 So welcome back to the next episode of The Therapy Show Behind Closed Doors with Bob Cook and myself, Jackie Jones. And this is episode 114. I can't believe that we're up to 114 already. I know. It's not. It is. And what we're going to be talking about in this one. 104. No, 140. Okay, I'll believe you. I thought it was a bit too much. It's a very suspicious look on your face though, Bob, for those people that can't see on the podcast. It doesn't seem long ago, since we did the 100th. I know. It's frightening, isn't it? Yeah, so it is. And it's about running therapy groups, which I'm really interested in, is Bob. I've never run a therapy group, so I can pick your brains on this. Sure. I was just looking at myself actually in the, very narcissistically, in the Zoom that we're doing. I've realised my beard is very long. Anyway, I must say, anyway, very, very long. Well, I would say he's coming up to Christmas, but it's not, is it? We're in the middle of summer. Well, but anyway, sorry for the people who are on pack podcasts. You just have to imagine my beard's very long. A bit like Father Christmas, I think. Or they can pop over onto our YouTube channel and they can see you in the flesh on the YouTube channel, Bob. It's up to them. A little bit of a plug there. Yeah, absolutely. Okay, what did you say something was about? The subject is running therapy groups. And you never run what? I've never run a therapy group. Couples is the most I've done. I've done parents and children. I've done that and I've done couples, but I've never actually ran a therapy group. I was just... Imagine it's a bit like putting fires out sometimes. It is. I was just thinking about, when did I run my first therapy group? I think it was about February 1987. And then I ran one every week until I was 69. So back in 1987, I think I was 37. It's like 35 years ago or something, Bob. Every week and sometimes I was running therapy groups twice a week, three times a week. In fact, you could call me a group psychotherapist. I mean, I'm still running intensives three times a year. In fact, I finished one not long ago. So yeah, I'm well versed in the whole arena of group therapy. That is for damn sure. And I see group therapy as a very important methodology of psychotherapy. Quite often people... How can I say this? Progress into group therapy after they've cut their teeth, if you like, on individual therapy. And then they practice out the new ways and healthy ways of being in a group. So it doesn't have to be that way. I mean, you can start in a group, but I'd be very surprised if you didn't have some individual therapy sessions. First, even if it's only to find out what you want to work on, what the group therapy contract will be. So it's highly unusual for people to go straight into therapy groups. You said that, Bob. I wasn't sure when you said cutting your teeth and you start off on individual therapy. I didn't know whether you were talking about the clients or the therapy. Oh, no, definitely, definitely the clients. And it's very important because it wouldn't be what's right. I don't think it would be appropriate to go straight into a therapy group. I think there needs to be some time spent with the individual therapist who's going to run the group therapy. So you've got a sense of what you're going to work on. You've got some sense of building up an attachment with the therapist. You've got trust in the therapist. You have some sense of how many people are going to be in the therapy group, what the structure is, how often it's going to run for this one hour, two hours, three hours. Those sort of admin things provide a structure and a purpose and identity to any group. So people can bring anything to a group therapy session. It's not like there's a theme to it. I want to say kind of like Alcoholics Anonymous or a therapy group around addiction. It doesn't necessarily need to have a theme. People can come with anything. Yeah, okay. So now we're into what types of groups we're talking about. So there's many types of groups with a therapeutic content. So for example, the ones you've mentioned there, AA, for example, that's got a therapeutic contact if you like to it. But it's specifically to doing problems, etc. You've got addiction groups, which could be to do with any form of addictions, whether it be drug-based, alcohol-based, sex-based, computer-based, any types of addictions. So we have different types of groups, perhaps for different things. Yeah. I agree with you. We also have general psychotherapy groups, which can deal with anything. Relationship issues, to self-esteem issues, to substance abuse, to many general things. And people usually come from their individual therapy into the group therapy, where they have a contract with the individual therapy, an overall group contract, if you like, on what they might be working on. That might be to be less depressed, to be more relaxed, to be content with themselves, to whatever it is, but it will have been sorted out with the individual therapist that's running the group, on what that might be. And as I said, usually they've been in therapy for at least six months before the end of the group. So there's different types of groups. And also, not only the different types of groups, there's different structures to groups. So in other words, there could be one hour in length, could be one and a half hours in length, could be two hours in length, could be three hours in length. Also, the composition of the group might be four people in the group, might be six people in the group, might be eight group, people in the group. And usually it's determined by how long the group is in how many people will be in a group. People in AA groups might be more in number. So we have different structures, different purposes, different identities, and different timings of groups. So there's a lot of classification in groups. And then, of course, we have groups that are run by modalities. So for example, a Gestalt psychotherapy group, a transaction analysis psychotherapy group, a CBT therapy group, a existential psychotherapy group, we could go on and on. So there's a lot in the structure identity purposes of groups. Yeah. So would you have a theme, you know what I mean, before each session, do you kind of as a, you know, the person that's running it, do you have anything planned or is it just literally whatever the individuals bring on that particular session? Well, again, it depends on the purpose identity and structure of the group. So for example, some therapist could start up a group that lasted 10 weeks and might have a theme. Right. Like, for example, assertiveness. Yeah. Theme on depersonalization or a theme on whatever subject really, but might have themes like you have just said. And that might be, you know, only for eight weeks. And then they start with another theme. Or it could be for six months. And then we start with another theme. Or it could be for two weeks. And then we start for another theme. So there are theme based groups. Absolutely. So basically it's up to the therapist what kind of a group they want to run, where there's a need maybe in their area for the type of group. Yeah. Yes, you're completely right. Let me just say what I think is more than normal. Yeah. It's that there's many varieties of groups that are therapeutic content in nature. There's many different types of structures, purposes and identity of therapeutic groups. There's many types of groups which are theme based, which have a therapeutic content to it. I mean, you yourself, if you never run any type of group with any type of theme or any type of structure at all to it, Jackie. I have a membership, but I think that's like support based on therapeutic principles. I wouldn't say that it's a therapy group. It's more based on the principles, if that makes sense. I don't know whether I've been overthinking therapy groups. Well, there's many, many different types of therapy groups. I've just said different types of classical therapy. If I talk about what I think the norm under the term psychotherapy groups in inverted commas, we could start there. I think I could probably fall into an inverted commas psychotherapeutic group definition. So they run every week, so it isn't like 10 weeks and then they stop and another 10 weeks and then they stop and another 10 weeks. They run forever. You might have Christmas off, but for example, you might. Usually, often people have Christmas Day off or might have one before that. But it will go. So like I said, I started running groups when I was 37 and my last group ended when I was 65. That's every week. Now, the same members aren't in the group for 35 years. You just read my mind then. I was going to say this. It wasn't the same people for 35 years, was it? No, no, no. But when people entered my group, they didn't have a time limit to it. Yeah. So for example, they could be in it. I didn't take anyone in it that was going to be under three months. Okay. It was a long term, usually. People used to stay in my group up to a year. And then I could stay five years, because they're seven years. Looking back, I don't know the longest term that somebody stayed in my group, but I suspect it might be five or six years. And it would depend on what the contract is and why they've come in it. Usually, they will have seen me. They might come from my clinical individual psychotherapy load, which is usually the case. Then we discuss what they want to go into group four. Now, people don't just join groups without a reason, a therapy group I'm talking about. They usually, and I keep saying usually on purpose, because there's many other ways to run therapy groups. And what I'm saying might not be normal, but I think it is more the norm. And that is that the members of the group come from the clinical load of the therapist. And they may have been seeing or in treatment for some time with the therapist. And the therapist that says to the person, well, I think it would be good for you to join a group more than just me, where we can look at how we can practice those particular new coping mechanisms or whatever it is. Or they think for other reasons that it might be useful for somebody to join a group. And that's nearly always the case. Now, I wouldn't have anybody joining my group who at least minimum hadn't done three months of me. Yeah. Which is 12 sessions. Yeah. Usually more than that. So they built up a relationship with you and there's trust there and you kind of know a bit of their history and maybe whether they're going to be triggered in the group or I suppose they've got to be a good fit in an established group as well, aren't they? Yeah, I think what you're talking about here is very essential to the running of a whole million year psychotherapy group. And that is, when does lots of things, when do they join the therapy group? Are they a good fit for this particular psychotherapy group? What are they going to be working on? What do they see as therapy? You know, how far they come in their individual therapy? All these things are what you just said important things to consider before they come into a psychotherapy group. As you're talking, I'm thinking my membership is kind of a similar vein, even though I don't think it's a group. You know, they're quite precious of it, do you know what I mean? And I'm not sure how open they are to new members coming in. Yeah. Well, that's a good point being here because there's open groups and there's closed groups. So for example, we decided when I first started, let's take one group I started in 1987, that it would be two hours in length and there would be eight people in it. And therefore we could call it a closed group. Nobody could join it until one person had left it and the space had actually occurred. And then somebody could apply to go into it. Or how they would apply is talk to me, of course. And then we'd work out a contract and what they wanted from the therapy group. And then they would join that therapy to group. But eight was the cut off and eight was the close. So in other words, it was an inverted commas closed group. Now, it isn't about the members of that group deciding who they wanted in the therapy group. Now, it might be some other therapist might run it that way. But the decision on who should be in the group was securely on my shoulders. Yeah. And they would come nine times out of 10 for my clinical treatment case load. And they would only go into a group for specific purposes and it wouldn't fit into their clinical treatment. Yeah. And they would only go in a group when they'd at least had a relationship with me for minimum three months. Usually much more than that. Much more than that. We'll say minimum three months. So it will be a closed therapy group. So the main reason that you're saying that they would go from individual to group is to kind of practice the things that they've been working on in their personal therapy in a wider setting, in a safe environment, so to speak. Yeah. Well, number one, they get to know me. Yeah. Develop an attachment with me. And they've got trust in me. So when they're in the group, they've got a safe anchor or a safe pair of hands to turn to, to provide psychological safety. Yeah, definitely. And that's really important. What was the other point you made? You said another point. Was it about that they would join for my clinical treatment road trip? It is. Yes. Right. Yeah. Because eight people is a lot of people, Bob, for you to manage in a therapeutic setting, I would have thought. It was eight people for at least 30 years. It wasn't until I started to sort of wind down my psychotherapy practice when I was 63, 64, where I started to think about reducing it to six. And then, you know, I was going to retire for working with groups of 65. So I went down from eight to six, and the groups went down. There were three a week to two a week to one a week. And then eventually, I think we ended our last one. Okay. I'm actually thinking that people in that group now, as I speak, I feel quite, I don't know, reflective and how much we achieved. I certainly want people there from the start, but they've been there maybe three or four years. Yeah. And I think there was four people when we stopped. So, but for at least 25 years, there were eight people. I've been in a group, when I was doing my training, I was in a group therapy, you know, sessions on a weekly basis, and there was four of us in that group. But as a therapist now, I'm thinking how it's easy for some people to hide in a group setting. You know, to go every week and not actually invest in their own personal therapy in there. But, you know, we get things through osmosis, just being in a room and listening to the conversations that go on are other people sharing their things. Everybody in the room kind of learns from that experience. Yeah, it's a great support. Yeah, absolutely. But the different dynamics in the group, for you to maintain a certain level with eight, there's always the, you know, the stronger characters that talk a lot more than other people and share a lot more. And they're awesome. Now, here we are. You know, seriously, we have half an hour is not long enough for this podcast. We should do a separate podcast on different styles of running therapy groups. So, I'm going to sort of generate it and we must honestly have... We can do a part two straight after this one, Bob. We can do a part two next week, if that's what you want to do. Well, we're now into different types and styles of running groups. So, for example, okay, I ran a style of group which you'll probably call a hybrid style of therapy group. Now, what I mean by hybrid is this. And that is doing inadvertent commas individual psychotherapy in a therapy group. Okay. And what that means is that the person would contract for a certain amount of time in the group. So, there's eight people. They would contract for half an hour. No less, they can stop up to 10 minutes if they want to, but they've got half an hour. Yeah. And that makes that you're working with four people. Yeah. And the other four people have first priority a week after if they want to take it up. Okay. Now, if they don't want to take it up, somebody else would take it up. Yeah. So now you've got four people in two hours. Yeah. Right. There's advantages and disadvantages of that system. The biggest disadvantage is that there is little time for group process. In other words, there's little time, if any, to bring the group in. Yeah. And the only way you could do that is if the therapist had in their heads, they, the person, part of the half an hour they give the person would include feedback from the group on any of the members who've got the identification of some things they wanted to share in support of the client. Yeah. Otherwise, it'd be no group process. Yeah. And what I mean by close to group process is having time to bring other members of the group in to talk about feelings, to talk about identification, to talk about support for a client and the content they have actually bought. So in the hybrid style of the work that I'm talking about, individual psychotherapy in a group, the disadvantage is the absence of perhaps much, much, I don't know if that's the word, absence of time for much group process. Yeah. Advantage is that the client becomes the star of their own treatment, not the group. Yeah. Second advantage of a hybrid style is that in my opinion, everybody gets the time to work if they want it. Yeah. If you're in a group process style, it is easy like you have just said that somebody to stay more with you. Yeah. And in your language, hide. Yeah. So if you had a group of eight and it was a two-hour session, then literally they would have individual every two weeks, if that's what they chose to do. In the style of group, are you at? Yeah, yeah. Yeah. So there isn't a set formula for running a group therapy, then it's down to the individual that runs it and the clients that are in there. The way that a psychotherapy group pursues the one-state group usually is determined on the training model that they actually have been in. So for example, I trained in 1985, sorry, 1985 was until about 1992 in transaction analysis psychotherapy and I spent some of that training in how to run groups, plus the fact I was in a psychotherapy group myself for quite a long time. Yeah. Now the model that I had from it, you know, that I was, that I knew very well from being in the group myself was a hybrid style of running. Yeah. So I learned it from watching the person, my own therapist, in this particular group. She learned it, I suspect, up to the same methodology and also I think and I have never asked her, but certainly I got trained in how to do what is called, I can explain this to you, the Goulding type of individual psychotherapy in a group. So the model I learned was not only from my own psychotherapist, but also from the theory of the specific type of transaction analysis model. Right. Now I guess, I guess that if you trained in Gestalt psychotherapy or if you trained in existential psychotherapy or if you would train in psychosynthesis psychotherapy, you would have different models of running different groups. Yeah. Often determined by a psychotherapy group that you might have been in for your own treatment or at a very least trained in. Otherwise, I've got a model, have you? No, no, exactly. Yeah, I enjoyed being in a group. I think I got a lot from being in a group because, you know, I enjoyed the individual, but I did enjoy being in a group as well. And I kind of, you know, the four years that I was doing my training, I think I was an individual maybe for the two years before I went into the group. And I think that was a good time for me. I kind of worked through a lot of my own personal stuff and was in a better understanding of myself and, you know, my drivers and all that sort of stuff to then feel comfortable to go into a group. And what type of group was it? Was it a hybrid group or a group? Yeah. Yeah, a hybrid group. And Ramford too, I was, you know, and there was four of us in there. So we kind of got an hour each if that was what we wanted to do. And there was time for group process in that. Wow. Yeah. We've only been a smaller group. Yeah, yeah, yeah. That's because it was four people. Yeah, yeah. Though it was hybrid in nature where the client was to start and took centre stage, yeah, like the therapist also brought in feedback and perhaps a bit of process. Though I'm not sure what, we'd have to define what we mean by process, which is, I certainly, I think it would probably be a good idea to have another podcast next week just to describe some of the things that are coming out of it. We could call it how to run a psychotherapy group's part two or something. Yeah. When we talk about group process, again, there's different definitions of what people call group process. Now, both you and me, I suspect when we talk about running a hybrid style of psychotherapy group, we're really talking about the way you've described it, maybe the way I write it, feedback from the group individuals on the therapy they've just been witnessed and any identification that came from it. Yeah. I think it would be an idea to do part two next week on this, Bob, and kind of carry on the conversation with it. Does that make sense, what I've just said? Absolutely, absolutely, yeah, because I suppose the person that's, you know, in charge of the therapy group will have an idea of whether anybody's going to be triggered by the content of what's been spoken about, but the people within that group might necessarily know people's backgrounds to know whether they're going to be triggered by the conversation that's going on. So I think it's important that they have a chance to feed that batch. Yeah, so is this a mix? Definitely. So this is a mixture of a hybrid group with a feedback loop. Yeah. Now, if you go back further in time, you might have, which I'm not sure I will call a psychotherapy group, but you might have what we call feedback loop psychotherapy groups or even educate, educative psychotherapy group or even psychoanalytical psychotherapy group, but the one we are talking about here and that what I was trained in and had my own therapy in around for 35 years is what I'm describing. Yeah. Now, the problems and advantages to explain some of them, other problems, anyone's listening to this group who wants to start therapy groups are probably identified with or if they're thinking of running therapy groups, it'll give them some issues to reflect on. Number one issue that nearly always comes up in therapy groups is especially the way we are running it that I've described running it here as a hybrid group with some feedback. Number one, that's not in any linear order, but I'm going to say one, two, three, four. One is competitiveness for time. Yeah. Linked in with competitiveness for time from the therapist. Yeah. Because the therapist, transventually, is the parent. So it becomes like a family system where if we're going to use this analogy, where the clients become the siblings in a family. Yeah. And I can see how that plays out in a group therapy session, definitely. Yeah. So you would have had that in yours, even though it was only four people. Yeah. Yeah. So what, competitiveness of time, competitiveness from time, specifically from the therapist and wanting to be special to the therapist. Yeah. Now, that brings us to advantages and disadvantages, but it will be a common theme. Other issues that get played out with time, you know, before these sort of time issues and the competitiveness issues, actually often money and power dynamics will raise his head in therapy groups. Now, not so much in the hybrid style, because the client is the star, but it will. And thirdly, people often individually or group therapy will act out over money, especially if you've got a system where you might give discounts for certain people, like, you know, whether they haven't got much money or I could give various reasons why somebody, one therapist might discount a member in a group. However, all those sort of issues around money get acted out individually and even more so in groups. Yeah. Next issue for people in groups is to think about personality types. You, this is the therapist I'm talking about, the personality types to have in a group. So you sort of hit on it when we started and when you said the therapist needs to think about the right fit for those eight or four people. Yeah. Six. I don't think she had two because that's a duo. Three is a trio. I think it becomes a group once you hit to about four. Yeah, that makes sense. Yeah. Yeah. I was thinking somebody either a supervisor who has a group of three, but I think that's more of a trio in my head. But, you see, when you get four, five, six, eight, 10, I think we're more into groups then. And I think the therapist needs to think about or the leader of the group who's the therapist needs to think about, well, what personality styles we'll make for a harmonious group here. Now, again, for people listening might not use this diagnostic model I'm going to mention or might even not use this continuum of health I'm going to mention, but I'm just going to talk about one classification of personality traits people often think about. It's called the DSM-9 or DSM-10 diagnostic statistical manual. And if we look at, if we take that classification, we have names like paranoia, schizoid, histerolyc, borderline. And we need to start thinking about, well, if we're going to take people who have got particular disorders into your group, or are you going to just have a group where you're dealing with neurotics, which is a different ball game. But if you're going to take people from different parts of the health continuum of traits to disorders, then you need to think about it because, and this is no discredit to what people are, classification I'm talking about here, but I wouldn't encourage psychotherapists, particularly, to have more than two board, in inverted commas, borderline clients, for example. Standardly, yeah. I wouldn't also encourage people to have too many passive-aggressive clients or too many schizoid clients. So if you had many people who are quite high on the passive-aggressive continuum, then we're going to have a group where passivity becomes the norm. If we're going to have a group, quite a lot of histronics, we're going to have a group where people see their work a lot through feelings, rather than thinking, and that might be all right. But if you talk about the harmoniousness and process of a psychotropic group, these are things to reflect on. Yeah, because you don't want the group therapy sessions to be challenging, but yet you don't want them to be easy. People have got to work on relationships within that dynamic group. You want them to be challenged to a certain extent. Like you say, you don't want a whole group of histronic people that are all just working on the feelings. You want some people in there that are kind of more, I don't know, thinking people so that you've got thinking and feeling people working out how to communicate with each other. Yeah, you're right. And I also think that one thing is to reflect on is where the people are on the continuum of health and neurosis to psychosis. Yeah. So if they're going to be, you're going to have a lot of people out of the eight on the high level of the continuum, where it's going towards high disturbance, then that's certainly something to think about because there's no people, you know, a different place on the continuum, say, neurotic traits and disorders. So I think you need to think about how you balance the psychotherapy group and certainly reflect on these issues I've just talked about. Yeah. So shall we leave it there, Bob, if we're going to do a part two? Yeah, let's call the part two, styles of running a psychotherapy group. Okay. How does that sound? Because that's, I would like to talk about the different styles between process groups and what I've just called hybrid groups, where the individual part is the star, rather than the process of a group. Yeah, definitely. So we'll do that in the next one, Bob. So on this one, it's about establishing ground rules with the participants that are there so that they know what type of group it is that's running. The length of time that it runs, whether it's a closed group or an open group, those sorts of things, you know, how conflicts are handled within that group, what's the point of the group, whether there's a theme to it, or we just bring our own stuff every week. How do you contract for a group? Just quickly to finish on. Is it the same as individual group? The way I used to do it, as I said earlier on, nobody just goes into any of my groups. They have to have some sort of attachment with me, been in treatment with me, and that's when you would contract with the group. Okay. And you talk about how you might sabotage that contract in a group if you did. So all that contracting process would be done with me in the individual session, and then when you moved into the group, then you would explain to the other group members why you're here and what your contract is. But it would have to be a contract for change, not a contract for past timing, for example. Yeah, yeah, absolutely. I've really enjoyed that, Bob. It's made it a lot clearer for me. Oh, good. Yeah, I think I've been making my ideas and thoughts around group therapy a lot more complicated, maybe, than what they needed to be. Yeah, I think it could be a complex and straightforward process, but you know in this, and the complexity is that over time and now there's many, many different styles of running groups. Yeah, which we will discuss in the next one. Look forward to it. Look forward to it. Okay, until next time, Bob. Thank you very much. You're welcome. Bye. Bye-bye. You've been listening to The Therapy Show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.