I moved to the Washington area a few years ago and went about the process of setting up a practice. I asked several colleagues how various things were done in this area, as different parts of the country prefer different techniques and services.

A well-rounded practice, as I had grown to believe, offered many types of services -- individual psychotherapy, couples psychotherapy, services aimed at one population or another, and group counseling and therapy.

Much to my surprise, however, everyone told me that: "Washington isn't really a group town."

Most of the places I have worked in the past offered many types of groups with great popularity. So I questioned further. Responses were again generally the same: "I've tried to run groups, but they just don't seem to go."

As the newcomer, I was determined to be different -- the successful one, the one who was able to run a large and successful program of group counseling.

Three years later, I am here to report that while my individual therapy practice is alive and well, I failed to develop an active group component.

Why isn't Washington a "group town"?

One apparent roadblock is the myth that group therapy is inferior to individual therapy, or that it is primarily for use in the "transition stage" after individual assistance and before finishing.

This philosophy seems to be held by practitioners and in my view seriously minimizes the potential value of the group therapy.

I think it is important to separate the notions of group counseling and group therapy. Group counseling, to me, focuses mainly on the present concerns and abilities of the group participants. Group therapy, on the other hand, provides an opportunity to explore personal issues, feelings and thoughts through the unique insights of other people.

While groups may have the disadvantage of direct time lost to an individual (therapy time must be shared), groups have the advantage over individual work in that they offer an opportunity for learning and practicing social skills, allow for feedback on styles of interacting, provide the chance to give to someone else, establish a forum for gathering insight into alternative perspectives, and create a vehicle for support and closeness. Groups often don't "go" because therapists underestimate or underconceptualize the power of groups.

Another reason groups don't "go" is that potential members give in to their fear about being in a group and a therapist accepts this fear without challenge.

I have hardly ever met a person who was not afraid to go into group therapy or counseling. Who wouldn't be? The thought of facing as many as 10 strangers and sharing one's vulnerabilities is frightening. Being scared is appropriate, but this fear should not be used to avoid a potential powerful source of help. In my experience, the act of dealing with this fear and entering a group despite it is an important therapeutic experience.

The efficacy of group counseling and therapy can be and is continually debated (however, not often in front of potential consumers). Differences in philosophy will always exist. This is frustrating to a group advocate such as myself, but reality.

My biggest concern is that the reason that Washington is not a "group town" is business and administrative reasons.

Among the biggest problems in offering any type of group is that there is an inherent administrative problem: You have to be able to gather anywhere from six to 10 individuals who are willing and able to meet at the same place at the same time and who are therapeutically appropriate to be interacting with each other.

An individual practitioner who may see 20 to 40 individuals in a given week rarely has this many people who are compatible and willing to be in a group.

In order to be able to offer a group, the practitioner may have to establish a "waiting list" and begin the group when enough people are on the list (a problem, because inevitably when the last one is ready, the first one no longer is).

The second alternative is to contact colleagues and see if they have anyone who might be interested. This presents a major business problem because the referring therapist then usually loses the client. The competition for clients in Washington is generally rigorous enough to make this a major consideration for many practitioners.

Washington, it seems, isn't going to be a "group town" until two changes occur: Consumers become more educated on the value of group counseling and group therapy and begin to ask for this service. Practitioners become willing to risk sharing their patients with a colleague's group and trust that a colleague will return the favor. In order for this to become a reality, it would be helpful for practitioners to have a central coordinating point where they could find out about group offerings. This might be most effectively accomplished by a group of practitioners interested in groups.

The biggest stumbling block, however, is our own insecurity, inherent to the job, of never being really confident that the flow of clients will continue.

Perhaps the reality of mental health as a business will preclude group counseling and group therapy from ever becoming widely offered services. However, until we can creatively overcome this obstacle, a very valuable vehicle for growth will be missing from the Washington mental health scene.