Defining the Group-Therapy Approach

Group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together at the same time. Receiving therapy in a group changes the therapist-client relationship dramatically, and therefore affects outcomes. While group therapy is sometimes used alone, it is more often used as part of a greater treatment plan that may include one-on-one therapy and/or medication.

The term "group therapy" is sometimes loosely used to indicate any group of individuals that are experiencing and discussing distress (support groups, for instance). Group therapy can be based on any theoretical approach, from cognitive-behavioral to humanistic. However, in the psychodynamic sense, it specifically indicates a situation where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring, and examining interpersonal relationships within the group. In short, the interpersonal dynamics that play out in the group are reflections of what happens in real life.

Group dynamics

The group context and group process is explicitly used as a mechanism of change by developing, exploring, and examining interpersonal relationships within the group and seeing them as reflections of what happens in real life.

Therapeutic Principles

Dr. Irvin D. Yalom outlined key therapeutic principles, which are derived from reports of individuals who have undergone group therapy. These principles summarize the benefits of group therapy:

• Altruism: Group members share their strengths and experiences in order to help others. The experience of being able to give something to another person can lift the member's self-esteem and help develop more adaptive coping styles and interpersonal skills.
• Catharsis: The experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.
• Cohesiveness: It has been suggested that this is the primary therapeutic factor from which all others flow. Because all members share a common goal, there is a shared sense of belonging, acceptance, and validation.
• Corrective recapitulation of the primary family experience: Seeing the group as a family may help group members gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful interactive patterns in present relationships.
• Development of socializing techniques: The group setting provides a safe and supportive environment for members to take risks by practicing interpersonal behavior and improving social skills.
• Existential factors: Group therapy helps members realize that they are responsible for their own lives, behaviors, and decisions.
• Imparting information: Group members report benefiting from sharing information about themselves and one another, such as personal experiences.
• Imitative behavior: One way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members.
• Instillation of hope: In a mixed group that has members at various stages of the treatment process, seeing members that are in later stages of coping or recovery may give hope to those in early stages.
• Interpersonal learning: Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member's behavior and impact on others.
• Universality: Sharing an experience with a group helps people see that they are not going through something alone. It also serves to remove a group member's sense of isolation, validate their experiences, and raise self-esteem.

History of Group Therapy

The founders of group psychotherapy in the USA were Joseph H. Pratt, Trigant Burrow, and Paul Schilder on the East Coast in the first half of the 20th century. After World War II, group psychotherapy was further developed by many therapists. In particular, Irvin Yalom's approach to group therapy has been influential not only in the United States but across the world. 

An early development in group therapy was the T-group or training group (sometimes also referred to as sensitivity-training group, human-relations-training group or encounter group). This is a form of group psychotherapy where participants (typically, between eight and 15 people) learn about themselves and about small-group processes in general through their interaction with each other. They use feedback, problem solving, and role play to gain insights into themselves, others, and groups. It was pioneered in the mid-1940s by Kurt Lewin and Carl Rogers and his colleagues as a method of learning about human behavior in what became the National Training Laboratories (now NTL Institute) in 1947. 

Efficacy of Group Therapy

Group therapy has proven to be very effective for the treatment of depression and traumatic stress, such as that suffered by sexual abuse survivors and people with post-traumatic stress disorder (PTSD). There is also good evidence for effectiveness with chronic traumatic stress in war veterans. However, there is less robust evidence of good outcomes for patients with borderline personality disorder. These patients may require additional support beyond group therapy. This theory is borne out by the impressive results obtained using mentalization-based treatment, a model that combines group therapy with individual therapy and case management. Clinical cases have shown that the combination of both individual and group therapy is typically the most beneficial for most clients.

Criticisms of Group Therapy

As mentioned, the term "group therapy" is sometimes loosely used to include support groups and other non-psychiatric groups. Because of this, a person seeking the benefits of group therapy or a support group may have trouble distinguishing between the many options that exist. Someone looking for the help of a professional psychiatrist may not get the medical attention they need if they enter a more casual group. Additionally, group therapy alone may not be sufficient for some psychiatric disorders.