What is group therapy?

Introduction

Society to a greater or lesser degree always forms itself into groupings, whether they are for economic stability, religious expression, educational endeavor, or simply a sense of belonging. Within the field of psychotherapy, many theories and practices have been developed that deal with specific problems facing individuals as they try to relate to their environment as a whole and to become valuable members of society. Available approaches range from psychoanalysis
to transpersonal therapy. Taking advantage of the natural tendency for people to form groups, therapists, since the years following World War II, have developed various forms of group therapy. Therapy groups, although they do not form “naturally,” are most frequently composed of people with similar problems.

Immediately after World War II, the demand for therapeutic help was so great that the only way to cope with the need was to create therapeutic groups. Group therapy did not boast any one particular founder at that time, although among the first counseling theorists to embrace group therapy actively were Joseph Pratt, Alfred Adler, Jacob Moreno, Trigant Burrow, and Cody Marsh. Psychoanalysis, so firmly placed within the schools for individual psychotherapy, nevertheless became one of the first therapeutic approaches to be applied to group therapy. Gestalt therapy
and transactional analysis
have proved extremely successful when applied to the group dynamic. Fritz Perls was quick to apply his Gestalt theories to group therapy work, although he usually worked with one member of the group at a time. Gestalt group therapists aim as part of their treatment to try to break down the numerous denial systems that, once overcome, will bring the individual to a new and more unified understanding of life. Eric Berne, the founder of transactional analysis, postulated that the group setting is the ideal therapeutic setting.

Types and Advantages of Group Counseling

Among the different types of group counseling available are those that focus on preventative and developmental aspects of living. Preventative group counseling deals with enhancing the individual’s understanding of a specific aspect of life. These aspects range from simple job-seeking skills to more complex studies of career changes in midlife. Developmental groups are composed of well-adjusted people who seek to enhance their social and emotional skills through personal growth and transformation. Conversely, group therapy is concerned with remedial help. The majority of people entering group therapy are aware that they have dysfunctional components in their life; they are seeking group work as a possible way of resolving those problems. The size of most groups ranges from four to twelve participants. Sometimes all the members in the group belong to one family and the group becomes a specialized one with the emphasis on family therapy. Treating the problems of one family member in the larger context of the whole family has proved successful.

There are as many approaches to therapy as there are therapists; thus, the direction that any given group takes will be dependent on the group leader. Group leadership is probably the one factor that is vital in enabling a group to succeed in reaching both individual and group goals. A leader is typically a qualified and trained therapist whose work is to lead the group through the therapeutic process. Often there will be two therapists involved with the one group, the second therapist sometimes being an intern or trainee.

There are definite advantages, both economic and therapeutic, to group therapy. The economic burden of paying for therapy does not fall solely on one person’s shoulders; moreover, the therapist can use his or her time economically, helping a larger number of people. More important, group work may be much more beneficial than individual therapy for certain people. Often the group setting will produce conditions similar to those the member faces in real life and can thus offer an opportunity to face and correct the problem.

Stages of Group Sessions

In group therapy, a “session” consists of a number of meetings; the number is specific and is usually determined at the beginning by the group leader. Flexibility is a key concept in counseling, however, and if a group requires more time and all the participants agree, then the number of sessions can usually be extended. Therapists have generally come to accept five stages as being necessary for a group to complete a therapy session. These five stages do not have definite boundaries; indeed, if a group experiences problems at any stage, it may return to earlier stages.

Orientation is a necessary first step in establishing a sense of well-being and trust among the group’s members. A therapy group does not choose its own members; it is a random and arbitrary gathering of different people. Each member will assess the group critically as to whether this group will benefit him or her. One way for participants to discover the sincerity of the membership of the group is to reveal something of the problem that brought them to the group in the first place, without going into a full disclosure (the point at which a member of a group will share private feelings and concerns). An individual can then assess from the responses of the other members of the group whether they are going to be empathetic or critical. After the orientation stage comes the transitional stage, in which more self-revelation is required on the part of the individual members. This is usually an anxious time for members of the therapy group. Yet despite this anxiety, each member must make a commitment to the group and must further define the problem that has brought him or her to the group in the first place.

When the transitional stage has proved successful, the group will be able to begin the third stage, which involves a greater sense of cohesiveness and openness. This sense of belonging is a necessary and important aspect of group therapy. Without this feeling, the subsequent work of resolving problems cannot be fully addressed. By this time, each member of the group will have disclosed some very personal and troubling part of their lives. Once a group cohesiveness has been achieved, the fourth stage—actually wanting to work on certain behavior-modifying skills—becomes dominant. At this point in the therapeutic continuum, the group leader will play a less significant role in what is said or the direction taken. This seeming withdrawal on the part of the leader allows the group participants to take the primary role in creating changes that will affect them on a permanent basis.

As with all therapeutic methods and procedures, regardless of school or persuasion, a completion or summation stage is vital. The personal commitment to the group must be seen in the larger context of life and one’s need to become a part of the greater fabric of living. By consciously creating a finale to the therapy sessions, members avoid being limited in their personal growth through dependence on the group. This symbolic act of stepping away from the group reaffirms all that the group work achieved during the third and fourth stages of the therapeutic process.

Group Dynamics

Group work offers participants an opportunity to express their feelings and fears in the hope that behavioral change will take place. Group therapy takes on significance and meaning only when the individual members of the group want to change their old behavioral patterns and learn a new behavioral repertoire. Most individuals come from a background in which they have experienced difficulties with members of their immediate family. Whether the problem has been a spousal difficulty or a parental problem, those who enter into therapy are desperately looking for answers. The very fact that there is more than one person within the group who can understand and sympathize with another’s problem begins the process of acceptance and change. The group dynamic
is thus defined as the commonality of purpose that unites a group of people and their desire to succeed.

A group will very quickly become close, intimate, and in some ways self-guarding and self-preserving. Through continually meeting with one another in an intense emotional environment, members begin to look on the group as a very important part of their lives. When one member does not come to a meeting, it can create anxiety in others, for the group works as a whole; for one person not to be present undermines the confidence of those who already lack self-esteem. There are also those who come to group meetings and express very little of what is actually bothering them. While even coming into the therapeutic process is one large step, to disclose anything about themselves is too painful. For those who remain aloof and detached, believing that they are the best judge of their own problems, the group experience will be a superficial one.

Emotional Involvement and Cohesiveness

According to Irvin D. Yalom, therapy is “an emotional and a corrective experience.” The corrective aspect of therapy takes on a new meaning when placed in a group setting. There is general agreement that a person who seeks help from a therapist will eventually reveal what is truly troubling him or her. This may take weeks or even months of talking—generally talking around the problem. This is equally true of group participants. Since many difficulties experienced by the participants will be of an interpersonal nature, the group acts as a perfect setting for creating the conditions in which those behavioral problems will manifest. One major advantage that the group therapist has over a therapist involved in individual therapy is that the conditions that trigger the response can also be observed.

For those people who believe that their particular problem inhibits them from caring or even thinking about others, particularly those with a narcissistic or schizoid personality, seeing the distress of others in the group often evokes strong sympathy and caring. The ability to be able to offer some kind of help to another person often acts as a catalyst for a person to see that there is an opportunity to become a whole and useful member of the greater community. For all of its limitations, the group reflects, to some degree, the real-life situations that each of its members experiences each day.

The acknowledgment of another member’s life predicament creates a cohesiveness among the members of the group, as each participant grapples with his or her own problems and with those of the others in the group. As each member becomes supportive of all other members, a climate of trust and understanding comes into being. This is a prerequisite for all group discovery, and it eventually leads to the defining of problems and thus to seeking help for particular problems shared by members. When the individual members of a group begin to care and respond to the needs of the other members, a meaningful relationship exists that allows healing to take place. Compassion, tempered by understanding and acceptance, will eventually prove the ingredients of success for participating members.

Assessing Effectiveness

Group therapy has not been fully accepted in all quarters of the therapeutic professions. Advocates of group therapy have attempted to show, through research and studies, that group therapy is equally effective as individual therapy, but this claim has not settled all arguments. In fact, what has been shown is that if the group leader shows the necessary warmth, understanding, and empathy with the members, then success is generally assured. If the group leader is more on the offensive, however—even taking on an attacking position—then the effects are anything but positive.

Group therapy continues to play an important role within the field of professional care. Perhaps what has been lacking and will need to be reassessed is not so much whether the theories work but whether the participants gain as much as they can from group work. There has been a general lack of systematized study and research into the effectiveness of group therapy, especially as far as feedback from the participants of the group therapy experience is concerned. This reluctance on the part of psychologists and counselors to assess more closely the type of therapy that is being offered will change as participants of group work expect a greater degree of accountability from the professionals who serve them.

Bibliography

Corey, Gerald, and Marianne Schneider Corey. Groups: Process and Practice. Monterey, Calif.: Brooks/Cole, 2009. Print.

Donigian, Jeremiah, and Richard Malnati. Critical Incidents in Group Therapy. 2d ed. Belmont, Calif.: Brooks/Cole-Wadsworth, 1999. Print.

Fehr, Scott Simon. 101 Interventions in Group Therapy. New York: Haworth Press, 2008. Print.

Kutter, Peter. Basic Aspects of Psychoanalytic Group Therapy. Hove: Routledge, 2015. eBook Collection (EBSCOhost). Web. 30 Nov. 2015.

Peterson, Vincent, and Bernard Nisenholz. “Group Work.” In Orientation to Counseling. 4th ed. Boston: Allyn & Bacon, 1999. Print.

Rogers, Carl R. On Becoming a Person. Boston: Houghton Mifflin, 1995. Print.

Rutan, J. Scott, Walter N. Stone, and Joseph Shay. Psychodynamic Group Psychotherapy. 4th ed. New York: Guilford Press, 2007. Print.

Yalom, Irvin D. The Theory and Practice of Group Psychotherapy. 4th ed. New York: Basic Books, 1996. Print.