Maximizing the therapeutic effectiveness of small psychotherapy groups

Abstract

It is generally accepted that a 7-10 member therapy group is the ideal size. The realities of outpatient group psychotherapy, however, are that groups are often considerably smaller than that. Yet, despite these realities, little attention has been paid to how small groups may be effectively led. This paper will examine the dynamics of less-than-ideal-sized groups and suggest how their effectiveness may be maximized. LITERATURE REVIEWMajor literature reviews, such as those by Yalom (1975} andFulkerson, Hawkins andAlden (1981}, emphasize the value of therapy groups with five members or more in contrast to those with fewer than five members. Yalom (1975) writes:My own experience and a consensus of the clinical literature suggests that the ideal size of an interactional group is approximately 7, with an acceptable range of 5 to 10 members. By contrast he adds:When a group is reduced to the size of 4 or 3, it often ceases to operate as a group; member interaction diminishes, and therapists often find themDr.

Small and unfilled psychotherapy groups: Understanding and using them effectively

“…For example, groups may be started for patients with AIDS, eating disorders, or manic depressive illness without waiting for enough prospective members to completely fill a group. Cohen and Rice (1985) point out that overlapping circumstantial and dynamic factors may contribute to groups not filling up. A private practitioner's referral system may be inadequate or the internal dynamics in a clinic administration may be in conflict with the development of groups filling to a robust size.…”

A time-limited group therapy model for men sexually abused as children

“…The small membership remained an important factor in the group's life, but similar to the other groups, the men found the experience rewarding and helpful. Although most literature on groups supports the notion of groups larger than four members (Fulkerson et al, 1981;Yalom, 1975), Cohen and Rice (1985) argue that outpatient therapy groups are frequently smaller. Dimock (1988) suggests that six-member groups for adult male survivors provide a safe environment for men to establish trust and allow their vulnerability to show.…”

“…Although our second group was conducted with three members, we still advocate larger groups considering the difficulties evidenced by small membership. (Cohen & Rice, 1985). A group consisting of four to six members is an ideal size, but, retrospectively, beginning with seven members is suggested due to the high dropout rates these groups frequently produce.…”

Challenges in the design, planning and implementation of trials evaluating group interventions

“…Groups with five or more members allow the formation of meaningful relationships [34] and cohesive group functioning [6]. Although some maintain that therapeutic benefit can be derived in groups with < 5 members [35,36], there is evidence that with < 5 members, interaction, group identity, attendance and group image is poor [6,37]. Upper limits to group size may depend on how many people a therapist can practically manage [38] but it has been found that fewer verbal interrelationships occur [33] in groups with > 8 members, and social fission [39] and conflict [40] are more common in larger groups.…”