Techniques of group therapy

Group therapy techniques

What is group therapy?

Group therapy is one format to receive psychotherapy, or talk therapy. In group therapy, you can expect to have one or more therapists working with a group of about a dozen people. Often, the group has a common issue or challenge they are working through, such as addiction or grief. The group setting may also be beneficial if the issues you want to work on include social skills, self-esteem or anxiety.

A group setting can help us put our own struggles into perspective, and it can create a network or community that may not be available otherwise. It also helps normalize what we’re going through. Often, part of therapy is acknowledging what we’re going through (and accepting it) to start working on improvements. If you think you’re the only one feeling a particular way, it’s easy to disregard or diminish your feelings or symptoms, and they can get worse.

The group can also help build good skills toolkits through exposure to how others are coping and succeeding. This can be especially important if we’ve not had good models for emotions and behaviour in other parts of our lives. It can also help us build empathy for others by hearing how their challenges are affecting them emotionally.

Types of group therapy and what to expect

There are some types of group therapy for people who have an existing relationship, like family therapy. Outside of that, it’s more likely that this is a new group of peers you do not know.

Group therapy can benefit people who are struggling with a variety of mental health conditions, including:

Attention-deficit disorder (ADHD)
Eating disorders
Generalized anxiety disorder
Post-traumatic stress disorder (PTSD)
Addictions or substance abuse (including video game addiction)
Anger management
Grief therapy
Divorce
Depression
Obsessive-compulsive disorder (OCD)

There are open and closed group therapy options. In an open model, you may see members come and go each week. In closed therapy, your group is established and stays the same for the duration of the sessions. Often, group therapy happens over a set number of weeks and sessions.

You might talk to a therapist or counsellor on your own before choosing to do group therapy. They can help guide you to options that will work for you: large or small groups, groups focused on the issues you’re working through, or groups that involve therapy techniques that will be most helpful for your progress.

What techniques are used in group therapy?

Group therapy can utilize a number of therapy modalities (techniques) during treatment depending on the needs and goals of the group. For example, groups focused on cognitive behavioural therapy (CBT) techniques will work on addressing or changing distorted thinking patterns that can lead to negative emotions and behaviours, whereas interpersonal therapy (IPT) groups will focus on how mental health is impacted by our relationships and other people around us.

There are some key differences in how group therapy sessions are structured. Here are a few different types of group therapy formats:

Process groups: The focus of the group will be interpersonal interactions and relationships. The group is guided by one or two therapists and usually has no more than eight members. Through group interactions, members learn how their behaviours might be dysfunctional in the outside world because they’ll workshop them together and get feedback from each other through the process.
Support groups: These usually serve a specific function like guiding a group of people through grief or following a traumatic accident or injury. They tend to have a set number of sessions and have an end date.
Psychoeducational groups: Unlike process groups, this type of group therapy relies more on the education and training guided by the therapist. Members may still share a common thread, like the same diagnosed illness, and each person will benefit from knowing they’re not alone. Members of the group learn about their disorder together, and practice new skills with the support of one another around them, but it’s less about their relationships to one another.

The problem-solving, awareness, interpersonal and cognitive/behavioural skill-building in group therapy can be incredibly effective for many people. Group therapy may also be more affordable than individual therapy, and may help newcomers feel at ease with the process of talking with a therapist or counsellor.

Find therapists that specialize in group therapy on First Session.

Keys to great group therapy

Decades of research, including more than 50 clinical trials, have shown that group therapy is as effective as individual therapy for many conditions, including depression, obesity and social anxiety. Partly as a result of that research, demand for group therapy is up, and many new psychologists are being asked to lead groups in hospital and community mental health settings.

Yet the ability to run therapy groups is a special skill. In fact, APA’s Commission for the Recognition of Specialties and Proficiencies in Professional Psychology includes group psychology and group psychotherapy as an evidence-based specialty.

“Group therapy isn’t just individual therapy in a group,” says Martyn Whittingham, PhD, an Ohio counseling psychologist and president of APA’s Div. 49 (Society of Group Psychology and Group Psychotherapy). “It has its own techniques, its own processes and its own strategies, and unless you really understand those, you’re going to struggle. You need to be part of a community of people who are committed to learning and growing in this work.”

Unfortunately, many psychologists receive little training in the area.

“In most graduate programs, group therapy is an elective course, so it’s possible for students to graduate without knowing anything about group dynamics or group therapy, and take a job where they’re running groups,” says George Washington University psychology professor Cheri Marmarosh, PhD, Div. 49’s president-elect. “But without training, these students don’t know how to intervene when problems arise among members of the group, and they may not have adequate supervision. They’re just expected to go in and do it based on their individual psychotherapy training.”

How can psychologists step in to provide group therapy and ensure that their leadership meets patients’ needs? Group therapy experts offer their advice:

Get training. Taking a course on group therapy or group dynamics provides essential background on group development, conflict and how to address it in groups, as well as how to foster group cohesion, identify and repair ruptures, and deal with diversity in groups, says Marmarosh. Such training can also help psychologists better understand how to screen potential group members and how to prepare members for what to expect during the sessions.

To find such training, visit the APA Div. 49 website (www.apadivisions.org/division-49) as well as the webinars and continuing-education courses offered by the American Group Psychotherapy Association (www. agpa.org).

Compile the right group. Not every patient is an appropriate candidate for every group, Whittingham says. That’s why it’s important for the psychologist to conduct a high-quality screening and preparation interview with each potential group member before the group begins. Before these meetings, Whittingham suggests using tools such as the 19-item Group Readiness Questionnaire (GRQ), which is designed to identify risk factors for potential dropout or poor outcomes. This kind of assessment can help inform therapists’ clinical judgment so they can decide whether they need to spend more time preparing members or redirecting them to a treatment where they are more likely to be successful. “This can give you a quick look at issues that are predictive of dropout, such as low motivation or a specific type of interpersonal problem such as overt hostility or a tendency to disclose too deeply too quickly,” Whittingham says. If their assessment and individual interview suggest they may not be a good fit for the current group, perhaps their needs would be better served in individual therapy, or in a different group setting.

It’s also important to educate your referral sources about inclusion or exclusion criteria for group therapy, he says.

“You wouldn’t want to get a general group therapy referral for a client who has just gone through an intense sexual assault, for example, until they’ve perhaps gone through at least some individual therapy,” Whittingham says. “These types of clients might understandably have difficulty focusing on other people given what they’ve just been through themselves. So, it’s important to identify people’s readiness for group.”

Set expectations up front. During the initial individual intake, ask clients what they expect group therapy to look like and how quickly they expect change to occur, to ensure their hopes are in line with reality, says Roger Greenberg, PhD, distinguished professor of psychology at the State University of New York Upstate Medical University. Particularly if they say they expect to feel better within a couple of weeks, it’s important to explain that change will likely occur over a period of months.

“Remind them that it took them a while to get to the point where they were feeling uncomfortable enough to want to do something about it, and so, like everything else, it will require time to see true change,” Greenberg says.

It’s also important to dispel any notions that group therapy is conducted the same way it’s portrayed on television, Whittingham says.

“Often, clients imagine it’s going to be a lot of shouting or being attacked, so leaders need to help members understand that group can actually be a really enjoyable thing where they learn a lot from other people, not just from the therapist,” he says.

It’s also important to prepare members for possible challenges this type of therapy can present.

For example, patients who avoid conflict or disengage when relationships become difficult need to know that group discussions can become difficult. “Discuss how they might react if they experience a desire to flee, and help them commit to attending a minimum number of sessions,” says Marmarosh.

Build cohesion quickly. Some groups more naturally lend themselves to being cohesive from the get-go. “In grief groups, for example, you don’t have to work as hard to get people to feel connected once they start talking about why they’re there,” says Whittingham. However, groups without an easily identifiable common bond—those geared toward cognitive-behavior therapy, for example—might take a bit more work to help members feel connected. One strategy group leaders can use is to break the group into pairs and have them take time during the first session to get to know each other, Whittingham says. Icebreakers that encourage members to delve deeper or have fun together can also promote group bonding.

“Finding commonalities is crucial to building group cohesion, and sometimes these things emerge organically, but often the therapist will have to illuminate them for members by using linking techniques,” he says.

Including more experienced clients in the group who have already had positive experiences with this type of therapy is another smart tactic for building cohesion.

“Experienced patients are able to serve as models for how an ideal client would participate in the treatment, and this seems to enhance treatment participation and speed up the development of a sense of group cohesion,” Greenberg says.

Get feedback . Research shows that therapists cannot easily predict how well a group member is doing in therapy and whether he or she will drop out, Marmarosh says.

In addition, the field of health care in general is moving toward outcome measurements as a way to track progress and improve outcomes. Several assessment tools—some of which are free—are available to help therapists gain insight into which clients might be at risk for treatment deterioration or dropping out of therapy altogether. These include progress monitoring measures such as the Outcome Questionnaire (OQ), developed by Brigham Young University psychology professors Gary Burlingame, PhD, and Michael Lambert, PhD, as well as therapeutic relationship measures such as the Group Climate Questionnaire (GCQ-S) and the Group Questionnaire (GQ).

“Don’t trust that you can clinically jump into a member’s mind and know how they’re doing, because you can’t,” says Burlingame. “The data on this are very clear.”

Identify and address ruptures. Disagreements are almost inevitable in group therapy, but it’s important that group leaders spot and work through concerns as soon as they arise among members, Marmarosh says. Sometimes ruptures in group cohesion are obvious and confrontational, such as when a group member comments that they don’t understand how something being discussed is relevant, or if they challenge the intervention. Other times, ruptures can be more passive, with a member who begins to come late, doesn’t show for sessions, stops making eye contact or doesn’t contribute to discussions.

“You can also look for nonverbal cues, such as eye rolling, fidgeting or just looking frustrated when other people in the group are talking,” she says.

To address these issues, the therapist can gently bring it up directly with the member or with the entire group by asking if others are feeling frustrated as well, Marmarosh says.

Greenberg agrees, noting that giving clients the sense that they are an active part of the therapeutic process is one of the best ways to address discord.

“Make sure they know that you’re willing to listen and make changes that will be in line with what the client thinks they would find helpful,” he says.

Learn more about group therapy by visiting the website of APA’s Div. 49 (Society of Group Psychology and Group Psychotherapy), www.apadivisions.org/division-49/index .

FORMS, OBJECTIVES AND TECHNIQUES OF GROUP THERAPY. Severe personality disorders [Psychotherapy strategies]

FORMS, OBJECTIVES AND TECHNIQUES OF GROUP THERAPY

Before I describe the main group methods that are used in the context of this approach, I would like to clearly define the therapeutic function of these methods. In our model, each patient primarily needs one person who is in charge of the patient's therapy in the department and who is responsible for the therapeutic, administrative and legal aspects of the patient's stay in the hospital. This staff member—the hospital physician, administrative psychiatrist, administrator, or psychotherapist responsible for the patient's therapy program—ideally should be a medical doctor, as the hospital is required by law to be a medical doctor to make decisions about hospitalization and psychiatric care. The transfer of such power to a non-medical is possible, but this requires a change in the entire complex system of transfer of power in the department. nine0003

In addition to the staff member in charge of therapy and the individual psychotherapist, a variety of task-oriented groups, such as day-to-day tasks of ward life, therapy sessions, and social work, should be available to each patient. These groups allow you to reproduce in the hospital the main areas of the patient's life: home and social environment, where you can productively engage in study, work, recreation and creativity. These groups are usually small, but may involve a large number of patients – ideally, the group processes associated with large groups do not come into play (see Kernberg, 1980, ch. eleven). Task-oriented groups should be highly structured and focused on their work, this reduces the danger of the emergence of a “group that shares the basic premise” and the danger of activating the regressive processes inherent in large groups. Such groups may include only one employee or a small number of them.

Each patient also needs to have structures in place for the leaders of such groups to communicate with each other, with the person in charge of the patient's therapy, and with his psychotherapist; the topic of communication is the interaction of the patient with each employee. This is the task of the team - both one specialty and interdisciplinary - at the meeting. nine0003

Another very important type of meeting is for informal communication between the staff and the individual patient, where “life learning” issues are discussed among the staff surrounding the patient in the ward and in the classroom. Ideally, this should be a free discussion of a specific task in which both employees and patients participate. At such meetings, the ratio of the number of employees to the number of patients should be quite high. In addition, only a wise distribution of responsibilities among the staff allows not to lose productivity in work, otherwise it may turn out that all employees are simultaneously connected with all patients. In other models of the therapeutic community, the meeting of the entire community often plays the role of such meetings, and this role may even be almost in the first place. I do not, however, find it useful to use the therapeutic community meeting in this way, as it may serve other purposes. In a more traditional, non-therapeutic community mental health facility, the two functions that I have described as the team meeting and the "learning for life" meeting are performed by the doctor's daily rounds. nine0003

The model I have proposed involves the use of group psychotherapy for most patients, which raises difficult questions about the relationship between individual and group psychotherapy (I will address these issues a little later).

Although it is necessary to do some research into family relationships in all or most patients, family therapy, due to the growing interest in it, is in many places the only form of such work. I separate the help of an experienced social worker, which is necessary for most or all patients, from the psychotherapy of the whole family. In some cases, family therapy is necessary, but if the patient also goes to group therapy and to an individual psychotherapist, there is a danger of overlapping these modalities, which weakens or destroys the effect of each individual approach and contributes to splitting and acting out. nine0003

My model includes therapeutic community meetings where all staff and patients attend; such gatherings should occur frequently enough to mark significant changes in the social and emotional climate in the department, but not more frequently. It is important to limit the frequency of community meetings to avoid wasting resources on too many meetings that take up a lot of time, energy and staff attention, which reduces productivity.

The community meeting has two main objectives: it explores the social processes affecting the entire patient and staff community as a whole, and it examines the processes taking place at the meeting itself; in other words, processes characteristic of large groups. The study of the social system includes the clarification of real interpersonal conflicts that require intervention from the administration of the community. At the same time, it is necessary to create an atmosphere of informal and spontaneous communication (as opposed to the bureaucratic, formal handling of information and the agenda) so that the processes occurring in a large group can be explored. nine0003

Thus, the community meeting must examine the processes affecting the entire community and use its understanding to make adequate decisions. But at the same time, one should be sufficiently tolerant of the activation of primitive object relations, characteristic of large groups, in order to be able to diagnose the regressive group processes of the entire community, expressed, in particular, in a change in morality, in the emergence of specific primitive themes and in the distortion of the entire social system. under the influence of a particular patient, under the influence of group processes occurring in the department, or under the influence of the administration of the hospital or department. nine0003

The therapeutic community meeting should be chaired by an experienced person. This is followed by a staff-only meeting where the community meeting is reviewed and the administrative tasks assigned to it are discussed. The list of group structures included in my model is completed by the organization of patients, parallel to the administrative group of department staff and connected with it by administrative links that allow negotiating on behalf of the group of patients with the staff and administration of the department. Now consider the goals and technical aspects of each of these groups. nine0003

2.1. PURPOSE OF GROUP WORK

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Alternative Forms of Therapy If one or both spouses have undifferentiated personal identities, then other forms of psychotherapy can be recommended to them, either in combination with couples therapy or instead of it. As a rule, we work individually with

goals and objectives, methods and techniques, sessions

Boston pulmonologist Joseph Hershey Pratt, who was involved in the treatment of tuberculosis, at some point in his practice decided not to treat the disease, but the patients themselves. He suggested that their psychological state plays one of the most important roles in the development and course of infection. Since there was no opportunity to work with the sick one by one, he organized group sessions. A month later, it became clear that, compared with individual, they showed better results. People felt much better, were on the mend. nine0003

This happened in 1905. Since then, a new direction began to actively develop - group psychotherapy. Joseph Hershey Pratt is considered to be the founder. After his so successful practice with tuberculosis patients, he theoretically substantiated the positive results obtained. A few years later, he developed a GP technique for those who do not suffer from physical illnesses.

What it is

Group psychotherapy is one of the methods of treatment, which involves the creation of a separate group of people to eliminate psychological and partly physiological disorders under the guidance of a psychotherapist. Unlike an individual approach, it solves the patient's problems on the basis of revealing his essence in the process of interpersonal communication. nine0003

From history

Pratt's idea was picked up by the Romanian psychiatrist, psychologist and sociologist Jacob Levy Moreno. The founder of psychodrama and sociometry first used the term "group psychotherapy". He actively applied it in practice. The direction reached its peak of popularity in the post-war years (the second half of the 40s of the XX century). There were not enough hospitals in the destroyed cities, and the number of people in need of psychotherapeutic help was huge. Therefore, general sessions were organized everywhere for several people at once. nine0003

In the 1960s the direction was significantly expanded and began to be actively used for the treatment of clinical cases. The American humanist Carl Rogers, the creator of the famous "I-concept", attached great importance to it. He introduced the concept of "encounter group", thereby laying the foundations for anti-authoritarian non-directive psychotherapy.

Concepts

There are three related concepts that are often confused in the sources, which is a gross mistake.

Group psychotherapy

A small (up to 20 people) group is created on purpose. Most often it includes people with similar problems. A distinctive feature is active interaction. They come into contact with each other, communicate, share experiences. The psychotherapist directs, gives tasks, sometimes can step back to observe from the sidelines.

Collective psychotherapy

The group is created specially, unites people with similar problems. May include 50 or more people. The participants practically do not interact with each other, their role is more like a spectator. The psychotherapist is in the center of attention, does all the work: tells, inspires, convinces, etc.

Psychotherapy in the group

The group is not created on purpose, as it already exists. It can be a family, a class, a work team, classmates. Most often, one global problem is solved - an interpersonal conflict between several participants at once. The task of the psychotherapist is to organize the work so as not to aggravate the situation, but, on the contrary, to improve relations.

Types, directions

Some directions in psychotherapy were originally created as group ones: sociodrama, psychodrama, psychogymnastics. They do not exist outside of this method. Other concepts also actively use this form of work: existentialism, gestalt therapy, art therapy, etc. Even client-centered offshoots resort to its help, recognizing that a person is a social being and is most fully revealed only against the background of communication and contact with other people. nine0003

In 1982, the well-known practicing psychologist and psychotherapist Kjell Erik Rudestam published the book “Group Psychotherapy. Psycho-correctional groups: theory and practice”. Despite the fact that almost 30 years have passed since then, today it is the most complete encyclopedia of all psychotherapeutic schools, directions and concepts that use GP in their work (with examples and techniques):

gestalt therapy;
psychodrama;
transactional analysis; nine0124
body-oriented therapy;
dance movement therapy;
theme-centered therapy;
art therapy;
behaviorism and others

In his monumental work, Rudestam also considers several types of groups:

T-group (training) — emotional empathy for other people;
encounter (group of meetings and directions) - self-knowledge, establishing close contact with others, realization of personal potential; nine0124
gestalt - gaining internal control, developing the ability to take responsibility for one's own emotions and actions;
skills training - mastering various forms of behavior "here and now", encouraging each member of the group to react to the actions of others;
and others

In 2011, an American psychiatrist and psychotherapist, Professor of Psychiatry at Stanford University Irwin David Yalom published the book Stationary Group Psychotherapy. nine0003 Irvin Yalom's book "Stationary group psychotherapy"

It cannot be said that he created a new direction or added something fundamentally authorial to it. And earlier in the conditions of hospitals such sessions were organized in addition to the main course of treatment. However, he generalized all this, systematized and described in detail the practical application:

efficiency;
general principles;
targets;
estimated composition and size of groups;
management strategies and techniques; nine0124
"here and now" approach;
problematic situations: rapid change of patients, eccentric incidents;
working models of high-level and low-level stationary psychotherapy groups.

Today Yaloma's Stationary Group Psychotherapy is a reference book for all those who have to work with clinical diagnoses in hospital wards.

Goals and objectives

The main goal of group psychotherapy is to reveal the patient's internal conflicts, contradictions, problems based on the analysis of his interpersonal interaction in the group. Thanks to the tasks set, which are solved together, the correction of inadequate attitudes, overcoming emotional and behavioral patterns almost automatically takes place. But you need to keep in mind that each concept brings its own specifics to this goal:

gestalt - learning self-control when communicating with others;
psychodrama - development of creative potential;
Body Oriented - remove shells through physical contact, etc.

On the way to achieving the main goal, group psychotherapy solves three main tasks:

Self-understanding - awareness of one's own motives that control behavior.
Development of a positive attitude towards oneself.
Self-regulation - control of one's thoughts, behavior, actions. nine0124

In the process of solving these problems, the patient develops adequate self-awareness through interpersonal communication with others and group dynamics.

Basic concepts

Dynamics - the life cycle of a group, including all processes occurring in it, interpersonal contacts, distribution of roles, interdependence of participants.

Norms - standards of behavior that define relationships in a group: sincerity, openness, acceptance of others, tolerance, lack of criticism, activity. nine0003

Roles - the degree of influence of participants on each other:

alpha - leader, leads, encourages activity, directs, gives confidence;
beta - an expert with the knowledge necessary in various situations, inspires respect, advises;
gamma - anonymous, behaves passively, but at the same time adapts to the conditions, adapts, considers himself a leader;
omega - aloof, closed, little contact with others.

Cohesion - the need to work in one team to solve common problems. Tension is the opposite concept, denoting a mismatch of interests and views, a violation of the standards of behavior in a group, an increase in conflict.

Projection - the imposition of past interpersonal stereotypes on new ones that other participants brought with them and voiced.

Subgroups - informal breakdown of the main group into smaller ones. It can be based on age, gender or intellectual principles. nine0003

Phases of development - stages of the process characterized by specific activity and performing the functions necessary for the psychotherapist:

Phase I - group formation, adaptation to new conditions, acquaintance, pseudo-integration, regression and uncertainty;
II phase - increase in activity, struggle for leadership, distribution of roles, rebellion against the psychotherapist;
Phase III - acceptance of the norms in force in the group, the decline in tension, the establishment of personal contacts, disclosure, cohesion, cooperation; nine0124
Phase IV - active work, emotional support, solving major problems, reassessing priorities.

The first three phases usually take 10% of the total number of sessions, the last - 70%. For example, if the course of treatment consists of 10 meetings, the first three correspond to the first three phases, the remaining 7 to the last. But this is an ideal scheme that works only if the groups are formed correctly and there are no participants among them with open deviant behavior.

Principles

Group psychotherapy is based on 10 principles.

Awareness: advice and instructions are given on how to behave and what to do.
Universality: to convince the client that his problems are not unique and inherent in other people.
Cohesion: Solving Problems Together.
Altruism: willingness to help each other.
Communication: confidential conversations, discussion, feedback forms, role-playing games.

Hope: each participant must be confident in the effectiveness of the classes.
Multiple Transfer: Create close, family-like relationships within the team.
Imitation of leaders and experts.
Catharsis: emotional outburst, maximum disclosure of personality, when the pain that has been accumulating inside for a long time comes out.

All these principles can be clearly seen in the work of a properly formed group. It is they who lead to a positive result and a complete recovery. nine0003

Methods, techniques, techniques

Depending on the direction in which the psychotherapist works, the following methods of group psychotherapy are distinguished.

Group discussion

Discussion of a common problem for all participants, clarification of personal aspects of its solution for each separately. Group discussion can be:

interactive — aimed at clarifying interpersonal relationships;
biographical - acquaintance with the history of each participant; nine0124
thematic - discussion of sore, topical topics.

Psychodrama

A role-playing game is organized on a topic that connects all participants, where everyone presents their own vision of the situation. Includes three stages:

Warming up - distribution of roles.
Psychodramatic action.
Discussion.

Psycho-gymnastics

Involves communication, role-playing without words - using only movements and facial expressions. nine0003

Projective drawing

Like psycho-gymnastics, it is a non-verbal method of group psychotherapy. All participants are given sheets of paper, drawing tools, and a topic is announced that is consonant with the main problem. Half an hour is allotted for the drawing, after which time is given to each illustration, it becomes the center of the discussion.

Music therapy

In active group music therapy sessions, participants compose their own compositions. Then they discuss them, talk about the emotions under the impression of which they were written. In passive classes, listening to famous arias, operas, songs, melodies is organized, followed by a discussion about them. nine0003

Depending on the chosen method, the psychotherapist uses different techniques: role play, conversation, discussion, repetition, metaphor, dream analysis, reflection of affect, etc.

Practice

All group psychotherapy sessions follow a different scenario. Sometimes even a psychotherapist is unable to predict what will happen in a particular class. After all, each participant brings something of his own to the solution of a common problem. However, before starting, everyone must receive a series of instructions that reflect the norms of behavior, which are strictly forbidden to violate:

the problem is the same for everyone, it cannot be centered on oneself;
but for everyone it has acquired personal factors that should be sorted out;
one must learn to listen and hear others;
you can not criticize others for a different view and attitude to the same problem.

For each separately formed group, the psychotherapist prescribes his own rules, as he knows the personal characteristics of the participants. He introduces them to clients at a preliminary individual consultation. nine0003

Groups usually consist of 5 to 20 people. In total, a minimum of 4 sessions is required, the maximum number is not limited: as long as participants are willing to meet and work together, new sessions are scheduled until everyone is fully recovered. Some leave the team before the rest, if they already come to the realization of the exit and the reassessment of values.

Case study. A woman's husband left her, causing her to suffer from depression, complicated by obsessions. She pursued one goal - to return him by any means. All attempts to improve relations failed, and each of them only worsened her condition. Individual sessions of psychotherapy proved to be ineffective, and she was included in a group of women who experienced the same tragedy.