Individual vs. Group psychotherapy: What are the Essential Differences?

• The therapeutic alliance in group psychotherapy is with the group itself (comprised of the group psychotherapist and the group members) and not just with the psychotherapist.
• Different therapeutic factors are at work in group psychotherapy. In group psychotherapy, interpersonal feedback from peers is considered the most powerful therapeutic factor.
• The attachment process is different in group psychotherapy. The attachment is to the group itself and attachment issues are analyzed and worked through within this context.
• In group psychotherapy, a client participates in a plethora of roles and relationships and learns about the many complex roles and relationships that make up the fabric of life.

In this article group psychotherapy will refer to interpersonal group psychotherapy as described by Yalom (2005).  It was first published in 2009 in the Santa Clara CountyPsychological Association Newsletter.

Individual and group psychotherapy are both considered highly therapeutic forms of psychotherapy to treat psychological problems. But there are very different ways that these modalities are therapeutically beneficial to our clients. What are some of the essential differences between individual and group psychotherapy?

Significantly Different Therapeutic Alliance

Considerable evidence links the concept of therapeutic alliance with psychotherapy outcome for a “wide range of diagnoses an populations. (Klein et al (2013) Individual psychotherapy is a place for a client to work through psychological issues as these issues emerge within the context of a one on one therapeutic alliance with a psychotherapist. However, “group therapy alliance can be understood as the perception of the emotional bond held by an individual group member for the group and an agreement on the goals and tasks for the group therapy among group members with therapist” (Tasca, Balfour, Ritchie, & Bissada, 2007, p.1).

Different Therapeutic Factors At Work

Different therapeutic factors are at work in group psychotherapy than in individual psychotherapy. Holmes & Kivlighan, (2000) compared individual and group therapy and concluded that there are different factors that reflect different processes in individual and group treatment. They found that the factors of relationship-climate and other versus self-focus were emphasized more in group psychotherapy, whereas the factors of emotional awareness-insight and problem definition-change were more important to the process of individual treatment. In his review of the literature. Yalom (1995) identified 12 therapeutic factors of group therapy. Of the 12 factors identified, interpersonal input (feedback from others) was found to be the most valuable to group members. Yalom (1995) concluded that group interaction and group cohesiveness are the power of therapy groups. This is a substantially different therapeutic process involving different therapeutic factors than individual psychotherapy.

Different Working Through of Attachment Issues

According to Bowlby (1988), in psychotherapy, the therapist “provides conditions in which his patient can explore his representational models of himself and his attachment figures with a view to reappraising and restructuring them” (p. 138). In individual psychotherapy the attachment process takes place with the psychotherapist and the client’s therapeutic process unfolds within the safety and protection of this one on one relationship. In Group psychotherapy, however, the attachment process takes place with the group and clients work through attachment issues as these issues are triggered by others in the group. McClosky (2002) comments that “at every level of group life, misattunement to affect will trigger insecure attachment patterns”(p.140). Tasca, Balfour, Ritchie, and Bissada (2007) in their study comparing group therapy vs. individual therapy with a group of patients with eating disorders, discussed the “activation of attachment strategies” in group therapy and found that the replaying of “core relational patterns in group therapy interactions” provided the opportunity for group members to display dysfunctional patterns and then to experiment with “new ways of being with others and the self” (p.12). They concluded that group psychotherapy provides more material to work with than individual psychotherapy.

The Opportunity To Learn About Many Types Of Roles And Relationships In Group Psychotherapy

Individual psychotherapy requires an intense focus on the individual client and the therapeutic work proceeds in terms of insight gained from the understanding of patterns that have emerged from unmet developmental needs or in more of a problem-solving psychotherapy, then individual problem solving strategies are developed within the context of the client-psychotherapist relationship. The group client is not center stage but must share that stage but with 6-10 other psychotherapy clients. In order to be “cured” the client must work within the community of people that comprises a group and it is the group itself, not the psychotherapist or psychotherapist-client relationship that is the primary healing agent.(Yalom, 1995).

The group psychotherapy client participates in a plethora of relationships: with the psychotherapist as well as with other group members. Each member also experiences through observation and involvement in the group, the therapy of other group members. “In group psychotherapy in comparison with individual psychotherapy, there are more people to learn from identify with, disclose to, and with whom to form significant therapeutic relationships” concluded Holmes & Kivlighan. (2000, p. 483).

The complexity of participating in group psychotherapy mirrors the complexity of living in the world of relationships. The therapeutic work in group psychotherapy frequently takes place along many levels at the same time. The group psychotherapy client must learn to be both client and psychotherapist and also to negotiate with others in getting his/her needs met. For example, one depressed and anxious client in group was actively learning how to express his emotional needs in the group, working through trauma issues that were triggered by the memories of another group member, participating in a discussion of the group process, and assisting his fellow group members by providing support, observations, and insight.A lot to do ? The development and cultivation of healthy relationships requires that we are fully “present” in many roles, often at the same time.

In both individual and group psychotherapy, clients learn about the “work” and “joy” of being in relationships that have honesty and emotional depth. Group psychotherapy requires by it’s very nature of relationships that clients learn about a sense of community and to participate fully in all of the many complex roles and relationships that make up the fabric of life.

References

1. Bowlby, J. (1988). A secure base:Parent-Child Attachment and Healthy Human Development. New York:Basic Books.
2. Klein, A., Markowitz, J., Rothbaum, B., Thase, M., Fisher, A., & Kocsis, J. (2013) The Relationship between the Therapeutic Alliance and Treatment Outcome in Two Distinct Psychotherapies for Chronic Depression. Journal of Consulting and Clinical Psychology,4, 627-638.
3. Holmes,E.,& Kivlighan, Jr.(2000). Comparison of Therapeutic Factors in Group and Individual Treatment Processes. Journal of Counseling Psychology, 4, 478-484.
4. McCluskey, U. (2002).The dynamics of Attachment and Systems-Centered Group Psychotherapy. Group Dynamics:Theory,Research and Practice ,6,131-142.
5. Tasca, G., Balfour, K. Ritchie, L., & Bissada, H. (2007). The relationship between attachment Scales and Group Therapy Alliance Growth Differs by Treatment Type for Women with Binge-Eating Disorder.Group Dynamics, Theory, Research, and Practice,11, 1-14.
6. Yalom, I.D. (2005). The Theory and practice of group psychotherapy. (5th ed.), New York:Basic Books.