It is usually not the first type of counseling that people consider, but group therapy is an efficient and powerful way to address many of life’s difficulties. Group therapy occurs when one or more therapists facilitate discussion within a group of people on a specific topic or a more general process. Most often, group therapy is targeted toward a particular population. For instance, a group may revolve around helping people with substance abuse or depression.
Groups are either content-focused or process-oriented. Content-focused groups have a structured protocol. These include groups that aim to provide psycho-education or skills training. Process groups may also be formed around a particular topic but are more unstructured. In these groups, members have a more prominent role in leading the discussion. Process groups may include interpersonal groups and support groups. You might wonder why someone would seek group therapy rather than individual therapy, but there are some distinct advantages. Let’s explore what makes group therapy such a desirable treatment modality.
Advantages of Group Therapy
· One of the main strengths of group psychotherapy is how it instills a feeling of universality. In other words, the feeling that you are not alone in dealing with your problems. This is a powerful aspect of group work because coping with various difficulties can make us feel like we have been left isolated on an island. Universality can provide clients with hope.
· Similarly, group therapy offers peer support that cannot be matched by individual therapy. Even groups that are more psycho-educational provide support by other members. The importance of support can’t be underestimated. It can make the difference between success and failure in therapy and in life.
· Another important aspect of group therapy is how much you learn. It may be obvious that you will gain education from a content-focused group but you will also learn a lot from process groups. For example, other group members will present ideas for coping measures that you can adopt in your own life. You can also learn from group leaders or other members who role-model how they handle similar problems.
· An often overlooked part of group therapy is how it helps in overcoming shame. Many people feel shame over their mental illness and/or their behavior. However, when you are surrounded by people with similar difficulties, you find acceptance and support. You realize that there are people who will embrace you rather than shun you. Groups can give you the confidence to face the world.
· Group psychotherapy tends to be cheaper than individual psychotherapy. For some people, it may be the only type of treatment they can afford.
Yeah, But Does It Work?
The advantages of group therapy appear to be substantial but does it help with mental health issues and can it be as effective as individual therapy?
Group therapy exceeds the American Psychological Association’s Society of Clinical Psychology standards for efficacy for many disorders, including major depressive disorder, bipolar disorder, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, substance use disorder, schizophrenia, and borderline personality disorder. And for many mental health issues, group therapy is as effective as individual therapy.
For example, in a review of multiple studies, sexual abuse survivors exhibited significant improvement after a group therapy protocol.
And group therapy has been found to significantly reduce symptoms of anxiety and depression. What’s more, in this same study, group therapy was found to be as effective as individual therapy
Lending credence to the importance of peer relationships within group therapy, it has been found that the ability to interact with group members is largely responsible for its effectiveness.
Group therapy also has benefits for the therapist. It provides counselors the opportunity to see how clients relate to other group members rather than rely on client self-report about how they interact with people in their life.
Group Therapy Activities
There are literally hundreds of group therapy activities that therapists utilize to promote growth and healing. The following are some of the most popular, broken down into several categories. These include activities for adults, children, and two common problems often treated by group therapy: addictions and anxiety/depression.
Fun Facts is a popular ice breaker. Clients fill out a slip with a fun fact about themselves. Then group members must figure out who wrote it.
People Search involves a list of traits, talents, or experiences, as determined by the therapist(s). Each member receives the list and is given a certain amount of time to find someone in the group who is a match. When the match is found, that person will then sign off for that item. The first person to have their list completely signed wins. This can serve both as an ice breaker and a jumping-off point to explore the qualities of group members.
Affirmations are one of the most used group therapy activities with many variations. In one version, the therapist gives each client a sheet of paper. Clients write their name on it and then all the papers are passed around so each group member has the opportunity to write affirmations for that person on their sheet. Once their original paper is returned to them, they can read and explore the meaning with the group. This can lead to a therapeutic discussion about how others view them and how they feel about themselves.
In Stand Up, Sit Down, the group leader makes a statement about a characteristic of a person. For example, they could say, “anyone with blonde hair”. If that statement is true for the child they stand up. Kids remain seated if it’s not true for them. This can be a simple ice breaker but therapists can also create more relevant statements that lead to deeper group explorations.
In Hot Potato, children pass the potato (or any object) around the group until the music stops. Whoever is holding the potato at that point has to share some information about themselves. Depending on the topic, they may have to share a bad experience, a family memory, etc.
We have probably all played Charades, the game where you act out a phrase about a certain topic (e.g., a TV show or movie) and other people have to guess what it is. Charades is also highly adaptable for group therapy. Therapists or group members can come up with topics to be acted out. For example, children may be asked to guess about topics related to their families or interpersonal problems.
A common activity for groups dealing with addiction involves Triggers. In this activity, you have the group identify and discuss common triggers for their particular addiction. Group members and leaders can then suggest different coping strategies they could use to stay sober when triggered.
This next activity, Most and Least Likely to Relapse, is done further into a group when you feel you have supportive group members. Clients receive blank pieces of paper and are asked to write the names of who they think is most likely and least likely to relapse. Group leaders then read the names aloud. Clients selected as “most” and “least likely” have the opportunity to process this information with other members of the group.
Depression and Anxiety
Discussing Negative and Positive Beliefs is a common activity of cognitive-behavioral therapy (CBT) groups that focus on depression and anxiety. Take a sheet of paper and write out three negative beliefs you have. Theses may include thoughts like, “you will never be successful” or “no one will love you”. Then write out three positive responses to those comments, such as, “you have already taken steps to be successful” or “someone will love you for you”. You then further explore your negative beliefs and your coping thoughts with the group.
A healthy lifestyle, including proper sleep, a healthy diet, and regular exercise contributes greatly to improved mood and decreased anxiety. Go around the group and have each person say something that they would like to accomplish to improve their diet, sleep, or exercise. It should be realistic and operational but there is no wrong answer. It is what we call Healthy Brainstorming. After everyone goes, have each person choose one habit they want to attempt for the next week and create a plan to implement it.
Group Therapy Resources
The following are just some of the many group therapy activity resources available:
· The Rita Zniber Foundation put together a comprehensive child group counseling guide to help children who may be suffering from emotional problems. Included are numerous group activities every therapist can use.
· Positive Psychology always does a nice job giving us a unique perspective on all things psychology. In this article on group therapy, they review the importance of group therapy and include a valuable list of activities.
· My Group Guide is a website dedicated to group therapy. You can find numerous resources, including group activities. Some are free but you must pay a fee to gain access to all of them.
· Psychotherapist Liana Lowenstein has put together a nice list of activities for children, adolescents, and families. Not all are specific to groups but many of the individual activities can be adapted to a group setting. The best part about the list? Each activity is the favorite of a particular therapist and describes how it can be used in specific therapeutic situations.
Group Therapy Checklist For Therapists
1. Recruit group members. It is important to find individuals that have something in common but also have some diversity in their backgrounds. You want people to feel comfortable but also be different enough to promote discovery. Some people will not make productive group members and could sabotage the group. It is important to meet with them individually beforehand and measure their fit for the group as well as realistically manage their expectations.
2. Set group size. The size of the group matters. Too small a group and you are losing the power of different points of view. Too large and individuals don’t feel like they have a voice. About six to eight members are ideal.
3. Set up the room ahead of time. You want to promote inclusivity and privacy without feeling claustrophobic or stuffy. Having members form a circle is a popular choice because it promotes intimacy and participation.
4. Begin on time. This sets the proper tone and expectation that the group needs to be taken seriously and the members’ time is to be respected.
5. Create group rules. You may want to take time in the first session to come up with the regulations that will help the group run most productively. The more the group is involved, the more they are invested in following the rules. Some common group rules are that 1) no one talks when others are talking and 2) group subject matter does not get discussed outside of group.
6. Getting to know each other is one of the most important aspects of a group. If the group members feel comfortable and trust each other, the group is going to be much more effective. If not, you will find people holding back or feeling unsupported. Icebreaker activities are integral in achieving this step.
7. Check-in with members. It is not mandatory but it is generally a good idea to take the temperature of the group members before you dive into a certain topic. This may serve to prevent individual problems from infecting the group and can introduce topics that may need further exploration.
8. Be prepared. This is especially true with a content-specific group but it is a good idea even with process groups. An educational group is going to have a specific topic and you will need to be prepared to educate the group members. Process groups may not have a specific topic but you will need to be prepared to address a relevant area if discussion lags.
9. Facilitate participation. There are always going to be group members that want to talk more than others. It is the job of the group leader to make sure that the less vocal members get an opportunity to participate.
10. Summarize and ask for feedback. Providing a verbal summary of each group session is a good idea as the group ends. It serves as a review and may invite further clarification or other questions. Getting member feedback is also valuable. You need to know how the group is being viewed. If members do not feel the group is addressing their needs, they are most likely to sabotage the therapy or drop out.
11. Document. No one likes treatment notes but it is crucial to document group progress right after each group ends. Let’s face it, you aren’t going to remember the necessary details if you wait until the next day.
Group psychotherapy is a highly effective treatment modality. And for some problems, it might be preferable to individual therapy. Fortunately, plentiful group resources exist to aid both therapists and clients. Telehealth sites, such as Theraplatform, are only one of many resources. If you feel like group therapy may benefit someone you know, feel free to reach out to a licensed therapist for help.