Around session five of such a group, Ms. A arrives in a manic state; previously depressed, she now reports that she is feeling much better. The reason for this is that she has started to cut herself again. No one else in her life, apart from those of us here in the group, is aware that she harms herself. And she feels great!

Ms. A is wild-eyed and her repeated declaration that she is feeling very, very good, worries the therapist. This feels like a crisis and it is the first that the group has produced, so it is at a sort of crossroads.

Some group members seem to withdraw into themselves; others are ready to respond as though they interpret their task as one of advising and influencing Ms. A. They offer reasons for not cutting herself, strategies for refraining from doing so when the impulse arises, and so on. However, these are not well received by Ms. A, who has become the focus of considerable attention. Indeed, the therapist is

What and Who Belong in the Group ? Managing Early Crises

aware that she has repeatedly told the group how wonderfully effective is the self-harming behavior; it makes her feel great.

One by one, the group members give up. At the same time, the therapist feels an increasing sense of anxious responsibility: Ms. A is going to need more help than this group is capable of providing. Perhaps she will have to be referred elsewhere. At the very least the therapist will have to see her individually, in order to try to address her dangerous self-harming behavior. He or she feels angry with Ms. A and afraid that the group will disintegrate.

At moments like this, the therapist's own state of mind may be a good indicator of what issues are being worked out in the group. Generally, when we experience a sense of crisis, it suggests that very basic conflicts and fears are being dramatized; here, it would seem to be the conflict between individual and group needs.

Attention is focused on an individual whose problems seem intractable and "too much" for the group. The therapist feels he or she has made a grave misjudgement and is losing faith in the group's ability to manage Ms. A's disturbance. He or she becomes aware of the attention focused on him/her: everyone else is at a loss, so what can the therapist come up with?

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