Do I have to do group therapy?
It’s not everyone’s cup of tea. Or they don’t think it is at the beginning. The idea of addressing mental health concerns through group therapy or group-based intensive programs like our partial hospitalization program [link] can feel intimidating, uncomfortable, or just not helpful. But research shows that group therapy is just as effective as individual therapy (or better!), and it can mean getting into treatment more quickly.
Read on to learn why you should consider group treatment, and how to make the most of it.
What the data says
Numerous reports show that group therapy is as effective as individual therapy for many mental health conditions, including depression and anxiety. One analysis of 67 studies found that there “were no differences between formats for rates of treatment acceptance, dropout, remission, and improvement. Additionally, there were no differences in outcome between formats by patient diagnosis.”
Group therapy is also efficient. By one estimate, meeting just 10% of the need for mental health support in the US through group therapy would allow 3.5 million more Americans to access services.
Our experience
At Alaska Behavioral Health, group therapy has helped speed up access to care. When clients are able to get mental health care as soon as they realize they need it, they tend to get better faster, stay in treatment for shorter periods, and discharge sooner. It’s a positive feedback loop: good for the client and good for the community: a spot opens sooner for another new client.
In Anchorage, our adult partial hospitalization program offers intensive, short-term treatment in a group setting. This is appropriate for clients who are severely distressed or have chronic symptoms and haven’t made progress with outpatient therapy. With same day or next-day access, this can be appropriate follow up for someone who has visited the ER because of the severity of their symptoms.
One client’s path
Zach recently graduated from PHP and offered to share his story – in hopes others would find and get help sooner than he did. He’s 36 years old and estimates he’d been “missing out” on aspects of his life due to mental health issues for a good 15 years.
Born and raised in Alaska, he graduated from UAA and has worked a series of jobs, often seasonal, or staying only a year or so, not really progressing in a career, or in life.
“I couldn’t really keep attention with some of the things I was doing. And I just kind of felt frustrated with kind of everything in the world, but felt like I had never, you know, gotten the proper medical attention for it, essentially.”
He’d tried outpatient therapy and didn’t find it helpful. He’d had a misdiagnosis at one point and got put on medication that he didn’t like. After that experience, he’d decided what he thought was going on, and self-medicated with alcohol, food, caffeine, behaviors. At some point, excessive purchasing was a way to get a dopamine rush.
With help from his family, he learned about the PHP program, and was ready to try something new.
After speaking with Zach and our staff, we came up with these tips for making the most out of group treatment.
How can I make the most out of a group treatment program?
Take time to get a diagnosis you trust.
After his previous diagnosis and medication experience, Z needed to spend the time to feel confident in his providers and their diagnosis. With his PHP clinician, he figured out, as he puts it, “What I’m struggling with that might be different than the average person.”
Take advantage of access to a psychiatric prescriber.
“The biggest thing was just regaining the trust of a doctor that would prescribe me medication based off of the things I was saying, not just kind of a snap diagnosis.”
Working with one of AKBH’s providers, Zach quickly found a medication that really helped.
The PHP program includes at least once weekly appointments with a prescriber, so that clients and providers can check in often, talk about what is working, and make quick adjustments if needed. Not all PHP clients utilize medication as part of their treatment; they still meet with a prescriber to discuss symptoms and solutions.
Give it time.
“At first, I really didn’t like it. I really did not like how it was going. I did not like the group dynamic of it. ” – Zach
PHP Clinician Mara Jones says probably about half of the clients who come to PHP want to get better, and want to get help, but aren’t really sold on group therapy. “It’s an open group, we have clients joining at all times. So we’re not curating the group that is there. They have different life experiences, they are from different walks of life. But at the end of the day, they are all dealing with anxiety, depression, trauma that is affecting their lives.”
The basic skills taught in the program are the same for all clients, but staff work with clients to help them see how they apply to their situation. Zach says working with staff helped him “turn PHP into something that would work better” for him. They met with him before group began in the mornings to help him work on some of his individual needs.
“And that combined with medication created a kind of a situation where I was what I would call back in control of the hopelessness.”
But then he had some work to do:
“You know, having gone so long without the medication, where that put my mindset and how to build back out of that mindset is also a part of it that I learned.”
So he made a conscious decision to get as much as he could out of the group curriculum that was being taught.
Engage with the curriculum.
Not every moment will feel relevant for you, Zach says. Sometimes other participants may go off on a tangent for a while that doesn’t feel important and maybe feels annoying. Learning to accept that was one of his most valuable lessons.
One of the biggest things I learned in the class was just because you accept something doesn’t mean you approve of it. And so I just told myself, I accept this, but like, I still don’t approve of how that person’s acting or whatever.
By the end of the class, he would color or doodle through those times, not letting them get under his skin.
One theme that was helpful for him was thinking about the cognitive triangle: thoughts, feelings, and behaviors – what he can control, and what he can’t.
“And just the relationship between the three of them and how the two pillars you can control, your thoughts and your actions, those two, but your feelings or your emotions, you can’t really. Just being able to kind of understand that relationship between those has helped a lot.”
Practice.
It’s like sports – the more you practice your coping skills, the more automatic they become.
That concept of focusing on what he can control? Zach had tried to work on that himself for years but wasn’t quite able to make the changes himself.
“Learning what they taught in the class and gone through the coursework and then having the ability to implement it much easier kind of just told me that like, okay, that coursework was effective.”
The PHP group practices different mindfulness techniques: meditation, journaling, art project – and helps clients think about how to attach that to an existing habit, such as taking 10 minutes to journal while you eat breakfast. They think about creating small routines for situations that are typically stressful, like the transition from work to home at the end of the day.
It Works.
Zach was motivated, and by really digging into the curriculum, he was able to make changes quickly.
Overall, in general, in almost all aspects of my life, I’m less annoyed by just about everything, just through kind of coping mechanisms that I was able to learn in those three weeks.
Clinician Mara Jones says it may not happen that quickly for everyone, but before clients finish the program, staff want to see that clients are practicing the skills learned and have stabilized enough to step down from daily group to outpatient therapy once or twice a week. “I want them to see that there is some hope and create some momentum that propels them in outpatient care.”
Jones says some clients think they haven’t made progress, but the team looks at data to show them they have. They take assessments regularly, like the GAD-7 for anxiety or the PHQ 9 for depression. “We can point out the shifts over their time in PHP, we can point out the changes in their daily habits that are helping, and that is really motivating.”
Access Services
Alaska Behavioral Health’s PHP is offered in person in Anchorage, with rolling admissions. Clients are often able to start the same day or the day after an assessment. If you’re motivated to make some changes in your life, call us today at 907-563-1000.
