Group Therapy – The Great and the Powerful

When I think about group therapy, I cannot help but think of the 1975 movie “One Flew over the Cuckoo’s Nest.” For those who haven’t seen the movie, there are multiple scenes of sedated and unruly asylum patients sitting in a circle, answering questions posed by an authoritarian, cold, and distant nurse. The group therapy seems less about helping people and more about establishing a hierarchy between patients and staff. In the 1999 movie Fight Club, the protagonist frequents several support groups in which people share their struggles with testicular cancer and other challenges. Several poorly lit and despair filled AA groups have been featured in countless TV shows and movies. My point is that, in my opinion, group therapy is generally portrayed as boring, depressing, and hopeless. However, group therapy can be an incredibly genuine, powerful, and fascinating experience.

People might not know there are many different types of group therapy. A cognitive-behavioral therapy group is radically different from a support group or a communication skills training group. One type of therapy groups are called interpersonal process groups (these are the type of group discussed in this article). These groups teach people how to establish and create close and gratifying relationships and are based on the recommendations outlined by Irvin D. Yalom, a professor of psychiatry at the Standford University School of Medicine, in The Theory and Practice of Group Psychotherapy (5th ed.). While interpersonal process groups are largely focused on relationships, Harry Stack Sullivan’s interpersonal theory of psychiatry suggests symptoms of mental disorder are directly related to a person’s experiences in their relationships (as cited by Yalom, 2005, pp. 20-23). Therefore, by focusing on improving a person’s interpersonal functioning we can simultaneously improve mental health.

Research suggests that positive relationships are strongly linked to happiness (Reis & Gable, 2003; Adler et al., 2012) and can reduce trauma symptoms and promote recovery (Briere & Scott, 2013, p. 24). Irving Yalom (2005, p. 24) summarizes significant literature exploring the importance of positive relationships by explaining “People need people – for initial and continued survival, for socialization, for the pursuit of satisfaction.”

Some people may have the misperception that group therapy is only conducted because it is “cheaper” than individual therapy. While there is some truth to the idea that group therapy originates for a post-world war 2 era, where it was valued for economic reasons, since that time we have discovered that it has some real advantages to individual therapy.

Unlike individual therapy or psychoeducational courses, interpersonal process groups possess a number of unique characteristics that make them an exceptional opportunity to improve an individual’s interpersonal functioning. Dr. Yalom explains:

There is evidence that certain clients may obtain greater benefit from group therapy than from other approaches, particularly clients dealing with stigma or social isolation and those seeking new coping skills (p. 53).

Carl Rogers believed three core conditions were most important in therapy – congruence, empathy, and unconditional positive regard. While a full description of the core conditions is beyond the scope of this article, I want to point out the vast majority of modern therapists are thoroughly taught to communicate empathy, to be congruent and authentic, and to demonstrate unconditional positive regard. This facilitates successful outcomes in therapy, but it can also lead clients to wonder if their therapist only likes them because they are their therapist. In other words, when a client tells their therapist “nobody likes me” and the therapist challenges this with “how do you explain me liking you?” The client usually responds with “you’re my therapist, you have to like me.” Many clients will question the relationship that forms between the therapist and client; rationalizing they are only able to form a relationship with a therapist who is extensively trained in forming good relationships with people.

One of the many advantages of group therapy is when you form close and gratifying relationships with the other group members it can be more meaningful, because they do not have to like you at all. When you behave in a genuine and authentic way in the group, the relationships you form in the group, reflect the types of relationships you make outside of the group. This way the group can understand how you might act when you are at home, with friends, or spending time with family. We all have blind spots – things we don’t know about ourselves and what others think about us. In group therapy, the other group members can use their own experiences with you, to help you understand how others might perceive your behavior. You can reflect on the degree to which you behavior in relationships is getting you what you want, which is usually close and gratifying relationships with others. Finally, if you decide your behavior is not helping you form satisfying relationships, with an open mind you can choose to experiment with behaving differently in the safe and supportive environment of the group.

So when someone suggests that your behavior could be perceived as “defensive” and this is echoed by several of the other group members, we can work to uncover what you specifically did that was “defensive.” The other group members can provide you with feedback about how they feel and what they think when you act “defensively.” Then you can consider if this behavior may actually harm your relationships, and if so you can begin experimenting with not being as defensive within the group.

Here is a model I created to explain the overall process of Interpersonal Group Therapy:

Group therapyThis type of group takes a lot of honesty, support, and encouragement. The first few sessions typically involve building trust within the group so participants can get to know one another, and feel more comfortable both giving and receiving feedback. As the group bonds, we learn about how people may typically act in relationships and how this behavior may be interpreted by others. To make the most of this experience, participants must have an open mind and a willingness to try new ways of relating to others.

Unfortunately, group therapy is not for everyone. Some clients are not ready, willing, or able to make changes. Other clients may disrupt the group from achieving their goals. Other clients might be in the middle of an interpersonal crisis and may be too distressed to function within the group.

To summarize, people’s beliefs about group therapy, are generally inaccurate and there are many different types of group therapy. Interpersonal process groups can help people learn how to establish and maintain close and gratifying relationships by increasing awareness about how we function in groups, and providing opportunities to experiment with new ways of relating to others. Group therapy can motivate great change and personal growth but it also requires honesty, a willingness to keep an open mind, and an interest in making changes to how we behave in relationships. Lastly, group therapy is not for everyone, but for those who are ready, willing, and able it can be an amazing opportunity.

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