Adverse Outcomes in Group Psychotherapy: Risk Factors, Prevention, and Research Directions

Roback brings growth and self-help groups in beside therapy groups because the evidence on any one kind is sparse and the lines between them blur. On the leader’s side, he points to forceful leaders who press for fast, intimate disclosure and impose their own values, and who miss members whose defences are giving way; to leaders who give too little structure, leaving members exposed to harsh feedback from each other; and to hostility, exploitation and abuse of power. On the group’s side: attack or rejection by the group, blunt criticism in a group that does not yet hold together, more feedback than a person can take in, strong emotion met with silence or rebuff, and breaches of confidentiality. On the member’s side: serious prior difficulties, low self-esteem, expecting no discomfort, high sensitivity with few social skills, and conflict about disclosure and closeness.

His suggestions for prevention include screening and preparing members so that they know what to expect, training leaders to curb unproductive confrontation and to notice who is being hurt by it, and giving leaders colleagues to talk to. Much of it applies to a circle’s facilitator: how hard disclosure is pushed, whether feedback lands in a group that already holds together, and what happens when someone’s strong feeling is met with silence.