Dr. Dennis Morrison is the Chief Clinical Officer at Eleos and the owner of Morrison Consulting. Previously, he has served as Chief Clinical Officer at Netsmart Technologies, CEO of Centerstone Research Institute (CRI), and CEO of Center for Behavioral Health (CBH).
Group therapy was a cornerstone of my clinical practice—and remains my favorite treatment intervention, partly because it is so effective, but also because it is very intellectually stimulating. Yet despite its impact, it’s still underutilized across much of behavioral health.
Let’s dive into why that might be, explore the hidden benefits of group care, and discover how simplifying documentation can help leaders reintegrate this modality into their practice.
My Personal Journey with Group Care
Early in my career, I worked in a substance use disorder (SUD) program, where most care happened in groups. I learned early on that addictions cannot be separated from mental health care. (Based on that experience, when I became CEO of a mental health center, one of my first acts was combining the outpatient mental health and addiction departments into one.)
After my stint in SUD, I spent four years in an intensive partial hospitalization program serving high-functioning adults. We delivered roughly six hours of care each day, largely via groups (two process-oriented groups daily, complemented by various psychoeducational groups designed to build specific skills and knowledge).
Our process-oriented groups followed Irvin Yalom’s model of group psychotherapy, with two co-therapists working collaboratively in each session. My co-therapist, Sylvia—an exceptional group practitioner and social worker—became a mentor and friend who deepened my understanding of group dynamics and therapeutic processes. Over our four-year partnership, we facilitated approximately 3,000 hours of process-oriented psychotherapy groups together, while each of us independently conducted an additional 2,000 hours of psychoeducational groups.
That experience remains one of the most professionally rewarding in my career.
Why Groups Aren’t Used More Often
Group therapy remains the predominant treatment modality within SUD treatment settings. Still, despite its proven effectiveness, groups are underutilized in general mental health for several reasons.
Lack of Training
Many clinicians receive disproportionately more graduate training in individual therapy compared to group work. While group training is encouraged in most clinical training programs, the amount is not standardized. Some do have specific expectations for group training, but that appears to be the exception rather than the rule, especially for doctoral-level education.
At my alma mater, for example, master’s-level counselors-in-training must complete two 50-hour practica, and 10 hours of each must be group-focused. But PhD students have no such requirement beyond taking a mandatory three-credit class in group therapy. An informal and highly unscientific review of this situation leads me to conclude that group therapy training typically constitutes only about 10-30% of clinical education for psychologists and social workers, leaving many practitioners feeling underprepared to facilitate effective group experiences. Worse, the lack of emphasis on group versus individual therapy conveys a subtle second-class status to this modality in the minds of therapists-in-training.
Client Discomfort
The prospect of sharing intimate thoughts and feelings with a therapist is challenging enough for many clients. The additional layer of sharing these vulnerabilities with fellow group members can feel threatening and create a significant barrier to treatment engagement.
Operational Obstacles
Even when providers are ready and clients are willing, logistics can get in the way. Groups present unique hurdles, including:
- Coordinating schedules for multiple participants
- Securing appropriate meeting spaces
- Managing complex check-in processes
- Handling varying attendance patterns
While none of these barriers are insurmountable, the substantially greater documentation burden for groups may be the most significant deterrent.
The Documentation Problem
As much as I liked treating groups, I can honestly say that documenting the process was extremely tedious.
Compared to individual appointments, clinicians face considerably more complex charting challenges for group sessions, which usually require two tiers of notes:
- Process notes that go into all participants’ charts and describe the workings of the group in general, without identifying any individual participants, and
- Individual participation notes, which are specific to that particular client’s chart.
This is a much more onerous task than the “one-client-one-note” requirement in individual therapy.
Over the past six years, Eleos has made significant strides in assisting clinicians with their individual therapy documentation requirements.
Now, that same functionality has been made available for group therapy notes as well—removing the documentation barrier for groups.
The Unique Power of Group Care
The reluctance to embrace group therapy is particularly unfortunate given the robust evidence supporting its effectiveness.
Research consistently demonstrates that for most mental health conditions, group and individual therapy produce clinically equivalent outcomes. However, groups offer unique therapeutic advantages that individual therapy simply cannot replicate.
Universality: “I’m Not Alone”
One of the most potent therapeutic factors in group therapy is the experience of universality—the sense that others share the same struggles, thoughts, and feelings. While an individual therapist might reassure a client that “everyone feels that way,” hearing peers with lived experience expressing similar struggles carries greater therapeutic weight.
This interpersonal validation occurs organically within group settings and can fundamentally shift a client’s sense of isolation and embarrassment.
Peer Learning and Perspective
Groups create a natural laboratory for developing and refining coping strategies. When group members provide feedback about each other’s interpersonal approaches and share techniques that have proven helpful in their own lives, the resulting exchange is qualitatively different from what can occur in individual therapy.
When I was practicing in a group setting, the sincerity and creativity of peer feedback consistently amazed me—offering perspectives and solutions that might never emerge in one-on-one therapy.
Real-Time Practice and Feedback
Groups provide immediate opportunities to practice new behaviors, receive feedback, and work through interpersonal challenges in real-time. Members can address patterns of relating, communication difficulties, and social anxieties within the safe environs of the group.
Why Groups Add Up
Beyond clinical benefits, groups offer compelling financial advantages that could help address current funding challenges. Here are two ways to look at this impact:
Revenue-Based Benefits
For clients with insurance coverage, groups can generate more revenue per clinical hour than individual therapy. While third-party payers typically reimburse group sessions at a lower per-unit rate than individual sessions, the mathematics work in favor of groups. For example:
If individual therapy bills at $150 per hour and group therapy at $75 per hour, a group needs only three members to exceed the revenue of individual therapy.
One can argue that the differential hourly rate between groups and individual therapy is misplaced, given that they show similar clinical benefit, but that is a discussion for another time.
Cost-Based Benefits
For organizations serving uninsured or underinsured populations, groups dramatically reduce the per-client cost of service delivery. For example:
Using a hypothetical unit cost of $75 per clinical hour (including salary, benefits, and overhead), individual therapy costs $75 per client served. That same clinician facilitating a five-person group reduces the per-client cost to just $15—a five-fold increase in efficiency.
A Scalable Answer to the Workforce Crisis
The looming mental health workforce shortage underscores the urgency of this discussion. Projections suggest that by 2036, the United States will face 500,000 unfilled positions for mental health professionals.
This anticipated shortage will create worsening backlogs of needed care, making efficient service delivery models, such as group therapy, potential solutions to this problem.
Group therapy represents a scalable solution that could help bridge this gap while maintaining quality care.
By serving multiple clients simultaneously, experienced clinicians can maximize their impact and reach more people in need.
How to Expand Access Without Breaking the Budget
Many community-based behavioral health organizations operate as 501(c)(3) tax-exempt entities, receiving this status in exchange for providing community benefits such as free or reduced-cost care. While this arrangement benefits both organizations and communities, the capacity for unreimbursed care is not unlimited.
Budgets are finite—particularly during times of funding uncertainty—which is why it’s important to “quantify the mission.” In a related blog, I broke down how organizations can identify how much indigent care they can truly afford to provide.
Groups serve as a strategic tool for expanding access to free or low-cost services. When managed effectively, they help reduce per-client costs while maintaining therapeutic effectiveness. By providing more care to more people while keeping costs under control, organizations can expand their community benefits without compromising financial sustainability.
The Bottom Line: Making the Case for Group Therapy
The underutilization of group therapy represents a missed opportunity in behavioral health. The evidence overwhelmingly supports its clinical effectiveness, while economic realities make it an attractive option for both revenue generation and cost-effective care delivery.
As we face an impending workforce crisis and growing demand for mental health services, embracing group therapy is a viable option.
The therapeutic power of shared experience, peer support, and interpersonal learning that groups provide cannot be replicated in individual settings. By addressing the barriers to group implementation and recognizing its unique contributions, we can better serve our communities while building more sustainable and effective mental health care systems.
While utilizing group therapy may require retraining for some clinicians as well as creative solutions to logistical challenges, the biggest barrier—tedious documentation—is no longer an issue. An AI-powered tool like Eleos’ Groups Audio enables clinicians to focus on treatment rather than notes.
Request a personalized demo today to learn more about Groups Audio Sessions.
