If you're considering psychotherapy, several options are available. One of those options is group therapy. Depending on the nature of your problem, group therapy can be an ideal choice for addressing your concerns and making positive changes in your life. What should I expect?Group therapy involves one or more psychologists who lead a group of roughly five to 15 patients. Typically, groups meet for an hour or two each week. Some people attend individual therapy in addition to groups, while others participate in groups only. Many groups are designed to target a specific problem, such as depression, obesity, panic disorder, social anxiety, chronic pain or substance abuse. Other groups focus more generally on improving social skills, helping people deal with a range of issues such as anger, shyness, loneliness and low self-esteem. Groups often help those who have experienced loss, whether it be a spouse, a child or someone who died by suicide. Benefits of group therapyJoining a group of strangers may sound intimidating at first, but group therapy provides benefits that individual therapy may not. Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be. Groups can act as a support network and a sounding board. Other members of the group often help you come up with specific ideas for improving a difficult situation or life challenge, and hold you accountable along the way. Regularly talking and listening to others also helps you put your own problems in perspective. Many people experience mental health difficulties, but few speak openly about them to people they don't know well. Oftentimes, you may feel like you are the only one struggling — but you're not. It can be a relief to hear others discuss what they're going through, and realize you're not alone. Diversity is another important benefit of group therapy. People have different personalities and backgrounds, and they look at situations in different ways. By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns. More than supportWhile group members are a valuable source of support, formal group therapy sessions offer benefits beyond informal self-help and support groups. Group therapy sessions are led by one or more psychologists with specialized training, who teach group members proven strategies for managing specific problems. If you're involved in an anger-management group, for instance, your psychologist will describe scientifically tested strategies for controlling anger. That expert guidance can help you make the most of your group therapy experience. Joining a groupTo find a suitable group, ask your physician or your individual psychologist (if you have one) for suggestions. Also check with local hospitals and medical centers, which often sponsor a variety of groups. When choosing a group, consider the following questions. Is the group open or closed? Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time. They may all take part in a 12-week session together, for instance. There are pros and cons of each type. When joining an open group, there may be an adjustment period while getting to know the other group attendees. However, if you want to join a closed group, you may have to wait for several months until a suitable group is available. How many people are in the group? Small groups may offer more time to focus on each individual, but larger groups offer greater diversity and more perspectives. Talk to your psychologist about which choice is better for you. How alike are the group members? Groups usually work best when members experience similar difficulties and function at similar levels. Is group therapy enough? Many people find it's helpful to participate in both group therapy and individual psychotherapy. Participating in both types of psychotherapy can boost your chances of making valuable, lasting changes. If you've been involved in individual psychotherapy and your progress has stalled, joining a group may jump-start your personal growth. How much should I share? Confidentiality is an important part of the ground rules for group therapy. However, there's no absolute guarantee of privacy when sharing with others, so use common sense when divulging personal information. That said, remember that you're not the only one sharing your personal story. Groups work best where there is open and honest communication between members. Group members will start out as strangers, but in a short amount of time, you'll most likely view them as a valuable and trusted source of support. Group therapy is the treatment of multiple patients at once by one or more healthcare providers. It can be used to treat a variety of conditions including but not limited to emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD). This activity outlines the principles of group therapy and explains the role of the interprofessional team in evaluating, treating, and improving care for patients who undergo group therapy. Objectives:
As the need for behavioral intervention and long-term psychiatric care is steadily rising, alternative methods of treatment must be employed by physicians and healthcare teams to meet this increasing demand. Group therapy provides a solution to this problem by allowing for the treatment of multiple individuals simultaneously. Doing so allows healthcare providers to reduce wait times and increase accessibility. This approach is especially necessary for rural and low-income areas where clinics are often understaffed and have a high volume of patients. Furthermore, group therapy can be used to treat a multitude of conditions including, but not limited to, emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).[1][2][3][4] Yalom Therapeutic Factors It is vital to patient success that providers understand the mechanisms that exist in group therapy. These factors are:
Goals
Selection of Patients When deciding which patients will benefit the most from group therapy, providers utilize the therapeutic alliance. The more the provider and patient agree on the goals and tasks of therapy as well as the stronger the relationship they share, the more likely the patient will have success in group therapy.[6] An additional selection method providers can use to gauge group therapy viability is the NEO-Five-Factor Inventory. This measure of personality suggests that those who score high on extraversion (openness) and conscientiousness (hard-working) dimensions are more suited for group therapy, while those who score high levels of neuroticism (emotionally reactive) are less suitable for group therapy.[7] Group therapy will be useful for the treatment of patients who exhibit interpersonal difficulties and pathology; patients who lack self-awareness; patients who are action-oriented; patients who suffer from isolation and require the stimulation group interaction provides, and those who will benefit from interacting with peers who can both challenge and support them.[8] Special attention must be paid to ensure patients unfit for group therapy do not get selected as their inclusion can have deleterious effects on both the patient and the group. Specific exclusion criteria are limited to patients who are unable to participate in the major activities of the group due to logistical, cognitive, or interpersonal factors. Additionally, patients in acute distress or actively suicidal should not be considered for group therapy and instead need independent management. Outside of these factors, the exclusion criteria for patients should be more relative than absolute. As a result, a patient unfit for one group due to conflicting personality traits may fit in a group that has similar traits to the patient. Different Stages of Treatment It is necessary to include patients at different stages of treatment to help facilitate individual recovery. By comparing themselves to other patients further along in the recovery process, patients can start to imagine themselves in a similar position. Additionally, seeing patients worse off than them but still contributing to the group can provide motivation, keeping patients committed to the treatment process.[9] Identical or Similar Conditions Group therapy sessions should include members suffering from similar conditions. Doing so allows patients to realize that their symptoms are not exclusive to them, and others share similar feelings. This feeling of universality can create a sense of community within the group and facilitate the treatment process by fostering feelings of acceptance and belonging. Structuring groups with members diagnosed with similar conditions also allow group members to learn from and instruct one another. Interpersonal learning allows members to gain new perspectives on their conditions and learn successful ways to cope. Additionally, members who typically experience social fear as a result of their symptoms become more comfortable with exposure to social situations.[2][9][10][11][12] In addition to adhering to the principles of group therapy, providers should use different styles of group therapy based on the diagnosis and needs of the patients. Psychoeducational Groups Psychoeducational groups are useful for educating patients about their diagnosis as well as their inclinations and consequences associated with these inclinations. These groups also serve to encourage patients to stay committed to their treatment plans. Additionally, psychoeducational groups teach patients to avoid maladaptive behaviors while also instilling positive behavior change. When organizing a psychoeducational group, the provider should follow a highly structured plan and develop a curriculum. Sessions should last anywhere from 15 to 90 minutes, and chairs should be organized in a horseshoe or circle configuration where the provider is the focus. During psychoeducational group sessions, the provider will act as an educator. Teaching should be performed actively as passive note-taking is inefficient and allows patients to escape the focus of the group. To ensure patient engagement, providers must foster a culture of interaction by creating an environment where patients feel comfortable speaking. Additionally, when leading a session, the provider should incorporate different learning styles, such as visual learning, auditory presentations, and hands-on activities, to accommodate the wide variety of methods in which patients learn.[13] Skills Development Groups Skills development groups are useful for patients whose diagnosis has prevented the adequate skill development necessary to function in everyday life. This style of group therapy also focuses on coping methods, emotional control, and socialization techniques. By focusing on specific skills that patients lack, providers can help prepare patients for the treatment process and give them the tools to recover. Providers running skills development groups should base the content of the group on the needs of that group's patients. As a result, the actual material discussed will vary significantly from group to group. Skills development sessions should range from 45 to 90 minutes in length and be organized in either a horseshoe or circle configuration. These groups should be limited to 8 to 10 patients as it is highly interactive and provides ample time for each patient to practice the skills taught. The provider themselves must have mastery of the skills they plan to teach so they can effectively teach them to the group.[14] Cognitive-Behavioral Groups Cognitive-Behavioral groups are useful for changing patients’ learned behaviors by altering their beliefs and perceptions. These groups can also change patients’ perceptions of themselves, turning negative thoughts of being different and unlovable into more positive thoughts. This change in thought process can be extremely freeing to patients as they learn to live with their issues rather than being ruled by them. The content discussed in these groups will also vary greatly. The provider should focus on beliefs, coping skills, thought processes, or behavior based on the needs of the patients. The orientation of the room for this particular style of the group should be a circle as the horseshoe orientation can interfere with the cohesiveness of this group. Sessions should last anywhere from 60 to 90 minutes. Similar to psychoeducational groups, the provider of cognitive-behavioral groups should take an active role during the session; however, discretion must be used to ensure the provider does not over-participate negating the members' ability to interact. It is vital to the patients’ success that the provider acts as a guide and let the group work through most issues themselves. Since the discussions in these sessions are focused on thought and behavior modification, patients may feel uncomfortable and try to resist these changes. Providers must be prepared for this resistance and gently guide the members through their issues with just the right amount of empathy and firmness.[15] Support Groups Support groups can be used to help patients who have already begun receiving treatment to maintain their new behaviors and reinforce their new belief systems and thought processes. These groups also focus on the management of symptoms of day-to-day life. During sessions, patients usually discuss recent problems and how they dealt with them. Support group sessions should last anywhere from 45 to 90 minutes. Sessions should also be conducted in a circular configuration. Unlike psychoeducational and cognitive-behavioral groups, the provider of support groups is less directive and should act only as a facilitator. As such, the provider should assist patients in developing connections with one another and emphasizing similarities between patients. The provider’s main contribution to the group should be limited to positive reinforcement and to bring to attention appropriate interactions patients exhibit.[16] Group Development Providers should be aware of the different stages of group development as a transition through each stage indicates group growth and change. Transitioning through all five stages is necessary for patients to benefit from group therapy.
Length of Treatment The duration of group therapy treatment is highly individualized and subject to a high degree of variation. Patients should receive therapy until they achieve relief from their symptoms and can begin to develop a normal life with strong relationships and a sense of belonging; this can take anywhere from weeks to months or even years to occur. To facilitate patient improvement, providers should structure the ending of therapy processes. By establishing a set end date during treatment, the provider can prepare the patient for an eventual departure with the patient working towards the achievement of his or her goals until that date. Patient Confidentiality Similar to individual treatment, the provider or group leader in group therapy sessions are bound to the laws of confidentiality concerning patients' medical history, diagnoses, and other personal information. The other group members, however, are not bound to these same laws and face no legal consequences for sharing information from sessions. As a result, individual patient confidentiality can be difficult to maintain, especially in larger groups where leaders have less control over what information gets shared within the group. The ability to share personal information can play a positive role in the treatment process. Some patients may feel uneasy sharing certain details for fear of who may repeat them, which can cause harm to patients' mental wellbeing as they struggle to contribute while maintaining their confidentiality. To reduce this tension, providers should adopt a set of confidentiality/sharing guidelines that the group agrees to and discuss with members the limitations of confidentiality before the first session.[18] Effectiveness Research has shown that group therapy is an effective method to treat a myriad of psychiatric and behavioral disorders. Patients often report a reduction in symptoms after receiving group therapy treatment. Additionally, group therapy is found to affect patients positively through Yalom Therapeutic Factors. These factors do reduce symptoms of diagnoses while also providing patients with beneficial skills to learn, develop, and live with their symptoms. As long as patients are subject to proper screening before group therapy sessions, they will receive benefits.[1][10][19] Concurrent Treatment Although group therapy is an effective method of treatment in itself, providers may also choose to incorporate other treatment methods to treat patients further.
Cost-efficiency Group therapy provides a cost-efficient method of treatment, as fewer trained professionals are required to provide treatment to a larger number of patients. A reduction in cost can increase the accessibility of therapy, as costs are often covered by insurance plans.[1] Flexibility Treatment in a group setting allows providers to be more flexible with their sessions. Doing so can increase attendance to therapy sessions since providers can schedule sessions during after work and after school hours. Additionally, the inclusion of multiple sessions throughout the day allows providers to treat a larger volume of patients throughout the day, further reducing wait times in high-volume areas.[1] Training Opportunities The group format can be used as an avenue to train medical students, residents, and other healthcare professionals by allowing them to serve as co-therapists. The provider can oversee the less experienced professionals as they work with patients, effectively creating on-the-job coaching; this can be especially useful in low resource areas where access to trained professionals is limited.[1] Other Issues Conflict Conflict is a natural and expected aspect of group therapy sessions. Many conflicts may not be obvious to the group members, and it is the responsibility of the provider to bring these covert conflicts to the members’ attention. The provider is not required to solve the conflict; however, he or she must make an informed decision on how to deal with the conflict based on the interest of the group. It may be worthwhile to address the conflict, as there is an opportunity for the group to learn. Members’ responses to conflict can be complex and unpredictable. When conflict arises, providers should use the last five to ten minutes of the session to speak with patients individually and allow them to voice their concerns. Patients Who Ramble Occasionally, a patient may continue to talk for an unnecessary length of time. It is essential to address this patient and see what he or she hopes to gain when doing so. If the patient is unsure as to why they are dominating the conversation, the provider should use this opportunity to teach the patient how to express his or her thoughts and feelings better. Lack of Engagement It is the provider’s responsibility to ensure members are alert and attentive during group sessions. When members seem disengaged, the provider should interject and see why members are losing interest. The inclusion of interactive activities can help members to be more engaged in the group discussion.[11] Patients’ Limits Providers are encouraged to push their patients to engage with the sessions; however, it is crucial to be aware of a patient’s individual limits. If the provider’s initial request for the patient to continue engaging meets with resistance, then the provider should respect this wish. Providers should remain patient, understanding, and empathetic with their patients and continually encourage without forcing patients to act against their will.[9] Pharmacotherapy and Group Therapy Occasionally, patients receiving group therapy will also benefit from the inclusion of pharmacotherapy. In situations where the provider prescribing the medication differs from the provider providing treatment, proper communication between the two parties is vital to patient success. A thorough report of the patient and his or her reaction and benefits from the medication must be shared with the provider treating with group therapy. Mutual respect for one another and the well-being of the patient are required to prevent adverse reactions and ensure the patient receives the highest quality of medical care. Additionally, putting less of a value on either of the two treatment processes can negatively impact patients, so the therapist should always follow proper inclusion and management of both treatment processes.[21] When pharmacotherapy is part of the patient's therapy, it is prudent to have a qualified pharmacist examine the patient's medication record, checking for proper dosing, potential drug interactions, and inform the other members of the healthcare team of any red flags. Social workers can play an important auxiliary role to providers during group therapy sessions. The social worker's presence as a layperson voicing their thoughts and feelings can help facilitate group interaction and reduce members’ resistance to contributing. Also, social workers can assist patients in attempting to reintegrate into their “normal” lives by answering patient’s questions concerning work, relationships, and other lifestyle changes.[22] An interprofessional team approach can benefit participants in group therapy, where information is shared among various disciplines leading to improved patient outcomes, so long as appropriate privacy considerations are maintained at all times. [Level 5] Nurses trained in psychiatric and behavioral sciences can take on the role of group therapy leader and host group therapy sessions. Their responsibilities reflect those of other healthcare providers, and supervision is not required when a properly trained nurse is leading group therapy.[23] Review Questions1. Deblinger E, Pollio E, Dorsey S. Applying Trauma-Focused Cognitive-Behavioral Therapy in Group Format. Child Maltreat. 2016 Feb;21(1):59-73. [PubMed: 26701151] 2.Wolgensinger L. Cognitive behavioral group therapy for anxiety: recent developments. Dialogues Clin Neurosci. 2015 Sep;17(3):347-51. [PMC free article: PMC4610619] [PubMed: 26487815] 3.Sayın A, Candansayar S, Welkin L. Group psychotherapy in women with a history of sexual abuse: what did they find helpful? J Clin Nurs. 2013 Dec;22(23-24):3249-58. [PubMed: 24118587] 4.Vidal R, Castells J, Richarte V, Palomar G, García M, Nicolau R, Lazaro L, Casas M, Ramos-Quiroga JA. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015 Apr;54(4):275-82. [PubMed: 25791144] 5.Ezhumalai S, Muralidhar D, Dhanasekarapandian R, Nikketha BS. Group interventions. Indian J Psychiatry. 2018 Feb;60(Suppl 4):S514-S521. [PMC free article: PMC5844165] [PubMed: 29540924] 6.Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000 Jun;68(3):438-50. [PubMed: 10883561] 7.Lahey BB. Public health significance of neuroticism. Am Psychol. 2009 May-Jun;64(4):241-56. [PMC free article: PMC2792076] [PubMed: 19449983] 8.Grunebaum H, Kates W. Whom to refer for group psychotherapy. Am J Psychiatry. 1977 Feb;134(2):130-3. [PubMed: 319691] 9.Malcolm L, Mein G, Jones A, Talbot-Rice H, Maddocks M, Bristowe K. Strength in numbers: patient experiences of group exercise within hospice palliative care. BMC Palliat Care. 2016 Dec 13;15(1):97. [PMC free article: PMC5155388] [PubMed: 27964735] 10.Ramírez P, Febrero B, Martínez-Alarcón L, Abete C, Galera M, Cascales P, López-Navas AI, González MR, Ríos A, Pons JA, Parrilla P. Benefits of Group Psychotherapy in Cirrhotic Patients on the Liver Transplant Waiting List. Transplant Proc. 2015 Oct;47(8):2382-4. [PubMed: 26518934] 11.Larsson E, Lloyd S, Westwood H, Tchanturia K. Patients' perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study. J Health Psychol. 2018 Oct;23(12):1521-1532. [PubMed: 27473160] 12.Hauksson P, Ingibergsdóttir S, Gunnarsdóttir T, Jónsdóttir IH. Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting. Nord J Psychiatry. 2017 Aug;71(6):465-472. [PubMed: 28598705] 13.Martin K, Giannandrea P, Rogers B, Johnson J. Group intervention with pre-recovery patients. J Subst Abuse Treat. 1996 Jan-Feb;13(1):33-41. [PubMed: 8699541] 14.La Salvia TA. Enhancing addiction treatment through psychoeducational groups. J Subst Abuse Treat. 1993 Sep-Oct;10(5):439-44. [PubMed: 8246317] 15.Najavits LM, Weiss RD, Liese BS. Group cognitive-behavioral therapy for women with PTSD and substance use disorder. J Subst Abuse Treat. 1996 Jan-Feb;13(1):13-22. [PubMed: 8699538] 16.Cooper DE. The role of group psychotherapy in the treatment of substance abusers. Am J Psychother. 1987 Jan;41(1):55-67. [PubMed: 3578607] 17.Kumar S, Deshmukh V, Adhish VS. Building and leading teams. Indian J Community Med. 2014 Oct;39(4):208-13. [PMC free article: PMC4215500] [PubMed: 25364143] 18.Lasky GB, Riva MT. Confidentiality and privileged communication in group psychotherapy. Int J Group Psychother. 2006 Oct;56(4):455-76. [PubMed: 17040183] 19.Lucre KM, Corten N. An exploration of group compassion-focused therapy for personality disorder. Psychol Psychother. 2013 Dec;86(4):387-400. [PubMed: 24217864] 20.Ormont LR. Principles and practice of conjoint psychoanalytic treatment. Am J Psychiatry. 1981 Jan;138(1):69-73. [PubMed: 7446786] 21.Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014 Feb;13(1):56-67. [PMC free article: PMC3918025] [PubMed: 24497254] 22.CHANCE E. Group psycho-therapy and the psychiatric social worker. Ment Health (Lond). 1948 Aug;8(1):8-12. [PMC free article: PMC5078299] [PubMed: 18885358] 23.Lorentzen S, Ruud T. Group therapy in public mental health services: approaches, patients and group therapists. J Psychiatr Ment Health Nurs. 2014 Apr;21(3):219-25. [PubMed: 23581992] |