Brighton and Hove Psychotherapy

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Online Therapy In the Press

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A New Psychotherapy Group

Starting a new psychotherapy group always gives me a sense of excitement. Until everyone is in the room together you never quite know what’s going to happen. And of course, that’s just the beginning.

Growing a group

In group analysis we often talk about ‘growing’ a group. It’s a useful way to describe the process. Tilling the ground, adding nutrients to the soil, planting seeds, watering, feeding; all these gardening activities symbolise the tasks involved in trying to create a nurturing environment for individuals to come together and flourish as a therapy group.

Firstly, finding a good setting is very important. (I am lucky to already have a lovely group room at Brighton and Hove Psychotherapy in which my two current groups meet, so this isn’t a task I have to be concerned about).

After the setting I settle on a regular time and day of week for the group to meet. And then I see if I can find individuals who might be interested, can make that time, and who I feel might benefit from a group.

Suitability for group therapy

Although exploring who will join the group means giving time and support for potential members to work out if a group will be right for them, I will also be thinking about their suitability for group therapy, and this particular group.

A fundamental question in my mind will be about the level of interest the person might have in themselves and others. Curiosity is vital for individuals to benefit from the group and, also, for the group to benefit from them.
And it needs to be the right time. For e.g. someone who has had a very recent trauma or bereavement, might need to get help with this first before they are ready to be in a group.

The joining process – boundaries and culture

The group culture is important in making the group feel safe and therapeutic so there are certain boundaries that people need to agree to – e.g. confidentiality etc – before joining.

See my blog on The Process of Joining a Therapy Group for more detail about this and other aspects of the joining process.

Differences between joining a new group and an established one

There are certainly some differences in joining a new group than an established one. One of the features – if not advantages – is that you are at the core of the experience from the start and will inevitably have influence in shaping how the group forms early on. It’s perhaps akin to being the oldest child, as opposed to children who come after who may never quite fully share and know all the family history.

The first session

The first session of a new group is nerve racking for everyone – including me! Generally, it goes much better than people expect. Inevitably it can feel a bit awkward at first, but once these initial steps have been taken people usually do start to feel comfortable enough to begin opening up. Often people are surprised by how intimate it can feel so early on.

Common ground is usually found and, for many, it’s a major relief from the outset to see how their worries and fears become quickly normalised.

New group starting

I will be starting a new psychotherapy group later this year, running Thursday mornings on a weekly basis. If you’d like to find out more or explore the possibility of joining, do get in touch with me through my practitioners’ page.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes – 

The process of joining a therapy group

What is ‘othering’ and why is it important?

How psychotherapy groups can help change our internalised family systems

Is a Therapy Group Right for Me? Am I Right for a Therapy Group?

What happens in Therapy Groups? The role of the Therapist

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The Process of Joining a Therapy Group

Below, I am going to outline the process for joining a therapy group. It is important to say at the outset that I am describing my own practice and while the underlying principles will generally be shared by other group analysts, the specific processes and procedures will be variable. 

Taking the First Step

People come into my groups in a variety of ways. Some people get in touch because they have decided for themselves that group therapy might be helpful for them; they may even have been in a therapy group in the past, or a group might have been suggested to them. 

If you fall into this category, the chances are you will have already been thinking about the benefits of a group and are now ready to take that next step in joining one.

Others come with a little more uncertainty. They may have had a group suggested to them by their therapist or been assessed and a group strongly recommended. If someone hasn’t been thinking about a group before and doesn’t know much about group therapy, this suggestion can come as a surprise and, for some, take some getting used to.

If you fall into this category, then you may be feeling a little more cautious and might need more time to think about this idea of group therapy. 

Initial Consultation

When anyone gets in touch with me, with an interest in joining a group at the practice, I offer a short, free telephone consultation. This usually takes around 20-25 minutes and gives us both an opportunity to think about; why they are considering a group, whether group therapy is suitable for them and what spaces are available in which groups here at our practice. I may also ask a few questions about their background, current situation, and particular issues and most likely, we will touch on what might be beneficial and challenging about being in a group for them. 

This telephone conversation can lead to a range of outcomes. For the purposes of this article, I shall focus solely on what happens if we agree that a group appears to be timely and suitable for the person and I have a group space at a time they can make. 

Assessment

While the telephone conversation is useful in clarifying any immediate obstacles to someone joining one of my groups, it is not an assessment. Therefore, the next step would be to have a face-to-face assessment. This is done in-person if possible – unless of course it is an online group we are considering. 

This session will explore in greater depth what we would have covered briefly on the telephone. I will also ask more about the person’s history and encourage some thinking about their relationship to groups, such as, family, school, friends, work etc. As in all psychotherapy assessments, I will want to find out a bit more about the person’s relationships, problems, needs, risks, medication, previous psychological input, and levels of function. 

This session also gives them the opportunity to think in more depth about the idea of being in a group. This is helpful to get a firmer sense of why a group might help but also what challenges a group might present to them. 

Sometimes we need more than one of these assessment sessions before we’re clear that the person is ready and wanting to join a group. 

Finding a Time to Join

Once we’ve agreed that someone is ready, we need to think about when they will join. In a new group this is relatively straight forward – I give all prospective members a start date and they all join at the same time.

Joining an established group is a little more complicated as the group also needs to be ready to accept a new member. These groups are called ‘slow’ and ‘open’ which means while people join ongoingly we make sure this happens at a slow pace. This helps the group continue to feel stable and secure. 

As well as this factor, before the individual joins the group, they also need to be ‘ready’ and they will need some help in preparing for this. 

Preparation and Contracting 

I have generally found that anyone joining a group requires at least 2 or 3 preparatory sessions. Some need more and some decide to do some individual work with me first before joining the group. 

The preparatory sessions offer an opportunity to explore further the themes picked up in the assessment process. In addition, people often find it helpful to make some space for any anxieties that might arise.

This preparatory stage also allows me to talk about what is expected of group members. To keep the group therapeutically safe, all members are asked to agree to certain boundaries. An obvious example is confidentiality. Another is that members do not have contact with each other outside the sessions. These and other boundaries can be seen as making a contract with the group to keep it safe and therapeutic. 

First session

The first session can feel daunting, even for those relatively confident in groups. 

In a new group there can be a lot of anxious feelings in the group which can take several sessions to start to properly settle. However, everyone is in the same boat and often people find that reassuring and helpful. It can also feel important for some to feel that they have been in a group from its earliest inception.

In an established group, being the new person is always going to feel challenging to some extent and likely to bring up earlier experiences of being new (for e.g., starting school). However, the atmosphere is likely to be much calmer and less anxious than that of a brand-new group. Established members will also be able to help the new member settle in. Some people can also enjoy the feeling of being special that their newness gives them. 

Despite the expected anxious feelings new members are often surprised how quickly they form bonds and get to know other members of the group. This process is helped by the preparatory work and the boundaries agreed to by the members. 

Conclusion 

Whatever the experience of joining a therapy group the likelihood is it will feel powerful and tap into earlier histories and experiences of both groups and beginnings. The emphasis on stages of initial consultation, assessment, preparation, and contracting, are all in place to hopefully help and support the new group member in their own joining process. 

Joining a Group

If you are interested in exploring joining one of the groups mentioned above, please do contact me through the enquiry form.

Groups run by Claire Barnes

Claire currently runs two groups at Brighton and Hove Psychotherapy 

  •  once weekly group on Thursday evenings
  •  twice weekly group on late Monday afternoons, and Wednesday evenings.

She is also now taking referrals for a new face-to-face group, to run on Thursday mornings at the same practice and address. 

 

Further reading by Claire Barnes

What is ‘othering’ and why is it important?

How psychotherapy groups can help change our internalised family systems

Is a Therapy Group Right for Me? Am I Right for a Therapy Group?

What happens in Therapy Groups? The role of the Therapist

What happens in Group Therapy: Mirroring

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Is a Therapy Group Right for Me? Am I Right for a Therapy Group?

Are you finding it hard to know if group therapy is what you need or want? Below, I outline a few of considerations that might be helpful when thinking about joining a group.

Considering a Therapy Group?
You may have had a group suggested to you or know someone who is in or has been in a group. Perhaps you are aware of difficulties arising for you in groups and want to explore these further. And/or maybe you have had individual therapy in the past or recently and feel you have explored what you needed to in that work.

Whatever has led you to think about joining a therapy group, the idea is likely to feel a new and unknown prospect for you.

Group Therapy and ‘Real Life’
Group Therapy is often described as being closer to ‘real life’ than individual therapy. The other people in the group are not there in a professional role and although the group therapy culture is one of respect and support, members are also encouraged to respond and relate in authentic and spontaneous ways to each other. For some people this is off-putting but for others this is an attractive proposition and seen as a way of more directly experiencing some of the relationship dynamics they might have struggled with in the past or present.

The constant mirroring in groups between members offers ongoing feedback (what happens in groups: mirroring). Many people find this helps them develop a stronger idea of who they are in relation to others. If you are aware that you struggle with your sense of self or identity you will likely benefit from being in a therapy group where you can experience feedback from others as well as observe for yourself your similarities and differences.

Group members tend towards being supportive to each other but do, when the group is working well, offer a realistic mix of positive and challenging responses to each other. Some people who feel particularly fragile in the face of less positive feedback from others can find this too threatening a prospect.

Is this the right time for a group?
If, for example, you have had a very recent trauma or bereavement you may feel you need some more focussed one to one help on your individual circumstances and a group may not therefore be the place at this stage for you. However, this might not feel clear cut and the group therapist would be able to explore this with you. They might even be able to offer to work with you individually over your recent experiences until you feel ready for a group.

Groups and Belonging
Group therapy can be particularly helpful for people who have conflicts around belonging. This might relate to their family history, perhaps feeling they were always outside the family for different reasons, or it might connect to other aspects of their history or identities. Groups give a powerful sense of belonging. Once you join a group you are always part of it. Even after people leave, they are remembered as part of the group’s history. Groups also allow members to move in and out of experiences of outsider and insider-ness. This can offer experiences of, and help understand, relationships to belonging.

Isolation and shame
Like issues around belonging, groups can be particularly helpful for those who feel trapped by feelings of shame and alienation (shame). Most people find an immediate relief in a therapy group when they start to share their worst feelings and thoughts. The chances are always likely that at least someone in the group (and very often the majority) will feel similarly. Usually new members find that shameful thoughts, feelings or experiences become quickly normalised by the rest of the group.

For some though, the idea of making public what feels shameful is too big a step. Some people might benefit from seeing an individual therapist first where they can ‘test out’ their secret feelings, if the idea of speaking in a group feels too frightening.

Some feelings of isolation are easier to dispense with than others. Being in a group does not necessarily stop the individual having these feelings, and indeed the public nature of the group can heighten them. However, it is this very nature of group therapy that creates an opportunity to directly understand and address these difficulties.

The Therapy Group as Alternative Family System
Being in a group can feel like being in a family. Group members can start to represent family members to each other.
Families have their own ‘systems’, but the group creates an alternative (generally more benign and authentic) system which challenges the unconscious assumptions of members’ family systems.

This aspect of groups includes the opportunity to explore dynamics from past and present with siblings (Sibling Rivalry Part 1 and 2). Group members can often feel strong sibling-like feelings towards each other.
People who have had difficult family dynamics growing up, in my experience, gain a lot from the way the therapy group offers this alternative family system and allows explorations of sibling relationships.

What if you don’t like Groups…
If you do not like groups and the idea of being in a group scares you, you may, understandably, not want to join one. However, this might well be why a group could be the right kind of therapy for you. I explored this in more depth in another blog called ‘if you don’t like groups, could it be time to join one‘.

Commitment and Ambivalence
Joining a group requires making a commitment from the outset. Most group therapists will ask that you agree to a minimum of between 6 months and a year. This is an important requirement because someone arriving and leaving quickly can disrupt the group. So, I end this piece with the first question you perhaps need to ask yourself – can you practically make this commitment at this time.

This is a different question than having mixed feelings or ambivalence which is very normal and common when thinking about joining a group.

If you are not sure about whether you can or want to make the commitment, the group therapist can explore your uncertainty with you and help you decide.

Summary
This piece touches on some of the different considerations about joining a therapy group. I have not covered all aspects but focussed on those dilemmas and considerations that, have come to light most often in my experience of helping people think about joining a therapy group.

 

To enquire about psychotherapy sessions with Claire Barnes, please contact her here, or to view our full clinical team, please click here.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

The Problem with Change

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

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What The Role of the Therapist in Therapy Groups?

This piece is part of a series offering thoughts on the experience of being in a therapy group. It may be helpful to read if you are thinking about joining a group or running groups or if you are already in a group. 

When I am discussing with someone about joining a group, a common question is often around my role as therapist in the group.  Below I outline different aspects of the group therapist’s role as I see it. 

Dynamic Administrator

One important aspect of role of the therapist is to take care of the administration of the group. This includes managing boundaries and making decisions that maintain the group as a safe therapeutic space. This is called Dynamic Administration. 

This role includes assessing and deciding who will be in the group and establishing a physically safe and uninterrupted space for the group to meet in. It also includes setting out and maintaining boundaries for the group to keep it operating safely, consistently, and therapeutically.  

Group Preparation

The group therapist will also help the individual prepare for joining a group. As part of this, they will invite the potential member to speculate what kinds of experiences could be helpful, and what might feel more challenging, in the group. This can sometimes be a general discussion but is particularly useful when based on what the therapist and individual already know about their history – especially their history of groups. (see How important are our groups?)

The Group Therapist in the Group

One of the things I always say, in response to questions about how I will be in the group, is that I follow the group rather than lead it. This rejection of the role of group ‘leader’ is central to group analysis and its democratic principles. Instead of being called a leader, the therapist in Group Analysis is called a conductor. 

In group analysis, the therapist as is viewed as another member of the group. This does not mean they are not present in the role of therapist but more that the task of therapy is also shared with the group. 

The therapist as another member also refers to the concept of a network that all the members create together through their communications and relationships in the group – consciously and unconsciously. The group therapist is a part of this network and influences it – and is influenced by it – like every other member. 

Although they are a member of the group the conductor is very much there as a therapist and not a patient. So, they will act in similar ways to a therapist in individual work. They will not – or very rarely – disclose personal information and their focus is on the therapeutic needs of the group and the individuals in the group. 

My experience as the group therapist or conductor is that I move in and out of different positions in the group process. Sometimes I feel very central and very much a part of discussions, other times I am more in an observer’s role. When I speak it can sometimes be to the group as a whole or other times to an individual or individuals in the group.

As a group develops and becomes more used to working therapeutically together, I find how I take up my role often changes as well. What the group might want from me at the very start is often different as time shifts. And these changes can also take place from session to session. Individuals also might need or want different things from me as they do from other members, and this changes as well. 

Summary

This is a brief account of the role of the group therapist or group conductor, but I hope it has been able to give a flavour of what it might be like in a therapy group in relation to the therapist. I have described three aspects of the group therapist’s role – dynamic administration, preparing the individual joining a group, and the role of conductor in the group. 

 

To enquire about psychotherapy sessions with Claire Barnes, please contact her here, or to view our full clinical team, please click here.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

The Problem with Change

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

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What happens in Group Therapy: Mirroring

In this and other blogs I try and describe and discuss what it is like being in a therapy group. Here, I focus on the phenomenon of mirroring in groups which is an important group analytic concept, process, and experience.

Mirroring and Early Development

To understand why mirroring is important in any therapy, it is helpful to understand its role in early childhood development. Early in life, the baby relies on the care giver/s to provide ‘mirror reactions’ – that is, responses mirroring back their self. An obvious example might be a baby smiles and a parent mirrors back the smile they see the baby making. This helps the infant develop a distinction between ‘what is me’ and ‘what is not me’. In other words, a sense of self. Many of us have not had enough or effective enough mirroring early on in our lives and one of the key therapeutic elements of all talking therapies seems to be the corrective experience of having oneself mirrored back.

The Therapy Group as a Hall of Mirrors

Mirroring is a particularly important experience in group therapy and Foulkes (a founder of group analysis) likened groups to ‘a hall of mirrors’.

In a therapy group, members constantly reflect their responses to each other, while at the same time see themselves reflected, or not, in the behaviours and communications of others. As an individual in the group over time these reflections and reactions help to create a picture of oneself in relationship to others. As Foulkes put it:

A person sees themself, or part of themself – often a repressed part of themself – reflected in the interactions of other group members. They see them reacting in a way they do themselves, or in contrast to their own behaviour. They get to know themselves … by the effect they have upon others and the picture they form of them. 

Foulkes p 110 Therapeutic Group Analysis (my changes from masculine to neutral pronouns)

Vignette

To give a picture of mirroring at play in a group, below is a fictionalised account of a fictional group discussion between 4 members A, B, C, D

A is talking about his childhood and his experience of his disapproving father. B comments that the way A describes his father reminds her of sometimes how he is in the group. A goes quiet.

C says to B that she felt she came in too critically towards A, she often seems to be down on him. B says that A reminds her of her own critical father.

C says she is always much more struck by A’s vulnerability and wonders why B can’t see this. She’s worried now that he’s become silent.

A says he’s remembering last week an argument with his son who was angry he was always on his back. He realises he can be like his father at times.

D points out how C herself had jumped in to defend A. C wonders about it in terms of her own father who she felt was bullied by her mother. C says she envies how B seems to be able to say what she thinks. She always feels she needs to protect the other person.

A recognises he can be disapproving sometimes in the group and in his family. But he has never thought of himself as vulnerable. He feels moved by C’s protection, but it also feels new and strange to him.

In this vignette you can hopefully see the analogy of the hall of mirrors at play. The group members are constantly reacting to each other. The more the group allows openness and spontaneity the more can be revealed.

For example, the members reveal two different aspects of A seen by B and C. A is familiar with one but unaware or in denial of the other. He is moved when his vulnerability is seen but also disconcerted. B and C while having genuine but different responses to A also then recognise the parts of themselves or not that they are seeing in him – and for C what she also sees in B.

Responses to Mirroring

Mirror reactions can reveal ‘truths’ which may then be responded to by the individual in a range of ways. Mirroring in group therapy often operates at a complex and spontaneous level and can go on consciously and unconsciously, verbally and non-verbally. This experience is then hopefully utilised therapeutically by the group and the group therapist.

In my constructed vignette, the group members’ observations and responses are conscious and easy to verbalise. They are all able to make use of their responses to each other and the discussion is constructive and productive. It’s perhaps easy to see how their insights could lead to further therapeutic explorations in relation to past and current relationships. In a live group session however, responses to feedback can be more varied and complex.

“affect, understanding or intuition seen in or associated with others, can reveal truths about the self that may be welcomed, opposed, taken flight from or attacked.

Schlapobersky p 255 From the Couch to the Circle: Group Analytic Psychotherapy in Practice

Some ‘truths’ are deeply unconscious and like in the case of A can feel disconcerting when exposed. Others are harder in other ways to receive and may take time to be utilised, if ever.

Conclusion

The process of mirroring is only one aspect of what goes on in groups. However, it plays a key role in the group therapeutic experience. Many people seem to find group therapy particularly helpful for their confidence and sense of identity. While this will be down to many factors, mirroring between group members plays an essential part, helping the individual develop a sense and understanding of who they are.

 

To enquire about psychotherapy sessions with Claire Barnes, please contact her here, or to view our full clinical team, please click here.

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

What is it like being in a Psychotherapy Group? Case study – Joe

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

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Groups for Mental Health

“What we cannot hold we cannot process, what we cannot process we cannot transform, what we cannot transform haunts us. It takes another mind to help us heal ours. It takes other minds and hearts to help us grow and re-grow the capacities we have to transform suffering.” Joseph Bobrow

I would like you to consider the above quote in relationship your mental wellbeing. Are you confused by your reactions to thoughts, emotions and feelings, do they seem to come out of the blue? In a group you have a space, with others, to connect with and explore where these feelings and emotions are coming from.

In Group Analytic Psychotherapy, we learn to identify emotional states of mind, fear, anxiety, anger, love, and hate whilst we experience the biological reaction in our bodies; the mental and physical experience of trauma and stress.

At the present time we are facing the daily trauma of living through a pandemic that is killing people worldwide. We are bombarded with information through social media. We try to make sense of what is true/real and what is not. The social and collective nature of what we are experiencing impacts on our relationships with those close to us. The social matrix is changing rapidly we feel out of control, we look to those in power to take control and feel angry when they seem to let us down. This leads to greater divisions in the social matrix divisions occur that lead to greater anxiety and chaos, which, can predispose us to difficulties with regulating our reaction in our work or close intimate relationships.

The group provides a space for the transformation of our thoughts and preoccupations, working through our experiences, creating understanding through thinking, talking and feeling the emotion behind anger and stress. The group space, with an experience group conductor, can hold and contain you through this process.

 

To enquire about group sessions with Thea Beach, please contact her here, or to view our full clinical team, please click here.

 

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Group Psychotherapy in a post ‘Pandemic World’

Termination and endings in Psychotherapy

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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What is it like being in a Psychotherapy Group? Case study – Joe

In my experience, when exploring joining a therapy group, people often ask what it will be like. I thought it might be helpful to write a fictional narrative to give a flavour of the therapeutic experience of being in a group. This ‘case’ is not based on a real individual although some of the conflicts and difficulties will undoubtedly feel familiar to many. To keep this blog as a short read, I have simplified the details, and have focussed on just one aspect of a person’s history, difficulties, and group experience.

Joe

Joe would always say his childhood was fine. Nothing bad or traumatic happened. No real problems. As an adult, however, Joe felt increasingly alienated in his life and relationships.  In particular, he had struggled to maintain long-term relationships, which was causing him pain, disappointment and worry about the future. 

After his last relationship ended in a familiar way, Joe came into therapy with a sense of loneliness and emptiness. Through discussing this with the therapist, Joe came to feel that a group might be helpful for his difficulties.

Early stages

Once in the group, Joe found that by listening to the way others talked about their experiences, and hearing their feedback to his own, he could start to formulate some different perspectives on himself. 

Particularly new for Joe, was an insight into the ways he had felt neglected as a child. Joe began to connect old memories and recall new ones which gave a picture of a lonely child overlooked by two busy and distracted parents. It was a shock to recall this vulnerable and neglected younger self.

Joe was immediately struck by the supportive and open atmosphere in the group. At first, he found the curiosity and empathy that other group members showed towards him strange. Over time the other members pointed out how often he dismissed his emotional experiences, and the ways that he avoided being taken care of in the group.  Joe realised this was the first time in his life where he felt his emotional needs might be important. 

New Insights

Accepting that his early experiences might have been difficult and impactful was the first step for Joe. He began to realise how he had developed an emotional independence as a means of survival and had therefore set out to deny the needy part of himself. Keeping his needs at bay also required creating a distance between himself and others. Joe was desperately fearful of this defensive system falling apart, and of being thrown back into the loneliness of his childhood. 

A few months in to being in the group, Joe had an important insight that his relationships often began to fall apart around the same time that he started to feel an emotional commitment. Joe’s break-through was heightened by being able to link this to what he was discovering about himself and the feedback he was getting about the way he pushed people away in the group.

As time went on, Joe was able to open-up more in the group. He explored the patterns of relationships failing and was also able to learn from others who also reflected on their own historical and current relationship struggles, as well as developments and successes. 

Making External Changes

After about 18 months Joe was feeling settled in the group. He had started a new relationship, and with the support of the group was more conscious of what was getting stirred up in him and mindful of his impulses to escape the intimacy this person offered him. 

Crisis

The group had helped Joe get in touch with the painful experiences of his childhood that he had tried to deny and avoid. He found himself increasingly in touch with emotional needs that he had not had sufficiently met as a child. This made it harder to tolerate the times in the group where he felt unheard or overlooked. The more Joe opened himself up to his need, the more he felt wounded and frustrated when it was not met. 

Joe announced very suddenly that he was going to leave the group. The group members questioned the timing of this decision and Joe agreed to give it more time and thought.

The group and therapist helped Joe to think about the parallels with the times in his life where he tended to finish a relationship just as it was beginning to be. Joe realised that the frustration and upset he had been feeling in the group was bound up with intimacy. He started to see that leaving at this point was another way of avoiding the frustrations of having intimate relationships. Being able to make a link between what was happening to him in the group and his pattern of relationships helped Joe to properly understand himself on a profound and deeper level. 

3 years on, Joe is still in the group. Last week the other members and therapist were delighted when he told them he and his partner have decided to get married. 

Discussion

Joe benefited enormously from the therapy group from the outset and had been able to make significant progress and changes in his life, However, it was when his ‘problem’ manifested in such a live way in the group that something was able to transform on a deeper level. Joe’s frustration with the group was a turning point in his therapy as he had to confront pain reminiscent of his childhood and see how his habitual strategies of ‘ending’ relationships was a way of avoiding the reality of intimacy. 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

Silences in Therapy

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

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Group Psychotherapy in a post ‘Pandemic World’

I wonder how you have coped with the forced isolation imposed on all of us during the corona virus.  Has the weekly hand clapping made you feel more part of your local community providing some small contact with others during the week? Or have you been part of a family meeting on Zoom or with friends?

Now, that we are beginning to return to more familiar routines you may be wondering if joining a psychotherapy group might help with the re-adjustment to the ‘new norm.’

Our relationships with family, friends and fellow workers can be a source of inspiration and support; however, often it is these relationships that baffles us.  Joining a group can offer a space for you to share experiences and gain an understanding of yourself.

Why should you join a group?  Ask yourself, what are the difficulties I need to address?  These usually fall into one of two groups:

Emotions and feelings – which disrupt life including general performance of daily living skills. You may be taking medication to treat the affects of a disorder.  Common symptoms include anxiety and depression, obsessive-compulsive disorders, eating disorders and social anxiety.

Relational Challenges – we are dependent on our relationships with others to live a happy and secure life.  However, these often challenge us in ways we do not understand. The signs and symptoms above are often caused or cause problems in relationships both personal and at work.

What happens next?  When you contact Brighton & Hove Psychotherapy, your enquiry will be passed onto me.  I will then contact you via your chosen method of contact to discuss your concerns.  We will then set up an appointment to meet.

The initial Session – at this first meeting, you and the psychotherapist will have a discussion in order to get to know you. If you both feel joining a group would be helpful another session will be set up.  A questionnaire will be sent to you to complete.

Follow-up – at the next session, we will use the questionnaire to follow-up your history, which will have formed the bulk of the first session. What are you hoping for by joining the group? Depending on your needs for preparation prior before starting the group will be agreed.  I will ask your permission to share your name with the group in order to check out whether there are any boundary issues i.e. you do not know personally anyone in the group already.

Usually there will be at least one more session before you join the group.

The first Session – joining the group for the first time is always a challenge, you already know the psychotherapist and the names of the group members.

There is no set agenda, the group runs using free association.  The boundaries of the group are – (1) always start and finish on time, (2) it will meet in the same venue, (3) it is a confidential space which each person agrees to before joining the group and (4) the members of the group do not have contact outside of the group. It provides a predictable space and time every week for a minimum of 40 to 42 weeks a year.

 

FAQ’s

Can I be in a group and continue with my individual psychotherapy?

No, the group is the primary therapy for the whole time the person is in the group.  A process called splitting can occur if group members are attending psychotherapy outside of the group.

How does Group Psychotherapy work?

The group provides a space to explore relationships in action.  As we all come from families or experiences of care in our young life, these influences stay with us and shape how we are later on as adults.  The small group offers a space to reconnect with that experience and re-work, often-traumatic events, in a safe and secure environment.  In addition to making connections to the past, we can explore current relationships in our families, couples, social and work life. Change of this sort takes time therefore you will need to make a commitment of time for processing and integration.

How confidential is the group?

The group is a confidential space where members of the group are asked not to have contact outside of the group or to share what happens in the group outside of the group space.

How many people are in the group?

A small group has a maximum of 8 members, 9 with the conductor.

Why is the Group Psychotherapist called a Conductor?

This relates to the role of the psychotherapist in the group.  As the group matures the group members become familiar with each other; they know each other’s stories and begin to see the patterns each one may be playing out in their lives.  The role of the psychotherapist will be to bring together the voices much the same way as the conductor in an orchestra brings in various instruments during a performance.

Dorothea Beech is a Group Analyst with many years experience working in the UK and overseas.  She worked as A Group Analyst in South Africa as a Lecturer at Cape Town UCT and at Kwa Zulu Natal University in Durban, lecturing on a Masters Program in Group Work.  Her MA in Applied research was on Eating disorders. Her interests are in cultural diversity and trans-generational influences on the individual.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

Termination and endings in Psychotherapy

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

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Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

 

Thea Beech is a UKCP registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst.  Her work in psychodynamic psychotherapy spans 20 years in the NHS and for the last 10 years overseas in South Africa.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

Group Psychotherapy: The Octopus and the Group – what do they have in common?

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Silences in Therapy

Silences are an inevitable and potentially helpful part of the therapeutic process. However, a number of people I see as a therapist express a feeling that they are not getting something right when a silence arises in our work together. The psychotherapy world (in particular the psychoanalytic and group analytic fields) has also had some difficulties historically with accepting the value of silence.

A few years ago, I wrote about silence in relation to group analysis (Barnes, 2015) I felt compelled to do this as I had been working with a psychotherapy group that was gripped for some time by long, crippling silences. These silences affected the whole group and were intensely paralysing – for the group members and for me. I found it hard to help the group but also wasn’t helped myself by the general absence of clinical literature on this subject.

In my paper I made a case for the value and role of silence in therapy and specifically therapy groups. I explored how silence is a part of speech and that all speaking relies on pauses and breaks for our communications to make sense (this is, perhaps, most obviously understood in music). These rhythms and patterns in our communications are particularly important and central to the processes of therapy.

By just seeing silences as unhelpful we lose the opportunity to be curious about the different kinds of silences and what they might mean.  Below are some of the kinds of silences that can come up in the therapy relationship.

  • A common silence in therapy arises when both therapist and patient, or members of a therapy group, pull away from verbal interaction and retreat into a more internal space. Often, in my experience, this is when a discussion then moves onto a deeper level.
  • Sometimes silences are used to protect from scrutiny. Using silence as a defense can be bound up with early experiences of intrusion or a difficulty in asserting one’s self in interpersonal relations – the only protection then is to withdraw.
  • Then there is the paralysed silence, like the one that seemed to incapacitate my group for so long. People often say they can’t think in this kind of silence. When we’ve explored it more it seems they feel increasingly self-conscious in the silence and under pressure to break it – like it’s all too much responsibility. This seems to me bound up with shame.
  • But sometimes words just fail and just don’t feel enough. Silence can be used to convey this. Or to show a respect for the enormity of what is being felt.

In thinking about silence and speaking it’s also important to bear in mind the thoughts of French psychoanalyst Andre Green who pointed out how “behind the noise of words speech can be silent” (Green 1972). At times we talk in order to silence something uncomfortable, or just too painful.

Holding a silence can be a way – perhaps sometimes the only way – of staying with what feels difficult and communicating this.

References –

Barnes 2015 ‘Speaking with Silence. An Exploration of Silence and its Relationship to Speech in Analytic Groups’, Group Analysis, Vol 48 number 1

Green 1972’ On Private Madness,’ reprint Hogarth Press 1986

 

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

 

Further reading by Claire Barnes

Sibling Rivalry – Part 1

Sibling Rivalry – Park 2

What is loneliness?

50 years on, how free are we from homophobia?

If you don’t like groups, could it be time to join one?

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Group Psychotherapy: The Octopus and The Group – what do they have in common?

On my way into work the other day I happened to be listening to the radio when a program called “Inside Science” was playing.  The theme for the program was “Alien Minds”.  A man called Peter Godfery–Smith was talking about his book “Other Minds”.  He described how we assume the existence of a central nervous system, like our own, a brain commanding the peripheral nervous system.  He then went onto describe the Octopus, whose decision making processes, not sure this is the right word, are distributed throughout the body, the tentacles can act separately to the rest of the body.  He describes the research that discovered this; the podcast is available for you to listen to on BBC podcasts.

 Why did this stay with me? And why is it relevant to the group? When talking about groups we hear about a group mind, or the social unconscious (Hopper) using the symbol of something central acting on the individual, however, the description of the octopus would perhaps provide a better metaphor for group processes.  As individuals we like to think we are free to act from an autonomous position, however when we begin to think about all the influences around us, some known, others we are not aware of, we realize life is more complex than we thought.

When you join a group or team you have access to many minds working together, it multiplies the opportunity for self-awareness, for sharing experiences, for helping others as well as being a help and understanding.  Of course on the other side of this is what you are told might be difficult to hear, emotions connected to competition and rivalry, challenges long-held ideas, exposure to others who do not think as you do emerge.  However, if we are to build the resilience we need to face these difficult emotions in order to reach our potential.  

As the group develops, like the octopus, the group is held together through its biological connections that make it an integrated organism.  In the group, a matrix of interactions forms from the histories each member brings to the group, which cross from generation to generation as part of transgenerational processes, the social context with its vast variety of influences, economic, political and familial.

 As this plays out in the group each person has the opportunity of gaining insight and understanding into how they have been shaped by the many groups they have encountered throughout their lives and shared history. Relationships evolved, often unconsciously, to influence how we behave in the present, repeating patterns that may not be healthy and need adjustment to enhance our mental wellbeing.

Thea Beech is a Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst and works from our Hove practice.  She is currently running an psychotherapy group which is accepting new members.

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What is Sibling Rivalry? – Part 2

Over two blogs I have focussed on one area of sibling relationships, namely rivalry. In part 1, I looked at some aspects of sibling rivalry as they can surface in childhood. In part 2, I will suggest how these might impact on ongoing struggles in adult life, before suggesting ways in which problematic issues with rivalry can be helped.

Sibling Rivalry in Adulthood

Feelings of competition and rivalry are perfectly normal and to be expected in adulthood. However, when childhood rivalry has been particularly problematic and unresolved, this can shape and lead to intense struggles later in life. Below are some thoughts about sibling rivalry and adulthood.

An obvious impact is in relationships to competition. Difficulties might particularly arise at work, socially, in educational settings, or any other situation where competitive feelings are heightened. This might lead to over competitiveness at the expense of other experiences – for example friendship, fun, comradeship etc. The rivalrous person may be driven towards success, however, often these feelings just seem to cause paralysis, procrastination, and low-self-esteem, as the individual constantly measures themselves against others.

As siblings are the earliest relationships they become a kind of template for later relationships. If feelings have never really got beyond negative experiences of aggression and dislike, this can make it hard to establish positive, caring and cooperative adult relationships.

Siblings who hold onto intensely rivalrous feelings, may be unable to establish a good adult relationship with each other. They therefore lose out on what these uniquely close alliances can potentially offer.

Sometimes sibling rivalry that’s not overt in childhood later manifests in adulthood. This can often be triggered through a change in the family dynamic. The most common is the serious illness or death of one or both parents. In these circumstances, feelings of rivalry can intensify or, if latent, can suddenly manifest. This is particularly common if there are issues around sharing responsibility or care for the parent, or around inheritance.

Fair shares and mutual concerns

Dennis Brown, a group analyst, wrote a paper entitled ‘Fair shares and mutual concern: The role of sibling relationships’ (1998). He explored how these rivalrous battles with siblings belong to an early stage in the individual’s development and that in healthy childhood psychological growth there is a shift to a more cooperative position towards siblings and therefore later relationships.

Our relationships with our siblings are usually the earliest experiences of grappling with love and hate for our peers. It’s important that aggression, jealousy and rivalry can be countered by experiences of love, companionship, and affection. Achieving this in childhood helps this balance of positive and negative feelings in later relationships.

The potential for change

But if this change hasn’t taken place in childhood can anything be done in adulthood? Below are some suggestions of how to work towards resolving the more crippling preoccupations with ‘fair shares’ towards a greater feeling of ‘mutual concern’ for and with others.

One way forward is to try and develop an adult relationship with your adult sibling. Sometimes family members get stuck in a narrative belonging to the past. We carry the child templates of our siblings inside us without perhaps getting to know the adult version. This is particularly compounded if relationships don’t develop outside of the family environment, for example when siblings only ever see each other in the presence of the rest of the family, particularly parents.

During or after times when you find yourself preoccupied with doing better than others, or having painful feelings of inadequacy or exclusion, it can help to reflect on links between this experience and what you may have felt as a child in your family. This can help you step away and separate from those past dynamics, reminding you that this is no longer the actual situation you find yourself in.

I mentioned earlier that sibling rivalry can worsen or manifest after a major family dynamic change such as brought on by the illness or death of a parent. Sometimes the opposite shift can happen. For example, the loss of one or both parents, or other family events, can suddenly bring problems of historic rivalry between some siblings to a natural end.

The Role of Group Psychotherapy

Group psychotherapy is particularly helpful in working through the difficulties arising from unresolved sibling rivalry.

Being in a therapy group stirs feelings of rivalry for everyone in it. In this way, it tackles rivalry in a way that individual therapy (where you have all the attention to yourself) can’t. Bringing these feelings alive and to the foreground means they can be worked with head on in the safety of a therapeutic environment.

In a therapy group, members find that each other remind them of their siblings, some more obviously than others. This offers an opportunity for working through difficulties that they may have had growing up with actual siblings. Members can then develop the kind of affection and closeness with rivals that might not have felt possible growing up or since.

Group members often find that the group feels a bit like an alternative family. This gives the opportunity for everyone – including ‘only’ children – to have different kinds of ‘sibling’ experiences than those they grew up with.

Conclusion

Preoccupation with ‘fair shares’ is symptomatic of a world where we feel pitched against each other and encouraged to see ourselves as alone. These feelings can be particularly heightened if the conflicts of our earliest peer relationships have not been resolved. Psychotherapy and counselling give the opportunity to explore and understand these deep rooted and painful experiences and how they may continue to have impact. Psychotherapy groups emphasise our connectivity as human beings. This challenges the notion that we are on our own, offering a direct release from the paralysing grip of rivalrous conflicts, towards greater co-operation, affection, and ‘mutual concern’ in our relationships.

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

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What is a Psychotherapy Group?

Most of us, at one time or another, have avoided groups.  Whether it was not attending a party, preferring to stay at home and watch TV after a long week or finding a reason not to go to that meeting at work because it always makes us feel uncomfortable. 

When I suggest to a client that group psychotherapy might be helpful, the impression I am often initially left with is it raises anxieties for them.  These are usually based on concerns about talking to strangers about personal and intimate aspects of our lives. 

Worries about confidentiality, sharing space with others and getting needs met with others competing for attention can also dominate.  All of these are perfectly reasonable objections and reassuring people that they will not encounter such experiences is not the purpose of the work before joining a group.

What can group psychotherapy offer?

A group offers the opportunity to tackle competitiveness, dealing with rivalry and finding a voice in a group. What you will be gaining is a sense of your self through the eyes of the group, giving you a perspective on yourself from each member. A mirror for reflection, through the process of sharing with others and learning from them. The relationships in the group offer a place to play out fears in a safe and contained space.

What can you expect if you want to join a group? 

The type of group I have described above is called “A Slow Open Group”.  It consists of a Group Analyst or Conductor, from 5-8 members, meets weekly for 1.5 hours for 42 weeks a year.  You will join the group for a minimum period of 6 to 12 months.

This seems like a big commitment, are you a member of a gym with 12 months membership, which is usually rolled over; this is like a gym workout for the mind with the added advantage of a team of players to work with.

If you are joining a new group you will have seen your group conductor sometime before the group starts, he or she will have spent time with you getting to know you, finding out whether there are any boundary issues with other members.  This is a “stranger group” knowing someone beforehand, a friend, family member, however distant, is not conducive to developing a safe and confidential space for open and free discussions.

The group provides a relational field or matrix for exploring and understanding our emotional lives.  Your needs may be in your relationships within the family /partnerships/ friends or at work managing others, handling team rivalries or even in the area of sport where managing morale is essential.   Isn’t it in every aspect of our communal lives?

Dorothea Beech is a UKCP-registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst.  She will be starting a slow open group in October running weekly from our Hove practice.

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