Group Anxiety

Group therapy is a potent form of counselling. Support groups and other types of psychosocial groups meet for nearly every type of illness, problem area or social issue. Group therapy can be very beneficial to many individuals, but there is undoubtedly a degree of anxiety about the decision to join a group. Speaking from my own experience of being a member of a long-term therapy group as well as conducting groups, I have become familiar with some of the anxieties and concerns which seem to deter people. This I feel is a great pity, much of the anxiety about joining a group is usually dispelled in the first few sessions as the rapport and trust builds up between the participants. Nevertheless, the anxiety about groups persists. In my series of blogs about groups, I wanted to look at some of the frequently mentioned concerns about group therapy and try to dispel some of them.

One of the reasons given for not wanting to join a group is that people are concerned about issues of confidentiality. Some time back I was speaking with a young friend of mine who has already had several experiences of individual therapy for their anxiety. They were complaining that although individual therapy had helped them a lot they still didn’t feel their issues had been fully resolved. “Why don’t you give group therapy a try then?” I asked. Their reply was instant and dismissive, “why would I give my secrets up to a bunch of strangers?”  More recently I learned that from a sense of having ‘tried everything else’ my friend had finally joined a therapy group. This time, they were much more positive about groups. They reported many of the positive advantages to be gained from group therapy and they had discovered that sharing their ‘secrets’ was a profoundly liberating and healing experience.

One of the reasons my friend was able to feel comfortable about joining a therapy group was that the group leader had taken time to discuss the essential confidentiality that is created within the group.

News on my friend’s experience made me reflect on their earlier rationale for avoiding groups and their idea that secrets would be exposed and that this would in some way damage them. So in a way, it wasn’t so much about being in a group that worried them as a deeply held set of beliefs around the concept of secrecy. I believe that the experience of sharing within groups offers a safe environment to explore our personal and inter-personal relationships to the parts of ourselves that we feel compelled to hideaway. Secrecy itself is the act of hiding and concealment. Both secrecy and confidentiality refer to contained or restricted information within a relationship. Both involve the conscious act of withholding from others thereby creating a dynamic of inclusion or exclusion.

Groups can hold a secret. A family group may harbour secret information about n alcoholic relative for example. Perhaps the secret is held as a covert manifestation of familial shame. Similarly, a therapy group can become a repository of confidential information. Clearly in groups information is shared which makes group members privy to personal material. It is understood in therapy groups that the information along with the identities of the group members must be withheld from the outside world. What is said in the group stays in the group.  This kind of withholding is not secrecy but a function of confidentiality. Secret and confidential relationships are justified ways of protecting something precious or valuable, like survival, freedom, or personal growth but there is a big difference between a secret and a confidence.

The Secrets that we keep

The secrets that we keep tend to be clustered around emotionally charged biological, psychological and social events experienced during our lifetimes: sexual union, pregnancy, physical and social decline, physical and mental decline, poverty, criminality and so on.

The emotions associated with secrecy by the powerful emotions of shame and guilt together with rage, anger and fear. Sometimes in a group information is shared for the first time, something is disclosed which had never been revealed. This revelation of a secret provides the group with an opportunity to discuss the emotional impact of being locked into secrecy in the past and the relief experienced when in the safe, confidential, group environment the fear of punishment, retribution, shame or loss no longer holds any potency. Secrets are offered up in the therapy group so that they can finally be relinquished.

Building Confidence, breaking silence

In contrast to secrecy with its withholding of guilt and shame, confidentiality can be viewed as a therapeutic factor. Information shared in confidence within the group is not withheld in a spirit of fear or antagonism to some agency outside the group. Information is withheld from the outside world by the group which forms a nurturing and protective boundary co-created by the group members.

The essential therapeutic factor of confidentiality within groups is that change can take place within the group boundary which ultimately will help group members relate more creatively, openly and constructively with those outside group. In other words, confidentiality is highly prised as a therapeutic factor in group work as it provides an optimal condition for growth as opposed to the restrictive nature of secrecy.

My friend has learned that a therapy group offers a unique landscape with a climate of safety necessary for personal reflection and personal development. The group integrated their inner and outer world through the revelation of their ‘secrets’. Internal splits evoked by long-held secrecy has finally been healed rather than perpetuated. My friend now feels free from the secrets that underpinned their guilt and shame and fuelled their anxiety about the consequences of their secret being revealed and, I am pleased to report, they are no longer daunted by the idea of therapy in groups!

Written by Allan Todd – Group Analyst in Training