As I was thinking yesterday about what I wanted to write about in this column, a colleague called and said “Amy, we need to send someone to meet with and support the mental health needs of the staff who have been responding to the Buffalo shooting.” My immediate response was “Great. We are in. But… what would this person do? What is the intervention?” We sat in silence for a moment. This colleague and I have been collaborating on disaster mental health and emergency response work for several years. And in that moment, it struck us, again, that there is something missing in our tool kit.
We both knew that it needed to be a group intervention. A primary effect of interpersonal trauma is the disruption of social relatedness and attendant isolation of the victim. Relatedly, we know that one of the best predictors of outcome following a disaster is the amount of social support and connectedness people perceive themselves to have. Group interventions offer the cohesion, universality and related therapeutic factors that promote connectedness and healing.
At the same time, rates of depression and anxiety across the country are at peak levels and the demand for mental health services has skyrocketed. Wait lists for therapists in my own county in New York are as much as 400 people long. Individual therapy is not a viable solution to getting people access to the help they need. Furthermore, these mental health concerns, particularly as they have arisen during the pandemic, are largely interpersonal in nature, making group interventions potentially both more efficient and effective. Yet group interventions in private practice are quite underutilized, which compounds challenges with equity and access.
These issues are just two of so many we currently face that illustrate what members of our division know well: groups are an intervention of choice for addressing many of the social and psychological problems we face as a country and a planet. Yet I am not convinced our current models of group intervention and training have kept pace with need and demand. I offer here just two quick examples of opportunities for advancement that I see in my work and my role as division president.
- In a column for this newsletter that I wrote as President-Elect, I said:
In my day job, I am the director of the Institute for Disaster Mental Health at SUNY New Paltz. As a long-time ‘group person’, I came to the field of disaster work with some clear ideas about the role of groups in disaster recovery, yet the confluence of the two fields is not near where it should be. Among the many lessons of the past year, we have learned that disasters will be an increasingly common factor in our world, and that groups have a major role to play. As just one example, the sheer numbers of people impacted by disasters around the globe will necessitate the provision of early interventions in groups, yet we do not know nearly enough about how to make that happen. Now is the time to figure it out.
A year and a half later, I am not aware of any solid advances on this front. Yet according to the national Gun Violence Archive, from the day I wrote that column until today, there have been 900 mass shootings (defined as those in which a minimum of four victims were shot, either injured or killed, not including any shooter who may also have been killed or injured in the incident). While the horrific impact on the victims and their families is clear, the extended impact on the communities is often left unaddressed. The need for an evidence-based group-based intervention to support people in the early aftermath of a disaster remains a gap in our current tool kit. It’s urgent that we figure that out.
- We need models that increase access to group services. As part of the equity efforts of our division, Martyn Whittingham, Cheri Marmarosh, Pete Mallow and Michael Scherer have been working on a national solution to improving quality and access to mental health care. They currently have an article accepted to a special issue of the American Psychologist that will outline the health economics case for private practitioners increasing their use of group. In it, they make the case the current workforce shortage of therapists is leading to burnout of therapists and the inability of clients to access needed care before it become more chronic and severe. They demonstrate the health economics case for increasing group therapy in private practice. The results of their economic analysis show that if 10% of unmet need was met by groups and not individual therapy, 3.5 million more people could be seen, over $5 billion saved and over 34,000 less new therapists needed. It also makes the case that group therapy needs to be a required class in psychology graduate programs and that assessment is needed to ensure outcomes – something already happening in Germany, Australia and England. APA Practice Directorate and AGPA are both exploring strategies for discussing this with private insurers and government agencies.
However, for this solution to solve the problem, we need new models of training across the spectrum, from graduate school through to professional development for practicing psychologists. Our emerging Continuing Education program is one avenue for this work that we are actively engaged in. There are certainly others.
These are just two examples. All my years of training and work have cemented in me the belief that what we know and do as group psychologists and group psychotherapists holds so much potential for addressing many of the current challenges are world faces. Let’s get together and talk about that! Some of these important topics will be addressed throughout our division programming when we are together in Minneapolis in August. Topics will include addressing microaggressions in group and in supervision, furthering our understanding of on-line groups in a variety of contexts, advancing the use of groups in private practice, developing sexual assault support groups, and dealing with the death of a group member. In addition to these content sessions, we will have a number of opportunities to (re)connect with each other including celebrating our newest Fellows and award winners, and our first in-person Division 49 Social Hour since 2019. Come join us. I look forward to seeing you there!