KEY THEME

Group therapy involves one or more therapists working with several clients simultaneously.

KEY QUESTIONS

Individual psychotherapy offers a personal relationship between a client and a therapist, one that is focused on a single client’s problems, thoughts, and emotions. But individual psychotherapy has certain limitations. The therapist sees the client in isolation, rather than within the context of the client’s interactions with others. Hence, the therapist must rely on the client’s interpretation of reality and the client’s description of relationships with others. Group and family therapy provides the opportunity to overcome these limitations (Norcross & others, 2005; Schachter, 2011).

Group therapy involves one or more therapists working with several people simultaneously. Group therapy may be provided by a therapist in private practice or at a community mental health clinic. Often, group therapy is an important part of the treatment program for hospital inpatients. Groups may be as small as 3 or 4 people, or as large as 10 or more people (Burlingame & McClendon, 2008).

Virtually any approach—psychodynamic, client-centered, behavioral, or cognitive—can be used in group therapy (Free, 2008; Tasca & others, 2011). And just about any problem that can be handled individually can be dealt with in group therapy (Garvin, 2011).

Group therapy has a number of advantages over individual psychotherapy. First, group therapy is very cost-effective: Because a single therapist can work simultaneously with several people, it is less expensive for the client and less time-consuming for the therapist. Second, rather than relying on a client’s self-perceptions about how she relates to other people, the therapist can observe her actual interactions with others. Observing the way clients interact with others in a group may provide unique insights into their personalities and behavior patterns. Sometimes, the group can serve as a microcosm of the client’s actual social life (Burlingame & others, 2004; Yalom, 2005).

Third, the support and encouragement provided by the other group members may help a person feel less alone and understand that his or her problems are not unique. For example, a team of family therapists set up group meetings with family members and co-workers of people who had died in the attacks on the World Trade Center (Boss & others, 2003). The therapists’ goals included helping the families come to terms with their loss, especially in cases where the bodies of their loved ones had not been recovered. One woman, who had lost dozens of co-workers, some of them close friends, explained the impact of the group sessions in this way:

As I saw the widows dealing with their loss, and believing it a bit more, it helped me to accept it even more. It was easier with sharing together. Strength in numbers. It makes you feel less alone. Out of the thousands of people you bump into, not everyone can understand what you’ve been through. If I am with any one of the families, I know they will understand what I am going through. We comfort each other. Even a blood sister might not understand as well.

Group therapies in the aftermath of other disasters, including Hurricane Katrina, have provided similar support (Salloum & others, 2009).

Fourth, group members may provide each other with helpful, practical advice for solving common problems and can act as models for successfully overcoming difficulties. Finally, working within a group gives people an opportunity to try out new behaviors in a safe, supportive environment (Yalom, 2005). For instance, someone who is very shy and submissive can practice more assertive behaviors and receive honest feedback from other group members.

Group therapy is typically conducted by a mental health professional. In contrast, self-help groups and support groups are typically conducted by nonprofessionals. Self-help groups and support groups have become increasingly popular in the United States and can be very helpful. As discussed in the In Focus box, “Increasing Access: Meeting the Need for Mental Healthcare,” the potential of these groups to promote mental health should not be underestimated.

Most forms of psychotherapy tend to see a person’s problems—and the solutions to those problems—as primarily originating within the individual himself. Family therapy operates on a different premise, focusing on the whole family rather than on an individual. The major goal of family therapy is to alter and improve the ongoing interactions among family members. Typically, family therapy involves many members of the immediate family, including children and adults, and may also include important members of the extended family, such as grandparents or in-laws (Nichols, 2012; Sexton & others, 2004).

Family therapy is based on the assumption that the family is a system, an interdependent unit, not just a collection of separate individuals. The family is seen as a dynamic structure in which each member plays a unique role. According to this view, every family has certain unspoken “rules” of interaction and communication. Some of these tacit rules revolve around issues such as which family members exercise power and how, who makes decisions, who keeps the peace, and what kinds of alliances members have formed among themselves. As such issues are explored, unhealthy patterns of family interaction can be identified and replaced with new “rules” that promote the psychological health of the family as a unit.

Family therapy is often used to enhance the effectiveness of individual psychotherapy. For example, patients with schizophrenia are less likely to experience relapses when family members are involved in therapy (Kopelowicz & others, 2007; O’Brien & others, 2014). In many cases, the therapist realizes that the individual client’s problems reflect conflict and disturbance in the entire family system (Smerud & Rosenfarb, 2011). For the client to make significant improvements, the family as a whole must become psychologically healthier. Family therapy is also indicated when there is conflict among family members or when younger children are being treated for behavior problems, such as truancy or aggressive behavior (Connell & others, 2007).

Many family therapists also provide marital or couple therapy (Bischoff, 2011). (The term couple therapy is preferred today because such therapy is conducted with any couple in a committed relationship, whether they are married or unmarried, heterosexual or homosexual). As is the case with family therapy, there are many different approaches to couple therapy (Lebow, 2008; Snyder & Balderrama-Durbin, 2012). For example, behavioral couple therapy is based on the assumption that couples are satisfied when they experience more reinforcement than punishment in their relationship. Thus, it focuses on increasing caring behaviors and teaching couples how to constructively resolve conflicts and problems. In general, most couple therapies have the goal of improving communication, reducing negative communication, and increasing intimacy between the pair.