Useful Information About Group Therapy
This information is for people considering weekly group therapy. It’s helpful when you begin group therapy to have some general ideas about how groups can help and how you can get the most out of the experience. Group therapy is different from individual therapy because many of the helpful events take place between members, not just between the leader and the members. This is one reason why it’s important for all members to have comprehensive preparation (at least 3 individual sessions) before beginning a group with me. These 3 sessions will usually be sufficient for exchanging information and developing a strong therapeutic bond . You’ll take home a few pages of informative reading, and I’ll carefully explain 2 pages of Group Guidelines, and give you several handouts outlining how to get the most out of your group experience. Please read this material carefully and feel free to discuss any part of it with me and/or with any other therapist you’re seeing.
Group therapy has been a special interest and activity of mine for 40 years, partly because I find clients get so much more healing in groups that isn’t available in individual therapy. I am a Certified Group Psychotherapist (CGP), with the American Group Psychotherapy Association, and a Founding Member in that National Register of Certified Group Therapists [both inactive]. The CGP credential requires completion of at least: 300 hours of leading or co-leading group psychotherapy, a minimum of 75 hours of supervision in group psychotherapy with a highly qualified supervisor, and a 12 hour course in the theory and practice of group psychotherapy. I’ve led, participated in, and supervised many kinds of weekly out-patient and in-patient groups, weekend and full day intensive therapy groups.
I. Do Groups Really Help People?
Group Therapy has been a widely used and standard part of treatment programs for almost 40 years. Sometimes it is the only treatment and sometimes it is combined with other treatments, such as medications, individual therapy, 12-step, exercise, etc. Group therapy has proved to be a very effective and efficient treatment. Clinical studies comparing individual and group therapies have found that group is usually equally or more helpful than individual therapy.
II. How Group Therapy Works
Group therapy is based on the fact that most of the psychological and physical difficulties people have in their lives are clearly reflected in the nature of their relationships with others. Trained group leaders know how to use the positive forces in personal relationships to help members resolve personal problems. As children, we all learn ways of getting close to others and ways of solving issues with them. In general, these early patterns are then applied in adult relationships. Despite good intentions, these early, learned ways are often not helpful for adult happiness. Symptoms such as anxiety, unhappiness, poor self-esteem, or a general sense of dissatisfaction with life can usually be resolved through long-enough, often-enough repeated experiential learning in the group.
III. Group Agreements
- Confidentiality. It is critical that people’s private information from group will not be repeated outside the group, except to a professional bonded to confidentiality. Of course, you want to discuss some of your own learnings with people close to you, and even then it is very important not to mention other members’ names or personal information. Although we can’t prevent it, a significant breach of confidentiality from these therapy groups is extremely uncommon. Please be sure that you don’t talk about other members with non-members, just as you don’t want them to talk about you.
- Attendance and Punctuality. Do your very best to attend all sessions and arrive on time. The group functions as a team, and if even one member is absent or late, group is not the same. For your sake, as well as for the sake of all the members, please be a regular attendee. If for some reason it is impossible for you to attend, be sure to call well in advance, so that the group will know you are not coming and why. When absolutely necessary, it is far better to come late or leave early than miss the group.
- Alcohol or Drugs. It is important that you are not under the influence of alcohol or drugs (except prescription medicines). Smoking is not allowed in the office.
- Socializing with Group Members. It is important to think of your group as primarily a treatment setting, not as a replacement for other social activities. Friendships will likely develop, but the main focus of the group is personal awareness and change. Romance, dating or sex between members would be very destructive to everybody’s therapy. Group therapy is an opportunity to learn how to be close to both sexes without these complications. Members are strongly encouraged to have outside contact with each other. (E-mail is good only for information, NOT for anything emotional.) When you have outside contact with group members, it is vital that the feelings be shared in group so they can be understood and used for therapy. Please make a commitment to report these contacts during group, especially your feelings around these contacts.
IV. Common Myths About Group Therapy
- The Myth: Group treatment is a cheaper, second-rate form of treatment which saves money, but yields inferior results. The Truth: While group treatment is an efficient way of treating several people at once, the main reasons for using it are 1) that it works so well and 2) that it is a powerfully broad therapeutic tool. For most people it is equal to or better in positive outcomes than individual therapy.
- The Myth: Group therapy is a forced confessional in which everyone has to reveal all the personal details of their lives. The Truth: In general, group members talk a great deal about relationships between the group members, common experience patterns in relationships, and the very different personal meanings and interpretations every person creates of the same experience. It is often not necessary or even distracting to know specific early familial details. Members will find increasing comfort regarding how much they want to disclose about their personal lives. Details about where you live or work are not necessary for effective involvement in the group, and over time, you will feel more and more comfortable being open, honest and direct with these familiar and trustworthy people.
- The Myth: Being thrown together with other people with emotional problems will be too upsetting and make me worse. The Truth: Fear of ‘the blind leading the blind’ is understandable, but in practice, people find that the process of talking about their problems with others who understand is very helpful. Indeed, learning that others have had surprisingly similar problems is usually reassuring. Group therapy clients are also often surprised to find how much they have to offer other people, and that people are much more alike than different. It may take a while to recognize how our own difficulties are no less and no more interfering than other people’s.
- The Myth: People with emotional problems are likely to lose control, or become so upset that they cannot function, or become angry enough to be destructive. The Truth: Members are very carefully screened, so there is a low probability of this happening. The group leader(s) is (are) there to encourage the group and to transform negative into neutral or positive possibilities, or to moderate things if tension gets high. You will be safe and protected.
- The Myth: The group ma reject or judge me, or get me to go along with things that are not good for me. The Truth: These are examples of fears that almost everyone has when they enter any new social situation and are very unlikely to occur. Giving advice is strongly discouraged.
V. How to Get the Most Out of Group Therapy
- Get involved in the group process. The more actively involved you are, the more you will benefit by learning to identify and change the sorts of things you find upsetting or bothersome. Be as open, honest and direct as possible in what you say. Group time is precious; it is a place to work on serious issues and have fun, not just pass the time of day. Listen carefully to what people are saying; think through what they are saying; think through what they mean and learn to make sense of it. You can help others by letting them know what you make of what they say and how it affects you (feedback). Many of the issues talked about in groups are standard human issues with which we can all identify. At the same time, listen mindfully to what is said to you about your part in the group. This process of learning and changing how we “come across” to others is critical to personal growth in the group. Curiosity, courage and forbearance are required to accept subtle or surprising truths about how others experience us.
- Use the group as a ‘living laboratory”. It is a place where you can safely try out new ways of talking to people; a place to take reasonable risks. You are a responsible member of the group and can help make it an effective experience for everybody by discussing your personal thoughts, feelings and beliefs about other members, especially things we usually hide from others.
- Do your best to translate your inner reactions into words. Group is not a party where things should be said in a proper, polite fashion. It is a place to spontaneously and sometimes intensely explore the meaning of what goes on and the inner reactions that get stirred up.
- Remember that how and when people talk is as important as what the say. As you listen to others and as you think about what you yourself have been saying, think beyond the words to the other messages being sent. 80% of personal meaning is expressed in body language and intonation and only 20% comes from the actual words said. Sometimes the meaning of the words does not match the tone of voice or the facial expression or the actual behavior described. The important, subtle differences between sadness and depression, assertion and aggression and between scare and anxiety will also be clarified.
- Do your homework. Groups often include highly structured exercises or personal homework. Whatever the nature of your group, it is very important that you do what is asked and actively share the results. The group will be maximally effective when everyone keeps their agreements and does their part – watch the video when absent.
VI. Common Early Difficulties
Feeling anxious about being in group. Almost everyone experiences it to some extent. Talking about these feelings with the group is a good way to learn how discussing tender things with trustworthy people helps reduce anxiety.
- Looking to the leader for the answers or control. It is the role of the leader to encourage members to talk with each other, to help the group stay focused and to help manage feelings that are released, and to offer support, structure and safety. However no one, including the leader, can usually supply simple solutions to complex problems. One of the tasks for each member is learning to take responsibility for initiating important choices and changes, and to discover and benefit from the process of talking intimately with others, not just getting pat answers or advice, which is usually not useful.
- Fear of becoming emotional. It is okay to be emotional. Learning to understand rational reactions, patterns and habits is very important; though not always easy. Expressing feelings is a necessary part of learning emotional intimacy skills.
- Experiencing a sense of puzzlement or discouragement after the excitement of the first few sessions. It is important to discuss this with the group. Because groups need many months to develop full benefit for members, be sure to share and discuss your uncertainty or frustration in the group.
- Feeling of disappointment, frustration, competitiveness, or anger. Most of us have difficulty managing these sorts of feelings and it is an important part of the group’s task to express and examine them, in order to learn to make it easier to deal with them creatively and constructively.
- Using the lessons learned. Work hard to apply and practice what you learn in group in outside, everyday situations. Research has shown that the more you can apply and use what you learn, the more your learnings and growth from group experience will be brought into the rest of the everyday world, and the more you get out of it.
- Remember, life and group therapy can be lots of fun; so practice expecting and allowing yourself more and more fun and contentment.
From Ron Fox, PhD ’01.
Extensively edited by Bob Dick, PhD., CGP, AC. ‘09