Overview

Group psychotherapy involves talking about personal difficulties with people you’re still getting to know. Members meet regularly to discuss what brought them to treatment and respond to one another, typically sitting in a circle. Most groups described in published research have roughly seven to ten members. Taking part involves more than listening: you try different ways of relating and hear how others experience those attempts.

The group’s purpose shapes how sessions unfold. Interpersonal and psychodynamic process groups focus on what happens between members in the moment. They’re often open-ended, with people joining as others leave. Skills and psychoeducational groups, including cognitive behavioral groups, follow a curriculum and usually meet for a preset number of sessions. Some bring together people with a shared diagnosis or experience. Others include people with different difficulties, reflecting some of the variety in relationships outside treatment.

Before joining, screening and preparation help establish whether the group’s purpose, membership, and structure fit what you’re seeking. Expectations about attendance, participation, contact between members, and confidentiality are discussed at this stage. Screening and preparation are associated with fewer people dropping out and a stronger emotional connection among members.

Across randomized trials, group and individual psychotherapy have generally produced comparable outcomes for common difficulties, including depression, anxiety disorders, and substance use. The group format also allows a clinician to treat more patients per hour. Many people attend alongside individual therapy or medication. Communication between the clinicians involved is an ordinary part of that care.

What to Expect During Treatment

1. 1Referral and initial screening, in which the facilitator considers whether the group's purpose, composition, and structure match what the prospective member is seeking.
2. 2An individual pre-group interview covers your history, current symptoms, goals for the group, and prior experience in treatment; standardized selection measures are sometimes used.
3. 3Preparation and informed consent, including the group's norms on attendance, participation, and contact between members, and a written confidentiality agreement.
4. 4Orientation to the group's structure and goals, the facilitator's role, and what members can expect in early sessions, which is associated with lower dropout.
5. 5Forming sessions, in which members are usually anxious and oriented toward the facilitator while safety and cohesion are established.
6. 6Working sessions, where you raise your own material, give and receive feedback, and, in structured groups, work through the curriculum and between-session practice.
7. 7Ongoing attention to group dynamics, including conflict between members, roles that form within the group, and subgrouping, all of which the facilitator names and manages.
8. 8Periodic review of each member's individual progress, with coordination as needed with an individual therapist or prescribing clinician.
9. 9Termination, whether at the end of a time-limited group or when a member leaves an open-ended one, in which the changes made are reviewed, the ending of the relationships is addressed directly, and onward referrals are arranged if further care is indicated.

How does Group Psychotherapy work?

• Hearing someone describe an experience you recognize may ease the feeling that your difficulty is yours alone or something to be ashamed of. This is called universality. It can be difficult to reproduce in individual therapy when the clinician hasn’t lived through the same circumstances. Irvin Yalom identified universality as one of the therapeutic factors specific to group treatment, and the American Group Psychotherapy Association adopted these factors in its practice guidelines.
• The ways you relate to other members often resemble how you relate to people elsewhere in your life. Long-standing patterns become visible to several people at once, giving you a chance to hear candid feedback and try a different response straight away. This process, called interpersonal learning, has empirical support. Patterns from earlier relationships may also emerge. New experiences with the group can help you understand those patterns differently.
• The emotional bond that develops among members is called cohesion. It’s the group equivalent of the relationship between a patient and an individual therapist. Cohesion appears to account for much of the treatment effect and to make other therapeutic factors possible. Clear structure, consistent membership, and the facilitator’s attention to the emotional climate generally help this bond develop.
• Helping another member can change how you see yourself in a way that reassurance from a clinician often does not. This is described as altruism. Seeing a peer make progress can also offer hope and a credible example of change.
• Members learn by watching how others handle a problem and practicing communication skills themselves. Mistakes generally carry less cost in the group than in relationships outside it. In skills and psychoeducational groups, facilitators spend more time teaching, with members practicing the material in sessions and completing assignments between meetings. The group also offers accountability and opportunities to work through problems together, with recognition that others face similar difficulties.

When It's Recommended

• Major depressive disorder and persistent depressive symptoms, where group formats have shown comparable outcomes to individual treatment
• Anxiety disorders including generalized anxiety disorder, social anxiety disorder, and panic disorder
• Grief, bereavement, and other loss-related distress, where hearing others describe a similar experience may reduce isolation
• Social and interpersonal difficulty, including chronic loneliness, conflict in close relationships, and difficulty reading or responding to social feedback
• Post-traumatic stress disorder, often in structured, diagnosis-specific groups
• Substance use disorders, frequently as part of a wider treatment program
• Situations where practicing a specific skill set, such as emotion regulation or assertiveness, is a primary goal
• Patients who have completed individual treatment and may benefit from a setting in which changes can be tested with other people

Recovery & Aftercare

• Group psychotherapy is generally an ongoing course of treatment, so there is no physical recovery period
• Sessions may surface strong feelings, and some members notice a period of emotional activation for some hours after a session before it settles
• Benefit typically accrues over weeks to months; time-limited groups run a set number of sessions, while open-ended groups continue for as long as members find the work useful
• Ending is treated as part of the treatment, and the closing phase addresses the loss of the relationships built in the group as well as the gains made
• Many members continue individual therapy or medication alongside the group or after it ends, and some return to a group later

Alternative Treatments

• Individual psychotherapy, which offers sustained one-to-one attention and a confidentiality boundary held by the clinician
• Medication management, alone or alongside psychotherapy
• Family or couples therapy, when the presenting difficulty is centered in a specific relationship
• Peer-led support groups, which offer shared experience without a trained clinical facilitator and are not a form of psychotherapy
• Intensive outpatient or partial hospitalization programs, which combine group work with a higher level of clinical oversight

Frequently Asked Questions