Tuesday, 5 May 2015

Group Therapy. 05.05.15

Someone asked me what I think of group therapy. I’m happy enough to answer the question, with a few disclaimers:
  • As per usual, I’m not a trained expert on this subject. All I’m doing is expressing my opinion. So the question I’m answering is “what do I think of group therapy?”, NOT “is group therapy good or bad?”.
  • I have had no involvement whatsoever with Alcoholic Anonymous, Narcotics Anonymous, Al-Anon, Narc-Anon, or any of the long-established programmes working around substance abuse who use group meetings. I know a handful of people who have had great success with their programmes, and another handful who struggled for various reasons. I don’t know if any of the problems I’m about to mention apply to these programmes. For all I know, the way they run their meetings is completely different from anything I have seen.
  • I have had some experience with group therapy during training and because of work. I found that they didn’t work for me, most probably because of a combination of my goals and style not matching the setting. I’m really not keen on engaging in public emotional displays. I don’t object to other people doing so, but it’s not my thing. Therefore, when talking to strangers, I tend to express concerns or problems in a very factual manner, and look for suggestions on solutions, rather than sympathy. Similarly, when people present me with a problem, I tend to want to eventually help them solve it. In the groups I had to participate in, that went down like a lead balloon. That impression stuck with me, so I'm not a particularly unbiased observer.
So, take this with several pinches of salt.

***

I have noticed several recurring problems in group therapy. They don’t occur in all therapy groups. They are not representative of an inherent flaw in the system. All of them imply the phrase “unless the group moderator watches out for this.” However, I have seen them occur often enough to make me wary.

1. Those who speak the most, often speak the most. Unless time is allocated equally, talkative members can end up taking up most of the session. The quietest members can be left with little or no time. That doesn’t do much to make them feel valued by the group.

2. People are rewarded for emotional displays, regardless of their appropriateness. If members have any kind of meltdown, they get extra attention. For some people that is incredibly embarrassing, but for some that’s a reward. Furthermore, there is a terrible reluctance to say “you’re making a mountain out of a molehill”. This can encourage an increase in emotional volatility for the purpose of attention-seeking, which isn’t a great help in everyday life.

3. There is great reluctance about calling people on their bullshit. Some people have problems. Some people are problems: they create their own problems because of their behaviours, attitudes, and lifestyle choices (please note I’m talking about stuff like “getting drunk and stealing cars and driving them into walls every weekend”, not “wanting to wear gender-inappropriate colours”. There are very valid reasons why some behaviours are not supported by society.). Because group therapy is often based around acceptance, tolerance, and anti-judgementalism, these issues are often left unmentioned. Because of this, problem people often aren’t compelled to modify their damaging behaviour, and may even receive further confirmation that their behaviour is OK.

4. Confirmation Bias is the tendency to search for, interpret, or recall information in a way that confirms one's beliefs or hypotheses. This can combine with the point above, when several problem people end up gathering and ‘proving’ to each other that they’re ok, and the world around them is screwed up. 

5. Predators/Knights. Unless participants are screened, people may join the group with less than savoury intentions. White Knights seek wounded people to ‘look after’, in order to bolster their own ego. Predators just want easy targets. Neither is helpful to have around, particularly during recovery, and both are naturally drawn to settings with a high density of suitable prey.

6. Conflicts of intentions. Unless participants are screened, they may not share the same intentions. Some may want to deal with those problems once and for all. Some may want to learn better ways to live with their problems. Some just want an opportunity to vent, or get extra attention because of their problems. Some may be sent there by the courts and have no intention whatsoever of sharing, caring, or making any changes. People working towards different goals can make difficult partners on a journey.

7. Groupthink. The desire for harmony or conformity in the group can result in dysfunctional decision-making outcomes. Conflicting ideas may be suppressed or openly attacked because they challenge the smooth running of the group, even though they would be better for the members’ welfare. Dissenters are often pilloried.

8. The numbers are bad for modelling. One of the easiest ways of picking up new behaviours is by modelling, i.e. imitating others. In a group therapy setting, most of the people present share a common problem. That suggests that they don’t yet have the skills to solve it or avoid it. When people do develop those skills, they often leave the group.

9. Seniority. In many groups, seniority is a component of status, at least because it often takes people a while to become comfortable in a new setting. In a therapy group, the most senior participants are often those who are most bogged down – otherwise they would have moved on. Although their determination may be astonishing, the fact that they are stuck ought to be a severe warning. That fact is often glossed over.

10. Crab bucket mentality. Jealousy is a natural human response to people having something we don’t, or doing better than us. We have to teach children not to be jealous, or at least not to act out their jealousy. People who fall into the crab bucket mentality haven’t learnt this lesson. Like crabs stuck in a bucket, clutching at those who are climbing out and preventing their escape, they end up undermining the results of those who are doing better than them.

11. Everyone is different. Although many of our responses and drives are very similar, we’re ultimately all individuals. The more different you are from the ‘norm’, the less you are likely to have in common with those undergoing group therapy with you. As a consequence, much of what is said and done may not work for you. Mentioning that is unlikely to be well-received, because you may be seen as challenging the group.

As I said, none of these problems HAVE to happen. It is up to the group’s moderators to keep it running smoothly and in the right direction. I think my main problem is with that direction: my definition of ‘support’ is probably unconventional. If I have a problem, I normally want to solve it. Anything that doesn’t take me towards my goal – that of not having the problem – doesn’t really get classed as ‘supportive’. For people with different goals, needs, and personalities, this may not be true.

***

Inevitable Book Plug: Predators, Knights, and Crab Bucket people are discussed more extensively in Chapter 11 of my first book, A Woman's Toolkit for Recovery from Violence and Trauma, out on Amazon.co.uk and Amazon.com.

No comments: