When Shakespeare came to group therapy


	Alan Bodnar, Ph.D. is the Co-Director of Psychology Training at Westborough State Hospital, Mass. and a consultant in the field of leadership development.

By Alan Bodnar, Ph.D.

Lately, our Poetry and Fiction group has been sputtering. Our numbers have declined to a few regulars and newcomers to the hospital, sampling the fare before finalizing their schedules. We also have the occasional drop-in, there because he missed the bus for the mall trip that is part of the hospital's community exposure program. All in all, it did not seem like the right time to introduce William Shakespeare to the group and so, when one of our regulars requested the bard, I was skeptical. However, as advertised, we do take requests and, from another point of view, who better than Shakespeare to strike a chord of empathy with the common human struggles that become so much harder when you face them with mental illness?

Also, because there is nothing that Shakespeare has not treated in his plays or sonnets, it would be easy enough to select a memorable passage, appropriate to the audience and short enough to be clarified, discussed and applied to real life situations, all in the space of a 45-minute group session. My co-leader and I decided to focus on those passages that many of us were expected to memorize in high school English classes. "To be or not to be," Hamlet's famous soliloquy on the merits and risks of suicide, was certainly relevant to more than one group member, but maybe not the easiest place to start.

Perhaps Macbeth's exercise in reality testing would make a valuable point about relapse prevention. "Is this a dagger which I see before me…? / ...or art thou but / A dagger of the mind, a false creation, / Proceeding from the heat-oppressed brain?" On the face of it, you couldn't ask for a better example of the way we encourage our patients to evaluate their experiences for early warning signs of psychosis. Then again, did we really want to make an example of a man about to commit murder? Of course, if we focused instead on the anguish and remorse that followed the deed, we might be able to provide a useful lesson about the importance of considering consequences as a buffer against impulsive behavior.

Lady Macbeth could help us there with her futile attempts to wash away her guilt along with the blood of her victim, "Out, damned spot! out, I say!" Ah, if only Spot, the pet therapy dog, wasn't visiting with a group of patients in the room across the hall from us. Just imagining the potential for misunderstanding and the chaos that would follow was enough to send us looking for another passage.

In the end, we chose Portia's plea for mercy from The Merchant of Venice "The quality of mercy is not strained." In 14 brief lines, Shakespeare makes the case for mercy conferring advantages on those who give and those who receive and ends with a powerful explanation of how mercy is "mightiest in the mightiest," as it "becomes the throned monarch better than his crown." Spike (not his real name), the first group member to respond, associated it to one of his favorite games involving the application of intense pressure to the body of your opponent until he says, "Mercy." Maybe it wasn't exactly what we had in mind, but all therapy begins by meeting people where they are and, if the bard is truly universal, he surely has something to say to Spike.

The rest of the group needed little encouragement before they were talking about times in which they needed mercy from others as well as times when they were in a position to show mercy. A few had fallen under the spell of a relapsing loan shark, borrowing a dollar or two for cigarettes or snacks from the vending machines and then being expected to repay the loan with one-hundred percent interest compounded weekly.

Very little has changed in the 400 years since Shakespeare wrote about a Venice where Portia pleads for mercy from another loan shark intent on exacting a pound of flesh for his services. As expected, there was no one in the room who would not want mercy from their own financial or moral creditors. There was also a universal sentiment in favor of showing mercy to those who have brought inconvenience and disappointment into our lives. Focusing on prevention, we might have brought Hamlet's Polonius into the conversation, counseling his son to be "neither a borrower nor a lender." We decided to leave that soliloquy for another day since an authority figure quoting hospital policy could easily have been too severe a test of the group's capacity for trust at this stage of the game.

Try as we may to democratize our dealings with one another, there is always a power differential in the relationships between staff and patients. A young woman in the group could imagine herself asking her treatment team to restore privileges that had been suspended after she returned late from a pass. We joked about her using Portia's words about mercy being "above this sceptered sway" and "enthroned in the hearts of kings." That was more than a month ago and I am still waiting for the phone call from her unit director. He would ask if I had anything to do with the speech she made during her treatment team meeting and whether or not I thought she had gone too far to suggest that mercy "is an attribute of God himself; / And earthly power doth then show like God's / When mercy seasons justice."

"Forsooth," I would reply, "These words are razors to my wounded heart," and that being said, leave him to draw his own conclusions.

When Shakespeare came to group therapy (February 2009 Issue)

By Alan Bodnar, Ph.D.

When Shakespeare came to group therapy
(February 2009 Issue)