Group therapy
Encyclopedia
Group psychotherapy or group therapy is a form of psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

 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
Group dynamics
Group dynamics refers to a system of behaviors and psychological processes that occur within a social group , or between social groups...

 is explicitly utilised as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.
The broader concept of group therapy
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...

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
The term anger management commonly refers to a system of psychological therapeutic techniques and exercises by which someone with excessive or uncontrollable anger & aggression can control or reduce the triggers, degrees, and effects of an angered emotional state...

, mindfulness
Mindfulness-based Cognitive Therapy
Mindfulness-based cognitive therapy is psychological therapy which blends features of cognitive therapy with mindfulness techniques of Buddhism. MBCT involves accepting thoughts and feelings without judgement rather than trying to push them out of consciousness, with a goal of correcting...

, relaxation training
Relaxation technique
A relaxation technique 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 anxiety, stress or anger...

 or social skills
Social skills
A social skill is any skill facilitating interaction and communication with others. Social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning such skills is called socialization...

 training), and psycho-education
Psychoeducation
Psychoeducation refers to the education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as...

 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
Expressive therapy
Expressive therapy, also known as expressive arts therapy or creative arts therapy, is the use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final product...

 such as dance therapy
Dance therapy
Dance therapy, or dance movement therapy is the psychotherapeutic use of movement and dance for emotional, cognitive, social, behavioral and physical conditions. As a form of expressive therapy, DMT is founded on the basis that movement and emotion are directly related...

, music therapy
Music therapy
Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...

 or the TaKeTiNa Rhythm Process
TaKeTiNa Rhythm Process
The TaKeTiNa Rhythm Process, developed by Austrian percussionist Reinhard Flatischler, is a musical, meditative group process for people who want to develop their awareness of rhythm....

.

History of group psychotherapy

The founders of group psychotherapy in the USA were Joseph H. Pratt, Trigant Burrow
Trigant Burrow
Trigant Burrow, was an American psychoanalyst, psychiatrist, psychologist, and, alongside Joseph H. Pratt and Paul Schilder, founder of group analysis. He was the inventor of the concept of neurodynamics.-Life:...

 and Paul Schilder. All three of them were active and working at the East Coast in first half of the 20th century. After World War II group psychotherapy was further developed by Jacob L. Moreno
Jacob L. Moreno
Jacob Levy Moreno was a Jewish Romanian-born Austrian-American leading psychiatrist and psychosociologist, thinker and educator, the founder of psychodrama, and the foremost pioneer of group psychotherapy...

, Samuel Slavson, Hyman Spotnitz
Hyman Spotnitz
Hyman Spotnitz was an American psychoanalyst and psychiatrist who pioneered an approach to working psychoanalytically with schizophrenics in the 1950s called modern psychoanalysis...

, Irvin Yalom, and Lou Ormont. Yalom's approach to group therapy has been very influential not only in the USA but across the world, through his classic text "The Theory and Practice of Group Psychotherapy". Moreno developed a specific and highly structured form of group therapy known as Psychodrama
Psychodrama
Psychodrama is a method of psychotherapy in which clients utilize spontaneous dramatization, role playing and dramatic self-presentation to investigate and gain insight into their lives. Developed by Jacob L. Moreno, M.D. psychodrama includes elements of theater, often conducted on a stage where...

. Another recent development is the theory and method of group psychotherapy based on an integration of systems thinking is Yvonne Agazarian's "systems-Centered" approach (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
S. H. Foulkes
Siegfried Heinrich Foulkes , born Siegfried Heinrich Fuchs in Karlsruhe, Germany, was the founder of Group Analysis, a specific form of group therapy, and the Group Analytic Society, London, which has an international membership in many countries....

 and Wilfred Bion
Wilfred Bion
Wilfred Ruprecht Bion DSO was an influential British psychoanalyst, who became president of the British Psychoanalytical Society from 1962 to 1965....

 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
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...

 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
Group analysis is a method of group psychotherapy originated by S. H. Foulkes in the 1940s. Group work was perhaps born of the need to deal economically and efficiently with a large body of returning soldiers with shared problems, but it soon developed into a much broader form in which individuals...

 and the Institute of Group Analysis
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...

, while Bion was influential in the development of group therapy at the Tavistock Clinic
Tavistock Clinic
The in London was founded in 1920 by Dr. Hugh Crichton-Miller, a psychiatrist who developed psychological treatments for shell-shocked soldiers during and after the First World War. The clinic's first patient was, however, a child. Its clinical services were always, therefore, for both children...

. Bion has been criticised, for example by Yalom, for his technical approach which had an exclusive focus on analysis of whole-group processes to the exclusion of any exploration of individual group members' issues. Despite this, his recognition of group defences in the "Basic Assumption Group", has been highly influential.

Bion's approach is comparable to Social Therapy
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 Lois Holzman...

, first developed in the United States in the late 1970s by Lois Holzman
Lois Holzman
Lois Holzman is a cofounder with Fred Newman of the East Side Institute for Group and Short Term Psychotherapy and the Institute's current director...

 and Fred Newman
Fred Newman
Frederick Delano "Fred" Newman was an American philosopher, psychotherapist, playwright and political activist, and creator of a therapeutic modality called Social Therapy.-Early life:...

, 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.

Therapeutic principles

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.
  • 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
Unconscious mind
The unconscious mind is a term coined by the 18th century German romantic philosopher Friedrich Schelling and later introduced into English by the poet and essayist Samuel Taylor Coleridge...

 identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference
Transference
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...

 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
Observational learning
Observational learning is a type of learning that occurs as a function of observing, retaining and replicating novel behavior executed by others...

 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
Catharsis or katharsis is a Greek word meaning "cleansing" or "purging". It is derived from the verb καθαίρειν, kathairein, "to purify, purge," and it is related to the adjective καθαρός, katharos, "pure or clean."-Dramatic uses:...

 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
Self-awareness
Self-awareness is the capacity for introspection and the ability to reconcile oneself as an individual separate from the environment and other individuals...

 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
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 the others within the unit. Milieu therapy is thought to...

 of a psychiatric in-patient unit or ambulatory psychiatric Partial hospitalization
Partial hospitalization
Partial hospitalization, also known as PHP , 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 center up to seven days a week...

 (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
Expressive therapy
Expressive therapy, also known as expressive arts therapy or creative arts therapy, is the use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final product...

 such as drama therapy
Drama therapy
Drama Therapy is the use of theatre techniques to facilitate personal growth and promote mental health. Dramatherapy is used in a wide variety of settings, including hospitals, schools, mental health centers, prisons, and businesses...

, psychodrama
Psychodrama
Psychodrama is a method of psychotherapy in which clients utilize spontaneous dramatization, role playing and dramatic self-presentation to investigate and gain insight into their lives. Developed by Jacob L. Moreno, M.D. psychodrama includes elements of theater, often conducted on a stage where...

, art therapy
Art therapy
Because of its dual origins in art and psychotherapy, art therapy definitions vary. They commonly either lean more toward the ART art-making process as therapeutic in and of itself, "art as therapy," or focus on the psychotherapeutic transference process between the therapist and the client who...

, and non-verbal types of therapy such as music therapy
Music therapy
Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...

. Group psychotherapy is a key component of Milieu Therapy
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 the others within the unit. Milieu therapy is thought to...

 in a Therapeutic Community
Therapeutic community
Therapeutic community is a term applied to a participative, group-based approach to long-term mental illness, personality disorders and drug addiction...

. 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 psychotherapy uses an outside text such as a novel or motion picture to provide a "stable delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...

" 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
Red Orc's Rage is a recursive science fiction novel and part of the "World of Tiers" series of novels by Philip José Farmer. The plot of the book was inspired by the work of American psychiatrist A.James Giannini, M.D, who used earlier books in Farmer's series as role-playing tools and aids to...

.

Group therapy is now often utilized in private practice settings (Gardenswartz, 2009, Los Angeles, CA).

Research on effectiveness

There is clear evidence for the effectiveness of group psychotherapy for depression: a meta-analysis
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...

 of 48 studies showed an overall effect size
Effect size
In statistics, an effect size is a measure of the strength of the relationship between two variables in a statistical population, or a sample-based estimate of that quantity...

 of 1.03, which is clinically highly significant. Similarly, a meta-analysis of five studies of group psychotherapy for adult sexual abuse
Child sexual abuse
Child sexual abuse is a form of child abuse in which an adult or older adolescent uses a child for sexual stimulation. Forms of child sexual abuse include asking or pressuring a child to engage in sexual activities , indecent exposure with intent to gratify their own sexual desires or to...

 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
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...

, 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
Mentalization based treatment
Mentalization-based treatment is an innovative form of psychodynamic psychotherapy, developed and manualised by Peter Fonagy and Anthony Bateman. MBT has been designed for individuals with borderline personality disorder , who suffer from disorganised attachment and allegedly failed to develop a...

, a model that combines dynamic group psychotherapy with individual psychotherapy and case management
Case management (mental health)
Case management is the coordination of community services for mental health patients by allocating a professional to be responsible for the assessment of need and implementation of care plans. It is usually required for individuals who have a serious mental illness and need ongoing support in areas...

. 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.
Group Therapy has been shown to be as or more effective than individual therapy for higher functioning
Global Assessment of Functioning
The Global Assessment of Functioning is a numeric scale used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and...

 adults (Gardenswartz, 2009, Los Angeles, CA). Clinical cases has shown that the combination of both individual and group therapy is most beneficial for such clients. (the "multiplicative" effect).

See also

  • Self Help Groups
    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. There are several international mental health self-help organizations including Emotions Anonymous, the...

  • Twelve-step program
    Twelve-step program
    A Twelve-Step Program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems...

  • Expressive therapy
    Expressive therapy
    Expressive therapy, also known as expressive arts therapy or creative arts therapy, is the use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final product...

  • Drama therapy
    Drama therapy
    Drama Therapy is the use of theatre techniques to facilitate personal growth and promote mental health. Dramatherapy is used in a wide variety of settings, including hospitals, schools, mental health centers, prisons, and businesses...

  • Family therapy
    Family therapy
    Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...


  • Play therapy
    Play therapy
    Play therapy is generally employed with children aged 3 through 11 and provides a way for them to express their experiences and feelings through a natural, self-guided, self-healing process...

  • Psychotherapy
    Psychotherapy
    Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

  • Social Therapy
    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 Lois Holzman...

  • Milieu Therapy
    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 the others within the unit. Milieu therapy is thought to...

  • Systemic Constellations
    Systemic Constellations
    The Systemic Constellation process is a trans-generational, phenomenological, therapeutic intervention with roots in family systems therapy , existential-phenomenology , and the ancestor reverence of the South African Zulus...


External links

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