Various authors have proposed a series of factors by which group therapy is therapeutic or curative. Irvin Yalom, emeritus professor of psychiatry at Stanford University and an international reference in group psychotherapy, developed an inventory made up of eleven factors that determine the main therapeutic mechanisms of group therapy.

Instill hope

Receiving a treatment with the hope that it will be effective increases the chances that it will be effective in what you want to treat, as is the case with the placebo effect. In group therapy, as in any treatment, some patients improve, and others do not. In this case, the advantage of group therapy is that patients who do not improve do see other patients improve. Witnessing his improvement favours the patient who has not improved to continue harbouring or hoping to recover as his partner. This effect is achieved in group therapies run by professionals and in support groups offered by associations.

Universality

By universality, we refer to the “universality of experience”; that is, in the group, patients can find other people who have had the same experiences. Commonly, the behaviours associated with the consumption of alcohol and other addictive substances can be shameful and marginal, favouring social isolation and an overwhelming feeling of loneliness. The group offers these people an opportunity for frank and candid social exchange. In addition, they can feel a significant relief when realizing that other people are in the same situation and are not the only ones suffering from the disease and its consequences.

Convey information

Therapeutic groups also allow didactic interventions by the therapist. For example, in relapse prevention groups, the therapist can give general guidelines on what a patient can do in a risky situation where the desire to use again arises. Therefore, therapists teach group members coping mechanisms and relaxation or stress reduction techniques. On the other hand, in the support groups of associations, such as Alcoholics Anonymous, the didactic part is established by reading the experiences of other alcoholics or addicts.

If the didactic interventions come from the therapist, the advice comes from the other group members. It is common that, during group sessions, group members give their opinion and share their experiences with other members who are raising a problem or a specific situation.

Altruism

The help that patients give to each other in group therapy is not possible in individual therapy. This altruistic help to others who need help allows the patient to feel she can give something to others. Moreover, it makes you realize that you have much to offer other people, unlike how you probably thought before joining the group. This altruistic help experience is gratifying for people and increases the self-esteem of those who help. In addition, it helps patients see that they are not alone in the world, that other people also have needs, and that they can help them meet them. This therapeutic factor of altruism is unique to group therapy since patients in individual therapy rarely feel useful to the therapist.

Development of socialization techniques

In all treatment groups, there is, to a greater or lesser extent, social learning in the form of acquiring basic social skills. Depending on the type of group and the group’s objectives, these social skills will be acquired by mere social interaction under the supervision of the therapist, or they will be objectives in themselves and worked on through didactic interventions. The group look can transmit sincere feedback that offers each patient information, allowing them to deepen their maladaptive behaviours and responses.

Imitative behaviour

Patients who attend group therapy can incorporate those behaviours, reasoning, or emotional responses that they see in the therapist or other patients. This is what is known in psychology as vicarious learning.

Catharsis

Catharsis, which expresses intense repressed emotion, is not therapeutic, although the classical Greek translation is purification. What can be therapeutic is sharing feelings, thoughts or opinions in a group where the subject feels accepted, not judged or questioned. Therefore, the mere act of expressing a strong negative emotion is not, in itself, therapeutic, but feeling accepted by others when expressing them is very useful to people.…

Support groups, such as 12-step communities (Alcoholics et al., for example), take advantage of some of the healing potential of group therapy, but they do not take full advantage of it. A demanding educational background in group therapy and years of experience are necessary to take full advantage of the above benefits. Support groups offered by associations offer much to patients but cannot be matched or replaced by professional groups. Lack of experience and training can lead inexperienced therapists to react intuitively by adapting their poor knowledge or experience (not their professional experience).

There are indeed few psychotherapists with solid postgraduate training in group therapy and extensive addiction experience. Many therapists trained in group therapy have no addiction training, and vice versa. Group therapy is also used to treat other psychiatric disorders and symptoms; For example, there are groups on stress and anxiety reduction, obsessive-compulsive disorder, depression, grief, psychosis, anorexia nervosa, bulimia nervosa, binge eating disorder, etc. Each diagnostic category has some peculiarities and specific needs that are convenient. Group therapy for grieving people is different from those with psychosis or addictions. Therefore, addiction group therapists need to be specialized in group therapy and addiction.

Even within addictions, there are different stages. The needs of people thinking of giving up drinking differ from those of people who have been abstinent for more than six months. Therefore, the groups can be classified according to the phase of addiction in which the patients are. However, in mutual support and self-help groups, patients in different phases of their illness and recovery meet.

Likewise, there are differences between substances consumed. Generally, the needs of a person who uses intravenous heroin are different from those of a person who drinks alcohol or a person who is addicted to playing online poker. For this reason, and here it does coincide with mutual support and self-help groups, people are usually divided into groups by substance.

In group therapies, classifications are usually made according to age. For example, it is common for adolescents and young adults to be in a different group than middle-aged people. It is logical to think that the ideology of an adolescent, his sense of life, his concerns and his aspirations have little to do with those of a middle-aged person. On the contrary, no distinctions are usually made about the age of those attending the meetings in mutual support and self-help groups.

Finally, some populations may have specific needs, and making specific groups with people who belong to this population is required. For example, groups are made with people who have addiction and HIV, with people who have an addiction and a mental illness, with people who have an addiction and are homosexual, with people who have an addiction and are at risk of social exclusion, etc. However, associations’ self-help and mutual support groups rarely make these distinctions. This is good on the one hand because it does not exclude anyone and accepts everyone equally. However, on the other hand, it may not cover the special needs of these populations that may require addressing certain issues more specifically.

Multifamily group therapies

Multifamily therapy is halfway between family therapy and group therapy. It means bringing patients with the same condition and their families together in the same space. These groups have very complex interactions and are difficult to manage, but they can be very useful for patients and their relatives who suffer from the disease in the background. These groups aim to improve family dynamics, especially about the patient’s main problem: addiction.

Patients with addictions to alcohol or other drugs tend to externalize their discomfort with actions (acting out) precisely with their consumption that everyone sees. However, family members who are not users tend to go unnoticed, hiding their pathology from others and not externalizing it (acting in). Non-consuming family members learn that it is preferable to go unnoticed in a dysfunctional family environment without provoking the consuming family member, who usually acts by consuming more or presenting behaviour problems. Family group therapists must be alert to identify these family members because they can also suffer from many discomforts and, sometimes, mental disorders such as depression or anxiety.

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