Group Therapy: Concepts, Ethics, and Dynamics

Group Therapy

A structured form of psychotherapy where multiple individuals meet regularly with one or more trained therapists to work on emotional, psychological, or interpersonal challenges.

Social Microcosm

A concept by Yalom where patterns that show up in everyday life inevitably emerge in group and can be explored in real time.

Benefits of Group Therapy

Cost-effective and time-efficient, offers peer feedback and support, mirrors real-life relationships, allows for vicarious learning, decreases isolation, and provides universality.

When is Group NOT Appropriate?

Group therapy is not ideal for individuals with active psychosis, severe social anxiety, high-risk clients needing immediate stabilization, or clients in crisis.

Screening and Preparation

Key ethical responsibilities to determine group appropriateness as emphasized by Yalom and Leszcz.

Appropriateness for Group Therapy

Suitable if the client has interpersonal goals, can tolerate group feedback, and is motivated to grow.

Group Member Rights

Rights include informed consent, confidentiality (though limited), voluntary exit, safe space, and the right to ask questions.

Group Therapist Responsibilities

Responsibilities include establishing ground rules, maintaining confidentiality, obtaining informed consent, attending to group dynamics, and upholding ethical guidelines.

Informed Consent

Must be both verbal and written, tailored to the group format, including purpose, roles, expectations, and risks.

Confidentiality in Group Therapy

While therapists maintain confidentiality, members cannot be legally bound to it, requiring explicit discussion and reinforcement.

Differences Between Individual and Group Therapy

Individual therapy involves one-on-one attention, while group therapy is driven by peer interactions.

Therapist Self-Awareness

Group therapists must reflect on their own experiences, triggers, and conflict styles, and be mindful of power dynamics.

Empathic Attunement

A skill group leaders must develop to ethically hold the group container.

Boundary Maintenance

A necessary skill for group leaders to ensure a safe therapeutic environment.

Process Reflection

A skill that involves reflecting on the group's process to enhance therapeutic outcomes.

Risks of Group Therapy

Includes discomfort and potential conflicts among members.

Mandated Reporting Laws

Legal obligations that group leaders must handle concerning confidentiality.

Dual Relationships

Ethical issues that arise when a therapist has multiple roles with a client.

Documentation Practices

Standards set by APA that group therapists must follow.

Ethical Issues Around Termination

Concerns that arise when a member leaves the group or the group ends.

Power Imbalances

Dynamics that must be monitored by group therapists to ensure fairness.

Microaggressions

Subtle, often unintentional, discriminatory comments or behaviors that group therapists must address.

Cohesion in Groups

The sense of belonging and unity among group members that therapists should foster.

Vicarious Learning

Learning that occurs through observing others' experiences in the group.

Confidentiality

A core ethical principle; more complicated in group settings where it depends on mutual member agreement and reinforcement.

Here-and-Now

A group process focus on immediate interactions, emotional reactions, and dynamics between members and leaders.

Group Cohesion

The sense of solidarity, trust, and safety within the group - a powerful therapeutic factor linked to positive outcomes.

Ethical Guidelines

Standards of practice from bodies like the APA, ACA, and AGPA that dictate confidentiality, consent, and professional conduct.

Group Contract

Agreements made between therapist and members about structure, goals, and behavioral expectations, often included in the consent process.

Mandated Reporter

A therapist's legal responsibility to report certain disclosures (e.g., abuse, harm to self or others), even in group settings.

Group Structure

Refers to the organized makeup of the group and how it functions internally and within its larger sociocultural context.

Individual Collection View

The group is seen as a set of individuals, with one as the therapist. Interactions and treatment are based on individual issues rather than collective dynamics.

Bounded Entity View

The group is a coherent unit that is structured by its time, task, and space, with internal roles and processes that are distinct from the external environment.

Intrapersonal

The internal world of each individual - motives, needs, defenses, trauma, attachment models, etc.

Interpersonal

The patterns of behavior and interaction between group members (e.g., alliance, conflict, mirroring, boundaries).

Group-as-a-Whole

The collective culture, shared norms, emotional climate, unspoken rules, and group myths or fantasies.

Psychoeducational

Skill-building, content delivery.

Support Groups

Emotional sharing, validation.

Interpersonal Process

Relational patterns, feedback.

Trauma-Informed

Safety, trust, regulation.

CBT/ACT-Based

Skills + cognitive/emotion work.

Systems View of Group Dynamics

Each member, role, and subgroup acts as a system within a system, interacting with the others and influenced by broader ecological factors.

Core Structural Components

The essential elements that make up the psychological structure of individuals in a group.

Person

The individual's psychological structure includes defense mechanisms, coping styles, relational templates, working model of self and others, empathy, insight, and ability to tolerate emotional material.

Role

The bridge between self and group, which can be formal, interpersonal, or symbolic.

Formal Role

A defined position within the group, such as therapist or participant.

Interpersonal Role

Roles that reflect relational dynamics, such as rescuer, rebel, peacemaker, or silent one.

Symbolic Role

Roles that serve as representations of deeper group dynamics, such as scapegoat or truth-teller.

Subgroups

Divisions within the group that can be dysfunctional or functional.

Dysfunctional Subgroup

A subgroup that divides the group, such as cliques or scapegoating.

Functional Subgroup

A subgroup that highlights differences that can be explored safely.

Context

The immediate setting and larger forces like culture, racism, and politics that influence group dynamics.

Individual Therapy

A modality that offers personalized pacing and focus in a private space.

In-Person Group Therapy

A modality that allows for easy observation of nonverbal cues and stronger group cohesion.

Online Group Therapy

A modality that provides convenience and accessibility, especially for rural or disabled clients.

Group vs. Individual Therapy

Group therapy focuses on interpersonal learning and belonging, while individual therapy emphasizes intrapersonal depth.

In-Person vs. Online Therapy

In-person therapy offers relational depth and structure, whereas online therapy provides flexibility and broader reach.

Levels of Analysis

A clinical model that examines group functioning through intrapersonal, interpersonal, and group-as-a-whole lenses.

Systems View

A perspective where individuals, roles, and subgroups are interdependent systems operating within larger contexts.

Role (in group therapy)

An identity or behavior pattern that a group member adopts, reflecting early relational templates or cultural positions.

Subgroup System

A subset of group members with shared positions, alliances, or issues, which may be constructive or divisive.

Contextual Factors

The institutional, cultural, political, and systemic elements that influence how a group forms, functions, and is perceived.

Closed Group

A group with fixed membership - no new members are added after the group begins, increasing cohesion and safety.

Open Group

A group with a rotating membership where new clients may join at various stages.

Brief Group Therapy (BGT)

A structured, time-limited form of group therapy with clear goals and a focus on symptom reduction and interpersonal learning.

Pre-Group Meeting

An individual orientation session with prospective group members used to establish expectations, assess fit, and introduce group norms.

Subgrouping

The formation of cliques or alliances within the group. Can disrupt cohesion and exclude other members.

Extragroup Socializing

When members develop relationships outside of the group. This can erode boundaries and reduce safety if not discussed openly.

Therapeutic Alliance

The collaborative bond between therapist and client (or group leader and members) that predicts engagement and outcome.

Goal Compatibility

The degree to which group members share similar goals or therapeutic intentions - important for cohesion and success.

Group Size

Optimal is 6-10 members, depending on purpose and structure.

Duration & Frequency

Typically, groups meet weekly for 60-120 minutes.

Short-term psychoeducational groups

8-12 sessions.

Interpersonal or trauma groups

20+ sessions.

Goals of Pre-Group Meetings

Clarify group purpose and format, assess member readiness and appropriateness, review confidentiality and informed consent, orient members to norms and expectations, build safety and reduce anxiety.

Effectiveness of BGT

CBT and interpersonal groups for depression show 3x improvement rates over waitlists.

Meta-analyses support BGT

For binge eating, panic disorder, and some presentations of borderline personality disorder.

Short-term groups

Show better retention, though long-term therapy benefits personality-disordered clients more.

Yalom's emphasis on pre-group session

Foundational to successful group therapy.

Anticipated Challenges in Group Formation

Leaders should be prepared to manage goal incompatibility, high turnover, slower gratification, and subgrouping.

Proactive stance

Can reduce early dropouts and support smoother group development.

Interactional work in BGT

Should not be sacrificed - leaders must remain flexible and creative in facilitating depth.

Initial alliance in pre-group

Building an initial alliance and setting expectations.

Clarifying fears in pre-group

Clarifying fears and misconceptions (e.g., myths that group is confrontational or unhelpful).

Therapeutic journey tone

Setting a positive and realistic tone about the therapeutic journey.

Emotional climate

The overall emotional environment within a group.

Group norms

The shared expectations and rules that guide behavior within a group.

Relational patterns

The typical ways in which group members interact with one another.

Conflict expression

The manner in which disagreements and tensions are communicated within a group.

Leadership dynamics

The interaction and influence between leaders and group members.

Progressive-Linear Models

Models that view development as a sequence of stages, each building on the last.

Forming

Members depend on leader for safety; polite, testing waters.

Storming

Conflict and emotional expression emerge.

Norming

Cohesion and shared norms develop.

Performing

Members engage in meaningful, autonomous work.

Adjourning

Closure, reflection, and group ending.

Dependence-Flight

Avoidance of vulnerability; overreliance on leader.

Counterdependence-Fight

Resistance and rebellion emerge.

Power-Authority

Group resolves authority issues and becomes self-governing.

Overpersonal Enchantment

Euphoria about group closeness.