In group therapy, therapists deal with a certain number of patients simultaneously. The method is less costly than individual therapy: it can have an effect on a number of people at the same time, offering the advantage of more effectively exploiting a given period of time. During group therapy sessions, attention can be focused on a single participant, while the others are listening or actively participating, thereby allowing for a form of vicarious learning (observational or ‘social’ learning). Moreover, within the group, social pressure can be surprisingly strong. If during an individual therapy session a therapist tells a client that his behaviour is hostile even when the hostility is unintentional, the message may be rejected. However, if three or four other people agree with the therapist’s interpretation, it becomes much harder for the individual not to accept it.
Furthermore, many people derive a sense of comfort and support simply from the awareness that others also have problems similar to their own. Many of the techniques adopted in individual therapy can also be used to treat individuals participating in a group session. There are thus groups which function adopting a psychoanalytical orientation, Gestalt therapy groups, client-centered therapy groups, behavioural therapy groups and numerous other kinds. When forming a group for therapeutic purposes, various factors have to be taken into consideration.
Patient selection. It is easier to identify persons for whom group therapy should be ruled out rather than those for whom it would be an appropriate strategy. In general, patients suffering from an acute form of psychosis or depression, psychopaths or individuals with problems linked to substance abuse are not good candidates for this type of therapy, although special-purpose groups may provide some benefit. Hospitals and clinics do not allow much flexibility as far as the selection of participants is concerned as normally all of the patients in a ward or unit are required to take part. Activities organised outside the context of a hospital offer therapists greater control over who might derive an advantage from taking part in group therapy.
The preparation of patients. Most therapists try to become acquainted with individual participants at least minimally before inviting them to take part in a group. Apart from contributing towards the selection process, this phase helps the therapist prepare participants for the experience of working in a group: for example, informing them about the basic rules, such as the obligation to treat everything that emerges during group sessions as strictly confidential and the necessity to abstain from aggressive behaviour. The preparation of participants is associated with lower drop-out rates, fewer non-productive periods of silence and better results. It may also be one of the most important factors for complete success in group treatment.
The frequency and duration of sessions. Groups generally meet for one or two hours every week. In psychiatric clinics and hospitals, group sessions tend to be shorter as the inpatients are generally more disturbed than outpatients and would find it difficult to cope with long sessions.
Cohesion. In general, it is noted that when a reasonable degree of group cohesion is attained, i.e., when its members feel involved in the group or experience a sense of loyalty in relation to the group, members participate more willingly, with greater enthusiasm and are more open to therapeutic action.
Ending a course of group therapy. Ideally, a group would wind up when all of its members have attained their therapeutic goals, but that is something that occurs very rarely. External factors, insufficient funds, members who get transferred and similar events or situations may all play a key role in the dissolving of a particular group. The conclusion of group therapy may moreover induce a broad spectrum of emotions, ranging from happiness to a sense of abandonment. These feelings normally become topics of discussion for the group.Hospital contexts and public contexts. Most of the points so far discussed refer to groups whose members are currently not in a psychiatric hospital. Groups composed of hospital or clinic inpatients differ from these groups in various ways. Generally, in hospitals, patients are assigned to a group which meets every day. These groups are characterised by a rapid turnover and are more heterogeneous with respect to groups formed by persons who are not hospitalized. Hospital inpatients tend to be more ambivalent in comparison with non-hospitalized subjects as participation in the groups is compulsory for them. Moreover, they suffer from disorders that are more severe and when they are not sedated and under the effect of neuroleptic drugs or antidepressants their capacity to actively take part in a group is considerably reduced. The therapeutic aim of groups of hospitalized patients is to help them recover their former level of functioning and prepare them for discharge and external treatment. The leaders of these groups generally play a more active role and encourage patients to participate with greater insistence with respect to operators that hold group therapy sessions at public venues. Finally, unlike the situation typical of external groups, contact between hospitalized patients outside the group is frequent as they actually live together.