On Learning to Love Group Therapy

When I resumed clinical training last fall after being on a long academic detour for two decades, the biggest area of learning for me has (so far) likely been in the realm of group therapy, first at a theoretical level and now at a clinical and practical level. Very rapidly, and to my amazement, I have gone from strong, if very unthinking, skepticism about groups to an increasing love for work with groups.

I had a class in group therapy in the spring during which the first major revelation came in clarifying that group therapy is not just a collection of individuals who are doing individualized therapy while others watch and benefit vicariously—a kind of therapy as spectacle, as it were. Such an idea of group therapy filled me with a sense of horror that is, moreover, dependent upon my being something of a snob when it comes to education, prizing above all people who’ve obtained MD’s and Ph.D’s. Why should I want to air my problems in a room full of unlettered voyeurs?  

Slowly, however, I came to realize that groups work as such, that is ensemble (as we say in French) rather than as merely a loose aggregate of individuals who happen to find themselves in the room at the same time, each sequentially taking a turn to engage the therapist while the others watch largely in silence. Further, I’m realizing that people can and do learn from others regardless of what degrees or credentials they may possess, and that sometimes these people can be more beneficial, more intelligent, and less blind than the “expert” who has all the degrees in the world. 

The big person to help here has, of course, been Yalom. His landmark book, Group Therapy (the sixth edition of which comes out this December), which I’ve been picking my way through for most of this year, has been so very helpful in many ways. I will be writing more about it in the coming weeks. 

One of his insights I especially appreciated: the fact that groups allow members an opportunity to feel and be helpful. As he puts it, “People need to feel they are needed and useful” (p.14). 

This is a dynamic that Harold Searles, whom I recently stumbled upon, described well in his 1975 paper “The Patient as Therapist to his Analyst.” He argues there, as Yalom does, that all of us have a “psychotherapeutic striving” to be agents of healing to one another. (Indeed, Searles goes even farther to argue that at least part of what we might label “pathology” comes from having this urge to be helpful thwarted.) 

The idea that therapists can and do learn from their patients is another insight I have been regularly encountering in just about every work I have read this year across American and British practice and several theoretical traditions. In this it accords well with something I learned from Stanley Hauwerwas many years ago, and have found a constant part of my experience in the classroom: the extent to which professors learn from their students. In either case what is required is a certain degree of humility and graciousness not to see oneself as an omniscient expert and students or patents as bereft of any insight or wisdom. 

Some of the virtues of groups are highlighted in this article, which points out a forthcoming book by Christie Tate, Group: How One Therapist and a Circle of Strangers Saved My Life. With any luck, I may be able to read it in the coming weeks. I've also written to the author to see if she is open to doing an interview about it. Here, in the meantime, is the publisher's blurb:

The refreshingly original debut memoir of a guarded, over-achieving, self-lacerating young lawyer who reluctantly agrees to get psychologically and emotionally naked in a room of six complete strangers—her psychotherapy group—and in turn finds human connection, and herself.

Christie Tate had just been named the top student in her law school class and finally had her eating disorder under control. Why then was she driving through Chicago fantasizing about her own death? Why was she envisioning putting an end to the isolation and sadness that still plagued her in spite of her achievements?

Enter Dr. Rosen, a therapist who calmly assures her that if she joins one of his psychotherapy groups, he can transform her life. All she has to do is show up and be honest. About everything—her eating habits, childhood, sexual history, etc. Christie is skeptical, insisting that that she is defective, beyond cure. But Dr. Rosen issues a nine-word prescription that will change everything: “You don’t need a cure, you need a witness.”

So begins her entry into the strange, terrifying, and ultimately life-changing world of group therapy. Christie is initially put off by Dr. Rosen’s outlandish directives, but as her defenses break down and she comes to trust Dr. Rosen and to depend on the sessions and the prescribed nightly phone calls with various group members, she begins to understand what it means to connect.

Group is a deliciously addictive read, and with Christie as our guide—skeptical of her own capacity for connection and intimacy, but hopeful in spite of herself—we are given a front row seat to the daring, exhilarating, painful, and hilarious journey that is group therapy—an under-explored process that breaks you down, and then reassembles you so that all the pieces finally fit.