Ideas - The Value of Group Therapy

Episode Date: April 8, 2024

Is group therapy underused in treating mental health? Psychiatrist Molyn Leszcz calls it an “incredibly powerful” approach, where patients heal each other and themselves through support and, sometimes, challenge. Scholar Jess Cotton agrees, tracing the radical roots of an idea that she thinks could hold a greater place today.

My name is Graham Isidor. I have a progressive eye disease called keratoconus. Unmaying I'm losing my vision has been hard, but explaining it to other people has been harder. Lately, I've been trying to talk about it. Short Sighted is an attempt to explain what vision loss feels like by exploring how it sounds. By sharing my story, we get into all the things you don't see

about hidden disabilities. Short Sighted, from CBC's Personally, available now. This is a CBC Podcast. Groups had never appealed to me before in terms of therapy. I would say I felt a little hesitant the first time. This one takes place in a psychologist's office. You log on and people are encouraged to keep their cameras on. So you see everybody there and there was a small group. Whether it takes place online or in a real-world room, it can sound pretty daunting.

Join a group of strangers, listen and speak, even about things you've never told anyone, maybe not even yourself. Welcome to Group Therapy, and welcome to Ideas. I'm Nala Ayyad. Group therapy takes many forms, from skills workshops around a specific issue, to something quite different. In other psychotherapy groups, there isn't a set curriculum. Today we're going to talk about social anxiety triggers. The curriculum are the people, the interpersonal interactions. These groups can offer perspective on how we think and behave, the truth we may not see. We'll say, hey, you're doing that thing again, cut it out, try to redirect the person to get closer to what the real subject matter is.

That would rarely, if ever, happen in individual therapy. Research suggests that group therapy can be as effective as one-on-one and with special properties all of its own. That's got some experts asking if group therapy could play a greater role in mental health care. The vast majority of people who struggle with depression, anxiety, trauma, substance use, the major mental illnesses, aren't getting the care that they need. So group psychotherapy is a way to meet that need. psychotherapy is a way to meet that need. Exploring the value of group therapy.

That's the focus of this documentary from Ideas producer, Lisa Godfrey. One of the most basic differences in group therapy is you see the other people seeking help. Sometimes they even pop up in those little squares on your computer screen. It was probably like mid-pandemic, a year in, things were, you know, stressful. Hi, my name is Pega Malahajan. I was suffering. I was ready for anything. I would have done anything. And at the time, one-on-one therapy wasn't really accessible to me anyways. And this program was subsidized and it was targeted towards my age group. So it was young adult, adult. I was Googling things and I came across Anxiety Canada, which is an advocacy group, but they also offer group therapy and therapy services. And they had a online application. So you filled it out. If they think that you're a

good fit for the program, like it can help you, then they set you up. People are encouraged to keep their cameras on. So you see everybody there and there was a small group. It was not more than 10 people, very intimate setting. And the therapist kind of laid down what it would be like every week, you know, we go through a different exercise, have the opportunity to share stories and experiences and learn from those things and do examples and like actually practice the skills that they were telling us to do. So it was very actionable. It wasn't just talking. It was very much like brainstorming and thinking and problem solving. Of course, the therapist is mediating it. And of course, it's very much like there's group rules to be

respectful and things like that and make sure it's a safe space for everybody. There's a power dynamic in there that I think is, it's in all aspects of health care. But especially, I think, in therapy and mental health challenges, you really got to be careful with that. And she was really great. She kind of took away that dynamic. So yes, she was a teacher. She would teach us the strategies. She'd be leading the program. She would be mediating the discussion. Where is it appropriate to dig deeper? When is it appropriate to back off? Like that was her expertise, right? But at the same time, she was really relatable. I think the one thing that really surprised me is how similar people in different walks of life, how similar their experiences can be. And that in itself is one of the therapeutic aspects of group therapy, in my opinion,

because struggling with mental health and mental health challenges is an isolating experience. You feel like you're alone or the only one. And all of a sudden when you're in group, you see other people who you don't know, you know, they're from different places, they've had a different walk of life, they're different age, they're from a different generation, and yet they are experiencing very similar things. And that in itself is kind of a shock for the first time, especially if you've never done group before, or if you've done only individual, right? It's very shocking to hear, oh, somebody else is experiencing a lot of the feelings I am. But also you're learning strategies, actionable strategies that you can do every day for months and it will continue after group has ended.

That you learn those things to help you cope with anxiety or whatever issue that you know you're struggling with so that was huge I prefer online I think it's going to be very person dependent but in my situation I was a student I was also working so it was actually very convenient I could log in from home I could be doing homework or come back from work and just log on. That actually made it more accessible for me. I get that people would be hesitant about the online, but everybody was really invested, right? It wasn't a referral thing. It was like, you found this, you're in a really dark place, so you're going to show up and give it your all. Pega Mulhaysan on her virtual anxiety meetup, a very 2020s iteration of group therapy.

But the general idea? That's been around for a long time. The roots of group psychotherapy go back actually over 100 years ago to a physician who developed interventions for patients with TB who were in sanitaria. And the idea was he brought people together to talk about the illness and to encourage them to share coping strategies. And he found that there were enormously therapeutic benefits of bringing people together in a group, sharing a common malady. Mullen Lesch is a psychiatrist and author. Group therapy then began to expand in North America and in Europe. And I think it's important to recognize that there are two different parallels.

The American model was learning about the self, expanding personal growth. The European approach to group psychotherapy was more influenced by not the expansiveness idea, but the trauma repair process. Trauma that came from fighting two world wars. We are perhaps simply in an embryological state of the development of human civilization. I was looking at the work of the psychoanalyst Wilfred Bayon, and during the Second World War, he innovated this idea of group psychoanalysis. He saw that there was a lot of traumatized soldiers returning from war, and there were hospitals that were overrun with patients. And he thought, you know, what can we do here as psychoanalysts coming in, undertaking this role of military psychiatry? I'm Jess Cotton. I'm an early career fellow at the University of Cambridge. Jess works in the English department, and she's currently doing historical research on loneliness, which brought her to the other end of the spectrum. Ideas of collectivity and the ways in which cultural and psychonautic resources have helped draw people together, essentially.

Wilfred Bion, sometimes pronounced Bion, served in a tank battalion during World War I. He was a very young officer at the time, and he found war devastating. Then World War II rendered another generation of soldiers shell-shocked. There were a lot of them. With his colleague, John Rickman, he decided to think about treating the men in groups. And this was quite a kind of radical proposition at the time. It kind of democratized psychoanalysis. So working class patients, people who didn't normally have access to psychotic treatment suddenly became patients through group analysis. The setting for the trauma work was a public space at Northfield Hospital, which is near Birmingham in England. And it wasn't only the grouping of patients that was radical. He creates these very provisional setups where he gets a bunch of men together in a room and asks them to begin

working through their complexes. The things that might unconsciously be shaping their emotions and behavior. What happens when he does so is that the psychoanalyst goes from being this very central, masterful figure in the room to being, to kind of taking a back seat, to being a conductor. A kind of democratizing of authority. Bion was thinking about these things at a specific historical moment in Europe. His idea of the importance of group work takes shape against the backdrop of Nazism. So there is this general widespread anxiety about the force of a leader, general widespread anxiety about the force of a leader, the blinding kind of force of a leader that can produce very robotic subjects. So, Bion is really thinking about how

psychoanalysis conducted at a group level can push back against that blind sense of leadership. So, precisely because Bion was anxious about the role of leaders, he wanted to create these leaderless groups. So he absents himself from the group. He merely conducts it. And in doing so, he allows the former or soldiers-in-waiting, so to speak, the opportunity to work through their own relationships to power and their own feelings towards authority. And it was only by developing this healthy relationship to authority, to working out how groups work, that Bynes thought there could be a healthy relationship to military structure. Documents from the time show that Bion and Rickman saw the work producing positive results for the troubled soldiers.

Members of the group begin to react very strongly to take on other people's emotions, and then by taking on those emotions, kind of reveal the other person's emotions to them, but also to begin to develop new, healthier relations with each other, since they're not only working through a problem, but practicing enacting that relation in a kind of group in a communal setting. Bion's Northfield experiment had been influential. But he was kicked out of these hospitals after six weeks that the military really saw as deeply subversive. But on the other hand, he was training these soldiers to go back into the

military. So, you know, on the one hand, it's encouraging revolt, but in the longer picture of supporting the state. And he would continue to do so for a brief period when he went back into work in the Tavistock Clinic in London, which is really the kind of clinic that's associated with group analytic therapy. associated with group analytic therapy. The experimental work of Bion and his peers helped integrate mental health treatment into public health in England. And then there was a second experiment that lasted longer and it was seen as part of this development of what's known as the therapeutic community in England in this post-war period, like the therapeutic community in England in this post-war period.

So this prioritization of therapy as part of the national health. As for whether treating traumatized soldiers in an experimental way was quite ethical, I don't think those questions were coming up immediately. And I think perhaps that they were still practicing within the institution of psychoanalysis itself. They were kind of conducting these discussions in fairly orthodox ways. We are perhaps simply in an embryological state of the development of human civilization. state of development of human civilization. Bion, Rickman and their contemporaries were walking the line between convention and subversion when it came to group psychoanalysis.

But soon after came a more radical thinker. What psychoanalysis serves is to cure certain very concrete symptoms, such as, for example, the other vestige. One can have a phobia of torment. Marie Langer was an Argentine psychoanalyst born in Vienna in the 1910s. She was trained in Freudian analysis there, but as a female analyst and a Jewish one, working in mid-1930s Austria, she was an outsider, a political one too. She had quite a colorful history.

So she arrived in Argentina via Uruguay during the Second World War, but she had previously been part of the Communist Party. She had taken part in the Spanish Civil War. But for several decades, starting in 1942, she found her intellectual home in Argentina's psychoanalytic community. As someone who had been very much influenced by ideas on the left, she was interested in kind of thinking about how psychoanalysis might take on a more

public role. So it kind of emerged in dialogue with a series of colleagues in Argentina at that moment. Jess Cotton sees Marie Langer's group work in two chapters. The first chapter really takes off from her thinking about women's relationship to fertility and pregnancy and working with groups of working-class women in Buenos Aires in the 1950s. So she begins to kind of think about how psychoanalysis might give women a language to work through their complexes. Feelings shaped also by society itself. She wanted to think about not only how we carry individual neurosis or the history of our past traumas, but how we take part in collective neuroses that we continually projecting onto other people. act, how they project anxieties onto each other, they could kind of work through something that was not simply an individual problem of motherhood, but a more social problem of motherhood, which is to say the fantasies of motherhood being this pure state or idealized idea.

Marie Langer herself knew that pregnancy was not always uncomplicated. She miscarried when she was part of the effort of the Spanish Civil War. So she was interested in the ways in which psychoanalysis could create a complex language for maternity and help women on a collective level. And Langer only became more radical as time went on. The second chapter in the 1970s, at a moment when there was a rightward turn in Argentina, she begins to publish these remarkable and revolutionary papers

that argue for psychoanalysis as a kind of force of revolution. So she leaves the International Psychoanalytic Association and begins to kind of think about more radical ways to practice psychoanalysis, both in Argentina and later when she's in Mexico and Nicaragua. Her second exile due to politics. She saw psychoanalysis, group psychoanalysis, as a way of working through political trauma. By working through this trauma, it allowed for a more radical sense of community. She called herself a mental health worker. I think that she saw psychoanalysis as a tool of liberation, which is to say that whether it's by treating mothers in the 1940s or by thinking through political exile and trauma in the 1970s,

her wider aim was to give the ordinary people a language in which they could see their problems as socially conditioned rather than individual. rather than individual. Meanwhile, in England, and in particular in the United States, a new kind of group therapy was on the rise. This is partly to do with the rise of the counterculture, so this new kind of drive towards collective experimentation and group therapy, which is gradually seeping into social and industrial

practices really provides a kind of umbrella for these desire for experimentation, new feelings of alienation, abandonment, a number of kind of countercultural guru figures begin to step in and to kind of propose their own versions of group therapy, which are really about not simply working through a complex or about connectivity or community, but about radical transformation, out-of-body experiences. I suppose there is an interesting paradox because, of course, Bynes' version of group therapy was to absent the psychoanalyst from the therapy session to be for the silent presence.

And these versions of group therapy were kind of the opposite, where you suddenly got this cult-like figure, and it kind of encouraged these therapists to become celebrity figures, essentially. He came with an entourage. There was a hush over the crowd, like, he's here. I'd never laid eyes on him before, so it was like, oh. The group practice became more ethically dubious. I think there was this institutionalized going off the rails, essentially, is what group therapy sanctioned. That's not entirely true. There were some versions of group therapy that were slightly more above board,

but it really, in the 1960s, a whole host of schools and institutes that were running these practices that were essentially encouraging patients to have sexual relationships with one another and with therapists. They were encouraging often very kind of outlandish practices. The Sullivanian Institute on the Upper West Side of New York were offering low or free rent in exchange for what essentially was a kind of group package of parity, sex, and low rent. There was group therapy as forms of drug rehabilitation centers. So really many practices of group therapy become entirely eccentric, hippie-ish, cultish practices in these decades that really just give full expression to countercultural ideas of losing the self, refining the self. I think in many of the ideas behind this cultish behavior is rooted in vaguely mainstream psychonautic thought like Wilhelm Reich, who was very into a bodily expression of psychoanalysis in Jacob Moreno's ideas of psychodrama. So there is

often the cultish ideas starting a kind of legitimate orthodox psychoanalysis, but then they just get taken to very eccentric and ethically dubious proportions. So the group itself becomes a cult, essentially. Wilfred Beyond's Revolutionary Trauma Treatments, Marie Langer's Radical Collectives, the 20th century group experiment obscured in a counterculture haze. And now, half a century on, neither Europe nor America has quite managed to achieve mental health treatment for the masses. Some might say that the great democratizing experiment of our time is technological.

What if a teenager's cell phone could be a way to help address and alleviate some of their problems? They live on their phones. They're comfortable texting. The mental health app. Talk into the phone and let's listen to the sound of your voice to see, are you feeling anxious or depressed today? The Journal of the American Medical Association Psychiatry said a few years ago that there are 10 to 20,000 of them in existence for everything from stress to depression to anxiety.

Dua says they use artificial intelligence to get a read on your tone of voice, and it only takes 30 seconds. I always say there is no health without mental health. I always say there is no health without mental health. But having researched the 20th century history of group therapy, scholar Jess Cotton is not convinced. have a real tangible narrative and communal connection that allows them to think differently about their own psychic history and how it exists within a kind of social setting. So I think, to me, that group analysis offers an obvious alternative and a really useful solution, a way of closing the gap between a technological model which can't provide the care that's needed for patients that are vulnerable and even for people that are seen as quote-unquote

normal. And yet, of course, there aren't the resources for individual psychotherapy or psychoanalysis. So group analytic therapy seems to me like the obvious avenue to pursue if we are kind of seriously interested in addressing what is often seen as a mental health crisis today. You're listening to an Ideas documentary about the history and practice of group therapy with... Dr. Jess Cotton, an early career fellow at the University of Cambridge. And... Pega Mohajan. Group participant. Ideas is a podcast and a broadcast

heard on CBC Radio 1 in Canada, on US Public Radio, across North America, on Sirius XM, in Australia, on ABC Radio National, and around the world at cbc.ca slash ideas. Find us wherever you get your podcasts. I'm Nala Ayyad.

Hey there, I'm Kathleen Goldtar, and I have a confession to make. I am a true crime fanatic. I devour books and films and, most of all, true crime podcasts. But sometimes, I just want to know more. I want to go deeper. And that's where my podcast, Crime Story, comes in. Every week, I go behind the scenes with the creators of the best in true crime. I chat with the host of Scamanda, Teacher's Pet, Bone Valley, the list goes on. For the insider scoop, find Crime Story in your podcast app. Something has shifted. The research and reporting seem to agree.

The lack of social capital in society is killing people. It's a lonely time in human history. The dismantling of social community structures that held people and kept people connected has dissipated. That was even before COVID. It's a stressful time too. Conflict and climate change, social, political and economic troubles. More and more people are looking for mental health help alongside people suffering major disorders. There has been an explosion in need.

That's why some experts are convinced that group therapy could play a larger part in treatment efforts. If 10% of unmet need for mental health care was provided by therapists doing one group in their practice, it would save about $6 billion a year in health care and provide care to several million individuals. It's never been more important. Here again is Ideas producer Lisa Godfrey.

Here again is Ideas producer Lisa Godfrey. An advocate for group therapy in all its forms is Mullen Lesch. I'm a psychiatrist. I'm a professor of psychiatry at the University of Toronto. I've worked in the area of group psychotherapy all of my professional life. psychotherapy all of my professional life. I recently finished a term as president of the American Group Psychotherapy Association, home to about 2,000 mental health professionals from around the world who are committed to advancing mental health through the practice of group psychotherapy. He kind of wrote the book on group therapy, or co-wrote it. I've had the opportunity of working with Irvin Yalom, who I trained with early in my career, and we published together the fifth

and sixth edition of A Theory and Practice of Group Psychotherapy. On a personal level, when you were in training, What first attracted you to the idea of group therapy? The personal answer is that I always recognized and appreciated the importance of the group as a source of community and support. My parents were survivors of the Holocaust and emigrated to Canada and created a small community of other survivors. So we grew up in this extended community group because there was no one from the next generation. It was the parents, those who were lucky enough to have kids, that was the community. And people supported one another,

and they helped one another. Professionally, when I began to train as a psychiatrist, I began in Winnipeg. I came to Toronto to finish my residency and worked at Mount Sinai Hospital, where I've been, in essence, since. And the chief of psychiatry at that time, Stan Greben, asked me if I wanted to develop group psychotherapy at Sinai and at the University of Toronto. And I said, I'd be keen to do that. I was looking to establish myself. And I was off to Palo Alto and Stanford and had a fantastic experience working very closely with Irv Yalom. Why have you stuck with it? Why has it been rich enough to sustain your interests through decades of professional life? It's an incredibly powerful way to help people. way to help people.

And you see people's humanity emerge in the context of the group work and the way in which they are able to help and heal themselves and one another. I feel group psychotherapy has always been important. It's never been more important, I think, than it is right now for at least three reasons. One reason is that there has been an explosion in need for mental health care. The vast majority of people who struggle with depression, anxiety, trauma, substance use, the major mental

illnesses, aren't getting the care that they need and certainly aren't getting substantial psychotherapy or counseling. So group psychotherapy is a way to meet that need. Our research shows that group psychotherapy is a triple E treatment. It's equivalent to individual therapy in terms of its outcome. It's effective. There's no question about that. And it's economical from the perspective of the payer. So in a public health care system like in Canada, it's a less costly way to provide good care to people.

Like in Canada, it's a less costly way to provide good care to people. So groups provide both a direct opportunity for affiliation and connection, and some groups also provide people with the learning that allows them to take that outside of the group and to create an adaptive spiral where the changes that they've made in group therapy they're able to make in their life at large. Well, let's talk about that. And first of all, how does a person get into group therapy? Are they referred? You get into a group if you seek care in a community agency, in an addiction program, or by referral from your family doctor to a department of psychiatry where they do group therapy. As a potential group participant, am I really getting the intensive help that I would

need? Are you guys just trying to save money? The fact that it is more economical is a side benefit. The value of group therapy is its effectiveness. And the stuff that you're dealing with may actually be quite constructive and helpful to you to talk about with other people, people with lived experience, people who have coped with similar kinds of things. People can understand what you're wrestling with. There's often an incredible strength in the feedback that members of a group give to one another. And group therapy is a very powerful way to both be supportive and hold people accountable.

There was a great article written a number of years ago in the New York Times by a fellow named David Payne, a patient, who talked about the difference between individual therapy, which he felt fed his narcissism without him knowing it, and group psychotherapy, where he learned an enormous amount about himself. He said, I always look... Well, I'm actually still in group therapy, so 19 years. When I first got into group, I had a habit of telling stories the way that I typically tell stories in the real world. I'm a writer and a teacher. I've published five novels and a memoir, Barefoot to Avalon. I would try to build suspense and leave the punchline for last. And I found, much to my surprise and chagrin, that it was

pissing people off. It was like they wanted to get to the point and hear the punchline first. Tell us the punchline and then let us get in there and find out what's really going on here. So rather than me being whatever charming or whatever I thought I was being by telling the story in the way I was accustomed to do, I learned to cut to the chase. I found individual therapy much more tolerant, indulgent, and supportive of whatever my emotional needs were. And not that you don't get a sympathetic hearing in group. I think you do. But it's a much more challenging and abrasive is a little too strong a word for it, but people will come in and they will present whatever it is that's bothering them on that given week. Seven times out of 10, they'll tell the story in some

way that will reflect a dysfunctional pattern that they typically use, that other people in the group have seen them use a thousand times before and will say, hey, you're doing that thing again, cut it out. Then they'll try to redirect the person to get closer to what the real subject matter is. That would rarely, if ever, happen in individual therapy. I don't think they're always right from challenge, from finding out some error or flaw or misperception in my understanding, rather than from a confirming and supportive view. Now, that doesn't mean that there's not room for support. I think there absolutely is. And you do get that in group. I think, as I said in the New York Times,

when I published my memoir, Barefoot to Avalon, around that same time, I was, without completely knowing it, I was near the end of my marriage. I was starting to drink in a different way that was beginning to verge on and ultimately went over the line into alcoholism. By the way, I've been sober now since 2006. So I wanted something, you know, I needed some sort of psychological support and it was accidental. The group thing, it wasn't as though I said, oh, let me research a new way of doing it. Somebody said something, one person mentioned it, I heard about it. I went to see one of the therapists who ran that group on an individual basis first. She suggested that I might try it. And so I entered it experimentally. And, you know, for, I think this is fairly typical typical the first six months were

really tough you know it's like being knocked down by an ocean wave over and over again and getting foam and sand and you know up your nostrils and you know trying to regain your your footing in the surf. But over time, I saw changes, real changes, meaning, for instance, I stopped drinking. And two, I ended up ultimately leaving my marriage as a result of the changes that I went through in that group. In my experience, there's something about being challenged by something that's outside your current comfort zone that requires you to open up and internalize and incorporate something that is not part of your pre-existing equipment that actually makes you gain structure. I don't like it when I get challenged in group. I don't think any of us like it when we get challenged about ways that we are maybe not seeing things clearly. But I tend to

learn by having to open myself up to that and having to take it in. And at the end of the day, I think that helps to make us a little bit bigger and a little bit stronger than we were before we had to do that. Writer David Payne's view of the group experience. Writer David Payne's view of the group experience. And psychiatrist Mullen Lesch says he's not alone. There are many ways that people use that kind of interpersonal learning and self-understanding to change the way they are. What we try to do with patients coming into these kinds of interpersonal, dynamic, process psychotherapy groups is establish a set of goals before they come in. And we've been working

to reframe that into a compass statement. And this is something somebody would work on before they come into the group and then introduce themselves within the group. So an example of a compass statement might be, my name is Joe and I grew up in a family with an alcoholic father who was threatening and abusive. And I learned to silence myself, keep my head down and my mouth shut. And as a result, I've been isolated and felt inferior and inadequate all of my life. I want to come into the group and learn how to take my rightful place in this group and in society at large. And I'm going to try to take more risks and let people know what I'm feeling and thinking

and hope that I'm going to be greeted with a different kind of response than the one I grew up with. It gives everyone a kind of awareness of the direction of the work that so-and-so needs to do. And so when Joe asserts an opinion that is different to what others in the group are espousing, we're able to look at what does it mean to him to be able to do that? How is he experiencing that?

What does he think other people are feeling and thinking about him? And rather than living in his head, we can open that up for feedback, for dialogue, for interaction. And so if he gets feedback that says, I admire your courage, and I'm glad you said what you did because I hadn't considered that until you spoke about it. How corrective is that kind of experience? And that's what we aim to do in group psychotherapy, to create a social microcosm,

to have people work together in the here and now, the interpersonal, the interaction, and then to learn about themselves, change their behavior, change their self-understanding, operationalize that, and hopefully achieve a corrective experience, a healing experience, not contrived, not fake, authentic, genuine, that they then take in and can use in their relationships at large.

Interactions between struggling people. The group as a social microcosm, supporting and challenging. Group therapy seems like a delicate dance. The so-called leaderless group had better have a great conductor. Pursue group therapy with people who are well-trained. Inquire. Ask them what their training is, what their approach is, how do they work, what are the things that they work well with. Mullen-Lesch says that the American Group Psychotherapy Association, with its worldwide membership, has established standards, including the status of certified group therapist. Wise advice.

Sometimes, though, you may not be in a state to do that kind of thorough research or to find the right fit for yourself. Maybe you have complicated feelings about groups in the first place. I don't know how I would classify as an introvert with extrovert tendencies, so groups had never appealed to me before in terms of therapy. My name is Heather Hughes. I am a freelance writer and copy editor. About five years ago, Heather was living in New Orleans after a major mental health crisis. I had recently been discharged from a psychiatric facility and I was still severely depressed. And I was desperate, just trying to find any form of, not even therapy, but any way to try and bring myself out from that abyss. and bring myself out from that abyss.

At the same time, she says, she felt uncomfortable with the idea that her mental illness would become her identity. So she sought out an unconventional kind of support, a different gathering of people. A 12-step group, Alcoholics Anonymous, there was a meeting close to where I was. And I made sure it was an open meeting, that it wasn't just solely for people who identified as alcoholic to go to. And I went to that, and no one was like, what? Get out. No one looked at me a stance.

I would introduce myself. My name is Heather and I am not an alcoholic. There were a variety of factors why I preferred it to group therapy. And I tried different groups shortly after I was discharged. And AA was the one that felt the most useful to me and the most comfortable, as much as I could feel comfortable in a severely depressed state. It was a few meetings before I spoke. Speaking was not a requirement. I was anonymous. I could be as anonymous as I wanted to be. There wasn't a therapist who was overseeing it. Members of the group were basically self-monitoring. And it was

free, which also made it appealing. With AA, I found that being surrounded by people who were also struggling, not necessarily with what exactly what I was struggling with, although depression is often a component of alcoholism, but they all understood what it was like to be in pain and struggling. in pain and struggling. Whereas in more structured or what would be considered, I guess, traditional group therapy, it felt like there was an impatience to speak, just thinking, ruminating on yourself and kind of waiting for whoever was speaking to stop speaking. And in AA, because the time of sharing is monitored, it's two, maybe three minutes at the most, there's never anyone grandstanding. There's never anyone hijacking or dominating the meeting. In group therapy, depending on the therapist, and group therapy, depending on the therapist, that was not always the case. I want to just clarify that I am not anti-therapy moderated by a psychiatrist, psychologist, social worker. In my experience, I did not find one that was as beneficial as a 12-step group.

as a 12-step group. And one of the problems with doing research is if you're looking at a time of crisis or shortly after a crisis, I know from my own experience, I was not as capable as I ordinarily was, you know, pre-breakdown. Often people who are feeling their worst have to be their own advocates if they don't have a support system. And I didn't. So I had to search for everything when I was at my least capable. Now, having gone through the experience, I have an idea of like what better to monitor, how to monitor my feelings. And I have an idea of what I would do in case I have another breakdown and hopefully would prevent myself from fully like falling apart. Other things that I found work for me, it could be as simple as just walking, being outside and just seeing some form of nature, wildlife, multi-stage or multi-step forms of self-care. In terms of the 12 step groups, I haven't been to one for a while,

partly with the pandemic, and it was all virtual, and that does not work for me. I need to be in the presence of others. With depression, it's the feeling of being utterly alone. And there were certainly people in my life who cared about me and knew the extent to which I was suffering, but I had nothing to hold on to. And that was not necessarily true, but for me, it was the truth. No one is going to feel connected to everyone in the group. There are people you may find extremely annoying. There are people who you may feel an aversion to. Not everyone in the group is going to feel drawn to you, but within that period when the group is there as a whole, there is a connection because there's a shared experience with having had extreme suffering and emotional pain and fear, even if the illness might be different, they understand. You don't have to pretend. And there are people who have come through that. There are people there who have come through that suffering and emerged and are not just surviving, but even are in, you know, I don't want to say not surviving, but thriving. But they have come through and they're functioning again and able to enjoy life.

But they haven't just said, well, I don't need this group anymore. and just said, well, I don't need this group anymore. Writer Heather Hughes. She's doing really well, by the way, and has been living temporarily in Argentina, where she's pursuing her love of tango. And speaking of tango... Yeah, it is a dance, this finding the right kind of group for you.

One that supports and suits your individual needs when and where you need it. It isn't easy. But Mullen Lesch says the right group even has the potential to be life-changing. You told me a really compelling story about someone who was encouraged to do something that they were hesitant to do by the group. Do you remember that story? Oh, absolutely. Tell me. Absolutely. This was a woman in one of our metastatic breast cancer groups, a lovely woman, salt of the earth,

in her late 60s. She was in a period where she was relatively stable, and she talked in the group about the fact that she would like to take advantage of that period of stability to see her brother who lived in another country across the world. And the group encouraged her to do so. And she said, I can't. I can't travel now. And the group said, why? And she said, I have responsibility for looking after my 92-year-old mother-in-law. And women in the group thought about this. And one woman said, why don't you give your adult children the gift of giving you this trip? And they can look after their grandmother for the time that you're away. And it was like it crystallized in that moment. She said, that's a brilliant idea. You can imagine the backstory. This is a woman who was a giver and loved her kids and would not

want to burden them and never asked for anything. She asked for this. She went on the trip. She came back from the trip and celebrated the trip with the group members and then became ill and died three weeks later. We met with her family after her death and her children said, we are so grateful to this group for encouraging our mom to ask us to do that because it allowed us to try to balance the books with this woman who was so generous to us and so hard for us to give to. It's going to help us with our grief to know that we gave her this wonderful trip before the end of her life. And if she had waited three weeks, it might have been too late. So very, in some ways, very practical things can come through group as well. The women in the group said,

all we're doing is what women have done for centuries. Talk together, support one another, help them cope with life and family. you've been listening to an episode about the value of group therapy with psychiatrists Moulin Lesh and writers David Payne and Heather Hughes. You can find out more about them on our website cbc.ca slash ideas. This documentary was produced by Lisa Godfrey. Web producer for Ideas is Lisa Ayuso. Danielle Duval is our technical producer. Senior producer is Nikola Lukšić. The executive producer of Ideas is Greg Kelly. And I'm Nala Ayyad. For more CBC Podcasts, go to cbc.ca slash podcasts.