Book Review: Why Group Therapy Works and How to Do It

A Guide for Health and Social Care Professionals. (Routledge, 2020)
By Christer Sandahl, Hjördis Nilsson Ahlin, Catharina Asklin-Westerdahl, Mats Björling, Anna Malmquist Saracino, Lena Wennlund, Ulf Åkerström, Ann Örhammar. 

This book is a significant addition to previous Group Analytic literature that takes a practical orientation and focuses on how we might establish and conduct a group. Kennard and Robert’s “A work book of group analytic interventions”, Dorothy Stock Whitaker’s “Using groups to help people”, Schlapobersky’s “From the Couch to the Circle: Group-Analytic Psychotherapy in Practice”, Behr and Hearst’s “Group-Analytic Psychotherapy: A Meeting of Minds”, Rutan and Stone’s excellent “Psychodynamic Group Psychotherapy” and, of course Yalom, are examples of this genre.

If you will forgive me, I will digress and briefly, at least, write about another area that increasingly came to mind when reading the book. I’ll talk about playing the violin. Those of you who have taken up the bow will know that this is an arduous and difficult occupation. There are many things to think about: staying in tune when one can only rely on muscle memory and one’s ear; playing with a straight bow; mastering numerous bow strokes; playing in different positions up the neck; mastering vibrato, double stops, crescendos and decrescendos; maintaining tone along the bow; being able to play in many different keys and many different positions; understanding differences in style, so that techniques to play Beethoven are not appropriate to playing Vivaldi, etc, etc. The complexity of this may seem overwhelming and a focus on one aspect may well mean that other aspects of playing are lost – a focus on intonation may cause other aspects of technique to be lost, for example. Many hours, and indeed years, of practice are necessary to achieve some mastery of this most difficult instrument. Expert tuition is necessary: to provide knowledge and guidance and also to correct personal idiosyncratic issues and failures of technique, and to bring into consciousness negative aspects of practice that have previously been beyond awareness. So the personal may well come into this: a tendency to avoid drama, conflict, aggression in music; to play things safe leading to wan and boring playing; inhibition due to performance anxieties may all come into focus. Some individuals, also, may be “naturals” and others will struggle to achieve competence.

It seems clear to me that these ruminations came to mind because of the parallels I was drawing with group therapy practice. It is clear that merely reading a violin playing manual, of which there are many, will help to develop knowledge, reinforce learning and current practice, and will occasionally produce insights and illuminations that will transform playing in some way, but which may be incomprehensible to someone who has never picked up an instrument, a group therapy manual may be expected to work in the same manner. Expert tuition and engagement with the instrument is also necessary and necessary over the long term.

So, to the book. In terms of content an initial Introduction briefly explains the unique characteristics of group therapy, outlines aspects of the author’s professional journeys and provides short summaries of the books chapters. The second chapter, “The significance of the group” describes the thinking of Ronald Fairbairn, D. W. Winnicott, Foulkes and John Bowlby and thus sets out a relational perspective on psychotherapy. There is a focus on an attachment perspective and the chapter introduces ideas and evidence on the importance of early development, and the importance of mentalization ability. Finally, the authors explain how these ideas relate to the practice of group therapy.

The third Chapter, “What is a group – really?” examines various perspectives on groups, including the ideas of Kurt Lewin. The following chapter outlines the history of groups with a focus on patient groups, dynamics, and therapies and considers the ability of the group to be a healing environment. Further chapters focus on the practicalities of forming, starting and conducting a group; the assessment of group members and how to engage them in the therapeutic process; and the process of termination. Additional chapters discuss a variety of differently structured groups: slow open, CBT and psycho-education groups, and focused group therapy.

It is clear, from the title, that this book’s ambition is to provide a practical guide to the activity of group therapy, that most difficult of the psychotherapies due to the complexity of group interactions and relationships and the vicissitudes of practice in an often sceptical world. How well does it achieve this goal? Well, in reading it I was envious that the current group analytic trainees will have  access to this first-class coverage of the ideas and practicalities involved in setting up a functioning group. I wish that something like this had been available for me in my own training. Vignettes are peppered throughout the text vividly and pertinently supporting the text. This book should now be on the essential reading material for all Group Analytic trainings and will certainly be an essential text far wider than this readership.

Terry Birchmore
birchmore@yahoo.com