While many clients prefer individual therapy, group therapy offers various benefits beyond what we might typically expect in individual therapy. First, group therapy offers the opportunity to learn vicariously from the experiences of others who share in the group. Learning from the others’ mistakes means getting valuable lessons without having to suffer the consequences of learning from our own trials and errors. When this sharing is back and forth, everyone benefits. Another important benefit of group therapy is getting feedback from other group members. It should be noted that such feedback can be no better than the information upon which it’s based. For this reason, telling “the truth, the whole truth, and nothing but the truth” is essential for getting the most helpful feedback. Opening up like this requires trust in the group leader and the other group members, both that they will respond constructively in the group and that they will honor the confidentiality of the material being shared.
Feedback from the Group Leader
Feedback, whether from an individual therapist or from a group leader, carries the extra baggage of being “authoritative” – which can be both good and bad. On the positive side, the education, training, and experience of the leader can offer some valuable concepts, principles, and knowledge that members can apply in their own lives. Yet authoritative feedback has its downside, as well. On the one hand, group members might embrace the feedback or advice of a group leader as the ultimate truth, without any questioning – buying into the authoritative reassurance of, “Trust me, I’m a doctor,” even when it is neither stated nor intended. Members could use such blind trust to avoid personal responsibility for their own actions (e.g., “I was only following the doctor’s orders – you can’t blame me for this mess.”). On the other hand, authoritative statements can trigger a backlash for those who have “authority issues.” This often involves an attitude of, “Who are you to tell me what I should think or do?” This reflex reaction often involves rebellion, opposition, or defiance, which is quite different from the reflective understanding of independent thought (e.g., processing and weighing how the feedback is relevant to one’s particular situation, then reaching one’s own conclusions about its usefulness). A useful perspective on feedback from authorities is implied in the famous line from The Wizard of Oz, when Toto pulls back the curtain to reveal the wizard as a little old man: “Pay no attention to the little man behind the curtain.” This paradoxical message actually redirects the viewer’s focus from the larger-than-life authority image projected on the wall to the actual person behind that projection. In doing so, it conveys the message that even the experts in whom we place our trust are only human, too. This realization suggests that we can only empower ourselves when we think for ourselves.
The Group Leader and Confidentiality
The group leader should maintain the confidentiality of information shared within the group, except for some particular circumstances. These include situations where there is a risk of members harming themselves or others, reasonable suspicion of incidents of abuse or neglect of children or elders, and court orders and subpoenas for records. However, ther are times when group members may want the leader to provide progress reports or treatment summaries to their referral sources, particularly when these sources are requiring satisfactory involvement in treatment. In these cases, members must sign an authorization to allow the leader to share information. This latter exception to privacy may well discourage some members from being completely candid in the group, yet it should be noted that members have little to worry about as long as they continue to do the next right thing.
Feedback to and from Group Members
Peer-to-peer feedback can reduce many of the pitfalls of authoritative or expert advice noted above. Often it is easier to receive and use feedback based on peers’ similar personal experiences rather than on advice based on abstract knowledge and principles. Here, offering one’s own past or current experience on the issue is usually more productive than passing judgment or offering advice. Sharing one’s similar experiences emphasizes the peer-to-peer relationship in the group, in contrast to an unequal relationship, such as between therapist and client or mentor and student. It is important that the feedback be offered in a positive, constructive manner, rather than with an attitude of criticism, judgmentalism, condescension, or blame. Members who offer authoritative advice tend to evoke resentment from other members, who can be even more resistant to receiving the expertise of their peers than they are when it comes from authority figures.
There may also be times when members are motivated to provide feedback because they view another member’s participation as infringing upon their rights as group members (e.g., monopolizing the group time, interrupting other members, or introducing topics irrelevant to the group purpose). Here, it is important to discuss the situation in terms of the disruptive behavior and its impact on one’s comfort and involvement in the group, rather than through an attack on the other’s character or personality. We can then ask for a change in that offending behavior. This offers the opportunity to practice one’s assertiveness skills. For some, this may require some toning down of verbally aggressive feedback, which may have a rather judging or blaming tone. For others, the challenge is to speak up for oneself in the first place, particularly when one has tended to avoid conflict in order to keep the peace.
One of the primary benefits of group therapy is in receiving feedback from others who can be neutral and objective because they are not involved in our daily life. For this reason, we encourage exercizing caution in developing relationships with other members outside the group. Such relationships outside the group could adversely affect our willingness to share in the group. After all, if we could easily open up with our family and friends, we might not need therapy in the first place. A further concern is the potential for conflicts to arise during interactions outside the group. These events could interfere with the effective functioning of the group. Should such situations arise, it could be helpful for the members to share the issues with the group. Otherwise, the group leader and the other group members may notice some underlying tension, yet not have enough background information for understanding and addressing it.
Confidentiality among Group Members
An essential condition for group therapy is confidentiality among its members, as we cannot comfortably share our personal issues when we do not feel safe in doing so. So like Las Vegas’s tourist slogan (i.e., “What goes on in Vegas, stays in Vegas.”), group members need to preserve the privacy of information shared in the group. We are free to share our own personal experiences in group therapy, but this should never involve divulging the identity or personal information of other group members. While group leaders are unable to guarantee that all members will honor the confidentiality of others, we will do our best to reinforce the code of confidentiality. Serious or repeated violations of privacy could result in excluding the violator from further group involvement, not as punishment, but for the safety of the other members. So as to discourage this from happening, group members are encouraged to discuss their privacy concerns any time that these arise during the course of the group. This also presents an opportunity for group members to exercise their self-worth in asserting their concerns and rights within the group.
Summary of Benefits of Group Therapy
Group therapy offers many of the benefits of individual therapy, while also providing an opportunity to learn from one’s peers. This learning can come not only from what members share in the group discussion, but also from the style through which we interact with others. Furthermore, members have the opportunity to receive feedback from their peers, as well as from the group leader. The group also provides a sort of laboratory in which its members can experiment with developing new and potentially more effective ways of interacting with one another. These benefits can be more striking when its group members share significant issues in common, such as substance problems, anxiety and depression, or codependency. Because of the members’ often hard-learned lessons from the school of hard knocks, I often refer to them as my “panel of experts.” Their real-world experience complements the conceptual and theoretical understanding that is often provided by the group leader. With such understanding among its members, groups can function as a dress rehearsal in dealing with many of the issues its members face in daily life.