Group Therapy / WHY DO IT- Evidence Based Treatment

      Group therapy is appropriate and cost effective for clients with everyday life problems, body-mind disease/dis-spiritedness, or any of the usual diagnosable anxieties, depressions and relationship issues.  Group Therapy can involve a wide variety of theoretical approaches, treatment strategies and techniques focusing on thoughts, emotions interpersonal relations and/or behavior.

A review of 32 studies in which patients were randomly assigned to either individual or group psychotherapy [both conditions using the same theoretical approaches], found that equivalent results were obtained in 75% of the studies, and that the group modality was more effective in 25%. (Toseland & Siporin, 1986)  Three more recent randomized studies examined dynamically oriented, time-limited treatment groups using more sophisticated research methodology showed no difference in outcomes between individual and group approaches (Pilkonis et al, 1984; Piper et al, 1984; Budman et al 1988).  Using a randomized control design (Piper et al, 1992), time limited/12-session groups for clients experiencing excessive or extended grief about major losses were analysed .  Forty-five percent of their client sample had a diagnosis of Major Depression and [likely partly because “…universality and altruism… are very powerful features of group therapy that are not provided by individual treatment.”], this study found  strong treatment effects according to both statistical and clinical criteria (Effect Size more than 0.80 out of 1.0 on two standard measures [the SCL-90 and the Beck Depression Inventory).  The positive changes were maintained or improved at six month follow-up.

       The evidence cited above indicates that individual and group forms of the same treatment styles show similar improved outcomes.  The small group format provides an atmosphere of cohesion that carries with it a number of therapeutic ingredients greatly enhancing the value of specific treatment techniques.  These  ingredients include: instilling Hope, Acceptance, Compassion, Universality {people are much more alike than different}, and altruism {helping others}.    This set of supportive factors is very similar to the good effects of a positive therapeutic  relationship usually found in individual therapy  (Doeherty 1985).

     Many clients with treatment resistant anxiety and depressive disorders have habitual,  unconscious personality styles that resist change.  For example, depression is frequently accompanied by strong, rigid habits of thought and behavior which prevent closeness with other people and increase alienation, loneliness and shame.  Clinical experience shows that social norms within a therapy group toward more mature and satisfying behaviors  are more likely to break through life-long, unsatisfying interpersonal patterns than in individual therapy.

     Groups are an effective means for providing psychoeducational information regarding diagnostic concepts such as depression and anxiety.   Distinguished from treatment groups, longer term  support groups may be used to maintain the seriously ill client in the community and reduce the frequency of relapse requiring hospitalization.  Such groups provide a mixture of support and psychoeducation that enhances compliance with other treatment components, as well as providing an opportunity for regular assessment   of potential complications.  The simultaneous use of psychiatric medications along with group treatment can also be useful, the medications acting on targeted genetic or chemically related symptoms, while the group exerts psychological and social influence  leading to increased confidence, comfort and interpersonal competence.

     The effective use of the small group format requires specialized leader-training , and  ideally also, experience as a client in group therapy .  Management of the group context calls for skills and experience well beyond those learned for doing individual therapy.  Without experienced leadership, groups may become ineffectual, resulting in a general sense of demoralization, or even harmful due to mismanagement of group conflict or outside-of-group experiences (MacKenzie, 1990).

     Given the relative cost-effectiveness and the overall equivalence of outcomes, there seems little reason why various psychotherapeutic approaches to the treatment of psychological and physical pain cannot be routinely provided through  group therapy.

Prepared by K. Roy MacKenzie, M.D. December, 1992 ;  edited  by Bob Dick PhD, CGP, AC

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