By Dr Bruce Bradfield
Group psychotherapy is a form of psychotherapeutic intervention in which one or more facilitators, depending on the size of the group, works together with a small number of people who share a similar therapeutic need, range of lived experiences, or therapeutic aim. The group process uses the interpersonal dynamic existing within the group as a vehicle for change and growth, relying on the notion that honest, authentic communication between empathically engaged human beings can be a healing and deepening experience. Group psychotherapy is based on a therapeutic atmosphere in which the group members benefit through the sense of sharing their experience with others who may understand these experiences deeply, perhaps through having lived through such experiences themselves. This frames the group as an empathic and mutually compassionate interpersonal environment. Such processes uphold the equal value and worth of each member, offering this as a therapeutic experience in the service of the development of a feeling of being valuable and worthy in a shared space. Added to this, the groups focus on the development of a capacity for each group member to think about their future with hope, as group members find themselves motivated and held up by those around them. The group interpersonal dynamics provides a unique opportunity for members to explore inner and interpersonal conflicts within the safety and protection of the group space, with the group therapist being as responsible for maintaining this safety as each group member him or herself.
Central to group work is the development of a contract or agreement, in which the members of the group, as well as the therapist, discuss and clarify the essential ingredients necessary to cultivate a feeling of safety and a climate of trust for the group as a whole. The process of group psychotherapy relies heavily on the sacredness of the space, as defined by absolute confidentiality, commitment to mutual respect and upholding an attitude that tries hard to be free-thinking, non-judgmental, and accepting of difference. There is a commitment to trying ones best to listen, to claim the opportunity to being listened to, and to engage in a manner that is free, fluctuating, and always driven by an effort to be fair, assertive and gentle with oneself and others in the group. The commitment to being a member of the group is offered as a demonstration of care and respect for oneself and the other group members, and is one in which there is a commitment to being together in a carefully protected, private and lasting community. Group psychotherapy focuses on the development of the freedom of the individual members to explore and communicate their experiences of themselves and their lives, in an environment that emphasizes the importance, value and meaningfulness of each member’s story. The process focuses on uplifting the often unconscious thoughts, feelings, memories and associations which the members have to their own narratives, and to the narratives of others in the group. The interactions between members is used as a vehicle for developing understanding, for identifying the differences in the way we think we are seen by others and the way we are actually seen, and for seeking the support and empathy of others who are “in the same boat”. As such, group therapy can offer a useful opportunity to test ones subjective reality with others, in the context of safety and trust. As a process, rather than an event, group psychotherapy relies on the idea that the deepening of a feeling of trust and safety taking place over time in a shared space can have a variety of benefits for the individual. On the one hand, this feeling of trust and safety can influence the ways in which members experience themselves and others beyond the context of the group, enabling a capacity to relate to trustworthy others in a trusting manner. Also, when we trust another person, we feel more able to communicate our needs, conflicts, feelings and desires in relation to others. We are more able to relate in a spontaneous and unrestricted manner, given that we feel able to trust in the inherent and enduring respectfulness with which the other treats us. Trust, as developed in the group therapy space, can therefore facilitate our potential to find and establish trusting relationships outside.
An important difference between group psychotherapy and individual psychotherapy relates to the individual’s experience of “not being the only one who struggles”. Often in the context of individual psychotherapy there can be a feeling of imbalance at the level of the therapist’s perceived health and wellness, and the patient’s vulnerability and weakness. Although this polarity is never really real in the context of individual therapy, it is felt. In group psychotherapy this feeling is much less prevalent. Not only is there a greater degree of likeness and a feeling of “being together with others who struggle like I struggle”, there is also a difference at the level of the facilitator, whose role in the context of a group psychotherapy process is often necessarily more disclosive. The facilitator in group psychotherapy is more than an observer. He is a participant, although he may participate in a manner that is different from the group members.
As an experience in which there is an emphasis on deriving benefit from the warmth and support of those around us, group psychotherapy is also based in the reality of human contact, in which there is always and necessarily some degree of conflict, disagreement and dissent. This is an important and healthy element of the process, and locates the group in a constant reminder that we participate as individuals who live in the real world, where we have to reconcile ourselves with taking the rough with the smooth. Whilst we may be identified with one another, we may connect at the level of certain life experiences, and we are united in a respect for the group’s contract, we always have separate minds with differing responses to the world around us. The more the group process is able to respect and support this difference, the freer the group members will be to examine and process their struggles.
The groups processes that are offered at the practice are framed by the psychodynamic school of psychological thought. The groups, in this sense, will unfold as a relatively unstructured exploration of ideas and feelings which emerge spontaneously in the group members and in the facilitator. The rate of the group will be determined by group members’ readiness to move, rather than by any type of organization that is imposed by the facilitator. In this sense the group will be responsible for its own organization, with the facilitator as a guiding force and encouraging presence. As a psychodynamically oriented process, the groups will emphasize the importance of being able to think freely about the contents of our minds and the minds of others. As such, the place of shame is often a key focus in groups, as this relates to the limitations which we impose on ourselves, through limitations that have been imposed on us, on what we are and are not allowed to think and feel. The group in this sense is framed as an effort to liberate restricted thought patterns, emphasizing this liberation as key to the psychological health of the individual. In terms of psychodynamic thinking this amounts to an effort to develop internal dialogue, in which parts of ourselves that we are aware of, and parts that we are unaware of, can come into contact, and converse. This activity can have useful and enduring implications for psychological health.