Group Therapy vs Individual Therapy: Pros, Cons and Who Each Suits

For many common conditions, group therapy and individual therapy work about equally well when they deliver the same treatment. A 2016 meta-analysis of 67 studies that compared the two formats directly found no meaningful difference in outcomes, dropout or remission. The choice usually comes down to fit: what you need help with, how comfortable you are sharing with others, privacy, scheduling and cost.

Individual therapy offers more tailoring and privacy. Group therapy adds peer support, the chance to practice with other people in the room, and often lower cost per session. Some treatments, such as dialectical behavior therapy (DBT), deliberately use both.

Group vs individual therapy at a glance

What the evidence says about effectiveness

Head-to-head comparisons

The strongest test of format compares group and individual versions of the same treatment within the same study. A 2016 meta-analysis in the journal Psychotherapy found 67 such studies. In the 46 that compared identical treatments, patients and doses, outcomes were equivalent, and there were no differences between formats in rates of treatment acceptance, dropout, remission or improvement. Depression, anxiety and substance use disorders showed the largest improvements in both formats.

Anxiety disorders

A 2020 meta-analysis of 57 randomized studies in generalized anxiety, social anxiety and panic disorder found group therapy more effective than no treatment, with no significant difference from individual therapy or medication in the smaller number of head-to-head studies. It also found that mixed-diagnosis groups appeared about as effective as diagnosis-specific groups, though the authors called for more evidence. For social anxiety specifically, a 2016 meta-analysis of 36 trials, mostly of group CBT, found no differences between group and individual formats. A group can be particularly useful in social anxiety because the room itself becomes a place to practice; see social anxiety disorder treatment.

Depression

NICE's 2022 depression guideline lists group CBT and group behavioral activation among the treatment options for less severe depression, and ranks group CBT second only to guided self-help on its reading of clinical and cost-effectiveness. For more severe depression, NICE's list starts with individual CBT combined with an antidepressant, followed by individual CBT and individual behavioral activation. For people who have recovered and want to stay well, it lists group CBT and mindfulness-based cognitive therapy as relapse-prevention options; see MBCT for preventing depression relapse.

PTSD

A 2019 meta-analysis of 20 trials found group therapy for PTSD clearly better than no treatment, particularly exposure-based group CBT, but the authors said little is known about how it compares with individual therapy. Individual trauma-focused therapies remain the better-established first choice; the guide to CPT, PE and EMDR explains those options.

DBT: where group and individual therapy work together

Standard DBT is built from several parts: individual therapy, group skills training, telephone coaching and a consultation team for the therapists. The skills group teaches skills in a class-like format, while individual sessions apply them to your own life.

A 2015 trial led by DBT's developer tested which parts matter. It randomized 99 women with borderline personality disorder and recent suicidal or self-harming behavior to standard DBT, DBT skills training with case management, or DBT individual therapy without skills training. All three reduced suicide attempts similarly, but the versions that included skills training did better on self-harm and depression, and standard DBT had lower dropout than individual therapy without skills. The authors concluded that DBT interventions that include skills training are more effective than those without it.

A 2019 meta-analysis of 24 trials also found group therapy for borderline personality disorder more effective than usual treatment. If you are considering DBT, ask whether a program offers the full model or only parts of it. The guide to borderline personality disorder treatment covers DBT and alternatives, and the practice's DBT page and DBT vs CBT article give more background.

Privacy and confidentiality in groups

Privacy is the concern people raise most often about groups. Here is how it works in practice.

• The therapist is bound by professional confidentiality, just as in individual therapy.
• Group members are asked to keep what they hear in the group private. The American Group Psychotherapy Association's practice guidelines recommend a group agreement covering confidentiality and members' responsibility to protect each other's privacy.
• That agreement is not strictly enforceable on members; only the therapist's confidentiality is. AGPA's ethics guidelines ask group therapists to know the limits of privileged communication in group settings and to inform members of them.
• Therapists are expected to explain how contact between members outside sessions is handled, because outside relationships affect the group.

Practical steps help. You can share at your own pace, use only your first name, and tell the leader before joining if you might know someone in the group. If you work in a small professional community or a public-facing job, individual therapy may simply be the more comfortable choice.

Cost and access

Group sessions can cost less per session than individual sessions because the therapist's time is shared. NICE's ranking of group CBT for less severe depression explicitly took cost-effectiveness into account. Groups can also be easier to find in some settings because one therapist can see several people at once.

Before joining, ask about the full cost of the program rather than a single session, how many sessions are included, and whether your insurance covers group therapy in or out of network. If you plan to use out-of-network benefits, the guide to comparing in-network and out-of-network costs explains how to estimate what you will actually pay.

Who each format tends to suit

Group therapy is usually not the right first step during an acute crisis, if you are actively suicidal, during an untreated manic or psychotic episode, or when you cannot yet tolerate being in a room with others. In those situations, individual assessment and stabilization come first. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

What a group session is like

Groups vary widely, and it helps to know which kind you are joining.

• Skills or psychoeducational groups, such as group CBT, behavioral activation or DBT skills, run like a structured class with homework and a set curriculum.
• Process groups focus on the interactions among members, with less structure and often an open-ended timeline.
• Support groups, often peer-led, offer connection but are not therapy, and they are often not run by a licensed clinician.

AGPA's guidelines describe preparing members before the first session, including reviewing the group's goals, expectations of members and how confidentiality will be protected. A pre-group meeting with the leader is a good sign. Also distinguish group coaching or educational programs from group therapy: they can be valuable, but they are not treatment.

Common worries about joining a group

Hesitation about groups is normal, and most worries have practical answers.

• "My problems are not as bad as everyone else's," or "they are worse." Well-run groups screen members so that the group is a reasonable match, and leaders keep the focus on shared skills and experiences rather than comparison.
• "I will be judged." Groups set norms about respect at the start, and leaders are responsible for enforcing them. Many people report that hearing others describe the same struggles is a relief.
• "I will not get enough attention." That is a real trade-off. If you need a lot of individual tailoring, individual therapy or a combination may serve you better.
• "Someone will repeat what I say." Confidentiality agreements reduce this risk but cannot remove it, which is why you choose what and how much to share.
• "I am too anxious to speak." For social anxiety this is often the point of the group: it is a supported place to practice, and leaders pace participation.

Three ways to decide, depending on your situation

Most people do not need to pick one format forever. These decision paths reflect how clinicians commonly think about it.

If your main goal is learning a defined set of skills

Skills such as DBT emotion regulation, CBT for insomnia, or behavioral activation for depression are taught well in groups, and the group gives you practice and accountability. Start with the group if one is available with a trained leader, and add individual sessions if you find you cannot apply the skills to your own situation.

If your difficulties are complex or very private

If you are dealing with several conditions at once, a recent trauma, or material you are not ready to share with peers, start individually. Once you are more stable, a group can add peer support and practice. The guide to medication, therapy or both covers how therapy fits with medication if you are also considering that.

If you are trying to stay well after recovery

Relapse-prevention programs such as group CBT and MBCT are delivered in groups by design. They work best when you are already well enough to attend consistently and do home practice.

Questions to ask before joining a group

• What kind of group is this: skills, process or support? Is it closed (same members throughout) or open?
• Who leads it, and what training do they have in this treatment?
• How many members are there, and how are they screened?
• How long does it run, and what happens if I miss a session?
• What are the confidentiality rules, and what happens if someone breaks them?
• Can I combine the group with individual therapy or medication management?

What the evidence does not show

• Equivalence on average does not mean every group equals every individual therapy. It holds best when the treatment, patients and dose are the same.
• For PTSD, the comparison between group and individual therapy is still uncertain.
• Researcher allegiance to a format influenced results in some head-to-head studies.
• For PTSD, evidence on group therapies other than CBT is thinner.

The guides to CBT and psychodynamic therapy and how long therapy takes help with the next decisions, and the practice's guide to finding your therapy match covers fit more broadly.

How this practice approaches therapy formats

The practice's ongoing care includes psychotherapy, including CBT and DBT, along with psychiatric evaluation, medication management and coaching. Its online program includes a Course + Live Group Coaching option with weekly virtual calls with Dr. Lewis; it is an educational course and does not provide diagnosis, individual medical advice, medication management or emergency psychiatric care. Whether the team runs any therapy groups, such as a DBT skills group, is a question to ask on the free discovery call. You can read about the practice's psychotherapy services and begin with the Patient Interest Form. More guides are collected in Choosing Psychiatric Care.

Frequently asked questions

Can I do group and individual therapy at the same time?

Yes, and some treatments are designed that way. Standard DBT combines individual therapy with a skills group. If you see different clinicians for each, ask them to coordinate.

Do I have to talk in group therapy?

Most groups let you participate at your own pace. Skills groups focus on learning and practicing techniques, so sharing personal details is usually optional. Ask the leader what is expected.

Is online group therapy as good as in person?

Many groups now run by video. The research summarized here mostly studied in-person groups, so ask how an online group handles privacy, such as members joining from a private space.

What if I know someone in the group?

Tell the leader before the first session or as soon as you notice. Leaders usually have a plan for this, which can include joining a different group.

Is a support group the same as group therapy?

No. Support groups, often peer-led, offer connection and shared experience. Group therapy is led by a trained clinician and follows a treatment plan or method.

Does insurance cover group therapy?

Coverage varies by plan. Ask your insurer whether group psychotherapy is covered in and out of network, and what you would be reimbursed per session.

Sources

1. Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy (Burlingame GM et al.), PubMed 27918191, 2016. pubmed.ncbi.nlm.nih.gov
2. Efficacy of group psychotherapy for anxiety disorders: A systematic review and meta-analysis. Psychotherapy Research (Barkowski S et al.), PubMed 32093586, 2020. pubmed.ncbi.nlm.nih.gov
3. Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials. Journal of Anxiety Disorders (Barkowski S et al.), PubMed 26953823, 2016. pubmed.ncbi.nlm.nih.gov
4. Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research (Schwartze D et al.), PubMed 29179647, 2019. pubmed.ncbi.nlm.nih.gov
5. Depression in adults: treatment and management (NG222), Recommendations. National Institute for Health and Care Excellence (NICE), 2022. nice.org.uk
6. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry (Linehan MM et al.), PubMed 25806661, 2015. pubmed.ncbi.nlm.nih.gov
7. Practice Guidelines for Group Psychotherapy. American Group Psychotherapy Association, n.d.. agpa.org
8. Group psychotherapy for borderline personality disorder: A meta-analysis of randomized-controlled trials. Psychotherapy (McLaughlin SPB et al.), PubMed 30869973, 2019. pubmed.ncbi.nlm.nih.gov
9. Ethics in Group Therapy (AGPA and IBCGP Guidelines for Ethics). American Group Psychotherapy Association, n.d.. agpa.org

Educational information, not medical, tax or legal advice. Decisions about diagnosis, medication and treatment belong with a clinician who knows your history.