Group psychotherapy or group therapy is a form of
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
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
art therapy
Art therapy (not to be confused with ''arts therapy'', which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art thera ...
,
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
or
interpersonal therapy, but it is usually applied to
psychodynamic
Psychodynamics, also known as psychodynamic psychology, in its broadest sense, is an approach to psychology that emphasizes systematic study of the psychological forces underlying human behavior, feelings, and emotions and how they might relate t ...
group therapy where the group context and
group process
Group dynamics is a system of behaviors and psychological processes occurring within a social group (''intra''group dynamics), or between social groups ( ''inter''group dynamics). The study of group dynamics can be useful in understanding decision- ...
is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.
The broader concept of ''group
therapy
A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis.
As a rule, each therapy has indications and contraindications. There are many different ...
'' can be taken to include any helping process that takes place in a group, including
support groups, skills training groups (such as
anger management
Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully.Schwarts, Gil. July 2006. Anger Management', July 2006 The Office Politic. Men's Health magazine. Emmaus, PA: ...
,
mindfulness
Mindfulness is the practice of purposely bringing one's attention to the present-moment experience without evaluation, a skill one develops through meditation or other training. Mindfulness derives from ''sati'', a significant element of Hind ...
,
relaxation training
A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relax ...
or
social skills training), and
psychoeducation
Psychoeducation (a portmanteau of psychological education) is an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness. Psychoeducation is most oft ...
groups. The differences between psychodynamic groups, activity groups, support groups, problem-solving and psychoeducational groups have been discussed by psychiatrist Charles Montgomery. Other, more specialized forms of group therapy would include non-verbal
expressive therapies such as
art therapy
Art therapy (not to be confused with ''arts therapy'', which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art thera ...
,
dance therapy
Dance/movement therapy (DMT) in USA/ Australia or dance movement psychotherapy (DMP) in the UK is the psychotherapeutic use of movement and dance to support intellectual, emotional, and motor functions of the body. As a modality of the creativ ...
, or
music therapy
Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music t ...
.
History
The founders of group psychotherapy in the United States were Joseph H. Pratt,
Trigant Burrow Nicholas Trigant Burrow (September 7, 1875 – May 24, 1950) was an American psychoanalyst, psychiatrist, psychologist, and, alongside Joseph H. Pratt and Paul Schilder, founder of group analysis in the United States. He was the inventor of the conc ...
and
Paul Schilder
Paul Ferdinand Schilder (February 15, 1886, Vienna – December 7, 1940, New York City) was an Austrian psychiatrist, psychoanalyst, and medical researcher.
Neurological research work (in both neurophysiology and neuropathology), coupled with an a ...
. All three of them were active and working at the East Coast in the first half of the 20th century. In 1932
Jacob L. Moreno presented his work on group psychotherapy to the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
, and co-authored a monograph on the subject. After
World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
, group psychotherapy was further developed by Moreno,
Samuel Slavson
Samuel Richard Slavson (December 25, 1890 - August 5, 1981) was an American engineer, journalist and teacher, who began to engage in group analysis in 1919. He is considered one of the pioneers of group psychotherapy for his contributions to its r ...
,
Hyman Spotnitz Hyman Spotnitz (September 29, 1908 – April 18, 2008) was an American psychoanalyst and psychiatrist who pioneered an approach to working psychoanalytically with patients with schizophrenia in the 1950s called modern psychoanalysis. He also was ...
,
Irvin Yalom, and
Lou Ormont. Yalom's approach to group therapy has been very influential not only in the USA but across the world.
An early development in group therapy was the
T-group or training group (sometimes also referred to as
sensitivity-training group, human relations training group or encounter group), a form of group psychotherapy where participants (typically, between eight and 15 people) learn about themselves (and about small group processes in general) through their interaction with each other. They use feedback, problem solving, and role play to gain insights into themselves, others, and groups. It was pioneered in the mid-1940s by
Kurt Lewin
Kurt Lewin ( ; 9 September 1890 – 12 February 1947) was a German-American psychologist, known as one of the modern pioneers of social, organizational, and applied psychology in the United States. During his professional career Lewin applied hi ...
and
Carl Rogers
Carl Ransom Rogers (January 8, 1902 – February 4, 1987) was an American psychologist and among the founders of the humanistic approach (and client-centered approach) in psychology. Rogers is widely considered one of the founding fathers of ps ...
and his colleagues as a method of learning about human behavior in what became the
National Training Laboratories Kurt Lewin founded the National Training Laboratories Institute for Applied Behavioral Science, known as the NTL Institute, an American non-profit behavioral psychology center, in 1947. NTL became a major influence in modern corporate training prog ...
(also known as the
NTL Institute Kurt Lewin founded the National Training Laboratories Institute for Applied Behavioral Science, known as the NTL Institute, an American non-profit behavioral psychology center, in 1947. NTL became a major influence in modern corporate training pro ...
) that was created by the
Office of Naval Research
The Office of Naval Research (ONR) is an organization within the United States Department of the Navy responsible for the science and technology programs of the U.S. Navy and Marine Corps. Established by Congress in 1946, its mission is to plan ...
and the
National Education Association
The National Education Association (NEA) is the largest labor union in the United States. It represents public school teachers and other support personnel, faculty and staffers at colleges and universities, retired educators, and college stude ...
in Bethel, Maine, in 1947.
Moreno developed a specific and highly structured form of group therapy known as
psychodrama
Psychodrama is an action method, often used as a psychotherapy, in which clients use spontaneous dramatization, role playing, and dramatic self-presentation to investigate and gain insight into their lives.
Developed by Jacob L. Moreno and h ...
(although the entry on psychodrama claims it is not a form of group therapy). Another recent development in the theory and method of group psychotherapy based on an integration of systems thinking is
Yvonne Agazarian's
systems-centered therapy (SCT), which sees groups functioning within the principles of system dynamics. Her method of "functional subgrouping" introduces a method of organizing group communication so it is less likely to react counterproductively to differences. SCT also emphasizes the need to recognize the phases of group development and the defenses related to each phase in order to best make sense and influence group dynamics.
In the United Kingdom group psychotherapy initially developed independently, with pioneers
S. H. Foulkes and
Wilfred Bion
Wilfred Ruprecht Bion DSO (; 8 September 1897 – 8 November 1979) was an influential English psychoanalyst, who became president of the British Psychoanalytical Society from 1962 to 1965.
Early life and military service
Bion was born in M ...
using group therapy as an approach to treating combat fatigue in the Second World War. Foulkes and Bion were psychoanalysts and incorporated psychoanalysis into group therapy by recognising that
transference
Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
can arise not only between group members and the therapist but also among group members. Furthermore, the psychoanalytic concept of the unconscious was extended with a recognition of a group unconscious, in which the unconscious processes of group members could be acted out in the form of irrational processes in group sessions. Foulkes developed the model known as
group analysis
Group analysis (or group analytic psychotherapy) is a method of group psychotherapy originated by S. H. Foulkes in the 1940s. Group psychotherapy was pioneered by S. H. Foulkes with his psychoanalytic patients and later with soldiers in the Nort ...
and the
Institute of Group Analysis
The Institute of Group Analysis is a training organisation for group psychotherapists in the analytical tradition, based on the groundwork begun by S. H. Foulkes in forming the body of theory and practice now known as Group Analysis.
History and ...
, while Bion was influential in the development of group therapy at the
Tavistock Clinic
The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kin ...
.
Bion's approach is comparable to
social therapy
Social therapy is an activity-theoretic practice developed outside of academia at the East Side Institute for Group and Short Term Psychotherapy in New York. Its primary methodologists are cofounders of the East Side Institute, Fred Newman and L ...
, first developed in the United States in the late 1970s by
Lois Holzman
Lois Holzman is director and co-founder of the East Side Institute in New York, New York, where she developed social therapy methods with Fred Newman (philosopher), Fred Newman. She is known for her research and work on play therapy, social therap ...
and
Fred Newman, which is a group therapy in which practitioners relate to the group, not its individuals, as the fundamental unit of development. The task of the group is to "build the group" rather than focus on problem solving or "fixing" individuals.
In Argentina an independent school of group analysis stemmed from the work and teachings of Swiss-born Argentine psychoanalyst
Enrique Pichon-Rivière
Enrique Pichon-Rivière (June 25, 1907 – July 16, 1977) was a Swiss psychiatrist naturalized Argentine, considered one of the introducers of group psychoanalysis in Argentina and generator of the group theory known as ''Grupo operativo'' (Ope ...
. This thinker conceived of a group-centered approach which, although not directly influenced by Foulkes' work, was fully compatible with it.
Therapeutic principles
Irvin Yalom proposed a number of therapeutic factors (originally termed ''curative factors'' but renamed ''therapeutic'' factors in the 5th edition of ''The Theory and Practice of Group Psychotherapy'' (1st edition 1970, 5th edition 2005).
* Universality
: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
* Altruism
: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 that has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems with which they are still struggling.
* Imparting information
: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
The unconscious mind (or the unconscious) consists of the processes in the mind which occur automatically and are not available to introspection and include thought processes, memories, interests, and motivations.
Even though these processes exist ...
identify the group therapist and other group members with their own parents and siblings in a process that is a form of
transference
Transference (german: Übertragung) is a phenomenon within psychotherapy in which the "feelings, attitudes, or desires" a person had about one thing are subconsciously projected onto the here-and-now Other. It usually concerns feelings from a ...
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 socializing 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
* Imitative behaviour
:One way in which group members can develop social skills is through a
modeling
A model is an informative representation of an object, person or system. The term originally denoted the plans of a building in late 16th-century English, and derived via French and Italian ultimately from Latin ''modulus'', a measure.
Models c ...
process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.
* Cohesiveness
: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.
* Existential factors
:Learning that one has to take responsibility for one's own life and the consequences of one's decisions.
* Catharsis
:
Catharsis
Catharsis (from Greek , , meaning "purification" or "cleansing" or "clarification") is the purification and purgation of emotions through dramatic art, or it may be any extreme emotional state that results in renewal and restoration. In its lite ...
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.
* Interpersonal learning
:Group members achieve a greater level of
self-awareness
In philosophy of self, self-awareness is the experience of one's own personality or individuality. It is not to be confused with consciousness in the sense of qualia. While consciousness is being aware of one's environment and body and lifesty ...
through the process of interacting with others in the group, who give feedback on the member's behaviour and impact on others.
* Self-understanding
: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 that underlie one's behaviour.
Settings
Group therapy can form part of the
therapeutic milieu of a psychiatric in-patient unit or ambulatory psychiatric
partial hospitalization
Partial hospitalization, also known as PHP (partial hospitalization program), is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment ...
(also known as
day hospital A day hospital is an outpatient facility where patients attend for assessment, treatment or rehabilitation during the day and then return home or spend the night at a different facility. Day hospitals are becoming a new trend in healthcare. The num ...
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
Psychodrama is an action method, often used as a psychotherapy, in which clients use spontaneous dramatization, role playing, and dramatic self-presentation to investigate and gain insight into their lives.
Developed by Jacob L. Moreno and h ...
,
art therapy
Art therapy (not to be confused with ''arts therapy'', which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art thera ...
, and non-verbal types of therapy such as
music therapy
Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music t ...
and dance/movement therapy.
Group psychotherapy is a key component of
milieu therapy
Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities. Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and th ...
in a
therapeutic community Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. The approach was usually residential, with the clients and therapists living together, but increasingly residential ...
. 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. However, interactions between the culture of group psychotherapeutic settings and the more managerial norms of external authorities may create 'organizational turbulence' which can critically undermine a group's ability to maintain a safe yet challenging 'formative space'. Academics at the
University of Oxford
, mottoeng = The Lord is my light
, established =
, endowment = £6.1 billion (including colleges) (2019)
, budget = £2.145 billion (2019–20)
, chancellor ...
studied the inter-organizational dynamics of a national democratic therapeutic community over a period of four years; they found external steering by authorities eroded the community's therapeutic model, produced a crisis, and led to an intractable conflict which resulted in the community's closure.
A form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts. Projective psychotherapy uses an outside text such as a novel or motion picture to provide a "stable
delusion
A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
" 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. It was popularized in the science fiction novel, ''
Red Orc's Rage
''Red Orc's Rage'' (1991) is a recursive science fiction novel by American writer Philip José Farmer, part of his " World of Tiers" series . The plot of the book was inspired by the work of American psychiatrist A. James Giannini, M.D, who use ...
''.
Group therapy is now often utilized in private practice settings.
Group analysis has become widespread in Europe, and especially the United Kingdom, where it has become the most common form of group psychotherapy. Interest from Australia, the former Soviet Union and the African continent is also growing.
Research on effectiveness
A 2008 meta-analysis found that individual therapy may be slightly more effective than group therapy initially, but this difference seems to disappear after 6 months. There is clear evidence for the effectiveness of group psychotherapy for
depression: a
meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
of 48 studies showed an overall
effect size
In statistics, an effect size is a value measuring the strength of the relationship between two variables in a population, or a sample-based estimate of that quantity. It can refer to the value of a statistic calculated from a sample of data, the ...
of 1.03, which is clinically highly significant. Similarly, a meta-analysis of five studies of group psychotherapy for adult
sexual abuse
Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...
survivors showed moderate to strong effect sizes,
and there is also good evidence for effectiveness with chronic
traumatic stress Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM). The experience of traumatic stress include subtypes ...
in war veterans.
There is less robust evidence of good outcomes for patients with
borderline personality disorder
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of unstable interpersonal relationships, distorted sense of self, and strong ...
, 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 that 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.
Computer-supported group therapy
Research on computer-supported and computer-based interventions has increased significantly since the mid-1990s. For a comprehensive overview of current practices see:
Computer-supported psychotherapy.
Several feasibility studies examined the impact of computer-, app- and media-support on group interventions. Most investigated interventions implemented short rationales, which usually were based on principles of cognitive behaviour therapy (CBT). Most research focussed on:
* Anxiety disorders (e.g. social phobia, generalised anxiety disorder
)
* Depression (e.g. mild to moderate Major Depression
)
* Other disorders (e.g. hoarding
)
While the evidence base for group therapy is very limited, preliminary research in individual therapy suggests possible increases of treatment efficiency or effectiveness.
Further, the use of app- or computer-based monitoring has been investigated several times. Reported advantages of the modern format include improved between-session transfer and patient-therapist-communication,
as well as increased treatment transparency and intensity.
Negative effects may occur in terms of dissonance due to non-compliance with online tasks, or the constriction of in-session group interaction.
Last but not least, group phenomena might influence the motivation to engage with online tasks.
See also
*
Family therapy
Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychology and clinical social work that works with families and couples in intimate relationsh ...
*
Henry Ezriel
*
Self-help groups for mental health
Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. Despite the different approaches, many of the psycho ...
*
Twelve-step program
Twelve-step programs are international mutual aid programs supporting recovery from substance addictions, behavioral addictions and compulsions. Developed in the 1930s, the first twelve-step program, Alcoholics Anonymous (AA), aided its members ...
*
Impact therapy
*
American Group Psychotherapy Association
The American Group Psychotherapy Association (AGPA) is a not-for-profit multi-disciplinary organization dedicated to enhancing the practice, theory and research of group psychotherapy.
Membership
American Group Psychotherapy Association is a nati ...
, founded in 1943
Notes
Further reading
*
*
{{Authority control
Psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...