Introduction

An effective way to work toward increased awareness of self is in group therapy, a safe, low-risk environment, where the presence of others seeking the same goal, offers us support, as well as a lived experience of being regarded and accepted by others.

In as much as it is in our day-to-day close relationships with others that we most notice and experience our inner emotional reactions, group therapy, though a structured environment, creates a situation of realness where inner reactions can be experienced and processed in a way that is conducive to increased consciousness of self.

In essence, the therapy group becomes a safe environment where we can work at dismantling our defences, take off our masks, and access our inner worlds, enhancing our relationship with ourselves. Essentially, group therapy aims to enhance the individual’s relationship with self; to learn ways of maintaining a constant sense of self-worth, a self-value that is not based on what I do or have, but who I am at the core of my being.

Through the experiential learning that is group therapy, growth-inhibiting ways of relating to oneself and others are questioned, and the fixed roles that one might experience in one’s life are explored and challenged. One is helped to remove obstacles that block the process of growth.

Benefits of Long-term Group Therapy

• Grow in your sense of self-worth and learn how to maintain it.

• Learn about your interpersonal style.

• Experiment (in a safe environment) with new interpersonal behaviours.

• Learn to express your feelings, both the negative and positive emotions.

• Address and overcome compulsive behaviour patterns

• Alleviate symptoms of anxiety and depression

• Help create and maintain meaningful relationships in one’s life.

• Learn to integrate previously disassociated parts of yourself.

• Learn to be more trusting of groups and other people.

Long-Term Group Guidelines

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Before you enter into group therapy, it is important that you read and understand these guidelines, so that you have a good sense of what to expect, and how to be in the group in a way that enhances your own growth and healing.

If you are going to benefit optimally from group therapy, it will need to be experienced by you as a safe environment. To this end, I view one of the key roles of the therapists as ensuring that a group is a safe place for you. One way I do this is by putting structures in place that enhance the safety of the group for all the members. I have included these structures in the second part of these guidelines. But initially, let’s have a look at the theory of group therapy.

The theory of group therapy

It is our woundedness and our entrenched ways of coping with our inner pain that hampers our freedom to function optimally in our present-day relationships and adult life. This woundedness originated in our early formative years. It takes the form of repressed emotions and accompanying defence mechanisms, as well as unhelpful attitudes towards, and beliefs about ourselves and others that result in us experiencing a lingering shame or low self-worth.

For most of us, a way of coping with and surviving our woundedness has been to attempt to distance ourselves from our pain, trying to turn a blind eye to it, trying to distract ourselves from our suppressed emotions, by busyness or other habitual compulsive or addictive ways of thinking and behaving, as well as patterns of avoidance (avoiding situations and ways of relating that we know will evoke emotional intensity for us).

The inner child

An analogy that can help us understand our inner pain is the inner wounded child. We all carry the emotional residue of the past within us, both in the form of repressed emotional energy and in terms of unhealed emotional memories. These memories and the accompanying emotions will be revisited in present times of vulnerability when an encounter with another remotely resembles an interactional dynamic we experienced in a relationship with our respective parents. It is as though we have a wounded child within, whose wounds are scratched open at these times.

The intensity of our present-day emotions is a function of the unresolved emotion from our growing up years. Our preferred way of working with our emotions, which can exacerbate the build-up of emotion within us, also intensifies the experience of emotion at particular moments in our lives. To put it another way, within us is recorded all those situations and events that were emotionally impactful on us as a child, especially those relational experiences with significant others, that left us feeling vulnerable as a result of feelings of sadness, hurt, disappointment or fear. If one does not actively work with these emotions in the present, in ways that facilitate their healing, these emotions will be felt again and again in our more intimate relationships.

So for most of us, we are sitting with a belly full of emotions that have been stored in the unconscious from the moment they were first evoked in us. We may not remember the events of early childhood, but emotional memory does. The existence of this unresolved emotion within is particularly evident when we experience an intensity of emotion that may seem disproportionate, or at times irrational, or unrelated to what is actually going on in the present. This is referred to as spontaneous age regression and is a moment where we will know most vividly our real experience as a child.

The healing of our inner being in group therapy

In group therapy, we want to begin to relate differently, both in our attitude towards ourselves (our wounded inner child) and in our interaction with others. Essentially, we want to go towards our emotional pain rather than try to disown, deny or distance ourselves from it. We want to acknowledge, recognize, identify that wounded child within, allowing him/her to be known by others, creating the opportunity for our wounded child to be validated, regarded and accepted by others. As we experience others being okay with our wounded inner child, indeed loving towards that once hidden child that they now encounter, we too begin to love that child ourselves, moving towards our inner child in a way that integrates the child (our true selves) with our adult self.

All the ingredients for your healing will be present in the context of the group – in the experience that is generated in each session. This is your material – your experience of others during a session and your concomitant behaviour (not participating or communicating, is also a behaviour), together with your inner world as it is conscious to you; as you are impacted upon by the happenings in a session.

This (your behaviour and your inner world) is your truth at this moment in your life. Allowing others to know you in your truth and experiencing their ongoing acceptance of you (even though they know your truth) – is the heart of therapy. This feeds your growing acceptance of yourself and this is the healing way.

The journey of healing then is characterized by a growing awareness of our inner world. Sometimes we will be dismayed, shocked, surprised at what emerges within us. Loving our whole being with all those tendencies, emotions, thoughts, fantasies, attitudes that emanate from a wounded, pained, defended and hidden inner child brings about healing. Conversely, our irritated, harsh, degrading, demanding, shameful attitude towards self keeps the child well hidden and prevents any deeper healing.

Our emotional woundedness

There are four predominant emotions that are common to all of us in our original childhood pain. They are sadness (grief), fear, anger, and shame. It will be helpful for you to normalize the experience of these emotions both during and between sessions.

Sadness

It is appropriate and normal for a child to feel sad when they experience a lack of acceptance and regard from the significant caregivers in their life. Lack of acceptance takes the form of disregarding or invalidating the child’s feelings, conveying to the child both overtly and covertly that how they feel is unimportant, shaming the child for feeling the way they do, minimizing the child’s feelings and needs. The child is dependent on caregivers around him to fulfil his needs for esteem, affection, and unconditional positive regard. When he doesn’t have this normal child need fulfilled, it is experienced as traumatic for the child. The wounded child remains within us, wanting the truth of his story to be known, wanting someone to give him permission to grieve the past, to weep about what happened.

Fear

The true self (our inner child) has been in hiding for many years. She has remained hidden out of fear, fear that if she comes out of hiding, she will receive the same non-accepting response (experienced as abandonment) that originally sent her into hiding. As adults now, we struggle to be our true selves because we experience a deep vulnerability to messages and nuances of disapproval, criticism, lack of acceptance, rejection and abandonment of some kind. In that moment we experience the full extent of the child experience in our formative years – the anger, fear, loneliness, and sadness of that situation for the child.

It is inevitable that you will re-experience these emotions. Your task is not to abandon your inner child at these times, but rather to empathise with him in that you are experiencing a vivid picture of how life was for him in his early years. You abandon your inner child by treating him like he was previously treated in his emotional vulnerability – by denying his feelings, acting as though your feelings are unimportant, shaming yourself for feeling the way you do, refusing to give yourself permission to feel particular feelings, acting out these feelings in self-defeating ways, blaming others for your feelings rather than owning them yourself.

In all innocence and spontaneity, the child, (responding to its inner truth because that’s all she knew in those initial years of life) reacted to her environment in all her truth. Her truth (in the form of emotions) was not received acceptingly, and she became scared of the possible love withdrawal and/or abandonment of the significant others around her. She automatically went into hiding, trying, at all costs to win over acceptance. “I would rather inhibit myself (adapt) than lose the support of the significant other in my life.” As adults, we have continued to be inhibited, hesitant, calculated, plotting, avoidant in the reactions of our environment because of that initial fearful response we received in our early years. As we now in group dare to become less inhibited and more spontaneous again, we will experience that old fear again, as we predict that others might be disapproving and rejecting.

Anger

The lack of acceptance and lack of unconditional regard as a child evoked anger in the child. With the anger not being validated or heard, it too had to be repressed. We all carry unresolved anger within us, angry at being let down by our caregivers, disappointed that we did not receive the unconditional positive regard that we deserved.

There are two broad categories describing individuals and anger. Firstly, there are those who struggle to access their anger. Anger was not okay as a child, and they have continued to listen to that introjected parental voice. Working differently with our anger is an unavoidable part of the healing journey. In group therapy, as we over time, gradually dismantle those defences that have kept our inner child hidden we will inevitably begin to access that unresolved anger that we carry. Identifying, acknowledging, naming and owning your anger is your task. With time, the intensity of the anger dissipates, pointing you to the underlying pain that the anger is trying to bring to your attention.

Then there are others who readily access their anger in everyday life, and channel all their emotional responses through anger (eg. When someone doesn’t accept me, I get angry; When someone doesn’t agree with me, I get angry; When I feel hurt, I get angry; When I am disappointed that others haven’t responded to me how I would have liked them to, I get angry). They will have no problem identifying their anger. It is ever-present. Letting go of their anger, so that their more vulnerable emotions can come to consciousness is their task. “Yes, I was badly let down as a child, and up to this point in my life, I have continued to experience others not living up to my expectations and experience constant anger about that. I now acknowledge and own my anger, and tell you my truth. My anger is not about the present day. I was neglected as a child, my feelings were not considered, my needs were not regarded, and I am deeply pained by that”.

Shame

Shame is the resultant disposition we experience when we have been given the impression that our feelings are not okay. Shame-bound means that whenever you feel particular feelings or needs, you immediately feel ashamed or irrationally guilty.

We are not born with this shameful feeling toward ourselves and our emotions. We begin to experience shame as significant others treat us shamefully when we are “being” in a way that is authentic to our inner emotional experience. The origins of shame begin from our earliest experiences of life, as we went about being true to ourselves, an authentic emotional infant and toddler, and we were shamed for having particular natural emotional responses. Because our emotions are fundamentally who we are, an individual being ashamed of his emotions begins to feel ashamed of himself. “I am not okay when I am angry, I am not okay when I am hurting, I’m not okay when I am sad or disappointed, then I must be not okay.”

As you begin to think differently about your emotions and give yourself permission to acknowledge and feel the full range of your emotions, you will inevitably initially experience shame. It is important not to “follow” the shame or buy into its authenticity.

The Practical Application in the Group

Inner Healing occurs through relationships, through the experience of acceptance and regard from another, where their commitment to you is manifested in the way they relate to you, characterized by giving to you through an openness and honesty that places your growth above their need to be liked or esteemed in that moment.

Your task is to build such relationships, by allowing others to get to know you on a deeper level, so that you can receive their acceptance and regard, and then for you to give to others by sharing your inner world with them as it becomes conscious to you in relationship to them – your emotions, thoughts, perceptions, observations, imaginings (fantasies).

As we move into this deeper way of relating, we notice an increased level of vulnerability and the more constant presence of our wounded inner child. Others will evoke old unresolved, unhealed childhood emotions in us. In this way, they will help you to know your inner world more. As these feelings are evident to you, (feelings of warmth, joy, appreciation, affirmation, connection, attraction to feelings of sadness, hurt, fear, anger, disappointment, frustration, shame), it is your task to begin to give your inner child a voice. Remember the child felt all these feelings in his early years, but had to repress them. Firstly, because there was no one there to hold him (physically and emotionally) in his experience of his emotion, and secondly because he got the message that the expression of his emotion brought about a disapproval and distancing from others. Giving our inner child a voice now means that we begin to identify, name, describe our emotions as we are aware of them in relationship with others.

You will notice that at times your emotions are received with an altruistic empathy and regard. These will be helpful experiences for you in group, corrective experiences where your emotions are being responded to in a qualitatively different way to how they were responded to as a child. At other times, you will notice that others struggle with your expression of your emotions, primarily because your expression will evoking emotions from their wounded child, and in the expression of their emotions, you might feel unaccepted, criticized, rejected and/or emotionally abandoned. These times, though difficult, are equally important for your healing. Firstly, they create a situation of realness, in that these moments when our respective wounded inner children are evoked simultaneously, are common moments in all our intimate relationships, situations that can’t be avoided, but can be worked through constructively and in a way that precipitates growth. Secondly, these situations create opportunities for us to practice not abandoning ourselves (through self-defeating behaviour, acting out, isolating or distancing behaviour, going toward a place of depression and despair), to sit with the difficult, painful and uncomfortable feelings of our inner child (in essence, be with our inner child) even if the other person cannot understand or validate our feelings at this moment. These moments in our relationships here in group are probably the most difficult, but are the same time most rewarding and growth-filled for you in terms of your relationship with yourself. They represent life. We want to be able to live day to day life, with the knowledge that whatever curve ball comes our way, and whatever emotions are evoked in us, we are able to maintain a constant sense of self-worth.

Structures that enhance the safety in the group

If you are going to benefit optimally from group therapy, the group will need to be experienced by you as a safe environment. To this end, the therapists view one of their key roles as ensuring that the group is a safe place for you. One way we do this is by putting structures in place that enhance the safety of the group for all the members. Below is an outline of those structures.

1. Confidentiality:

The issue of confidentiality is probably more straight forward and unambiguous when it comes to individual therapy, in that the therapist is bound by a clause of confidentiality, while the client is free to divulge any content of any session to anyone. In group therapy, in one sense we are all both “therapists” and clients. Others are daring to disclose to us, in an open and honest way, deep levels of their being. Our response, in them trusting us sufficiently to confide in us at this level, is to reassure them that we will not speak about them or the content of their sharing outside of the group. This is a fundamental quality of all healthy intimate relationships, and is not unique to group therapy.
The difficulty inevitably emerges in terms of our own therapeutic work in group which will, for the most part, involve other individuals in the group. It would be unrealistic and probably unhelpful for us not to share our own personal experience of group with our spouse at times, particularly in the fact that our ongoing growth during our therapy will constantly impact on our marital relationship and our patterns of relating generally. In as much as our experience will involve our fellow group members, exercising discretion in these conversations will be necessary, practising the art of being respectful to those to whom you are growing close, and who are daring to trust you with ever deeper levels of themselves.

2. Regular Attendance:

There is an expectation that when you enter into a therapy group, you will be committed to attending every session; that is, that you prioritize your therapy in your weekly commitments. The need for this level of commitment is two fold. Firstly, in order for your therapy to be a growth-filled and healing experience for you, it requires that your relationships with both the therapist and other individuals in the group be experienced on a deeper, more vulnerable level than you would experience other relationships in your life. Remember that it is our experience of ourselves in relationship to others that is therapeutic and healing. Irregular attendance prevents the possibility of your relationship in group reaching a quality that is optimal for growth.

Furthermore, in terms of your ongoing growth in your relationship with yourself, your decision to prioritize your therapy is an indispensable communication from yourself to your inner child and pivotal in the process of re-parenting your inner child. In as much as we might have got the impression as a child that there were more important issues in our parents’ lives than our well-being and emotions, to continue to convey that message to our inner child is counter-productive to your therapy. Discerning then, what is unavoidable absenteeism and what is more a difficulty in prioritizing your inner child, becomes an ongoing growing experience during your therapy.

Though there are other factors that impact on the duration of your therapy and the depth of your healing, I estimate that for every session that you are absent, you can add a month onto your therapy in terms of the duration necessary for achieving your goals.

The other factor that pertains to absenteeism is not only do you miss out, but your absenteeism can contribute to a culture of irregular attendance in your group which adversely affects the safety and therapeutic climate of the group. If you want to benefit from this environment, you will have to contribute to nurturing and sustaining the environment, and each person does this, first and foremost by regular attendance. In as much as commitment, closeness and vulnerability in relationships (healthy intimacy) might be key issues that you are addressing for yourself in therapy, you might notice a strong pull within yourself towards irregular attendance at times, and an ability to justify and rationalize your irregular attendance to both yourself and others. Though others will probably help you to stay honest with yourself in this regard, it will remain your responsibility to constantly resist the tendency within yourself to control the levels of closeness and vulnerability by means of irregular attendance.

3. Punctuality:

Each session will begin promptly at the time stipulated. Your punctuality and difficulties in this regard, impact on both yourself and the group in the same way as irregular attendance.

If the therapists deem that your irregular attendance or lack of punctuality is adversely impacting on the group, they will approach you to co-evolve with you some other form of therapy to address these issues specifically, before you re-enter long-term group therapy.

4. Extra-group meetings:

Contact outside of group between members in one form or another will inevitably occur, though, generally speaking, it is not to be encouraged. If by chance or design, members do meet outside the group, it is helpful to both themselves and the group if they disclose that encounter in the next session and share their inner experience of that encounter with the group. Failure to do so can bring about an accumulation of unfinished business between members and/or contribute to alliances forming between members that can hamper the therapeutic process of those members, and impact on the general safety of the group.

Given the intensity of this therapeutic environment and the levels of vulnerability that are necessary in order to experience inner healing, it is normal and natural for members at times to be conscious of feelings of attraction to other group members and a concomitant desire to encounter individuals outside group session time. For these emotions to be disclosed and processed in the context of the group is helpful. Acting on those feelings and pursuing that relationship outside group can jeopardize the therapy of both individuals.

4a. Extra-group contact extends to therapist: While you are a member of the group, all communications between yourself and the group therapists will be disclosed in the group. The exception to this is if you are in individual therapy with one of the group therapists. The fact that you are in individual therapy and the content of your individual sessions will always remain confidential. All telephone conversations, text messages, emails to the group therapist will not be considered confidential. If you have a need while you are in group therapy to consult or confide in a professional, it is advisable for you to enter into individual therapy with another therapist. At times you might experience a need or desire to have a once-off individual session with one of the group therapists. These sessions are also not confidential. They too are part of the group process for you and are deemed helpful to talk about in group.

5. Therapist’s notes:

Another factor that contributes to the establishment and maintenance of this therapeutic environment is the positioning of the therapist in the group. In truth, the therapist does not and cannot ‘do’ the healing. Remember it is through the relationship that we heal. Therefore the therapists can ‘be’ in a way that facilitates the healing process for each individual. This way of being is primarily characterized by entering into relationship with you in the here-and-now and doing what every individual is encouraged to do – share his consciousness of his inner world with the other, as his inner world registers the impact of the other on him – his emotions, his inner thoughts, his perceptions, his observations, his insights. The therapist needs to balance this way of being with another way of being and that is to not dominate the group process. To this end, the therapist sends his therapeutic notes from each session to each group member. These notes are a summary of all that impacted upon his inner world throughout that session and serve to ‘feed’ his relationship with others without him dominating the group. In as much as the therapist’s physical presence will impact on your inner world, a description of his inner world in the form of these notes will also impact on you. Like all group process it will be helpful for you to bring forward your inner world as it is impacted on by the therapeutic notes. If for some reason you don’t find receiving these notes helpful, feel free to mention that in group and the therapist will refrain from sending them to you.

6. “Being” in group:

Given the unusual and unfamiliar nature of group therapy and the need for us to break old patterns of relating and relate differently in order to grow, it is at times difficult to know “how” to be in group. Though the bottom line is to speak your truth, there are communication and interpersonal skills that are conducive to building relationships. These are outlined below:

6.1. Try as far as possible to focus on the here-and-now. Notice what is happening in the group. Notice the feelings that are evoked in you as things are happening in the group. Go towards verbalising your inner world in this regard.

6.2. Assume personal responsibility for your thoughts and your feelings. Avoid blaming others.

6.3. Avoid giving suggestions and fostering dependency.

6.4. Learn to listen to others.

6.5. Attempt to experiment with new behaviours.

6.6. Experiment with giving and receiving feedback. When feedback is to be given, the following can be kept in mind:

a) Be specific
b) Give feedback as soon as possible
c) Be direct
d) Share the positive and the negative
e) Tell how the other makes you feel
f) Don’t deal with why, but with what you see and feel
g) Acknowledge the feedback you receive
h) Don’t make excuses
i) Seek clarification
j) Think about it
k) Be aware of becoming defensive
l) Ask for feedback

6.7. Experiment with self-disclosure. This may involve past or current events in one’s life, hopes and aspirations for the future and current feelings towards other individuals. Self-disclosure is important :

a) It is a prerequisite for the formation of meaningful interpersonal relationships.
b) Self-acceptance must be preceded by acceptance by others (i.e. to accept oneself, one must permit others to know one as one really is).
c) Those who reveal themselves are more likely to be liked by others.
d) Those who disclose too profusely, arouse anxiety rather than affection by others.
e) Group members who do not disclose themselves have little chance of genuine acceptance by other members and therefore have little chance of experiencing a rise in self-esteem.
f) Self-disclosure is a complex social act. Time, place, and person must always be considered.
Remember these are ways of relating that we are moving towards. It is not necessary to be concerned about not “being” in a way that is in keeping with the above. Give yourself permission to be imperfect and make mistakes, and exercise patience with yourself.

7. The account: The benefit that you will experience from your therapy will be as a result of your group meeting over time on a weekly basis. The life and sustenance of the group is dependent on it convening on a regular weekly basis. For this reason you are required to pay for all sessions whether you are in attendance or not. Furthermore I require that you pay for your therapy a month in advance. For example, during the last week of a month you will receive a statement for the forthcoming month. You are required to settle your account before the first session of the new month. For those who are on a medical aid you will need to settle your account with me first and then reclaim from your medical aid. Your medical aid will not pay for sessions in advance. You will need to wait until the end of the month before submitting the account to your medical aid. Please note that I am required to state on the account those sessions that you did not attend. Generally, medical aids will not refund you for those sessions. If you are on a medical aid and you are not in a position to pay in advance please speak to me about that so that we can negotiate and agree on a way forward in this regard.

8. Termination: It will always remain your decision and your prerogative when and how to terminate your group therapy. However, below are some guidelines in this regard that will facilitate your ongoing growth and healing as you make the transition between being in a group and life after group therapy.

When you terminate your group therapy is obviously dependent on your goals and aspirations for yourself in terms of your growth and healing. Given the nature of our inner world and the resistances and defenses that we experience as a result of the old ways of coping with our inner pain, it is normal and expected that you will experience the desire to terminate your therapy at various times during the course of your therapy. Discerning whether these are signs that you are avoiding a particular issue within yourself (or struggling to go towards a particular area of unhealed pain within you), or whether you have worked through all the core issues that have been preventing a way of being that is conducive to ongoing growth and healing is difficult. It is therefore helpful, as with all emerging movements from your inner world, to bring forward these emotions that are prompting a desire to leave group and be open to feedback from the group in this regard and go towards those fears that might be emerging from your wounded inner child.

The characteristic picture of the healing journey is the slow and gradual dismantling of our defenses, bringing about the experience of increasing levels of vulnerability. This vulnerability creates the possibility of experiencing our original pain (those emotions we first experienced as a child at those times when we were not emotionally held) in a safe environment of group. However, the experience of this original pain (fear, anger, sadness, grief) triggered by these current relationships in group takes the form of therapeutic crises. Given its unfamiliarity and “rawness”, it can trigger strong emotions that prompt us to want to flee at these moments. It is preferable to resist acting on these feelings of wanting to flee and welcoming this moment as an opportunity to work through this old pain that you have been carrying for many years. It is inevitable, normal and good that you experience these therapeutic crises. Without them your therapy will be limited and void of any deeper and more permanent healing.

Your termination in and of itself is a therapeutic crisis. Remember you will have journeyed with a group of individuals and related and communicated to them in a way that is unparalleled to any other relationship in your life up until this point. It is helpful to be open and honest about your thoughts, plans and vision about your termination of your therapy, giving others and yourself time to work through the emotions helps in this regard.

For reasons pertaining to the safety of the group, it is not possible for you to leave your group and then return to that group sometime later. If it was permissible for individuals to leave and then return to the same group, this norm would not facilitate a culture of commitment to work through those difficult moments in relationships and therapy, and would not help the trust building process in the group. You would always be welcome to join another group in the practice and continue your therapy with that group.