Group Therapy: Principles, Benefits and Effectiveness

What Is Group Therapy?

Group therapy is a form of psychotherapy that takes place in a group setting with one or more therapists and several clients. It is conducted in spaces such as private practices, hospitals, and community centers, and it supplements individual therapy or acts as a stand-alone mental health intervention.¹

What Is the History of Group Therapy?

Internist Joseph Pratt and psychiatrists Trigant Burrow and Paul Schilder founded group psychotherapy in the United States during the first half of the 20th century.²

During World War II, psychoanalysts Wilfred Bion, John Rickman, and Michael Foulkes treated soldiers in group settings to boost morale. Although they are not considered the founders of group therapy, their contribution is thought to have transformed groups’ roles and provided greater insight about and attention to group therapy.³ They also observed that group therapy helped clients develop better communication and socialization skills, taught them how to accept criticism, and facilitated honest expression of emotions and issues.

In 1970, American psychiatrist Irvin Yalom and his colleagues further developed group therapy and published The Theory and Practice of Group Psychotherapy. Yalom’s theory, approach, and practice of group therapy became globally influential.⁴ Yalom advocated for group therapy because he believed that group work constructed a particular dynamic that advanced healing for clients while also facilitating the therapist’s own growth as a clinician. He understood that the delicate and essential relationship between the clinician and each group member had the opportunity to propel individuals into more significant progress. His seminal book outlines the principles of group psychotherapy through the perspective of individuals who participated in group work and reported on the process. It also serves as a guide to clinicians and sets forth expectations for each stage of group therapy, ways to address particular problems that might arise during the course of treatment, and specialized group therapy techniques.

How Does Group Therapy Work?

Group therapy uses techniques similar to those of individual psychotherapy but requires therapists to manage group dynamics. In particular, therapists and clients must work together to establish safety, respect, honesty, privacy, and dedication within the group. Group members do this by actively listening to one another, reflecting on what others say, questioning and confronting problems, and empathizing with each other.⁵ Creating healthy interactions with other people who struggle in similar ways provides individuals with paths to resolve anxiety, fear, shame, guilt, loneliness, and other emotions associated with mental health difficulties.⁶

Groups may be as small as 3 people and as large as 15 people. They generally meet at least once a week and, depending on the need or type of group, can meet twice per week.⁴ The maximum length of a group tends to be 25 sessions or six months.⁷ Traditionally, groups meet in person; however, nowadays, many groups may meet virtually.

Group therapy is most effective when people attend sessions consistently. Inconsistent attendance or participation can compromise treatment outcomes.⁷

Principles of Group Therapy

According to Yalom’s influential work in the Theory and Practice of Group Psychotherapy, 11 key factors are essential to group therapy:^2,4,8

• Instillation of hope: A sense of optimism is created by building participants’ confidence about the great potential of being in group therapy and that recovery is possible.
• Universality: Group members are shown that they are not alone in their struggle and that other people may have similar thoughts, feelings, and behaviors.
• Imparting information: The group therapist and/or fellow group members seek to educate participants about session content using a psychoeducational format.
• Altruism: Helping and supporting others creates an important motivational mindset.
• The corrective recapitulation of a primary family group: Dysfunctional patterns or relationships in the group members’ individual families can be identified and transformed into healthier versions.
• Development of socializing techniques: Group therapists promote social skills, empathy, tolerance of others, and healthy interpersonal behaviors.
• Imitative behavior: Group members both model and imitate behaviors to develop a sense of functional, healthier patterns.
• Interpersonal learning: Interpersonal interactions between group members help participants better understand how they experience and interact with others; these interactions also allow group members to perceive how other people experience their feelings and behaviors.
• Group cohesiveness: Cohesiveness allows for a group to run smoothly and occurs when members feel valued and a sense of belonging within the group.
• Catharsis: Emotional release allows for greater insight to be gained; cohesiveness is a crucial requirement for catharsis to bring meaning and understanding to emotions.
• Existential factors: Therapists help group members explore fundamental human experiences like responsibility, death, isolation, freedom, and a sense of purpose.

Potential Benefits of Group Therapy

Although some people may be skeptical about receiving treatment with others, group work potentially offers significant benefits. For example, group therapy allows participants to find a support system, hold each other accountable, and challenge one another. It also enables members to gain insights into how to cope with difficult life situations.² Additionally, group work can help put things into perspective; hearing other individuals voice similar issues allows group members to experience relief when they see that they are not alone. Lastly, when members see individuals in the group who struggle in similar ways make positive and lasting changes, it can instill a sense of hope, optimism, and drive to accomplish the same for themselves.⁹

Effectiveness of Group Therapy

Research studies have demonstrated the effectiveness of group therapy in multiple contexts and for a variety of conditions and disorders, such as depression, anxiety, eating disorders, and social phobias:

• American researchers Fals-Stewart, Marks, and Schafer (1993) recruited 93 participants with obsessive-compulsive disorder (OCD) and assigned them to one of three study groups. Participants in the first group received group therapy, participants in the second group received individual therapy, and participants in the third group received no therapy, acting as the study control group. After analyzing the clients’ responses to the Yale-Brown OCD Scale, the Beck Depression Inventory, and the Self-Rating Anxiety Scale, the researchers found that participants undergoing group and individual therapy experienced equal reductions in levels of distress caused by OCD symptoms, depression, and anxiety when compared to the control group.¹⁰
• Norwegian researchers Thimm and Antonsen (2013) conducted a retrospective study utilizing hospital database review to study 143 individuals who met diagnostic criteria for depression and had received cognitive behavioral group therapy for depression between 2002 and 2013. The researchers analyzed their scores on the Beck Depression Inventory and found that participants experienced a significant reduction in depression and anxiety after cognitive behavioral group therapy.⁷
• Australian researchers Byrne, Fursland, Allen, and Watson (2011) recruited 125 individuals with eating disorders. All participants attended assessment and treatment sessions. The treatment was composed of four stages: engaging and education, reviewing progress and barriers, modifying factors that maintained the eating disorder, and focusing on maintenance of gains and relapse prevention. The researchers found that cognitive behavioral group therapy led to complete or partial remission for participants with anorexia and provided significant improvements in eating behaviors.¹¹
• Iranian researchers Jabbari, Basharpour, and Narimani (2020) recruited 24 participants with social anxiety disorder. Twelve participants in the experimental group received acceptance and commitment group therapy for anxiety disorders, while the control group was put on a waiting list. After analyzing participants’ reports on the Self-Compassion, Difficulty in Emotion Regulation, External Shame, Social Anxiety, and Acceptance and Action Questionnaires, the researchers found a significant reduction in social anxiety and depression symptoms.¹²

Further research has established that group therapy may help improve the following mental health conditions:

• substance use disorders¹³
• obsessive-compulsive disorder¹⁰
• social anxiety disorder¹⁴
• depression⁷
• addiction^15,16
• domestic violence or abuse¹⁷
• general anxiety¹⁸
• eating disorders¹¹
• grief¹⁹