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Understanding group therapy

Your Questions about Group Psychotherapy,
answered by Marvin Kaphan, LCSW

Submit any question you may have about Group Psychotherapy, and the experts of GPASC will attempt to provide you with an accurate answer. Please address questions to the editor, Marvin Kaphan, MSW at mnk22@columbia.edu

Q.What is Group Therapy?

A form of psychotherapy in which a group of patients, who don't know each other outside the group, meet at regular intervals for the purposes of treatment and change. Group Psychotherapy is a general term to describe a variety of approaches, differing widely in their theoretical bases and treatment techniques. Groups are often used to focus on a specific problem.

Q.Why does it work?

In the safe environment of a therapy group, where nothing the patient says or does can be affect his/her job, friends, love life, etc., s/he is able to experiment with taking risks that might be too frightening in his/her daily life. Secrets that have never been exposed to outsiders can be revealed. Since members of a group are usually very honest about their reactions, the patient gets quite an accurate picture of how others see him/her and his/her secrets. S/he often discovers that not only can others accept these secrets that seemed terrible to the patient, but exposing vulnerabilities can draw others closer.
In addition, the group becomes an emotion laboratory, where the patient can learn to understand his/her own reactions by watching the patterns of others' reactions.

In Individual Therapy, the patient is often discussing interactions with others that have happened outside the therapeutic environment. These are all in the past tense and filtered through the patient's eyes and recollections. In a group, the interactions are observed by the therapist and other group members as they happen.

Q.Is Group better than Individual Therapy?

Group Therapy is certainly different in many ways from Individual Therapy. Each provides specific advantages that the other does not to the same degree. Therefore, some patients benefit more from group, while others benefit more from individual. There are some patients who are completely unable to use group. Most patients, however can gain a great deal from either environment, and the majority can get most out of a combination of both.

Q.Can I have one therapist for Individual Therapy and
    another for Group?

Often an individual therapist will decide that a patient s/he has been treating is ready to benefit from Group Therapy. If the therapist runs groups, s/he may suggest that the patient join one of these. If the therapist does not run groups, or has none that are appropriate for this particular patient, s/he may refer the patient to a group therapist for group, while continuing to see the patient individually. GPASC members often offer this service. This procedure requires very close collaboration between the two therapists, and should never be attempted without the approval of the individual therapist.

Q. Why is psychotherapy more effective then medication.

It is not necessarily true that psychotherapy is automatically superior to medication. The fact is that they attack different parts of a problem. The man who created the term psychosomatic was upset by the popular misunderstanding of the term. People have taken it to mean psychogenic (physical illness caused by a mental problem). His point was that every physical illness has emotional factors in its causation and consequences, and every emotional problem has physical factors in its causation and its consequences. Therefore, it's foolish to ignore either aspect in dealing with a problem.
For example, research indicates that in treating depression, psychotherapy helps, and anti-depressive medication helps, but the combination is synergistic (it helps more than simply what would be expected: 1+1=3). As far as we know, the process in depression is that the emotional problem leads to the body sucking up neurotransmitters that the brain needs to carry messages from one nerve to the next. The anti-depressive medication interferes with this process, the psychotherapy aims at removing the cause of the depression. In anxiety, anti-anxiety medication eases or eliminates the symptom, which can make it possible for people to function, but can keep them from feeling the need to find the cause.

Q. How would you define a mental illness?

Literally, mental illness would mean a disease of the intellect, but it is commonly used to indicate any impairment of the brain or the emotions that interferes with functioning and/or produces great distress. Among the problems psychotherapists treat are: anxiety, depression, panics, phobias and compulsions.

Q. What causes them?

See above. Most psychotherapists would agree that past experiences combined with inborn vulnerabilities contribute to causation.

Q. How do you feel about antidepressants? Negative effect?
     Side effects?

See above. While anti-depressants are extremely helpful, about 30% of patients taking them complain of some degree of sexual problems.

Q. What are the benefits of psychotherapy?

Beside relief of symptoms, patients report experiencing more satisfaction in their lives in general, especially with the longer term therapies. Consumers Reports did an excellent study of the results of psychotherapy within the last few years, you might want to locate that.

Q. Do you think that therapy and medication are effective together?

Usually, but see above

Q. Do you believe that family doctors should be able to
     prescribe meds. to patients?

Family doctors do prescribe medications. Some of them are very knowledgeable about psychotropic (affecting the emotions) medication.

Q.. Do you think that many patients are misdiagnosed?

The problem is not misdiagnosis as such. There is reason to believe that a large percentage of medical complaints conceal emotional illnesses such as depression. Physicians are becoming more and more aware of the need to look deeper to spot these problems. Managed care tends to limit the amount of time a physician can spend with a patient, which makes this harder.

Q. Should children be put on medication?

Current thinking is that Ritalin has been prescribed somewhat too quickly and too frequently for children who are having behavior problems, but there seems to be no question that it is really necessary and valuable in some situations.