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What’s the Point of Group Therapy Anyway?

A photo of group therapy

People new to addiction treatment at Castle Craig Hospital sometimes question the worth of group therapy. They may consider it unnecessarily challenging and if asked, say they prefer individual counselling. It can take several sessions to appreciate the benefits of working with a group.

Group therapy is effective, make no mistake. A group often achieves more than an individual counsellor might – that’s true in many settings, besides mental health therapy. The collective wisdom, expertise and experience of a group is always likely to be powerful though sometimes it can seem threatening as well.

However, individual therapy is powerful too, though in a different way. There is usually room for both in a treatment plan for addiction recovery. At Castle Craig Hospital, group therapy, together with individual counselling, is at the heart of our treatment programme for all types of addiction.

Therapy Is About Change

Most therapy is about change. And change usually happens gradually. It can take a group to nurture an addicted person into the lasting changes needed for recovery, just as it can, as they say, ‘take a whole village to raise a child’.

What Sort of Change Is Needed?

For successful recovery from addiction, change must be both behavioural and attitudinal. Thus, if a person stops drinking alcohol to please his family but clings to the view that its not fair because he doesn’t really have a problem, then he is unlikely to stay sober long. Only when change involves the complete personality – behaviour, thoughts, attitudes, values and core beliefs – can a person truly feel the benefits and go on to lead a new kind of life.

How Does Change Happen?

Change often happens through a combination of insight, challenge and support. People can simply change themselves without any help sometimes. Sometimes they change through reading self-help books (there are plenty of those). But when bad habits and attitudes are deeply embedded, some sort of outside assistance is usually needed. This commonly takes the form of one-to-one counselling or group therapy, or both.

Not Everyone Is Suitable for Group Therapy

Although most people are likely to benefit from a group format, a few may not. Such people are likely to have concurrent disorders such as severe PTSD or other trauma issues, clinical depression or severe anti-social behaviour. In these cases, highly specialised groups led by trained professionals may help. Otherwise, individual counselling will be the answer.

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Groups and One-To-One Therapy Compared

Groups and individual counselling differ in two fundamental ways – relationships and dynamics.

Relationships

In one-to-one situations, the client alone is the focus of the therapist and receives their complete and unconditional positive regard, provided that the client is honest, open and willing to change. The purpose of the therapist is to reflect back to the client what they see and to act as a guide in facilitating change.                                                                                          In a group setting, this relationship is different. The therapist becomes primarily a facilitator but also a kind of stage manager and enforcer of rules where necessary. The client is now just one of several equals in a group and must adjust to this role over time – groups can take several sessions to establish trust.

Dynamics

Individual counselling is a dynamic of mutual respect. The counsellor will lead the client through a dialectic process of question and answer and will normally avoid criticism, judgment and advice of a directive nature. By showing the client how they see them, they can expect to help identify goals for change and methods by which to achieve them.

A group is much less predictable. Participants are required to show respect to each other but some, especially newcomers, may find that hard. This does not detract from the power of the group – everything that happens is a learning opportunity of some kind – self-discovery or observation of others’ behaviour are pathways toward change. But group dynamics can sometimes deteriorate into chaos, tears or shouting. Nevertheless, members are advised to ‘trust the process’.

The group itself is a micro-example of real life and that is its strength because it teaches people about themselves – how they react to situations and how others see them

What Are the Benefits of Group Therapy That You Don’t Get in a One-To-One Session?

  • The power of example: seeing a person do something that you yourself find difficult, can be inspiring and motivating. If a group member shares feelings or opens up on a difficult subject, then others will follow, especially when they see the benefit that comes from taking that risk.
  • A group provides a mirror or sounding board. Group members reflect back to the speaker their perception of what has been said, providing invaluable feedback that the speaker will soon learn to treat with respect.
  • The sharing of knowledge and insights can lead to a greater degree of self-discovery. Thus, if a group member shares how their pride stopped them from asking for help it may lead another person to question their own pride.
  • Group members learn empathy and understanding by ‘putting themselves in another’s place’ when a situation is discussed. Instead of taking a judgmental attitude on say, drink-driving, they may learn to say: ‘there but for the grace of God go I’ and thus discover how thoughts, feelings and actions are all connected.
  • Groups can mount a powerful challenge. For example, when denial leads a person to insist that their addiction problem is not really serious, the counter opinion of (say) eight people that they do indeed have a serious problem is likely to be influential in breaking that denial.
  • A group provides a microcosm of real life. Learning to interact within a group gives insights into social behaviour generally. Group newcomers can be bigoted, deluded and socially inept and other members will learn to confront, adapt and accept, just as happens in real life.
  • When a group is performing with mutual honesty and trust, people become hopeful and motivated because they have a sense of purpose, a sense of belonging and a sense that their needs are being met. In such a state, they are likely to recognise the benefits that recovery can give and furthermore, want it for themselves.
  • An established group can be a great source of support and compassion. The process of change through self-disclosure and self-discovery often involves emotional pain. A fully performing group can play a vital part in the healing process.
therapy-treatment-rehab

Therapeutic Factors

The benefits above might be consolidated into four main factors that characterise the inherent strength of a therapy group: the instillation of hope, the expression of feelings without being judged, the understanding of interpersonal relationships and the enhancement of social interaction.

Groups Are Unpredictable and Evolve

Groups go through a three-stage process of ‘forming, storming and performing’. This means that they are constantly changing, very much as relationships in real life develop. Everyone has something to bring to a group and members learn that the more they put in, the more they get out. When a group is performing well, members will share feelings and thoughts without fear and cooperate to bring out the best in each other while the facilitator needs to do very little. When a group finds itself stuck – in distrust, fear or anger, then the facilitator may need to introduce techniques or exercises to overcome the negative dynamic. When a facilitator finds themself having to work harder than the members, then something is wrong and the corresponding benefit to all will be less. But, at every stage that a group finds itself in, there will be value because people will learn from it by considering their own responses – thoughts, feelings and behaviour. They will change and evolve too. This group learning process is likely to be more complex and more varied than that of individual counselling which will be more focused and person-centred.

Twelve Step Groups

A Twelve Step group, such as an AA meeting can be said to be a form of group therapy although of a different kind to a professionally led therapy group. An AA meeting is non-judgemental and non-confrontational, follows a pattern and is about speaking and listening as separate activities rather than discussion and confrontation. There is no ‘facilitator’ at an AA meeting though there will be a chairperson whose job is to introduce speakers and follow an agreed format. Emphasis here is on the power of example, bearing witness, affirmation and support for the struggling, yet there are many benefits to be gained. The basic (though usually unexpressed), requirements for any kind of therapy group are honesty, openness and willingness to change. The power of this kind of group lies in the exchange of experience, strength and hope.

Fear of the Group

Newcomers to treatment are often ambivalent about group therapy and this is understandable. Very few people have had experience in everyday life of expressing their deep feelings and uncomfortable truths about themselves in front of a group of their peers. If given a choice, most would opt for one-to-one counselling because they perceive that as safer. Yet, those thinking that way should perhaps remember that addiction is an attachment disorder, and recovery is about re-connection to society.

A Group Helps You Grow

“People need people – for initial and continued survival, for socialisation, for the pursuit of satisfaction. No one – not the dying, not the outcast, not the mighty – transcends the need for human contact.” (Irvin D Yalom, The Theory and Practice of Group Psychotherapy.)

The best place to learn reconnection and to help you grow is likely to be a therapy group. Therapy groups do not happen just in residential treatment – they can be attended as part of day-care treatment in many areas too.

If you think you might have an addiction problem or know someone who might need help, please call the Castle Craig Hospital 24 hour helpline on 0808 271 7500. We are always ready to listen and advise on the best way forward.

Get in touch today

To find out how we can help you, please telephone Castle Craig on our 24-Hour Helpline: 0808 271 7500. or click here to arrange a free addiction assessment or here for more information.

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