Group therapy is a specific form of psychotherapy that is provided by one or more therapists, to a group of people, at the same time. Studies show that when administered properly, group therapy can be as effective as individual therapy.

The guiding principle of group therapy for substance abuse is “power in numbers.” The ultimate goal of group therapy is to create a sense of belonging or relatability through understanding, which happens when group members share their common experiences with drug and alcohol addiction. Group therapy provides those in recovery from substance use disorders with peer support and accountability in an environment where they can learn new skills and coping mechanisms from each other.

This article explains group therapy, including how it works, what it helps with, and who it is for.

What Is Group Therapy?

The first recorded session of group psychotherapy was in 1906, when Dr. J. H. Pratt, a Boston physician, provided group instruction about home care to tuberculosis patients. While working with these patients he noticed the beneficial emotional side effects that occurred as a result of these group sessions.

Group therapy was then proven especially helpful in the 1940s in treating World War II veterans who had experienced trauma as a result of combat. In 1944, the US Army released a report commending the benefits of group therapy. It’s since become an increasingly popular type of therapy.

Today, group therapy is very common and is frequently used to treat a wide range of addiction and co-occurring mental health conditions, including:

Anxiety
Anger management
Bipolar disorder
Depression
Eating disorders
Phobias
Substance abuse

Group therapy is offered in a variety of different settings, including:

Addiction treatment centers
Community centers
Correctional facilities
Hospitals
Mental health clinics
Private practices

Group Therapy vs Individual Psychotherapy

Techniques used in group therapy differ from those employed in individual therapy. Individual therapy consists of one-on-one sessions where the therapist focuses on the individual feelings and needs of the patient. During group therapy, the therapist often facilitates discussions amongst group members which are designed to help people share experiences and work towards solutions to problems together.

Whether group therapy or individual therapy is most effective depends entirely on the individual and their unique needs. It’s common for people who are recovering from substance abuse to participate in both individual and group therapy. When paired together, individual therapy and group therapy complement each other as part of a comprehensive addiction treatment program.

General Characteristics of a Group

According to the American Psychological Association, therapy groups can be of any size but usually contain 5-15 people on average. Sessions are commonly held on a weekly basis and last 1-2 hours.

Group sessions are designed to be either open or closed. Open groups allow members to join at any time. Whereas, closed groups are made up of a specific group of people who all become members at the same time.

Some patients will only do group therapy, whereas others may attend group sessions alongside individual therapy and other treatments. Group therapy may occur more frequently (e.g. on a daily basis) if an individual is enrolled in an inpatient addiction treatment program or participating in a self-help support group, such as Alcoholics Anonymous.

Types of Group Therapy for Addiction Treatment

There are several different kinds of group therapy commonly used in treating substance use disorders. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), they generally fall into one of the following types of therapeutic models:

Cognitive behavioral therapy (CBT): These psychotherapy groups are focused on relapse prevention and helping people develop new skills and coping mechanisms, including how to manage difficult emotions like anger.
Interpersonal process psychology groups: This form of psychotherapy is focused on working through trauma that may have occurred in an addict’s life. Processing these experiences provides individuals with deeper insight into their own behaviors, which leads toward personal acceptance.
Psychoeducational groups: Psychoeducational groups are a form of group therapy that is focused on providing education through peer information-sharing and the development of healthy coping mechanisms. During sessions, a qualified therapist leads the discussion, encouraging group members to share their experiences and set goals.
Skills development groups: This form of group therapy is designed to help people develop, hone and practice skills that are required to remain abstinent and avoid relapse. This typically includes relaxation training, meditation, and life skills training.
Support groups. Substance abuse recovery groups are voluntary associations of people who share a common desire to overcome their addiction. They are focused on providing relapse prevention and peer support.

Other forms of group therapy include:

12-step programs: Many support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) use the 12-step model, where members work on their recovery with the help of a sponsor, whom they can call for guidance, or when they’re at risk of relapsing. In lieu of a trained therapist, group sessions are usually led by a fellow group member who is also in recovery. It’s common for people to continue to attend 12-step groups for many years.
Non-12-step programs: These include Self-Management and Recovery Training (SMART) Recovery, Women for Sobriety, Secular Organizations for Sobriety (S.O.S.), LifeRing Secular Recovery, and more.
Relapse prevention groups: This form of group therapy is designed to provide continuous relapse prevention support through a combination of psychological education that discusses the consequences of addiction, cognitive behavioral therapy, and skills development.
Expressive groups: These groups are focused on providing experiential therapy through art, drama, music, and other group activities.
Culturally specific groups: These recovery groups offer culturally specific support and activities.

Benefits of Group Therapy for Addiction Recovery

Recovering from a substance use disorder can feel isolating. Group therapy provides an opportunity for people in recovery from substance abuse to learn more about themselves, and their relationships with others, while being surrounded by a small community of people who have similar issues and experiences.

Group therapy provides members with a sense of belonging and acceptance, which can help boost confidence and self-esteem. Overall, sharing experiences and emotions with one’s peers has shown to reduce stress, guilt, and shame among group members.

As a result, group therapy becomes a place in which members can learn how to avoid engaging in destructive behaviors, such as seeking out substances, and instead, practice new, healthy coping behaviors alongside their peers.

Group therapy also provides psychologists with a unique perspective. Instead of relying on a patient’s self-reports, in a group setting, therapists can observe relational patterns in action, as individuals reveal their struggles through interactions with other group members.

Many of the underlying root causes of addiction stem from traumas that happened in groups (I.e. family, school, religion). During therapy sessions, the therapy group acts as a stand-in for one’s family of origin. This provides individuals with the opportunity to address and heal old wounds derived from past group settings (for example, social anxiety, low self-esteem and interpersonal conflicts) in a way that’s simply not possible in individual sessions.

Goals of Group Therapy

The goals for group therapy are based on specific therapeutic elements, designed to achieve a range of positive benefits. These include:

Altruism: Group therapy encourages people to step outside of themselves and find ways to be in service of others.
Corrective recapitulation: The family-like setting of group therapy can help people work through conflicts they may have within their family of origin.
Catharsis: By providing a safe space, group members are able to give voice to difficult feelings and experiences they may not have been comfortable sharing in other settings.
Existential factors: Group therapy helps individuals work through daily stressors
Instillation of hope: Being amongst group members with similar issues and hearing how they’ve overcome challenges gives people a sense of hope that recovery is possible.
Imparting information: By sharing personal experiences with each other, group members are able to gain knowledge about how to manage recovery.
Imitative behaviors: Through group therapy, participants have the opportunity to learn new coping skills from the behaviors of other members that help them maintain sobriety.
Interpersonal learning: Group therapy teaches participants about interpersonal connections and how to form relationships.
Group cohesiveness: Members receive a sense of acceptance and belonging from group therapy.
Universality: Surrounded by people who’ve had similar experiences with substance abuse, members see that they are not alone in their recovery.
Socializing techniques: Group therapy helps people feel less alone while teaching valuable social skills.

How Group Therapy Helps Treat Substance Abuse

According to SAMHSA, group therapy is designed to help people in recovery move through the six stages of recovery. These include:

Pre-contemplation: In this stage of recovery, individuals are not yet considering changing their substance abuse because they do not think they have a serious problem. They are attending group therapy because other factors led them there (e.g. family, friends, a therapist, or the legal system).
Contemplation: While attending group sessions and receiving guidance from a therapist, the individuals begin to consider altering their consumption or quitting substances altogether.
Preparation: The patient may still be using substances, but now recognizes the benefits of quitting.
Action: At this point, the individual chooses a strategy to end their substance abuse. They begin making the necessary changes to follow through with a plan, alongside the support of the therapist and other group members.
Maintenance: The individual works tirelessly to remain abstinent and avoid relapsing. At this point, some people achieve full recovery.
Recurrence: Since the individual has gained a better understanding of themselves and their behavior while attending group therapy, if a relapse occurs, it’s easier for them to return to the maintenance stage.

Group Therapy With Other Treatments

Depending on the severity of the addiction and the substances being abused, the patient may need to undergo medical detox and medication-assisted treatment before they’re able to begin group therapy.

For example, individuals with an opioid use disorder may require medications such as methadone or buprenorphine to manage withdrawal symptoms. Often, mental health professionals will determine when an individual is ready for group therapy. Depending on the patient and the type of group therapy, a therapist may refer them to group therapy immediately or, alternately, once they reach the maintenance phase.

What to Expect in a Group Therapy Session

During group therapy, chairs are often arranged in a circle so that everyone in the group is able to see each other during the session. However, if the group is larger, seating may be arranged in rows facing a podium. While therapy sessions vary depending on the type of group therapy, group sessions tend to have the following structure:

Introduction: Members introduce themselves and briefly state why they are attending group therapy. This may occur at the start of group therapy, at the beginning of every session, or whenever a new group member joins if it’s an open group. Introductions may also include ice-breaker activities designed for group members to get to know each other. During this portion of group therapy, it’s common for group members to test each other’s boundaries. While this can be jarring initially, it can lead to deeper, more beneficial work as therapy progresses.
Updates: Next, returning group members may opt to share updates and experiences since the last group session.
Group discussion: The facilitator or therapist will then decide what shape the meeting will take. This may involve group discussion amongst members or a focused educational session.

In addition to the above, the group therapist or facilitator may also use a variety of different learning tools, including, audio and visual aids, homework, memory improvement techniques, written projects, and role-playing.

How Long Does Group Therapy Last?

The length of time an individual will remain in group therapy depends on a variety of factors, including the type of therapy being administered, a person’s level of motivation to participate, and what stage of recovery they’re in.

Substance abuse treatment programs often require patients to attend a minimum number of sessions over a set period of time (e.g. 6 sessions over a 3-month period). However, group therapy sessions lasting up to one year may also be recommended. These kinds of therapy sessions usually take place at an outpatient rehab center or as part of an intensive outpatient program.

If an individual is being treated at an inpatient treatment center, they may attend group therapy daily for the duration of their stay.

Lastly, if an individual is in the maintenance stage of recovery, they may choose to join a support group, 12-step group, or another relapse prevention group, for peer accountability and support. In the case of 12-step groups, many people are active members for years.

How Effective is Group Therapy in Treating Addictions?

According to the American Psychological Association (APA), group therapy works as well as individual therapy for many conditions. Over 50 clinical trials have compared patients who participated in individual or group treatment, and all studies found that both formats produced the same level of improvement for a variety of mental health and substance use disorders.

Studies have also shown that interacting with peers during group therapy provides unique therapeutic benefits. In fact, according to Stanford University’s Irvin David Yalom, MD, author of the 2005 book “The Theory and Practice of Group Psychology,” participating in group therapy with one’s peers may be more helpful than receiving guidance from a therapist since people are more likely to connect and identify with their peers.

Support groups such as 12-step programs like Alcoholics Anonymous (AA) can also be very effective in helping people in recovery from substance abuse. In fact, the National Institute on Alcohol Abuse and Alcoholism looked at people who were formally treated, informally treated (attended AA meetings), and untreated individuals who suffered from alcohol abuse, and found that 49% of individuals who attended AA were abstinent, as compared to 46% of people who received formal treatment.

It’s also important to note that group therapy exceeds the APA’s Society of Clinical Psychology’s standards for efficacy in treating bipolar disorder, major depressive disorder, panic disorder, post-traumatic stress disorder (PTSD), social phobias, obsessive-compulsive disorder, bulimia nervosa, binge-eating disorder, substance use disorder, schizophrenia, borderline personality disorder, and general personality disorder.

Questions to Ask When Considering Group Therapy

While group therapy is known to be effective in treating substance abuse disorders, research shows that it is most effective when the group members have a common identity and a sense of shared purpose.

Furthermore, research shows that two leaders or group therapists are better than one. Members of co-led groups experience greater benefits than those who participate in individually led groups. An additional person who can listen and respond makes a difference when group leaders are trying to follow multiple interactions.

Therefore, it’s important to find a group therapy scenario that is well-suited to your personal needs. Before choosing group therapy, here are some questions to consider.

Is the topic or theme specific to what you’re experiencing?
Is the demographic of the group (e.g. age, gender) appropriate and one that you’d feel comfortable in?
Is it an open or closed group? Which do you prefer?
Can you easily access the group meetings?
Does the group therapy schedule work with yours so that you can attend consistently and on time?
Is the cost affordable? Will you have to pay out of pocket or do you have some coverage through an insurance plan?

If you’re unsure of what kind of group therapy would be best, speak with a mental health professional. They’ll be able to provide you with the necessary information so you can make the best decision for you or your loved one.

Cost of Group Therapy

The cost of group therapy varies based on factors such as location, frequency of treatment, and individual insurance coverage. However, group therapy is often up to half the cost of individual therapy, which makes it an attractive option for many people.

Group therapy is usually offered as part of an inpatient or outpatient addiction treatment program and therefore, included in the overall cost of rehab.

Insurance

Depending on your insurance plan, the cost of group therapy may be covered to a certain extent. Many insurance plans will cover group therapy as long as it is evidence-based, run by a professional, and medically necessary.

Additionally, individuals may also receive coverage if group therapy is part of a comprehensive addiction treatment program. Under the Affordable Care Act in the United States, substance abuse treatment must be covered under ACA insurance plans. ACA plans also can’t disqualify you for having a pre-existing substance use disorder or cap spending on addiction treatment. Many private medical insurance providers also offer addiction treatment coverage to varying degrees.

When researching which rehab options that include group therapy, consult your insurance provider to find out what kind of coverage is available.

Free and Low-cost Group Therapy Options

In addition to the options outlined above, many free and low-cost group therapy options exist. Addiction recovery support groups and 12-Step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are usually free, although you may be asked to contribute to operational costs such as room rental, coffee, and snacks.

Your doctor is a valuable source of local information. They will be able to put you in touch with support groups and group therapy providers in your area that work in addiction recovery.

Risks and Drawbacks of Group Therapy

Although there are many benefits to group therapy, there are also drawbacks that make it not suitable for everyone.

Less private: Group therapy often requires that participants share their personal struggles with the group. People with social anxiety or those who have a fear of public speaking may find group therapy uncomfortable and therefore, be better suited to individual therapy.
Confidentiality: While it’s easy to keep what’s shared in individual therapy confidential between the patient and the therapist, this becomes more difficult in a group setting. Individuals who are very private and concerned about confidentiality may find individual therapy a better fit.
Lack of individual attention: During group therapy, individuals are required to share the stage with other members. People with more severe mental health issues or those who are prone to downplaying their struggles in a group setting may benefit more from the one-on-one approach provided by individual therapy.
Member dropout: If members don’t consistently attend and participate, they may not receive the full benefits of group therapy.
Facilitator drawbacks: Unless a facilitator is a licensed mental health professional, they may not be equipped to deal with some of the issues that arise in group therapy. Poor leadership from a facilitator is also a risk factor.
Interpersonal conflicts: If someone is prone to conflict in their interpersonal relationships they might not get along with certain group members.
Not recommended for people experiencing mental health crises: For example, someone who is feeling suicidal or in need of medical detoxification should seek emergency healthcare services, not attend a group therapy session.

Get Help With Addiction Group Therapy

Regardless of where you are on your addiction recovery journey, group therapy can generate a sense of belonging, peer support, and personal accountability while also providing individuals with the necessary coping skills to live a fulfilling life free of alcohol and drug addiction.

If you or a loved one is struggling with drug or alcohol addiction, know that you’re not alone and that treatment is available. We are here to help.

Group Therapy for Substance Abuse & Addiction