I feel so strongly about ending group therapy but they won't let me!
June 14, 2018 5:03 PM   Subscribe

I've been in therapy since December. My therapist is great. We've mostly worked through the issues that I came into therapy with, and things were going good...until she recommended that I join a clinical group. And that is the very thing that is spiking me my suicidal ideation as of late. I'd like to get out but it's becoming very clear that I can't, and this is becoming a very big problem.

To recap, I suffer from depression and anxiety and have a variety of issues that come with that. I feel good about what we've worked on since December, but the general feeling of hopelessness was still there. Given my high suicidal ideation and two prior suicide attempts, in January my therapist recommended that I go on antidepressants. Which I did. For a variety of reasons, I went off them in late-March.

Looking back on it, going off my meds was a fantastic decision. I was experiencing high SI on them and since going off them it has definitely increased. I even had a 2 week span without any of those thoughts. However it was shortly before this time that I was perhaps at my very worst that my therapist has seen me, and she recommended I do psychological testing with another therapist at the practice. Which I did. When the results came back very negative, that is when she recommended I enter group therapy. Despite always being reluctant to the idea of it when she had brought it up before, I said OK.

So all of this happened during a time when I started feeling really better. When I did my psych test, I was feeling really bad...but it was weeks later when she got the results and recommended group therapy, at which point I went off the meds and was doing much better. I've been in group DBT therapy for two months, and it is increasingly becoming a problem. After the first week I went, I didn't want to go back. But I did. However after this past week, I just can't keep going.

(I should mention that my therapist previously led these group DBT sessions at the very practice I'm doing it at. So there's that.)

While I still experience SI, and I don't think that will change anytime soon, lately it has been lower...except for about group. Group is the very thing that is giving me suicidal thoughts. In DBT we talk about TIB, which is Therapy Interfering Behavior, and I strongly believe with no exaggeration that going to group is that.

There is nothing wrong with my group therapist or the people in group, but I can't keep going. Before group on Wednesday, I seriously contemplated killing myself...specifically because I didn't want to go. And then I went.

I feel forced. I feel cornered. She has stated multiple times that if I discharge from group, then she will give me two weeks to find another similar clinical setting, and if I don't then she will have to terminate. This is even with my saying that group is the thing causing me this discomfort and high SI. A few months ago I brought up in session and how I'm attracted to her and feel attached to her, which is what is making this so hard. I don't want to get a new therapist. My attraction to her is a non-issue as far as focus in session goes, and one of the main things we are working on is developing attachment to others outside of therapy.

There are a couple ways I can proceed from here, but I feel like nobody is listening to me. I get that this is her clinical recommendation, but this is having a negative impact on me and may be the very reason I go to the hospital within the next week.

Help! Am I missing something here? This all feels out of my control. I would have zero distress over the past week if it weren't for this, and I think it's ripping me apart.
posted by signondiego to Human Relations (10 answers total)
Is the problem that there are additional consequences (eg: insurance issues in paying for other therapy) if the current therapist "...will have to terminate."? Because if this therapist is coercing you into doing something that triggers your suicidal ideation, it seems like terminating this line of therapy isn't a bad thing.
posted by straw at 5:13 PM on June 14, 2018 [20 favorites]

I am not a therapist, nor your therapist, but I believe that if you were my client and if I were in that capacity to treat you... I would be extremely uncomfortable with your expression of attraction - which not only could be construed as possessive and dangerous, but could also be a larger part of the reason that your therapist would be trying to wean you off her. She sounds like she might be trying to do it gently, by delivering you to group therapy - but your negative reaction to it, and recoiling from it to strengthen your attachment to her, could be the means by which you will lose that therapeutic relationship. I'm not saying that this is the case for certain, but that it is one of many possible scenarios. If you think this is a possibility, and want to avoid a negative fallout, then I would simply remove yourself from her treatment before you are forcibly removed.
posted by itsflyable at 5:25 PM on June 14, 2018 [27 favorites]

DBT is not for everyone. A family member tried it, stuck with it but in hindsight it was so triggering that she spent the whole time managing her trauma and not learning.

I know that many DBT therapists require both group and individual counseling together but if that was your therapist's thing, I'm surprised that she didn't tell you that at the very beginning.

You have choices, your therapist should be doing what she thinks is best but you too have knowledge of yourself that deserves serious consideration.

Your only choices seem to be (1) continue with this therapist at the cost of going to group (a very high cost indeed), (2) quit the group, have your therapist tell you that she needs to terminate with you, find a new therapist and see what happens. The cost of this is having to find a new therapist and start over but that seems better to me than option 1. I suppose there is a small chance that you will quit and your therapist will change her mind, but that one you have no control over.

By the way, if she terminates you due to your decision to drop out of the group, she has an ethical and probably legal obligation to give you a referral to a couple of options of a new therapist. If she is good, she will be able to give you some good recommendations so option 2 may be less of a disaster than you imagine.
posted by metahawk at 5:28 PM on June 14, 2018 [7 favorites]

@straw: No insurance issues or any consequences of that nature.

@itslfyable: Actually, my attraction to her is something that we dealt with many months ago and hasn't come up since then. My difficulties in doing a possible termination with her lie in that but more importantly in that she is a really good therapist for me and I don't want to find a new one. Group is the only thing setting this off.

@metahawk: She does do DBT but definitely does not require people to also be in group. However, the group does require that you also be in individual therapy. She only referred me to DBT group once my SI had been high for some time. She did mention referrals.
posted by signondiego at 5:33 PM on June 14, 2018

Does she have an explanation for why she can't work with you if you're not in the group? Does she have a response when you ask her why doing something that triggers suicidal thoughts is a requirement to get treatment from her?

Her behavior seems very confusing and I wonder if she has given you an explanation that is unsatisfactory, if she's stonewalling when you ask, or if you haven't asked. Whichever it is, moving on to a new therapist may actually be the best move, though I know how brutal it is to search for a new one. Perhaps, if you are making a good faith effort to find a new therapist, she will be willing to extend the two week deadline.
posted by gideonfrog at 5:47 PM on June 14, 2018 [1 favorite]

There is one recurring thread in your post and comments that I am picking up on that may be useful for you to examine. It sounds like you are looking for a loophole- some way to have your affinity for your current therapist, and desire to continue your attachment to her, outweigh her professional (and your personal!) best judgment. This is not serving you.

You use language like "they won't let me!" and "I'd like to get out but it's becoming very clear that I can't". You also voluntarily mention your attachment to her, your and her shared understanding that you must learn to attach to others, not just her alone, and finally you mention your attraction to her. (I did catch and understand your perception that this attraction is a non-issue for her currently).

To me it sounds very much like part of what she is trying to address in group therapy is giving you a more wide open view of the world. One where you do not perceive the option of you leaving your current therapy paradigm as not being allowed to do what is right for you.

You have two clear choices-

1) stick with group therapy (BTW- don't try to parse her reasons for making this recommendation- just accept what she says at face value. She is a licensed clinician and if you trust her as much as you say, trust that she is giving you the best possible advice here as well).
You know this is leading down a bad path. Here's why:
a) It sounds like your attachment hasn't waned (which is a goal you both are working towards)
b) you have SI in group therapy settings
c) despite your trust/attachment to her, you perceive her recommendations for you as strong-arming you into suicidal tendencies-- and this is simply not the reality, as you do have a second choice.

2) find a new therapy route, with another therapist, that will not require group therapy. While this might be very, very scary, it is something that you and she could potentially be in partnership to identify a new therapist who
i.) does not require group therapy and
ii.) I would STRONGLY suggest is someone you are not currently or could see yourself becoming attracted to.
This would address:
a) forming attachment with a new person outside of her
b) your SI tendencies being triggered in group therapy and
c) being able to re-frame the way you see therapeutic recommendations. Again, it is going to be a huge shift in your world if you can get that someone recommending a choice that scares you does not mean your back is against the wall or that you are being disallowed from making the choice that is right for YOUR best interests. You will in your life have to make choices that are uncomfortable, but that ultimately help you grow, heal and thrive.

Please know I am writing all this out with deep compassion for you and your plight. I can only imagine it is extremely difficult to be in your shoes. I am advocating for you preserving your life, and opening up your perception of the world. You will have to decide which of the two options above is really worthwhile to you. I strongly advocate for the second. Please take care of yourself and I wish you the very best!
posted by seemoorglass at 6:28 PM on June 14, 2018 [29 favorites]

Do you feel like you understand why your therapist feels so strongly that you need to be in group therapy? I know you don’t feel listened to, but is she saying something you’re having trouble hearing? You describe this therapist as great, so you must respect her judgment.

That said, you really haven’t been seeing her that long. I know that finding a new therapist sucks, but it might be your best option. I personally hate groups, and if a therapist did this to me, I’d find a new therapist.

But you also need to understand that you do have a choice - it’s not the option you want - but she can’t make you do anything unless she has reason to believe you’re going to hurt yourself. The fact that you’re framing this as being forced to do something is troubling. The complication is that she has a choice as well. She gets to decide how she’s going to practice. There is no solution that allows you to override her choice.
posted by FencingGal at 6:43 PM on June 14, 2018 [3 favorites]

I am not a therapist, nor your therapist, but I believe that if you were my client and if I were in that capacity to treat you... I would be extremely uncomfortable with your expression of attraction

Attraction to the therapist is a normal and expected development in the course of therapy and most therapists should be trained to help you work through it as some kind of transference. Even if they don't use the language of transference, they know they bring up strong feelings in patients and can use that to help patients think about other relationships. Unless it's gone past talk or into some kind of inappropriate transgression of the therapist's life beyond the office, expressing attraction that you feel in therapy is what you are supposed to do, so you can use it to get insights.
posted by nantucket at 8:26 PM on June 14, 2018 [5 favorites]

Is your therapist insisting that you find another DBT group if you leave your current one, or just that you do group therapy in general? I spent about six months in DBT group therapy and found it enormously re-traumatizing for my PTSD. I don't have SI but also often felt "forced" into group (my therapist at the time was also the group therapist) and all the DBT methods really pushed my resistance buttons. And then we had to talk about why I was resistant and it would turn into this whole cycle of invalidation and feeling shitty about myself.

A different therapeutic modality might work better for you, is what I'm saying.
posted by camyram at 9:01 PM on June 14, 2018 [3 favorites]

Thanks everyone. Really great advice in here. In particular I find intriguing that a few of you were triggered by DBT itself, and that could be my issue here. I almost sent myself to the hospital over this today but now I am thinking a little more clearly and am going to discharge from group and figure the rest out with her in my next session.

To answer @camyram: She is definitely OK with another group, as long as it's in a similar treatment setting. I'm not sure how I feel about that, but I will talk it over with her.

I still find it hard to just walk away from her and see a new therapist, but all this feedback has helped tons. Thank you.
posted by signondiego at 3:09 PM on June 15, 2018 [2 favorites]

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