Long-term intensive group psychotherapy – a magnificent therapeutic modality in danger of extinction

Group Psychotherapy provides exactly the kind of safe, but intense transformative environment some of us need to heal deeply.

On June 14, 2020, Dr. John Salvendy, co-founder and first president of the Canadian Group Psychotherapy Association sadly passed away. In 1984 he became my group psychotherapy supervisor during my psychiatric residency at the University of Toronto. Within 3 years he taught me everything I needed to know to begin my own 35 years of group psychotherapy practice. We quickly became friends as we both shared our common European roots. For years we presented group psychotherapy workshops at the annual meeting of the Canadian Group Psychotherapy Association and used to go for our bi-weekly Sunday walks sharing our imagination on all kinds of subjects. Sadly, his passing coincides with a message that recently appeared on the Canadian Group Psychotherapy website saying: ‘We regret to inform you that we are not able to respond to requests at this time. Please check back later’. It is my understanding that the association had to suspend its activities for lack of interest in group psychotherapy in Canada. What a shame, given that it is such a rich, powerful, and effective[22] modality in the field of psychotherapy.

Long-term psychodynamic psychotherapy, or ‘long-term intensive interactional group psychotherapy[21] assumes diverse and diagnostically heterogeneous group membership and an open-ended time scale’ (Wikipedia). I have been running 4 open-ended groups of 12 members each over the past 30 years. The sessions take place weekly and everyone is committed to attend every session. When after several years a group member has accomplished the work of personal transformation they set out to complete, they leave the group and someone new joins. Not only is a group like that a fertile cauldron of transformative energy, but it is also very cost-effective. For psychiatrists here in Ontario the cost per group member is about ⅙ of an individual session of the same length. To run a group like that effectively requires special training within the field of psychotherapy, the way a plastic surgeon requires specialized training within the field of surgery.

There are many therapeutic groups being offered by mental health professionals, most of them short-term. The one we are addressing here is a fundamentally different kettle of fish. Members of my groups have three things in common: (1) They are all productive members of society with professions, jobs, hobbies, and families; (2) they have significant psychological symptoms that interfere with or sometimes even impede their capacity to fulfill their social, familial and personal obligations and aspirations; and (3) they have the capacity to introspect, examine their own mind and meaningfully explore who they are within the context of the intimate relationships that develop in the group. Their symptoms may have traumatic or other origins and may include relationship issues, PTSD, depression, anxiety, OCD, stress, and other manifestations of psychological suffering. Patients with active substance dependence issues or psychosis, and those who are either not able or willing to examine themselves, are not accepted in these groups.

The group process is unstructured, in order to allow the unconscious to speak. Whatever emerges during sessions is the manifestation of how everyone shows up in life. This affords group members the opportunity for self-examination, understanding, transformation, and application of new and more adaptive mental, behavior, and relationship patterns within the group at first, and eventually in their daily lives. What makes such a group so rich and effective is that group members learn through 4 levels of engagement: (1) By observing and listening to other people’s stories and interactions; (2) by getting actively involved in helping other group members explore themselves; (3) by having the group actively involved in helping them explore themselves; and (4) by addressing here and now interpersonal dynamics that arise in the course of each session. The group leader helps members develop a direct, respectful, and supportive style of communication that allows everyone to experience the safety of the intimate group process, as the often hard and painful exploration of truth unfolds towards new levels of integration, personal satisfaction, life success, harmonious relationships, and inner peace. On this basis, members learn to make better life choices, and over time many symptoms they originally came for disappear or reach manageable levels that do not interfere anymore with everyday life.

The principle of universality allows group members to lose their sense of embarrassment and isolation, learn to validate their experiences, and develop strong self-esteem as they recognize shared experiences and feelings among group members as widespread, universal human concerns. Because the group is mixed with members at various stages of development and recovery, everyone can be inspired and encouraged by other group members, which instills hope. Those who have overcome a problem can consolidate their self-esteem by realizing that they have developed the wisdom to help others with what they have learned to apply for themselves, and those who still struggle can benefit from that wisdom of others. The group provides a safe and supportive environment, where altruism can flourish, thereby consolidating our human nature as deeply relational. Members feel safe to take risks and extend their repertoire of socializing techniques for the purpose of improving their social skills, including interpersonal behaviors and the way they listen and talk to each other. Imitative behavior can be an important part of social learning through a modeling process, as members learn to observe and imitate the therapist and other group members in the way they share personal feelings, show concern, and support others.

Members learn to help each other and give their insights to others, which lifts their self-esteem and thereby helps develop more adaptive coping styles and interpersonal skills. In doing so, members often unconsciously experience their relationships with the group therapist and other group members quite similar to those with their own parents and siblings, creating a form of group transference specific to this type of group psychotherapy. With the help of the therapist’s interpretations, this allows participants to engage in a corrective recapitulation, reworking, and transformation of their primary childhood family experiences. By gaining an understanding of the impact of childhood experiences on their psyche and personality, participants may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships. Through the development of attuned communication, as this process can be summarized by, all members feel a sense of belonging, acceptance, and validation. which gives the group a sense of cohesiveness. In such a cohesive environment, it is safe to experience relief from emotional distress through catharsis, a free and uninhibited expression of emotion. In telling their story to a supportive audience, members obtain relief from chronic feelings of isolation, shame, and guilt. Through this process of interacting with others in the group, who give feedback on one’s behavior and impact on others, group members achieve a greater level of self-awareness and self-understanding with the achievement of deeper insight into the way their problems developed and their behaviors were unconsciously motivated. Last but not least, and technically not a direct aspect of psychotherapy, useful factual information can occasionally get imparted from the therapist or other members in the group, which is often reported as very helpful.

In our increasingly fast-paced, narcissistic society (although COVID-19 may seriously challenge this trend), in which self-interest trumps all sense of community and responsibility for others, people often misinterpret group therapy as less valuable than individual therapy, even though the above explanations make it abundantly clear how rich and fruitful a process it really is. As I explained elsewhere here and here, people also look for quick fixes even when none is to be had. Not long ago I assessed a new patient with a significant history of childhood abuse. When I gave her feedback and my recommendation for this kind of therapy, she said she did not want to be so involved and asked me for a ‘quick fix’ so that she ‘can get on with life’, despite the fact that she had had years of short-term ‘quick fix’ interventions in the past, with no measurable result. Insurance companies are notorious for pushing quick fixes, apparently not realizing that they create revolving door situations that I assume must cost way more than a well-run longterm psychotherapy that addresses issues more permanently. The human mind in general looks for quick fixes, uncomfortable with the reality of much human healing that unfolds at the pace of watching your grass grow. There is no way around it, and this kind of group provides exactly the kind of safe, but intense transformative environment some of us need to heal deeply to the point of being able to thrive in our own skin without constant relapses, or worse, progressive deterioration.

Of course, not everyone is suitable for these kinds of groups, not the least because it is challenging to participate in such a rich and multifaceted process. Those who do, however, are usually rewarded by what they often call ‘an experience of a lifetime’, having had the privilege of participating in a group with like-minded and like-hearted people capable of a degree of intimacy, insight, and empathy not found anywhere else in life.

Copyright © 2022 by Dr. Stéphane Treyvaud. All rights reserved.

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Searching Everywhere But Where It Counts

Forgetting that we have a mind.

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October 12, 2024

Before you worry about symptoms such as depression and anxiety and how to improve or get rid of them, before you get your blood boiling arguing with people who can't deal with anything beyond their own viewpoint, before you develop and become ensconced in your own opinions, before you vilify who disagrees with you, before you shake your head wondering how seemingly obvious facts cannot be agreed upon, before you assume you have no blind spots, before you despair that crowds never learn from history, before you become bitter at humanity's collective stupidity, before you get passionate about religion, mythology, and archetypes, before all that, wouldn't it make sense to inquire into the source of all of it - these symptoms, views, opinions, thoughts, actions, distortions and, frankly, miseries?

While it does not take rocket science to realize that the source of it all is the embodied human mind, for most, embarking on its exploration is at best a big challenge, at worst insurmountable, non-sensical or incomprehensible. How many times have you heard nonsense like “I don’t believe in psychology”, as if the existence of the moon were a matter of belief? How often do patients enter their physician’s office complaining of being anxious or depressed, and are sent home with a prescription without one question that would try to understand how their mind creates such suffering? Many people, including professionals who should know better, live and act as if they had no mind.

The mind is the source of all subjective phenomena and experiences, and we are astoundingly unaware of it. Our mind’s task is to ensure survival and the propagation of our species, not to ensure we live our best life. To this end, it needs to be efficient, rather than concerned about maximizing its potential. Efficiency results by pairing down information processing to the bare minimum. Embedded in the way mind functions are mechanisms that cause reality distortions, delusions, wild beliefs, and a profound obliviousness of one’s own ignorance. Whether we like it or not, our mind drives our lives like our heart pumps blood through our veins. The universe's natural processes have caused us to evolve that way, and for better or worse, we are stuck with a mind that functions sub-optimally as it creates profound reality distortions that seem at first blush to have successfully allowed us to multiply and propagate towards earth dominance. In the long run, however, it turns out that humanity may end up stampeding dangerously close to extinction. To thrive both individually and as a species we must come to terms with our rather dangerous mind and train ourselves to use it beyond its basic survival mode by accessing its inherent potential evolution has graciously also built into it. That takes work, training, effort and patience.

Our human mind provides the capacity for reflection. The mirror reflects what’s in front of it, meaning that as reality beams itself onto the mirror’s surface, the mirror beams it back to us as an image we can then examine from the outside. Notice how what gets examined by looking at the mirror is not reality itself, but an image of it. Our brain provides a similar process in the form of consciousness, whereby it maps reality in a virtual form we then can observe and manipulate. However, while the mirror reflects reality exactly as it is, the virtual reality consciousness creates is not only a map of reality, but that map is modified into a new creation. The brain as mapper functions as our central relationship organ that enables us to reflexively develop a relationship to reality and ourselves by having access to a virtual, mapped and modified reality we can ponder and manipulate. This is how we are self-aware.

As an aside, the mind is more than the creator of a virtual adaptation of reality we can reflexively relate to and have a relationship with. It can transcend self-awareness, and knowingly experience reality and awareness without the detour of mapped mirroring duality. That is the shift from observation to being, from knowing we exist in a universe to realizing we are the universe. More about that in another context.

The eye has a blind spot where the optic nerve enters the retina, but you don’t see it. You have the impression of enjoying a seamless field of vision without two black holes in the middle, even though the holes are there. The brain manages to fill in the missing information to make the field seem seamless. Extrapolate that to the whole brain to realize that to function effectively for everyday survival our brain adapts our field of consciousness in two ways: It fills what’s missing to provide a sense of continuity and simplifies available information to not overwhelm you. It hides blind spots from you to provide continuity and withholds information to ensure efficiency. Both these mechanisms distort reality to ensure survival, while simultaneously laying the foundations for ignorance and suffering.

We each have many blind spots, but the core blind spot affecting us all is the proclivity to live as if we had no mind. We use our minds without realizing the extent to which our experience of reality is created by our mind. Without our conscious knowledge our brain creates the reality we experience. We don’t notice that the reality we experience is our brain’s creation. We mistake our brain’s constructions for reality. This results in a dangerous situation, in which we ignore the fact that our experience is subjectively constructed. We mistakenly believe that what we see and experience is automatically true, and because it seems true it seems real, and because it seems real it cannot be changed. Our primordial blind spot towards the brain’s constructions robs us of freedom of choice, of the power of clear view, wise discernment, and respectfully compassionate mutual understanding.

Our mind’s constructions seem so real that we hold on to them for dear life and want to shove them down other people’s throats without exploring their veracity. We get strongly identified with what we believe we know, emotions take over, and the capacity to hear each other vanishes. Identification with mind processes is the single most destructive problem in the way humans use their minds. Emotions suffocate the mind’s spaciousness to freely consider, question, doubt and explore, and before we know it, we are in conflict. If we cannot agree on facts, emotions drive us to use force to impose our views instead of inquiring more deeply into the divergent realities, and if necessary, compromising to try to resolve complexities. Force can take the form of yelling and screaming at each other, or legal and physical action.

The reality our mind constructs and we can have a relationship with, is in fact threefold. We first have objective reality, which is what happens in the universe independent of whether we know about it or there is anyone around to witness it. This reality consists of energy flow that is independent of how our brains and minds construct reality, and therefore as far from information as energy flow can get. The black death virus killed thousands of people without them knowing what viruses are or being able to see them. Although this is the easiest reality to agree upon, like in the case of flat-earthers, emotions still manage to cause distortions of objective facts.

Subjective reality is our own private experience nobody else has access to. This energy flow is entirely within as a construction by our own brain and mind. Although it is largely independent of objective reality, it is profoundly shaped by interactions with others. Even if everyone denies that I am in pain, if I experience pain, it is totally real for me. That is a difficult reality to agree upon, because seeing it from the outside requires trust and our capacity for empathy.

Then there is intersubjective reality, which is the reality of stories. This energy flow is deeply symbolic in the sense that language and stories are symbolic, therefore experienced as information flow, and a mutual co-creation with others. It is the reality that emerges through mutual narrative construction and is neither objective, nor subjective. It only exists in the interpersonal realm containing people who are willing to participate in it by accepting the shared reality. One such reality is money, but there are many others such as all collective ideas we can share. Money means nothing and has no reality unless it is shared in the interpersonal space. This is also a difficult reality to deal with, because it depends on the mutual capacity to regulate the multilayered energy flow between our intuition, our emotions and our intellect. When that occurs, empathy and clear insight become possible, allowing a degree of harmony within the intersubjective dance of energy and information flow to emerge. Any dance couple may dance a Tango, but those in conflict will not be able to present a harmonious dance.

To manage these three realities we each have a relationship with, requires a good deal of self-awareness and emotional regulation many people don’t have. Much of the time, the mind remains transparent like air to our eyes, invisible or not known, yet profoundly determining how we relate to real reality and live our lives. Like children playing in a house on fire, we remain oblivious to the many ways our ignorance of mind causes suffering and destruction all around.      

Copyright © 2024 by Dr. Stéphane Treyvaud. All rights reserved.

The Basic Human Right to Stupidity

Silence and stupidity are the foundations of mental health.

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October 1, 2024

As biological beings we function in analog mode, shifting from one physical and mental state to another, using intelligence to solve problems and consciousness to guide our intuition to make the best possible choices. In contrast to intelligence, which we also find in AI (artificial intelligence), consciousness involves both feelings and the capacity to self-reflect, resulting in the ability to resist reality and by extension suffer. Our biological organism functions naturally as a continuous energy and information flow changing with time through an infinite number of states (like the grandfather clock that shows the whole flow of time), while AI is digital, based only on two discreet states, 0 and 1, from which it organizes information (like your digital watch that only shows the exact time it is now). AI as an information processing system is completely alien to our organic nature. AI is an algorithm that like a table has no feelings and never sleeps, never needs a rest, never feels anything, and is incapable of ethical consideration (if it seems to have ethical reflections it is because it has been programmed to imitate ethical views, not because it feels anything). In social media it is programmed to make money by eliciting user engagement through emphasis on information that activates feelings in human beings, such as anger, awe, attraction, joy etc. The AI algorithm just chugs along as a soulless, emotionless information process like robots or zombies if you prefer the world of fantasy.

Humans, in turn, need rest, sleep, and the cultivation of various mental states through play, intimacy, physical activity, problem-solving, daydreaming and meditation. Within that richness of mental states lies creativity, and at the core of creativity is silence and stupidity. The cultivation of silence, and by extension unknowing, is paramount for the discovery of contexts within which all knowing is embedded. Stupidity relates to the fact that a majority of thoughts we have are crazy, non-sensical, false, deluded, unintelligible, and mysterious. Like a tree spreading millions of seeds, only a few of which will thrive into a new tree, our mind spews out millions of thoughts and fantasies, only a few of which are reflective of truth and conducive to living the good life. Nevertheless, that prolific productivity is the bedrock of creativity and requires skillful management. If we want to be healthy, we need to create a safe, private space for those thoughts to live, evolve, and be processed within the entirety of the mind. That space is the silence of contemplation and the safety of intimacy. Under the incessant barrage of the AI algorithm through social media we have been robbed of such a space, because we are swept away into the algorithmic stream of likes, dislikes, approvals, disapprovals, comparisons, competitions etc. The energy of stupidity then, is used to feed our narcissistic nature and flow unchecked into the public domain of the internet, with really nefarious results.

We are far from having developed the full potential of mind. More often than not we succumb to our internal algorithm of conditioned reflexes, behaviors, reactions and mindless activities that cause untold suffering. If mind has a choice between easy and difficult, it will always choose easy. Easy is what can be manipulated in the concrete world; it is easier to control the body and fast, for example, than to practice mind concentration. We have a certain command over the body and the external world, but not over our mind. Faced with the challenge of mind exploration, we must engage in a rigorous mind training and learn to observe it without judgment.

Most importantly, non-judgmental inquiry requires the privacy of our own intimate space with ourselves and a few chosen people we trust, where stupidity can have full latitude of manifestation. Caring for stupidity requires free private and intimate time, which should be a basic human right. Stupidity and silence are gold mines guaranteeing mental integration and expansion of awareness towards larger contexts. Once we have incorporated such mind hygiene into our lives, we are better equipped to meet the demands and responsibilities of reality, including social reality, and wisely chose what we responsibly allow into the public domain. The non-judgmental attitude of intimate and private investigation needs to give way to the discerning attitude of social manifestation and public expression. In the public domain it has catastrophic social consequences if anything goes and the first thought that enters one's mind is spewed out. Social authenticity in the public domain has nothing to do with spontaneously spewing out whatever stupidities and unformed thoughts fly through one’s mind. It is rather based on one’s capacity to cogently and responsibly express what is relevant to the demands of any life situation after having sifted through the chaos of one's thoughts. In that sense, opinions must be carefully crafted if we want a society that functions wisely.

This dialectic between internal freedom for stupidity and silence and external responsibility for wisdom and perspective requires a difficult ingredient – the capacity to face the truth. Information and truth are not the same, and most information is not truth. We are flooded daily with plenty of information, but truth is a rare and costly kind of information integration process that requires hard work and time to be discovered. Truth is costly because it demands research and investment. Fiction and fantasy (not as literary genres) are cheap and don't require any investment; they can be made as attractive as you would like them to be. They are simplistic, deluded and disconnected from reality. Truth on the other hand is complicated and complex, often painful and unattractive, and the hallmark of our mind’s connection with reality.

Copyright © 2024 by Dr. Stéphane Treyvaud. All rights reserved.

Important Changes to the Mindsight Intensive Program 2024-25

Important changes to the Mindsight Intensive program 2024-25

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October 1, 2024

1. Administrative introduction:

In order to accommodate divergent needs of individual students in the group, I am considering modifications in the group's process. After the first 10 weeks of the fall trimester, during which we lay foundations together as one group, we might explore the possibility of giving students the opportunity to continue through the winter and spring in one of two separate streams of their choice depending on their perceived needs. The decision to continue as one group or split into two will organically emerge from a process of discussion within the whole group when the time comes.

Here are the two streams:

  • There are those who primarily feel the need to develop and consolidate the scaffolding of meditative technique as their main objective.
  • Others feel generally quite confident in their mastery of meditative technique, and are therefore more focused on exploring the psychodynamic, socio-political, existential and spiritual implications of embodying the daily meditative attitude their mastery of technique affords. This includes the expansion of awareness into the modes of nothingness and emptiness.

These two interest streams are paradoxically both complementary and potentially conflicting. On one hand, mindfulness practice invites the student to cultivate beginner’s mind in a non-striving, non-hierarchical fashion. On the other hand, there is a sequential evolution of skill in one’s ability to apply meditative techniques, much like when one learns to play an instrument, creating a hierarchy of skills and stages the meditator walks through over time. Mixing students from both streams in one group is important as it allows for mutual fertilization of experience, expertise and wisdom. By the same token, this differentiation of needs sometimes requires different teaching approaches and emphases in the material that is taught. Naturally, I always endeavor to navigate those two streams within the group as a whole in a way that allows for integration of the two.

2. Long-term commitment:

Students who are interested in the Mindsight Intensive already have mindfulness experience. Therefore, they are all familiar with how challenging it is to embody mindfulness as a way of life. It is therefore assumed that everyone signing up seeks immersion into the hard work required to meet defenses and avoidances head on that can sometimes arise during practice. This can only be achieved through the long-term effort that facing our mind’s complexity deserves and demands. The program is thus structured to run through a whole academic year of thirty sessions, and students with different, more short-term needs who might want to leave after a trimester or two should not join. The work’s intensity requires group cohesion and safety, as well as a shared sense that we can count on each other to work through tough challenges and moments together.

3. Session structure:

Every session will have the following elements:

  • A meditation guided by me of at least 1/2 hour.
  • Time for processing individual students’ journey through the trials and tribulations of their practice. This is the difficult part, because it requires from each student to honestly take on and address difficulties, defenses and avoidances that may arise during their practice and their daily lives. Ignoring these challenges invariably causes the journey to falter and shrivel back into the automaticity of the monkey mind.
  • Theoretical considerations necessary to make sense of our mind explorations presented by me, and sometimes elaborated through group exercises and processing.

4. Immersion at home:

  • In every session I will suggest homework. By diligently following and practicing the homework, the student can enter a path of transformation that will automatically and effortlessly unfold.
  • Before starting the program, please make sure to rearrange your schedule so that you can dedicate around an hour/day to formal mindfulness meditation practice. This may vary at times depending on both external circumstances and internal mental states, but aiming for that amount of time will ensure rewiring and transformation. Although formal practice time can occasionally be broken up throughout the day, what ensures penetration of depth (see my blog ‘Depth in Mindfulness’) is the long uninterrupted stretch of time that inevitably causes deeper conditionings and unconscious forces to emerge into the light of awareness.
  • Throughout the duration of the program, students can request ad hoc individual sessions, should they feel that the available group time has not provided the opportunity to address important issues that arise. For this to be covered by OHIP, you must have been seen by me in consultation through your family physician’s referral within the last two years. If you are not a regular patient of mine, ask Reena whether you must first get your doctor’s referral to see me or not.

Copyright © 2024 by Dr. Stéphane Treyvaud. All rights reserved.

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