Psychotherapy involves using psychological methods to treat mental or emotional problems, e.g. to help patients to develop coping strategies.

In group psychotherapy, patients discuss things in a group environment with the psychotherapist controlling and facilitating. The group setting is particularly good for focusing on relationship problems. The group setting provides a safe area to practise new behaviours which, it is hoped, will lead to a lasting change.

What does a typical group therapy session involve?

• The sessions are confidential and patients are asked to commit for a certain number of sessions (the length can vary between weeks to months).
• In each session there will be about 8 patients on average with usually two or more therapists. The make-up of the groups can be fixed - for example, married patients only or female patients only.
• Patients share their emotional and personal problems within the group. Importantly, patients are not coerced into taking part, the idea being that they open up as their confidence in the group setting builds.
• In response to the problems raised the other members provide feedback, which can be both positive and negative. For example, another group member may have had a similar problem which they managed and they can share how they coped. The main aim is that patients become aware of their maladaptive behaviours and alter these to more healthy behaviours.

What are the aims of group psychotherapy?

1. To help patients to identify maladaptive behaviours.
2. To solve emotional difficulties through feedback and thus improve one's ability to cope with difficult problems.
3. To provide a supportive surrounding for the participants.

Who is group psychotherapy for?

Patients with:

• Relationship difficulties.
• Some personality disorders.
• Schizophrenia.
• Depression.
• Anxiety and also agoraphobia, and obsessive-compulsive disorder (OCD).
• More specific groups, e.g. a bereavement group, sexually abused women.

Techniques involved in group psychotherapy

Various techniques can be used to solve problems in group psychotherapy. These can include verbal techniques or expression through drama.

What is the evidence for the effectiveness of group psychotherapy?

Schizophrenia

• The benefit of group psychotherapy in schizophrenia is not clear. In one trial of 88 inpatients with acute schizophrenia, group cognitive behavioural therapy (CBT) was associated with lower hospitalisation rates. However, these changes were not apparent in the long-term.^1,2
• Another study did not find that group CBT improved severe auditory hallucinations in schizophrenic patients.³
• There are not many randomised controlled trials of group psychotherapy in schizophrenia. This is in comparison with family interventions which have been shown to have clearer benefits.⁴
• More research is needed to review the effects of group psychotherapy and more studies on patient subgroups are also required, e.g. elderly and young patients with schizophrenia.⁵

Depression

Again, there is a lack of research studying group psychotherapy in depression.

• Group psychotherapy is helpful in cancer patients with depression and improves both emotional and psychological distress. There may also be beneficial effects on survival.⁶
• Group psychotherapy may also be useful in depressed adolescents but the benefit is unclear.⁷

Are there any adverse effects of group psychotherapy?

This is a very controversial area. There is a need for more studies comparing group psychotherapy with other treatments. Group therapies, whilst helping some, may have a negative affect on others - e.g. worsening of presenting symptoms and/or appearance of new symptoms.⁸The reasons for failure can be multifactorial, e.g. difficult interaction between a patient and a therapist.⁸

Document references

1. Bechdolf A, Kohn D, Knost B, et al; A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months. Acta Psychiatr Scand. 2005 Sep;112(3):173-9. [abstract]
2. Bechdolf A, Knost B, Kuntermann C, et al; A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatr Scand. 2004 Jul;110(1):21-8. [abstract]
3. Wykes T, Hayward P, Thomas N, et al; What are the effects of group cognitive behaviour therapy for voices? A randomised control trial. Schizophr Res. 2005 Sep 15;77(2-3):201-10. [abstract]
4. Pilling S, Bebbington P, Kuipers E, et al; Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med. 2002 Jul;32(5):763-82. [abstract]
5. Granholm E, McQuaid JR, McClure FS, et al; A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry. 2005 Mar;162(3):520-9. [abstract]
6. Blake-Mortimer J, Gore-Felton C, Kimerling R, et al; Improving the quality and quantity of life among patients with cancer: a review of the effectiveness of group psychotherapy. Eur J Cancer. 1999 Oct;35(11):1581-6. [abstract]
7. Beeferman D, Orvaschel H; Group psychotherapy for depressed adolescents: a critical review. Int J Group Psychother. 1994 Oct;44(4):463-75. [abstract]
8. Roback HB; Adverse outcomes in group psychotherapy: risk factors, prevention, and research directions. J Psychother Pract Res. 2000 Summer;9(3):113-22. [abstract]

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