The problem with group therapy

While the practice can have tangible, even life-changing benefits, its negative outcomes go underreported.

The problem with group therapy

While the practice can have tangible, even life-changing benefits, its negative outcomes go underreported.

For an individual seeking some form of psychotherapy, the practice of group therapy can serve as an alternative or addition to individual sessions with a psychologist or counselor. Group therapy aims to give everyone’s stories equal weight, offering a judgment-free space for their voice to be heard and their experiences to be validated.

But in any group setting, some voices emerge as more dominant than others, taking up more time and space. Often, these voices belong to men. While group therapy can have tangible, even life-changing benefits, the negative outcome of this form of treatment goes underreported, under-researched, and often unspoken. Studies and interviews with former patients and trauma survivors have found that group therapy itself can be a traumatic, alienating environment that encourages silence and self-blame. Former patients say group therapy hurt more than it helped, and some still struggle to heal.

“I have experienced what it's like to have an abusive partner insist on going to a counseling session together, only to use it to deploy DARVO-style psychological terror,” said Sarah, whose name has been changed. “It was the second-most manipulative thing I've experienced in my life in terms of an individual abuser using institutional power to control and harm me.”

The acronym DARVO — Deny, Attack, and Reverse Victim and Offender — typically refers to a perpetrator’s response to therapeutic intervention or other efforts to confront or hold them accountable for their behavior. According to a 2017 study in the Journal of Aggression, Maltreatment, and Trauma, DARVO encompasses various emotional tactics used to silence victims of abuse, escape culpability, and encourage victims to blame themselves.

This multi-part, often unseen strategy includes denial of the abuse, “gaslighting” a victim into believing the abuse didn’t happen or wasn’t “that bad,” attacking the victim’s credibility, and assuming the role of victim themselves. This can confuse victims of abuse, and not knowing who to believe, many remain silent. Meanwhile, the perpetrator is free to keep their reputation and relationships in tact, and hide the abuse from onlookers and therapists.

Former patients say group therapy hurt more than it helped, and some still struggle to heal.

According to the National Domestic Violence Hotline, abusive individuals may often manipulate a traditional therapy session by minimizing the abuse or shifting the blame to their partner in an effort to silence them, and this pattern can also play out in group settings.

“Group therapy and [12-]step programs do have the potential to provide great benefits, but also to do great harm, ” Clifford Lazarus, a licensed psychologist and co-founder of The Lazarus Institute, told me.

Group therapy sessions are typically led by a psychologist or psychoanalyst. They can focus on a range of specific issues like depression, eating disorders, or substance abuse, while others may function as support groups for those experiencing social anxiety, grieving the loss of a loved one, or struggling with gender dysphoria. Groups can vary in size from intimate meetings of four or five participants to as many as 15, and usually gather on a regular schedule, sometimes on an ongoing basis. Some welcome new members at any time, some may be closed and limited to a specific number of weekly sessions.

Group therapy first came into practice in the early 1900s as a technique used to treat patients suffering from tuberculosis, according to the Anxiety and Depression Association of America. In order to prevent the disease from spreading, families of tuberculosis patients typically sent their loved ones away to sanitariums in remote, isolated areas where death was imminent and unavoidable. Patients often succumbed to severe depression and existential dread as those around them died from the terminal illness, and some physicians believed that leading regular group meetings could help patients process feelings of grief, loneliness, and fear of death.

Others later adopted group therapy to help veterans returning from World War II in need of treatment for trauma and post-traumatic stress disorder. The practice eventually expanded to clinical psychology and social work. In 1970, the psychiatrist Irvin D. Yalom published The Theory and Practice of Group Psychotherapy which outlines the key principles of the practice, including interpersonal learning, imitative behavior, the instillation of hope, universality, imparting information, altruism, addressing and correcting childhood experiences, and catharsis.

Since then, group therapy has become a mainstay in hospitals, rehabilitation centers, and mental-health clinics. But according to Steven Stosny, founder of the Love Without Hurt program, which provides “boot camps” for dealing with resentment, anger, and emotional abuse, abusive individuals may be attracted to therapeutic settings as a source of validation, a judgment-free “safe space” to rewrite their narratives. “Most abusers justify their behavior through blame, denial, or minimization. They see themselves as victims,” he told me. Group members and leaders can inadvertently reinforce this behavior and validate an abuser’s perceived victimhood, much to the detriment of family members, romantic partners, and survivors present within the group.

“I got very bad, very dangerous advice. Blind leading the blind. It was hell.”
Jane, former group therapy participant

Stosny attributes many of the pitfalls of group therapy to a widespread emphasis on emotional validation. “This reinforces the cognitive distortions of abusive perspectives,” Stosny said. “They make the abusers feel like they should receive support rather than give it, which reinforces the sense of entitlement that is well-documented among abusers.”

In some ways, as Lazarus points out, validation from a group of supportive peers is the whole point of group therapy. Group settings can help people process experiences and stories that are sometimes difficult to hear, stories about things they’ve done that they might regret. No one who struggles with mental illness, addiction, or grief should suffer in silence, or be thrown away completely. However, Lazarus added, “group therapy is not supposed to justify or ‘normalize’ pathological or antisocial behavior.”

Not all group therapy is created equal, and these foundational flaws can hurt survivors the most. Informal, peer-led groups for coping with grief, depression, or addiction can be the most accessible, but they can also be the most harmful. “A lot depends on the theoretical orientation, skill and experience of the group facilitator. In non professionally run groups, the potential for harm is often greater,” Lazarus said. “However, without proper qualified guidance, this can make trauma recovery harder for survivors and exacerbate symptoms of PTSD, or just make them feel unsafe.”

Without oversight from a trained professional, group environments have the potential to allow abusive individuals to rationalize or justify past behavior. “Unless they specialize in abuse, ordinary therapy groups do not appreciate the narcissistic worldview of most abusers and how skilled they are at impression-management,” Stosny said. “Skilled therapists can validate the feelings of their clients while getting them to focus as well on the perspectives of their loved ones as a way of modifying their perspectives.”

A 2017 study published in Acta Psychiatrica Scandinavica points to some of the adverse effects of group therapy. Among a controlled group of inpatients, 60 to 65 percent experienced steady mood deterioration during treatment, and 34 percent left the program prematurely due to unwanted emotional reactions. An earlier study in the The Journal of Psychotherapy Practice and Research indicates that groups may allow therapists or facilitators to express negative or positive biases toward certain individuals, or overlook vulnerable, less outspoken members of the group who may be struggling. When offered a safe space to affirm and justify their past behavior, the study suggests that an abusive individual may also recognize opportunities to sexually exploit, demean, or emotionally abuse other group members, something an under-qualified facilitator may not notice.

This can push survivors out of the group, or discourage them from seeking help altogether. “The effect on victims is to increase their already unconscionable self-doubt, as it seems that authorities are against them, as well as their abusers. Whatever is said, therapists or others in those groups will be manipulated by abusers to make them right and victims wrong,” Stosny said.

Abusive individuals may also be drawn to individual, couples, or group psychotherapy in order to conceal their behavior, or give the appearance of remorse. “I have absolutely seen, time and time again, abusers use ‘going to therapy’ as a rubber stamp on their passport back to redemption,” Sarah, now in her early 30s, said. “This has been hugely troubling because it doesn't necessarily always address the needs of the survivor, and also because ‘therapy’ isn't a quick fix. For some people it's not a fix at all. It takes the right therapist, commitment, and most importantly, time. Abusers may go to therapy, relate a version of events that is totally distorted, and get nothing but validation.”

This can be especially problematic when special circumstances require individuals like Sarah to attend a group therapy program, where they sometimes serve as a captive audience for abusers recounting triggering stories of their past behavior. “Over the years I’ve done group therapy, more often because I was required to due to being coercively institutionalized or hospitalized, than because I wished to,” Sarah said. “I didn't feel comfortable at all sharing in those settings, and often found that I would end up playing therapist myself. I just couldn’t engage. It wasn't a good fit.”

When offered a safe space to affirm and justify their past behavior, an abusive individual may also recognize opportunities abuse other group members.

Jane, whose name has been changed, remembers her own frustrating experience with legally mandated group therapy for substance abuse. “I was forced into it first by my parents, then the law, then in the most expensive rehab possible with some ‘brilliant’ addictionologist (which is apparently a thing) and he told me to go to meetings. 1930s medicine in 2017? Give me a break,” she said. “I got very bad, very dangerous advice. Blind leading the blind. It was hell.”

In the best cases, group therapy can be an essential, life-saving resource; trauma-specific, survivors-only groups can offer solidarity and support without the risk of inviting abusive men or inadvertently protecting their feelings. The National Domestic Violence Hotline recommends that perpetrators of abuse seek out therapy for their own needs separate from a partner or other survivors of family abuse, intimate partner violence, and sexual assault, or those struggling with mental illness who often turn to group therapy for help. “I got my healing when I was just ready for it on my own,” Jane said. “Getting a therapist and individual therapy, mixed with changing habits and behaviors, is all it really took for me.”

“A therapy group is supposed to be a safe place, an environment and social milieu that allows people to feel emotionally safe to express their real thoughts and feelings,” Lazarus said. “They are intended to help people understand the explanations for their problematic actions, not excuse them, and learn more adaptive coping responses.”

Lazarus believes group therapy can still be beneficial when facilitators prioritize trauma survivors, and are able to recognize and address harmful group dynamics. However, he said that there may always be a risk of abuse, and abusers, within group-oriented environments. “The only professionally responsible answer is, it depends.”

Sofia Barrett-Ibarria is a writer in Los Angeles.