The power of the group: How neuroscience supports expanding the therapeutic dyad through group psychotherapy

Group psychotherapy represents a therapeutic modality that provides unique affordances for patients, allowing layers of engagement by the patient in the psychotherapeutic process that are not available in dyadic psychotherapeutic treatment. This article considers psychodynamic group psychotherapy through the lens of current neuroscientific concepts. In doing so, we offer a framework for clinicians to consider how beliefs and habits that are originally adaptive become maladaptive and persist, and why patients hold on to maladaptive beliefs about the world and their own agency that are not reflective of the present-day moment. Neuroscientific proposals describing how early-life adaptations may result in longstanding false inferences regarding cause and effect in the world and within their emotional experiences will be evaluated alongside related psychological concepts. We will present and define the importance of neuroscientific concepts to the practicing psychotherapist, such as predictive processing, active inference, and the mentalization of interoception, as applicable to psychological and behavioral processes evidenced by the patient. The value that group psychotherapy specifically adds to processes needed to generate meaningful change will be explored in depth. How the milieu of group psychotherapy presents epistemic affordances to the patients in the group, which can then be leveraged in multiple ways to increase therapeutic benefit, will be addressed. Affordances in the group that offer patients unique interpersonal opportunities to address intrapersonal experiences such as mentalization of interoception and the activation of inference processes, creating lasting change, will be examined. The means by which interactions among group members decrease epistemic vigilance, increase epistemic trust, and facilitate epistemic foraging, thereby supporting necessary changes in mentalization capacity for patients, will be described. A case example will bring to light the elements, both neuroscientifically based and psychologically based, that are presented regarding the power of the group. Through access to and engagement with the process opportunities the group presents, patients can be supported by both therapists and other group members, affecting meaningful changes and ongoing present-moment adaptations over time for the individuals.