Group Therapy

Group information

This information on group therapy will center on several factors to consider when thinking about the role that group therapy will have in your practice. For a better resource on group therapy, especially group psychotherapy, pick up the latest edition of Theory and Method of Group Psychotherapy by Irving Yalom (I think the 5th edition is the latest). Having been a co-therapist in both a psychotherapy and psycho-educational group I have seen the promises and the difficulties groups can have on the lives of clients.

Three practical considerations concerning groups are: the group, the therapy, and the therapist. Groups tend to work best when the members share similar ages, intelligences and developmental levels. Age is a primary concern with groups for adolescents and children, with developmental level playing a larger role in the adolescent area. Furthermore, gender should play a role in group selection with these age cohorts as well. Finally, there is some discrepancy in thought concerning the role of the problem in selection for a group. Evidence and thought both support homogeneity and heterogeneity.

Groups can also function as closed or open entities. Closed groups are often more task-oriented and function in a short-term fashion. In this form of group, the members are constant from beginning to end. In an open group, members come and go and the group does not really have a specified ending. These groups tend to be more psychotherapeutically oriented. Group size seems to be most effective when it ranges from 7 to 10 members.

Irving Yalom is the leader in theory and method of group psychotherapy. He posits three stages to a group. In the first stage group members are searching for a way to connect with one another and the group as a whole. This stage is dominated by a lack of depth to the communication as the group members feel one another out. In the second stage, group members begin to entrench themselves in particular roles and a social ethos begins to emerge. This stage is marked by an increase in resistance as the members realize they are going to have to “share” the therapist. The final stage is marked by the development of group cohesiveness. Here the group becomes genuine in word and action and a sense of group empathy emerges. Following the establishment of cohesiveness the group matures and much of its “real” work begins. Yalom also believes that the group becomes a small social reality for each individual where they play out their healthy and unhealthy behaviors. Therefore, the group becomes the place where maladaptive behaviors can be tested and reframed in relative safety.

The therapist plays a key role in the group, especially in the beginning stages. The therapist is responsible for creation and maintenance of the group and for building a safe atmosphere for cohesion to emerge. The therapist also keeps the group from wandering too far from its purpose through a gentle nudging back to the present atmosphere of the group. Co-therapists also offer a unique opportunity for group members to see others modeling appropriate behaviors, especially during conflict.

For further review: Theory and Practice of Group Psychotherapy, Fifth Edition