Group therapy is when about 3-12 clients, who do not know each other outside of the therapy setting, meet weekly with a therapist to participate in a therapeutic experience that is designed for individual enrichment. Group therapy can address issues that are as broad as the human experience or as narrow as a specific, shared symptom. Interventions range from psychoeducation to observations of how individuals interact with others in the here-and-now intimacy of a group. This allows for therapists to repair interpersonal challenges that often developed in a person’s family of origin and that currently impact interpersonal relationships. It is common for clients in individual therapy for body focused repetitive behaviors, such as skin picking and trichotillomania, to want to improve personal relationships. Group therapy is a faster, cheaper way to help clients develop the ability to connect with, hear, and trust others.
The most common question, is “Why would someone subject themselves to talking about their deepest secrets with a group full of strangers?!?” Conversely, clients sometimes ask, “Why would I want to listen to other people’s problems? Wouldn’t that just make me feel worse?” In both cases, the answer is that group therapy is an opportunity for clients to identify with what is universal about their life experiences, to reduce feelings of shame, and to develop resilience by witnessing resilience in how others work through shared life experiences.
Most of us are impacted by real stories of real people. It is easy to dismiss statistics or platitudes as further examples that most people do not understand our experiences. In group therapy, clients are inevitably in different stages of their recovery from mutual symptoms. Getting to know someone who doesn’t pick their skin anymore or someone who hasn’t pulled their hair in months can show that it is possible. Even seeing others make degrees of progress can inspire clients to change. And when setbacks happen, which is normal, clients get to see someone show up anyway, instead of hiding in shame. They also see clients who have setbacks receive acceptance from the group. Watching others slip and then get back on track shows group members that not only can they recover from regression, but they can confidently follow examples of people who have been through it before them and achieved those goals. While some aspects of personal growth are individual, and not every strategy works for every person, witnessing the way others they have grown to know well in therapy have navigated the journey can help motivate participants without pressure. Alternatively, reading success stories of someone on the internet can sometimes backfire, making a person feel worse because there is no true witnessing of real-time life struggles that have led to success.
Universality is especially important for clients with BFRBs, such as Skin Picking Disorder and Trichotillomania (Hair Pulling Disorder). Clients tend to feel so alone, isolated, and ashamed, as if they are the only people who pick or pull. Clients can believe they are gross and that no one would accept them if they really knew the nitty gritty details of their picking and pulling rituals. Group therapy shows clients that they are not, in fact, alone.
When I meet a new picker or puller, I am quick to reassure them, saying “Nope! What you are describing is all standard BFRB stuff!” However, it feels so much better and more believable to hear it from a room full of people who are in their own process towards recovery than to hear from just one therapist who you paid to discuss it. Not only do others pick and pull, they like doing it, and many even eat it! Instead of judging others or feeling shame, clients quickly sigh relief and start laughing at themselves. A handful of “me too’s” is a great antidote for shame.
This is what some new-to-group clients expect from group. They imagine it as a classroom or a workshop setting. I have even started new groups very much in that form, giving clients a chance to build comfort with each other and develop a common language before diving in with vulnerable information. I am a proponent of psychoeducation in counseling. While coming to new insights and solutions organically can happen and is quite powerful, some things can simply be answered or addressed with suggestions of things to try.
An example would be information about what is known to be true, based on research about trichotillomania. Other examples might be what strategies are helpful in the car for picking and pulling, what is the ABC method of managing skin picking disorder, etc. Group is a great environment for these questions to come up and to learn information about the disorder. Other participants ask questions you might not even think to ask, which is where that group setting element is helpful. When someone thinks to ask a question or build on someone else’s point, the information becomes available to everyone in the group. Cognitive Behavior Therapy and other methods shown to be helpful for skin picking and hair pulling have many informational elements that function well in a group therapy setting.
It feels good to help others. When it comes to secretive behaviors as skin picking and hair pulling, it is rare to get such an opportunity “in the wild.” A sense of purpose is developed when a person can turn their suffering into much needed help for others. Clients don’t have to be perfect or even in recovery to be helpful. I watch group members help each other each week, the receiver gets wisdom and/or comfort. The helper gets a sense of pride, competence, and meaning, as they were able to have a positive impact on someone’s helplessness, worthlessness, and shame. Shame for both participants starts to dissolve. Sometimes it is specific advice or lessons learned the hard way. More often, it is a heartfelt disclosure, a moment of being real, without the intent of actually affecting others, that lands just right on the ears of the person that needed that message the most.
You can read about social skills and watch how-to videos, but lasting learning comes from practicing social skills first-hand. Group Therapy is a safe setting to work at building relationships with others and to interact awkwardly with opportunities for second chances. Practice communicating badly, without judgment, as you develop grace and tact. We discuss social elements from “real life” and curiously link them to patterns seen in “real time” during group. Are you using passive behaviors at the office and resentfully ruminating while pulling hair at night? Group is a great place to learn about assertiveness, among other social skills, and to practice actually asking for what you need directly from others in the room. Group therapy will provide the support of the therapist and other members, whom understand you, are also worried about being accepted themselves, and want you to succeed. Everyone involved will have the opportunity to experiment with new behaviors without fearing rejection.
Failure is an excellent teacher, but so is success. Corrective experiences come up in therapy in so many contexts. For example, most of us have had a relationship end unexpectedly and in an ambiguous way. Having a relationship end in a therapy setting, such as a group member finishing and saying goodbye, allows us to have a healthy goodbye. It’s not a big a major life loss, but just a meaningful enough grief to provide an opportunity to learn how to experience healthy closure as a personal relationship ends.
Also, boundary-setting is a huge corrective relational experience in group therapy. How often in your childhood and current life are you wishing you could ask for your needs to be met? Or express feelings of resentment over non-reciprocated support? It can become a default reaction to freeze instead of speaking up, speak in a way that others can ignore, or get stuck in situations in which your boundaries are habitually not respected. In group therapy, especially in groups for BFRBs, group members are encouraged to practice their assertiveness skills in real time and set boundaries.
Participants learn what it is like for the group to hear and respect such needs so that they can learn to project self-worth outside of the group. It is a safe setting to learn to do this for the first time, to do it badly, and to tiptoe and stumble until you figure it out. Wouldn’t it feel nice to suddenly find yourself asking for what you need at home and at work! You might find it’s not nearly as scary as you once imagined. In fact, the new way of communicating could reduce anxiety and drama in your everyday life. Less anxiety and less drama can help you cope with less skin picking and hair pulling! There are so many subtle ways that interpersonal dynamics influence BFRBs, which can be shifted towards health in group therapy.
One of the key differences between group and individual therapy is the social microcosm. In individual therapy, you may retell stories from social interactions and some may be seen between you and the therapist. Ultimately the therapist has to guess at some level what is observed and thought by the other parties involved. In group, there are enough other personalities participating that relationship dynamics that you struggle with at home, work, with friends, or even within your family will start to evolve amongst the group members. But instead of seeing that tension lead to screaming matches across the dining room or avoidance and political games of the office, you get to discuss what is happening in a mature fashion. Let’s be honest, most of us have picked or pulled when mulling those events over! Learn how you contribute to these patterns and identify what triggers are shifting you away from making choices that are in your best adult interest.
Group therapy helps with so many issues, even beyond mental illness, and improves general wellness and relationship health. At Courage Counseling, our groups are specifically for adults who are living with a BFRB (Body Focused Repetitive Behavior) such as skin picking, trichotillomania, and nail/cheek/skin biting.
If you believe you may benefit for any of the reasons above, please contact me today to learn more about joining a therapy group!