Group therapy is an evidence-based modality of therapy that is used to treat a range of problems including relationship difficulties, personality issues, grief, trauma, substance abuse, anxiety, and depression.

Groups have been shown to be a powerful way for individuals to learn about themselves and their intimate relationships. Developing intimate relationships with complete strangers can seem daunting, but when group members are able to develop deeply personal relationships, experiences can be profoundly healing and transformative.

12 Tips for Participating in Group Therapy

1. Set an intention to be open.

Enter the group with an intention to develop relationships with other group members. Equip yourself with the courage to be transparent, curious, and self-reflective. Articulate your personal thoughts, feelings, and judgments as they emerge during the group. You will become more connected to yourself and others as you claim time to speak and become engaged in the task of group therapy.

2. Respect and guard group boundaries.

Maintain confidentiality of content in the group and the anonymity of group members. Arrive on time. Stay for the duration of the group. Attend each group session and if you have to be absent, let the group know in advance. Keep all interactions between group members to the group room, and if that boundary is breached, bring the interaction back to the group. Protect the boundaries by speaking to your behaviors around boundaries. Let others know how you feel about their behaviors. The group will feel safer when you respect and attend to boundaries.

3. Practice authentic connection.

Share your inner subjective experience — how others affect you, and how you connect (or don’t connect) to what is being shared. Look for commonalities with others in the group. Notice how you connect with other’s stories, feelings, goals, etc. Share your inner subjective experience — how others affect you, and how you connect (or don’t connect) to what is being shared. Notice when you feel closer to someone and when you pull away. Allow yourself to dislike someone or a behavior. At first, you may feel that you do not fit in with other group members — you may see yourself as superior, inferior, or just incompatible based on any number of demographic or other dimensions. Letting others know of how your perception of these differences is getting in the way of your trusting the group can be the first step to building authentic connection.

4. Take up your fair share of group time.

Notice when you choose to be silent instead of saying what is on your mind. Add your log to the fire. Notice what you choose to edit. Be curious when you are chronically taking up more air time than others. You will get out of group only as much as you risk expressing verbally.

5. Take a risk: Avoid social niceties.

Early in the group, it may be hard to avoid wanting to be liked or trying not to offend. However, you will need to take risks to learn about yourself in relationships and your impact on others. Your willingness to look unvarnished, illogical, vulnerable, and unresolved will evolve as the group matures. Don’t be helpful. Your authentic feelings about a topic or person are more useful to the individual (and the group as a whole) than your approval and/or solving their problem.

6. Be curious about yourself and others.

Ask questions about others and invite others’ curiosity about you. If you find yourself curious about someone in the group, ask questions. The person can always decline to answer. Above all, bring your curiosity about yourself. Ask for feedback. Ask if something you do is off-putting or generates closeness. Welcome and invite others’ to provide you with their unfiltered experience of you.

7. Bring any topic.

Share your suffering, your pain, your dilemmas, your worries, your failures with group members and ask them to confront and hold you until you find the courage and clarity to make changes. Also bring your joys and successes. Explore your love and your hate. Evoke God and spirituality. Actively bring what you need to talk about when you need to talk about it regardless of what others might be going through.

8. Examine your choices.

Bring up life decisions with the group early on in your decision-making process — including thoughts about possibly leaving the group. Ask the group for help in identifying the problem, looking at your motivations, identifying your options, and evaluating how they might work out for you. What are you trying to fix and how? The process will highlight some of your issues around identifying your needs, identifying your intentions, and how your choices undermine your own thriving.

9. Trust the process.

By sharing whatever arises inside of you, at a given moment you are giving over to the process, contributing your share of the human story, giving others a chance to get you, and facilitating a process through which you will learn to trust. But don’t wait for the process to take you to where you need to go. What you are willing to share will evolve over time. You will have to initiate self-disclosure, correct mis-representations of yourself, and divulge secrets to present yourself more authentically.

10. Take care of your relationships in the group first.

Keep in mind that while an outside issue may be a useful starting point in the group, the greatest learning will happen when thoughts, feelings, and judgments come up about group and during group. We call this being in the “here and now” or “being in the room.” Stay in the room, as much as possible. Ask yourself what you can or can’t connect with, whom you identify with, and whom you have written off. At first, it may feel difficult to bring up feelings in the heat of the moment. So as in any long-term relationship, come back to leftover feelings with the intention of getting closer.

11. Make a better family for yourself.

You have to get stuck in group so you can learn to get unstuck.The group is designed to bring up unconscious issues so that you can learn to notice and let go of old ways of treating yourself and others. Most likely, some of these ways of being will come up early in the group. You have to get stuck in group so you can learn to get unstuck. Be curious about the intensity of your reaction. Remember the ‘7-minute rule,’ i.e. if your emotions are very intense and last more than 7 minutes, you are in transference . While it may feel overwhelming to feel yourself so exposed, remind yourself that this is when you will learn the most about the unconscious patterns you bring to relationships. You have the opportunity over the next few months to create corrective experiences with this group.

12. In short, make it your group.

Don’t wait to get what you need from members of the group or the therapists. Let people know when you feel discontent. If you want to add your voice, interject or interrupt. If the group does not feel as alive as you want, say so. If you want more, be real and vulnerable with someone in the room. If you don’t trust someone, address your feelings with some urgency. If something is going unacknowledged, point it out. If the therapist said something you don’t like, speak up. This is your group — regardless of how long you have been a member.

Many mental health professionals offer group therapy. You can search for a therapist near you, here.

I was at a party chatting with a stranger when he asked me what sort of work I do. I told him I am a marriage and family therapist who specializes in group therapy. “Group therapy!” he said. “I thought that went away after the ’60s.”

I’m happy to report that group therapy did not, in fact, go away in the 1960s. However, many people, like the guy at the party, don’t realize that group therapy exists as a powerful therapeutic option to consider instead of, or in addition to, individual therapy.

People may dismiss group therapy because it’s a therapeutic approach more often utilized in hospitals and treatment centers than in private practices. It can be difficult to find private practice therapists who run groups. Sometimes, it requires a lot of research and phone calls to find a group. However, plenty of therapists do run groups in their private practices, and this unique experience is worth the effort it might take to find it.

So, what’s so special about group therapy?

• It provides community and connection. Challenges tend to be harder when there is no one to share them with. In group therapy, individuals find relief through sharing their thoughts and feelings. Personal sharing creates connection and emotional support.

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• It’s an opportunity to learn from others. In group therapy, members learn from the other members. They see others successfully coping with depression; hear multiple perspectives on problems; observe others take emotional risks and be rewarded; and discover things about themselves by seeing those things in someone else. For example, seeing a fellow group member judging themselves can help a person understand the injustice and cruelty of his or her own self-criticism.
• It can bring about shame reduction. Receiving acceptance and understanding from fellow group members about something that feels shameful and uncomfortable may reduce shame and promote self-growth.
• It cultivates honest input from multiple sources. Defense mechanisms prevent people from receiving the insight they seek from therapy. Defenses ignore what a therapist might say because that’s just one person’s opinion, but when a group of people say the same thing, it’s not so easy to ignore. Helpful input breaks through the defenses, increases insight, and facilitates therapeutic change.
• It’s a safe space for interpersonal learning. One of the greatest benefits of group therapy is interpersonal learning. In individual therapy, people talk about their relationships; in group therapy, people engage in relationships with the other members of the group. If a person is very passive in his or her relationships—never asking for things, never saying “no”—he or she is likely to be passive in relationships with the other group members. Whatever a person’s relationship style, it will eventually be reenacted in the group. This reenactment allows all parties to become aware of this relationship dynamic. Once a person is aware of his or her typical way of interacting with others, the group provides a safe laboratory in which the person can try behaving differently. Standing up for oneself, setting boundaries, and expressing intimate feelings are the types of healthy relationship behaviors that can be developed in group therapy.
• It’s generally a more affordable option. Although cost varies from setting to setting and from therapist to therapist, group therapy rates tend to be more affordable—in some cases, roughly half the cost of individual therapy. This allows people to stay in therapy longer than their financial situation might otherwise allow them to.

No, group therapy is not dead. All around the country, people are gathering in groups to be more truthful, more engaged in relationships, and more open to insight than they are the rest of the time. Group therapy is very much alive! Are you ready to give it a try?

Therapy groups are formed around a common interest to promote cohesiveness, a central factor in the strength of the group. Generally, this central factor includes common life experiences as well as a common issue. Social anxiety is certainly an issue that affects all ages.

The group you’ve joined has three teenagers and three adults (ages 25-45). As you mentioned, generally groups of adolescents are kept separate from adult groups; this was addressed by the psychiatrist leading the group, but you do not write if there was any discussion around this issue. Discussion is a vital part of group therapy, as it is in individual treatment. I have questions about the group, and if there was a real discussion. Will the split ages split the group? Has good two-way communication been established?

Did everyone in the group start at the same time? It might be easier to have a discussion where everyone is equally new, although your questions should be addressed in any case. Was the group invited to share reactions, questions, and thoughts? There might have been a discussion, but in your questions you say that the “psychiatrist addressed” the age difference. Does that simply mean he or she mentioned it, and then the subject wasn’t taken up by group members? If there was no discussion including all members of the group, then there was not much dialogue and the question must still be addressed.

Will you meet for a certain number of weeks, months, or is this left open-ended? Will people be joining the group as you go along? Will group members have a say in this? At this time, the group is evenly split. This would change by the addition of one other member.

One factor in creating a group is homogeneity, which includes age. Homogenous groups are generally easier to manage from the group leader’s viewpoint and also show greater and quicker improvement than heterogeneous groups.

Are there external factors affecting the group leader, in this case a psychiatrist? The psychiatrist might have invited different age groups to attend so that enough people would participate to make a group.

To help you make your decision, I thought you might like to know some facts about group therapy, as explained by Irvin Yalom in his book, The Theory and Practice of Group Psychotherapy. Yalom is a pioneer in group therapy who identified what makes group therapy work.

Here is a list of five important factors:

1. Universality: Shared feelings and experiences. Members of your group have similar experiences pertaining to social anxiety, for example, but the age difference will have an effect here.
2. Altruism: Group members help each other, which has a powerful effect. Will the older members be able to help the younger members? Will the younger members accept help? Will their help be valued by the older members? Helping and being helped by group members is a powerfully curative experience.
3. Instillation of hope: If people in your group have been members for different lengths of time, then someone who has been working longer might be a good role model for a new member. The older members in general might be good role models for the adolescents.
4. Corrective recapitulation of the primary family experience: Sometimes people in therapy groups feel as though the group members are like members of their own families. This happens in a group where everyone is about the same age, but also in a group like yours, where the generations are a split. In this case the family experiences might feel a bit too real, which could hinder optimal group functioning.
5. Cohesiveness: This is the most powerful and elementary factor affecting the group. Each member of the group has to feel that he or she belongs in the group and is accepted and validated. This might be a problem in the group that you described.

If you like, you can think about these points and see what your answers are, or even bring them to the group, first consulting with the group leader as to the policy regarding outside references, which might be experienced as interference.

Thanks for asking this interesting question. I hope this helps you decide what to do.

Kind regards,
Lynn

Clinicians who practice individual therapy have the responsibility of developing a therapeutic bond with their clients, tracking the progress of their clients throughout therapy, and measuring treatment outcome. Along the way, therapists must ensure that the measures they are using are delivering results, and if not, they must change their approach. These steps become even more daunting when they are undertaken in a group setting. Group therapists have the same responsibility to their clients as do therapists conducting individual therapy; however, they must maintain this responsibility with each and every client in their group.

A team of experienced group therapists recently published an article providing guidance for preparation, evaluation, and conclusion of group therapy for clinicians. Dallas R. Jensen, Assistant Clinical Professor in the Counseling and Psychological Services Department at Brigham Young University, spearheaded the effort and outlined several key components for effectively managing group therapy sessions. The first and most important aspect of accurately assessing group therapy progress is gathering practice-based evidence (PBE). Research has shown that clients are more accurate predictors of treatment outcome than clinicians’ assessments. Therefore, Jensen recommends that therapists use a variety of several well-established tools to determine group member eligibility, progress, and outcome.

The Group Therapy Questionnaire (GTC) is an excellent tool to determine group member readiness. This tool allows therapists to examine the level of willingness of the member, previous group experience, and other factors that could influence participation, such as suicidal ideation, substance dependency, therapy fears, and goals. The Group Readiness Questionnaire (GRQ) is a similar tool often used. Jensen suggests other measures, such as the Working Alliance Inventory (WAI), the Cohesion to Therapist Scale (CTS), Therapeutic Factors Inventory (TFI), and the Group Climate Questionnaire (GCQ) to accurately assess the level of cohesion within the group and gauge group fidelity, tone, trust, and acceptance. Although there are several outcome scales to choose from, Jensen notes that the Outcome Questionnaire-45 (OQ-45) is the most commonly used and can be administered via computer or in person. Group therapy assessment is an area of research that is still relatively new, but is critical to group success. “We further encourage clinicians to share results and lessons learned in the literature and in professional settings, so as to continue developing this burgeoning effort,” concluded Jensen.

Reference:
Jensen, D. R., Abbott, M. K., Beecher, M. E., Griner, D., Golightly, T. R., Cannon, J. A. N. (2012). Taking the pulse of the group: The utilization of practice-based evidence in group psychotherapy. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0029033