Delivering treatment to a group of people together is a commonplace practice in mental health and justice-involved settings. Both efficient and equally effective as individual therapy, group therapy reduces wait times for treatment interventions, reduces therapist burnout, and, importantly, provides an ideal platform for promoting the social determinants of wellness, such as connection, hope, and purpose (Whittingham et al., 2023; Beck et al., 2021).
We know from our experience as group facilitators and trainers that these terrific benefits are not always easy to bring about. We often see difficulties such as group members (1) having low energy and little enthusiasm for the group content, (2) feeling disconnected from each other, (3) finding it difficult to participate in the group, and (4) not seeing the relevance of the content or skills to life outside group.
Recovery-Oriented Cognitive Therapy or CT-R—a person-centered and strengths-based approach to care (Beck et al., 2021)—can help address these challenges. By adding a few brief strategies and interventions to your content-focused or skills-based group, you can enhance the therapeutic impact and collective experience for your group’s members.
1. Start Each Group with a Connecting and Activating Activity
Why do this: Group sessions do not exist in a vacuum. People come to sessions with their own unique experiences of the day, their anxieties, and challenges. This can manifest in different ways, including low energy, disconnection, and distraction, all of which can make it difficult to participate within the group setting. One way to counter this is to introduce an activity at the beginning of the group session that elicits energy and focus and allows peers to actively connect with one another. The right activity to start the group can help each group member feel more at their best, promote a sense of belonging, create the feeling of a community and, ultimately, help everyone feel ready to make the most out of the group session.
How to do this: Group facilitators should introduce this intervention at the beginning of group by providing a brief rationale: “To get the most out of our time together, it might be helpful to get started with something that is going to help us all feel a little better, get energized, and get to know each other a little more.” Ideally, the group facilitator can elicit ideas for action together directly from group members, though initially, might need to float out ideas to demonstrate what can work. You might suggest taking turns listening to group members’ favorite songs, asking everyone to show a dance move, or sharing advice on making favorite dishes, etc. The group facilitator will know that an activating and connecting activity is effective when the group becomes more animated, spontaneous, energetic, and connected.
Why this works: CT-R theory includes an idea of modes. The disconnected mode is a time when people feel less like themselves, more stuck, and when negative beliefs are more active and accessible. When group members are in this mode, these beliefs are key to the challenges we see: low energy, not feeling like participating, not expecting the group experience to be successful or worth one’s time. The activity you plan can bring about a switch to the adaptive mode. These are the moments when a person is feeling more like themselves or at their best. Positive beliefs associated with feeling capable, connected, having more energy, and feeling more hopeful about the group experience become more active and accessible.
Pro tips: Starting group with activities that get everyone into the adaptive mode can be a great opportunity to define roles within the group—for example, one member can come up with possible activities during each session, one can take the poll for which one to do, and another can lead the group in doing it. Roles can contribute to group cohesion while also providing opportunities for individual group members to notice positive beliefs they are experiencing, such as capability, worth, contribution. Another way to add to cohesion is to develop together a phrase that captures the spirit of the group and why people might want to keep coming back: a mission. This could be “Project Resilience,” “Getting Better All the Time,” or “Achieving the Dream Team,” among other possibilities.
2. Draw Conclusions with Group Members Throughout the Session
Why do this: When group members are collectively or individually “at their best”—i.e., when they are engaging in an activity, helping one another, and/or celebrating successes— facilitators should note these successes, drawing members’ attention to these wins. This allows group members to notice their strengths and positive attributes, increasing access to positive beliefs (e.g., “I can connect with others,” “I am capable,” “Others see me as valuable”) and buffering against negative beliefs (e.g., “I am a failure,” “Others don’t appreciate me,” “What’s the point?”).
How to do this: Connecting and energizing activities and roles also provide the facilitator with the chance to guide group members to draw conclusions about these in-group experiences. This is done by asking targeted questions. For example, the facilitator might say to the group, “What did everyone notice about doing that together?” The facilitator could also provide examples, such as, “I noticed that I was feeling (more connected/energized/happy) when we were doing it; what did others notice?” In addition to becoming aware of the benefits of this type of connecting activity in the group setting, the facilitator can ask questions to generalize the experience (e.g., “If we all felt more energized doing this activity together, would it be worth doing more often?” or “What would it look like to do something like this outside of group?”).
Why this works: Most people, involved in a mental health setting or not, have a bias to notice the negative. We are sometimes quick to expect things to go poorly (e.g., “It won’t work out”) or evaluate things negatively, often taking the blame (e.g., “It must be my fault. I can’t do anything right”). By intentionally highlighting the successes within the group setting, the facilitator can counter the bias, helping members strengthen positive beliefs—about themselves, their relationships with others, or their futures. Doing this consistently helps members increase access to and ability to generalize these positive beliefs outside of group.
Pro tips: Facilitators can use the group mission to help members notice how their actions may be in line with what they are hoping to get out of group. For example, if group members establish a mission that is focused on empowerment, such as “Together, We’ve Got This!” the facilitator might link successes within the group to overall strength and resiliency.
3. Elicit and Develop Hopes for the Future
Why do this: A challenge in group therapy is to make the content or skills relevant to the person’s life. Facilitators can help group members experience the applicability of skills and ideas they’ve learned to their lives outside of the group. One way to address this challenge is to use the person’s hope for the future—their aspirations—to contextualize the use of these skills.
How to do this: Facilitators can elicit each group members’ aspirations by asking about their desires for the future. For example, they may ask, “If everything were the way you wanted it to be, what would that look like?” or “If the challenges didn’t feel so bothersome, what might life look like?”. It can be helpful to spend some time encouraging group members to develop a vivid picture of their hopes for the future as well as a deeper understanding of the meanings and values these aspirations represent. To enrich the image of an aspiration, the facilitator could consider asking questions such as, “What would your days look like if you [achieved this aspiration}?” or “Whom would you be spending time with?”. To uncover underlying meanings of values and aspirations, the facilitator might ask the group, “What would be the best part about achieving [these aspirations]?” or “How would others see you if you were able to do [achieve an aspiration]?”
Once aspirations have been elicited and discussed, the facilitator should briefly revisit them at the beginning of subsequent sessions to elicit motivation and hope–“Last time we were together some people mentioned wanting to [say the aspiration, such as help others]; does that sound right?”) Then, the session can be focused upon these aspirations (e.g., “Should we think of ways that [list the specific skills we are learning] might get us closer to those hopes for the future?”). These questions can guide the group’s discussions and empower members as they experience successes using the techniques or tools learned in group.
Why this works: Aspirations (hopes for the future) are a source of great meaning and motivation. Ultimately, aspirations are the context for trying something new, taking steps towards a desired future, and navigating challenges that come up. This can make aspirations a powerful anchor for groups—the why members might consider coming back or putting in the oftentimes difficult work around mental health.
Pro tips: The facilitator can maintain engagement and connection by jumping around the room during these discussions to get input from all members and highlighting areas of commonality (e.g., “It seems like connection is important to a lot of us”). Highlighting similarities can strengthen the alignment of group members and further discussions around ways to support one another as they move towards their aspirations.
By weaving CT-R principles into skills-based or content-focused groups, facilitators can create more energized, connected, and personally meaningful experiences for members. These small but intentional shifts help activate people at their best, strengthen positive beliefs, and anchor group content in each person’s hopes for the future. Ultimately, CT-R offers a practical pathway for making group therapy more engaging and transformative.
Beck, A.T., Grant, P.M, Inverso, E., Brinen, A.P., & Perivoliotis, D. (2021). Recovery Oriented Cognitive Therapy for Serious Mental Health Conditions. Guilford Press.
Whittingham, M., Marmarosh, C. L., Mallow, P., & Scherer, M. (2023). Mental health care equity and access: A group therapy solution. American Psychologist, 78(2), 119–133. https://doi.org/10.1037/amp0001078