14.5 Group Therapies

For some people, group therapy is a better fit than individual therapy. First developed in the 1940s, group therapy has adapted to the ever-changing demands of work in the clinical field (Yalom & Leszcz, 2005). Usually, group therapy is led by one or two therapists trained in any of the various approaches (such as psychoanalytic or cognitive). Sessions can include as few as 3 clients, or up to 10 or more, often facing similar problems. There are groups to help people cope with shyness, panic disorder, chronic pain, compulsive gambling, divorce, grief, and sexual identity issues, to name just a few. It is not always a psychological disorder that brings people to group therapy, but instead a desire to work on a specific issue.

Group members share their problems as openly as possible, and it is valuable to hear they are not alone in their struggles or desire to improve. Research typically shows that group therapy is as effective as individual therapy for addressing many problems. It is actually the preferred approach for interpersonal issues, because it allows therapists to observe clients interacting with others. The therapist’s skills play an important role in the success of group sessions, and the dynamics between clients and therapists may be similar to those that arise in individual therapy. (Clients may demonstrate resistance or transference, for example.)

Finding Strength in Others Members of the Brave at Heart breast cancer support group convene at the Harold Leever Regional Cancer Center in Waterbury, Connecticut. Self-help groups provide valuable support for people facing similar struggles, but they usually are not led by mental health professionals.

AP Photo/The Republican-American, Jim Shannon

Other group settings for interpersonal growth are self-help groups. Among the most commonly known are Alcoholics Anonymous (AA), Al-Anon, Parents without Partners, and Weight Watchers. Members of self-help groups provide support (not therapy) to each other while facing bereavement, divorce, infertility, HIV/AIDS, cancer, and other issues. Typically, sessions are not run by a psychiatrist, licensed psychologist, or other mental health professional, but by a mental health advisor or paraprofessional trained to run the groups. A typical AA leader, for example, is a “recovering alcoholic” who grasps the complexities of alcoholism and recovery, but is not necessarily a mental health professional.

Family members often participate in these groups, because when it comes to relating to other people, there is always room for growth. Any family therapist could tell you that.

We Are Family: Family Therapy

Introduced in North America in the 1940s, family therapy focuses on the family as an integrated system, recognizing that the interactions within it can create instability or lead to the breakdown of the family unit (Corey, 2013). Family therapy explores relationship problems rather than the symptoms of particular disorders, teaching communication skills in the process. The family is viewed as a dynamic, holistic entity, and the goal is to understand each person’s role in the system, not to root out troublemakers in the family, assign blame, or identify one member who must be “fixed.” Because families typically seek the resolution of a specific problem, the course of therapy tends to be brief (Corey, 2013). Suppose a teenage girl has become withdrawn at home and is acting out in school, and the whole family decides to participate in therapy. The therapist begins by helping the parents identify ways they encourage her behaviors (not following through with consequences, for example), and may examine how their marital dynamics affect the kids. If it becomes evident that the marriage is in trouble, the parents might seek therapy without the rest of the family, which brings us to the next topic: couples therapy.

Let’s face it, most couples have issues. High on the list are conflicts about money (“You are so stingy!”), failures to communicate (“You never listen!”), languishing physical bonds (“No dear, not tonight”), children, and jealousy (Storaasli & Markman, 1990). But when these problems begin to cause significant distress, couples therapy is a smart choice. Couples therapists are trained in many of the therapeutic approaches described earlier, and they tend to focus on conflict management and communication. One goal of couples therapy and relationship education programs is to provide guidance on how to communicate within relationships (Scott, Rhoades, Stanley, Allen, & Markman, 2013).

Couples therapy can yield positive results for many couples—they stay together, feel more satisfied with the relationship—but some seem to benefit more than others. This is especially true for those who are committed to saving their relationships (Greenberg, Warwar, & Malcolm, 2010). People who respond well to couples therapy seem to have higher marital satisfaction and are emotionally engaged (Jacobson & Addis, 1993). Those who participate in relationship education programs prior to marriage may be better off as well, as these may help couples identify some of the situations that could lead to divorce, including a spouse being unfaithful, problems with aggression, and substance abuse.

Like any treatment, group therapy has its strengths and limitations (TABLE 14.3). Group members may not get along, or they may feel uncomfortable discussing sensitive issues. But conflict and discomfort are not necessarily bad when it comes to therapy (group or otherwise), because such feelings often motivate people to reevaluate how they interact with others, and perhaps try new approaches.

Evaluating group therapies can be difficult because there is so much variation in approaches (psychodynamic, cognitive behavioral, and so on). However, strong evidence exists that couples and marital therapy are effective for treating a wide range of problems (Shadish & Baldwin, 2003). Likewise, the outcomes for group therapy rival those of individual therapy for many types of clients and problems (Burlingame & Baldwin, 2011; Yalom & Leszcz, 2005). As with individual therapies, the role of the group therapist is of critical importance: Empathy, good facilitation skills, listening, and careful observation are important predictors of successful outcomes. So, too, are the preparation of the group members, the therapist’s verbal style, and the “climate” and cohesion of the group (Burlingame & Baldwin, 2011).

All the therapies we have discussed thus far involve interactions among people. But in many cases, interpersonal therapy is not enough. The problem is rooted in the brain, and a biological solution may also be necessary.