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What About Group Therapy?

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What happens in a process group? Group therapy has a long, rich history in the field of mental health, peppered with names like Rogers, Bion, Lewin, and Yalom. A few decades ago people spoke of powerful experiences in encounter groups, psychodrama groups, and at the Tavistock Institute. But today we mostly hear about the benefits of support groups and recovery groups. Those issue-specific groups are incredibly helpful, but I wondered; do those classic group therapy experiences, those raw, in-your-face dynamic groups, still exist? I have much to learn about group therapy, so I’ve invited an expert to fill in my considerable gaps in knowledge. Ryan Spencer, MFT, is a Certified Group Psychotherapist and President of the Group Psychotherapy Association of Los Angeles (GPALA). He leads adult process groups at his private practice in Pasadena, California. I also hear he plays a mean game of basketball. Ryan recently took a moment between groups to generously share his considerable wisdom. Ryan Howes: What's the current status of group therapy? Ryan Spencer: Group therapy is alive and well and just about everywhere -- universities, hospitals, mental health agencies, churches, rehab clinics, etc. I think group therapy is one of the most misunderstood modalities of psychotherapy for three main reasons: 1. Most clinicians specialize in some form of individual therapy and don’t have experience or training in group therapy, 2. Group therapy is often portrayed poorly or parodied in the media (think Go On or Austin Powers or The Bob Newhart Show) 3. Group is scary -- it’s hard enough to share one’s problems with a therapist let alone a group of strangers. RH: Who is the ideal candidate for group therapy? RS: Group is for everyone. Think about it, everyone deals with groups (family, work, social settings) and everyone has room to improve in their ability to relate with others, whether increasing vulnerability or having better boundaries, understanding one’s feelings and sharing them, or being more assertive. There are groups for addiction, depression, chronic pain, chronic mental illness, anger, couples, personal growth, anxiety management, social skills training and just about anything else you can think of. RH: How is it different from individual therapy? RS: There are a number of differences:

  1. It’s more affordable.

  2. Group is one step closer to real life than individual therapy. You are dealing with real people rather than only a mental health professional. In a healthy group you have many different perspectives that provide for more robust feedback, exploration and experimentation.

  3. Group members learn from seeing others work.

  4. More people = more transferences = emotionally rich environment = ability to work on, express and tolerate strong emotions in oneself and in others.

  5. The therapist can see their patient in a social environment rather than relying on the patient’s self accounts.

RH: Impressive list. How does confidentiality work for groups? RS: Most groups have a set of guidelines they ask each member to respect. In these guidelines the leader will make clear how members are to treat each other’s information. In my process groups, I ask members to not share any personal or identifying information about group members. They can share about their experience or about the leader but not other group members. I also ask that if they share anything with each other outside the group that they bring that back to the group to contain the emotional experience inside the group. RH: Ah yes, the process group, the classic group experience. What actually happens in a process group? RS: The therapist has usually screened all members in individual sessions for appropriateness of fit and to prepare each member to use the group. Group members are instructed to check in with themselves moment by moment and take note of their feelings, thoughts, and associations in reaction to what is happening in group or toward other group members. There is usually a focus on the "here and now" as well as issues each group member is having in their lives. Leaders rarely introduce topics but help the group form trust and share openly. As group members gain trust and interact more freely with each other, they use and recreate the same relational patterns and styles that have hindered them in their lives. In a healthy group, members can receive feedback on how they come across and the impact they have on others, which gives them valuable information about how they relate and are perceived. Then group members can choose to work on their relational style in the group and practice to do it with the people in their lives.

RH: Sounds like powerful stuff. Can you give an example? RS: “Sally” was taught that anger was bad when she was a child and struggled as an adult to set boundaries with her friends, co-workers and husband. In group she would say "I'm being such a bitch" when she felt angry at another group member. Members of the group told her that they didn't see her as a bitch but they perceived that she didn't like something that was going on in the group. The group member that she was angry at said she could even dial up the anger. Through working in this way she learned how to use her anger more effectively to be assertive. RH: How can people find a group? RS: First, if you are in individual therapy, talk with your therapist about group therapy and what kind of group might benefit you. Secondly, you can contact the American Group Psychotherapy Association ( to get in contact with the local affiliate society who should have some database of groups. In Los Angeles we have a searchable database on the GPALA website ( Finally, just Google the type of group you are looking for and see if there is a group running in your area.

RH: So, am I to understand you’re in favor of groups? RS: Groups are amazing. We are all born into a group and function in groups daily. Group therapy is a place where one can be re-familied, meaning a healthy group can help one learn and grow in ways that their original family was unable. Additionally, most people struggle with either conflict or intimacy if not both. Group is a great way to better understand how to relate with others and work on more effective ways to love and fight.

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