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Emotional work in groups

Emotional work involves awareness and engagement of one’s feelings and expression of emotions, specifically those feelings that may lead to positive behaviour change. When we get close to the feelings that we had felt first in response to an important event, processing of those feelings may lead to new understandings of ourselves, and the expression of different behaviours. In men’s groups participants commit to engage their own feelings and support others in the appropriate processing and expression of feelings.

Feelings are often but not always aroused in response to interpersonal encounters with others. Feelings are usually accompanied by an urge to be expressed. Feeling happy, sad, creative, joyful, irritable, lonely, upset, disturbed, etc. are experienced by people all over the world and commonly result in certain attitudes and behaviours.

Awareness and expression of feelings affect the quality of our lives. When we bottle up certain feelings, for example if we refrain from expressing feelings of loss or abandonment it may be converted into feelings of irritability and unhappiness or expressed through behaviours of hostility and aggression. Exploring, understanding and expressing feelings may lead to positive self-esteem and improve one’s relationship with oneself and others.

What is group therapy?

Group therapy is a form of psychotherapy or counselling in which a small number, usually about 6-8 persons, meet on a regular basis with a therapist or group counsellor. The purpose of group therapy is to assist each group therapy participant with emotional processing and expression to promote behaviour change, the resolution of symptoms, improved self-esteem, enhanced confidence and problem solving.

How does group therapy works?

Unlike the simple two-person relationship between client and therapist in individual therapy, group therapy offers multiple relationships to assist the individual in growth and problem solving.

The noted psychiatrist Dr. Irvin D. Yalom in his book The Theory and Practice of Group Therapy identified “curative factors” that are the “primary agents of change” in group therapy.

Instillation of hope

All clients come into therapy hoping to decrease their suffering and improve their lives. Because each member in a therapy group is inevitably at a different point on the coping continuum and grows at a different rate, watching others cope with and overcome similar problems successfully instil hope and inspiration. New members or those in despair may be particularly encouraged by others’ positive outcomes.

Universality

A common feeling among group therapy members, especially when a group is just starting, is that of being isolated, unique, and apart from others. Many who enter group therapy have great difficulty sustaining interpersonal relationships, and feel unlikable and unlovable. Group therapy provides a powerful antidote to these feelings. For many, it may be the first time they feel understood and similar to others. Enormous relief often accompanies the recognition that they are ‘all in the same boat’.  This is a special benefit of group therapy.

Information giving

An essential component of many therapy groups is increasing members’ knowledge and understanding of a common problem. Explicit instruction about the nature of their shared difficulties, such as not being able to sustain successful relationships, or uncontrolled stress or anxiety, is often a key part of the therapy. Most clients leave the group far more knowledgeable about their specific issues than when they entered. This makes them increasingly able to help themselves and others with the same or similar problems.

Altruism

Group therapy offers its members a unique opportunity: the chance to help others. Often clients who struggle in their relationships with others believe they have very little to offer others because they have needed so much help themselves; this can make them feel inadequate. The process of helping others is a powerful therapeutic tool that greatly enhances members’ self-esteem and feeling of self-worth.

Corrective recapitulation of the primary family

Many people who enter group therapy had troubled family lives during their formative years. The group becomes a substitute family that resembles—and improves upon—the family of origin in significant ways. Like a family, a therapy group consists of a leader (or co-leaders), an authority figure that evokes feelings similar to those felt toward parents. Other group members substitute for siblings, vying for attention and affection from the leader/parent, and forming subgroups and coalitions with other members. This recasting of the family of origin gives members a chance to correct dysfunctional interpersonal relationships in a way that can have a powerful therapeutic impact.

Improved social skills

According to Yalom, social learning, or the development of basic social skills, is a therapeutic factor that occurs in all therapy groups. Some groups place considerable emphasis on improving social skills, for example, with adolescents preparing to leave a psychiatric hospital, or among bereaved or divorced members seeking to date again. Group members offer feedback to one another about the appropriateness of the others’ behaviour. While this may be painful, the directness and honesty with which it is offered can provide much-needed behavioural correction and thus improve relationships both within and outside the group.

Interpersonal learning

Human beings are social animals, born ready to connect. Our lives are characterized by intense and persistent relationships, and much of our self-esteem is developed via feedback and reflection from important others. Yet we all develop distortions in the way we see others, and these distortions can damage even our most important relationships. Therapy groups provide an opportunity for members to improve their ability to relate to others and live far more satisfying lives because of it.
Research shows that group therapy participants exert a powerful Imitative behavioural influence on the communication patterns of each other through modelling certain behaviours. For example, a group member may model active listening, giving non-judgmental feedback, and offering support. Over time, members pick up these behaviours and incorporate them. This earns them increasingly positive feedback from others, enhancing their self-esteem and emotional growth.

Group cohesiveness

Belonging, acceptance, and approval are among the most important and universal of human needs. Fitting in with our peers as children and adolescents, pledging a sorority or fraternity as young adults, and joining a church or other social group as adults all fulfil these basic human needs. Many people with emotional problems, however, have not experienced success as group members. For them, group therapy may make them feel truly accepted and valued for the first time. This can be a powerful healing factor as individuals replace their feelings of isolation and separateness with a sense of belonging.

Catharsis

Catharsis is a powerful emotional experience—the release of conscious or unconscious feelings—followed by a feeling of great relief. Catharsis is a factor in most therapies, including group therapy. It is a type of emotional learning, as opposed to intellectual understanding, that can lead to immediate and long-lasting change. While catharsis cannot be forced, a group environment provides ample opportunity for members to have these powerful experiences.

Existential factors

Existential factors are certain realities of life including death, isolation, freedom, and meaninglessness. Becoming aware of these realities can lead to anxiety. The trust and openness that develops among members of a therapy group, however, permits exploration of these fundamental issues, and can help members develop an acceptance of difficult realities.

How should I behave in a group therapy session?

• When groups are formed group members go through common rituals such as introductions, sharing of expectations and fears of being in a group, and contracting on ground rules, among others.
• In the initial stages of the group the group facilitator will promote a group contracting discussion in which members may agree on the duration of each session, the number of sessions, the group objectives and outcomes and the ground rules that will guide the conduct of members.
• The group leader’s role is that of fostering and maintaining the development of trust as members develop gradual feelings of belonging and safety in the group.
• Group members usually begin to risk sharing themselves at a deeper level only once the group atmosphere guarantees a degree of comfort, support, trust and acceptance.
• Some of the ground rules members may agree on usually include confidentiality, the use of cell phones, punctuality, respect, etc.
• Group participants are expected to make a commitment to the group. Each person’s presence in the group becomes important to both the facilitator and the other group members.
• Members are encouraged to share their attitudes and feelings as honestly and directly as possible.
• Individual are encouraged to be themselves, to spontaneously share thoughts, to listen attentively and to provide feedback to others where this is appropriate.

What benefits may I derive from attending a group?

As with everything in life, the benefits derived from attending group depend on participation. Research provide evidence that those who feel more connected to group for example, report on having derived greater benefits from attendance.

You may not experience an immediate sense of comfort or relief from anxiety or other feelings causing you discomfort, but over time you will begin to experience:

• A sense of belonging, connectedness, and fellowship with others
• A feeling that you are not alone, that there are others who share your concerns and challenges
• An opportunity to learn from others including being exposed to role models on how to behave, as well as acquiring specific social skills like how to express emotions, how to assert oneself and so on
• Those feelings of relief that accompanies expressions of deeper emotions and feelings
• An opportunity to deal with all sorts of challenges including loneliness, concentration problems, anxiety, panic attacks, irrational fears, relationship problems, low moods, sadness, and much more….

Men’s groups are able to deepen a man’s experience in several ways. Just as a man was thrust into the world of men from mother’s orbit, the men’s group recapitulates this trajectory. But instead of entering a hardened and competitive male world, he enters one that is interpersonally receptive. The men’s group is supportive of feeling rather than rejecting of it. The men of the group nurture each other in a uniquely male way through verbal and nonverbal gestures (Rabinowitz & Cochran, 2002).

The men’s group can help a man confront his disappointments and losses. Instead of denying past hurt, shame, and wounding, the men’s group asks its members to bring this out into the open where it can be healed by the supportive actions of the group. It is safe to get angry, to cry, or to express one’s frustrations and grief.

The men’s group challenges the gender role norms of culture (Stein, 1983). Instead of maintaining rigid patterns of behaviour that result in the avoidance of intimacy, addiction, and privately experienced distress, the group encourages warmth, support, and trust so that conflict can be dealt with in a straightforward fashion. Men are free to engage in confrontation because they trust that they will gain personally from the interaction. Affection, rather than being avoided, can be used to show caring among men.

Men learn also how to take their doing orientation to life’s problems into the being world with each other. Rather than try to solve problems, men are given a chance to express feelings, empathize and support each other, and learn to stay with uncomfortable emotions. Although “fixing” is not a part of the men’s group, using the male tendency toward action is. Through exercises and activities, men learn to “be” with their inner experience.

The men’s group encourages men to approach and enter the emotional “portal” of depth. Men are asked to give up some of their control and vulnerability in order to explore beneath their social roles and facades. Men support each other in taking on this challenge.

The attractiveness and success of group therapy for men is built on the premise that the group situation is often a better fit for many men, especially those with traditional gender role orientations, than individual psychotherapy (Brooks, 1998, 1998a). Even though many men who participate in a men’s group have also been in individual therapy, they freely acknowledge that the multiple relationships that are developed in a well-run group are often better able to push them to deal with conflict, emotion, and interpersonal connection than an individual therapy approach that involves only the one relationship between therapist and client (Rabinowitz, 2001).

Men’s therapy groups build on the support that men can uniquely give each other. Sharing similar physical bodies, similar socialization, and similar relational perspectives, men often feel a different kind of support than what they receive from the women in their lives. One man in a weekly therapy men’s group said it this way, “I have always gone to women for emotional support to my tender and expressive side. With my male friends, I tended to relate about sports, school, and work and not burden them with the stuff I would tell my mother or girl friend. I felt like I couldn’t be completely real with either women or men. In the men’s group, I have found out that most men feel this way. It has been such a feeling of a burden lifted to realize I can be totally myself here; gentle, aggressive, compassionate, wild, or competitive and still be accepted by these guys, who I initially thought were going to judge and reject me.” (Rabinowitz & Cochran, 2002, p. 158)

Men’s groups help men trust other men again. In our competitive culture, men are often pitted against each other at work or even at play. The buddies one might have had growing up are more difficult to find in the adult world. Many men find the pressures of work and family take most of their energy and time. It is easy to lose touch with one’s emotional self by trying to obey the social rules in each aspect of life. In a men’s group, it is expected that each man will talk about who he really is, not just his work or social persona. Through the rules of confidentiality and through honest sharing, men learn they are not alone and, in the process, build trust with each other at a personal level.

Men’s groups give hope and rebuild confidence in members. In very few settings, do men actually verbalize and show each other support, respect, and care. The men who initially come to group are often emotionally isolated and discouraged, receiving very little positive support from relationships or work (Rabinowitz, 2001). Often they are in the midst of a personal crisis, such as divorce or other significant loss, or they are in a situation in which they must change in order to avoid family dissolution or incarceration. Some are recovering from addictions to drugs, sex, gambling, or work. Self-disclosure of impotent feelings, as well as the expression of anger, frustration, and sadness, is usually met by supportive comments, sharing of similar experiences, and even supportive physical touch (Rabinowitz, 1991). A man may begin to feel less alone and find hope from the camaraderie found in the group.

Many men who are dependent on women for initiating interpersonal conversation and giving them social validation find the all male group challenging. While some men’s groups have female leaders, the group situation brings up a different set of dynamics for men than a group made up of both men and women. Competition centres not on the need to posture for female attention as is common in mixed groups, but more around personal insecurity and inadequacy. Without women, men are forced to deal with their discomfort with each other, including learned homophobia (Rabinowitz, 2001). Introjected anger toward other men may also be a source of discomfort, stemming from unexpressed resentment toward the father and socialized distrust of other men. The men’s group can potentially provide a corrective emotional experience for men who have been culturally alienated from each other (Brooks, 1996).

Men’s groups challenge men to constructively deal with interpersonal conflict. Many men have been socialized to avoid conflict through distracting activities, intellectual rationalization, rage, or silence. Heated exchanges sometimes arise in a men’s group. Depending on the stage of the group, men will respond to these interpersonal challenges with varying effectiveness. In the early stages of a group, conflict is typically ignored in order to focus on commonality between members. While this allows for early trust building, it also sets the stage for conflict later in the group process (Sternberg, 2001).

Once initial trust has been established through mutual sharing and self-disclosure, group members will begin to tire of being “nice” to each other. If allowed to go on for too long, “niceness” will become a group norm that supports safety but no challenge. In order for a men’s group to work, it must provide a challenging psychological atmosphere (Brooks, 1998). Group leaders must encourage and model interpersonal confrontation as well as support for the men. Learning to deal with confrontation can help participants acknowledge their own feelings, value interpersonal feedback, and understand the projective nature of many confrontational remarks. These interpersonal skills can be used in relationships in the world outside of the group to facilitate intimacy and connection.

Men’s groups allow for the safe expression and containment of strong emotion (Brooks, 1996). Many men have been taught that to express strong feeling exposes too much personal vulnerability. For men who are detached, unassertive or depressed, anger releasing exercises may encourage openness to feeling in the body, leading to more emotional honesty. In domestic violence groups, men learn strategies to control their anger and identify other emotions such as fear, sadness, and hurt that often have been overridden by expressions of rage. Successful groups for men who have been physically abusive utilize self-awareness of body oriented emotional cues and the situational factors that trigger anger and hostility (Levin-Rozalis, Bar-On, & Hartaf, 2005). Being able to transfer the learning from group to home life is perhaps the most challenging task for men who lose control of their emotions (Pandya & Gingerich, 2002).

Men’s groups also encourage men to re-explore their family of origin roots. Through the processes of story telling, interpersonal encounters, and strong emotional expression, the story of one’s earlier life often emerges. Memories about mother, father, siblings, friends, and others who had significant impact in the man’s life are often rekindled. It is not unusual for a man to recall something his father said or did when he was a boy, or to reflect on the interactions with siblings that helped shape views on trust, masculinity, or his sense of self. The past unlocks some of the mystery of current interpersonal problems and allows for a reframing of current emotions, reactions, and behaviours (Rabinowitz, 2001).

Men’s groups also address the existential predicaments of life. In the presence of his peers, a man can face his fears of the unknown. Often group discussion centres on the willingness to take risks. Ultimately, this is based on the assumption that life is finite and that if a man is to make the most of his time here, he must be willing to risk leaving the safety of the familiar and move toward the potential unknown (Yalom, 1980). Men may come to grow intellectually ready to leave a job or let go of a dysfunctional relationship, but are often deeply frightened of risking life change. The men’s group uniquely encourages men to take the risk. The voices from a well-functioning group often counterbalance the internalized society, family, and work messages that say “don’t change” or “just be a man and suck it up.” The group not only encourages each man to take a risk in his life, but also provide the support necessary to absorb the consequences of his actions.

References to reading materials

• Cochran, S., & Rabinowitz, F. (2003). Gender-sensitive Recommendations for Assessment and Treatment of Depression in Men. Professional Psychology: Research and Practice, Vol. 34, No. 2, 132–140.
• Diamond, M. J. (2006). Masculinity unravelled: The roots of male gender identity and the shifting of male ego ideals throughout life. Journal of the American and Psychoanalytic Association, 54(4), 1099-1130.
• Jansen, S. (2016). Emotional experiences of participants in all-male psychotherapy groups. Unpublished doctoral dissertation. University of South Africa, South Africa.
• Jewkes, R., & Abrahams, N. (2002). The Epidemiology of rape and sexual coercion in South Africa: An overview. Social Science and Medicine, 55(7), 1231-1244.
• Kiselica, M. S. (2003). Transforming psychotherapy in order to succeed with adolescent boys: Male-friendly practices. JCLP/In Session, 59(11), 1225–1236.
• Yalom, I.D. (1966). The Theory and Practice of Group Psychotherapy.
• Rabinowitz, F.E. “Group therapy for men”, In: G.R. Brooks & G.E.  Good (eds.)
• http://www.continuingedcourses.net/active/courses/course026.php

Introduction

The men’s group is an all-male process group. The purpose of a process group is to work through unconscious behaviour dynamics. Put in another way in a group process members get an opportunity to confront and deal with “denied aspects of the self” that may set them up for relationship failure, addiction behaviours, and unexplained anger, irritation or “defensive detachment” a style of avoiding full psychological and emotional presence.

In an-all male group men form a masculine culture, a safe space from which to “fish inwards”. With the assistance of the fellow “fishermen” and the facilitator they are provided with a sanctuary from which to risk looking inwards, acknowledging psychological, emotional and spiritual aspects of themselves that are usually ignored or denied.

The major purpose of the group is personal growth and development, in the sense of the concept JIHAD- it is NOT a support group, although many members find the group an important source of belonging and support.  JIHAD here is interpreted as an inner struggle to subdue and tame the lower self. The focus of inner change is on the member, not on partners, wives, children or employees.

Inner growth may cause discomfort and tensions sometimes to the point of a “healing crisis”. This may create in some members a strong urge to “take flight from the group” especially during the early stages. It is therefore important to prepare members for group participation and to issue them with this “health warning”.

Structure of the group

Norming and storming phase

The first phase of the group is concerned with culture building. The group usually starts with a round of introductions so that members get to know each other in a neutral way. This may be followed by short “chalk talks” by the facilitator in which she introduces the purpose of the group, and facilitate discussions about the process that the group will follow.

During this phase members also agree on ground rules and the particular behaviour code that the group will follow.

The task of the facilitator and the team is to foster trust building, clarity of purpose, agreement on ground rules etc. During this time the facilitator may deliberately slow down self-disclosure so that the group first become safe, comfortable and ready for the personal processing that lay ahead.

Working phase

During this period a member may “recognise themselves in others”, share stories of achievement, loss, joy, pain etc. Members start to share their thoughts and feelings to the degree that is comfortable for them.

Members may work through “frozen pockets of pain”, unexpressed grief and loss, review difficult relationships, learn new ways of dealing with themselves etc.

During this phase members’ working through of issues may be facilitated by the introduction of reading materials, and activities like the “ice berg” or “river” exercise.

This is a phase of intense sharing, learning and reclaiming emotional and spiritual aspects of the self.

Termination phase

After many months or years a member may decide it is time to move on for whatever reason. The whole group gets prepared to say goodbye to the member. It is the responsibility of the member to give the group advanced notice (6 weeks or more) of intention to leave. It is vital for everyone’s growth that the leaving process is handled with sensitivity, so that the way members leave also becomes a growth and learning opportunity for those who leave and those who stay behind.

Addition of new members

The group is facilitated according to the “slow open” format. From time to time the group opens up to allow members to leave and to welcome new members. Existing members are given advanced notice by the facilitator that she is preparing a new member to enter the group.

Important boundary checking has to be done at this stage because if a new member is related in any way to an existing member the new member may not be allowed to stay and has to find a new group to join or enter once the boundary issue no longer applies.

Once new members enter the group may go back to the norming and storming phase to allow for integration and culture building that includes the new members.

The facilitator’s role may shift back to being active and directive. Once the group shifts back into working phase the facilitator’s role once again shift to a more laid back but alert role in the group.

Role and Responsibilities of the members

Somewhere it’s been said that the essence of manhood is responsibility…..

The role of the member is to be an active participant through listening and sharing. It is the responsibility of the member when it is appropriate to share with the group their reason for participation. It is the member’s duty to bring the issues that they struggle with and to engage the group as an ally in achieving their personal growth goals. These goals may relate to finding their calling in life, improved marital relations, more engaged father-son or father-daughter relations, a greater sense of self-worth or just being a more content and fine human being to have around.

Presently in our society when we turn to our television, radios and social media it is about stress, and when we read the newspapers or listen to the news it is all about stress. Some policemen and those who have ready access to firearms seem to be wiping out their partners and children in response to stress. Teenagers in the Western Cape are assumed to be using tik because of stress, and we can go on and on. We seem to be in the grips of stress and there is seemingly no way out.

In this discussion my approach to stress management is not to tackle the anatomy of stress or to break stress down into different parts and to rehearse its symptoms. Instead we go to the heart of the matter about stress. And the heart of the matter seems to have nothing to do with stress at all. It starts with the belief systems, the attitudes and values we seem to bring to the issue of stress.

There are off course many external sources of stress, the relational, occupational, organisational and institutional dimensions of stress. But for a moment we will be focusing on the only aspect of stress over which we have control and that is ourselves. I focus here on the personal dimension of stress, your unique contribution and response to stress. I want to create an awareness of belief systems and stress.

Thinking shapes behaving. When we change our thinking our behaviour automatically shifts. So the first step in changing behaviour is to review our thinking. We examine our taken-for-granted ideas about stress. We explore basic assumptions about stress. One of the major factors that generate stress is that so many people have become out of touch with what is deeply important to them. There seems to be a gap between how they spend their time and what they feel is meaningful to themselves.

There appears to be confusion between personally felt commitments, appointments, schedules, goals and activities. In other words there is an apparent disconnect between people’s values and what they do with and how they manage their time. What people feel is important in their lives, their compass, vision, mission, values, principles, conscience, and direction do not connect with how they lead their lives.

The result is that people feel torn by the many things they have to do. By the numerous responsibilities and demands placed on them. We all feel challenged by the moment to moment decisions that we have to make day to day. Stress is inevitable and some degree of stress helps with performance. However, the watch word is balance. To maintain a fair exchange between the bad and good stress of life ensure that you regularly engage in some activities:

• That give expression to your deepest values, beliefs and major priorities
• That restores or replenishes your energy because it connects you to fun, vigour, relaxation and joy

For example:

Spirit meets Psyche

How can it help? When to refer?

Nowhere have I seen the power of communication demonstrated more dramatically than in therapy groups, where clients struggle to reach out to one another with their words. Individuals who often have not been able to make or maintain relationships, learn how to do so. They learn new tools, and to appreciate the power of their own communication. At a more pragmatic level, in the current mental health climate of getting the most bang for the buck, group therapy is a frequent treatment of choice. Meta studies have demonstrated that the efficacy of group process not only matches individual therapy, but often surpasses it. Children, adolescents and adults alike can benefit from group therapy.

Group therapy is often is utilized as a primary therapeutic modality where the volume of patients is high, e.g., in healthcare systems, cancer centers and psychiatric units. After an initial assessment of need, patients can be immediately placed in an appropriate group. In addition, group therapy is the treatment of choice for specific populations where peer pressure or confrontation provides useful therapeutic leverage, e.g., drug and alcohol treatment and the treatment of acting-out adolescents.

Some theorists and therapists view major diagnostic categories from an interpersonal perspective. They think of depression not simply as an intrapsychic event, but also as a difficulty in building and maintaining relationships. This perspective offers the clinician an alternative or adjunct strategy to individual therapy for depression. If, via group therapy, one changes relationship patterns, one then changes an individual;s level of social isolation, self-efficacy increases, interpersonal rewards increase and the depression begins to disperse. Similarly, some anxiety states can be thought of as interpersonal problems, and treated effectively in group therapy via mutual support and in-vivo desensitization.

As these two examples suggest, the enormous variety of group therapy options can make decisions about referral confusing. There are general therapy groups and specialized groups, brief groups and long-term groups, psychoeducational groups, support groups, focused groups and process groups, to name a few. Groups are offered in private practice settings, in healthcare systems, in churches and in self-help settings. They are led by people with a wide range of skill and experience, from the well-intentioned layperson to the credentialed professional with advanced, specialized training.

To further complicate the picture, individuals can be referred into a group at virtually any stage of therapy. Group can be the primary treatment or an adjunct treatment. Participation can be concurrent with individual therapy, giving a client the advantage of both an intrapsychic focus and an interpersonal learning arena. Or, it can function as a useful sequel to individual therapy. When sequenced, the client is usually seen in individual therapy until emotional stability is reached and then s/he; graduates to group where s/he can become proficient in the language and skills of relationship, emotion and intimacy. Sometimes a brief, specialized group such as an assertiveness or anger management group to can be helpful while a person is in ongoing individual or couples therapy.

Brief therapy groups often have a focus, e.g., a specific symptom cluster like phobic behavior, and use a psychoeducational approach for skill building. The commonality of concern helps a group to coalesce, and supports those group members who feel different, odd or isolated. Group members can then proceed rapidly to a learning agenda. Sexual abuse survivors, the bereaved, subassertive individuals and people with borderline personality features often find focused therapy groups useful.

Open-ended groups are more reliant on the give-and-take of complex interpersonal processes. In this way, they closely mirror daily communications that people have with friends, co-workers and spouses, and within family systems. Such groups tend to be less structured, relying on clients personal agendas and interpersonal dialogues to provide the dynamic for self-discovery and change. Unstructured groups are effective for people who can learn from seeing aspects of their own feelings, attitudes and behaviors reflected back to themselves via others as though in an interpersonal hall of mirrors. Unstructured groups are excellent at breaking down and re-forming character structure, providing support, teaching communication skills, identifying problematic interaction patterns not likely to be revealed in individual therapy, broadening role repertoire and increasing a client;s capacity for empathy. In an effective group, education and skill building occurs within the process of the group itself, and can be crafted to fit each group member;s needs, defenses and learning style.

As mentioned earlier, individuals can be referred into group at any stage of therapy. When considering the possibility of referral to group therapy, the following list of considerations might be helpful. Most group therapists would be happy to discuss individual situations, and to help you decide whether group therapy is likely to be useful for your client. This collaborative process can provide an additional perspective for the primary therapist, as s/he considers various treatment plans.

Considerations for Referral to Group:
1. What do I want group therapy to offer this client?
Specific skills
General learning arena

2. What are my motivations for considering referral?
Am I frustrated, feeling stuck, or annoyed with this client?
Does this client need more support, more mirroring, more opportunity to practice to full range in interpersonal skills?

3. How is the client likely to do in group therapy?
What is the client’s ego strength?
Consider frustration tolerance, impulsivity, capacity to utilize new information, and learning style.
How might the client react to confrontation?

4. Where is the client in the process of therapy?
Does the client need group therapy and individual therapy at the same time or should these modalities be in sequence?
Should this be a graduation; into group or a support to the ongoing therapy?

5. If the client is in both individual and group therapy at the same time, do I want to remain on board; as the individual therapist?

6. What specific type of group might best benefit this client?

If, after looking at these questions, you move toward referral, consider the training and experience of potential group therapists, the types of groups they provide, whether there is a willingness to work collaboratively with you and a willingness to refer you to other group therapists if they don’t provide the group you need. The Certified Group Therapist (C.G.P.) credential is acknowledged by the American Group Psychotherapy Association and demonstrates that a therapist has gone through a training program including coursework and supervision. It is generally recognized as the national standard.

If you decide to pursue a possible group therapy recommendation, be prepared to talk about your rationale and the potential risks and benefits of group work with your client. Remember that s/he may be anxious about your reasons for this referral, and about the group experience itself. Be prepared to talk as much as s/he needs to, and don’t hesitate to recommend that the client talk with the group therapist as well. I think you’ll find that the world of group therapy offers you and your clients some powerful interpersonal opportunities.

Source: http://or.americanmentalhealth.com/thepowerofgrouptherapy.trust