Why Is Group Therapy So Common in Treatment?
If you think about mental health and addiction recovery programs, most have similar features, one of those being group therapy. There are also various mutual-help meetings that exist, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Recovery Dharma, and SMART Recovery, to name a few.
Group therapy or a meeting is a place where an individual goes when they are struggling with a problem. From a treatment perspective, they may find themselves in a therapy group on a near-daily basis - especially if pursuing rehab or a Partial Hospitalization Program (PHP) - to… do what exactly?
That often depends on your program, the type of treatment it provides (primary mental health, primary addiction, etc.), the group facilitator, and the treatment interventions and modalities they gravitate toward.
At the heart of group therapy, however, a primary purpose is connection. When you enter a space and realize other people are going through something similar, it can make you feel less isolated and alone.
Irvin Yalom and the Power of the Group Process
Irvin Yalom is a psychiatrist and psychotherapist who provided a scientific, theoretical, and clinical framework for group therapy when he published The Theory and Practice of Group Psychotherapy in 1970, a text that is still used today in therapist training and graduate education.
For Yalom, the group facilitator’s purpose is to guide the group into the here-and-now space - tapping into the content of the group, the interactions between members, and the current feelings that are arising from the content being discussed, even when that content is from the past.
The content of the group varies, again based on the treatment program and the goals of the clients joining that group. The content and what a client says, or perhaps doesn’t say, in a group is important from a clinical and assessment perspective.
But equally important - some may argue even more so - is how the client is interacting with the facilitator and their peers, what emotions they are displaying or avoiding, how authentic they are being, and what emotions arise during those interactions.
Within a group, a person can learn different ways to interact with and respond to others, especially if conflict arises. They can then apply these skills to interactions outside of the group, strengthening their overall social interactions and recovery efforts.
Why Groups? Why Not Just Individual Therapy?
But why groups? Why not just individual therapy?
Individual therapy is almost always going to be a common feature across treatment programs. Even in 12-step meetings, there is often a one-on-one component between sponsor and sponsee.
The power of a group - the instillation of hope, universality, imparting information, and altruism, to borrow a few of Yalom’s terms— - is something that individual therapy alone cannot accomplish in quite the same way.
In a group, a person isn't only receiving support from a therapist. They are seeing other people struggle, change, succeed, make mistakes, try again, offer feedback, and show up for one another.
What Does Rat Park Teach Us About Connection and Recovery?
And how do we know this? How do we know that a person’s environment and social interactions are a key component of recovery?
One well-known piece of research that explored this question was psychologist Dr. Bruce Alexander’s “Rat Park” research.
In the late 1970s, Dr. Alexander and a team of researchers compared rats living in isolated laboratory cages with rats living in an enriched environment that included other rats, space, and opportunities for activity and interaction.
The rats had access to plain water or water containing morphine.
Alexander and his colleagues found differences in morphine consumption between rats housed in isolation and those living in the enriched “Rat Park” environment. Rats living in the enriched environment generally consumed less of the morphine solution. The research also explored what happened when previously isolated rats were moved into the more socially and environmentally enriched setting.
These findings became influential in conversations about how environment and connection may influence substance use. It is important to recognize that Rat Park does not prove that isolation causes addiction or that connection alone prevents it. Later research and attempts to replicate the original findings have also produced more complicated results.
What the study does help illustrate is something clinicians continue to see in treatment: the environment surrounding a person matters.
Addiction, Mental Health, and the Brain
This does not dismiss the fact that addiction and mental health disorders involve changes and differences in brain functioning.
People living with a mental health condition, those in active addiction, or those in recovery may experience differences involving brain structure and function, chemical signaling, neural connectivity, and neurotransmitter systems, depending on the specific condition and individual.
Connection does not replace treatment, medication when appropriate, individual therapy, or other evidence-based interventions.
It can, however, be an important part of the larger recovery process.
Connection as a Protective Factor in Recovery
What Dr. Alexander’s research helps us consider is how our environment, social interactions, and connections can serve as resiliency factors that may help protect against problematic substance use and aid recovery efforts when addiction does occur.
This concept can also translate to mental health concerns like depression, anxiety, PTSD, and ADHD, where isolation, limited support, and a lack of meaningful or stimulating activity may contribute to a person's overall well-being and functioning.
Our brains require positive connections, social interactions, and healthy stimulation to survive and thrive.
That is part of why treatment does not happen solely between a therapist and an individual client.
Sometimes recovery happens when you sit in a room with other people and realize:
I am not the only one going through this.
