By Wendy Wild, PsyD
Beck Institute Faculty
Cognitive Behavior Group Therapy (CBGT) has become even more applicable over the past year. As patients report increased symptoms of anxiety, depression, PTSD, substance use disorders, and other mental health problems, the gap between the demand for mental health services and the supply of mental health professionals has widened. CBGT allows evidence-based treatments to reach more people, meeting a significant public health need, and research shows group treatment nearly matches the effectiveness of individual treatment for a wide range of disorders and presenting problems (McRoberts, Burlingame, & Hoag, 1998). Enhancing provider comfort providing group therapy and enhancing the willingness of clients to engage in group treatment would allow greater access for many people in need.
Making the structure of the group session explicit demystifies the process of therapy. The structural elements of the session remain the same, (i.e., mood check, building a bridge from the previous session, setting an agenda, etc.). The group therapist’s job is to ensure fidelity to the Cognitive Model and to balance content, structure, and process.
Clinicians may wonder how to manage these three pieces while simultaneously accounting for different personalities within the group. For example, a group may contain a client who tends to overshare, one who tends to reject help, and one who is hesitant to speak up, among others. The therapist needs to encourage each client to participate in the group process, drawing out the patient who rarely shares, using empathetic summary reflection to the one who overshares, and rolling with resistance, avoiding being confrontive, with the help rejector.
One of the major benefits of group therapy is creating social connectivity, not only with the therapist, but also with fellow group members. This has been helpful during this time of social distancing and, in many cases, social isolation. One of the groups I run focuses on chronic pain management; those who suffer from chronic pain know it can be isolating, especially for those who experience “invisible” pain. Receiving validation from and uniting with others in a group setting encourages empathy, helps patients apply to themselves the adaptive advice they would give to others, and allows them to spend more time with people who understand them. In addition, the chronic pain group provides an opportunity to celebrate achievements and reinforce self-compassion when interventions do not work. Group members often readily reframe others’ beliefs of failure and can help others (and themselves) shift to a mindset of learning skills to overcome obstacles.
After addressing barriers clinicians face when it comes to leading a group, we must recognize the barriers clients face as well. Some of the most common include fears that group treatment will not work, fears of being judged, and fears that others in the group will be critical. The clinician’s job, in these cases, is to enhance motivation, provide psychoeducation about the utility of group therapy, and address specific fears and concerns. Clinicians can share their experience and what the research says, then ask clients if they are open to testing their assumptions as a kind of behavioral experiment. Clients find that CBGT has many benefits one would expect, as well as a great deal of unique, positive experiences. These include meeting more people, widening one’s support system, being part of a community, and creating more opportunities to connect.
Since the 1990s, there has been a wide variety of studies demonstrating the effectiveness of group therapy (Burlingame, Fuhriman, & Mosier, 2003; Burlingame, Strauss, & Joyce, 2013). Research shows groups are more successful when they are not manualized, allowing clinicians to choose interventions based on a cognitive conceptualization and adapting the structure according to the needs of the group. This allows the group therapist to be responsive and creative while meeting the unique needs of the group of individuals they are treating.
Dr. Wild will be leading our upcoming CBT for Groups interactive virtual workshop this Thursday, May 6, from 8:45 AM – 4 PM Eastern Time.
CBT for Groups
Thursday, May 6, 2021
Burlingame, G. M., Fuhriman, A., & Mosier, J. (2003). The differential effectiveness of group psychotherapy: A meta-analytic perspective. Group Dynamics: Theory, Research, and Practice,7(1), 3–12. https://doi.org/10.1037/1089- 26184.108.40.206.
Burlingame, G. M., Strauss, B., & Joyce, A. S. (2013). Change mechanisms and effectiveness of small group treatments. In M. J. Lambert, A., E., Bergin, & S. L. Garfield (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 640-689). Hoboken, NJ: Wiley-Blackwell.
McRoberts, C., Burlingame, G. M., & Hoag, M. J. (1998). Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective. Group Dynamics: Theory, Research, and Practice, 2(2), 101–117. https://doi.org/10.1037/1089-26220.127.116.11.