Group psychotherapy instead of one-on-one?

The effectiveness of group psychotherapy has long been scientifically proven. As early as the early 20th century, the first physicians and psychologists agreed that it was as effective as the individual therapy method for a wide variety of mental illnesses. Yet, contrary to its long-known benefits for patients, it is still given far too little attention today and is established only in inpatient settings rather than in outpatient settings.

Yet group psychotherapy is clearly superior to individual settings, especially in social contexts, and offers a high level of evidence for depressive and somatoform disorders, anxiety disorders, and schizophrenia, among others. A large number of people have difficulty having fulfilling relationships, perceiving their own needs and feelings, and communicating them. The dynamics of the group can make the crucial connection at the point between current feelings, behavior and causes in childhood, as well as help in the development of new patterns of thinking and behavior.

Why psychotherapy in groups?

Almost everyone feels they belong to a wide variety of groups. Whether it is in the family, at work, or in a sports club, the feeling of connectedness and interaction in a group significantly influences self-image. In addition, it provides security and mental support in difficult situations. The interdependence that arises in the process contributes significantly to the development of stable individual autonomy.

However, members must also be able to withstand having only limited control in the group setting, which many people find difficult. Therapeutic groups offer introspection as well as interaction with others as an access route to understanding one’s own experience and behavior. Patients in particular benefit from group therapy because interaction is often needed to resolve inner conflicts. At this point, psychotherapeutic groups offer a “playing field” where new things in experiencing and interacting with others can be tried and practiced.

Positive effects of group

Group psychotherapy brings many positive effective factors with it:

• Hope: Participants in a group psychotherapy have regular contact with other members who have already made progress and who are now better able to cope with similar difficulties.
• The feeling of not being alone: Especially at the beginning of a group psychotherapy, the feeling of uniqueness, which is amplified by social withdrawal, especially in patients with mental illness, is reduced and a great relief is experienced.
• Altruism: Group members receive something by giving something to others. The thoughts of not being able to offer anything significant to the other participants and not being important are corrected, thus strengthening self-esteem.
• Information gain: Instructions, hints or advice from fellow patients or the therapist can be experienced as very helpful. Often, it is not the direct advice but the systematic guidance that is an important factor.
• Social interaction: By observing and interacting with other group members and their feedback, new techniques in social interaction are developed.
• Corrective Experiences of the Primary Family Group: Patients often interact in group psychotherapy as they did in previous family structures. Reliving the old patterns in the group setting can lead to new experiences and different patterns of response.
• Interpersonal learning: Problems in basal interpersonal skills (e.g., affect perception and anticipation of one’s own behavior) and transference-related distortions in perceptions of others can be reduced with new emotional group experiences and reflection.

Framework and process

In group psychotherapy, several patients are treated together. In this process, the psychological and social group dynamics are used to achieve certain therapy goals. Such a group usually consists of six to ten members, depending on the procedure, and is either closed (same participants throughout the entire therapy period) or open (new participants join regularly due to the end of therapy of individual participants) in design.

Smaller groups tend to represent family-like dynamics. During the session, which lasts about 90 minutes, the patients report on their problems and associated feelings either relatively freely or guided by the therapist. Through the feedback of the other participants, the patients receive an assessment of their problems as well as suggestions for dealing with them. Each participant is free to decide how much he or she wants to reveal about him or herself.

Precisely because most groups are made up of people who do not know each other in advance and come together purely for the purpose of therapy, all participants are bound by an absolute duty of confidentiality. While group sessions in the outpatient context usually take place once a week, they are offered at least twice a week in the inpatient setting. A combination of individual and group therapy is also possible in both contexts.

Types of psychotherapeutic groups

There are a number of psychotherapeutic schools that deal with working in groups. Depending on the problem and especially the objective, the following therapeutic methods can be considered:

Behavioral therapy group therapy: The solution of the patient’s problems occurs through the change of unfavorable behaviors. The protected setting of the group can make it less challenging to try new behaviors. There can be a flexible, as well as clearly structured process with predetermined exercises.

Psychoanalytically oriented group therapy: By allowing patients to freely talk about their problems here, unstructured situations arise that help them relive relational experiences from childhood and associated feelings. The therapist takes on the role of conductor and helps to recognize the personality structure of the individual members and to enable new relationship experiences.

Client-centered group therapy: The therapist always behaves towards the group members in an appreciative, empathic way and shows what he thinks and feels. He confronts them with problematic behavior patterns, but otherwise tends to stay in the background and avoids evaluations or advice. The patients are the focus of attention with their wishes, values and feelings.

Family therapy, systemic therapy and couples therapy: It is assumed that the psychological symptoms of a patient or even the general psychological stress of the family have arisen because of unfavorable relationship patterns and are maintained by them. Quite important for the members is to understand these patterns and develop solutions to problems or stresses together.

Group therapy in psychodrama: The patient is the main actor and stages his problem in the form of a play. In the process, he can assign other roles to other participants. Through the spontaneous re-enactment of situations, the creativity of the members should be awakened and they should learn to find more appropriate behavior for previously problematic situations. Patients who are not involved in the game give sensitive and, if necessary, critical feedback afterwards. In addition, there is an exchange of which life experiences were remembered during the role play.

The optimal composition

For the therapeutic success of the individual members of a group psychotherapy, its composition is crucial. For all to benefit from therapy, a certain degree of heterogeneity of personality traits as well as life experience is important. So is variety of verbal activity and passivity. This usually results in a colorful array of disturbance patterns and other attributes such as age, gender, and education. Fundamental to the composition of a group are also the objectives and framework.

The degree of heterogeneity is also determined by the duration of the therapy. Longer therapy groups prefer a highly heterogeneous composition, shorter groups a somewhat less homogeneous composition.

According to some studies, heterogeneity in the personality trait extraversion and homogeneity in the trait agreeableness have not been found to be beneficial. Many therapists also report that it is useful to always have two patients on board who can find a similarity with each other. This is because if there is too much divergence of one member with the rest of the group, it is more likely to have detrimental effects on the rest of the group.

Now who is suitable for a group?

The following characteristics identify suitable candidates for group therapy:

• Ability to talk about own feelings and views
• Successfully coping in previous therapies or previous positive group experiences
• Compliance with framework agreements (times, group duration, etc.)
• Awareness that current relationships are influenced by family of origin dynamics
• Existence of at least one functioning relationship
• Willingness to make contact and enter into a suicide contract even in the midst of a severe crisis or suicidal ideation
• No risk to health from group participation
• Excessive dependence on the individual therapist
• High intrinsic motivation

For group psychotherapy to be successful, not all criteria must always be met. Fundamentally, it is important that the candidate is open to working with a new concept and is willing to endure conflict in it if necessary.

Categories: Therapy