Group Therapy: Types, How It Works, & What to Expect

CHOOSING THERAPY

Group therapy is an affordable and effective form of treatment in which a small group of participants and one or more facilitators meet to interact and discuss a variety of different topics. Groups generally consist of five to 15 participants and meet on a consistent schedule.Topics and style vary widely by need, and are available in person and online.

Core Concepts of Group Therapy

Group therapy is different than other therapy options as it relies on the power of competent and structured leadership in combination with group cohesion. When everyone is working together, the support provided is more significant than anything accomplished alone or by just two people.

There are twelve therapeutic factors upon which group therapy is built:10

• Altruism

• Catharsis

• Cohesiveness

• Corrective recapitulation of the primary family experience

• Development of socializing techniques

• Existential factors

• Imitative behavior

• Imparting information

• Installation of hope

• Interpersonal learning

• Self-understanding

• Universality

In combination, these characteristics are what make group therapy unique.

Types of Group Therapy

Given the wide diversity of group topics and participant needs, there are numerous types of group therapy, but psychotherapy and self-help groups are two of the most common. While some are more conversational, others are more informational or task-oriented. Some are open (meaning anyone may attend at any time), while others are closed.

It is important to note that this type of therapy is not recommended for those experiencing a crisis. For example, someone who is attempting suicide or in need of medical detox should seek emergency services, not attend a group therapy session.

Psychotherapy Groups

Psychotherapy groups are led by a trained mental health professional and include two or more participants. The focus of such groups is to understand and identify life problems as well as the thoughts, emotions, and behaviors that contribute toward them.

Group members process their problems and work to develop healthy coping and problem-solving skills with an intended outcome of regaining control and improving overall well-being. Psychotherapy groups are generally offered at hospitals, residential and outpatient treatment centers, group recovery environments, and community mental and behavioral health clinics.

Self-Help Groups

Self-help groups are self-governing and are run by member volunteers who have demonstrated maintained recovery. Such groups are built upon the concept of reciprocal healing, meaning that the members share a common problem and exchange social support. Twelve Step groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Dual Recovery Anonymous (DRA), and so on, are some of the more common self-help groups.

Process Groups

Process groups focus on processing an experience, emotion, problem, et cetera. Rather than look at things superficially, process groups dig deeper into understanding the why, who, what, when, where, and how. Though there is not always an answer to everything, working it through provides further insight, which leads toward acceptance. Being in the group setting, this also affords the benefit of multiple perspectives.

Task Groups

Task groups focus on successfully achieving a meaningful goal of a client, group, or entire community. For instance, a group of mental health professionals may come together to devise an awareness or prevention campaign, such as with topics of suicide or substance use. These groups require the appropriate personnel, identification of an issue, adequate planning, thoughtful delivery, and evaluation of outcomes.

The Benefits of Group Therapy

As with most things, there is power in numbers, and group therapy is no exception. With more people to provide support and hold one another accountable, the likelihood of successful outcomes increases. Those reluctant to attend group therapy, particularly if they are more introverted or socially anxious, oftentimes find that group participation even leads toward improved social skills and interest.

Some of the more common benefits of group therapy are:

• Groups can act as a support network and a sounding board.

• Other members of the group often help you come up with specific ideas for improving a difficult situation or life challenge, and hold you accountable along the way.

• Regularly talking and listening to others also helps you put your own problems into perspective.

• It can be a relief to hear others discuss what they’re going through, and realize you’re not alone.

• By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns.

Being heard is extremely therapeutic in that it removes the pent-up emotions that, if left unacknowledged, may lead toward one or a combination of physical and mental health conditions.

What Can Group Therapy Help With?

Group therapy may be utilized by people dealing with any variety of issues. While substance use is a common topic of group therapy, it is also useful for those dealing with grief and loss, trauma, divorce, low self-concept, interpersonal skills issues, major life transitions, and diagnosable mental health disorders. These include (but are not limited to) eating, major depressive, anxiety, bipolar, and personality disorders.

Unfortunately, for many individuals struggling with a particular issue or diagnosable mental health or substance use issue, close people in one’s life cannot directly relate and oftentimes struggle to provide adequate support. By participating in a group, members begin to feel normalized in a community of people who “get it.”

Group members also possess unique insights into things that may or may not have worked in the past. Sharing this information helps better inform members of potential strategies that may prove most suitable for themselves.

Common Group Therapy Activities

Depending on the age and needs of the group as well as the creativity of the facilitator(s), group therapy activities may range from something more interconnected to something more introspective.

More interconnected activities may include cooking, cultural exploration, and music. Cooking creates a fun bonding experience. Cultural exploration allows for a discussion of diversity—members may learn more about varied perspective and experience. Music, whether played or listened to, affords an opportunity to discuss how music resonates with one’s life and may serve as a coping strategy.

More introspective activities may include journaling, meditation, or creating something artistic. Upon connecting with oneself on this personal level, group members may reflect upon the experience together. Though the activity was done solo, many group members find connections among what they did, how they did it, and why it was done.

Group Therapy Examples

The focus of group therapy may vary by type. For instance, psychoeducational groups educate members on a particular topic—providing useful information, coping skills, and other helpful resources. Process groups focus on processing an experience, emotion, and so on. Task groups focus on successfully achieving a meaningful goal of a client group or entire community.

Family Therapy

Just how families vary widely, so does family therapy. Rather than solely focusing on how the family members act individually, it further explores the family unit as an entity in and of itself. Doing this demonstrates how each member must equally participate for the family unit, and ultimately the individuals, to attain better wellbeing. Common topics include, but are not limited to, boundary setting, loss of a family member, parental development, interpersonal communication, addictions, goal-setting, et cetera.

Divorce Groups

For many, divorce is a traumatizing experience, while for all, it is a period of significant life change. A person going through a divorce may have lost a significant number of people that they relied on for support. Accordingly, the group setting provides a platform for members to speak their truths while having the camaraderie of others who have also gone or are currently going through divorce.

Substance Abuse

Addiction groups are especially powerful at holding others accountable—breaking down barriers of denial while acknowledging and amending past wrong-doings. This is significant, as acknowledging the problem and taking accountability are two of the most challenging steps toward recovery. Doing this, then, helps clear the pathway toward the successful rebuilding of one’s life.

Family Member with Mental Illness

These groups provide support for those who are struggling with a family member with mental illness. The stress and heart-break of such an experience leaves many individuals feeling unheard, unloved, and disregarded. Sharing one’s experience and receiving support, in return, helps alleviate these feelings among many others.

Cost of Group Therapy

Group therapy is generally less expensive than individual psychotherapy. A primary reason for this is because it essentially splits the cost of the professional’s time across multiple members. Further, many providers offer sliding scale and pro bono services for those demonstrating financial need.

Reimbursement rates from managed care organizations such as insurance companies, Medicaid, and Medicare are also lower than individual psychotherapy, which reduces cost. Many plans will cover group therapy so long as the group is evidence-based, run by a professional, and is medically necessary.

It is commonplace for many self-help groups to provide free services. Many of these groups are run by government or grant funding as well as donations and voluntary contributions by members. Because facilitation is generally done by a volunteer member, there is no cost for a trained professional. As such, the cost makes it an especially appealing form of treatment.

How to Find Group Therapy Near You

Many organizations offering group therapy have websites available online. Conducting a web search along the lines of “group therapy” following the specific topic and preferred location is a great place to start. From there, it is recommended to contact the organization or facilitator directly to ask any questions and assess if it’s the right fit for you.

Who Is Able to Offer Group Therapy

Professionally led group therapy must be conducted by a licensed or certified mental and/or behavioral health professional or supervised clinical intern. This may include, but is not limited to, psychiatrists, psychologists, social workers, professional counselors, and substance abuse counselors. Many professionals also have other specialized certifications, such as marriage and family, equine-assisted, music, substance abuse, yoga, social justice, et cetera.

Key Questions to Ask When Considering Group Therapy

Without careful consideration, the risk for dropping out of group therapy increases, which may ultimately lead toward disinterest in groups all together. It’s important to ask questions regarding specific topics covered, group demographic, cost, and more to determine whether the group is right for you.

Considering your individual needs, some questions to ask are as follows:

• Is the group topic specific to what I am experiencing?

• Do I prefer attending an open or closed group?

• Is the group demographic make-up one in which I feel comfortable (e.g., age, gender)?

• Is the location one to which I have reliable transportation?

• Will the group schedule work with my schedule so that I may attend consistently and on time?

• Is the cost affordable? Do I have sufficient out of pocket funds and/or coverage through my managed care plan?

What to Expect at Your First Group Therapy Session

During someone’s first group therapy session, the facilitator generally acclimates new members to the group process and rules. At this stage, many members are reluctant to share their experiences and emotions as a result of not knowing what is expected, how others will relate to them, and trust issues.

Icebreaker activities are commonly used when groups first meet or are introducing a new member. These activities help members get to know one another by perhaps sharing their name, a personal experience, something motivating, something fun, et cetera.

Here it is also common for members to test boundaries with one another. The good news is that constructive confrontation and vocalization of issues early on leads towards more constructive work in the later stages of therapy. If one member has an issue with another member, it is important to resolve the issue immediately so it does not become a much larger issue in the future.

Perhaps the most rewarding part of what to expect is leaving the group meeting with additional support. Again, the immense value of having this support cannot be underestimated.

Is Group Therapy Effective?

The American Psychological Association concluded that about 75% of people who enter psychotherapy demonstrate at least minimal improvement.6 The National Alliance on Mental Illness (NAMI), National Institute of Health (NIH), National Institute on Drug Abuse (NIDA), Mayo Clinic, Centers for Disease Control (CDC), and Substance Abuse and Mental Health Services (SAMHSA)—among others—have also concluded that group therapy has proven benefits as compared to not participating in treatment.

An article comprised of statements from leading researchers and theorists published by the American Psychological Association had the following to say about group therapy:

• Group therapy appears to be gaining popularity for two reasons: More clients are seeking it out as a more affordable alternative to one-on-one psychotherapy, and more research is demonstrating its effectiveness, say psychologists who practice it.

• For many conditions, group therapy works as well as individual therapy. More than 50 clinical trials have compared patients who were randomly assigned to individual or group treatment, and all of those studies showed that the two formats produced the same level of improvement for many disorders.

• Group therapy exceeds Society of Clinical Psychology standards for efficacy for major depressive disorder, bipolar disorder, panic disorder, post-traumatic stress disorder, social phobia, obsessive-compulsive disorder, bulimia nervosa, binge-eating disorder, substance use disorder, schizophrenia, borderline personality disorder and general personality disorder.

• Research is finding that the most effective groups have a common identity and a sense of shared purpose, according to a meta-analysis of 40 studies.

• When it comes to a group format, new research shows two leaders are better than one. Members of co-led groups experience greater benefits than those of individually led groups. That second set of eyes and ears makes a big difference when group leaders are trying to follow multiple interactions.

• Research is also shedding light on exactly how groups help people heal. One important factor is the ability to interact with peers.

• Numerous studies have found that peer interactions tap into many therapeutic factors.

• Hearing from peers may be more helpful than receiving guidance from a therapist since peers can identify with one another. Those peer interactions appear to translate to real-world gains. A meta-analysis of five studies found that sexual abuse survivors improved markedly after participating in group therapy.

• Group therapy also offers advantages for the psychologist: The approach allows therapists to observe relational patterns. Rather than rely on the accuracy (or inaccuracy) of self-reports, patients reveal their problems through interactions with other members.

Risks of Group Therapy

Although there are many benefits to group therapy, there are also risks. One such risk is that of member drop-out.8 If members are inconsistent with attendance or unwilling to fully participate, treatment outcomes will be compromised. Individual factors for risk include negative leadership, group process, or patient characteristics.9 With addictions groups there is also the potential of individuals selling drugs to other members.

Downsides of Group Therapy

Especially when groups are not led by a licensed or certified professional or supervised intern, there is potential for the leader to be ill-equipped. Individuals who have a fear of public speaking may find the group setting uncomfortable. Those who struggle interpersonally may find themselves in continued conflict with other group members.

Another consideration is that of confidentiality. While it is one thing to keep sessions between a therapist and client confidential, it is much more challenging when additional group members are involved.

Group Therapy vs Individual Psychotherapy

Individual psychotherapy is generally where an individual is assessed for diagnosis, collaborates on an individualized treatment plan, and works with a mental health professional toward selected individual goals. Sessions focus on processing thoughts, emotions, and behaviors (past and present as appropriate) while participating in various “homework assignments” whereby the client works toward healthy coping and problem-solving skills.

It is relatively common for mental health professionals to recommend that clients participate in both individual psychotherapy and group therapy.1,3 In this case, individual psychotherapy meets the individual needs of the client while group therapy provides additional support. If the mental health provider and group facilitator are on the same page, then much of what is said in one setting will be reinforced in the other.

Mandated Group Therapy

Mandated group therapy is intended to remediate a condition that may prove detrimental to the well-being and safety of that individual and/or others. Common issues for court mandated group therapy include the following:

• The person has been convicted of a sex crime. Some states’ sex offender registries require participation in sex offender treatment.

• The person has lost custody of their child because of abuse, neglect, or addiction.

• The person is involved in a child custody dispute, and the court thinks one or both parents need either a psychiatric evaluation or mental health treatment.

• The person has a mental health condition or addiction and the court offers treatment as an alternative to jail or prison time.

• The person is incarcerated, and the parole board offers treatment as a condition of early release.

• The person is a threat to themselves or others. A person with intense suicidal ideation may be ordered to get a psychiatric evaluation or be held in a mental health facility for a set period of time. People with homicidal or violent thoughts may also undergo coerced treatment.

• The focus of the type of group therapy assigned is specific to the presenting issue. Accordingly, treatment may focus on addiction recovery, anger management, parenting, skills-building, trauma processing, and so on.

The History of Group Therapy

The history of group therapy began in Boston, MA in 1906, when Dr. J.H. Pratt provided group instruction while treating patients with tuberculosis (TB). The initial intent here was to provide group instruction to those who could not afford institutional assistance. While conducting these groups he noted “beneficial emotional side effects,” which may serve as some of the earliest notes on the efficacy of group therapy.

Group therapy was then proven especially useful in treating World War II veterans who experienced extreme reactions to combat. Upon the US Army releasing a report in 1944 commending positive outcomes, group therapy become a progressively more popular treatment modality.

June 10, 1935 celebrates the founding of Alcoholics Anonymous (AA), which is still the leading support group for addiction recovery. One notable statistic from a study conducted by the National Institute on Alcohol Abuse and Alcoholism specific to AA is that an “eight-year follow-up showed that 46% of those who chose formal treatment were abstinent while 49% of individuals who attended AA were abstinent.” It is interesting to note the 3% higher rate of success for members over an 8-year period who actively participated in AA versus traditional treatment. Again, there is power in numbers.