Man is a social animal who remains group-oriented to ensure survival, connection and belonging. Our lives begin in family groups and we function thereafter as members of groups at school, work and in communities. The origin of the power of the group as an agent of change to promote healing lies buried in antiquity. But, as noted by Rutan and Alonso (1979), group psychotherapy, where one’s family and community are represented in the room, provides unique opportunities to work on issues of intimacy and individuation.
The first modern systematic use of groups to promote healing is generally cred- ted to Joseph Pratt who, at the turn of the 20th Century, incorporated groups into his efforts to treat patients with tuberculosis. Evidence of the effectiveness and efficacy of group psychotherapy has continued to accumulate since then and is well documented.
A summary of the relevant literature can be found in the brochure published by the American Group Psychotherapy Association aptly entitled, “Group Works!” Group psychotherapy with adults, adolescents and children when used alone or in combination with other treatment interventions (e.g., psychotropic medications) has been found to be useful in treating a broad variety of problems, including depression, anxiety, serious medical illness, loss and addictive disorders (AGPA, 2003).
Just as there is no single form of individual psychotherapy, there is no single form of group psychotherapy. Groups come in different sizes and shapes. Different purposes and goals lead to the articulation of different group contracts.
Thus, the size of the group may vary, as well as the length of time and number of sessions, whether the group membership is open or closed, its composition, the format hat is followed, the ground rules that are adopted and how leader and member roles and responsibilities are defined and developed. Similarly, different theoretical orientations guide the group psychotherapy that is practiced, including psychodynamic, general systems, interpersonal and cognitive/behavioral approaches.
Since it is the job of the psychotherapist to treat individuals not groups who are seek- ing help, some group leaders, especially those who are psychodynamically oriented, pay careful attention to the process of the group, while others make only limited use of group process and dynamics.
Among those who advocate for the importance of examining the group process, some emphasize an examination of the intrapsychic level of the group process, that is, individual members’ internal lives, their character formations, typical defenses, internal objects, etc. Others prefer to focus more on the interpersonal level of the process, exploring relational styles of members and how their internalized conflicts are reenacted in the interpersonal field of the group. Still others systematically examine the group-as-a-whole level of the process, attempting to highlight developmentally early relationships of members with persons in positions of authority.
Since no single form of group psychotherapy has been proven to be more effective than any other, what common ingredients might underscore the efficacy of all these different group approaches? This question has led to a body of research that has attempted to identify the “therapeutic factors” in group therapy. Among those identified have been: the instillation of hope, universality, imparting of information, altruism, the corrective recapitulation of the primary family, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis and existential factors (Yalom and Leszcz, 2008). Of these, high levels of cohesiveness and interpersonal learning have been consistently linked with successful outcome (Burlingame and Fuhriman, 2003).
One recent application of group psychotherapy has involved the use of group interventions in the treatment of trauma. A growing body of empirical data supports their effectiveness (Schein, 2006). Several aspects of groups appear to make them particularly well suited to working with trauma and disaster victims.
To begin with, groups can provide a safe, nurturing, non-judgmental environment where participants can feel accepted and emotionally supported. Relief from the aloneness, isolation and disconnectedness that trauma survivors frequently feel can be especially valuable. Meeting together with others who have endured similar frightening, overwhelming and deeply disturbing experiences provides an opportunity for group members to put into words those very experiences that have been so difficult to talk about with others.
Establishing a holding container enables group members to find their voices, share their experiences, disclose painful feelings and begin to speak the unspeakable. The dreadful nature of such experiences, along with the accompanying feelings of shame, loss, rage and anguish, often are kept secret. Frequently, these reactions interfere with and sometimes preclude survivors from broaching their concerns with others.
Participating in a group with other survivors rather than seeking individual attention can relieve the social stigma and cultural barriers that often impede help-seeking and enable emotionally isolated survivors to recognize that they are not alone.
Furthermore, the presence of other people in the group generates opportunities to reveal, validate and to bear witness to what has happened. In the process of so doing, members begin to restore their disrupted external connections with others as well as begin to repair the often profound rifts in their internal assumptive worlds about themselves, relationships, life and the way the world usually works.
The very act of sharing information about what happened can quell misinformation and upsetting rumors. The group can provide a context for education and the proper dispersal of information, especially with regard to needed available resources and how to secure them. The courage, strength, compassion and resilience displayed by group members often serve to inspire participants and to stimulate a renewed sense of hope about the future. By helping other group members, individual participants can both augment their own damaged sense of self-esteem and relieve the collective sense of helplessness survivors experience.
In addition, groups enable members to share and learn new ways of self-care and new strategies for coping. The acquisition of such tools can promote healing and restore more effective levels of functioning.
Finally, by providing opportunities for sharing, emotional support and new learning in a safe environment, groups can help disaster survivors to begin to repair their disrupted sense of trust in their leaders, the world around them and other people (Klein and Schermer, 2000; Klein and Phillips, 2008; Buchele & Spitz; 2005).
References available from author.
Robert H. Klein, Ph.D., is a senior clinician, teacher and supervisor, who has been a faculty member at the Yale School of Medicine for more than 30 years and a Distinguished Life Fellow and past president of the American Group Psychotherapy Association. He may be reached at firstname.lastname@example.org.
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