Group Therapy in Social Group Work

What is Group Therapy?

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together. Group therapy focuses on the group of clients and attempts to benefit from sharing their experiences. In group therapy, both patient-patient interactions and patient-therapist interactions are used to effect changes in maladaptive behaviour in each group member. (Raghda Elgamail)

Group therapy is “a form of psychotherapy that involves one or more therapists working with several people at the same time (Cherry, 2017).”

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Group psychotherapy is a treatment of a psychological problem in which two or more patients/clients interact with each other on both emotional & cognitive levels in the presence of one or more psychotherapists who serve as catalysts (the person who can be related to or who can understand the other's point of view), facilitators or interpreters. (Syeda Omama Shahab)

Group therapy is a type of psychotherapy in which one or more therapists interact with multiple clients concurrently. This therapy is generally available in several settings, including private practices, hospitals, mental health clinics, and community centres. While group therapy is occasionally used alone, it is frequently combined with individual therapy as part of a comprehensive treatment strategy.

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Goals of Group Therapy

1. Help Individuals Identify Maladaptive Behavior
2. Help with Emotional Difficulties through Feedback
3. Offer a Supportive Environment

While most therapeutic sessions attempt to make people feel more at ease, autonomous, and in charge of their life, group therapy has a slightly different goal than individual therapy. Group therapy is often the most practical option for individuals dealing with situations that touch many people. The most common recommendation for group therapy is as part of a larger therapeutic plan to facilitate sharing, connection and coping.

In group therapy, there are two types of goals:

1. Process Goals, and  
2. Outcome Goals

During a group session, process goals relate to comprehending personal concerns and relating to others. This is commonly referred to as the healing process. The behavioural changes that individuals want to achieve as a result of group therapy are known as outcome goals.

The primary purpose of group therapy is to foster a sense of belonging or relatability by facilitating understanding via sharing everyday experiences. As a result, group therapy works best when it addresses a common concern among all group members. The group's success depends on this global relatability.

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Purposes of Group Therapy

a) To help build an atmosphere of trust and safety.
b) To enforce rules and norms.
c) To provide feedback.
d) To get a member's input, reaction or feedback.
e) To draw connections between members or point out themes
f) To correct irrational or faulty thinking.
g) To empower participants.
h) To offer support when needed.
i) To reinforce helpful contributions.
j) To encourage constructive risk-taking

Types of Group Therapy

The group therapy session's general tone and direction will change according to the group type. There are numerous types of groups, each with a distinct focus, but they all fall into one of two categories:

1) Psychoeducational – These groups are designed to arm members with the knowledge and skills necessary to address or cope with whatever brought them to the group; they are typically arranged around specific subjects or modules.

2) Process-Oriented – These organisations are primarily concerned with sharing experiences, connecting, and forming connections; a conversation among members takes precedence over a predetermined agenda (GoodTherapy, 2013).

Groups can be further classified according to discussion topics and the group's structure. Several of the most often used therapy groups include the following:

1) Self-Help Groups – These are often led by individuals who are not trained group facilitators but have suffered with or successfully overcome or handled an issue and seek to assist others.

2) Medication Groups - These groups focus on medicine compliance; the goal is to educate clients about their medication, ensure they follow their doctor's instructions and alleviate their sense of isolation.

3) Interpersonal Therapy Groups – These groups are designed to delve deeper into the clients' current relationships to better understand current problems; the emphasis is on the present rather than the past in these groups.

4) Encounter Groups— These groups place members in potentially uncomfortable and difficult group circumstances in the hope of eliciting more change than a typical therapy group.

5) Psychodrama — This novel group therapy involves participants acting out significant events in their lives. These theatrical re-enactments have the potential to elicit intense emotions, which are explored following each "scene" (Counselling Connection, 2010).

The size of a group therapy session is also determined by the type of group but can range from three or four to twelve or more individuals (although more than twelve participants may not be as effective). Group sessions are often held once or twice a week for one or two hours each. Although six sessions are typically advised, group therapy frequently lasts up to a year or longer (Cherry, 2017).

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Group therapy sessions are classified into two types.

1) Open groups: new members are welcome to join at any time; for instance, Alcoholics Anonymous is an open group that welcomes new members at any time.

2) Closed groups: therapy sessions are restricted to a core group of participants; additional members may be admitted only when a new group is formed (Cherry, 2017).

While the content of a group therapy session varies according to the topic, participants, and stage of treatment, the following are some typical features:

The participants will convene in a room arranged in a big circle of chairs. The session may begin with group members introducing themselves and discussing their reasons for seeking therapy. Members may also share their progress and updates since the previous group meeting in the following sessions (in closed groups) or in each session (in open groups). The session's flow will be determined by the same elements mentioned above but will most likely follow one of the following broad paths:

1) Free-form: each participant may participate in the group as much or as little as s/he like. Participants are the primary drivers of the discussion, with the therapist providing facilitation and guidance.

2) Planned: In some instances, the therapist may have a predetermined program for the meeting, complete with planned activities and skill-building exercises for the group members to participate in (Cherry, 2017).

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11 Principles of Group Therapy

1) Universality- the feeling of having problems similar to others, not alone
2) Altruism - helping and supporting others
3) Instillation of hope - encouragement that recovery is possible
4) Guidance - nurturing support & assistance
5) Imparting information - teaching about problem and recovery
6) Developing social skills - learning new ways to talk about feelings, observations and concerns
7) Interpersonal learning - finding out about themselves & others from the group
8) Cohesion - feeling of belonging to the group, valuing the group
9) Catharsis – release of emotional tension
10) Existential factors – life & death are realities
11) Imitative behaviour – modelling another's manners & recovery skills.

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Yalom's therapeutic factors of Group therapy

It is typically used in conjunction with individual therapy and occasionally medicine, while it may be used alone for specific concerns or problems. According to Dr Irvin D. Yalom, one of the most known group therapists, there are eleven fundamental principles of group therapy:

1) Instilling hope: Because group therapy frequently involves clients at various levels of their treatment, some of the newer clients may be encouraged by observing the positive effects on those who are further along in their treatment.

2) Universality: Simply being a part of a community of people who understand and have dealt with similar issues can help clients realise they are not alone and that pain is universal.

3) Sharing knowledge: Group members can be excellent sources of information.

4) Altruism: Group therapy allows individuals to exercise altruism by assisting others in the group, which is likely to benefit them.

5) The primary family group's remedial recapitulation: The process of clients learning and examining their childhood experiences, personalities, behaviours, and feelings, as well as learning how to detect and avoid damaging or non-helpful behaviours, is referred to by this euphemistic premise.

6) Socialisation techniques: Working in a group provides good opportunities to socialise, practise new behaviours, and experiment in a safe atmosphere.

7) Imitative behaviour: Clients can watch and model positive and helpful actions toward others in the group, including the therapist, by observing and imitating or modelling them.

8) Interpersonal learning: The client can learn more about themselves by interacting with the therapist and other group members and receiving feedback.

9) Group cohesion: Group therapy sessions can help people feel like they belong and are accepted by others.

10) Catharsis: This theory is founded on the healing effects of sharing one's feelings and experiences with others; talking through them in a group can help ease pain, guilt, and tension.

11) Existential factors: While group therapy provides direction and support, it also teaches clients that they are accountable for their own acts and the consequences (Cherry, 2017).

This set of ideas demonstrates that working in a group has numerous advantages over working alone. While some of these ideas can be applied to individual therapy, most are best used in a group context.

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Functions of Group Therapy

a) Sharing experiences

b) Support to & from group member
c) Socialisation
d) Imitation
e) International learning

Role of a Group Therapist

The group therapist is the primary orchestrator of change within the group. While group members also exert an influence, the group therapist creates the therapeutic climate and is responsible for focusing the group on relevant tasks. The therapist should actively structure group discussions to encourage the members to stay on topic and on task to achieve desired outcomes. The therapist's roles include:

1. The decision to establish a group
2. Determine the setting and size of the group
3. Choose the frequency and length of the group sessions
4. Decide on open vs closed groups
5. Select a co-therapist for the group
6. Formulate policy on the group therapy with other therapeutic modalities
7. Creating a therapy group
8. Formulate appropriate group
9. Select clients who can perform the group task
10. Prepare clients t for group therapy
11. Construction and maintenance of the therapeutic environment
12. Build the culture of the group explicitly and implicitly
13. Identify and resolve common problems (e.g., membership turnover, sub-grouping, conflict)
14. Being aware of individual group members
15. Directing the focus of the group.

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Skills of the therapist

Group therapists' skills are displayed in different ways and at various stages during the life of the therapy group. Group therapists must know which skills are at the core of leading an influential group while also ensuring any skills employed are done quickly and appropriately.

Interestingly, in the group environment, while some of the skills are primarily the therapist's responsibility, other skills may depend more on the cooperative efforts of group members in conjunction with the group therapist (Gladding, 2003). Some of the specific therapist skills include but are not limited to the following:

a) Facilitating: In groups, the therapist facilitates or ensures the smooth and effective progression of the group process, the interaction between group members and group dynamics.

b) Protecting: This involves safeguarding group members from unwarranted attacks by others in the group. This is a vital skill in group therapy, especially at the beginning stages, where members are more likely to be combative.

c) Blocking: In blocking, the therapist intervenes to stop counterproductive behaviour either verbally or nonverbally.

d) Linking: In linking, the therapist points out-group members that share the same concerns and encourages them to work together.

e) Diagnosing: In the group work setting, diagnosis is when the group therapist identifies certain behaviours and categories in which a group member may fit. This is based on the therapist's observations and doesn't necessarily include psychological instruments. For example, a group therapist may notice that the group tends to blame rather than develop constructive ideas.

g) Delegating: In delegating, the group therapist assigns a task to the group or one or more of its members. The idea behind delegation is to share the responsibility group development with the group members.

h) Creativity: because group work is very creative, group therapists need to be skilled in divergent ways of thinking and behaving. With an increased capacity for creativity group, therapists can help themselves and the group to become more productive through innovative ideas and methods of approach in times of crisis and when forming a sense of community within the group.

Other therapist's skills

• Encourage participation of all group members
• Observe and identify group process events
• Attend to and acknowledge group member behaviour
• Clarify and summarise group member statements
• Open and close group sessions
• Impart information in the group where necessary
• Model effective group leader behaviour
• Ask open-ended questions in the group
• Empathise with group members
• Confront group member's behaviour
• Help group members attribute meaning to the experience
• Help group members integrate and apply what they learn
• Demonstrate ethical and professional standards of group practice
• Keep the group on task and accomplish shared and individual goals.

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6 Techniques of Group Therapy

a) Cognitive therapy
b) Behavioral therapy
c) Roleplay
d) Story Writing and Sharing
e) Task-oriented groups
f) Therapeutic activity groups

Functions of Group Therapist

a) Emotional Stimulation
b) Caring
c) Meaning Attribution
d) Executive Function

5 Guidelines of Group Therapy

a) Maintain Confidentiality
b) Commitment to Attendance.
c) Socialising with Group Members
d) Putting Feelings into Words, Not Actions.
e) Role of Leader and Members

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5 Rules of Group Therapy

Regardless of the form of group treatment you attend, the basic guidelines will almost certainly be the same. These guidelines must be observed to ensure the group's safety and the treatment's effectiveness. While many groups may have different criteria, there is a basic set of five guidelines necessary for group therapy to be successful. These five rules are as follows:

1) Preserve Confidentiality. Throughout group therapy, all group participants and leaders must keep everything discussed in private. Failure to follow this guideline can erode group trust and impede members' healing attempts.

2) Attendance Commitment. This is another critical criterion for practically any organisation — each member must attend each session, come on time, and remain for the duration of the session. Apart from the fact that the absent member is missing out on crucial information and practice, absence, late arrival, or early departure can cause disruption within the group.

3) There will be no socialising with other members of the group. Group therapy is not a social activity; it is ideally therapeutic (ideally!). Developing intimate friendships or other relationships with group members can jeopardise the group's success, especially if members feel afraid to disclose personal information due to an incident involving another group member. Friendships should be conserved for the period following the group's disbandment.

4) Communicate Through Words, Not Through Actions. This guideline is the polar opposite of the customary counsel given to storytellers: "Show, don't tell!" Because people react differently to physical contact, it is critical to communicate verbally rather than physically.

5) Participate. Group therapy is ineffective if members do not participate! Healing and growth are contingent upon group members' ability to connect, share, and learn from one another. For this treatment to be effective, all group members must participate fully.

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What Is The Best Way To Run A Group Therapy Session?

1. Start with age, grade, class, and goals, then prepare the teachers, parents, and students that you may make adjustments in the first few weeks based on group dynamics for students' benefit.

Spend the first sessions honing in on student personalities, interests, preferences, academic skills and levels of performance, motivating factors, and other factors contributing to success- then adjust. 

2. Flexibility! We want the schedule to be perfect from the start, and no one likes the extra work of making changes, but flexibility is vital. It is OK to make changes when needed.

3. Don't feel like goal areas are the only requirement for groups. Sometimes interests, personalities, academic level, skills, etc., are more significant in facilitating successful sessions.

1. Social skills groups: Sometimes, I have found it beneficial to group a student working on social skills with a student who is not. I have had groups with two students working on social skills struggle to engage and participate despite my best efforts. Still, once they have a natural peer model of targeted communication skills or even a peer they were already familiar with and liked, they open up and are more receptive to engaging.
2. Relationships: Especially in Middle School and High School, students can be involved in social drama and conflict that interfere with sessions. Sometimes pairing males/females together or separately can help groups work better.
3. Cultural Competence: Be alert of the student's linguistic, cultural, and other unique factors that would impact the session.

4. Engagement. Strategise how all the students can be engaged in the session.

1. Games: Preparing individualised cards/questions paired with a board game.
2. Cooperative Games: Play games where the group has to "win" a challenge together.
3. Shared Text: Design literacy-based sessions on a shared text while targeting individual goals.
4. Combined Responses: Have both students answer questions, engage in the activity, and then take data on students' individual goals in the last couple minutes of the session.
5. Support: Encouraging students to help one another with responses if appropriate.
6. Model: Model acceptance, encouragement, a celebration of strengths, and respect for all.
7. Focus Tasks: Have a paper/pencil task for the students to work on when it's not their "turn" (i.e., drawing pictures of items with their sounds, filling in a chart for their accuracy, articulation colouring page, seek and find, underlining- quick and straightforward entities to maintain focus on session and goal).

5. Privacy. Let parents/guardians/students know that if they would like to discuss specific aspects of their therapy (i.e., goals, progress, etc.), you will meet separately with them due to privacy needs. Offer to stay on after the other student leaves, meet a few minutes early, or set up a separate time.

It's important to remember these 5 tips when training your teams on how to facilitate a group therapy session.

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5 Ways to Run a Successful Therapy Group

1) A Strict Non-Violence Policy: While it's crucial to avoid being unduly pushy or controlling in a group therapy session, several other essential characteristics must be avoided. Violent, threatening, or otherwise intimidating behaviour is one of them. Many people, particularly those with social or self-esteem difficulties, will shut down when confronted with antagonising behaviour, leaving the group ineffective. In the worst-case situation, they'll need a lot of assistance to try the same notion again, and they might have to do so with a different group. This type of behaviour should be avoided if feasible, but it should be dealt with calmly and directly if required.

2) Make the Group Fun: This idea is frequently overemphasised in groups for children, but it is underutilised in organisations for adults. Fun is a crucial concept to include; socialising is supposed to be enjoyable. It won't be much use if the group comes out as dull, monotonous, repressive, or frivolous; people may still profit, but it won't serve them well as a society model. Adults have a variety of alternatives for making therapy enjoyable, ranging from the ubiquitous coffee and doughnuts to games and activities to famous films that address the issues that the group is addressing (in a constructive manner).

3) Respect a Participant's Privacy: The group — or anyone else — is not due to any personal or private information. Participants in a group therapy session should never be forced to reveal any specific piece of information at any point. This sense of vulnerability and responsibility runs opposite to what is required to address a wide range of common psychological issues that persons with various diseases face. The group leader's responsibility is to actively defend participants against such infringement, rather than merely avoiding requiring anything of them.

4) Encourage, but Don't Force, Participation: By deciding to attend group therapy sessions, a person has already made the first step toward assisting themselves in confronting their problems. Most of the time, such a person has sought individual counselling elsewhere, indicating that they have already taken significant measures toward healthy living. Participants should be urged to participate as gently as possible, but they should never be compelled to do so before ready.

5) Be Straightforward and Direct, but Unassertive: Anyone leading a group therapy session should be open and honest about the group's objective, including what it plans to do, for whom, and how, and what obstacles they hope to help others in attendance overcome. At the same time, this should not come off as if individuals in attendance are being singled out or targeted. One of the most essential features of group therapy is that the participants feel like they are part of a supportive social circle. If they believe they are up against a united front of resistance or accusation, the group might be thrown off balance and even become counterproductive.

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Benefits/Advantages of Group Therapy

There are numerous reasons why group therapy is a treatment worth considering for participants. Among the primary advantages are the following:

1. It enables individuals to gain support and encouragement from other group members, reducing their feelings of isolation and loneliness.
2. Group therapy enables group members to serve as role models for other group members, mainly when the group consists of people at various stages of treatment. 
3. Even if all participants are at the same stage, some will naturally be more successful than others in dealing with particular challenges. Group members can share their experiences and learn from one another.
4. Because the therapist's time is shared with other clients, it is typically less expensive than individual treatment.
5. Group therapy creates a safe space for group members to experiment with new habits without fear of being judged.
6. Interacting with others in group therapy enables the therapist to observe firsthand how a client interacts with others and behaves in social situations, allowing the therapist to provide each client with tailored feedback and suggestions (Cherry, 2017).
7. People who participate in group therapy can benefit from the support and encouragement of their peers. People in the group can see that others are going through similar experiences, which might make them feel less alone.
8. Members of a group can serve as role models for others. Other group members can realise that there is hope for healing by watching someone effectively deal with an issue. As each person grows, they can become a role model and a source of encouragement for others. This can aid in the development of sentiments of accomplishment and success.
9. Group therapy is frequently relatively inexpensive. Instead of focusing on just one client at a time, the therapist can focus on a much wider group of people, lowering the cost to the participants.
10. Group therapy provides a secure environment. The environment allows people to practice habits and actions in a safe and secure environment.
11. The therapist can observe firsthand how each person reacts to others and behaves in social circumstances by working in a group. The therapist can provide valuable feedback to each client based on this information.

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7 Ice Breakers and Activities for Adults

Many different activities and exercises can be done in groups in addition to specific subjects for discussion in group therapy. A handful of these actions are outlined in the following paragraphs.

1 Therapy Goal Setting: Group treatment sessions are more challenging to facilitate than one-on-one therapy sessions. However, with appropriate goal-setting, interactive dynamics and potential communication challenges with larger groups may typically be anticipated.

2 About Your Partner: This activity can be an excellent opening for couples therapy groups. These questions aren't overly probing, but they might serve as a good reminder of the couple's emotional bond and relationship history. It can also assist them in learning more about themselves and their relationship.

3 Two Truths and a Lie: This exercise is terrific for icebreakers, but it's entertaining to do with people who already know each other. It allows individuals to reveal something personal about themselves, utilise their imagination and ingenuity to concoct a compelling story, and learn exciting facts about the group's other members.

4 Mindful Speaking: This group therapy activity focuses on participants' communication and mindfulness abilities, and it's a terrific all-around activity for any treatment. Cultivating an awareness of mindful speech can be an excellent method to set the tone for couples group therapy, or even when working with families, where emotion regulation is a focus.

5 Cooking: Getting group members to participate in an activity involving both active hands and focus is a terrific approach to help them become more familiar with one another and open up. Cooking is ideal for this activity since it brings people together to do something enjoyable while still connecting with others in the group.

6 Strength-Spotting: The purpose of this Qualities Spotting group activity is to assist participants in identifying and recognising psychological or character strengths in themselves and others. One of the most potent advantages of doing this generally isolated exercise in a group setting is that participants can receive feedback on their own talents from people around them.

7 Check-In Questions: Most therapy groups begin with each member "checking in," providing any progress updates, and sometimes sharing something noteworthy from their week or something they've learned since the previous session. If you're working with people who are hesitant to speak in front of a group, having a list of questions to lead the check-in process can be beneficial.

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10 Techniques, Ideas, and Games for Youth and Teens in Group Therapy

Many of the exercises and activities listed above can be used in group therapy with children, but some are better suited to this age group. Below are some practices and strategies that perform well with younger groups.

1 Icebreakers and Trust-Building: This section contains about a half-dozen icebreaker suggestions suitable for both teens and adults in group therapy.

2 Categories: Participants are requested to divide into smaller groups based on a category, such as favourite colour, favourite meal, number of siblings, and so on, in this icebreaker. It will assist teens in becoming more comfortable communicating with one another and learning new things about their peers.

3 Human Knot: Because this exercise demands physical interaction between group members, it may not be appropriate for all groups. Everyone forms a circle and takes the hand of someone who isn't right next to them, then tries to untangle the knot without losing go of anyone's hand.

4 Fear in a Hat: This icebreaker works best in a group if everyone is at least somewhat familiar with the other members. Everyone puts out their deepest, darkest dread on a sheet of paper. These papers are collected and placed in a hat. Each team member will create a worry, read it aloud, and try to figure out who wrote it.

Trust-building exercises are also excellent for making group members feel at ease with one another and encouraging a safe and secure environment in which to share information.

5 Minefield: Members of the group should be paired up. If there are an odd number of members, the therapist can team up with one to make the group more balanced. Tell each couple to blindfold one member and have the other guide them around the room looking for a particular object or object. When the object(s) has been discovered, the partners can switch if there is adequate time.

6 Eye Contact: For this essential exercise, participants are divided into pairs and must stare into each other's eyes for 60 seconds. Maintaining more extended eye contact will assist group members in becoming more comfortable with one another, practising a crucial aspect of social interaction, and connecting on a deeper level.

7 Trust Fall: This tried-and-true trust exercise is still a great approach to establishing group trust. Have each person climb onto a table and fall backwards into the arms of the other group members without looking back. For a reason, this is a classic: it works!

8 Silent Appreciation Mapping: This engaging gratitude activity allows kids and adolescents to express themselves while exercising their creativity. A whiteboard or a large sheet of paper, as well as several coloured pens, are required. Divide your leading group into three to five smaller groups.

9 My Favorite Animals: This is a fun game for kids and young adults that combines creativity, imagination, absurdity, and active participation. Instruct the participants to list their top three favourite animals in order. Members must write down the animal's name and three attributes they admire about it for each animal.

Ask each group member to analyse how each animal reflects them differently after identifying and describing their three favourite animals. The first animal and its three qualities represent how you want others to see you. The second animal and its three rates mean how people actually see you. The third animal and its three qualities represent who you are.

10 Inside and Outside Worksheet: This Inside and Outside Worksheet might be a valuable tool for families with young children in treatment. It's designed for a youngster to complete, and the answers can be discussed as a family to help understand and find solutions to family issues.