How to attend group counseling

What is group counseling?

A counseling group is usually comprised of six to eight students who meet face to face with one or two trained group therapists and talk about what most concerns them. Members listen to each other and openly express thoughts and feelings about what other members do or say. These interactions give members an opportunity to increase understanding of self and others, try out new ways of being with others, and learn more effective ways to interact. The content of the group sessions is absolutely confidential; members must commit to confidentiality: that is they may talk about their own experience with whom they choose, but may not identify other members or what they say outside of group.

Why does group counseling work?

When people interact freely with other group members, they tend to recreate the same patterns of interactions that happen to them outside of the group. This creates the opportunity for meaningful change or increased self acceptance. With the help of the group leaders, members learn how their behavior affects other people. The group becomes a safe place to experiment with alternative ways of treating oneself and others, ways that can be more satisfying and successful. Many of us feel we are somehow weird or strange or that some aspect of ourselves seems unacceptable because of our problems, or thoughts, or the ways we feel. It is very encouraging and humanizing to learn that others have some similar difficulties, thoughts, and emotions. The focus shifts from considering ourselves defective to learning to live our lives as fully and richly as we can.

What do I talk about?

Talk about what initially brought you to Counseling and Consultation Services. Tell the group members what most bothers, worries, or concerns you — the things that affect your self identity. If you need understanding, let the group know. If you think you need pointed feedback about something you say or do that seems to have a negative impact, you can let them know that. It is important to learn ways to tell people what you expect of them. Unexpressed feelings are a major reason people experience difficulties. Revealing feelings — self disclosure — is an important part of group and affects how much you will gain from the group experience. The most useful disclosures are those that relate directly to your present concerns and how you feel about yourself. How much you talk about yourself is your decision; it will depend in part on your own comfort level and how much you are committed to change in a given area. If you have questions about what might or might not be helpful, you can always ask the group leaders and/or fellow members for guidance.

Nature of group counseling

  1. Participation in the group
    You control, and are ultimately responsible for, what, how much, and when you tell the group about yourself. The more you become involved, the more you are likely to benefit.
    • Most people find that when they feel safe enough to share personal issues, counseling groups are very affirming.
    • Many people are helped by listening to others and thinking about how what others say applies to themselves.
  2. Advantages of group counseling
    Ways that group counseling may be more enriching for some than individual counseling include:
    • You can benefit from the group even during sessions when you say little but listen carefully to others. You will find that you have some important things in common with other group members, and as others work on their concerns, you will learn much about yourself. In the group environment, others serve as “mirrors” who reflect aspects of yourself which you can recognize, and then choose to change or accept as they are.
    • Group members will bring up issues that strike a chord in you, issues of which you may not have been aware.
    • A natural process of enhanced acceptance of self and others occurs as one learns to relate on deeper, more personal levels with others in the group.
    • The group provides an opportunity for personal experimentation. It is a safe place to risk learning more about yourself and new ways of interacting.
  3. Group atmosphere
    • The first group task is to establish an atmosphere of safety and respect. Group leaders are trained to help the group develop into such an environment.
    • An important benefit of group counseling is the opportunity to receive feedback from others in a supportive environment. It is rare to find friends who will gently point out how you may be behaving in ways that can be hurtful to yourself and others. This is a unique benefit of a therapy group. The leaders will help members give feedback in a direct, yet respectful way so that you can understand and utilize new awareness and experiences.
  4. Group counseling vs. individual counseling
    • Groups are often the most effective method to treat the types of concerns that university students face.
    • A common myth is that groups are somehow second rate treatment. Group counseling is recommended when your counselor believes that it is the best way to address your concerns.
    • People tend to find input from peers more meaningful for some things, and value “experts” more for other things. In a group, you get both.
    • Your counselor can discuss the advantages or disadvantages of a group for your particular concerns and needs.
  5. Fears about beginning
    • It is common for students to experience initial discomfort over the prospect of talking in group. This initial anxiety is normal. Most people have never been exposed to a group counseling environment and do not know what to expect. Almost without exception, members become comfortable as their group participation progresses.

What is expected of me?

If the group is to be effective, your commitment is key. Here is what is expected of you:

  • Do not miss sessions. The group needs the continuity of the reliable presence of everyone involved. If you do have to miss, let the leader know in advance. And incidentally, many students have told us that the sessions they attended when they least felt like coming were among their most valuable.
  • Come on time and stay for the whole session (same reason as above).
  • Feelings, including those that seem negative or unacceptable, are an integral part of the group experience—an opportunity for unique learning. We encourage group participants to talk about them as openly as possible. Your group leaders will help you and other group members express difficult feelings in ways that are constructive and growth-producing.
  • Respect confidentiality. Who comes to the group and what they have to say must not be shared outside the group. This is crucial to promote a trusting, safe environment—the primary condition for any therapy to be valuable.
  • When you are ready to leave the group, let the group know of your decision before your last session so that unfinished business can be completed, goodbyes can be said, and a sense of closure reached. This is another significant learning aspect of therapy groups.

Group therapists are responding to COVID-19 by rapidly transitioning from in-person to online therapies.

How to attend group counseling

Research shows that group therapy is as effective, and in some cases, can be more effective, than individual therapy. At a time when social isolation is occurring in unprecedented ways, the role of groups as a protective factor is an important one. Online groups also offer therapists an efficient and effective way to support the mental health of the larger community during the COVID-19 epidemic.

Treatment types and billing codes for online groups

There are two specific code sets for telehealth group therapies under the emergency guidelines for Medicare:

  • Group Psychotherapy by Telehealth (CPT Code 90853), which, as of March 30, 2020, was added to the temporary emergency provision of services rules changes for Medicare.
  • Health Behavior Assessment and Intervention Group codes (96164 and 96165).

Maintaining an ethical practice

Group telehealth requires competency in two areas — group therapy and telepsychology. Group therapy has been infrequently used in telehealth, so the applicable ethical and legal framework is still emerging. Before starting a telehealth group, psychologists should refer to the APA Ethics Code and to the APA Practice Guidelines for Telepsychology.

Establishing privacy and confidentiality

APA Ethics Code 10.03 states that in group therapy psychologists should “describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.”

While the group leader must maintain confidentiality, a group member (in most states) is under no such legal or ethical imperative. While potentially beneficial, video platforms are more hazardous than in-person groups, placing the client’s confidentiality at greater risk.

Potential breaches to confidentiality may include, but are not limited to:

  • A group member attending group in a non-secure location where a nonmember (such as a family member or roommate) can see or hear the group.
  • A member recording or taking a screenshot of the group members.
  • A member using recorded material to share the identity of or blackmail the group or a specific member.

The consequences to a group member whose privacy is compromised may be significant to them individually and to the therapeutic nature of the group as a whole. That’s why it’s important for group psychologists to alert all members to the greater risks of teletherapy via a more prolonged informed consent process. Group members may then be presented with several treatment options, including but not limited to:

  • Showing their faces during the session.
  • Wearing a disguise or blocking their faces using non-threatening, pre-approved masks that still allow for speech to be heard. (Note: Psychologists will not be reimbursed if a patient blocks the video feed of his or her face; this service would be considered telephone therapy, which is not reimbursable).
  • Using a fictitious name or only an initial as on-screen identification.
  • Temporarily leaving the group.
  • Finding another treatment modality.

The therapist should present the potential benefits of the group and contrast them with the potential for harm.

Group leaders should have clients read and sign informed consent forms for group telehealth before the first session, so they are aware of the risks, benefits and limits to confidentiality. It is the group leader’s responsibility to adhere to and uphold the highest privacy standards possible for the group.

Using a HIPAA compliant video platform

Privacy is a central concern in the ethical and legal provision of group therapy via telehealth. While privacy guidelines have been more relaxed due to COVID-19, and though the Health Insurance Portability and Accountability Act (HIPAA) requirements do not guarantee confidentiality, clinicians are strongly encouraged to utilize a HIPAA compliant platform to provide the highest level of security for the group whenever possible.

The federal government has waived penalties for HIPAA violations by providers in connection with the “good faith” provision of telehealth for the duration of the public health emergency.

Improving treatment with pre-group screening appointments

Group leaders should continue to conduct group screening appointments. Reviewing the informed consent and established group guidelines is critical to reducing group dropout rates, setting expectations, clarifying goals and maintaining the fidelity of the telehealth treatment.

Setting guidelines for group telehealth

Group leaders are encouraged to ask members to:

  • Be in a space free of distractions, where the patient is alone and can speak freely. Inform others in the location that they should not be disturbed during this time.
  • Wear appropriate clothing commensurate with attending group in person.
  • Have the technological means to attend the group. This includes being on a secure internet connection, rather than public or free Wi-Fi. Keep the video steady and at eye contact level. Phones or computers should be put on airplane mode to minimize interruptions. Wearing headphones or keeping the volume low can prevent sound from travelling to another room.
  • Follow any group-established policy regarding if a member, or the entire group, gets disconnected. If the group agrees, this may include having a member call in for the remainder of the session. Adhere to the group policy about how to handle a breach in confidentiality, such as a nonmember bystander witnessing the group or someone walking into a room while the group is meeting.

Practicing across state lines

Therapists must pay attention to state and federal guidelines for practicing across state lines if they are not licensed in the state where group members are receiving telehealth. Consult with your state licensing board regarding interstate practice policies.

Note: At press time (April 10, 2020) telephone therapy was not a billable service; however therapists should check for updates on billing and reimbursement on the Practice Resources in Response to COVID-19 webpage.

It’s hard to watch someone you care about struggle with their mental health. It’s even worse when you know they could benefit from professional help. Approaching an individual and encouraging them to seek therapy can be a tricky situation. If done the wrong way, you could aggravate the person or turn them against the idea entirely. However, there is an effective way to have this conversation.

Here are some steps you can take to tell your loved one about the benefits of seeking therapy.

Show Support

Misconception about mental health and therapy has intensified stigma in society. Your loved one may be aware that they need help, but may be afraid to seek it if they think you will judge or treat them differently. Therefore, it is essential to use non-stigmatizing language when talking with them about their mental health. Assure them that you will support them through the therapy process.

Demi Lovato is one of the most vocal celebrities about her mental health issues. She mentioned on multiple occasions how important it was for her to have people around that really care about her wellbeing. She credits her support group for being able to go through everyday life. Demi asks for advice from her loved ones and asks them to let her know when they feel something’s off: “So whether it’s with my management team or with my friends, every choice that I make, I run by people. And that’s what’s really helped me—vocalizing what you need.”

Be Sensitive to Timing and Place

Talking to someone about mental health requires emotional sensitivity as well as physical sensitivity. The “where” and “how” the topic is presented may determine how a person reacts to your suggestions. Your loved one may not be as bold as Kesha when she shared her condition and struggles with the world while receiving an award.

Don’t start this delicate conversation in front of other people or where others can hear as this may cause discomfort. And avoid grouping up in an intervention-style conversation as people do on TV shows. Allow the person struggling to decide whether they want others to know. This way, they feel respected and in control of their own treatment.

Also: Avoid talking to someone when they are in a bad mood, tired, have tight deadlines at work or if they’re doing something important. They may dismiss you or disregard the weight of the topic. Approach the person when they’re in a good mood, relaxed and undistracted. Try as much as possible to keep the conversation private, friendly and relaxed.

Prepare for Resistance

Not all people who hear about therapy will be willing to try it out. You need to be prepared to make your case if your loved one resists your suggestion. Here are some ideas that you can use to highlight the importance of therapy:

  • Try to use your relationship as leverage, in a loving way. Whether you’re their sibling, friend, spouse or relative, tell them how important your relationship with them is to you. And how it could benefit from their seeking therapy. However, avoid giving an ultimatum as it can cause emotional distress.
  • Name their admirable qualities. It’s easier to appeal to someone by pointing out what you like about them. When you point out someone’s positive qualities, they will be motivated to take the necessary steps to better themselves even further.
  • Explain specific areas of problematic behavior. Most people who refuse therapy may claim that they don’t have a problem. By pointing out specific problems without coming off as judgmental, you can help them see the need for seeking professional help.

Offer to Help

You can try to embolden someone to go to therapy, but unless you are willing to offer meaningful support, it’s not going to encourage them. Some people do not know where to start when seeking help. Guide them in finding a suitable therapist in the area, depending on their preferences. You can contact offices on their behalf or research various professionals, their credibility and reviews.

Some people are scared of seeing a therapist alone or signing up for group therapy. Offer to go with them until they’re comfortable. You can sit in the waiting room during their first few sessions. Make sure to assure them that you won’t ask prying questions about the counseling unless they want to share.

Seeking therapy is one of the best steps that a person with a mental health condition can take. However, it’s an effort that requires great strength and courage. Share your suggestions as openly as possible and leave them to make the decision that best suits their needs. Above all things, assure them of your continued love and support throughout the process.

Mike Jones, owner, and contributor at Schiz Life, is fighting against mental illness stereotypes. He has immersed himself into the schizophrenia community and is offering advice regularly on specific treatments, tips for diagnosis, and differences between this condition and other mental disorders. Mike is passionate about fitness, clean eating and sudoku. You can follow Mike on Twitter @mike_jones35

1. Confidentiality

Anything said between any two or more group members at any time is part of the group and is confidential. I understand that everything said in group is confidential. I agree to keep secret the names of other members of the group and what is said in the group. I agree to keep secret anything which occurs between or among group members. I understand that there is an exception to this confidentiality which applies to the group leader. If the group leader believes that someone is in danger, the leader has a professional obligation to take direct action in order to keep everyone safe.

I agree not to keep secret from the group anything which occurs within the group. Anything which occurs between or among any members is part of the group is kept secret from anyone outside of the group but is not kept secret from the group. This also applies to any individual meetings you may have with a group leader. I understand that if I violate this confidentiality I could be removed from the group.

2. Privacy (The Stop Rule)

No group member is ever required to answer any question, to participate in any activity, or to tell anything. If I am asked questions or asked to participate in an activity which makes me feel uncomfortable, I understand that I have the right to pass, that is, the right to refuse. I agree that will never pressure other group members to participate in any discussion or activity after the member has passed or refused. I understand that the group leader is obliged to protect this right. I also understand that I will benefit more from group the more I am able to take risks in sharing and participating.

3. Dignity

No group member is ever humiliated, hazed, or abused in any way. I agree to avoid this destructive behavior.

4. Violence or intimidation

Violence or intimidation toward other group members is never tolerated. I understand that I must never be violent or intimidating toward other group members and that if I threaten to harm persons or property I will be asked to leave the group.

5. Alcohol and Other Drugs

Group members cannot participate in the group under the influence of alcohol or other mind altering drugs. When under the influence of chemicals, persons do not have access to their emotions and have less control over their behavior. I understand that if the leader believes that I am under the influence of alcohol or other drugs, I will be asked to leave the group.

6. Exclusive relationships

Dating and other exclusive relationships between or among group members are not a good idea. The relationships can make other group members feel left out. When a couple breaks up, for example, this can be most painful and may make it impossible for these people to continue in the group. Since anything which occurs between or among group members is part of the group, members who are dating or in very exclusive relationships may be embarrassed when their intimate moments are discussed in the group.

7. Gossip

Gossip and secret grudges can be very destructive in a group. I agree that if I have something to say to another group member, I will try to say it to the member directly rather than talk about him/ her behind his/her back.

8. Attendance

I agree that I will attend every meeting unless an emergency arises. If an emergency should arise I will notify the group leader prior to the meeting to tell him or her that I will be unable to attend. I understand that the group leader will tell the group what has happened. I understand that if I have three unexcused absences, my continued group membership will be discussed.

9. Internet Connectivity

I feel very strongly that the members of the group should form and participate in an online group limited to the group members. Of course, the same cautionary notes apply to the internet communications in terms of both confidentiality and inter-group sharing. (I have used this model very successfully, and it significantly enhances a healthy form of interconnection.)

10. Responsibilities

I understand that it is the group leader’s responsibility to enforce these procedures and guidelines. The group may, when it wishes, propose other procedures and guidelines which will be up to the group to monitor.

11. Termination

Usually, group members decide, within the group, with the leader, when it is time to leave the group. Sometimes it is necessary for a group member to leave the group unexpectedly. This can cause group members to wonder if they have harmed the leaving member. I promise that if I must leave the group unexpectedly, I will come to a last group meeting and tell the members that I am leaving and say goodbye. I agree to announce this at the beginning of the last meeting so that the group has time to ask questions and say goodbye. If I decide to leave the group the group members may express their concerns but also respect the decision of the person wishing to leave.

I have read the procedures and guidelines for group and agree to be bound by them while I am a member of the group

_____________________ ____________
Group Member Date

I promise to faithfully enforce procedures and guidelines for this group.

It’s hard to watch someone you care about struggle with their mental health. It’s even worse when you know they could benefit from professional help. Approaching an individual and encouraging them to seek therapy can be a tricky situation. If done the wrong way, you could aggravate the person or turn them against the idea entirely. However, there is an effective way to have this conversation.

Here are some steps you can take to tell your loved one about the benefits of seeking therapy.

Show Support

Misconception about mental health and therapy has intensified stigma in society. Your loved one may be aware that they need help, but may be afraid to seek it if they think you will judge or treat them differently. Therefore, it is essential to use non-stigmatizing language when talking with them about their mental health. Assure them that you will support them through the therapy process.

Demi Lovato is one of the most vocal celebrities about her mental health issues. She mentioned on multiple occasions how important it was for her to have people around that really care about her wellbeing. She credits her support group for being able to go through everyday life. Demi asks for advice from her loved ones and asks them to let her know when they feel something’s off: “So whether it’s with my management team or with my friends, every choice that I make, I run by people. And that’s what’s really helped me—vocalizing what you need.”

Be Sensitive to Timing and Place

Talking to someone about mental health requires emotional sensitivity as well as physical sensitivity. The “where” and “how” the topic is presented may determine how a person reacts to your suggestions. Your loved one may not be as bold as Kesha when she shared her condition and struggles with the world while receiving an award.

Don’t start this delicate conversation in front of other people or where others can hear as this may cause discomfort. And avoid grouping up in an intervention-style conversation as people do on TV shows. Allow the person struggling to decide whether they want others to know. This way, they feel respected and in control of their own treatment.

Also: Avoid talking to someone when they are in a bad mood, tired, have tight deadlines at work or if they’re doing something important. They may dismiss you or disregard the weight of the topic. Approach the person when they’re in a good mood, relaxed and undistracted. Try as much as possible to keep the conversation private, friendly and relaxed.

Prepare for Resistance

Not all people who hear about therapy will be willing to try it out. You need to be prepared to make your case if your loved one resists your suggestion. Here are some ideas that you can use to highlight the importance of therapy:

  • Try to use your relationship as leverage, in a loving way. Whether you’re their sibling, friend, spouse or relative, tell them how important your relationship with them is to you. And how it could benefit from their seeking therapy. However, avoid giving an ultimatum as it can cause emotional distress.
  • Name their admirable qualities. It’s easier to appeal to someone by pointing out what you like about them. When you point out someone’s positive qualities, they will be motivated to take the necessary steps to better themselves even further.
  • Explain specific areas of problematic behavior. Most people who refuse therapy may claim that they don’t have a problem. By pointing out specific problems without coming off as judgmental, you can help them see the need for seeking professional help.

Offer to Help

You can try to embolden someone to go to therapy, but unless you are willing to offer meaningful support, it’s not going to encourage them. Some people do not know where to start when seeking help. Guide them in finding a suitable therapist in the area, depending on their preferences. You can contact offices on their behalf or research various professionals, their credibility and reviews.

Some people are scared of seeing a therapist alone or signing up for group therapy. Offer to go with them until they’re comfortable. You can sit in the waiting room during their first few sessions. Make sure to assure them that you won’t ask prying questions about the counseling unless they want to share.

Seeking therapy is one of the best steps that a person with a mental health condition can take. However, it’s an effort that requires great strength and courage. Share your suggestions as openly as possible and leave them to make the decision that best suits their needs. Above all things, assure them of your continued love and support throughout the process.

Mike Jones, owner, and contributor at Schiz Life, is fighting against mental illness stereotypes. He has immersed himself into the schizophrenia community and is offering advice regularly on specific treatments, tips for diagnosis, and differences between this condition and other mental disorders. Mike is passionate about fitness, clean eating and sudoku. You can follow Mike on Twitter @mike_jones35

Group therapists are responding to COVID-19 by rapidly transitioning from in-person to online therapies.

How to attend group counseling

Research shows that group therapy is as effective, and in some cases, can be more effective, than individual therapy. At a time when social isolation is occurring in unprecedented ways, the role of groups as a protective factor is an important one. Online groups also offer therapists an efficient and effective way to support the mental health of the larger community during the COVID-19 epidemic.

Treatment types and billing codes for online groups

There are two specific code sets for telehealth group therapies under the emergency guidelines for Medicare:

  • Group Psychotherapy by Telehealth (CPT Code 90853), which, as of March 30, 2020, was added to the temporary emergency provision of services rules changes for Medicare.
  • Health Behavior Assessment and Intervention Group codes (96164 and 96165).

Maintaining an ethical practice

Group telehealth requires competency in two areas — group therapy and telepsychology. Group therapy has been infrequently used in telehealth, so the applicable ethical and legal framework is still emerging. Before starting a telehealth group, psychologists should refer to the APA Ethics Code and to the APA Practice Guidelines for Telepsychology.

Establishing privacy and confidentiality

APA Ethics Code 10.03 states that in group therapy psychologists should “describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.”

While the group leader must maintain confidentiality, a group member (in most states) is under no such legal or ethical imperative. While potentially beneficial, video platforms are more hazardous than in-person groups, placing the client’s confidentiality at greater risk.

Potential breaches to confidentiality may include, but are not limited to:

  • A group member attending group in a non-secure location where a nonmember (such as a family member or roommate) can see or hear the group.
  • A member recording or taking a screenshot of the group members.
  • A member using recorded material to share the identity of or blackmail the group or a specific member.

The consequences to a group member whose privacy is compromised may be significant to them individually and to the therapeutic nature of the group as a whole. That’s why it’s important for group psychologists to alert all members to the greater risks of teletherapy via a more prolonged informed consent process. Group members may then be presented with several treatment options, including but not limited to:

  • Showing their faces during the session.
  • Wearing a disguise or blocking their faces using non-threatening, pre-approved masks that still allow for speech to be heard. (Note: Psychologists will not be reimbursed if a patient blocks the video feed of his or her face; this service would be considered telephone therapy, which is not reimbursable).
  • Using a fictitious name or only an initial as on-screen identification.
  • Temporarily leaving the group.
  • Finding another treatment modality.

The therapist should present the potential benefits of the group and contrast them with the potential for harm.

Group leaders should have clients read and sign informed consent forms for group telehealth before the first session, so they are aware of the risks, benefits and limits to confidentiality. It is the group leader’s responsibility to adhere to and uphold the highest privacy standards possible for the group.

Using a HIPAA compliant video platform

Privacy is a central concern in the ethical and legal provision of group therapy via telehealth. While privacy guidelines have been more relaxed due to COVID-19, and though the Health Insurance Portability and Accountability Act (HIPAA) requirements do not guarantee confidentiality, clinicians are strongly encouraged to utilize a HIPAA compliant platform to provide the highest level of security for the group whenever possible.

The federal government has waived penalties for HIPAA violations by providers in connection with the “good faith” provision of telehealth for the duration of the public health emergency.

Improving treatment with pre-group screening appointments

Group leaders should continue to conduct group screening appointments. Reviewing the informed consent and established group guidelines is critical to reducing group dropout rates, setting expectations, clarifying goals and maintaining the fidelity of the telehealth treatment.

Setting guidelines for group telehealth

Group leaders are encouraged to ask members to:

  • Be in a space free of distractions, where the patient is alone and can speak freely. Inform others in the location that they should not be disturbed during this time.
  • Wear appropriate clothing commensurate with attending group in person.
  • Have the technological means to attend the group. This includes being on a secure internet connection, rather than public or free Wi-Fi. Keep the video steady and at eye contact level. Phones or computers should be put on airplane mode to minimize interruptions. Wearing headphones or keeping the volume low can prevent sound from travelling to another room.
  • Follow any group-established policy regarding if a member, or the entire group, gets disconnected. If the group agrees, this may include having a member call in for the remainder of the session. Adhere to the group policy about how to handle a breach in confidentiality, such as a nonmember bystander witnessing the group or someone walking into a room while the group is meeting.

Practicing across state lines

Therapists must pay attention to state and federal guidelines for practicing across state lines if they are not licensed in the state where group members are receiving telehealth. Consult with your state licensing board regarding interstate practice policies.

Note: At press time (April 10, 2020) telephone therapy was not a billable service; however therapists should check for updates on billing and reimbursement on the Practice Resources in Response to COVID-19 webpage.

Depending on the nature of your problem, group therapy can be an ideal choice for addressing your concerns and making positive changes in your life.

How to attend group counseling

If you’re considering psychotherapy, several options are available. One of those options is group therapy. Depending on the nature of your problem, group therapy can be an ideal choice for addressing your concerns and making positive changes in your life.

What should I expect?

Group therapy involves one or more psychologists who lead a group of roughly five to 15 patients. Typically, groups meet for an hour or two each week. Some people attend individual therapy in addition to groups, while others participate in groups only.

Many groups are designed to target a specific problem, such as depression, obesity, panic disorder, social anxiety, chronic pain or substance abuse. Other groups focus more generally on improving social skills, helping people deal with a range of issues such as anger, shyness, loneliness and low self-esteem. Groups often help those who have experienced loss, whether it be a spouse, a child or someone who died by suicide.

Benefits of group therapy

Joining a group of strangers may sound intimidating at first, but group therapy provides benefits that individual therapy may not. Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be.

Groups can act as a support network and a sounding board. Other members of the group often help you come up with specific ideas for improving a difficult situation or life challenge, and hold you accountable along the way.

Regularly talking and listening to others also helps you put your own problems in perspective. Many people experience mental health difficulties, but few speak openly about them to people they don’t know well. Oftentimes, you may feel like you are the only one struggling — but you’re not. It can be a relief to hear others discuss what they’re going through, and realize you’re not alone.

Diversity is another important benefit of group therapy. People have different personalities and backgrounds, and they look at situations in different ways. By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns.

More than support

While group members are a valuable source of support, formal group therapy sessions offer benefits beyond informal self-help and support groups. Group therapy sessions are led by one or more psychologists with specialized training, who teach group members proven strategies for managing specific problems. If you’re involved in an anger-management group, for instance, your psychologist will describe scientifically tested strategies for controlling anger. That expert guidance can help you make the most of your group therapy experience.

Joining a group

To find a suitable group, ask your physician or your individual psychologist (if you have one) for suggestions. Also check with local hospitals and medical centers, which often sponsor a variety of groups.

When choosing a group, consider the following questions.

Is the group open or closed?

Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time. They may all take part in a 12-week session together, for instance. There are pros and cons of each type. When joining an open group, there may be an adjustment period while getting to know the other group attendees. However, if you want to join a closed group, you may have to wait for several months until a suitable group is available.

How many people are in the group?

Small groups may offer more time to focus on each individual, but larger groups offer greater diversity and more perspectives. Talk to your psychologist about which choice is better for you.

How alike are the group members?

Groups usually work best when members experience similar difficulties and function at similar levels.

Is group therapy enough?

Many people find it’s helpful to participate in both group therapy and individual psychotherapy. Participating in both types of psychotherapy can boost your chances of making valuable, lasting changes. If you’ve been involved in individual psychotherapy and your progress has stalled, joining a group may jump-start your personal growth.

How much should I share?

Confidentiality is an important part of the ground rules for group therapy. However, there’s no absolute guarantee of privacy when sharing with others, so use common sense when divulging personal information. That said, remember that you’re not the only one sharing your personal story. Groups work best where there is open and honest communication between members.

Group members will start out as strangers, but in a short amount of time, you’ll most likely view them as a valuable and trusted source of support.

Thanks to Ben Johnson, PhD, for contributing to this article.

How Group Therapy Works

How to attend group counselingThere are four main stages of group therapy. Once the group is formed there is generally a pre-group meeting. Each group member is screened to make sure they will be an asset to the group rather than a setback.

The four stages of a group, once established, are; the initial stage, the transition stage, the working stage and the final stage.

Each stage has a purpose and there are different expectations that must be addressed as the group progresses through each stage. The counselors and group members have roles that they fall into that also change as the group transforms.

Group Therapy – Initial Stage

The first stage of a group is the initial stage. The purpose of the initial stage of a group is to establish expectations of what the group is going to be like. These expectations include trust, roles, and goals. Confidentiality and conflict need to be addressed immediately. Also, any culture concerns must be dealt with. The counselors are there to explain the process and to support each member when dealing with confrontation. The group members must be participatory and involved. This can be tricky with court appointed group members but if the expectations of involvement are explained thoroughly they will learn that it is either participate in the group or face legal consequences.

Group Therapy – Transition Stage

The transition stage is a very difficult stage to get through. This stage comes after the initial stage and is when most of the group members feel anxious about sharing their feelings with strangers. Some members become defensive and resistant while others may be shy and fearful. It is the role of the counselor to keep the transition period on track and as pleasant as possible. This stage can be extremely uncomfortable for the counselor as they may be confronted, belittled, or attacked. If the counselor is good at leading groups the group will learn to trust and respect the counselor during this stage by leaving the negativity out. For the members to get the most out of the group they must participate cordially and this includes listening and giving advice.

Group Therapy – Working Stage

Once the transitional stage has settled, group members will start to feel comfortable enough to really get into the deeper issues that the group was designed for. This is called the working stage. This stage comes after all the kinks get worked out during the transition stage and is when each member is able to explore their thoughts and emotions which may be triggered by someone else’s words. The counselor in this stage will guide the group through this process using techniques and challenges that bring out emotions.

A good counselor will know how to guide by using minimal words themselves. Counselors should be able to read each group members verbal and non-verbal language. Group members in this stage need to be honest about their feelings and not be afraid to speak their mind. They should not feel as though they are being judged or criticized and if they are, it is the counselor’s job to address these issues.

Group Therapy – Final / Understanding Stage

Lastly, the final stage is when the group understands that they are no longer going to be together. This stage allows the group members to reflect on their experience and decide how they will use the knowledge that they acquired in their future occurrences. This stage often comes with feelings of sadness and separation. During this stage, feedback is very important. It is the role of the counselor to educate on what each member should expect from the experience which includes reminders of confidentiality and change that may not be noticeable immediately. Group members will be encouraged to give feedback to other group members as well and in the end it is up to each member to decide what to do with the experience that they received.

All groups are progressive and very unique. Some groups get a lot from their experience while others leave empty handed. The success of a group is a combination of how each group member performed and how well the group leader was able to lead and keep everyone on track. Either way, group work as proven to be quite successful. The stages of the groups vary in length and duration and also depend on the goals and purpose of each group. If a group leader leads a successful group they will know because the group members will be able to change successfully with the help of the group experience.

Is Your Group Therapy Leader Effective?

In a chemical dependency or addiction setting, being a group leader can be very difficult. All group leaders have it difficult but in chemical dependency, members of the group can still be adjusting to sobriety so their judgment may be a little clouded. One of the most important things a group facilitator can do is to properly screen members before the group starts. It can be detrimental to the entire group if a member is not ready or prepared for the experience. For example, in a chemical dependency setting if all of the group members have two weeks of sobriety under their belt and somehow someone who is not sober is allowed to participate then a catastrophe could possibly surface.

There is so much more to being an effective group leader once the process starts. For instance, knowing how to handle conflict, resistance, and how to guide the group in the right direction is very important for the leader to understand. Diversity seems to always have some sort of role in a group setting so an effective group leader will be able to understand different cultures and how to establish trust between all cultures.

Corey, Marianne Schneider, Gerald Corey, and Cindy Corey. Groups: Process and Practice. Belmont, CA: Brooks/Cole, 2010. Print.