Group therapy works when group members open up, give each other feedback, and become devoted to helping one another to heal and to grow. The best way I have found to promote these conditions is to add heat, so I built a “sweat therapy” sauna as a prototype for mental health and substance abuse treatment settings. I’m not suggesting my treatment is new: sweat rituals including the Finnish sauna, American Indian sweat lodge, Russian banya, Islamic hammam, and Korean jimjilbang are among the oldest forms of group therapy, dating back thousands of years. What I’m suggesting is that the oldest is still the best.
The dimensions of my “sweat therapy sauna” are 10 feet by 10 feet by 7 feet, and it can accommodate 12 people. Like a common sauna, it was built with conventional wood-framed construction with insulation between vertical studs. The interior is lined with cedar walls and benches. The seating is circular and the stove sits in the center to promote group cohesion. It is windowless to promote intimacy and introspection, and it has a stereo system to make use of the therapeutic benefits of music.
Every Thursday evening, group members arrive at about six o’clock and strip down to bathing suits. Most are struggling with psychosocial and substance abuse problems. I pull open the large heavy cedar door, and the participants enter the intense 180-degree-Fahrenheit heat permeated with the smell of cedar and sage. They take their seats around the circle and lean against the back of the sauna as the heat begins to do its work on tense muscles. I throw a ladle of water on the rocks, creating a blast of steam to begin the session.
I usually set up sweat therapy sessions to include three 15-minute rounds in the sauna with 5-minute breaks in between. The first round is devoted to describing the problems and status of progress. The second round is usually silent to give the participants and me space to fully appreciate the issues at hand. This silent round can be nondirected: “I am going to ask that the next round be a silent one. Feel free to meditate, pray, or think about whatever you wish.” Or it can be directed: “During the silent round, I would like you to try to identify three goals that you think you should focus on for the next week.” The third round serves as time to process whatever introspection occurred. Finally, the session concludes with 15-minute recuperation. Drinking water is always available during the sessions and participants are encouraged to stay hydrated.
While sweat therapy helps with many medical and psychological problems, research suggests that the prime candidates include depression and anxiety disorders, PTSD, substance abuse, conduct problems, chronic pain, and eating disorders. My own doctoral research in counseling psychology studied the use of the sweat lodge ceremony as group therapy for Navajo youth with disruptive behavior disorders. This led to two randomly assigned/controlled studies with university students comparing group counseling in saunas to group counseling in a standard office setting. Our research found that sweat therapy groups had better group cohesion and interpersonal learning, as well as fewer dropouts than groups in a standard office setting.
Sweat rituals also provide stress relief and cardiovascular exercise. Physiologically, a sweat ritual is similar to moderate-intensity aerobic exercise activities, with two important exceptions: There is no muscle tension and no adrenaline surge. The sweating experience causes a state of deep muscle relaxation and meditative attentiveness.
Intense heat exposure can be therapeutic, but it can be deadly. Like a powerful drug, the way it is used makes the difference. The context, preparation, temperature, rest periods, and recuperation time are all important. That does not mean that there is just one way or even “a best way” to do it. In my book Sweat Therapy: A Guide to Greater Well-Being, I encourage people to explore culturally specific sweat practices that are consistent with their own background. You can intensify your own personal sweat practice by adding meditation, music, smudging/incense, yoga, or bringing a friend or two with you.