In June of this year Dr. John Salvendy, co-founder and first president of the Canadian Group Psychotherapy Association sadly passed away. In 1984 he became my group psychotherapy supervisor during my psychiatric residency at the University of Toronto. Within 3 years he taught me everything I needed to know to begin my own 35 years of group psychotherapy practice. We quickly became friends as we both shared our common European roots. For years we presented group psychotherapy workshops at the annual meeting of the Canadian Group Psychotherapy Association and used to go for our bi-weekly Sunday walks sharing our imagination on all kinds of subjects. Sadly, his passing coincides with a message that recently appeared on the Canadian Group Psychotherapy website saying: ‘We regret to inform you that we are not able to respond to requests at this time. Please check back later’. It is my understanding that the association had to suspend its activities for lack of interest in group psychotherapy in Canada. What a shame, given that it is such a rich, powerful, and effective modality in the field of psychotherapy.
Long-term psychodynamic psychotherapy, or ‘long-term intensive interactional group psychotherapy assumes diverse and diagnostically heterogeneous group membership and an open-ended time scale’ (Wikipedia). I have been running 4 open-ended groups of 12 members each over the past 30 years. The sessions take place weekly and everyone is committed to attend every session. When after several years a group member has accomplished the work of personal transformation they set out to complete, they leave the group and someone new joins. Not only is a group like that a fertile cauldron of transformative energy, but it is also very cost-effective. For psychiatrists here in Ontario the cost per group member is about ⅙ of an individual session of the same length. To run a group like that effectively requires special training within the field of psychotherapy, the way a plastic surgeon requires specialized training within the field of surgery.
There are many therapeutic groups being offered by mental health professionals, most of them short-term. The one we are addressing here is a fundamentally different kettle of fish. Members of my groups have three things in common: (1) They are all productive members of society with professions, jobs, hobbies, and families; (2) they have significant psychological symptoms that interfere with or sometimes even impede their capacity to fulfill their social, familial and personal obligations and aspirations; and (3) they have the capacity to introspect, examine their own mind and meaningfully explore who they are within the context of the intimate relationships that develop in the group. Their symptoms may have traumatic or other origins and may include relationship issues, PTSD, depression, anxiety, OCD, stress, and other manifestations of psychological suffering. Patients with active substance dependence issues or psychosis, and those who are either not able or willing to examine themselves, are not accepted in these groups.
The group process is unstructured, in order to allow the unconscious to speak. Whatever emerges during sessions is the manifestation of how everyone shows up in life. This affords group members the opportunity for self-examination, understanding, transformation, and application of new and more adaptive mental, behavior, and relationship patterns within the group at first, and eventually in their daily lives. What makes such a group so rich and effective is that group members learn through 4 levels of engagement: (1) By observing and listening to other people’s stories and interactions; (2) by getting actively involved in helping other group members explore themselves; (3) by having the group actively involved in helping them explore themselves; and (4) by addressing here and now interpersonal dynamics that arise in the course of each session. The group leader helps members develop a direct, respectful, and supportive style of communication that allows everyone to experience the safety of the intimate group process, as the often hard and painful exploration of truth unfolds towards new levels of integration, personal satisfaction, life success, harmonious relationships, and inner peace. On this basis, members learn to make better life choices, and over time many symptoms they originally came for disappear or reach manageable levels that do not interfere anymore with everyday life.
The principle of universality allows group members to lose their sense of embarrassment and isolation, learn to validate their experiences, and develop strong self-esteem as they recognize shared experiences and feelings among group members as widespread, universal human concerns. Because the group is mixed with members at various stages of development and recovery, everyone can be inspired and encouraged by other group members, which instills hope. Those who have overcome a problem can consolidate their self-esteem by realizing that they have developed the wisdom to help others with what they have learned to apply for themselves, and those who still struggle can benefit from that wisdom of others. The group provides a safe and supportive environment, where altruism can flourish, thereby consolidating our human nature as deeply relational. Members feel safe to take risks and extend their repertoire of socializing techniques for the purpose of improving their social skills, including interpersonal behaviors and the way they listen and talk to each other. Imitative behavior can be an important part of social learning through a modeling process, as members learn to observe and imitate the therapist and other group members in the way they share personal feelings, show concern, and support others.
Members learn to help each other and give their insights to others, which lifts their self-esteem and thereby helps develop more adaptive coping styles and interpersonal skills. In doing so, members often unconsciously experience their relationships with the group therapist and other group members quite similar to those with their own parents and siblings, creating a form of group transference specific to this type of group psychotherapy. With the help of the therapist’s interpretations, this allows participants to engage in a corrective recapitulation, reworking, and transformation of their primary childhood family experiences. By gaining an understanding of the impact of childhood experiences on their psyche and personality, participants may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships. Through the development of attuned communication, as this process can be summarized by, all members feel a sense of belonging, acceptance, and validation. which gives the group a sense of cohesiveness. In such a cohesive environment, it is safe to experience relief from emotional distress through catharsis, a free and uninhibited expression of emotion. In telling their story to a supportive audience, members obtain relief from chronic feelings of isolation, shame, and guilt. Through this process of interacting with others in the group, who give feedback on one’s behavior and impact on others, group members achieve a greater level of self-awareness and self-understanding with the achievement of deeper insight into the way their problems developed and their behaviors were unconsciously motivated. Last but not least, and technically not a direct aspect of psychotherapy, useful factual information can occasionally get imparted from the therapist or other members in the group, which is often reported as very helpful.
In our increasingly fast-paced, narcissistic society (although COVID-19 may seriously challenge this trend), in which self-interest trumps all sense of community and responsibility for others, people often misinterpret group therapy as less valuable than individual therapy, even though the above explanations make it abundantly clear how rich and fruitful a process it really is. As I explained elsewhere here and here, people also look for quick fixes even when none is to be had. Not long ago I assessed a new patient with a significant history of childhood abuse. When I gave her feedback and my recommendation for this kind of therapy, she said she did not want to be so involved and asked me for a ‘quick fix’ so that she ‘can get on with life’, despite the fact that she had had years of short-term ‘quick fix’ interventions in the past, with no measurable result. Insurance companies are notorious for pushing quick fixes, apparently not realizing that they create revolving door situations that I assume must cost way more than a well-run longterm psychotherapy that addresses issues more permanently. The human mind in general looks for quick fixes, uncomfortable with the reality of much human healing that unfolds at the pace of watching your grass grow. There is no way around it, and this kind of group provides exactly the kind of safe, but intense transformative environment some of us need to heal deeply to the point of being able to thrive in our own skin without constant relapses, or worse, progressive deterioration.
Of course, not everyone is suitable for these kinds of groups, not the least because it is challenging to participate in such a rich and multifaceted process. Those who do, however, are usually rewarded by what they often call ‘an experience of a lifetime’, having had the privilege of participating in a group with like-minded and like-hearted people capable of a degree of intimacy, insight, and empathy not found anywhere else in life.
Copyright © 2020 by Dr. Stéphane Treyvaud. All rights reserved.