 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of The Therapy Show behind closed doors where we demystify what happens behind the therapy room door. And I'm really looking forward to this episode because we're going to look at group therapy versus individual therapy. So I'm Jackie Jones and I'm here with Bob Cook who's who's an expert at this. I've never done group therapy Bob so this is this is new to me I'm going to learn something. Okay so so much to talk about with this whole subject but let's make a start on this. So I've been running individual sessions or working clinically with the individuals for 37 years and running groups for 30 years. So I stopped working with groups four or five years ago. I used to run them two or three times a week so I've done a lot of working groups and a lot of work individually so I can talk about the difference between the two of them. I've been in groups I've had group therapy I've just not facilitated it myself. Oh well you'll be able to talk because you've had individual work and group work so you can talk about what you see as the difference of the client. Yeah yeah so that's okay. So I don't quite sure where to start the podcast but I can tell you a little bit about how group therapy works. So again it will it will depend really on people this might have different thoughts to me but I can just tell you how I've done that. I was trained in transaction analysis psychotherapy I was trained in integrative psychotherapy so the major modality of the group was from a TA perspective and basically I would have a group from six to eight people two hours the group would run and it'd be every week so two hours six to eight people every week and they would need to have seen me individually for three to six months at least so I've got a sense of attachment with them. Yeah so we've worked out a contract on what they're going to work on in the group so you see them first to get an attachment going usually at least three to six months or more and then you get a contract for the group therapy and what they want to work for in the group. Usually I said a minimum of three to six months but quite often for a lot longer so usually and it's all time because sometimes people have been in therapy before and they specifically want to come for group therapy but for the sake of this word I keep using usually people come and have individual therapy and then progress if you like into a group. It isn't they go into group and then go to individual therapy they go to individual therapy and then they progress to a group so people who went into my groups would have seen me individually for quite a while before going into a group. Yeah I can understand why why that happens. Yeah one of the things that's really important is that the person going into the group has a secure base with the group facilitator i.e. me in this case. Of course if they haven't got that they may not be able to deal with the you know the fluctuations or the difficulties that may occur in the group they need a secure base with me and also they need to have worked out what they want to do in the group contractually before they go into a group. They have to have worked out individually what they want from the group and they'll only know that through work with me. So would you say what it would be a different thing they contract for the group therapy as they do individual. They wouldn't just have the same sort of issues in individual and then go in a group and not really re-contract or anything. Well let's sort of have a pathway into a group so somebody comes how it usually is people come or someone comes to therapy let's say they come with depression, anxiety and they start individual therapy with me. They contract on working with depression or working with the anxiety whatever it is and then we start working on that and then as we go on we might as we start to heal some of the depression come to a conclusion and they might benefit more or they continue their work or integrate their work if they join a group to cement the process. Yes yeah I can I can see why why it would be a good thing to move from individual into a group with particular things yeah. Yeah so it doesn't work the other way around. No. A group therapy is an excellent format for practicing what you've individually learned. Yeah. Before you go and practice it in real life so you can go and practice some of the new behaviors with a small amount of people who are going to be very supportive with you before you actually integrated in real life or you can see it as a stepping stone. Yeah. Integrating these new behaviors. Yeah so for the therapist do they need extra training to facilitate a group as to individually. Very good question. I think they need to have at least been in group therapy themselves a model then on how group therapy works. Yeah. Because if you not at least had an experience of being in a group then you have no model to work for. Yeah. No that makes sense isn't it. Yeah okay and and sometimes that isn't always the case. I was thinking of two particular very experienced therapists who worked for six seven years individually and I was by synchronicity and they don't know each other and I'm their supervisor. Both of them said they don't live in the United Kingdom that both of them said we are going to start a group up. Now I haven't had any extra extra group training on this except they've probably done a module in their training four years ago and both the say both people from the same institute actually neither of them had any experience of being in a group and as I said in the supervision with them this will probably hold you back even though I can help you with how you want to run this group. So in my opinion if you could get some training somewhere even if there's only some cpd training on running groups it would be useful otherwise I'll help you yeah which is what happened eventually with both of them. Yeah because the dynamics are completely different I would imagine group to individual. Well again it depends on how you plan to run this group. So if you're running a what we call process oriented group and that means that for the two hours you'd be dealing with what comes out of the process. Okay yeah so you can say okay you've got two hours and simply over to you. Yeah and then you would deal with what comes out the process in a pro what is called a process oriented group. Yeah now that would mean you being involved that would mean you being highly participative yourself and you would do the therapy or the teacher of the process process oriented group. Now I think I personally think that takes quite a lot of I think somebody needs a model of that type of training and it would be good if they have some training in that group. There's another style of group which will just called hybrid therapy group or another way of putting this is doing individual therapy in a group. Yes. So I know there's somebody who comes to the group sorry say six people in the group and they would contract for what they want to do or work on in the group and the therapist would be part of that bilateral contract and then they would work individually on that in the group. Yeah so we've got six people usually what happens is that at least two or three people perhaps four would work one week and then other people would work next week if they hadn't worked the week before. So if you're the style of therapist where you're going to work with the individual in the group and you've been an individual psychotherapist yourself that doesn't take that much more training. Yeah I would have to guess that that was the type of group that I was in the hybrid where it was individual therapy within a group if that makes sense yeah. Yeah absolutely and in and in transaction analysis world and I know you come from that most therapy groups tend to be working individually in the group style yeah and I don't think that needs that much particular specialized training because a most trainees have been in that type of group themselves and b they probably got some of that training in the group and c their supervisor can help them with that and for their experience of working clinically individually holds them in great stead. Yeah so it does depend what type of group you're going to run therapeutically I think to answer your question about specialized training yeah but does that is that clear? Yes yeah yeah I didn't realize or group therapy was just group therapy I didn't really realize that there was kind of different ways of doing it. Oh yes there's many different ways there's working within the process like I've just said. See that I've got this fantasy about that I kind of imagined that being like it was in the 70s where people sat round in a room discussing you know subjects and just general sharing of experiences and things like that is that is that what that kind of therapy is group therapy? Yes and no so what you're describing could be called what was called in the 70s and early 80s an encounter group okay where you would go and simply encounter what happened in the group and there'd still be a leader that would help deal with the so-called encounters but there wouldn't be contracts it wouldn't be every week for you know six months you wouldn't have had to be an individual therapy to go in that type of group you'd simply go and encounter the experience. Okay I thought that those types of groups were very unprotective and I wouldn't recommend them. Okay it's kind of like you know those old pictures that you see of like Eric Byrne and all those when you know in the early days of things where they were all sitting round smoking in country chairs just I don't know what happened in those rooms but that's kind of what my fantasy is of early group therapy. Well early early group therapy if you're going to bring Eric Byrne into this I think was partly educative therapy okay he would teach about the parent adult child he would teach about games he would teach about rackets he'd teach about script and he was highly cognitive right there was not much emotional work going on in those early group burn groups you're talking about now if you're talking about early Gestalt groups rather than TA groups where they would look at emotions and they do a lot of re-childing where they look at you know the power of the past effects of present but more from a no emotional point of view there wouldn't be so much educative therapy and it wouldn't be so cognitive. Yeah I think that what we're talking about is how the style of how you would run a group and I think a lot of the TA groups particularly are individual therapy in a group style without dealing with the process and dynamics of what happens in the group. Okay so for example if you had the process group style and it started off with somebody saying you know well actually I feel quite depressed however when I come to this group I often feel even more depressed because I don't feel anybody really listens to me about how hard it is for me and how isolated I feel okay so the group facilitator might say oh can I really hear what you're saying and Jack what do you think about what John's just said oh well I don't really agree with that but sometimes I switch off because I find you quite boring I don't know if that's the depression and then the facilitator said oh and what do you feel back in response to that Jack so it's dealing with what's happening in the group yeah because somebody else might come in then and say I feel pretty angry the way you responded to Jack have you got no empathy and then the facilitator says be processing the group so it's kind of like now that you've you've explained it that's what we did at the end of the weekend's training was kind of group process where we all got together and discussed what had gone on over the weekend or whatever so you processed what was happening in the group yeah oh right so I've experienced that then yeah that's different from a therapy group yes oh I've done both then yeah you go me however I think you need more training to run a process style group than you do individual in a therapy in a group style because you need to be able to handle the what I would call the groups dynamics as well it's much more of I think a more challenging system I can see that yeah yeah now both those styles I think have their merits and disadvantages 34 years of running groups I always had the group of you know working individually with people in a group said they come to individual therapy with me have contracts and take them back into groups it wouldn't be time ended in other words it wouldn't be just for six weeks for six years yeah people usually stayed in groups maybe a year or so they'd work through their contract do the healing they need to do and leave some people might stay three in three or four years people might leave after six months there's no time orientation to it would you would you see people individual and in the group concurrently at the same time well that's a really interesting question I'll answer that and say no okay then I'll go on to say why and then I'll go on to say some of the disadvantages and advantages of both of those so one of the problems about seeing somebody individually and keeping hold of them so they in other words they may have an individual session on the Friday and come to their group position on the Monday one of the advantages of that just knows about the issue that the client has individually and they can work off the back of that and then they can take it into the group and so and there's more group time and more psychological time for the clients one really big disadvantage though is that the people in the group may have fantasies about what the therapist i.e the special person is doing with the client individually because they don't have access to that right so that can encourage what I'm going to call psychological splitting yeah where there's a splitting process going on between what is the person deals with individually which never gets back to what's being held in the group now you could have an open contract so what's being dealt with individually is then shared in the group so that takes away perhaps the secrets part of all this lot but it doesn't take away necessarily the splitting part where people in the group may feel they're not special and this other person is special yeah and I think that would you play out yeah so personally people didn't now the disadvantage against that is is the person who's seen me for individual style and wants to also see me continue their individual work and being in the group may feel abandoned by me if I say you've got to be in a group so we have it's a very delicate set of negotiations yeah which again I suppose goes back to what you started off saying that you need to have been seeing them you know for a minimum of three to six months so that transition isn't an abandonment or seen as an abandonment by you if they did move into a group yes that's correct but but or stroke and they might might not find that transition easily or even though they've decided in to do in the adult for advantageous reasons and might not be able easily to let go of me yeah and want to have individual therapy and have group therapy at the same time yes yes and with certain clients I could see that that is something that they would want to do extra bob during the week yeah so that's too now part of this title of this podcast is you know you put it down as individual versus group therapy and you know this the way I see group therapy as I said is a developmental process on from individual therapy for them to practice their new behaviors in groups however what you might say is when the disadvantage of group therapy is things like people might withdraw in groups they may go underground in groups they might fear people with drawn natures like skits always for example might find groups very difficult they may feel humiliated and ashamed in groups they may recreate their past dysfunctional system in a group we could go on yeah in groups might find it particularly challenging and therefore maybe there's a discussion for individual therapy being the more appropriate method rather than having them ever go in a group yeah so I didn't insist everybody goes in the groups at all if I felt that people would get a lot out of being in groups in terms of vicarious learning mutual learning support etc etc then I may suggest it but for some people I think they might find lots of things in the transfers sharing me all sorts of things I can think about groups might be inappropriate style of therapy or step too far yeah yeah I found it really easy to hide in the group which I suppose at the time was something I saw as a positive I could go and I was learning vicariously I took an awful lot in because being on the receiving end of it I was quite surprised how much I kind of got through osmosis if you will listening to somebody else's therapy session I also got something from that even though it wasn't you know me undergoing it if that makes sense but I did find it easier to hide in the group yeah absolutely and also that may or may not have been good for you but there's other issues which people would find hard in groups and therefore perhaps it's a really good reason why they're never going groups you know shame, humiliation, playing out things I mean I could say it's very important for those very reasons to be in a group however I didn't push people into groups it was more if they decided it wasn't from them it wasn't from them yes yeah because I suppose you know the dynamics of the group need to be considered as well that if there's a new member coming into the group you know how that's going to impact on the group as a whole and then if that member leaves that that's also going to impact on the group so there's a lot of group process going on a lot of the time I would have thought that's right and another advantage for individual therapy many clients might say well we have a whole hour to ourselves we're in groups we might have 20 minutes yeah two weeks or whatever it is but in individual therapy we get a whole hour we get we get all your attention you know so there's some advantage is of individual therapy some people like them groups because of all the things I've taught and also interestingly enough money may come into it because groups are cheaper than individual therapy so people had different reasons to go into group therapy and as I said I might encourage people but if they don't want to go that's their prerogative and their choice because it's a contractual process yeah yeah it's not just like meeting up once a week and chatting and shooting the breeze there's still a contractual process to it there's still yeah yeah and it will be a therapy contract so it'll be far away from what you just said but I know what you meant it wouldn't be at all seen in the line you just said it but it would be very exclusively therapeutic there wouldn't be any past farming allowed yeah depends how you run the group I mean you might want to call well I had people sharing for five minutes good news that they've actually some good news has happened to them during the week so you might want to call that past I actually called it very therapeutic by the way but I think groups can be very challenging for people that may be a good enough reason to do it for some other people it might be exclusively difficult and in some ways it could even be re-traumatising so I think therapists need to think very carefully about who they invite into groups and why they invite people into groups and what the clients get out of it being in groups yeah because I suppose as the therapist there's an awful lot to think about because you know if you're working in a particular area you don't necessarily know whether those people might know each other before they enter the group which could be an issue do you know what I mean there's there's a lot of things to consider I suppose if you're going to run a group this I suggest you have if you've had not been in a group before all stroke and here you have some supervision sessions yeah or you actually start running groups because how you start the group who you're having the group the composition of the group the contracts of the group the pitfalls of groups they are I think they need to be discussed before you start your venturing if you like into the world of being a group therapist yeah because I know some therapists who you know because of the workload and you know I suppose the need to see more clients than having a group potentially you know freeze up some of the therapist's time if you've got six clients in a group and you're working for two hours that means that you can potentially see more people in your week because you're not seeing six people individually which is kind of like a full day's work that's interesting for practical reasons I agree with you many therapists say that I think it's the wrong reason to run a group me too that I was just putting that out there that's the reason why most therapists I know start groups is purely for that reason I'm not saying that that isn't a reason but I think that you need to have a passion and I think for running groups and also I do believe there needs to be some training even if you do it in supervision before you start the group I mean I understand the practical reasons I understand the economic reasons but if you just have those as the reasons in themselves then I think you may lose some passion for group therapy yeah so for if for anybody and the listeners so it's about you know clients that have been in individual therapy for three to six months before you even you know consider them going into groups look at the type of group that you would want to run whether that's a process group or whether that's the hybrid as individual therapy within a group look at accessing extra training yeah or taking it to your supervisor prior to that and discuss with the client why you're suggesting they're going to group yeah and go with the client yeah if they say don't want to be in a group then it's really important you don't force them into a group because you want to start the group off or all the reasons you just said there economically or practically I think the the bit we need to think about here is service of the client and the clinical reasons behind individual group therapy yeah yeah well the monetary or practical reasons behind and I can see that the client does get benefits from it what is there a minimum and a maximum number that you would you know what what what constitutes a group I never went above eight okay that was simply on time reasons okay so would you pass three as a group therapy session well you know what's the lower end of that because I suppose two is like couples therapy well the issues that get talked about endlessly in groups is competitiveness competitiveness over time and money so if you're going to run a group of eight people you I I suggest and this is what I did let's say we're not likely to get through more than three or four a week in terms of having exclusive time with me yeah so the contract will be that you will get priority the following week if you haven't worked the week before yeah number one and secondly an understanding that the vicarious nature of a group probably means that you're actually doing therapy all the time anyway yeah I can see that yeah yeah but I need talking about yes so back to your other question anything past two is a group okay if you talk about couples therapy so duo yeah so you wouldn't really start a group in my opinion with less than five four or five people okay people drop out yeah I mean and really you do need to start if I was suggesting and we started a group I mean I would suggest they start with at least a minimum of six but you're right anybody over two would be designated as a group yeah so that's that's brilliant Bob thank you and you know following on from that conversation of duos or couples um we're going to talk about couples therapy versus individual in the next podcast yes certainly are that's an interesting subject again I could talk forever about but I look forward to that okay doc see you in the next one okay 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