Creating and launching a therapy group is a challenge to even the most seasoned clinician. Two coaching questions I often receive on this topic are, "Mari, I want to start a group, but I am worried I won't fill it" and, "I've never done group therapy...how do I even begin?"
I love this question! And, because it is asked of me so often I thought I'd outline some helpful tips to support other therapists who are new to group work.
However, before we begin, I think it would be helpful and important to include a quick overview on my group experience:
As a Licensed Marriage and Family Therapist, a Certified Sex Addiction Therapist and Supervisor, the founder of Growth Counseling Services, and the author of, "Facing Heartbreak: Steps to Recovery for Partner's of Sex Addicts", I've been leading therapy groups for the last decade.
I first began my training in group therapy starting with my internship many moons ago! I vividly recall being assigned the domestically violent men's group at an agency. This was an alternative prison sentence group with 18 angry men and little ol' me. We met each week in a dark and dusty conference room for an entire year. Thankfully the agency provided excellent supervision and additional training in DV, and, over time, I learned the ropes and fell in love with the process of helping these men learn, heal and grow.
My next group experience was working with female survivors of abuse. I worked with these lovely and courageous women for nearly two years while completing my clinical hours. During this time I also started a teen girls group, and a parenting support group. By the time I had my license and was starting my own private practice, I had several years of group work under my belt.
I went on to specialize in working with partners and spouses of sex and porn addicts. And eventually with the sex and porn addicts as well. I have been leading weekly therapy groups in this specialization for 8 years, and have had a 3 month wait list for my groups for the last 6 years.
So there you go - that is the quick nutshell version of my group experience. Needless to say, I am passionate about group work! And as a coach, I absolutely love helping other therapists start their own groups to support hurting people in need of a healing community.
Now, on to the good stuff!
Here are my top tips to support your first steps in creating your own successful therapy group. Of course there is so much more to the group process than outlined here, but I wanted to provide some first steps to be of support:
1. Be Specific. Have a clear vision of what the group focus is and be very specific. For example, instead of Anger Management, niche that down to: Anger Management for Exhausted Professional Women. This will help you hone in on where to market to your ideal group client.
2. Create a name for your group that adds hope. For example, my women's group at Growth Counseling is for female partners of sex and porn addicts. However, I don't call my group, "Partners of Porn Addicts" because it felt shaming and labeling, and because that would focus on the problem not the solution. Instead, I named the group, "H.E.A.R.T" which is an acronym for, Heal, Encourage, Accept, Restore, Trust. When the women share with a friend or family member that they are going to their "Heart Group" meeting, it adds confidentiality to the work as well.
3. Decide if your group will be open or closed. I prefer a closed group after the second meeting to encourage group bonding and less interruption. Figure out what feels best for you. Perhaps an open group is more your style. Just do your homework on each.
4. Have a time period for the group to meet. 1 meeting per week, for 90 minutes, segmented into 12 week modules have been the sweet spot for me. Then we break for 2 weeks, and then start the next 12 week module. Clients who may be a little reluctant or shy in starting group feel better knowing that there is a start and end date. That said, when you facilitate a positive group experience, very often clients will move forward into the next module.
Important note: Keep in mind that Mondays are challenging days for people due to holidays sometimes falling on Mondays. Fridays most folks are exhausted or heading out of town. In some communities, Wednesday nights are bible study nights. I have found that Tuesday, Wednesday or Thursdays are ideal, and if you don't mind working on Saturdays (I don't like to, but you may), then Saturday mornings work well too. Another tip: Be sure to give your clients enough time to get to your group after work, or get the kids taken care of. I like the 7-8:30 PM hour.
5. Theme your modules. I like to theme each group module to keep it fresh and inspired for the group members (and for myself!). I also like to select a book and exercises that align with that theme. For example, in my HEART women's group our current theme for this 12 week module is "Phoenix Rising", and the book I selected to support the theme is, "Rising Strong" by Brene Brown. A helpful tip: Your therapy group is not a book club, so the book should be what I call the "back ground music" as a support to your work.
6. Group exercises are important. Have exercises that you can do within the group, and/or exercises that the the group clients can do at home and then bring in to discuss. If you are in need of group exercises, you may enjoy, "The Creative Clinician: Exercises and Activities for Clients and Group Therapy." I've received some lovely feedback from therapists who have used this material here.
7. Law and Ethics. Make sure you have all of your legal and ethical foundation pieces in place. That includes informed consent forms, limits of confidentiality, group rules, signature forms, contact out of group, mandated reporting, attendance, and so forth. If you prefer not to reinvent the wheel, The Group Therapy Forms Packet will be of support so that you have your client forms ready to go.
8. Have a solid policy. Know what your policy is for missing group, group rules, late arrivals, food in group, cross talk, cell phones, payments, etc. and so forth (this is all outlined in the group forms packet), and have a pre-group interview process in place as well as a termination policy. You will want to make sure that you carefully screen your group clients to ensure that your group is the right fit for them, and that they are the right fit for your group.
9. Have good boundaries with group members and individual clients. It is fine to have an individual client attend a group you are leading, but I would be very careful before inviting the spouse of a client into a group you are facilitating.
For example, let's say you are starting a therapy group for dads. Great idea! Now let's say you work with a couple and the dad of this couple asks to join your group. And, while we are at it, let's say he has his wife's blessing to do so.
Pretty great, right?
Well...maybe not. Let's say your dad shares in group one night that he has been having an affair with the nanny. Oops! Oh crap. Do you have a no secret policy in place? How will you handle this information. What is your ethical responsibility here? What do your group forms outline? If you share this information with the wife in a couple's session without having forms and signatures in place, you have put yourself in a very precarious situation both legally and ethically. If you do not share it, you are now the secret keeper, and should this come out in a future couples session, the wife will experience the trauma of betrayal by both her husband, and you as her couples therapist who has been holding this information.
10. Seek additional support and consulting when needed. Launching a group take some work, but is a very rewarding experience. If you have further questions on group facilitation, curriculum and how to set up payments, fee collection, and process flow, it would be wise to seek out a colleague who is experienced in group work, or attend a webinar, a professional workshop, or hire a coach for a session or two to help guide you. It is best not to do this work in isolation - so having supportive peers to consult with is also important.
I could fill two more blogs on how to create, launch, market and facilitate a successful therapy group, but I will stop here for now. I hope this information has been of support and encouragement. Group therapy, when set up and facilitated properly, can be such a rewarding and enriching experience, not only for the therapy client, but for the clinician as well.
And, it can be a beautiful way to create a leveraged income stream (for more information on creating multiple income streams, this blog will offer great tips!).
I wish you all the best on your journey forward! Introduce yourself in the comments below, ask a question or two, or if you prefer to connect privately and schedule a consult session, you are welcome to reach out for further support at firstname.lastname@example.org
Kindly and in support,
Mari A. Lee, LMFT, CSAT-S