In her late 20s, Christie Tate struggled with crushing loneliness, bulimia, and suicidal thoughts. Then, she had a conversation that changed her life. Try group, a friend told her \u2014 as in group psychotherapy.<\/p>\n
Like most people, Tate had thought of therapy as a two-person endeavor: a therapist smoking a pipe and a patient on the couch. She\u2019d been there, done that, with little to show for it.<\/p>\n
Group therapy was different. It harnessed the power of numbers. Each week, Tate, five or six other clients, and a therapist gathered together. Then, in no particular order, members talked about their lives, and analyzed their interactions with each other.<\/p>\n
In those days, Tate\u2019s problems were exquisitely painful, but also mysterious. She felt she couldn\u2019t connect with people, but didn\u2019t know why. But, the others could observe Tate\u2019s interactions from the outside, in real time. Within a few months, fellow group members were showing Tate \u201call the ways I kept myself alone,\u201d she said. \u201cIt\u2019s all the ways I opt out or sit back or withdraw because I\u2019m scared, or ashamed, or in pain, or can\u2019t speak to my needs.\u201d<\/p>\n
Group is a social microcosm<\/a> \u2014 meaning that every member eventually behaves in a group the way they behave in life.<\/p>\n Group cajoled and comforted Tate as she stopped dating unavailable men, changed her relationship to food, and eventually got married. For Tate, author of the memoir Group: How One Therapist and a Circle of Strangers Saved My Life<\/a>, group therapy was transformative. More than 20 years later, she\u2019s still attending. Yet, most people don\u2019t know even group therapy is an option.<\/p>\n Even as psychotherapy has become something of a cultural fixation \u2014 with relentless discourse about emotionally immature parents<\/a>, the rise of chatbot counselors, and TikTok therapists earning billions of views<\/a> \u2014 almost all of the content is focused on individual approaches. Here, the internet reflects the real world. In 2023, the American Psychological Association estimated that less than 5 percent<\/a> of American private therapy practice is dedicated to group work.<\/p>\n But research suggests group methods can be just as effective<\/a> as individual therapy for many conditions, ranging from depression and anxiety to eating disorders and chronic pain.<\/p>\n In some cases, group may even have advantages. For those struggling with shame, isolation, or loneliness, group can be uniquely effective, said Bonnie Buchele, a psychoanalyst and group therapist in Kansas City, Missouri. (It\u2019s more affordable too; group rates can be half or two-thirds that of individual therapy.) In the midst of a simultaneous mental health care shortage<\/a> and loneliness epidemic<\/a> \u2014 not to mention an era of incredible political division \u2014 \u201cgroup,\u201d Buchele said, \u201chas more to offer than ever.\u201d<\/p>\n Why most people don\u2019t do group therapy<\/p>\n In the summer of 1905, American psychiatrist Joseph Pratt organized groups of tuberculosis patients<\/a> with the goal of tracking their condition. Pratt found that the encouragement between members was just as, if not more, important to their recovery than any facts about their disease. He leaned in, encouraging more exchange between patients, in the process hosting the first group therapy sessions.<\/p>\n Group methods continued to gain prominence<\/a> after World War II, thanks in part to English psychoanalyst Wilfred Bion, who worked with traumatized veterans. Bion was interested in flattening the hierarchy that gave psychiatrists power over patients and allowed his groups to form \u2014 and reform \u2014 their own structures. Bion\u2019s later papers, which added theory to what he observed among patients, influenced group therapists around the world.<\/p>\n In the 1960s, however, the encounter group movement<\/a> took center stage. Overnight, it seemed like everyone from churchgoers to New Age enthusiasts was in group, said psychologist and researcher Gary Burlingame. \u201cThe closest thing I can think of in today\u2019s world is with social media,\u201d he said.<\/p>\n Unfortunately, some encounter groups encouraged emotional disclosure without limits, or were at the mercy of leaders with authoritarian streaks. Soon, there were reports of group members experiencing breakdowns, hastily ending their marriages, and even deaths by suicide.<\/p>\n Therapy groups \u2014 gentler ones, with principled leaders, and practices rooted in empirical evidence \u2014 continued to meet, especially in institutional settings like hospitals and day treatment programs for various disorders. But, group therapy has never again been as zeitgeist-y as it was in the \u201970s. Today, the East Coast hosts a \u201crigorous, healthy, big group psychotherapy community,\u201d Buchele said. But, many other parts of the country do not.<\/p>\n Even if you\u2019ve heard about group (and have access to a reputable one), there are still a million reasons not to join. Meeting times are inflexible to accommodate the greatest number of people. Group participants have to share time with others. Some weeks, some members may not speak at all.<\/p>\n And group can be terrifying. Members must sacrifice some of their privacy and open themselves up to uncomfortable feelings like shame. Therapists strive to be warm and compassionate, but your peers can (and sometimes will) dislike you. The opinion of a single therapist can be dismissed quite easily, but when every member of a therapy group agrees that your behavior is unacceptable, it\u2019s hard to say they\u2019re all wrong.<\/p>\n \u201cNot everybody wants that intensity,\u201d Tate said. \u201cIt\u2019s a power washing, and you may just want a gentle rinse.\u201d (Admittedly, Tate\u2019s group is an outlier: Her therapist does not require confidentiality among members; members are allowed to fraternize outside of the group; and members can, in theory, stay for a lifetime, instead of a more typical path toward graduation.)<\/p>\n But, all these inconveniences are part of what gives group therapy its advantages.<\/p>\n Wherever three or more people are gathered, you\u2019ve got a group. But, what turns a sports team or a cappella club into therapy?<\/p>\n For one, a therapy group isn\u2019t just a bunch of randoms. The therapist in charge identifies members who might relate to, or generate productive conflict for, each other. They keep in mind potential challenges, like a client who won\u2019t speak or a client who won\u2019t stop speaking, and try not to put too many of these folks in one room. They screen out clients who might be better suited to individual therapy, including clients who are likely to undermine the group<\/a>. And they\u2019re sensitive to diversity \u2014 in particular, of not creating a \u201csingleton,\u201d a person with a significant identity no one else in the group shares.<\/p>\n Finding acceptance can be healing in its own right. Finding acceptance in the midst of conflict is even more powerful.<\/p>\n The first few group meetings are some of the most important. A long-running group is, like the ship of Theseus, almost entirely reconstituted over time, as individual group members move on. But, early dynamics are likely to stick, according to psychiatrist Irivin Yalom, co-author of the 832-page textbook The Theory and Practice of Group Psychotherapy<\/a>. Facilitators must model norms of openness and respect from the jump, as well as how to work in what Yalom calls the \u201chere and now.\u201d<\/p>\n Yalom argues that group is a social microcosm<\/a> \u2014 meaning that every member eventually behaves in a group the way they behave in life. That\u2019s why, instead of talking about past conflicts with people who aren\u2019t present (the \u201cthere and then\u201d), members are encouraged to talk about what\u2019s happening between members in session (the \u201chere and now\u201d).<\/p>\n For author David Payne, individual therapy had been focused on pain from his past. By contrast, \u201cgroup therapy forced me to see who I was now, the sometimes injurious adult I had become,\u201d as he wrote<\/a> in a 2015 essay for the New York Times. \u201cFor me, that was the bitter pill that led to change.\u201d<\/p>\n At the time, Payne was an alcoholic in an unhappy marriage. \u201cWithin a month I\u2019d run afoul of everyone,\u201d Payne recalled in his essay. \u201cHardly a session passed without someone telling me I\u2019d \u2018erased\u2019 them or someone else around the circle.\u201d Payne would be telling a story, a group member would offer an interpretation, and he\u2019d go on telling his story, only to repeat the group member\u2019s interpretation as if it were his own idea. \u201cOnly when the group prevailed on me to tape record and listen to the sessions did I realize they were right,\u201d Payne wrote, adding: \u201cEventually, I came to see that it was fear. Fear of needing them, of needing anyone.\u201d<\/p>\n The social microcosm can also be inverted; the way you behave in group therapy can become the way you behave in life. \u201cGroup is a lab,\u201d said psychologist Jackie Darby<\/a>. \u201cI can set the experiment with my [individual] client, but in group, you\u2019re going to practice it, and then we\u2019re going to analyze it.\u201d<\/p>\n That\u2019s why such gatherings are also called \u201cprocess\u201d groups. Content \u2014 the mere words exchanged \u2014 is second to the process by which interactions in the room unfold. That\u2019s true even, and perhaps especially, when members are in conflict. While the grist can be large (anger with someone\u2019s callous response to another member\u2019s hardship) or small (frustration with a chronically late member), the group mills it all.<\/p>\n A well-handled conflict benefits everyone. An antagonist discovers their negative impact on others, while their fellow members practice sticking up for themselves. Even an observer to the conflict may undergo what Yalom calls \u201cvicarious learning,\u201d in which they discover how they want to handle (or not handle) the next squabble in their own lives.<\/p>\n A cohesive group will also be full of validation and generosity. \u201cA lot of people anticipate groups not to be welcoming to them,\u201d said psychiatrist Molyn Leszcz, who co-authored with Yalom the most recent editions of The Theory and Practice of Group Psychotherapy. Finding acceptance can be healing in its own right. Finding acceptance in the midst of conflict is even more powerful.<\/p>\n \u201cI can be mad at you and still love you, you know,\u201d one group member told Tate after a particularly charged session. \u201cNo, actually, I didn\u2019t know that,\u201d Tate recalls thinking. But, eventually, she learned.<\/p>\n Group in the age of loneliness<\/p>\n In 2023, former US Surgeon General Vivek Murthy identified<\/a> isolation (physical separation from others) and loneliness (a feeling possible even in a room full of other people) as some of the biggest threats to the health of Americans today. Roughly one in three adults<\/a> report experiencing loneliness on a weekly basis.<\/p>\n