Which therapy — group or one-on-one — suits your needs?
The choice often comes down to what is affordable and available to you
I don’t like group therapies. I cannot take them seriously. In the past, when I would join one, I’d inevitably imagine all of us as if we were in the movies. It was just a matter of time before some bejeweled Stevie Nickstype with wet eyes would get up and run out after being offended by someone — a snarling Goth — who had questioned her gluten-free lifestyle.
I’ve taken a harm-reduction group and an after-care group for addictions. Afterwards, I’d write down things that struck me as funny — research for a book I told myself — instead of doing (ridiculous, I thought) homework: “Write a letter to your sober self.”
So that’s me but there were people in both of those groups who were taking the therapies seriously and who showed improvement — I was the only person who didn’t graduate from the harm-reduction group; the others were able to curb their drinking significantly.
I don’t hate all group settings: I attend 12-step meetings. But those meetings are not therapy; there’s no facilitator and it’s really frowned upon to “crosstalk,” in other words, commenting on something someone just shared.
One form of group therapies are the ones that help people deal with unexpected events that cause deep mental distress such as death, or cancer diagnosis — it can be really isolating to try to manage with trauma on your own.
Other group therapies focus on specific mental-health problems such as depression, substance abuse, or social anxiety.
According to the 2013 study Psychologi- cal Group-Treatments of Social Anxiety Disorder (SAD): A Meta-Analysis by Pim Cuijpers and others, it was found that group therapies were more effective than individual therapies when treating SAD. The groups analyzed relied on Cognitive Behavioural Therapy (CBT) model — a type of therapy that modifies your ways of thinking and behaving through talking and designing ways of dealing with a problem (for example, designing a worksheet outlining relaxing techniques). It was the interaction between the members that was found especially effective — the patients were able to practice in a safe setting before going out into the world.
According to the Canadian Association for Mental Health (CAMH), group therapies last from 20 to 50 minutes and involve “following clear goals you have dis- cussed and decided on with your therapist.”
Different sizes of groups offer different advantages: with smaller groups, there’s more time to share but large groups “offer greater diversity and more perspective,” according to the American Psychology Association.
There are strict agenda-based groups and, in other groups, you talk about the issues that come up in the previous sessions.
The interactions with others allow members to receive feedback to things they share and that includes encouragement and challenging — the snarling Goth situation did happen at one group setting I attended (no, it wasn’t me).
With time, the people in the group become familiar to each other, and feel safe enough to use each other as additional supports outside of the setting of the group. In my 12-step meetings — as much of an unapologetic non-joiner I am — I have made some amazing friends and we’re there for each other when the going gets tough. At the same time, I had a friend who hated her cancer-support group because of the people who kept calling the disease a “gift.” She quit. This is the side-effect of all groups: people will irritate you and if they irritate more than help, perhaps individual therapy is where it’s at.
A more intimate, one-on-one relationship with a therapist allows for more in-depth feedback about the mental-health issues. In a psychodynamic therapy, for example, the focus is on understanding how past behaviour influences the present— this is so the patient becomes able to arrive at a deeper level of self-awareness. This kind of therapy is usually longer and less structured. An individual CBT therapy would last from eight to 20 sessions and the therapist serves the same role she would serve in a group setting so the individual relationship is not that important but when I did it, years ago, it was the attention of the psychiatrist that made all the difference.
The assessing clinician should help you pick the right size and the type of therapy that would benefit you — this person has to “have education and experience dealing with your kinds of issues, and is someone whom you can trust and respect,” according to CAMH.
Dilys Elizabeth Haner, a PhD candidate in clinical developmental psychology, says, “Unfortunately, a lot of the time, the ‘choice’ (of therapy) comes down to what is affordable and available.
“We do know that for some types of issues, group therapy is iatrogenic, that is, tends to make the problem worse,” she adds. “For example, adolescent girls with anorexia don’t tend to do well with group therapy, as they can start to compete with each other to be the most successful at having an eating disorder. So in those clear-cut cases, individual therapy would be recommended. With so many other cases, it usually comes down to what’s available and affordable.”
Jowita Bydlowska is the author of Drunk Mom, a memoir. She is writing a series of columns on mental health.