How Are You Maintaining Therapy Groups In Your Work Settings?
Suzanne Cohen, EdD, CGP, FAGPA

I am a psychologist and have been in private practice for more than 20 years. I currently run two psychotherapy groups—one since 1974, and the other since 1986. I also ran two time-limited groups (nine months and two years) with a psychiatrist co-leader between 1995 and 1998. Referrals for these groups came from our practices, as well as from local colleagues.

I feel very fortunate to lead two wonderful groups. The number of members waxes and wanes, but my enthusiasm and commitment to these patients remains undaunted. Currently, both groups have six members, and the median lengths of stay are four and seven years.

I carefully evaluate and prepare individuals for my groups. Dropouts and premature terminations are rare. Three-quarters of the members come from my individual and couples therapy practice. If I accept someone into my group who is in individual therapy elsewhere, I make sure that I have a good relationship with that therapist and that he/she unequivocally supports group participation. I maintain regular contact with the other therapist and see the group patient monthly on an individual basis. I use these sessions to discuss fears and resistances related to group issues, thereby helping the patient to use the group more effectively. Each member explicitly agrees that material from individual sessions will be discussed in the group.

In addition to my commitment to my groups and patients, I actively participate in the local group therapy community in leadership and teaching roles. I supervise groups at two agencies, participating in the care of patients very different from those in my private practice. My work as a supervisor also exposes me to a wide variety of group formats including psychoeducational and dialectical behavioral. I also participate in a peer consultation group that provides support and serves as the core of my referral network. All these activities help broaden my appreciation of the breadth and scope of the group modality. Maintaining my enthusiasm for group therapy and being willing to share it are two keys underlying the success of my groups.

Barry Helfmann, PsyD, CGP, FAGPA
I have been in full-time private practice leading four or five groups for the last 25 years. All my groups are adult and are psychodynamically based. I am the managing partner of a group practice that consists of 15 psychologists. I lead all the adult groups. We also have two adolescent and 10 child play therapy groups led by other therapists.

While the groups are thriving in our practice, things are clearly more difficult for those therapists who want to build a group subspecialty. Patients currently are staying for shorter treatment durations than in the past. Many of my new patients often stay between 12 and 24 months. Previously, most patients stayed for a considerably longer period of treatment. This requires a greater number of referrals than were needed before, even as recently as five years ago. It also makes for greater comings and goings and a feeling of less stability in the group. While I believe that the same dynamic is operating in individual therapy, it has obvious different implications for group. Almost all of my colleagues who I speak to around the country report that they are doing fewer groups than in the past, or none at all.

But there is some good news. I have found that other therapists (outside of my group) are referring more of their individual patients to me for group. This is becoming similar to the way it used to be. I believe that as managed care has lessened in our area, therapists are not so afraid to refer their patients out. Psychiatrists, in particular, are referring patients for group whom they are medicating.

One of the things that I do is to continue to maintain good professional relationships with colleagues in the community. I am often called for advice or help, which I try to provide if I can. I continue to be actively involved in my local professional area and in the national scene through AGPA and the Registry. People from other parts of the country will refer someone coming to my area as I do. With authorization, I keep the individual therapist informed about his or her patient in group when issues arise that I believe they need to be informed about. This working together attitude is good clinical practice and referral maintenance as well.

If one is able to be viewed as cooperative and competent, then the ability to develop and maintain groups is greatly enhanced. I believe that groups require more of this effort in today's world if one is committed to doing such groups.

This article was published in the October/November 2002 issue of The Group Solution.