Group therapy? Really?

One of my favorite things while working for a managed health care system was facilitating group therapy. It was required that all therapists run a minimum of two groups per week. At one point I was running four and wanted more. I loved group therapy. Each and every time I was so impressed by the people who showed up and made their way through the process. It’s a bold move to show up and commit to group therapy. The knee jerk reaction to group is usually, “No way. Not for me.” This is completely understandable. Picturing yourself sitting in a circle, sharing intimate details about your life with total strangers is off-putting to most. So why consider group therapy? What’s so great about it? How does it even really work? Here are a few things to consider:

Research supports its efficacy.

A term you will hear again and again from the medical community, particularly the psychiatric community, is “evidence-based.” What does that mean? To define it in a supremely basic way, it means there is research showing how useful it is rather than a professional recommending it because they think its a good idea/they like it/they have a hunch about it. (The methodology behind how something becomes “evidence-based” has come under fire recently and is worth considering.  But that’s another article.) Group therapy is what we would call an evidence-based practice. There’s decades of research and endless studies showing how helpful and effective group therapy can be. Dr. Irvin Yalom, the granddaddy of modern group therapy and author of the seminal text, “The Theory and Practice of Group Psychotherapy” outlines 11 therapeutic factors that make group therapy effective: installation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors. These 11 factors are all ways group can be of benefit to the participants. 

You will sit in a circle and share, but don’t let that freak you out.

There are two types of group therapy: process and psycho-educational. Most groups operate as a hybrid. You will sit in a circle. You will likely go around, say your first name and maybe how you are feeling that day and maybe share one thing you’ve done that week for yourself. A basic check-in. A process group would then proceed to “open it up to the group.” Meaning the focus would be on sharing experiences and getting support and feedback from the group (ideally from the group and not the therapist). A psycho-ed group would also likely require you to sit in a circle. You would also likely go around and engage in some type of check-in. However, a psycho-ed group is primarily going to be skill-based and the therapist(s) will be providing the group with specific tools and how to use them. It’s more like a class.  The majority of groups these days are a process/psycho-ed combo and are CBT (Cognitive Behavioral Therapy) based (another evidence-based practice).  Beyond the standard check-in, you will never ever be forced to share. If you aren’t in the mood to participate in the check-in, you can always say pass. The idea of group is to show up. Just being in the room will help. Every member comes to group from a different starting point and the therapists know this. This is also one of the ways group is so effective.  Members who are more hesitant are often encouraged by the members who are perhaps more experienced with therapy or simply more comfortable in a group setting. The experience of being encouraged and encouraging someone else is of tremendous benefit to both parties. It is ok to be skeptical of the group when it starts. That’s normal. Having thoughts of, “Will this help me?” or even, “This is so pointless, but I will try it one time and see,” are both totally normal. I ran two CBT based depression/anxiety groups for 5 years. They each met once a week and ran on an 8 week cycle. On the first night of group I would ask, “How many of you are sitting there thinking that there’s no way this group is going to help me?” More than half the hands would go up each and every time.  

image: aaron blanco tejedor

Listening to other depressed people will make me more depressed.

In my experience this is the most common reason people resist group therapy. They fear they will be listening to sad stories, which will only increase their depression. The thought is understandable. A depression group would suggest that people may be talking about depression. But it rarely means they are talking about depressing things. In group, people typically share their experience with their diagnosis or a specific disorder. They are sharing about their depression (or anxiety or OCD), which is quite different than a bunch of depressing stories. Groups exist for nearly every single diagnosis at this point and research shows that hearing other people’s stories creates a feeling of, back to Yalom, universality. A shared boat experience. Logically we can recognize that we are not the only one who is depressed, or anxious, or has experienced loss, but the nature of those experiences actually cause our brain to think the opposite. 

I’ll never find a group for me.

Groups are everywhere. You just have to ask the right people. If you have a psychiatrist or therapist, start by asking them. If you are part of a managed health care system, they often offer group therapy. Clinics, mental health organizations and larger group practices in your area often have groups available. Groups are offered for almost all psychiatric disorders and cover a wide range of modalities (CBT, DBT, art, play). 

Leave a Reply