Is individualism getting in the way of group therapy?

Pausing the caregiving series, The Way Things Are Going, this week to share some thoughts about the way things are going in my therapy world.

In my private practice, I’ve been working on some long held goals of mine. One of which is to facilitate more group therapy and community-based offerings. Partly as a way to live my values about equity and accessibility of therapy, but also as a path that offers so much joy and healing. An obstacle I didn’t expect to find, is a general reluctance in people to attend. Over the years, I have had many clients share with me feelings of loneliness, disconnection from others, difficulty creating and sustaining friendships, isolation, relational cutoffs, and lack of community around diagnosis or life experiences. My idealistic self thought to problem solve: let me create and offer groups! I have some group therapy offerings right now that have been wonderful, but really challenging to get more folks attending and attending consistently. No doubt that is typical growing pains of creating something new. However, it has lead to me wonder why people are seemingly less interested, especially when there is such a clear need for relational healing? Is individual therapy strengthening individualism? Is group therapy less appealing because the voice of the “expert” is not just the therapist? I’ve been reflecting on this a lot and feel it worthy of exploring in this post. Hope it inspires change and more willingness when considering joining group therapy!

“There is no human deed or thought that lies fully outside the experience of other people”

(Irvin Yalom, The Theory and Practice of Group Psychotherapy).

When you hear the words “Group Therapy” and what comes to mind? Most people associate group therapy with: Alcoholic Anonymous, movie scenes where very sad looking people are sitting in crappy chairs speaking very heavy things, or a hospital setting where the group members are obviously not well and kind of unrelatable? Please know—these depictions are not 100% accurate and don’t represent all of what group therapy can be.

Group psychotherapy began in 1905 with Joseph Hersey Pratt supporting patients in a hospital setting. It has a long history from supporting veterans returning to civilian life to patients whose lives were spent inside hospitals to cultural movements. Irvin Yalom, an author I love, has developed the leading text about group psychotherapy dynamics and writes so beautifully both about the role of therapist and the relational component within groups. There are different types of group therapy (arts based, psychoeducational, skills development, support groups, cognitive behavioral, interpersonal, etc.) and different styles of running a group. The way that I have learned, participated and facilitated groups is collaborative, power-sharing, and has rituals (beginning, middle, end). Group therapy has risks: it can be unpredictable, isn’t 100% confidential, has potential to harm through the way it’s run and other participants. Group therapy can be vulnerable, provoking and deeply moving.

Individualism is the idea that we are all unique and need to be autonomous to achieve realization. Americans are highly individualistic. It’s kind of the American dream: that we all have the power to achieve what we want. We’ve been taught about our rights and freedom and ability to speak/choose from early ages. In individual therapy, you get specialized care to tailor to your needs and goals. More people seem to be interested in therapy and generally more aware of mental health than ever. While individual therapy is efficient (only takes you 50-60 minutes per week or every other week) and gives you the ability to say you’re putting in the work on yourself. Is it really effective? Especially if the issues are relationally, interpersonally driven? You need others to heal and to correct your perception of self/other.

“Do not mistake the appearance of efficiency for true effectiveness.”

(Yalom, The Theory and Practice of Group Psychotherapy).

Maybe it’s not individualism preventing folks from being willing to try group therapy. Maybe it’s more about keeping up appearances: by privately seeing your therapist weekly instead of vulnerably being in community with others, your life can generally stay the same. Maybe this is called fear or shame. In the book The Theory and Practice of Group Psychotherapy, Yalom writes, “People need people—for initial and continued survival, for socialization, for the pursuit of satisfaction. No one- not the dying, not the outcast, not the mighty—transcends the need for human contact.” In the self-compassion world, common humanity is the idea that through shared experiences of pain (all hardships = pain) we can feel less alone in the world (therefore psychologically safe). We need a safe place to heal within relational contexts. This is what group therapy provides. The people in your life may not be able to provide you with unconditional love, are skilled enough to validate you without judgement, or support you the way you need. This is what group therapy provides. Individual therapy can sometimes feel like much accountability, a direct spotlight on you and all your growing edges. Group therapy provides insight into other people’s lives and struggles (common humanity). It can sometimes be easier to learn about oneself when information is applied to others. This is why so much personal growth happens in learning environments. Group therapy allows the participants to hold each other accountable, too but with agreements to keep the group safe. Individual therapy can also be pricey, groups are generally more affordable. There’s many benefits to group that could reduce fear and shame is people could be brave enough to try it.

I’ll share a mistake I made in facilitating a group once. This group had two participants and two therapists facilitating. We had met three times and the roster was just continuing to be low. I thought maybe it’s not helpful to have such a small group and maybe it’s not efficient for me and this other therapist. Without much thought, I pitched the idea of closing group by the fifth or sixth meeting. The two participants were both very vocal about how upsetting this would be, how much they look forward to this group and didn’t understand why would it need to end. I felt embarrassed and humbled. Of course, we could continue. Of course, they were benefitting. How could I have assumed they weren’t gaining something from having this time, space, support and new friendships? Here I am, reinforcing beliefs about efficiency and forgetting my own intentions for initiating this offering. It was a great lesson for me: there is therapeutic value in being with other and a support can be felt with even one other.

I’ll continue saying more about The Way Things Are Going (Part 3) next week! Hope reading about group therapy and individualism might inspire you to say, “I’ll try it!” if/when considering attending group therapy.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.