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Group therapy is a form of psychotherapy during which one or several therapists treat a small group of clients together as a group. This may be more cost effective than individual therapy,and possibly even more effective.
Quoted with permission is the report of one client:
- "What I got out of group therapy: I was treated with respect, listened to, not judged. I was able to say in "public" what my symptoms were and how I felt. I met other people who had what I had which relieved the feeling of isolation. I learned from the other members of the group what worked for them and copied the skills that worked for me. I got encouragement from the others when I wanted to die. I got compliments when I did well or said something they liked. I had a chance to give and get feedback. I got to hear myself think out loud as I vocally processed what I was dealing with, thus getting it clearer in my own mind."
In group therapy the interactions between the members of the group and the therapists become the material with which the therapy is conducted, alongside past experiences and experiences outside the therapeutic group. These interactions are not necessarily as positive as reported as above, as the problems which the client experiences in daily life will also show up in his or her interactions in the group, allowing them to be worked through in a therapeutic setting, generating experiences which may be translated to "real life". Group therapy may also include other therapeutic forms than "talk" therapy, such as creative therapy and psychodrama. Group therapy is not based on a single psychotherapeutic theory, but takes from many different approaches.
The kind of therapist interactions will vary by psychotherapeutic theory while the amount of therapist interaction will vary due mostly to the type of group setting. A support group type of setting may have little or no therapist interaction while individual therapy in a group setting may have considerable therapist interaction.
Types of therapy group
There are a large number of different types of group therapy. They can be classified by therapeutic approach, type of problem being treated, characteristics of group members etc.
Benefits of group therapy
Some of the many benefits of group therapy:
- Exploring issues in a social context more accurately reflects real life.
- Group therapy provides an opportunity to observe and reflect on your own and others' social skills.
- Group therapy provides an opportunity to benefit both through active participation and through observation.
- Group therapy offers an opportunity to give and get immediate feedback about concerns, issues and problems affecting one's life.
- Group therapy members benefit by working through personal issues in a supportive, confidential environment and by helping others to work through theirs.
Many studies have looked at the effectiveness of group therapy and these have been reviewed in a number of meta-analyses:
- Burlingame et al (2003) conducted a meta-analysis of 111 experimental studies that compared various group therapies with control groups and found substantial evidence to indicate the benefits of groupwork. For example, the overall group therapy versus control group effect size of 0.58 indicated that the average person attending a group was better off than 72% of people who received no group intervention (e.g. remained on a waiting list).
- A meta-analysis by Tillitski (1990) combined results from nine studies that incorporated 75 outcome measures taken from 349 group members. Only studies that contrasted group, individual, and control conditions with a pretest-posttest design were selected. Results indicated that both group and individual therapies (of various models) had a measurable effect that was consistently greater than that of controls.
- McRoberts et al (1998) conducted a meta-analysis of 23 outcome studies that directly compared the effectiveness of individual and group therapy formats when they were used within the same study. Their results matched previous reports that indicated group and individual interventions are equally effective.
Thus, such studies point to two basic conclusions:
- There is considerable research evidence to indicate that various types of group therapy are effective with a variety of populations in a variety of ways, but particularly in the areas of education, personal growth, therapeutic change and support.
- Grouptherapy is usually as effective (and occasionally more effective in terms of some benefits) as individual therapy.
Models of group psychotherapy
The practicality of running psychotherapy groups
=The middle phase of running a psychotherapy group
Groups and the issue of efficiency
On the face of it it is tempting to think that if one therapist can deal with 8 clients at once in a group that that this would save time. After all if each client took 10 session and was appropriately treated in a group 800 hour of individual time could be condensed into 80 hours of group time, saving 720 hours!! If only it were so but of course in reality much of the advantages dissipate: *Group sessions last longer than the individual hour, typically 90 minutes.
- To select 8 people for a group one tends to have to assess 2-3 times that number to find enough appropriate candidates.
- Even then some of the selected people may turn out to be unsuitable and not able to make progress, requiring individual work anyway.
- Groups seem more prone to dropouts so while one may start with 8 participants it would not be unusual to end with only 3-4 regular attenders.
- Proper, thoughtful conduct of groups does require significant preparation time, as the therapist has to consider interactions within the group as well as each individuals characteristics.
- Writing up notes of the group is also a significant overhead.
- In some settings traveling to and preparing the room needs to be taken into account
- If groups run for a time often two therapists are involved to cover holidays and illness and this immediately negates many of the efficiency savings.
- If we add to all this that group therapy may not be as effective as individual treatment Morrison (2001) it is best to regard most group therapy as an option on its own merits and forgo the efficiency argument, which is best sustained with regard to the limited appropriateness of large group therapy.
Although some studies have specifically compared group and individual interventions in terms of cost-effectiveness and found groups to be more cost and resource efficient than providing individual therapy for the same number of people (e.g. McCrone et al, 2005).
Current Trends in Group Therapy
- Social Therapy, first developed in the United States in the late 1970's by Lois Holzman and Fred Newman, is a group therapy in which practicioners relate to the group, not its individuals, as the fundamental unit of development. The task of the group is to "build the group" rather than focus on problem solving or "fixing" individuals.
Therapy group variables studied
The optimal size for groups is a function of the group activity. Where groups anticipate personal exploratory work on the part of participants then 6-8 may be the upper limit, giving each participant time to present and work through their issues.
Technical considerations for group psychotherapy
- Group Analysis
- Group and Organization Mangagement
- Group Decision and Negotiation
- Group Dynamics: Theory, Research, and Practice
- Group Processes and Intergroup Relations
- International Journal of Group Psychotherapy,
- Aspects of group process
- Cog's Ladder
- Conjoint therapy
- Consciousness raising groups
- Encounter group therapy
- Group development
- Group dynamics
- Group-dynamic games
- Group process
- Human potential movement
- Interpersonal relationships
- Large group therapy
- Principles of group therapy
- Sensitivity training
- Small group
- Support groups
- Systemic Constellations
- Talking circle
- Therapeutic community
- Transactional analysis
- Twelve step programs
- Types of group therapy
- Burlingame, G, Fuhriman, A & Mosier, J (2003) The differential effectiveness of group psychotherapy: A meta-analytical perspective. Group Dynamics: Theory, Research and Practice, 7, 3-12.
- McCrone, P, Weeramanthri T, Knapp M, Rushton, A, Trowell, J, Miles, G & Kolvin, I (2005) Cost-effectiveness of individual versus group psychotherapy for sexually abused girls. Child and Adolescent Mental Health, 10, 26–31.
- McRoberts, C, Burlingame, G & Hoag, M (1998) Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective. Group Dynamics: Theory, Research and Practice, 2, 101-117.
- Tillitski, C (1990) A meta-analysis of estimated effect sizes for group versus individual versus control treatments. International Journal of Group Psychotherapy, 40, 215-224.
Key texts – Books
- Bloch S and Crouch E (1985) Therapeutic Factors In Group Psychotherapy Oxford University Press: Oxford
- Foulkes, S H (1948) An Introduction to Group Analytic Psychotherapy London: Heinemann. Reprinted London : Karnac, 1983
- Foulkes, S & Anthony, E (1965) Group Psychotherapy: The psychoanalytic approach. London: Karnac.
- Foulkes S H (1975) Group Analytic Psychotherapy; Method and Principles pp 27-63
- MacGowan, M (2008) A Guide to Evidence-Based Group Work. Oxford: Oxford University Press.
- Manor, O (ed) (2009) Groupwork Research. London: Whiting and Birch.
- McDermott, F (2002) Inside Group Work: A guide to reflective practice. Crows Nest: Allen & Unwin.
- Stock Whitaker, D (2001) Using Groups to Help People. London: Routledge.
- Toseland, R & Rivas, R (2005) An Introduction to Groupwork Practice. London: Pearson.
- Yalom, I (2005) The Theory and Practice of Group Psychotherapy. New York: Basic Books.
Additional material – Books
- Bion, W (1961) Experiences in Groups. London: Tavistock.
Key texts – Papers
- Dewar, M. (1996) The Technique of Group Therapy. Therapeutic Communities Vol. 17, No. 4 : p.p. 92 - 94.
- Foulkes, S.H. (1996) Principles and Practice of Group Therapy. Therapeutic Communities Vol. 17, No. 2 : p.p. 95 -99.
- Grantham, P Seminars in Effective Groupwork; The Essential Toolkit for Running Groups. See 
- Grantham, P & Budnik, Y (2006) Styles of therapeutic groups: rethinking the model of White & Lippitt. Abstracts from the All-Russia scientific conference on clinical psychology: The future of clinical psychology. Perm, Russia.
- Morrison, N. (2001). Group cognitive therapy: Treatment of choice or sub-optimal option? Behavioural and Cognitive Psychotherapy, 29, 311-332.
Additional material - Papers
- Google Scholar
- Doel, M & Sawdon, C (2001) What makes for successful groupwork? A survey of agencies in the UK. British Journal of Social Work, 31, 437–63.
- Popovic, M. (1975). Group therapy: Psihijatrija Danas Vol 7(2-3) 1975, 7-23.
- Popovic, M. (1977). Clinical inpatient therapy: Psihijatrija Danas Vol 9(1) 1977, 91-97.
- Useful directory site for UK groups -for specific needs
- Useful site about group psychotherapy and shame, with extensive links to other group therapy sites
- McGowan's website
Group therapy: Academic support materials
- Group therapy: Lecture slides
- Group therapy: Lecture notes
- Group therapy: Lecture handouts
- Group therapy: Multimedia materials
- Group therapy: Other academic support materials
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