group psychotherapy, a means of changing behavior and emotional patterns, based on the premise that much of human behavior and feeling involves the individual's adaptation and response to other people. It is a process carried out in formally organized groups of three or more individuals who seek change, whether their problem is alcoholism, overeating, or poor social skills. The composition of a group may be heterogenous or homogeneous with reference to the age of the members or the type of problem. The therapist may be directive or nondirective, allowing the group to set their own agenda for discussion. The group becomes a "sample" of the outside world, reproducing conditions of interpersonal relationships; its members jointly participate in observing personal motivation and styles of interaction. They also participate in attempting new behaviors and dealing with the consequences of such behaviors, with the intended result that they will eventually be able to employ these behavior patterns outside the group. In observing the totality of the events that take place in group therapy, the process by which elements of personality are developed in each member is also studied.

Origins of Group Therapy

The technique of formally organized group therapy is said to have been devised by J. H. Pratt in 1905. Pratt was holding general-care instruction classes for recently discharged tuberculosis patients when he noticed the impact of this experience on their emotional states. In 1925 psychoanalyst Trigant Burrow became dissatisfied with individual psychoanalysis, and began experimenting with group techniques. Burrow hoped to decrease the authoritarian position of the therapist, and to more thoroughly examine interpersonal interactions. The application of group therapy methods to prison inmates and discharged mental hospital patients was pioneered by Paul Schilder and Louis Wender in the 1930s. At that time group therapy was found to be particularly useful in the treatment of children and adolescents. The development of group therapy was given impetus during World War II, as a result of the large number of soldiers requiring treatment.

Types of Group Therapy

There are various types of group therapy; approaches include behavior therapy, psychoanalytic therapy, sensitivity training, or Gestalt psychology (see psychotherapy). The composition of groups varies as well, with family therapy and marriage counseling common forms in recent years. Peer group therapy usually consists of a group of individuals who have similar problems, and can be mediated by a psychoanalyst or by the members themselves. Many people seeking help prefer this sort of group therapy over individual therapy, largely because of the comfort derived from knowing that others share their problems. The approach is nondirective, and in some cases, the individual can continue attending sessions whenever they are needed. Alcoholics Anonymous (AA) is a well-known peer support group, run entirely by members. AA has been influential in the formation of similar groups, particularly support groups centered on addictions.

Form of psychotherapy in which several patients or clients discuss their personal problems, usually in the presence of a therapist or counselor. In one approach to group therapy, the chief aim is to raise members' awareness and morale and combat feelings of isolation by cultivating a sense of belonging to the group; a notable example is Alcoholics Anonymous. The other principal approach strives to foster free discussion and uninhibited self-revelation; members are helped to self-understanding and more successful behaviour through mutual examination of their reactions to people in their lives, including one another.

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Group psychotherapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Cognitive behavioural therapy or Interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilised as a mechanism of change by developing, exploring and examining interpersonal relationships within the group. The broader concept of group therapy can be taken to include any helping process that takes place in a group, including support groups, skills training groups (such as anger management, mindfulness, relaxation training or social skills training), and psycho-education groups. The differences between psychodynamic groups, activity groups, support groups, problem-solving and psycoeducational groups are discussed by Montgomery (2002).. Other, more specialised forms of group therapy would include non-verbal expressive therapies such as dance therapy, music therapy or the TaKeTiNa Rhythm Process.

History of group psychotherapy

The founders of group psychotherapy in the USA were Joseph H. Pratt, Trigant Burrow and Paul Schilder. All three of them were active and working at the East Coast in first half of the 20th century. After World War II group psychotherapy was further developed by Jacob L. Moreno, Samuel Slavson, Hyman Spotnitz, Irvin Yalom,and Lou Ormont. Yalom's approach to group therapy has been very influential not only in the USA but across the world, through his classic text "The Theory and Practice of Group Psychotherapy". Moreno developed a specific and highly structured form of group therapy known as Psychodrama.

In the United Kingdom group psychotherapy initially developed independently, with pioneers S. H. Foulkes and Wilfred Bion using group therapy as an approach to treating combat fatigue in the Second World War. Foulkes and Bion were psychoanalysts and incorporated psychoanalysis into group therapy by recognising that transference can arise not only between group members and the therapist but also among group members. Furthermore the psychoanalytic concept of the unconscious was extended with a recognition of a group unconscious, in which the unconscious processes of group members could be acted out in the form of irrational processes in group sessions. Foulkes developed the model known as Group Analysis and the Institute of Group Analysis, while Bion was influential in the development of group therapy at the Tavistock Clinic. Bion has been criticised, for example by Yalom, for his technical approach which had an exclusive focus on analysis of whole-group processes to the exclusion of any exploration of individual group members' issues. Despite this, his recognition of group defences in the "Basic Assumption Group", has been highly influential.

Bion's approach is comparable to Social Therapy, first developed in the United States in the late 1970s by Lois Holzman and Fred Newman, which is a group therapy in which practitioners relate to the group, not its individuals, as the fundamental unit of development. The task of the group is to "build the group" rather than focus on problem solving or "fixing" individuals.

Therapeutic principles

Yalom's therapeutic factors (originally termed curative factors but re-named therapeutic factors in the 5th edition of 'The Theory and Practice of Group Psychotherapy' are derived from extensive self-report research with users of group therapy

• Universality

The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member's sense of isolation, validate their experiences and raise self-esteem

• Altruism

The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self esteem and help develop more adaptive coping styles and interpersonal skills.

• Instillation of hope

In a mixed group which has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems that they are still struggling with.

• Imparting information

While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group, for example about their treatment or about access to services.

• Corrective recapitulation of the primary family experience

Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process which is a form of transference specific to group psychotherapy. The therapist's interpretations can help group members gain understanding of the impact of childhood experiences on their :personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present day relationships.

• Development of socialising techniques

The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behaviour and improving their social skills

• Imitative behaviour

One way in which group members can develop social skills is through a modelling process, observing and imitating the therapist and other group members, for example sharing personal feelings, showing concern and supporting others.

• Cohesiveness

It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance and validation.

• Existential factors

Learning that one has to take responsibility for one's own life and the consequences of one's decisions.

• Catharsis

Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.

• Interpersonal learning

Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member's behaviour and impact on others.

• Self-understanding

This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one's problems and the unconscious motivations which underlie one's behaviour.

Settings

Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit or ambulatory psychiatric Partial hospitalization (also known as Day Hospital treatment). In addition to classical "talking" therapy, group therapy in an institutional setting can also include group-based expressive therapies such as drama therapy, psychodrama, art therapy, and non-verbal types of therapy such as music therapy. Group psychotherapy is a key component of Milieu Therapy in a Therapeutic Community. The total environment or milieu is regarded as the medium of therapy, all interactions and activities regarded as potentially therapeutic and are subject to exploration and interpretation, and are explored in daily or weekly community meetings

A form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts. Projective group therapy uses an outside text such as a novel or motion picture to provide a "stable delusion" for the former cohort and a safe focus for repressed and suppressed emotions or thoughts in the latter. Patient groups read a novel or collectively view a film. They then participate collectively in the discussion of plot, character motivation and author motivation. In the case of films, sound track,cinematography and background are also discussed and processed. Under the guidance of the therapist, defense mechanisms are bypassed by the use of signifiers and semiotic processes. The focus remains on the text rather than on personal issues.

Research on effectiveness

There is clear evidence for the effectiveness of group psychotherapy for depression: a meta-analysis of 48 studies showed an overall effect size of 1.03, which is clinically highly significant. Similarly, a meta-analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect sizes , and there is also good evidence for effectiveness with chronic traumatic stress in war veterans. There is less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes. The authors comment that these poor outcomes might reflect a need for additional support for some patients, in addition to the group therapy. This is borne out by the impressive results obtained using Mentalization based treatment, a model which combines dynamic group psychotherapy with individual psychotherapy and case management. Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups, however long-term intensive interactional group psychotherapy assumes diverse and diagnostically heterogeneous group membership, and an open-ended time scale for therapy. Good outcomes have also been demonstrated for this form of group therapy.

See also

• Self Help Groups
• Twelve-step program
• Expressive therapy
• Drama therapy
• Family therapy

• Play therapy
• Psychotherapy
• Social Therapy
• Systemic Constellations

Notes

External links

• Useful directory site for UK groups -for specific needs
• Useful site about group psychotherapy and shame, with extensive links to other group therapy sites
• East Side Institute for Group and Short Term Psychotherapy
• American Group Psychotherapy Association
• Useful information about Lou Ormont's Method of Modern Group Analysis
• Contents of International Journal of Group Psychotherapy 1969-Present
• A good bibliography of ther group therapy literature