Unfortunately, the stigmatization of mental illness is a barrier for many in seeking professional advice and treatment (2). Mental health professionals are well equipped to provide information to people experiencing depression; however, it remains common to avoid professional help with mental illness (2). Increasingly, online support groups have become a source of support for people who are reluctant to seek community-based resources, which speaks to the needs of those who are depressed to receive guidance from others who are also experiencing depression. Although trained facilitators produce the best results in group therapy for depression, online support remains a relevant resource for those who are reluctant to seek help in the community (5). The proactivity of those who seek online support is an identifiable strength in this population. However; as this is such a broad target group, identifying strengths might be more appropriate on an individual level.

 

 

Alternatively, groups designed this way do not allow for individualized interventions, which can be problematic for this population because of the breadth of potential symptoms, experiences, and underlying causes of depression (1, 12). 

 

Facilitating evidence-based therapeutic group work is a highly specialized skill that requires special training (8). Commonly, therapists are not equipped to address the needs of group dynamics. Facilitators can best serve those experiencing depression by understanding group development, stages and dynamics to encourage group cohesion and effectively address conflict and diversity (8,10). 

 

Disempowerment in the field of mental health can also arise from an over-emphasis of the professional-to-client relationship rather than a person-to-person relationship. Group facilitators should reflect on their attitudes and those of their organization to identify disempowering and paternalistic attitudes and policies (4,11). Should a facilitator find themselves working in a manner that perpetuates oppression, they can mitigate group therapy members experience of this by (4): 

Depression occurs in every demographic and can impact people differently; therefore, group composition also needs consideration. Group therapy with this population is more successful when cognitive and emotional functioning is similar between members. Aligned levels of functioning also reduce dropout rates and can ensure the needs of group members are adequately addressed (6,10, 13). 

 

Storming is represented by this population when cohesion levels off or devolves, and individuals compete with one another for attention.  As tensions arise group members begin to move away from their initial feelings of finding likeness in other group members to needing to differentiate their problems as unique (10). Facilitators can use this stage as an opportunity to incorporate and model more assertive responses to encourage the group to move beyond introductory pleasantries while being mindful that some members of this population will suffer overwhelm when they observe feelings in others they have been suppressing (10). 

 

Performing is demonstrated by this population when members increase their capacity to see themselves in one another and learn from others' experiences (10). Commonly an emotional leader will emerge within the group, a person who models genuine engagement with self-examination. The emotional leader can be a valuable member of the group; however, facilitators must refrain from preferential engagement with the emotional leader, which can lead to resentment within the group (10). 

 

CBT, or psychotherapy group work with people experiencing depression, has the effect of benefitting the group as a whole through the experience and impact of cohesion, collaborative goal setting, and normalization (10,12,13). The group also functions as a venue for experimenting socially, learning from observing and listening to others, and performing as co-therapists (12). When these psychosocial interventions occur alongside proven therapeutic methods, CBT and psychotherapy, while also delivering accurate information about depression, the benefits produce positive short, and long-term outcomes (7, 12).

 

For some, there may be a tendency to glorify the group experience and gloss over the challenging aspect of the experience. Facilitators should foster an authentic reflection on the group process and encourage participants to balance their closing statements and reflect on the various feelings they have experienced (10). Another consideration for facilitators during closing is that they should resist the urge to explore conflict and stoke productive conversation when there is insufficient time to wrap up new conflict. Finally, group endings offer the facilitator an opportunity to model how to internalize the experience on a personal level and how the collective experience will endure beyond the group's conclusion (10). 

Having participated in a collective group experience can reduce the likelihood of future depressive episodes because of group therapy's ability to address psychosocial, psychotherapy, and educational support factors; these variables have proven to predict the likelihood of depression symptoms recurring (7,9). 

 

 

(2)  Barney, L. J., Griffiths, K. M., & Banfield, M. A. (2011). Explicit and implicit information needs of people with depression: a qualitative investigation of problems reported on an online depression support forum. BMC Psychiatry, 11(1). https://doi.org/10.1186/1471-244x-11-88

(3)  Forsyth, D. R. (2021). Social influence theory and research: Implications for group psychotherapy. In C. D. Parks & G. A. Tasca (Eds.), The Psychology of Groups: The Intersection of Social Psychology and Psychotherapy Research (pp. 87–104). American Psychological Association. http://www.jstor.org/stable/j.ctv1chrwgm.9

 

(4)  Larson, G. (2008). Anti-oppressive practice in mental health.
Journal of Progressive Human Services,
19(1), 39–54. https://doi.org/10.1080/10428230802070223

(5)  Lorentzen, S., & Ruud, T. (2013). Group therapy in public mental health services: approaches, patients and group therapists. Journal of Psychiatric and Mental Health Nursing, 21(3), 219–225. https://doi.org/10.1111/jpm.12072

(6)  Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299–2312. https://doi.org/10.1016/s0140-6736(18)31948-2

(7)  McDermut, W., Miller, I. W., & Brown, R. A. (2001). The efficacy of group psychotherapy for depression: A meta-analysis and review of the empirical research. Clinical Psychology: Science and Practice, 8(1), 98–116. https://doi.org/10.1093/clipsy.8.1.98
(8)  Novotney, A. (2018, April). Keys to great group therapy. American Psychological Association. https://www.apa.org/monitor/2019/04/group-therapy
(9)  Sundquist, J., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. (2018). Long-term improvements after mindfulness-based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial. Early Intervention in Psychiatry, 13(4), 943–952. https://doi.org/10.1111/eip.12715

(10)Tasca, G. A., Mikail, S. F., & PhD, P. H. L. (2020). Group psychodynamic-interpersonal psychotherapy (1st ed.) [E-book]. American Psychological Association.

(11)Tenenbaum, S., & Singer, K. (2018). Borders of belonging: challenges in access to anti-oppressive mental health care for Indigenous Latinx gender-fluid border-youth. AlterNative: An International Journal of Indigenous Peoples, 14(3), 245–250. https://doi.org/10.1177/1177180118785383

(12)Thimm, J. C., & Antonsen, L. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice. BMC Psychiatry, 14(1). https://doi.org/10.1186/s12888-014-0292-x

(13) Walter, I. R., PhD. (2019, November 9). How to establish a therapeutic culture in group Therapy. Family Therapy Basics. https://familytherapybasics.com/blog/2017/9/20/how-to-establish-a-therapeutic-culture-in-group-therapy

 

This population requires several considerations to improve the likelihood of positive outcomes. Cautious recruitment, suitability for group work, and suitable membership composition are critical for this population. This is a broad target group, and members are best served by working with those at similar levels of functioning. Facilitators should be cognizant of power issues, and trained in either psychotherapy or CBT. Group leaders should also understand how to foster cohesion amongst people with depression while navigating group phases with agility. Understanding the sensitivity of this population to group endings is also essential. With due care, group therapy for people experiencing depression is a successful intervention for many people who experience this common and challenging mental illness.