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 extragroup 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 conflictresolution. 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.
edited by Brenda S. Melton, Ph.D.