eNewsletter - June 2017

Behavioral Health Partners


Avoiding the Downside of Focusing on Content over Process in Group Therapy
M. Joann Wright, Ph.D.

One of the challenges behavioral health clinicians face is getting stuck in content instead of working with process.  Process is an essential component of the widely utilized psychotherapy intervention, Acceptance and Commitment Therapy (ACT).

Although this notion certainly applies to individual work, it is even more critical in group therapy as individuals in a group setting often tend to tell the story of what they are grappling with without a clear focus on the outcome of doing so. If you have, for example, 12 people in the room and everyone is doing that, it is easy to find yourself at the end of your group without much therapeutic drive.

When approaching your group members from the content (form) level, you are problem solving, or following the individual stories of your group members. This is opposed to what we suggest in ACT; approaching your sessions by focusing in on process or function of what is being said.  

Minds are used to attending to content, so it’s easy to be pulled into it. Think about how often a group member hooks you into talking about the details of a problematic event, and your response is to fix it, validate it, or follow the story further. 

For example, if a client says “I’m useless,” it’s easy to join the content of those words, and spend time deliberating, disputing, or saving the person from having such a thought. Instead, we want to discover how that thought influences the person’s behavior; the function. Let’s look at the difference below.


  • Group Member: “I had another bad blind date. There’s no one out there for me.”
  • Therapist: “Rats!  I’m sure you’ll find someone. What went wrong?”

In an effort to help the person feel authenticated and optimistic, the therapist chased down the content. This can create more fusion and stuckness as result. By asking “what went wrong?” the therapist is inviting the group member to swim in the content of her story longer. Instead, by choosing to explore the function of her words, the therapist can hypothesize that her comment suggested an attachment to her conceptualized self, a fusion to rules about what dates should be (i.e., what made this date “bad” for her would be a product of her perceived rules about dating), and offer ways to defuse from her conceptualized self (self-as-content) and make room to contact the observer self (self-as-context):


  •  Group Member: “I had another bad blind date. There’s no one out there for me.” 
  • Therapist: “So, you’re having the thought that there is no one out there for you?”

    Here, the therapist is eliciting defusion (“you’re having the thought…”) and contact with the observer self (looking at the thought instead of from it). She is focusing on the function of the thought; that the group member perceives the date as “bad” through her fusion with the rules of dating, as that she will not be able to find someone suitable. 

    This allows the group member to become disconnected (defused) from her thought and move through it. This also arms the group member with a way to build a new relationship with her thoughts that is more flexible and useful, as opposed to simply following the story and problem-solving. 

Choosing function over form can really add power to your work.


M. Joann Wright, Ph.D.

Dr. Wright is currently the Director of Clinical Training and Anxiety Services at Linden Oaks Behavioral Health, where she trains over 20 doctoral students annually.

At Linden Oaks, she established and continually develops the Anxiety Program including services for adults and adolescents, as well as individuals with Asperger’s.  She specializes in several treatment areas including Dialectical Behavior Therapy, Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy. 

Dr Wright is also a frequent lecturer, writer and public speaker on the subject of anxiety treatment.  Most recently, she authored a book about Learning ACT for Group Treatment.