What does a general group therapy structure look like in a practice? Do you think some of your existing clients would benefit from group therapy? What happens at the end of a client’s time in group therapy?
In this podcast episode, Alison Pidgeon speaks with Lisa Wolcott about Group Therapy in Private Practice.
Meet Lisa Wolcott
Lisa Wolcott is a psychotherapist in private practice, licensed in FL and CA. She has a growing and thriving group practice and provides individual, couple, and group therapy. She’s a certified group therapist, a leader in group work, certified Daring Way™ provider, and weaves in the work of Brené Brown on courage and vulnerability. Lisa believes group work is the most direct pathway to personal growth, and deep, satisfying, authentic relationships of all kinds–all the skills we need for being human. She’s a mom and business owner and lives with her family in Florida.
Email Lisa at: firstname.lastname@example.org
In This Podcast
- Lisa’s group therapy tips
- Logistics of group therapy
- Ending group therapy
Lisa’s group therapy tips
Have lots of conversations about group therapy with your colleagues and clients before offering group.
- This allows people to understand what the dynamics are and how they may relate to the situation
Group is a commitment:
- Let clients know that their presence affects people as well as how their absence affects people.
Lay down the expectations:
- Give the clients a fair warning about what they may experience without frightening them. Provide them with an idea of what they may experience because it can help prepare them for the tough times to know that the tough times are necessary for their treatment.
It’s a lot of preparation and laying the groundwork … and letting [the clients] in on the fact that there will be times where they feel resentful and [encourage] them to bring that into the group. There will be times where they feel triggered and just want to leave the group, but that’s where the most important work happens. (Lisa Wolcott)
Logistics of group therapy
There are different ways of bringing clients into group therapy. You could have:
- A separate filing system dedicated to converting clients into group therapy clients when they first sign-on
- Speak to your already existing clients who you think would be a good fit for your group, and who you think would benefit from being within a group therapy context.
When you are considering adding a member to the group, prepare the already existing group first for a session or two.
Lisa’s group logistics:
- Group therapy runs once a week
- Sessions are 90-minutes long
- The average cost is $50 to $65 on a sliding scale
- Some clients pay cash and some pay with insurance
Ending group therapy
In Lisa’s experience, people spend an average of three to four years in group therapy before feeling ready to step away. Sometimes they have to move away due to life circumstances, such as going to study or getting a job in another town or state.
I don’t see a lot of fall-off in terms of [people saying] “I’m not getting anything out of this group anymore”. I think people can continue to grow in the group as long as they stay in the group, and I love people who stay long-term, but everybody’s different. (Lisa Wolcott)
Some people join groups for assistance with a specific issue. Once they feel that the issue has been resolved or they are more capable of handling it, they will privately come to the therapist and discuss a potential upcoming exit.
Prepare the group beforehand when you know that there is a client with whom they have been working that is leaving soon.
In general I say [to] let the group know as soon as you’re thinking about it so that people can honor and process the work you’ve done and you can have the gift of hearing the impact you’ve had on other people because it’s usually much more significant than they realize and that’s just a wonderful thing. (Lisa Wolcott)
Useful links mentioned in this episode:
- Visit the Wolcott Counseling website
- Connect with them on Facebook, Instagram, Twitter, and LinkedIn
- Email Lisa at: email@example.com
- American Group Psychotherapy Association
Check out these additional resources:
- Shannon Heers on How To Incorporate Group Therapy in Your Practice | GP 90
- Group Practice Launch
- Group Practice Boss: www.practiceofthepractice.com/grouppracticeboss $149 a month
- Email Alison: firstname.lastname@example.org
- PoP Group Practice Owners Facebook Group
- Free resources to help you start, grow, and scale
- Work with us
- Consult With Alison
- Alison Pidgeon on Therapy for Your Money Podcast
- Practice of the Practice Network
Meet Alison Pidgeon, Group Practice Owner
Alison Pidgeon, LPC is the owner of Move Forward Counseling, a group practice in Lancaster, PA and she runs a virtual assistant company, Move Forward Virtual Assistants.
Alison has been working with Practice of the Practice since 2016. She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
Transformation From A Private Practice To Group Practice
In addition, she is a private practice consultant for Practice of the Practice. Allison’s private practice ‘grew up.’ What started out as a solo private practice in early 2015 quickly grew into a group practice and has been expanding ever since.
Thanks For Listening!
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Welcome to the Grow a Group Practice podcast. I’m Alison pigeon, your host. We are doing some podcast recordings, all about group therapy in private practice. We had a previous episode with Shannon Heers, where we talked all about how she does group therapy in her practice and today we are talking to Lisa Wolcott, who is a psychotherapist in private practice located in Florida. She has a group practice. She is familiar with individual group and couples therapy and she’s a mom and a business owner. She has lots of great advice about more of the clinical side of having a group therapy in your private practice, how she you decides who’s appropriate for group and how she runs her groups and all of those things.
So this is a great interview to listen to if you’re considering having group therapy be part of your practice. She also wanted to mention that a great resource is the American Group Psychotherapy Association, which also has a conference every year that she said is really fantastic. If you’re interested in getting more training or just having more support or resources around conducting group therapy, that is a great website to check out. It’s agp.org. We’ll have that in the show notes, but she said it’s a conference she goes to every year and she would highly recommend it. So here is my interview with Lisa Wolcott.
[ALISON] Hi, Lisa, welcome to the podcast.
[LISA WOLCOTT] Hi Alison. Thanks for having me.
[ALISON] I’m really glad that you are joining us today and I’m excited to ask you all about group therapy, but before we get started, can you introduce yourself and your practice?
[LISA] Sure. I’m Lisa Wolcott and I run a group practice with two other clinicians called Wolcott Counseling and Wellness in Gainesville of Florida. We’re doing telehealth right now, but we do in-person. I’m licensed in California and Florida, so I can do telehealth in both states.
[ALISON] Oh, nice. Very cool.
[LISA] We work mostly with individuals and couples and then I do group therapy on top of that.
[ALISON] Okay, very good. And do you take insurance or are you all self-pay or is a mix of both?
[LISA] It’s a mix of both. So I am out-of-network with one insurance and network with another and that’s basically it for me. I think the same is true for one of my independent contractors and then the third one doesn’t take insurance. Okay,
[ALISON] Great. So I wanted to ask you about the groups that you run in your practice, because that’s often a question that we get asked, just logistically how does that work and how do you fill up the groups and all of that thing. It sounds like that’s something you’re passionate about. So maybe you could start out just by telling us how did you get started with doing group therapy in your private practice?
[LISA] Sure. Well I’m a big fan of group therapy. I actually was a client of group therapy in my early twenties and it made a big difference in my life. So when I became a therapist, I had in the back of my mind, I knew I wanted to do that someday. I was nervous to get started at the beginning, and this was probably about a decade, 12 years ago. So I decided to recruit just from my individual clients in the practice where I was at the time and offer an eight-week session of group therapy for people to try it out. Just, I thought it would be more palatable for them and me to just have a time limit on it. So at the end of the eight weeks, I think everybody wanted to keep going. Maybe one person couldn’t. It has been going ever since that was back in, I think that was back in 2010, not the same people, but the same group has been kind of running continuously. I’ve added a couple other groups here and there when I’ve had more clients that weren’t the right fit for that group. So I’ve run two groups at a time at times but right now I’m running the one.
[ALISON] Okay, great. So what was the topic of that first group?
[LISA] It’s not topic-based. It’s called psychodynamic group therapy. So it is really process-oriented, which is focusing on the here and now, helping people express feelings and challenge their own assumptions. One of the things that’s great about group therapy is you have this kind of microcosm of real life starts to develop in the room. So whatever patterns and dynamics people are struggling with in their “real life,” they’re going to bring into the room. Eventually it’s going to start playing out in the room. It’s in place and an opportunity to point that out. It reflects on what’s going on, challenge, assumptions. I just love group therapy for that reason because people get to reflect on, oh, I said, this thing, I saw that expression on that person’s face and then I reacted based on like what I think they reacted to in me. And we can slow things down and say what just happened and really unfold that, and help them have a very different experience and it can be really life-changing for them.
[ALISON] That can be such a powerful experience for people. I had some work experience working in an adult day hospital and one of the groups was more of the processing type group and yes, it’s fascinating to see how it helps people and kind of the aha moments that they have.
[ALISON] So is there any kind of like criteria that you establish to determine, like who would be a good fit for that type of group versus who wouldn’t be a good fit?
[LISA] Yes. When I’m wanting to add people to the group I’m thinking I want to have enough overlap, like in the ven diagram, enough overlap that they have things in common and then the outlying things, I want them to have at least one other person, hopefully. Like if everybody in the group is married and I have one single person and I happen to know that that’s a really sore topic for them or a hurtful thing for them, then I’ll want to have somebody else in the group that they can relate to. Sometimes it doesn’t work out in terms of gender or in terms of ethnicity or in terms of marital status or economic status but we just try to work with that in the room when we can. But I just try to have some overlap for each person to have somebody they can identify with in the group.
I don’t want to have people that I haven’t worked with. I do something a little different than a lot of group owners or group practice practitioners and I pull pretty exclusively from my own clients because that’s just personally what I feel comfortable doing. I want to know a little bit about the background and I want to have kind of an even playing field in terms of people’s access to me and feeling connected to me in the practice. But a lot of people will pull from outside their own practice and have a mixture and that works really well for some people, but for me, I want to know a little bit about them.
So I don’t invite people to group right away. I kind of think of it as, like when you’re thinking about a little kid growing up, first they’re home alone with parent, and then they might go to preschool and be in like a small preschool and then they’re like ready for school. So I think of group that way. They’ve done some individual work, they have kind of a solid base. They’ve got a connection and now they’re ready to kind of go out into the world and practice some of those skills.
[ALISON] That’s a neat way to think about it. So do you accept anybody in your group? Who’s not already an individual client of yours?
[LISA] I haven’t so far. It’s not a hard and fast rule. I just haven’t needed to do that yet. I haven’t needed to go outside the practice yet.
[ALISON] So how many people end up in the group at any one time?
[LISA] The ideal size for me is around eight people. I’ve had groups that are as small as four and as large as I think, 12 or 13, which is a little unwieldy. The smaller size is not ideal because if one person’s sick, then it’s kind of turns into couples counseling, or like a really, really small group or a few people are out. So ideally you have like 6, 7, 8 people. That’s the best size for me.
[ALISON] Nice. So if somebody is thinking about starting group therapy and their private practice, do you have any specific tips for them or just maybe things that you learned along the way that you didn’t realize you started doing it?
[LISA] Yes. I think having a lot of conversations about group before you go into group is really important, so they can kind of anticipate some of the feelings that might come up. I tell folks, you’re going to find that, if my group is on Tuesday night, you’re going to find that Tuesday night becomes a really important night to you. And they’re like, why? I don’t even know these people and I can’t see them outside of group. That’s one of the rules I have in group is no socializing outside of the group. So you don’t exchange phone numbers, you don’t even know each other’s last names. It’s kind of like an AA group. It’s just first name only. People have a lot of wishes, express, like I could I wish I could be your friend outside group. I wish we could, someone’s suffering and I want to be able to bring you food or I want to be able to do something with you.
I know you’re really lonely right now. We could be friends outside groups. There’s a little bit of hostility sometimes toward the group leader. So I just try to kind of lay all that out at the beginning and say, these are some of the things that can be hard about group but there’s a really solid reason for keeping the intensity of the group within the group. And you’ll kind of see it when you experience it and you’ll understand it when you experience it. That’s been the case.
I also talk about group is a commitment and your presence affects people and your absence affects people. So real life happens. Sometimes people are sick or a business trip takes them out of or something like that. Your place in the group is your place in the group. So it’s kind of like a gym membership, or you got tickets to a concert. You don’t get a refund because you weren’t there. It’s your place in the group. You’re taking a seat in the group and that can be hard for people like I have to pay, even if I’m sick and I have to pay, even if I have to go to a wedding. But over time, I think people adjust to that reality and that’s one of the reasons I keep the cost a little bit lower than individual. We can talk about that in a minute, but yes, it’s a lot of preparation, laying the groundwork, having them anticipate or letting them in on the fact that there will be times where they feel resentful and to bring that into the group. There will be times they feel really triggered and just want to leave the group. That’s actually where the most important work happens.
[ALISON] So sounds like a lot of setting expectations from the beginning and getting them prepared for what the experience is going to be like. I like that you brought up about there might be hostility towards you at some point as the group leader, because I remember talking about that in graduate school. We had a class on group therapy and read Irvin’s book and it said at some point in the group the group’s going to kind of turn on you. I was like, I’m very young in my early twenties in graduate school and I’m like, “What? My group’s going to turn on me? What do you mean?”
[LISA] Yes, and it’s actually such a great moment in group, because you realize the deference and the kind of pedestal that they have you on, that’s gone and something real is happening in the room. So it’s like, yes, I agree, it’s very scary to contemplate it. But once you’ve gone through it a couple times, it feels like, yes, it’s really happening. Real work is happening in the room.
[ALISON] Yes, because guess that’s one of the signs that like, they trust you. They trust you to have those potentially difficult feelings to come out and voice whatever they’re not happy with.
[LISA] Yes, yes, yes. nd no one’s going to get angry if they don’t feel safe.
[ALISON] Exactly. Exactly. So probably at this point you’ve done it enough times that you just feel like you can handle it.
[LISA] Yes. It’s always a little, it always feels like you’re on a little bit shaky ground. It’s a lot more comfortable to have everybody be happy and feel good. But that’s, you know not a lot of work is happening in the room when that’s going on. When I’ve had several weeks in a row where it just feels like everyone’s being really nice and supportive, I start to wonder like, okay, what’s really going on? Sometimes it’s really genuine, but sometimes there’s this feeling of like, I can’t bring this up because I’m going to bring everybody else down and there’s some work to do around, like that’s what we’re here for, is it’s not bringing people down. It’s getting real and going with what’s really happening in your life.
[ALISON] Nice. Very cool. So maybe we can switch gears a little bit and just talk about maybe more of the business side of setting up groups and kind of how you see that from just the, I guess the financial piece or the logistical pieces of setting that up, all the prep work that goes into it, what it actually costs to deliver that service, all of those kinds of things.
[LISA] Part of the cost is kind of already, part of the cost of starting a group I feel like for me is already folded into the ongoing workings of the practice, because I am pulling from my individual clients that are already in therapy with me. So I’m not setting up a separate interview schedule. I have done that in the past with another practice and it’s like you set up an interview schedule, you have people come in for like half an hour interviews to tell them about the group, ask them a little bit about their background. I just never really liked that model. I didn’t feel like I had time for it or had got enough information that helped me make a good decision about whether or not someone was appropriate for groups. But that is the way a lot of people do it.
So I just wanted to mention that that is an extra time and money consideration. For me, I spend part of the time when I’m working with a client and I start to think, oh, this would be a really good client for group. I’ll just introduce the concept of group and we’ll talk about it here and there, maybe over a few weeks or a few months and then I’ll say, I think I have an opening group and I think you’re a great fit and let’s talk about it. And we spend part of our individual session on that. I run group for once a week. It’s once a week. It’s ongoing. There’s no, except for when I first started, there was no start date or end date. And I usually talk with someone about group. I have an idea of when the day I want them to start.
I usually want them to start with somebody else or not the only outlying new person. So I usually have two or three people start at a time and I’ll get them ready for group maybe a month or so before my group is actually ready for them so that group, my group can process the fears and anxieties and fantasies about having a new person start the group. Then we have the first day where they enter group. A group runs for 90 minutes once a week. Right now I’m doing my groups on Thursday nights and like I said, I’ve had back to back groups before, so I’ll do a 90-minute group, 15 minute break, another 90-minute group. That’s a little exhausting.
I could do that more when I was a little bit younger but I’m just kind of arranging my schedule so I have less time in the morning where I’m doing individual. I charge kind of an average of $50 to $65 for groups. So I let people know that that’s a sliding scale and I kind of let them pick and choose where they want to be on that scale. I’m going to be raising my rates at the beginning of the year by about $10 and I’ve let people know that a couple months ago, And I do have some people that pay full fee and some people that use insurance.
[ALISON] Okay. And how has the billing insurance for groups gone for you? Is that pretty smooth or?
[LISA] It’s really smooth. It’s sort of the last thing of my week, Thursday nights. I don’t see clients on Fridays. So Thursday night after group, I finish up my billing. I use Simple Practice and I just go in and hit the credit card for each of them. That’s part of the preparation too, as we talk about how I do billing. And they usually already know because they’ve been an individual client of mine.
[ALISON] Okay. Got it. So for you, it sounds like really the motivation for running a group was, obviously you’re very passionate about it and you find it to be really valuable. But is there another advantage in terms of like, is it more profitable for that hour and a half for you in terms of seeing an individual client or?
[LISA] Oh yes, because you’re seeing, if you have 11 people and they’re all paying $60, that’s obviously going to be more money than seeing one client for an hour and a half. So it definitely is more profitable. Just depends on how many people are in your group. So it’s not a huge profit driver for me. For me, it’s really, it’s such a personal gratification for me when I work with people. There’s a lot we can do in individual therapy. I love doing individual therapy and I love doing couples work. It’s a lot you can do but I work with a lot of people with relational issues, with bad relationship history, current bad relationship, past bad relationship, family of origin stuff.
And there’s so many false beliefs, negative narratives they have about themselves. And seeing those things get untangled and replaced with new narratives in group and seeing it happen a lot faster. That’s one of the reasons I like doing group too, is I feel like it’s a therapy accelerator. It really makes things happen more quickly because it’s happening in real life. You’re having these relationship changes happen in the room at the moment that you’re doing it.
[ALISON] So I know you mentioned before about the group is kind of open ended in terms of people can kind of come in and go out and there’s no a start and end date, but how long do people typically tend to stay in group? And what is that process like when, do they realize they’re ready to be done or do you talk to them about, “Hey, it seems like you’re ready to be done,” or what does that look like?
[LISA] They realize it and/or life circumstances take them away. So I work in a college town, so there’s a lot of graduate students that do group, a lot of young professionals and there is a fair amount of transient in the group or in the town because of that. So a lot of times it’s someone’s moving away for graduate school or for a job. But I would say the average time is about three years. So people spend about three, four years in groups. Some people much longer. I had one person in group for seven or eight years and her reason for leaving was she had a baby and actually thought seriously about like, she even came to one group with her infant, but it was right at the beginning of COVID. And I think the combination of COVID and having an infant was the end for her.
The constellation of the group, the people in the group become really important to each other. So she left maternity leave, was thinking about coming back, but new people had entered the group. Some of her favorite people had moved on because of jobs and it just wasn’t the same group. So that can happen too. I think people mostly I don’t really see a lot of fall off in terms of like, I’m not getting anything out of this group anymore. I think people can continue to grow in group as long as they stay in group. And I love people who stay long term, but everybody’s different. Some people have like I’m in therapy because I have this belief or I have this issue with relationships. And once they get into a really good relationship and they’re feeling really different about themselves or they’ve achieved some other life goal, they feel like, okay, I’ve done what I came here to do. And that’s great.
[LISA] Then they kind of just discuss with you, like, “Hey, I think I’m ready to be done.”
[LISA] Oh yes. I meant to say this earlier, one of the preparations for group is you come in and you’re expected to be there. You’re really important to group. Of course life happens, but I don’t want you to join group unless you think you can really be there almost all the time, if not all the time. And then if you’re thinking about leaving group give warning, so people can process and say goodbye and say a real goodbye. It doesn’t always happen. There are some people that ghost the group and that’s terrible. The group will talk about it for years afterwards.
There’s still somebody who left back in, I think 2015 that a couple people in group are still like, “Wow, remember that person? I wonder what happened to her.” It really resonates for a long time when someone does that. So in general I say let the group know as soon as you are thinking about it so that we can really process and honor the work you’ve done and you can have the gift of like hearing the impact you’ve had on other people, because it’s usually much more significant than they realize. And that’s just a wonderful thing.
[ALISON] Cool. Have you done any groups besides the processing groups, any other topics?
[LISA] Well, I’m an LCSW, so I started off in foster care and inpatient psych, and then I moved into medical social work, and I was a social worker for years at Stanford and then here in Florida’s hospital. So I ran caregiver support groups, I ran kind of informational medication groups, not medication, information about medical processes, about the transplant process groups. I ran discharge planning groups and inpatient psych and I participated like as an adjunct co-therapist in several other groups that the inpatient psych rehabilitation therapy, art therapy, things like that. I would join in with those. So yes, I’ve done a lot of different groups. In my private practice has been process groups but we are thinking seriously about starting a group for new moms, also a process group, but just for moms that have just given birth to about 18 months, that adjustment period. We’re thinking of starting a group, just so people have some place to talk about what they’re going through in isolated time.
[ALISON] Absolutely. I think that’s great because that’s actually a population that we see a lot of in my practice and yes, that can be such a tough time. I think obviously the pandemic has put a whole nother layer of isolation and maybe not getting as much support as you need with a baby.
[LISA] Yes. The pandemic has been quite an interesting experience with group. We initially went online and everybody loved it at first because they were like, “Oh my gosh, I can see everyone’s face at the same time. It’s like looking at the Brady bunch screen.” That was really cool but then after a few weeks, people didn’t like it, because they were missing so much body language and just presence in the room. So we met outdoors for about nine months in a church playground and it worked for those nine months because things were pretty shut down. There wasn’t a lot of traffic, there was a lot of noise, but that’s changed now. It’s a lot more noisy and it got really dark and that got old last winter. So we went back online and we’ve stayed online. I had Christmas lights up and lanterns and it was baskets of blankets just to make it possible to meet outdoors.
[ALISON] Oh, wow. Wow. Yes, that’s a good example of getting creative with all the changes we’ve had to deal with the past year and a half. Anything else about groups that we didn’t cover that you think would be important for other practice owners to know?
[LISA] No. I just think it’s like such a great addition to doing individual therapy or couple’s work. It’s just a lot more social and a lot more fun. And I think it really feeds the spirit of therapists too, to be with a group of people. It’s kind of an unusual experience when you are doing a solo practice or even in a group where everybody’s doing their own thing. I think it can be a really fun addition.
[ALISON] Awesome. So if folks are interested in learning more about your practice, or if they have a question for you, how can they reach you?
[LISA] They can reach me through social media or through my website or my email. My email is email@example.com. My website is wolcottcounseling.com. Oh, and I have a therapy dog in the office and that’s a fun thing to have for the group and for individuals. So he has his own Instagram, his name is Rocky, The Therapy Dog. Then my Instagram is Wolcott Counseling.
[ALISON] Oh, nice. So does Rocky come to group?
[LISA] He does.
[ALISON] Oh, nice.
[LISA] And it’s really fun when there’s someone missing from the group. He’ll sit in their chair and hold their seat.
[ALISON] What kind of dog is he?
[LISA] He’s a little mixture of, we think a menpan and corgi.
[ALISON] Oh, okay. Cute. All right. Well, thank you so much, Lisa, for talking with us today. It was really helpful to hear about how you run your groups and your practice. Yes, it was great talking with you.
[LISA] Yes, it was great talking to you too, Alison. Thank you.
[ALISON] I hope you enjoyed that interview. If you’re wanting to connect with other group practice owners who are at the same level you are, and you want more support, you want consultants to ask questions, consider joining our Group Practice Boss membership community, which is run by Whitney Owens and I. You can find more information at practiceofthepractice.com/grouppracticeboss.
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This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. This is given with the understanding that neither the host, Practice of the Practice, or the guests are providing legal, mental health, or other professional information. If you need a professional, you should find one.