Co-therapy can be a wonderful way to share the challenge and excitement of group leadership.

Since beginning my career as a group leader, more than half of my group therapy experience has been partnered – a total of twenty male and female co-leaders, with whom I have had 4 very long co-therapy relationships (6-19 years), 8 substantial partnerships (1-3 years), and 8 very brief co-therapy experiences (leading training groups and workshops).

All but one of these have been wonderful, rewarding experiences that I would happily repeat. And even that one was not without its bright side – co-leading a couples group that continued without any attrition for the one-year term of the group (we persevered and so did all four couples!). Although I nearly “divorced” my clinical partner after our first group session, which painfully highlighted serious clinical limitations that would ultimately propel him into a more suitable profession, I learned a lot about tact and enough about self-restraint to keep me out of jail.

I also learned from my experience with him how essential it is for co-leaders, even if they like each other personally (we had had a few friendly chats over lunch), to find out more about one another’s clinical work. In particular, it is important to have a good understanding of differences and similarities in terms of clinical styles and orientations, as well as strengths and weaknesses (including affect tolerance, need for control, transparency, and activity level). This kind of careful consideration is in sharp contrast to the “arranged marriages” that often occur in training clinics where co-therapists too often are thrown together without the opportunity to discuss any of these issues.

Advantages of Co-therapy:

For me personally, the pull for co-therapy is simple – anything that is pleasurable is more so if shared.

An advantage for many leaders is the opportunity to actually get a group going. Two therapists together may have greater opportunities (double the referral base) for gathering the critical mass needed to begin a group and keep it alive.

Co-therapy also provides support, in many ways, for the group leaders. Coverage is facilitated for therapist vacations and illness, and responsibility can be shared for notes, billing, and follow up calls. The presence of a respected colleague also maximizes the opportunity to discuss clinical interventions and how they may be most usefully worded. Having a supportive partner in the room can be especially useful when transference (and/or countertransference) is unusually hot, or when a leader is under siege by a particularly difficult member or by the group as a whole.

Along with this, the learning opportunity for co-therapists is a benefit that cannot be overestimated. The growth that comes from watching and being watched, giving and receiving ongoing feedback, and having another way of thinking about what is transpiring in the group.

For patients there are also many advantages, including the opportunity to watch an effective pair working together, to have two skilled sets of eyes and ears tracking the group process, and to have greater continuity and predictability by maximizing coverage for vacations and illness.

Disadvantages of Co-therapy

Key among the disadvantages is reduced financial compensation, since fees for group therapy are generally the same whether led by one or two leaders. In addition, the time commitment is greater to allow an opportunity for co-leaders to confer with one another before and after each group.

There may also be personal/emotional costs, such as a greater sense of vulnerability because of the increased exposure of being watched by a colleague. Competitive feelings are also inevitable (the possibility of feeling diminished, or concerns about who looks kinder, smarter, more effective, more giving) as the leaders deal with their real differences, as well as ways that they are differentially perceived by group members. In these ways and others, co-therapy may rekindle old dyadic issues for the leaders, both from their families of origin and from adult partnerships and marriages.

Clearly, the costs of co-therapy need to be carefully weighed against the benefits of two minds sharing the challenges of the group therapy adventure.

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This article is adapted from: Vannicelli, M. Co-Therapy: Two Be or Not Two Be. Newsletter of the Northeastern Society for Group Psychotherapy, Spring 2006.