Could group therapy help cure the mental health crisis?
'You see people's humanity emerge in group work,' says psychiatrist Molyn Leszcz
*Originally published on Dec. 18, 2023.
Lack of affordability. Long wait times. Problems accessing care in the first place.
These are just some of the barriers that people find when looking for help with their mental health, according to a 2023 Statistics Canada study.
Molyn Leszcz agrees. He's a psychiatrist at Toronto's Mount Sinai Hospital and professor of psychiatry at the University of Toronto.
"The vast majority of people who struggle with depression, anxiety, trauma, substance use, (or) the major mental illnesses — aren't getting the care that they need."
He offers a solution based on the focus of his own forty-plus-year career.
"Group psychotherapy is a way to meet that need. It's an incredibly powerful way to help people."
How group therapy works
Sharing with 8-10 strangers may strike people as less appealing than one-on-one care from a therapist.
But Leszcz, a former president of the American Group Psychotherapy Association, calls it a "triple E treatment." He cites the AGPA's recent findings, published in the journal American Psychologist.
"It's equivalent to individual therapy in terms of its outcome. It's effective. And it's economical from the perspective of the payer," said Leszcz.
Groups exist for a range of personal identities and health conditions. Some offer short-term support and skills around a specific issue such as anxiety. Others run long-term and are more general in nature.
Leszcz says people typically enter group therapy through "a community agency, in an addiction program, or a referral by their family doctor."
As to why group therapy is effective, Leszcz points to the fact that the diverse participants in the group — with their similarities and differences — are themselves central to the process.
While overseen by a therapist, "[t]here is often an incredible strength in the feedback that members of a group give to one another."
Support and challenge in 'group'
American novelist David Payne wrote about his traumatic past in the nonfiction memoir Barefoot to Avalon. He says he was in a serious crisis by the time he first entered group therapy in 2004.
"I was near the end of my marriage. I was...starting to drink in a different way that ultimately went over the line into alcoholism. I needed some sort of psychological support."
Sober since 2006, Payne found his group supportive at times, yet unwilling to indulge him.
In search of the truth, he says, group members "wanted to get to the point. [They'd say] 'Tell us the punchline and then let us get in there and find out what's really going on.'"
Payne attends group therapy to this day.
"I don't think any of us like it when we get challenged about ways that we are maybe not seeing things clearly. But I tend to learn by having to open myself up to that."
Group therapy as social microcosm
Jess Cotton, a literary scholar at the University of Cambridge, points out that several early innovators of group therapy saw a person's psychology as shaped by society, as well as their individual history.
Wilfred Bion was an English psychoanalyst who experimented with group therapy in public health facilities in the 1940s. His patients were traumatized soldiers, who had returned in great numbers from fighting in the Second World War.
In a Europe haunted by fascist leaders, and working with men who'd been subject to military hierarchy, Bion aimed to change the power balance in therapy.
"He merely conducts it. And in doing so, he allows the (soldiers) the opportunity to work through their own relationships to power, their own feelings towards authority," said Cotton.
Cotton names Austrian-born Argentine psychoanalyst Marie Langer as another 20th century group therapy innovator. Langer, an increasingly radical leftist who came to call herself a "mental health worker," believed in the revolutionary power of group psychiatric support, accessible to all.
She began by setting up maternal groups for working-class women in 1950s Buenos Aires.
"By putting women into a room and seeing how they interact," said Cotton, Langer was convinced they could "work through something that was not simply an individual problem, but a more social problem of motherhood — fantasies of [it] being this pure state."
Misuses and uses of group therapy
For all of its usefulness, Cotton says that group therapy went "off the rails" in the United States during the 1960s.
The rise of certain charismatic therapists at the time led to a shift in group power dynamics that undermined Wilfred Bion's notion of the leaderless group, she noted.
This, and extreme counterculture thinking of the times, took self-growth to "eccentric and ethically dubious proportions," according to Cotton. "The group becomes a cult, essentially."
Cotton thinks this brief period of its history may have had contributed to the misperception that group therapy is somehow a lesser form of psychiatric care.
Yet, in a time when people are now turning to mental health apps for help, Cotton says that group therapy is "the obvious therapeutic avenue to pursue if we are seriously interested in addressing what is often seen as a mental health crisis today."
She believes it is important to "learn from how group analysis can go wrong, how it can become ethically dubious. But to return to its more radical and socially useful moments."
At its best, says Cotton, group therapy can offer people "a real tangible narrative and communal connection that allows them to think differently about their own psychic history."
If you are thinking of suicide or know someone who is, help is available 24 hours a day, nationwide by calling the Suicide Crisis Helpline at 988 or text 988.
If your safety, or the safety of a loved one is at risk of an immediate crisis, call 911.
Listen to the full episode by downloading the CBC IDEAS podcast from your favourite app.
Guests in this episode:
Jess Cotton is a Leverhulme Early Career Fellow in English at the University of Cambridge, and wrote about group therapy's 20th century history for Aeon.
Heather Hughes is a writer and editor who wrote about her experience with support groups for The Temper.
Molyn Leszcz is a psychiatrist at Mount Sinai Hospital, a professor of psychiatry at the University of Toronto, and co-author (with Irvin Yalom) of The Theory and Practice of Group Psychotherapy.
David Payne is a memoirist and novelist who wrote about his group therapy experience for the New York Times.
*This episode was produced by Lisa Godfrey.
