What Is Group Therapy? How It Works and Who It Suits

What is group therapy, how do sessions run and who is it for? Learn how group psychotherapy works, its benefits and how it differs from individual therapy.

Imagine sitting in a room with a few people who are struggling with something similar to you. One of them describes, in their own words, a feeling you have not been able to tell anyone about for years, and a quiet thought crosses your mind: "So I'm not alone." Group therapy is a form of psychotherapy built on the healing power of exactly this experience. Although it is less well known than individual therapy, it is a research-supported approach used across many areas of difficulty. In this article we look at what group psychotherapy is, how it works, who it may suit, and what you should know before joining a group.

What Is Group Therapy?

Group psychotherapy is a regular course of psychotherapy delivered to a small group of participants and led by one or two mental health professionals. Participants usually share a similar area of difficulty or come together around a similar goal. Sessions are typically held weekly and may run a little longer than individual sessions.

What separates this from a casual conversation or a solidarity meeting is the presence of a structured therapeutic framework. The professional facilitator sets the ground rules, creates a safe environment, guides the interaction and makes sure that what is said serves a therapeutic purpose. Self-help groups and support communities are valuable too, but they are not the same thing as a professional psychotherapy process.

What types of groups are there?

Groups can take different shapes depending on their aims and structure:

• Psychoeducation groups: These aim to build knowledge and skills on a specific topic (for example stress management, anxiety or parenting skills). They are more structured, with an emphasis on teaching and practice.
• Skills-focused groups: In these groups, skills such as emotion regulation, social skills, communication or anger management are learned step by step and tried out within the group.
• Cognitive behavioural groups: These are groups with an agenda and a set number of sessions, aimed at a specific problem area (for example social anxiety or depression). Participants examine their patterns of thinking and behaviour together.
• Process-oriented groups: These focus less on the topic being discussed and more on the interactions that emerge "here and now" within the group. Participants notice their relationship patterns through their reactions in the group.
• Support groups: In these groups, people who come together around grief, chronic illness, the burden of caregiving or a shared life experience share their experiences with a professional present.

Groups can also be closed (starting and ending with the same participants) or open (allowing new participants to join over time).

How Does Group Therapy Work?

To understand the effect of group work, it helps to remember that human beings are fundamentally relational. Many psychological difficulties arise within relationships, are maintained within relationships and can also heal within relationships. The group acts as a small but safe laboratory for this kind of relational learning.

Research on group psychotherapy points to several key factors that explain its healing effect:

• A sense of universality: The thought "I'm the only one going through this" gives way to the realisation that "Other people experience similar things too." This can considerably ease shame and loneliness.
• Instillation of hope: Seeing others in the group make progress is a powerful source of hope that change is possible.
• The healing power of helping others: When someone who feels worthless discovers that they can support another person, the way they see themselves can begin to shift.
• Interpersonal learning: Reactions within the group mirror the relationship patterns of everyday life. Feedback from other participants allows a person to see themselves through other people's eyes.
• Sharing information and skills: Participants learn not only from the professional but also from one another's ways of coping.
• Belonging and acceptance: Being part of a group and accepted as you are can be restorative, especially for people who have experienced exclusion or loneliness.

Say someone who feels intense anxiety about speaking in public joins a group. In the first sessions they hardly speak at all. A few weeks later they express themselves in a short sentence and see that the other participants listen supportively rather than judging them. This experience becomes living evidence that tests the belief "If I speak, everyone will laugh at me." This kind of learning can have a different, and often more direct, impact than what is achieved by talking in an individual session.

In a group, you do not only listen to other people's stories; inside those stories, you begin to hear your own voice.

Who Is Group Therapy Suitable For?

Group work can be used with different age groups and across many areas of difficulty. It may be a particularly valuable option in the following situations:

• People who experience social anxiety, shyness or difficulty forming relationships,
• People struggling with feelings of loneliness and exclusion,
• People going through a shared life transition such as grief, divorce, migration or retirement,
• People living with a chronic illness or caring for a loved one,
• People who want to develop emotion regulation, anger management or communication skills,
• Teenagers (at a stage of life when interaction with peers is especially important),
• People who have already made some headway in individual therapy and want to try out what they have learned within relationships.

If you experience intense anxiety in social settings, the idea of a group may feel daunting at first. Yet facing that anxiety in a safe setting can be one of the group's most important contributions. For more on social anxiety, you can take a look at our article on social phobia. Similarly, if you have felt lonely for a long time, what we have written about feeling lonely may help you make sense of that experience.

Who might group therapy not suit?

Like any form of therapy, this method may not be everyone's first choice. For example:

• People going through an intense crisis or at high risk of self-harm may first need an individual assessment and support.
• People with a very intense, as yet unprocessed trauma may be overly affected by what others share; in that case, individual work may be recommended first.
• People who have serious difficulty following group rules (such as confidentiality or respectful communication) can create a difficult environment for themselves and for the other participants.

For this reason, a preliminary meeting is usually held before you join a group. It is meant to assess both whether the group is right for you and whether you are right for the group. If the group is not considered suitable for you at that meeting, this is not a rejection; it means a different approach is recommended that will serve you better for now. Many people first build a certain foundation through individual work and then reconsider the group option once they feel ready to join. Following this order may help you make more of the opportunities a group offers.

Differences Between Individual Therapy and Group Therapy

Individual and group work are not rivals but complementary approaches that respond to different needs.

• Focus: In individual therapy, the whole session is devoted to you, and you decide what to talk about. In a group, time is shared, but listening to others is therapeutic for you too.
• Depth and pace: In individual sessions, you can go into personal and sensitive topics in more detail and at your own pace. A group, on the other hand, offers the chance to directly observe and experiment with interpersonal patterns.
• Feedback: In individual therapy, feedback comes from one person, your therapist. In a group, you encounter the perspectives of several people.
• Confidentiality: In individual therapy, confidentiality is the therapist's professional obligation. In a group, confidentiality is a group rule that all participants agree to follow.
• Social practice: A group provides a setting in which relationship and communication skills are tried out live.

Some people use both approaches at the same time or one after the other. For example, someone working in individual therapy on issues from their past can also experience that awareness within relationships in group sessions. Which approach is right can be assessed with a professional, in light of your needs and goals. If you want to focus one-to-one on your own concerns, the individual therapy process may be a more suitable place to begin.

Before You Join a Group: Practical Tips

If you are thinking of joining a group, the following steps may make the process more productive:

1. Find out the group's purpose and structure. Which problem area is the group for, how many sessions will it run, how many people will be in it, and is it open or closed? Ask these questions at the preliminary meeting.
2. Ask about the facilitator's training. You have every right to know about the facilitator's training in mental health and their experience with group work.
3. Set your own goal. Set personal goals such as "to share my own experience in the group at least once" or "to listen without becoming defensive when someone disagrees with me."
4. Treat early nervousness as normal. It is perfectly natural to feel odd, tense or out of place in the first few sessions. A group's sense of trust builds over time.
5. Open up at your own pace. No one has to share their deepest secrets in the first session. Listening is also a way of taking part.
6. Voice any discomfort. If something in the group bothers you, say so to the facilitator or, when appropriate, within the group. This is an important part of the group's learning process.
7. Attend regularly. A group's effect grows with continuity. Absences affect your experience and that of the other participants.

When Should You Seek Professional Support?

If the difficulty you are experiencing has lasted for several weeks and is affecting your daily life, your work or your relationships, you may want to consider talking to a mental health professional. In that meeting, you can work out together which form of therapy suits you; sometimes individual work is recommended, sometimes a group, and sometimes a combination of the two.

An individual assessment before joining a group is especially important in the following situations:

• If you are experiencing intense feelings of hopelessness or helplessness,
• If there are marked changes in your sleep, appetite or energy levels,
• If you have recently been through a severe traumatic event,
• If you have thoughts of harming yourself or ending your life.

In the last case, do not wait; in an emergency, call 112 (Turkey's emergency services) or go to the nearest emergency department. During a crisis, the priority is ensuring safety and individual support.

How Is Group Work Approached in Therapy?

In groups run with a cognitive behavioural approach, each session usually follows a specific agenda. At the start of the session, participants briefly share how their week has gone, and then the topic of the day is addressed: for example, thinking patterns that maintain anxiety, avoidance behaviours or problem-solving skills. Participants try out the techniques in the group, learn from one another's examples and set small tasks to practise before the next session. The group's support can be an extra source of motivation for completing these tasks.

From a schema-focused perspective, the group can also be seen as a setting in which unmet childhood needs, and the patterns linked to them, come to life. For example, a participant who always puts other people's needs before their own may keep trying to help others in the group while avoiding talking about their own troubles. When the facilitator gently brings this pattern into view, the person has the chance to try out a new behaviour in a safe setting.

In groups for children and teenagers, the method is adapted to the age group. Through play, drama, drawing and structured activities, work can be done on areas such as recognising emotions, taking turns, cooperating and friendship skills. In these groups, regular update meetings with parents are also part of the process.

Frequently Asked Questions

Do I have to speak in the group?

No. You decide when and how much to share. In the first sessions, simply listening is a valuable form of participation. As the group's atmosphere of trust develops over time, many people begin to share spontaneously.

Is what is said in the group repeated outside?

One of the basic rules of group work is that participants do not share outside the group what they hear inside it. This rule is discussed openly in the first session and agreed by all participants. The facilitator is bound by professional confidentiality, but it is important to know that, in a group setting, confidentiality depends on the care of all participants.

Is group therapy as effective as individual therapy?

Research shows that group psychotherapy can bring meaningful benefits across many areas of difficulty. However, which approach is more suitable varies according to the person, the problem and the goal. For some people the group is more helpful, for others individual therapy, and for others a combination of the two.

Can group work be done online?

Yes, some groups can be run online. This makes it easier for people living in different cities or abroad to take part. In online groups, it is important for confidentiality that each participant joins from a place where they can express themselves comfortably and where others cannot overhear.

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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