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Why does group therapy get such a bad wrap? Who benefits from group therapy and who doesn't? How does group therapy impact treatment outcomes?
Your guide to deciding if group therapy is right for you.
It's one of the most predictable reactions in therapy. The "Ew, strangers" grimace. Almost without fail, when the topic of group therapy comes up clients will make the same face: face-turned away, eyes creased, lips disappear. You might know the look.
What's up with that? My suspicion is that years of rom-coms and Law & Order have put the exact same image in all of our heads. Group therapy means "I'm going to have to sit in a big circle with a bunch of strangers, spill all my deep dark secrets, share my mushy-gushy feelings, and ugly cry".
A terrifying prospect, indeed. Well, newsflash: most groups are nothing like that. While group therapy isn't always for absolutely everyone, those of us that could benefit the most are some of the first to write it off.
Group therapy is a tried and true therapeutic method that allows us to learn new skills, get much needed feedback addressing our social "blindspots", and provide a catalyst effect for therapeutic progress. Like it or not, we're hardwired to be social creatures. Healing happens in relationship. This is the very premise of individual therapy. So wouldn't it make since that we could harness and amplify that effect by healing in community?
Let's take a look at some things to consider when deciding if group therapy might be right for you.
Consideration #1: Every Group is a Snowflake
Not every-group is for every-body. There are many different types of groups and the subjects/target populations vary wildly. The key to reaping the benefits of group therapy is to spend some time thinking about (or discussing with your individual therapist) what kind of group might be most helpful to you. Let's start with the different types of groups:
Psychoeducational Groups
These groups are specific to certain diagnoses and are all about education. Newly diagnosed chronic medical condition? Just coming to terms with your depression? A Psychoeducational group may be right for you.
The focus of these groups is to help individuals of a specific demographic in developing new coping strategies that are specific to a particular issues. Examples include substance abuse groups, anxiety groups, specific illnesses groups, or phobia groups. Psychoeducational groups are short and time-limited. Once the content has been covered, the group is over and members go their separate ways.
These groups don't typically involve a lot of deep, personal sharing. Psychoeducational groups are often most appropriate for individuals that were newly diagnosed or just coming to terms with their conditions. They're not a substitute for therapy, but often provide members with the resources to continue care elsewhere once the group has concluded.
Skill Groups
These Groups are more broad by nature, covering a wider range of topics and thus there is often a wider range of people that might benefit. For example, our practice offers several DBT skills groups. While the skills are consistent and pre-determined, the range of people who may benefit from these skills is relatively broad. DBT skills are good for depression, anxiety, trauma symptoms, personality disorders, relationship difficulties, and more.
Skills groups are centered around introducing, practicing, and improving the coping skills we need to navigate the world successfully. Think of these groups more like "classes". Skill groups are often a great adjunct to individual therapy, meaning that these groups are most effective when their members are also doing individual work with a therapist.
Like Psychoeducational groups, these groups don't involve a lot of very deep or personal sharing about individual member's struggles. Skills groups are focused around getting members the tools that they need to be successful and collectively troubleshooting any obstacles along the way.
Process Groups
These Groups focus on connecting members to one another, utilizing these intersecting group dynamics as an agent of healing and change. You may see these groups for all sort of specific populations: a parenting support group, a terminal cancer support group, a recent divorce support group, etc.
These types of groups are what most people think about when the think "group therapy". They're often centered around deep sharing and personal disclosure. They're also typically much less structured than Psychoeducational or Skills Groups. Group members take the lead and once the group is off the ground the therapist tends to simply act as referee or conductor, ensuring that the train stays on the tracks and that everyone remains (emotionally) safe. While these groups are sometimes time limited, they tend to be longer than other groups and some don't end at all, but run continuously.
Consideration #2: Being Seen, Not Just Heard
One of the key benefits of group therapy is that it offers participants something that is often quite elusive: a sense of community. Sure, it's nice to have a space to vent. It feels good to be listened to and not be interrupted. That is important! But group therapy offers something even deeper.
Generally speaking, groups are built with specific populations of people or specific issues in mind. The result is a group of people with some level of shared life experience. You'll have something in common with fellow group members long before you physically walk into the room for the first session.
This creates a sense of being "seen", not just heard. These commonalities create a "felt-sense" that these people understand who I am, what I've been through, and actually care. That's a balm for the soul! Why? Most of us walk through our lives wearing masks. These masks change to fit the scenery or setting. If we're lucky, we may be able to take these masks off with certain loved ones and be our "authentic" selves, but so often we move through life wrestling with the paradox of wanting to be understood while being terrified to be truly "seen".
Groups offer a safe setting where we can try taking off our masks and not have to worry as much about the consequences. We get to experiment with being our authentic selves and begin to grow comfortable with the discomfort of being truly seen and understood. This in-and-of itself is healing.
Consideration #3: A Deeper Dive
One of the key benefits of group therapy is that it distributes the therapeutic work between group and individual therapy. In short, it can allow for a quicker and deeper dive with your individual therapist.
Let's go on a brief tangent and take a look at a typical "treatment hierarchy". When a client comes in to individual therapy, they often have several problems that they would like help with. The problem is that we only have an hour! We have to prioritize what is most important or most impactful to treatment and put a pin in the rest, as time allows. A typical treatment hierarchy (or order of priorities) might look like this: 1) life threatening behavior (self-harm, suicide, etc), 2) treatment interfering behavior (chronic tardiness, not doing between-session work, etc), and 3) quality-of-life interfering behaviors (trauma, depression, relationship conflict, etc).
Most people come into therapy to work on the 3rd item on the hierarchy: quality of life. So why is it last on the list? The first two items, life-threatening behavior and treatment-interfering behavior, act as major roadblocks to improving quality of life. We've got to clear the road before we drive down it. More issue often driving item 1, item 2, and some of item 3 are a "skills deficit". Since the tools we currently have seem to be making the problem worse, we need new tools!
So how does this relate to group therapy? It takes time and energy to teach clients new tools to address their various concerns. While this is time well spent, it often means that there are a multitude of things which clients might like to talk about (their relationships, trauma, parents, jobs, etc) that have to sit on the back burner until later on in treatment if we're spending a chunk of session time learning and practicing new skills. One of the biggest benefits of group therapy is that it often alleviates the "teaching" role of the individual therapist and allows for a deeper dive into the more "process" or insight oriented work that clients enjoy doing much more quickly.
Simply put, if I know that a client of mine is getting the step-by-step instruction around key coping skills in group, I can focus on application of these tools and helping clients understand patterns of behavior, which is why group therapy has such a positive effect on treatment outcomes.
Consideration #4: Enhancing Treatment Outcomes
I like to think of groups as "therapeutic catalysts". When you can match the right group to client needs, it accelerates and deepens the process and clients tend to report that they get a lot more out of therapy as a result.
There's an important piece of informed consent that I always like to go over with clients at the start of treatment: 1 hour of therapy once-a-week has never changed anyone's life. I know it sounds like I'm talking myself out of a job, but hear me out. At the most, clients sit across from me for 1 hour every week, sometimes less. Meanwhile, they're out living the other 167 hours of the week making their own decisions. You don't have to be a therapist or a math wiz to know that if you spend 1-hour a week practicing something healthy and 167-hours a week practicing something unhealthy, it's statistically much more likely that the unhealthy habit is the one that will stick.
Successful therapy requires a commitment from clients to take what we learn and practice these things in their day-to-day lives. Clients have to take these skills and apply it over-and-over again. But as anyone who has ever tried to correct a bad habit knows, change is hard (especially when no one is watching). Group therapy enhances treatment outcomes in several important ways. First, it doubles or triples the amount of direct therapeutic intervention clients are receiving on a weekly basis. Rather than sitting across from me 1-hour a week, clients are in a therapeutic environment for 2-3 hours of individual PLUS group therapy. That's a big increase!
Second, groups bring with them the power of increased accountability and positive peer pressure. If I know that my therapist is going to be checking in with me around how much I practiced that new skill we learned during our weekly appointment, I'm going to feel more pressure to actually practice because I don't want to disappoint them. If I know that my individual therapist, my group therapist, and my fellow group members are all going to expect me to put in the practice, that sense of accountability increases exponentially as does the likelihood that I will actually practice.
Finally, if I see those people who I recognize as "like me" or part of my community making positive changes that I want for myself, I'm more likely to invest in the therapeutic process because I'm more likely to believe that change is possible. This increase in practice and increase in investment often result in more significant and sustainable growth.
Consideration #5: More "Bang" For Your Buck
Money doesn't grow on trees, as the expression goes. I know group can seem like an added expense when you're already paying for individual therapy, and it is! However, it may be more accurate to look at group as an investment rather than a sunk-cost.
As we discussed above, group therapy can be effective in accelerating and enhancing treatment outcomes. One of the biggest draw-backs to therapy in general is that it takes time and consistency. If group therapy is effective in accelerating that process and creating larger, more sustainable changes, you may actually be saving some money in the long run because the overall amount of time you spend in therapy decreases. When we're dealing with treatment-resistant depression or significant trauma, therapy can sometimes take years of work. Any advantage we can add to help in that difficult work may be worth investing in.
There's a second way to look at investing in group therapy. Because groups are conducted in...well...groups of clients, practices can treat up to 10-12 clients for every 1 clinician. This significantly cuts costs for practitioners, which in turn means that it cuts costs for you too. While individual therapy can run between $75-$150/session on average, group therapy costs are typically between $20-$50/session. That's some big savings!
For most of this blog, we've been talking about group therapy as an adjunct or addition to individual therapy, but that doesn't mean you have to approach it that way. If things are financially tight, group may be the better starting place for clients. While they're not always the best setting for unpacking the deeper individual issues, they're a good way to feel connected to others (which is a good recipe for mental wellness) and learn a set of core coping skills that may begin to address the most disruptive symptoms of what you're wrestling with. Once these tools are onboarded, you can always bring them to individual therapy down the road.
Therapy is not cheap and while I strongly believe it's a worthy investment, group therapy may be a practical and effective way to alleviate some of that financial burden in getting the help you want.
I guess if there's one takeaway here, it's this: try it before you decide it's not for you.
We offer several groups that break from the stereotypical mold: practical, skills-focused, and affordable. If you are interested in seeing if group might be the missing ingredient in getting you "unstuck", this may be a good place to start.
Groups have a very specific connotation in our society: mush-gushy cry-fests. Not all of us are touchy-feely type of people and that's perfectly okay. Certainly, there are groups that are perfectly suited for touchy-feely kind of people, but there are also tons of groups that are practical and skills focused. If individual therapy by itself or just straight up pulling yourself up by your "bootstraps" isn't getting you where you want to be, it may be worth giving it a shot!