Sunday, July 15, 2012


I used to work in a residential treatment center for teenage boys.  It wasn't all that uncommon for one of the boys to get angry at me or to become hostile.  There was one resident in particular who used to threaten to kill me everytime I did or said something to upset him.  Eventually, I learned what made him angry.  I avoided doing these things whenever possible but some things were unavoidable.  I didn't take it personally.  It was my job to give him bad news.  If it had been someone else's job, he would've threatened to kill them instead.  It was just his way of reacting to things he didn't want to hear.
I was pretty thick skinned back then.  I had to be in order to survive in that setting.  I worked there for three years.  After I left, I started working as an outpatient therapist.  One of the things I found most refreshing about outpatient therapy was how my patients treated me.  They were appreciative!  During the entire three years I worked as a residential therapist there were only two - two - boys who thanked me for helping them.  As an outpatient therapist, there were at least two patients who expressed appreciation to me in the first week.  The difference was that my therapy patients actually wanted my help; most of the boys I worked with before were only there because they had to be. 

Looking back, my years as a residential therapist were a valuable learning experience.  I not only grew as a clinician during that time; I grew as a person.  I learned to set limits, to be consistent, and to maintain clearly delineated boundaries.  I learned how to let go of wounded feelings out of necessity; I couldn't refuse to work with a resident just because he said or did something to me that was cruel or hurtful.  I left that job a better person than when I started.  I assumed these were permanent changes and that the things I learned there would stay with me forever.

But time can make you forget.  I've grown accustomed to patients treating me with kindness and respect.  That's not to say that my interactions with patients are always cheerful or pleasant; they're not.  Still, I rarely - if ever- encounter the level of hostility I used to get from some of the boys at the residential center.  I guess that's why I was a bit taken aback last week when a patient became hostile during a group therapy session. 

I really didn't know how to respond.  Group therapy has always been a struggle for me anyway; I intentionally avoided doing therapy groups for about three years because talking in front of a big group of people makes me feel self-conscious and uncomfortable.  On top of that, a couple of weeks ago my supervisor asked me to sit in on some of the groups run by other clinicians.  Our clinic asks therapy group members to complete anonymous feedback forms; it seems my groups haven't been getting rave reviews.  The hope is that by observing other clinicians' groups, maybe I'll learn something that will help me become a better therapist. 

Suffice it to say, group therapy is not my forte.  Then, out of the blue, one of the group members blows up on me.  I expected him to walk out when he was done yelling.  I was kind of disappointed when he didn't.  The entire group fell silent; no one said a word.  (I guess I wasn't the only one who didn't know how to respond).  After a long period of silence, I looked up at the clock.  "Well," I said pleasantly.  "It's a little early, but we'll go ahead and wrap it up for today.  Thanks everyone."  With that, I stood up and went back to my office.

It occurs to me as I write this that maybe it's not the hostility that upset me after all.  It is what I thought initially, but writing this has helped me to sort out my thoughts.  I think the incident felt sort of like a confirmation of how bad I am at group therapy.  It's sort of disheartening.  I'd resisted doing groups for a long time.  Still, when I couldn't get out of doing them anymore, it turns out that it wasn't as bad as I'd thought.  But perhaps I was wrong about that.


  1. At least didn't say, to the culprit of the blow out, "Now, how does that make you feel?" Obviously the patient has many issues and trying to come to any understanding you run the risk of embarrassing them. Just skip doing group, too many factors involved to make a patient grow unless they bond right away with the common suffering.
    Do what you are good at(quit being hard on yourself), these are people not machines so it can a wise move.

  2. As you mentioned in the beginning of your post, when working in residential setting, don't take it personally. It wasn't you but something the person needed or wanted to express at that time for whatever reason. Maybe it was a gift to you to help you remember how you handled it before, how you appreciate being more appreciated in your current work setting and how to improve at group therapy. I appreciate your posts and I look forward to them each week. Thank you for what you do!,

  3. Well focus on your strength and don't worry so much about your weaknesses. I sure as heck prefer to talk to my coach one on one...

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