Group therapy is very common in the substance abuse field. As a substance abuse counselor, your chance of doing some group therapy is greater than most other types of counselors. For the first 8 years of my counseling career, I did almost exclusively individual therapy. When I took a job that would require some group therapy, I was a little concerned for many reasons. Over the next several years however, I really began to enjoy the group setting. I believe that in most situations that the ideal would be a combination of individual and group therapy.
From my experience, here are some of the pros and cons of group therapy.
- Time – This is unfortunately one of the main reasons group therapy is so common. It allows the counselor to be able to see more people.
- Frequency – This is related to time but is a benefit to the client. With individual therapy the most you are likely to see a client is once a week and often it is less frequently than that. With groups it could be several times a week.
- Support – Group therapy is not a support group, but it can certainly provide some of the benefits of a support group. Clients often feel like they are being judged. In a group with others who have similar issues they tend to feel more understood and accepted.
- Wisdom of the group – It is a wise counselor that realizes that he does not have all of the answers. In a group setting there is a wealth of knowledge gained from all of the life experiences that are represented.
- Confrontation – Time for a quick story. I had a client that I was seeing individually because she did not want to be in a group setting. After a couple of months, I felt like the individual sessions were not being productive and encouraged her to try the group sessions. She agreed and seemed to be doing fine in that setting. Then one day she was talking about some of the tragedies in her life and when she had finished one of the other group members very casually said “you sure are good at feeling sorry for yourself.” I had been having the same thoughts with this client but because my rapport with this client was not where I wanted it, I was struggling with how to address this issue. The other group members immediately defended the attacked client and began attacking the other client for not being sympathetic. But it opened the door and we were able to talk about healing and moving forward with life. Although clients may not do it as tactfully as you would like, they can be helpful in confronting issues that are sometimes received better from one of their peers.
- Clients realize they aren’t the only one with these experiences – It gives clients a chance to see that other people are having problems in recovery as well. Often they realize that others have problems that are worse than the ones they are dealing with.
- Some have social anxiety – Obviously group therapy isn’t for everyone. Over the years however, I have found that many who were initially uncomfortable in a group setting learned to thrive. Most of us are resistant to getting out of our comfort zone, but that is where we will experience the most growth.
- May not open up as much – Whether they have social anxiety or not, people are often less likely to open in a group. I have found the smaller groups to be more successful. For me, once there are over 10 people it starts to become more like a classroom setting.
- Facilitates drug connections – This may be the biggest negative and I have seen it happen more times than I would like to admit. If one person relapses, hopefully, the group will help bring them back, but sometimes they can trigger others to relapse. It is important to watch who is spending time with who outside the group.
- May know each other – If you work in an outpatient setting in a small town, this will be very common. Most of the time this is okay and could even be a positive. Sometimes however there could be some previous issues between group members. I always had the policy of not allowing couples in the same group, but really tried to avoid any relationships that were too close.
- Confidentiality/Trust – We always stress the importance of confidentiality. What is said in group stays in group. The fact of the matter is that we don’t have a way to guarantee this. If you don’t trust the people in your group, then you aren’t likely to share any personal information.
I think that there is a lot to be gained from group therapy, but also believe that there should always be at least some individual therapy. Later I will share some of my tips for having effective group sessions.