The Magic of Group
When I am assessing patients for the first time, my initial thought is to consider their condition of addiction first, and then I think about which group or groups I am going to introduce them to. I view individual therapy as an adjunct to group therapy. That is not to say there are some patients who will not tolerate group therapy. Very few, and for those whom I deem the group is inappropriate, we will begin with individual therapy.
Group therapy, however, has proven time and time again to get at the heart of the problem much faster than individual therapy.
Not Like TV
Patients coming in for the first time seem to assume they will be participating in individual therapy at least once a week. This may be what they assume treatment or therapy is all about, so when I immediately talk about the group, I can see the anxiety begin to rise. Patients begin to squirm in their seats; their expressions are worried and afraid. Patients generally don’t expect a group to be the answer to their problems.
Knowing and understanding this reaction, I begin to educate patients about being in a group. We are generally seated in my office. The patient is waiting for me to tell them what to do. I know they want a magic fix, but I have none to give them. Instead, I typically place the clipboard and tablet I use to take notes on to the side and look the patient directly in the eyes. Let’s review my reasoning.
I often lean just a little bit forward, and I say to them, “Let me tell you about the group. Let me prove to you why group is the preferred treatment for you. Most people who come in for the first time get nervous when I mention a group because they don’t have any idea what it’s like. Most people understand group therapy by what they see on TV or in the movies, and that is about someone standing in front of a group of people confessing their sins.”
Maintaining eye contact, I tell them, “This is not what group therapy is all about.”
Why Individual Therapy Has It’s Own Set of Fears
The conversation continues: “Let’s start with individual therapy. The patient walks into the therapy office for the first time, there are only two people in the room, and the patient is ready to dump everything that has been on their mind in that first session. The first session goes by quickly because the patient is talking about everything that has bothered them. The patient then leaves the room feeling good that they have unloaded their problems.
“Now comes the hard part.” I might pause here. I like to maintain eye contact and make sure the patient is listening and not daydreaming about when the session will end.
I tell them, “The therapist in individual therapy has told the patient that they will be coming in once a week for their session. As the second session approaches, the patient may think they unloaded their problems in the first session, so what is left to talk about? They still come in for the second session, and although there are some awkward silences, the hour passes quickly as the therapist nudges the patient to talk, and the patient is satisfied with the result.
“Now it’s time for the third session, and the patient begins to think, I don’t really have anything more to say, so what’s going to happen in this session? Are we just going to sit there and stare at each other? That, of course, makes the patient feel awkward even before they enter the room.
“As the patient contemplates this, their anxiety climbs, and they are then thinking of ways to either cancel the session or just not show up at all.”
I lean back. I let the patient absorb what I’ve said. I can see the light come on in their eyes. They understand exactly what I’m saying.
“We don’t want that to happen,” I say. “You can see that in individual therapy, the patient is in the spotlight for the entire hour. It is up to the patient to come up with things to say, which is a lot of pressure, a lot of anxiety on that patient, especially if they can’t think of things to say.”
It Takes Practice
The reason I go into such detail with new patients is that I want them to understand that individual therapy is not a natural process. It does not come naturally to most people. For therapy to be helpful, individuals need to learn what works best for them.
It is much like meditation. The first time someone tries meditation, the expectation is that they will fall into a trance or that they will immediately feel good. Yet meditation can be very helpful for people who have utilized it over time and practice it regularly. They learn which form of meditation is best for them: silent meditation, mindfulness, guided meditation, or even moving meditation, such as walking or yoga.
The same applies to therapy. It is a process that takes practice and coaching from the therapist to help the patient understand what to say and how to best utilize the experience.
What’s Different About Group Therapy
“Let’s look closely at group therapy,” I say, resuming my talk with the new patient.
“In group, the patient walks into the room and shares the space with 8 to 10 other people. They sit down and meet each of the other members, and it’s up to them whether to talk or not. Even if they choose not to talk, we know they will probably find the hour helpful just by listening to others as they talk. In group, the spotlight is only on the patient when they choose to speak.”
At this point, I want to help my new patient grasp the idea that they can participate just by showing up. “Can you see how anxiety is reduced immediately?” I ask them.
Understanding how group works gives patients the opportunity to think about what they want to say or how they understand the conversation. As therapists, we always want to reduce anxiety for patients, not increase it. This is the main reason why we feel that group is the preferred treatment for most of our patients at the Sameem Behavioral Health clinic.