Friday, July 16, 2010

Potential adverse effects of group therapy

I encountered an article today about a subject I've often thought about:  does group therapy actually have a risk of worsening underlying problems?

Here's a link to the article:,8599,2003160,00.html

The mechanism could typically occur in the treatment of addictions, which is the subject of this article.  The same mechanism might operate in the treatment of behavioural problems, including conduct disorders, eating disorders, maybe even mood disorders.

Basically, the concern is that the individuals in the group might actually "teach" others in the group about tactics to engage more deeply in the problem behaviour.  The social bonds formed in the group might expand a person's network to engage in addictive behaviours.  If some members of an addiction treatment group are severely involved in the addiction, are perhaps ambivalently committed to therapy, and may be connected to convenient resources in the community to access their addiction, this may facilitate other less severely involved members of the group to broaden their access to addictions.

In eating disorders, members of the group might "compete" with each other to some degree with eating disorder behaviours.  If there are social leaders in the group who are still highly involved in the eating disorder, this may cause a negative peer pressure on others who are starting out.  

On the other hand, an opposing, positive force in group therapy is encountering others who have understanding and personal experience of similar problems.  This can be especially important for problems where a person often feels judged or misunderstood.  Also, members of the group can teach others tactics to deal with moment-to-moment manifestations of the addiction.  In order for these positive forces to be manifest, the group itself needs to be composed of individuals who are probably similar in terms of problem severity, and where there are individuals members of the group who are progressing.  This introduces a social learning effect, in which an individual can see and emulate another individual with similar problems who is starting to make progress.  The similar problem severity among members of the group would hopefully reduce the likelihood of mildly afflicted group members being drawn into more severe illness behaviours.

Since progress through problems is always a dynamic, individualized process, it may be that involvements with groups ideally need to change dynamically as well.  If  individuals are moving quickly away from addictive behaviours, they may ideally need to nurture group connections which are similarly healthy.

This poses another problem for many with long histories of addiction or other socially dynamic health problems:  relationships which have been strongly associated with the addiction may need to left behind, or at  least boundaried very carefully.


Anonymous said...


I think group therapy is a neutral tool or interface which itself is neither good nor bad. However it's power can either be harnessed in a positive or negative ways.

You can relate this idea to any tool or technology such as guns, computers, cell phones, even science and psychotherapy can be harmful or helpful dependent on who uses it and how it is employed.

Anonymous said...

Another idea which I have heard utilized in group therapy is a tier system or some other sort of classification system, in which members are sorted by some objective measurement (ie: time in treatment) into appropriate levels of treatment. In this way a certain level can have a very different focus or goal and the treatment can be more individualized.

Or you could sort individuals by an arbitrary measurement (such as age or the night of the week they are available to come.) Again there are both negatives and positives. The treatment may not be individualized enough and there may be problems associated with individuals (new to treatment) unknowingly enticing other individuals back into a disordered state. However, individuals (who have been in treatment longer) can act as catalysts for others who question the possibility of getting better.

Taken together I think individuals who have been in treatment longer and are closer to their desired healthful state will benefit from being in a treatment group based on their progress. However, individuals who have just begun treatment will most likely benefit in either group (arbitrarily assigned or objectively assigned group)

This is very similar to different methods of education classification. Should children be organized by age (some arbitrary measure) or their developmental ability (like reading level-- although this could be quite arbitrary as well).

I have see children who are classified as "behind" do very well with others who may be classified as "gifted." I have also seen children who are "behind" do really well with other children of the same developmental level. I think it really depends on accurate assessment of the child's needs and the reason they are labeled "behind."

However, I do believe that "gifted" children would most likely do better with other advanced children. Too often there are aids in schools who are there to help underdeveloped kids but there are not aids to specifically challenge the advanced kids.....

In conclusion I think the crucial variable is advancement position. The more advancement in treatment or education which is attained, the more important it is for those individuals to be placed in an advanced group (categorized by some objective measurement of progress.)

Anonymous said...

However I also acknowledge that this could cause other problems, such as, social detriments.

Oh and please excuse the terms I used for gifted, advanced, behind...etc. I don't know what words would be politically correct here. This also leads to the other idea of who or how do we objectively monitor academic progress or health? Both are very much socially, politically, culturally and financially influenced. So really in depends on the individual.

Lastly, I just wanted to add how group therapy assessment has taken on a new meaning with online communities/therapy groups. These again can be used in a negative or positive way.

GK said...

The article in Time particularly addresses the phenomenon of more severely afflicted individuals, particularly if they are part of a subculture (such as involving extensive substance use), drawing less severely afflicted individuals more deeply into the problem or subculture. I believe this is a possibility to be quite wary of in practice.

I can speak from personal experience, that being in a classroom in which a strong interest or aptitude for learning is a minority or undervalued position, is negative and disadvantageous educationally and psychologically. Therefore I would have to advocate, in the strongest possible terms, for the idea of at least giving children the option of spending their schooldays with other children sharing similar interests and aptitudes. Therapeutic aid for a disadvantaged person must never come at the cost of injuring someone else. An example of healthy compromise could be of stronger students having opportunities to tutor struggling students for a well-boundaried limited portion of the schoolday, if both students consent and are supervised.