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The Challenge of Group Psychotherapy

"I Want to Call It Quits and Run Back to My Support Groups Where I Was Loved!"

December 2002

The Challenge of Group Psychotherapy

I am a 55-year-old HIV-positive woman who has enrolled in a psychotherapy group for people living with HIV. I have been with this group for about a month and everything seemed to be going OK until last week when one member, a young woman, told me that she thought my recreational drug use was out of control and I should be concerned about my health. Another female member agreed, the rest of the group was silent but I saw that some members nodded their heads. I looked to our group leader, a psychologist, to defend me -- but he remained silent. I told the other woman that she must be the one who had a problem. She said I was defensive and afraid to give up my drugs and had low self-esteem. From then on, when the psychologist wasn't looking in my direction, I gave her nasty looks.

I keep going over and over in my mind why she said those things to me. Is she jealous? It's so easy for her! She's in her early twenties, thin and has no signs of HIV! Drugs help me feel good -- so what's the big deal? Afterwards two of the group members met with me for coffee. They are men also in their mid-fifties and they both told me I should take drugs to party any time I want and next week they plan to criticize the member who attacked me.

Now I'm confused. I'm turned off by my group leader for not defending me, I'm mad at the members who did not support me, and I have encouraged the two men to defend me next week, when I should be able to stand up for myself. Right now I want to drop out. I thought this would be like my other HIV-positive support groups but it's not. Help me! I want to call it quits and run back to my support groups where I was loved.


A Response to This Case Study

It is natural and normal to be somewhat hurt when anyone informs us that they don't approve of our conduct. Most humans have a strong desire for acceptance and to feel a sense of belonging with others. When criticized for our choices in substance use, we always have a choice to process what has been stated about us with an open mind or reject it upon contact. This often depends upon the circumstances and how it was stated. In your situation, what stands out most to me is your behavior and your confusion by the actions of your group members.

When anyone first enters into a group experience, one major concern can be: "Will I be accepted for who I am by the group members?" This would be a normal thought process for anyone entering into any new group situation -- the basic human need to belong and to feel welcomed is an ongoing process throughout life. However, a major therapeutic aspect of the group process is that you are there to work on your own issues and concerns and to conduct yourself in an open and honest manner. Only then is it possible for the individual to be open to developing cognitive and behavioral changes -- not only in the group but in their life more broadly. This is never easy! Actual change is very difficult and in order for change to take place the individual must have hope in the group-therapeutic process.

From your statement, your confusion and reaction may be in part due to your expectations of what group psychotherapy is. So first let's start by giving you a clear understanding of what group psychotherapy is.

The Group Experience

Everyone in your group is there to work on issues and concerns that affect their mental health, and they should have a sense of hope about this form of therapy. The psychologist who is your group leader has taken your unique situations into account in forming this particular group. However this is not an HIV support group (although it can be supportive). It is a working therapeutic group groomed toward developing insight through processing individual problems within a group dynamic. As your time with this group continues, you are going to be faced with important and sometimes very painful issues related to group process; it is not intended to be experienced in the same way a support group would be. Ultimately, by coming more aware of your own issues within the group, you will be better able to deal with the conflicts you face in the broader environment of your life. With that stated, let's break down your group a little more.

If it is like most groups, your group is likely to be a pre-selected, time-specified, closed group that meets on a weekly routine during a scheduled time slot to talk, interact and discuss problems within the group. Groups can be run by various mental health professionals, such as psychologists or certified social workers, and usually include from 8 to 12 people. Its purpose is to give you and the other individuals in your group a safe place where they can work out individual problems and emotional issues that brought you and the others to seek out psychotherapy in the first place. Hopefully within this process you and the other members gain insight into your own thoughts and behaviors, while also offering suggestions, impart information and give direct advice to others members within the group. In addition, members who have poor social skills can benefit from the social interactions that constitute a basic part of the group therapy experience. Members can learn new socialization techniques and ways of expressing their feeling by watching others and learning from them.

Understanding Your Own Participation

Please consider your past actions and be prepared to discuss these thoughts within the group in the following weeks. There is a danger to engaging with members outside of the group setting to discuss group issues. This is often counterproductive! Your concerns should be directed back to the group -- that's where the real work starts. Over the course of each week, attempt to process what was stated and how you reacted and why you reacted in the way you did. Was your conduct in anyway reflective of your actions within your life? It is quite normal in any group or relationships with people to have what is called a "honeymoon period." When groups first form people usually are on their best behavior, but in time people's true colors do show themselves -- that may be why you thought that the first month was OK. Now the honeymoon period is over, as it would be in any true relationship with people in life, and here is where the work really begins.

Your group leader is not there to defend you or for you to become more dependent on him, and you should not look to him for your answers. He is there to lead the group in a direction where group members may explore the concerns that are affecting them as individual. Although I was not present in your group, it is my assumption that you were not attacked. A group member told you of her own observation, and that's all it was. Could it be that this statement has been directed to you before or that there maybe some truth in what she stated, and thus you overreacted?

Recreational drugs and how we deal with HIV progression is an important area that can and should be addressed. For most people in your group, this would be a real issue. It is not easy to be an older member in any society or psychotherapy group and to listen with an open mind to a younger member's observations on their behavior. However, you should also be aware of other's feelings and their comfort zone, and be open to addressing the choices you make about drug use.

In conclusion all of your feelings of rejection, anger, confusion and resentment, should be directed back in the group where you can gain greater insight and focus on your emotions. Your feelings towards the person who criticized you, as well as your split-second reaction, should also be addressed. Her statements may indicate that it was fueled by jealousy as you have suggested or it maybe out of genuine concern for your actual drug use. Regardless if her observations were true or not, your first reaction was to attack back with words and in behaviors that were meant to hurt her. If you can honestly consider what was stated this maybe an encouraging indication that group psychotherapy, in the long run, maybe a very positive experience for you. However, you must be open to it as a therapeutic process and be honest about yourself with other members. Please consider staying with the group and following this process with hope. It may seem for you natural to want to "run away" but I would ask you to reconsider this action.

Good Luck!

Group Psychotherapy vs. Self-Help/Support Groups

Group Psychotherapy

  1. The leader is a mental health professional

  2. Members are selected (closed group)

  3. Group membership is limited in size

  4. Group meets a limited number of times

  5. Some form of payment required

  6. Socializing outside of group is restricted (i.e., no "sub-grouping")

  7. Rules are based on membership and therapist agreement

  8. Enforcement of rules of confidentiality

  9. Expectations and solution based on membership agreement

  10. Groups are based on individual client participation

Self-Help/Support Groups

  1. Leader is not always a mental health professional

  2. There is no real membership, with participants coming and going (open group)

  3. Group membership is unlimited in size, depending on need

  4. Group meets for indefinite period of time

  5. There is usually no payment, maybe just a voluntary donation

  6. People interact on all levels outside the group

  7. Rules may or may not be enforced, depending on the group

  8. Rules can be created based on past history and by present members

  9. The expectation is "for life" or "as needed" depending on circumstances

  10. Clients can remain quiet, such as by passing or remaining silent

  11. Confidential rules can be broken with no consequences, depending on the group

J. Buzz von OrnsteinerJ. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column.

This article was provided by Body Positive. It is a part of the publication Body Positive.
See Also
10 Things You Can Do to Enhance Your Emotional Well-Being
More on Support Groups for Coping With HIV