Group Psychotherapy: Considerations & Guidelines

By Leon J. Hoffman, Ph.D.
May 12, 2015

Group PsychotherapyEnsemble, visibility and education are key concepts for group psychotherapists.

Ensemble is the operative concept and primary goal of all effective groups (ensembles). Ensembles strive to function increasingly effectively in ensemble. I learned the significance of ensemble from lifelong experience as a chamber-music ’cellist. The importance of ensemble is demonstrated by the optimally functioning string quartet.

Psychotherapy groups, and string quartets, when functioning optimally represent the most democratic of settings and democracy, after all, is what is best for the most. The individual is encouraged to give his/her best in a way that most effectively benefits the group as a whole. That includes the group psychotherapist.

That leader may use an individual-in-the-group approach, an interactional approach or a group-as-a-whole approach, depending upon the clinician’s theoretical orientation and the needs of the patients. Process frequently trumps content. Combined therapy (individual and group psychotherapy provided by the same psychotherapist) may be the most elegant and effective treatment modality. Conjoint therapy (where the individual and group psychotherapists are different) is the other form of concurrent therapy.

Listening and observing are paramount in all finely tuned ensembles, whether string quartets, basketball teams, families, organizations or even nations of the world. To reach, excel and maintain oneself at the highest professional level, a group psychotherapist must be skilled at both. Nuances and subtleties (bodily and verbal) are crucial. Concentration and focus are always assumed.

Claudio Abbado, the late celebrated conductor, taught that we learn how to talk but we don’t learn how to listen. Both skills are required, and one learns early in string quartet playing that one must be able to play and listen at the same time. Similarly, one can learn to talk and listen simultaneously.

“Play out” is a significant dictum for ensemble players of all kinds. But noticing one’s impact upon others is equally important. It is easier to look out a window than into a mirror. That is where our beloved, underappreciated and not-well-enough-known field of group psychotherapy excels, since a psychotherapy group is a veritable hall of mirrors in which one can discover how others experience him or her.

Ensemble is facilitated by knowledge of, and adherence to, contracts (or agreements) and boundaries. Attending to them creates and maintains the necessary framework to ensure that the group psychotherapist will be able to develop a thriving ensemble. Contracts are needed for only one reason – to interpret deviations from them.

The elements of a contract (written or verbal) must be clear and complete. Boundaries guide people so that they can effectively manage myriad life complexities; structure binds anxiety. Confidentiality and extra-group fraternizing represent some of the boundary issues that group psychotherapists must deftly navigate. Finally, everyone is advised to attend to the following age-old profound wisdom: If one does not pay meticulous, scrupulous attention to one’s boundaries (personal, professional, occupational, political or other), all relationships will be ruined.

The absence of visibility remains the primary obstacle to our field’s well-being. Group psychotherapy may possibly be one of our country’s best-kept secrets. Hardly any person that one talks with has been, or knows anyone who has been a patient in group psychotherapy. Furthermore, there is no museum in the United States that has any permanent exhibit dealing with psychotherapy.

For myriad disparate and essentially unimportant reasons most Americans have little knowledge of what group psychotherapy is or what it has to offer for the prevention, cure and rehabilitation of countless life traumata.

For people who come from a dysfunctional background or suffer from problematic life distresses, group psychotherapy and psychotherapy generally offers patients a second chance to get things right. If one spends one’s formative years in France, one develops a French accent. Similarly, if one spends one’s formative years in a dysfunctional family, one develops a “dysfunctional accent.”

The good news for our group psychotherapy field is that we typically deal with learned behavior and almost anything learned can be unlearned with something better put in its place.

One never unlearns a limp or an accent without developing a serious, committed, generally long-term relationship with an outstanding expert (in our case, a group psychotherapist) and then works diligently to successfully integrate the new learning. Fortunately, there is realistic hope for virtually all human situations. Group psychotherapists need to regularly use the media, write articles for the lay press, present workshops in professional and other settings and do everything we can to inform the public of the offerings of our field. Visibility remains one of the foremost issues our field needs to navigate. Henry Ford, a century ago, stated, “Talk good about Ford, talk bad about Ford, but talk Ford.” That is, and has always been, the operative concept of all advertising – visibility.

Education (not simply training) for group psychotherapists is vital if one hopes to attract and successfully treat patients across a broad social spectrum experiencing diverse afflictions. Freud reminded all aspiring psychoanalysts that they had to be broadly experienced and knowledgeable. Up-to-date familiarity with the sciences and the arts is assumed, as is the culture in which the group psychotherapy is conducted.

C. P. Snow’s historic lecture “The Two Cultures,” given at Oxford, England, over a half-century ago described how the bifurcation between scientific, technical thinking and literary, cultural thinking was the primary reason for the demise of Western civilization – and that was in the 1950s.

Academic degrees may provide training but not the broad-based education that prepares the psychotherapist to have the capacity for deep emotional and intellectual understanding. In addition, the significance of mentors and role models (being one and having them) throughout one’s professional career cannot be overemphasized.

It may not be required that a group psychotherapist can correctly spell Nietzsche, but one should not only have heard of him but should be acquainted with at least some of his writings and the significance of his role. Finally, and importantly, all group psychotherapists should have had, and continue to have as needed, their own group psychotherapy experience as patients throughout their professional life, just as should all individual psychotherapists.

 Leon J. Hoffman, Ph.D., ABPP, LFAGPA, is a psychologist who conducts group psychotherapy sessions in Chicago, Ill. He may be reached at 312-952-6793. This article was condensed from one originally published in the newsletter of the Illinois Group Psychotherapy Society.

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