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What to Expect in Group Therapy

People these days usually are familiar with the concept of therapy. When it comes to group therapy, though, they have some confusion and worry. I’ve had teens tell me they will never in a million years share their feelings in front of other teens. I’ve had adults show up thinking they are attending a lecture, rather than being active participants in a therapy session. I’m here to define group therapy and answer some common questions.

What is group therapy?

Dr. Irvin Yalom is considered by many to be the father of group therapy. His book, The Theory and Practice of Group Psychotherapy, is a seminal text in psychiatry. Dr. Yalom’s original group therapy focused on the group dynamic being healing in itself. There was no set agenda or group topic. Group members learned to modify their unhelpful interpersonal behaviors through interactions with the other group members.

Group therapy at its simplest is psychotherapy that occurs in a small group (typically 3-8 members) rather than individual sessions. This can look different in so many different settings. Many modern therapy groups focus on teaching coping skills in a group setting, rather than solely focusing on learning from the group dynamic.

Groups typically have one or two therapists as the leader. Usually, it’s expected that all of the group members are working on similar problems (e.g., parenting an anxious child, coping with combat-related PTSD, learning social skills), although their individual concerns may be unique. It’s expected to talk some in the group, but no one is forced completely out of their comfort zone. You can think of it kind of like being in a very active discussion course in college.

For example, standard Dialectical Behavior Therapy (DBT) always has a group component. Group members (and their parents, for teens) learn the 4-5 modules of DBT skills in a lecture format. They then practice the skills together through activities and discussion. Group members are encouraged to participate and offer their own examples, and they are expected not to share stories that may be highly triggering to other group members (e.g., telling the details of their self-harm behavior). In DBT, group is one component of treatment, which also includes individual therapy sessions.

In addition to DBT, where you’ll most often see therapy groups is in hospital settings, such as the Department of Veteran’s Affairs (VA) and residential, inpatient, or partial hospitalization settings. Integrated care clinics, such as Kaiser Permanente, community mental health centers, and private practices also offer group therapy. There are also evidence-based social skills groups, such as the PEERS Program.

What are the rules in group therapy?

Most therapy groups will have a rule that is something like “what happens here stays here.” It is expected that group members will not share other members’ identities or stories outside of the sessions. Sometimes, people in a group may know each other from work, school, or their religious organization. That is okay, as long as they are comfortable staying in the same group and maintain each other’s privacy.

Therapy groups may also have a rule that the members should not begin dating each other or initiating any exclusive friendships during the time of the group. This helps to keep the group drama-free.

Other expectations may include regular attendance (zero or few absences, depending on the length of group), attending in person or being fully present on a video platform, having an individual therapist in addition to group, behaving respectfully toward other members, and not attending under the influence of alcohol or drugs.

Most groups will outline the rules on the first day; they may have set rules or ask the members’ opinions on rules for the group.

Why choose group therapy over individual therapy?

For some forms of therapy, such as DBT, it is not possible to be part of the treatment program without attending a group. Group therapy can also be used as a step-down from individual therapy for someone wanting to continue treatment but not needing as much individual support. It could also be a starting point for therapy, before transitioning to individual care. Here are some pros and cons of group therapy:

Do people actually like group therapy?

Yes! Like I said, almost all of the teens that I referred to DBT groups (of which I was a leader, often) argued with me and their parents that group would essentially ruin their lives. By the time they were graduating group, they expressed sadness at leaving their group members and leaders, bewilderment as to how they would fill their time without group (in comparison to before, when they thought they would never fit it into their schedule), and pride in themselves for learning skills and making major progress in their mental health.

When I run groups with parents focused on managing their child’s anxiety or behavior, they often give me feedback that they loved sharing in the experiences of other parents, knowing that they are not alone and being able to give advice to others.

To conclude, group therapy can be incredibly beneficial, but also intimidating in the beginning. I hope this post gives a better sense of the purpose and expectations. Please provide feedback in the comments below.

Interested in attending group therapy? You can find groups in the same way you’d search for an individual therapist.

Check out the therapy groups being offered by my practice, Anxiety Specialists of Atlanta.

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