Group Therapy: Types, How It Works, & What to Expect

What Is Group Therapy?

Group therapy is different from individual therapy options as it relies on the power of a skilled, competent leader in combination with group cohesion to promote change. Most groups focus on specific mental health topics, have 5-15 members, and meet regularly. When everyone is working together, the support provided can be more significant than anything accomplished alone or by just two people.

By participating in a group, members begin to feel normalized in a community of people who “get it.” Group members also possess unique insights into techniques and coping mechanisms that may or may not have worked in the past, empowering other members to try these strategies as well.

There are twelve therapeutic factors upon which group therapy is built:²

1. Altruism
2. Catharsis
3. Cohesiveness
4. Corrective recapitulation of the primary family experience
5. Development of socializing techniques
6. Existential factors
7. Imitative behavior
8. Imparting information
9. Installation of hope
10. Interpersonal learning
11. Self-understanding
12. Universality

In combination, these characteristics are what make group therapy unique.

Group Therapy Vs. Support Groups

While group therapy and support groups may seem similar in many ways, the biggest difference lies in their purpose: group therapy aims to help people change, while support groups exist to help people cope. Support groups are especially important for people who find themselves in situations that cannot be changed, like grieving the loss of a loved one. Group therapy is best for people who have the agency to change their lives for the better with the social, emotional, cognitive, and behavioral skills to make it happen, which they can gain in the group therapy setting.

What Can Group Therapy Help With?

Topics for group therapy can vary greatly, depending on the needs of the community. Group therapy may be utilized by people dealing with any variety of issues including substance misuse, eating disorders, anxiety and depression, and life transitions like divorce.

While substance use is commonly addressed in group therapy, other group therapy topics include:

• Grief and loss
• Trauma
• Divorce
• Low self-concept
• Interpersonal skills issues
• Major life transitions
• Eating disorders
• Depression
• Anxiety
• Bipolar disorder
• Personality disorders

If Someone Is in Group Therapy, Do They Also Need Individual Therapy?

For many people in group therapy, individual therapy may also be helpful. With certain populations, engaging in both individual and group therapy increases someone’s chances for success in achieving lasting change in their life.³ If a person’s progress in individual therapy seems to be plateauing, supplementing their treatment with group therapy can reignite momentum in their individual work.

For those who are in crisis or are experiencing suicidal thoughts, individual therapy is warranted. Group therapy can then be explored as a treatment option once the person is stabilized and no longer in crisis.⁴

Types of Group Therapy

Given the wide diversity of group topics and participant needs, there are numerous types of group therapy, but psychotherapy and self-help groups are two of the most common. While some are more conversational, others are more informational or task-oriented. Some are open (meaning anyone may attend at any time), while others are closed. Many people find online group therapy to be a helpful resource, while others may prefer going in-person.

Here are the most common types of therapy groups:

Psychotherapy Groups

Psychotherapy groups are led by a trained mental health professional and include two or more participants. The focus of these groups is to understand and identify life problems as well as the thoughts, emotions, and behaviors that contribute toward them.

Group members process their problems and work to develop healthy coping and problem-solving skills with the goal of regaining control and improving overall well-being. Psychotherapy groups are generally offered at hospitals, residential and outpatient treatment centers, group recovery environments, and community mental and behavioral health clinics.

Cognitive Behavioral Groups

While cognitive behavioral therapy (CBT) groups will utilize the same therapeutic principles as individual CBT treatment, there are some unique aspects to CBT group therapy. Group therapy offers more opportunities for normalization, positive peer modeling, and social exposure, not to mention valuable social support. However, research shows that individual and group CBT are equally effective, with no significant differences in outcomes for those who engage in CBT group therapy or individual therapy using CBT.⁵

Interpersonal Groups

Group interpersonal therapy, also known as group IPT, is a time-limited, evidence-based approach to address mood disorders by aiming to improve a client’s relationships and social functioning.⁶ Delivered in a group setting, clients are asked to pay close attention to their thoughts, feelings and reactions as the group progresses, offering valuable in vivo insight into the inner workings of their interactions with others.⁷

Skill Development Groups

Often used in treating anxiety, depression, substance use disorders, and PTSD, skill development groups aim to teach clients valuable skills to improve their daily functioning.⁸ Skill development groups focus on teaching and practicing positive coping skills to equip group members to better manage their mental health challenges.

Self-Help Groups

Self-help groups are self-governing and are run by member volunteers who have demonstrated maintained recovery. Such groups are built upon the concept of reciprocal healing, meaning that the members share a common problem and exchange social support. Twelve-step groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Dual Recovery Anonymous (DRA), and so on, are some of the more common self-help groups.

Process Groups

Process groups focus on processing an experience, emotion, or problem. Rather than look at things superficially, process groups dig deeper into understanding the why, who, what, when, where, and how. Though there is not always an answer to everything, working it through provides further insight, which leads toward acceptance. Being in the group setting, this also affords the benefit of multiple perspectives.

Task Groups

Task groups focus on successfully achieving a meaningful goal of a client, group, or entire community. For instance, a group of mental health professionals may come together to devise an awareness or prevention campaign, such as with topics of suicide or substance use. These groups require the appropriate personnel, identification of an issue, adequate planning, thoughtful delivery, and evaluation of outcomes.

Support Groups

Support groups are unique from group therapy in that they exist to help people cope with difficulties in their lives through valuable peer support. The focus of support groups is to provide a like-minded community where people can share their stories, give and receive empathy and validation, and make social connections. Support groups exist for people from all walks of life, including chronic illness, cancer, bereavement, and addiction.

Common Group Therapy Activities

Depending on the age and needs of the group as well as the creativity of the facilitator(s), group therapy activities may range from something more interconnected to something more introspective.

More interconnected activities may include cooking, cultural exploration, and music, offering members the opportunity to connect over the shared experience. More introspective activities may include journaling, meditation, or creating something artistic. Upon connecting with oneself on this personal level, group members may reflect upon the experience together. Though the activity was done solo, many group members find connections among what they did, how they did it, and why it was done.

The Benefits of Group Therapy

With more people to provide support and hold one another accountable in group therapy, the likelihood of successful outcomes increases. Those reluctant to attend group therapy, particularly if they are more introverted or socially anxious, oftentimes find that group participation even leads toward improved social skills and interest.¹

Here are some of the more common advantages of group therapy:¹

• 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 helps you put your own problems into perspective.
• It can be a relief to hear others discuss what they’re going through, and realize you’re not alone.
• By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns.

Group Therapy Examples

The focus of group therapy may vary by type. For instance, psychoeducational groups educate members on a particular topic—providing useful information, coping skills, and other helpful resources. Process groups focus on processing an experience, emotion, and so on. Task groups focus on successfully achieving a meaningful goal of a client group or entire community.

Group Therapy for Divorce

Divorce is a period of significant life change, and it can be traumatic for many people. A person going through a divorce may have lost a significant number of people that they relied on for support. The group setting provides a platform for members to speak their truths while having the camaraderie of others who have also gone or are currently going through divorce.

Group Therapy for Substance Use & Addiction

Addiction groups are especially powerful at holding others accountable—breaking down barriers of denial while acknowledging and amending past wrong-doings. This is significant, as acknowledging the problem and taking accountability are two of the most challenging steps toward recovery. Practicing these things in a group setting helps clear the pathway toward successful recovery.

Group Therapy for People With a Mentally Ill Family Member

These groups provide support for those who are struggling with a family member with mental illness. The stress and heart-break of such an experience leaves many individuals feeling unheard, unloved, and disregarded. Sharing one’s experience and receiving support, in return, can help alleviate these feelings.

Is Group Therapy Right for You?

There are many potential benefits to participating in group therapy, however group therapy isn’t necessarily right for everyone. In order to make the best decision regarding your treatment, there are a few things that are important to consider, like your ability to be open with people you don’t know as well, and the potential that you may need to try a few groups before finding the “right fit.” Also, if you’re in a crisis, individual therapy would be a better option.

Here are some factors that can help you determine whether or not group therapy is right for you:

You Need to Be Willing to Share

Group therapy is only effective if all group members are actively engaged and committed to consistently participating in the group. Having the vulnerability to share your story with the group will not only benefit your own therapeutic journey, but will also be beneficial to others in the group, as you will likewise benefit from hearing their stories.

It is important to note that, though confidentiality is highly valued in group therapy, it is not guaranteed. While self-disclosure is critical to the group process, there are more people present to hear sensitive material as opposed to individual therapy.⁹

You Might Need to Try More Than One Group to Find the Best Fit

Just as finding the right individual therapist can take time, selecting a therapy group that is the best fit for you can also be a process.

When exploring group therapy options, ask yourself:

• Do you prefer small or large groups?
• Is the group’s meeting place easily accessible to you?
• What days and times can you commit to meeting?
• What are the facilitating therapist’s qualifications?
• Do you agree to the group’s guidelines?

Group Therapy Isn’t for Crises

Group therapy is not appropriate for a person in crisis. If someone is experiencing suicidal ideation, or otherwise in crisis, individual therapy (and sometimes hospitalization) is indicated in order to help stabilize the person.

How to Find Group Therapy Near You

Many organizations offering group therapy have websites available online. Conducting a web search along the lines of “group therapy near me” plus the specific topic is a great place to start. From there, you can contact the organization or facilitator directly to ask any questions and assess if it’s the right fit for you.

Who Is Able to Offer Group Therapy

Professionally led group therapy must be conducted by a licensed or certified mental and/or behavioral health professional or supervised clinical intern. This may include, but is not limited to, psychiatrists, psychologists, social workers, professional counselors, and substance abuse counselors. Many professionals also have other specialized certifications, such as marriage and family, equine-assisted, music, substance abuse, yoga, social justice, et cetera.

Can You Do Group Therapy Online?

Online group therapy is a relatively new treatment offering that provides increased access to services for people in remote areas, those who have transportation barriers, or those with other challenges that make online therapy a more attractive alternative. Studies have shown that online therapy is promising in terms of its efficacy.¹⁰ However, some unique challenges exist in the online group therapy setting, such as a therapist’s lack of control over the online environment, absence of in-person interaction, and the slower development of group cohesion.¹¹ While online group therapy may not be the best fit for everyone, some clients find it even more beneficial than in-person groups.

Key Questions to Ask When Considering Group Therapy

Without careful consideration, the risk for dropping out of group therapy increases, which may ultimately lead to disinterest in groups all together. It’s important to ask questions regarding specific topics covered, group demographic, cost, and more to determine whether the group is right for you.

Here are some questions to ask the facilitator before joining a therapy group:

• Is the group topic specific to what I am experiencing?
• Do I prefer attending an open or closed group?
• Is the group demographic make-up one in which I feel comfortable (e.g., age, gender)?
• Is the location one to which I have reliable transportation?
• Will the group schedule work with my schedule so that I may attend consistently and on time?
• Is the cost affordable? Do I have sufficient out of pocket funds and/or coverage through my managed care plan?

Cost of Group Therapy

Group therapy is generally less expensive than the cost of individual psychotherapy. A primary reason for this is because it essentially splits the cost of the professional’s time across multiple members. Further, many providers offer sliding scale rates and pro bono services for those demonstrating financial need.

Reimbursement rates from managed care organizations such as insurance companies, Medicaid, and Medicare are also lower than individual psychotherapy, which reduces cost. Many plans will cover group therapy so long as the group is evidence-based, run by a professional, and is medically necessary.

It is also common for many self-help groups to provide free services. Many of these groups are run by government or grant funding as well as donations and voluntary contributions by members. Because facilitation is generally done by a volunteer member, there is no cost for a trained professional. As such, the cost makes it an especially appealing form of treatment, however it may not be appropriate for more serious mental health problems.

What to Expect at Your First Group Therapy Session

During someone’s first group therapy session, the facilitator generally acclimates new members to the group’s process and rules. At this stage, many members are reluctant to share their experiences and emotions as a result of not knowing what is expected, how others will relate to them, and trust issues.

Icebreaker activities are commonly used when groups first meet or are introducing a new member. These activities help members get to know one another by perhaps sharing their name, a personal experience, something motivating, something fun, et cetera.

It is also common for members to test boundaries with one another. The good news is that constructive confrontation and vocalization of issues early on leads towards more constructive work in the later stages of therapy. If one member has an issue with another member, it is important to resolve the issue immediately so it does not become a much larger issue in the future.

Perhaps the most rewarding part of what to expect is leaving the group meeting with additional support. Again, the immense value of having this support cannot be underestimated.

How Long Will I Be in Group Therapy?

Most therapy group sessions are 50-120 minutes long and meet once or twice a week, depending on the intervention model. Most time-limited group interventions last anywhere from 6-20 weeks. Research shows that client improvement in a group therapy setting usually happens in a short period of time, between 2 and 3 months.¹²

Is Group Therapy Effective?

The American Psychological Association concluded that about 75% of people who enter psychotherapy demonstrate at least minimal improvement.¹³ The National Alliance on Mental Illness (NAMI), National Institute of Health (NIH), National Institute on Drug Abuse (NIDA), Mayo Clinic, Centers for Disease Control (CDC), and Substance Abuse and Mental Health Services (SAMHSA)—among others—have also concluded that group therapy has proven benefits as compared to not participating in treatment.

The American Psychological Association had the following to say about group therapy:¹⁴

• Group therapy appears to be gaining popularity for two reasons: More clients are seeking it out as a more affordable alternative to one-on-one psychotherapy, and more research is demonstrating its effectiveness, say psychologists who practice it.
• For many conditions, group therapy works as well as individual therapy. More than 50 clinical trials have compared patients who were randomly assigned to individual or group treatment, and all of those studies showed that the two formats produced the same level of improvement for many disorders.
• Group therapy exceeds Society of Clinical Psychology standards for efficacy for major depressive disorder, bipolar disorder, panic disorder, post-traumatic stress disorder, social phobia, obsessive-compulsive disorder, bulimia nervosa, binge-eating disorder, substance use disorder, schizophrenia, borderline personality disorder and general personality disorder.
• Research is finding that the most effective groups have a common identity and a sense of shared purpose, according to a meta-analysis of 40 studies.
• When it comes to a group format, new research shows two leaders are better than one. Members of co-led groups experience greater benefits than those of individually led groups. That second set of eyes and ears makes a big difference when group leaders are trying to follow multiple interactions.
• Research is also shedding light on exactly how groups help people heal. One important factor is the ability to interact with peers.
• Numerous studies have found that peer interactions tap into many therapeutic factors.
• Hearing from peers may be more helpful than receiving guidance from a therapist since peers can identify with one another. Those peer interactions appear to translate to real-world gains. A meta-analysis of five studies found that sexual abuse survivors improved markedly after participating in group therapy.
• Group therapy also offers advantages for the psychologist: The approach allows therapists to observe relational patterns. Rather than rely on the accuracy (or inaccuracy) of self-reports, patients reveal their problems through interactions with other members.

Risks of Group Therapy

Although there are many benefits to group therapy, there are also risks. One such risk is that of member drop-out.¹⁵ If members are inconsistent with attendance or unwilling to fully participate, treatment outcomes will be compromised. Individual factors for risk include negative leadership, group process, or patient characteristics.¹⁶ With addictions groups there is also the potential of individuals selling drugs to other members.

Downsides of Group Therapy

Especially when groups are not led by a licensed or certified professional or supervised intern, there is potential for the leader to be ill-equipped. People who have a fear of public speaking may find the group setting uncomfortable.⁴ Those who struggle interpersonally may find themselves in continued conflict with other group members.

Another consideration is that of confidentiality. While it is one thing to keep sessions between a therapist and client confidential, it is much more challenging when additional group members are involved.⁴

Group Therapy Vs. Individual Psychotherapy

Individual psychotherapy involves working one-on-one with a mental health professional toward selected individual goals. Sessions focus on processing thoughts, emotions, and behaviors while participating in various “homework assignments” to help the client work toward healthy coping and problem-solving skills.

It is relatively common for mental health professionals to recommend that clients participate in both individual psychotherapy and group therapy.^1,4 In this case, individual psychotherapy meets the individual needs of the client while group therapy provides additional support. If the mental health provider and group facilitator are on the same page, then much of what is said in one setting will be reinforced in the other.

Mandated Group Therapy

Mandated group therapy is intended to remediate a condition that may prove detrimental to the well-being and safety of that individual and/or others.

Common issues for court mandated group therapy include:¹⁷

• The person has been convicted of a sex crime. Some states’ sex offender registries require participation in sex offender treatment.
• The person has lost custody of their child because of abuse, neglect, or addiction.
• The person is involved in a child custody dispute, and the court thinks one or both parents need either a psychiatric evaluation or mental health treatment.
• The person has a mental health condition or addiction and the court offers treatment as an alternative to jail or prison time.
• The person is incarcerated, and the parole board offers treatment as a condition of early release.
• The person is a threat to themselves or others. A person with intense suicidal ideation may be ordered to get a psychiatric evaluation or be held in a mental health facility for a set period of time. People with homicidal or violent thoughts may also undergo coerced treatment.
• The focus of the type of group therapy assigned is specific to the presenting issue. Accordingly, treatment may focus on addiction recovery, anger management, parenting, skills-building, trauma processing, and so on.

The History of Group Therapy

The history of group therapy began in Boston, MA in 1906, when Dr. J.H. Pratt provided group instruction while treating patients with tuberculosis (TB). The initial intent here was to provide group instruction to those who could not afford institutional assistance.⁴ While conducting these groups he noted “beneficial emotional side effects,” which may serve as some of the earliest notes on the efficacy of group therapy.⁴

Group therapy was then proven especially useful in treating World War II veterans who experienced extreme reactions to combat. Upon the US Army releasing a report in 1944 commending positive outcomes, group therapy become a progressively more popular treatment modality.⁴

June 10, 1935 celebrates the founding of Alcoholics Anonymous (AA), which is still the leading support group for addiction recovery. One notable statistic from a study conducted by the National Institute on Alcohol Abuse and Alcoholism specific to AA is that an “eight-year follow-up showed that 46% of those who chose formal treatment were abstinent while 49% of individuals who attended AA were abstinent.”¹⁸ It is interesting to note the 3% higher rate of success for members over an 8-year period who actively participated in AA versus traditional treatment. Again, there is power in numbers.