Building a Foundation: Group Therapy Constructed on the Holding Environment and a Brave Space
Anna Kusiak
The George Washington University
Abstract
This reflective analysis examines the foundational role of the “holding environment,” as conceptualized by Donald Winnicott (1960, 1965), in fostering therapeutic effectiveness through cohesion within group psychotherapy. Drawing from a formative experience as a novice Mental Health Specialist leading a psychiatric inpatient group, the paper examines the challenges of facilitating meaningful engagement in the absence of psychological safety and structure. Integrating group therapy scholarship from Irvin Yalom and contemporary vulnerability research by Brené Brown, psychodynamic theory bridges with the concept of a “brave space” as an extension of the holding environment. The six pillars of a brave space – vulnerability, perspective taking, leaning into fear, critical thinking, examining intentions, and mindfulness – are presented as practical mechanisms through which therapy facilitators can cultivate emotional containment while encouraging authentic and timely risk-taking. Without the establishment of both a holding environment and a brave space, group cohesion remains unlikely, regardless of participant composition or facilitator intention. Ultimately, this paper contends that therapeutic groups thrive when leaders intentionally construct environments characterized by consistency, empathy, attunement, and clear boundaries, transforming interactions that may otherwise feel transactional, fruitless, or even harmful into spaces capable of supporting vulnerability, connection, and growth.
Keywords: group, cohesion, holding environment, brave space, inpatient
Introduction
The summer after my junior year of college, I got a job as a Mental Health Specialist in a psychiatric hospital in Massachusetts. I struggled with imposter syndrome regarding nearly every responsibility the job required. How could I, still a year from receiving my bachelor’s degree, possibly provide any form of counseling that could be truly beneficial for these patients with serious mental health issues? Up until my first shift, my understanding of psychiatric disorders, for the most part, was what I had read in my textbooks. I would quickly come to learn that the somewhat two-dimensional, often culturally incompetent descriptions (to be frank) I had worked to memorize for my undergraduate exams would do much less to help me understand the lived experiences of my patients than I had hoped.
The feeling of being an imposter became most intense when I found myself leading a group therapy session for the first time. The group itself was called Daily Planning: a way to help patients, especially those who had been recently admitted to the unit, set up their day, set a goal, and ask any questions they may have had about the schedule or what to expect from their care team. I briefly shared my name, went over that day’s offered activities, and then opened the group for comments or questions. Though there were six people present in the group, they were noticeably disconnected from one another. They were each waiting for their turn to share their goal or ask a question, and when they weren’t sharing, many were on their phone or otherwise exhibiting some level of disengagement. Most patients shared little more than ten seconds worth of dialogue. I was too nervous and hyper-focused on making sure I answered each question accurately based on the hospital schedule I had memorized to address the noticeable lack of cohesion. As I now know, cohesion within a group therapy session is of paramount importance – it consistently and significantly contributes to positive outcome (Yalom & Leszcz, 2020). I left the group feeling somewhat dejected, expecting the rest of the group members probably did too. In looking back on my first experience as a group facilitator, I realize that, because I provided no foundation for the group members to feel safe and comfortable enough to risk any real vulnerability, their disengagement was almost inevitable.
The Holding Environment
Donald Winnicott (1960, 1965) introduced the term “holding environment” in connection to the mother-infant relationship. His theory compares the practice of mothers holding their children to the environment that therapists and clinicians should create for their patients – one that is warm, safe, and comforting (Winnicott, 1965). In its most basic form, the holding environment explains that infants’ healthy growth is related to the presence of a “good enough” mother (Bahn, 2022; Winnicott, 1965). In infancy, mothers provide a safe environment to address their babies’ needs; the “good enough mother” will tend to her child’s needs adequately but not perfectly, which will allow the child to manage frustration in a setting they understand to be safe (Winnicott, 1965). As these experiences repeat, children will internalize their mothers’ holding capacity and develop independence and the ability to self-regulate in stressful situations (Bahn, 2022; Winnicott, 1965). Similarly, successful therapists provide a supportive atmosphere for their patients to navigate and process difficult emotions and eventually move towards autonomy. According to Biscontini (2024), Winnicott emphasizes that this caring and sympathetic relationship is crucial for change and healing. Though Winnicott (1965) himself never directly applied his ideas to group psychotherapy, psychologists like Irvin Yalom and S.H. Foulkes later brought his theories into the context and practice of group therapy dynamics.
So how is the holding environment put into practice within a group therapy session? First, the group facilitators must be consistent and reliable. They have to engage with both themselves and with the other group members in a compassionate and empathetic way. They must provide a sense of stability for their group members (Biscontini, 2024). The group leader should provide emotional space for the group members, being careful to not be overly directive or overwhelming (Biscontini, 2024). This echoes Winnicott’s (1965) concept of the “good enough mother” – responsive and present but not invasive or controlling. Without proper holding, the group members may be unable to be wholly authentic, emotionally shutting down or hiding behind a false self (Winnicott, 1960, 1965). Even worse, members may feel abandoned, exposed, or potentially even retraumatized when sharing about deeply personal topics. When the group feels unsafe, or members feel a sense of chaos or invalidation, this may result in the enactment of old relational wounds (Yalom & Leszcz, 2020).
A Brave Space
Though the necessity of a “safe space” is often emphasized in creating both a holding environment and group cohesion within a group psychotherapy context, it does not fully account for the impact of power dynamics within the group (Brown, 2022). For some, no group space may ever feel entirely safe. But that might not be fatal to the group dynamic. Researcher Brené Brown advocates for what she calls a “brave space,” which prioritizes vulnerability rather than protection. A brave space will encourage group members to lean into difference and discomfort in order to speak openly about individual experience and worldview. In addition, Brown (2022) defines the difference: “To call people into a brave space was to summon everyone to try something together. To promise people a safe space was to make everyone a promise about everyone else. And that’s impossible to keep” (Ross, 2021, as cited in Brown, 2022).
It was Stubbs (2019) who developed six pillars of a brave space based on Brown’s concept: vulnerability, perspective taking, leaning into fear, critical thinking, examining intentions, and mindfulness. Vulnerability is “the birthplace of innovation, creativity, learning, accountability” (Brown, 2022, as cited in Stubbs, 2019) that happens when group members ask questions about what they do not understand and share their personal story to provide context for their comments. Perspective taking is acknowledging the lived experience of others in the group as their own truth, and in an attempt to better understand each group member, “listening to understand instead of listening to respond”. According to Stubbs (2019), leaning into fear is the idea of reframing our mindset about a nerve-wracking situation (within the group) that we may prefer to avoid as instead providing an opportunity for growth. Taking the risk of leaning into difficult conversations is crucial to both group cohesion as well as personal growth. Critical thinking is being open-minded to the idea that our own thoughts may be limited, and thus experiencing criticism not as a personal attack, but as a way to broaden and further develop our thinking. Examining intentions is a way of checking boundaries, asking if we are sharing for the purpose of furthering dialogue or rather in a way that is self-serving. This is a way to remain accountable for what we each bring to the group and pushing ourselves to always operate from a place of personal integrity. And finally, mindfulness is the active practice of remaining present within the group; by slowing down and acknowledging our internal dialogue and emotions in a non-emotional way, we can consciously work to “be in the moment with intention” (Stubbs, 2019, p. 1). When the formulation of a brave space begins by framing the group culture within a set of clear norms, boundaries, and expectations, the group members are able to look back on this set of guidelines if they find themselves on the edge of a rupture.
Implementation Within The Group Setting
In my view, the holding environment serves as the indispensable structural foundation upon which a brave space must be constructed. I argue that without the primary containment and emotional safety offered by a holding environment, the interpersonal risk-taking demanded by a brave space becomes unattainable, feeling less like an opportunity for growth and more like a potentially retraumatizing exposure. In my theoretical conceptualization, both frameworks require that the facilitator actively offer presence, empathy, emotional attunement, transparency, and dependable boundaries. Only when a clinician first constructs a reliable holding environment can participants feel grounded enough to step into a brave space and take the emotional risks necessary for genuine connection.
So, with the holding environment and a brave space in mind, I would have framed my first group, Daily Planning, quite differently. Of course, even if I had, at the time, been familiar with and experienced in the holding environment and a brave space, that would not have meant that the group dynamic would be successful for each member. There were other significant factors affecting the potential outcome. The groups on the unit were optional, which meant that every day a different number and assortment of patients would show up. According to An and Kivlighan (2023), members of more cohesive group therapy groups are more likely to consistently attend sessions.
There was also no separation of group members based on diagnosis or clinical goals. In this open inpatient psychiatric setting, any patient admitted to the milieu was automatically invited to attend group sessions without prior assessment or clinical stratification. This open-door model creates an inherent systemic challenge: standard group psychotherapy literature asserts that cohesion is far less likely to develop without intentional pre-group screening (Yalom & Leszcz, 2020). In traditional outpatient psychotherapy, Yalom and Leszcz (2020) argue that clients should be screened out if they are likely to struggle with fundamental group tasks such as self-exploration, self-disclosure, or mutual respect – whether due to acute psychosis, severe cognitive impairment, lack of psychological mindedness, or motivational deficits. In an inpatient unit, however, facilitators cannot screen out acute or incompatible patients; individuals with active mania, profound depression, severe trauma, or acute psychosis are placed into the same circle. When patients are admitted without tailored screening, the facilitator cannot rely on diagnostic alignment or shared readiness to create safety. Instead, the responsibility falls entirely on the clinician to provide immediate, real-time containment and active boundary management so that the vast differences in acuity and functioning do not derail group safety or lead to relational ruptures.
Another important factor was that I was also inexperienced in facilitating a group at the time. The learning curve in leading group therapy sessions is steep, and I was at the bottom of that curve. Fostering cohesion requires several core conditions: consistent membership, intentional group composition, clear group norms, structured emotional containment, and an attuned facilitator capable of navigating interpersonal conflict. Because so many of these stabilizing variables – stable attendance, pre-group screening, and seasoned facilitation – were absent on the unit, fully realized group cohesion was structurally improbable.
Conclusion
Many factors can make group therapy less or more effective. However, cohesion within group therapy seems extremely unlikely without the development of the holding environment and the brave space, even following a thorough selection process by an experienced group leader. The holding environment and brave space are the foundation on which any long-term successful group therapy session is built; without the implementation of both, the group cannot thrive. During my facilitation of Daily Planning that morning, years ago, the framework that I set for the group was close to nothing. Had I worked to set clearer and consistent expectations and boundaries, I may have set my patients up for a far more effective, safe, and in-depth experience of group therapy. Of course, it takes time to build trust, and creating an environment for patients/clients to feel comfortable is proven over time. But with consistent effort each day, Daily Planning likely would have transformed from a rather short, transactional question-asking session to a genuinely meaningful space for connection, authenticity, and vulnerability.
For novice doctoral students and early-career clinicians, this formative experience underscores several vital principles for group facilitation. Effective clinical practice requires prioritizing relational process over rigid agendas; psychological containment stems from the facilitator’s emotional presence and grounding rather than strict adherence to procedural checklists. Furthermore, clinicians must recognize that vulnerability cannot precede safety; expecting deep self-disclosure without first establishing clear holding norms risks premature exposure rather than genuine connection. In high-turnover or inpatient settings where screening is limited, facilitators cannot rely on ideal group composition, but must instead actively step into the role of the holding environment – setting firm boundaries and micro-norms that allow a brave space to organically take root.
References
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Bahn, G. H. (2022). Understanding of holding environment through the trajectory of Donald Woods Winnicott. Journal of the Korean Academy of Child and Adolescent Psychiatry, 33(4), 84–90. https://doi.org/10.5765/jkacap.220022
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