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Today, there are many varieties of group therapy, including standard interpersonal or psychodynamic therapy groups; open-term or time-limited groups; and CBT, psychodrama, and DBT groups. There are groups for specific populations or themes: men, women, gay, eating-disordered, first-break psychosis, medical illness, social anxiety, mind-body, and, of course, addictions. Naturally there are now cybergroups that make a group experience possible for people living in isolated places.
Groups have many healing qualities, but one of the most important is the basic human support they provide—giving a sense of belonging and group cohesion, factors that are increasingly scarce in our fragmented society. One client, reflecting on what he'd gained from the group as he was terminating therapy, said that what he found hardest to leave was the sense of being part of something—the feeling that the group was always there for him in a basic way. "My life is so much better, and I am so grateful," he said, "but I'll just plain miss being here with you guys every Tuesday evening!"
So why isn't group therapy a more widely used treatment? For one thing, many insurance policies will pay for only a fixed number of visits, so group members who want to continue past the allotted 10 or 20 sessions must pay out of pocket for much of the year. This is a false economy on the part of the insurance companies. Since group sessions are so much less expensive than individual sessions, the reimbursement for a dozen private sessions would pay for the better part of a year of group sessions.
Another issue is client resistance to joining a group. Some clients are afraid they'll get less attention from the therapist in a group—"I don't want to share my therapist" is a common refrain. Other reactions include "How can a group of people with problems help me?" or "I can't imagine telling my problems to strangers" or "What if I don't like the group—or the group doesn't like me?"
These concerns are legitimate. It can be scary joining a bunch of strangers, with whom intimate personal stories will be shared, and sometimes it doesn't work out. I've never had a client who didn't like at least one person in a group, although I've had clients who came to feel they weren't in the right group.
What skills does a good group leader need? One of the most important is the ability to do mental multitasking. You'll usually be thinking on at least four levels at once: about the individual members, the interpersonal interactions, the group as a whole, and your own internal reactions. Some therapists are not good at this, preferring the more intense focus of individual treatment.
Other clinicians dislike the exposure involved in leading a group. In fact, it is more uncomfortable to make a mistake in front of six or eight of your clients than to make one in the relative privacy of an individual session. I was genuinely embarrassed when I made the billing error with my client. While I knew that what my client did was therapeutic for her, it still stung me, all the more so because it happened in front of an audience—one that was pleased to see me brought down a peg, I might add.
Clinicians without a substantial referral base may find it too difficult to keep their groups filled. It's demoralizing to have a group dwindle down to two or three members. Some clinicians have formed group-therapy networks to solve this problem, marketing the network and referring to each other's groups. Involvement in local and national group-therapy associations can help keep group referrals coming too.
Should you just start a group yourself? Definitely not without specific training! The American Group Psychotherapy Association (www.agpa.org) has developed guidelines
Group therapy can be an excellent treatment for most clients. It's cost-effective, and in many ways a better mirror of "real life" than individual therapy. Whatever happens in group, you'll never be bored!
Eleanor Counselman, Ed.D., C.G.P., F.A.G.P.A., is immediate past president of the Northeastern Society for Group Psychotherapy and an assistant professor of psychiatry at Harvard Medical School. She's published numerous articles on psychotherapy and has a private practice in Belmont, Massachusetts. Contact: EleanorF@Counselman.com. Tell us what you think about this article by e-mail at email@example.com, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.