The Theory and Practice of Group Psychotherapy


Of all the types of psychotherapies, group psychotherapy has evolved over the years. This particular type of therapy is ideal for situations that for addressing problems that are associated with mental wellbeing. Group psychotherapy involves either one or more therapists who lead several patients with psychic issues. Generally, members of the group dedicate some hours to meeting every week. Among the issues that psychotherapists handle include substance use disorders, psychosis, social anxiety, and panic disorders among others. Most commonly, group psychotherapy helps in reducing the pain that might occur as a result of the loss of a loved one. However, joining a group may appear threatening to some individuals at first but it has many benefits that individual psychotherapy cannot provide. The cohesion within group therapy is a vital aspect only if the selection of the clients was done systematically to ensure the growth of the group up to an advanced level.

Group Cohesiveness

Group cohesiveness is an important factor that influences group therapy. Precisely, cohesiveness is explained as the attractiveness of a group to its members. There is a common method of measuring a group’s cohesiveness by totaling an individual’s attraction to the team (Yalom & Leszcz, 2020). Other techniques include Group Questionnaire (GQ) which was established by Gary Burlingame and his colleagues (Yalom & Leszcz, 2020). For other therapeutic factors to function optimally, group cohesiveness is a precondition. As such, it is important to create an ideal client-therapist relationship through attractiveness that would otherwise enable risk-taking, catharsis, and interpersonal exploration to grow.

Therapy groups are crucial because of the nature of a team which involves sharing the affective world of an individual and then being accepted by other members. Group cohesiveness establishes a positive self-fortifying loop of credence, self-revelation, compassion, approval, and trust again (Yalom & Leszcz, 2020). The members of a cohesive group can establish a durable relationship based on the existent attractiveness within the team itself (Yalom & Leszcz, 2020). Therefore, great care should be taken by a leader within a particular therapeutic group to address problems that may jeopardize cohesion within a team.

Notably, cohesiveness creates group acceptance and trust which act as mechanisms by which troubled personalities can be assisted. The characteristics process that is initiated includes the increased willingness of the client to freely express his feelings, and the ability to test reality and become more discriminatory in feelings (Yalom & Leszcz, 2020). In addition, the clients in the group may become aware of the discordance between their experiences and self-concept (Yalom & Leszcz, 2020). Although it is the client’s experience that matters most, the therapist’s actions and conduct may have a resounding effect on the acceptance and trust within the group.

Selecting Clients and Composing Groups

Efficient group therapy must start with good client selection because the clients assigned to inappropriate groupings are improbable to benefit from their therapy experience. In most cases, the majority of clinicians choose clients for group psychotherapy by deselecting which primarily entails determining that certain individuals can not fit in a particular group and are excluded (Yalom & Leszcz, 2020). Moreover, the criteria for inclusion are also employed by clinicians to form a therapeutic group. Motivation is an essential characteristic that is always checked in a person before incorporation into a group (Yalom & Leszcz, 2020). In as much as selection aids and clinical observations have produced inclusion criteria, the study of failures in group psychotherapies has resulted in an exclusion basis.

Apart from selecting group therapy members, great emphasis should also be placed on individual suitability for a specific group. The appropriateness of an individual to a certain group is pegged on the client’s behavior. The most common procedures used in predicting the behavior of a client in a group are standard diagnostic and interpersonal intake interviews, and the client’s previous group therapy history (Yalom & Leszcz, 2020). Other strategies include specialized diagnostic procedures, interpersonal nosological systems, attachment style, and interpersonal or personal inventories (Yalom & Leszcz, 2020). Whichever scheme is applied to behavior prediction, it should be noted that the client’s character is a key consideration in a group’s composition.

Predictions of how each client will experience a group and how others will experience him enable a therapist to construct effective groups based on suitable guidelines. Also to be regarded in the composition of groups is the heterogeneity or the homogeneity aspects of the therapy group created (Yalom & Leszcz, 2020). With regards to efficient therapy groups’ performance, some general clinical considerations should be made to make some members in the outfit advocates of constructive group norms. No certainty is guaranteed about the best composition of a therapy group.

Creating the Group

As soon as the clients for a therapy group are selected, therapists must embark on launching the team. The therapists must secure a suitable meeting place and effect several realistic decisions on the structure of their grouping. Furthermore, the second group of people who will refer clients to the family must be regarded (Yalom & Leszcz, 2020). Nonetheless, effective cooperation by the second team is indispensable to the success of the therapy family as a whole.

There are no special rooms or venues for the group meetings apart from ensuring that such settings have afforded privacy and freedom from distractions. The sitting arrangement in which each member sees one another in a circle is highly recommended. Rectangular seats that or sofas that seat three or four people are avoided on most occasions (Yalom & Leszcz, 2020). The circular or round table meetings are preferred because they help in fostering cohesion among the members of the therapy group.

With the growing need to go for less expensive and more effective forms of therapy, therapists are opting for brief group therapy. Some clinicians define brief groups as the short-term group life span that can ascertain some particular objective. Often, eight therapeutic sessions or fewer are enough to return many clients to their pre-crisis levels (Yalom & Leszcz, 2020). Indeed, the real measurement of client progress paired with consistent objective feedback about the client’s experience and therapy can assist in determining how much therapy is sufficient.

Clinical practices differ in individual sessions with clients before group therapy. Some therapists, after meeting prospective clients in a once or twice selection interview do not meet with the clients on an individual basis while others continue individual sessions till clients start in the group (Yalom & Leszcz, 2020). Certainly, pregroup meetings and preparation for group therapy develop mutual identification with the therapist and in turn, breed cohesion.

In the Beginning

After a therapy group has been created, all the members start to manifest themselves interpersonally, thereby creating their social sphere. The first meeting is a key formational stage of a group’s psychotherapy meeting which is characterized by tasks of members’ engagement and affiliation. The first stage is usually marked for orientation, undecided participation, search for meaning, and dependency (Yalom & Leszcz, 2020). Additionally, the second phase of the first meeting is primarily concerned with conflict, dominance, and rebellion among members of the group (Yalom & Leszcz, 2020). Last is the stage for cohesiveness development which culminates in the growth of the group (Yalom & Leszcz, 2020). However, there is no clarity on the precise inviolate sequence of growth development of group therapy.

Different factors apart from the clients impact heavily and invariably on group development. Chance or rather a group composition is one such influence in the growth of the team. Other people who may change quintessential group developmental trends include those individuals with monopolistic inclinations, indecent exposure, licentious self-disclosure, or an unrestrained tendency to exert dominance (Yalom & Leszcz, 2020). Generally, the clients have a substantial effect on the growth of a group as a whole.

The preliminary developmental series of a therapy team is powerfully influenced by membership problems. The integrity and stability of a group are always threatened by turnover in membership, tardiness, and absences (Yalom & Leszcz, 2020). Significant absenteeism may divert the team’s attention and energy away from the developmental responsibilities toward the challenge of upholding membership. Consistently, the therapist must ensure that he replaces the dropouts as necessary by adding new members to the therapy group. To avert further complications that may arise in a team, the therapist must therefore professionally steer his team.

The Advanced Group

When a therapy group has grown to an advanced level, major therapeutic factors such as catharsis begin to operate with full force and effectiveness. Members associate more deeply with the group and use their interactions to address the concerns that brought them to the session. At the core of members’ engagement lies the ability to assist the clients to understand their interpersonal skills (Yalom & Leszcz, 2020). Inarguably, the advanced group’s stage inculcates cohesiveness that encourages risk-taking and self-disclosure.

Depending on the needs of a group, it is sometimes deemed fit to split a group into smaller outfits that consist of two or more members of the entire team. A subgroup is created from the belief of more than two members that they can obtain gratification from one another than the whole group (Yalom & Leszcz, 2020). Whether the groups are split or not, conflicts that arise from human groupings cannot be avoided as therapy groups consist of persons. Remarkably, conflict is inexorable in the course of a group’s growth and its absence may show some disfigurement of the developmental sequence.

An integral part that is equally feared and valued by many participants in group therapy is self-disclosure. Though it entails a lot, self-disclosure may entail past or current events in a person’s life, dreams and fantasies, hopes or aspirations, and the current feelings of a person towards others (Yalom & Leszcz, 2020). Following self-disclosure is another important phase of group therapy that is known as the termination stage. At termination, there is a mutual, planned ending to a therapeutic session with a review and consolidation of work done, mourning, and celebration of the next episode of life (Yalom & Leszcz, 2020). Therefore the last parts of group therapy must be understood by participants as they are the important force in the change process.

The Challenging Group Member

Problematic clients who merit particular attention by therapists are the monopolist, the silent client, the boring type, the help-rejecting complainer, the acutely psychotic or bipolar, the schizoid, and the characterologically difficult ones. The anathema of many groups is the interminable monopolists who appear impelled to talk incessantly (Yalom & Leszcz, 2020). The monopolists may continue to describe conversations with others in illimitable detail. Equally challenging to a therapist is the less disruptive silent participant. The main issue with silent clients is that some researches indicate that the more a member is active and influential in a team, the more he is likely to benefit from the group’s interactions (Yalom & Leszcz, 2020). Additionally, being boring, like being silent and monopolizing should be taken seriously. It is only group psychotherapy that may be specifically helpful to these challenging members since the team will model how to engage with their emotions and lend them support.

A rare fully developed behavior that can also pose an immense challenge to a therapist is the help-rejecting complainer which is a clinical syndrome. Many groups are therefore designed to work with this particular caliber of people and that is the reason why acutely psychotic clients benefit from team psychotherapy (Yalom & Leszcz, 2020). Remarkable successes that can be attributed to group interventions include pharmacotherapy adherence by acutely psychotic participants. As well, schizoid patients are common visitors to therapy groups. The convalescents are sentimentally blocked, segregated, and distant often seeking group therapy out of the senseless search for imaginary missing things (Yalom & Leszcz, 2020). More profoundly, the last two categories of difficult clients are persons with borderline and narcissistic traits. The notable thing with problematic clients is that their behavior is an amalgam of their traits and psychodynamics within the therapy group.


Yalom, I., & Leszcz, M. (2020). The theory and practice of group psychotherapy (6th ed.). Hachette Book Group.

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PsychologyWriting. "The Theory and Practice of Group Psychotherapy." December 1, 2022.