The concept “group therapy” encompasses a large number of different interventions, which can focus on the management of specific problems, on the acquisition of behavioral and cognitive skills or on the social benefits of the group experience itself.
In this article we will describe what they are The phases of group therapy and what types exist. We will also synthesize the development of this therapeutic method and the main theoretical orientations in this regard.
Group therapy is, in short, the type of psychotherapy that is characterized by having several patients in its sessions, and which aims to improve the quality of life of each of them as individual beings, and not necessarily improve the relationship between them. That is, group therapy is not the same as family therapy or couples therapy; The participants do not know each other, although as a general rule they have characteristics in common regarding the problem that leads them to go to the psychologist.
What is the reason for group therapy? Mainly, that patients help each other, acting as an element of support and progress of therapy, for various reasons; However, the therapist must work to make this possible, in addition to doing his or her part to intervene in the patients.
History of group therapy
Group therapy as we know it began to develop in the 1920s and 1930s. In the 1920s Pratt applied pioneering group interventions for the management of tuberculosis, while Lazell did it with schizophrenia patients.
Psychoanalysis, which was very popular in the first half of the 20th century, had a great influence on early group therapy. Wender transferred Sigmund Freud’s ideas on family functioning to therapeutic groups, while Schilder adopted the analysis of dreams and transference as a methodology.
Moreno’s psychodrama It was one of the first group therapies to acquire some relevance. Moreno worked on group dynamics through dramatic procedures focused on emotion, close to interpretation. At the same time, in the 1930s and 1940s, Redl began applying group therapy to children, and Slavson did the same with adolescents.
Group therapy became popular in the United States after World War II. Slavson founded the American Group Psychotherapy Association, while his rival Moreno created the American Society of Group Psychotherapy. Later, other schools and authors had a notable influence on these therapies, such as Gestalt, the neo-Freudians, Ellis or Carl Rogers.
Starting in the 60s, the different traditions specialized and developed. A clear distinction began to be made between therapies focused on the treatment of specific disorders and others closer to what we know today as psychoeducation. Cognitive-behavioral therapies They acquired great relevance in the most practical aspect of group therapy.
Group types
There are many different ways to classify therapeutic groups. We will focus on some of the more fundamental differentiations, especially those that concern group composition and structure.
1. Psychoeducational and focused on the process
Psychoeducational groups aim to provide their members with information and tools to manage difficulties. They can focus on pathologies, as is the case with psychoeducational groups for relatives of people with psychosis or bipolar disorder, or on specific topics, such as emotional education for adolescents.
In contrast, process-centered groups, closer to psychodynamic and experiential traditions, focus on the usefulness of the group relationship itself to promote emotional expression and psychological change in the people who participate.
2. Small and large
A therapeutic group is usually considered small when it consists of approximately 5 to 10 members. In these groups, interaction and cohesion are greater, and in many cases close relationships are created. The ideal group size It is between 8 and 10 people, according to experts.
Larger groups are more productive, but tend to make it too easy to form subgroups and divide tasks. Furthermore, participants in large groups tend to feel less satisfied than those in small groups.
3. Homogeneous and heterogeneous
The homogeneity or heterogeneity of a group can be assessed based on a single criterion, such as the presence of a single problem or several, or at a general level; For example, the members of a group may vary in gender, age, socioeconomic level, ethnicity etc.
Homogeneous groups tend to function faster, generate more cohesion, and be less problematic. However, heterogeneity, especially in specific disorders or difficulties, can be very useful to present different behavioral alternatives.
4. Closed and open
In closed groups, the people who are present when the group is created are also present when it ends, while In open groups, members vary to a greater extent usually because they remain active for longer.
Closed groups generate greater cohesion but are more vulnerable to members leaving. Open groups are applied, for example, in psychiatric hospitals and in associations such as Alcoholics Anonymous.
In this section we will describe the four phases of group therapy according to Gerald Corey. Although other authors speak of different phases, most classifications of the stages of the group process converge on key aspects.
1. Initial or orientation stage
In the orientation phase the central task of the therapist is establish trust of group members towards him and towards the rest of the participants. The rules, both explicit and implicit, must also be clear. There is frequently a clash between the needs for autonomy and those for belonging to the group.
2. Transition stage
After the initial stage it is possible make members feel doubts about the benefits they can obtain from the group, as well as fear of exposing themselves. It is common for conflicts to appear between members and for the therapist’s authority to be questioned.
3. Work stage
According to Corey, in the work phase, cohesion occurs between the participants based on the addressing specific problems and conflicts that arise in the group itself. The therapist may challenge members with the goal of moving toward therapeutic goals.
4. Final or consolidation stage
In the consolidation stage, a recapitulation of the progress made by members which aims to integrate the experience of group therapy into everyday life.
Participants may feel some sadness and fear of facing new difficulties without help from their peers and the therapist, so it is advisable to prepare well for the end and plan follow-up sessions, if necessary.
