Jay Earley, Ph.D.

This article briefly describes the interactive approach to group therapy. It is written for therapists who may be interested in finding out more about this method.

In a 1992 survey (Dies 1992), the American Group Psychotherapy Association divided group therapists into three categories according to their orientation in leading groups—psychodynamic, interpersonal, or action-oriented. The interpersonal approaches focus primarily on the personal interactions and relationships among the group members, as typified by Yalom’s classic text (1995). Action-oriented approaches included cognitive/behavioral, Gestalt, TA, and psychodrama—the common element being a commitment to action in addition to self-exploration. This includes not only action on the part of group members, e.g. behavioral experimentation or role playing, but also an active leadership stance from the group therapist that may include suggestions, questions, and structured activities in addition to interpretations.

Orientation of the Interactive Approach

Because of this, action-oriented groups tend to be leader-centered groups, where the group members interact primarily with the leader rather than with each other. This usually means that there isn’t much attention paid to the relationships between group members and the unfolding of the group process. As a result, this valuable aspect of group work is usually not fully utilized in these approaches to group therapy. The interactive method changes that; it is an approach to leading groups which is both action-oriented and group-centered. It encourages experimenting with new behavior and an active leadership stance while focusing primarily on interpersonal interactions between group members and group process.

Therapists. Therefore this method will be of special interest to action-oriented group leaders who want to expand beyond leader-centered or structured groups. If you were trained in an action-oriented method and want to lead groups with a greater emphasis on interpersonal and group process, this approach should appeal to you. I have been training group therapists for many years, and because of my background in Gestalt therapy, a good number of Gestaltists and other action-oriented therapists have come to me to learn how to lead interactive, group-centered groups.

Many therapists are not wedded to one particular school of therapy but have a general education in the field and perhaps draw from a variety of approaches. If you are eclectic and have a personal preference for an active leadership style, this approach to group-centered groups will probably interest you. This method may also be of interest to psychodynamic and interpersonal therapists who want to lead time-limited groups. My active leadership style tends to move groups quickly into the heart of the interactive process rather than allowing them to gradually find their way, and so it is useful for short-term groups.

Contributions. This approach is based on a comprehensive theory of therapeutic change in group therapy. Though the literature on group therapy contains original theory about group-as-a-whole dynamics, its understanding of interpersonal and intrapsychic dynamics is largely borrowed from individual therapy. I found existing theories not fully adequate to explicate many interesting interpersonal dynamics, so I have created a new theory which is specifically oriented toward group therapy.

The interactive approach draws from a variety of existing schools to form a creative whole of its own, which I believe represents an advance in the field. It has been influenced by interpersonal and psychodynamic group therapy, Gestalt therapy, object relations, self psychology, cognitive therapy, and transpersonal psychology. This approach is similar to Yalom’s in focusing on the interpersonal interactions between group members as the primary means for therapeutic change. In addition, it focuses on contact and intimacy between group members as an important aspect of therapeutic healing. It shares with psychodynamic groups (Rutan & Stone 1993) an emphasis on insight about unconscious process and childhood origins of current problems. It borrows from Gestalt therapy (Perls et al. 1951) an active leadership style which focuses on responsibility, spontaneity, and vitality and helps members heighten awareness of their moment-to-moment experience. The approach targets both short term symptom and problem resolution and long term characterological transformation.

My Experience. I have been leading therapy groups for nearly two decades. Groups have become the major focus of my professional life, igniting my passion and providing fulfillment. As both a leader and participant, I love therapy groups—the excitement of the here-and-now encounters between people; the intensity of the work; the caring and love that develop among group members over time; the profound therapeutic changes that clients achieve; those special moments of group bonding and the overall sense of community that develops. It is very satisfying to participate in a group that creates the equivalent of a healthy extended family or tribe.

Type of Therapy Group. Therapy groups can be divided into two general categories—general purpose and problem-focused groups. Problem-focused groups (McKay 1993) tend to be oriented toward specific populations and issues—bereavement, anxiety, sexual abuse, AIDS, substance abuse, assertiveness, etc. Usually these groups are quite structured or use a support group format. General purpose groups accept people with a variety of presenting problems. In addition to the above-mentioned goals, their purpose is to help clients make deeper changes in their character structure. Therefore, these groups need to operate for a longer time, often one to three years or more. The interactive method is oriented toward general purpose outpatient groups for adults, though it can be modified to handle time-limited groups and specific populations. It can also be combined with other group modalities such as supportive work, psychodrama, structured exercises, or individual work in the group setting.

How Interactive Groups Work

In keeping with the interpersonal nature of the interactive approach, the primary focus of the group work is on the relationships among the group members and what is happening at the moment in the group. The group becomes a microcosm for members’ lives, and any interpersonal problems they have will most likely occur sooner or later with someone in the group. Thus, rather than just talking about the problems in their lives, members act them out in the group, and this gives them a chance to get feedback on the way they impact others, to become aware of their feelings and motivations, and to experiment with new, healthier behavior.

One common type of interaction involves a dialogue between two members. One person might say, "John, I’d like to talk to you. You know, last week when you confronted Sarah, I felt annoyed at you (or I admired you, or I was intimidated by you)." Then John might respond by saying, "Gee, what was it that made you feel that way?" Then the two members would have a dialogue. If there was conflict, they would try to work it out. If they were confused about what was happening between them, they would attempt to clarify their process. If they felt good about each other, they might work on connecting more deeply.

During this process, the leader facilitates them, helping them to be more aware of what they are feeling in the moment, especially in response to what the other person just said, and helping them to improve their communication skills, especially assertiveness and sensitivity to others. The leader is particularly interested in helping members to become aware of their interpersonal patterns, such as neediness, avoidance of intimacy, defiance of authority, codependence, etc. For each pattern, clients are helped to be aware of when it happens in group, what they are feeling at the time, the underlying motivation, its childhood origin, and the role it plays in their lives. Then they can work on healing the pain that underlies the pattern and experimenting with healthier behavior in the group.

Other common types of group work involve clients exploring their feelings about being in the group or the group-as-a-whole exploring an issue that is affecting everyone. The interpersonal work for each client changes over time. When people first join a group, they work on the way they relate to people they are just getting to know. Once they have been in the group for a year or more, they will have a chance to develop close connections with some other group members, and therefore they will begin to deal with intimacy issues.

Summary of Unique Features

The above description might apply to many approaches to group therapy, especially those with an interpersonal flavor. Here I will be more specific by summarizing some the unique feature of the interactive approach.

Therapeutic Change Process. The approach includes a new perspective on the therapeutic change process which emphasizes those interpersonal aspects of change that are particularly important in groups. In addition to the importance of insight and accessing feelings, it emphasizes the value of experimenting with healthy behavior and receiving healing responses from other group members and the leader.

Active Leadership Stance. The style of leadership is both active and empowering for group members. As a leader, you ask questions to elicit clients’ awareness of their experience in the moment and the deeper issues that underly their reactions. You sometimes make suggestions about new behavior or attitudes that clients can try experimentally. When necessary you actively intervene to make sure that the group is safe enough for members and is moving in a therapeutic direction. However, the details of the work are initiated by the group members, and they are encouraged to be responsible for their own therapeutic direction. When an interaction or exploration is proceeding appropriately, you may be silent for long stretches of time. Action-oriented leaders sometimes must make an internal shift in attitude in moving from a leader-centered to a group-centered mode.

The Interactive Norm. This method actively promotes the norm that the primary focus of the group is the interpersonal interactions between group members. They are expected to take responsibility to initiate work on their relationships with each other and their feelings about being in the group. The leader doesn’t wait for this work to emerge gradually but actively encourages it.

Presence and Contact. In this approach, we are interested not only in behavior and its unconscious meaning, but also the quality of presence and contact as group members explore themselves and interact with each other. When is a client being purely intellectual? When is he distracted? When is a group member inhabiting his body and feeling his emotions? Is a client taking in the support and caring she is receiving? Is a person allowing himself to be touched by others?

Intimacy and Relational Healing. The interactive method pays special attention to the relationships that develop. Clients develop multiple transferences with the leader, other members, and the group-as-a-whole. These are important not only because they provide the stimuli for exploration of deep psychodynamic structures and their childhood origins, but also because of their potential for healing. When two people work through the transferential difficulties between them and develop a deep connection with each other over time, this can be profoundly healing for their underlying wounds.

References

Dies, R. R. (1992). Models of group psychotherapy: Sifting through confusion. International Journal of Group Psychotherapy, 42, p. 1-17.

McKay, M. (1993). Focal Group Psychotherapy. New Harbinger Press.

Perls, F., Hefferline, R. F., & Goodman, P. (1951). Gestalt Therapy. New York: Bantam.

Rutan, J. S. & Stone, W. N. (1993). Psychodynamic Group Psychotherapy. New York: Guilford.

Yalom, I. (1995). The Theory and Practice of Group Psychotherapy (Fourth ed.). New York: Basic Books.

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