My therapy group on Wednesday was very, very difficult.

Not surprisingly, we returned to the topic of my difficulties engaging with the group, and the fact that I’m questioning whether group therapy is the right approach for me. We talked about gender a little first, and whether the fact that it’s a mixed-sex group is a problem, but then Group Therapist said something that really upset and angered me.

He said that me wanting to leave the group is basically just avoidance. I explained that I feel as though to get much out of the group, I’d need to have already overcome the issues I’m there for in the first place – and he said I should let the group help me overcome them, and that he thinks group therapy is the only thing that will help me with said issues.

Ouch.

The thing about letting the group help me is interesting. I hadn’t really thought of it like that, but I think he has a point there – although another member of the group did then immediately say that they didn’t know what to do to help, and that they felt quite powerless in the situation. Not the most encouraging response.

But the reason I’m so angry is that when I was assessed, I was offered a choice between group or individual psychotherapy, and I was told either would help me. When I found that a difficult decision to make, Group Therapist reassured me that it wasn’t irrevocable, and that if one approach didn’t work for me I could go back on the waiting list for the other. (I also feel as though he nudged me towards group therapy a bit by offering me a place in this group before I’d made my mind up, though I appreciated the information at the time.) Now that I feel group therapy isn’t working, I’m a little shocked that he would go back on his word, dismiss my reasons for wanting to leave as not valid, and imply individual psychotherapy wouldn’t actually help.

I’m also upset by his assertion that I’m just being avoidant. I understand that giving up on a particular type of therapy, when you’re finding it difficult and think another approach might work better, could be about avoidance but it could also be a healthy and appropriate treatment decision. It may even be a little bit of both. From my point of view, to understand all the different factors at play you have to tease them out and examine them closely (and isn’t that what therapy is supposed to be all about?) We haven’t really done much of this, and I appreciate I’m not making it easy by finding it so hard to open up in group, but that GT thinks he knows best anyway I find arrogant and unhelpful. Maybe he’s calling my bluff, trying to draw me out that way – but if so, I wish he’d f*** off.

It was early on in the 90 minutes that he said it, and the rest of the session involved a lot of silence. I’m normally OK with silence in the group. That is, I find long silences difficult to break, but they don’t make me particularly uncomfortable or uneasy. This time was different. The silence seemed oppressive, thick and heavy, suffocating. I was literally finding it difficult to breathe. Then GT suggested we all share how we were feeling in order to ‘move things on’. Nobody did. I couldn’t find the courage to speak up about how hurt and angry I was with GT, and whatever anyone else was thinking, they didn’t want to share it either.

One of the things that concerns me most about group is that I’m not usually like this – or not to this extent. Yes, I find it hard to open up to people, and I’m cowardly about confrontation, and that undoubtedly makes life difficult for me, but I’m not normally this dysfunctional in my relationships. The psychoanalytical group environment brings all my issues to the surface and magnifies everything. It’s meant to do this, I know that, so that we can really understand my issues and tackle them at a deep level – but not all therapy works this way, and I’m questioning whether it’s necessary.

I’ve written before about some of the things I’ve preferred about person-centred therapy, which has helped me in the past. But one aspect I didn’t really touch on is the environment. By being flexible to my needs, and though unconditional positive regard, my person-centred Ts created an environment that felt safe and nurturing, and where it was as easy as possible (not that it’s ever easy) for me to engage with them and to change. It was all about bringing out the best in me and often about getting as much as we could out of the time available. Psychoanalytical group therapy could not be more different.

I think one disadvantage of the person-centred approach, at least as I’ve experienced it, is that sometimes issues can get missed. Certainly the biggest problem I had with F was I sometimes felt her view of me was too positive – that she didn’t always ‘get’ how much I was still struggling during relapses. So it’s not that I think person-centred is good and psychoanalytical is bad. I think they can both be valid approaches to treatment, with their own strengths and weaknesses (and I think the same of well-conducted CBT too). What it comes down to is which is going to be best for me, and there’s no easy answer to that question.

I had a bit of an epiphany today, though. One thing I’ve learned through therapy with GT is how much the environment makes a difference – and to what extent I use changing my environment as a way of tackling problems. For example, when I was really struggling with B/Ping after dinner, I started spending my evenings in places where I wouldn’t binge – I would go for a walk or to the library or visit friends. When a bitchy or stressful work environment caused a relapse of depression, I changed jobs (I’ve done this twice). When I’m pulling from my eyebrows a lot, I cover them with a scarf or hat so I can’t access them. Leaving the group for (possibly person-centred) individual therapy would also be an example of this. I don’t think there’s necessarily anything wrong with this, and I don’t regret any of the decisions I’ve just described, but I do think I’m probably over-reliant on tweaking my environment and I’d like to be able to cope better in difficult situations rather than having to leave. Maybe that’s what GT meant about avoidance. Harumph. Two epiphanies for the price of one. Anyway, the original one was:

One of the things I don’t like about GT is I feel he sees the way I am in group, in a difficult environment that brings all my issues to the surface, as somehow ‘truer’ than how I am in situations where I’m able to cope just fine. I think he sees my functioning normally in the right setting, or when my mental health is good, as a front and not as the real me. I realised today that I cannot agree with this. For an environment to bring out the best in me, that ‘best’ has to be there in the first place. It’s all within me, the good and the bad. I need this to be understood and while it sounds ridiculous to suggest that a therapist wouldn’t understand that, I do feel the things I’ve achieved and the progress I’ve made with my mental health over the past ten years, before I started working with GT, get discounted. I could be wrong. This could well be transference. And the only way to know for sure is to discuss it with him… which brings me back to my original problem.

I think the person-centred counselling was about a series of increments. Baby steps, tackling the easier issues first, starting from an encouraging environment. The one danger with that approach is that as things get harder and scarier you may step off the ladder. By contrast, my psychoanalytical group is baptism by fire. If you can address your problems in that environment you’ll probably be sorted everywhere. The question is, can I take the heat?