A guide to group therapy – Patient information leaflet

This aim of this leaflet is to provide information about Group Therapy at the Regional Department of Psychotherapy. If you are not sure about anything in this leaflet please ask a member of staff.

We are a team of highly trained and experienced psychotherapists who provide group and individual therapy.

The service is also delighted to host training therapists, who may be involved in delivering group therapy.

All therapists are registered by the appropriate professional bodies and codes of conduct, which may differ according to professional background and training.

There are many different types of therapy, based on different traditions and schools of thought. Benfield House specialises in psychoanalytic psychotherapy.

Psychoanalytic psychotherapy is a type of therapy which aims to help identify your problem, to understand its underlying meaning, how it has come about and to work it through.

Your problem could involve a range of difficulties, such as
• symptoms
• feelings
• behaviours and relationship difficulties

The therapy involves talking as openly as possible to the therapist, working together to try and understand the problem and looking at any difficulties that arise in your relationship with the therapist. This process helps to increase your understanding of yourself, helping you to see how your problems interfere with how you relate to others.

Psychoanalytic psychotherapy originates in the work of Sigmund Freud and the developments of later psychoanalysts working in this tradition.

Psychoanalytic psychotherapy has been adapted from this and applied to work within the NHS.

• All psychiatric symptoms have a meaning, in terms of the life of the person experiencing them.

• Mental health difficulties and symptoms are linked to the presence of emotional conflicts between different parts of the personality. These conflicts and difficulties are linked both to inborn biological factors, like temperament, and to actual experience, particularly early experience and relationships.

• These conflicts are often unconscious, and can be played out in relations between different parts of the self, and in relation to other people, and the world more generally – sometimes including the system of care.

• The aim of psychotherapy is to create a setting where difficulties can be relived and better understood, so that there becomes more choice and flexibility in the person’s life. The aim is not considered to be complete “cure”, which is not realistic, or removal of painful emotion and conflict, which are part of life, but increased self knowledge, and a degree of change.

• Change does not come easily. Though there might be a conscious striving to do things differently, there are often other parts of the personality working against, and resisting this change.

• Psychoanalytic psychotherapy is an attempt to provide a setting where intellectual understanding and emotional experience can come together, in a way that can help the person move on with their life.

Groups are run on the same sorts of psychoanalytic principles as those applying for individual psychotherapy. For this reason it is usually considered that anyone who might benefit from individual psychotherapy might also benefit from, and consider, the group option.

There are specific reasons why you might want to consider group therapy;
• The group offers an opportunity to learn about how others might see you, and the types of interaction you tend to get into with other people. You may, for example, feel that you try too hard to help people, and neglect your own needs. You may feel that you never fit in, and easily become offended, or that you avoid certain situations of conflict. You may feel that you don’t know who you are in a group situation, that you have no identity, or lots of different contradictory identities. There may have been an issue in your family of rivalry and jealousy between siblings and these sorts of feelings may get stirred up in other group situation. Who is getting something? Who is losing out? If you feel that these sorts of issues are your main problem then you should consider a group therapy.

• The group can lessen a sense of isolation, as you realise there are other people in the group who may have had similar experiences and/or difficulties.

• Unlike individual psychotherapy it is possible to take up different roles in a therapy group; you might be explore your own feelings in the group, but also be in a position to observe and comment on the struggles of other group members. You may find that you can both help, and be helped by, other group members.

• Having completed your consultation you may have to wait for a place within a group. The therapist who saw you for a consultation will discuss with the clinical team the sort of group that could best help you and once a place becomes available you will be invited to meet the group leader(s) to discuss joining the group. At this meeting you will be able to talk about the sort of group you will be joining, its frequency and all other ground rules.

• Should you be waiting longer than six months, you will be sent a review appointment by the psychotherapist who you saw for your consultation. In this way we can monitor your progress and update you on our own in relation to your wait. A letter will be sent to your referrer and other relevant third parties following these review appointments. A note will also be entered into your electronic record on the Trust database.

• It is likely to be recommended that you join our Preparation for Therapy group before embarking on a longer-term group. The Preparation for Therapy group runs for eight weeks and gives you the opportunity to better understand by experience what a psychotherapy group is like before committing to a longer term treatment. The group also gives you the opportunity to think with the group and your therapists about whether group therapy feels the right way forward for you. Following the ending of the group there will be an individual review meeting. This group may not be suggested if you have had previous group or individual therapy in the Department.

• There are a number of long term psychotherapy groups ran by the department. There will be people in the groups (usually 6-8) with different diagnoses. Some of these groups will be “closed” and fixed term, perhaps running for a year or a two year period. In these groups everyone will be scheduled to start and finish therapy at the same time, though some new members may come in if any original members leave.

• Other groups will be “slow-open” and will be ongoing. This means that members will begin and leave at different times. When people do leave is a matter of individual judgement, as to when they feel they have got as much from the group as they can, or for another reason. We recommend however that in order to give the group a chance to be effective potential group members should plan for a minimum of one year. There is a maximum time, and this is of two years.

• Most groups at Benfield House have between 6-8 members, usually men and women, and across different age ranges, and with a range of difficulties.

• In some groups there are two psychotherapists, often, but not always, a man and a woman, whilst in others there is a single psychotherapist.

• The psychotherapists’ role in most groups is similar to that of the individual psychotherapist. They are required to be real and genuine in their interactions, but also not to put their own personality to the forefront, and to help create conditions where group members can better experience, express and reflect on their pattern of interaction with the group, including with the group therapists.

• This means that the therapists will usually, again in common with individual psychotherapy, usually refrain from offering direct advice, or from immediately acting to reduce anxiety, or from directly answering questions without first enquiring what might have prompted that particular question at that particular time.

It is important to create a setting where group members can express their feelings, and explore their relationships as freely as possible. At the same time very powerful feelings can emerge in any group situation. The fear of this can lead to anxiety. This can be helped by a secure framework for the group, and some basic group rules/ guidelines. There may be different for different groups but the basic guidelines are as follows;
• Group members are asked not to talk about the group outside, and to respect confidentiality.

• Group members are asked to have no contact with each other outside of the group during the period of group therapy.

• If there are difficulties in attending group members are asked to discuss these in the group.

• If group members feel that they want to leave group therapy we ask that members give four weeks notice and try to attend the group during that period.

• Powerful emotions can arise during group therapy, sometimes including anger. It can be very therapeutic if this can be expressed and put into words. However verbal abuse or direct aggression will not be accepted in the group situation.

• Any member who attends under the influence of drugs and/or alcohol will be asked to leave the session, and encouraged to return the following week.

During the time that you attend the group, there are various ways that communication is shared with third parties. These include;
• An electronic record of the group session and any relevant information about the individual group member concerning his or her progress. This information is accessible only to clinicians working with the group member and who are employed by the Trust. For example, they may include a group member’s CPN, or Psychiatrist or Care Coordinator. This record enables up to date communication to take place between professionals involved in the system of care.

• The person who has referred the group member will already have received a consultation report about that individual and the recommended further treatment option, (in this case a group). This report will have been copied to other professionals involved and who are not employed by the Trust – for example, the group member’s GP, or social worker or primary care psychologist.

• Once a group member has begun group therapy, the group leader(s) will write to the original referrer on approximately a 6 monthly basis, this will be a brief communication, advising them of the group member’s progress in the group, any changes made and any concerns about clinical risk as is appropriate.

• If during the course of your group therapy treatment, your therapist considers that you are at risk of harm due to your health issues, and he or she considers that another intervention may be helpful, he or she may discuss with you the possibility of contacting your GP or a third party on your behalf to provide more immediate support. It is important to note that if a therapist is sufficiently concerned about the immediate wellbeing of yourself or others there is a duty of care to ensure safety and your confidential information may be shared with relevant professionals, such as your psychiatrist or the crisis team without your consent. We would however endeavour to inform you of this prior to this communication whenever possible.

• Your therapist is not at liberty to share information about you in the group that has been communicated to him or her by a third party outside the group. For instance, if your therapist is approached by a third party about a matter of medical confidence in relation to one of the group members, he or she is not at liberty to share this communication with the group. In this instance, he or she may speak to the group member individually and is likely to encourage this communication into the group although it would remain the decision of the group member as to whether to do so or not.

• On occasions group members may feel overwhelmed by the feelings stirred up by the group process. At times this can result in individual’s hurting themselves following a group session. Group members are encouraged to return and to talk about their experiences and the group and group leaders will try to help the person understand what has happened. The aim is to develop a capacity to bear feelings, put words to them and in understanding their origins, reduce risk over time.

• However, in some situations where risk increases or if a group member experiences an acute crisis, in order not to interfere with the therapy process, other agencies may be called on to provide more immediate support. In conjunction with the therapy this can enable treatment to proceed.

• It is important to note that this will only be necessary for some group members and will be negotiated on an individual basis as and when required.

At the end of the group therapy a discharge summary will be written to the referrer and copied to relevant third parties.

Should you have any questions having read these information sheets, we would be pleased to answer them.

Centre for Specialist Psychological Therapies
Regional Department of Psychotherapy
Benfield House
Walkergate Park
Benfield Road
Newcastle upon Tyne
NE6 4PF
Tel: 0191 287 6100
Fax: 0191 287 6101
Email: [email protected]
Please note that information sent to the Trust via email is sent at your own risk.

• United Kingdom Council for Psychotherapy UKCP
Website: www.psychotherapy.org.uk

• British Psychoanalytic Council – Information, news and debate about psychoanalytic and psychodynamic psychotherapies
Website: www.psychoanalytic-council.org

• Royal College of Psychiatrists
Website: www.rcpsych.ac.uk

• PALS
The Patient Advice and Liaison Service can be contacted on free phone
0800 032 02 02 or email [email protected] for advice and support.

• Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., & Crowe, E. (2014). Short‐term psychodynamic psychotherapies for common mental disorders. The Cochrane Library.
http://www.update-software.com/pdf/cd004687.pdf
• Garland, C. (Ed.). (2010). The groups book: psychoanalytic group therapy: principles and practice. Karnac Books.
• Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. The British Journal of Psychiatry, 199(1), 15-22. http://bjp.rcpsych.org/content/199/1/15.long
• Lemma, A. (2003). Introduction to the practice of psychoanalytic psychotherapy (pp. 1-14). John Wiley & Sons, Ltd.
• Lindfors, O., Knekt, P., Heinonen, E., Härkänen, T., Virtala, E., & Helsinki Psychotherapy Study Group. (2015). The effectiveness of short-and long-term psychotherapy on personality functioning during a 5-year follow-up. Journal of affective disorders, 173, 31-38.
http://www.researchgate.net/profile/Olavi_Lindfors/publication/269312632_The_effectiveness_of_short-_and_long-term_psychotherapy_on_personality_functioning_during_a_5-year_follow-up/links/54891df60cf2ef344790a865.pdf
• Shedler, J. (2012). The efficacy of psychodynamic psychotherapy. In Psychodynamic Psychotherapy Research (pp. 9-25). Humana Press.
http://internationalpsychoanalysis.net/wp-content/uploads/2009/11/Shedlerarticle.pdf

If you want to make a comment, suggestion, compliment or complaint you can:
• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website www.cntw.nhs.uk (click on the ‘Contact Us’ tab)
• telephone the Complaints Department 0191 245 6672
• email [email protected] Please note that information sent to the Trust via email is sent at your own risk
• We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.
You can provide feedback in the following ways:
– the quickest way for you to do this is to complete our short online survey at www.cntw.nhs.uk/poy
– complete a Points of You survey, available from staff.

Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

Published by the Patient Information Centre
2021 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Ref, PIC/656/0621 June 2021 V9
www.cntw.nhs.uk Tel: 0191 246 7288
Review date 2024