A GUIDE TO GROUP PSYCHOTHERAPY

Abridged from a publication of the Canadian Group Psychotherapy Foundation (1995)

What is psychotherapy?

Psychotherapy is a way to find solutions to life's emotional, personal and social difficulties by talking and reflecting with a skilled professional psychotherapist. Many people find that this kind of examination gives them a new way to look at their lives.

What is group psychotherapy?

Group psychotherapy involves a small group of people who share the same concerns or problems. The leader ( a group psychotherapist) encourages and guides discussion, fosters mutual support among the group's members, and helps them recognize, understand and resolve their difficulties.

The help members give one another is what sets group psychotherapy apart from other approaches to therapy.

What kinds of group psychotherapy are there?

One type of group psychotherapy is more effective for people who have distinct, well-defined problems-

such as eating disorders, drug dependence, or marriage trouble. The focus here is often educational and informative.

But sometimes our problems are not so clear, our feelings more difficult to untangle. We know we feel unhappy or become disabled, but don't know why -- and would have a tough time explaining our emotions to anyone else. In situations like these, there is a second type of group psychotherapy, which helps resolve the distress caused by these more general personal and social problems. Discussion in these groups is free-flowing: some groups act out life events to help people relate therapy to their real lives.

How do I choose a group?

It's important to find a group that targets your particular needs. Speaking to your family doctor, or another professional you trust (such as a social worker or minister) is a good way to start your search. He or she can recommend group psychotherapy services available in your area or suggest that you consult with a particular specialist or group psychotherapist.

If you develop a clear, unclouded idea of what your problem is, a short-term , problem-centred group would probably be best. If you're confused about your feelings, a more general, longer-term group may be a better choice. Longer-term general groups come in two forms:

Support group: this is the best option for people who feel overwhelmed, whose lives seem overloaded with unmanageable change and pressure, or people who have been seriously ill or have become disabled. These groups tend to be informal: members are not expected to attend regularly, they attend the group when they feel the need. And members are encouraged to socialize outside the group and to look to other kinds of support groups for extra help.

Change Group: this kind of more disciplined therapy asks a little more of its members, who are expected to attend every session and to avoid socializing with one another away from therapy. Members are also asked not to take part in any other therapy groups. The focus is self-examination. The goal is to change self-defeating attitudes.

What about self-help groups?

Recent years have witnessed an avalanche of self-help groups. These open and democratic organizations offer a forum for mutual support and guidance. But -- unlike group psychotherapy -- self-help group that deals with life problems are usually not led by a professional psychotherapist or held in a professional setting.

Where does group psychotherapy take place?

The setting for group psychotherapy is usually a clinic, agency or a professional's office. Hospital patients, however, may join group psychotherapy as part of their overall treatment programme. (in which case the turnover is often rapid as patients are discharged).

How long does each group psychotherapy session take? What about the long-term commitment?

Most meeting last an hour or two. As for the overall time commitment, groups can last a couple of months to a couple of years. Some go on indefinitely with members graduating and new ones joining from time to time. Hospital patients may attend just a few meetings while they are in the hospital, though sometimes they are encouraged to continue after discharge.

Who conducts the group?

When the setting is a clinic, agency or professional's office, the therapist must be properly qualified: a licensed member of a mental health discipline and trained in group psychotherapy.

However in-patient groups as part of an overall treatment program can be led by any member of the patient's professional team: a nurse, occupational therapist, social worker, psychologist or physician.

Unfortunately the title "psychotherapist", or "therapist", is not regulated by law. This means almost anyone can set up an office and market his or her services as a therapist.

You are entitled to have a therapist whose behaviour is ethical. If you ever have any questions or complaints about a therapist's honesty or integrity, contact the professional body that has licensed him or her.

What about the cost of group psychotherapy?

Research shows that group psychotherapy is both effective and economical. Its ultimate benefits outweigh the financial costs. Most provincial health plans cover group psychotherapy sessions when they take place in a medical setting. If you receive therapy in a non-medical setting you will b e expected to pay a fee. However, some private insurance plans will help cover the cost. Be sure to have an open discussion and a clear agreement with your therapist about billing and payment. ]

group psychotherapy is not magic and it's hard work. Though it may not be suitable for everyone, many people have found that it has brought peace to their lives.

This information is provided as a public service by the Canadian Group Psychotherapy Foundation. The Foundation is a non-profit organization that provides public education and supports training and research in the field of group psychotherapy. (Charitable registration No. 0905307-19)


The following is from Dr. K. Roy MacKenzie's book, "Time-Managed Group Psychotherapy: Effective Clinical Applications"

Information Regarding Group Therapy

This information sheet is intended for people who are about to begin Group Therapy, or who are considering it as a possible treatment. It is useful when starting Group Therapy to have some general ideas about how groups help people and how to 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 group leader. 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 40 to 50 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 which may include individual therapy, drugs and other activities. Group Therapy has been shown in research studies to be an effective treatment. Studies which 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 types 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 works:

Group 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. Often these early patterns are then applied in adult relationships. Sometimes these ways are not as effective as they might be, despite good intentions. 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 offer an opportunity to learn more about these "interpersonal" patterns.

There are many different kinds of groups. Some groups are designed to provide the members with information about some topic, like eating disorders; others focus on a particular skill, like assertiveness. Some groups are quite structured and may use a written manual, for example cognitive-behavioral groups; while others focus on understanding more about yourself and the nature of your important relationships. No matter what kind of group you are in, this Information sheet is designed to let you know about how groups work and how you can get the most from your group experience.

Common myths about group therapy:

(1) While 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 most of the "talking therapies" are about equally effective.

(2) 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 life. 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.

(3) Some people worry that being in a room with other people with difficulties 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.

(4) Some of the media presentation of groups suggests that people will lose control in groups and become so upset they can't 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 if the tension gets too high.

(5) 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.

How to get the most out of group:

(1) The more you can involve yourself in the group, the more you will get out of it. In particular, try to identify the sorts of things that you find upsetting or bothersome. 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. It takes time to appreciate how much a group can help you. So it is important that you commit yourself to come to a few sessions of the group before deciding if it's worthwhile for you. Discuss with your therapist before the group starts what the expectations are in terms of the length of your particular group.

(2) One way of thinking about group is to view it as a "living laboratory" of relationships. It is a place where 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 to 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 sounds all right, and then trying to make sense of the experience.

(3) 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.

(4) Remember that how people talk is as important as what they say. As you listen to others and as you think about what you yourself have been saying, try to think beyond the words to the other messages being sent. Sometimes the meaning of the words does not match the tone of voice or the expression on the face.

(5) Because the group is a place to learn from the experience itself, it is important to focus upon 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 others know or don`t know.

The diagram below outlines this. One of the tasks in group is to try to make the box called "public knowledge" larger by three main methods: first, to talk about things which you normally keep hidden about yourself or speaking about your thoughts concerning others (self-disclosure); second, to listen to what others are saying about what might be your blind spots (receiving feedback); and third, to listen hard and think hard so that you can understand more about yourself (personal insight).

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 Common stumbling blocks:

(1) It is normal to feel anxious about being in groups. Almost everyone experiences 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.

(2) 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 ready 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.

(3) Try hard to put into words the connection between how you are reacting or feeling 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.

(4) Many group members find themselves experiencing a sense of puzzlement or discouragement after the excitement of the first few group sessions. Please live 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 lived through this it is in a much stronger position to be helpful

.(5) 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 examine them. Sometimes these negative feelings may be toward the leader. It is equally important that these also be talked about.

(6) Try hard to apply what you learn in group to outside situations. Many group members have found it very useful 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. Many people report that keeping a regular personal journal is helpful in keeping on track with important issues between sessions. 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.

(7) 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 may hear and decide to make a big change. Please wait so that you have a chance to think about your ideas and talk about them in the group before making important life decisions.

Group expectations:

(1) Confidentiality: It is very important that things that are talked about in the group do not get talked about 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 outside the group.

(2) 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 of 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. In that way the group will know you are not coming and won't find itself waiting to get down to work until you arrive. For outpatient groups, it is useful for the group to spend some time periodically talking about major absences such as trips or vacations and discuss how to plan for these as a group.

(3) Socializing with other 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 interferes with 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 of these can be taken into account. You are asked to make a commitment to report such contacts within the group. (Note: Some groups that deal with learning and applying social skills may encourage members to practice together.)

(4) Contact between group sessions: The therapist does not generally expect to have contact with group members outside of the group itself, unless it is something very urgent. All such contacts will be considered as part of the larger frame of the group experience and the therapist may bring this material back into the group sessions. It is generally advisable not to engage in any other regular therapy while in the group with the exception of seeing your doctor for medication management. Any concerns or plans about seeing other therapists need to be discussed with the group leader before the group begins.

(5) Alcohol or Drugs: Groups are places for sensitive personal discussions. It is important that you not come to a session under the influence of alcohol or drugs except prescription medicines. This is not to say that 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 effected. No food, drinks or smoking is allowed in the group room. These tend to be distractions from the work of the group.

Permission is granted for this material from "Time-Managed Group Psychotherapy: Effective Clinical Applications" by Dr. K. Roy MacKenzie, American Psychiatric Press, Inc., 1997, to be reprinted for clinical use.

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