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Group psychotherapy column: Sparky tilts at windmills

The author disagrees with two recent publications indicating group therapy exists for monetary savings and is less successful than individual therapy

By John Breeskin, PhD, ABPP

I am really quite a mellow person, however, when something raises my ire, I react very strongly. This column will illustrate this phenomenon all too well. I wish to discuss two recent articles, one in The Wall Street Journal and the other similar one in a publication by the American Group Psychotherapy Association (AGPA), of which I am a card-carrying member. The unhappy title from the Wall Street Journal is, “No Joke: Group Therapy Offers Savings in Numbers.”

The first article is not difficult to read or to understand, as it takes a simplistic view of group therapy as a treatment modality. I have no trouble with this idea; however, the rationale offered is that group therapy is cost-effective, and that should be its selling point. To use cost-effectiveness in this manner is not only misinformed, it is ultimately ridiculous.

Group therapy has inherent benefits, and doesn't need to be judged on a dollars and cents basis. To make my point, I want to discuss the Great Bed of Ware. There was a tavern, during medieval times, on a main road out of London, where weary travelers could put up for the night. The bed itself was approximately 10' x 10' and was covered with a green fabric. It looked like a gigantic putting green. As mud spattered travelers came off the road they were chucked on the outer periphery of the bed with their feet in the middle, while still wearing their boots. There was always room for one more. The warmth of the bodies in the bed was substantial and kept out the chill night air. In addition, people woke up next to one another and shared a common experience. This is my concept of group therapy. We gain warmth, support and belonging as basic human needs.

The Wall Street Journal article goes on to suggest that the reluctance to consider group therapy as a treatment model is due, in part, on the idea that mental illness is infectious and the feeling that if a therapist's attention is directed toward another group member, there will be less available to the others. This is a deadly example of the scarcity model. In fact, behavior of one individual and group is a learning laboratory for all of the others. It is an enhancement model. The metaphor here is Stone Soup.

The article then goes on to say that an inherent problem in groups is to find sufficient clients. This is nonsense: I have run as many as six groups a week with unbelievable attendance. In fact, one men's group of mine did not have an absent group member for 17 straight weeks. This should go in the Guinness Book of World's Records.

I consider individual therapy to represent a model of the world which is unhelpful. The idea that one person is there for another person’s benefit suggests that individual therapy is like a hothouse orchid, which can only flourish in an artificial environment. The fact that group therapy powerfully reflects the family of origin is an obvious point. Needs are met, through negotiation, in the marketplace; this is a realistic view of life.

The idea that certain diagnostic categories do not belong in Group is erroneous as long as the Noah’s Ark Rule is kept firmly in place.

The Wall Street Journal article goes on to suggest that the reluctance to consider group therapy as a treatment model is due, in part, on the idea that mental illness is infectious and the feeling that if a therapist's attention is directed toward another group member, there will be less available to the others. This is a deadly example of the scarcity model. In fact, behavior of one individual and group is a learning laboratory for all of the others. It is an enhancement model. The metaphor here is Stone Soup.

(No more than two schizophrenics, no more than two borderlines or no more than two depressives otherwise the group can become symptom driven.) In fact, the idea of more than two depressives in a group is quite depressing.

The idea that a therapist has less power in groups than he or she has in individual therapy just isn't true since the group leader’s task is to develop indigenous leaders, which, in time, will replace him or her in the center of the group. All is not lost in this article, however, since the final quote is: "By the group we are wounded and by the group we are healed.”

The second article from the AGPA itself, unfortunately, mimics the first article with the same tired economic rationale but has errors all of its own. The statement that children, adolescents and adults can all successfully participate in groups is just plain false. There are specific exclusionary criteria, which flat-out contradict this conclusion.

I hope the reader of these articles will become aware of the inherent value of group therapy as a treatment modality and not get caught up in an economic value argument.

References

Helliker, K. (2009). No joke: group therapy offers savings in numbers. The Wall Street Journal, D1. Retrieved from http://online.wsj.com/article/SB123785686766020551.html

American Group Psychotherapy Association (2009) - Group psychotherapy emerges as a cost-effective and highly beneficial mental health treatment in challenging economic times [Press Release]. Retrieved from http://www.agpa.org/newsroom/releases/2009%20Press%20Releases/AGP A-4-09-groups-work-in-economic-downturns.pdf