What's the first image that comes to mind when you think about "psychological therapy"? A room, a box of tissues, a few books, maybe a framed inkblot picture on the wall, and two armchairs. In one armchair sits a patient; in the other, a psychologist. Fewer people would picture a similar room where, instead of two armchairs, there are chairs arranged in a circle, the setting of a group therapy session.
A brief history
The origins of group therapy can be traced back to 1905, when a physician named Joseph Pratt began holding meetings for patients in a tuberculosis ward at a Boston hospital. In those meetings, the patients talked about what they were going through in their treatment. Although these gatherings were not originally conceived as psychotherapy, Pratt noticed that they improved the patients' morale and helped them cope with the challenges of treatment, and even appeared to contribute to better health outcomes.
A few decades later, psychiatrist Jacob Levy Moreno, best known for developing psychodrama, coined the term "group psychotherapy" and established the professional and organizational foundations of the field.
As in many cases throughout history, what really propelled group therapy forward was war. Many soldiers returned from World War II with combat-related trauma, in need of psychological treatment. Inspired by group work with these soldiers, Wilfred Bion and Siegmund Heinrich Foulkes developed and refined the field of group therapy, weaving in principles that had until then been used mainly in individual therapy.
So how many therapists are sitting in that circle of chairs?
In a group psychotherapy room we won't find two armchairs, but a circle of chairs. Who's sitting in those chairs? The answer that pops to mind is: a group of patients, and one or two therapists. If we think about group therapy this way, a question arises: how can one or two therapists treat a whole group of patients at the same time? Surely one-on-one treatment is "worth more," isn't it?
But if we look again at this circle of chairs, we can actually see a therapist sitting in each and every one of them. According to Moreno, unlike individual therapy, where the roles are fixed — the patient is always the patient, the therapist is always the therapist — in group therapy, participants can serve as "auxiliary therapists" for one another.
How can group participants serve as auxiliary therapists for other participants?
Many people walk around believing they're dealing with challenges that are uniquely their own, that no one else could really understand. For some, discovering that other people struggle with something similar is a huge source of relief, or even hope. A lot of strength can be drawn from identifying with someone else, and from learning from their experience.
What really happens in a group?
But discovering that we're not alone is only one of the ways group members help one another. Based on cultural representations of group therapy, we picture it in a somewhat simplified way: someone in the group shares a difficulty and receives supportive, sympathetic responses that reassure or empower them. But the reality of group life also brings about moments that can leave a group member disappointed, angry, or hurt, very much like similar experiences in real life.
So why take the risk? After all, someone seeking therapy is doing so in order to feel better. Why would they choose a setting where they might get hurt and experience complicated emotions?
The possibility of experiencing, within the therapeutic group, situations similar to ones familiar from elsewhere in a participant's life does involve some risk, but alongside that risk lies a real opportunity. How can that be?
Let's step outside the room we imagined, into the reality of our lives. Most of our lives unfold through contact with other people. Interpersonal relationships can nurture our growth, but they can also hold us back and be a source of frustration.
In everyday life, we're always part of some group or another. Think, for instance, of the family we grew up in, kindergarten, our school class, the "gang" from school days, a workplace, a WhatsApp group that never stops buzzing, or even the random, temporary group that formed at a hostel on a backpacking trip. Did you feel you belonged to that "gang"? Did you watch from the sidelines?
In a therapeutic group, there's an opportunity to observe the role that each participant plays in the dynamics they create within the group, and to derive from this an understanding of the role they play in the dynamics of their own life.
Alongside the discovery of the capacity to experience enjoyment, curiosity, and growth through other participants, the safe environment of a therapeutic group also allows for working through disappointment, anger, hurt, and other difficult emotions. It's not uncommon to hear group members say during a session: "What's happening to me right now, with you, feels familiar. This happened to me with my friends from work too." Working through these experiences within the group can genuinely improve how someone copes with similar experiences in real life.
Why does this require a group facilitator?
Couldn't you do the same thing with friends in a living room? Well, not quite. The facilitator's role is to make sure the participants engage with each other in ways that support the therapeutic process, and to notice and intervene when the dynamics between participants undermine it. From this follows that the relationships between participants, here and now, are the focus of the group's therapeutic process. The facilitator, being part of the group while also observing it from the outside, can offer the group professional insight into what's happening between its members in this very moment. If there is basic trust in the group, both among the participants themselves, and between them and the facilitator, something "magical" can happen over time, something only possible in a therapeutic group.
Is group therapy right for me, and what should I look into?
For some people, the idea of group therapy feels naturally appealing. For others, just imagining themselves sitting in a room with ten other group members triggers a wave of panic. That panic, which might put someone off the idea of joining a therapeutic group, is in itself a hint that a therapeutic group could actually be a good opportunity for them.
How can someone know if they'd benefit from this kind of therapy? The basic, necessary condition is a strong curiosity about interpersonal relationships.
For the therapeutic group to genuinely be a safe environment that allows for a real therapeutic process, it's important to look carefully into the facilitator's training, how much experience they have, and what ethical guidelines they follow. Before joining a group, it's customary to have an individual meeting to assess fit and align expectations. In that meeting, it's worth discussing all of this openly, and raising any concerns about the process ahead.
That was "60 seconds on" group therapy. It's hard to capture such a rich and varied world in so few words. To understand a bit more deeply what happens in this kind of therapy, we recommend reading, as a representative example, the novel The Schopenhauer Cure, in which Irvin Yalom, one of the leading writers on group therapy, describes a fascinating and moving group process. The flowing dialogues between group members illustrate the basic idea proposed by Foulkes, that the group is essentially a "hall of mirrors," in which a group member sees themselves reflected in their relationships with other group members, and comes to know themselves through the effect they have on others and through how others see them.
And of course, nothing replaces firsthand experience.
Written together with my colleague Dr. Avishai Ze'evi. A shortened version of this text was first published in Hebrew in the Health section of Israeli paper Haaretz, on December 30, 2019.