What I've Learned Running Ongoing Therapy Groups (And Wish I'd Known Sooner)

When I first started facilitating ongoing therapy groups, I thought the hardest part would be managing the clinical work. I was wrong. The real challenge? Creating a container that could hold people's stories while they came and went like tides—some staying for months, others drifting away after a few sessions, and new faces appearing just when the group started to feel settled.

I'll never forget my first ongoing group attempt. It started with six enthusiastic members and ended three months later with two regulars and a string of awkward goodbyes. I learned the hard way that ongoing therapy groups differ from time-limited cohorts in one fundamental way: there is no fixed end date. Members may enter or leave at different points in their healing journey, and my job as facilitator was to maintain a stable therapeutic container amid that fluid membership.

Done well, an ongoing group becomes what Irvin Yalom describes as a "social microcosm"—a living laboratory where participants practice new interpersonal skills, receive honest feedback, and build community that outlasts any single crisis.(Amazon) Done poorly (and trust me, I've been there), it can devolve into a revolving door of disconnected stories and unmet expectations.

After years of both beautiful breakthroughs and spectacular failures, here's what I wish someone had told me when I started.

Start With Your Why (And Actually Mean It)

I used to think I could wing the purpose conversation. "We're here to work on relationships," I'd say vaguely, hoping it would somehow work itself out. It didn't. Every decision I make now flows from what I call my therapeutic North Star—a crisp statement of purpose that I can recite in my sleep.

When I'm screening someone, I ask myself: Are you running a process group for adults with relational trauma? A skills-based group for managing chronic anxiety? Get specific about:

• Who you're serving and why. This isn't just for marketing—it's your screening filter.
• Your treatment approach. Whether it's interpersonal process, DBT skills, or ACT metaphors, name it and own it.
• Your therapeutic stance. I've learned I'm naturally more insight-oriented than skills-focused, and that's okay.
• How long you expect people to stay. I now tell everyone upfront that I recommend at least three months, with a check-in at six.

I literally wrote my frame in one paragraph that I quote verbatim during screening calls. It felt awkward at first, but consistency builds trust and sets boundaries before anyone even walks in the door.

The Intake Dance (Or: How I Stopped Winging It)

In my early days, I'd take anyone who could fog a mirror and pay the fee. Bad idea. Now I know that admissions are the make-or-break moment for group cohesion.

My current system saved my sanity:

1. I standardized everything. Every screening is now a 20-30 minute call with the same template. I cover presenting concerns, goals, prior group experience, suicide risk, and boring logistics. No exceptions.
2. I assess group readiness honestly. I look for three things: can they reflect on their own behavior, can they sit with discomfort without melting down, and can they both give and receive feedback? If someone seems too fragile or too explosive, I refer them for individual work first. I learned this the hard way when one member's crisis dominated six weeks of group time.
3. I space out new arrivals. One new person every 2-3 weeks max. I used to think more was better for momentum, but research shows that cohesion—which directly predicts outcomes—suffers when groups feel unstable.(PubMed)
4. I prep the existing group. I always announce new arrivals a week ahead and ask my veterans to remember what it felt like to be new. They're usually amazing at this.

I document every screening the same way in my notes, so if I'm sick, my co-facilitator knows exactly where things stand.

The Invisible Architecture That Holds Everything Together

I used to think rules were for rigid people. Then I watched my loosey-goosey approach create chaos when Sarah started showing up 20 minutes late every week and Marcus monopolized every session. Now I know that norms aren't restrictions—they're the invisible architecture that makes vulnerability possible.

Every time someone new joins (and periodically for everyone else), we revisit:

• The sacred rule of confidentiality. "What's said here stays here—including names." I don't just say it; I explain why it matters.
• How we handle attendance. I ask for two weeks' notice for planned absences and a check-in call after any no-show. It sounds controlling, but it actually creates safety.
• Our feedback culture. We use "I" statements, stay curious instead of judgmental, and check our assumptions before interpreting someone's behavior.
• What we do when things get messy. Because they will. I tell groups that conflict isn't the problem—avoiding repair is. Some of my best therapeutic moments have come from working through ruptures.

I keep these agreements visible, either posted in my virtual waiting room or on a handout people can reference. It's amazing how often someone will point to them and say, "Wait, I think we're breaking our own rule here."

The Rhythm That Creates Safety

I'm naturally a "let's see what emerges" facilitator, but I learned that structure actually creates more freedom, not less. My groups now follow the same 90-minute flow every week:

Time What We're Doing & Why 0–10 Settling in (usually a brief mindfulness moment or check-in) 10–15 Agenda setting (people name what they want to work on) 15–75 The actual work (processing, role-plays, skill practice) 75–85 Integration (what are you taking from today?) 85–90 Logistics and closing (always end on time)

I tweak the timing based on the group's needs, but I've learned that predictability helps people's nervous systems relax. When people know what to expect, they can go deeper.

Keeping Everyone in the Circle

My biggest ongoing challenge is preventing the "old-timers club" phenomenon. When people have been together for months, they develop inside jokes and shared references that can make newcomers feel like outsiders at a family reunion.

Here's what I do to keep everyone included:

• I gently manage airtime. When someone's been talking for a while, I'll say something like, "Tom, I want to hear from someone who hasn't shared yet, and then we'll come back to you."
• I actively connect stories. "Jada, your fear of being judged reminds me of what Carlos was exploring last month. Carlos, does this resonate with your experience?"
• I name what I notice. "I'm noticing the energy in the room shifts whenever we talk about money. What's happening for each of you right now?"
• I use rituals intentionally. New members bring a meaningful object in their second week. When someone leaves, we do a round of appreciations. These moments create connection across different lengths of membership.

The goal isn't to eliminate the special bonds that develop over time—those are precious. It's to make sure longevity creates depth, not hierarchy.

The Art of Saying Goodbye Well

Departures used to trigger my own abandonment stuff, so I'd either cling too hard or disconnect too early. I've learned that how people leave matters as much as how they arrive.

My current goodbye process:

• Two sessions' notice when possible. Obviously, if someone's in crisis, safety comes first. But when it's a planned departure, I ask for time to process it together.
• A private exit interview. Fifteen minutes to review what worked, what didn't, and what their next steps might be. This protects both them and the group.
• A meaningful goodbye ritual. Sometimes it's appreciation rounds, sometimes it's sharing hopes for their future. The group usually knows what feels right.
• Strategic waiting before filling the spot. I've learned to let the group breathe for at least a full session before bringing someone new in.

I also started tracking what happens to people after they leave (with their consent). It's become both a source of hope for current members and valuable feedback for me about what's working.

Measuring What Matters (Without Sucking the Life Out of the Room)

I used to resist data collection because it felt clinical and impersonal. But I've learned that measurement actually helps me serve people better. I keep it simple:

• Session Rating Scale and Outcome Rating Scale monthly. Two minutes, captures both session quality and life improvement.
• Personal goals we track together. Everyone picks 1-3 specific goals at intake, and we revisit them every three months.
• Quick pulse checks. One word for how you're feeling at the start, one sentence about takeaways at the end. I jot these in my notes.

Twice a year, I share aggregated improvements with the group (no individual details, obviously). It's powerful for people to see that they're not just surviving—they're actually growing.

The Practical Stuff That Nobody Talks About

Let me save you some trial and error on the logistics:

What I Learned The Hard Way Group size Six to eight people is the sweet spot for depth. I tried twelve once—never again. Ten is manageable only if you have a co-facilitator. Money matters Flat weekly fee regardless of attendance. It sounds harsh, but it promotes commitment. I limit sliding-scale spots and make them time-bound. Co-facilitation Game-changer. Having a second perspective, vacation coverage, and live supervision is worth every penny. We meet 15 minutes before and after each session. Space and tech In-person needs movable chairs and a clock I can see. Virtual requires HIPAA compliance, breakout rooms, and always—always—have a backup dial-in number.

The American Group Psychotherapy Association (AGPA) Practice Guidelines have been my bible for everything from confidentiality to cultural competence.(agpa.org)

When Things Go Sideways (And They Will)

Here are the problems I see most often and what I've learned to do about them:

When This Happens I Now Do This Instead of This Chronic lateness Explore the impact on the group together Ignore it and build resentment One person dominates Set gentle time limits and structured feedback Hope they'll notice on their own Energy drops after new members Group exercise on shared values and purpose Panic and add more new people I'm burning out Quarterly consultation and planned breaks Push through and get bitter

I've learned that structure isn't the enemy of spontaneity—it's what makes spontaneous healing possible.

Growing the Container Along With the People

The most important thing I've learned? The group structure itself should be a living experiment. Twice a year, I dedicate a full session to meta-conversation: What's working? What feels stale? What do you need more or less of?

I collect both written and verbal feedback, change one thing at a time, and explain my reasoning. When people see that our container can evolve without falling apart, they learn something profound about resilience and adaptation. Plus, they take ownership of the process in a way that makes my job infinitely easier.

What I'd Tell My Younger Therapist Self

Running an ongoing therapy group is one of the most rewarding and challenging things I do. It offers people opportunities for sustained growth that you just can't get in individual therapy. But the open-door nature demands thoughtful structure and constant attention.

If you get the foundation right—clear purpose, systematic intake, consistent norms, and rituals for hellos and goodbyes—you create a stable ecosystem where vulnerability can flourish. Add attuned facilitation and regular feedback, and your group won't just survive the comings and goings. It will thrive, session after session, year after year.

And when you mess up (because you will), remember that repair is always possible. Some of my best therapeutic moments have come from owning my mistakes and modeling how to make things right.

Ready to fill those empty chairs? For a step-by-step plan to recruit members and launch your first group, see our companion guide "How to Start & Fill a Therapy Group."