Unique Meaning-Making Opportunities in Group Psychotherapy
Sarah King, BA
Department of Professional Psychology, George Washington University
Starting my sophomore year of college, I became fascinated with the study of meaning in life. Works by Viktor Frankl, Michael Steger, and Emily E. Smith allowed me to articulate for the first time why certain experiences, jobs, and hobbies felt more meaningful than others, and this felt deeply empowering. Now, in the first semester of my PsyD at George Washington University, I cannot help noticing how group psychotherapy is uniquely situated to foster meaning-making in ways that are distinct from individual therapy. Smith’s (2017) framework for meaning in life, detailing pillars of belonging, purpose, transcendence, and storytelling, shares notable overlap with Yalom and Leszcz’s (2020) group therapeutic factors of instillation of hope, universality, altruism, interpersonal learning, and group cohesiveness. Joyce and colleagues (2011) streamline Yalom and Leszcz’s (2020) eleven group therapeutic factors into four condensed group factors: instillation of hope, secure emotional awareness, awareness of relational impact, and social learning. These condensed factors reinforce the relevance of Smith’s (2017) pillars in conversations surrounding meaning-making in group given the clear links that can be drawn between them. Belonging, a pillar that emphasizes “mutual care,” reciprocity, and acceptance of self and others is inextricable from the instillation of hope factor which relies on a foundation of connectedness (Smith, 2017, p. 57; Joyce et al., 2011). So too, secure emotional expression involves storytelling, awareness of emotional impact intersects with transcendence, and social learning may inform a group member’s purpose in the therapeutic space. It is of note that while these pillars of meaning are conceptualized as distinct entities, there is significant cross-fertilization between them; for example, storytelling can beget belonging in an instance when a group member shares vulnerably, and others offer support. The group therapy model more closely approximates the contexts of our lives (families, workplaces, classrooms, friends, teams, clubs, organizations, religious groups), suggesting that meaning made in group can inform meaning-making outside group as well.
The concept of belonging, described by Smith (2017) as the “most important driver of meaning,” (p.50) is fortified in a group context due to the potential for members to connect with each other, the group leader(s), and the group-as-a-whole (Marmarosh et al., 2013). In my work on an inpatient unit for adults with severe mood disorders, I noticed that group therapy promoted feelings of universality amongst patients who individually expressed thinking that they were exceptionally sick and untreatable (Yalom & Leszcz, 2020). According to Marmarosh et al. (2022), groups can provide belonging through solidarity and subsequent destigmatization. The road to belonging in individual therapy must be paved differently, given that there is only one perspective besides the patient’s and said perspective must rigorously consider the purpose of self-disclosure. As stated by Ribeiro (2020), group therapy facilitates “numerous transferences,” enabling members to learn more about themselves and their sense of belonging through who they connect with as well as who they do not (p. 79).
Group members can derive purpose and transcendence by contributing to and observing behavioral improvement in others (Yalom & Leszcz, 2020). Within the group context, one has opportunities to both give and receive empathy, a powerful practice that works to challenge maladaptive internal working models such as “others don’t need me,” and “I don’t need others.” The “beyond-the-self” impact that defines both purpose and transcendence may be easier to glean within a group therapy context compared to a therapeutic dyad (Smith, 2017; Liang & Klein, 2022). Additionally, research suggests that therapist privilege can have distancing quality in the therapeutic dyad, particularly when a therapist fails to display awareness of privileged identities and power dynamics (Chang & Berk, 2009; Balmforth, 2009). A group setting may help alleviate this effect given the variety of additional identities represented in the room. To describe another instance of transcendence in group, I will pinpoint my experience leading “Daily Planning” groups on an inpatient unit; in this setting patients would often reveal plans for discharge to the group, which elicited emphatic applause and congratulations from others, others who had been in the hospital for weeks or even months. An individual’s discharge was a cause for collective celebration – an illustrative example of reflexive functioning (Marmarosh, 2022). To belong to something beyond-the-self is to transcend, and nurturing the group-as-a-whole through individual contributions is a purposeful act, demonstrating how these three pillars of meaning (Smith, 2017) reinforce each other in a group therapy context.
As noted by DeLucia-Waack (2011) a heterogeneous group maximizes multicultural “learning opportunities” (p. 83) through diverse storytelling and personal experiences. Given that group therapy is a microcosm of the larger society, microaggressions and other manifestations of oppressive systems are inevitable (Bemak & Chung, 2019). Exchanges related to social identities are going to stir up strong emotion in the group, yet the long-term cohesion of the group “depends on an ability to negotiate difference” (Gitterman, 2019, p. 105). In addition to raising critical consciousness, stories that group members bring in related to loss, discrimination, and oppression provide the group an opportunity to impact the script by providing attentiveness, support, and empowerment to the impacted member. Many patients on the unit expressed shame and guilt related to their mental illness hospitalization. I saw patients within group therapy contexts come together to question the deeply entrenched, American, capitalist ideal that productivityequates to purpose. This collective reframe of strength is pushing through to strength is reaching out challenges a Western status quo that encourages relentless independence and the suppression of feelings.
Group therapy provides a special opportunity for meaning-making, yet the setting also possesses a noteworthy potential for harm if group leaders are not careful; for instance, if one group member is the sole representative of a “culturally distinct group” this individual could be vulnerable to “scapegoating” (DeLucia-Waack, 2011, p. 91). This is an especially dangerous dynamic if the individual was unaware that they would be the sole member of this minority identity before joining the group. Furthermore, DeLucia-Waack (2011) illustrates another essential point that group therapy is not appropriate for a variety of clients – for instance, not all groups are well-functioning enough to support borderline personality organization or anti-social personality traits. Group leaders must employ critical thinking, cultural humility, and courageous intervention to ensure that pillars of meaning do not crumble into their opposites (Debiak, 2007).
Certain group therapy formats position meaning-making at the forefront – to name a few, groups for refugees, cancer patients, or survivors of suicide – but belonging, purpose, transcendence, and storytelling undergird the group therapy process regardless of the extent they are explicitly emphasized (Marmarosh et al., 2022). As a group leader in training, I hope to bolster the inherent meaning-making capacities of the group therapy process, employing interventions to highlight each pillar. Early on in a group’s formation, I might ask members to share what behaviors contribute to their sense of belonging as a part of establishing group norms. I could utilize “bridging,” a tactic that asks a group member not involved in a particular interaction to comment on it, to invite purposeful contribution and reflection beyond-the-self. As the group’s life progresses and cohesion increases, I might draw attention to how different members share stories, particularly if there has been a change (i.e., “I noticed, Cam, during what you just shared with us that you gave many more details than you did just a few weeks ago; thank you for trusting us with those”). I will keep in mind that silence tells a story as well. Only a few months into my doctoral training, I view group psychotherapy as an especially dynamic, invigorating, and albeit treacherous endeavor – an endeavor with extraordinary meaning-making potential for members and leaders alike.
References
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