Therapy is far more diverse than many clients realize. Beyond the familiar one-on-one model, social work group practice draws on the power of community to support healing and connection. Advocates from the American Psychological Association (APA) note that group therapy can be just as effective as individual treatment, with some experts even suggesting that every private practice offer at least one group. The social work community echoes this, with the International Association for Social Work with Groups (IASWG) recognizing group work as a distinct and important domain within the field. Licensed clinical social workers (LCSWs) are trained and authorized to lead these groups, using them to provide emotional support, build skills, and promote more equitable access to care.
To make the most of this powerful modality, social workers need familiarity with a wide range of group therapy approaches and techniques. Whether they are leading groups directly or supporting clients through case management, they must be able to determine which methods best serve different populations and situations. Below, we will explore key group therapy techniques and how they can promote group cohesion while encouraging both individual and collective growth.
Humans have long sought insight and healing within the group setting. In therapy, however, groups are carefully curated to provide safe and structured environments in which every interaction serves a therapeutic purpose. With origins in Jane Addams' settlement houses and official recognition gained via the National Conference of Social Work (NCSW) in 1935, group work has long been a mainstay of social work practice.
According to the American Group Psychotherapy Association (AGPA), the group provides a "safe, supportive, and cohesive space to address personal, relationship, and societal issues." Within groups, members feel empowered to explore topics or challenges that they may struggle to navigate in other settings.
Therapy groups expose members to numerous perspectives that they might otherwise never encounter, encouraging them to learn from one another while actively practicing communication skills. These groups may also accommodate clients who would otherwise be unable to commit to therapy due to financial constraints.
Groups encourage camaraderie, which, in turn, can combat the sense of isolation that so many clients face in their day-to-day lives. The National Association of Social Workers (NASW) draws attention to this core benefit, revealing the unique value of the group to "foster a sense of community and mutual aid."
Therapy groups can take many forms, but are often designed to help members navigate specific life stages or mental health conditions. These groups may also be categorized according to targeted goals or preferred therapeutic modalities.
For example, psychoeducational groups aim to improve awareness and help members understand their circumstances or conditions, while mutual aid groups prioritize peer support and are designed to empower members.
As with individual therapy, there is no one-size-fits-all approach. Different groups will better serve various clients, depending on the challenges they currently face or the goals they find most relevant.
Therapy groups often utilize well-established evidence-based models that also inform one-on-one interventions. These models differ in their treatment goals and even their underlying modalities. Still, all offer the chance for members to feel connected and supported in ways that individual therapy cannot always replicate.
As one of the most widely recognized and research-backed therapeutic modalities, cognitive-behavioral therapy is effective for both individual and group sessions. CBT group therapy encourages participants to identify unhelpful ways of thinking and replace them with healthier thought patterns.
Unhelpful beliefs may be easier for clients to detect when observed in other members, sparking "aha!" moments that, in turn, lead to self-reflection. In the group environment, CBT activities could include thought records, mood monitoring, or even role-play exercises that encourage adaptive thinking.
Designed to boost psychological flexibility, ACT helps clients acknowledge and accept their own thoughts or feelings. Within the group environment, this may involve building compassion by exposing members to each other's unhelpful thoughts. By observing others judge themselves harshly, members may come to realize that they, too, are prone to unfairly criticizing themselves.
Within a group environment, members may find it easier to connect with the "observing self" or "self as context," which involves a stable and grounded sense of self, capable of observing difficult thoughts without feeling trapped by them.
Drawing on a time-limited approach to addressing major mental health challenges, interpersonal process groups help clients navigate conflict. Group arrangements are, by nature, well-suited to IPT due to this modality's emphasis on interpersonal connection. IPT group therapy may incorporate "movie scripts," in which members walk through emotionally charged situations to better understand their relational styles and different ways of interacting.
Initially developed to address borderline personality disorder (BPD), DBT works well in group settings due to its emphasis on skill development. This modality helps clients deal with intense emotions or impulsivity. Within a DBT skills group, members develop the ability to tolerate distress and regulate their emotions.
In group therapy, clients learn to apply these skills by practicing them in supportive environments, where they can see firsthand how interpersonal effectiveness plays out. Members may know about or practice TIPP skills for distress tolerance (temperature, intense exercise, paced breathing, and progressive muscle relaxation) or may even role-play to develop assertive communication skills.
Trauma-informed therapy acknowledges the considerable impact that traumatic experiences can have on the lives of clients or patients. This approach is valuable because it helps members feel safe and understood. Trauma-informed groups may use the Sanctuary Model's Safety, Emotions, Loss, and Future (SELF) framework to organize group interactions and help members work through difficult experiences. The Seeking Safety model supports members impacted by both trauma and substance abuse.
Not all patients or clients will be desirable candidates for specific groups or even for group therapy in general. Through screening, social workers can determine not only whether individuals can benefit from such services, but also whether they can contribute to the overarching group dynamic.
Placement in group therapy often begins with referrals, which allow physicians, social workers, and other clinical professionals to recommend candidates they feel will be well-served by these environments. Contraindications reveal when specific methodologies (or group therapy in general) should not be pursued. For instance, some clients could compromise the group's emotional safety. Others may require a more individualized approach.
Informed consent ensures clients know what to expect from the therapeutic process. This should detail the therapy's purpose and intended methodologies. As a critical component of social work, informed consent upholds client autonomy and dignity. Therapists should disclose their treatment orientation, detailing the frameworks or perspectives they bring to the therapeutic process.
Group therapy presents unique challenges from a facilitation perspective. Facilitators must balance the needs of each individual with the broader needs of the group while also trusting group members to provide insight and support for one another. To succeed amid these significant challenges, facilitators must develop several group therapy leadership skills:
Group therapy is not effective unless all members feel psychologically safe. It takes intentionality to cultivate this sense of safety, along with group facilitation skills such as empathy, emotional intelligence, and cultural sensitivity. Through active listening, therapists can model attunement, demonstrating that every member's feelings and perspectives matter. Ground rules enhance perceptions of safety by reminding members that the information they disclose will remain confidential.
Group therapy can be complicated by the reality that no two groups will look or function in quite the same way. This depends largely on group dynamics, which, as social psychologist Kurt Lewin explained, reveal the "power of the fluid, ever-changing forces that characterize interpersonal groups."
While therapists can guide these dynamics by establishing ground rules and dictating the overall flow of the group session, they also grant members the freedom to shape the group's culture through their feedback and sheer presence. Facilitators also shape conflict resolution in groups, using moments of conflict to help members learn how to navigate interpersonal challenges.
Establishing a sense of structure can help group therapy experiences feel safer and more predictable. This will largely depend on the purpose of the group, but it's common to begin with opening rituals such as check-ins or even mindfulness activities. From there, groups may shift into psychoeducational mode, with facilitators introducing members to concepts or strategies that they can then practice via role-play exercises.
Group therapy is particularly effective within specialized populations because groups are often designed to address distinct challenges or share common experiences. For example, specific groups may be designed to help members work through mental health concerns such as social anxiety or substance use disorders. Demographic factors may also influence groups, assisting members to feel seen and supported.
A significant share of teens and young adults report feelings of loneliness and isolation, fueling a mental health epidemic that can make young people more vulnerable to substance abuse and other severe mental health problems. Experts regard this loneliness epidemic as a "mismatch between interpersonal skill and context."
Promising research suggests that, by providing opportunities for social interactions — and by also "influencing cognitive and emotional responses" to those very interactions — group-based interventions can alleviate feelings of loneliness in teens. Groups designed to accommodate younger members may also incorporate developmentally appropriate formats or activities to boost interest and engagement.
Group therapy can serve similar functions throughout the lifespan, but in adulthood, it may target a wide range of challenges. For example, therapy groups may cater to adults undergoing transitions such as menopause, along with those navigating challenges in the workforce or grief after losing loved ones. Group therapy can effectively combat loneliness in seniors by fostering social connections and developing essential skills, much like it does for adolescents.
Group therapy provides valuable support for individuals with substance use disorders and is often offered within the context of recovery residences or transitional housing. These groups inspire, with members observing not only their own progress in recovery, but also the progress of others. This can also play into relapse prevention planning, helping members identify triggers and spot early signs of relapse.
Experts from the Substance Abuse and Mental Health Services Administration (SAMHSA) suggest that groups help members address "problems from which they have attempted to flee by means of addictive substances," even describing group therapy and addiction treatment as "natural allies."
All therapeutic interventions present significant challenges for social workers and counselors as they seek to evaluate outcomes and inform future therapy practices. In group therapy, however, this can be especially complicated, as members from the same therapeutic groups may see dramatically different outcomes influenced by a wide range of factors.
Therapists use questionnaires and symptom reduction tools to assess the effectiveness of group therapy. Symptom scales, such as the PHQ-9 and GAD-7, offer insights into therapeutic progress, while Goal Attainment Scaling (GAS) provides a person-centered and distinctly collaborative approach to evaluating individually meaningful outcomes.
Aggregated scores and group questionnaires extend beyond individual progress to examine broader outcomes, while attendance and participation rates illustrate group engagement. Assessment standards developed through a collaboration between the Association for Assessment and Research in Counseling (AARC) and the Association for Specialists in Group Work (ASGW) reference the limitations of self-reporting and indicate the need to distinguish between "group process versus group outcomes."
Group therapy can bring elevated risks to both facilitators and group members. From the therapist's perspective, risks could encompass not only potential ethical challenges or emotional burnout, but also possible compliance or even legal issues. These can be alleviated through proactive risk identification and management. Maintain precise documentation by providing clear evidence of appropriate care, along with proof of informed consent.
Logistical complications have previously prevented many clients or patients from pursuing therapeutic interventions, and, unfortunately, these concerns are often exacerbated when group therapy enters the picture. While one-on-one therapy provides a certain level of flexibility, group sessions are largely fixed, making it more difficult to work around scheduling conflicts. Tech-driven delivery models can expand access while accommodating diverse patients.
In-person environments may offer more opportunities to practice interpersonal skills, but can present scheduling complications — especially for patients with limited geographic access or other mobility restrictions. Telehealth expands access, enabling clients to participate in virtual group sessions while maintaining meaningful interactions with facilitators and other group members. Hybrid opportunities may be available, offering a middle ground between the convenience of virtual meetings and the connection of in-person interactions.
While the public's vision of the 'typical' therapy group includes one facilitator and between five and eight members, diverse arrangements are possible, with some groups seeking input from multiple facilitators or a wider range of group members.
Group size can have a significant impact on cohesion. Small groups offer opportunities for closer connection but risk "pivoting toward individualized therapy" rather than leveraging the benefits of multiple (and diverse) perspectives. Keep in mind that, while it is common for group sessions to be guided by a single facilitator, some groups may involve two therapists. Group supervision should also be considered, as it helps practitioners pursue continuous improvement and may also alleviate ethical concerns.
Group supervision provides just one of many valuable opportunities for enhancing programs and promoting ethical practice. Practitioners should continually strive for improvement, strengthening their clinical and communication skills through ongoing reflection, feedback, and training.
Continuous quality improvement (CQI) encourages therapists to enhance their services over time through client input and personal reflection. This involves careful tracking of client progress, along with surveys or audits that shine a light on potential areas for improvement. The concept of the Session Rating Scale (SRS) can be adapted to reflect group dynamics, providing opportunities for each member to offer input based on their perception of the therapy experience.
Equity is a chief concern across the spectrum of mental health care, with practitioners well aware that the patients or clients who most need their services often find therapy financially or logistically out of reach. Group therapy, as mentioned previously, offers an opportunity to address these concerns, with group sessions often proving more affordable than conventional one-on-one modalities.
Facilitators can further enhance equity by offering telehealth solutions and forming culturally responsive groups that cater to marginalized communities. Social workers are uniquely positioned to promote equity by functioning as client advocates and by helping connect clients with relevant resources.
Therapeutic group models should be informed by treatment orientation and should reflect clinical goals, matching models based on primary clinical targets and group context. For example, Seeking Safety may be preferred when working with group members who have experienced trauma, while IPT helps members struggling with depression and social conflict.
When screening potential group members, prioritize fit and safety: determine individuals' goals and comfort, but also assess for risks (such as suicidality or potential violence) that could make groups feel unsafe. Be mindful of practical considerations like transportation or language needs. Offer prospective members alternative treatment strategies if contraindications emerge.
Avoid blaming or shaming group members who dominate discussions. Instead, build mutual sharing into the structure of the group via round-robin or time-sharing arrangements. Follow up with members later to reflect on group expectations.
Use symptom scales (such as the PHQ-9 and GAD-7) in conjunction with Goal Attainment Scaling (GAS) to track progress, along with attendance and homework completion, to assess engagement. Reflect on these metrics monthly and adapt group strategies as needed.
Prioritize informed consent for virtual care and then verify that spaces truly qualify as private. This means ensuring that members wear headphones and using virtual features such as disabled recording and waiting rooms.
Establish a consistent rhythm that incorporates check-ins, mindfulness exercises, instruction, and group activities to reinforce skills. Wrap up by sharing feedback and main takeaways.
Extend engagement beyond the group environment with tip sheets or simple activities that members can practice in their own lives. Encourage members to watch short videos to reinforce key concepts. Upon gathering again, take time to celebrate small wins.
Empower clients through social work group interventions. Develop facilitation skills with IWU's social work programs. Learn to promote justice and address diverse challenges as you pursue your bachelor's degree — or expand your social work skills through our master's program. IWU accommodates diverse students with advanced tracks and even hybrid learning opportunities.
Browse our programs to learn more about our Division of Behavioral Sciences. You're welcome to get in touch to learn more. Reach out for additional information, or, when you're ready, apply to a degree program you find compelling.
