Process groups: what they are, how they work, and how to find one
A process group is a small therapy group, usually led by a licensed therapist, where the work is the relationships in the room. Instead of following a lesson plan, members talk about what is happening between them as it happens, and the group becomes a kind of live practice space for how each person relates to other people. If that sounds vague, stay with me. The thing about process groups is that they are quietly one of the most studied formats in group therapy, and for a lot of folks they do something individual therapy cannot. In my work I have seen people learn more about their patterns in three months of a good process group than in a year of talking about those patterns alone.
What is a process group?
A process group is a therapy group that focuses on the here and now: what members feel toward each other, what gets stirred up, what goes unsaid. The term comes from the interpersonal model of group therapy developed by Irvin Yalom, building on the earlier work of Harry Stack Sullivan. The core idea is simple. The way you are in the group is, over time, the way you are out in the world. So the group becomes a place to notice that, get honest feedback, and try something different while a therapist holds the frame.
This is different from the groups people picture first. A psychoeducation group teaches a skill or a topic. A support group gathers people around a shared experience, like grief or a diagnosis. A process group is less about content and more about contact. Unlike individual therapy, where it is just you and the therapist, a process group gives you a roomful of relationships to learn from in real time.
Who is a process group for?
Process groups tend to help people whose struggles show up in relationships. Folks who feel lonely even around others. People who keep ending up in the same kind of conflict and cannot see why. Anyone who has done a stretch of individual therapy and understands their patterns intellectually but still repeats them. In practice, the people who get the most from these groups are the ones willing to be a little uncomfortable and a little honest.
They are not the right first stop for everyone. If you are in acute crisis, a process group is not the place to start. And if you want a clear curriculum and concrete tools to take home this week, a structured group like a CBT group or a DBT skills group may fit better. There is no wrong door. There is just the door that fits where you are right now.
What does the research say?
The evidence for the interpersonal, process-oriented model is deep. A few anchors.
- The efficacy of group psychotherapy is well established and broadly comparable to individual therapy across many conditions (Burlingame & Strauss, 2021). You are not trading effectiveness for affordability when you choose a group.
- Group cohesion, the felt sense of belonging and trust, reliably predicts better outcomes. A meta-analysis of 40 studies found a significant positive relationship between cohesion and symptom improvement across diagnoses and settings (Burlingame et al., 2011). Cohesion is to a group what the therapeutic alliance is to individual work.
- Interpersonal learning, the heart of a process group, has measurable payoffs. In one study of group therapy for women with binge eating disorder, interpersonal learning was associated with improved self-esteem (Gallagher et al., 2014). What happens between members is not a side effect. It is the mechanism.
- Yalom catalogued the active ingredients of group therapy, things like universality, catharsis, and interpersonal learning, and decades of research have backed the model that process groups are built on (Burlingame & Strauss, 2021).
What happens in a typical session?
Most process groups run weekly for 75 to 90 minutes, with six to ten members and one or two therapists. There is usually no agenda. Someone starts, the conversation goes where it goes, and the therapist’s job is to keep the group looking at what is happening between people rather than only at events from the week. You might notice you always go quiet when one member speaks. You might get feedback that you come across colder than you feel. None of it is graded. It is just material.
The first few sessions can feel slow or awkward. That is normal, and honestly it is part of it. Trust takes time to build, and the group cannot do its work until members feel safe enough to be real. Most groups ask for a commitment of a few months so the group can find its footing. What I tell people is to give it four to six sessions before deciding. The early discomfort is often the exact thing you came to work on.
How do you choose a process group?
A few things to weigh before you commit.
- The leader’s training. Process groups ask a lot of the therapist. Look for a licensed clinician with group experience. It is fair to ask how long they have run groups and how they handle conflict in the room.
- Open or closed. A closed group starts together and stays together. An open group adds members over time. Closed groups often go deeper. Open groups can start sooner. Neither is better, they are just different.
- The screening call. Good process groups screen new members first. That is a green flag, not a hurdle. It means the leader is building a group that can actually hold the work.
- Format and cost. Virtual or in person, and what it costs. Every listing on The Group Guide shows this up front, so you are not guessing.
If you want help knowing what to ask, our guide on how to vet a group before you join covers the red flags and the green ones. And if the format question is what is tripping you up, online versus in-person groups breaks down the tradeoffs.
Finding a process group in our directory
The Group Guide lists therapy and support groups in all 50 states. You can browse process groups in the directory and filter by virtual or in person. If your area is thin, search virtual groups to open up the whole country. And if you are a clinician who runs a process group, you can claim a free founding-member listing so the people who need this format can actually find you.
Other resources
- American Group Psychotherapy Association: agpa.org. The main professional home for group therapy, with a referral directory.
- NAMI (National Alliance on Mental Illness): nami.org. Free peer support groups nationwide.
- 988 Suicide and Crisis Lifeline: call or text 988 any time, free and confidential, if you are in crisis.
FAQ
What is the difference between a process group and a support group?
A support group gathers people around a shared experience, like grief or a chronic illness, and the focus is mutual support and shared coping. A process group focuses on the relationships among members in the room, using what happens between people as the material for change. Support groups are often peer-led and free. Process groups are usually led by a licensed therapist and treat the group itself as a place to practice relating differently.
Are process groups as effective as individual therapy?
For many concerns, yes. The research on group psychotherapy shows outcomes broadly comparable to individual therapy across a wide range of conditions (Burlingame & Strauss, 2021). A process group also offers something individual work cannot: live feedback from several people and a chance to practice new ways of relating in the moment. The best choice depends on your goals, and some people do both at once.
Do I have to share personal details right away?
No. You set your own pace. Process groups work because trust builds over time, and a good leader will not push you to disclose more than you are ready to. Much of the early work is simply noticing what you feel as others talk. You can participate meaningfully long before you share anything deeply personal, and the noticing itself is part of the change.
How long should I stay in a process group?
Most groups ask for a commitment of a few months, and many people stay six months to a year or longer. The early sessions are about building trust, so leaving too soon means missing the part where the real work happens. A reasonable plan is to commit to four to six sessions, then talk with the leader about whether to continue. There is no fixed finish line, only the point where you have what you came for.
How much do process groups cost?
It varies. Clinician-led process groups often cost less per session than individual therapy, and some accept insurance or offer sliding-scale fees. Community organization groups in our directory are always free. Every listing on The Group Guide shows the cost before you reach out, so you can sort by what fits your budget. If cost is a barrier, ask the leader directly. Many have options they do not advertise.
References
Burlingame, G. M., McClendon, D. T., & Alonso, J. (2011). Cohesion in group therapy. Psychotherapy, 48(1), 34–42.
Burlingame, G. M., & Strauss, B. (2021). Efficacy of small group treatments. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield’s handbook of psychotherapy and behavior change (7th ed., pp. 583–624). Wiley.
Gallagher, M. E., Tasca, G. A., Ritchie, K., Balfour, L., Maxwell, H., & Bissada, H. (2014). Interpersonal learning is associated with improved self-esteem in group psychotherapy for women with binge eating disorder. Psychotherapy, 51(1), 66–77.
The Group Guide is a directory. Group leaders write their own listings, and we do not vet, supervise, or endorse the groups listed here. We are not a clinic and we do not provide clinical services or guarantee outcomes, that is the group’s work, not ours. If you are in crisis, call or text 988.