In a perfect world, when practicing group psychotherapy, all group members have immediate buy-in, group cohesion is achieved early, and all members get the therapeutic value they are seeking. In reality, cohesion is an ongoing process that ebbs and flows. Resistance to group therapy is very real and can stunt a group’s ability to grow and achieve its goals.
I spent a year of my clinical training working with adolescent groups in a psychiatric hospital setting. It often felt like there were more barriers to successful group psychotherapy than there was actual therapy happening. Many of the patients had strong antagonistic feelings towards the hospital, being hospitalized, therapy in general, group therapy, etc., etc. They also, very openly, often were very resistant to me, for a number of reasons sometimes voiced, other times unspoken. Add to that environment the general chaos of the setting along with my own inexperience as a therapist, and we had some pretty explosive moments. That is not to say I didn’t have successful groups or that patients didn’t end their stay feeling they had gained something. But, between the growth and satisfaction, I learned that resistance in groups is very real and can be very difficult for both patients and therapists.
Being a student at the beginning of my training, I struggled with feeling effective and competent. Aside from grappling with what resistance meant about my own abilities, I also struggled with the idea that patients who truly needed psychotherapy were not receiving the care they deserved. Worse, I worried that some would leave with negative opinions on how effective or useful therapy could be for them at all. Through a lot of consultation and supervision, I learned how to handle working with resistance in groups to achieve greater cohesion and success.
To best deal with resistance, it must be addressed. Continuing with therapy when not all members are fully present and open to the experience is detrimental to each individual as well as the group as a whole. Addressing resistance directly shows that you as a therapist respect group members and their differing viewpoints. I often found that some of my best group sessions blossomed out of stopping the group after 10 minutes of resistance, acknowledging the problem, and listening to what members had to say about what was getting in the way. As a new clinician, I lived for those moments and the following group sessions because we reached a new level of understanding and respect that allowed for real therapeutic gains.
A major lesson in dealing with resistance, particularly with teens, was learning how to find an ally. I most successfully turned resistance into trust when I managed to get a group leader to buy into what I was selling. When one member was actively engaged, peers were more likely to open up to the possibility that group therapy could be useful to them. My adolescent allies usually loved being a co-leader with me and took the role very seriously, even going as far as calling out other members’ resistance and disruption. Addressing resistance with groups is a great way for a therapist to show genuineness and break those barriers that members are putting up.
Shanny Shmuel, M.S. is currently a Psy.D. student at Widener University’s Institute for Graduate Clinical Psychology.