What Can Be Expected From Individual and Group Therapy?

In my work as a specialist in sexual addiction therapy, I have participated in various recovery modalities.  Talk therapy, with individuals and with partners, is the one in which I spend much of my counseling time.  Group therapy is another means to recovery, and I have done it both professionally with Lifestar Network and with the Addiction Recovery Program (ARP) of the Mormon Church.  And even though I am not a sexual addict and cannot sit in on Twelve Step program meetings such as Sexaholics Anonymous (SA) or Sex Addicts Anonymous (SAA) because of that fact, I have clients who regularly attend such programs. These support groups can be very important.

However, I want to share my ideas about one-on-one (or one-on-two) talk therapy, and group therapy, and what should be expected from each modality. I have not taken the time frankly to do research on this topic.  I only share here my observations from my seven years of experience intimately involved in both, and how I frame those observations to my clients. 

I believe both personal and group therapies to be beneficial, but they usually serve different purposes for the person attempting to move past sexual addiction, or any other addictive behavior or substance for that matter.  I would recommend that both be considered, for reasons that I will articulate, but admitting that there are plenty of examples of people involved only in personal psychotherapy, and only in group therapy, who achieve recovery.

Group Therapy

Often, people confronted by a partner, or confronting themselves on the nature of their lives as a result of having addictive behaviors, will seek out so-called "recovery groups," such as SA or SAA, or Sex and Love Addicts Anonymous (SLAA).  These organizations grew out of granddaddy of recovery groups, Alcoholics Anonymous (AA).  Sometimes, in rural areas where there are currently no SA, SAA, SLAA, or other less well-known sexual addiction recovery groups, people who wrestle with sexual addictive behaviors will attend AA meetings--usually held just about everywhere.

Almost always, like AA, sexual addiction recovery groups center their "doctrine" or "beliefs" on the Twelve Steps, and as part of those steps, attenders are asked to consider the value of a belief in a "higher power."  These groups are very careful not to describe or mandate what the higher power should be; only that it is an imperative for them to hold some kind of belief in a power larger than itself.  The idea is that they on their own have been unsuccessful in abandoning the addiction.

To offer a very brief summary of the Twelve Steps, the First Step requires that the addict admit his/her powerlessness over the addiction and the subsequent unmanageablility of their life.  Steps Two and Three discuss the need for a Higher Power and the importance of that belief in recovery. Step Four requires a fearless moral written inventory, after which Step Five requires a confession of the addict's "immoral" behavior.  Steps Six and Seven deal with being honest about discovered weaknesses articulated in Step Four, and turning them over to the Higher Power.  Steps Eight and Nine requires that amends be considered then made, or forgiveness offered, to those who have been harmed or who have harmed them.  Step Ten is a daily check in with one's self as to daily recovery. Step 11 adjures the addict to seek spiritual guidance, and Step 12 suggests that the "good news" of the Twelve Steps be shared with others.

The Twelve Steps can be a challenge for some who feel that part of their addictive behaviors have been caused by rigidly religious parental figures, and feel anger toward what they feel is forceful overreaching by those figures. These people now want nothing to do with a higher power.  

When attending a group, one is confronted with real stories of addiction and how the addiction has affected loved ones and others.  Ideally, it is a time of vulnerability and reality, of appreciation and attitude corrections, but most importantly, a time of connection and support from and with other group members.  It can be overwhelming, raw, emotional, affirming, sometimes disgusting, but a respite of time to be among others who share similar experiences and that get addiction.  It is about the group, which at times can feel like church fellowship.

Group members are encouraged to interact with others one-on-one after the meetings, to find a sponsor who is in recovery and has been so for a number of months or years, to read the literature of the group, to attend the particular meeting they are attending plus other meetings--sometimes 30 meetings in 30 days or even 90 meetings in 90 days.  Attending meetings can be very much like attending church services.

Group meetings are meant to be supportive, but not therapeutic.  Some of the group members may be in individual therapy but it is not a requirement of the group.  Done diligently, the work of the Twelve Steps for many can be all that is needed, because while "doing the Twelve Steps," the addict comes to understand the "whys" of his/her addiction; why they acted out sexually, why they sought out solutions in a substance, why they continue to use the addiction.  Regrettably, few actually "do the Steps" which can often happen because usually the groups' emphasis and focus is on sobriety, and members can think that by mere attendance at the group their addiction will go away.

Individual Therapy

The reasons why people engage in addictive behaviors can be complicated or complex. And while support is offered by a group, the particular reasons for the addiction are best understood and dealt with through individual contact with a professional who can dispassionately observe the addictive behavior and offer possible insights--or help the addict to gain his/her own insights.  That is far more challenging to do in the dynamic of a group.  The addict's sponsor, assuming he/she has made the effort to have one and makes contact daily or many times a week, can offer one-on-one insight to the addict.  But again, this mentoring process is not always carried out.

If an addict understands why he/she engages in the addictive behavior, they are on the road to recovery.  Otherwise, they can forever "white knuckle;" or in other words, attempt to use willpower to achieve sobriety.  But sobriety is not recovery.  Certainly, sobriety is needed for recovery--allowing the reasons for the addiction to manifest because the entire focus is no longer on the addiction.  But until the "whys" are identified, willpower will ebb and flow, and the addict will likely never really be able to be free of the addiction.

In the work that I do in my attempt to help clients to achieve long stetches of sobriety, for example, a client can "slip up" or "act out" their addictive behavior(s).  I engage my client, one-on-one, to analyze what he/she did or didn't do that led to the behavior.  I like to put the behavior "under the microscope" so that my client can learn from his/her mistake.  This type of very specific work can best be accomplished through individual therapy, week in and week out.

As the client and I look at what happened, especially if it happens routinely, we begin to notice what core issues were at play that led to the behavior. What did the client do or not do that led up to the behavior.  As a client understands and assimilates what has been occurring, I view this as the beginning of true recovery.  They are in the process of discovering the "why" of the acting out behavior(s). They begin to take control over the addiction as opposed to allowing the addiction to control them.

I believe that most psychotherapists are capable on some level of helping a struggling addict who wants to be rid of an addictive behavior.  However, it has been my experience that we who specialize in addiction recovery, and in my case, sexual addiction recovery, are best qualified to understand the dynamics of addiction and addiction recovery and can best help the addict. In my case, it is my speciality.  It is wonderful for the addict to understand and feel that the therapist really knows what transpires inside their mind and heart.

So there is good to be had from both individual and group therapy.  I encourage clients seeking recovery to avail themselves of both.  Hopefully, this posting helps bring clarity to what can be expected from each.