Group therapy is a form of psychotherapy where one or more therapists treat a small group of clients together. Group therapy, like individual psychotherapy, is intended to help people who would like to improve their ability to cope with difficulties and problems in their lives. The therapist uses the emotional interactions of the group members to help them get relief from distress and modify their behavior. The aim of group psychotherapy is to help with solving the emotional difficulties and to encourage the intra- and interpersonal development of the participants in the group. At least 3, and usually more, group members are necessary to establish the critical mass that allows the types of interactions that give the psychotherapy group its unique character. From 6 to 10 members is considered an ideal number, and 13 or more are too many. With too many members, it is impossible to create a therapeutic atmosphere and have enough time for each member to work personally. The group meets regularly at stated intervals, usually once a week, for a specific period of time, for the purpose of bringing about psychological change in the group members. The length of each session can be from 1½ hours to 3 hours. The duration of the group—from a few months to a few years—depends on many components, such as the severity of the problems and the outcome goals sought. Having a designated leader is an essential aspect of group therapy.
Group psychotherapy and group therapy are often used synonymously with group therapy being the colloquial and shortened version. Group therapy is also used on occasion to represent a broader category of group work. In addition, some practitioners use the terms group counseling and group psychotherapy interchangeably. However, position statements issued by the Association of Specialists in Group Work (ASGW) of the American Counseling Association (ACA) have defined the terms as two different entities with group psychotherapy being one of four distinct group types: task groups, psychoeducational groups, counseling groups, and psychotherapy groups.
Task groups are designed to accomplish identified work goals. They include committees, task forces and social action groups, study circles and learning groups, planning and discussion groups, and other group experiences where the participants have a task to accomplish that is external to the individual members. Psychoeducational groups provide participants with information, skills, and increased awareness of some life problem and the knowledge and tools to better cope with it. The goal is to prevent various psychological problems and educational deficits by imparting, discussing, and integrating factual information.
Counseling groups are very similar to therapy groups. However, counseling groups are not concerned with the treatment of more severe behavioral and psychological disorders. The main differences between psychotherapy and counseling groups is that counseling groups are not aimed at major personality changes; they deal primarily with conscious problems and they focus on resolving specific short-term concerns.
The psychotherapy group, more than other types of groups, is designed primarily to help individuals with chronic or acute emotional or mental disorders that produce marked distress and impairment. The group allows individual group members to reconstruct major personality dimensions and remediate in-depth psychological problems. Thus, psychotherapy groups focus upon addressing personal and interpersonal problems of living, modifying perceptual and cognitive distortions, reducing repetitive patterns of dysfunctional behavior, and promoting personal and interpersonal growth and development among participants who are experiencing severe or chronic maladjustment. Psychotherapy groups allow for the development of appropriate group norms and task elements necessary to support the intensity of the social and emotional interaction that promotes change. While conceptualized, composed, and conducted as an intervention to deal with those needing intense interpersonal work to modify major psychological dysfunctions, it can also provide attention to interpersonal problem solving and to psychoeducational information and skill acquisition as a part of the overall therapeutic group experience.
Psychotherapy groups provide a safe environment in which group members can experiment with new ways of looking at life, experiment with new behaviors, and offer a powerful opportunity for positive change. Even though group psychotherapy frequently focuses on participants with severe problems, the scope of group psychotherapy is extremely broad. Psychotherapy groups are used to treat individuals with mild to moderate personality problems, interpersonal conflicts, and neurotic disorders. Psychotherapy groups are especially helpful in improving interpersonal relationships, although evidence suggests they are quite useful for anxiety and depression. Groups are ideally suited to people who are struggling with issues like intimacy, trust, and self-esteem. The group interactions help the participants to identify, get feedback on, and change the patterns that are sabotaging their relationships outside the group. The great advantage of group psychotherapy is working on these patterns in the “here and now”—in a group situation similar to members’ reality and close to their interpersonal events. Members learn how they can achieve more happiness in general and how to create meaningful, supportive, and loving relationships with others. Groups also create a setting where, through seeing others who are struggling with similar concerns, participants find their issues normalized, and through seeing others succeeding, participants are given hope.
Group psychotherapy is based on the fact that mental dysfunction and emotional illness can be relieved through the psychological effects of several people upon one another. Improvement in mental functioning tends to alleviate psychological distress and may eventually alleviate mental illness. This has inspired numerous efforts to utilize the healing force of the group to meet the therapeutic needs of a wide range of clients—individuals at all phases of the life cycle with highly diverse problems needing treatment. Simultaneously, virtually all schools of psychotherapy have embraced group practice and have attempted to incorporate their respective conceptual frameworks into group work. As a result, group psychotherapy is not based on a single theoretical perspective, but takes from many theories what seems to be most helpful. The techniques used in group therapy can be verbal, expressive, psychodramatic, and so forth. The approaches can vary from psychoanalytic to behavioral, from Gestalt to encounter, from existential to rational. Each approach has its advantages and drawbacks.
Groups differ not only in their theoretical approach, but also in their focus and application. Some of these differences may be based on the therapist’s general orientation and specific approaches; the goals of the treatment; the subjects of the treatment, including problem areas and client characteristics; setting; and the time and duration components of the group.
Groups can be categorized as either small or large, short term or long term, outpatient or inpatient, ongoing or time limited. Psychotherapy groups can be open groups or closed groups. Open groups replace members as they drop out or terminate. Closed groups, after a period of forming, do not allow new members to join. Psychotherapy groups can be heterogeneous or homogeneous. Heterogeneous groups have members with quite different presenting diagnoses, complaints, or life problems. Homogeneous groups are made up of people with the same presenting diagnosis, complaint, or life problems. Usually psychotherapy groups are composed of individuals who do not have preexisting emotional ties to each other, although couples may become a part of a group of unrelated persons or may join other couples in a couples’ group. Families also may be treated using a group modality—referred to by names such as multifamily group psychotherapy, family group consultation, and others. Some psychotherapy groups focus on a specific area of common concern, such as relationships, anger, stress-management, and so forth. These groups often have an educational or teaching component and are frequently more time limited than general process-oriented psychotherapy groups. These homogeneous groups are especially beneficial for providing support, normalizing the concern, and encouraging modeling of participants who are successfully addressing their issues.
Group therapy is also used in psychiatric hospitals, general medical hospitals, and outpatient clinics to help clients deal with the psychological impact of terminal illness, cancer, attempted suicide, and stress. Individuals with profound ego impairment can be treated in psychotherapy groups in hospital groups, post-hospital follow-up groups, and day hospital groups. Group psychotherapy is extremely helpful as a part of an overall institutional treatment program in combination with psychological medication, individual therapy, and milieu therapy. Large psychotherapy groups are usually conducted in community or institutional settings, and such groups are often organized to work on a specific problem—for example alcoholism, obesity, rehabilitation, or another area of concern.
The prototypical psychotherapy group is the open, heterogeneous, outpatient group that meets weekly for 6 months or more, admitting new participants as necessary to maintain a critical mass. The group therapist, leader, or facilitator chooses as candidates for the group those people who can benefit from group interaction and who are likely to have a useful influence on other members in the group. Most screening and selection procedures are subjective and rely on the intuition and judgment of the group leader. Usually, a moderate amount of social ability and psychological-mindedness, along with some commitment to change interpersonal behaviors and some positive expectations about the benefits of group treatment, are considered important for participation in a group. Certain individuals are less likely to benefit. These include people who are extremely self-centered, acutely psychotic, highly paranoid, or actively suicidal, or extremely aggressive and hostile people, with a tendency to act out.
Group psychotherapy is the deliberate effort to alter the feelings, thinking, and behaviors of group members. In group therapy, past experiences, experiences outside the therapeutic group, and especially the interactions between the members of the group and the therapists become the material for the therapy. Frequently, the people in the group represent others in participants’ past or current lives with whom they have difficulty. Essentially, the problems that the clients experience in daily life will also show up in their interactions in the group, allowing the problems to be worked through in a therapeutic setting, generating experiences and behaviors that may be transferred back to life outside the group.
Members of the group share with the others in the group personal issues that they are facing. Participants can talk about events they were involved in during the week, their responses to these events, and the effectiveness of those responses. Participants can share their feelings and thoughts about what happened in previous sessions, and relate to issues raised by other members or to the leader’s words. Other participants can react to words and behaviors, give feedback and encouragement, provide support or criticism, or share their thoughts and feelings following interactions. The leader does not determine the subjects for discussion, as subjects rise spontaneously from the group. The members in the group feel that they are not alone with their problems, and they discover that there are others who are experiencing similar issues. The group can become a source of support and strength in times of stress for the participant. The feedback they get from others on behavior in the group can make them aware of maladaptive patterns of behavior. At that point, they can change perceptions and points of view, and they can adopt more constructive and effective reactions. The psychotherapy group can become a laboratory for practicing new behaviors.
Group psychotherapy is suitable for people with a large variety of problems and difficulties, from people who would like to develop their interpersonal skills to those with emotional problems such as anxiety, depression, and so forth. While support groups are developed for people in the same situation or crisis (e.g., groups for bereaved parents, groups for sexually abused women), the prototypical psychotherapy group is as heterogeneous as possible. The leader will try to include men, women, young and old people, married, and singles when choosing people for the group in order to create a microcosm of the participants’ world. As noted earlier, the likelihood that group participants will manifest their particular issues in the group makes group psychotherapy especially effective for people with interpersonal difficulties and problems in social, personal, or work relations.
Group psychotherapy is usually more cost effective than individual therapy, and possibly even more clinically effective. Evidence from studies published over the last 20 years supports the overall effectiveness of group psychotherapy, and differential effectiveness is dependent upon complex interactive variables present in group treatment.
There are many benefits of group therapy. Because of the confidential, supportive atmosphere, group members can work through personal issues themselves and help others to work through theirs, with members benefiting both through observation and active participation. The group allows members to explore their issues in a social context that mirrors real life, and it provides members with an opportunity to observe and reflect on social skills and to give and receive immediate feedback about issues, problems, and concerns affecting life.
Many professional helpers conduct psychotherapy groups: psychologists, counselors, social workers, psychiatrists, and psychiatric nurses and technicians. The best group psychotherapists are well-trained, reliable, and ethical professionals. Reputable group psychotherapists usually belong to professional associations. In the United States, for example, membership in American Psychological Association (APA), ASGW, American Group Psychotherapy Association (AGPA), and other counseling organizations suggests a professional commitment. The only two credentials that apply specifically to group therapists and assure some degree of expertise are the Certified Group Psychotherapist, or CGP, granted by the AGPA and the Diplomate in Group Psychology awarded by the American Association for Professional Psychology (ABPP). However, many psychologists, counselors, and so forth are very effective as group leaders even though they have not attained these professional credentials.
Counselors and Therapists; Family Counseling; Interpersonal Learning and Interpersonal Feedback; Psychoeducation; Self-Help Groups
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