Experiential learning of group therapy training has historically been widely accepted; however, there are few contemporary reports in the literature regarding experiential training groups for mental health professionals (1–6). There are no recent data evaluating such training groups for psychiatry residents. In the absence of such data, residency program directors may view training groups as negative experiences of little value and may believe that residents are disinterested in or opposed to such groups (4). The current article addresses this gap in the literature by examining residents’ experiences of, and considering the potential relevance of, the University of Toronto Department of Psychiatry's annual experiential “Group Day,” based on 3 years of evaluations completed by participants (N=149).
Group Day is an annual, full-day educational event, and participation at least once during 5 years of residency training is mandatory; further participation is optional. Group leaders are invited by the Head of the Group Psychotherapy Program; they are faculty members, experienced in conducting groups, and are supervisors of group psychotherapy training for residents. They may be remunerated by their respective hospitals. Leaders prepare by meeting in advance, at the lunch break during Group Day for peer supervision, and after the day, to debrief.
Five to seven groups of approximately 8 to 10 residents each are assembled to ensure a heterogeneous mix of participants regarding year of training, gender, and previous experience, and to separate residents who currently work together. Group leaders are assigned with a view to avoiding any supervisory dyads within the group or other close relationships that may inhibit participants. To facilitate careful group composition, residents are asked to register in advance.
A flyer with a description of the day, noting that it is experiential rather than didactic, is circulated in advance, along with a summary of feedback from participants from the previous year and selected readings (available from the authors).
The structure of the day is the following:
Brief welcome and introduction
Experiential groups (2 hours)
Lunch break (1 hour); facilitators meet for peer supervision
Experiential groups resume (2½ hours)
There is no formal didactic component to the day. Learning is experiential and occurs through the process of actual participation in the group. Participation is required for the entire day.
Group leaders establish the group’s purpose and norms (e.g., confidentiality); maintain a climate of safety; build cohesion; and model respect, openness, and caring (4, 5). Group leaders emphasize an interactional here-and-now focus, moderate the pace of the group, promote interpersonal learning, and capitalize on opportunities to explain group process and facilitator techniques (5). Early in the day, group leaders explicitly address residents’ fear of exposure and vulnerability among colleagues and faculty members (1).
The explicit aim of Group Day is to provide an educational experience, not a therapy experience, although residents may experience the training group as a source of support. A moderate degree of personal disclosure energizes and enriches the experience for trainees; however, group leaders are mindful of the need to keep personal disclosure at a level appropriate to the educational purpose (7). Group leaders focus on horizontal disclosure (e.g., the current experience of sharing and what it is like being in the group), and steer away from vertical disclosure (e.g., family of origin and outside relationships). Group leaders may also facilitate disclosures of shared experiences such as the challenges of professional training, versus highly personal ones. This also facilitates the rapid development of cohesion.
Key features consist of judicious leader transparency and an emphasis on cognitive integration of emotional activation in the group. This is best exemplified by the commitment to describe what the leader is thinking and how he or she determines when to intervene. Ensuring trainee safety is paramount, and group leaders would rather have less emotional activation and disclosure than too much.
Group Day is a formative experience for residents; as such, there is no evaluation of resident “performance.” At the end of the day, residents anonymously complete a three-page evaluation survey of the day (available upon request), which captures the information listed below. Most questions are open-ended and generate qualitative descriptions.
Resident year and current clinical training setting
Prior experience attending Group Day (Yes or No)
Current and prior experience conducting group therapy
Personal and professional expectations for the day
Actual experience of the day
Perceived most and least effective aspects of the day
Perceived relevance of the day to residents’ clinical work
Feedback for specific leaders
Quantitative ratings of satisfaction with the day and perceived effectiveness of the leaders
Whether the learning and “Day” created a safe atmosphere (new item in 2011)
Quantitative data from evaluations were summarized descriptively, and qualitative data were analyzed, using a grounded theory approach by faculty members not involved in leading a group.
A group of 50 to 60 residents attend each year (out of a possible 175). In the three most recent years, evaluations were completed by 149/170 participants (88%). A majority of residents are PGY2s and PGY3s; 46% of the residents report having some experience providing group psychotherapy.
In all, 72% of residents said that they obtained a great deal of what they sought from Group Day; 98% found the group process very useful or moderately useful; 97% found experiencing the patient role very useful or moderately useful; 96% found peer feedback in the group very useful or moderately useful; and 95% found self-disclosure very useful or moderately useful.
Residents typically identified the following expectations for Group Day (in decreasing order of frequency):
Gaining firsthand experience as a group participant
Appreciating the patient’s perspective
Understanding the difficulty of disclosure and doing so safely
Learning about themselves in a safe setting
Learning more about their colleagues and making a connection with them
Learning about group process and facilitation techniques
Improving their skills as group leaders (including therapist self-disclosure and boundaries, eliciting affect, and encouraging feedback and redirecting group members)
The majority of residents’ expectations were met or exceeded. Residents were surprised by the degree of group cohesiveness and personal disclosure, and that the process of connecting and sharing was natural and spontaneous. They reported gaining insights about themselves and feeling empathy for their colleagues. Despite some apprehension, residents rarely reported discomfort with the level of disclosure and emotions evoked by the day. All respondents perceived Group Day to be an emotionally safe learning experience. Residents commented that they found Group Day to be a “surprisingly moving,” “very rewarding,” and “very powerful” experience. They were also surprised at how much they learned through an experiential approach and reported that theoretical concepts became more real.
Residents reported enhanced appreciation of the patient’s experience and the therapeutic nature of groups, increased knowledge of group dynamics and the role of the group leader, and improved facilitation skills. They identified many ways in which Group Day was pertinent to their clinical work, including focusing on the here-and-now, dealing with affect, responding to silences, addressing anxiety about disclosure, establishing safety, titrating the effective degree of intervention by the facilitators, selecting level of inference of interpretations, and working with transference and countertransference.
A small number of residents expressed disappointment that there wasn’t more didactic teaching.
Table 1 summarizes residents’ perceptions of the most and least effective aspects of Group Day (in decreasing order of frequency).
TABLE 1.Residents’ Perceptions of the Most and Least Effective Aspects of Group Day
| Add to My POL
|Most effective aspects of Group Day||Least effective aspects of Group Day|
|Experiential focus||Length of the day|
|Characteristics of other group members (e.g., openness, empathy, and humor)||Limited breaks|
|Group cohesion||Inadequate introduction to the day|
|Establishment of a safe environment||Lack of didactic teaching|
|Effective and transparent facilitation||Inhibition due to group members already being professionally acquainted with one another|
|Diverse group composition|
An evaluation of the Group Day experiential group learning process for psychiatry residents demonstrates that this is an effective educational approach from residents' perspectives. A substantial majority of residents report a high level of satisfaction and positive changes in their knowledge, skills, and attitudes regarding group psychotherapy.
Two other reports in the literature describe similar outcomes, despite significant differences in their formats. Nathan and colleagues conducted interviews with psychology students who participated in a weekly experiential group for 25–30 sessions and who reported a thoroughly positive, relevant, and highly-valued experience (1). In a qualitative study of Master’s-level counseling students participating in a 15-session experiential learning group, Kline and colleagues found that participants developed enhanced self-understanding, openness to interpersonal involvement, awareness of their interpersonal behavior and its effect on others, and understanding of others’ experiences and motives with respect to interpersonal behaviors (8). Similar to these two reports, the authors found that challenges such as establishing clear aims and addressing the impact of group composition are balanced by positive experiences such as gaining appreciation for the patient experience, learning about one’s own behavior in groups, increased openness to authentic involvement, enhanced understanding of others’ interpersonal behaviors, learning the facilitator’s role, understanding group processes, and rendering theoretical knowledge more meaningful (1, 8).
The structure of Group Day may influence the evaluation results. Some residents attend Group Day more than once, and this self-selection may influence the overall results. Also, to encourage attendance, residents are provided with evaluation data from the previous year, and this may bias their expectations.
The authors have several recommendations for faculty members of other residency programs who wish to hold an experiential group training event. It is essential to secure the support of the director of postgraduate training, in the absence of which it would be difficult to mount such an event (4). It is helpful to schedule Group Day on a day of the week when it is customary for residents to be away from clinical duties for formal teaching; this has facilitated an acceptance of Group Day throughout the training program and minimizes any tendency for external or internal pressures to discourage residents from attending. We recommend providing didactic teaching elsewhere within the residency curriculum and not at Group Day, as it has the potential to detract from the here-and-now process of the experiential group. Group leaders must recognize the importance of proper pacing and that the balance will be more weighted toward cognitive integration versus emotional activation as compared with a therapy group. Experiential groups are not without some risk, but careful planning, clarity about objectives, group norms and boundaries, and a commitment to trainee safety appear to provide good safeguards (6, 9). A clear orientation in advance and at the commencement of a training group, attention to group composition, and the use of experienced group leaders are also crucial. Finally, we emphasize the need for regular evaluation to ensure the quality of the training group experience and its ongoing support within psychiatry residency programs.
We gratefully acknowledge feedback by the following faculty members who also conducted the resident groups: Dr. G. Chandler, Dr. M. Fefergrad, Dr. K. Khorasani, Dr. S. Kirsh, Dr. L. Murphy, and Dr. K. Schwartz. We also thank Dr. M. Novak and Dr. D. Robertson for synthesizing the evaluation data.