The public perception of psychotherapy primarily exists as a personal, one-on-one event, but this is only one option. In many settings, including mental health treatments and addiction rehabilitation, group therapy can be an exceptionally powerful tool. Available alone or in conjunction with individual therapy, group therapy provides a large setting in which to discuss challenges, ideas and experiences with others in a similar place in life.
At FHE Health, we embrace the opportunities available in all forms of psychotherapy, including group therapy. As a key part of our rehabilitation program, our addiction medicine professionals encourage group experiences to help the members of our community to move forward in a healthy, strong and stable manner.
What to Expect in Group Therapy
Unlike individual therapy, which generally features one therapist and one patient, group therapy usually involves one or more psychologists who lead a group of anywhere from five to 15 patients. The size and scale of a group depend on the number of individuals in a particular program and a group’s needs, but a small-sized group is often believed to be superior to a large one in promoting a more comfortable, inclusive environment. The benefits of a smaller group include; more speaking time for your self and focus on your own specific issues, while the benefit of a larger group can be less anxiety about speaking and more opportunity to learn from interpersonal experience.
Most groups exist to target a specific problem, like learning about the disease of addiction and overcoming abusive substance use habits. These groups can also serve mental health purposes, targeting conditions like depression, anxiety, panic disorders, and bipolar disorder.
The structure of each group meeting will vary greatly from one organization to another but often includes discussion on a topic related to the group’s purpose. All participants are required to play an active role by sharing, providing feedback and remaining engaged in discussion. Many programs don’t tolerate passive attendance: the purpose of group therapy is to share, reveal vulnerabilities and learn from one another.
The principles of group therapy are similar from one format to another and hinge on the basis of universality. All group members have similar experiences to share, offering interpersonal learning and the development of socialization techniques. In many ways, group therapy functions as a recapitalization of the primary family group, offering a cohesiveness that helps group members grow together.
Most group therapy sessions last from 30 to 90 minutes but are most commonly around an hour in duration. This provides enough time for all members to share as needed without resulting in a loss of interest. Group sessions can be open or closed: In an open group, new members can join at any time, while in a closed group, all members begin and end a course of therapy at the same time. These terms are commonly applied to A.A. groups as well, where open groups are available for anyone to join as they please without any sort of application, and closed groups are part of a membership. At FHE Health, our groups are traditionally open to accommodate new members to our programs.
The Structure of Group Therapy
In a typical group therapy session, the psychologist leading the group begins by introducing the day’s topic. This theme will likely be related to the course of treatment, like feelings of remorse in drug use or the exploration of drivers behind the abuse. To start a discussion, the therapist will likely ask a question, such as a request for particular experiences, and encourage group members to share. This information can then lead to additional conversations in the same vein.
Some groups move from one topic to another organically, while others are encouraged to stay close to a particular day’s topic or theme. Yet others may not have a topic and may instead ask that members talk about thoughts, feelings or attitudes that warrant sharing or discussion.
Certain group members are more inclined to share than others, and this is normal and natural. To keep all group members involved, psychologists may ask questions directly of participants. Members of a group are urged to be as open as possible; there are still benefits to be had from sitting quietly and listening to other’s stories, but there are more to be had from participating.
Benefits of Group Therapy
In rehabilitation, many individuals are uncomfortable, stressed or anxious. The idea of participating in a group setting may exacerbate these feelings, at least initially, but there are many benefits that can accompany group therapy.
While potentially stressful initially, many members will find group therapy to serve as a support network and a sounding board. Due to the oversight provided by professionals, group members are unlikely to be mean, aggressive or angry without risk of discipline like loss of privileges, making it possible for members to share without risk of judgment. Other group members can provide sympathy when discussing a problem and can also offer specific advice related to solving a personal struggle.
In addition, listening to the thoughts, ideas, and challenges of others can result in the ability to put one’s own problems into perspective. While everyone’s journey to recovery is different, others are likely to have experienced similar problems or more complicated circumstances that can provide insight into individual goalposts in recovery. It’s helpful for those in rehabilitation to realize that they aren’t alone and that other people are dealing with similar or potentially worse roadblocks.
Diversity can also be an advantage of group therapy. Those from different cultures, races, and backgrounds may offer a unique take on a situation that wouldn’t have been available otherwise. These kinds of experiences also allow participants to learn more about other cultures and kinds of people, encouraging tolerance and acceptance for those from more isolated communities.
Group therapy sessions in a rehabilitation setting are also beneficial in that they are led by trained professionals in psychology, providing structure and groundwork not always present in organic group settings. These individuals can utilize their training to keep discussions productive and supportive, ensuring that each meeting offers something of value to all participants.
Overcoming Anxiety in Group Learning
Anxiety often holds people back from seeking help. The stress of potentially being judged, facing critiques from peers or simply opening up about sensitive subjects can make many people uncomfortable. Group settings can be overwhelming by nature, especially for those with a dual diagnosis or who are embarrassed, ashamed or stressed about being in a treatment program. However, overcoming anxiety can both benefit progress in rehabilitation as well as serve as an advantage of group therapy.
It is not uncommon for patients, as they are at their rock bottom, to feel unique and isolated in their despair. They believe that ‘no one can relate to the depths I have sunk to, the things I have done.’ It is shocking to clients how similar their stories and experiences are to their peers in treatment. No person’s story is the same, but there are patterns, and by hearing other client’s stories, they realize that they have been down similar paths. What we can do is identify for them the paths that, so many before them, walked to get to a better life.
“Some clients may feel hesitant to open up in group, but this goes away as clients experience our groups, which are led by professionals that help them see the benefits, consistent with research, showing the best practices of group therapy to be more beneficial than individual therapy for many disorders,” says Chief Clinical Officer Dr. Nelson.
Settings for Group Therapy
Group psychotherapy can take place in many settings within the continuum of care at FHE Health and beyond. The most common include:
- Residential: In inpatient programs, participants meet in groups one or more times a day to discuss topics related to the course of treatment, personal feelings about residing in inpatient care and other topics deemed necessary to successful recovery. Group therapy in a residential setting can lead to tight bonds between group members, as they are living together in addition to meeting in therapy.
- Outpatient: Group therapy is at the center of outpatient programs, providing a way for those who have completed residential treatment to stay engaged with the recovery community. Partial hospitalization programs may have two long group sessions per day of treatment, while an intensive outpatient program may have just one.
- Aftercare: The end of a structured rehabilitation program isn’t necessarily the end of working with others. FHE Health has our own alumni nights that include community events and meetings. We also host a number of open, weekly groups on our campus that are available after formal treatment has completed. After the conclusion of PHP and IOP options, many members of the recovery community choose to continue on in Anon groups, like Alcoholics Anonymous — another form of group therapy.
Types of Group Therapy
The Substance Abuse and Mental Health Services Administration has identified these five common group therapy models that health care providers can effectively use in treatment for substance use disorder. Often, groups combine more than one type of model as appropriate.
Cognitive Behavioral/Problem-Solving Groups
Cognitive behavioral therapy (CBT) has long been effectively used to help clients change unwanted behaviors, particularly early in the treatment process. A variety of approaches fall under the umbrella of CBT, all of which aim to reframe negative self-talk and thought patterns that lead to substance use. In these sessions, clients can develop the coping skills they need to recover from addiction. They set short-term and long-term goals and monitor their thoughts and behavior to replace unhelpful frameworks with positive tools for health and wellness.
Interpersonal Process Groups
This type of interpersonal therapy promotes change and healing from a psychodynamic point of view. This theory suggests that behavior is determined by several internal mental conflicts, driven by our early experiences and perceptions. As group members interact with one another and discuss the given rehab group topics, individuals work with the facilitator to identify thought and behavior patterns that contribute to substance use disorder. This adaptable model is appropriate for various stages of recovery and group demographics.
Psychoeducational Groups
This type of group therapy is facilitated by a leader who presents educational materials about the physical, medical, mental and behavioral impacts of substance abuse. Psychoeducational group therapy is most appropriate when clients have limited knowledge or understanding of the potential consequences of substance use. This approach can also help clients become ready to seek treatment for addiction and educate families about substance use disorder. Group leaders strive to provide knowledge and skills participants can use to make positive choices and changes.
Skills Development Groups
In this type of program, counselors teach clients the skills they need to achieve and maintain a substance-free lifestyle. The purpose of group therapy with this model is to help participants develop coping skills such as how to relax and handle stress, manage anger, deal with cravings and stay away from substance use triggers. During each group session, members role-play with each other and get a chance to see these skills in action. Most clients can benefit from learning these skills, but an assessment before the group begins helps the therapists plan relevant educational content.
Support Groups
Peer support groups provide guidance during the major lifestyle transition that recovery requires. Group members develop improved self-confidence and practice interpersonal skills, as well as discussing practical concerns about sober living and other facets of recovery. While support groups can be effective at any stage of substance use disorder treatment, they’re especially helpful for people who are new to addiction therapy. An advantage of group therapy is that it provides a valuable community of peer support.
Group Therapy at FHE Health
At FHE Health, group therapy is one of the cornerstone services that we provide. All programming, both residential and outpatient, incorporates substantial exposure to group therapy.
In a group atmosphere, members of our addiction medicine and mental health programs are able to build connections with other individuals overcoming the same issues. In conjunction with individual therapy and holistic care, our addiction medicine professionals use group therapy to help our patients uncover the underlying causes of abuse, highlight treatment strategies and improve mood and perspective throughout rehabilitation.
If you or someone you know is considering entering into treatment for addiction or mental health challenges, we are here to help. Please contact FHE Health to learn more about our approach to group therapy or for intake information.
References:
https://europepmc.org/abstract/med/9771814
https://www.agpa.org/home/practice-resources/evidence-based-practice-in-group-psychotherapy/substance-use-disorders
https://www.ncbi.nlm.nih.gov/books/NBK64223/
https://www.apa.org/helpcenter/group-therapy.aspx
