Group therapy: How to learn about yourself in the company of strangers

Groups typically have about six members and meet for 90 minutes each week, with participants encouraged to commit for at least a year

The phrase “going into therapy” usually conjures up the image of sitting down in a room with one intently listening therapist. But what if there are another five occupied chairs in that room, along with your therapist? That’s the setting for group analytic psychotherapy.

To find out more, I sit down with a group, naturally, of analytic psychotherapists, to ask some basic questions.

What is group analytic psychotherapy?

It’s a form of personal therapy that takes place within a group. The basic premise, as Mick Price who has a practice in Ashbourne, Co Meath, explains, is that all our difficulties, challenges and psychological traumas occur in groups of one sort or another.

“We are born into groups, work in groups, socialise in groups – the chances are the triggers of those traumas emanate from the group.” With roots in Sigmund Freud’s work on how the unconscious mind drives human behaviour, this form of therapy was pioneered by the German-British psychiatrist and psychotherapist SH Foulkes.

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The “analytic” refers to the unconscious processes that inform most of the things we do, says Anna Comerford, who has a practice in Dún Laoghaire, Co Dublin. “Repeating stuff and repeating situations we thought we had learned from before but, for some reason, we are compelled to repeat.”

“What we are working with is the social aspect of the person,” says Audrey Duncan, who is based in a medical centre in Clonmel, Co Tipperary. Within a group of strangers, “people can see how they behave in relation to other people and that gives them insight to how they are”.

Patterns of relating to other people are more or less established in childhood, says Comerford. These are likely to be replayed, unwittingly, within the therapy group and it is through the responses of others that valuable learning can be achieved.

In addition to therapeutic use, the approach can be applied to the corporate world, as you are working with group dynamics, says Price, who does consultancy work with businesses and organisations.

What size groups are we talking about and how are they set up?

Typically a clinical group operates with about six members meeting at the same time, same place, for 90 minutes each week. After a group analytic psychotherapist establishes a group, under the supervision of another therapist, it is likely to continue for years, with people joining and leaving. Diversity in terms of age, culture and gender is important, for a wider sharing of perspectives.

“Slow open” is the term used for the group, with participants encouraged to commit for a minimum of a year. It means group members are at different stages of the therapeutic process and the more experienced can support those still paddling in the shallows. The therapist, who may run a number of different groups, will meet you individually several times first. This assessment is key to ensuring you are right for a group and a group is right for you. The therapist also does their best to ensure that nobody in the group knows each other, or knows a family member of a participant.

That can’t be easy in Ireland, surely?

The need to maintain a stranger group is one reason for the thorough individual assessment. It is always first names only in the room and participants go their separate ways as soon as the session ends.

All five therapists contributing to this Q&A insist it is extremely rare that a significant connection would emerge after a person has joined a group. But if it does happen, the therapist will arrange for the newcomer to transfer to another group. Duncan says she has only had to do that twice in 30 years of group therapy.

“People are protective of their own anonymity anyway, so they will travel 10 or 12 miles, or go from one side of the city to another,” says Price. Also, what does it mean to know somebody? Being on nodding acquaintance, for instance, wouldn’t be prohibitive.

I would trust a therapist to respect confidentiality but could I trust a whole group?

Confidentiality is sacrosanct and this is made very clear in the initial assessment. “We get a really good sense of the person before going into the group,” says Duncan. “We all have a checklist and tell them that everybody else in the group has gone through the same checklist. Confidentiality is probably the top priority. If we get the sense that somebody can’t hold that confidential space then they are not going to be one of your group.”

Group members are asked not to contact each other or meet up outside that room. If they do bump into each other, it’s fine to say “hello” but not stop for a conversation. For reasons of transparency, Duncan asks group members to mention any such chance encounters at the next weekly meeting.

It’s quite an intimate connection and when someone wants to leave, you’re also thinking of the group and how it will be for them

—  Valerie Preston, psychotherapist

Is there a set topic for a meeting?

No, there is no agenda. It’s a free-flowing discussion that can go in any direction. The therapist’s role is “a bit like a conductor of an orchestra, making sure that the relevance and appropriateness of the sharing is therapeutic,” says Price. There’s no pressure on people to talk. Everybody has their own pace and time, says Comerford. “The requirement, and it is not time limited, is that you work towards saying whatever is going through your mind in the here and now.”

But it is not always about talking. “One of the greatest learnings for people in that 90 minutes is to sit with silence,” says Duncan.

How do I know if group analytic psychotherapy would suit me?

Issues such as anxiety, poor self-esteem, low-level depression and inter-personal difficulties can all benefit from this type of psychotherapy. But you need a degree of mental stability to engage so the therapists would not be recommending it for those in the throes of severe mental health problems. They also all agree that it is a means of personal growth. Somebody might come, or be referred, to a therapist with a “presenting issue” related to, say, work. Then, after a couple of sessions, it may become clear that, yes, it’s about work, but it’s about something else intrinsic to the person too. A sense of curiosity about oneself and one’s relationships is a pre-requisite if you are going to be sufficiently motivated enough to stick with it. People are asked to attend for at least a year, some say two years.

“It has to become part of their weekly routine for a period of time for any kind of lasting change to be established,” says Comerford. “That is the value of this kind of therapy.” You are expected to work towards being able to speak openly and honestly.

“The connections people make with the group helps them to stay,” explains Valerie Preston, who runs groups in Phibsboro, Dublin. “It’s quite an intimate connection and when someone wants to leave, you’re also thinking of the group and how it will be for them.” Generally, people are asked to give at least four weeks’ notice of leaving, so they can work through their reasons and guard against impulsive decisions.

The longevity brings a financial commitment for those attending private therapy groups. You can expect to pay from about €150-€180 a month for the weekly, 90-minute sessions but that’s considerably cheaper than attending individual therapy for an hour a week. These therapists all offer a sliding scale of fees too.

I get that it is cheaper but is it diluted therapy or does group analytic therapy offer benefits that individual therapy can’t?

Yes, the group aspect has its own distinct value. It is not only a safe way to explore how you interact with others but is also a window to other people’s thought processes.

Group analysis emerged in the UK at Northfield military psychiatric hospital, where Foulkes worked during the second World War, as therapy for traumatised troops. Initially, it was seen as economic to do this in groups because you could turn over more numbers, says Price, but then the therapeutic advantage of this approach was recognised.

“The group is the tool of therapy,” says Comerford. “In the group everybody is a mirror for everybody else.” It offers people the chance to talk in ways they haven’t talked before and to see different ways of being. “It is about the person getting their life to a better place – wherever that is for each of them, that is where the work is.”

Take people with social anxiety, says Duncan. “We can tell people what they need to do but in the group, they can experience it while being safe. You are offering them the experience of what you’re telling them to do and you’re with them while they’re going through it.”

Price says it is an investment in yourself, as the group will take you out of your own world and offer a chance to experience life as others see it. “That brings a huge richness to people.”

Do we have to be in the same room or can it work online?

Like so many other human activities, group analytic psychotherapy went online during the Covid pandemic. “Most of us would have gone from the room to Zoom very quickly because we had to,” says Duncan. But she believes you cannot beat the human connection of in-person groups. “In a room you can really listen and people can be really heard.”

“It is a rare enough luxury these days where you can sit with fellow human beings for an hour and a half and have them be present to you because the world has gone virtual,” says Price. However, he thinks online groups have their value, although it tightens the demands around boundaries because people must ensure they can’t be overheard.

“It’s a bit like individual versus group; it’s not an either/or they are completely different experiences but one is as valuable as the other.”

How would I find a group?

The growth of group analytic psychotherapy in the Republic has been driven by private practice, since professional training started here in 1987. Unlike in the UK, where this form of therapy is embedded in the NHS, there is only a limited number of groups within the HSE’s free national counselling service.

You could talk to your GP about a referral or go on to the website of the Irish Group Analytic Society (igas.ie), the professional body for group analysts in Ireland, to find a therapist yourself. The society is one of 11 organisations represented by the Irish Council for Psychotherapy (psychotherapycouncil.ie).

Duncan, who works in Clonmel’s Mary Street Medical Centre and has patients referred to her by GPs, believes there are huge opportunities for this type of therapy in primary care. The GPs may see patients only periodically, but if they are referred for group work, she sees them every week.

How do therapists train to deliver this?

The School of Psychotherapy in St Vincent’s University Hospital, Dublin, is the only place in the Republic you can train to be a group analytic psychotherapist. The six-year training, conducted over nine weekends a year, includes a foundation course, diploma and a master’s affiliated with UCD’s School of Medicine. There are three aspects: academic learning, clinical training and personal therapy, all of which occur in groups.

The School of Psychotherapy is holding a series of information briefings over the coming months about the one-year foundation course, which will next run from September 2023-June 2024. More information from theschoolofpsychotherapy.ie

‘You are going to see parts of yourself that you are deeply uncomfortable with’

Artist Mary A Kelly looks back and sometimes wonders did she really attend group analytic psychotherapy every week for 10 years?

As somebody whose first degree was psychology and who had done individual counselling, she knew that when it comes to therapy, “if you are really going to get to the deep stuff”, you have to give it time. But when she started with a group in Blackrock, Co Dublin, conducted by psychotherapist Mary Hardiman, she had no idea she would be giving it that much time.

Why group therapy? “One of the considerations, to be blunt, is it’s cheaper. I am not a great believer in short-term counselling, even though some people find it good.”

Anybody going into group analytic psychotherapy is advised to commit for at least one year. Kelly reckons it takes about a year to develop depths of trust that allow you to open up. After that it becomes second nature.

“It becomes a very healthy way of dealing with life. We can be very blinkered about our own behaviour. It can be a huge challenge to begin to open up – kicking and screaming often – and really look at things.”

Going into that room, and taking your chair in the company of strangers, everything is stripped off you. People are there, not with the façade they usually present to the world but “in their realness”, she says. “When everything is stripped away, the most essential things in life are dealt with, which is the emotions and the feelings and the living of life.”

It gave her a higher level of awareness – “often of my own ignorance in fact. To me, it was a very privileged way of exploring life at a fundamental level that most people don’t have the opportunity to do – or don’t take the opportunity, or are afraid to take the opportunity.”

There was no “road to Damascus” moment, she says. Real change happens slowly and it comes from within.

“I myself was going through huge changes – separation and divorce. I couldn’t believe how long it took me to fully deal with that. I think it might have been a huge help in that translation.” There were lots of other things going on in her life, she says, “but that would have been a big one”.

Therapy is challenging. “You are going to see parts of yourself that you are deeply uncomfortable with. You are going to try and hide it and excuse it,” she says. “Genuinely painful stuff is not that accessible. To move down into it is a very tough thing to do.”

What does she say to those who might question the wisdom of such digging? “The more you bury, as I learned early in my life, the more it acts out inside you. It can unconsciously determine a huge amount, usually stuff that isn’t very beneficial to you.”

To leave the group after a decade was hard because “I loved it”, she says. “It was a way of pulling yourself out of life and looking at things, almost religious in that sense and questioning yourself. It becomes a habit.” Leaving the people with whom you have shared so much is also difficult, even though you have had no interaction with them outside that room.

“In a strange way you are closer to them, because of what is talked about, than a lot of people you are close to in life. That’s the irony.”

However, she knew the time had come to leave. “I didn’t need to do it any more – there really is a time to move on.” And out of that therapy room she brought inspiration for a series of art works entitled “Chair” (2018-2020), focusing on seats as “the holding blocks for the passage of people, time, self and life”.