When I opened the door to my office and stepped into the waiting room, I was immediately struck by the beauty of the young woman seated there. She had long blond hair, translucent skin and blue eyes, as if Marilyn Monroe herself had somehow come back to life and was now here to see me for a consultation about group therapy. I invited her into my office. She sashayed across the room, radiating sexual energy; and I was mesmerized until she sat down and I asked her, “How can I help you?” I snapped back into reality, as a group psychotherapist interviewing a prospective group member, and listened intently as she told me why she was seeking my help.
Her individual therapist recommended group therapy because Debbie’s addictions were out of control (all identifying information has been altered to protect confidentiality). As a child, she had been sexually abused by her alcoholic father. As an adult, Debbie had been self-medicating her intense social anxiety with alcohol and sex. She told me her history of deeply conflicted love relationships. Debbie tended to cling to destructive relationships and destroyed healthier ones. Though bright and competent, Debbie had had a series of affairs with her married male bosses that fired her after a few weeks of employment. As she was telling me this, Debbie stood up and walked toward me. When I asked, “What are you doing?” She said: “I want to sit on your lap.” In a firm voice I said, “No! Sit down and talk.” Debbie reluctantly sat down and spoke. She was clearly angry that I frustrated her need to go into action, but she did talk about her use of sex to control her anxiety. It was her way of feeling powerful in relationships with men. Had I allowed her to sit in my lap, she would have had immediate contempt for me. Aside from the obvious ethical implications, the treatment would have been destroyed before it even began.
I agreed with Debbie’s individual therapist that group therapy could help her learn to develop constructive ways to manage social anxiety, but this would be a daunting task for her. Clearly, Debbie had difficulty controlling her impulses, helping her would be a challenge. I told her that I would work with her but under several conditions: 1. Join a 12-step support group in addition to the group therapy 2. No alcohol for 24 hours before and after group 3. Abide by the group contract of no outside contact with other members 4. No physical contact or any kind in the group (if members are allowed to hug, there is always the danger that they will hit too) 5. Agree to allow me to talk freely with her individual therapist about any and all matters related to her treatment. She agreed to give group a try; but I had the sense that Debbie’s heart wasn’t really in it. It seemed to me that she was just complying with her individual therapist’s referral to group therapy. In my experience as a group leader, I have observed that when a patient merely complies with the treatment plan, the odds are that sooner or later, (s)he will defy that plan. I wasn’t totally surprised that before too long Debbie began sabotaging the treatment.
I placed her in a group with high functioning people. The women in the group were successful strong and accomplished, able to advance in their careers without an over dependence on men for guidance. Debbie was competitive with these women and tried to best them in the only way she knew, her alluring ways with men. In group, Debbie was quite a colorful character, a femme fatale. She told us that she informed prospective boyfriends that her theme song was a variation of Madonna’s ”Gonna Dress You Up In My Love.”. Only half-jokingly, she told them, ”Gonna Mess You Up with My Love.” That’s her disclaimer. If you choose to stay, don’t say she didn’t warn you. She knew what she was doing was off-putting but felt helpless to stop it, even if she had wanted to. Debbie derived too much gratification from symbolically killing off the men in her life. In their book, “Stop Walking on Eggshells”(1998), Mason and Kreger begin by saying:” People with Borderline Personality Disorder (BPD) challenge those close to them with their often bewildering mood shifts and unpredictable behavior” ( p. vii). That’s a fancy way to state the obvious: in relationships, borderlines make a mess.
Debbie enjoyed teasing the men in group with such lines as: ”I love my nookie” and ”I’ve got the red hot hornies.” When I asked her if she had gotten the reaction she wanted, she nodded her head– yes. One fellow, Don, was captivated by her and told her so. She was flattered, of course, but that’s where it stopped. Another member, Matt intuitively understood her game but hated her for it. This was partly because he was the male version of her. The women in the group had mixed feelings toward Debbie. Some admired her ability to draw male attention and were jealous of her power over them; but another woman, Martha, saw through the veneer and felt compassion for the unhappy woman.
Debbie told the group a prophetic dream, a portent of things to come. She dreamt that a man dressed like a rabbi, with a white beard, long black coat and yarmulke, invited her to enter a synagogue and join the congregation, but she refused. I asked the group how they felt about the dream and what they thought it meant. Marc said he was alarmed. He thought the dream was about the group. He believed the dream meant that I was the rabbi trying to lead Debbie to a higher level of awareness but she wasn’t interested. I didn’t know if his interpretation were correct; but I told him that I liked the way he was thinking.
Debbie skipped sessions without calling ahead of time. When I asked her: “Why was it okay not to call?” Her answer was flip and bluntly dismissive. Debbie said:” Calling you was not a priority”. She missed as many group meetings as she attended and when she did attend, Debbie would show up at least 15 minutes late, at times, reeking of alcohol. As she walked to her seat, I asked: “What do I smell?” She said it was her new perfume. “Strong fragrance, isn’t it ?” she chuckled. Paula sarcastically quipped: “Smells like booze”.
Soon thereafter, I received a call from Debbie’s individual therapist. She asked if I knew that Debbie had started an affair with Hal, one of the married men in the group. This was news to me. Neither Debbie, nor Hal, spoke about their outside relationship. I thanked her for this information then fretted about what to do with it. Hal had his own axe to grind with me. Having grown up under the yoke of a tyrannical and controlling father, Hal often challenged my authority. He enjoyed taunting me. For instance, at the end one session, as he handed me his check, he pulled it back as I moved forward to take it. He laughed heartily. It seemed to me that having an affair with Debbie was Hal’s way of flipping me the bird, oedipal style.
I knew that the dynamic process had been compromised by their affair and that to preserve the group’s integrity, one of them had to be removed—But which one? The rule of thumb in a case like this is– the newer member must leave. Before taking action, however, I decided to join the resistance. At the following group meeting, I began by addressing the members in hushed tones:” Shhhh! There are secrets in the group and I advise that we all whisper”. I deliberately avoided eye contact with both Hal and Debbie. Members looked at each other incredulously. But before anyone could respond, Debbie stood up and headed for the door. I told her: “Sit down and talk!” This time she didn’t listen. Debbie stormed out. My phone calls to her went unheeded. Although, she spared me that angst of having to remove her from the group, I nonetheless worried about what my part was in her failed treatment.
Debbie could not set limits for herself but she initially seemed relieved when I set them, even though she resented it. Since sex was such a prominent defense for Debbie, it was my belief that her individual therapist had been correct in making the referral, even though the treatment outcome was unsuccessful. Debbie sexualized her dependency needs. Far from stabilizing her, this solution only caused her even greater stress and anxiety. A key to the potential success of her group treatment would have been if Debbie could have cultivated nurturing and safe relationships with the women members. This could have provided her with a corrective emotional experience. But Debbie couldn’t help herself. She was compelled to repeat the same self-destructive and destructive pattern of her life; and I was reminded of the need for humility in this profession. Not all group members will allow themselves to be helped.
Reference
Mason, P.T. & Kreger R. (1998). Stop walking on eggshells. Oakland, CA: New Harbinger Publications, Inc.
