Group psychotherapy or group therapy 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 "ontgomery (#$$# .%&' (ther, more specialised forms of group therapy would include non!verbal expressive therapies such as art therapy, dance therapy, or music therapy. Contents

& )istory of group psychotherapy # Therapeutic principles * +ettings , -esearch on effectiveness . +ee also / 0otes 1 2urther reading 3 4xternal links

)istory of group psychotherapy

The founders of group psychotherapy in the 5+6 were 7oseph ). 8ratt, Trigant 9urrow and 8aul +childer. 6ll three of them were active and working at the 4ast Coast in the first half of the #$th century. 6fter :orld :ar II, group psychotherapy was further developed by 7acob ;. "oreno, +amuel +lavson, )yman +potnit<, Irvin =alom, and ;ou (rmont. =alom>s approach to group therapy has been very influential not only in the 5+6 but across the world. 6n early development in group

therapy the T!group or training group (sometimes also referred to as sensitivity! training group, human relations training group or encounter group is a form of group psychotherapy where participants themselves (typically, between eight and &. 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!&?,$s by @urt ;ewin and Carl -ogers and his colleagues as a method of learning about human behavior in what became The 0ational Training ;aboratories (now 0T; Institute that was created by the (ffice of 0aval -esearch and the 0ational 4ducation 6ssociation in 9ethel, "aine, in &?,1 "oreno developed a specific and highly structured form of group therapy known as 8sychodrama. 6nother recent development in the theory and method of group psychotherapy based on an integration of systems thinking is =vonne 6ga<arian>s Asystems! CenteredA approach (+CT , which sees groups functioning within the principles of system dynamics. )er method of Afunctional subgroupingA introduces a method of organi<ing group communication so it is less likely to react counterproductively to differences. +CT also emphasi<es the need to recogni<e the phases of group development and the defenses related to each phase in order to best make sense and influence group dynamics.

In the 5nited @ingdom group psychotherapy initially developed independently, with pioneers +. ). 2oulkes and :ilfred 9ion using group therapy as an approach to treating combat fatigue in the +econd :orld :ar. 2oulkes and 9ion were psychoanalysts and incorporated psychoanalysis into group therapy by recognising that transference can arise not only between group members and the therapist but also among group members. 2urthermore 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. 2oulkes developed the model known as Group 6nalysis and the Institute of Group 6nalysis, while 9ion was influential in the development of group therapy at the Tavistock Clinic.

9ion>s approach is comparable to +ocial Therapy, first developed in the 5nited +tates in the late &?1$s by ;ois )ol<man and 2red 0ewman, 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 Abuild the groupA rather than focus on problem solving or AfixingA individuals. Therapeutic principles

=alom>s therapeutic factors (originally termed curative factors but renamed therapeutic factors .in the .th edition of >The Theory and 8ractice of Group 8sychotherapy> .

5niversality

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

6ltruism

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

:hile 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. 2or example, about their treatment or about access to services.

Corrective recapitulation of the primary family experience

"embers often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that 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.

Bevelopment of sociali<ing techniCues

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

(ne way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members. 2or 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. )umans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. 6 cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.

4xistential factors

;earning that one has to take responsibility for one>s own life and the conseCuences of one>s decisions.

Catharsis

Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. :hen 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 through the process of interacting with others in the group, who give feedback on the member>s behaviour and impact on others.

+elf!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.

+ettings

Group therapy can form part of the therapeutic milieu of a psychiatric in!patient unit%*'%,' or ambulatory psychiatric 8artial hospitali<ation (also known as Bay )ospital treatment .%.' In addition to classical AtalkingA 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 and danceDmovement therapy. Group psychotherapy is a key component of "ilieu 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 subEect to exploration and interpretation, and are explored in daily or weekly community meetings.%/' )owever, interactions between the culture of group psychotherapeutic settings and the more managerial norms of external authorities may create >organi<ational turbulence> which can critically undermine a group>s ability to maintain a safe yet challenging >formative space>.%1' 6cademics at the 5niversity of (xford studied the inter!organi<ational dynamics of a

national democratic therapeutic community over a period of four yearsF 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.%3'

6 form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts.%?' 8roEective psychotherapy uses an outside text such as a novel or motion picture to provide a Astable delusionA for the former cohort and a safe focus for repressed and suppressed emotions or thoughts in the latter. 8atient 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. 5nder 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 populari<ed in the science fiction novel, -ed (rc>s -age.

Group therapy is now often utili<ed in private practice settings (Gardenswart<, #$$?, ;os 6ngeles, C6 .

Group!analysis has become widespread in 4urope, and especially the 5nited @ingdom, where it has become the most common form of group psychotherapy. Interest from 6ustralia, the +oviet 5nion and the 6frican continent is also growing. %&&' -esearch on effectiveness

There is clear evidence for the effectiveness of group psychotherapy for depressionG a meta!analysis of ,3 studies showed an overall effect si<e of &.$*, which is clinically highly significant.%&#' +imilarly, a meta!analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect si<es,%&*' 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 si<es.%&.' 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 "entali<ation based treatment, a model that combines dynamic group psychotherapy with individual psychotherapy and case management.%&/' "ost outcome research is

carried out using time!limited therapy with diagnostically homogenous groups. )owever, long!term intensive interactional group psychotherapy%&1' 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.%&3' Group Therapy has been shown to be as or more effective than individual therapy for higher functioning adults (Gardenswart<, #$$?, ;os 6ngeles, C6 . Clinical cases has shown that the combination of both individual and group therapy is most beneficial for such clients. (the AmultiplicativeA effect . +ee also

+elf )elp Groups Twelve!step program 4xpressive therapy Brama therapy 2amily therapy 8lay therapy 8sychotherapy +ocial Therapy "ilieu Therapy +ystemic Constellations

BanceD"ovement Therapy

Group therapy provides psychotherapy treatment in a format where there is typically one therapist and six to twelve participants with related problems. +ometimes a therapist may recommend group therapy over individual psychotherapy for a variety of reasons. It may be that the group format is better suited for the person or the concern they are dealing with, or that the specific type of treatment has a group therapy component (such as dialectical behavior therapy .

8eople in group therapy improve not only from the interventions of the therapist, but also from observing others in the group and receiving feedback from group members. The group format, while not providing the one!on!one attention of individual formats, has several advantages.

+imilar to family therapy, group therapy is a style that can incorporate any of the psychotherapy schools. The advantages of group therapy includeG

Increased feedback Group therapy can provide the patient with feedback from other people. Getting different perspectives is often helpful in promoting growth and change.

"odeling 9y seeing how others handle similar problems, the patient can rapidly add new coping methods to his or her behaviors. This is beneficial in that it can give the patient a variety of perspectives on what seem to work and when.

4xample "ary listens to 7oan talk about how telling her husband that he hurt her feelings was more productive than simply getting angry at him and not speaking. 6s she listens, "ary thinks of how she might try this same strategy with her husband. +he can then try out this new behavior by practicing with the men in the group. ;ess expensive 9y treating several patients simultaneously, the therapist can reduce the usual fee. In most cases the cost of group therapy is about one!third that of individual therapy. Improve social skills +ince so much of our daily interaction is with other people, many people learn to improve their social skills in group therapy (even though such an issue may not be the focus of the group . The group leader, a therapist, often helps people to learn to communicate more clearly and effectively with one another in the group context. This is inevitably leads to people learning new social skills which they can generali<e and use in all of their relationships with others.

5nlike individual therapy sessions, group therapy offers participants the opportunity to interact with others with similar issues in a safe, supportive environment. 8articipants can try out new behaviors, role play, and engage with others in not only receiving valuable feedback and insight from other group members, but also in giving it.

"any people who have never tried group therapy before are frightened by the idea. +haring intimate information and details about oneHs life (and problems can be challenging enough to do with a single therapist. To do so with six other strangers might seem overwhelming. 2or this reason, for most people group therapy is usually not the first treatment option offered.

"ost people who try group therapy do become comfortable and familiar with the process over a short period of time (within a few weeks . There are clinicians and researchers who also claim that the group psychotherapy process produces stronger and longer!lasting results for many people, as compared to individual psychotherapy.

6s the group members begin to feel more comfortable, you will be able to speak freely. The psychological safety of the group will allow the expression of those feelings which are often difficult to express outside of group. =ou will begin to ask for the support you need. =ou will be encouraged tell people what you expect of them.

In a group, you probably will be most helped and satisfied if you talk about your feelings. It is important to keep in mind that you are the one who determines how much you disclose in a group. =ou will not be forced to tell you deepest and innermost thoughts.

Groups with greater than &# participants should usually be avoided, as it becomes increasingly difficult for people to attain sufficient time to make the group process work as effectively as it does with smaller groups. ()erkov, ". (#$$/ . 6bout Group Therapy. 8sych Central. -etrieved on 0ovember &?, #$&*, from httpGDDpsychcentral.comDlibDabout!group!therapyD$$$/11