Resurrection After Rape Community Group
Discussion, question-and-answer, general social support, and journal processing for progress-oriented rape survivors. No crisis, no damaging or triggering conflicts--this is for individuals who want to contribute to collective, cooperative action toward the goal of making actual PROGRESS through rape trauma. Much of this work is based on the book "Resurrection After...
(Long and clinical; sorry--I just had to capture some things on my mind)
"It is imperative that clinicians remember that decades of research consistently demonstrate that relationship factors correlate more highly with client outcome, than do specialized treatment techniques." (L. Castenguay, et. al., 1996)
"In many studies, what therapists say and do in the therapy hour that promotes a good working alliance has proven to be the most important contributor to change and positive treatment outcome." (E. Teyber and F. McClure, 2000)
The therapeutic alliance isn't everything in therapy--it's the only thing. No other single factor affects therapy outcomes more than the quality of the client-therapist relationship. One study (Lambert and Barley, 2000) reviewed over 100 previous outcome studies and found that specific techniques used by the therapist accounted for only 30% of the positive outcome. However, the quality of the bond between the therapist and client predicted the results more than 40% of the time!
Factors that influenced this bond included credibility (does this therapist know what they're talking about? And does the client trust the therapist's "rightness" on tough topics?), trustworthiness (Is the therapist "real", and do they truly care about you?), and expertness. The therapist-client relationship is a vehicle that enables and facilitates the specific counseling techniques used by the therapist.
What does this mean in plain language? It means that there is objective data that consistently finds that how the therapist and client *feel* about each other MATTERS. In fact, it is the top predictor of the outcome. It isn't an indicator of "poor boundaries" or "inappropriate emotion" for the therapist to care deeply about his client (and vice-versa); in fact, it is probably the most crucial, necessary, vital aspect of treatment.
In the book "How to Fail as a Therapist," the authors (Ph.D.'s in psychology) include this specific error: "emphasizing technique over relationship-building." The authors states, "The lesson here is one that is all too commonly missed: The therapeutic relationship trumps technique...interviews with clients repeatedly show that...Even though you may have all of your licenses, credentials, and degrees prominently and tastefully displayed on your office walls, it takes time and relationship building to gain the confidence of most clients." One client (who is a DS member) who came through my group in January (who is mentioned by name in my book) still stays in touch with me, and told me this past Friday, "You're the only therapist I've had who I actually want to stay in touch with."
Another mistake therapists make is failing to communicate sufficient empathy and signs of support for their client. It is ESSENTIAL that a therapist show a warm sense of support, care, and dedication to his or her client. I can have the best books, research, and techniques training in the world, but until I am able to show genuine affection and connection to my clients, it means nothing. Many clients terminate therapy because they feel that their therapists lack these qualities.
This can be difficult, too, because as a therapist i have to be able to say difficult and painful things to my clients--they have nicknamed them "Damn you, Matt! moments" (or "DYM's" for short)--and some aren't ready. Some clients don't want corrections in their thinking, they want sympathy and acknowledgment of their pain. And this can be tough, because I don't have a molecule in me that is willing to simply validate pain and allow a hurting person to remain otherwise unmoving in recovery. I regard this as "velvet-gloved abuse."
As a result, when someone complains of flashbacks, panic attacks, distress, self-injury, and suicidal thoughts, I have to tell her directly and honestly that these things do not get better on their own with the passing of time; in fact, they get worse. I have to tell her that the only way out of this is THROUGH it--to stop fleeing and face it directly, and use clinically-guided therapy to overcome these pains. Some people are ready to hear this and it offers them hope for a way out; others are shocked at my "cruelty" because of my refusal to soothe, pet, and console them in their present state. But this blunt, difficult realism can be part of a healthy therapist-client relationship; my patients know that regardless of my love and care for them, they will never receive a watered-down version of truth. As a result, they trust the feedback to be clear, honest, and uttered with genuine concern for them. They also know that they can dispute things with me, disagree, confront me, even lash out at me, and I will not, under any circumstance, retaliate.
If someone is uncomfortable with the direction of treatment, or the traits of the therapist-client relationship, or the techniques being used, or my conclusions, I'm not going to feel threatened and get "nasty" or snide in response. Usually, a client who fears that their therapist would retaliate with anger is transferring her own experiences with a parent of the same gender as the therapist (in my case, for example, a patient who thinks I would punish or yell at or retaliate against her for "standing up to" me or confronting me is the daughter of a punitive father, and she transfers that lifelong learning into her expectations of ME, despite zero evidence of me being any such way whatsoever.)
--Intermission--
Coming up: why clients sometimes squirm with discomfort at being empathized with by a caring therapist.
"It is imperative that clinicians remember that decades of research consistently demonstrate that relationship factors correlate more highly with client outcome, than do specialized treatment techniques." (L. Castenguay, et. al., 1996)
"In many studies, what therapists say and do in the therapy hour that promotes a good working alliance has proven to be the most important contributor to change and positive treatment outcome." (E. Teyber and F. McClure, 2000)
The therapeutic alliance isn't everything in therapy--it's the only thing. No other single factor affects therapy outcomes more than the quality of the client-therapist relationship. One study (Lambert and Barley, 2000) reviewed over 100 previous outcome studies and found that specific techniques used by the therapist accounted for only 30% of the positive outcome. However, the quality of the bond between the therapist and client predicted the results more than 40% of the time!
Factors that influenced this bond included credibility (does this therapist know what they're talking about? And does the client trust the therapist's "rightness" on tough topics?), trustworthiness (Is the therapist "real", and do they truly care about you?), and expertness. The therapist-client relationship is a vehicle that enables and facilitates the specific counseling techniques used by the therapist.
What does this mean in plain language? It means that there is objective data that consistently finds that how the therapist and client *feel* about each other MATTERS. In fact, it is the top predictor of the outcome. It isn't an indicator of "poor boundaries" or "inappropriate emotion" for the therapist to care deeply about his client (and vice-versa); in fact, it is probably the most crucial, necessary, vital aspect of treatment.
In the book "How to Fail as a Therapist," the authors (Ph.D.'s in psychology) include this specific error: "emphasizing technique over relationship-building." The authors states, "The lesson here is one that is all too commonly missed: The therapeutic relationship trumps technique...interviews with clients repeatedly show that...Even though you may have all of your licenses, credentials, and degrees prominently and tastefully displayed on your office walls, it takes time and relationship building to gain the confidence of most clients." One client (who is a DS member) who came through my group in January (who is mentioned by name in my book) still stays in touch with me, and told me this past Friday, "You're the only therapist I've had who I actually want to stay in touch with."
Another mistake therapists make is failing to communicate sufficient empathy and signs of support for their client. It is ESSENTIAL that a therapist show a warm sense of support, care, and dedication to his or her client. I can have the best books, research, and techniques training in the world, but until I am able to show genuine affection and connection to my clients, it means nothing. Many clients terminate therapy because they feel that their therapists lack these qualities.
This can be difficult, too, because as a therapist i have to be able to say difficult and painful things to my clients--they have nicknamed them "Damn you, Matt! moments" (or "DYM's" for short)--and some aren't ready. Some clients don't want corrections in their thinking, they want sympathy and acknowledgment of their pain. And this can be tough, because I don't have a molecule in me that is willing to simply validate pain and allow a hurting person to remain otherwise unmoving in recovery. I regard this as "velvet-gloved abuse."
As a result, when someone complains of flashbacks, panic attacks, distress, self-injury, and suicidal thoughts, I have to tell her directly and honestly that these things do not get better on their own with the passing of time; in fact, they get worse. I have to tell her that the only way out of this is THROUGH it--to stop fleeing and face it directly, and use clinically-guided therapy to overcome these pains. Some people are ready to hear this and it offers them hope for a way out; others are shocked at my "cruelty" because of my refusal to soothe, pet, and console them in their present state. But this blunt, difficult realism can be part of a healthy therapist-client relationship; my patients know that regardless of my love and care for them, they will never receive a watered-down version of truth. As a result, they trust the feedback to be clear, honest, and uttered with genuine concern for them. They also know that they can dispute things with me, disagree, confront me, even lash out at me, and I will not, under any circumstance, retaliate.
If someone is uncomfortable with the direction of treatment, or the traits of the therapist-client relationship, or the techniques being used, or my conclusions, I'm not going to feel threatened and get "nasty" or snide in response. Usually, a client who fears that their therapist would retaliate with anger is transferring her own experiences with a parent of the same gender as the therapist (in my case, for example, a patient who thinks I would punish or yell at or retaliate against her for "standing up to" me or confronting me is the daughter of a punitive father, and she transfers that lifelong learning into her expectations of ME, despite zero evidence of me being any such way whatsoever.)
--Intermission--
Coming up: why clients sometimes squirm with discomfort at being empathized with by a caring therapist.
It is impossible for me to even conceive telling anyone that I have not built a bond with. I mean I hadn't told anyone at all and had kept it to myself for 20ish years. Time will definetely not heal you! I tried that for so many years and it hit me in the face over and over again.
If you realize that you can make poor choices and your therapist isn't going to let that fly, you develop a respect that is relative to your closest friend looking at you and saying, "Yea right!" If you know you are going to get back the truth, the bare bones of it, and that it is not a textbook answer you become willing to work/fight through it. It is truly about you and your life experiences.
Instead, of getting that okay we will try next time, let me think of a different way to get in there. That is if they are actually trying to work with you to win the battle within yourself. I don't know, if you have any bit of a personality, it seems like a pretty easy job. How was your week? How's work going? etc....is that not just stress management therapy??? If you have a therapist reflective of this...start shopping around, because you are not going to make any progression towards healing at least that is my take on my experiences with this type of therapy. Journaling is cheaper.
Find a therapist that will take those leaps with you, but not for you. A therapist not afraid to make you mad, or ask the tough questions, and that actually expects nothing less than your whole truth and hard work. A therapist that you bond with and you do not want to let them down. Because, truth be told we all to often let ourselves down and are use to doing that. Then, after a while you realize I am not going to let myself down, anymore! I deserve the best me and to Love myself! It is the only thing that worked for me and I am very thankful! Life is more alive now, because I am living it! :)
Are you? It's worth the battle!
I appreciate this post because it validates so much for me. I have had a relationship with my cirrent therapist for over a year now. But, I had come out of a horrible predicament with a psychiatrist, and I needed to be honest with this new therapist and tell him why I was being sent to him for treatment. I expected him to take the side of the psychiatrist. I expected him to be cautious with me and to treat me like I needed to earn his respect...that I had to prove myself to him...not the other way around...not even mutually proving ourselves to one another. No, I believed that it was me who had to show how worthy I was of his care. He is the one who challenged me on that issue. He is the one, the first one to tell me that I have a right to set, and maintain boundaries! It was a WOW moment for me, such a simple idea as that is, he said it in a way that, for the first time, I understood. I have had many such moments with Dr. Chandler. He is genuine, and he is concerned...but always professional, which I also need. The psychiatrist tried to be my friend...and for awhile, that was okay, it made me feel like I was important, but, I had one critical issue in his office, and his entire demeanor changed and he was openly hostile and accusatory with me. To most people who don't know me, it may seem like he is the professional, and he must be right...but, he was wrong, and I proved that with Dr. Chandler..and with the new psychiatrist, Dr. DeMoya. Both of these men, YES MEN...both of them listened to the details of my prior disasterous therapy...and they both had similar responses. They asked me how they could do it differently, how could they work with me to combat this issue of dissociation. They included me in my own care...not just a predetermined conversation every week, pat me on the head and tell me how wonderful I am....no, Dr. Chandler and I discuss, and turn over ideas and he helps me to understand how I come to the conclusions I draw, as well as when I have a good thought or idea...NO SUGARCOATING. I want and need truth.
From a patient's standpoint, these are the things I brought with me to therapy:
A wounded spirit in need of revamping, but a desire to do whatever it took to make recovery happen.
Frustration, anxiety, anguish, fear, hurt; basically every human emotion that can affect one's ability to prize one's self.
Confusion over what I could expect from therapy, and how I could expect help...what could I do differently to make this work for me? I had lots of questions, but...I had, and still have an openness to ideas, and, the hard fact that I have some issues that are deeply-rooted that I have to work hard to dismantle and rebuild in the correct way.
Mostly, I have the need, and the desire to be honest - to a fault, with my therapist. There is so much shame associated with rape, but, a client...a hopeful recoveree...anyone desirous of healing has GOT to be willing to be open, and honest in therapy. It is the hardest thing I have had to do, to face my own shortcomings that have made this trek more difficult, but it is the kind direction of someone who cares that has made the difference.
So Matt, I totally agree that the client-therapist bond is critical to recovery. Trust, on both sides is crucial, and an open and honest sharing of thoughts and feelings for, and about one another should be welcome, on BOTH sides. We clients are cautious, and we tend to believe that everyone is 'out to get us', that there are no trustworthy souls in this world, but hurt cannot dictate our relationship with our therapist, nor can mistrust. We mustn't attach our hypervigilance to THAT relationship, we must be cautious, but we must be willing to accept the concern, and the love, within the bounds of professionalism. I know I love my therapist...definitely NOT in a sensual way, but in a respectful and friendly way. I couldn't work with him any other way.
Now on to the next part: why some clients balk at empathy and warmth from therapists (or anyone).
(I'll use "we" as the pronoun for convenience)
If we grew up in painful families, or had painful childhoods because of tempestuous caregivers, one of the things we learned is that communication is never clear and honest. Each expression of love or affection is merely a code for another "hidden" meaning, a cipher or a hieroglyph we have to learn to decode. When dad says "I love you," it doesn't truly mean he loves us. It might mean something else, something manipulative, something nefarious. A hug is not just a hug--it's grooming for some form of other manipulation. When a hurtful parent raises us, we learn to cower, become vigilant, and to form safe and secret collusions in the family with siblings, or with a more passive and "gentle" parent (who is often the one trying manage the tightrope-walk between the family eruptions and the "make things appear fine" family mask).
When we grow up in this environment, several things happen. We crave love, respect, and acceptance, but we also fear and doubt it when we DO find it. We oscillate between the warmth of being valued, and then beginning the decipherment habit: "what does this REALLY mean?"
So when I, as a therapist, form a bond with this hurt person in therapy, there is a pattern that the relationship takes. It initially inspires remarkable work and growth in the patient, who is finally safe and pleased that her efforts are validated. And then just as things reach their zenith, she might sabotage the entire bond out of fear that the bond is actually a vehicle for exploitation or manipulation, not a "true" and honest connection. The childhood fear resurfaces: "What does this REALLY mean? What agenda is this coaxing me into?" The experience may be authentic and perfectly appropriate, but to the survivor of a painful childhood *nothing* is ever as simple as it seems, and *every* indicator of acceptance, warmth, or respect are seen as guises and gambits. (I once had a former patient eagerly participate in treatment, offer and accept hugs, and write letters and cards about her enthusiasm with the work we were doing, only to later angrily "switch" and retroactively re-interpret those very things as hurtful "re-creations" of abuse from childhood--no, really!--precisely because shows of care and affection were never honest in her childhood family; they were ruses. So experience "taught" her that they must be ruses now, too, and thus very threatening!)
Growing up in painful families causes some of us to create a fantasy "ideal" caretaker, someone who doesn't exist in our lives but whom we hope exists somewhere "out there" for us. When someone begins to care about us, we may idealize them and value them tremendously in the eager search for that "me-completing nurturer." But this idea never works: people have flaws, people fail, people err. And that demolishes our hope in the ideal nurturer, and we might switch (or oscillate) from that extreme idealization/valuation of the caretaker, to extreme and enraged devaluation of them. By making mistakes, by being fallible, by screwing up, they have not merely annoyed us; they have exploded our dream of finding the ideal. (this, by the way, is a classic trait of Borderline Personality Disorder, but it's not exclusive to it either; non-BPD persons can also feel disillusioned and betrayed by the manifestations of flaws in our beloved).
This may seem to be a self-sabotaging way to think, but it's really more than that. It's also a form of self-defense. How? By clinging to the notion that there is an ideal caretaker, mentor, ally, partner, or lover out there, we psychologically protect the "good object" (ourselves) from the "bad object" (the failing caretaker). In a therapist-client bond, this is why some clients switch from you're the only one who can help me; you're perfect" to "I can't believe you would hurt me like this! I looked up to you! You're not who I thought you were!" (That last comment, of course, is completely true.) Thus, we sever ties with more and more healthy relationships, because we cling to the possibility of a perfect other somewhere out there. By not being able to integrate good with bad, to see people who love us as generally decent, albeit flawed, we risk annihilating bonds with others who could really benefit us, simply because they deprive us of the possibility of perfect nurturing.
In *some* therapist-client bonds, these ways of thinking collide. The desperate search for love and understanding is ruined by childhood lessons. We believe love is out there, but when it's right in front of us, we strip it down out of a belief that its displays (encouragement, hugs, support, patience, kindness) are but bait, trails of breadcrumbs leading us into traps and mystery...because that's how it was at home.
-----Intermission--------------
In our lives we have people that will never be forgotten, my counsellor is one, the gratitude i can't explain in words, the impact she has had in my life(in a positive way), this is one 'friend' i will never forget, one 'friend' that has helped me learn that by myself i can, i can shape my own life.... and that i'm doing.
I respect you and believe you so I'm not arguing with you but sometimes maybe you DO get the ideal caretaker? And then they "fail you" by dying? Then doesn't that make you sort of aware of what the ideal is, and you can see it in other people? I know nobody is perfect and everyone has flaws, but isn't it like Nadine62 said, that those people have seen it before? My therapist isn't perfect I'm sure, but he's the only real ROCK in my life, and I know someday that will change and he will make my husband my rock, or make ME my rock, but until then , feeling like he IS perfect doesn't mean I won't love my husband or my friends, right?
One thing that a well-trained therapist has to keep in mind is that we therapists are DESIGNED to intentionally fail as caretakers, simply because the success of our work eventually sets our client free from dependence on us, which ends our entire role as nurturer (which is healthy, but look at how many clients grieve or become distraught when the topic of termination is broached). An idealized therapist also LOSES the power to help his/her clients, too, for several reasons:
1. The client complies totally, but for the sake of pleasing the therapist--not for the sake of personal growth;
2. The therapist begins to relish their exalted status and shies from difficult confrontations that would have promoted client growth;
3. The client has idealized her therapist, and thus feels devastated, abandoned, or turned away when the treatment must come to an end (or when the therapist fails his/her "perfect provider" role by confronting the client, or simply by the inadvertent human offenses we all commit unintentionally...hey, we therapists have bad moods and say the wrongs things, too);
4. The client becomes "addicted" to the therapist, which results in subtle efforts to extend treatment relationships (sessions continuing over time, "last-minute" major disclosures, intense crisis just before termination, etc.)
5. The client avoids difficult issues because they would seem pleasing to her therapist, or because she wants the therapist to enjoy the appearance of successful work ("gosh, he's trying so hard, and i really like him--I don't want him to know how many problems I still have!")
6. The risk of inappropriate sexual contact. (astonishingly, studies have found that as many as 8.3% of male therapists admit to sexual contact with female clients)
I depend on NOT being idealized in order to do good work. I am constantly asking my clients what helps them, what mistakes I am making, what topics I am over or under-emphasizing, and how to be a better clinician for them. We therapists NEED critique, which presupposes imperfection. A "perfect" caretaker has no room to improve, and thus cannot be critiqued. Frankly, I downright BUG some of my clients (the term "Damn you, Matt!" has been passed down since it was coined January of this year)! But the payoff has been that even after difficult work, my clients later remark at how careful and protective I have been. Even former clients who have become angry with me have, thankfully, acknowledged that I was always appropriate with such boundaries, never causing them to feel unsafe or threatened. But this is only because I use my fallibility as a therapeutic tool: "tell me what you and i need to change in our work so that you will continue to benefit."
As for your last sentence, I'm not sure how to answer it. The way it's asked seems to plead for a response that confirms what you hope the answer will be. But nobody can answer this for you but you. I know that as a husband, I would feel woefully defeated if my wife discovered her archetype of an "ideal nurturer" in someone ELSE. For one thing, we are all fallible humans. I am a jerk at times. I disappoint. I annoy. And somehow, my wife loves me and lives with it. So what chance would I have if she discovered her ideal nurturer somewhere else? I can't match that. The more ideal he is to her, the more devalued I feel because she would be using a standard I can't accomplish. Truthfully, I might even begin to suspect that this is more than "idealized care-taking" at work, and perhaps "therapy-lingo" codewords for "I have a crush on this guy/therapist."
Incidentally, as a therapist this is a very familiar area. It's a psychological phenomenon that some clients develop warmer feelings for their therapist (not saying that's what's happening here, but it's worth adding to this topic generally). This can even include erotic thoughts and dreams. Some of this is normal transference, and a high-quality, well-trained therapist knows this and is receptive to the topic being talked about. there is something nearly-addictive about being listened to empathetically, being taken seriously, treated like we matter, and not abused that attracts us, ESPECIALLY if there was a desert of such care in our childhood. My female clients with cold or rejecting fathers are the ones most likely to idealize me, and there is even a predictable correlation between the time we begin working on childhood abuse by a father-figure, and the attempts made by the female client to bring small gifts and cards to me. It's not offensive, it's simply a natural product of the work. Fortunately, most good therapists know this, and can handle it gracefully (although the female client is usually slightly put off by what feels like callous rejection at first, but this eventually recedes and she and I continue positive work 99% of the time).
I am almost desperate for recovery. I am so focused on recovery, that I will do whatever is asked of me in therapy. But, when a thing is too hard for me to tackle, I know it is in my own best interest to tell him I am struggling. I can't hide my emotions from him too well. He has learned me. He is more intuitive regarding my emotions then I ever imagined an "outsider" could be. I have to admit, I know the point is to grow, and move on, but I will miss this man who has come to mean so much to me.
Most of the time, this works well. I had one case, which still stings, when it didn't, and I got retroactively blasted by a former patient for not intuitively discerning her feelings on certain matters, thus causing her discomfort she had *never* previously disclosed, and which she explained by saying--against all available evidence--that she thought I would have been mad and angry-father-like if she had addressed the topic. Like I said, we aren't psychic.
Now, in the case of some clients, and in particular some Axis II disorders, rapport can be harder to build. For example, my job is to nudge clients into new ways of thinking and interpreting things; after all, if they think the same way at discharge as they did at admission, then what's the point? But in some cases, what is meant as a therapeutic challenge to previous beliefs feels to the client like a devaluation of her distress, and perhaps even a heartless attack against her. This is painful for therapists, who genuinely care for our clients, and are chagrined that our gentlest, most earnest efforts to give our clients new alternatives to former beliefs is felt by the client as a personal dismissal or assault against their feelings. When an angry client respond to us with feedback like, "you just don't get it, do you? you pretend to care, but you don't. Don't you realize how much this hurts? Are you TRYING to abuse me?", it halts the process because we know there is a HUGE disconnect between what we are actually attempting, and what our client feels.
But fundamentally, more and more therapists are agreeing that we should acknowledge what has long been a taboo word in therapy: Love. In old-school Freudian therapy, the therapist had to remain a neutral "blank slate" for the client to project their beliefs on. But more and more research finds that not only is that not helpful, it may actually hinder that process! As therapists begin to disclose their collective experiences without taboo, we are finding a common theme: that we must be able to find something in each client of ours that is lovable. And while that doesn't mean going around and haphazardly proclaiming Love to our clients, it DOES mean treating them lovingly.
Do I love my clients? Yes, absolutely. Do I tell them I love them? 99%, no--I have uttered that acknowledgment to perhaps three clients in the past two years. Two understood its context and responded warmly and appropriately, and one I mis-read and it panicked her to hear. (whoops! The risk of harming even one in 500 clients is too large; sadly, I am not as liberal with my openly-warm personality as I had been just four months ago, since this is about the client's needs, not mine).
So when Mockingbird and others write on DS that they care deeply about their therapist, it warms my heart. What needs to be understood, of course, is the difference between loving appreciation and respect for one's therapist, and transference of "crush" feelings.
Thanks Matt. That makes a whole lot of sense actually. Wow! That really puts a different spin on the conversations that we had back then...well, actually the conversations that I had with a blank slate...but still. Thanks again!
so Lucinda, perhaps you were one of those "how to damage your patient" outcomes at that time. Freud believed that projection is necessary for therapists to explore, and thus must remain blank so that they are interpreted by the client into whatever role the client most needs to resolve. He was VERY right about projection (my former client who blasted my loving/empathetic approach actually likened me to, of all people, her coldly-distant and abusive father! No, really! Her rationale was that she assumed if she spoke up in any disagreement, I would angrily harm her, just he would have done in her childhood). Projection and displacement are fascinating (and we should probably talk about them more here).
But Lucinda, that is exactly what happened. Sadly, the projection in that case was "he must not care about me. I must be dull." I had a recent patient who believed that her own issues and feelings were less important than others in the group, so she remained detached and passive/withdrawn during entire groups. Then at the end, she would become irate and chastise the group for "not caring about" her, because the group members had not interacted with her enough! So she projected her own feelings ("I am bland and undeserving of attention, so I won't participate in the group") onto the other group members ("They're not engaging me! they think I'm bland and undeserving of attention!").
So praise Tunkashila ("the Creator", in Sioux), indeed, for how far out of that you have come. And praise Tunkashila that therapists are learning from past mistakes.