Group psychotherapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Cognitive behavioural therapy or Interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilised as a mechanism of change by developing, exploring and examining interpersonal relationships within the group. The broader concept of group therapy can be taken to include any helping process that takes place in a group, including support groups, skills training groups (such as anger management, mindfulness, relaxation training or social skills training), and psycho-education groups. The differences between psychodynamic groups, activity groups, support groups, problem-solving and psycoeducational groups are discussed by Montgomery (2002). Other, more specialised forms of group therapy would include non-verbal expressive therapies such as dance therapy, music therapy or the TaKeTiNa Rhythm Process.
Yalom’s therapeutic factors (originally termed curative factors but re-named therapeutic factors in the 5th edition of ‘The Theory and Practice of Group Psychotherapy’ are derived from extensive self-report research with users of group therapy.
The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member’s sense of isolation, validate their experiences and raise self-esteem
The group is a place where members can help each other, and 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.
Instillation of hope
In a mixed group which has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems that they are still struggling with.
While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group, for example about their treatment or about access to services.
Corrective recapitulation of the primary family experience
Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process which is a form of transference specific to group psychotherapy. The therapist’s interpretations can help group members gain understanding of the impact of childhood experiences on their :personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present day relationships.
Development of socialising techniques
The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behaviour and improving their social skills
One way in which group members can develop social skills is through a modelling process, observing and imitating the therapist and other group members, for example sharing personal feelings, showing concern and supporting others.
It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance and validation.
Learning that one has to take responsibility for one’s own life and the consequences of one’s decisions.
Catharsis is 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.
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 behaviour and impact on others.
This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one’s problems and the unconscious motivations which underlie one’s behaviour.
Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit or ambulatory psychiatric Partial hospitalization (also known as Day Hospital treatment). In addition to classical “talking” therapy, group therapy in an institutional setting can also include group-based expressive therapies such as drama therapy, psychodrama, art therapy, and non-verbal types of therapy such as music therapy. Group psychotherapy is a key component of Milieu Therapy in a Therapeutic Community. The total environment or milieu is regarded as the medium of therapy, all interactions and activities regarded as potentially therapeutic and are subject to exploration and interpretation, and are explored in daily or weekly community meetings.
A form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts. Projective group therapy uses an outside text such as a novel or motion picture to provide a “stable delusion” for the former cohort and a safe focus for repressed and suppressed emotions or thoughts in the latter. Patient groups read a novel or collectively view a film. They then participate collectively in the discussion of plot, character motivation and author motivation. In the case of films, sound track,cinematography and background are also discussed and processed. Under the guidance of the therapist, defense mechanisms are bypassed by the use of signifiers and semiotic processes. The focus remains on the text rather than on personal issues.
Research on effectiveness
There is clear evidence for the effectiveness of group psychotherapy for depression: a meta-analysis of 48 studies showed an overall effect size of 1.03, which is clinically highly significant. Similarly, a meta-analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect sizes , and there is also good evidence for effectiveness with chronic traumatic stress in war veterans. There is less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes. The authors comment that these poor outcomes might reflect a need for additional support for some patients, in addition to the group therapy. This is borne out by the impressive results obtained using Mentalization based treatment, a model which combines dynamic group psychotherapy with individual psychotherapy and case management. Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups, however long-term intensive interactional group psychotherapy assumes diverse and diagnostically heterogeneous group membership, and an open-ended time scale for therapy. Good outcomes have also been demonstrated for this form of group therapy.