Wednesday, August 20, 2014

NOT ALWAYS AS IT SEEMS

Chris is in his early 30s. A talented accountant, he’s succeeded in many areas of his life despite a less-than-ideal childhood. His father was a harsh and erratic disciplinarian and the whole family simply endured his volatile moods. Once Chris left for college and was able to distance himself from this unpredictable environment, he started to realize that he had real trouble letting his guard down enough to connect with others. After getting settled in a good job, he decided individual therapy might be beneficial. Therapy really helped him understand how his difficulties at home were complicating his life. Even though Chris was receptive to new viewpoints and input, he recognized his difficulty in translating them into his relationships with others. His therapist, Laura, appreciated his commitment and effort in his individual work and believed that interaction with others in group therapy could advance his interpersonal goals. With this in mind, Laura, who is also a certified group psychotherapist, suggested he consider joining one of her groups. Chris liked the idea of adding group therapy to his work in individual therapy.

In group, it wasn’t long before Laura observed how the usually-affable Chris clouded over whenever Joe took the floor. She also noticed his apprehension when Mary periodically collapsed into tears. In Chris’ individual session, he openly expressed annoyance at Joe’s tendency to ‘hijack’ discussions with his own specific agenda. Chris explained that when Joe inserts himself and takes over, how despite his best effort to stay unruffled, he feels angry. Mary’s tears frighten him because he never understands what causes them, so he doesn’t say anything. Laura shared how at these times she senses that he seems to stiffen. At first Chris was confused by Laura’s description of his behavior in group. Upon reflection though, he shared that when he doesn’t know what to do, he just shuts down. Chris went on to say that he doesn’t think being in group is helping him.

Clinical Considerations
In Laura’s supervision session with me, she explained that Chris associates Joe’s tendency to dominate the group with his father’s behavior. However, Laura was puzzled about whom Mary might represent for Chris. I wondered if perhaps both Joe and Mary represent Chris’ father. Laura noted the parallel impact of Joe’s intrusiveness and Mary’s tears on her client and how these expressions of intense emotion seem to stimulate vulnerability in Chris. Laura then expressed concern that the group experience might be too overwhelming for Chris. When he “shuts down”, it is at the expense of his own progress: each time he emotionally leaves the group, he loses an opportunity to explore his feelings and ultimately to change his behavior. I recalled how moved I was by Chris’ trust with her in individual therapy and Laura wondered if Chris could access his secure connection to her when he is in group. If he could, then group could become the safe environment he needs to make the changes he wants. Laura believes that in time Chris will be able to identify and explore his instinct to retreat in the face of intensely expressed emotions and the vulnerability they represent. She looks forward to the time that Chris will be able to openly connect with others in his group.