The Theory and Practice of Group Psychotherapy (110 page)

SOME GOALS OF GROUP PSYCHOTHERAPY

Many individuals seeking therapy feel isolated and dissatisfied in their particular life situation. They may have difficulties establishing and maintaining close, mutually gratifying, and meaningful relationships with others. Frequently they are interested in learning more about how they relate to others.

Group therapy offers an opportunity to:

• Receive and offer support and feedback

• Improve interpersonal relationships and communication

• Experiment with new interpersonal behaviors

• Talk honestly and directly about feelings

• Gain insight and understanding into one’s own thoughts, feelings, and behaviors by looking at relationship patterns both inside and outside the group

• Gain understanding of other peoples’ thoughts, feelings, and behaviors

• Improve self-confidence, self-image, and self-esteem

• Undergo personal change inside the group with the expectation of carrying that learning over into one’s outside life

CONFIDENTIALITY

All statements by participants in psychotherapy must be treated with the utmost respect and confidentiality. It is an essential part of ethical, professional conduct.

a) Therapists

Group therapists are pledged to maintain complete confidentiality except in one situation: when there is an immediate risk of serious harm to a group member or to someone else.

If you are in concurrent individual treatment, we request your permission to communicate with your individual therapist at regular intervals. Your therapists are your allies and it is important for your therapy that they communicate with one another.

b) Group Members

Confidentiality is similarly expected of all group members. Group members must maintain confidentiality to create a safe environment for the work of therapy and to develop trust within the group. Most individuals in therapy prefer to keep the therapy a private place and refrain from any discussions about it with others. If, however, in discussions with friends or family, you wish at some point to refer to your group therapy, you should speak only about your own experience, not about any other member’s experience. Never mention any other member’s name or say anything that might inadvertently identify any group members.

WHAT DO YOU DO IN THE GROUP?
HOW ARE YOU EXPECTED TO BEHAVE?

There will not be a prescribed agenda for each session. Participants are encouraged to talk about any personal or relationship issues relevant to the problems and goals that led them to therapy.

Participants are encouraged to offer support, to ask questions, to wonder about things said or not said, to share associations and thoughts. Much emphasis will be placed on examining the relations between members—that is, the “here-and-now.” Members will often be asked to share their impressions of one another—their thoughts, fears, and positive feelings. The more we work in the here-and-now of the group, the more effective we will be.

Disclosure about oneself is necessary for one to profit from group therapy, but members should choose to disclose at their own pace. We never pressure members for confessions.

In order to construct a therapeutic group environment, we ask that members always try to say things to other members in a way that is constructive. Helpful feedback focuses on what is happening in the here-and-now, does not blame, is relevant, and connects the member receiving the feedback with the member offering the feedback. This kind of direct feedback and engagement is novel: rarely in our culture do individuals speak so honestly and directly. Hence, it may at first feel risky, but it may also feel deeply engaging and meaningful.

Direct advice-giving from group members and therapists is not generally useful. Neither are general discussions of such topics as sports or politics helpful unless there is something about a current event that has particular relevance to one’s personal or interpersonal issues.

The therapy group is not a place to make friends. Rather, it is a social laboratory—a place in which one acquires the skills to develop meaningful and satisfying relationships. In fact, therapy groups (unlike support or social groups) do not encourage social contact with other members outside the group. Why? Because an outside relationship with another member or members generally impedes therapy!

How is therapy impeded? To explain this we need first to emphasize that your primary task in the therapy group is to explore fully your relationships with each and every member of the group. At first, that may seem puzzling or unrelated to the reasons you sought therapy.

Yet it begins to make sense when you consider the fact that the group is a social microcosm—that is, the problems you experience in your social life will emerge also in your relationships
within
the group. Therefore, by exploring and understanding all aspects of your relationships with other members and then transferring this knowledge to your outside life you begin the process of developing more satisfying relationships.

If, however, you develop a close relationship with another member (or members) outside the group, you may be disinclined to share all your feelings about that relationship
within
the group. Why? Because that friendship may mean so much that you may be reluctant to say anything that might jeopardize it in any way. What happens in a therapy group when openness and honesty are compromised? Therapy grinds to a halt!

Therefore, it is best that members who meet outside the group (by chance or design) share all relevant information with the group. Any type of secrecy about relationships slows down the work of therapy. At times members develop strong feelings toward other members. We encourage that these feelings be discussed, both positive feelings as well as other feelings such as irritation or disappointment. Group members are expected to talk about feelings without acting on their feelings.

Group Therapists

Your group therapists are not going to “run the show.” Their role is more that of a participant/facilitator rather than of an instructor. Therapy is most productive when it is a collaborative and a shared enterprise. Keep in mind that the input from other members may often be as important as, or even more important than, the leaders’ comments. The therapists may make observations about group interactions and behavior, or about what particular individuals say or do in the group. They might also comment on progress or obstructions within the group.

When you have something to say to the group therapists, we hope that, as much as possible, you do so in the group sessions. However, if there is something urgent you must discuss with the group therapists outside of group, between sessions, this can be arranged. But it is useful to bring up in the next group meeting what was discussed with the therapists. Even relevant material from your individual or couples therapy with another therapist should be shared. We hope that there will be really no issues that you cannot talk about within the group. At the same time, we recognize that trust develops only over time and that some personal disclosures will be made only when you feel sufficiently safe in the group.

INITIAL LENGTH OF TRIAL PERIOD OR COMMITMENT

Group therapy does not generally show immediate positive benefit to its participants. Because of this fact, participants sometimes find themselves wanting to leave therapy early on if it becomes stressful for them. We ask that you suspend your early judgment of the group’s possible benefits and continue to attend and to talk about the stresses involved and your doubts about group therapy.

We ask that you make an initial commitment to attend and participate in your therapy group for at least 12 sessions. By then you will have a clearer sense of the potential helpfulness of the group.

ATTENDANCE AND GROUP COHESION

The group works most effectively if it is cohesive, reliable, and predictable. Regular attendance is a key part of that, so we request that you make it a priority in your schedule. Group therapy progresses best when each member values and respects the commitment and work of each participant. Regular attendance and active participation in the meetings is an important way to demonstrate that respect and valuing. Similarly, arriving on time to each session is important. If you know that you are going to be late or absent, we ask that you call the group therapists as far ahead of time as possible so that they can let the group know at the beginning of the session.

If you know a week or more ahead of time of a necessary lateness or absence, inform the group at an earlier session. We ask that you also inform the group of your vacation plans well ahead of time if possible. The group therapists will do the same.

There may be times when the group is the last place you want to be, because of uncomfortable feelings. These times may in fact be unusually productive opportunities to do the work of psychotherapy. In the same vein, you can anticipate that some of the difficulties that you have experienced in your life will express themselves in the group. Don’t be discouraged by this. It is in fact a great opportunity, because it means that you and the group members are tackling the important issues that concern you.

You have decided, by agreeing to participate in group therapy, to begin a process of giving and receiving support and working toward needed changes in your personal and interpersonal life. We look forward to the opportunity of working together with you in this group.

Notes

Additional reference information and suggested readings of relevant articles can be found at
www.yalom.com
. Where specific references exist at
www.yalom.com
, a † has been added to the text in this book.

CHAPTER 1

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2
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3
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4
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5
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6
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7
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8
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9
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