Better Together

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The importance of group therapy continues to grow alongside wait lists to see individual therapists, a situation that began early in the Covid pandemic. So, ICYMI, we’re reposting Well-Being Editor Mary Carpenter’s story from last September. 

By Mary Carpenter

“I FOUND my voice” is how Virginia finance manager A.M. described her experiences—as we all saw happen over about five years—in a recent DC therapy group. Her first move was not merely speaking up when she felt shy or taking a controversial position, but exploding suddenly to take on a group member who’d regularly made hurtful comments to others without anyone ever confronting her. That day, A.M.’s voice broke in, angry and pointed but also thoughtful and articulate, after years of her near-silence. In the weeks to come, A.M. would come out with amusing comments and begin tackling issues that had plagued her for as long as we knew.

With anxiety and depression on the rise since the beginning of the Covid pandemic—reported by more than four of every 10 adults, about 43%, according to a recent census—and mental health professionals in short supply for individual therapy, more people are joining therapist-led groups. (Other kinds of groups include those led by peers.) What group therapy can offer, Nicole Cammack, psychologist and advisor for the mental health platform Sesh, told the Washington Post, is “broader perspective [for] solving life’s troubles.”

“Social anxiety, anger from others and fear of humiliation” are reasons people are reluctant to join therapy groups, writes Harvard psychiatrist Joseph Shay in his research paper titled “Terrified of Group Therapy.” But Shay concludes, “the research literature has established the definitive benefits of group therapy [such as] having opportunities to observe and change relationship patterns.”

“Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be,” posts psychotherapist Ben Johnson on the American Psychological Association website. Johnson points out that group therapy gives members the chance to receive feedback from many individuals and to address relationship concerns, such as asking for help and dealing with conflict.

And group therapy can be more effective than individual for mood disorders, such as depression and bipolar disorder, according to a recent meta-analysis by psychologists at Penn State and Brigham Young University. Contemporary therapies, such as C.B.T. (cognitive behavior therapy) and D.B.T. (dialectical behavior therapy), often incorporate therapy groups as do treatment programs for eating disorders and substance use.

Group therapy has been around since the early 20th century but burst onto the scene with the early 1960s “human potential movement” in the form of encounter groups —which “encourage strong emotional expression; the participants are not labeled patients; the experience is not labeled ‘therapy,’ but nonetheless the groups strive to increase inner awareness and to change behavior,” according to the report from a 1970 task force of the American Psychiatric Association.

“The number of encounter groups has proliferated to such a degree . . . the intensive group experience movement [is] one of the most rapidly growing social phenomena in the United States,” wrote the task force, chaired by Stanford University psychiatrist Irvin Yalom, considered by many the “father” of group therapy. Among 200 or so encounter groups in the Palo Alto, California, vicinity at the time, intensive “marathon” psychodrama groups met in concentrated stretches—such as up to 36 hours over weekends.

At Stanford summer school in 1969, I had friends who participated in these groups, which sounded terrifying when one described the dramatic emotional encounters designed to break people down, with the goal of making them more receptive to change. A few years later, though, a college course called “Encounter Groups” began with one that met every day for two weeks—which seemed safer, maybe because we were in college together. Nonetheless, some people got very angry, others cried, and I discovered a few things about myself.

But not nearly as much as during my five years in the DC group that included financier A.M. Most “therapy” groups are either “open” with new members joining at any time; or “closed” with everyone beginning at the same time and a specific meeting length, such as 12 weeks. Mine, on the other hand, varied in size from five to seven members with each of us starting at a different time when a slot opened up—after meeting several times beforehand with the psychologist group leader.

I joined after my life took several major turns and, after years of various one-on-one therapies, I thought a different format might help me navigate the future. Believing everyone else knew each other very well, I was on edge in early meetings but hesitant to pose personal questions of the others because these had enraged my mother. I never asked how long each had been a member, and only slowly found out that a few others were relatively new like me. Slowly I experimented with querying the members, and then talking about my own family background, my work and my sons, more honestly than I was used to. Slowly I felt a new acceptance among people I hadn’t known at all, which surprised me.

What also surprised me was afterwards when a work colleague I’d always thought had her life very together emailed that she had “LOVED group therapy.” Later she wrote: “(after avoiding even the idea of it) . . . it was such a non-threatening way to learn about myself without being defensive—I learned a lot through the back-and-forth among the other members of the group; it felt safe . . . I learned that people can disagree, even fight, and nobody dies!”

These were my thoughts exactly— also that A.M.’s explosion improved my group, and we all learned a lot. Although some of us had grumbled about the upsetting member, very circumspectly and briefly, no one had spoken up before. When A.M. started off, I felt a tension that was familiar in the presence of conflict. But then I began to appreciate her outburst and finally exuberant, as if the air were clearing, and we began to explore issues we’d all been having. And no one died.

—Mary Carpenter regularly reports on need-to-know topics in health and medicine.