In my work as a group psychotherapist, I am constantly reminded of the importance of maintaining the boundary between therapy and not therapy, not only because of the treacly consequences that can ensue when things get messy but also because of what is revealed about the members’ character structure when they bang headlong into the rules. It is always fascinating to me how fantasy trumps reality when unmet emotional needs get played out in the treatment .  This was most recently illustrated when a former group member contacted me for the phone number of a member of his  group. My rule is that members are anonymous to each other, only known by their first names, while they are in group treatment with me.  However, if both parties are amenable to it, and if they are willing to wait six months after a member terminates group, then they can have contact  outside of treatment.  This particular member, “Harold” left me a voicemail, only  a week after terminating treatment.  In it he said that of all the members, the one he missed the most was “Maude”. She was his favorite. In the next breath, Harold said that this was because she owned an investment firm and   that since he was no longer a group member, he wanted her to manage his money. I laughed to myself; now that he’s out of the group, Harold wants to immediately morph therapy into not therapy. I believe that once a patient, always a patient and so I was suspicious of Harold’s unconscious agenda. It wasn’t too deeply imbedded, I thought.  Having just left treatment, Harold had to know that his   desire for outside group contact was, at the very least, against the rules of my group practice. “ The no contact for six months rule” is in place to ensure that the desire for contact is more than just an acting out of members’ inability to tolerate the separation anxiety of leaving treatment. But there was more to Harold’s unconscious agenda–there was also an unspoken message to me.   Since money is always symbolic., Harold’s request for Maude’s phone so soon after leaving treatment told me that Harold’s need to be taken care, his need of immediate gratification, took precedence over his need to be analyzed. He was implicitly saying:” To hell with your rules, I want to be fed”.

When I told Maude about Harold’s request at the next group meeting, one member, Hortense, raised an objection.  She thought it was inappropriate for me to bring such a private matter to the group’s attention.   But another member, Hyman, understood. He said that since Maude and Harold are only known to each other through their group participation, then this was a group matter and that it involved everyone in it.  For Maude’s part, she was flattered by the proposal and quickly agreed to have her phone number given to Harold.  She said that her business had taken a recent downturn and she could surely use the business.  When I suggested that we talk about everyone’s feelings about this before going into action, she became angry with me for frustrating her need to ‘close the deal’.  It seemed to me that her emotional hunger was getting in the way of her thinking this through.  But it wasn’t until she told us that if Harold did call her, she could not discuss their business relationships with us because of client confidentiality– that I saw a big red flag.

Under any other circumstance, confidentiality between a client and his financial advisor, makes perfect sense; but not in this context because of the nature of their relationship prior to a business one. The ethical precept of confidentiality gets turned on its head in this case because a perversion of the ‘as if’ nature of the treatment relationship  that would  take place through the establishment of a dual relationship between Harold and Maude, that is, both as group siblings and as business associates.  If  morphing  the ‘as if’ relationship of group siblings into a client-advisor one leads to a conscious withholding of all Maude’s thoughts and  her feelings in the group, then this relationship would be destructive to her treatment.  The directive in group is; “say how you feel to the members of the group and why you feel that way”.  Clearly, a nascent business relationship between Harold and Maude would be a bad idea. Although Maude was angry with me, she understood that I would not give Harold her number.  I could not support this arrangement.  At the same time, if Harold were able to use his internet savvy to somehow find Maude, I couldn’t prevent that from happening and we’d have to deal with it should it occur.

Harold’s fantasy could in no way be matched by reality.  Even if Maude were to able to convert straw into gold, it still would not satisfy Harold.  His experience of childhood maternal deprivation has created an insatiable need to suckle. That is my understanding of the underlying unconscious want of his request. Today’s feast can never compensate for yesterday’s famine.   For her part, Maude’s need to be needed,  learned at the breast of an emotionally vacuous, narcissistic and depressed mother,  has compromised her good judgment, in her relationships in life and now in the group setting.  The early childhood maternal deprivation she suffered, that  led her to adopt  a role reversal in which she had to  take care of her child-like mother, now as an adult drives her to put her own needs aside and to first attend to the needs in others, in this case, Harold, even if it’s at her own expense.  The group experience fosters the ignition of strong regressive urges in group members.  To treat these fantasies as reality, more often than not, leads to disaster.  Reality can never match the magical power of the wishes of the omnipotent, yet impotent, infant.