Wednesday, March 26, 2014

Gaining and Growing from Group Therapy

Group therapy can be a dynamic, productive adjunct to individual, couples or family therapy modalities. Group therapy can provide clients with the benefits of multiple perspectives, empathic support and the ability to practice relationship and conflict-management skills. Groups can provide an arena in which clients can re-enact, and thus repair, troublesome relationship patterns. Clients report finding the support and empathy offered by their cohorts in group to be a powerful source of healing. Clients who have difficulty trusting others can be challenged to practice boundary setting, emotional expression and appropriate testing of others. Groups generally fall into three categories.

PROCESSING GROUPS: These groups provide opportunities for members to gain insight, to develop healthy relationship skills, and obtain support and validation from others. Processing groups are generally led by a clinician, who helps to facilitate discussion, keep the treatment space safe, and guide the group when challenges arise. Groups may focus on a shared diagnosis (i.e., depression, trauma recovery, divorce recovery) or may be open to clients who are looking for an experience of safe sharing and support that can include a range of life topics, developmental issues and a focus on personal growth. These groups may meet for a set amount of weeks, or may be ongoing for as long as members wish to attend.

PSYCHOEDUCATIONAL GROUPS: These groups include a didactic, "teaching" format in which the clinician provides information and education to clients about a specific skill set. For example, dialectic behavioral therapy (DBT) offers members skills to regulate emotions, tolerate distress and learn to relate to others in healthier ways. In our practice, we have used bibliotherapy in a group setting, utilizing a book about growing up with an emotionally unhealthy mother to organize members around a common theme, provide skills and insights about how that experience impacted them, and to teach clients about resiliency, forgiveness and rebuilding. I've worked in groups of legally-involved young people to teach anger management skills. Psychoeducational groups may or may not include time for processing, sharing and relationship-building among members. These groups tend to be time-limited to the length of the course curriculum.

SUPPORT GROUPS: Twelve-Step groups like Alcoholics Anonymous, Al-Anon and Narcotics Anonymous may be some of the most well-known types of support groups. In these groups, members generally convene around a shared topic or concern (bereavement, addiction, a family member with mental illness) for purposes of gaining support, reducing isolation and learning effective methods of coping with their situation. Some support groups, like AA, are member-led and operate on an agreement of confidentiality for its members. Others, such as groups for family members of someone struggling with mental illness, may include a professional facilitator. Support groups are often free to attend and can be ongoing.

If you or your counselor think a group experience could provide you with unique insights or kick-start the pace of your treatment, seriously consider the benefits of group therapy. The Internet has listings of supportive, psychoeducational and process-oriented groups in your area. Just as trying a new exercise regimen can work out muscles that may have been missed by previous physical activity, group therapy can offer a new depth and breadth to your growth and healing.

Tuesday, March 18, 2014

Walking in the Garden of Grief

Loss is universal to human experience. We cannot live our days without saying "good-bye" to something, whether it be a person, an experience, a stage of life, or a feeling. And loss doesn't necessarily become easier to manage as we move through the lifespan. I've witnessed unbearable grief with a client mourning the loss of her 90-year-old father, who had lived a long and vibrant life. She reported that his advanced age only provided her with more joyous moments to miss, more time shared that she had to release to the past. I've cried with young children who have lost a pet, been uprooted by a move across country, and been forever changed by the death of a parent. Loss of jobs, family homes, precious mementos in a flood -- grief and letting go are practices we may try to avoid, but will find us wherever we hide.

Bidding farewell to one we have loved threatens to crush the life out of our barely-beating heart. Acknowledging a life dream that has died is as real a death as any other. In our modern culture, we have few models for effective grieving. While religious rituals may be helpful, often clients report the day-to-day living with their losses continues to be a struggle long after the loss is first experienced. And recent research suggests that grieving doesn't follow any formulaic process, as we once believed. Everyone experiences loss a bit differently, in different stages and directions, for vastly different periods of time. Time MAY help to ease the exquisite ache of a loss; for some, however, grief is the background for the rest of their days. Like the saying goes, "We won't make it out of here alive," nor will our journey through life be unmarked by loss, grief and sadness. But in our grieving is the imprint of our love for that departed soul, our joy for that stage of life, our pride in our accomplishments in that profession. Our grief mirrors our investment in living, a testament that proclaims "I was here. I loved, I created, I cared. I lived." A worthy epitaph, indeed.

Wednesday, March 12, 2014

Come to the Dark Side, Luke

In the modern era, psychologist Carl Jung popularized the concept that all human beings harbor "shadow selves", parts of ourselves that contain impulses, thoughts, actions and emotions that we label as "bad," destructive, unsavory, even humiliating. Archetypal psychologists reference sources from our Greek mythology to our cultural unconscious to highlight ways our "dark sides" inform our lives and the lenses through which we see the world. Most of us, though, are, at best, embarrassed of these shadowy selves and, at worst, terrified of what they mean about who we are. Even in the therapy room, both client and counselor focus on helping the client leave behind pathology, pain and bad habits. We encourage forward movement, an embracing of health, positive choices and productive insight. But much can be learned by studying, even welcoming, our shadows and the rich material that accompanies their energy.

What would summer be without winter as its counterpoint? How would we understand love and compassion without knowing callousness, fear and hatred? What we call "darkness" is a part of the continuum of human experience, and those shadows have as much to teach us as the lighter spots marked with joy, peace and freedom. Jealousy, for example, is a soul-cringing, corrosive feeling, a poison that curdles our stomachs all the while it is churning our hearts and minds into terrifying fantasies. And yet jealousy's presence also indicates a desire to be connected to another, to be known and safe and important to our beloved, the craving for consistency and certainty in our affairs of the heart. Certainly, we know there are no guarantees in life, much less relationships. But stopping to consider what these gut-grabbing emotions signal to us can bring us to a deeper ability to experience our humanness. It's our nature to avoid pain: touching a hot stove ONCE is enough for most of us, thank you. But perhaps not fleeing in the opposite direction every time we feel pain, shame, co-dependence or rage may be our best medicine. Accepting, even daring to embrace, the darkness within us brings us wisdom of a kind we can uncover in no other way. Our darkness will never fade. Better we learn, grow and deepen from it than continue to curse it. By acknowledging our shadows, we stretch ourselves to our true expanse -- an amazing greatness graced by the poles of emotion and experience, and the knowledge of ALL that it means to be human.

Wednesday, March 5, 2014

Shelving the "Shoulds"

Part of therapy is setting goals, helping clients clarify where they are heading and how to get there. So often, I hear clients recite a litany of behaviors, choices, attitudes and feelings they think they, or others, "should" be demonstrating or following. "I should work out more." "My spouse should appreciate me." "My boss should give me a raise." "I should be more patient with my kids." "I should be kinder, wiser, more flexible, less judgemental, more responsible, less fearful....." The lists of ways folks think they "should" be different can appear endless. But I remind clients that I have never met a "should" that's been helpful.

By design, "should" brings with it guilt and obligation, a reminder of the ways we have failed or fallen short. "Should" does not include the element of choice, of free will. Now, I ask clients, try replacing the word "should" with "could". The energy of these statements, and our feelings about them and ourselves, transforms dramatically. "I COULD work out more" embraces the possibility of a course of action -- it doesn't castigate me for not choosing that action. "My spouse could appreciate me" allows for the hope that gratitude for our part in the relationship can develop, rather than disparaging our spouse for behaviors he or she is NOT doing. The truth is, there are no universal "shoulds," no absolute rules about what an individual MUST do, feel or choose in order to be happy, healthy or at peace. When we put aside the judging, limiting tone of "should", we allow room for empowered choice and owned responsibility. Try it. You COULD find yourself feeling freer as a result.