Group is upsetting

Group was horribly upsetting. I’m up in the middle of the night worrying so might as well write about it.

The worst part for me is losing trust that Ron knows what the hell he is doing.

Anyhow. New group member M reports that last week’s group triggered her into a major episode of cutting, which she is worried will turn into her attempting suicide again. She’s only been out of hospital two weeks.

Ron look really bad, not like a man who’s had a vacation. He is pale and haggard.  Apparently he and M have just had a session about this.

Ron’s idea seems to be to do a long session with M during group time. He’s wanting her to speak from the dissociated parts that cause her to cut.

M does not seem upset, as in she’s not crying, she seems cheerful and outgoing describing her experiences. The part of her that self-harms is totally behind the scenes. So Ron wants to talk to that part, and get her to show emotion.

So there’s a long part of the group where they go back and forth. He’s providing insight, she’s kind of looking at him thoughtfully, pretty well unmoved by anything he says. Then she goes back to her cheerful descriptions.

I sit there pretty angry once again. Because I don’t think this is what group is good for. I don’t think it’s really for these individual therapy breakthroughs that Ron seems to be looking for.

So all the stuff I was wanting to find out from last week got thrown out the window. Everyone in the group tries to help M, but really, we don’t know what will help. I ask her what she would find a helpful response, and she doesn’t know.

I do say after about forty minutes that I find the situation upsetting and overwhelming, that cutting is not something I have experience with. It’s hard to say this, so I kind of whisper it. Ron asks M what it’s like to hear this, and she says it’s OK, she understands she’s not that normal. He pays no further attention to how I might be feeling. OK, I understand she takes priority. Even though what he’s trying to do with M doesn’t seem to be going anywhere.

After a while, discussion veers away from M for a bit, thank goodness. Ron seems to give up on the therapy he’s trying to do.

E starts talking about her experience of self-harm during the last week. M and E mention that they are triggering each other into doing more self-harm. There’s quite a bit of discussion about how self-harm feels, why it feels good….E gets emotional while she’s talking about it, which M never does.

A talks about his sister, who had a hard time in school, and whom M reminds him of, and he starts crying. Then he talks a bit more about his family.

I talk a bit about my family also, about how they never discuss anything that happened in the past. Ron asks me if they are like that about my cancer. I’m not sure, as it’s so recent. I say that my mother still asks me how I’m doing.

It seems to me that the regular group just gets thrown out the window with these crisis situations. Relationships between group members are no longer discussed. I thought that’s what group was for? I’m pretty sure M is not going to have a therapy breakthrough in group that suddenly solves her self-harm, however hard Ron tries. Group isn’t for that. IMO.

I’m sad that we couldn’t continue group in the regular way. And now, do I have to worry every time that the stress of the group is going to cause M to cut, the way it did last week? Or worse?

I think some people are not stable enough for this kind of group, if they’re really at serious risk. Group is not reassuring. I’ve found the benefit comes in examining the relationships within it. M has never done that aspect. When she participates, it tends to be when she is in a crisis, and she talks only about herself. Understandable. But why do this in a therapy group?

The other aspect is that I don’t think I was the only person upset by this, but the situation encourages people to sit on their real responses. We want to help, so it makes sense. But meanwhile, Ron has spent so much effort telling us it’s OK to say your real reactions, that’s what is healing. But in these situations with M, he does not encourage it. I was the only person who said anything about being uncomfortable and overwhelmed. Ron really only focuses on M in these crisis scenarios, and all the nice words about ‘be real’ go out the window.

And I lose the sense he cares about me at this time. He only seems to want to help M. When the conversation turns general, he kind of gives up.

I was so relieved when other people started talking about their stuff. If it had been an hour and a half individual therapy with M, I couldn’t have stayed.

The other thing being, I get really mad in these situations. I’m trying to explain why. I feel that Ron is abandoning his ideas of how groups should work and what they’re for. Anyway, I sit there fuming, angry with Ron but knowing that this is not the time to get into it. There’s a girl sitting here who will cut herself to shreds if I say the wrong thing.

OK, that sounds really harsh. It’s just, I don’t know what to do. And now I can’t sleep.

  1. Hi Ellen. Agreed, it does sound strange for him to do this. I suppose that when he thinks someone’s life might be on the line, he’s willing to bend the rules to help…? But why not just schedule more individual sessions with that person instead?

    I don’t have any answers, of course. Sorry you are dealing with a difficult situation. I am sure, as before, that this will also pass as you have time to process and work through your emotions. Try and remember that the frightening times do in fact pass through in time.

    • Ellen said:

      Things do calm down don’t they. I feel better again today. I talked to Ron about this and he said I was ‘threatened’ – he thinks it’s my problem. He did say I should talk about it in group. My opinion remains that if the stress of the group is triggering dangerous behaviours, the group isn’t the right place for that person at that time.

      Thanks for your suppport!

  2. Karen said:

    I have to agree with you when you say that some of these people aren’t really stable enough to be in the group. Psychological therapy is intense enough when it’s on an individual basis, but there is always the risk of that being amplified in a group, and it seems to have been here. I’m not saying that there’s no room for up-and-downness, but I think a person should be broadly stable before entering such a highly charged environment.

    I don’t really understand Ron’s thinking here, and I’m not surprised you’re pissed off. And I totally understand your frustration about feeling restricted in what you say, lest someone be triggered. I want to say, “well, that’s their problem, not yours,” but I know all to well that I wouldn’t listen to that myself, so I’ll just say that I’m sending empathy and hugs.

    Take care Ellen. I’m sorry you’re going through this 😦 xo

    • Ellen said:

      Good to know I’m making some kind of sense then, even at 4 am. Ron does think this is my own issue, but he thinks I should bring this up in group and not be inhibited. But someone teetering on the edge like that – how can it not disturb me? And I was the only person to voice any negative feeling at all…so I feel like a bitch already. Thanks Karen

  3. laura said:

    was there any exploration of what specifically triggered M in last week’s session? Like, what areas should be roped off? did you think there was really a connection? I think group therapy is often used in inpatient settings too, I can see how it might be comforting for her to see others who struggle with similar issues (dissociated parts, self harming behavior), others who feel isolated in their strangeness.
    we have a hierarchy of neediness in our group too, and I’ve been noticing that I have been feeling abandoned by the group leader (and I don’t have nearly the relationship with him that you have with Ron) as he focuses on others who apparently need him “more”.
    I’m noticing that everyone is looking to get what they need, altho we might not be aware of what we need. People like M have priority (we think) over us, and we don’t like that – but we are complicit in ceding priority. Especially if you’re not really aware of what you need, other people who pursue their needs more actively and directly (or whose needs seem more urgent) are threatening. It’s like we say politely, ‘You first.’ and they have the nerve to go first! We say, ‘you take the last cookie’ – and they do! So, what are we going to about it? How are we ever going to get a cookie with people like that around?

    It’s not supposed to be your worry that she’ll cut herself to shreds – that’s his responsibility. You probably have no idea how or if you could prevent that. Maybe what would be really helpful to her is for others to say what’s really going on for them. It seems like you could share your observations of Ron (he seems haggard), question his method and how that worries you, and that you feel abandoned.
    How does it look, this morning?

    • Natalya said:

      Completely agree with you, Laura. I do feel sorry the group is deteriorating like it is. It sounds like something needs to change if the group wants to function better.

    • Ellen said:

      From what she said, it was simply E mentioning that she cut. I guess I assumed it was also the stress of being in the group. RE hospitals, I think group therapy covers a multitude of sins. I would doubt that there’d be a psychodynamic group in a mainstream hospital setting. More likely support groups, educational, CBT/DBT.

      It’s true, we are complicit in ceding priority. I do this a bit less than other groupies, but I do it for sure. But then, some things do have priority – suicide, dangerous behaviour. But there’s only so much a group can do here.

      I was wondering if it might be most helpful to her to get people’s real reactions. Hard to say. I did bring all those things up with Ron. He thinks it’s my problem, much the way you describe, that I’m feeling ‘threatened’.

      I’m getting over it now, two days later. Thanks for the insights.

  4. Hugs Ellen, I reacted badly to this when I read it the first time. I realized that my reaction had to do with my own experience. M sounds so much like my mother using ‘life threatening’ (my mother used illness instead of cutting) crisis to garner all the attention, expecting everyone else to make it better, and appears to be enjoying the whole process. I’m afraid my reaction would be to hand her a knife and say ‘go for it.’ Because I am sick and tired of being blamed for someone else’s mess. Yea, I would certainly bring it up with Ron in your next session. Consider your reaction and think about similarities in your past. If you have a really strong reaction to a situation, there is a very good chance that it has happened before and is unresolved. My suggestion is use this experience as a spring board to exploring hidden scenarios that you didn’t think were important at the time but still bother you. Hoping you feel better today. Ruth

    • weareonebyruth said:

      Ellen, can you please delete my thoughtless comment. I should wait to post when I react strongly for all the wrong reasons.

    • Ellen said:

      I appreciate hearing your reaction Ruth. I was also feeling angry at the time, though I wished I felt more sympathetic. With your history with your mother, that makes a lot of sense. I don’t have as good a reason for my anger, at least, in my family no one is ever dramatic in this way.

      I’m not sure that M was trying to manipulate the group actually. She didn’t blame us for her behaviour. I can’t really fault her for anything she did in group. Just it felt disruptive to me. It was too extreme for people to be comfortable giving their real reactions, which is what group is for.

      Those are good suggestions. I wasn’t really able to do that. I talked about my concerns, much like I did in this post. Ron was not very sympathetic, but did feel I should go ahead and voice my feelings in the group. I think he suggested I was jealous of the attention he was paying to M.

      Thanks for sharing your reactions Ruth. You’d make a good group therapy member. 🙂

      • weareonebyruth said:

        Thank you. I am feeling better today too.

  5. I’m sorry Ellen. The group sounds very difficult. I would find it hard to examine my feelings and reactions when I was concerned that someone else was on the edge of harming themselves or suicidal. I can see why you feel frustrated and powerless. I hope you talk about your concerns about M with Ron in your session today. I think it feels hard to talk about it because you feel like you are blaming Ron for how the group is working and it would be easier if you could just talk about your feelings about what is happening in the group. I haven’t found a way around that yet.

    • Ellen said:

      Thanks for understanding Di. I did talk about it in my session, but it wasn’t terribly productive. I did blame him, and he likely doesn’t appreciate that. He’s very sure he is doing the right thing. I hate how they use therapy language when you’re trying to raise a concern, making it all about me. Thanks for commenting.

  6. Ellen, I don’t know if this helps, but you are absolutely right on target with all of your concerns… Here is a paragraph from THE book about group therapy: “Most clinicians agrees that patients in the midst of some acute crisis are not good candidates for group therapy, but are far better treated in crisis-intervention therapy in an individual, family, or social network format. Deeply depressed suicidal patients are best not referred to group therapy:… they do not receive the very specialized attention they require in a group setting (except at enormous expense of time and energy to the other members); furthermore, the threat of suicide is too taxing, too anxiety provoking for the other group members to manage.” pp 229-230 The Theory and Practice of Group Psychotherapy by Yalom

    I hope that this can be worked out satisfactorily so that group can function reasonably well again. It sounds like a mess. 😦

    I really thought it important to validate your concerns, though. Just so you know, I can pretty much guarantee that when Ron studied about groups in graduate school, he read Yalom. EVERYONE reads Yalom, no matter what else they read, because what he wrote is that good.

    • Ellen said:

      I especially like the part about the situation being ‘too anxiety provoking for the other group members to manage’. I read Yalom’s book a few months after starting group, and I loved it. It’s kind of long, but clear and so interesting, and it explained what a group might be trying to do, when I really had no idea. Yes, Ron has read this.

      Maybe I’ll send him your quote. I brought up my concerns and he really made them all about me, my fears, my reluctance to voice my feelings in the group. I said I bet others feel like me but are just afraid to say so. He doesn’t seem to think so.

      That’s a helpful reference, thank you Cat’s.

      • You are very welcome! Even good Ts can sometimes mess up and have a hard time seeing that they might have made a mistake. Good luck!

  7. Juliet said:

    This sounds really bad 😦 And I agree with the general opinion on here: People that take part in groups should be stable…. other than that I’m sorry that this meeting sucked so hard. Hopefully, next week’s meeting could be used to discuss this. I could imagine that most people wouldn’t say to M how they are feeling about it because she doesn’t seem to be stable enough to handle feedback. But maybe others will tell Ron in their sessions how they thought it went. Because I really can’t imagine that you were the only one feeling like this. xx

    • Ellen said:

      I really wonder if I was the only one. Absolutely no one else said anything about it. I guess Ron thinks M is stable enough to handle feedback, since he encouraged me to express my feelings in group. Thanks Juliet. xox

  8. I wonder if you feel angry because it’s one person’s pain demanding the attention of the entire group, as well as stifling the real feelings of everyone else in that but that person. It can be a very familiar situation for anyone who has been abused. The abuser’s needs are so often presented as so much more important than everyone else’s, their crisis so much more real, and there is no room for anyone else’s needs or experiences. In reality, your needs are as important as M’s, your pain as real, the crisis you are in just as urgent. But when M can’t manage hers, your needs go out the window.

    Just thinking out loud here.

    Take care.

    • Ellen said:

      That’s an interesting way of looking at it Ashley, I like it. I had not thought of it in this way. True that my needs go out the window, as they did when I was abused. There was a way the group that evening reminded me of my family, where no one except one individual is allowed to express themselves. Nice to meet you and thanks for the insight.

      • You’re welcome. I’m glad it seemed to help.

        Take care.

  9. I don’t think it’s fair to say that it’s general opinion that people in group should be “stable”… that’s pretty judgmental and really angers me. We each bring to group our own issues. If she needs to be re-admitted to hospital, that will happen. And as someone who often struggles with suicidal feelings (as a result of both trauma and bipolar), and a long-time self-harmer, I like to think that I *bring* as much to group as I take. SH and suicidality is not about attention seeking, weareonebyruth, and it’s pretty insulting that you think it’s somehow about you. It’s not. And you’re not calling someone on their bullshit by “offering them a knife” … you are just being cruel.

    And Ellen, you are not going to like this, but the person I objected to most in *my* group was the person with DID… I felt that someone in parts had no business being in group… basically, that it was completely inappropriate for a woman who switched in and out of child parts to participate in group therapy. One minute we’d be talking to an adult, and the next to a 5 year old. It was so frustrating. I felt silenced, because there were things (like sexual abuse) that I would not talk about in front of a kid… so I kept my mouth shut. And then I was angry, super angry, because I felt like she was robbing me of *my* time in group.

    So who’s right? You think someone experiencing episodes of SH and suicidality doesn’t belong in group, I don’t think someone with parts belongs in group… Could we both be wrong? Is there room for us all?

    We resolved this in my group by talking, talking, talking, with the help of the facilitators. I expressed my anger, and feeling silenced, and my fellow group member explained her experience of being there and switching in and out of parts. And we came to understand each other.

    I hope you go back and continue the conversation. And don’t quit therapy. He is a good therapist, and imho it’s worth working this out with him and the group.

    Sorry for the rant. I’m just super pissed and triggered. Not so much by you, E, but by the tone of these comments.

    • Ellen said:

      I was actually kind of aware that any readers who self-harm could be triggered by my post, and I am sorry about that aspect, though this is my own experience. I do worry that someone who is suicidal, as M was only weeks ago, could be triggered by the stress of this therapy to make another attempt. I think it is a legitimate concern. I’m not completely sure that I’m right, but that is a concern I have. I did find the group reverted back to not giving their real reactions, but trying to offer solutions, reassurance, or their own stories, kind of like anecdotes.

      I don’t mind about your group experience at all. For one thing, I don’t have DID myself. For another, I have worried about triggering other members when I went into a flashback in the group. I’m no angel here. It must have taken a lot of courage for you to speak up in that group, and I’m glad that had a good outcome.

      I didn’t say some who experiences SH and suicidality doesn’t belong. I have problems with the second myself anyway. It’s more that if they’re in a current acute crisis, the group isn’t the right venue to deal with it.

      I actually did quit therapy after my last session. Because, um, it made me want to kill myself, and not because we touched on my past either.

      I can tell you are triggered and I thank you for expressing yourself and not just abandoning my blog. Takes courage.

  10. weareonebyruth said:

    Catherine I agree with you on some of your points. I stated that I had a bad reaction. My comment is more of a statement about my past and someone in my past using death as a manipulation. It was not about getting attention, it was about controlling me. I agree with you that my reaction was not healthy or kind. It was about sharing a feeling without justifying it, double checking it to see if I had any ‘right’ to feel that way. Emotions don’t play by a tidy code. Ellen’s post triggered me but it is not her fault and it is not her responsibility to rewrite what she wrote. Since I was named specifically some of the anger you are expressing is at me. I think flaming Ellen is a misdirect since she is already in a bad place. Pointing out your belief that she is the problem in your opinion, I don’t believe is helpful or kind. I have battled with feeling suicidal myself. It is a complex thing that can be used for many reasons. If you would like to contact me directly and vent your anger at me, feel free to contact me at weareonebyruth at gmail dot com.

    Ellen, I apologize that my thoughtless comment caused you to be at the receiving end of the above comment. Is it possible to remove my comment because it is about my past and not about your present frustration. Take care.

    • I *never* said she is the problem, and I wasn’t flaming her. We know each other IRL, and I am pretty confident that she can handle my anger which if you read carefully, was never directed at her. And why on earth would she rewrite what she posted? It’s her blog… and I am glad that she has this place to share and write with all of us… just like I use my blog to write whatever is in my heart.

      I have never been in group with her… so my comments are about MY experience, not hers. I was just pointing out that while some of you think suicidal people / self-harmers shouldn’t do group therapy… for me MY difficulties in group have been people with are actively switching… Does that make me right and her wrong? As i said, no… we could both be right, and we could both be wrong. It was just my experience.

      In my group we found a way for ALL of us to be there, and be there safely and learning to share all of our selves. My post actually has a happy ending… we were all able to stay in group and with lots of tears and breakdowns in communication, we eventually worked it out… despite our differences.

      • Ellen said:

        I didn’t get that you said I was the problem for sure Catherine. I’d be happy to be in group with you BTW.

        I said what I have to say in reply to your first comment. Take care

    • Ellen said:

      Please don’t apologize Ruth. I thought your comment was completely valid, and you explained the reasons for your reactions very well. My blog isn’t a place where you have to double check all your reactions for ‘correctness’, whatever that is.

      Could you and Catherine come and attend my group and work things out? He he. Just a little joke. This conversation reminds me of group therapy.

      Both of your comments were valuable to me. So I hope no one stops commenting please? I didn’t feel attacked by Catherine’s comment. I think too that I did have a certain angle to the self harm issue that someone who suffers from this could find triggering.

      Ron also thinks that this is my own problem, so if Catherine thinks that, she’s in good company. I didn’t totally get that from what she said though.

      Cheers. Please no worries.

      • weareonebyruth said:

        I posted a comment today on my blog about assuming others are behaving like my abusers. Apparently I did this today with Catherine’s comment. Reread it with the clearer understanding I see better what you mean. Thank you Ellen and Catherine for sharing your perspective so that I could understand it more clearly. I grew up with a lot of ‘correctness’ and still see it where it doesn’t exist.

        • Ellen said:

          Thanks for dealing with this so thoughtfully Ruth. Take care.

  11. I had another thought about this and that is that it is M’s choice to self-harm. She is responsible for making that decision–regardless of what else is happening in her life. No one is making her cut. It sounds like you feel as if she is holding you responsible rather than taking the responsibility on herself. (“There’s a girl sitting here who will cut herself to shreds if I say the wrong thing.”) Abusive families are full of people who blame their behavior on everyone else. Maybe that was triggering as well.

    • I agree that M’s decision to SH is hers alone, as it is when I choose to cut. And I am glad that you feel she is taking responsibility for it. We all have various ways of coping with overwhelm… hers is SH (as is mine… as well as other addictive behaviours such as overeating and porn)… I view SH and suicidality as chronic conditions for me, not necessarily crisis situations. I do recognize that they may be frightening or appear manipulative to people who are not living with them on a daily basis. But for me, as possibly for M, when the suicidal feelings cross over into crisis level we have our one to one therapists/psychiatrists who can help us make the decision to enter hospital. So what may appear to be at crisis level from the outside may not be so acute. Painful and difficult and exhausting and overwhelming, yes, but nothing to tippy-toe around. As a group member I would want other people to challenge me if they feel manipulated, to take time for their own issues, to challenge the facilitator, to speak up and continue talking until they felt heard and understood. But not to try and fix me or come up with solutions… that’s way more than any one group member can do.

      I think I am reacting so strongly to this (as I said in an email to E), is because in my own family history those who were supposed to help me when I attempted suicide as a teenager turned their backs on me, and that rejection is still very raw for me all these years later, and I am projecting it left and right over this comment thread. Just so you know where I’m coming from. I feel like folks are saying that some people are “too crazy” for group… and on the surface I might look like one of those people. But I’m not. I have had years of one to one therapy, and group healed places in me that individual counseling could not touch, which is why I think it’s so important.

    • Ellen said:

      To be fair Ashana, I don’t think M is holding me responsible really. The fact that it was the group itself that triggered her though concerned me. Then she linked that to her suicide attempts. She isn’t blaming the group, but it’s like any highly charged situation where someone is in a lot of pain – you hesitate to unleash your negative feelings at that point. M actually blames a part of herself that’s beyond her normal awareness, but that takes over sometimes.

      Your family experience sounds so very difficult, similar to commenter Ruth’s. My family didn’t have that going on. The feeling of being silenced though, for whatever reasons, is very very familiar.

  12. I actually don’t hold the opinion that some people are “too crazy” for group. I really don’t know what is required to be in group. I assume it’s a decision everyone can and should make for themselves–whether you are ready for it, and whether you are able to use it to their benefit or not. Just as everyone can decide for themselves what therapist to see and what kind of therapy to seek.

    I can’t say I know whether M is taking responsibility for her behavior or not. I wasn’t there, and can’t judge her attitude about it. But I did wonder if Ellen felt held responsible for it–either because someone in group implied she was (such as M or Ron), or because being held responsible for the poor coping behaviors of someone else was something in her own history that was triggered by this experience.

    My own mother was a self-harmer and a chronic suicide. She always, always blamed the rest of the family–including the kids, even when we were tiny. Hers was an act of violence and revenge and a repositioning of herself as victim when in reality she was an abuser. A favorite line was, “Look what you’ve done to me.” That doesn’t mean everyone else who self-harms or suicides is like that, but for anyone with that in their backgrounds, it leaves particular scars–including a sense of being responsible for the pain of others when you are not. And I just wondered.

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