The People's Therapist

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.

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