Group therapy is an evidence-based psychotherapy approach where one or two trained mental health professionals facilitate treatment sessions with multiple clients simultaneously. The American Psychological Association recently identified group psychotherapy as a unique specialty. In this setting, the group collaborates to improve each member's symptoms and self-awareness.

Evidence suggests that group psychotherapy is as effective as individual psychotherapy, making it a valuable and cost-effective treatment option that can expand access to mental health care.

Research demonstrates that group psychotherapy has been shown to be equivalent to individual therapy for many disorders, including anxiety, depression, grief, eating disorders, and schizophrenia. Recent meta-analyses have found that group therapy is as effective as individual therapy for an array of symptoms and conditions, with the added benefit of potentially serving more people at lower costs. In fact, meeting the unmet psychological need in the United States with group therapy would save more than $5.6 billion and require 34,473 fewer new therapists than individual therapy. If just 10% of this need were met by group instead of individual therapy, 3.5 million more people could be seen.

Table of Contents

  • Who Is Group Therapy For?
  • The Role of Group Therapy in Treatment
  • Types of Group Therapy
  • What to Expect in Group Therapy
  • Group Therapy Activities and Techniques
  • Making the Most of Group Therapy
  • Ethics and Confidentiality
  • Frequently Asked Questions
  • How Therapy Can Help

Who Is Group Therapy For?

Group therapy can help people address a wide range of mental health concerns and life challenges. This approach can be used to treat a variety of conditions, including, but not limited to, trauma, anxiety, depression, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder. Some of the topics commonly addressed in group therapy include:

  • Addiction and substance use disorders - Groups provide peer support and accountability during recovery
  • Trauma and abuse - Sharing with others who understand similar experiences reduces isolation
  • Anxiety and depression - Learning coping strategies while realizing you're not alone in your struggles
  • Grief and loss - Processing bereavement with others navigating similar pain
  • Relationship issues - Practicing communication skills and receiving feedback in a safe environment
  • Anger management - Learning emotional regulation techniques alongside peers
  • Eating disorders - Addressing disordered eating patterns with group support
  • Chronic pain or illness - Coping with health challenges through shared experiences

Groups can be particularly fruitful for people of marginalized identities, offering support and solidarity from others with similar experiences. For instance, a meta-analysis of group interventions for trauma and depression in refugee adults and children led by Maryam Rafieifar, PhD, a social worker now at Montclair State University in New Jersey, found reduced symptoms of posttraumatic stress.

Keep in mind that a therapist may not recommend group therapy as a treatment option at first. One reason is that it can be difficult to share personal information in a group setting, especially at the beginning of treatment. However, many people find that their initial nervousness quickly fades as they experience the supportive nature of the group environment.

The Role of Group Therapy in Treatment

Many people use group therapy alongside other forms of treatment, creating a comprehensive approach to mental health care. Some clients may be simultaneously involved in other therapies, such as individual psychotherapy and pharmacotherapy, with various healthcare professionals, including social workers, psychologists, psychiatrists, nurse practitioners, nurses, and rehabilitation therapists. Some treatment programs for more seriously ill patients may require participation in multiple modalities, including occupational therapy, rehabilitation therapy, vocational rehabilitation, and substance use treatment. This comprehensive approach enhances the client's treatment experience, provides essential support, and expands the range of issues that can be addressed.

You may be doubtful about receiving treatment in a room of strangers. However, there are many research-supported benefits to participating in group therapy:

Universality and Connection

In addition to effectiveness in reducing symptoms, group offers members a sense of belonging, purpose, hope, altruism, and meaning throughout treatment. Members often express relief when they discover others share similar struggles, reducing feelings of isolation.

Social Learning

Group members can learn from observing how others cope with similar problems. Seeing peers successfully manage challenges provides hope and practical strategies.

Interpersonal Learning

The group becomes a social microcosm where members can practice new ways of relating to others and receive immediate feedback in a supportive environment.

Cost-Effectiveness

Preliminary studies demonstrate its potential: a 2023 network meta-analysis found group CBT equally effective as individual CBT for depression but with 40% lower per-patient costs.

It's important to note that group therapy differs from self-help or support groups. The main distinction is that each group therapy session is led by at least one qualified therapist. During sessions, therapists teach research-backed techniques and facilitate therapeutic processes that other types of groups cannot guarantee.

Types of Group Therapy

There are many different types of therapeutic groups, but most can be categorized into several main approaches:

Psychoeducational Groups

These groups focus on providing members with information about specific mental health conditions and teaching healthy coping skills. In psychoeducational groups, the therapist takes on the role of teacher, leading structured sessions with specific learning objectives. Topics might include:

  • Understanding symptoms and triggers
  • Medication management
  • Stress reduction techniques
  • Communication skills
  • Relapse prevention

Process-Oriented Groups

These groups emphasize the interpersonal dynamics and relationships within the group itself. The therapist acts as a facilitator rather than an instructor, helping members explore their patterns of relating to others. In process-oriented group therapy, the group is in charge of their sessions.

Cognitive-Behavioral Therapy (CBT) Groups

This study addresses the gap in understanding the varied effectiveness of group cognitive behavioral therapy (gCBT) delivered by different professionals. This study aims to address this gap by conducting a systematic review of randomized controlled trials (RCTs) that evaluate gCBT and compare it to inactive controls in adults with a clinical diagnosis of depression. CBT groups focus on identifying and changing negative thought patterns and behaviors.

Skills-Based Groups

These groups teach specific skills such as:

  • Dialectical Behavior Therapy (DBT) skills - Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness
  • Social skills training - For individuals who struggle with social interactions
  • Anger management - Techniques for managing intense emotions

Support Groups

While technically different from therapy groups, support groups led by mental health professionals combine peer support with professional guidance for specific populations or conditions.

What to Expect in Group Therapy

Understanding what happens in group therapy can help reduce anxiety about joining a group. Here's what you can typically expect:

Group Structure

Group therapy is the treatment of multiple patients at once by one or more healthcare professionals. Group sizes typically range from 6 to 12 members, though some specialized groups may be smaller or larger. Castore's (1962) study of the number of verbal interrelationships in inpatient groups of varying sizes demonstrated sharp drops in verbal interrelations when the group reached nine and seventeen members, concluding that five to eight members is optimal for patient participation. Here again, however, the nature and goals of the group in question determine optimal size.

Meeting Schedule

Patients could enter and exit IPT-G every eight sessions and follow up to 24 sessions. CBT-G was a closed, semi-structured psychotherapy group for patients with major depressive and anxiety disorders, with a maximum of 14 sessions. Groups typically meet weekly for 1-2 hours, though frequency and duration vary based on the specific program and treatment goals. Trials specified that participants had to attend a median of 62.5% (range 16.7%-80%) of sessions, in order to receive a 'therapeutic dose'.

Physical Setting

Most groups meet in a quiet room with chairs arranged in a circle so that each person can see everyone else. This arrangement promotes equal participation and connection among members.

Types of Groups

Groups can be either:

  • Open groups - New members can join at any time
  • Closed groups - All members start and progress through the program together

The combined N for individual studies and meta-analyses was 21,425 and the number of studies (k) included across both individual studies and meta-analyses was 172. This extensive research base demonstrates the widespread use and effectiveness of various group formats.

Typical Session Flow

1. Check-in - Members briefly share how they're doing or any updates since the last session

2. Topic introduction - The therapist may introduce a theme or skill for the session

3. Group discussion or activity - The bulk of the session involves group interaction, skill practice, or processing

4. Wrap-up - Summary of key points and preparation for the next session

Group Therapy Activities and Techniques

Modern group therapy incorporates a variety of evidence-based activities and techniques designed to promote healing and growth:

Mindfulness and Relaxation Techniques

Mindfulness plays an imperative role in any therapy setting. Meditation has many proven benefits, from boosting happiness, improving sleep, reducing stress, and enhancing focus. Common mindfulness activities include:

  • Guided meditation
  • Body scan exercises
  • Deep breathing techniques
  • Progressive muscle relaxation

Cognitive-Behavioral Activities

Cognitive Behavior Therapy (CBT) employs cognitive behavioral techniques that focus on changing negative thought patterns that lead to damaging behaviors and beliefs. Activities may include:

  • Thought challenging exercises
  • Behavioral activation planning
  • Problem-solving workshops
  • Role-playing challenging situations

Creative and Expressive Activities

Art therapy can be a powerful tool in group settings, allowing participants to express themselves creatively and explore emotions that may be difficult to verbalize. Expressive arts therapy incorporates various forms of creative expression, including drawing, painting, sculpture, and photography.

Interpersonal Activities

  • Role-playing - Practicing difficult conversations or new communication styles
  • Feedback circles - Structured sharing of observations and support
  • Conflict resolution practice - Learning to navigate disagreements constructively
  • Trust-building exercises - Activities designed to foster group cohesion

Psychoeducational Components

Groups often include educational elements such as:

  • Mini-lectures on mental health topics
  • Skill demonstrations
  • Homework assignments to practice between sessions
  • Resource sharing

Technology-Enhanced Activities

With the rise of telehealth, a systematic review was conducted to collate what is currently known in the published and grey literature on online group therapy, using the PRISMA framework. Online groups may use:

  • Breakout rooms for small group discussions
  • Screen sharing for educational materials
  • Digital whiteboards for collaborative activities
  • Online mood tracking tools

Making the Most of Group Therapy

To get the most benefit from group therapy, consider these evidence-based strategies:

Active Participation

One of the most powerful aspects of group therapy is that it allows members to navigate conflict in a semisheltered social environment. Engaging fully in group activities and discussions enhances therapeutic outcomes.

Openness to Feedback

Group therapy provides unique opportunities to receive feedback from multiple perspectives. Being receptive to others' observations can accelerate personal growth.

Practice Between Sessions

Many groups assign homework or encourage members to practice skills between meetings. Members work together to develop coping strategies, practice new behaviors, and support each other's growth.

Building Relationships

The relationships formed in group therapy often become an important source of support. The results showed that cognitive behavioral group therapy is highly effective for women with breast cancer, significantly reducing depression and anxiety while improving pain-coping strategies. The findings highlight the therapy's potential as a beneficial intervention for managing psychological and pain-related challenges.

Cultural Considerations

Cultural diversity, groups and psychotherapy around the world. Examining social identities and diversity issues in group therapy: Knocking at the boundaries are important considerations for creating inclusive group environments.

Ethics and Confidentiality

Ethical guidelines are fundamental to group therapy practice:

Confidentiality Agreements

All group members must agree to protect the identities and personal information of fellow members. What is shared in group stays in group. This creates the safety necessary for authentic sharing and vulnerability.

Professional Boundaries

When a therapist serves as both the group leader and the individual therapist for a client, it fosters a deeper relationship between the therapist and the client. However, this may also raise concerns among group members about potential favoritism, underscoring the need for clear boundaries.

Limits to Confidentiality

It's important to understand that confidentiality has limits. Therapists are obligated by law to report if members express intent to harm themselves or others, or if there are disclosures of child or elder abuse.

Creating a Safe Environment

The group therapist must maintain a professional, respectful, and ethical environment free from discrimination, harassment, or any behaviors that make members feel unsafe or threatened.

Frequently Asked Questions

How do I know if group therapy is right for me?

Group therapy can benefit most people, but it may be particularly helpful if you want to improve interpersonal skills, feel isolated in your struggles, or could benefit from peer support. The Group Readiness Questionnaire can help assess how receptive a patient may be to group therapy.

What if I'm too anxious to share in a group?

It's normal to feel nervous at first. Patients who are not ready for groups can still benefit, but may need preparation and preorientation. You can participate by listening initially and share when you feel comfortable.

How is group therapy different from support groups?

Group therapy is led by licensed mental health professionals who facilitate therapeutic processes and teach evidence-based skills. Support groups, while valuable, may not have professional leadership or structured therapeutic interventions.

Can I do both individual and group therapy?

Absolutely! Many people find that combining individual and group therapy provides comprehensive support. This comprehensive approach enhances the client's treatment experience, provides essential support, and expands the range of issues that can be addressed. Combined therapy: When a therapist serves as both the group leader and the individual therapist for a client, it fosters a deeper relationship between the therapist and the client.

How long does group therapy typically last?

Duration varies by program. Some groups are time-limited (8-16 weeks), while others are ongoing. Data collection begins at inclusion, continues during the 8-week intervention, and is followed up after 6 months. For the primary outcome, all patients are followed until six months after the last therapy session.

What happens if I don't connect with my group?

Give it a few sessions, as groups often need time to develop cohesion. If after 3-4 sessions you still don't feel it's a good fit, discuss your concerns with the group leader or consider trying a different group.

How Therapy Can Help

Group therapy offers a unique and powerful path to healing through the combination of professional guidance and peer support. Research on group therapy over the past 30 years has been summarized in 11 meta-analyses, including 329 randomized controlled trials and 370 comparisons between group therapy and various control groups, together involving over 27,000 patients. Meta-analytic results demonstrate that group therapy is effective compared with nonactive treatment and is equivalent to other active treatments for various mental disorders.

The benefits extend beyond symptom reduction. Group therapy helps people develop:

  • Stronger interpersonal skills
  • Increased self-awareness
  • Better coping strategies
  • A sense of belonging and community
  • Hope through witnessing others' progress
  • Confidence in their ability to help others

Whether you're dealing with depression, anxiety, trauma, relationship issues, or other mental health concerns, group therapy provides a supportive environment for growth and healing. The shared human experience of struggling and overcoming challenges together creates a unique therapeutic power that individual therapy alone cannot replicate.

If you're considering group therapy, reach out to a mental health professional who can help you find the right group for your needs. Remember that taking the first step into a group setting requires courage, but the potential rewards—connection, understanding, and healing—make it a journey worth taking.

Find a Therapist

Ready to explore group therapy options? Use the GoodTherapy directory to find qualified group therapists in your area who specialize in your specific concerns. Many therapists offer both in-person and online group options to meet your needs and preferences.

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