What are the benefits of group therapy? Group therapy can help patients overcome various mental health conditions and improve interpersonal skills. Explore the therapeutic factors, goals, and patient selection process for effective group therapy sessions.

Therapeutic Factors in Group Therapy

Group therapy is a powerful treatment modality that leverages the power of interpersonal interactions to facilitate patient growth and healing. According to the Yalom Therapeutic Factors, the key elements that contribute to the success of group therapy include:

• Universality: Patients realize that they are not alone in their struggles, as others in the group share similar thoughts, feelings, and issues.
• Altruism: Patients can enhance their self-concept by offering support and assistance to their fellow group members.
• Instillation of Hope: Witnessing the progress and success of other group members can inspire patients to envision a similar path to recovery.
• Imparting Information: Patients gain valuable knowledge and insights from both the group facilitator and their fellow group members.
• Corrective Recapitulation of Primary Family Experience: Patients have the opportunity to properly recreate and address family dynamics in a controlled therapeutic setting.
• Development of Socialization Techniques: Patients learn effective and appropriate ways to interact with others.
• Imitation of Behavior: Patients can gain new understanding and insights by observing the behaviors and interactions of their fellow group members.
• Cohesiveness: Patients experience a sense of support, trust, and belonging within the group.
• Existential Factors: Patients realize that they are ultimately responsible for their own life decisions and outcomes.
• Catharsis: Patients have the opportunity to share personal experiences from the past and present, which can be emotionally cleansing.
• Interpersonal Learning: Patients gain a deeper understanding of their interpersonal impact through feedback from other group members, while also creating an environment for mutual learning.
• Self-Understanding: Patients develop a better understanding of the covert factors influencing their behaviors and emotions.

Goals of Group Therapy

The primary goals of group therapy can be divided into two categories:

Process Goals

The process goals of group therapy are focused on facilitating the patients’ growth in comfort and function within the group setting. This includes helping patients develop a sense of trust, belonging, and cohesion with the other group members.

Outcome Goals

The outcome goals of group therapy are focused on applying the therapeutic benefits to the patients’ lives outside of the group. These goals may include behavioral corrections, the development of interpersonal and relationship skills, education, the installation of preventative measures and coping strategies, and the eventual return to normal functioning within society.

Patient Selection for Group Therapy

When selecting patients who are most likely to benefit from group therapy, healthcare providers consider several key factors:

Therapeutic Alliance

The strength of the therapeutic alliance between the provider and the patient, as well as the level of agreement on the goals and tasks of therapy, are strong predictors of the patient’s success in group therapy.

Personality Traits

Providers can also utilize assessments like the NEO-Five-Factor Inventory to gauge a patient’s suitability for group therapy. Patients who score high on the extraversion (openness) and conscientiousness (hard-working) dimensions are generally more suited for group therapy, while those with high levels of neuroticism (emotional reactivity) may be less suitable.

Ideal Group Therapy Candidates

Patients who are likely to benefit the most from group therapy include those who exhibit interpersonal difficulties and pathology, lack self-awareness, are action-oriented, suffer from isolation, and can derive valuable stimulation and peer interaction from the group setting.

Maintaining Confidentiality and Managing Disruptions

Ensuring patient confidentiality and effectively managing any disruptive issues that arise during group therapy sessions are crucial for the success of the treatment process. Providers must clearly establish and enforce confidentiality policies, while also having strategies in place to address and resolve any internal conflicts or disruptive behaviors within the group.

The Importance of Interprofessional Collaboration

Providing effective group therapy requires a collaborative effort from an interprofessional team of healthcare providers, including physicians, nurses, therapists, and other relevant specialists. By working together, the team can ensure that patients receive comprehensive, coordinated, and high-quality care throughout the group therapy process.

Conclusion

Group therapy is a powerful and versatile treatment modality that can be used to address a wide range of mental health conditions. By understanding the therapeutic factors, goals, and patient selection process, healthcare providers can optimize the effectiveness of group therapy and help their patients achieve meaningful and lasting improvements in their overall well-being and functioning.

Group Therapy – StatPearls – NCBI Bookshelf

Continuing Education Activity

Group therapy is the treatment of multiple patients at once by one or more healthcare providers. It can be used to treat a variety of conditions including but not limited to emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD). This activity outlines the principles of group therapy and explains the role of the interprofessional team in evaluating, treating, and improving care for patients who undergo group therapy.

Objectives:

• Describe the elements of group therapy that can increase the chance of patients benefiting from the treatment process.

• Review the presence and management of issues of patient confidentiality during group therapy sessions.

• Summarize the management of internal issues that disrupt group therapy sessions.

• Explain the importance of interprofessional collaborative efforts when providing treatment in a group setting.

Access free multiple choice questions on this topic.

Introduction

As the need for behavioral intervention and long-term psychiatric care is steadily rising, alternative methods of treatment must be employed by physicians and healthcare teams to meet this increasing demand. Group therapy provides a solution to this problem by allowing for the treatment of multiple individuals simultaneously. Doing so allows healthcare providers to reduce wait times and increase accessibility. This approach is especially necessary for rural and low-income areas where clinics are often understaffed and have a high volume of patients. Furthermore, group therapy can be used to treat a multitude of conditions including, but not limited to, emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).[1][2][3][4]

Function

Yalom Therapeutic Factors

It is vital to patient success that providers understand the mechanisms that exist in group therapy. These factors are:

1. Universality: Patients realize that others exist who share similar thoughts, feelings, and issues.

2. Altruism: Patients can improve their self-concept by assisting other patients.

3. Instillation of hope: Patients benefit from witnessing the success of other group members and can envision themselves following a similar path.

4. Imparting information: Patients gain knowledge and information from both the group members and the provider.

5. Corrective recapitulation of primary family experience: Patients can benefit from the opportunity to properly recreate family dynamics in a controlled environment.

6. Development of socialization techniques: Patients learn effective and proper ways to interact with others.

7. Imitate behavior:  Patients gain new insight and understanding through the observation of other group members.

8. Cohesiveness: Patients experience feelings of support, trust, and belonging to one another.

9. Existential factors: Patients realize that they are responsible for their life decisions.

10. Catharsis: Patients share personal experiences from both the past and present.

11. Interpersonal learning: Patients gain an understanding of their interpersonal impact via feedback from other members as well as create an environment for one another to learn.

12. Self-understanding: Patients understand the covert factors influencing their behavior and emotions.

Goals

• The process goals of group therapy are to facilitate patients’ growth in comfort and function within the group.

• The outcome goals of group therapy are applied to the patient’s life outside of the group and include behavior corrections, development of interpersonal and relationship skills, education, the installation of preventative measures and coping skills, and an eventual return to normal functioning within society.[5]

Selection of Patients

When deciding which patients will benefit the most from group therapy, providers utilize the therapeutic alliance. The more the provider and patient agree on the goals and tasks of therapy as well as the stronger the relationship they share, the more likely the patient will have success in group therapy.[6]

An additional selection method providers can use to gauge group therapy viability is the NEO-Five-Factor Inventory. This measure of personality suggests that those who score high on extraversion (openness) and conscientiousness (hard-working) dimensions are more suited for group therapy, while those who score high levels of neuroticism (emotionally reactive) are less suitable for group therapy.[7]

Group therapy will be useful for the treatment of patients who exhibit interpersonal difficulties and pathology; patients who lack self-awareness; patients who are action-oriented; patients who suffer from isolation and require the stimulation group interaction provides, and those who will benefit from interacting with peers who can both challenge and support them.[8]

Special attention must be paid to ensure patients unfit for group therapy do not get selected as their inclusion can have deleterious effects on both the patient and the group. Specific exclusion criteria are limited to patients who are unable to participate in the major activities of the group due to logistical, cognitive, or interpersonal factors. Additionally, patients in acute distress or actively suicidal should not be considered for group therapy and instead need independent management. Outside of these factors, the exclusion criteria for patients should be more relative than absolute. As a result, a patient unfit for one group due to conflicting personality traits may fit in a group that has similar traits to the patient.

Different Stages of Treatment

It is necessary to include patients at different stages of treatment to help facilitate individual recovery. By comparing themselves to other patients further along in the recovery process, patients can start to imagine themselves in a similar position. Additionally, seeing patients worse off than them but still contributing to the group can provide motivation, keeping patients committed to the treatment process. [9]

Identical or Similar Conditions

Group therapy sessions should include members suffering from similar conditions. Doing so allows patients to realize that their symptoms are not exclusive to them, and others share similar feelings. This feeling of universality can create a sense of community within the group and facilitate the treatment process by fostering feelings of acceptance and belonging. 

Structuring groups with members diagnosed with similar conditions also allow group members to learn from and instruct one another. Interpersonal learning allows members to gain new perspectives on their conditions and learn successful ways to cope. Additionally, members who typically experience social fear as a result of their symptoms become more comfortable with exposure to social situations.[2][9][10][11][12]

In addition to adhering to the principles of group therapy, providers should use different styles of group therapy based on the diagnosis and needs of the patients.

Psychoeducational Groups

Psychoeducational groups are useful for educating patients about their diagnosis as well as their inclinations and consequences associated with these inclinations. These groups also serve to encourage patients to stay committed to their treatment plans. Additionally, psychoeducational groups teach patients to avoid maladaptive behaviors while also instilling positive behavior change. 

When organizing a psychoeducational group, the provider should follow a highly structured plan and develop a curriculum. Sessions should last anywhere from 15 to 90 minutes, and chairs should be organized in a horseshoe or circle configuration where the provider is the focus.

During psychoeducational group sessions, the provider will act as an educator. Teaching should be performed actively as passive note-taking is inefficient and allows patients to escape the focus of the group. To ensure patient engagement, providers must foster a culture of interaction by creating an environment where patients feel comfortable speaking. Additionally, when leading a session, the provider should incorporate different learning styles, such as visual learning, auditory presentations, and hands-on activities, to accommodate the wide variety of methods in which patients learn.[13]

Skills Development Groups

Skills development groups are useful for patients whose diagnosis has prevented the adequate skill development necessary to function in everyday life. This style of group therapy also focuses on coping methods, emotional control, and socialization techniques. By focusing on specific skills that patients lack, providers can help prepare patients for the treatment process and give them the tools to recover.

Providers running skills development groups should base the content of the group on the needs of that group’s patients. As a result, the actual material discussed will vary significantly from group to group. Skills development sessions should range from 45 to 90 minutes in length and be organized in either a horseshoe or circle configuration. These groups should be limited to 8 to 10 patients as it is highly interactive and provides ample time for each patient to practice the skills taught. The provider themselves must have mastery of the skills they plan to teach so they can effectively teach them to the group.[14]

Cognitive-Behavioral Groups

Cognitive-Behavioral groups are useful for changing patients’ learned behaviors by altering their beliefs and perceptions. These groups can also change patients’ perceptions of themselves, turning negative thoughts of being different and unlovable into more positive thoughts. This change in thought process can be extremely freeing to patients as they learn to live with their issues rather than being ruled by them. 

The content discussed in these groups will also vary greatly. The provider should focus on beliefs, coping skills, thought processes, or behavior based on the needs of the patients. The orientation of the room for this particular style of the group should be a circle as the horseshoe orientation can interfere with the cohesiveness of this group. Sessions should last anywhere from 60 to 90 minutes. 

Similar to psychoeducational groups, the provider of cognitive-behavioral groups should take an active role during the session; however, discretion must be used to ensure the provider does not over-participate negating the members’ ability to interact. It is vital to the patients’ success that the provider acts as a guide and let the group work through most issues themselves. 

Since the discussions in these sessions are focused on thought and behavior modification, patients may feel uncomfortable and try to resist these changes. Providers must be prepared for this resistance and gently guide the members through their issues with just the right amount of empathy and firmness.[15]

Support Groups

Support groups can be used to help patients who have already begun receiving treatment to maintain their new behaviors and reinforce their new belief systems and thought processes. These groups also focus on the management of symptoms of day-to-day life. During sessions, patients usually discuss recent problems and how they dealt with them. 

Support group sessions should last anywhere from 45 to 90 minutes. Sessions should also be conducted in a circular configuration. 

Unlike psychoeducational and cognitive-behavioral groups, the provider of support groups is less directive and should act only as a facilitator. As such, the provider should assist patients in developing connections with one another and emphasizing similarities between patients. The provider’s main contribution to the group should be limited to positive reinforcement and to bring to attention appropriate interactions patients exhibit.[16]

Group Development

Providers should be aware of the different stages of group development as a transition through each stage indicates group growth and change. Transitioning through all five stages is necessary for patients to benefit from group therapy.

1. Forming stage: During the forming stage, patients will exhibit feelings of anxiety, distrust, and uncertainty concerning the group. There will be a high level of dependence on the provider, and actual group interaction will be low during this stage. Providers should use this opportunity to educate the group and establish cohesiveness by discussing goals and expectations. 

2. Storming stage: In this stage, patients will now be comfortable sharing intimate details with one another. Additionally, the formation of subgroups may occur as patients establish a hierarchy. Internal conflict will predominantly occur in this stage of group development. The provider should aim to resolve disruptive conflict and encourage patients to develop strong and personal relationships with one another. The reinforcement of goals and the purpose of the group can help bring patients together. 

3. Norming stage: After conflict resolution has occurred, the group will enter the norming stage. While in the norming stage, patients’ commitment to the group and its goals will strengthen, and group cohesiveness will increase. Patients will take on much of the leadership work initially performed by the provider. As such, the provider should take a less active role in the discussion and instead facilitate discussion and provide insights. The return of conflict is a sign of regression to a previous developmental stage, and the provider should intervene to bring the group back to this stage.

4. Performing stage: Upon entering the performing stage, the group has greatly matured relative to the earlier stages. Provider intervention is low, as the group functions almost entirely on its own.  Patients are aware of each other’s strengths and weaknesses and can help each other develop and grow. 

5. Adjourning stage: The final stage of group development is the adjourning stage, which signifies that group therapy is coming to an end. Patients may experience feelings of sadness and anxiety as they will no longer be attending sessions. During this stage, the provider should assist patients in voicing their feelings and facilitate discussion of closing topics. Additionally, the provider should help patients plan for life outside of group therapy and assist patients in saying goodbye. Improper management of a farewell process can negatively impact patients and hurt the progress they have made.[17]

Length of Treatment

The duration of group therapy treatment is highly individualized and subject to a high degree of variation. Patients should receive therapy until they achieve relief from their symptoms and can begin to develop a normal life with strong relationships and a sense of belonging; this can take anywhere from weeks to months or even years to occur. To facilitate patient improvement, providers should structure the ending of therapy processes. By establishing a set end date during treatment, the provider can prepare the patient for an eventual departure with the patient working towards the achievement of his or her goals until that date.

Issues of Concern

Patient Confidentiality

Similar to individual treatment, the provider or group leader in group therapy sessions are bound to the laws of confidentiality concerning patients’ medical history, diagnoses, and other personal information. The other group members, however, are not bound to these same laws and face no legal consequences for sharing information from sessions. As a result, individual patient confidentiality can be difficult to maintain, especially in larger groups where leaders have less control over what information gets shared within the group.

The ability to share personal information can play a positive role in the treatment process. Some patients may feel uneasy sharing certain details for fear of who may repeat them, which can cause harm to patients’ mental wellbeing as they struggle to contribute while maintaining their confidentiality. To reduce this tension, providers should adopt a set of confidentiality/sharing guidelines that the group agrees to and discuss with members the limitations of confidentiality before the first session.[18]

Clinical Significance

Effectiveness

Research has shown that group therapy is an effective method to treat a myriad of psychiatric and behavioral disorders. Patients often report a reduction in symptoms after receiving group therapy treatment. Additionally, group therapy is found to affect patients positively through Yalom Therapeutic Factors. These factors do reduce symptoms of diagnoses while also providing patients with beneficial skills to learn, develop, and live with their symptoms. As long as patients are subject to proper screening before group therapy sessions, they will receive benefits.[1][10][19]

Concurrent Treatment

Although group therapy is an effective method of treatment in itself, providers may also choose to incorporate other treatment methods to treat patients further. 

• Conjoint therapy: When performed conjointly, the provider treating the patient in the group differs from the provider treating the patient individually. Doing so provides patients with different therapeutic settings, allowing them to learn as an individual and apply those teachings in a group setting.

• Combined therapy, on the other hand, occurs when the provider treating in the group setting also treats the patient individually. This method of concurrent treatment allows providers to thoroughly assess patients and provide individual coaching, which is applicable in the group setting. When placing a patient into a group, special care should be used to ensure the patient gets put into a group homogenous for symptoms and diagnosis.[20]

Cost-efficiency  

Group therapy provides a cost-efficient method of treatment, as fewer trained professionals are required to provide treatment to a larger number of patients. A reduction in cost can increase the accessibility of therapy, as costs are often covered by insurance plans.[1]

Flexibility

Treatment in a group setting allows providers to be more flexible with their sessions. Doing so can increase attendance to therapy sessions since providers can schedule sessions during after work and after school hours. Additionally, the inclusion of multiple sessions throughout the day allows providers to treat a larger volume of patients throughout the day, further reducing wait times in high-volume areas. [1]

Training Opportunities

The group format can be used as an avenue to train medical students, residents, and other healthcare professionals by allowing them to serve as co-therapists. The provider can oversee the less experienced professionals as they work with patients, effectively creating on-the-job coaching; this can be especially useful in low resource areas where access to trained professionals is limited.[1]

Other Issues

Other Issues

Conflict

Conflict is a natural and expected aspect of group therapy sessions. Many conflicts may not be obvious to the group members, and it is the responsibility of the provider to bring these covert conflicts to the members’ attention. The provider is not required to solve the conflict; however, he or she must make an informed decision on how to deal with the conflict based on the interest of the group. It may be worthwhile to address the conflict, as there is an opportunity for the group to learn.  

Members’ responses to conflict can be complex and unpredictable. When conflict arises, providers should use the last five to ten minutes of the session to speak with patients individually and allow them to voice their concerns.

Patients Who Ramble

Occasionally, a patient may continue to talk for an unnecessary length of time. It is essential to address this patient and see what he or she hopes to gain when doing so. If the patient is unsure as to why they are dominating the conversation, the provider should use this opportunity to teach the patient how to express his or her thoughts and feelings better.

Lack of Engagement

It is the provider’s responsibility to ensure members are alert and attentive during group sessions. When members seem disengaged, the provider should interject and see why members are losing interest. The inclusion of interactive activities can help members to be more engaged in the group discussion.[11]

Patients’ Limits

Providers are encouraged to push their patients to engage with the sessions; however, it is crucial to be aware of a patient’s individual limits. If the provider’s initial request for the patient to continue engaging meets with resistance, then the provider should respect this wish. Providers should remain patient, understanding, and empathetic with their patients and continually encourage without forcing patients to act against their will.[9]

Enhancing Healthcare Team Outcomes

Pharmacotherapy and Group Therapy

Occasionally, patients receiving group therapy will also benefit from the inclusion of pharmacotherapy. In situations where the provider prescribing the medication differs from the provider providing treatment, proper communication between the two parties is vital to patient success. A thorough report of the patient and his or her reaction and benefits from the medication must be shared with the provider treating with group therapy. Mutual respect for one another and the well-being of the patient are required to prevent adverse reactions and ensure the patient receives the highest quality of medical care. Additionally, putting less of a value on either of the two treatment processes can negatively impact patients, so the therapist should always follow proper inclusion and management of both treatment processes.[21]

When pharmacotherapy is part of the patient’s therapy, it is prudent to have a qualified pharmacist examine the patient’s medication record, checking for proper dosing, potential drug interactions, and inform the other members of the healthcare team of any red flags.

Social workers can play an important auxiliary role to providers during group therapy sessions. The social worker’s presence as a layperson voicing their thoughts and feelings can help facilitate group interaction and reduce members’ resistance to contributing. Also, social workers can assist patients in attempting to reintegrate into their “normal” lives by answering patient’s questions concerning work, relationships, and other lifestyle changes.[22]

An interprofessional team approach can benefit participants in group therapy, where information is shared among various disciplines leading to improved patient outcomes, so long as appropriate privacy considerations are maintained at all times. [Level 5]

Nursing, Allied Health, and Interprofessional Team Interventions

Nurses trained in psychiatric and behavioral sciences can take on the role of group therapy leader and host group therapy sessions. Their responsibilities reflect those of other healthcare providers, and supervision is not required when a properly trained nurse is leading group therapy.[23]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

Deblinger E, Pollio E, Dorsey S. Applying Trauma-Focused Cognitive-Behavioral Therapy in Group Format. Child Maltreat. 2016 Feb;21(1):59-73. [PubMed: 26701151]

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Wolgensinger L. Cognitive behavioral group therapy for anxiety: recent developments. Dialogues Clin Neurosci. 2015 Sep;17(3):347-51. [PMC free article: PMC4610619] [PubMed: 26487815]

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Sayın A, Candansayar S, Welkin L. Group psychotherapy in women with a history of sexual abuse: what did they find helpful? J Clin Nurs. 2013 Dec;22(23-24):3249-58. [PubMed: 24118587]

4.

Vidal R, Castells J, Richarte V, Palomar G, García M, Nicolau R, Lazaro L, Casas M, Ramos-Quiroga JA. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015 Apr;54(4):275-82. [PubMed: 25791144]

5.

Ezhumalai S, Muralidhar D, Dhanasekarapandian R, Nikketha BS. Group interventions. Indian J Psychiatry. 2018 Feb;60(Suppl 4):S514-S521. [PMC free article: PMC5844165] [PubMed: 29540924]

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Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000 Jun;68(3):438-50. [PubMed: 10883561]

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Lahey BB. Public health significance of neuroticism. Am Psychol. 2009 May-Jun;64(4):241-56. [PMC free article: PMC2792076] [PubMed: 19449983]

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Grunebaum H, Kates W. Whom to refer for group psychotherapy. Am J Psychiatry. 1977 Feb;134(2):130-3. [PubMed: 319691]

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Malcolm L, Mein G, Jones A, Talbot-Rice H, Maddocks M, Bristowe K. Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliat Care. 2016 Dec 13;15(1):97. [PMC free article: PMC5155388] [PubMed: 27964735]

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Ramírez P, Febrero B, Martínez-Alarcón L, Abete C, Galera M, Cascales P, López-Navas AI, González MR, Ríos A, Pons JA, Parrilla P. Benefits of Group Psychotherapy in Cirrhotic Patients on the Liver Transplant Waiting List. Transplant Proc. 2015 Oct;47(8):2382-4. [PubMed: 26518934]

11.

Larsson E, Lloyd S, Westwood H, Tchanturia K. Patients’ perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study. J Health Psychol. 2018 Oct;23(12):1521-1532. [PubMed: 27473160]

12.

Hauksson P, Ingibergsdóttir S, Gunnarsdóttir T, Jónsdóttir IH. Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting. Nord J Psychiatry. 2017 Aug;71(6):465-472. [PubMed: 28598705]

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Martin K, Giannandrea P, Rogers B, Johnson J. Group intervention with pre-recovery patients. J Subst Abuse Treat. 1996 Jan-Feb;13(1):33-41. [PubMed: 8699541]

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La Salvia TA. Enhancing addiction treatment through psychoeducational groups. J Subst Abuse Treat. 1993 Sep-Oct;10(5):439-44. [PubMed: 8246317]

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Najavits LM, Weiss RD, Liese BS. Group cognitive-behavioral therapy for women with PTSD and substance use disorder. J Subst Abuse Treat. 1996 Jan-Feb;13(1):13-22. [PubMed: 8699538]

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Cooper DE. The role of group psychotherapy in the treatment of substance abusers. Am J Psychother. 1987 Jan;41(1):55-67. [PubMed: 3578607]

17.

Kumar S, Deshmukh V, Adhish VS. Building and leading teams. Indian J Community Med. 2014 Oct;39(4):208-13. [PMC free article: PMC4215500] [PubMed: 25364143]

18.

Lasky GB, Riva MT. Confidentiality and privileged communication in group psychotherapy. Int J Group Psychother. 2006 Oct;56(4):455-76. [PubMed: 17040183]

19.

Lucre KM, Corten N. An exploration of group compassion-focused therapy for personality disorder. Psychol Psychother. 2013 Dec;86(4):387-400. [PubMed: 24217864]

20.

Ormont LR. Principles and practice of conjoint psychoanalytic treatment. Am J Psychiatry. 1981 Jan;138(1):69-73. [PubMed: 7446786]

21.

Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014 Feb;13(1):56-67. [PMC free article: PMC3918025] [PubMed: 24497254]

22.

CHANCE E. Group psycho-therapy and the psychiatric social worker. Ment Health (Lond). 1948 Aug;8(1):8-12. [PMC free article: PMC5078299] [PubMed: 18885358]

23.

Lorentzen S, Ruud T. Group therapy in public mental health services: approaches, patients and group therapists. J Psychiatr Ment Health Nurs. 2014 Apr;21(3):219-25. [PubMed: 23581992]

Disclosure: Akshay Malhotra declares no relevant financial relationships with ineligible companies.

Disclosure: Jeff Baker declares no relevant financial relationships with ineligible companies.

Group Therapy – StatPearls – NCBI Bookshelf

Continuing Education Activity

Group therapy is the treatment of multiple patients at once by one or more healthcare providers. It can be used to treat a variety of conditions including but not limited to emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD). This activity outlines the principles of group therapy and explains the role of the interprofessional team in evaluating, treating, and improving care for patients who undergo group therapy.

Objectives:

• Describe the elements of group therapy that can increase the chance of patients benefiting from the treatment process.

• Review the presence and management of issues of patient confidentiality during group therapy sessions.

• Summarize the management of internal issues that disrupt group therapy sessions.

• Explain the importance of interprofessional collaborative efforts when providing treatment in a group setting.

Access free multiple choice questions on this topic.

Introduction

As the need for behavioral intervention and long-term psychiatric care is steadily rising, alternative methods of treatment must be employed by physicians and healthcare teams to meet this increasing demand. Group therapy provides a solution to this problem by allowing for the treatment of multiple individuals simultaneously. Doing so allows healthcare providers to reduce wait times and increase accessibility. This approach is especially necessary for rural and low-income areas where clinics are often understaffed and have a high volume of patients. Furthermore, group therapy can be used to treat a multitude of conditions including, but not limited to, emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).[1][2][3][4]

Function

Yalom Therapeutic Factors

It is vital to patient success that providers understand the mechanisms that exist in group therapy. These factors are:

1. Universality: Patients realize that others exist who share similar thoughts, feelings, and issues.

2. Altruism: Patients can improve their self-concept by assisting other patients.

3. Instillation of hope: Patients benefit from witnessing the success of other group members and can envision themselves following a similar path.

4. Imparting information: Patients gain knowledge and information from both the group members and the provider.

5. Corrective recapitulation of primary family experience: Patients can benefit from the opportunity to properly recreate family dynamics in a controlled environment.

6. Development of socialization techniques: Patients learn effective and proper ways to interact with others.

7. Imitate behavior:  Patients gain new insight and understanding through the observation of other group members.

8. Cohesiveness: Patients experience feelings of support, trust, and belonging to one another.

9. Existential factors: Patients realize that they are responsible for their life decisions.

10. Catharsis: Patients share personal experiences from both the past and present.

11. Interpersonal learning: Patients gain an understanding of their interpersonal impact via feedback from other members as well as create an environment for one another to learn.

12. Self-understanding: Patients understand the covert factors influencing their behavior and emotions.

Goals

• The process goals of group therapy are to facilitate patients’ growth in comfort and function within the group.

• The outcome goals of group therapy are applied to the patient’s life outside of the group and include behavior corrections, development of interpersonal and relationship skills, education, the installation of preventative measures and coping skills, and an eventual return to normal functioning within society.[5]

Selection of Patients

When deciding which patients will benefit the most from group therapy, providers utilize the therapeutic alliance. The more the provider and patient agree on the goals and tasks of therapy as well as the stronger the relationship they share, the more likely the patient will have success in group therapy.[6]

An additional selection method providers can use to gauge group therapy viability is the NEO-Five-Factor Inventory. This measure of personality suggests that those who score high on extraversion (openness) and conscientiousness (hard-working) dimensions are more suited for group therapy, while those who score high levels of neuroticism (emotionally reactive) are less suitable for group therapy.[7]

Group therapy will be useful for the treatment of patients who exhibit interpersonal difficulties and pathology; patients who lack self-awareness; patients who are action-oriented; patients who suffer from isolation and require the stimulation group interaction provides, and those who will benefit from interacting with peers who can both challenge and support them.[8]

Special attention must be paid to ensure patients unfit for group therapy do not get selected as their inclusion can have deleterious effects on both the patient and the group. Specific exclusion criteria are limited to patients who are unable to participate in the major activities of the group due to logistical, cognitive, or interpersonal factors. Additionally, patients in acute distress or actively suicidal should not be considered for group therapy and instead need independent management. Outside of these factors, the exclusion criteria for patients should be more relative than absolute. As a result, a patient unfit for one group due to conflicting personality traits may fit in a group that has similar traits to the patient.

Different Stages of Treatment

It is necessary to include patients at different stages of treatment to help facilitate individual recovery. By comparing themselves to other patients further along in the recovery process, patients can start to imagine themselves in a similar position. Additionally, seeing patients worse off than them but still contributing to the group can provide motivation, keeping patients committed to the treatment process.[9]

Identical or Similar Conditions

Group therapy sessions should include members suffering from similar conditions. Doing so allows patients to realize that their symptoms are not exclusive to them, and others share similar feelings. This feeling of universality can create a sense of community within the group and facilitate the treatment process by fostering feelings of acceptance and belonging. 

Structuring groups with members diagnosed with similar conditions also allow group members to learn from and instruct one another. Interpersonal learning allows members to gain new perspectives on their conditions and learn successful ways to cope. Additionally, members who typically experience social fear as a result of their symptoms become more comfortable with exposure to social situations.[2][9][10][11][12]

In addition to adhering to the principles of group therapy, providers should use different styles of group therapy based on the diagnosis and needs of the patients.

Psychoeducational Groups

Psychoeducational groups are useful for educating patients about their diagnosis as well as their inclinations and consequences associated with these inclinations. These groups also serve to encourage patients to stay committed to their treatment plans. Additionally, psychoeducational groups teach patients to avoid maladaptive behaviors while also instilling positive behavior change. 

When organizing a psychoeducational group, the provider should follow a highly structured plan and develop a curriculum. Sessions should last anywhere from 15 to 90 minutes, and chairs should be organized in a horseshoe or circle configuration where the provider is the focus.

During psychoeducational group sessions, the provider will act as an educator. Teaching should be performed actively as passive note-taking is inefficient and allows patients to escape the focus of the group. To ensure patient engagement, providers must foster a culture of interaction by creating an environment where patients feel comfortable speaking. Additionally, when leading a session, the provider should incorporate different learning styles, such as visual learning, auditory presentations, and hands-on activities, to accommodate the wide variety of methods in which patients learn. [13]

Skills Development Groups

Skills development groups are useful for patients whose diagnosis has prevented the adequate skill development necessary to function in everyday life. This style of group therapy also focuses on coping methods, emotional control, and socialization techniques. By focusing on specific skills that patients lack, providers can help prepare patients for the treatment process and give them the tools to recover.

Providers running skills development groups should base the content of the group on the needs of that group’s patients. As a result, the actual material discussed will vary significantly from group to group. Skills development sessions should range from 45 to 90 minutes in length and be organized in either a horseshoe or circle configuration. These groups should be limited to 8 to 10 patients as it is highly interactive and provides ample time for each patient to practice the skills taught. The provider themselves must have mastery of the skills they plan to teach so they can effectively teach them to the group. [14]

Cognitive-Behavioral Groups

Cognitive-Behavioral groups are useful for changing patients’ learned behaviors by altering their beliefs and perceptions. These groups can also change patients’ perceptions of themselves, turning negative thoughts of being different and unlovable into more positive thoughts. This change in thought process can be extremely freeing to patients as they learn to live with their issues rather than being ruled by them. 

The content discussed in these groups will also vary greatly. The provider should focus on beliefs, coping skills, thought processes, or behavior based on the needs of the patients. The orientation of the room for this particular style of the group should be a circle as the horseshoe orientation can interfere with the cohesiveness of this group. Sessions should last anywhere from 60 to 90 minutes. 

Similar to psychoeducational groups, the provider of cognitive-behavioral groups should take an active role during the session; however, discretion must be used to ensure the provider does not over-participate negating the members’ ability to interact. It is vital to the patients’ success that the provider acts as a guide and let the group work through most issues themselves. 

Since the discussions in these sessions are focused on thought and behavior modification, patients may feel uncomfortable and try to resist these changes. Providers must be prepared for this resistance and gently guide the members through their issues with just the right amount of empathy and firmness.[15]

Support Groups

Support groups can be used to help patients who have already begun receiving treatment to maintain their new behaviors and reinforce their new belief systems and thought processes. These groups also focus on the management of symptoms of day-to-day life. During sessions, patients usually discuss recent problems and how they dealt with them. 

Support group sessions should last anywhere from 45 to 90 minutes. Sessions should also be conducted in a circular configuration. 

Unlike psychoeducational and cognitive-behavioral groups, the provider of support groups is less directive and should act only as a facilitator. As such, the provider should assist patients in developing connections with one another and emphasizing similarities between patients. The provider’s main contribution to the group should be limited to positive reinforcement and to bring to attention appropriate interactions patients exhibit.[16]

Group Development

Providers should be aware of the different stages of group development as a transition through each stage indicates group growth and change. Transitioning through all five stages is necessary for patients to benefit from group therapy.

1. Forming stage: During the forming stage, patients will exhibit feelings of anxiety, distrust, and uncertainty concerning the group. There will be a high level of dependence on the provider, and actual group interaction will be low during this stage. Providers should use this opportunity to educate the group and establish cohesiveness by discussing goals and expectations. 

2. Storming stage: In this stage, patients will now be comfortable sharing intimate details with one another. Additionally, the formation of subgroups may occur as patients establish a hierarchy. Internal conflict will predominantly occur in this stage of group development. The provider should aim to resolve disruptive conflict and encourage patients to develop strong and personal relationships with one another. The reinforcement of goals and the purpose of the group can help bring patients together. 

3. Norming stage: After conflict resolution has occurred, the group will enter the norming stage. While in the norming stage, patients’ commitment to the group and its goals will strengthen, and group cohesiveness will increase. Patients will take on much of the leadership work initially performed by the provider. As such, the provider should take a less active role in the discussion and instead facilitate discussion and provide insights. The return of conflict is a sign of regression to a previous developmental stage, and the provider should intervene to bring the group back to this stage.

4. Performing stage: Upon entering the performing stage, the group has greatly matured relative to the earlier stages. Provider intervention is low, as the group functions almost entirely on its own.  Patients are aware of each other’s strengths and weaknesses and can help each other develop and grow. 

5. Adjourning stage: The final stage of group development is the adjourning stage, which signifies that group therapy is coming to an end. Patients may experience feelings of sadness and anxiety as they will no longer be attending sessions. During this stage, the provider should assist patients in voicing their feelings and facilitate discussion of closing topics. Additionally, the provider should help patients plan for life outside of group therapy and assist patients in saying goodbye. Improper management of a farewell process can negatively impact patients and hurt the progress they have made.[17]

Length of Treatment

The duration of group therapy treatment is highly individualized and subject to a high degree of variation. Patients should receive therapy until they achieve relief from their symptoms and can begin to develop a normal life with strong relationships and a sense of belonging; this can take anywhere from weeks to months or even years to occur. To facilitate patient improvement, providers should structure the ending of therapy processes. By establishing a set end date during treatment, the provider can prepare the patient for an eventual departure with the patient working towards the achievement of his or her goals until that date.

Issues of Concern

Patient Confidentiality

Similar to individual treatment, the provider or group leader in group therapy sessions are bound to the laws of confidentiality concerning patients’ medical history, diagnoses, and other personal information. The other group members, however, are not bound to these same laws and face no legal consequences for sharing information from sessions. As a result, individual patient confidentiality can be difficult to maintain, especially in larger groups where leaders have less control over what information gets shared within the group.

The ability to share personal information can play a positive role in the treatment process. Some patients may feel uneasy sharing certain details for fear of who may repeat them, which can cause harm to patients’ mental wellbeing as they struggle to contribute while maintaining their confidentiality. To reduce this tension, providers should adopt a set of confidentiality/sharing guidelines that the group agrees to and discuss with members the limitations of confidentiality before the first session.[18]

Clinical Significance

Effectiveness

Research has shown that group therapy is an effective method to treat a myriad of psychiatric and behavioral disorders. Patients often report a reduction in symptoms after receiving group therapy treatment. Additionally, group therapy is found to affect patients positively through Yalom Therapeutic Factors. These factors do reduce symptoms of diagnoses while also providing patients with beneficial skills to learn, develop, and live with their symptoms. As long as patients are subject to proper screening before group therapy sessions, they will receive benefits.[1][10][19]

Concurrent Treatment

Although group therapy is an effective method of treatment in itself, providers may also choose to incorporate other treatment methods to treat patients further. 

• Conjoint therapy: When performed conjointly, the provider treating the patient in the group differs from the provider treating the patient individually. Doing so provides patients with different therapeutic settings, allowing them to learn as an individual and apply those teachings in a group setting.

• Combined therapy, on the other hand, occurs when the provider treating in the group setting also treats the patient individually. This method of concurrent treatment allows providers to thoroughly assess patients and provide individual coaching, which is applicable in the group setting. When placing a patient into a group, special care should be used to ensure the patient gets put into a group homogenous for symptoms and diagnosis. [20]

Cost-efficiency  

Group therapy provides a cost-efficient method of treatment, as fewer trained professionals are required to provide treatment to a larger number of patients. A reduction in cost can increase the accessibility of therapy, as costs are often covered by insurance plans.[1]

Flexibility

Treatment in a group setting allows providers to be more flexible with their sessions. Doing so can increase attendance to therapy sessions since providers can schedule sessions during after work and after school hours. Additionally, the inclusion of multiple sessions throughout the day allows providers to treat a larger volume of patients throughout the day, further reducing wait times in high-volume areas.[1]

Training Opportunities

The group format can be used as an avenue to train medical students, residents, and other healthcare professionals by allowing them to serve as co-therapists. The provider can oversee the less experienced professionals as they work with patients, effectively creating on-the-job coaching; this can be especially useful in low resource areas where access to trained professionals is limited. [1]

Other Issues

Other Issues

Conflict

Conflict is a natural and expected aspect of group therapy sessions. Many conflicts may not be obvious to the group members, and it is the responsibility of the provider to bring these covert conflicts to the members’ attention. The provider is not required to solve the conflict; however, he or she must make an informed decision on how to deal with the conflict based on the interest of the group. It may be worthwhile to address the conflict, as there is an opportunity for the group to learn. 

Members’ responses to conflict can be complex and unpredictable. When conflict arises, providers should use the last five to ten minutes of the session to speak with patients individually and allow them to voice their concerns.

Patients Who Ramble

Occasionally, a patient may continue to talk for an unnecessary length of time. It is essential to address this patient and see what he or she hopes to gain when doing so. If the patient is unsure as to why they are dominating the conversation, the provider should use this opportunity to teach the patient how to express his or her thoughts and feelings better.

Lack of Engagement

It is the provider’s responsibility to ensure members are alert and attentive during group sessions. When members seem disengaged, the provider should interject and see why members are losing interest. The inclusion of interactive activities can help members to be more engaged in the group discussion.[11]

Patients’ Limits

Providers are encouraged to push their patients to engage with the sessions; however, it is crucial to be aware of a patient’s individual limits. If the provider’s initial request for the patient to continue engaging meets with resistance, then the provider should respect this wish. Providers should remain patient, understanding, and empathetic with their patients and continually encourage without forcing patients to act against their will. [9]

Enhancing Healthcare Team Outcomes

Pharmacotherapy and Group Therapy

Occasionally, patients receiving group therapy will also benefit from the inclusion of pharmacotherapy. In situations where the provider prescribing the medication differs from the provider providing treatment, proper communication between the two parties is vital to patient success. A thorough report of the patient and his or her reaction and benefits from the medication must be shared with the provider treating with group therapy. Mutual respect for one another and the well-being of the patient are required to prevent adverse reactions and ensure the patient receives the highest quality of medical care. Additionally, putting less of a value on either of the two treatment processes can negatively impact patients, so the therapist should always follow proper inclusion and management of both treatment processes.[21]

When pharmacotherapy is part of the patient’s therapy, it is prudent to have a qualified pharmacist examine the patient’s medication record, checking for proper dosing, potential drug interactions, and inform the other members of the healthcare team of any red flags.

Social workers can play an important auxiliary role to providers during group therapy sessions. The social worker’s presence as a layperson voicing their thoughts and feelings can help facilitate group interaction and reduce members’ resistance to contributing. Also, social workers can assist patients in attempting to reintegrate into their “normal” lives by answering patient’s questions concerning work, relationships, and other lifestyle changes.[22]

An interprofessional team approach can benefit participants in group therapy, where information is shared among various disciplines leading to improved patient outcomes, so long as appropriate privacy considerations are maintained at all times. [Level 5]

Nursing, Allied Health, and Interprofessional Team Interventions

Nurses trained in psychiatric and behavioral sciences can take on the role of group therapy leader and host group therapy sessions. Their responsibilities reflect those of other healthcare providers, and supervision is not required when a properly trained nurse is leading group therapy. [23]

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References

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Deblinger E, Pollio E, Dorsey S. Applying Trauma-Focused Cognitive-Behavioral Therapy in Group Format. Child Maltreat. 2016 Feb;21(1):59-73. [PubMed: 26701151]

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Wolgensinger L. Cognitive behavioral group therapy for anxiety: recent developments. Dialogues Clin Neurosci. 2015 Sep;17(3):347-51. [PMC free article: PMC4610619] [PubMed: 26487815]

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Sayın A, Candansayar S, Welkin L. Group psychotherapy in women with a history of sexual abuse: what did they find helpful? J Clin Nurs. 2013 Dec;22(23-24):3249-58. [PubMed: 24118587]

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Vidal R, Castells J, Richarte V, Palomar G, García M, Nicolau R, Lazaro L, Casas M, Ramos-Quiroga JA. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015 Apr;54(4):275-82. [PubMed: 25791144]

5.

Ezhumalai S, Muralidhar D, Dhanasekarapandian R, Nikketha BS. Group interventions. Indian J Psychiatry. 2018 Feb;60(Suppl 4):S514-S521. [PMC free article: PMC5844165] [PubMed: 29540924]

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Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000 Jun;68(3):438-50. [PubMed: 10883561]

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Lahey BB. Public health significance of neuroticism. Am Psychol. 2009 May-Jun;64(4):241-56. [PMC free article: PMC2792076] [PubMed: 19449983]

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Grunebaum H, Kates W. Whom to refer for group psychotherapy. Am J Psychiatry. 1977 Feb;134(2):130-3. [PubMed: 319691]

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Malcolm L, Mein G, Jones A, Talbot-Rice H, Maddocks M, Bristowe K. Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliat Care. 2016 Dec 13;15(1):97. [PMC free article: PMC5155388] [PubMed: 27964735]

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Ramírez P, Febrero B, Martínez-Alarcón L, Abete C, Galera M, Cascales P, López-Navas AI, González MR, Ríos A, Pons JA, Parrilla P. Benefits of Group Psychotherapy in Cirrhotic Patients on the Liver Transplant Waiting List. Transplant Proc. 2015 Oct;47(8):2382-4. [PubMed: 26518934]

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Larsson E, Lloyd S, Westwood H, Tchanturia K. Patients’ perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study. J Health Psychol. 2018 Oct;23(12):1521-1532. [PubMed: 27473160]

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Hauksson P, Ingibergsdóttir S, Gunnarsdóttir T, Jónsdóttir IH. Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting. Nord J Psychiatry. 2017 Aug;71(6):465-472. [PubMed: 28598705]

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Martin K, Giannandrea P, Rogers B, Johnson J. Group intervention with pre-recovery patients. J Subst Abuse Treat. 1996 Jan-Feb;13(1):33-41. [PubMed: 8699541]

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La Salvia TA. Enhancing addiction treatment through psychoeducational groups. J Subst Abuse Treat. 1993 Sep-Oct;10(5):439-44. [PubMed: 8246317]

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Najavits LM, Weiss RD, Liese BS. Group cognitive-behavioral therapy for women with PTSD and substance use disorder. J Subst Abuse Treat. 1996 Jan-Feb;13(1):13-22. [PubMed: 8699538]

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Cooper DE. The role of group psychotherapy in the treatment of substance abusers. Am J Psychother. 1987 Jan;41(1):55-67. [PubMed: 3578607]

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Kumar S, Deshmukh V, Adhish VS. Building and leading teams. Indian J Community Med. 2014 Oct;39(4):208-13. [PMC free article: PMC4215500] [PubMed: 25364143]

18.

Lasky GB, Riva MT. Confidentiality and privileged communication in group psychotherapy. Int J Group Psychother. 2006 Oct;56(4):455-76. [PubMed: 17040183]

19.

Lucre KM, Corten N. An exploration of group compassion-focused therapy for personality disorder. Psychol Psychother. 2013 Dec;86(4):387-400. [PubMed: 24217864]

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Ormont LR. Principles and practice of conjoint psychoanalytic treatment. Am J Psychiatry. 1981 Jan;138(1):69-73. [PubMed: 7446786]

21.

Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014 Feb;13(1):56-67. [PMC free article: PMC3918025] [PubMed: 24497254]

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CHANCE E. Group psycho-therapy and the psychiatric social worker. Ment Health (Lond). 1948 Aug;8(1):8-12. [PMC free article: PMC5078299] [PubMed: 18885358]

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Lorentzen S, Ruud T. Group therapy in public mental health services: approaches, patients and group therapists. J Psychiatr Ment Health Nurs. 2014 Apr;21(3):219-25. [PubMed: 23581992]

Disclosure: Akshay Malhotra declares no relevant financial relationships with ineligible companies.

Disclosure: Jeff Baker declares no relevant financial relationships with ineligible companies.

90,000 myths, reality, benefits. , Gestalt Therapy – Gestalt Club

Group work for me personally turned out to be
one of the most profound ways of therapy, especially if the initial
relationship query. For some reason, in the group “heard better”, and the new
material is quickly integrated into life. Somehow feedback from
participants or from the leader in the group according to the degree of impact more than
powerful and intense, like support. I didn’t find it there
unfortunate people, rather I was surprised that most of me
cute. No one forced me, I was not taught anything, and no one
did not condemn me. But I got the opportunity to appear in the world not
the way others want it, but the way I choose to be myself and
be with others at the same time. This is an important and useful experience, which
undoubtedly enriched my life, because by the nature of my activity I
turned out to be a public person, and it was important for me to learn not to lose
myself.

But at the same time, group therapy is an activity
shrouded in a huge number of myths and legends. art, including
including cinema, added a twinkle to their appearance, more precisely
they were also born. However, not everything that is shown on the screen is true, but
not everyone can see the group work with their own eyes. For example, we often
In total, it is the clinical groups that show (that is, the situation
neurosis), and we naively believe that they all pass. But no.
There is truth, there is lies. I decided to name the most
common doubts about group therapy and share
their experience and understanding in this regard.

The group lasts quite a long time – almost 9 months (although
it’s not always the same). Participants need to know “who these people are and
what they want. ” In this group, a detailed biography is not important,
simply enough to understand the context of what led each of
present for the group. In the event that one of the participants
undergoes personal therapy with the leader, this does not apply in any way and
not illuminated during the therapeutic process.

If in everyday life or even in individual
therapy, we can’t always say what’s really spinning
in a language, then a group is a place where everyone communicates with everyone and
trying to understand himself, not the other. Experiencing one or the other
emotions towards the other, the participant can clarify something very
important for yourself and get a new experience. It could be about affection
or even antipathy. At the same time, the form of destructive activity is prohibited in the group.
aggression, which makes communication safer than in life.
Irritation is the personal responsibility of the one who experiences it,
the group and the facilitator help to find a form of expression for this feeling and
understand how and why it occurs.

Because the group is a vehicle for understanding oneself through
others, then honest feedback is the main guarantee and the main
group therapy condition. To do this, participants use
I-messages and try to be aware of what is happening to them.
The facilitator pays a lot of attention to this process, providing
support for each participant.

Group therapy is an opportunity
clarify or establish or even end relationships as in
past, as well as in the present, with the members of the group. Members
are in some way a tool with which you can
recreate an exciting situation, try a new way of behaving and
study the reaction to it. The group is a place where you can see
side of their behavior and understand how others feel.

Everyone who came to the group has his own history and
reasons to be there. understanding of this and the context in which
other participants turned out to be alive and have their flaws,
creates support for changes in their own lives.

And here are the myths that sit tightly in the head, not like
interested person, but even some psychologists. What and
to say, I came to my first group, incredulously looking sideways at
all those present and the first couple of months just sat out.
I was looking closely at when something like what I write about will begin.
below.

1. I have to be frank about my problems, and I
would not want it.

The idea of ​​forced self-exposure came to me
seems to be largely due to cinematography. “Hello my
name is Dasha and I…”. Indeed, at a certain stage
development in psychology, there was only the concept of “patient”, and
The therapeutic relationship was built primarily from the position that
“The therapist knows better about the patient’s ulterior motives.” Now
psychology is much more open, and more and more people come to the group
“clients” – that is, healthy people who want to understand
relationship difficulties. The position of the patient can
find at addiction groups, clinics or
psychoanalysts.

You will definitely need to give your name (or a fictitious
the name by which the participant wants to be called during the whole
therapeutic process). It will be necessary to say exactly the purpose of coming
per group. Further frankness is a personal matter for everyone.

2. About my history and the fact that I was in the group, will hear later
all internet

The psychotherapeutic process in principle is a place
frank conversations, and the rule of confidentiality is
foundation. The host guarantees the confidentiality of everything that
said on the group, but apart from everything else, each of
present also assumes responsibility for the safety
safety of the therapeutic space. This applies to everything: who
present on the group, stories, biographies of participants, up to
whether to be friends on social networks.

Participation in a group – a certain kind of risk and test
for trust. But everyone, including the presenter, has something to share and
there is something he only talks about in the group. respect for
this space is the key to creating a successful platform for
changes.

3. I don’t have time to talk about what
worries

Really limited during group work
time for each of the participants and good for those who also have
personal therapy, then the therapeutic process goes faster. But
the group is always about relationships in the “here and now”, about living
experiment, and therefore the experience gained in the group is assimilated
stronger. Also, silence can be experienced more strongly, because
participation has to be paid with money: “I come, I am silent, and money
I spend – I didn’t sign up for this. ”

In both cases, the host helps to turn
attention to how a person manifests himself in a group and correlate with that
how it is in his life. Perhaps the feeling that “life
passes by” is also present in everyday life, but only in the group
there is an opportunity to understand how it is organized and how it can be
to correct. Therefore, time is not the main thing, the main thing is inclusion.

4. I will be forced to do something

The group is often confused with personal growth training. On
them, the participants are really offered to do something that displays
them beyond everyday life. In these sessions, participants train
master new facets of the possible, from this there is a feeling
mild euphoria. In essence, training is the acquisition and development of new
skill. How long is a rather rhetorical question.

The group is aimed at deep and high-quality
changes. Changing internally, the environment of a person also changes,
and this is not always a joyful and cheerful process. For this you need to have
sufficient support, courage, a sense of fortification,
opportunity to experience different feelings. So no exercise
except for those aimed at increasing awareness of what is happening, at
group does not occur. A person goes his own way and chooses himself
the pace at which it happens.

5. They will tell me what to do

No, but participants can share their experiences. Feeling
the fact that others are facing similar problems, and they are alive, and
not avatars on the Internet, that they, too, may have doubts
may be at an impasse – this awareness strengthens faith in oneself.
Growth comes not only from receiving support, but also from providing
her.

6. It will be a meeting of unfortunate people

This assumption is also pulled from ready-made
psychotherapeutic cliches. Unhealthy people go to their
specialized groups, and it is difficult to get there. Healthy people –
on their own, and there they create their relationships and receive their
experience. The group is generally held in order to better understand oneself and
to see from the outside, and not engage in “analysis” of their actions, all
postponing life.

And then the moment comes when not yet a client, but
just a person who decides to undergo group therapy. In this case we
we are talking about a closed group where there is a set of constants
participants from start to finish. It’s really exciting and
there must be a lot of courage and trust to take this step,
accept responsibility for future attendance at all meetings,
calculate approximate financial costs – but these are the ten steps
which the individual goes through on their own. Getting into the group
one has to make the journey again in order to stay there
really helpful and productive.

So, how can you help the therapeutic process.

1. State your requests and goals that you want to achieve in
as a result of group work, as well as before each meeting. At the end
listen to yourself and evaluate how satisfied you are with what
happened in the group.

– What did you lack in order to be completely
satisfied process?

– How and at what moments did you stop yourself to
be fully present in the group?

– It will be valuable if you share your observations in
group.

2. Pay attention to how you feel
members of the group? Are there those who evoke the strongest feelings
(love, hate, envy)?

Try to understand which of your relatives (or simply significant people)
does this person remind you of?

It would be great if you could share this with the group.
The group is the place where there is an opportunity to complete, recreate
or just explore complex family relationships or relationships, not
completed in the past.

3. Try to share your feelings and emotions in general in
group. It helps you understand how you are
you block needs in yourself and most importantly – you get
the freedom to choose how to deal with those needs.

4. Try to keep track of your passes. If you have
there is a desire to miss a meeting or repeatedly appear
urgent matters during group work, there may be two
factor:

– Attitude towards the leader (and then it is important to understand what exactly you
you want to say gaps?)

– Attitude towards group process (and then what
happens in a group that you don’t want to go to it?)

5. If there is a desire to make fun of what is happening in the group,
try to notice:

moment?

– What is your personal experience of what is happening?

– The process of “joking” can be a kind of reaction
running away from something or from any relationship. Awareness of this
process can make everyday life richer and brighter.

6. If you want to give advice, pay attention to
how you feel about doing it. Often for the desire to give advice
some need is hiding, realizing it, you can also improve
the quality of your own life.

In any therapeutic process
a special place is given to the completion process. It’s important so
as it gives space to a huge number of possibilities. It’s necessary,
because it is only by completing the old that one can start the new.

It happens that a person himself feels himself
unnecessary and incapable of being in a relationship with anyone, but in
reality is not so, and at every moment of his life others to him
also apply. Expressing one’s feelings and emotions towards
others – a necessary condition for honest feedback and formation
clear picture of reality. Which is actually the beginning of the path to
relationship.

If you feel like finishing your
work in a group, try to warn about this in advance in order to
so that each of those present can realize and express to you their
feelings and emotions. In real life, this possibility
rarely granted, resulting in an unfinished relationship
accumulate and take away a large amount of vital
energy.

If you feel that the thought of
unbearable, then try to trace:

– What feelings do you have?

– What are you fantasizing about finishing?

– What feelings do you hold?

Once again, it would be helpful to share these
experiences with the group or with the leader. Completion experience is also related
with your daily life and awareness of how this
process can greatly enrich your life.

And in general – try to use your time in
useful group, be interested, feel free to contact
therapist in case of incomprehensible situations, because this is the place where
there really is an opportunity to gain new experience and build
into your life.

I wish you to be open to these opportunities, and I will be glad to see you
you in your group!

References:

Whitaker D. Group as an instrument of psychological
help

Gaverdovskaya P. // Individual or group
psychotherapy: what to choose?

Rudestam K. Group psychotherapy

Group psychotherapy, benefits and features simultaneously with several people, as a rule, having similar or identical Problems. Collective therapy has a number of significant advantages, such as increased motivation, receiving powerful moral support. Group psychotherapy classes according to the most effective modern methods are offered by Kiev family psychologist and psychotherapist Natalia Gavrilenko.

Who needs group psychotherapy sessions?

Group psychotherapy, as well as individual psychological consultations, is practiced to solve a number of problems, in particular:

• depressions;

• eating disorders;

• toxic relationships accompanied by psychological and emotional dependence on a partner;

• phobias, panic attacks;

• problems with self-esteem and self-doubt;

• difficult family situations;

• neurotic disorders;

• obsessions;

• psychosomatic deviations.

This format of classes is extremely effective for self-doubt, isolation, excessive shyness, problems with communication, socialization, building interpersonal relationships. Group members who are simultaneously undergoing psycho-corrective classes support each other, and the person understands that he is not alone in his problem.

About the benefits of group therapy

Group therapy has a number of benefits:

1. Powerful moral support.

2. Opportunity to receive non-judgmental feedback not only from a specialist, but also from other group members.

3. Strengthening motivation when working on oneself, solving certain problems.

4. Getting rid of feelings of loneliness.

5. Opportunity to exchange experiences.

6. Application in practice of certain mechanisms aimed at socialization, building constructive relationships with other people.

7. Insulation reduction.

8. Acquisition of practical communication skills.

In fact, the group is a certain space where each of the participants gets the opportunity to self-discovery due to a special atmosphere, acceptance by others, mutual trust. The effectiveness of collective psychotherapy is also explained by the fact that the group is a mini-model of society, where a person uses those patterns of behavior, principles of communication that he also applies in everyday life.

With the help of a specialist, participants note how they relate to themselves and other people, track their thoughts, feelings and emotions, and build constructive interaction. Further, the experience gained and applied in practice is being introduced into real life.

Forms of group psychotherapy

Members of psychotherapeutic groups can be patients suffering from certain disorders, as well as healthy people who need emotional support for personal development, overcoming difficult situations, and solving psychological problems.

Group therapy may take one of the following forms:

1. Thematic. Its main feature is the presence of something in common that unites the members of the group (experience, certain problems, professional affiliation, life circumstances, etc.).

2. Mixed – has a more diverse composition of participants, which may be limited (for example, by age category, gender, the presence of a specific problem that needs to be addressed).

The optimal form of group psychotherapy is selected by a specialist on an individual basis.

How are the classes going?

Collective psychotherapy groups typically have 5 to 10 participants. Sessions are held on average once every 1-2 weeks. However, group psychotherapy can have significant differences both in the duration of sessions (from half an hour to several days) and in the number of meetings (from several days to several years).