As many of you know, in 2018, the American Psychological Association’s Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP) recognized group therapy as a specialty. It couldn’t have come at a more important time in our history. Over the last several months, we have been coping with the COVID-19, a virus that has killed over 138, 358 people in the United States and 586,174 worldwide (July 16, 2020, CDC). This virus has brought with it complicated mourning, job loss, and the exposure of social inequities. On top of an already taxed situation, the murder of Breonna Taylor and George Floyd, among others, exposed police brutality, systemic racism, and the emotional and physical burden it has placed on Black lives. The emotional pain, ever-present fear and anxiety, and lack of clear leadership has led to a lack of cohesion as we confront both the virus and racism. Div. 49 and our knowledge of group theory and practice has much to say and do to make a difference.
Given the value of groups during COVID, I asked Don Forsyth, Bernhard Strauss, and Gary Burlingame to work on a manuscript with me devoted to the pandemic. The paper we submitted examines the group level factors that influence how we understand the prevention of the spread of the virus, navigate the issues of job loss, grief, and social injustice, and how on-line groups and group psychotherapy can help relieve people’s suffering. This manuscript is still in review, and this is a brief description of how group research, theory, and practice can help us navigate the pandemic and systemic racism. I look forward to the special edition on COVID that our editor for Group Dynamics, Georgio Tasca, PhD, is currently finalizing. It will be an important contribution to the field. Like Georgio, our division members have given a tremendous amount to support us through this challenging time, and I would like to shine the spotlight on their important work as I highlight groups during COVID-19.
Reducing the risk of contracting COVID-19: How group dynamics influence the process
I first learned about group dynamics when I took Donelson Forsyth’s, PhD, class at Virginia Commonwealth University in graduate school. I never told him this, but he was probably the best professor I have ever worked with. He was a great teacher, excellent researcher, and had a great sense of humor. But more than that, he was a creative thinker who had a gift for writing, appreciating the power of groups, and inspiring others to value them as well. He has been leading the field of group dynamics for over 30 years and has continuously fought to have group processes recognized as they influence people all the time.
Given our individualistic society, it is not surprising that we often pay attention to the individual factors-- why a person does not wear a mask, why an individual is at risk, or why someone does not maintain social distances. We often neglect the group processes and dynamics that are always influencing how people are coping with a crisis, like COVID-19. It is imperative that we not only look at the individual factors driving behavior, but we also pay attention to the group dynamics at play. Forsyth (2020) uses group dynamics to understand how people interpret the accuracy of information they receive, follow recommendations to maintain social distancing, and resist challenges to personal freedom. Forsyth argues that when people are determining the risk of COVID-19, they naturally look at those around them and the groups they belong to. If the CDC warns about the dangers of the virus, people hear that, but they will also look around to see if it matches their current experiences with people they know.
This may explain why people in Florida were initially resistant to social distance when the rates of infection were low in that state. In addition, many people have chosen to socialize even when the recommendation has been to quarantine. Forsyth (2018) argues that people have a strong need to belong, and this basic need is even more powerful during stressful times. Belonging and joining a group during stress can bring health benefits, but when there is a pandemic and people need to socially distance, it can be dangerous. Having this knowledge that people are reacting with more complexity than pure ignorance, denial, or individualism is important as we work to contain COVID-19. We are all in this together, and the more we understand and appreciate why people are not following public health recommendations, the more we can find ways to challenge the avoidance of recommendations, restore group cohesion, and facilitate change.
Relying on the group to cope during COVID-19
Groups can reduce the stress of isolation/loneliness, address the stress of racial and economic inequities, and facilitate cohesion that binds us together despite ruptures and conflict. As you all know, group researchers and therapists have long recognized the importance of group cohesion and studied how it facilitates safety and the ability to tolerate tensions in the group (Yalom & Leszcz, 2005). During COVID-19, people are often interacting in groups such as peer groups, families, and co-workers. Group therapists have even bonded and formed telehealth groups (during the pandemic) to keep them active with professionals along with reducing stress levels, decrease isolation/loneliness along with addressing racial inequities. Brindely, Mosier, and Hicks (2020) studied cohesion in medical settings and found that having clear tasks and being prepared facilitated cohesion in medical teams that saved the lives of COVID-19 patients.
Joining groups is one way that individuals can cope with the effects of quarantining (Brooks et al. (2020). For example, the elderly are required to isolate to decrease mortality rates and are more likely to feel lonely during COVID-19. Researchers have applied a group intervention for lonely older people and found it to increase social activity, improve well-being, and decrease the need for health services (Supiano & Luptak, 2013). In our Division, we have some older members like myself, but we also have younger members who value group connection. During this pandemic, Division 49 professionals, Dr. Misha Bogomaz organized a community conversation hour with more than 80 people attending. Dr.’s Leann Diederich, Eric Chen, and Michele Ribeiro helped lead the breakout groups. It was a meaningful way that we could rely on our group, our division, to support one another through COVID-19. Thank you for creating the space for our members to connect.
Social inequality and groups to promote change
During the pandemic, we were forced to see that not everyone was affected the same way. Black minorities had the highest rate of mortality in major cities that were hit hard by the virus. Yancy (2020) provides sobering statistics that, 50-70% of COVID deaths were Black individuals even when they represented 14-30% of the total population of a city. A similar pattern occurs globally with predominantly Black countries having the greatest infection and death rate compared to predominantly white countries. We have also seen significant increases in racism toward people who are Chinese or of Asian descent. Issues of racism, discrimination, and healthcare inequities add incredible stress to individuals and relate to mental (Carter & Forsyth, 2010; Murali & Oyebode, 2004; Schwartz, 2017) and physical health (Sacker et al. 2009). The added losses of Breonna Taylor and George Floyd, among others, heightened our awareness of systemic racism in the country and reminded us of the pain and suffering endured by people of color.
Although hatred and discrimination in groups has a deleterious impact on health and wellbeing (Pasco & Richman, 2009), we know that groups also can provide a resource for minorities and marginalized populations during this pandemic. Belonging to groups with others who have similar experiences increases a sense of belonging and provides support, and group therapy can address white privilege, intersectionality, systemic racism, and foster empathy for diverse group members. Michele Riberio, PhD, edited a wonderful book that came out this year on diversity in group psychotherapy titled Examining Social Identities and Diversity Issues in Group Therapy Knocking at the Boundaries. The book is relevant to all of us as we engage in group work, and I encourage you to read it, as I did. I know it facilitated my own exploration of these challenging issues within myself and will make me a better group leader.
Additionally, under the leadership of Eric Chen, PhD, chairperson of Div. 49’s Diversity Committee, we had a well-attended online presentation by Aziza Belcher Platt, PhD, titled "Black Lives Matter in Therapy Groups Too: How Do Therapists Disarm Racial Microaggressions?" Eric and the diversity committee also added resources on our Google Drive that include links to books, videos, and training opportunities. Please take a look at these terrific resources. Thank you, Eric, for the invaluable leadership that you have been providing our division. You have made an important impact on us all.
During the APA convention in August, we will have a Zoom town hall addressing social injustice at 4:45 on Thursday, Aug. 6, 2020. We welcome you attend this important meeting, and this is only the beginning. We need to continue to work together to share our knowledge of group dynamics as they influence our own development, intergroup dialogues, address systemic racism, and train anti-racist group leadership and therapists. Our work has much to offer organizations, sport teams, graduate education in applied psychology, internships/externships, and practicing group therapists.
Group therapy and mental illness during COVID-19
Bernhard Strauss, PhD, and Gary Burlingame, PhD, have been a force of nature that has brought evidence-based practice to group psychotherapy. Their hard work pulls together the literature supporting group therapy, and their recent meta-analysis of nearly 50 RCTs that compared individual and group therapy treatments revealed equivalent outcomes (Burlingame, Seebeck, Janis et al., 2016). Strauss and Burlingame provide empirical support for the use of group therapy to address disorders on the rise due to COVID-19. These include anxiety disorders (Schwartze, Barkowski, Strauss et al., 2017), post-traumatic stress disorder ( Schwartze et al., 2019), major depressive disorders (Janis et al., 2020 ), substance abuse disorders (Lo Coco, Melchiori, Oieni et al., 2019) and complicated mourning (Wallace et al., 2020; Sun et al., 2020). Their work has been critical as we maintain our specialty status within psychology.
Online groups and COVID-19
One of the most significant impacts group has during COVID-19 is reaching out to people and providing online groups. I see all my patients online, the groups I am supervising have moved online, and we are now seeing more and more treatment move to tele-therapy. Our division along with the American Group Psychotherapy Association has provided many outstanding resources devoted to training group therapists. In our division, Martyn Whittingham, PhD; Jennifer Martin, PsyD; and Leanne Diederich, PhD, presented a well-attended webinar on the ethics of online group therapy. Based on the needs of our members, we included resources on our website that include links to online group and links to paperwork that may be useful to group therapists as they move on-line.
In addition, we have collaborated with AGPA to develop a survey we will be sending out to you shortly to learn more about group therapists’ experience of online group therapy. This survey under the leadership of Georgio Tasca and Joe Miles and collaboration with Molyn Leszcz, Zipora Shechtman, Rainer Weber, Gianluca Lo Coco, and Salvatore Gullo will help us understand how we can help group therapists and understand the benefits and limitations of on-line treatment. I hope that you will consider filling it out.
Implications for our division
Forsyth was right (but don’t tell him I said that). It is critical that we examine the group-level processes pertaining to the prevention, maintenance, and treatment of people during COVID-19. Although we often are aware of the individual factors we emphasize during this pandemic, the social factors are equally important. Group dynamics influence the tension we see when people are ambivalent about wearing masks or social distancing, the ways people cope with social isolation, and the ways groups can provide relief from depression, anxiety, substance abuse, and loss. Group dynamics also influence power, privilege, racism, discrimination, and scapegoating. Group leadership also influences group dynamics.
Leadership during COVID-19
Greenbaum (Monitor, July/August 2020) recently covered a story about leadership in times of crisis to address how leaders influence the group during COVID-19. It emphasized the importance of leader empathy, clear communication, understanding of crisis intervention, and managing personal reactions while supporting the group. These are all excellent; however, they did miss some that we know are important from social psychology and group psychotherapy theory, research, and practice. We have an enormous amount of valuable information on leadership. Spoiler alert: I will address these important issues in my Presidential Address in August when I talk about group leadership. I hope you will watch it because understanding who makes a strong leader is critical as we are selecting our leaders who will guide us during COVID-19, address systemic racism, reduce poverty and healthcare inequality, and confront discrimination. Never has there been a more critical time in history to apply what we know about groups and leadership to our current circumstances.
Celebrating groups during APA’s 2020 virtual convention
I am so proud and impressed by the hard work people in our division have been doing. Thank you. This has been one of the hardest few months of our lives and it is not over. I wish we were seeing each other at the upcoming convention. I know we all could use a fun social this year. Although I am very sad, we will not be celebrating in person, I am excited about our conference that Lisa De La Rue, PhD, has organized. She has done a terrific job, and she will be describing the presentations and schedule in more detail in this newsletter. Thank you, Tom Treadwell, EdD, for all your work creating and publishing the newsletter. It is an important way we all share our work during the year. As a member of Div. 49, please let us know if you have things you would like to share with the group or let us know if you would like us to do more to address specific issues. We do want to hear from you.
With regards to the upcoming convention, I look forward to the presentations and to honoring our fellows and awardees during a public zoom meeting on Friday 4:45pm eastern time. We have many people who have earned recognition in our field. I also look forward to a crazy fun zoom social hour after at 6:00pm. We plan to do our traditional raffle (not sure how yet), play online games (not sure what that looks like either), or spend time catching up. I hope you and your families are safe and thank you for all you are doing to make a difference during this challenging time.
References
Brindley, P. G., Mosier, J. M., & Hicks, C. M. (2020). Pandemic airway management: A cognitive aid to increase safety and team cohesion during intubation, donning, and doffing. Journal of the Intensive Care Society, 1-2. 1751143720931614.
Burlingame, G. M., Seebeck, J. D., Janis, R. A., Whitcomb, K. E., Barkowski, S., Rosendahl, J., & Strauss, B. (2016). Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy, 53(4), 446–461. htptps://doi-org.erl.lib.byu.edu/10.1037/ pst0000090.supp (Supplemental)
Carter, R. T., & Forsyth J. M. (2010). Reactions to racial discrimination: Emotional stress and help-seeking behaviors. Psychological Trauma: Theory, Research, Practice, and Policy,2, 183–191. doi:10.1037/ a0020102
Forsyth, D. R. (2018). Group dynamics. Cengage Learning.
Forsyth, D. R. (2020). Group-level resistance to health mandates during the covid-19 pandemic: A groupthink approach. Group Dynamics: Theory, Research, and Practice. In press.
Janis, R., Svien, H., Jensen, J., & Burlingame, G. B., (under review, 2019). Efficacy of group psychotherapy for major depressive and bipolar disorders: A meta-analysis. Psychotherapy Research.
Lo Coco, G., Melchiori, F., Oieni, V., Infurna, M. R., Strauss, B., Schwartze, D., … Gullo, S. (2019). Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. Journal of Substance Abuse Treatment, 99, 104–116.https://doi.org/10.1016/j.jsat.2019.01.016
Murali, V., & Oyebode, F. (2004). Poverty, social inequality and mental health. Advances in psychiatric treatment, 10(3), 216-224.
Sacker, A., Head, J., Gimeno, D., & Bartley, M. (2009). Social inequality in physical and mental health comorbidity dynamics. Psychosomatic medicine, 71(7), 763-770.
Schwartz, J. A. (2017). Long-term physical health consequences of perceived inequality: Results from a twin comparison design. Social Science & Medicine, 187, 184-192.
Schwartze, D., Barkowski, S., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2017). Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized, controlled trials. Group Dynamics: Theory, Research, and Practice, 21(2), 77. doi:10.1037/gdn0000064
Schwartze, D., Barkowski, S., Strauss, B., Knaevelsrud, C., & Rosendahl, J. (2019). Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research, 29(4), 415–431. doi: 10.1080/10503307.2017.1405168
Sun, Y., Bao, Y., & Lu, L. (2020). Addressing mental health care for the bereaved during the COVID‐19 pandemic. Psychiatry and Clinical Neurosciences.
Supiano, K. P., & Luptak, M. (2014). Complicated grief in older adults: A randomized controlled trial of complicated grief group therapy. The Gerontologist, 54(5), 840-856.
Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of Pain and Symptom Management.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
Yancy, C. W. (2020). COVID-19 and African Americans. Jama, 323, 1891-1892.