Special Issue on Group Psychotherapy

It has been an honor and privilege to guest edit this special issue of the American Journal of Psychotherapy on group psychotherapy. This special issue examines the question, “Why group?”—an inquiry that is both simple and complex. Why refer a patient to group? What are the benefits and limitations of group? The authors of the seven articles and two book reviews included in this issue were invited to explore these complex questions and, hopefully, to provide some answers.

This special issue focuses on process-oriented, psychodynamically informed group therapy. Psychoeducational and skills-based groups, such as cognitive-behavioral therapy, dialectical behavior therapy, and interpersonal therapy, are also valuable, but they are not covered explicitly in this issue. I expect, however, that some of the general principles discussed herein are salient to any group, regardless of its theoretical orientation.

Therapeutic groups are run in various treatment settings, including outpatient, inpatient, medical hospital–based, and military clinics; universities; community-based programs; and private practices. They are also used to train psychiatry residents, clinical social workers, psychologists, and other mental health professionals. Like therapists who practice individual psychotherapy, group therapists have many therapeutic orientations. Depending upon a patient’s diagnosis and goals of treatment, therapists may use a variety of group structures. These include short- and long-term groups; homogeneous and heterogeneous patient populations; groups for issues such as bereavement, sexual abuse, developmental trauma, and particular medical issues (e.g., cardiac issues, cancer, diabetes, obesity); and groups that focus on preventative health care.

Regardless of their orientation or configuration, groups provide a rich opportunity to explore the typical and atypical ruptures and repairs that take place in interpersonal interactions. Group therapy is a veritable social laboratory for studying projection. Members have the opportunity to become aware of and re-own their projections. This process results in a clarification of where an individual’s boundaries end and other peoples’ boundaries begin, delineating what is “mine” from what is “yours.” As a result, the distinctiveness of each group member and his or her issues gradually comes into focus. The rupture and repair that follow inevitable interpersonal misunderstandings lead to increased feelings of safety, trust, and group cohesion. Honoring everyone’s subjectivity—their emotional truth—contributes to a greater acceptance of others and of oneself. Consequently, one’s window of emotional tolerance (1) widens and develops.

Psychodynamically oriented group therapy is an effective vehicle for examining the maintenance and violation of boundaries; competition, including sibling rivalry; authority issues; fears of exclusion or inclusion; and feelings of shame, envy, and guilt. In group, therapists can see a patient’s interactions with others in real time, as opposed to hearing about them in individual therapy, where transference is played out one-on-one. When groups work well, the conflicts and blind spots that trouble people and the strengths that sustain them in their outside lives resurface in the group. When reenactments from the outside world occur in group, a potentially rich emotional learning experience unfolds. Groups may function as an opportunity to rework this material in a safe environment where members have come to care about each other. Group members become “therapists” for one another. The rich mixture of multiple transferences and countertransferences presents a rare opportunity for group members and the group leader to identify enactments when they arise in group.

Running groups is challenging and complicated. A lot of action happens all at once. Therapists must manage secrets and intimate disclosures, the tone of the room, body language of participants (the somatics), and knowing glances between members. How does one keep all of this straight? The complexity of group challenges the leader to decide whether and when to respond to an individual, subgroup, or the group as a whole. The leader, as well as group members, must become comfortable with dynamics that are both difficult to manage and impossible to control, including violations of the group contract, members who monopolize speaking time, and subjects that are difficult to talk about in a space less private than individual therapy. Therapists also face the fear of having one’s work observed, the fear of mob attack, and the fear of being accused of favoritism. Therapists working in private contexts must also manage the practicalities of running a psychotherapy practice, such as building referral sources, collaborating with the primary psychotherapist, and putting to rest the fear of competition (i.e., Will the group therapist take a patient away from individual work?)

The benefits of group have been outlined by Irvin Yalom (2), who identified 11 therapeutic factors that contribute to improvement and change in a participant’s emotional being: instillation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors. The sixth edition of The Theory and Practice of Group Psychotherapy, which is reviewed in this special issue (3), expands upon each of these factors.

The special issue opens with Rosendahl et al. (4), who present an in-depth review of the research of group psychotherapy over the past 30 years, with an emphasis on its efficacy. Whittingham et al. (5) detail group therapy as a specialty and dispel the myth that if a clinician is trained in individual psychotherapy, he or she can run groups without specialized training. Rutan’s and Shay’s articles are where the proverbial rubber hits the road. Rutan (6) focuses on the differences between group and individual therapy. The styles of attachment developed in families of origin and the reenactment in adult life come into focus in group and have a chance to be repaired. Shay (7) invites the reader to explore the centrality of shame in running groups and the potential of experiencing fear as a participant in a group.

Chang-Caffaro and Caffaro (8) address the complexity of running a group with a cotherapist through the lens of attachment and interpersonal integrative group psychotherapy. As in all dyads, differences and similarities as well as rupture and repair are central. This article is complex, fascinating, and wise. Haim Weinberg has always been a front-runner in teletherapy. Little did he know how salient his wisdom would become in the context of the mass adoption of telemedicine related to COVID-19! Weinberg (9) skillfully takes the reader through the perils and pleasure in running virtual groups. Ribeiro (10) tackles the difficult issues of diversity and systemic racism that play out around us and that ultimately infiltrate group therapy, consciously and unconsciously, in the form of microaggressions. She underscores how self-examination of our biases keeps us from enacting our countertransference. Without such self-examination, it would be very difficult to help clients to navigate their own thoughts, feelings, and impulses.

The special issue ends with reviews of two books. Lefforge (11) gives us a wonderful analysis of Core Principles of Group Psychotherapy, edited by Francis J. Kaklauskas and Les R. Greene. Lothstein (3) had the tremendous job of reviewing the sixth edition of The Theory and Practice of Group Psychotherapy, by Irvin Yalom and Molyn Leszcz, central figures in the group psychotherapy world. Both volumes are classics.

It has taken a group effort to produce this special issue. I wish to thank all the authors who contributed their wisdom to this compendium. The issue also greatly benefited from blind reviewers’ valuable critiques and suggestions and helpful input from Jerry Gans and Molyn Leszcz. I could not have succeeded in getting this edition out without the unflagging support of Heidi Koch-Bubel, Demarie Jackson, and editor in chief Holly Swartz. I wish to give a heartfelt nod to the spirit of my late husband Tufan Bener, whose editorial skills are always with me.