Opinion Post for Writing 201: Ongoing Group Therapy Versus Time Limited Focused Therapy

This post is an “Opinion Piece” that I am trying out in my online Blogging Class, Writing 201, which is about writing long blog posts. In my opinion, a new approach to therapy groups, involving a very specific focus and a time frame with a beginning, middle and end, is more effective that the traditional “ongoing” therapy group. This is one of those times I would agree with health insurance companies. They typically pay for group therapy, but if they limit sessions, the patient can still attend a group from beginning to end when the therapist is using this new approach.

What is an ongoing traditional therapy group? I found a terrific description of the basis of almost every group of this kind, with the basic formula of what you gain from going to a group on a long-term basis, years rather than months:

Here is the perfect description of any basic ongoing open-ended non-limited therapy group for adults, found on the website of Psychologytoday:

“Interpersonal Psychotherapy: Insight oriented, ongoing group for individuals looking to increase self-awareness and ability to navigate interpersonal relationships.
Group Details, Issues: Peer Relationships, Relationship Issues, And Self Esteem.”

The issues described are really the basic issues that you can gain from any group that is effective, even a peer led 12 Step free anonymous peer group.

So the question is: which kind of group is better, i.e., more effective, and useful for both therapist(s) group facilitators and patients? An ongoing “traditional” therapy group or a time limited specific, structured and focused therapy group?

The ongoing group has a more general focus, such as an ongoing women’s group for adults with depression and anxiety issues, which has no limit of number of sessions, but may have a limit of amount of group members. An example of a time limited specific therapy group would be an Art Therapy group for people with eating disorders and body image issues, that involves a commitment to 12 weekly sessions, with a structure that includes meditation and art making as coping skills, and may even have a syllabus for each week culminating with the last session in Week 12.

In this post, I will find real therapy groups on different Internet sites, like the one quoted above, but I will not have any statistics as to where the group therapy modality is headed, and whether the time limited group is the kind of group that will be in the majority for therapy groups run by therapists in private practice for the future, and what the current trend is, though I am assuming there is a trend of this new kind of group growing. This post will not address any group therapy in hospitals, agencies, non-profit organizations, etc., but only groups held in private practice.

Historically, psychotherapists in private practice who facilitate therapy groups have had “ongoing” therapy groups, which involve patients coming to a therapy group for an unlimited amount of weekly sessions. In addition, if the group was started as a group with a limit of, say 8 people, when patients leave, the therapist would try to fill the spot, so the nature of a therapy group traditionally involves new people joining at any time and people leaving at any time as well. While the therapist and location as well as kind of group is the foundation of the group, over time there is usually a core group of members who come consistently, creating the true stability of the group. This is the kind of group you have probably seen portrayed in movies. I can remember scenes in films of group therapy, but I couldn’t find anything by googling it, and I can’t remember which films I’ve seen group therapy in! I am not talking about One Flew Over the Cuckoos Nest or Girl Interrupted and other films where the group therapy is set in a treatment facility. I know I have seen a movie where a character followed another character to their group therapy in NYC, set in a therapist’s office, but I’ve forgotten what happened. These scenes always show people sitting in chairs in a circle in a therapist’s office. Even 12 Step Meetings are now routinely portrayed in movies, and even satirized in children’s movies, such as in the movie “Wreck It Ralph”. A great realistic portrayal of the 12 Step Sex Addicts Anonymous Group is the main focus of the movie, “Thanks For Sharing”.

Many art therapists, as well as other kinds of therapists, still run therapy groups that are ongoing and don’t have a specific end date. In fact, I have been running two of those kinds of groups for a number of years: a women’s art therapy group for depression and anxiety and an ongoing Art Therapy Supervision group for professionals. With ongoing groups like these, the group is considered like an individual in therapy. Typically, such therapy groups don’t have a specific start and end date and no limit to amount of sessions. You can join a group like that at any time, and you will be the new person for a while, then eventually if you stay, you will become absorbed into the group and just continue to attend on a weekly basis and perhaps see someone else join and be the new person on the block.

Other newer kinds of group therapy involve a set amount of time, like a ten or more week group with specific goals or focus, such as a 12 week art therapy group for Adults with eating disorders and body image issues, with structured 1.5 hour sessions involving at least five minutes of meditation prior to the art making portion of the group. With this kind of group, there might even by a kind of syllabus as to what the weekly art project would be, and the art therapy would be described as a tool for learning alternate coping skills to combat the specific issues addressed. This kind of group is appealing to a person who wants to have clearly defined therapeutic goals, to know in advance how much money s/he would be spending, what they would be doing in the group every week, as well as knowing that goals would be presented in week 1 and hopefully met by Week 12. In addition, a prospective member would know that the same people would be attending weekly. All group members would be committed to weekly attendance for this 12 week Unit and the group would be defined as “closed” from the first week, meaning no new members can join within the time of the 12 weeks. The climate of psychotherapy in the American public these days, in my opinion, involves a trend toward choosing therapy groups with very specific goals, objectives and time limits.
I have a great example of this newer type of group, a 7 month program a colleague of mine is starting. Here is the title: Sacred Centers:
A Creative Approach to Working with the Chakras
The Art of Yoga Therapy 7 month program.

She has a detailed list of what the program will entail and it is group focused but has a specific syllabus and a structure mentioned in the title, based on the 7 chakras.

People new to therapy, whether individual or group, tend to want more clear ideas of what it entails, what they are responsible for, and what they would get as a concrete measurable result in their life, either from attending a group or trying out individual therapy. As a therapist, I find the idea of specifying what the therapy process entails to be a good challenge. In my experience of groups, I have found the ongoing framework to be more challenging and frustrating than I had imagined before trying out my first private practice group. (As a student in training, we run a lot of art therapy and other kinds of groups, and at a typical job at an agency or facility of some kind, there are also lots of groups to run, but the private practice group, in my experience, is a whole different ball game, so to speak.)

Right out of graduate school, I started an ongoing group, entitled Nurturing Your Artist Self, that met weekly to begin with, and involved members making ongoing art projects of their choosing. I did this group in my private art studio while working at a hospital and then at an agency where I did all sorts of groups. This group was for myself as well because I wanted to have time to make art with others in a non therapy group, so it was a peer-led group, which is another kind of group that can be useful, as it is usually free or very low fee, like a monthly materials fee. It was defined as an Open Studio group, which means in art therapy speak that it is non-directive and members can come and go with the only limit being the amount of members in the group.

Art Therapy groups with directives involve the art therapist presenting the group with a specific art project to do, and thus, all members are usually making the same thing, such as an Affirmation Box, with clear instructions on the art making process: pick a box, decorate it with the materials presented, choose Affirmations from cards provided or make up your own, write them down, make each one decorative, and use it at home in some way of your own choosing.

So a non-directive group functions like an Open Studio where each member just works on whatever they want to work on with any materials they choose, and typically takes several sessions to finish what they are making. Different group members finish their pieces at different times, so the challenge is how to share your art with the other group members in such a group. As my first group described above was a peer-led group of mostly old grad school classmates, the artists were familiar with making art with other art therapists and also knew each other already, so people spontaneously shared their artwork and looked at what people were doing without a formal sharing of art work, which is typical component of any art therapy group done anywhere.

This “Nurturing Your Artist Self” group, begun in the year 2000, turned out to be very challenging for me for the specific reason that there was not adequate consistent attendance, which I found out was important for keeping the group going on an ongoing basis. The group turned out to attract other art therapists new to the field who wanted to make art on a regular basis and found my group to help them stay motivated and get the benefit of doing art with others in a group atmosphere, which has many benefits. Everybody loved the group and people made some very creative art, but people cancelled a lot, and I had to turn it into a monthly group pretty quickly, as it was unreasonable to expect attendance on a weekly basis. This group, which came from my graduate thesis article about artist blocks, was actually the seed for my current Art Therapy Supervision group. Another ongoing group, but with a very specific focus, a specific structure to each weekly 1.5 hours and a member number limit, as well as my being a Supervisor, so the current group is not peer led.

For many therapists and patients, this kind of ongoing open structured group works well. Their own therapist often refers many people who join a therapy group. Some even attend their individual therapist’s therapy group while seeing the same therapist in individual therapy; thus, if they are in individual therapy that has no time limit, the idea of an ongoing group makes sense, even if the group has some specific goals in it. Most patients, if they do not move to another area, tend to stay in a group like this for a long time. Most people who leave groups like this leave early after a few sessions if they decide the group is not a good fit for them. The advantage for a therapist in private practice of an ongoing group is that there will be a core amount of people in the group getting to know each other over time, as well as having the occasional new person joining the group to inject some new energy to the group, as these types of groups over time can become stale.

My current weekly Art Therapy Supervision group is my first successful attempt at an ongoing group, as I did not consider the Nurturing Your Artist self group to be really successful to survive over a period of years with a core number of members, which is one of the properties of most ongoing therapy groups. I started two of these Supervision Groups in 2008, and I continue to run the one Tuesday evening ongoing Supervision Group, which has had as many as 6 members/supervisees and as few as two members, (the 2 member amount of time was short enough that the group survived and grew new branches so to speak), so I have seen an ebb and flow in this group over about 6 and a half years. I did not have to stop this group from running during that time and continue it to the present. This Art Therapy Supervision group has had the same two-part structure over the years. The first 45 minutes are spent working on ongoing art projects and the second 45 minutes involve one member doing a Case Presentation with options for group members to make “Reaction Art Pieces”. In my experience with supervision groups, the format of limiting to one person presenting a specific case per week works the best in terms of the group process and the therapist members learning from each other.

From a therapist’s point of view, the ongoing group is often a good idea because the group continually evolves, and, as people become “regulars”, the exploration and group process deepens and the group goes from the beginning phases to other phases of group therapy. The longer group members stay, the more opportunity for growth and practice in asserting oneself, being seen, learning to listen to others and respond honestly to others. Many therapists and group members find this kind of group very rewarding, as the group process is fascinating, and group members really “take over”, meaning the therapist intervenes less in a very developed longstanding group. Participating in group therapy as a patient typically involves the goals of learning about your styles of communication and attachment styles and learning about your effect on others directly through the group process in the here and now and through observations of other members of your behaviors in the group as well, as your reports of your issues and patterns of behavior outside the group. In such groups therapists tend to agree that the group members learn the most from other group members. The group typically goes from an early phase of people getting to know each other and getting used to the group process, to more intense work, which may involve direct confrontations and conflict resolutions in the group itself. Such a group develops in terms of members becoming attached to the group and the person or people running it, so ending an ongoing group involves a time limited termination process. Many traditional psychotherapy ongoing groups can last for years, and there is often an unspoken assumption that the group will continue as long as the therapist is in private practice.

In my experience in private practice, facilitating an art therapy group on an ongoing basis can be rewarding, fascinating, and challenging,but also frustrating in certain ways. Actually, the inspiration for this post is my current experience during this holiday time of questioning how long I want this group to continue, as well as wondering if the group is the right fit for me as an art therapist and my focus and skills, as well as being inspired and curious about the very unique group program my yoga art therapist colleague is doing, described above.

The current art therapy group I have been leading weekly in my studio has followed the typical path of a traditional ongoing interpersonal focused group therapy, with the group agreeing on things and asking for their needs to be met, independently from my “controlling” the group or group process. Despite the group being an art therapy group in a studio setting, the core group members are more focused on the group discussion than the art work made in the group. The group members started with little understanding of what the art therapy element of the group was about and what the art making was going to accomplish for them, so they began the group with an understanding of the value of the group discussion and their own ideas about how the discussion should be structured. The art making was the “psycho educational” component of the group, and began with the group having a basic trust in the art making process as healing and a willingness to make art during the group. I also make the same art projects in the group working with the materials alongside them, both to model the art making and to participate actively and help members feel comfortable. The group from the beginning expressed the need for an art directive, so the art projects have been very specific. At this point, my end of year reflections about my life and even my purpose for being on this earth, and trying to maximize my use of myself and be open to new experiences, which is of course a much larger spiritual question but includes everything I am doing in my work life, both as an artist and art therapist.

Not everyone is a good fit for a therapy group, just as each therapy group has something specific to offer group members. And, SSI am discovering, this is a kind of process and journey, and it is possible for the group to “outgrow” itself, for the group to reach a stopping point, where all of the goals stated in the beginning of this post about interpersonal relationships and improving self-esteem, may have been met, and the group reaches a fork in the road.

So, why start a group as a therapist in private practice and why join a therapy group in addition to or instead of individual therapy? Or why not join a 12 Step Anonymous Group instead, which is a peer led type of group? 12 Step groups are very effective for a lot of people, especially now that there is one in just about every flavor, from Overeaters Anonymous to Hoarders Anonymous, etc. 12 Step Groups are free and there is no specific regular attendance required. Private therapy groups run by therapists are not free, though they typically cost less than individual therapy and many therapists use a sliding scale or very low fee, especially for groups with at least 5 or 6 members. Some people join therapy groups that are specific in nature, like groups for people with eating disorders. Therapy groups are more stable than 12 Step Groups,as they usually require regular attendance, typically on a weekly basis and are limited to a certain amount of members. If you join such a group, you will see the same therapist or therapists and then same group members weekly, so they will get to know you well. Even in a closed time limited focused group in private practice, group members would gain the same consistency and some amount of “depth” and connection to other group members.

SO I am doing searches on the Psychologytoday website for different types of groups you could join right now for the New Year. Most group therapy, whether time limited or ongoing, tends to focus on relationships, as obviously,no matter whether it is about parenting, romantic relationships, or other topics, group therapy has the advantage of automatically involving you in your relationships with all the other people in the room. Here are some examples of different kinds of group therapy I have found on the Internet in my “research”. All groups are listed on the psychologytoday.com website unless otherwise described.

Here is an example of a time limited specific therapy group, an 8-week one for men about grief held in Minnesota:

“This will be an 8 week therapy group established as needed to focus on various men’s issues. Please call for more information or see website: crocushillcounselingcenter.com.”
Issues: Grief, Gender Issues: Men’s, Age: Adults”

It is unclear whether this is a group that can be ongoing in that it may be held in 8 week cycles, either changing group members every 8 weeks or open to members to repeat the group. The way it is described implies that it may well be.

Here is one that seems to be ongoing, accepting new members, but quite specific in focus, issues and population it would be appropriate for:

“This is a women’s group addressing trauma that may have been experienced in life.” Issues: Trauma and PTSD, Gender Issues: Women’s, Age: Adults

Here is one in NYC that appears to be ongoing as well as describing specific group exploration as well as adding a psycho educational component, the creatively worded “laboratory for intimacy”, which is a great phrase for any kind of therapy type group:

“Relationship Group: Group as a Whole: Being present with feelings and thoughts that are occurring in the moment. We learn to deepen our relationships by building trust, and creating a safe space as a laboratory for intimacy. Group Details: Issues: Relationship Issues, Sexuality: Gay Issues, Gender Issues: Women’s, Age: Adults

Here is another ongoing group in NYC. What I find interesting about it is the reference to style of therapy and theories intended to be used by the therapist with the group, implying that in this type of group, the therapist will be actively steering the group with certain stated intentions:

Recovery Group: For women in recovery from eating disorders, addiction, or for women who wish to work on body image. Focus is experiential, psychodynamic and internal family systems focused.
Group Details
Issues: Eating Disorders
Sexuality: Gay Issues
Gender Issues: Women’s
Age: Adults

Here is an example of a drama therapy group, which appears to be time limited, as the therapist mentions a “culminating” performance. Unlike the typical ongoing group title (Men’s Group, Grief Group for Adults, etc.), this therapist has been creative even in her title of the group, “Transform Your Life Script”, sells the group as very goal oriented and transformational; join this group and you will change in some profound ways that are very specific. Notice how specific the therapist is in her description of what the group entails in a session and what the goals of the group are. She also is “selling the group” directly to the prospective group member by addressing you in her “pitch”, a very different style from the traditional short description of an ongoing therapy group. You know what you will do in the group, what you are going to get into, even what kind of risks you may be invited to take, what challenges you will share with other group members, and how the therapist is going to help the whole group make very specific transformational changes in their lives. Like a lot of groups, this group is addressing the issue many adults face at some point in their life, feeling “Stuck” or at a confusing point in their life’s journey, while wanting their life to change, and wanting to transform themselves in some profound way. The advantage of drama therapy is spelled out in the description. Of course, as a creative arts therapist, I am biased in favor of the expressive arts therapies as a major component of group therapy, as I believe in the transformative power of images and non-verbal sharing.

Transform Your Life Script Drama Therapy Group
Do you feel stuck or dissatisfied with work or relationships? Do you struggle with low self-esteem? Do you desire change, but lack a supportive space to realize it? Live the life you want to live. Transform your life script! In this group, we’ll utilize drama therapy exercises, psychodrama, mindfulness techniques, and a culminating performance to help you: access your creativity; receive support and encouragement; establish therapeutic goals; externalize unhelpful patterns; practice implementing new behaviors; and make healing steps towards integrating change. No previous theater experience is required. Shy people are welcome!
Group Details
Issues: Grief, Relationship Issues, And Self Esteem

Here is an example of a very specific type of art therapy group in Brooklyn at an art therapy center, which is ongoing, (Link: https://nycreativetherapists.com/burnout-prevention)
Typically therapists will have a waiting list for a closed group, so that when someone leaves the group, the people on the waiting list have an opportunity to join as it is an ongoing group. This group is specifically aimed at “helping Professionals”/healers, so the members are a very specific group with a lot in common, and the goals of the group are specific, but the ongoing nature of the group actually matches the purpose, as the idea of burnout prevention is that you need to continue self-care on a regular basis. Going to this type of ongoing group is an automatic way to implement burnout prevention by its very nature, sort of like my supervision group, as my supervision group is designed to have a ‘Burnout prevention” aspect embedded in the nature of the group, the art making with others.

Age: Adults
Ongoing Saturday Art Therapy Group
Preventing Burnout for Helping Professionals
Reduce the impact of secondary and vicarious trauma in one of our supportive art therapy groups or trainings. Content includes psycho-educational information on the symptoms of traumatic stress and concrete solutions, based on current literature, to resolving it. Designed for social workers, creative arts therapists, caseworkers, child life specialists, special Ed teachers, and other helping professionals working with challenging clients. Groups meet bi-weekly Accepting participants for our 3:30 group (the 1:00 group is closed to new members for now

The other interesting aspect of this group is that it states in its description that a psychoeducational component is a significant aspect of the group. Psychoeducation is often seen now as a useful aspect of working with traumatized people in therapy, so the psycho educational component of a group can be directly opposed to a loose, non-directive, natural group process approach. In this type of group, the members are ok with the therapist also being a kind of teacher and with being very aware of the interventions the therapist uses that are educational, versus other forms of therapeutic interventions.

The traditional model of group therapy involve a trust in group process and also a philosophy of having the therapist “meet the group where they are at”, so interventions involve the therapist pointing out ways that group members have themselves created a theme for the group. In other words, the therapist points out ways the members are connected, if the group members “miss” this crucial component. However, with this approach, the group drives the direction of the group and the content, whereas in psycho educational groups and very specifically focused groups, the therapist has a lot more control over the structure AND content of the group.

Perhaps this is the most significant aspect of the difference between the two types of groups. Not whether the group is ongoing or time limited or even the kind of topics addressed, but whether the content of the group is created almost completely by the group or by the prompt of the therapist’s description of what kind of group members s/he looks for the group, or whether the group is very structured in content, very “directive”, such that even discussion can be controlled by the therapist limiting people to certain topics or redirecting them to whatever the therapist has picked as the focus. So the role of the therapist in these two types of groups is very different, no matter what the “modality” (“talk/discussion”, art therapy, music therapy, etc.), and the role of the group members is different, even if both types of groups have the same goals.

Most likely the newer type of group will have different goals from the traditional type, as it is very specific and advertises itself as resulting in measurable changes for group members.

So, where is art therapy in all of this if it makes a difference to the main idea of this post? Art therapy by nature lends itself to any kind of group. An art therapy group may have a structure in terms of the art directive being very specific, even asked for by the group, so in that sense the directives are driven by the group needing a directive even if the therapist tends to have a non directive style, while at the same time group process may be very organic and group driven. This type of art therapy group could at the same time be run in the traditional group focused style, even if the time is structured by the therapist (i.e. Ten minute verbal “check-in” at beginning of group followed by art making and discussion group driven with a directive the group agrees on.) In a very focused group, the directive may involve specific materials but be less specific, however the role of the art therapist is completely different. S/he controls the topic of conversation/discussion, as well as the rest of the content of the group.

Interestingly both types of groups lend themselves to the therapist leading the group to being in the “here and now”. In the traditional group led process, the therapist may stop the group in its process to ask members to check in with what they are feeling in the moment about some interchange that has “arisen” from the group process, so in this format, the therapist is skilled at finding those “teaching moments” and skilled at mostly getting out of the way of the group while witnessing and sometimes steering them to the here and now.

In the focused format, the group members are aware that a great deal of the content of the group will be about the here and now. “Stories” and “personal narratives” will more likely arise through symbols in the artwork or something that comes up in a role-play etc.

Now, having written this very long meandering post, I think my original question is not what I am really concerned with answering, as I have sort of convinced myself in process of writing this that both types of groups have a lot of merit and usefulness.

I think the question I am asking myself is really more personal, the question that actually engendered the whole post: “What kind of art therapy group is now of interest to me that would be in sync with my current interests in art therapy and in connecting with others in a meaningful way? What would feed me? Am I in a very different place in my own journey than I was several years ago wanting to run an art therapy group in my private practice? Do I actually like, enjoy, learn and grow from the traditional structure of an “Insight oriented, ongoing group for individuals looking to increase self-awareness and ability to navigate interpersonal relationships” as quoted in the beginning of the post?

Or, am I interested in exploring something else? Something for me as an artist? Something for me as an art therapist?

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