Group therapy is a powerful treatment modality when done right. Research affirms it as equally effective compared to individual therapy, and the relatively lower cost puts this service within reach of patients who struggle to access behavioral health care due to financial constraints. For certain types of patients, such as those looking to build social skills, group therapy may even be preferred over one-on-one encounters.
Like any other treatment, successful group therapy requires training and experience from the provider. You can’t simply move your individual therapy sessions into the group setting. Group encounters have their own challenges and require a unique set of strategies to maximize results for patients.
That’s especially true when you’re managing group therapy in virtual settings. Running a strong group session today may involve more than in-person facilitation skills. It may also require clear workflows for scheduling, telehealth, confidentiality, attendance, documentation, and group participation across multiple clients at once.
Learn how to run a successful group therapy session that will have a strong therapeutic impact on your clients.
Know the Rules and Regulations for Group Therapy
A helpful group therapy experience begins with some ground rules. Become familiar with the mandates and best practices that will contribute to a safe and effective treatment environment:
- Maintain confidentiality. Therapists are legally bound by confidentiality. In most cases, group members are not. Providers should nevertheless set a clear expectation that all group members will keep confidential any information shared within sessions.
- Keep relationships professional. Group dynamics may suffer if members date one another or become close friends outside of the group. These relationships can be pursued once the group disbands, but during treatment, it’s best to avoid them.
- No threatening behavior. Violence, threats, manipulation, and other types of threatening behavior will not be tolerated.
- No substance abuse. Members must not attend group sessions under the influence of drugs or alcohol.
- Obey applicable state laws. Providers should stay up-to-date on regulations related to the treatment types they offer, and whether or not they can treat patients across state lines via telehealth.
If you’re running group therapy over telehealth, this step becomes even more important. Patients should understand not only the clinical rules of the group, but also the expectations for joining from a private space, using headphones when appropriate, protecting other members’ confidentiality, and avoiding side conversations or distractions that can weaken the group environment.
For online group therapy, it also helps to explain how the group should use platform features such as mute, video, screen names, and chat. Setting those expectations early makes the session feel safer, more organized, and easier to facilitate.
With these ground rules in place to protect group dynamics, you can move on to other factors of successful group treatment: your workflow, your atmosphere, and the nuts and bolts of running a therapy session.
Put Proper Systems in Place
Before you enroll a single patient in your new venture, make sure your daily workflow supports the logistics of group management. Working with multiple patients at the same appointment affects everything from how you schedule sessions to how you take progress notes, and a system that runs smoothly makes for a better patient experience.
- Getting started: Identify referral sources who may mention new clients to group programs and inform them about the type of program you offer. Create a marketing plan to notify existing patients and the community of your new treatment group(s).
- Participant screening: Group therapy tends to show better results when participants have been evaluated before enrollment. Some individuals aren’t ready to address their struggles with a group yet, and some may have harmful interpersonal dynamics that would make other members uncomfortable. Pre-screening options include one-on-one evaluation with each potential member, or taster sessions where you can observe their demeanor within groups.
- Scheduling: You’ll collaborate with group members to select a meeting day and time that works for everyone. Decide how you’ll communicate for this task: patient portal, phone, or email. If your calendar offers a reporting feature on overall appointments scheduled, use it to pinpoint popular days and times that are more likely to work for everyone.
- Documentation: How will you document the group session along with assessing each individual as needed? Some providers copy and paste their group notes into every patient’s progress notes. For faster work, find a note-taking solution that auto-populates your group progress note into the individual notes for everyone on the roster.
- Billing: Competent billing becomes even more important when managing reimbursement for multiple patients with differing insurance at the same appointment. To get paid on time, you need organized billing and personnel you trust, whether they’re in-house employees or an outsourced billing services company.
For virtual groups, scheduling needs to be even more intentional. You’re not just finding a time when everyone is available. You’re making sure participants can reliably join from an appropriate setting, understand how to access the session, and receive reminders that reduce missed or late arrivals. If you’re building this part of your workflow, group therapy software can make it easier to manage rosters, scheduling, and documentation in one place.
That’s one reason group workflow matters so much. Scheduling, documentation, and billing all become more complex when multiple clients are participating at once. If reimbursement is part of your evaluation process, our article on how to maximize your reimbursement for group therapy sessions is a helpful companion resource.
Set Expectations for the Group
To run a successful therapy group, you and the other members of the group share responsibility for creating a positive atmosphere. At your first group session, prepare clients for the realities and responsibilities of being a group member.
Lay out your attendance policy clearly. Explain that group treatment revolves around participation and interaction with others, so that if members don’t attend faithfully, they shortchange not just themselves but the rest of the cohort. Impress upon them their interdependency as they co-create an environment for growth.
Describe the agenda of an average session and encourage everyone to ask questions about the process. Make sure to set realistic expectations regarding the goals of this treatment.
Group therapy can give members tools for healing, but it won’t be an overnight solution for problems. Addressing behavioral health takes time. Framing it this way will help head off frustration and disappointment for those who want a quick fix.
For telehealth groups, it’s also important to explain what happens if someone joins late, loses connection, or has trouble participating. A clear process helps protect the flow of the group and keeps one disruption from affecting everyone else.
Late arrivals, in particular, can be more disruptive in virtual groups than in person. It helps to decide in advance whether late participants will be admitted immediately, held briefly while the facilitator finds a transition point, or asked to reconnect at the next session if they miss too much of the group. No matter what your policy is, explain it ahead of time so expectations are clear and group cohesion stays protected.
Set the Objective
The group as a whole, and each session in particular, should have an objective. Objectives could be to learn coping mechanisms, make behavioral changes, challenge unhelpful beliefs, practice new skills, gain self-insight, or learn more about a behavioral health diagnosis.
At your first session, talk with patients about specific benefits or changes you hope they will experience, and ask them what their objectives are for being here. At every subsequent session, give the group some indication of this week’s objective. Patients who have a goal in mind during the session are more likely to stay on track and feel motivated toward a destination.
The specific goals will reflect the type of therapy you’re giving. A support group for bereaved family members might exist to provide support and encouragement during the toughest days of grief. A psychoeducational group, on the other hand, might aim to teach management techniques for a particular disorder or set of symptoms.
This clarity becomes even more important online. In telehealth groups, a shared objective helps anchor the session and reduces the sense that members are simply logging into a loosely structured conversation. The stronger the group’s purpose feels, the easier it is to maintain attention, participation, and cohesion.
Learn Icebreakers
Come to the first few sessions with an icebreaker or other opening activity to jump-start conversation. The more you diffuse awkward silences early on, the easier it will be to maintain a supportive, inviting atmosphere that group members want to return to. Early investment in things like icebreakers can have an exponential downstream effect.
A quick Google search will return more icebreaker results than you can use, so dive right in and compile your favorites. Pick topics that don’t feel intrusive and that participants will enjoy talking about.
Virtual groups benefit from this just as much as in-person groups, and often more. A simple opening check-in, prompt, or structured warm-up can help members feel present before deeper discussion begins.
That shared start can make a telehealth session feel more cohesive and less transactional. If you’re looking specifically at virtual group workflows, how to make your group telehealth appointment a success is a useful next read.
Manage Interpersonal Dynamics
A good group therapy facilitator will pay close attention to group cohesion. Some groups may develop trust and an ease of communication on their own, while others need more help from the facilitator.
Be alert for characteristics and perspectives group members share in common and help bring them to the fore. The group might benefit from splitting into pairs for one-on-one work to get to know each other better.
Encourage group members to give one another feedback, and guide them in doing it constructively. Even disagreements can make group dynamics stronger when handled in a healthy way.
Help clients fight the tendency to shut down when conflict arises, and teach them the skills to manage conflict instead. The benefits of a therapy group depend on members’ ability to be honest with one another.
That being said, some interactions are harmful to group cohesion and need to be corrected right away. Examples include mean-spirited comments or criticism, gossip between participants about another group member, one member pressuring another to share personal details they aren’t ready to disclose, and other interactions that lessen the psychological safety of all group participants.
You may be able to solve the problem directly with the individual group members involved. However, if the incident has harmed the overall atmosphere of the group, you may need to address it with the entire cohort, while being careful to avoid shaming those involved.
In telehealth groups, cohesion requires more intentional facilitation. It’s harder to rely on body language alone.
Side conversations can be more distracting, and quieter members can disappear more easily into the background. Use direct prompts, structured turn-taking when needed, and regular check-ins to help everyone stay engaged.
It also helps to think ahead about how chat will be used. Chat windows and tools can support participation, especially for members who need a lower-pressure way to contribute, but it can also fragment attention if it becomes a parallel conversation.
Set expectations early about whether chat is for facilitator prompts, logistical issues, brief reactions, or full discussion. The goal is allowing chat to support the group, not compete with it.
Make Group Therapy Fun
Therapy may engage painful emotions, but patients also need enjoyable moments together. Lighthearted activities contribute to group cohesion and encourage good attendance.
Icebreakers and snacks set positive opening vibes with minimal effort, and you can sprinkle other activities throughout your session, such as:
- A song or movie clip that addresses patients’ issues in a positive way
- Group therapy games
- Collaborative projects (for example, drawing a mural together or writing a story one sentence at a time)
- A show-and-tell-style activity that allows participants to talk about their passions and hobbies
- Small prizes for exceptional attendance
In virtual settings, “fun” may need to look a little different, but it still matters. Shared reflection prompts, simple structured activities, visual exercises, and guided discussion can all help create energy without making the session feel forced.
The point isn’t entertainment. It’s helping the group feel connected enough that patients want to come back.
Successful Group Therapy Begins with You
You can set your therapy group up for success by adequately preparing for its logistics and challenges. Without preparation, creating a healthy group and treating patients successfully becomes more difficult.
Part of that preparation should involve a review of the practice management software that will be supporting your efforts. Any solution you use for scheduling, documenting, and billing should be built with the capability to manage groups, not just individual treatment.
For an all-inclusive Mental Health EHR and practice management resource that adeptly handles both types of treatment, check out Valant. Our software makes management a breeze whether you’re seeing one patient or ten. Create group rosters to schedule and bill en masse, and document group sessions easily without losing the flexibility to record individual patient information.
Contact Valant today to see how we can help you make your group therapy a success.
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