77 [Healing Series] Group Therapy

Transcript

Full shownotes: https://www.adopteeson.com/listen/77

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Haley Radke: This show is listener supported. You are listening to Adoptees On, the podcast where adoptees discuss the adoption experience. I'm your host, Haley Radke. And this is a special episode in our healing series, where I interview therapists who are also adoptees themselves, so they know from personal experience what it feels like to be an adoptee.

Today, we are learning all about group therapy. Let's listen in.

I'm so pleased to welcome to Adoptees On, Pam Greenstone. Welcome, Pam. Pam is a licensed professional counselor in private practice in Austin, Texas, and has been leading psychotherapy groups since 2002. So Pam, you approached me about doing a couple of episodes on our healing series about group therapy, and I was like, Okay, that sounds really cool. I don't really know what that is. So, why don't you first tell us a little bit about your story and how you got into being a group therapist?

Pam Greenstone: Sure. I am an adoptee myself, and was born in 1970 in Dallas, Texas, in foster care for two weeks, and then adopted by my family. And see…I think I'm in reunion right now since 2014, with both my birth mother and her family, and my birth father and his family.

I just returned, actually, from a family reunion with my birth father's family, which was incredible and wonderful. So yeah, I'm in full on in reunion. And I wanted to start by talking about the history of group therapy, and I think that'll lead into how I got involved in group, as well. So, in 1906 (it's been around for a long time), Joseph Pratt did what is considered kinda the first group therapy experience. And he brought together 15 tuberculosis patients, and thought it might be helpful to do education with them and have them talk about their experience. And then he also had them agree to certain things upon joining the group.

So those two factors–the fact that he was getting a group of people together to talk about their experience and then that they had this certain set of agreements, that made it the first group therapy, and it went well and the outcomes were really good. And so he (I think) kept doing it and kept spreading the word.

So a lot of doctors, and also psychiatrists would do this kind of work with schizophrenics, alcoholics, people that were struggling with socialization, and they were doing this until about the 1940s, just in their medical practices. But in the 1940s, it became a bigger deal, because there were all these World War II soldiers coming back with what they were calling “shell-shocked,” or “fatigue from battle,” and what we would now know as PTSD. And so just because they had to (there were so many patients), they started seeing them in groups. And from there, they started to see how good the outcomes were, how well these people did–even better than individual therapy in some ways.

And so that's when psychiatrists, psychologists started doing research, and writing books, and it became more of a mode of its own (a therapy mode of its own). And so since the 1940s, it's been what it is today, which is small groups of people getting together to talk about their thoughts, feelings, and reactions in the moment as they're having them, getting to know themselves, and getting to know the way they do their own relationships, finding ways to get along better with lots of different kinds of people, and what it is today, what you see today. In the year 2000, I was in graduate school and also coming out of the fog and also in my group therapy class. And when I saw the list of therapeutic factors in group–which I could go over them right now, if you think that'd be a good idea.

Haley Radke: Yes.

Pam Greenstone: It's Yalom. Irvin Yalom is a theorist. He's written books on existential group psychotherapy, and he listed out these therapeutic factors that we still have today and he's worked with them. So it's–these are things that happen in group that are helpful or therapeutic:
-installation of hope -universality–just knowing that what we're going through, everybody is going through -imparting of information (just like psychoeducation kind of stuff) -altruism–because in group, we're not only getting help the whole time, we're giving help the whole time. So helping others is really therapeutic. -recapitulation of the family of origin, or the family group (and that's when you're sitting in a room with a group leader who's a trained therapist who can sometimes feel like a parent, right? Or maybe there are two of them in the room, and then other members, which can feel sibling-like.)

All of a sudden we can start having feelings like we did in our family in different times in our development. And so that's–we can heal those wounds in the moment, if we're in a therapy group where we have room to express all of those kinds of feelings, or we can do things differently and learn to grow and change that way–have room to react and respond and say things in a different way than we usually would.

Then the other factors are: -developing socializing techniques -imitative behavior (just seeing how other people interact and using that and practicing with that and seeing if it works for you) -other kinds of interpersonal learning -group cohesiveness–which is just a sense of belonging (which is huge) -catharsis–which is like having strong feelings and talking through them at the same time -existential factors–just this sense that, in a way, we're all alone in the world, and that it's important to find ways of relating and connecting with one another in a deep way

So, listen to that list! So I was sitting in my group therapy class and I'm like, Why aren't we all in group therapy? Why isn't everyone in group therapy? I just thought, This is incredible. The fact that I was also going through coming out of the fog, I thought, Oh my gosh. For me, as someone with the wounds, and the trauma, and the loss that I've experienced in my life without a way of talking about it– I didn't know how to talk about that. I could see how group would provide me not only therapy and psychological help that I needed at the time, but also just a constant sense of belonging.

Once you become part of a group, you benefit from that group cohesiveness and that feeling of belonging the whole time. And I thought, Oh my gosh, that would hold me, and then also give me the therapy that I needed. And so I felt really lucky to be in that place where I was looking all at all of that stuff, all at the same time.

Haley Radke: So you were already doing training for therapy when you've discovered this, and then you just got really passionate about it.

Pam Greenstone: Oh my gosh. I had so much passion. I talked to everyone about it. I got in my own group, I started talking to my clients (once I started seeing clients) about it. And yeah, I'm a real advocate for it. I just can't believe how helpful it is in so many different ways.

Haley Radke: Well, I was just gonna ask, can you tell us what's the difference between having a therapist lead a group? So, group therapy versus peer-led support groups (which we've talked about before on the show as well).

Pam Greenstone: Yes, and I want to say that I… Of all the different kinds of groups, there are support groups, there are self-help groups, there are sometimes like book groups that follow along with a certain kind of self-help book, there are AA groups, or different kinds of 12-step program groups.

I refer to all of them. I think group is helpful in all kinds of ways, and if someone doesn't feel ready to join a therapy group, a support group might be a good fit for them. You know, so I just want to say that outright. And I think one difference is (because there are a lot of differences) is that in therapy groups, we really always try to bring it back to the here and now–bring it back to the moment. So when a member might be talking about something that's going on in their outside life, right? Say they're talking about… “Talking to my spouse and I feel so misunderstood.”

So they might tell that story. And then another member or the leader might say, “Is there a way that happens in here?” Or they might say, “I think that happened between us, and this was my experience of you in that time.” So there's this opportunity to bring, keep bringing everything back to the moment and to the relationships in the room, right?

And with that guidance of a therapist, you can grow your capacity to start observing yourself, right? In your relationships in the room, and then also in your relationships outside of this group therapy room. So that's one big difference. That doesn't really happen in support groups, and it shouldn't, because I think it's a therapy– It's a psychological kind of tool that a therapist is skilled in using, whereas a lay-led group, it's not gonna be as effective in helping us change, right? Change our interpersonal style, or make characterological change, which is very possible in a group setting with a therapist who's trained in a certain kind of group therapy.

Let me think of other ways it's different. Oh my gosh, there's so much structure in a therapy group. When you join, you adhere to a certain set of agreements, right? And the agreements are there to create a very holding and containing environment, so that people feel safe enough or brave enough to do the vulnerable and difficult work of sharing their thoughts and feelings and fears in the moment, right?

And so, it's usually a group that's going to be together for a long period of time. So that's holding, right? Knowing that it'll keep being there every single week. You attend weekly, and you try to be on time, and if you're not there (or if you're not on time), we tend to talk about that. What might be getting in the way of having all of the time in group? If there's a new member added, that's something that the group is told a few weeks in advance about, so that they could talk about their feelings and thoughts about that and prepare, right? And then the new member has gone through at least three intake sessions, and they know what the agreements are upon joining. And so they're brought in a way that's very structured and very predictable, right?

Because what happens in the room is completely unpredictable. Everybody's gonna be sharing their thoughts, feelings, and reactions in the moment, but we don't know what's going to happen. So I think there has to be a lot of structure available and in place, so that the more in the moment stuff can happen without feeling scared about that or like it might go off course. Those are some things I can think of right away. Does that…?

Haley Radke: Yeah! So you listed off this amazing–this big, amazing list. I tried to copy some of them down, the therapeutic factors. Do any of these happen in other groups? Like you were listing off the support and all those different, like in AA, da, da, da... Did any of those happen…?

Pam Greenstone: Yeah. So yes. Okay. Absolutely. Yeah, especially in AA, right? Installation of hope, universality, imparting information. There is so much that's happening between the people, right? In the room. I think in AA groups there, there's no crosstalk, right? You share what you wanna share (from my understanding of it), and you don't–people don't respond to that. And that's a way they create a holding environment, which is a little bit different.
In self-help groups, oh my gosh, so much of this happens. Yeah, absolutely.

I think you get any group of people together, and if you're open to it, there is so much wisdom, and beauty, and ability to connect there, if we let everybody just be themselves. And if they can allow themselves to be who they are, right? Those are the difficulties. Can we allow ourselves to be exactly who we are, instead of maybe trying to fit into what we think people want, or, Oh, I'm trying to avoid conflict, or…

These are the big things we work on in group therapy. “Wow, I noticed that I'm not really being myself. I'm just saying the things I think will keep things smooth in here.” Or “I want to make sure you like me, right?” Just all of those kinds of things come up, but we have– In group, we have room to observe that out loud, and then keep talking about it, and other people can relate as well, and okay, then what do we start doing about that? Or practicing in here that'll help create a change?

And in a self-help group, that doesn't tend to happen and we don't–we wouldn't necessarily want it to right? We want it to be about support, about learning things, about seeing how we all relate to one another in our shared experience, feeling less alone. I think that's more about self-help. That's more of what you get from self-help groups.

But they're all good, in my opinion, especially if they're– If you go to a self-help group or a therapy group and you don't feel pretty good most of the time, something's wrong. Not all groups are helpful and therapeutic. It's okay to listen to your instinct, and exit a group if you don't feel like it's a safe enough place for you.

Haley Radke: So, how would someone come to the realization that this kind of group therapy (for an adoptee, specifically), would be helpful to them? Versus going to see their therapist kind of week-by-week? What would spur someone on to say, Actually, I think I am gonna look into this?

Pam Greenstone: It can look a lot of different ways, but I think if they start to notice in their individual therapy certain patterns that happen in their relationships, right? But they can't quite make progress. They keep with their therapist, noticing these patterns, but not really feeling– feeling kind of stuck around it, right? So, maybe for an adoptee, they have more of an insecure feeling in certain kinds of relationships, and they notice that over and over and over again, but it doesn't seem to help them shift or make a change. That might spur somebody to go, Maybe if I do group work, it'll happen in the group in a way it wouldn't happen with an individual therapist and I'll be able to address it in the moment. And really start practicing in a contained way, new ways of doing it.

Haley Radke: Could you pause there and just tell us what that would look like? Give us an example of…so, they're sharing something in group, or maybe someone else is sharing something in group, and it rubs them the wrong way, and they have a negative reaction. Is there, I don't know, can you give us an example of how that would actually play out?

Pam Greenstone: Sure. Let me try to give you an example from my own experience in group. So for me, goodbyes in group were always very hard. So if someone started talking about leaving the group, I would have strong emotional reactions. I'd feel a lot of grief and I'd feel like I'd want to withdraw. It's almost like they–then they'd just be gone already, as a self-protective. So, I noticed that, right? In group, because a lot of people talk about leaving group, even when they don't leave. Because they're like, “Get me outta here! This is too hard.”

So when they would talk about it, I started noticing that kind of over time, that those same feelings and those same thoughts would come up for me. Well, I guess they don't need me, or I can't have a say in their decision. That was a common one for me. I would think, Well, they're gonna do what they're gonna do. I have–there's nothing I could do about it. I have no say.

So I would just shut down or not give my opinion, or not engage with them about my own feelings about that loss. So I started to notice that, and over time I found that if I could say a little bit of that (that was going on in my mind), it actually had an impact on the other member. And they used it to influence their decision, right? I was a part of their treatment team ( in their mind), and so they would use that, and it became part of their decision making process.

Haley Radke: And is there–do you have another example of, I don't know, someone feeling like they have this negative pattern? And so they can't get out of it with their own therapist, so they go to group, and then what kind of situation would happen in the group that could break that pattern for them?

Or is it something like, “This happens over time, this happens over time.” Or another member, or the therapist will reflect this back to them: “You've said this thing like 10 times before, what are you doing about it?”

Pam Greenstone: One example I can think of is, say a member has noticed jealousy, right? In their relationships with others, either friends or their spouse. So they notice that pattern; they can't quite seem to get a hold of it. So they go into group, and at first, when you're in group, you're really just–I mean, if you're talking, you're doing a good job. You're just letting the group get to know you, you're sharing about your life, you're observing, seeing how the group culture is, getting adjusted–but eventually, you're going to start to have that feeling, right?

That jealous feeling in a relationship, and it'll happen in a similar way to, say it does in maybe in your marriage or in a friendship, right? Where a friend starts talking about a vacation they're taking and you get jealous and shut down and distance yourself from them for a while. So when that jealous feeling happens in group, you have a lot of people watching you, and it's likely that someone's going to notice a change, or a withdraw, right? If that's unusual.

And so someone might check in, right? Or the leader might check in and say, “You haven't said anything since, you know, so-and-so talked about their vacation. What's going on?” So then you (the member) has an opportunity to talk about the feelings, and maybe that'll happen three times before they're able to actually say out loud, “I got so angry when you start talking about your vacation. I have no idea why.” Okay, so that might be what it looks like at first. Then maybe the next time it comes up, “That thing is happening again. I'm feeling angry and jealous, and I don't get why.” So then there just–there becomes more room, more space to describe the feelings and to have it go pretty well, it brings you closer to these people.

It brings you closer to yourself. You start to understand all the layers of that emotional experience, and then you start to get interested in it, instead of afraid of it, or instead of feeling like, Oh, this is gonna go wrong. So over time, you just get better and better at that particular emotional experience and using words in those moments, rather than behaviors.

And so then that's a mastering of a certain special, emotional, difficult, emotional experience for you. So then you have more room in all your relationships outside of group when it comes to that particular part of your, either personality, or your own history, your own psychology. So it's like water over a stone.

This is not–it doesn't happen overnight. It doesn't happen in one group session. It's like you slowly just keep growing your capacity to accept your own feelings and know that if you dive in there and start talking about them, it's probably gonna go pretty well. And you're probably going to end up feeling closer to the other person, and yourself.

Haley Radke: And I love just that you are actually– You have a chance to practice. Essentially, it's like practice relationships in a safe space. And you can just say whatever you want and then you can see the other person's reaction. And then you can have a do-over or have a back and forth until you can figure out, Okay. What should I have said here?

Pam Greenstone: Right. With all that room, where the culture is valuing of that kind of work. And in our families, that's usually not the case. We get criticized or we–people's defenses come up and there's not usually a chance to keep talking about it.

But what a therapist loves is when we talk about that. So that's going to be encouraged. You're going to get positive reinforcement, you're going to get positive messages like, “Wow, that was brave to say that.” You're probably not gonna get that out in the world as much–like maybe, in some of your friendships.

But that's not our culture as it is right now. So, until that day, I think groups can be really helpful. The other thing that I think of when you say that is that– I went to a training group one time and the leader suggested that… So all the members in this training group were group therapists (so there was a high level of kind of awareness and knowledge about group therapy).

But there was a member who was having trouble just asking for help at certain times from the leader. And so the leader just suggested, “Just yell out, ‘help.’” And the member was like, “What? I can't just scream out, ‘help! That's gonna be hard. I'm gonna feel embarrassed.” And the leader was like, “What's wrong with feeling embarrassed?” And then, “Well, people might have a bad, an angry reaction toward me if I just do that, if I interrupt them and do that.” “What's wrong with people having angry reactions to being interrupted?”

So it's just this constant—just making room for, yeah, that practicing and then that acceptance of whatever it is that people experience in the room, and a willingness to listen. So just because someone might not like being interrupted doesn't mean you can't interrupt them, and then keep talking about that, and then they can talk about that experience of being interrupted as well.

And there's room for that at–there's room for that, too. So over time, we just develop more, and more, and more room for lots of different kinds of people, experiences, and emotional communication.

Haley Radke: And one of the… Okay. So you said one of Yalom's factors was having that sense of family and what did you call it? Recapitulation?

Pam Greenstone: Corrective recapitulation of the primary family group or groups.

Haley Radke: Okay. So let's talk about adoptee-specific. Why is this so helpful for adoptees?

Pam Greenstone: So, as I was reading and thinking about our time today, I was reminded of a couple of quotes and one is I think by Harry Stack Sullivan and he said, “We are harmed in groups and therefore we must heal in groups.”

And then I also read about Winnicott. And Winnicott was a physician who was a child psychiatrist, and also a pediatrician. So he really knew and noticed a lot about babies and their relationship with their mothers. And he said, “There is no such thing as a baby. A baby can exist only in relation to a mother.”

And that really–when I read that, it struck me. It was like reading The Primal Wound, right? There is a way that our loss as adoptees who were relinquished is so–it's non-verbal. It's something our body remembers. And so, now let's bring in Yalom's idea of recapitulation of the primary family group or groups. And how adoptees or people that were raised within the foster care system can't necessarily put words to the loss or the grief that they experience when they sit down in a group of people, especially when one is a parent figure.

And so we have–I think we have times of remembering, or body sensations, or just senses, or feeling that we need to say. And we didn't have a lot of room to say any of that stuff in our adoptive families most of the time, especially for my generation or your generation (even though it was very palpable for me and what I've heard described by a lot of adoptees). And so for adoptees, it might come in the form of that–either a longing, or a sense that something's missing, or an insecurity about how long this might be able to last for us, or that at some point, we're gonna leave anyway (so why bother?).

So it might–it'll come up in lots of different ways. At first, maybe as sensations or feelings. And then over time, we'll be able to put that into words. And so I think it's incredible to be able to have that experience, and then also say it out loud, and then to have that welcomed, right? By the group and by the leader–not maybe 100% welcomed, because I'm not saying other members won't have their own reactions to it. But that the culture is of “I'm interested, I'm listening,” and that will be enough to allow an adoptee over time to value those insights when they have them. And then start saying them in safe enough groups of people, so they can feel understood, and heard, and get to know that part of themselves much, much better than we tend to know that part. Does that fit with what you're asking?

Haley Radke: Yeah, absolutely. Okay, so you said that when people join a group, they have a couple of intake sessions with a therapist, and they go over exactly what the expectations are for the group. Can you talk a little bit about that?

Pam Greenstone: Yes. I'll give you a set of agreements that are pretty basic and most groups would adhere to something like this.

So when I introduce the agreements, I say, “Now these are not rules that are to be followed. They’re agreements that you make, and we imagine that you won't be able to adhere to them all the time, and that the work is to talk about it and why it's hard to follow the agreements.” So the first one is:
-Agreeing to be present each week to be on time and remain throughout the meeting. -You agree to work actively on the problems that brought you to the group and talk about the important parts of your life.
-Agreeing to put feelings into words and not actions. -Agreeing to use the relationships made in the group therapeutically, and not socially. -Agree to remain in the group until the problems that brought you to group have been resolved. -Agree to be responsible for your bill. -Agree to protect the names and identities of your fellow group members -Agree to terminate appropriately.

So there are–it's protective that everybody makes these agreements because It's like saying, “We're gonna talk about these things when they don't happen.” For instance, like the one that's about paying your bill. What we're saying with that is, “We're gonna talk about money in this group.” And that's a good topic to talk about consistently. People struggle in their financial lives, and so when someone overpays, we talk about it like, “What was that about? What was going on? Is this something that happens? In your life, is it expressing or saying something? Do you feel like you're getting a lot out of group?” If they don't pay on time, maybe it's important for them to be talking about that part of their life, because it's happening in their outside life as well.

They're not paying their bills, or their lights have been turned off, or they're struggling financially. And people have a hard time saying that out loud in a group of people; a lot of shame comes up around that. So that's an example of a way that can work, and that creates this holding environment where everybody feels like they'll be able to bring these things up if they affect them.

So for one member, if a group member comes in late consistently, it might remind them of a member of their family, or somebody they grew up with? So every time that person comes in late, they're like, having all these feelings and all these thoughts. It's reminding them of their parent that was late picking them up from school all the time, or things like that.

And so it's almost like it gives permission to everybody. Like it's okay to talk about it and say, “I don't like it ever when you're late and I'd like you to never be late again.” And the other person has room to talk about what they're struggling with, why it's hard to be there. They don't wanna be there at all. So being late's much better than not coming.

Haley Radke: Oh, that's good. There's so many little insights, just from that. Just from having someone be late. I love that. Thank you so much for sharing about group therapy. And it's just so intriguing to me, the lessons you can learn from being in a group of people versus just one-on-one. So that was really, really interesting. Pam, where can we connect with you online?

Pam Greenstone: I think the best place to reach me would be my website, and it's pgreenstonetherapy.com.

Haley Radke: Perfect. Thank you so much. And we are gonna have you back to talk about–we just talked about how awesome group was, so we have to talk about, “How do you find a group?” So we will do that next time you're on the show. Thank you.

Wasn't that so interesting? I loved how Pam gave us all of these lists of benefits from being in a group setting, whether it's group therapy, or being in a peer-led support group (which might be the more manageable thing for some of us right now). And it also was just so validating for me to hear, because we've been working very hard to start a peer-led support group here in Edmonton, Alberta, Canada. And there's many popping up around the U.S., as well through Adoptees Connect, and around the world.

So, if group therapy sounds like something that you're interested in checking out, we are going to have another episode very soon where Pam talks us through finding a therapy group in our area. And the steps to go about doing that, and also alternatives if that's not really something that you're able to do at this point.

I want to recommend a couple of things for you to go back through while we're on summer break, and we're going biweekly. I have so many episodes in the Healing Series. It's mind boggling to me. If you go to adopteeson.com/healing, you'll see a list of all the therapists who have joined me. And underneath their bios, there's little icons for each podcast episode that they have been on, and you can see all the topics there. One of them in particular is “How to Start a Peer-Led Support Group,” and Jeanette Yoffe was on, and she talked us through that and gave some really good advice. And I found out that some of the support groups that are already happening have been listening to that episode and tweaking the way they're running the groups a little bit.

So that was very, very cool to hear. So, thank you for those of you who've shared that with me. And in other news–that's it! I am so glad to be back with you for this week, and I'm excited to share Pam's next episode with you very, very soon. And this fall, we'll be back every single Friday with a new Adoptees On podcast episode for you.

And there's going to be some other kind of exciting announcements coming up. So, if you want to make sure you're informed about all those things, you can go to adopteeson.com/newsletter and sign up for the (mostly) monthly newsletter. I keep saying monthly newsletter, but guys, my life is just so bonkers, that sometimes it's a little bit in between monthly. If that's something you're interested in, adopteeson.com/newsletter. Thank you for listening. Let's talk again, very soon.