The concept of “group therapy” encompasses a large number of different interventions, which can focus on the management of specific problems, on the acquisition of behavioral and cognitive skills, or on the social benefits of the group experience itself.

In this article we will describe what the phases of group therapy are and what types exist . We will also summarize the development of this therapeutic method and the main theoretical orientations in this respect.

History of group therapy

Group therapy as we know it began to develop in the 1920s and 1930s. In the 1920s Pratt applied pioneering group interventions for the management of tuberculosis, while Lazell did so for patients with schizophrenia.

Psychoanalysis, which was very popular in the first half of the 20th century, had a great influence on early group therapy. Wender transferred Sigmund Freud’s ideas about family functioning to therapeutic groups, while Schilder adopted dream analysis and transference as his methodology.

Moreno’s psychodrama was one of the first group therapies to acquire some relevance. Moreno worked on group dynamics through dramatic and emotion-centred procedures, close to interpretation. At the same time, in the 1930s and 1940s, Redl began to apply group therapy to children, and Slavson did the same with adolescents.

Group therapy became popular in the United States after World War II. Slavson founded the American Group Psychotherapy Association, while his rival Moreno created the American Society of Group Psychotherapy. Later other schools and authors influenced these therapies notably, such as Gestalt, Neofreudians, Ellis or Carl Rogers.

From the 1960s onwards, the various traditions specialised and developed. A clear distinction began to be made between therapies focused on the treatment of specific disorders and others closer to what we know today as psychoeducation. Cognitive-behavioral therapies acquired great relevance in the more practical aspect of group therapy.

Group types

There are many different ways to classify therapeutic groups. We will focus on some of the more fundamental differentiations, especially those concerning the composition and structure of the group.

1. Psychoeducational and process-centered

Psychoeducational groups aim to provide their members with information and tools to manage difficulties . They can focus on pathologies, as happens with the psychoeducational groups for relatives of people with psychosis or bipolar disorder, or on specific topics, such as emotional education for adolescents.

In contrast, process-oriented groups, closer to the psychodynamic and experiential traditions, focus on the usefulness of the group relationship itself to promote emotional expression and psychological change in the people who participate.

2. Small and large

A therapy group is usually considered small when it consists of approximately 5-10 members. In these groups, interaction and cohesion are greater, and in many cases close relationships are created. The ideal group size is between 8 and 10 people, according to the experts.

Larger groups are more productive, but tend to make it too easy to form subgroups and divide tasks. In addition, participants in large groups tend to be less satisfied than those in small groups.

3. Homogeneous and heterogeneous

The homogeneity or heterogeneity of a group can be assessed according to a single criterion, such as the presence of a single problem or several, or at a general level; for example, the members of a group may vary in gender, age, socioeconomic level, ethnicity , etc.

Homogeneous groups tend to function faster, generate more cohesion and be less problematic. However, heterogeneity, especially in specific disorders or difficulties, can be very useful in presenting different behavioural alternatives.

4. Closed and open

In closed groups the people who are present at the creation of the group are also present when it ends, while in open groups the members vary to a greater extent , usually because they remain active for longer.

Closed groups generate more cohesion but are more vulnerable to members leaving. Open groups are used, for example, in psychiatric hospitals and in associations such as Alcoholics Anonymous.

Phases of group therapy

In this section we will describe the four phases of group therapy according to Gerald Corey . Although other authors speak of different phases, most classifications of the stages of the group process converge on the key aspects.

1. Initial or orientation stage

In the orientation phase the central task of the therapist is to establish the trust of the group members towards him and the other participants. The rules, both explicit and implicit, must also be made clear. There is often a clash between the needs for autonomy and those for belonging to the group.

2. Transition stage

After the initial stage it is possible that members feel doubts about the benefits they can obtain from the group, as well as fear of exposure. It is common for conflicts to arise between members and for the authority of the therapist to be questioned.

3. Working stage

According to Corey, in the work phase, cohesion among the participants is produced by addressing concrete problems and conflicts that arise in the group itself. The therapist can challenge the members with the aim of advancing towards the therapeutic goals.

4. Final or consolidation stage

In the consolidation stage, a summary of the progress made by the members is carried out, with the aim of integrating the experience of group therapy into daily life.

Participants may feel some sadness and fear of facing new difficulties without help from their peers and the therapist, so it is important to prepare well for the completion and plan follow-up sessions, if necessary.