Updated: Feb 28
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Revealing feelings to others can be intimidating and tiring. Going through major crises or problems and dealing with chronic issues alone can be exhausting. However, there are people who go through similar issues and can be a source of comfort and support. Group Therapy can be an effective form of treatment by itself or with individual therapy.
What is Group Therapy in Mental Health?
Group Therapy is a form of psychotherapy. It involves a group of 2-12 or more individuals who share at least one common issue, with 1 or more therapists.  It may be part of the treatment for someone undergoing individual therapy, sole treatment, or a support group style setting for individuals that tackle an issue that does not amount to an illness.
Group Therapy by itself can be ideal for an individual’s issues.
Groups meet for an hour or two each week. 
It helps people feel less alone and isolated which can, in turn, result in depression and worsening behavioural issues. 
Group Therapy vs Individual Therapy
Individual therapy assesses for diagnosis, collaborates on an individualised treatment plan, and works towards selected individual goals. Sessions focus on processing thoughts, emotions, and behaviours. There is homework. Group Therapy provides additional support, especially if the individual therapist and group therapist are on the same page. 
Group Therapy vs Support Group
Table 1 below lists the characteristics of Group Therapy vs Support Groups in general. There may be similarities and overlaps in some of the characteristics, e.g. Theme. Group Therapy is not only for diagnosed conditions, but also for certain life situations, and the same is true for Support Groups. One is not better or worse than the other. An individual may even wish to be involved in both of these group settings at the same time during a certain period of their lives.
General themes E.g. Anxiety
Specific themes E.g. Parents with Sick children
Less Structured; may include Specific Presentations on a related topic
Attendance of Members
Open-ended; Coming and going, attending when they feel the need
Table 1: Characteristics of Group Therapy vs Support Group
Table 2 lists the benefits of Group Therapy vs Support Groups. These benefits arise from the different characteristics of each Group-Setting. While Group Therapy also provides a support network and makes people feel less alone, this effect may be less pronounced depending on the type. 
Table 2: Benefits of Group Therapy vs Support Group
What are the Therapeutic Principles in Group Therapy?
Altruism: Sharing strengths and helping others boosts self-esteem and confidence
Catharsis: Sharing feelings and experiences can relieve pain, guilt or stress
Corrective recapitulation of the primary family group: The Therapy Group is much like a family and each member can explore the way their childhood contributed to their personality and behaviours. They can also learn about unhelpful behaviours to avoid.
Development of socialization techniques: Practice new behaviours in a safe and supportive setting; experiment without fear of failure.
Existential factors: Members realise they are responsible for their own lives, actions, and choices.
Group cohesiveness: A sense of belonging and acceptance arises from having a shared goal
Imparting information: Transfer of Knowledge
Imitative behaviour: Imitate behaviour of members or therapist
Instils hope: Group contains those at various stages of treatment and gives hope to those in earlier stages
Interpersonal learning: Interaction and receiving feedback
Universality: People going through similar issues or situations. 
What is Group Therapy Used to Treat?
Group Therapy is available for all major types of psychological disorders. While this may not be true for small populations such as Singapore’s, Telehealth offers accessibility to Group Therapy for less common disorders. The list below is an unexpansive list of issues Group Therapy can treat and support.  The issues that are URL linked lead to our Guides on those issues.
Autistic spectrum disorders
Borderline personality disorder (Read our Complete Guide on Personality Disorders here)
Chronic Stress, Pain, or Illness (Read our Guide on Reducing Allostatic Load here)
Depression and other mood disorders
Domestic violence or abuse
Gender issues e.g. Gender Dysphoria
Relationship Issues (Read our Ultimate Guide To Building A Healthy Relationship here)
Sexual functioning issues (Read our Ultimate Cost Guide to Sexual Dysfunction here)
Somatic symptom disorders
What are the Approaches to Group Therapy?
While there are various types of Group Therapy, they can be divided into the following 2 approaches.
1) Psychoeducational groups educate members on specific issues and even healthy coping skills.
The therapist’s role is as an educator, who directs sessions and sets goals.
Bonds between group members are not important
E.g. Gaining Skills for Parenting, Caregiving or Stress Management
2) Process-oriented groups
The therapist is not an educator, but a facilitator.
Group members engage in group discussions and activities, which can create a sense of belonging
Group is in charge of sessions
E.g. Major Life Transitions such as Divorce, Retirement, and Aging 
What are the 3 Types of Group Therapy?
1) Skills Development Groups
Introduce and Improve Skills needed to cope with certain mental health conditions
While Psychoeducational aims to expand the behavioural and cognitive resources of members to aid them in making positive choices and avoiding harmful situations
2) Cognitive Behavioural Groups
Restructures beliefs that lead to unhelpful or harmful behaviours
3) Interpersonal process groups
Focuses on Interpersonal group dynamics and less on individual psychology 
Benefits to Group Therapy
Makes one feel alone by seeing that others are going through similar issues; can help one open up to these strangers and discuss feelings
Safe Place to explore one’s condition, share feelings, and practice behaviours
The therapist understands how everyone responds and behaves in social situations and provides valuable feedback
More affordable and less time between therapy sessions
In Process-Oriented groups, members receive support and encouragement from other members; and return the favour, which gives one feeling of accomplishment. They serve as a sounding board, offer ideas like suggestions and advice for life situations. These are varied, due to the diversity of backgrounds of the members. 
Importantly, there is accountability, especially useful for addiction groups. 
How is Group Therapy Effective?
The American Psychological Association (APA) concluded that about 75% of people who enter psychotherapy demonstrate at least minimal improvement. 
APA had the following to say about group therapy: 
Group therapy exceeds Society of Clinical Psychology standards for efficacy for major depressive disorder, bipolar disorder, panic disorder, post-traumatic stress disorder, social phobia, obsessive-compulsive disorder, bulimia nervosa, binge-eating disorder, substance use disorder, schizophrenia, borderline personality disorder and general personality disorder.
Peer interactions possess various therapeutic characteristics that are key to Group Therapy effectiveness.
Listening to peers that identify with one another may be more helpful than receiving guidance from a therapist. For instance, a meta-analysis of 5 studies discovered that survivors of sexual abuse were significantly well off after Group Therapy.
Accurate and Relevant Feedback can be given to members by the therapists, as they rely on observations of their interactions rather than self-reporting that may be inaccurate.
Effective Groups share a common identity and a sense of shared purpose.
Co-led Groups, or those with 2 leaders, are more effective than individually led ones as both leaders are able to follow multiple interactions better.
Fostering Openness, Warmth, and Egalitarianism aids in cohesion by encouraging a positive bond between members. 
Why Group Therapy Doesn’t Work
Group Therapy involves the clients or patients, the therapist(s) (also known as leaders), and the group itself. The following section lists the factors pertaining to each unit of Group Therapy as they contribute to failure in bettering a client or patient and even adverse outcomes or decline. For example, there may be dropouts or even suicidality. Sometimes one aspect is improved while another is decreased, like an increase in anxiety but a decrease in depression.
1. Poor fit
Charismatic leaders who are extremely confrontational; pressure members for immediate and highly personal self-disclosure; impose values. Do not notice crumbling defences in fragile members.
Laissez-faire or off-hands approach. Does not provide adequate structure and safety (negatively charged member-to-member feedback while leader does not provide safety)
The therapist’s negative bias or countertransference towards a member of the Group may impact the Group’s ability to help that individual.
Constant and Intense Negative Statements by Therapist is associated with high group tension, decreasing patient self-esteem, and escalation of risk for adverse outcomes
Therapist Personality Attributes
3. Selection Errors
Mismatch between therapeutic modality and a client’s severity of pre-existing psychopathology; Therapist may probe deeper than the client can tolerate
Group process may prop up undetected psychopathology which can undermine a supportive process
4. Personality Factors
Therapist negative countertransference; for instance, direct expressions of hostility, lack of respect, and sexual acting out
Referring members to different groups as punishment e.g. referring narcissistically uninvolved individuals to groups that they don’t like (and who cannot handle this)
Conscious and unconsciously motivated decisions due to therapist narcissism and pain.
Therapist personality maladjustment
Verbally aggressive, intrusive, overconfidence
Unable to detect clients’ increasing distress; severely narcissistic
Lack of or defectiveness in empathy
Unconcerned about emotional needs of clients
Technically rigid, e.g. difficulty relating to clients in normal human ways
Insecure technicians following fixed rules of procedures
Emotionally seductive e.g. foster intense feelings in clients without helping them understand them
Highly unethical; transgressing therapeutic boundaries e.g. sexual behaviour with clients
negative domination and exploitation of the patients. Clients can feel powerless to confront and conform instead (true self is in hiding and false self is praised and supported repeatedly)
Humiliation e.g. a therapist had clients wear self-demeaning signs during group sessions and rationalisation is ‘attacking narcissistic defences’. 
Group Process Effects
1. Work culture under skilful direction of leader knowledgeable in psychopathology, psychodiagnostics, group dynamics and interpersonal communication.
Group dynamics: intragroup cohesion, group norms, group roles, group pressure, conformity, communication structure, social comparison, and self-disclosure
2. Attack or other rejection of a group member (including the leader) was a primary mechanism of injury.
E.g highly critical interpersonal feedback about one's personal shortcomings are especially injurious without a cohesive group climate. This is in contrast to a helpful way of learning that is in a safe and supportive (with some solidarity) group about the inappropriateness of their interpersonal behaviour.
3. Feedback overload
Disparaging feedback delivered in an overly confrontational way creates confusion rather than helpful self-perspectives
4. Scapegoats and Persons assuming Deviant group roles are more likely to suffer Group’s wrath if attacked at specific developmental stages of the group.
5. A person can be rejected in the development phase before the group is strong and supportive if they disclose “highly charged material” (e.g., incest) as this information can be overwhelming for members
6. Group Silence and Rebuff, rather than empathy and support to an intense emotional expression by a member can be destructive for that individual
7. Confidentiality breaches or norm violations may be extremely damaging. E.g. member’s extramarital affair leaked outside can result in possible divorce.
Self-disclosure may arise from despair or other motivations and is risky if leaked
Individual Member Effects
1. Level of psychopathology -
Pre-morbid level of psychological disturbance
Severely narcissistic, borderline, or schizoid patients may be at the highest risk. Such individuals tend to have difficulty forming an alliance with co-members and may tend to assume deviant group roles.
2. Unrealistic expectations
Not expecting pain or discomfort as part of the therapy process; probably stumble from one catastrophe to the next in their lives.
3. Severe Self-Esteem Issues
4. Poorly developed interpersonal skills
5. High Interpersonal sensitivity
6. Tendency to assume deviant group roles
7. Conflicted about self-disclosure and intimacy
8. Negative countertransference they engender in therapist, e.g. self-critical, masochistic client with attachment to suffering may verbally attack the therapist to evoke retaliatory rage “sadistic countertransference”
9. Fears of fusion and dependency
10. Competitiveness with the therapist to emphasise independence
11. Therapist countertransference - aims to engulf the client
Compatibility of client and group; Some patients who have strong conflicts in one group may participate easier in others
Things to Consider for Group Therapy
Willingness to Share
If there is no willingness to share, a support group might be better initially, especially if one has social anxiety or phobia. Members of Support Groups do not have to talk.
Groups with exercises like role-playing and intense personal discussions can be overwhelming for people who are extremely private or uncomfortable around strangers.
Finding Appropriate Fit
Consider your needs and desires
Need compatibility with both therapist and group, not just with either one
Consult with a doctor
Open or Closed (discussed in the earlier section on Group Therapy vs Support Group)
Face-to-Face or Online
Ask what a typical session is like
Red flags: Promise of sure cure, High fees, Pressure to purchase product or service 
Not for Individuals in Crisis
Crisis or suicidal thoughts are better received with individual therapy 
What to Expect for Group Therapy
Groups meet in quiet rooms with chairs in a circle
Self-introductions and reasons for joining, icebreaker activities
Perhaps discuss progress, obstacles and setbacks since the last meeting
Activities centred around fostering open and honest communication, as well as trust between the group members and therapist(s). 
Attendance: Commitment in Closed Groups with a certain program; None in Open Groups
Verbal Expression of Feelings, and not physical
Screening; A Competent Group Therapy program will have screening; Of course, done by mental health professionals.
Fear and Anxiety; and others are most likely feeling the same
Leaving feeling like you have gained support 
What to Expect From Group Therapist(s)
Active listening – Hear both subtle and direct messages being communicated by the group
Reflecting – “Capturing the facts, feelings, or meaning underlying what members are saying and expressing this back to the members without sounding mechanical”
Clarifying – “Focusing on underlying issues and helping group members obtain a clearer picture of what they are thinking or feeling.”
Summarizing – Identifying common themes and providing a picture of where the group has been and where it is going
Facilitating – Supporting action and interaction within the group
Empathizing – “Adopting the internal frame of reference of group members”
Interpreting – “Explaining the meaning of group members’ thoughts, feelings, or behaviours within a theoretical framework”
Questioning – “Stimulating thought and action by asking about issues pertaining to a group member or the entire group”
Linking – Fostering inter-group interaction by highlighting common themes
Confronting – “Challenging members to face contradictions in their thoughts, feelings, and behaviours”
Supporting – Offering positive reinforcement to stimulate growth and change”
Blocking – Stopping counterproductive behaviours and protecting group members 
Groups go through different stages and you can read about what to expect from the various stages here.
What to Say in Group Therapy?
In the initial phases, do not reveal information that cannot help you grow; especially not personal information.
Share things that Therapist(s) asks for, no need to share if you do not feel comfortable. Just let them know.
Disclose information related to topic and issue; including your story relating to these points
Offer constructive feedback if requested
Definitely no personal attacks
Do not speak too long or be overly silent 
How to Get the Most Out Of Group Therapy?
Consult with a therapist or doctor for suggestions on how to find the best group for them; Medical centres and hospitals may also have information on available groups.
Consider if it should be the sole treatment for you.
Choose the right group, be prepared with realistic expectations and to follow rules
Participate fully and full attendance (if required)
In the early stage, many would be hesitant to share stories and emotions or even speak. Clients would not know expectations and how others will relate, and trust is not built. Boundaries will be tested. So it is normal to not speak much.
Constructive confrontation and vocalisation of issues help later on. Issues with other clients should be resolved immediately or it will grow into a bigger issue. 
For more tips, you may wish to read this short article.
Games/Activities for Group Therapy
While certain groups such as those based on CBT or DBT have their own set of activities, the following are some general activities (could be used for support groups) 
2 Truths and a Lie
Mindful Speaking - being aware of what you are going to say and the impacts of it afterwards
Strength Spotting - identifying psychological or character strengths in oneself and others
Eye contact 
Read in-depth and find more activities here.
Where Can I Find Group Therapy in Singapore?
For fees, please enquire the clinics as they usually do not state Group Therapy fees on their websites.
216, Joo Chiat Road, SOHO Life, #03-13, Singapore 427483
+65 8828 4006
Suite 11-02 11 Floor Novena Medical Centre 10 Sinaran Drive Singapore 307506
+65 3158 7621
11 Playfair Road, S367986
Outram Rd, Singapore 169608
+65 6222 3322
11 Jln Tan Tock Seng, Singapore 308433
+65 6357 8222
10, Sinaran Drive, Singapore 307506
#06-02 The Octagon, 105 Cecil Street, Singapore 069534
+65 8299 4866
Same as Couples Therapy
How Much Does Group Therapy in Singapore?
More affordable than individual Therapy as the mental health professional’s time is split across various members.
1. Is Group Therapy More Effective Than Individual Therapy?
It can be as effective, depending on the condition and/or needs of each person. Sometimes it reinforces individual therapy.
2. What is DBT Group Therapy Like?
Dialectical Behaviour Therapy, or DBT, is a Skills-Based Group, not a Process-Oriented Group. Group members receive training on skills and report it in the next session 
3. How Many Sessions For Therapy?
There are no set amount of sessions for Therapy, though Group Therapy is likely to have a fixed timeline.
4. What if I Know Someone Else?
They might also be struggling with similar issues. It might be a point of connection rather than discomfort 
5. Is Group Therapy Cheaper Than Individual Therapy?
Yes, Group Therapy can be significantly cheaper than Individual Therapy due to the fact that a Therapist’s time is split between multiple clients or patients.
Among the various forms of treatment and support, Group Therapy or even Support Groups can be helpful. While there is risk and drawbacks, consulting a mental health professional about possible Group Therapy may help. Sometimes people feel alone in their problems and interactions with others in a safe and supportive setting can go a long way in mental health and wellness.
Before you begin with Group Therapy, you may wish to read our Guides on the following issues if they are relevant to you:
At frankie, we make mental healthcare and wellness easy for all with just one small task a day. Head on guided wellness journeys that understand your stressors or triggers or work with our behavioural and wellness professionals - all from the comfort and privacy of your home. Sign up for our Closed BETA here.
About the Author
Faizi is a fresh marketing graduate who runs an Instagram page on Alexander the Great. His view on life is summarised by the book title, “Only Cry for the Living”, though he has not read the book. Spending much of his undergraduate years transitioning from a religious to secular life, he hopes for a better future for apostates and has given interviews to this end. For him, The Only Easy Day is not Yesterday, but Today, because Today is easier to get through than Yesterday or Tomorrow.
This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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