8.5.2 Other therapeutic group models

How the mechanism shapes the group

• In support and analytic groups, what happens between members is the treatment.

• In psychoeducational and cognitive behavioural therapy (CBT) groups, the group also delivers information and techniques efficiently.

• Facilitation follows purpose: redirect interruptions in a teaching group, but explore them when interpersonal learning is the treatment.

Cognitive behavioural groups

• Group CBT runs an agenda, teaching, practice and homework, but individual needs get less time.

• For depression, the National Institute for Health and Care Excellence (NICE) describes group CBT and behavioural activation as usually eight sessions with eight participants, ideally with two practitioners, at least one specifically trained.

A social anxiety group is itself exposure, so some people avoid it; explain the rationale and prepare members.

Expressive and arts therapies

• Art therapy, music therapy and dramatherapy are regulated professions with protected titles, so creative activity alone is not arts therapy.

• Moreno's psychodrama acts the situation out, and creative approaches suit people whose verbal expression is limited.

• Artwork is not a diagnostic test: ask the maker what it means.

• NICE advises considering arts therapies in psychosis or schizophrenia, particularly for negative symptoms, usually in groups led by a registered therapist.

Mutual aid and peer-led groups

• Twelve-step fellowships, SMART Recovery, hearing voices groups and carer networks vary in governance, so never assume clinical responsibility or confidentiality.

• A 2020 Cochrane review found high-certainty evidence that manualised Alcoholics Anonymous or twelve-step facilitation beat established treatments, including CBT, for continuous abstinence at twelve months.

• The risk ratio was 1.21 (95% confidence interval 1.03 to 1.42), and the benefit held at 24 and 36 months with likely healthcare savings.

• Twelve-step facilitation is a professional intervention that helps people engage with the fellowships, not the fellowship itself.

• NICE alcohol guidance says to tell patients about mutual aid and help them attend.

Psychoeducational groups

• Family psychoeducation in schizophrenia builds communication and problem-solving, reducing criticism, hostility and over-involvement without blaming relatives.

• NICE specifies at least ten sessions over three months to a year, single or multi-family by preference.

Skills groups

• Skills groups combine rehearsal, specific feedback, homework and realistic practice, because knowing what to do does not mean doing it while distressed.

• Examples include dialectical behaviour therapy emotion regulation and distress tolerance, social communication, problem-solving, parenting and relapse prevention.

Setting up a group

• Prepare members individually by agreeing goals, attendance and homework.

• Size: below about five the group struggles when someone is away, and above ten to twelve nobody gets much airtime.

• Closed groups build cohesion and a sequenced curriculum but shrink with each dropout; rolling groups cut waiting times but each session stands alone.

• Members cannot guarantee one another's discretion, so say so when agreeing confidentiality.

Managing risk

• Watch early dropout, attendance and individual outcomes, because a quiet member can deteriorate while the group looks successful.

• The SPIN and LSAS measures help monitoring in social anxiety.

• Deterioration, rising risk or unsafe behaviour may call for individual or more intensive care.