We’re sleeping on group therapy

Since COVID, therapy has become much more popular and much less stigmatized. We’ve had countless conversations about mental health: how common struggles like anxiety and depression are, and how treatable they can be. I’m thrilled about this. People who previously would never have sought help now feel comfortable reaching out and are benefiting from doing so. The people who love them benefit too.

I’d love to see the same progress happen with group therapy.

Most people have some idea of what group therapy is, but usually in its more familiar forms: self-help groups like AA, support groups for things like cancer or divorce, or skills-based groups that teach mindfulness or cognitive behavioral techniques. These can be incredibly effective, meaningful, and economical. I want to make a case for a lesser-known type of group: the process group.

Process groups aren’t organized around a particular problem or skill. They’re often open to people of different ages, backgrounds, and personalities. Their focus is what’s happening right now rather than “there and then.” Members are encouraged to notice and describe their thoughts and feelings in the moment. That sounds straightforward, but in reality it’s deceptively difficult. People often struggle to identify what they feel, put it into words, and then summon the courage to say it aloud. Process groups create a place to practice exactly those skills. They help people communicate more honestly and develop trust in others. And when you say something vulnerable and are met with understanding rather than rejection, the experience can feel deeply reassuring.

I once attended a training where someone described process groups as “pure fucking magic.” That phrase has stayed with me because as both a participant and a therapist who runs groups, I’ve repeatedly found myself thinking that there’s something about group that is difficult to fully explain. There’s a quality to it that feels larger than the sum of its parts.

One of the things I love most about group is getting to know people intimately who might never have become friends outside the room—people different from me in age, personality, background, or life experience. There’s also something freeing about showing up to therapy without needing a plan. Like many therapists, I’ve been in individual therapy for years, and sometimes I arrive without anything especially pressing to discuss. In my weekly process group, another member may bring in something painful or important, and I get to participate without always being in the spotlight. When a fellow member describes grieving her mother in a way that differs completely from my own experience, I often find myself having fresh insights into mine. I’m reminded over and over that people are all so different, and yet not nearly as different as we think.

Ginger Sullivan, a longtime group therapist and faculty member at the Center for Group Studies in New York, compares individual therapy to the early relationship between mother and infant: a nurturing, highly focused experience. Group, she says, is the next developmental step—the playground where we learn to navigate closeness, conflict, belonging, disappointment, and repair. I love this metaphor because there are certain things that are difficult to learn in the privacy of a one-on-one relationship.

I see examples of this both personally and professionally. I have a friend who, over the years, has occasionally said to me, “We should get coffee sometime and I’ll tell you the whole story.” Five years later, I still don’t know the whole story. She also wonders why she doesn’t have many close relationships. The problem isn’t a lack of desire; it’s difficulty tolerating the vulnerability intimacy requires. Group has a way of making these patterns visible. Professionally, I’ve watched people make changes in group that they struggled to make after years of individual therapy. Group can create hope and momentum. It can help people accept themselves in powerful ways. There is something different about opening up to seven ordinary people and receiving understanding than receiving it from a therapist you’re paying.

Group can also be hard. It’s intimidating to open up to others, and sometimes conflict emerges that can provoke anxiety, anger, embarrassment, or hurt feelings. I suspect this may be part of why process groups have never become especially fashionable. But I’d argue that these uncomfortable moments are not a drawback so much as part of the point. Relationships outside therapy are difficult too. Group gives us a place to practice.

We live in a time when loneliness and isolation seem increasingly common. We say we want authenticity and connection. We worry about technology and AI making us feel even more disconnected from one another. Process groups feel almost like an antidote. They require people to sit together and pay attention, to risk honesty, and to become known.

I live in Buffalo, New York, in a metropolitan area of over a million people. To my knowledge, only two therapists here offer this kind of group, together serving roughly sixteen patients. That feels like a major gap. I’ve long wanted to refer patients to process groups and often didn’t know where to send them. I want that to change.

I attend group less because I’m trying to solve a particular problem and more because I want to keep my instrument tuned. Group gives me a weekly opportunity to reflect, connect, and learn. I suspect many people would find the same thing. Even if you don’t feel like you “need therapy,” group can offer something difficult to find elsewhere: insight, connection, and growth.

A colleague once described group as “enlivening.” That felt exactly right to me. Group really is a kind of magic, and I’d like to see us stop sleeping on it.