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Why group therapy can be such a powerful tool for growth

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(Patrick Hruby / Los Angeles Times)
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This story was originally published in Group Therapy, a weekly newsletter answering questions sent by readers about what’s been weighing on their hearts and minds. Sign up here to get it in your inbox.

Sometimes when I talk about this newsletter, either in casual conversation or with experts I interview, people will think that this space is literally devoted to its namesake — group therapy.

If you’re a regular reader, you’ll know that it’s not. The name was intended to be tongue in cheek, a nod to our goal of making this newsletter feel like a community of readers learning together. We actually haven’t written about group therapy at all!

That changes this week, thanks to a question from a reader named Michael: “I’ve been doing therapy since 1987. Finally, a lot of issues are stabilized; alcohol intake and mental issues. It seems it is time to get to some type of group setting that meets in person. Can you recommend ways to find a group?”

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First, hats off to Michael for his long-term commitment to his mental health. I’m also grateful that he sent in a question about group therapy, because it can be so helpful for people dealing with all kinds of challenges, including grief, racism and oppression, substance use, and mental health conditions.

“Many patients enter therapy with the disquieting thought that they are unique in their wretchedness, that they alone have certain frightening or unacceptable problems, thoughts, impulses and fantasies,” writes celebrated psychotherapist and psychiatrist Irvin D. Yalom in his book “The Theory and Practice of Group Psychotherapy.” Group therapy can be an antidote to this potent kind of loneliness.

In this newsletter, we’ll talk about the difference between group therapy and one-on-one psychotherapy, how to find a group that’s right for you and the power of allowing others to witness and hold space for our suffering.

The different kinds of group therapy

Joseph Hersey Pratt, a prominent Boston doctor, hosted the first formal psychotherapy group in 1905. Pratt convened eight people living with pulmonary tuberculosis, and he noticed how beneficial it was for them to talk about their common struggles.

Since then, therapy groups have become a staple of mental healthcare in the U.S., particularly in inpatient and outpatient psychiatric programs. Psychotherapy groups are distinct from peer support groups — which can be amazing in their own right — because they’re led by therapists, usually charge a fee for service, and there’s a cap on the number of people participating, usually fewer than 10. (Here’s a good breakdown of the differences between support and therapy groups). Typically, therapy groups meet for an hour or two each week, online or in person.

There’s a lot of variation within the world of group psychotherapy. Here are two of the most commonly used models:

Psychoeducational groups

These groups are made up of people seeking support for common challenges, such as depression or anxiety, substance use, intimate partner violence or relationship issues. Or the group might cater to people with a variety of experiences who are hoping to gain skills or knowledge in particular areas, like mindfulness or managing emotions.

Psycho-ed groups are structured around facilitators teaching coping skills or other relevant information to members. For example, at the Los Angeles LGBT Center, where I’m an intern, we offer psycho-ed groups for neurodivergent people, polyamorous folks and people who are coming out, to name just a few. These groups support people in exploring their identities and give them the tools to face challenges unique to their communities. You’re more likely to be given homework in this kind of group.

If you’re new to group therapy, psycho-ed groups can be a good place to start. “If you have intense social anxiety and are overwhelmed by being in a group, the structure in a psychoeducation group can be helpful,” said Cheri Marmarosh, a clinical psychology professor at George Washington University who studies group psychotherapy.

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Interpersonal process groups

Though psycho-ed groups are structured, there are almost always opportunities to interact with other group members.

In process groups, engaging with others is the whole enchilada. There are no specific topics of conversation. Instead, everything is about what’s happening in real time, and understanding the relationships we have with ourselves and others.

“The facilitator’s job is to help members give feedback to one another about how they’re coming across, and deal with personal communication styles that get in the way of being close to people,” Marmarosh told me. “It’s much more focused on how you’re feeling and thinking in the room with other people.” For instance, some folks are afraid of taking risks and don’t disclose much; in a group, they may get feedback about how this pattern prevents them from deepening their relationships with others.

Specific issues that people tend to bring to process groups include feelings of loneliness, the need to please others, difficulties forming close or long-lasting relationships, anxiety in social situations and trust issues, according to the Williamsburg Therapy Group.

People tend to show up in group the same way they show up in real life, said Stefani Roscoe, a psychotherapist in Los Angeles. You’re likely to get a big reality check in a process group; for some, it’s the first time they’ve received feedback about what it’s like to interact with them. It can be a tough pill to swallow, but self-awareness is a vital catalyst for growth, experts said.

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“A lot of it is also becoming aware of what you’re experiencing in the moment and being able to speak to that,” Roscoe said.It’s a difficult and very important life skill to be able to say, ‘When you said that, it made me feel this way.’”

What’s the difference between one-on-one therapy and group therapy?

It’s fairly common for people to be in both individual and group psychotherapy at the same time because they’re such distinct experiences.

“Because we are conditioned in such a way that generates a lot of shame for our suffering, individual psychotherapy is really important to have a place where you can be and tolerate someone seeing you in the midst of what feels most vulnerable,” said Francis Weller, a California-based psychotherapist and writer whose work focuses on the communal nature of grief. “I’ve been doing therapy for 40 years, and I still think it’s a very valuable element in allowing someone to feel that sense of permission to be witnessed and seen in a transparent way.”

At the same time, he said, we unconsciously long for our pain to be witnessed and held by a group. “In the long story of evolution, most often times our grief and sorrow and loss and trauma were regulated in the context of community,” Weller told me. “It wasn’t such an individual, internalized experience.”

In one-on-one therapy, you have a relationship with one other person (your therapist). And as that relationship grows, so does trust and your ability to share your thoughts and emotions freely, and you gain self-awareness, Roscoe said. “And that’s all wonderful, “ she went on, “But group therapy is like individual therapy on steroids. You get into a room with six other people and have the opportunity for all of them to reflect things to you, challenge you, mirror you, provide safety and support for you. You start to learn that all this trust and change doesn’t have to happen only in the confines of your individual therapy session.”

In other words, group therapy is more like real life, and you get a lot more feedback from people with differing perspectives and personalities.

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A note of caution, though. If you’re seeking support for a very recent trauma, like witnessing the death of a loved one, or surviving sexual assault or a natural disaster, now might not be the best time to join a group, Marmarosh said.

“When someone’s flooded with emotion and overwhelmed, it’s going to be much harder to hear others and be empathetic,” she explained.

The benefits of group therapy

What you get out of group therapy will depend on how emotionally invested you are in the process, and, of course, what kind of group it is. But here are some of the many benefits you can reap from joining groups, according to our experts.

You realize you’re not alone: Grief, mental illness, having a marginalized identity — all of these experiences can be isolating. “Having other people going through it with you can take away the loneliness and shame,” Marmarosh said.

Groups help us emerge from the sense of “my wounds make me different from you,” Weller said. “I can’t tell you how profound it is for people to be weeping side by side with a group of others. Many times I’ll hear someone say, ‘I’ve never done anything like this before in my life, but it felt oddly familiar,’” he said. “We’re designed for it.”

You like yourself more: Process groups can help you accept the parts of yourself that you’ve neglected or actively disliked (and we all have those parts!). “Being OK with your whole self is the best thing you can reach for,” Roscoe said. “Are you angry today and feeling kind of irritable? That’s OK. Don’t feel like participating in group today? That’s OK. As long as you’re communicating it with others, then you’re OK in this world and there are people who will still love you regardless.”

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You relate in healthier ways: Groups give you the opportunity to get feedback on how you interact with others.

Psychotherapist Ali Miller gave these examples of what that can look like in a PsychCentral piece:

“Do you typically hang back until someone invites you to speak? Or do you take the lead? Do you only share positive information about yourself or things you’re struggling with? What parts of yourself do you let others see? What parts of yourself do you hide? How do you handle conflict? How do you get your needs met?”

“[Y]ou start to see you have way more choices available to you for how you relate to others,” Miller told PsychCentral. “It helps people get out of relational ruts, liberates people to get unstuck from patterns of relating that are not serving them.”

You feel hopeful: In groups that are designed for people in substance use recovery or those living with mental health challenges, there are often members in different stages of recovery. Seeing people with similar struggles who are farther along in their self-awareness and healing gives hope to those at the beginning of the process.

You address your biases: Roscoe prefers groups to be as diverse as possible in just about every way: age, race, religion, culture, language, immigration status, neurotypical versus neurodivergent.

Whether you see yourself as an empathetic person or not, you’re walking around with biases. We need to be aware of them and confront them when they show up,” Roscoe said. “If there’s a variety of people in your group, it’s going to show up, without a doubt.”

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When you’re in a diverse group, you’re able to observe white privilege, oppression, internalized racism and power differentials in real time. “It can be a great place to look at the impact of systemic oppression on people’s sense of self,” Marmarosh said.

How to find a therapy group

So now you’re sold on group therapy. How do you find a group that’s a good fit for you?

If you’re already in one-on-one therapy, a good place to start is by asking your therapist for recommendations, Roscoe said.

Another great resource is the American Group Psychotherapy Assn.’s database of certified group therapists. To be included in this database, therapists need to complete a certain level of group therapy training and supervision, Marmarosh said.

If you live in the L.A. area, it’s worth checking out this extensive list of therapy groups compiled by Glendale psychologist James J. De Santis. It includes 1,200 therapy and support groups for just about every identity and issue you can imagine.

Group therapy can be pricey, usually starting at $50 per session without insurance (some insurance companies will cover certain groups). Many community health organizations offer low-cost or free groups, though; I listed some of those in our mental health resource guide last year.

Once you’ve found a group that sounds like a good fit, Roscoe recommends interviewing your group therapist before committing. Ask them how long they’ve been running the group, the goals of the group and whether it’s open or closed. Is everyone new and starting at the same time, or will you be joining a group that’s been running for two years? “Some would rather start on the same foot, while others will feel it’s fine to join an established group,” Roscoe said.

“Trust your intuition,” she said. “If you don’t feel like it went well in your group intake, consider your other options.”

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. . .

If you’ve had your own experiences in group therapy, we’d love to hear them — and we might include your notes in a future newsletter. As always, thanks for learning with us.

Until next week,

Laura

. . .

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email GroupTherapy@latimes.com gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

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More perspectives on today’s topic and other resources

Group therapy is often stereotyped and overlooked as a way to deal with challenges in your life, but it can offer a variety of benefits if you are willing to try it. In this episode of the Therapist Uncensored podcast, two psychotherapists explain how group therapy can help you notice issues and habitual patterns in your life, and try out different responses and behaviors that might not feel comfortable yet in your everyday life.

Francis Weller’s “The Wild Edge of Sorrow” makes a strong argument for grieving in the company of others — because it’s what humans have been doing for millenniums. “In the absence of this depth of community, the safe container is difficult to find,” Weller writes. “By default, we become the container ourselves, and when this happens, we cannot drop into the well of grief in which we can fully let go of the sorrows we carry.”

Other interesting stuff

What does good psychedelic therapy look like? As MDMA and psilocybin treatments are well on their way to becoming mainstream medical treatments in mental health care. The therapy component has come under scrutiny, writes the New York Times. Here’s what’s common in many sessions — and what’s not.

As the world’s population continues to age, it is crucial that countries prioritize policies and programs that support the mental health of older adults, write researchers for the Hill. Their study found that countries with more comprehensive approaches to supporting older adults had lower depression rates.

Group Therapy is for informational purposes only and is not a substitute for professional mental health advice, diagnosis or treatment. We encourage you to seek the advice of a mental health professional or other qualified health provider with any questions or concerns you may have about your mental health.

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