It can be easy to slide into isolation when we’re feeling down, especially for those suffering from an invisible illness or problem, but this is the exact opposite of the action that is most likely to help us climb out of that pit.
Loneliness and isolation tend to breed more loneliness and isolation, but making the (often difficult or exhausting) effort to connect with others is just the thing we may need to start feeling better.
“The best part about being with a group is that you don’t have to do everything alone.” – Anonymous
As uncomfortable as it may sound, sometimes sharing difficult thoughts and feelings in a group setting can be extremely effective in facilitating healing.
This quote describes how sharing can help:
“Some of the most comforting words in the universe are ‘me too.’ That moment when you find out that your struggle is also someone else’s struggle, that you’re not alone, and that others have been down the same road.” – Anonymous
This is the core concept upon which group therapy was developed. This article will define group therapy, describe typical sessions, and provide several activities and exercises you can put to use in your group therapy sessions.
This article contains:
- What is Group Therapy? Definitions and Theories
- Group Therapy Session Outline
- 5 Guidelines and Rules for Group Therapy
- How to Become a Group Therapist
- Benefits of Group Therapy
- Common Discussion Topics in Group Therapy
- 7 Group Therapy Ice Breakers and Activities for Adults
- 10 Group Therapy Techniques, Ideas, and Games for Youth and Teens
- 4 Group Therapy Exercises and Worksheets for Depression and Anxiety
- Best Books, YouTube Videos, and Podcasts on Group Therapy
- Group Therapy and Group Counseling Near Me
- A Take Home Message
What is Group Therapy? Definitions and Theories
At the most basic level, group therapy is:
“a form of psychotherapy that involves one or more therapists working with several people at the same time (Cherry, 2017).”
It is usually a complement to individual therapy and sometimes medication as well, although it may be used as a stand-alone treatment for certain issues or problems.
According to one of the most renowned group therapists, Dr. Irvin D. Yalom, there are 11 key principles of group therapy:
- Instilling hope. Since group therapy often includes clients at different stages in their treatment, some of the newer clients can find encouragement from seeing the positive impacts on clients further along in their treatment.
- Universality. Just being part of a group of people who understand what you are going through and have experienced similar problems will help clients see that they are not alone, and that suffering is universal.
- Imparting information. Group members can be a great resource for information.
- Altruism. Group therapy gives members a chance to practice altruism by helping others in the group, an experience which will likely help them as well.
- The corrective recapitulation of the primary family group. This wordy principle refers to the process of clients learning and exploring their childhood experiences, personalities, behaviors and feelings, and learning how to identify and avoid destructive or non-helpful behaviors.
- Development of socialization techniques. The simple experience of working in a group provides excellent opportunities to socialize, practice new behaviors, and experiment in a safe environment.
- Imitative behavior. Clients can observe and imitate or model positive and helpful behaviors toward others in the group, including the therapist.
- Interpersonal learning. Interacting with the therapist and other group members and receiving feedback can help a client learn more about themselves.
- Group cohesiveness. Group therapy sessions can facilitate a shared sense of belonging and acceptance of one another.
- Catharsis. This principle is based on the healing powers of sharing with others; talking through your feelings and experiences in a group can help relieve pain, guilt, and stress.
- Existential factors. Although group therapy offers guidance and support through the group, it also helps clients realize that they are responsible for their own actions and the consequences that follow (Cherry, 2017).
This set of principles makes it clear that there are many advantages to working with a group rather than individually. While some of these principles may apply to individual therapy, most of them require a group setting.
Group Therapy Session Outline
The general tone and direction of the group therapy session will vary depending on the type of group. There are many different kinds of groups with different areas of focus, but they generally fall into one of two categories:
1) Psychoeducational – These groups are intended to provide members with the information they need to address or cope with whatever it is that brought them to the group; they are usually structured with specific topics or modules to cover.
2) Process-Oriented – These groups are more focused on experience, sharing with one another, and making connections; discussion among the members dominates this group rather than a set agenda (Good Therapy, 2013).
Groups can be further broken down by discussion topics and the structure of the group itself. Some of the most common therapy groups include:
- Self-Help Groups – These are generally led by someone who is not a professional group facilitator, but has struggled with or successfully overcome or addressed a problem, and wishes to help others through the process.
- Medication Groups – The focus of these groups is on compliance with prescribed medication; the intent is to educate clients about their medication, ensure compliance with the doctor’s instruction and decrease their sense of isolation.
- Interpersonal Therapy Groups – This type of group is intended to dive deeper into the clients’ current relationships to understand current problems; the focus of these groups is on the present rather than the past.
- Encounter Groups – These groups aim to immerse members in potentially uncomfortable and intense group situations in the hopes of provoking greater change than a typical therapy group.
- Psychodrama – This unique type of group therapy is based on members acting out significant portions of their life. These dramatic reenactments can provoke strong emotions, which are discussed after each “scene” (Counseling Connection, 2010).
The number of participants in a group therapy session also depends on the type of group but can range from only three or four people to twelve or more (although more than twelve participants may not be as effective). Typically, group sessions are held once or twice a week for one or two hours per session. The minimum recommended number of sessions is generally six, but group therapy often continues for up to a year or more (Cherry, 2017).
There are two kinds of group therapy sessions:
1) Open groups: new participants are welcome to join the sessions at any time; for example, Alcoholics Anonymous is an open session which invites new members to join in any session.
2) Closed groups: the therapy sessions are closed to a core group of participants; new participants may only be welcomed when a new group is formed (Cherry, 2017).
In terms of what will actually happen in a group therapy session, sessions can vary based on the topic, participants, and treatment progress, but these are some of the common features:
- The participants will meet in a room with chairs formed into a large circle.
- The session may begin with group members introducing themselves and explaining why they are in therapy.
- In subsequent sessions (in closed groups) or in every session (in open groups), members may also share their progress and any updates since the previous group meeting.
The flow of the session will depend on the same factors described above, but will likely follow one of these general paths:
1) Free-form: each participant will engage with the group as much or as little as s/he wants, and participants are the main drivers of the discussion with facilitation and guidance from the therapist.
2) Planned: in other cases, the therapist may have a set agenda for the meeting with planned activities and skill-building exercises for group members to engage in (Cherry, 2017).
5 Guidelines and Rules for Group Therapy
Whatever type of group therapy you attend, the general rules will likely be the same. These rules must be followed for the safety of the group and the effectiveness of the treatment. Certain types of groups may have additional rules, but there is a core set of five rules that are essential for successful group therapy.
These five rules are:
- Maintain Confidentiality. It is essential that everything said in group therapy is kept private by all group members and leaders. Failing to adhere to this rule can undermine trust within the group and hinder members’ attempts to heal.
- Commitment to Attendance. This is another essential rule for nearly any group – it is vital that each member attend every session, arrive on time, and stay for the entire session. In addition to the absent member missing valuable information and practice, absence, late arrival, or early leaving can disrupt the group.
- No Socializing with Group Members. Group therapy is not a social activity, it is (hopefully!) a therapeutic one. Forming close friendships or other bonds with group members can interfere with group success, especially if members become hesitant to share personal information because of another group member. Friendships should be saved for after the group has disbanded.
- Communicate with Words, Not Actions. This rule could be considered the exact opposite of the standard advice storytellers receive: “Show, don’t tell!” People have different reactions to physical contact, so expressing yourself through words instead of physical actions is an important rule to follow.
- Participate. Group therapy doesn’t have much of a therapeutic effect if the members do not participate! The potential for healing and growth rests on how much group members are able to connect, share, and learn from one another. It is essential for all group members to truly participate for this treatment to be effective.
How to Become a Group Therapist
There is no specific path to becoming a group therapist beyond the path to becoming a therapist in general. Most therapists who mainly offer group therapy also offer individual therapy and vice versa.
In general, the path to becoming a therapist consists of three components:
- Education: To practice as a licensed therapist in most states and countries, you must complete a Master’s program in any of the areas listed below. Many therapists choose to earn a doctoral degree as well, which qualifies them to be a licensed clinical or counseling psychologist. Visit www.cacrep.org to learn about accredited graduate-level counseling programs.
– Child Psychology
– Counseling Psychology
– Marriage and Family Therapy
- Clinical Experience: The requirements will vary by state and country, but expect to complete at least a couple thousand hours of supervised experience. For example, in California, you will need to complete at least 3,000 hours of supervised experience over the course of at least two full years, with at least 1,750 of those hours spent in direct counseling (www.counselor-license.com).
- Licensing Exams: Once you have completed your degree and your clinical experience, you can apply for a license and take the licensing exams. In the United States, this will likely be the National Clinical Mental Health Counselor Examination or the National Counselor Examination for Licensure and Certification. Again, requirements will vary by state and country, but in most cases, you will need to pass a rigorous examination to qualify for your license.
Depending on where you are located, you may also want to pursue membership as a Certified Group Psychotherapist (CGP) with the International Board for Certification of Group Psychotherapists. Becoming a CGP requires all of the same steps as becoming a therapist in addition to 12 hours of coursework in group psychotherapy theory and practice, 300 hours of clinical experience working with groups, 75 supervised hours of group psychotherapy, and references from a supervisor and colleague.
For more information on becoming a CGP, click here.
So what courses will you take on your journey to becoming a group therapist?
As noted earlier, that will depend on where you are pursuing a license to practice group therapy, but in general, your coursework will include:
- Psychological Theories
- Research Methods
- Clinical Best Practices
- Ethics in Therapy
- Interpersonal Psychology
- Group Psychology
- Family Psychology
- Child Psychology
- Specialty courses in your area of choice (www.goodtherapy.org)
In addition to these courses, you may take courses in diversity and social justice in counseling, career and life development, couples therapy and marriage counseling, addiction and substance abuse, and human development.
It is important for therapists to be well-educated and knowledgeable about several different areas of human psychology even if they plan on specializing, because you can never be sure about the problems that will arise when your client opens up. Cases that seem relatively straightforward may surprise you with layered complexity, while another client may present with a myriad of problems that can be addressed with a simple solution.
Therapists must be ready for anything, which is why a good foundation in all areas of clinical and counseling psychology is so important to build.
Benefits of Group Therapy
For participants, there are many reasons why group therapy is a treatment worth considering.
The main advantages include:
- It allows participants to receive support and encouragement from other members of the group, helping them to feel less alone or isolated.
- Group therapy provides an opportunity for group members to act as role models for other members, especially when the group is composed of participants at different stages of treatment. Even if all participants are at the same stage, some participants will naturally be more successful at managing certain types of problems than others, and group members can share their experiences and learn from each other.
- It is usually more affordable than individual treatment since the therapist’s time is shared with other clients.
- Group therapy provides a safe environment for group members to practice new behaviors without fear of judgment.
- Interacting with others in group therapy will help the therapist to see first-hand how a client interacts with others and behaves in a social situation, allowing the therapist to provide targeted feedback and suggestions to each client (Cherry, 2017).
The American Psychological Association notes another important benefit of group therapy: diversity. We all have different experiences, backgrounds, and personalities, which leads us to our own unique perspective on the world. Working with a group can help clients see things from a new perspective, which may illuminate new ways to take on old problems and new strategies to overcome obstacles that seem insurmountable (APA, 2017).
To make sure you are taking advantage of these benefits of group therapy, follow these suggestions from Dr. Patti Cox, the president of the Eastern Group Psychotherapy Society and experienced group therapist:
- Take a pledge. Signing a contract that outlines what is expected of each participant can encourage participants to engage and contribute to group discussions, and provide an incentive to engage even when it is difficult.
- Participate. Some days are more difficult than others when it comes to socializing and sharing with others, and that’s okay. However, the more a client pushes themselves to engage, the more likely they are to benefit from the session.
- Share. Even if a client feels that nobody cares about their problems or they have nothing useful to share with the group, chances are this is not consistent with reality. Everybody has something to share with others, and helping others has a funny way of helping you as well (Cherry, 2017).
You can download the printable version of the infographic here.
Common Discussion Topics in Group Therapy
The topics discussed in group therapy will depend on the focus of the group. Some groups are formed for specific reasons, like dealing with addiction or grief, or specific diagnoses, like depression or anxiety, while others are formed for broader purposes, such as anyone struggling with stress in college or LGBTQ individuals who could benefit from general social support.
The long list of reasons that a therapy group may be formed includes:
- Death of a loved one
- Marriage problems
- Family problems
- Loss of a job
- Social anxiety
- Substance abuse
- Major life transitions
- Breakup or divorce
- Child behavior problems
- And many, many more
In groups formed around substance abuse, discussion topics may include:
- Stay-busy activities (to cope with cravings)
- Preparing a speech for students (whether the speech will occur or not)
- Challenging perceptions
- Role models and behaviors to emulate
- A history lesson and planning for the future (history of substances and future of substance use and legality in the group’s country)
- Self-care (SimplePractice, 2017)
Blake Flannery (2014) outlines seven major categories of discussion topics and provides suggestions for each category. These topics include:
- Health and Wellness
Recognizing warning signs
- Personal Control
Cognitive Behavioral Therapy (CBT) or Rational Behavioral Therapy (RBT)
Grief, loss, and forgiveness
- Values and Beliefs
- Safety Planning
Warning signs for recidivism
- Mental Health Systems
How to talk to your doctor
How to get the support you need
- Chemical Dependency
12 steps / Alcoholics Anonymous or Narcotics Anonymous
Dual diagnosis (co-morbidity of multiple mental health conditions)
As this list of suggested topics demonstrates, there are dozens, if not hundreds, of topics for discussion in group therapy. Some of them will only be appropriate or effective in specific groups or situations, but some will be useful for all types of groups. The best discussion topics will depend on the focus of the group, the stage of treatment, and the type of session.
7 Group Therapy Ice Breakers and Activities for Adults
In addition to specific topics for discussion in group therapy, there are many other activities and exercises that can be conducted effectively in groups. A few of these activities are described below.
Goal Setting for Therapy
Group therapy sessions can be slightly harder to facilitate than one-on-one sessions. Interactive dynamics and potential communication difficulties with larger groups, however, can often be planned for with effective goal-setting.
On this site, you’ll find numerous articles on goal-setting to help you get your first group session on track. You will also find different interventions, exercises, meditations, and more in our Positive Psychology Toolkit. Many of these suggestions and planning materials can be applied to both individual clients and therapy groups.
A standard approach to goal-setting in therapy will generally involve:
- Goal Identification – What is it that your group seeks to address, resolve, or deal with?
- Establishing a starting point – You and your group should look to understand their current standing in relation to the goal, to better chart a path forward.
- Identifying what steps are required to accomplish the goal – Goal pursuit is typically simplified by identifying sub-goals so the process is more manageable. This also allows progress to be tracked and enables your participants to celebrate their achievements along the way.
- Making the first step – Your first group therapy session together is already an initial step in the right direction. You can use this session to discuss important practicalities, such as confidentiality clauses, expectations for participation, potential homework assignments, and etiquette.
We suggest you browse these articles for more ideas on how to set effective goals with your group therapy clients—this article on Goal-setting in Counselling and Therapy is a great place to start.
About Your Partner
This activity can be an excellent icebreaker for couples therapy groups. These questions don’t probe too deeply, but can be a good reminder of the couple’s emotional connection and relationship history. In addition, it can help them learn more about themselves and their partner.
The instructions are for the couple to simply take turns asking each other a question from each section below, or ask them all if they want a challenge or believe they have the right answers.
The questions are divided into six categories:
- Fun and Games (for example: Is there a TV show your partner is currently loving?)
- The Future (for example: How does your partner describe their ideal life?)
- You and Me (for example: Can you describe a time when your partner was proud of your relationship?)
- Other People (for instance: Apart from you, who can your partner discuss their difficulties with?)
- Careers (for example: How does their usual workday look, from start to finish?)
- Feelings (for example: How does your partner unwind at the end of a long day?)
Using these questions as a guide, couples can work through the activity together as a bonding activity. They can discover more about one another, reflect on past positive events, and share their hopes for a shared future. If the couples are comfortable with this idea, they can share out to the group on something they learned about their partner or a fun memory they recalled together.
Feel free to download and use this About Your Partner Worksheet.
Two Truths and a Lie
This activity is a great icebreaker but is also fun to do with group members that are already familiar with one another. It allows participants to share something about themselves, use their creativity and imagination to come up with a convincing lie, and learn interesting things about the other group members.
To lead a group through this activity, instruct all group members to take a few minutes to think about interesting aspects of their life. Give them five minutes or so to write down three “facts” about them, two of which are true and one of which is a lie.
Then, have the group members take turns reading their two truths and a lie, and let the other group members guess which ones are true and which one is a lie.
This activity can spark some great discussion and encourage positive social interaction between group members, so make sure not to cut it off too early.
This group therapy exercise focuses on communication and mindfulness skills in participants, and is a great general activity for all types of therapy. Cultivating an awareness of mindful speaking can be an effective way to set the tone for couples group therapy, where emotions management is the focus, or even when working with families.
This exercise can help participants bring presence to their interactions and step out of autopilot. It involves six steps.
First, as a therapist and facilitator, you will inform the group about the rationale for a Mindful Speaking exercise—its benefits in relation to whatever your session concerns, and how it can be broken down into three steps. Briefly, these are:
- Slowing down and bringing yourself into the current moment.
- Checking in with what you’re going to say, both in a rational and an emotional sense.
- Checking back in after speaking, tuning your awareness into the impact of your chosen words on yourself and on others.
Next, invite the group to pair off—one will take on a speaker role and the other will listen. The participant who is in a speaker role first can then pick a theme they’d like to talk about for a timed period of three minutes. Anything from their favorite vacation ever to their kids or similar.
You will set the timer so they can start talking—ask them to take it slow and be genuine, practicing the three steps outlined above. They should ideally be taking note all the while of the impact they are having on their listener partner.
Allow a reflective moment after the three minutes are up. This worksheet contains guided reflection and (potentially) discussion questions that you can provide the speaker, for instance, “How did it feel to speak mindfully compared to how you normally speak?”
To continue the exercise, encourage the participants to swap roles and repeat the activity. To see the other questions or print this handout for use in your group sessions, you’ll find it here.
Engaging group members in an activity that requires both busy hands and concentration is a great way to help anxious members get comfortable with one another and open up.
Cooking is perfect for this type of activity since it gets members working together, doing something fun, and it requires interaction with the other members of the group.
Further, the idea that food is a universal language is a common one, because it is one of the few things that brings everyone together! Everyone eats, and virtually everyone likes to talk about their favorite foods.
Gather the ingredients necessary for group members to work together to create a meal or snack that everyone can enjoy. Salads, sushi, and smoothies are recommended options for this activity since they don’t require a full kitchen to make.
If you want to capitalize on the atmosphere facilitated by group cooking, you can come up with discussion questions to guide the group afterward.
You’ll find more on cooking as a group therapy intervention in Farmer et al.’s (2018) paper, Psychosocial Benefits of Cooking Interventions.
This Strengths Spotting group activity aims to help participants identify and recognize psychological or character strengths in both themselves and others. One powerful benefit of conducting this typically individual exercise in a group context is that it enables each participant to get feedback on their own strengths from those around them.
This group therapy ice breaker has 4 parts; first, participants will first get into relatively small groups of between 5-10 people.
- The second step is about sharing positive success stories and listening to them. Each participant first tells a story about, for example, when they accomplished something they were proud of in a relationship or at work. As those around listen to the story, they can make notes on any strengths in the worksheet provided.
- Next, group members give strengths-based feedback to the speaker using the labels that they have written on (see the worksheet). They should read out loud each strength that they’ve identified and why they chose it, then give the card to the speaker. Each person in the group has a chance to be the storyteller throughout this exercise, repeating the activity each time.
- Finally, it’s good to follow up this activity with a debriefing discussion. Open up dialogue about what different participants feel they learned, the nature of the feedback, and any patterns they noticed. The worksheet itself contains more on these and other potential discussion questions.
Strengths Spotting can be a useful warm-up for an existing team or group, and works best if the facilitator gives an example positive story to get things started. Find the Strengths Spotting Worksheet here.
As noted earlier, most therapy groups begin with each member “checking in,” providing any progress updates, and perhaps sharing something interesting about their week or something they have learned since the last session. If you are working with members that don’t jump at the chance to speak in front of the group, having a specific set of questions to guide the check-in process can be helpful.
Group therapist Amanda Fenton provides an excellent set of guidelines and suggestions for check-in questions.
Fenton (2014) encourages therapists to ask themselves these questions when considering an effective check-in question:
- How much time do you have for the check-in? Two sentences? Two minutes? Five minutes?
- How can the check-in connect and support the rest of the agenda and the overall purpose of the gathering?
- What kind of tone do you want to create through the check-in? Playful? Serious? Connecting?
- Is this a group that is familiar with check-ins and has been meeting together regularly?
The most appropriate check-in question will depend on your answers to these questions.
For example, if you have time for a longer check-in from each member, a phrase like “tell us the story of…” can be a good prompt for members to share more than a few words. If you’re short on time and just want a quick update, using “say a few words on…” may be the better option.
For more tips on facilitating a check-in and the role of personal interactions between group members, have a look at the videos we’ve linked to below.
10 Group Therapy Techniques, Ideas, and Games for Youth and Teens
Many of the exercises and activities described above can be applied to group therapy with younger members, but some are more appropriate than others. Several exercises and techniques that work well in younger groups are listed below.
Icebreakers and Trust-Building
This section includes over two dozen different ideas of icebreakers that are appropriate for both teens and adults in group therapy.
Some examples include:
In this icebreaker, participants are asked to organize themselves into smaller groups based on a category, such as favorite color, favorite food, number of siblings, etc. It will help teens to get more comfortable interacting with each other and learn something new about the other members.
This activity requires group members to physically interact with each other, so it may not be appropriate for all groups. All members get in a circle and take the hand of someone who is not right next to them, then try to unravel the knot they have created without letting go of anyone’s hand.
Fear in a Hat
This icebreaker is best applied in a setting where everyone is at least somewhat familiar with the other members of the group. Everyone writes down their deepest, darkest fear on a piece of paper. These pieces of paper are gathered and placed in a hat. Each member will draw one fear each, read it aloud and try to identify who wrote it.
Trust-building activities are also great ways to get group members comfortable with one another and encourage a safe and secure place to share.
Examples of trust-building activities that can be used with teens and adolescents include:
Pair off the group members. If there is an odd number of members, the therapist can pair with a member to make it even. Instruct each pair to blindfold one member and tell the other member to guide them around the room in search of a particular object or objects. If there is enough time, the partners can switch when the object(s) has been found.
This extremely simple exercise simply divides members into pairs and requires them to look into each other’s eyes for 60 seconds. Maintaining prolonged eye contact will help group members get comfortable with each other, practice an important part of social interaction, and connect with each other on a deeper level.
This classic trust exercise is still a great way to build trust within a group. Have each member take their turn climbing onto a table and falling backward into the arms of the other members of the group without looking behind them. This one is a classic for a reason – it works!
Silent Gratitude Mapping
This engaging gratitude activity is a great opportunity for teens and adolescents to exercise their creativity and express themselves. You’ll need a whiteboard or a large piece of paper and different colored pens. Split your larger group into smaller groups of between 3 and 5 teens.
Instruct each member to reflect for a few moments on things in their lives that they feel thankful for. Once a few minutes have passed, they can write them on the paper or whiteboard. They should create a line that flows from each item (they can be circled or in a heart) to a reason for their gratitude.
Next, invite the participants to check out what other participants have written. This step is about drawing connections between the ideas they can see. A visual representation of this is given in the worksheet itself.
As an example, someone might have noted that they are grateful for their ‘home’, with a connection flowing to ‘comfort’ or ‘love’. Other participants might have written ‘love’ and they think “…That’s why I’m grateful for my Dad”. They’ll connect that reason with their circled ‘Dad’.
End the 10-15 minute exercise with a discussion. Your participants will now have a completed gratitude map that can be hung anywhere they choose. Read more about this Silent Gratitude Mapping activity.
My Favorite Animals
This activity is great for children and young adults, mixing creativity, imagination, silliness, and active engagement.
Instruct the group members to come up with their three favorite animals, in order. For each animal, the members are to write down the name of the animal and write three qualities you like about the animal.
Once each group member has identified and described their three favorite animals, ask them to consider that each animal represents you, in different ways. The first animal and its three qualities represent how you want others to see you, the second represents how people actually see you, and the third represents who you really are. This can be a great discussion for group members, helping them to explore their thoughts and feelings in a fun and easy way. It can also generate a lot of laughs!
Finally, have each member combine their three favorite animals into one. Flip the sheet over and invite them to draw or paint a picture of this animal in its habitat on the back. Tell the members to share these creations with the rest of the group, and prepare for a silly discussion!
Feel free to download and use our My Favorite Animals Worksheet as a guide for kids.
Inside and Outside Worksheet
This Inside and Outside Worksheet can be a great tool for families with young children in therapy. It is intended for a child to complete, and the results can be discussed as a family to facilitate understanding and come up with solutions for family problems.
This worksheet includes an outline of a person or child with six boxes to fill in, three on each side.
The directions instruct the child to fill in the blank “When I feel…” with a specific emotion.
Thinking about this emotion in a specific situation, the child is instructed to fill in the three boxes on the left side of the worksheet:
- I think…
- My body feels…
- I act this way…
Once the child has filled in these three boxes, their next step is to imagine that their thoughts change. Maybe this is a natural change, or maybe they are instructed to imagine their reaction if they purposefully change their thinking to something more positive.
When the child has this new thought in mind, they fill in the same three boxes, except these are on the right side.
This exercise can help the child compare how they think, feel, and behave when they are struggling with an emotion, to how they might think, feel, and behave if their thinking were to change. It can help children to understand the value of modifying their thinking to make it more positive, in addition to helping parents and other family members understand what the child is going through.
You can find this worksheet at the link above.
Getting To Know Me
This activity is most effective with a group of five or more members.
Come to the group session with a list of questions prepared. These questions should be fun and interesting questions that will help the members get more comfortable talking about themselves.
Potential questions could include:
- Where else might you have been at this moment if you hadn’t come to this group session today?
- What might you have chosen to do?
- Is it your own decision to come here, or does someone else encourage you to do so?
- How do you feel about coming here each week? What do you like best about this session? Is there something you don’t enjoy about this group session?
- What is your favorite thing about yourself, something that makes you feel positive and proud to be you?
- Are you particularly looking forward to anything? Is there something new that has happened in your life recently?
Nominate one member to be the questioner or the therapist can act as the questioner.
Ask each member one of these questions or all of these questions if time permits, and encourage them to give it some thought and answer it honestly and in a meaningful way.
These questions will help group members to become more comfortable talking and sharing with others, as well as helping members learn about one another. Try our Fast Friends Exercise for more questions you can use when your group members are ready to know each other better.
4 Group Therapy Exercises and Worksheets for Depression and Anxiety
Group therapy is commonly used in the treatment of people with depression and anxiety. A group setting is a perfect place for people suffering from depression or anxiety to connect with others, practice important social skills, and learn healthy coping strategies from one another.
While many of the activities and exercises mentioned above can be applied to individuals with any diagnosis or issue that brings them to therapy, there are some that can be especially effective for those with depression or anxiety. A few of these exercises and worksheets are listed below.
Dealing With Guilt Through Writing
While negative feelings such as guilt are not exclusive to those with a diagnosis of depression or anxiety, those suffering from these disorders often have the most trouble confronting those feelings. Many of those struggling with depression or anxiety will turn to unhealthy, unhelpful, or even harmful ways to cope. This activity can help them find new, healthy ways to cope.
This exercise aims to elicit the cathartic benefits of expressive writing therapy, a popular positive coping intervention that was developed in the 1980s. It’s a slightly adapted take on traditional expressive writing, however, in that it includes some questions and prompts to stimulate and guide participants as they write.
This group writing therapy intervention is designed to be conducted over three days.
On Day One, the focus is Reflection on what is underpinning those shameful or guilty feelings. Among others, participants use prompts such as:
- What is it you feel guilty about? and
- How do you feel right now about this?
Encourage your group to be as heartfelt and descriptive as they wish for a deep exploration of their feelings and thoughts.
Day Two builds on this reflection, but participants are encouraged to write a different and more positive ending to the event or situation they described on Day One.
The final part of this three-day writing therapy covers Lessons Learned, which includes prompts and questions such as “What kind of future behaviour would demonstrate that you learned this lesson?”
This activity can be particularly effective for group therapy that targets trauma or helps anxious people deal with stressful life events. Find out more about and download Dealing With Guilt Through Writing from our Positive Psychology Toolkit.
Setting and striving towards goals can be tough for us all, but for those struggling with depression, even setting a realistic goal can seem like a monumental task. This Goal Visualization activity can help facilitate goal-directed behavior in group members by:
- Enhancing their perspectives of success;
- Boosting their commitment and motivation; and
- Getting them started with the tactical aspects of the goal-setting process.
Essentially, goal visualization is mental imagery of the participant’s desired positive future, whether that relates to the goal achievement itself or simply to the process of working toward it. This worksheet provides some helpful theoretical insights into the activity.
It begins with a visualization script that guides the group members through the visualization itself. For example:
“I’d like you to think about a goal that you want to accomplish in the next year of your life. This might be a relationship goal, an educational goal, a personal goal, or a work-related goal. Take a moment to bring this goal forward and visualise it in your mind’s eye.”
Reading this out loud to your group will help them create a mental image of the future event; one in which it is attainable. Ideally, it should provide some insight into how this can be achieved and motivate them to pursue them.
This activity will help group members learn how to set positive, achievable goals and, immerse them in the experience of working toward them.
Schema Activation Formulation
This cognitive therapy worksheet can help clients trace the development of a particular schema and understand the subsequent reactions, sensations, and choices he or she makes.
On the left side of the worksheet is a box labeled “Event.” The clients should think hard about when they first developed a particular schema and trace it back to the event that created it. For example, if a client feels they will never be good enough, perhaps this schema came from a parent who gave no praise for a big accomplishment or told the child they didn’t do well enough.
Next, this box leads to a triangle labeled “Schema.” This is where the clients should write down the schema they hold, such as “I am not good enough.”
This schema leads to a set of four interrelated and interacting consequences of the schema: bodily sensations, emotions, thoughts, and behaviors. The clients should fill in each box with the corresponding descriptions of how this schema makes them feel, think, and behave.
Completing this worksheet in a group setting can help clients connect with each other and realize that they are not alone in their negative thoughts and beliefs. It can be far too easy to believe that we are the only ones struggling and suffering from mental health or emotional problems, but this is far from the truth. Working in a group will help relieve clients of this false belief and encourage them to share and connect with others.
This worksheet will be available for download soon.
Cracking the NUTS and Eliminating the ANTS
This fun activity is based on the work of renowned psychologists Elisha Goldstein, Aaron Beck, and David Burns.
NUTS refers to Negative Unconscious Thoughts, an acronym created by Goldstein and described in his book Uncovering Happiness. He believed that identifying and bringing awareness to these thoughts was the first and most important step in ridding ourselves of our negative, unhelpful, or harmful beliefs.
ANTS refers to Automatic Negative Thoughts, an acronym coined by David Burns in his groundbreaking book Feeling Good. Burns finds that these ANTS can cause depression and anxiety and lead to low self-esteem, self-doubt, and a host of other problems.
For this activity, the therapist should lead the group through a discussion of NUTS and ANTS, terms which can be used interchangeably when talking about the self-sabotaging habits we have.
To begin, have each group member write down five phrases that put the NUTS and ANTS into words, such as “I’m not good enough,” “There’s something wrong with me,” or “I don’t deserve to be loved.” Have group members reflect on these NUTS and ANTS, and identify any themes or patterns that connect them. Encourage members to discuss them as a group or in mini-groups.
Next, tell group members to think about how certain they are that their ANTS and NUTS are true. Have they ever challenged these thoughts? Can they find evidence for or against the ANTS and NUTS? Considering the evidence, which possibility is more likely: that they are true, or that they are false? Help them think of more factual ways to reframe these beliefs, such as “I am not perfect, but I don’t need to be,” or “I am a good person who sometimes makes mistakes.”
Finally, help group members see how much these NUTS and ANTS infiltrate their thoughts. Give group members a few minutes to identify their NUTS and ANTS and count how many they can identify within a certain period of time. When they are done, they can share their counts and their NUTS and ANTS with the group, if they are comfortable doing so.
To learn more about this exercise, we recommend Judith Belmont’s book 150 More Group Therapy Activities & TIPS, which will be described in more detail below. Alternatively, we have an extensive collection of free worksheets on challenging negative thoughts in this CBT worksheets article.
Best Books, YouTube Videos, and Podcasts on Group Therapy
The following books, videos, and podcasts are packed full of information on group therapy. Whether you’re a therapist who already facilitates group therapy, a mental health professional who is looking to incorporate group sessions into your practice, or simply curious about group therapy, you will find value in these resources.
Theory and Practice of Group Psychotherapy by Irvin D. Yalom and Molyn Leszcz
This book is an excellent book for those who wish to learn about Yalom’s signature group psychotherapy model. It can also be used as a textbook for therapy students or a resource for practicing therapists who wish to add group therapy to their practice.
Not only does this book cover the basics and the foundational assumptions and theories behind this group therapy model, it was also recently updated to include new developments in the field. Added topics include online therapy, specialized groups, ethnocultural diversity, trauma, managed care, and more.
This book enjoys a very positive 4.4 rating on Amazon, and boasts a litany of appreciative reviews. Click here to check out some of these reviews or purchase the book for yourself.
150 More Group Activities and TIPS (Treatment Ideas & Practical Strategies) by Judith Belmont
This book is a valuable addition to the therapist’s toolbox. It includes 150 activities, handouts, and strategies that can be used in group therapy. For each exercise or handout, the author breaks down the theory behind it, how to implement it, and how to understand and apply the results.
The author draws upon Dialectical Behavior Therapy, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and positive psychology to provide effective and engaging activities that will have a positive impact on clients’ treatment experience.
150 More Group Activities and TIPS builds off of the author’s previous book, 103 Group Activities and TIPS (Treatment Ideas & Practical Strategies). You can find the original book here and the new book here.
YouTube Video: Essential Skills for Effective Interpersonal Group Facilitation
In this YouTube video, psychologist June Lake discusses the Yalom model of group psychotherapy. You will learn about the foundations of this model, the necessary skills required to facilitate this type of therapy, and a brief overview of the approach. In addition, June discusses some of the most common mistakes new group therapy facilitators make and how to avoid them.
YouTube Video: Leading Therapy Groups with Adolescents
If you’re curious to see an actual group therapy session unfold, this video can satisfy that curiosity! In the video, two group therapists facilitate a group therapy session with teenagers. You will get an idea of the atmosphere of a group therapy session with adolescents and a model of effective facilitation from the two therapists. In the video description, there is a link to the full video if you’re hungry for more.
Podcast: Using Groups to Fill Your Private Practice
This podcast from Jennifer Sneeden and Katie K. May is a great resource for therapists who are considering the addition of group therapy sessions or workshops into their practice. Katie is a counselor in Philadelphia who runs a successful private practice, and in this podcast she shares some of the keys to her success.
Click here to check out the podcast.
Podcast: Benefits of Group Therapy
In this podcast, Kristine Hitchens, the Director of Family Programs at the Father Martin’s Ashley addiction treatment center, discusses the importance of group therapy in the treatment of addiction and outlines the many potential benefits.
You will find this podcast here.
You can download the printable version of the infographic here.
Group Therapy and Group Counseling Near Me
If you are interested in taking advantage of group therapy or counseling, the options available will depend on your location. A quick Google search for “group therapy near me” should turn up some helpful information.
However, if Google isn’t delivering on this search, there are a few helpful websites you may want to check out:
- The Mental Health America website can help Americans struggling with mental illness find groups to support or supplement their treatment.
- NAMI (National Alliance on Mental Illness) is another great resource for people in America.
- MeetUp is usually used for finding like-minded friends to share a hobby with, but it can also be used to find an informal support group.
- This website can also help match you with informal support groups for anxiety, depression, and related issues. Its results are generally within the United States, but there are some listings for groups in Australia, South Africa, and remote support groups.
A Take Home Message
This article is chock full of activities, exercises, worksheets, and techniques that can be put to effective use in group therapy. Most of these activities and exercises can be applied to a wide range of group therapy situations.
I hope you have found this article as informative and useful as I found researching it. Whether you’re a therapist or other mental health professional, or just curious about how group therapy can benefit you, you should find at least a few things in this piece that add to your knowledge or set of tools for group facilitation.
Let us know what you learned or found especially interesting in the comments below. Would you use any of these activities in your practice? Do you have any tips or advice on how to implement these activities and techniques?
As always, thank you for reading!
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