In David Fincher’s 1999 film Fight Club, the main character, played by Edward Norton, describes fellow passengers on business flights as “single serving friends.” The conversations are rewarding, but do not repeat. In this post I’m going to discuss single-serving group therapy and how helpful it can be, especially in a psychiatric hospital setting.
When I was in graduate school preparing for a career as a psychotherapist, I often thought about how difficult it would be to work in an inpatient psychiatric unit. Three years into my stint at such a place, I am happy to report that almost none of what I thought might happen actually happened. One of the best lessons I’ve learned in this environment is that depth psychotherapy in a group, sometimes called psychodynamic or attachment based therapy, works quite well with almost anyone, even in a single-serving group situation.
I first began learning how to lead a therapeutic group for an inpatient setting by reading Irvin Yalom’s Group Psychotherapy textbook. His section on an “acute inpatient therapy group” provides an excellent template for such an environment. Yalom writes, “You must help patients spot interpersonal problems and reinforce interpersonal strengths, while encouraging them to attend aftercare therapy, where they can pursue and work through the interpersonal issues identified in the group” (Yalom, 2005, p.493).
One way that I do this is by starting with my version of building a recovery plan. On the white board I write out: biological health, psychological health, social health, and spiritual health. This is basically using the bio-psycho-social-spiritual model of care as the focus of a group discussion. I then ask the group which area seems strongest to them right now and which area seems weakest to them right now. Pretty soon the group is talking about interpersonal issues with their hospital psychiatrist, family members or God. My job as I see it in such a group is to highlight the moments when group members are experiencing something similar and process what it’s like to feel understood and less alone. Sometimes I ask other group members what it’s like to hear someone share their experiences. By the end of group, most members report being able to easily begin creating a recovery plan that addresses all areas of health. They also often report how good it felt to participate in a group focused on mental health concerns. I always make sure to end group with an invitation for members to join the hospital’s free aftercare group where they can continue to work on their recovery if they choose.
What I find so interesting about this sort of group therapy experience is that it requires almost no prep time for me the therapist and it consistently receives high scores from patients when they report to their case managers what helped most during their hospitalization.
As a therapist who understands how the attachment system in the human brain works, I also believe that this sort of interpersonal group is successful because of how the group quickly becomes a safe haven for its members to risk with each other and receive comfort from the group. It’s amazing to me every time I see a deeply traumatized and severely ill patient open up and receive support from people he or she hardly knows. I believe experiencing how to engage our attachment instinct in a safe and effective way is one of the best tools any human can learn to use. It’s also easy to do in an adaptive way once you do it a few times in a therapeutic group. It’s an instinct after all.