I was working this morning with a patient I’ve been seeing for a few months. At the end of our session I suggested he join one of my psychotherapy groups that meet once a week in the evenings.
“What? You can do psychotherapy in a group? How does that work?”
I was a bit surprised – most people have at least heard of group therapy, but it seemed the perfect time for The People’s Therapist to explain the basics of this mysterious and powerful psychotherapy modality. At very least, in my limited space here, I can dispel a few of the myths:
Myth #1: Group psychotherapy will be like a 12-step group. I think this idea comes about because the most familiar group therapy-like experience for most people is AA, or another 12-step group. Some of my patients who have done AA or another 12-step group in the past act like they know what they’re getting into, and march in to my groups with extra confidence, only to find that this new experience is very different from what they’re used to.
There are a lot of ways to run psychotherapy groups, and most groups are far less structured than an AA group. The dreaded “cross-talk” which is forbidden in AA is not only permitted in most groups – it’s encouraged. There’s no opening ritual or closing prayer – it’s open and free-form. You sit down and talk about whatever’s on your mind. The only rule is that you keep it real, so you don’t waste time.
Most psychotherapy groups also meet weekly, and are closed – not drop-ins, like most AA groups. If you are a member of a psychotherapy group, you are committed to the other members, possibly for years, and it is your duty to show up every week and participate, even when you don’t want to.
Myth #2. Group is just cheap therapy for a bunch of people at once. One of the advantages of group therapy is that it is cheaper than individual sessions – with so many people, the fee is lower for each person. But it is not cut-rate cheapo therapy. In fact, I strongly encourage my patients to participate in “conjoint therapy” – which means going to group every week and dropping in for an individual therapy session every two or three weeks, too. Group is very different from individual treatment, but they complement one another and the combination is more effective than either on its own.
How is group different? It is not so much vertical, like individual, but horizontal. You don’t dig deep into your past so much – you already did that in individual. The focus in group is on watching how you interact with others. I think of group as taking the work of the individual sessions out into a laboratory, where you can test what you’ve learned in a controlled setting. There is nowhere in the world like a group room – a place where you can sit with perfect strangers and the assignment is to put your authentic thoughts and feelings into words and interact. It is a powerful, often life-changing experience.
Myth #3. For a group to work, everyone has to share a common life experience. I think this myth arises from people’s familiarity with support groups, rather than broader psychotherapy groups. A group focused on one issue – such as survivors of sexual abuse – is a support group.
I led a support group specifically for HIV+ gay men for many years, and it was a rewarding and useful experience, but my favorite groups have no specific focus and include the most diverse possible population. The HIV+ group created a safe place where guys dealing with that disease, and the stigma it still carried, could loosen up and share their experiences. But even in that group, there was plenty getting talked about besides HIV, including friendships, dating, career issues and lots of other topics.
I’ve had all sorts of people in my groups over the years. All ethnicities have been represented, people as young as 18 and as old as 78, rich and no-so-rich, men, women and trans people, gay, lesbian, straight and bi. Diversity only enriches the experience.
Myths #4 and 5: If I go to group, (a) I won’t want to share my therapist’s attention, so I’ll dominate too much or (b) I’ll be too scared to open up in front of all those strangers.
If you’re having these common worries about group, then it’s already working. These are transferences – you are transferring your expectations from prior life experiences onto a prediction about how group will play out when you get there.
The first lesson of group is that you will unconsciously relate to the group the way you related within your family. It’s useful to understand how that mechanism plays out, because it is also the way you relate to the world as a whole.
If you grew up having to fight to get the attention you needed in your family, you might play that role out in the group room when you arrive. If you grew up distrustful of others, expecting a negative response, you might shut down in the presence of the group.
Becoming conscious of these unconscious patterns, and practicing different ways of being, is the work of group therapy.
I could write about group forever – and I’ll probably be writing about it a lot more on this website. Group is some of my most challenging and rewarding work, and I’ve seen people take enormous strides in a group room that might have been impossible with individual therapy alone. Humans are social animals, and co-exist with one another. Group incorporates all those other people into the therapy experience – with powerful results.
If you’re like most people, now that you’ve learned a bit about group…you’re probably thinking about giving it a try. It’s a commitment. Most therapists require that you commit for at least 10 or 15 sessions, and this new way of doing psychotherapy will become a regular part of your life.
I promise, whatever happens, you’ll be changed by the experience – and you won’t forget it.
The People's Therapist 
Thank you for this particular posting. I run a women’s group and it has been a profoundly powerful experience for not just the members, but myself also. Having the commitment of long time membership, which allows depth in relationships between the members to form adding to the feeing of safety, has also provided an intimacy that the members say is impossible to find in their ‘real’ lives. The ladies range in age from 23 to 70+ and each bring their personal experiences and understanding about the human condition, as well as their unique neurotic adaptations to share and to work on. I was so excited to see your posting that I forwarded it my group members so that they could have your excellent reflection as well as the one that I provide them every time we meet. Thanks for sharing 🙂
Thanks for the feedback! Group is about my favorite thing in the world. I’m sure I’ll be writing more about it soon. Some of my groups have been running for over 4 years now, and they’re going strong. It’s a fantastic experience, to share authenticity with a group of perfect strangers in a special space together each week. It gives you hope for humankind.
I don’t think I’d be interested in a group. Trust is tough. Don’t think I’d do it.
That’s a good reason to give group a try. If you can’t trust people out in the world, it’s probably going to have a negative effect on your relations with other people at the workplace, in your family, and with your friends. I usually work on establishing trust in individual sessions before jumping into the group setting. It’s easier, I think, if you already feel comfortable with your therapist – he’ll be in the group room with you, so you know you have one friend in there. If someone feels uncomfortable in group – especially someone new, I’ll often step in and protect them, if they’re feeling over-loaded. You can take it slow – group takes getting used to. With a little luck, you’ll begin to find some allies in the group room and start to understand other people a bit more. That’s probably the greatest gift of group – an understanding of other people. You can take that out into the world, and it’s a very powerful piece of learning. You learn a lot about yourself in the process, too.
When my kids were killed in the accident i wouldn’t have gone within a mile of another mother of dead kids. A room full of grieving parents in group, not a chance.
You’re not the first person to tell me something like that. A rape survivor I worked with said she was dreading facing a room filled with people who had been through what she’d been through. There is an argument that a “support group” concentrates particular experiences – and that a more general group could be less stressful. On the other hand, support groups for people who have particular experiences are very popular – people sometimes seek out others who seem to share something with them. It’s really just a matter of choice. In any case, I’m not sure anyone can be defined by a particular experience. A group specifically for people who have lost children can still be very diverse, with members representing entirely different backgrounds, opinions and points of view.
Six months ago an acquaintance from my community lost her son to cancer. Her younger son was a friend and although I didn’t know the son who died I went to the funeral. When she and I came face to face at the funeral I knew there were few words that I could really say to her other than just be there for her, but my heart was just aching for her. She with tears in her eyes and all the dignity and grace she could muster much the way many older southern woman do and said to me “I expect we will be talking”. I’m a northerner, she a southerner, she’s my mother’s age, I her son’s, my kids died suddenly, and her son from cancer. On the day when your phone rings and you hear that news, you get stripped bare and there is not one difference we’re just mothers and they’re our kids, all else fades to the back ground So the two of us, a somewhat unlikely pair decided to have lunch together and have been lunching every other week for months, we have a budding friendship I dare say maybe minus the therapist (which I do, she doesn’t) I feel the positive effect …the connection that we share that we have with no other. Maybe we’ll call it our group of two!
Probably my biggest concern about participating in group therapy with random abject strangers in a setting with no common theme is that I might face (possibly well-intentioned) bigotry from ignorant or judgmental people. I am gay; I am atheist; I am Jewish; I am non-monogamous with no interest in entering any relationship that resembles a marriage. Instead of addressing the problems that have brought us to group, I anticipate having to put my own issues on the back burner while I slip into teacher mode to inform someone my problems would not disappear if I married a woman, prayed, settled down with one person, found Jesus etc. Similarly, I would have difficulty refraining from being judgmental were I placed in a random group with a rapist or gay-basher. How do participants get down to the therapeutic nitty-gritty when larger sociological issues could so irreparably divide them?
A group is intended to reproduce the world, so you can approach it in a controlled environment and learn to better handle living in it. I am surprised that the world around you is giving you such a hard time for being gay, atheist and Jewish, but if it is, it would make sense that you would “transfer” those expectations and expect to confront the same thing in the group setting. I very much doubt anyone in my groups would have a problem with a gay atheist Jew (especially since the leader of my groups – me – is a gay atheist Jew himself) – but even if, hypothetically, there were people in there with very different values or views, the general operating rules would apply, and should keep things productive. There’s no attacking in group, and people are asked to be authentically present. And I certainly wouldn’t deem a known rapist or gay-basher a good candidate for my group room – at least not until I was certain that he had moved past whatever it was in him that led to these crimes being committed. I screen candidates for my groups to make sure they can tolerate the room – i.e., that they will be respectful of others, and not attack, or flee the room if the emotions in there become overwhelming for them. For the most part, very little politics is discussed in the group room – that’s too much like a cocktail party. We’re there to discuss our lives, and our emotional lives.