Group, Family & Couples Therapy

Group therapy, along with family and couples therapy, represents a systemic, comprehensive approach to mental health that transcends traditional individual counseling methods. By bringing together individuals or relational units within a structured and supportive environment, these therapies leverage the power of shared experiences and mutual support to foster healing, growth, and understanding.

Erin L. George, MA-MFT, explains that marriage and family therapists, as well as other group counselors, come from a training background with the belief that human relationships are systemic; therefore, the therapeutic modalities used in group therapy work to target improving communication and more in interpersonal relationships. She says, “Attending family therapy is different than traditional one-on-one talk therapy. While attention will be given to each person’s experiences and concerns, the primary focus is to build better understandings, learn healthy boundaries, and improve relationships overall. Group therapy, specifically support groups, works as a way to build positive peer networks and practice healthy communication skills in a safe space.”

Whether addressing the challenges faced by couples navigating relationship dynamics, families striving to improve communication and resolve conflicts, or individuals seeking support among peers confronting similar issues, these therapeutic modalities offer unique benefits. They not only facilitate deeper insights into personal behaviors and emotions but also promote the development of interpersonal skills, empathy, and a sense of community. By exploring the principles, practices, and profound impacts of group, family, and couples therapy, the participants delve into a realm where psychological well-being is cultivated through connection, dialogue, and collective endeavor.

Group Therapy

As the name suggests, group therapy (including family and couples therapy) is a form of treatment involving a small group of individuals, generally between four and 12 in number, who meet regularly to talk, interact, and discuss problems with each other. Therapy groups are typically run by one or more group therapists who keep the group organized and on track therapeutically.

Therapy groups can be highly structured (with specific goals set for each meeting) or flexible (group members discuss whatever is important). Groups are often set up to address particular therapy agendas. For instance, a therapy group may address men’s or women’s issues, or it can focus on anger management, social anxiety, or chronic illness support. Participants are typically invited into the group based on the degree to which they fit the profile of an ideal member (e.g., having issues that the group is designed to address, being the right gender, etc.) and how likely it is that they may be able to contribute to the group as a whole.

However they are structured, most therapy groups have some basic ground rules that are usually discussed during the first session. Individuals are usually asked not to share what goes on in therapy sessions with anyone outside of the group. This rule protects the confidentiality of the other members and encourages people to be open and honest in their comments. Group members may also be encouraged to avoid seeing other members socially outside of therapy because of the harmful effect it may have on the dynamics of the group.

The emphasis on the patient-therapist relationship in individual forms of therapy is, in group therapy, replaced with an emphasis on the patient’s relationships with other patients or family members. Group therapists set agendas within the therapy setting, but they are most happy when they can get out of the way and allow group members to speak to one another directly. Patients are often more receptive to feedback they get from peers than they are to feedback from therapists, who are often perceived as authority figures.

Erin L. George, MA-MFT, explains, “Group therapists work hard toward the goal of achieving what is known as group harmony. When a group is working together to support one another, and even when members are mirroring positive behaviors, a therapist knows the group is working. Often, therapists will meet with group members individually outside of group therapy to check in about how they’re feeling about group meetings. Then, the therapist can go back to the group with any concerns, and a harmonious group can work together to solve them.”

In a group therapy session, members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding discussed problems. A well-functioning therapy group offers its members a safe and secure place where they can discuss and work out problems and emotional issues. Participants gain insight into their thoughts and behavior by listening to peers who are struggling with similar issues, by offering support and feedback to peers, and by accepting the support and feedback of other members.

Group therapy is often an ideal therapeutic environment for people who are having interpersonal difficulties, including depression (and anger and social anxiety problems), as the therapy is inherently interpersonal in nature. Affected group members usually benefit from the social interactions that are a basic part of the group therapy experience. In fact, one of the biggest benefits and main purposes of group therapy is that people who struggle with relationships, anxieties, and more can practice their skills in an environment where they’re comfortable. Additionally, the group therapist can watch how an individual interacts with other members of the group to help guide that person as they work on their social skills.

Group therapy provides a sense of identity and social acceptance for some participants. It can be very comforting to realize that other depressed people have similar symptoms, emotional issues, and life stressors. Learning how others cope with depressive symptoms may provide new strategies or ideas that people can try in their own lives. Group interactions can also offer people unique insight into their own behavior and provide immediate feedback about the success of new skills.

For instance, many people are not aware of their negative body language (tendency to slump, look down, sit with crossed hands and feet, etc.) or style of communication unless it is pointed out to them directly. Group members may also offer one another social support by providing words of encouragement and empathy. Lastly, by helping others in the group work through their problems, members can gain a personal sense of self-esteem.

As is the case with individual therapy, group therapies may draw on different psychological theories. For example, a depressed person may participate in a cognitive behavioral group that uses the meetings as a workshop for teaching cognitive restructuring and similar exercises involved in monitoring and changing thoughts and behavior. Alternatively, a group might be run more dynamically in nature and focus on interpersonal relationships, both at home and within the group itself.

Sometimes, group therapy is used as a way to transition people out of individual therapy. Groups can also be a cost-effective way to continue therapy after insurance benefits run out (group therapy sessions usually cost substantially less than individual therapy sessions).

Group therapy is probably not helpful as a sole therapy for severely depressed individuals (unless it occurs in the context of a larger therapeutic program). However, research suggests that cognitive behavioral group therapy can be very effective for people with mild to moderate depression.

Family and Couples Therapy

Couples therapy occurs when intimate relationship partners (married or otherwise) enter therapy together. Couples therapy doesn’t mean the two parties need to be in a relationship. Divorced parents with other partners, for example, often go to couples therapy together without their other partners to work on co-parenting issues and goals.

Family therapy occurs when an entire family comes in for therapy. Both of these forms of therapy take a Family Systems approach to the sessions. Therapists working from this approach treat the entire unit in front of them (e.g., the entire couple or the entire family) as the patient, and the individual members of these social groups are seen as components of that single patient.

Though the entry of couples and families into therapy may be motivated by problems that a single individual within the couple or family is having, the family systems therapist will tend to view the identified problem as a problem shared by all system members. In this way of doing therapy, a spouse’s depression is considered, at least in part, as a symptom of something going wrong with the relationship and not simply something going wrong with the individual.

Family therapy and couples therapy sessions delve into the details of the interactions between partners or family members as a core component of treatment. Both therapies examine the role of the depressed member in the overall psychological well-being of the family (or couple), as well as the role of the family (or couple) in creating depressive symptoms. Both family therapy and couples therapy aim to identify and then change destructive relationship patterns that may be contributing to the system’s difficulties.

For instance, if a family has been scapegoating one of its members, and that member has become depressed, the therapist will call attention to this scapegoating behavior. If one spouse is enabling the other’s use of alcohol, and both spouses are depressed, the therapist will call attention to this dysfunction as well. Family and couples therapy can also uncover hidden issues and teach people new strategies for dealing with emotions and behavior.

Family and couples therapy isn’t generally viewed as a good primary means of obtaining therapy for depressed individuals. Still, it can be an excellent adjunctive therapy strategy, as depressed individuals are both affected by and affect their relationship partners. This type of therapy is most useful when a person’s depressive symptoms are: 1) seriously jeopardizing his or her marriage and family functioning and/or 2) clearly being caused (or maintained) by dysfunctional marital and family interaction patterns.

Patients with mood disorders have a high rate of divorce. Many people (approximately 50%) report that they would not have married their spouse if they knew that he or she would develop a mood disorder. Family and couples therapy, therefore, can be a crucial and effective component of treating depression.

Deciding Between Group, Family, and Couples Therapy

When considering therapy, understanding the distinct benefits and environments of group, family, and couples therapy can guide you toward the modality that best aligns with your needs. Each form of therapy offers advantages and focuses on different aspects of healing and growth. Here’s a breakdown to help you decide which might be right for you.

Group Therapy

Ideal for: Individuals seeking peer support and the opportunity to share experiences with others facing similar challenges. Group therapy is beneficial if you’re looking to enhance your social skills, gain multiple perspectives on your issues, and feel a sense of belonging and understanding within a community.

Choose this if you’re comfortable opening up in a group setting and believe that hearing stories from others can provide insight into your own experiences. It’s also a cost-effective option for continuous support.

Family Therapy

Ideal for: Families experiencing communication problems, conflicts, or significant life changes affecting the family unit. This therapy is beneficial when issues involve or impact the entire family, such as behavioral problems in children, marital issues, or mental health conditions affecting one or more family members.

Choose this if you believe that the family dynamics contribute to the problem or that solutions require family-wide changes. Family therapy aims to improve understanding, communication, and functioning as a cohesive unit.

Couples Therapy

Ideal for: Couples facing difficulties in their relationship, including communication breakdowns, trust issues, or navigating life transitions together. This therapy can help couples strengthen their bond, resolve conflicts, and develop healthier interaction patterns.

Choose this if you and your partner are committed to working on your relationship and are willing to explore and change dynamics that are contributing to your problems. Couples therapy can be a powerful tool for rebuilding connections and fostering intimacy. However, it’s important to note that it is unethical for a family therapist or other mental health professional to see a couple with current or ongoing domestic violence issues. It’s only after anger management and other remedies have been undertaken that a couple with a history of, but no present signs of, domestic violence can be treated in couples therapy.