Group therapy offers a fantastic sense of a supportive community as clients take steps to make changes in their lives. Our Western world struggles greatly with people increasingly feeling isolated and often stigmatized if struggling with mental health issues.

Group therapy is also efficient from the perspective of two therapists being able to offer services to eight or more clients during a two-hour session, as opposed to each offering four hours of individual therapy.    

Group CBT helps clients understand their problems better by education from leaders on a number of topics. For example, clients can learn about the symptoms of depression and discover various coping skills. It also gives them a sense of not being alone. In a group setting, skilled therapists capitalize on the feeling of “being in the same boat” and peer support.

We always start our groups with a warm-up or icebreaker. A favorite among clients is “Two Truths and a Lie” where each group member tells three things about themselves of which one is incorrect. The group has to guess which one is the lie. This allows people to get to know each other better and generates humor and appropriate laughter.

Drop outs from groups are a problem. Studies including one conducted by myself and my colleagues found that people who have high expectations for the group being helpful were more likely to have excellent attendance and complete the group. Expectations can be assessed on a simple scale from one to 10.

There are a handful of published group CBT guides including my own from Wiley and Sons, 2014. There are also annual conferences such as the American Group Psychotherapy Associations (AGPA) where people can take courses on the basics of group therapy and group CBT workshops.

Research and clinical experience show that people with certain interpersonal styles may not benefit from group therapy and pose a risk of disrupting the group. These include but are not limited to an avoidant style, an aggressive style and an overly emotionally expressive style. Clients with those issues will likely do better in individual therapy, at least as a start. However, if the group is focused on anger or emotion regulation, a group format could be helpful.

Group therapy does require some administration work to put a group together. It’s best to have one admin person who is able to do that. As for getting a commitment from clients, it can be helpful to offer a pre-group orientation where prospective clients come together and learn about what to expect from group treatment. In our practice, clients do not make their final commitment to the group until they have attended the pre-group orientation.

We review ground rules in our first group sessions and those include not socializing with other group members during treatment. After the group therapy is over, we encourage socializing and ask clients in the last session to exchange contact information (entirely voluntary of course). We ask the group why they think we have the rule of not socializing during treatment. Their answers are always thoughtful, mature and along the lines of not wanting to create subgroups where people feel excluded.

Eight is a good number. To end up with this, we usually offer the group to 10 clients knowing that one may not start at all and another may drop out early. For online CBT groups, which can be very successful, up to 12 clients can participate so long as there are two to three facilitators. For more information, see the forthcoming book Practicing Online Group Therapy: Theory, Research and Technical Considerations edited by Arnon Rolnick, Haim Weinberg and Adam Leighton.

It is common to have some fears including privacy concerns before starting a group. This is addressed and normalized in the pre-group orientation session and during the first group sessions. We tell clients that they do not have to talk about themselves more than they wish to.

It is entirely possible to get a lot from a CBT group without sharing much about oneself. If a person is intensely private and/or socially avoidant, group therapy may not be something they will enjoy or benefit from.