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GROUP THERAPY:

Choosing a group and avoiding "Group Trauma"

By Barbara Elbl, MFT, CGP, San Francisco, California

Group psychotherapy can be powerful1, but not all groups are alike. There are many different kinds of groups, and it is important to seek out the kind of group that is best suited to your needs. In addition, not all group leaders have the same kind of expertise. Your choice of group, and your group leader's training and experience will have an important impact on the kind of group experience you end up having.

There are three broad categories of groups, each with a different purpose: support groups, psychoeducational groups, and interactive psychotherapy groups, sometimes called "process" groups, although technically speaking, a process group is a training group and not a therapy group. As a "test" of your potential group leader's expertise, he or she should be able to tell you which of the three kinds of groups, their group is. If they seem unclear about the distinctions, be careful! While it is possible to combine support and psychoeducation in a group, other attempted combinations can be dangerous. Let's take a look at a few of the significant ways in which groups differ, and need to differ, to be safe.

Support Groups

To run a support group, an experienced therapist or counselor needs little specialized group training. There is usually little pre-screening to join the group. Potential members usually can identify from the title of the group whether it is what they're looking for (for example, "cancer support group", "parenting support group", etc.) The goal is to provide support around a theme, where participants can share experiences, "normalize" phenomena, reduce stress or shame and isolation and increase their ability to carry on in life. The therapist works to promote safety, confidentiality and supportive sharing, and discourages sharing that is not supportive. Sometimes there is an educational component, with participants sharing information as much as the leader, but the primary focus is always on support. Support groups can be on-going or time limited and some even allow "drop ins." While there is usually some degree of confidentiality requested around what is discussed in sessions, members are sometimes encouraged to meet outside group sessions to offer each other continued support.

Psychoeducational Groups

This is the most structured kind of group because the focus is on education. It's usually time-limited (e.g., 12 weeks) and might even have sub-topics for each session. There might be a supportive component, i.e., sharing of experiences with respect to the education the leader is attempting to impart. The leader works to contain discussion in the service of his or her educational goals, and usually discourages "cross-talk" between group members, unless they are performing exercises under his or her direction. Participants are usually self-identified with minimal pre-screening needed. The education can be around a topic (e.g., chemical dependency, anger management) or around psychotherapeutic techniques or tools (e.g., journaling, mindfulness, CBT, DBT). While it would be reasonable to expect the leader to have advanced training in the topic or technique, advanced training in group psychotherapy is not required to lead this kind of group.

A Cautionary Note: Importantly with both support and psychoeducational groups, interactions between group members and the group leader must be contained within the boundaries described above. There are two reasons for this. In order for a group to have the ability to process the variety of interactions possible between people in a way that will help them and not hurt them, the group must be designed to do so, not true of support and psychoeducational groups. When you read the description of interactive groups below, you will find they are distinctly different. Secondly, unlike with support and psychoeducational groups, the leader of an interactive group needs advanced group psychotherapy training and experience, usually beyond what is provided in graduate school, something most clinicians do not have. When inexperienced group leaders do not carefully "keep the boundaries" of support and psychoeducational groups, due to lack of knowledge and skill, group members can and frequently have in the past, been hurt and even traumatized.

Interactive Psychotherapy Groups

In an interactive group, the goal of the leader is to facilitate psychotherapeutic change, as opportunities emerge in "here and now" emotionally laden interactions between group members. Usually, members are carefully screened for some ability to empathize, ability to tolerate some anxiety and feedback, and to stay committed to their own growth, long enough for group to have a significant impact (1 - 5 years). In selecting members, the therapist takes into consideration a good mix of personalities that will offer beneficial interaction opportunities, and carefully screens out individuals who might become problematic for the group, or for whom this kind of psychotherapy is not suitable.

Group members are usually required to maintain strict boundaries, that is confining any and all interactions within the group setting, so that feelings that come up between individuals can be processed within the group. Unlike with other kinds of groups, members are encouraged to bring forth transferential material (how others affect you), so that it can be explored and a (mental, emotional and behavioral) shift can occur, within group processes.

There is intentionally no structure beyond basic parameters, i.e., time, place, etc., thus encouraging anxiety to build and serve as a catalyst for personality characteristics to emerge, as well as to keep extraneous variables out of the picture. The leader works to promote safety, support, intimate communication, appropriate risk-taking and "genuineness," and both guides and promotes individual growth, as well as phases of development of the group-as-a-whole. The group therapist is skilled in using normal group developmental phenomena, such as "scapegoating," as opportunities for growth, and does not allow them to become traumatic. The leader is guided by group psychotherapy theory, such as Group Systems, Modern Psychoanalytic, Psychodynamic-Intersubjective, etc. The leader of this kind of group has specialized and advanced education, training and experience in the field of group psychotherapy.

As a clinician, I find running interactive psychotherapy groups extremely satisfying in terms of the results I have seen with my clients. As I often tell prospective group members, in individual psychotherapy, we often find the two of us talking about their life with others "outside the room." In group, we have the opportunity for that to happen inside the room, and for the group and I can to have an opportunity to intervene, help the client learn about him or herself and others, and experiment with alternatives to the repetitious patterns that keep them unhappy and wanting better relationships. Relatively soon, members begin to report positive change occurring spontaneously in their lives, in ways that they can connect to what's happened in group (such as saying "no" to others who push against their boundaries; asking for what they need, rather than flying into a rage or withdrawing; or, finding themselves comfortably participating in interactions, instead of anxiously avoiding people.) These experiences encourage on-going participation in group psychotherapy and on-going transformation, until goals have been met.

If you are seeking out healing and growth and want more self-confidence and better relationships, I hope you will consider group psychotherapy. You can find out more about group psychotherapy, and you can find listings of experienced Group Psychotherapists at the website of the American Group Psychotherapy Association: www.agpa.org

1 Toseland & Siporin, 1986, Furmingham & Burlingame, 1994 Burlingame, MacKenzie & Strauss, 2004

© 2/1/2010 Barbara Elbl

ABOUT THE AUTHOR

Barbara Elbl is an MFT in San Francisco and specializes in the treatment of anxiety and trauma. She runs psychotherapy groups for Self-confidence and Better Relationships, is a Certified Group Psychotherapist (CGP) and consults on running psychotherapy groups. Visit www.SanFranciscoTherapist.info for more about Barbara and Group Psychotherapy.

Please do not reproduce this material for distribution or publication without the author's written consent.



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