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Group therapy is the treatment of multiple patients at once by one or more healthcare professionals. This approach can be used to treat a variety of conditions, including, but not limited to, trauma, anxiety, depression, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder. This activity describes the principles of group therapy and enhances the knowledge and tools of interprofessional team members in facilitating effective group sessions. Objectives: Identify appropriate patient populations and clinical indications for group therapy based on presenting conditions such as trauma, anxiety, depression, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder. Assess guideline-concordant care for patients with disorders that may benefit from group therapy. Develop strategies to increase compliance with the use of group therapy. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who may benefit from group therapy. Access free multiple choice questions on this topic.

Group therapy is a form of psychotherapy in which 1 or 2 therapists work with multiple clients simultaneously. The American Psychological Association recently identified group psychotherapy as a unique specialty.[1] In this setting, the group collaborates to improve each member's symptoms and self-awareness. Evidence suggests that group psychotherapy is as effective as individual psychotherapy; therefore, this method has the potential to be more cost-effective and widen access to psychotherapy in underserved populations.[2] Theoretical Approaches There are many different forms of group therapy, each providing valuable insights into group dynamics and guiding the therapist on when and how to intervene effectively. This understanding is crucial, as a therapist's confidence during the session significantly impacts the overall function of the group, especially in the initial group sessions. Interpersonal group therapy: Based on the work of Harry Stack Sullivan and broadly influencing the other forms of group therapy, this approach centers on the client's desire for secure relationships. Clients maintain parataxic distortions, which are perceptions based on the realities of their past. The group leader's role is to foster cohesion within the group, creating a supportive environment where these distortions can be explored and understood. Psychodynamic group therapy: This approach focuses on helping clients gain self-insight and upholds the principle of psychic determinism—the idea that all thoughts and behaviors originate from preconscious or unconscious processes.[3] Wilfred Bion first developed this mode of group therapy as an army psychiatrist during World War II when there were not enough individual therapists available to treat service members. The therapist remains nondirective. The group expects that the therapist does the majority of the work. As frustration builds, the group regresses and exposes the clients' unconscious conflicts. The individual clients undergo projections and transferential relationships that the group ultimately helps them work through.

Psychodynamic group therapy: This approach focuses on helping clients gain self-insight and upholds the principle of psychic determinism—the idea that all thoughts and behaviors originate from preconscious or unconscious processes.[3] Wilfred Bion first developed this mode of group therapy as an army psychiatrist during World War II when there were not enough individual therapists available to treat service members. The therapist remains nondirective. The group expects that the therapist does the majority of the work. As frustration builds, the group regresses and exposes the clients' unconscious conflicts. The individual clients undergo projections and transferential relationships that the group ultimately helps them work through. Social systems group therapy: Based on Ludwig von Bertalanffy's theories, this approach emphasizes the clients' roles within systems, including the system of group therapy and the systems of the clients' families of origin. Groups naturally divide into subgroups in each of these systems. The therapist focuses on managing and openly discussing boundaries between subgroups. Cognitive behavioral group therapy: Developed by Aaron and Judith Beck, this approach emphasizes collaboration to describe and understand the relationships between behavior, thought, and emotion. These groups are highly structured and follow the general patterns of individual cognitive behavioral therapy. This approach typically has a preset number of sessions and a high degree of psychoeducation. Psychodrama: Based on the writings of Jacob Moreno, this approach has a designated client, called the protagonist, who writes dramatic performances of their experiences. Clients learn from playing themselves and from playing roles in others' experiences. The therapist acts as the director and helps with writing and casting. As the group progresses through performances, new nuances to the protagonist's experience and the experiences of the other clients are discovered. The protagonist may switch roles with different clients, and the therapist may introduce roles that speak out the suppressed elements of the protagonist's personality.[4]

Psychodrama: Based on the writings of Jacob Moreno, this approach has a designated client, called the protagonist, who writes dramatic performances of their experiences. Clients learn from playing themselves and from playing roles in others' experiences. The therapist acts as the director and helps with writing and casting. As the group progresses through performances, new nuances to the protagonist's experience and the experiences of the other clients are discovered. The protagonist may switch roles with different clients, and the therapist may introduce roles that speak out the suppressed elements of the protagonist's personality.[4] Redecision therapy: Developed by Robert and Mary Goulding, this approach combines Gestalt therapy and Transactional analysis using a brief series of long sessions that sometimes last 4 to 8 hours. Typically, this is conducted in larger-than-usual groups and focuses on 1 individual at a time. The client is asked about their desired change and the reasons behind it, then tasked with bringing up an affectively charged memory related to this change. By reconnecting with the child part of themselves, the client is encouraged to revisit and reverse self-limiting decisions made in childhood. This approach requires highly functional and motivated clients who can tolerate the strength of the regression. Existential group therapy: Based on the works of Irwin Yalom, this approach actively addresses the patient's existential anxiety, loneliness, guilt, and feelings of estrangement. The therapist fosters openness and prioritizes authenticity. Termination is permanent.

Some clients may be simultaneously involved in other therapies, such as individual psychotherapy and pharmacotherapy, with various healthcare professionals, including social workers, psychologists, psychiatrists, nurse practitioners, nurses, and rehabilitation therapists. Some treatment programs for more seriously ill patients may require participation in multiple modalities, including occupational therapy, rehabilitation therapy, vocational rehabilitation, and substance use treatment. This comprehensive approach enhances the client's treatment experience, provides essential support, and expands the range of issues that can be addressed. Combined therapy: When a therapist serves as both the group leader and the individual therapist for a client, it fosters a deeper relationship between the therapist and the client. However, this may also raise concerns among group members about potential favoritism, underscoring the need for clear boundaries. Some therapists choose to maintain a combined relationship with all group members, but this can lead to triangulation between the therapist and group members in conflict with each other. There is also the risk of accidentally disclosing information in the group that was shared in individual therapy. Conjoined therapy: When a client has a group leader or therapist and a separate individual therapist, regular and high-quality communication between the therapists is essential. Clients may elicit reactions from one therapist that impede the work being done with the other therapist, leading to triangulation. For example, a client may tell the individual therapist about the dynamics in group therapy and use the individual therapist's reaction to justify behaviors in group therapy. Both therapists must obtain releases of information to facilitate this process.[27]

Conjoined therapy: When a client has a group leader or therapist and a separate individual therapist, regular and high-quality communication between the therapists is essential. Clients may elicit reactions from one therapist that impede the work being done with the other therapist, leading to triangulation. For example, a client may tell the individual therapist about the dynamics in group therapy and use the individual therapist's reaction to justify behaviors in group therapy. Both therapists must obtain releases of information to facilitate this process.[27] Pharmacotherapy: Clients often receive pharmacotherapy for their psychiatric symptoms. The therapist should obtain the patient's medication history during intake as germane to treatment and the patient's function within the group, for example, if the patient is sedated during the group or decompensates. If the healthcare professional is also responsible for prescribing medication, they should schedule individual appointments to monitor the efficacy and adverse effects of the drug. As the group therapy concludes, the healthcare professional should arrange ongoing individual appointments or transition care to another healthcare professional to ensure continuity.[28] Lastly, care coordination is pivotal in ensuring seamless and efficient patient care. Clinicians, advanced practitioners, social workers, occupational therapists, rehabilitation therapists, and other healthcare providers must collaborate to streamline the patient's journey, from diagnosis through treatment and follow-up. This coordination minimizes errors, reduces delays, and enhances patient safety, ultimately leading to improved outcomes and patient-centered care that prioritizes well-being and satisfaction.