I encountered an article today about a subject I've often thought about: does group therapy actually have a risk of worsening underlying problems?
Here's a link to the article:
The mechanism could typically occur in the treatment of addictions, which is the subject of this article. The same mechanism might operate in the treatment of behavioural problems, including conduct disorders, eating disorders, maybe even mood disorders.
Basically, the concern is that the individuals in the group might actually "teach" others in the group about tactics to engage more deeply in the problem behaviour. The social bonds formed in the group might expand a person's network to engage in addictive behaviours. If some members of an addiction treatment group are severely involved in the addiction, are perhaps ambivalently committed to therapy, and may be connected to convenient resources in the community to access their addiction, this may facilitate other less severely involved members of the group to broaden their access to addictions.
In eating disorders, members of the group might "compete" with each other to some degree with eating disorder behaviours. If there are social leaders in the group who are still highly involved in the eating disorder, this may cause a negative peer pressure on others who are starting out.
On the other hand, an opposing, positive force in group therapy is encountering others who have understanding and personal experience of similar problems. This can be especially important for problems where a person often feels judged or misunderstood. Also, members of the group can teach others tactics to deal with moment-to-moment manifestations of the addiction. In order for these positive forces to be manifest, the group itself needs to be composed of individuals who are probably similar in terms of problem severity, and where there are individuals members of the group who are progressing. This introduces a social learning effect, in which an individual can see and emulate another individual with similar problems who is starting to make progress. The similar problem severity among members of the group would hopefully reduce the likelihood of mildly afflicted group members being drawn into more severe illness behaviours.
Since progress through problems is always a dynamic, individualized process, it may be that involvements with groups ideally need to change dynamically as well. If individuals are moving quickly away from addictive behaviours, they may ideally need to nurture group connections which are similarly healthy.
This poses another problem for many with long histories of addiction or other socially dynamic health problems: relationships which have been strongly associated with the addiction may need to left behind, or at least boundaried very carefully.