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?

I had an unexpected opportunity this week to discuss my group therapy situation with someone totally impartial. To cut a long story short, at around the same time as I was referred to the NHS psychotherapy service, I made contact with a local charity which runs short-term therapy and art therapy groups. At that time I didn’t know that the NHS would also offer me group therapy or that ongoing treatment would come through so quickly, so I planned to use the charity as a stopgap. I have since twice turned down a place in one of their groups because of my NHS therapy, but twice asked to stay on their waiting list because I wasn’t sure I was going to stick with my current group. So the lady who runs the charity (I’ll call her A) suggested I might like to come and have a chat with her about what I feel I need right now, and it seemed like the ideal opportunity to talk things through.

I went to see A on Wednesday afternoon and found her very helpful. She confirmed that many of the problems I’m having with the group, how difficult and awkward it is and how the environment seems to bring out the ‘crazy’ in me, are a normal part of the psychoanalytical process and don’t mean the therapy isn’t working properly. They are the price for what, hopefully, I will get out of therapy – a very deep understanding of myself and my issues. She also said that not everyone can tolerate what I’m going to call the side effects of psychoanalytical therapy, and there is no shame in that. It’s not for everyone. We agreed that it has to be my decision whether I want that kind of very intensive, in-depth therapy and deep understanding, or whether I’d prefer something with a more supportive and practical focus.

We then talked about the biggest problem I have in group, how hard I find it to open up and participate at all, in more detail. I realised that I rely on a complex and largely unconscious set of cues to tell me whether someone is ‘safe’ or not, and if just one person in the group is not ‘safe’ to talk to on a particular topic, I can’t bring it up. As a result of this (and perhaps because I was very clearly able to open up to her), A suggested that maybe individual therapy would be better for me. She encouraged me to discuss this in the group, while being very understanding of how intimidated I felt by the prospect.

I then brought up this issue:

There are many areas of my life that I think I’m reasonably happy about when I’m well, but when I’m depressed they not only get me down, but I view them as a likely cause of my depression. Is this just the ‘depression talking’ (distorted thoughts and beliefs) and me grabbing at straws to make sense of things, or are these real problems that I’m refusing to tackle and which do indeed make me ill?

A agreed with me that depression can make you see all sorts of ‘problems’ that weren’t there before, and she said how I am when I’m well might be a better guide. Do all my issues completely go away when I’m not depressed? I had to admit that they don’t, that my problems trusting or relying on people and letting them support me are pretty much a constant - but that when my mental health is otherwise good I usually feel quite happy managing by myself and as though I can cope that way. “When I’m depressed…” I started to say, and suddenly I realised that it’s a real problem when I’m depressed, it can’t just be a twisted-thinking-type symptom, because when I’m depressed I need more help from other people and that’s when my difficulties in reaching out – and, I suspect, the emotional connections I haven’t made when I’m well – really come back to bite me on the arse.

A took this one step further and suggested that although I feel able to cope by myself when I’m well, perhaps the fact I’m not talking things through with other people much means issues don’t get properly resolved, and then they build up, ultimately bring my mood down again. I don’t know whether this is the case, but I acknowledged it as a possibility. She said human beings aren’t designed to function alone, we need to lean on others to some extent, and I agreed with her on this. Maybe there are some people in the world who truly don’t need anyone else, but deep down I know that I’m not one of them.

We talked a little about how I could learn to trust people more and A suggested thinking carefully about who I trust, and how I can tell whether someone is trustworthy, and how I can test that out. I think that ties into my ‘safety’ cues, in a way. In some way I am already doing this, already deciding who can be trusted and with what, but the rule book is wrong and it needs to be rewritten – no small feat when it’s written with the emotional fabric of my life.

Still, the rule book isn’t always wrong, and I was feeling quite proud of myself that I’d judged A as very trustworthy and been able to open up to her. Then she suggested I come back and see her in a few weeks once I’ve talked to Group Therapist, and I realised what I was afraid of with her. As far as I’m aware, A doesn’t provide regular counselling; she works with people on an ad hoc basis. She also told me that if I leave the NHS group, and for example go on the waiting list for individual therapy, she’d be happy to support me in the mean time. This is brilliant, but my fear is that I will ask for too much. Without the structure of weekly or fortnightly sessions, I don’t know how much support I’m ‘allowed’ or would be seen as appropriate. It feels as though if I asked A (or anyone who was supporting me) for more than she could give, and had to be turned down, this would be The Worst Thing in the World. It feels as though it would destroy me.

Come to think of it, the one thing that nearly did destroy me – what made me want to end my life ten years ago – was when my then best friend walked out of my life because I had become too needy and she couldn’t cope with my depression. J was probably the first person in my life that I let myself rely on and that risk didn’t pay off for me. Rationally, I know the situation is very different. I know a mental health professional telling me they can’t see me as often as I would like, at a time when I have good coping skills and multiple avenues of support, is not the same as a one-and-only friend leaving for good when I had very little else. But I learned – or perhaps had reinforced – that asking for too much from others is bad, bad, bad and wrong, wrong, wrong to the extent that it would cost you your friends and possibly your life. That’s the kind of black-and-white place I was in back then, and I’m a lot more rational now, but the mind remembers the pathways it’s forged.

A suggested I get in touch once I’d spoken to my therapy group, but I knew if I left that office without making an appointment I would probably never contact her again. I told her that tends to be my pattern, so we’ve set a date to meet in three weeks’ time.

And I went to my therapy group that evening. It was difficult. I missed last week’s session because of the funeral, and it turned out someone in the group had admitted right at the end that they might have a drug problem, so everyone wanted to talk about that. I felt so frustrated and, yes, left out that everyone’s focus was on this other woman. The 90 minutes dragged on with no good opportunity for me to bring up what I needed to say. I prayed. I didn’t mean to pray, but it kind of slipped out (inside my head) and you should be careful what you pray for. With five minutes to go, another person mentioned that they find it hard to open up to the group and that was my cue. I shared that I find it very difficult too – to the point that I’m questioning whether group therapy is for me.

There wasn’t time to discuss it very much, so at the start of next week’s group, all the focus is going to be on me (gulp!) Group Therapist did say though that he wondered if it might be a gender issue. That I find it hard to open up because there are men in the group and it’s facilitated by a man. I don’t think it’s a gender issue. I have as many male as female friends and on balance I’m no more scared of the men in the group than I am of the women. That said, the coward in me is wondering whether requesting a female therapist (if I decide on individual psychoanalytical therapy) might be a way of avoiding saying that I’m not sure whether Group Therapist is a good match for me either.

To be continued…