The current paper is the Alonso Plenary Presidential Address given at the Annual American Group Psychotherapy Association's 2026 Conference. The plenary focuses on how we are uniquely suited to address the psychological stressors, trauma, and mass trauma group members carry into their therapy and support groups. We have at our disposal the multifaceted tools of healing, including (1) small groups, which provide a safe container to process, metabolize and create symbolic meaning; (2) large groups, where projections, stereotypes, racism, and unresolved social traumas can be expressed, examined, and transformed, and (3) support groups for communities facing manmade and natural disasters. The evidence-based support for the efficacy of group therapy, leadership considerations, the importance of DEIA constructs and community involvement, core values to enhance organizational cohesion and self-care strategies for group therapists are discussed.
While patient anxiety is well-documented in psychotherapy literature, the anxieties of the therapist, particularly in group settings, receive considerably less attention. This article explores the specific anxieties experienced by group therapists, their origins, their impact on the therapeutic process, and strategies for their management. It is a theoretical review integrating psychodynamic (e.g. Freud, Bion), relational (e.g. Mitchell), and neurobiological perspectives, illustrated with clinical case material. Group therapists' anxieties are often rooted in early group experiences, narcissistic vulnerabilities, and unconscious conflicts. They manifest as fear of the group as a whole, performance anxiety, and dread of inadequacy or loss of control. These anxieties can lead to restrictive interventions and relational ruptures. However, when mentalized and contained, they provide crucial insight into group dynamics and can be transformed into a vehicle for therapeutic growth. Acknowledging and working through anxiety is not a sign of professional failure but an integral part of effective group therapy. The therapist's capacity for self-reflection and mentalization is paramount in containing these anxieties and facilitating a successful therapeutic process.
Addressing social enactments in group therapy requires integrating developmental theory with cultural identity dynamics. As social power dynamics emerge, the effectiveness of psychoanalytic group psychotherapy can be enhanced by modifying perspectives on transference, resistance, and the emotional transparency of the leader. This paper proposes theoretical and technical modifications to respond to repetitions of social inequities in the group process, including revised thinking about resistance analysis, the group agreement and the contact function. These changes aim to equip leaders to engage more skillfully with social microaggressions and enactments. Clinical examples illustrate strategies for resolving identity-based group conflicts. We argue that attention to social enactments extends, rather than contradicts, developmental aims. When leaders remain accountable to social power, groups can foster psychological growth and emotional repair.
We present the development and preliminary psychometric evaluation of the Group Rupture Resolution Rating System (G-3RS), an observer-based measure of therapeutic alliance ruptures and repairs in group therapy. The G-3RS is a companion to the 3RS, an observer-rating system for ruptures and repairs in individual therapy. The G-3RS incorporates different levels of group interactions: member-, therapist-, and group-initiated ruptures and repairs. Raters coded 62 sessions of 21 Group Psychodynamic Interpersonal Psychotherapy groups for binge eating disorder using the G-3RS. The G-3RS demonstrated good interrater reliability at most group-interaction levels, and preliminary evidence for convergent validity. Clinical examples illustrate ruptures and repairs at different levels of group therapy interactions. The G-3RS may help researchers and clinicians better understand ruptures and repairs within groups.
Despite its demonstrated efficacy, group therapy remains underutilized in community mental health centers (CMHCs), where structural barriers and a chronic shortfall of funds impede implementation. This article examines the disconnect between academic research and the financial, organizational, and policy constraints that shape care in safety-net settings. Drawing from direct experience at a CMHC serving marginalized populations, we offer a financial analysis that illustrates how current reimbursement models create steep challenges for sustaining group therapy. Guided by domain theory, we present practice-based strategies-including standardized group formats, continuity-focused structures, and clinician cross-training-that respond to barriers across service, management, and policy domains. Rather than proposing one-size-fits-all solutions, we share adaptable frameworks rooted in the realities of CMHC work. We argue for a more context-sensitive approach to implementation-one that takes seriously the questions of access, sustainability, and equity that define group work in underresourced settings.
This paper was originally a panel discussion at the Annual American Group Psychotherapy Association 2025 Conference. Working with enactments of social oppression in groups presents special challenges for group leaders trained to work exclusively within a developmental model. When the group attends to issues of social power, the leader can be seen not only as a transferential figure but also as a representative of an oppressive social class. This shift from developmental to social transference often stimulates anxiety in the group leader, who then struggles with this charged transference. This article describes the author's personal journey to identify how implicit bias enabled her to work with the tension that arises as identity differences and social power become the focus of the group. Case examples illustrate how rigorous self-reflection and study enabled the group leader to use self-disclosure to highlight and resolve difficult social enactments.
Increased utilization after COVID-19, emerging effectiveness, and myriad benefits for clients and clinicians warrant further research on group teletherapy. Personal disclosure and empathy have been found to improve treatment effectiveness by increasing clients' abilities to function well in interpersonal settings. This study explored whether disclosure and empathy changed over time within group teletherapy for emerging adults. Group teletherapy notes were coded for initial disclosures, empathic responses, and similar disclosures to measure participants' levels of disclosure and empathy. Although participants made consistently frequent initial disclosures, engagement from fellow participants increased gradually through empathic responses and similar disclosures. This study reveals that group teletherapy may be a realistic modality for promoting interpersonal skills such as disclosure and empathy among emerging adults with mental illness.
Experienced and internalized weight stigma (IWS) are associated with a plethora of health and psychosocial consequences. In this study, we tested the outcomes of a 10-12 week, online, counselor-facilitated support group (We Deserve Space; WDS) for individuals who had experienced weight stigma. Twenty-five large-bodied individuals participated in three iterations of the WDS group. Participants average age was 43.68 years (SD = 13.84, range = 28-78). Revisions to WDS curricula were made iteratively in response to feedback. Paired samples t-tests yielded statistically significant improvements on all variables (IWS, antifat attitudes, depressive symptoms, loneliness, eating-disorder functional impairment, belongingness) from baseline to end-of-group, with effect sizes in the medium to large range. This study provides preliminary evidence that WDS may improve IWS, disordered-eating functional impairment, and psychosocial well-being in large-bodied individuals.
Group climate and treatment satisfaction are increasingly relevant in determining therapeutic outcomes in group therapy. Despite the growing use of virtual formats, limited research has explored these factors in online trauma-focused groups. A free, skills-based trauma therapy program was delivered online to 80 individuals in an urban setting. Trauma-related symptoms were measured pre- and postgroup using the PCL-5 and TSC-40. Postgroup assessments of group climate and satisfaction were captured using the GSC-S and a custom service satisfaction survey. Participants reported a positive group climate and high levels of satisfaction. Treatment satisfaction emerged as a significant predictor of symptom reduction. Notably, satisfaction with the practicality and real-world applicability of the group's content was closely linked to improved outcomes. These findings support the feasibility of online group trauma therapy and underscore the central role of participant satisfaction-particularly the perceived utility of therapeutic skills-in driving meaningful clinical improvements.
This study examined the feasibility of online group therapy for trauma survivors. Community-based participants (N = 178; 64% women; mean age = 43) self-referred for an eight-week psychoeducational, skills-based trauma therapy group, which was offered via secure video conferencing. Participants were diverse in terms of socio-economic status and ethnic identity. Participants completed the PCL-5 at registration (T0), pre-treatment (T1), and post-treatment (T2). T0-T1 reflected a waitlist period; T1-T2 represented the treatment phase. Mixed effects models showed significant overall PCL-5 reductions from T0-T2, with clinically meaningful change during treatment (T1-T2). PTSD symptom subtypes as measured by the PCL-5 (reexperiencing, avoidance, negative cognition/mood, arousal) also improved. Findings support telemedicine as a feasible option for fostering stabilization skills and reducing barriers to trauma treatment.
This article examines how mattering (the sense of being seen, valued, and needed) and anti-mattering (the belief one is invisible, insignificant, or expendable) are expressed symbolically and transformed in group psychotherapy. Anti-mattering symbols, such as lateness, withdrawal, a power struggle, relational devaluation, and an identity-based attack, are understood as expressions of epistemic mistrust: the expectation that relational recognition will be absent, unreliable, or irrelevant. Using five previously published clinical vignettes re-analyzed through a symbolic lens, a typology of mattering and anti-mattering symbols is presented, along with a six-step intervention sequence for transforming mattering. This process engages multiple members, sustains contact through interpersonal tension, and repairs ruptures in ways that are emotionally resonant and trustworthy, and ultimately transforms anti-mattering symbols. The framework integrates developmental, sociocultural, and psychoanalytic perspectives to restore epistemic trust, and expand the group's capacity for mutual recognition and interpersonal mattering.
This article is a product of the American Group Psychotherapy Association Annual Conference, Connect! 2025. The article reconceptualizes aggression as a neutral life force that can be utilized to heal internalized misogyny, contrasting with Freudian views of aggression as inherently destructive. It examines how misogynistic cultural messaging leads individuals to redirect aggression inward, through the narcissistic defense, creating self-critical patterns that reinforce oppressive norms. Group psychotherapy is particularly well-suited to address problems with aggression, misogyny, and internalized misogyny. Through theoretical analysis and clinical examples, the author demonstrates how embracing aggression transforms self-attacking patterns into empowered self-expression. The intersection of psychological analysis with sociopolitical context is presented as essential for addressing both personal suffering and systemic oppression. This framework offers clinicians a path to help clients develop conscious relationships with their aggressive energy, creating possibilities for individual healing of internalized misogyny and fostering social change.
The COVID-19 pandemic's impact on higher education, particularly the shift to distance learning, is examined in this study. Psychology graduate students' subjective experiences of online group supervision are explored, and the pandemic's influence on their learning is analyzed. Thematic analysis and computer-assisted qualitative data analysis of 14 student interviews reveal three distinct themes: (a) the presence of complex and ambivalent emotions; (b) significant influences of the online setting's characteristics on student experiences, including formal and limited communication, disembodied interactions, and distractions; and (c) unique interactions within the online supervision matrix involving supervisors and peers, as revealed through a group-analytic approach. The findings highlight the relationship between online settings and psychological processes during crises, offering insights to refine online supervision practices in an evolving social world.
The aim of this pilot study was to examine the effect of a solution-focused goal-setting group counseling program on the academic procrastination, academic self-efficacy, and goal commitment levels of 8th grade Turkish students. A quasi-experimental design was used to asses 17 students (7 students in experimental group, 10 students in control group) for 8 weeks. The results revealed that, compared to the control group, students in the experimental group showed a significant increase in goal commitment and academic self-efficacy, as well as a significant decrease in academic procrastination. Implications for future research and practice are discussed.
Existential groups (EGs) have been used in mental health care settings to help patients struggling with various mental illnesses, some proven effective in reducing psychiatric symptoms and increasing self-awareness, hope, and meaning in life. However, there is a need for greater knowledge of health outcomes, characteristics, and treatment variables of such groups. To provide clinically valuable knowledge for group therapists and further research, a scoping review was conducted to determine the characteristics of EG in terms of leaders' professions, time frames, diagnoses, locations, patients' and clinicians' affiliations, theoretical approaches or traditions, treatment rationales, and outcome variables and results. A systematic database search identified relevant papers published between 2013 and 2023. Of 4,838 unique publications, 22 were eligible for inclusion. EGs in mental health care featured numerous group characteristics linked to different group leaders' professions, clinical contexts and diagnoses. Multiple therapeutic rationales, together with different secular, spiritual and/or religious traditions were found to be applied in diverse ways. A quantitative method was used in 17 of the 22 studies, of which six were randomized controlled trial (RCT) studies. Both psychological and existential outcomes were measured, such as reduced psychiatric symptoms and increased self-awareness, hope, and meaning in life. Research on EGs in mental health-care settings has increased, characterized by robust study designs demonstrating the effectiveness of EGs. The findings can contribute to a more evidence informed implementation of EGs in clinical practice. However, more research is needed on semi-open long-term groups, long-term outcomes, and qualitative and mixed-methods designs.
Excoriation disorder (ED) involves uncontrollable skin picking, not explained by a dermatologic or other psychological conditions. ED is associated with emotion regulation impairment, psychosocial distress, and psychiatric comorbidities. This study investigated the efficacy of psychodrama group therapy (PGT) in reducing ED symptoms. A randomized controlled trial compared psychodrama group therapy (PGT, n = 26) and support group therapy (SGT, n = 27) as a control. The comparison included ED severity, psychosocial impact, emotion regulation, depression, anxiety, social adjustment, and general clinical status. Bayesian ANOVA models showed improvement in skin excoriation (BFincl = 1.15e + 7), emotional regulation (BFincl = 258.12), depression (BFincl = 89.73), impact of excoriation (BFincl = 71.69) and anxiety (BFincl = 20.27) over time for both groups. PGT was not more effective than SGT, but group psychotherapy is a valuable treatment option for ED.
Deaf and hard of hearing (D/HOH) individuals experience higher rates of mental health disorders and face significant barriers when accessing services, particularly in group therapy settings. This study investigates group therapists' perspectives on incorporating D/HOH clients into mixed-ability therapy groups predominantly composed of hearing individuals. Using a mixed-methods design, this study compares the experiences of therapists who have facilitated such groups with the perceptions of those who have not. Qualitative results highlight perceived barriers for therapists without experience working with D/HOH members, including concerns about group cohesion, communication challenges, and interpreter integration. Therapists with experience working with D/HOH members identified the benefits of mixed-ability groups, such as increased empathy, cultural learning, and strengthened group connections. These findings emphasize the need for expanded training, practical accommodations, and cultural competency development to ensure inclusive and effective group therapy for all.
