncomfortable. I don’t know if it’s an American thing, but I feel as though we typically find silence to be awkward. Whether face-to-face, talking on the phone, or exchanging texts, a longer-than-usual pause drives us crazy; even if we’ve spoken the last word, we’re compelled to fill that cringe-worthy gap.

      Sometimes, however, our fillers do more harm than good; interruptions are quieting, but silence inviting. I had the pleasure of watching the king of Group Therapy himself, Dr. Irvin Yalom, in action (on YouTube, at least). I remember taking notes in class and being surprised at how nonresponsive he seemed, both verbally and nonverbally. What kind of group leader was this so-called expert?! Even when there were pauses, he embraced the silence and allowed members to speak up when ready, which they did (he’s a sneaky one!). I grew to realize the importance of making a conscious effort to be an active listener and not attempt to fill conversational voids.

      Dr. Taylor, who I’ve mentioned in previous posts and who is battling the effects of Alzheimer’s himself, has said:

“Answers to my questions which are provided by others sound and feel to me like the answerer didn’t understand my question. Most people offer answers to their own questions, not mine…Perhaps too much time is spent trying to answer and question each other, when what I really need is to feel like I am being heard. I know you don’t have all the answers. You also don’t have all the questions! Neither do I! And the unanswerable questions keep coming and coming with each new symptom of the disease.”

      It’s often common practice to repeat questions to patients who have yet to offer a response. Usually, such recurrences differ only in volume or tone; we’ll ask the exact same question again, only louder as if it wasn’t heard and with more force as patience wears thin. There seems to be a direct correlation between response time and angst, no matter the conversers!

“My family will ask me to do something, and I don’t do it. Early in the disease process, they assumed I didn’t hear them. They would tell me again. This got old after a while. They became annoyed at having to tell me the same thing over and over again. Later on, they realized there was a possibility that my twisted brain fibers actually didn’t understand their words.” – Dr. Taylor

      As the semester progressed and I myself acted as a leader, I was delighted to recognize my first Yalom moment: I had welcomed a silent pause in one group member’s testimony, which led her to elaborate and share more deeply. Had I quickly tried to fill that gap, I would have interrupted her thought and she may not have continued. Similarly, I’ve worked with patients here who have mastered the ultimate awkward silence: they’ve frozen. Their affects have turned flat, their eyes glazed over, and I swear for a minute they’ve actually stopped breathing. Before I wipe the sweat from my forehead and the color is drained from my face, though, they surprise me and respond; my patience is rewarded and the painful reluctance to intervene pays off.

      Touché Yalom, touché.