Group psychotherapy

Moreno developed a specific and highly structured form of group therapy known as psychodrama (although the entry on psychodrama claims it is not a form of group therapy). Another recent development in the theory and method of group psychotherapy based on an integration of systems thinking is Yvonne Agazarian's systems-centered therapy (SCT), which sees groups functioning within the principles of system dynamics. Her method of "functional subgrouping" introduces a method of organizing group communication so it is less likely to react counterproductively to differences. SCT also emphasizes the need to recognize the phases of group development and the defenses related to each phase in order to best make sense and influence group dynamics.

In the United Kingdom group psychotherapy initially developed independently, with pioneers

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.

In Argentina an independent school of group analysis stemmed from the work and teachings of Swiss-born Argentine psychoanalyst Enrique Pichon-Rivière. This thinker conceived of a group-centered approach which, although not directly influenced by Foulkes' work, was fully compatible with it.^[3]

Therapeutic principles

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

• 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 that 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 socializing 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 modeling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.^[4]

• Cohesiveness

It has been suggested^[5] 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 that underlie one's behaviour.

Settings

Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit^[6] or ambulatory psychiatric partial hospitalization (also known as day hospital treatment).^[7] In addition to classical "talking" therapy, group therapy in an institutional setting can also include group-based

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.^[8] However, interactions between the culture of group psychotherapeutic settings and the more managerial norms of external authorities may create 'organizational turbulence' which can critically undermine a group's ability to maintain a safe yet challenging 'formative space'.^[9] Academics at the University of Oxford studied the inter-organizational dynamics of a national democratic therapeutic community over a period of four years; they found external steering by authorities eroded the community's therapeutic model, produced a crisis, and led to an intractable conflict which resulted in the community's closure.^[10]

A form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts.^[11] Projective psychotherapy 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.^[12] It was popularized in the science fiction novel, Red Orc's Rage.

Group therapy is now often utilized in private practice settings.^[13]

Group analysis has become widespread in Europe, and especially the United Kingdom, where it has become the most common form of group psychotherapy. Interest from Australia, the former Soviet Union and the African continent is also growing.^[14]

Research on effectiveness

A 2008 meta-analysis found that individual therapy may be slightly more effective than group therapy initially, but this difference seems to disappear after 6 months.

There is less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes.^[19] 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 that combines dynamic group psychotherapy with individual psychotherapy and case management.^[20]

Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups. However, long-term intensive interactional group psychotherapy^[21] 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.^[22]

Computer-supported group therapy

Research on computer-supported and computer-based interventions has increased significantly since the mid-1990s.^[23][24] For a comprehensive overview of current practices see: Computer-supported psychotherapy.

Several feasibility studies examined the impact of computer-, app- and media-support on group interventions. Most investigated interventions implemented short rationales, which usually were based on principles of cognitive behaviour therapy (CBT). Most research focussed on:

• Anxiety disorders (e.g. social phobia, generalised anxiety disorder ^[25][26][27])
• Depression (e.g. mild to moderate Major Depression^[28][29][30])
• Other disorders (e.g. hoarding^[31][32])

While the evidence base for group therapy is very limited, preliminary research in individual therapy^[33] suggests possible increases of treatment efficiency^[34] or effectiveness.^[35][36] Further, the use of app- or computer-based monitoring has been investigated several times. Reported advantages of the modern format include improved between-session transfer and patient-therapist-communication,^[29][32] as well as increased treatment transparency and intensity.^[26] Negative effects may occur in terms of dissonance due to non-compliance with online tasks, or the constriction of in-session group interaction.^[30] Last but not least, group phenomena might influence the motivation to engage with online tasks.^[30]

See also

• Family therapy
• Henry Ezriel
• Self-help groups for mental health
• Twelve-step program
• Impact therapy
• American Group Psychotherapy Association, founded in 1943

Notes