Group Therapy – Would you ever try it?

During my graduate degree, I had to take a course on Group Psychotherapy.  It was an experiential course, which meant I actually did group therapy with my classmates.  I would be both the counsellor/facilitator of the group and a participant when other students were practising the facilitator role. This was a process group as well so things would happen on the fly, you can’t be prepared for being triggered by someone else’s story and experience or triggering other people with your experiences.  I would be lying if I didn’t say I was scared shitless.  I had never myself been a group member, had all my thoughts, feelings, and experiences out there for other people to know.  I also didn’t know my classmates super well.  I don’t know what’s easier, not knowing other people or knowing people in the group.  On the one hand when you don’t know the other people, you have some anonymity.  On the other hand, maybe it’s easier sharing when there is someone else in the room you know very well.

Anyways during the first few classes we had to share a personal story about ourselves that we could prepare beforehand.  The first personal story I wrote was very surface and not very personal at all.  I did this to protect myself.  After hearing the first person who shared such a deep personal story that led herself and the group to tears, I realized this could actually be a very therapeutic experience for me I actually really try and put my heart and soul into this.  So I went home and rewrote my story as I didn’t go that first class since there were 30 of us in the class.

Quick Explanation on my use of the word Story

I know throughout this blog I often refer to experiences as story.  I know for some this may seem like I am minimizing an experience as stories are often fictional.  However, when I use the word story I am meaning personal experience.  A story can be described as an account of past events in someone’s life or in the evolution of something.  I did my practicum where a lot of the counsellors used Narrative Therapy which is a collaborative and non-pathologizing approach to counselling which centres people as the experts of their own lives (Narrative Therapy Centre, n.d.).  Stories in a ‘narrative therapy’ context are made up of events, linked by a theme, occurring over time and according to a plot. A story emerges as certain events are privileged and selected out over other events as more important or true. As the story takes shape, it invites the teller to further select only certain information while other events become neglected and thus the same story is continually told. These stories both describe and shape people’s perspectives on their lives, histories and futures.

Sharing in Group Therapy

After I had rewritten my personal experience story to share with the group.  I was very nervous. I had written about the trauma I had experienced when I was held up at gun point when I was a teenager working alone at a video store.  I had not talked about this experience in years, but it was always in the back of my memory.  It still had some long lasting effects on my life.  So this was a very deep personal story that no one in my class would have known about.  I knew beforehand that I would most likely cry since I was so nervous to be so vulnerable in a group I didn’t know.  And I was right.  I bawled like a baby.  As I read, my teacher (who facilitated the group for this exercise) encouraged me to take my time.  It is very difficult to read when you cry.

After I finished reading it, my teacher asked “What was it like to write it?”  I find it very therapeutic to write and I do keep a journal.  However, I had never written about this experience as it happened in my adolescence.  So I found it therapeutic to write down all my thoughts, feelings, and how it has impacted my life still to this day.  I never seeked counselling for this experience and I probably should have at least 1-2 sessions now that I look back on it.  This experience of sharing my story really helped me to grieve that experience and let out some feelings that were still there.  Now I feel that if I had to read it again I would be okay.  Some may worry that this experience would have re-traumatized me because that can happen when people share their trauma and they are not ready.  However, I think enough time had passed and that I had processed everything I had needed to.  It’s okay to feel scared, vulnerable, and uncomfortable in group therapy.  It’s completely normal and I can guarantee everyone feels the exact same way!

Here’s a little overview from my experience doing Group Therapy on what the strengths and limitations are.  Let’s start with the limitations.

Limitations

In group psychotherapy, the facilitator has a big role. The facilitator needs to be constantly aware of a range of group process issues, such as observing connections between group members, encouraging open dialogue, promoting expression of feelings, and encouraging useful feedback between group members (Corey, 2008). This can be challenging for a facilitator and some things may go unnoticed. For myself, it wasn’t an easy task being a facilitator. There was a lot of things you need to be aware of. Some days when I facilitated I was tired because it was the end of the day. It was a struggle to remain constantly engaged and facilitate the group. So as a facilitator you really need to be aware of yourself and what’s going on for you while trying to engage other groups members. Therefore, facilitators need self-awareness and awareness of what’s going on for others in the group which can be difficult to juggle. At my practicum site, our group is a process group. So you can’t really prepare for it. The process that unfolds each week can vary drastically week to week. I found that to be challenging. I am a person who likes structure and there was structure, but not knowing what may unfold made me nervous. I like to be prepared and in a process group you can only do that to a point.

Another limitation of group psychotherapy is maintaining confidentiality. Confidentiality is more difficult to maintain since there is now not one, but a group of individuals. Self-disclosure is at the core of group psychotherapy and there is now a group of individuals hearing these disclosures (Lasky & Riva, 2006). At the beginning of our large group and small group, the facilitator went over confidentiality. We were not to discuss any of these disclosures outside of class.  If you know someone in the group this can be challenging because if they discuss anything you discuss in the group it can leak out to other people losing your confidentiality and anonymity.

Strengths

There are many strengths and benefits with conducting group psychotherapy. The most obvious being it is more cost effective to perform group psychotherapy over one on one individual counselling. More people can be treated at once in a group setting (Vivyan, 2013). It can also be useful for people who find one on one therapy more uncomfortable (Vivyan, 2013).  Individual therapy could be more intrusive where a group setting can provide more anonymity making it less intrusive.

Human beings have an inherent need to belong to a group (Yalom & Lescz, 2005). It is something we instinctively desire, biologically it stems from the need to survive. In group psychotherapy, the group format can provide individuals with a sense of belonging, acceptance and validation (Yalom & Lescz, 2005). Yalom & Lescz (2005) term this process cohesiveness. In my smaller group, our group formed cohesiveness. I would say that it didn’t emerge right away, it took a bit of time for everyone to get to know each other and become comfortable with one another. It did help that most of us already knew each other from previous classes, so I would say in regular groups it could take a couple sessions. However once cohesiveness is formed, there is a strong bond between group members.

Another concept that is related to group cohesiveness is universality (Yalom & Lescz, 2005). Group members have shared experiences and feelings, which results in individuals feeling less isolated by their experiences and more validated. I was surprised by how many people in my group connected with some of my experiences and I was surprised by how many shared experiences I had with others when they read their stories. It is true that you feel more validated and less isolated by your experiences when you discover you have shared experiences. When I read my essay about my death anxiety, I felt so crazy reading it. I was sharing what I believed to be irrational crazy thoughts I had about dying.  I am young, why am I worrying about dying when I am healthy?! After reading my piece, I quickly learned that others felt the same way about death too!  So I felt very validated and that it is normal to have these experiences.  No one just talks about it unless you ask.

 Group psychotherapy can be cathartic. Group members may not have talked with others about significant events or emotional distress they have experienced. Within the safe and supportive environment of the group, members gain a sense of relief from disclosing their distressful experiences and feelings. I know for myself many of my essays were very emotional for me especially to read them aloud in front of others. It may have seemed like I was very distraught and upset about some of them, but on the contrary it was a healthy release of emotions and feelings.

Installation of hope is a concept that I have encountered in the group that I co-facilitated at my practicum. I co-facilitated a sixteen step group for substance use clients with my supervisor.  Installation of hope means group members feel greatly encouraged by hearing the experiences other members have had with overcoming similar problems. Many of our clients in this group share their experiences and struggles with substances, while instilling hope in others that they too can overcome substances. There is also an imparting of information between the group members as they learn from others problems, solutions, and other possible resources (Yalom & Lescz, 2005).

Group psychotherapy also provides individuals with an opportunity to learn from each other (Whitfield, 2010). Individuals learn from other group members’ experiences and also can learn more about themselves by doing so. For example when one of my group member’s shared her positive outlook on death, I learned that I do not feel that way about death. I have a real death anxiety. However, I learned that not everyone feels the way I do. We all have our experiences and are shaped by them.

Recommendations

I would suggest for clients who are trying out counselling this may be a good alternative.  It will not be as invasive as individual counselling because the group allows you some anonymity.  It also may be more cost effective for you as well than paying individual counselling fees.

You do have to be group ready, meaning it’s appropriate for you to be in the group.  So if you have significant trauma that may trigger others or re-traumatize you then it is a good idea to start off with individual counseling.

Also, find a group that will be addressing the issues you want to address like depression, substance use, or anxiety etc.  That way it will be most effective and meaningful to you!

Give it a few sessions, you may not like it at first like me.  But once your nerves are put at ease you may actually find you like it!

References

Lasky, G. & Riva, M. (2006). Confidentiality and privileged communication in group psychotherapy. International Journal of Group Psychotherapy, 56(4): 455-476. Doi: 10.1521/ijgp.2006.56.4.455

Narrative Therapy Centre (n.d.) About Narrative Therapy.  Retrieved from http://www.narrativetherapycentre.com/narrative.html

Whitfield, G. (2010). Group cognitive–behavioural therapy for anxiety and depression. Advances in Psychiatric Treatment, 16(3), 219-227.

Vivyan, C. (2013) Open Group CBT Therapy. Retrieved from http://get.gg/docs/CBT-OpenGroupTherapy.pdf

Yalom, J.D., with Leszcz, M. (2005). The theory and practice of group psychotherapy (5th Ed.) New York: Basic Books Inc.

 

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