Group Setting and Therapist Responsiveness: A Narrative Review

Abstract

Although therapist responsiveness is a crucial factor in the effectiveness of psychotherapy, its role in group settings remains under-explored. This narrative review examines therapist responsiveness in group psychotherapy, exploring its theoretical basis, empirical evidence and practical implications. A narrative literature review was conducted using major academic databases, including PubMed, ProQuest, APA PsycArticles, ScienceDirect and PMC. The 11 included studies are primarily small-scale qualitative projects, including case studies, clinical vignettes, and thematic analyses. This inevitably limits the generalizability of the results. A cross-cutting thematic synthesis of these studies reveals five dimensions of group therapist responsiveness: empathy; creating a welcoming atmosphere; paying attention to subjective experience; personalizing interventions within the group context; and facilitating reflectivity and mentalization. The main limitations of the present study’s methodology are its unregistered status and the exclusion of grey literature. Future research should focus on developing validated measurement tools, conducting experimental studies, exploring cultural variations, and assessing therapist responsiveness in online group therapy settings. This narrative review emphasizes the importance of responsive therapeutic approaches in psychiatric settings and group psychotherapy, and highlights the need for further empirical research to refine theoretical models and enhance clinical applications.

1. Introduction

Responsiveness in psychotherapy refers to the therapist’s ability to attend to and respond promptly to the specific needs of the patient. Bacal [1] introduced the term ‘optimal responsiveness’, meaning the ability of therapists to adapt all their behaviors to the uniqueness of the therapeutic relationship, transcending the theoretical reference model. Stiles et al. [2] added that the response must be ‘appropriate’ in the sense that it must support the patient’s needs in the context of their life. This implies a commitment to always doing the ‘right thing’ at the ‘right time’, pursuing therapeutic goals and taking into account the specific history of the relationship, including the resources and limitations of the context [3]. Responsiveness can thus be seen as a pervasive feature of the therapeutic relationship [4] and an important contributor to treatment effectiveness [5,6].

Although responsiveness may be similar to other therapist characteristics, such as active listening and emotional closeness, as highlighted by Rogers [7], it can be defined as an umbrella term encompassing several dimensions activated simultaneously. These include the ability to understand the patient’s needs arising in the present moment of the therapy and respond promptly. This overlap presents challenges in the clear operationalization and assessment of responsiveness, yet it underscores its critical role in effective therapeutic outcomes [8]. Recently, scientific debate has expanded the construct of responsiveness beyond individual therapy, examining its role in group psychotherapy [9], both in relation to the treatment of specific patients [10,11] and in relation to assessment tools [8,12,13,14].

In group settings, where interpersonal interactions and shared experiences guide the therapeutic process, the therapist’s responsiveness is crucial for managing group dynamics, resolving conflicts and ensuring that all members feel heard, valued and engaged. However, although there are studies, including experimental ones, that describe how responsiveness works, there are no reviews in the literature that summarize and analyze the responsiveness of group therapists. Responsiveness within groups generally appears to be similar to constructs such as therapeutic alliance [15], cohesion and climate [16,17,18]) and dynamics between group members [19]. Research has also highlighted the importance of therapist responsiveness in group settings, noting that adaptive interventions by the therapist can facilitate client reflexivity and the assimilation of problematic experiences. This process is crucial for clients dealing with issues such as social phobia, as it promotes deeper self-understanding and therapeutic progress [20]. Furthermore, extensive research has examined the various therapist characteristics that contribute to effective responsiveness [21]. In summary, therapist responsiveness—characterized by ethical behavior, cultural competence, adaptability to different contexts and the capacity to foster collaborative environments—is pivotal to the success of group therapy.

2. The Group Therapist

2.1. The Role of a Group Therapist

The role of a group therapist is multifaceted, requiring the integration of various interpersonal, cognitive, and emotional skills to facilitate therapeutic processes within a group setting. Unlike individual therapy, which is characterized by a dyadic relationship, group therapy involves navigating complex interpersonal interactions, fostering group cohesion, and managing diverse emotional responses among members. The primary responsibilities of the group therapist include establishing a safe and supportive environment, guiding discussions, addressing conflicts, and ensuring that all participants feel acknowledged and valued. Drawing upon the foundational work of Foulkes [22] in group analysis, the group therapist functions not merely as a directive authority but as a conductor, orchestrating communication and interaction rather than dominating discourse. Foulkes emphasized the relational network within the group, in which the therapist acts as a catalyst for shared insights and mutual influence among members. His concept of the group matrix, a shared psychological space that binds members together, highlights the necessity for therapists to remain attuned to both individual and collective processes. This perspective aligns with contemporary research emphasizing the importance of group dynamics, transference, and mirroring processes in therapeutic change [23]. Ultimately, a skilled group therapist integrates responsiveness, emotional attunement, and an understanding of group dynamics to facilitate both individual transformation and collective healing. According to Yalom and Leszcz, the group setting itself provides unique opportunities for members to receive feedback, observe others, and engage in corrective emotional experiences that promote psychological growth. By facilitating open communication, conflict resolution, and emotional expression within the group, the therapist helps create a supportive community that nurtures both individual and collective change. These therapeutic mechanisms, alongside the therapist’s ability to navigate group dynamics and validate each participant, contribute to group therapy’s efficacy in promoting change [24,25].

2.2. Group Therapist Characteristics

A group therapist embodies a set of key characteristics that are crucial for creating a safe, effective, and supportive therapeutic environment. These characteristics allow the therapist to navigate the complexities of group dynamics, manage diverse personalities, and guide individuals toward personal growth within a specific setting.

The most studied characteristics of the group therapist include:

• Empathy: a fundamental trait for any therapist, empathy enables the group therapist to deeply understand and resonate with the emotional experiences of group members. This emotional attunement fosters trust and openness, enhancing the therapeutic alliance within the group [26].
• Active Listening: a skilled therapist engages in active listening, attending to both verbal and non-verbal cues. This skill is essential for ensuring that each member feels understood and for recognizing underlying emotions and unspoken needs, which are crucial for effective interventions [25].
• Emotional Regulation and Attunement: emotional attunement refers to the therapist’s ability to recognize and appropriately respond to the emotional states of clients. This includes managing one’s own emotions and being sensitive to the emotional atmosphere of the group. Effective emotional regulation allows the therapist to maintain balance and guide the group through challenging moments, helping prevent emotional overwhelm or regression [23].
• Cultural Sensitivity: in increasingly diverse therapeutic settings, cultural competence is essential. A group therapist must be aware of cultural differences in emotional expression, communication styles, and group dynamics. This sensitivity ensures that all members feel respected and understood, and it helps prevent misinterpretations or conflicts arising from cultural misunderstandings [27].
• Flexibility and Adaptability: group therapy involves ever-evolving dynamics, and the therapist must be able to adjust their approach to suit the needs of the group. This adaptability is key in managing shifting group energies, addressing conflict, and responding to different levels of engagement from participants [23].
• Strong Therapeutic Alliance Skills: the therapist must build and maintain a strong therapeutic alliance with each group member, creating trust, respect, and mutual collaboration. Research has shown that a solid alliance is linked to positive therapy outcomes, as it creates a foundation for vulnerability, feedback, and personal growth [25,26].
• Group Process Knowledge: a profound understanding of group dynamics is critical for effective facilitation. This knowledge allows for the successful resolution of conflicts, the promotion of healthy interactions, and the cultivation of a shared therapeutic purpose [22,28].
• Ethical and Professional Integrity: ethical conduct is essential in maintaining the safety and well-being of group members. A group therapist must be transparent, set clear boundaries, and maintain confidentiality. They also need to possess a strong sense of ethical responsibility, guiding the group with professionalism and accountability [1].
• Leadership and Facilitation Skills: while the group therapist is not meant to dominate the group, they must take on a leadership role in guiding the group process. This involves structuring sessions, encouraging participation, managing conflicts, and ensuring that the group remains focused on its therapeutic objectives [23,29].
• Self-Reflection and Ongoing Growth: an effective group therapist is committed to continuous self-reflection and professional development. Examining personal biases, emotional reactions, and their influence on the group process is essential for maintaining a high standard of practice. This commitment to self-awareness and growth allows the therapist to remain open to feedback and refine their therapeutic approach [30].

In summary, the role of a group therapist extends beyond traditional clinical expertise, requiring a combination of interpersonal sensitivity, emotional intelligence, and an in-depth understanding of group dynamics. Integrating foundational theories from Foulkes [22] and Yalom and Leszcz [23] with contemporary research, an effective therapist fosters a therapeutic space that supports both individual and collective growth.

A crucial aspect of this role is therapist responsiveness, which involves adapting interventions based on the group’s evolving needs, emotions, and interactions. Responsive therapists are attuned to shifts in group dynamics, modifying their approach to address conflicts, and facilitate meaningful exchanges. This adaptability has been shown to be a key predictor of therapeutic success, as it allows therapists to optimize interventions in real time and ensure that each participant feels seen and supported [24]. By embodying key characteristics such as cultural sensitivity, emotional attunement, and ethical integrity, the therapist ensures the efficacy of group therapy in promoting psychological resilience and healing. Ultimately, the therapist’s ability to facilitate open communication and support emotional expression plays a vital role in the transformative potential of group therapy.

3. Rationale and Aim

The experiences of psychotherapists have always been of interest in psychotherapy research, particularly in recent years. However, there are still no studies in the literature that examine the therapist’s responsiveness within psychotherapy groups. This could be crucial, given the effectiveness of group treatment, particularly with certain patients.

Studies were selected in which psychotherapists play a leading role in groups with patients experiencing various issues. The psychotherapeutic model consists of three approaches: psychodynamic, cognitive behavioral and expressive. This provides a more comprehensive view of the construct of responsiveness and an opportunity to reflect on comparisons between models, a constant topic of debate in psychotherapy research.

The present research has focused on the figure of the therapist, exploring therapists’ different characteristics [31,32], such as their ethics [1,33], perception [34], and role [35] in different contexts, such as online [36] and transcultural [27,37,38]. The present narrative review aims to explore the responsiveness of the group psychotherapist, excluding other characteristics that are similar to the construct, but not fully assimilated. To this end, a review was conducted to describe the responsive attitude of therapists. This will help us better understand the specific characteristics of responsiveness, how to operationalize and evaluate them, and how to develop them through training and supervision.

4. Methods

The study itself has not been registered.

The research is guided by the following questions:

Q1: How responsive are group therapists within the group?

Q2: What group dynamics does this attitude provoke?

The three authors of this manuscript conducted independent research on the topic, examining only the full texts of studies. During several meetings, the researchers discussed these studies from an epistemological perspective and agreed which studies to include and which to exclude. The main criterion for comparison was whether the therapist displayed a responsive attitude in all the selected articles.

4.1. Eligibility Criteria

Inclusion and exclusion criteria are listed below:

Included:

• Full-text scientific articles;
• Studies on the relationship between therapist responsiveness and group psychotherapy since 2004.

Excluded:

• Reviews, systematic reviews and meta-analyses;
• Abstract;
• Book chapters;
• Grey literature.

4.2. Search

A preliminary search was conducted in Google Scholar to review the existing literature on the topic. A search was conducted for systematic reviews and meta-analyses on the subject, but nothing was found. Specifically, no prior review was identified that explicitly synthesizes group therapist responsiveness Although grey literature was consulted, it was excluded from the research as it was not specific enough to the subject of this paper. Between September and December 2024, more in-depth research was conducted using several academic databases, including PubMed, ProQuest, APA Psycarticles, ScienceDirect and PMC. These databases were chosen based on their comprehensive indexing of psychological and psychiatric literature, ensuring broad coverage of empirical studies on therapist responsiveness in psychotherapy.

PubMed and PMC provide access to peer-reviewed medical and psychological studies, ProQuest includes dissertations and multidisciplinary research on psychology-specific articles.

The search option ‘Academic Journals’ was specifically selected to exclude degree theses and grey literature. Finally, ScienceDirect offers access to research in the field of behavioral science.

The following keywords were used for each database: “therapist responsiveness” AND “group psychotherapy” AND “role of the psychotherapist” AND “therapist attitudes” AND “therapist characteristics” AND “group setting” OR “group”. These terms were selected to capture studies specifically examining therapist adaptability and its impact on group dynamics. Synonyms and related terms were considered but excluded to maintain specificity.

Subsequently, keywords such as “role of the psychotherapist”, “therapist attitudes”, “therapist characteristics” AND “group setting” OR “group” were excluded because they would not have been focused enough to meet the research objective, resulting in overly broad categories.

4.3. Selection of Sources of Evidence

Articles for which only the titles and abstracts were visible were excluded; only the full texts were evaluated.

This evaluation was conducted independently by all three authors of the article. There was constant dialogue throughout the process regarding the content of the articles, and ultimately, the studies that were deemed to be the most significant for the narrative review were agreed upon. Drawing on different theoretical models (psychodynamic, systemic, and humanistic), the three authors.

This search yielded a total of N = 705 articles, categorized as follows: PubMed N = 318, ProQuest N = 243, APA Psycarticles N = 7, Sciencedirect N = 42, PMC N = 95. This narrative review examines the period from 2004 to 2024. Building on Bacal’s 1985 [1] study of responsiveness, contemporary psychotherapy research has focused on the role and experiences of the therapist.

5. Results

The analysis of the selected articles revealed the following categories and recurring themes, which are useful for understanding the construct of group therapist responsiveness. These categories are described in detail in the following paragraphs and are listed below.

• Empathetic therapist

Therapists’ curiosity and attention towards patients’ personal stories indicates a highly empathetic attitude.

b.

Welcoming atmosphere

The psychotherapy groups described are welcoming and accepting, and are eager to learn about their members’ psychological experiences.

c.

Experience

To listen to a patient’s story is to go beyond the diagnostic label and understand the nuances of their unique experience.

d.

Personalization

In all of the selected studies’ psychotherapy groups, each individual member is considered unique within a group.

e.

Mentalization

Therapists’ empathy promotes the reflective capacity and mentalization of group members.

The results of all the studies are summarized in

Table 1. Group therapy responsiveness.

Study ID	Country	Sample Characteristic	Design	Theoretical Model	Group Characteristic	Identified Elements of Therapist’s Responsiveness	Main Finding
Beck and Coffey (2005) [39]	USA	N = 2 Therapists N = 1 Therapist N = 1 Co-Therapist	Case Study	Cognitive Behavioural	N = 1 Group Participants: N = 5 women, (ages 33 to 56) with PTSD caused by a Serious motor vehicle accident (12 sessions)	Case example: “It is critical that the therapists be alert to an individual feeling” (p. 10) “Therapists’ role in this treatment is conceptualized as that of a coach—someone who has awareness and appreciation for the individual’s current struggles yet encourages them to push the boundary slightly” (p. 10)	Therapists take a personalized approach with each patient in the group, creating a welcoming atmosphere
Chen et al. (2008) [40]	USA	N = 2 Therapists N = 1 30-year-old white woman N = 1 40-year-old, Latino, gay male	Case Illustrations	Cognitive Behavioural	N = 2 Groups Participants: Case 1: N = 7 three white, one black, two Asian Americans, and one Latina (ages 60 to 75) with Depression Case 2: N = 9 servicemen PTSD (ages 21 to 39) (Among the racial minority members in the group are two blacks and one Arab American	Cases illustrations: Case 1: “Therapist adopts an active style with the group and introduces cognitive restructuring as a way to explore each member s experience with depression” (p. 1262) Case 2: “The group therapist as a local clinical scientist deliberately considers, identifies, and implements culturally appropriate interventions, although they may be at variance from RSTs and practice guidelines” (p. 1267)	Therapist pay attention to the specific culture of the patients and their experiences
Joyce et al. (2010) [41]	Canada	N = 4 Therapists N = 2 women N = 2 men (ages 45 to 62).	Comparative trial	Psychodynamic	N = 18 Groups Participants: N = 135 (ages 22 to 74) short-term groups (STG) for Complicated Grief (weekly 90-minutesessions for 12 weeks)	Case descriptions: “During the sessions, the therapist attempts to create a climate of tolerable tension and deprivation wherein conflicts can be examined using here and-now experience” (p. 125) “Therapist’s interpretations might be delivered with more tentativeness and openness to correction by the patient.” (p. 133)	Therapist creating a welcoming atmosphere
Penttinen et al. (2017) [42]	Finland	N =1 Therapist 50-year-old, male Ph.D, a licensed and experienced psychotherapist	Case Study	Cognitive Behavioural	N = 2 Groups for Social Phobia Participants: N = 17 Case 1: N = 10 Case 2: N = 7 (12 weekly two-hour sessions)	Qualitative analysis of three conversational episodes with one female patient: 1.”Therapist offered a formulation of her problematic experience which was relevant to the intention of her dominant voice, but did not in any way address the feelings” (p. 11) 2. “Responded by listening empathically” (ibidem) 3: “Pointed to the significance of the client’s own construction of her problematic experience” (ibidem)	Therapist’s responsive attitude facilitates the patients’ assimilation of their experience
Euler et al. (2018) [43]	Switzerland	N = 2 Therapists N = 1 senior psychiatrist N = 1 advanced clinical psychologist (co-therapist)	Cyberball Task	Psychodynamic	Mentalization-based groups psychotherapy Participants: N = 23 patients with Borderline Personality Disorder N = 28 healthy participants three sessions of 75 min per week in their 2nd week after admission to the unit.	Case Discussion “Even the exclusion-prone patients appeared to be capable of seeing the therapists not as malevolent” (p. 7) “Anactive, responsive and reliable therapeutic stance has been described as a hallmark of all empirically supported therapies for BPD” (ibidem) “This fairly “inclusive”—to some extent perhaps even “over-inclusive”—attitude may partially explain why patients did not feel uncomfortable toward the therapists in our study” (p. 8)	Patients feel welcome within the group that develops mentalization
Arias-Pujol and Anguera, (2020) [44]	Spain	N = 2 Therapists N = 1 expert lead therapist N = 1 co-therapist	Mixed methods	Psychodynamic	N = 1 Group Participants: N = 6 Adolescents (Ages 13 to 15) with learning and interpersonal relationships (30 sessions)	Clinical vignette: “The lead therapist (T) plays a very active role, encouraging participation so that the adolescents can get to know each other” (p. 5) “The lead therapist (T) wants to know their opinions about the experience” (ibidem)	Therapists facilitate communication and develop mentalization
Wendt et al. (2021) [45]	Germany	N = 2 Therapists, experts women psychological (child and adolescent)	Qualitative interview	Cognitive Behavioural	N = 1 Group Participants: N = 7 Adolescents (ages 12–18) with Internet Gaming Disorder (8 modules of 90 min)	Interviews with therapist: “In addition to knowledge about gaming addiction, being a group therapist also requires you to keep up to date with computer games. (p. 14) “To stick strictly to the module is not possible with this topic anyway. […] It requires a therapist who is also experienced enough to respond flexibly to the needs [of the patients] at that moment.” (p. 16)	Therapists customize the intervention based on their specialist knowledge of psychopathology
Van Tilburg et al. (2022) [46]	Netherland	N = 18 Therapists N = 10 women N = 8 men with 5–10 years of experience	Qualitative	Cognitive Behavioural	N = 25 Groups Participants: N = 133 Men Intimate Partner Violence Perpetrators (60 sessions)	Audio recording (therapist’s interventions “ Showing interest, enthusiasm and empathy when participants report positive behavior in the context of the treatment objectives, giving recognition, giving compliments, thanking someone for his input, wishing someone positive things, talking about the group atmosphere, putting someone at ease, social small talk.” (p. 317) “Encouraging the participants” (p. 314) “Using humor, self-deprecation or laughing about a joke the patient has made.” (p. 317)	Therapists show empathy, understanding and exploration of the specific experience and creates a welcoming atmosphere
Grunberg et al. (2022 [47])	USA	N = 1 Therapist	Case Illustration	Cognitive Behavioural	N = 1 Group Participants: N = 3–6 women with Postpartum Mood and Anxiety Symptoms (weekly 50 min group, 7 sessions)	Case illustration “Therapists are flexible if women need to step out briefly to manage employment or child-related issues” (p. 5) “The facilitator encourages” (p. 9)	Therapist creates a welcoming atmosphere and is flexible with patients
Gryesten et al. (2024) [48]	Denmark	N = 5 Therapist Women (ages 33 to 54) with 4–10 years of experience	Hermeneutic-phenomenological thematic analysis	Cognitive Behavioural	N = 3 Group Participants: N = 15 N = 11 Women N = 4 Men with depression and comorbid diagnoses Routine Outcome Monitoring (ROM) (14 two-hour weekly sessions)	Interviews with patients: “Five themes were identified: (1) Individual attention (2) Psychological exploration (3) A focus on the patient’s life outside of therapy (4) Extended assessment (5) Agreement on therapeutic task” (p. 617)	Therapists respond to the specific needs of their patients, exploring their unique experiences
Jaber and Slobodin, (2024) [49]	Israel	N = 38 Psychotherapists N = 36 women N = 2 Men (ages 30–58 years), with 7.42 average years of professional experience N = 28 Muslim-Arab N = 6 Druze N = Christian-Arab	Qualitative	Art therapy	Groups of Art-therapy in schools in the Northern District of Israel for Children and Adolescents	Semi-structured Interviews: “Three themes were identified: (1) Distinguishing Arab identity from drama therapy (2) Drama therapy is perceived as an act of challenging ethnic and gender boundaries (3) Negotiating ethnic boundaries within the context of drama therapy” (p. 3)	Therapists pay specific attention to their own culture, recognizing its influence on their practice

.

6. Discussion

6.1. Common Emerging Themes Among Different Therapeutic Models

During the selection and analysis process, the researchers involved in this study—who came from different psychotherapeutic theoretical models (psychodynamic, systemic, and humanistic)—constantly discussed the quality of the research and the construct. This contributed to a critical and personal perspective. While the heterogeneity of perspectives offered a useful trans-theoretical contribution to exploring responsiveness more comprehensively, the lack of a researcher with a cognitive behavioral background meant that the phenomenon could not be observed through a more precise and specific lens. Nevertheless, the fact that the three researchers are also psychotherapists was beneficial, particularly in terms of operational implications, as it placed the research in a broader clinical context. The studies were selected based on descriptions of therapist behavior that can be defined as ‘responsive’, specifically in the context of group psychotherapy. The selected studies describe mental health interventions for various disorders and psychopathologies, using internationally recognized therapeutic models. Specifically, the reviewed studies describe psychotherapy groups conducted using three approaches: cognitive behavioral therapy (N = 7), psychodynamic therapy (N = 3) and art therapy (N = 1). Responsiveness is a concept that cuts across multiple therapeutic models, addressing multiple dimensions of the individual, such as their experience of psychopathology, cultural belonging, and personal characteristics (e.g., gender and age). The selected studies are primarily qualitative, comprising case studies and reports. Some of these studies also employed a series of tests to evaluate particular variables in the therapeutic process. The selected articles are consistent with the philosophical perspective of the research because they are based on small samples that have been adequately explored through observational reports. The research participants and the evaluation and interpretation of the obtained data answer the research question posed in this paper. This question explores how therapist responsiveness works, and the detailed observational reports on the behavior of group therapists in the selected studies provide comprehensive answers and support the hypotheses.

6.1.1. The Here and Now of the Group: An Empathetic Therapist Creates a Welcoming Atmosphere

Responsiveness is an “emergent” characteristic of the therapeutic setting [4,21,50] that develops phenomenologically in the here and now. It has a positive and facilitative connotation [51,52]. This emerging emotionality within the group could be likened to the group climate. Psychotherapists enhance the group climate by demonstrating empathy and cooperation with other group members [53] and by providing positive feedback [54]. The therapists in the reviewed studies generally express responsiveness by maintaining a supportive and accepting climate. For instance, in Joyce et al.’s [41] study, the therapist fosters an environment where group members can explore conflicts in the present moment. This approach encourages patients to express their feelings while avoiding immediate gratification. This ensures that patients have sufficient time to develop trust in other group members, opening them to dialogue and encouraging problem solving. Additionally, the therapist’s empathic attitude encourages patients to get to know other group members, fostering an atmosphere of curiosity and openness. In Beck and Coffey’s study in [39], the therapist is viewed as a coach who acknowledges group members’ challenges and encourages them to push themselves further, fostering an environment of trust and optimism. In Grunberg et al.’s [47] study, mothers are understood in terms of their need for time with their children. The therapist’s approach in this study is to provide emotional, informational and social support for the complex and personal experiences of new mothers, who often feel isolated. Similarly, in Euler et al.’s [43] study, the therapist makes the setting an “inclusive place” to strengthen relationships between patients. The therapist interventions described in the studies by Gryesten et al. [48] and van Tilburg et al. [46] are characterized by empathy and understanding. These interventions create a relaxed atmosphere in which understanding flourishes. Research interest in therapist empathy in the online setting has recently increased [55,56]. According to Weinberg [57], responsiveness and the use of self-disclosure could strengthen the therapist’s presence in the virtual group and increase their empathic attitude. The group atmosphere is one of the most important factors in the effectiveness of psychotherapy, alongside the therapeutic alliance and the therapist’s empathy. The studies reviewed suggest that the “glue” holding these constructs together is the therapist’s consistently responsive attitude towards group members. These members are not merely parts of a system, but active individuals with characteristics that, if recognized and supported, can contribute to creating a welcoming and supportive atmosphere. Therefore, responsiveness constitutes more than simple solidarity among members; it involves paying attention to the needs of individuals, who can also offer therapeutic support to the group as a whole.

6.1.2. Recognizing the Group Member’s Specific Experience: Personalization

The therapist’s responsiveness promotes what can be called “personalization” [21]. It is the ability to reserve the treatment for the patient with a specific problem under certain circumstances [58]. In a group context, personalizing the intervention means understanding what is useful for the individual group member and implementing specific and different treatment pathways from the other patients in the same group. The group is not a collection of equal individuals, but a meeting of people, each with their own personal history and way of experiencing psychopathology. Paying attention to the needs of the individual member of the group, however, does not mean doing individual psychotherapy in the group [59] but adopting an approach that could be definitively “intrasubjective,” that is, taking for granted the constitutive intersubjective nature of the person and thus supporting the phenomenology of individual growth through exchange with others. The responsive group therapist provides ongoing feedback on the group member’s personal experience in relation to the relationship with the therapist and other group members at a particular time in the group’s history and in a particular climate. In this sense, the responsive group leader is attentive, understanding and respectful, and provides a safe foundation for group members [60]. In the psychotherapy groups described in the studies reported in this review, the therapist is particularly attentive to the specific needs of the patient. Beck and Coffey [39] report the case of a psychotherapy group in which the therapist does not simply treat traumatic stress disorder in a generic way, but explores the subjective experience of the individual within the group, paying attention to all those aspects related to the individual’s history. In this respect, this study describes a therapist who is careful to capture the subjective nuances of the patient’s experience of suffering by providing written feedback on the patient’s description of the traumatic experience to ensure that he or she has understood it correctly. In addition, the therapist recognizes the specific moment the patient is experiencing and assesses whether they are ready to take further steps. To explore the experiential dimension in Pettintten et al.’s [42] study, the Assimilation of Problematic Experiences Scale APES [61,62], specifically the assimilation of problematic experiences for assessing therapeutic change. A significant finding in the study by Gryesten et al. [48] related to patients’ perceptions of therapists’ recognition and individual attention. Patients reported that they appreciated moments when therapists talked to them outside the therapeutic group context. In addition, therapists reflected on the potential therapeutic benefits of additional individual sessions when needed, while acknowledging the therapeutic context of the group; finally, therapists in the study observed in retrospect that such individual attention would be useful for some patients who needed specific treatment for their disorders. The responsive therapist thus explores the nuances of experience and attempts to personalize a standardized intervention such as Cognitive Behavioral Therapy. Finally, in Wendt et al.’s [45] study, also conducted with a qualitative interview-based methodology, the therapist’s experience with the specific disorder being treated (Internet Gaming Disorder) is required for personalized treatment and responsive care. A therapist’s responsiveness could also be indicated by their specific expertise in a particular type of psychopathology. In this study, therapists are required to specialize not only in group psychotherapy, but also in a specific psychopathology (Internet gaming addiction). In order to respond, therapists need to be aware of the characteristics of addiction and online gaming (e.g., what nicknames are used).

6.1.3. Understanding Individual Cultures to Build a Group Culture

Recognizing patients’ cultural specificities is another dimension of the relationship related to responsiveness [27,38]. According to Chen et al. [40], precisely because cultural minorities have been excluded from much of the group therapy research, it is essential that group therapists today are prepared to adapt treatment to their specific group. The need for multicultural competence is not static, but depends on the specific composition and characteristics of the group. This study defines the group therapist as a ‘local clinical scientist’ who provides interventions tailored to the cultural affiliation of patients. In this study, although there are differences in patients’ individual experiences of suffering, the struggle against racial discrimination is a common experience among patients, and this contributes to the development of therapeutic factors such as universality and cohesion. The group psychotherapist then needs to know, investigate and explore, through ethnographic observation, the cultural affiliation of the patients and the context in which the intervention takes place. For example, in the study by Jaber and Slobodin’s [49], 38 Arab–Israeli drama teachers (36 women) working in Arab–Israeli schools were interviewed. The thematic analysis of the interviews highlighted the importance of negotiating ethnic boundaries in the context of dramatherapy: therapists were challenged to use Western therapeutic approaches based on self-realization, autonomy, freedom and authenticity, in contrast to the values of the more collectivist and hierarchical Arab society [63]. In this sense, the qualitative interview was also used in this study to learn about the subjective experience of the Arab–Israeli therapist and his vulnerabilities in the context of transcultural work. In online psychotherapy today, recognizing the specific cultural dimension is essential. When therapists virtually enter their patients’ home who are often geographically distant, it implies a curiosity to explore the patients’ context and inhabit the new virtual setting together. In a contemporary context where wars are characterized by one culture dominating another and aiming to wipe out other ethnic groups, recognizing and embracing cultural differences seems to be the only way to resolve conflict. Actively promoting dialogue and mutual understanding, adopting a responsive attitude to observe similarities and differences, and carefully considering the needs of others can be a gateway to peaceful civil coexistence.

6.1.4. Promoting Reflexivity and Mentalization Within the Group

Being a responsive therapist in a group means paying attention to the personalized needs of each group member. This involves developing the ability to reflect on and understand one’s own and others’ experiences in the group context. The therapist fosters this skill by taking advantage of the relational exchanges that occur within the group. The ability to adopt a self-reflexive stance is considered central to progress in psychotherapy [64,65]. The concept of reflexivity has been used in psychotherapy research as a synonym for concepts such as metacognition, agency, reflexivity, self-monitoring, recursivity and self-awareness [66]. In Rennie’s [67] definition, reflexivity is understood as the formation of intentions within self-awareness as a result of turning one’s attention to oneself. It is about paying attention to one’s own experiences and interpretations. Several studies have highlighted the potential benefits of promoting reflexivity in organizational [68] and educational [69] contexts. In Parrello et al.’s study, the online reflective methodology enhanced the participants’ resilience. It encouraged group members to prioritize self-care, positively impacting their performance and ability to innovate. In the case study by Penttinen et al. [42], therapist responsiveness in a short-term group for social phobic patients is shown to increase patients’ reflexivity, which correlates with progress in assimilating their problematic experiences [62]. Reflexivity, understood as the degree to which members of a group reflect on and communicate the group’s goals, strategies, decision-making and communication processes, and adapt them to current or anticipated circumstances, is supported by the leader’s responsiveness. What the patient really needs in groups, therefore, is an empathic attitude on the part of the therapist. Within this scenario, the ability to facilitate the mentalization of group members is another characteristic of the responsive therapist. Therapist interventions that promote mentalization focus on encouraging reflection and understanding of oneself and one’s relationships with others. Several studies have demonstrated the usefulness of these processes in the treatment of psychopathology in adults [70] and adolescents [71,72]. Arias-Pujol and Anguera’s [44] study focuses on the role of the therapist as a facilitator of dialogue in an adolescent psychotherapy group. One way of facilitating dialogue is through mentalizing interventions. Mentalization is also a theoretical and operational assumption of psychotherapy groups for borderline patients in Euler et al.’s [43] study. Findings suggest that therapists’ normalization and validation of clients’ experiences during the first session are critical in establishing the therapeutic alliance with clients with borderline personality disorder [10]. The therapist promotes self-reflection by encouraging patients to think about the questions asked by the group with the goal of increasing self-awareness in the study by van Tilburg et al. [46]. The concept of mentalization within groups has very ancient roots. Consider, for example, Bion’s work in the mid-twentieth century. In his theoretical contribution, the psychoanalyst proposed that the group, and in particular its leader, constitutes a mentalizing and reflective container guided by the alpha function. This container is aimed at processing the non-reflective and implicit beta elements produced by the unconscious group and defended in a ‘basic’ mode. The selected studies reveal the same dynamic: the therapist’s constant activity in processing meaning and guiding the group towards more conscious and supportive ways of working.

7. Responsiveness in Contemporary Care Groups and Contexts

It appears to have similarities with responsiveness in dyadic settings, such as empathy and presence in the therapeutic here-and-now [21]. The personalization offered by a responsive stance in a group context is much more evident and meaningful, as it transforms the intervention into a therapy that attends to subjective experience in plural contexts, which can then be extended conceptually to social and community contexts. The way in which the therapist empowers individuals within group settings, as highlighted in the literature, is by promoting mentalization and reflexivity. In contexts of collective anxiety, such as pandemics, climate crises and international wars, developing awareness of oneself and others can be a crucial resilience factor. Another crucial group dynamic that the therapist responsively addresses is attending to the circulation of patient affect within the therapeutic here-and-now. An empathic, supportive and accepting group climate promotes the development of a group culture focused on solidarity and conflict resolution. The responsive group therapist fosters listening among participants, enabling them to share their personal narratives beyond diagnostic labels, psychopathological diagnosis and treatment paradigms. The theoretical models—cognitive-behavioral and psychodynamic—despite their clear differences in approach and management of psychopathology, share a common thread: a focus on and curiosity about the experiences of the patients, the therapist and the group as a whole. Experience, understood as an attentive presence in the therapeutic relationship, can be considered a characteristic of a responsive way of doing therapy, regardless of the specific reference model [21].

Experience is a characteristic not only of the bipersonal setting but also of group psychotherapy. A responsive attitude on the part of the group therapist is characterized by attentiveness to the subjective and specific experiences of each group member, rather than a one-size-fits-all approach based solely on a given psychopathological framework. This adaptability enables therapists to transcend rigid theoretical models and tailor interventions to the evolving needs of the group. Different therapeutic approaches incorporate responsiveness in distinct ways. Cognitive-behavioral group therapy, for example, has been critiqued for its structured nature, which may limit flexibility in addressing individual needs [34]. Therapists within these models are increasingly personalizing interventions to enhance engagement and therapeutic outcomes. Similarly, psychodynamic and art-based group therapies emphasize the recognition of personal narratives, cultural factors, and identity-related challenges, further reinforcing the therapist’s role in fostering a climate of trust, reflection, and emotional exploration. Specifically, the psychodynamic approach maintains a mainly relational and intersubjective working framework today. Through the study of therapeutic responsiveness, it can explore the emotional dimensions attuned to the patient and use them for the benefit of the group and itself. It takes care of its own experiences through training and supervision. Even more importantly, the study of the therapist’s responsiveness in art and expressive therapy groups is valuable because they can identify and develop the creative potential of the group members, creating a new culture based on their shared experiences.

8. Limitations

This narrative review offers valuable insights, but several limitations must be acknowledged. The small sample sizes and predominance of qualitative studies restrict the generalizability of the findings. Additionally, the lack of standardized assessment tools makes it difficult to compare results across different studies. Another significant limitation is the under-exploration of cultural factors: only a few studies have investigated how responsiveness varies among different cultural and linguistic groups. Another limitation of the study is the deliberate exclusion of grey literature on the subject, which could have provided additional information on the construct. As detailed above, however, the narrative review aims to evaluate experimental studies and expand the scope of future research. Finally, it should be noted that no protocol has been recorded for the formal assessment of the quality of the scientific articles examined.

9. Conclusions and Future Directions

This narrative review suggests that therapist responsiveness in group psychotherapy is a dynamic, multidimensional construct that plays a crucial role in facilitating therapeutic change. From what has emerged from this study, the dimensions that can be explored are: as far as the therapist is concerned (his or her level of empathy and capacity for mentalization); as far as the group is concerned; and it is good to explore its affective climate and how, within the group, a sense of recognition of one’s own specific experience and also a sense of acceptance develop. Exploring cultural background is another important dimension to investigate using interviews, focus groups and other qualitative tools.

In light of the characteristics that emerged from this narrative review, it is clear that a responsive group psychotherapist must pay more attention to individual group members while also paying maximum attention to the group climate. In summary, these two dimensions—individual and collective—are present simultaneously and interact continuously during the therapist’s interventions. These interventions aim to develop patients’ mentalization and reflective capacities through their experiences within the therapeutic group.

In addition, to develop psychotherapists’ capacity for mentalization, given its connection to responsiveness, they should participate in Balint groups [73] and training groups for the development of deliberate practice [74]. Participating in supervision groups can help therapists to become more responsive and culturally sensitive [75,76]. These groups can be held online [56]. If the groups consist of colleagues from different countries, awareness of different cultures can be promoted. However, it would be beneficial for trainees to include modules on developing personal competencies and responsiveness towards patients. Compared to other characteristics of the group psychotherapist, responsiveness is a detailed focus on the person within plurality. This seems to be consistent with the need in this cultural context to be recognized as individuals with their own histories and characteristics within a borderless community such as the virtual. Future research should continue exploring how responsiveness interacts with different therapeutic modalities, cultural factors, and technological innovations to enhance treatment effectiveness across diverse populations.