Social Support in Groups

• Therapeutic Alliance and Treatment Outcome by Brian O'Neill, editor Gestalt Therapy Forum, 1/28/97
  • Therapeutic Alliance in Cognitive Therapy by Barbara Fleming,Ph.D., 2/16/97
    • In groups also... by Judith Kraybill,Ph.D., 2/19/97
      
      

I was interested to read your post about social support in cognitive-behavioral anxiety groups. Could you tell us more about what specifically gives you the feeling that the cognitive-behavioral aspects alone are insufficient for long-term treatment success?

My own clinical experience in running many cognitive-behavioral anxiety disorder groups over the years is that the structured cognitive-behavioral group setting offers more than enough support in and of itself. In fact, early on in my experience, I found that there was too much social support. Patients became too dependent on the group for support, instead of finding more effective means of achieving that support in their home environments. Since then, I have tried to somewhat downplay that level of support, discouraging contact between group members outside of group time and working in a focussed manner within the group to help patients develop more social supports at home. When I have visited some leaderless support groups, I have been concerned by the tendency of patients to just share and focus on their symptoms, which has seemed counter-productive to me. It seems like it would be much more beneficial for the support to develop within the context of actively working together to achieve their goals.

I wonder if what makes the difference is how the groups are run? My understanding is that cognitive-behavioral anxiety groups are very collaborative and interactive. The focus is not on each patient interacting with the therapist (as in doing individual therapy within a group setting) nor in the therapist lecturing or teaching to the group. Instead, the focus is on encouraging group members to actively work together to help each other achieve their goals. Sure, the therapist has to spend some time with education and the teaching of skills. But there is a deliberate and constant focus on turning the focus back to the interaction between groups members. The support can be tremendous!

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