Based on the formal definition of psychotherapy, it is clear that this intervention requires at least one formally trained therapist, at least one client, and the collaboration of the therapist and client working together toward some set of goals. Certain types of group and individual interventions would not meet the definition for formal psychotherapy. These would include mentoring (unless the mentor is a formally trained psychotherapist), support groups (e.g., 12-Step groups or other self-help groups), exercise or yoga interventions aimed at treating psychological issues, numerous complementary and alternative types of therapies like art therapy, seeking advice from friends or peers, and other non-formal types of interventions. People may find that these interventions have a therapeutic benefit to them, such as exercising to relieve stress; however, they are not delivered by formally trained psychotherapists and they often do not utilize psychological principles (although some of these techniques may utilize certain aspects of psychological principles).
According to APA, there are many different identified types of psychotherapy. However, the most basic categorization of psychotherapy identifies two different forms based on the number of clients being treated. Individual therapy occurs when a single client is treated with psychotherapy by one or more therapists. Group therapy is broadly defined as psychotherapy that is delivered to two or more people at the same time by one or more therapists. This is the most basic designation of psychotherapy.
According to the book The History of Psychotherapy: Continuity and Change, the actual use of the term psychotherapy was derived in the 1800s from an English psychiatrist, Dr. Walter C. Dendy who used a talking approach to address issues faced by his patients. Dr. Dendy termed this approach psychotherapeia, which eventually became known as psychotherapy.
Group psychotherapy was most likely first practiced by a physician, Dr. J. H. Pratt, who attempted to instruct groups of people about aspects of caring for issues associated with tuberculosis. Pratt noticed that his groups developed their own circumscribed support systems and learned more efficiently than people trained individually. He began actually referring to these educational groups as group psychotherapy sessions. Following World War II, veterans were often treated in groups, and group psychotherapy became popularized.
Performing therapy to groups of individuals is associated with numerous advantages that benefit both the therapist providing the intervention and the people in the groups. Many of these advantages are the result of group processes that allow individuals and groups to benefit from working together. Group therapy is not generally considered to be superior to individual psychotherapy, and likewise, individual therapy is not generally considered to be superior to group therapy, but there are certain advantages to group therapy that can facilitate numerous healing processes. However, when groups are too large these benefits may not be accrued. The size of the group that is associated with the most effective treatment outcomes ranges from six to 12 members; however, some groups may have more than 20 members in them.
Benefits of Group Therapy
The psychiatrist Dr. Irvin D. Yalom is considered to be one of the major figures in researching and applying the principles of group therapy. He has published extensively regarding the advantages of group processes in therapy and summarized the advantages of group therapy as being:
- Universality: A major advantage of therapy groups is that participants realize that there are other individuals who share similar struggles, similar issues, and have similar problems. This principle of universality helps to foster a set of belongingness and identity, and to relieve tension and stress. It also has positive effects on the issues the group works to address.
- Broadened therapeutic alliance: The therapeutic alliance is the aspect of therapy that describes the working bond and sense of unity that occurs between the therapist and client as they work toward solving the client’s problems. The therapeutic alliance has been identified in numerous research studies as a major factor contributing to the successful outcome of the therapeutic process. In therapy groups, this therapeutic alliance is broader, such that it not only includes the working bond between the therapist and the client, but it also includes the working bond between the therapist and all the members of the group, and the alliance between the members of the group with one another. This broadened therapeutic alliance can be an important factor in successful treatment.
- Broader perspective: Because groups often have members with similar but diverse experiences, group therapy offers a broader perspective regarding the issues being addressed than individual sessions do. Most therapy groups include members at different levels of progress, and newcomers can benefit from the experiences of senior members, whereas senior members can benefit from discussing their issues with newcomers.
- Broader support system: The group offers a broader system of perceived support for participants. Having positive perceived social support is an important aspect in addressing one’s issues in a constructive manner. Group members can receive support from one another and provide support to others.
- Group identification: Many individuals and groups find that they are more willing to discuss their issues openly as a result of the interactions that occur in the group. When individuals can identify with other people who have similar problems, they are often more open to discussing their own issues and are more forthcoming.
- A chance to develop greater insight into one’s issues: As a result of sharing and listening to others, group members often find that they can develop greater insight into their own problems. Because most groups are focused on very specific issues (e.g., substance abuse, depression, some anxiety disorder, etc.), individuals in them find that they can learn from one another and develop greater insight into their own issues. When groups are too broad in their application or focus, the group process may actually become a disadvantage because individuals may not be able to relate to others who do not share similar issues to them.
- Modeling: Individuals often learned from others in the group by simply trying to replicate the actions of others. This form of learning is known as modeling, and it can be a very efficient form of learning new skills.
- Group processes: The very nature of the group process assists individuals in developing their social skills, ability to communicate, and inability to accept criticism from others.
- Connections: It is not uncommon for individuals in therapy groups to develop strong and lasting relationships with some of the group members. This can help to improve both the quality and quantity of the people in one’s social support network.
- Cost: Group therapy sessions are typically less expensive than individual sessions.
Disadvantages of Group Therapy
Even though there are numerous advantages associated with group therapy, there are also some potential disadvantages. Some of these disadvantages include:
- Less direct intervention: The therapist has less time to devote to each individual member of the group. This can be a disadvantage for some individuals.
- The squeaky wheel gets the grease: A few of the members of the group may take up most of the time in the session. This can be disadvantageous for individuals who are shy or hesitant about discussing their issues.
- Potential breaches of confidentiality: In therapy, the term confidentiality refers to the ethical responsibility of the therapist to not reveal information discussed in therapy to outside sources. There are a few identified situations where it is necessary for the therapist to breach confidentiality, but in general, therapists have an ethical obligation not to discuss the information shared in sessions with others. The fact that more individuals are exposed to a person’s issues in groups results in an increased risk that confidentiality will be breached. Even though individuals who attend group therapy sessions are always advised to keep the discussions confidential, group members are under no legal or ethical obligation to do so.
- Therapeutic alliance: The therapeutic alliance that occurs within therapy groups is much broader than the therapeutic alliance that occurs in individual therapy sessions. This can be advantageous in getting more opinions, hearing different experiences, and developing a stronger sense of identification with others; however, the therapeutic alliance is not as focused in a group as it is in an individual therapy session.
- Scheduling issues: Group therapy sessions must be accessible to multiple individuals. This means that the times are relatively set and cannot be adjusted to fit individual schedules.
- Development of cliques: Group therapists should be on the lookout for the development of subgroups within the overall group. When group members organize themselves into subgroups or cliques, this may result in certain alliances and tensions that can interfere with the progress of the group.
- Too many cooks spoil the broth: When groups are too large, the advantages of group processes are significantly weakened. Extremely large groups are often not advantageous to helping individuals reach their goals.
- Not right for everyone: Certain individuals may not be ready to participate in group therapy sessions or may not have the skills that are needed to benefit from group interactions. For instance, some individuals who are not motivated to participate may simply allow the group to work while they do not become involved directly in the group processes.
Some individuals may not be appropriate for group therapy, such those who have severe active psychosis, who are extremely manipulative, who are physically aggressive, who have significant cognitive issues, or who are extremely shy. In some cases, these individuals can attend individual group therapy sessions until the therapist believes they would benefit from participation in group therapy, and others may never be appropriate for participation in groups. It is also important to ensure that new members are appropriate for the group. For instance, a laborer with a substance use disorder may not be appropriate for a group that is designed for physicians with substance use disorders.
Benefits of Individual Therapy
There are some important advantages of individual therapy, such as:
- The client is the sole benefactor: In individual sessions, the client gets the sole attention of the therapist. This results in very focused and intense treatment.
- Greater intimacy: In individual therapy, the client gets direct feedback regarding their progress from the therapist; the therapist has a more focused and complete understanding of the client’s issues,; and the therapist and client develop a very strong and focused therapeutic alliance that may not be possible in group therapy.
- High level of confidentiality: Individuals can be assured that their confidentiality will be best protected when they only participate in individual therapy sessions.
- Focused treatment: The treatment that occurs in individual therapy sessions is much more personalized, focused, and articulated toward the needs of the individual.
- More comfortable pace: Because the therapist and client work together in individual sessions, the pace can be adjusted for the client. The client need not worry about moving too fast or too slow.
- Easier scheduling: Clients can schedule therapy sessions around their schedule, so there are fewer issues with fitting therapy into the rest of one’s life.
Disadvantages of Individual Therapy
There are some disadvantages associated with individual therapy sessions, such as:
- Expense: Individual therapy sessions are typically more expensive than group sessions.
- Nowhere to hide: Because the individual is the sole focus of the therapist, they must participate throughout the entire session and are responsible for doing the work on their own.
- One viewpoint: Even though therapists are the “experts” in their chosen field, participating only in individual sessions does not allow the person to get multiple viewpoints from others who share similar issues.
- Motivation: Some individuals may suffer from motivation issues and not want to reveal aspects of themselves they may find embarrassing to a single therapist. Sometimes, the group process allows individuals to feel more comfortable reviewing these issues.
Which Is Better: Group Therapy or Individual Therapy?
Which one is better? Neither form of therapy is actually better than the other. Instead, there are advantages to participating in group therapy that may make it more suitable for certain types of individuals. Likewise, there are advantages to individual therapy that may make it more suitable for certain types of individuals. Research findings indicate that both types of therapy are effective in the treatment of numerous issues.
The choice between individual and group therapy often occurs once an individual has had an initial session with a therapist to discuss their particular issues, and the therapist has assessed their situation. The therapist and individual can decide together on which approach would be best for the person.
Things to be considered include the size of the group, if one wants to share their problems with others, and how much personal attention one feels they need from the therapist in order for them to improve. In many cases, individuals can participate in both group and individual therapy sessions. This allows for the client to reap the benefits of both types of therapy.