Can You Really Teach Me to Lead a Group?

Subtitle: Group Therapy Helps Transform Lives

Summary: The complex treatment technique of Group Psychotherapy is well worth learning  

Dr. Siobhan Reilly was intent to make her point. “I really don’t think I need to learn how to do group therapy. After all, most of psychiatry is about one doctor working with one patient at a time.  I think I’ll have enough to do learning to work with one patient.  To be honest, I have so much to do that I can’t imagine how I can find the time to learn group therapy. I hope you understand. ”

I smiled and tried to help Siobhan rethink her bias against taking on a new challenge. “Siobhan, every couple and family is a kind of small group.  You want to work with families, so it is crucial for you to understand how a group works. The directness of her gaze informed me that she had understood, and was thinking about the validity of my argument. 

“Yes, you’re right, of course, but, in all honesty, the group work seems too complex for me to tackle right now.  I am shy and cannot imagine learning to marshal the forces of a number of patients at once. Can you help me?”  Her gaze told me that she was interested, if skeptical, that she could learn this skill.

“Yes, of course. You have all the attributes that predispose clinicians to work with groups. You love your work. You can digest the theory and research. You want to help patients. And you are enrolled in a top training program where I teach. Keep asking complex questions in class and see where you go.”  I felt pleased that she had been able to share her anxiety about group work honestly.  Despite understandable initial anxiety, with training, most mental health trainees can learn to work with groups. Part of my job is to teach them.

As a Clinical Professor in the Psychiatry Department at the Perelman Medical Center of the University of Pennsylvania, I teach physicians in training to be psychiatrists.  Not much stumps these exceptional learners and dedicated young doctorsEvery year for the last decade, I have taught  theory, research and practice of group psychotherapy to every psychiatric resident in the department of Psychiatry at the Perelman school of Medicine at the University of Pennsylvania. Skill in treating the interpersonal space between family and group members is so important that the academic course is mandated.  As a result, Physicians who are specializing in psychiatry find themselves compelled to absorb current thinking on how to form a group, how to lead a group, how to make a group stronger, and when to suggest group therapy for patients.

.What is so complex about learning to work with a group? When I ask what seems so tricky about this skill, Psychiatric Residents often mention the following dimensions:

·      Too many variables. It is hard enough to work with one patient but a therapy group has between 6 and 12 members, so it seems risky and hard to manage all this energy at the same time

Can I harm patients inadvertently?  Unskilled leadership can cause exacerbation of the very concerns that brought the patient into therapy in the first place. Skill and caring are necessary leadership components.

·      Difficult member behaviors. One member can spoil the group for the others by being late, complaining incessantly, interrupting others, or generally not honoring the policies of the group

Why bother to learn to lead group therapy?  If this treatment modality is so tricky to learn, why bother?  The power of a well-led group can tackle problems more quickly and effectively than other treatment means in certain situations. Clinicians recommend group therapy as an additional treatment technique for a variety of reasons:

·      Feedback: Group members improve not only from the interventions of the therapist, but also from observing others in the group and receiving feedback from group members. Different perspectives can be key in promoting growth and change.

  • Modeling: Members watch others change and add new coping methods to their own lives. These alternative perspectives provide powerful new tools for effective lives. 

  • Cost: By treating several patients simultaneously, cost is often reduced as much as one half that of individual treatment and is often covered by insurance.  

  • Social skill training: Group work demands and teaches communication skills. The group leader helps people to communicate more clearly and effectively, leading to helping members be effective in all interpersonal situations, not just the group itself. Participants can try out new behaviors, role play, and engage with others in not only receiving valuable feedback and insight from other group members, but also in giving it.

·       Support:Groups provide powerful support that extends to outside the group meeting.  Members carry the messages of their group with them into their daily lives. 

·       A Hall of Mirrors: Understandings and appreciating the concerns of others creates a mirror for one’s own life.  Many people experience mental health difficulties, but few have the chance to have an expertly led forum where a member can ask for or give feedback to another. This mirror for the self provides a perspective that invites transformations of unwanted behaviors. 

·       Diversity: The many personalities and backgrounds of members challenges ineffective assumptions and invite other approaches to life situations. 

·       A safe Harbor. Skillful group work provides a safe harbor, a neutral space with skillful leadership in which patients can discuss their life-altering concerns, hear themselves think out loud, and receive compassionate and skillful feedback from others. The psychological safety of the group creates the opportunity to express feelings which are often difficult to manage. Support and guidance give a member a sense of being part of a powerful team. Each member decides what to say, allowing safety in personal disclosure. 

·       Rapid ability to learn to use a group. The learning curve for members to adapt to group policies is easily mastered and well worth the training investments. Group psychotherapy process produces stronger and longer-lasting results when used wisely for dilemmas that lend themselves to group work. 

 

What is the standard of excellence in group therapy leadership? Unfortunately, anyone at all can call themselves a group therapist and advertise the skill for unsuspecting patients. A group has the power to harm as well as heal, so knowing how to find superb leadership is crucial in safe treatment.  A Certified Group Psychotherapist (CGP) is a clinical mental health professional who meets internationally accepted criteria of education, training and experience in group psychotherapy. A CGP is an ethical practitioner who is an expert in group psychotherapy and is committed to group psychotherapy as an autonomous treatment modality. Certified group psychotherapist is an expert who has basic skills, knowledge and expertise in providing group therapy. 

 

Armed with a more realistic perspective on the value of learning to lead groups for patients, and on the ease with which the skill can be learned, Dr. Reilly is on her way to obtaining her certification in group therapy as part of her training in psychiatry. Thousands of patients will benefit from her investment in her learning. 

To consider: Might I benefit from group therapy?  Do I know anyone who might benefit from group therapy?  If so, how can I get them the needed information about how to find a qualified expert?  

To explore: The website of The American Group Psychotherapy Association.  Get lost in learning about the world of groups.  http://www.agpa.org/cgp-certification/

Norris Clark