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INFORMATION ABOUT GROUP THERAPYThis information sheet is intended for patients who are about to begin group therapy, or who are considering it as a possible treatment. It is useful for people starting group therapy to have some general ideas about how groups help people and how they, themselves, can get the most out of the experience. Group therapy is different from individual therapy because many of the helpful events take place between the members and not just between the leader and the members. That is one reason why it is important that all of the members have a general introduction before beginning. Please read this material carefully and feel free to discuss any part of it with your therapist. The issues raised in this handout are also useful to talk about during the first few sessions in the group. Do groups really help people?Group therapy is widely used and has been a standard part of treatment programs for the last 30 to 40 years. Sometimes it is used as the main or perhaps the only treatment approach. This is especially true for outpatients. Sometimes it is used as part of a treatment approach that may include individual therapy, drugs, and other activities. Group therapy has been shown in research studies to be an effective treatment. Studies that have compared individual and group approaches indicate that both are about equally effective. The difference with groups, of course, is that a group has to form, and the members need to get to know each other a bit before it can be of the greatest benefit. Most people have participated in some type of non-therapy groups, for example in schools, churches, or community activities. Therapy groups will have many of the same features. The difference is that in a therapy group the leader has a responsibility to ensure that the group stays focused on its treatment goals and that all members participate in this. How group therapy worksGroup therapy is based on the idea that a great many of the difficulties that people have in their lives can be understood as problems in getting along with other people. As children, we learn ways of getting close and talking to others and ways of solving issues with others. In general, these early patterns are then applied in adult relationships. Sometimes these ways are not as effective as they might be, despite good intentions. Groups offer an opportunity to learn more about these "interpersonal" patterns. Very often, symptoms such as anxiety or unhappiness, bad feelings about yourself, or a general sense of dissatisfaction with life reflect the unsatisfactory state of important relationships. Groups are designed to help particularly with these sorts of problems. Other treatment approaches might help in other ways. |
Although it is true that groups offer an efficient way of treating several people at once, group therapy is not a cheaper or second-rate treatment in the sense that it has less power to help people than other treatments. As mentioned above, studies show that many of the "talking therapies" are about equally effective.
Some people are concerned that a therapy group will be like a forced confessional where they have to reveal all of the details of their lives. This is not the case. Groups will progress at their own rate as the members become more familiar with each other and can trust each other in general, groups talk about the patterns in relationships and the meanings these have for them. For this it is often not necessary to know specific details. Members will find their own level of comfort regarding how much they want to disclose about their personal lives. Details about where you live or work, even your last name, are not necessary for effective involvement in the group
Some people worry that being in a room with other people with difficult- ies will make everyone worse. This idea of the "blind leading the blind" is understandable, but in practice, people find that the process of talking about their problems is very helpful. Indeed, finding that others have had similar problems can be reassuring. Many group therapy patients are surprised to find that they have something to offer other people.
Some of the media presentation of groups suggests that people will lose control in groups and become so upset that they cannot function or maybe get so angry that they will be destructive. Very seldom is there any chance of this happening, and the group therapist will be alert and responsible to encourage the group if it gets too slow or to dampen things down is the tension gets too high.
When people picture being in a therapy group, they sometimes find themselves concerned that they may be rejected or excluded by the other group members; sometimes the fear is that they will be judged harshly by the other members, and sometimes they are afraid that they may lose their sense of themselves and be carried along by the group where they don't wish to go. All of these fears are perfectly understandable, and indeed, almost everyone experiences them to some extent when they enter a new social group situation. It is good to talk about these sorts of fears early in the group so that they can be understood and then put behind you.
The more you can involve yourself in the group, the more you will get out of it. Try to be as open and honest as possible in what you say. Group time is precious; it is a place to be working on serious issues, not just passing the time of day. Listen hard to what people are saying, think through what they mean, and try to make sense of it. You can help others by letting them know what you make of what they say and how it affects you. Many of the issues talked about in groups are general human matters with which we can all identify. At the same time, listen hard to what others say to you about your part in the group. This process of learning from others is an important way to gain from the group experience.
One way to think about group is to view it as a "living laboratory" of relationships. It is a place you can try out new ways of talking to people, a place to take some risks. You are a responsible member of the group and can help make it an effective experience for everybody. A good way to think about how a group can help people is this: Consider a person risking a different way of talking about personal matters, getting some response from the other members that it sound all right, and trying to make sense of the experience Do your best to translate your inner reactions into words. Group is not a "tea party" where everything has to be done in a socially proper fashion. It is a place to try to explore the meaning of what goes on and the reactions inside that get stirred up. .
Remember that how people talk is as important as what they say. As you listen to others as you think about that you yourself have been saying, try to think beyond the words to the other messages being sent. Sometimes the meaning of the works does not match the tone of voice or the expression on the face.
Because the group is the place to learn about the experience itself, it is important to focus on what is happening inside the group room between the members and between each member and the leader. Often, understanding these relationships throws new light on outside relationships. Many people have found it helpful to think about themselves in terms of the things they know and don't know about themselves, and the things that other know or don't know. One of the tasks of group is to try to make what is called "public knowledge" larger by three main methods: 1) talk about things that you normally keep hidden about yourself or speak about your thoughts concerning others (self-disclosure), 2) listen to what others are saying about what might be your blind spots (feedback), and 3) listen hard and think hard so that you can understand more about yourself (insight). .
It is normal to feel anxious about being in groups. Almost everyone experience it to some extent. One way of dealing with this is to talk about it at an early point in the group. This is a good model of the usefulness of talking about things so that they can be clarified and the anxiety related to them reduced. .
It is the role of the leader to encourage members to talk with each other and to help keep the group focused on important tasks. The leader is not there to supply answers to specific problems. One of the things you will experience in group is learning to benefit from the process of talking with other people and not just getting pat answers. .
Try hard to put into words the connection between how you reach and feel and what is happening between you and other people both in the group and outside. It is all right to be emotional. This process of trying to understand reactions or symptoms in terms of relationships is important. .
Many group members find themselves experiencing a sense of puzzlement or discouragement after the excitement of the first few group sessions. Please stick with it through this stage. It almost always occurs, and it reflects the fact that it always takes groups some time to develop their full benefit for the members. Once the group has experienced this, it is in a much stronger position to be helpful. .
From time to time in the group, you may find yourself having negative feelings of disappointment, frustration, or even anger. It is important to talk about these reactions in a constructive fashion. Many people have difficulty with managing these sorts of feelings, and it is part of the group's task to examinee them. Sometimes these negative feelings may be toward the leader. It is equally important that these also be talked about. .
Try hard to apply what you learn in the group to outside situations. Many group members have found it helpful to talk to the group about how they might go about applying what they are learning, then try it outside in their personal lives and report back to the group about how it went. Studies have shown that the more you can do this, the more therapy becomes "real" and the more you will get out of it. At the same time, remember that the rest of the world does not necessarily run the same way as a therapy group. Try out your ideas in the group first to test if your plans are well thought out. .
CONFIDENTIALITY. It is important that things that are talked about in the group are not repeated outside. You may, of course, want to discuss your experience with people close to you but even then it is important not to attach names or specific information to the talk. In our experience, it is extremely uncommon for there to be any important break in confidentiality in therapy groups. Please be sure that you don't talk about others, just as you don't want them to talk about you. .
ATTENDANCE AND PUNCTUALITY. It is very important that you attend all sessions and arrive on time. Once a group gets going, it functions as a group, and even if just one member is absent, it is not the same. So both for your sake and for the sake of all the members, please be a regular attendee. If for some reason it is impossible for you to make a session, then call in advance and discuss it with your therapist or at least leave the information. Then the group will know you are not coming and won't wait until you arrive to get down to work. For outpatient groups, it is useful for the group to spend more time periodically talking about major absences such as trips or vacations and discussing how to plan for these as a group. .
INITIAL COMMITMENT. Most outpatient groups meet for at least a few months. The exact number of sessions will vary according to the clinical judgment of your leader. It takes time to appreciate how much a group can help you, so it is important that you commit yourself to at least a dozen sessions of the group and that you discuss with your therapist before the group starts what the expectations are in terms of the length of your particular group. .
ALCOHOL OR DRUGS. Groups are places for sensitive personal discussions. It is important that you do not come to sessions under the influence of alcohol or drugs except prescription medications. This is not to say it is good or bad to use alcohol or drugs, but they get in the way of making the most of the group experience. As a general rule, you will be asked to leave the session if your behavior is significantly affected. No food, drinks, or smoking is allowed in the group room. These tend to be distractions from the work of the group. .
SOCIALIZING WITH GROUP MEMBERS. It is important to think of groups as being a treatment setting and not as a replacement for other social activities. Group members are strongly advised not to have outside contacts with each other. The reason for this is that if you have a special relationship with another group member, that relationship gets in the way of getting the most out of the group interaction. The two of you would find yourselves having secrets from the group or not addressing issues because of your friendship. If you should have some outside contact with group members, then it is important that this be talked about in the group so that the effects can be taken into account. You are asked to make a commitment to report such contacts within the group. .
Major life decisions. Many people come to therapy groups because things have not been going well in their lives. There is a temptation to take the first advice you hear and decide to make a big change. Please wait so that you have a chance to get the most out of your therapy before making important life decisions. .
Goal: Increased Self-Awareness, Interpersonal Growth, and Change through Art, Literature and Spirituality.
I agree to be present each week, to be on time, and to remain throughout the entire meeting. If I can't attend, I will inform the group and/or call the group therapist.
If the group leader cannot attend the group, she will make every effort to notify each group member. .
I agree to work actively on the problems that brought me to the group. Though the focus is on feelings, perceptions, and memories that are stimulated in the here and now, often the group interactions resurrect salient current and past elements in member's life experiences, both problematic and joyful, and these are important to discuss because we are trying to know each person as fully as possible. .
I agree to put feelings into words, not actions. This includes feelings of anger, affectionate and soothing touch among members. There is a place in therapy groups for a gentle touch or hug as an authentic expression of communicating deeply felt emotions, but these acts should always be examined for their full meaning and impact. .
I agree to use the relationships made in the group therapeutically, not socially. Members should discuss emotionally meaningful extragroup contacts in order to enhance learning and understand these interactions may well represent important ways of managing feelings evoked in the group. .
I agree to remain in the group until the problems that brought me have been resolved. .
I agree to be responsible for my bill. .
I agree to protect the names and identities of my group. Group members are encouraged to bring any concerns they have back to the group. Group members who do not maintain confidentiality will be asked to leave the group. .
If the group therapist seeks consultation from a colleague, no names and/or identifying personal data will be disclosed. .
I understand that the group leader cannot guarantee group confidentiality. There have been rare situations in which group documentation has been subpoenaed. Every effort will be made to maintain the privacy of the group. .
I may leave the group at any time, but will make an effort to give the group several weeks notice and to process understanding my leaving the group and termination with the group. .
Cell phones should remain off during the group. Tape recording and taking notes about group members is not allowed. .
Other: .
Group psychotherapy is first and foremost a type of psychological healing and interpersonal learning. It is the coming together of a group of people, with the group therapist, to explore who they are, how they interact, and what are some of the obstacles to interpersonal fulfillment in their lives. Dr. Irvin Yalom, a foremost leader in the field of group therapy, believes that all psychological problems are problems in interpersonal living. The healing and learning best take place in an interpersonal setting dedicated to the discovery and understanding one's personal obstacles and difficulties in relationships.
In view of these purposes, group therapy requires that each member be committed to foster the interpersonal process within the group sessions. This first requires that each member understand that regular attendance is a must. Each member is a very important part of the group process. Secondly, each member shows their commitment to their own and the others' healing and well-being by self-disclosing, by practicing empathic communication, by speaking directly to the other members and not simply to or through the therapist. The best group response to another member who is telling of their pain can be to acknowledge the pain in the other member and then match their self-disclosure with your own. This leads to a very important principle of interpersonal healing: mutual vulnerability.Being vulnerable to each other leads to a strong sense of cohesion amongst members. Also it is a great antidote to the loneliness and isolation that result from personal and interpersonal difficulties. And eventually it leads to trust which sets the stage for feeling safe and protected in the group so that more and more painful issues can be discussed and resolved.
Mutual vulnerability, then, is evident in the group when members do not simply ask each other questions about their problems, but tell each other how they feel when hearing another member speak of their pain and difficulties.There is mutual vulnerability when members tell each other of their similar experiences and difficulties and dhow they felt when they went through that experience. This helps to break down the loneliness and isolation also since members can see that they are not the only ones suffering a particular problem.
The group must have certain boundaries and norms so that it remains intact and safe for its members. One of the most important issues concerning boundaries is confidentiality. All members are held to strict confidentiality concerning not only what a particular member discloses but also who the members of the group are. It is appropriate to discuss one's own learning in the group with someone outside of group but it is not appropriate to discuss another member's disclosures or to reveal the identity of a member to a non-member. Everyone in the group must feel free to disclose their deepest and darkest secrets in the group without fear that someone outside the group will be hearing about them. Yet there are notable exceptions to the rule of confidentiality. The State of Missouri has ruled that there is no confidentiality in a therapeutic setting when or if child abuse is disclosed. The therapist is mandated by law to report the suspected child abuse. Also, if a client discloses the purposeful intent to harm another person, the therapist is to take reasonable precautions to thwart the harm even to the extent of attempting to inform the intended victim. This can require that the therapist break the confidentiality to explain to the intended victim why the therapist suspects they are in danger. Also if the therapist sincerely believes that a group member is a danger to himself, then the therapist will take measures that hopefully would prevent that person from doing harm to themselves, even if it means breaking confidentiality.
Other means of ensuring good boundaries are being on time for the sessions, paying for each session at the time of the session, calling when you are not going to make group, and restricting contact with other members, including the therapist, to the group. Group embers are discouraged from socializing with each other outside of group time. And talking over issues with the therapist outside of group sessions is discouraged. If there is some extra-group socialization or if a member feels they must talk to the therapist outside of group, then mention of this should be made in the group. This helps to prevent the group from splintering into smaller subgroups. Otherwise there frequently can be a diluting of the healing process and weakening of the cohesion within the group as a whole.
While it is important for feelings to be expressed freely and openly in group therapy, such freedom of expression cannot be an excuse for making others in the group extremely uncomfortable or frightened. Some fear in the face of strong emotion is inevitable, but fear that the expression of feelings will lead to acting out in a harmful or dangerous way in the group is not helpful. For example, it is important to talk about one's anger with real energy behind it. It is not appropriate to throw things, threaten another physically, or leave the room. While this most likely is self evident, it is better to make it clear and explicit. If a group member does not feel capable of self-control under the influence of strong emotion, then he or she may be asked to leave.
One of the basic tenets of group psychotherapy is that each member will re-enact in the group, either in symbolic form or in a rather direct manner, the major conflicts in their interpersonal life outside of group. This allows for self-observation, the reception of feedback, and the trying out of alternative, new ways of dealing with the conflicts. Most interpersonal problems are not the result of conflicts in relationships but of the various ways learned to deal with those conflicts. The group is a safe place to get the necessary feedback for change to take place and to try out some new ways of behaving interpersonally.
While it is true that major conflicts leading to difficult feelings are in our present lives, their roots are usually in the past. It is necessary, then, to know where we come from emotionally if we are going to understand who we are. We are all the product of many generations of conflict-generation and conflict-resolution. It has been said that we are trying to solve conflicts in our lives that have their roots two generations back in our family history. In view of this, it is important to use group psychotherapy to explore your family background and your generational history. Members need to encourage each other to do such exploration and share their own history.
Leaving group is actually part of the therapy. This process, called termination is best done over a series of sessions, usually around four. One of the difficulties most of us have in our relationships is dealing with its ending point. We fear the goodbye, the subsequent loss, the feeling of emptiness. The fear is normal, running from it is not and can leave us wounded in the next or other relationships in our lives. Therefore, in group therapy, we make protracted goodbyes, letting all those staying behind deal with us and their feelings about our leaving. Most leavings are ambivalent, that is, leave us with mixed and conflicting feelings that oftentimes are difficult to express. A termination done well can help us to live with our mixed feelings and to learn to express them in a way that does not wound us or others unnecessarily.
Because your place is ensured in the group whether or not you attend each session, and to reinforce the importance of attendance at each and every session, the fee for each session is charged whether or not you attend. Since such fees are not for face-to-face contact and treatment, no insurance slip can be issued for missed sessions. All sessions are 90 minutes long and are held on a weekly basis.
written by Roger L. Gennari, Ph.D.
