Outward Bound

According to Steve, the affair with his wife’s best friend began when his mother-in-law died. His grief-stricken wife mourned for weeks, then months, withdrawing and rejecting him.

“I was a typical, stereotypical man,” the 54-year-old businessman said. “ ‘Let’s mourn a week and a half and get on with it.’ ” He didn’t feel he could confide in their friends, nor in the members of his poker group. So when he went to talk to his wife’s friend, one intimacy led to another. They kept the affair secret for three years.

His wife knew something was wrong. They fought. They tried therapy. But when Steve went alone, he said the therapist tried to make him feel good about himself. When the couple went together, Steve tried to control the sessions. “I was a real bastard,” he admitted.

The only reason his wife didn’t leave him a decade ago, they both said, is that the therapist referred them to an unusual group treatment program, run by a team of social workers and family therapists, where the cure was not to look inward but outward--to re-create connections in their community.

The program at the Institute for Family Services here is an example of a renewed attention to group and community work among many therapists, fueled in part by managed care cost cutting. While considered a radical model by some, it aims to break down barriers between the public and private, in a notably dramatic move away from standard one-on-one counseling behind closed doors to “fix” an individual’s diagnosed “problem.”

“We work really hard to not keep therapy as a private issue. Our assumption is that it really is a public issue, a community issue,” said director Rhea Almeida.

The institute’s eclectic program blends a combination of elements: an overt social agenda, team teaching, and techniques modified from self-help and family therapy. Its 100 client families meet in separate groups for men, women and teens. Personal revelations may be shared with another group or any one of a nine-member team of therapists. Members are urged to join activist groups such as the National Organization of Men Against Sexism and, similar to Alcoholics Anonymous, to serve as outside sponsors to one another.

As part of the treatment, Steve was required to reveal his philandering not only to his wife and members of his group, but also to his lover’s husband, his teenage children and even his poker group.

“It was tough,” said Steve, an earnest and confident man who wears aviator sunglasses below his swept-back silver hair. His wife was so stunned, she didn’t understand what he was saying and he had to tell her twice. He thought his lover’s husband might shoot him.

But it was worth it, he and his wife said. By connecting with a group of men who took her side, Steve learned to respect her as an equal partner. He also expanded his circle of confidants. “Finally,” Steve said, “I had someone to talk to I could trust that I wouldn’t end up in bed with.”

The exposure was humiliating, his wife said, but, now, “The quality of our life is 10 times better. We’re dealing on an honest level where a lot of men and women are not.” She said she’s lost some women friends who wanted her to divorce him, but, she said, “You think what you’ve invested. We were married for 25 years. Nobody wins when you’re divorced.”

While critics worry about the lack of confidentiality, the institute’s work has inspired similar efforts throughout New Jersey and in Pennsylvania, Massachusetts, New Hampshire and North Carolina.

Many therapists, increasingly concerned with widespread isolation, are experimenting with ways to treat people by connecting them with more relatives, friends and acquaintances, said Tony Jurich, president of the American Assn. of Marriage and Family Therapists, based in Washington, D.C.

Social isolation can have physical consequences, as shown by a recent study that found people with a diversified network of friends and acquaintances came down with fewer colds after being exposed to a virus than their more isolated counterparts. Jurich said that many mental health issues from schizophrenia to abuse are like the cold virus. “If a person is in isolation, they’re vulnerable. If I can connect them with other people, I build up their immunity system.”

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Human beings are social creatures by nature, starting with a newborn’s dependence on a relationship with its mother to get food. But that natural sense of mutual reliance, according to various theories, has been strained by modern technological society, by increasingly impersonal workplaces, unbridled pursuit of individual happiness, the faceless communication of cyberspace and the physical isolation of suburbs.

Much extreme behavior, from violence to fanatical devotion to professional sports, stems from people wanting to interact with other people but not knowing how, Jurich said.

Some trace the idea of connection for mental healing back to public confessionals associated with early Christianity, or to the first commune movement in the U.S. in the 1860s. Various forms of the so-called community model have persisted over recent decades in opposition to the standard medical model in which a client’s condition is diagnosed and treated privately by a neutral expert.

Group therapy, for instance, first widely used after World War II as an efficient way to treat troubled soldiers, returned in the ‘60s as a way to treat drug addicts. Community therapy enjoyed a brief popularity at the same time by seeking political and social solutions like housing or legal aid to family problems. Support groups of strangers with the same concerns continue to help millions of people by showing how others like them have made progress.

Likewise, family therapists, having seen clients regress when they return to dysfunctional families or friends, have been bringing a wider circle of relatives into therapy for decades. Some “network” therapists have gathered dozens of people for intensive weekend sessions with suicidal clients, for instance. One New York psychotherapist includes a troubled adolescent’s friends in his sessions.

Jurich, who teaches in Manhattan, Kan., said he once treated a boy with low self-esteem by bringing into therapy someone his mother said he liked--the mail carrier. “The mailman was damn good. He could have been a great therapist,” Jurich said. The postal worker readdressed all the undeliverable mail to the boy and made sure he spoke more than a few cursory sentences to him every day.

Minnesota family therapist William Doherty is working with churches to create public healing rituals for families undergoing divorce or whose children are leaving home. He said he hopes to redefine therapy as “public work” and practitioners as “citizen therapists.”

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Almeida’s program is among the most radical because it teaches people that they are accountable to the group before themselves, said Monica McGoldrick, director of a New Jersey family therapy training institute, who has written about Almeida’s approach in “Ethnicity and Family Therapy” (Guilford Press, 1996).

“If you’re beating up your kid tonight even though you got sober, we can’t say, ‘Isn’t that good you’re sober?’ That accountability has to be built in right at the beginning,” she said.

Similarly, she said, “We can’t have violent men seen as perverts way out there, treated for their perversion. Violent men are just men and they mostly need a community of men to help solve it.”

Unlike other group therapies, it is open-ended and not tied to any particular diagnosis, she said. Before talking over their personal problems in group, the clients are taught to understand that almost any problem--from obesity to violence--is the result of power imbalances, which might be caused by gender, ethnic, social or other factors that go back thousands of years.

Almeida said too many troubled people think they can fix their problems if they only learn to communicate better or explain themselves, rather than understanding “it’s a much bigger problem than the individual can be responsible for. [Seeing the big picture] frees men up to understand they can take care of themselves and be available to others,” something few learned growing up, and it helps women clarify the issues, she said.

It is important to break down privacy, she said, because “the rule of privacy is the rule of patriarchy. It’s the way men maintain power, isolate women and children and resources.”

Strong-minded and soft-spoken, Almeida was born in Uganda to a family of Indian descent and grew up in a neighborhood where public and private barriers were never very high. Her relatives had a history of advising women on marriage across caste lines, admonishing men who beat their wives and sheltering abused women.

More than a decade ago when she was teaching family therapy at nearby Rutgers University, Almeida, a small woman who limps from a childhood bout with polio, began working with batterers. To ensure her safety in the men-only groups, she asked for lay volunteers among police officers and members of the Rotary Club. These men told the batterers that they often felt the same pressures the batterers felt, but “would never choose to use violence,” Almeida said.

She also sought female sponsors for women from among rich and poor--wealthy partners of high-profile spouses or undocumented workers--most of whom wanted to avoid official police or court systems. Impressed with the impact of the role models, Almeida used these volunteers as “community consultants” to augment her social education program. Over time, former clients like Steve replaced the volunteers as sponsors.

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Steve leaned forward on his chair, one of 19 men and two therapists at a weekly men’s group session at the institute’s nondescript office in a residential neighborhood. The therapists, a man and a woman, wore earphones, through which they could hear advice from colleagues who watched the proceedings behind a two-way mirror and through a closed circuit TV, a not uncommon practice in family therapy.

This evening, they were focusing on Jorge, a 16-year-old son of Cuban immigrants. Therapist Ken Dolan-Del Vecchio explained that earlier that afternoon in a teen group, Jorge’s distraught younger brother told how Jorge beat him up, cut the phone lines so he couldn’t call 911, broke doors and sliced up his mother’s favorite sofa.

Then, they heard his mother, Theresa, a member of a women’s group, describe how her fear of her son was similar to her fear of his abusive father, whom she banished from their home. Her sons had not seen him for four months. They heard that in the mostly minority neighborhood, residents could not rely on the police for help.

Steve asked Jorge how he feels about his father. “I can’t stand the man. He says one thing and does another,” the boy replied. Steve wondered out loud if perhaps Jorge’s brother is learning to regard him in the same way.

The men--who included a convicted child molester and previously violent husbands whose wives had obtained restraining orders--discussed alternatives to violence.

When the boy denied hitting anyone, an African American man told him, “Men learn they don’t have to hit. They can intimidate women just by a look or their voice.” Added Steve: “Or just by their size.”

Another man, an immigrant from Pakistan, suggested to Jorge, “You could also practice apologizing.”

Arms folded, eyes rolling, Jorge, who had already spent time in Juvenile Hall, looked alternately bored and intrigued at what the men had to say to him.

Behind the mirror, Rosemary Woods, the institute’s assistant director, remembered that the African American man was an artist and suggested he might be able to help Jorge. The artist and the other men wrote down their phone numbers, and the boy agreed to call if he felt he was losing control.

The institute staff claim a 75% success rate with court-mandated batterers, but outside evaluators have yet to complete formal studies. Jacqueline Samson, a clinical researcher at McLean Hospital in Belmont, Mass., said studies of more standard group therapies show that they clearly widen the safety net for people with eating disorders, anxiety and depression, and for those who need help with day-to-day control of impulses for, say, substance use.

In addition to the cold study, she said, “There’s a stunning body of data to suggest [group support] literally prolongs life in people who have had heart attacks. There have been groups with women suffering infertility where pregnancy rates improved.” Although in that case, the reason may be that members exchanged information about treatments, she said.

But there is less concrete data to show how group therapies affect people with a history of trauma or family violence, she said.

Another New Jersey therapist, Dorothy Cantor, past president of the American Psychological Assn., cautioned that Almeida’s approach might not be appropriate for everyone. “I worry about people who are suicidal. People whose hold on reality is slim,” she said. Neither is group work for every therapist, she said. “I don’t think you find too many only children leading groups,” said Cantor, an only child.

Almeida said some lawyers have complained that opening up secrets outside the group breeches rules of privileged client-therapist communication. She believes she is covered by legal decisions in many states obliging therapists to speak out if a client has made threats during therapy. A person’s secrets are evaluated in context, she said, and some, such as a child’s anorexia or HIV status, need not be revealed to others.

Others question how honest people are in groups without strict confidentiality rules, or wonder whether telling certain secrets outside an understanding group might create more problems than solutions. Said Jurich: “Some people may attribute some strange motives to a person who tells you he’s had an affair with his wife’s best friend.”

McGoldrick said Almeida’s program has elicited surprising antagonism among community members, notably some women’s centers that want to exclude men in treatment. “There are also quite a few men in the community who think she’s a man-hater.”

For some grateful clients, however, the group was their first exposure to any kind of community. One 33-year-old battered woman said she had withdrawn from any friends during her 16-year marriage and her relatives told her she deserved whatever happened to her. “I never had any true friends or a family until I got here,” she said.

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It’s still hard for people to believe violence happens in a neighborhood like his, said Gene, a well-connected executive looking up and down the block at the half-million-dollar estates on half-acre lots.

For years, Gene had kept his wife on a $50 a week budget while secretly investing $2,500 a month. He knew she was having trouble raising the kids and keeping up with his corporate social life. Still, when she finally broke down and they entered private therapy, all he could feel was that he was losing control.

No one would have known anything was wrong until a dark morning five years ago when police pulled him out, handcuffed him and drove him to jail.

The night before, they had just returned from dinner where each had had a few drinks. An argument erupted about kids and money. He pushed her face. She hit him with her shoe. He grabbed her by the hair and wrestled her to the ground. Then he said he began beating her head against the floor, all the while shouting, “Why don’t you listen to me?”

Gene says now that it was the darkest--and the brightest--moment of his life. As a result of the humiliating arrest, his wife’s subsequent divorce suit and a judge’s order to find treatment, he found himself in the institute’s program.

It took years, but now the couple say the program kept them from an unwanted divorce and brought equality and mutual respect to their family life. “He’s not a completely new person, but his approach is totally different with everybody,” said his wife, Nora, adding that she probably changed more than he did.

“Anyone who is given full control of anything will take over, but if you give it away, it’s your fault,” said Nora, who learned to assert herself.

When they start to slip back into old patterns, she either asks him to move out of their room or they go back to their groups at the institute. “It’s like AA,” she said. “One therapist or one sponsor can’t possibly give that person the time or the re-education on how to handle the situation and their emotions.” She has sponsored scores of other women.

Gene thinks their marriage is stronger now than ever, quickly adding that Nora should be the one to judge. Sitting across the kitchen table, only a few feet from where she had been beaten, she blinked away tears and said, “I think we’ll always be friends.”