Group therapy typically consists of a health care professional working with a group of between six and10 patients. Working with other addicts allows you to see that your problem is not unique. It also enables you to learn about what works and what doesn’t from others’ experiences, and draw on others’ strengths and hopes. A group format is ideal for confronting the denial and rationalizations common among addicts. Such confrontation from other addicts is powerful not only for the addict being confronted, but also for the person doing the confronting, who learns how personal denial and rationalization sustained addiction.
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In a group setting, the crucial coping mechanism of learning to be open and honest can be observed and practiced.
"Honesty is the key to sobriety" - secrecy and shame drive addictions, especially sex addictions, change occurs when an individual decides to become truly open, honest, and vulnerable.
Sex addicts often can create the illusion of openness and sensitivity by sharing and getting others to talk about sexual and romantic relations and experiences.
In recovery, group therapy can be especially helpful in breaking down this facade of pseudo intimacy because other group members are quite sensitive to the phoniness of these behaviors.
Becoming honest is a learning process that requires understanding, observation, modeling, and practice. For most sex addicts, there has never been a safe environment in which to acquire this coping skill. Their families were rigid, closed, secretive, and detached, or they were chaotic, intrusive, confusing, and enmeshed.
A second significant advantage of group therapy is that it offers the sex addict a safe place to get honest feedback from peers. In Twelve Step meetings, there is a rule against "cross talk".
Group therapy sessions provide consistency in membership and a time frame that allows for feedback, reactions, comments, advice, and interpretations between group members.
One reason for this is that the members of the group are committed to be there each week and the membership is limited (unlike in Twelve Step fellowships).
These features enable group sessions to provide opportunities that are not available to the person who attends only Twelve Step fellowship meetings.
Members can use their therapy groups for accountability and reality checks that may or may not be available to them elsewhere.
For example, a person who joins a group for therapy makes a commitment to attend the sessions regularly, and the other group members will hold the member accountable if there are absences or problems with lateness.
A sex addict found the accountability to attend therapy a surprising and at times difficult benefit. He was quite independent both at work and at home, so no one in his life ever asked him to be accountable for his time or noticed (or at least told him if they did notice) when he was irresponsible about his commitments and the needs of others (such as the need of group members to have him be there when he indicated that he would be). This slipperiness about accountability was an important aspect of his sex addiction because he would take advantage of his freedom to act out sexually and did not have to be concerned that others would ask where he was or what he was doing. He got in the habit of not thinking how others might feel about his absences and lateness. His group therapy, then, was a chance to start to learn that accountability is part of openness and honesty, and that these will lead to the real intimacy that he was longing for rather than the pseudo intimacy that he created while acting out.
This may sound like something that most people would normally get from their peers. Most sex addicts do not have a peer group with whom they are open and honest. This is the next advantage of group therapy. It allows sex addicts to have a safe peer group with whom they can share the intimate details of their lives, their deepest thoughts and feelings, and learn to experience the caring and support that such a group can provide.
Sex addicts do not know how to have normal relationships. Their families had poor and even damaging relationships with them while they were growing up.
They usually started acting out their sex addiction between the ages of 6 and 12. Consequently, they had secrets to keep from their adolescent peers and never learned to really be open and honest with equals. They tended to jump over peer relations and tried to have intimate or at least sexual contact with another who would make them feel loved and accepted. However, these relationships tended to be pseudo intimate -- if that -- because the addict was not really capable of real intimacy.
Before becoming intimate with an equal or dealing with the harm of early life relationships, most sex addicts need to learn how to have normal relationships with equals.
Some accomplish this in their Twelve Step meetings. Others need the higher level of structure and support offered by group therapy.
As with individual work, group therapy offers an opportunity for cathartic emotional experiences, that need to happen in a larger interpersonal environment than a one-to-one session. Sometimes group leaders structure this work in terms of a role-playing situation, a gestalt experiment, or a psychodramatic session. At other times, the safety and support of the group are enough for someone to share a traumatic life experience.
This leads us to another advantage of group therapy: the chance to experience nonsexual intimacy. Individual psychotherapy is obviously suited to the development of closeness and trust, but with people who have been abused and violated in such relationships, as is the case with incest and sexual abuse survivors, the group may in fact be a safer place to begin to learn how to be intimate. Our groups are separated by sex with the purpose of reducing the threat of finding a sexual partner in the group. Obviously, this does not help with homosexually oriented clients, but since our referrals come from both heterosexual and homosexual orientations, separating by sex provides the best chance for reducing the number of potential sexual partners in the group.
Sex addicts need a place where they can learn how to talk about their innermost needs and feelings. Intimacy is letting go of all barriers and allowing another person to know who you really are. It is letting go of your masks, defenses, and images. It is "letting your hair down" and "letting it all hang out." Some people can do this with only one person at a time and are too threatened by a group situation to reveal themselves as they truly are. For others, one-on-one contact is too much; they need the safety from abuse and manipulation provided by the group context. Seductive or harmful feedback or reactions by some group members will be pointed out by other group members or the group leader, so the group member is less likely to reenact the abusive experiences of the past. In individual work, there is the possibility that the therapist and the client will develop a "mutual admiration society." In the group, this incestlike dynamic will be less likely to occur and should be challenged by the rest of the group if it does develop.
One client of ours placed us on a pedestal and projected the need for an all-knowing, all-powerful parent onto the individual therapist. With the aid of the group process, this idealization was able to be addressed and the
dynamic changed in a way that offered the sex addict sources of nurturing and support besides the individual therapist. This is a common part of individual work and is usually referred to as transference. This example was of a positive transference, but the group can also help recovering people deal with issues of negative transference, where the person feels that the individual therapist is somehow harmful or is being destructive or manipulative. Again, the reality check function of the group can assist the person in learning how to have nonsexual, intimate relationships with others.
The last helpful aspect of group therapy that we will cover is universality. This does not mean that there are not other goals and advantages of group therapy; it simply reflects the main aspects of this approach to treatment that we have identified. "Universality" refers to the experience that people have when they realize they are not alone in terms of having difficulty with sexuality and romantic relationships. One of the most powerful aspects of group therapy and Twelve Step programs, and their related literature and publicity, is that people who are suffering with the disease finally discover that they are not the only person who is hurting because of sex and love. Addictions tend to isolate people, and sex addicts tend to be extremely isolated even when their acting out may involve many other people.
We frequently have the experience of sex addicts telling us that they feel so relieved, so comforted when they find out there are others who have the same affliction. Most have agonized in silence and secrecy, and feel that a great weight has been lifted from them when they experience the universality of going to a Twelve Step meeting or a group therapy session where they hear other sex addicts talking about the same struggles, the same shame, the same low self-esteem that they have been tortured with for many years. Often, they have felt subhuman, like perverts or outcasts. They are well aware of the highly judgmental and moralistic attitudes in our society toward people who cannot control their sexual or romantic relationships.
Often they have been called "whore," "slut," "pervert," "deviant," "'nymphomaniac," or "stud." Even if others have not explicitly said things like this to them, they have called themselves these and other names. This type of name-calling is very damaging to the already low self-worth of sex addicts. Name-calling implies that the people who are called names are in control and that they have a choice about how they think and behave. Addicts in active addictions are not in control and do not have the range of choices that normal individuals would have. Sex addicts are sick, and their illness drives them to act in ways that violate their own
as well as society's norms, expectations, values, and laws. Consequently, addicts are outlaws to themselves and feel as if they do not fit in, nor are they acceptable to society. Unfortunately, rather than setting limits on addictive behavior, this tends to drive sex addicts deeper into their addiction because they are desperately trying to find love and acceptance in their acting out. When they come to a group or meeting and find love and acceptance for simply showing up, the healing process is initiated. When they hear that others have the same problems and difficulties with impulse control, thoughts, feelings, and behaviors, they start to feel that they are once again part of the human race and to experience the universality of mankind.
Group therapy, then, has a number of goals and advantages vis-à-vis individual psychotherapy. In group psychotherapy, sex addicts can learn to be honest, open, and real, an essential coping skill for healthy, authentic living. Group therapy can provide feedback, "cross talk," reality checks, accountability, and consistency. The sex addict can begin to learn how to have normal relationships, especially with peers. They can discover how to get and accept support. The group can be a safe place for cathartic emotional experiences. The sex addict can learn and practice nonsexual intimacy, and can experience universality that breaks down the perception of being all alone. Some of these benefits of group therapy can also exist in individual work, such as feedback or nonsexual intimacy, but the quality and quantity will be different. Often it is helpful to have both, and to share group experiences with the individual therapist and vice versa.
The goals of the groups are the same: to facilitate learning to open up, to develop new coping skills like honesty, to get feedback ("cross talk") from peers, to receive affirmation of the person's value and worth, to learn to have healthy peer relationships, and to allow others to offer support and caring. The groups are also designed to offer the chance for cathartic emotional experiences, for reparenting and contacting the "inner child," and for improving the ability to experience and understand nonsexual intimacy.
Sex addicts are actually very lonely people. Most sex addicts have had abusive, neglectful, or damaging relationships with their families that need to be worked on in a group setting in order to experience healthier contacts with people that are:
· nurturing but respectful,
· affirming but challenging,
· caring but confrontational.
They may need to share with others -- perhaps for the first time -- the real nature of their early life experiences and to work through some of the trauma in order to be able to trust others and to allow themselves to have contact and intimacy.
Group members frequently are aware of and comment upon recognizing some part of themselves in another group member.
The mirroring function enables group members to experience themselves, helping on the pathway toward self-acceptance and reintegration of alienated parts of oneself.
Self-recognition and self-acceptance - a higher level of empathy and mutuality.
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Group therapy is often helpful as the group helps patients overcome feelings of shame and isolation. The group, with the help of the therapist, can also provide an experience of what is like to be involved in emotionally intimate relationships.
See also: Individual therapy, couple therapy