Group Psychotherapy
I specialize in providing group psychotherapy. Group is an outstanding psychological treatment for many emotional and interpersonal issues. Although the idea of sharing with a group of people can initially be intimidating, it can also be profoundly impactful and helpful. This is a powerful mode of change, and I encourage all my patients to consider group. The following text describes what a psychotherapy process group is, what benefits it can provide, what the rules are, and how to best take advantage of this type of group experience.
What is a Process Group?
Group psychotherapy has been shown to be an effective form of treatment for a wide variety of mental health issues, and in some cases, even more effective than individual therapy. For many people, the combination of individual and group psychotherapy offers the most benefit. There are many different kinds of groups, such as support groups (e.g., a grief group), psychoeducational groups (e.g., parenting a child with ADHD), skills groups (e.g., anger management), and diagnosis-specific groups (e.g., eating disorders). Unlike these more specific groups, the primary goal of a process group is to develop more effective and emotionally healthy ways of relating to yourself and to others. This is accomplished over time by focusing on the following tasks. |
Group Goals
The first task is to put your thoughts and feelings into words as you become aware of them. By improving your understanding of your own feelings, and the feelings of others, you increase your tolerance for difficult and complicated emotions, improve your ability to communicate them, and become more authentic with yourself and with others.
The second task is to tell the emotionally significant story of your life. This means, in addition to important facts about you, sharing your struggles, losses, hopes, fantasies, conflicts, and past experiences of guilt, shame, anger, and fear. This can be unfamiliar and uncomfortable at first. However, tolerating the discomfort that comes with vulnerability allows for growth, change and healing. The purpose of sharing your history in group is to help you and others better understand the ways in which you learned to emotionally protect yourself, to get your emotional needs met, and what you learned to expect from other people. These dynamics will inevitably unfold in group, and by knowing each other more fully, they can be explored collaboratively. By working with these dynamics differently than you have in the past, you can bring these changes to your relationships outside of group.
The Group Agreement
To allow members enough structure to safely take emotional risks, it’s important that the group members and the therapist understand and agree to a set of expectations, called a group contract. A clear group contract also allows the therapist and members to openly discuss when the contract is violated (e.g., missing groups, coming late, etc.), and to explore the resistance to these rules. These are the basic guidelines of this group contract:
How to Reach Your Group Goals
It helps to think of group therapy as a living laboratory where you can safely take risks and try out new ways of relating to others, getting your needs met, and offering support. The level and nature of how you participate in group will significantly determine how quickly you achieve your goals and reap other benefits. The more you involve yourself in the group, the more you will get out of it. To that end, you should keep in mind the following:
1. Identify your reactions: Specifically, try to identify your reactions to others in the room including the therapist. As you listen, notice your thoughts, feelings, bodily reactions, fantasies, and anything you feel compelled to do. Notice if you feel judgment, if you want to give advice, if you want to comfort or protect others, whether what they are saying creates any discomfort for you, any admiration, envy, competitiveness, hope, anger, etc.
2. Express your reactions authentically: Once you identify your thoughts and feelings in response to others, notice what blocks you from expressing yourself. Of course you don’t need to express each and every thought, but notice when you are inhibited from expressing relevant reactions and talk about what is getting in the way of sharing with the group. Some common reasons that people fail to express themselves authentically in group, as well as in life, are that they:
3. Be respectful in conflict: Disagreements are a natural aspect of all relationships, and you are encouraged to express them openly and respectfully. When you feel judgmental about somebody in group, practice talking about your judgments without labeling others by describing the behaviors that are bothering you. This may seem difficult to do. In group and in life, conflict is inevitable. Dealing with conflict and anger more effectively is a particular strength of group therapy.
4. Avoid “early group traps”: Every new group member is anxious, whether joining an ongoing group or an entirely new group. Anxiety tends to cause us to engage others with more rigid and scripted modes of behavior. Sometimes, this initial anxiety causes new members to fall into what we refer to as “early group traps.” Once a new member falls into a “trap,” it can be hard to get out and often people in this situation leave group prematurely. Even worse, such members often have some of their most painful feelings about themselves and others reinforced, rather than changed for the better. The following is a short list of early group traps:
5. Get help from your therapist: If you find yourself worrying about falling into any of the early traps or are having difficulty with the early group process for any other reason, ask the group therapist for help figuring out what to do. Raising the issue in group is frequently the most effective way to begin to deal with problem you might be having--indeed, you are likely not the only person having that feeling. However, you are also welcome to address it with the therapist outside of the group. Chances are, the therapist will have some good ideas about how to address the problem. It is their responsibility as your group therapist to help you engage in the process in the most effective way possible.
Additional resources:
The first task is to put your thoughts and feelings into words as you become aware of them. By improving your understanding of your own feelings, and the feelings of others, you increase your tolerance for difficult and complicated emotions, improve your ability to communicate them, and become more authentic with yourself and with others.
The second task is to tell the emotionally significant story of your life. This means, in addition to important facts about you, sharing your struggles, losses, hopes, fantasies, conflicts, and past experiences of guilt, shame, anger, and fear. This can be unfamiliar and uncomfortable at first. However, tolerating the discomfort that comes with vulnerability allows for growth, change and healing. The purpose of sharing your history in group is to help you and others better understand the ways in which you learned to emotionally protect yourself, to get your emotional needs met, and what you learned to expect from other people. These dynamics will inevitably unfold in group, and by knowing each other more fully, they can be explored collaboratively. By working with these dynamics differently than you have in the past, you can bring these changes to your relationships outside of group.
The Group Agreement
To allow members enough structure to safely take emotional risks, it’s important that the group members and the therapist understand and agree to a set of expectations, called a group contract. A clear group contract also allows the therapist and members to openly discuss when the contract is violated (e.g., missing groups, coming late, etc.), and to explore the resistance to these rules. These are the basic guidelines of this group contract:
- Confidentiality. Confidentiality facilitates emotional safety and risk taking, and must be maintained by all group members. What’s shared in group stays in group.
- Words, not actions. Members agree to put thoughts, feelings, and impulses into words rather than behavior. For example, one might say "I really want to take care of you and make you feel better", instead of giving a hug. Talking in place of acting maintains safety.
- All feelings are invited, accepted and explored. All positive and negative feelings are important. Setting limits on what feelings can or cannot be shared will inhibit members from talking openly.
- New member commitment. New members will commit to attending 14 meetings before deciding to become an ongoing member. If they decide not to continue, the member will attend two more meetings after announcing their decision to say goodbye.
- Contact outside of group. There should be no contact between members outside of group. Any contact outside the group should be shared at the next group session. It’s important that all members have access to everything that takes place between the members of the group.
- Meeting time. Group will start and end on time. Starting and ending on time shows respect for each member’s time, commitment and outside group responsibilities.
- Paying for group. Group members will pay the agreed upon fee, including for absences. If the fee poses a significant financial burden, concerns should be discussed with the therapist and the group.
- Missing group. Group attendance should be prioritized. If missing group is unavoidable, absences should be announced in advance when possible.
- Leaving group. Members agree to stay working in group until they feel they have met their group therapy goals. If a member is considering leaving the group, they agree to discuss these thoughts with the therapist and the group before making a decision. At that time, a member deciding to leave the group should announce their intention to leave, and then attend two more groups after that to allow for a healthy goodbye with the other members.
How to Reach Your Group Goals
It helps to think of group therapy as a living laboratory where you can safely take risks and try out new ways of relating to others, getting your needs met, and offering support. The level and nature of how you participate in group will significantly determine how quickly you achieve your goals and reap other benefits. The more you involve yourself in the group, the more you will get out of it. To that end, you should keep in mind the following:
1. Identify your reactions: Specifically, try to identify your reactions to others in the room including the therapist. As you listen, notice your thoughts, feelings, bodily reactions, fantasies, and anything you feel compelled to do. Notice if you feel judgment, if you want to give advice, if you want to comfort or protect others, whether what they are saying creates any discomfort for you, any admiration, envy, competitiveness, hope, anger, etc.
2. Express your reactions authentically: Once you identify your thoughts and feelings in response to others, notice what blocks you from expressing yourself. Of course you don’t need to express each and every thought, but notice when you are inhibited from expressing relevant reactions and talk about what is getting in the way of sharing with the group. Some common reasons that people fail to express themselves authentically in group, as well as in life, are that they:
- Believe their thoughts and feelings are not as important as other’s thoughts and feelings.
- Worry about taking more than their share of group time.
- Believe that they are being a burden to others.
- Are worried about hurting or offending others.
- Are concerned that others will judge them negatively.
- Fear generating anger in, or conflict with, one or more group members.
- Feel pressure to “please” (or fear disappointing) the group leader.
3. Be respectful in conflict: Disagreements are a natural aspect of all relationships, and you are encouraged to express them openly and respectfully. When you feel judgmental about somebody in group, practice talking about your judgments without labeling others by describing the behaviors that are bothering you. This may seem difficult to do. In group and in life, conflict is inevitable. Dealing with conflict and anger more effectively is a particular strength of group therapy.
4. Avoid “early group traps”: Every new group member is anxious, whether joining an ongoing group or an entirely new group. Anxiety tends to cause us to engage others with more rigid and scripted modes of behavior. Sometimes, this initial anxiety causes new members to fall into what we refer to as “early group traps.” Once a new member falls into a “trap,” it can be hard to get out and often people in this situation leave group prematurely. Even worse, such members often have some of their most painful feelings about themselves and others reinforced, rather than changed for the better. The following is a short list of early group traps:
- Not sharing enough. Anxiety can cause a new member to shut down their emotional process out of a desire for self-protection; however, this prevents others from getting to know them and vice versa. A failure to share one’s meaningful experience can generate negative feelings in members who have taken the risk to share.
- Dominating the discussion. Many people talk a lot when they are anxious. More importantly, they talk in such a way that they are not sharing feelings, but sharing facts or advice with others. This too prevents the other members from getting to know the person in a meaningful way and again tends to generate negative feelings instead of allowing for early bonding to take place.
- Violating the group contract. Members who arrive late, miss meetings, or violate other aspects of the group contract tend to arouse negative feelings in the other members and likewise impede the bonding process within the group. A single instance of a contract violation rarely disrupts the group process for long; repeated contract violations almost always do.
- Sharing angry feelings too intensely. For many people, anxiety tends to magnify the expression of anger unintentionally. It is important to remember that in a new relationship, one needs to be especially aware of being respectful and thoughtful about sharing anger with another group member.
- Suppressing negative feelings. This is perhaps the most common early group trap. As a group is forming, it is natural that most members want to be liked and accepted. It is equally true, however, that some negative feelings will be generated early in group. As new members often fear being viewed as being negative or complaining, they sometimes deal with negative feelings toward other members or the therapist by suppressing them. If the negative feelings are strong enough, the process of pushing them down can cause the member to slowly withdraw and emotionally disconnect from the group, and often leads to premature dropout. Remember, it is very important for success in group therapy to share your full range of feelings, even if it is uncomfortable to do so. That way, early negative tension can be released and addressed. This process, though anxiety provoking, often leads to deeper levels of trust throughout the group.
5. Get help from your therapist: If you find yourself worrying about falling into any of the early traps or are having difficulty with the early group process for any other reason, ask the group therapist for help figuring out what to do. Raising the issue in group is frequently the most effective way to begin to deal with problem you might be having--indeed, you are likely not the only person having that feeling. However, you are also welcome to address it with the therapist outside of the group. Chances are, the therapist will have some good ideas about how to address the problem. It is their responsibility as your group therapist to help you engage in the process in the most effective way possible.
Additional resources:
- Building Resilience Through Group Therapy, September 28, 2021, Hosted by Dr. Patricia Halligan, An Interview with Dr. Aaron Black
- Group, a dramatized short video series about group therapy, created by Dr. Elliot Zeisel
- Why Group Therapy Worked, David Payne, August 11, 2015, The New York Times