Group Therapy to Promote Adolescents’ Mental Health: Clinical and Empirical Evidence

Abstract

The contemporary world presents increasingly complex challenges for adolescents. In addition to normative developmental tasks, adolescents must now navigate epidemic health crises, armed conflicts, family dissolution, economic instability, and academic pressures. Consequently, adolescents experience diminished security and elevated levels of anxiety, loneliness, and depression. While the need for emotional support has intensified across all demographics, adolescents’ psychological needs remain particularly underserved. The American Psychological Association has recently advocated for the expansion of group therapy services, a format that aligns particularly well with adolescents’ socioemotional needs, serving as a developmental bridge from childhood to adulthood. Research on adolescents’ group legs much behind the adult literature. The aim of the current paper is to show the potential power of group therapy with adolescents based on a selective review of our empirical studies examining the impact of therapy groups on adolescents’ well-being. The reviewed papers encompass randomized controlled trials and process research identifying critical therapeutic factors, collectively establishing the intervention’s validity. Results demonstrate the superiority of these groups compared to non-treatment controls and equivalence to individual therapy in reducing stress, anxiety, and aggression while enhancing self-perception, self-control, and academic functioning. These findings support the conclusion that group psychotherapy significantly contributes to adolescent well-being. Considering adolescents’ high yet unmet need for emotional support, group therapy appears to be a valid alternative.

1. Introduction

Adolescence has long been characterized as a tumultuous developmental period marked by the transition from childhood to adulthood. The primary developmental task for adolescents involves achieving independence while developing coherent self-identity and personal integrity [1] Successful navigation from childhood to adulthood requires adolescents to develop emotional expression capabilities, affect regulation skills, cohesive identity formation, and social competencies [2], abilities optimally cultivated within group contexts [3]. Autonomous development necessitates gradual differentiation from parental influence, identification of peer reference groups, and formation of intimate friendships, all serving as transitional bridges to adulthood.

Contemporary global complexities have intensified adolescent developmental challenges. Sociopolitical upheavals, economic uncertainties, family instability, and public health crises directly impact both parents and their children. Many parents, overwhelmed by perceived environmental dangers, respond with overprotective behavior that impedes adolescent autonomy development. Conversely, parents struggling with their own life stressors may lack the capacity to address their teenagers’ emotional needs, resulting in heightened adolescent stress, anxiety, loneliness, and despair. While navigating adolescence presents challenges under optimal conditions, crisis situations, including family dissolution, health pandemics, and armed conflicts can prove devastating. Although demand for psychological services increases during such periods, service provision remains inadequate [4,5]. A recent analysis by Whittingham, Marmarosh, Mallow, and Scherer [6] documented that millions of Americans seeking mental health services encounter unmet needs. The authors propose that increasing the use of group therapy could address this service gap. Their economic analysis demonstrates that if each practicing psychologist incorporated one therapy group into their individual practice, an additional 3.5 million individuals could receive treatment while saving millions in healthcare expenditures. Thus, group treatment expansion could substantially enhance population mental health outcomes. However, the rationale for group therapy extends beyond cost-effectiveness. Recent empirical evidence has established group therapy as a mature clinical field demonstrating the “three Es”: Efficient, Effective, and Equal to individual treatment [7] While child and adolescent group psychotherapy research remains less developed than adult research, emerging evidence supports its efficacy, as presented in this review.

2. Group Therapy for Adolescents

Group therapy represents an optimal intervention modality for adolescents, providing a naturalistic setting that reduces stigmatization compared to individual therapy while offering extensive emotional and social support. Groups facilitate belonging, social skill acquisition, friendship development, and intimacy formation. However, adolescents present unique therapeutic challenges. Typically referred to by others rather than self-referred, they often lack enthusiasm for psychological intervention and therapeutic sophistication. Adolescents can demonstrate significant resistance, anger, and defiance. Traditional talk therapy may prove excessively threatening; therefore, specialized indirect and projective techniques are required, necessitating specifically trained group facilitators.

Group therapy varies in structure and objectives. The established typology for adolescent groups encompasses psychoeducational, counseling, and psychotherapy modalities [8,9] Group typology determines membership size, therapist qualifications, and therapeutic processes, though categories often overlap. Research indicates that 50% of child and adolescent groups are educational, 40% counseling-oriented, and only 10% are psychotherapy groups, with therapy groups demonstrating the greatest efficacy [10].

For this paper, we present a selective review of our studies based on three criteria: type of group (educational, counseling, psychotherapy), unique topic (e.g., trauma), and a population of adolescents. Each type of group is presented with one or more brief study descriptions to illustrate the variety of interventions and their outcomes.

Psychoeducational Groups

Psychoeducational groups, the most prevalent format, serve preventive and interventional functions through structured, content-oriented skill instruction. These short-term, cognitively oriented groups typically operate within school settings. For example, Social-Emotional Learning (SEL) groups effectively transform classroom dynamics through systematic social skill development [11]. SEL is defined as the process of acquiring core competencies to recognize and manage emotions, set and achieve personal goals, establish and maintain positive relationships, and handle interpersonal situations constructively [12]. SEL programs are usually delivered in segregated sessions but can also be integrated into content teaching. The following is a description of such a study [13].

The study assessed the effect of SEL integrated into a literature class named “affective teaching.” These lessons comprise a three-level structure: information, conceptualization, and emotion levels. The unique level is the emotional one, in which students have an opportunity to interact with each other on an emotional level regarding issues related to the subject taught. For example, a poem in which a boy acts aggressively is introduced. After discussing aggression as human behavior, possible triggers to aggressive responses, and consequences of aggression, students share their own experiences regarding aggression, question their own behavior, and look for ways to take better control over their anger. The group functions as a container for empathy and understanding, provision of support and constructive feedback, and modeling of positive behaviors.

The study: The study involved 1137 fifth- and sixth-grade students from 36 classrooms and 12 schools. Two parallel classrooms in each school were randomly divided into experimental and control conditions, in which the same curriculum was applied. Thirty-six student teachers, trained in the affective model, delivered six one-hour sessions during six weeks. The dependent variables included relationships, motivation to learn, content knowledge, and behavior. Relationships and motivation were measured through self-report questionnaires, content knowledge was based on test scores constructed for this unit, and behavior was assessed through observation. Two trained observers in each class assessed the students’ behaviors based on a form, including eight behaviors: four positive (e.g., providing support) and four negative behaviors (e.g., moving around in class). A hierarchical model of analyses (mixed models) was used to assess the students’ gains in the two treatment conditions.

Results: The analyses indicated greater improvement on all measures for students in the affective teaching conditions compared to the controls. Motivation for learning and perception of classroom relationships improved significantly more in the experimental classes. Interestingly, gains in content knowledge were higher in the affective teaching classes, even though one-third of the lessons were used for SEL. However, the most robust and interesting outcome is the change in behavior: first, because it was based on observations of actual behavior; and second, because not only did negative behaviors decrease, but positive behaviors also increased. These behaviors were measured every session, showing a linear increase in positive behavior and decrease in negative behavior per child. (see

Table 1. Treatment Condition and Behavior Outcomes on First and Last sessions.

Treatment Condition	Behavior Type	1st Session	Last Session
Affective Teaching	Positive	2.05	6.86
Affective Teaching	Negative	4.27	1.92
Conventional	Positive	2.05	2.63
Conventional	Negative	4.65	4.19

).

The results are clear: in affective teaching sessions, negative behavior decreased, and positive behaviors increased impressively, while no change was observed in the conventional condition. Furthermore, gains in relationships and behavior were significantly correlated with gains in motivation and knowledge.

Discussion: This study points to the association between learning and social-emotional variables. SEL appears to be important for students’ mental health, and efforts to enhance it are strongly advocated. Moreover, the study shows that student teachers (teaching for the first time) can be efficient in contributing to children’s psychological growth and should be considered an important resource for children’s mental health.

• Counseling Groups:

Counseling groups better serve adolescents experiencing emotional turmoil. These small groups (6–10 participants) facilitate personal and interpersonal problem resolution for developmental growth. Operating preventively or interventionally, they may address specific topics or remain open-ended, typically focusing on situational or developmental challenges, including friendship difficulties, conflict resolution, and family transition coping. Effective counseling groups require a secure climate that encourages self-expression and interpersonal learning opportunities. Our recent investigation of adolescents experiencing high conflict with parents demonstrated the effectiveness of such groups [14].

The study: Eleven schools in the Arab population agreed to participate in the study. Six hundred eighth- and ninth-grade students completed a screening instrument measuring the level of parent–adolescent conflict. The cutoff point for inclusion in the study was the 30% who scored highest on the screening questionnaire; thus, 173 participants comprised the study population. Students were randomly divided into experimental and control conditions. While the experimental students attended the counseling groups, the control students continued their studies in the classroom. They were placed in small groups (8–10) conducted by trained school counselors within their schools. These students and their parents completed three questionnaires: level of conflict, intensity of conflict, and a youth outcome questionnaire that measures well-being, at three time points: pre-, post-, and follow-up (after 4 months). The intervention focused on intense conflicts in their homes, including short films presenting common conflicts. Analyses were conducted with hierarchical models (mixed models) for three variables and three time points.

Results: Participants in the treatment groups showed more favorable outcomes compared to control participants on all three measures. All differences were significant as reported by mothers (see

Table 2. Reduction of Conflict Per Condition.

Outcome Measure	Condition	Pre-Treatment Mean	Post-Treatment Mean
Level of Conflict	Experimental	7.98	4.64
Level of Conflict	Control	7.05	6.96
Intensity of Conflict	Experimental	2.39	2.10
Intensity of Conflict	Control	2.49	2.15
Frequency of Difficult Behaviors	Experimental	1.03	0.77
Frequency of Difficult Behaviors	Control	0.87	0.94

).

Discussion: These are important outcomes, considering the impact that intense conflict with parents has on children and adolescents. However, family issues have not been a subject for intervention or research in schools. The results of the current study suggest that parent–child conflict is an important target for intervention and can be effectively addressed in schools

• Psychotherapy Groups:

Psychotherapy groups address more severe personal and interpersonal difficulties, dysfunctional behaviors, or diagnosed developmental and mental disorders. These groups emphasize individual issues through psychodynamic exploration to enhance functioning. Self-expression, self-exploration, insight development, and behavioral change are actively promoted. These intimate; less structured groups require very small membership. Populations include students with learning disabilities (LD), attention deficit hyperactivity disorder (ADHD), aggressive behaviors, and antisocial tendencies.

The groups examined in the following studies represent psychotherapy groups. Participants included children with LD, ADHD, and aggressive and antisocial behaviors, exhibiting elevated stress and anxiety levels alongside diminished self-esteem, self-efficacy, and self-regulation. While some demonstrated withdrawal patterns and others displayed externalizing behaviors, all required psychological wellness and behavioral functioning enhancement. Students referred to our counseling centers present diverse developmental, social, emotional, and behavioral difficulties. They experience stress, anxiety, suspicion, and mistrust, requiring substantial encouragement and support. Groups must, therefore, be small and intimate, providing secure foundations for cognitive and emotional exploration leading to insight development and behavioral change [15]. This conceptualization determines group objectives, theoretical frameworks, methodologies, and therapist behaviors.

Primary objectives include stress and anxiety reduction, adolescent empowerment, relationship trust reconstruction, enhanced self-understanding, and increased commitment to necessary behavioral modifications. These goals necessitate psychodynamic approaches guiding adolescents toward self-exploration. Recognizing emotions as fundamental to human action, our intervention emphasizes emotional processing. We developed an emotion-focused modality based on Emotion-Focused Therapy (EFT) established by Greenberg [16] for individual therapy and Johnson [17] for couple therapy.

The EFT-Group modality encourages emotion identification, expression, and comprehension. However, our adolescent clients lack preparation for such processes, possessing minimal emotional vocabulary and limited self-examination skills. Therefore, we implement three developmental stages aligned with theoretical orientations suggested by Prochaska and Norcross [18]:

Stage 1: Foundation Building (Sessions 1–4)

The initial stage emphasizes mutual support, emotional vocabulary development, and constructive feedback skills. Group contracts, rules, and objectives are established through therapeutic games and activities. This humanistic orientation phase reduces anxiety and enhances security while establishing supportive norms maintained throughout treatment.

Stage 2: Working Phase (Sessions 5–11)

This central stage involves participants exploring life events impeding well-being through cognitive and emotional processing. Empowered by therapists and peers, participants share personal experiences and feelings while developing behavioral understanding. Psychodynamic principles guide this emotionally focused stage [19]. To facilitate intimate disclosure among young clients, we employ projective techniques and arts-based interventions, including bibliotherapy (literature utilization), art therapy (visual creation), phototherapy (photographic exploration), cinematherapy, and therapeutic cards. For example, during the use of therapeutic picture cards, a girl selects an image of a forest and explains, “This forest reminds me of my life; I wander in the forest not knowing if I can find the way out.” From this point, she shares her experiences with group members. They ask questions encouraging her to explore the situation on cognitive and emotional levels, share similar experiences, provide support, and occasionally offer help. These identification-based methods advance therapeutic progress while maintaining engagement through playful elements [19].

Stage 3: Termination (Sessions 12–15)

The final stage consolidates gains, processes termination, and plans future application of developed skills. We consider this stage very important as it is the bridge to real life. Participants say goodbye to each other through positive feedback, which has an empowering long-term effect. They also serve as mirrors to acknowledge each other’s gains and remind each other about goals they need to work on in the future. All these are achieved through structured activities and oral and written exchange.

3. Research Methods and Results of Therapy Groups

3.1. Validity of the EFT-Group Modality (Compared to No Treatment)

Initial studies established intervention validity through controlled comparisons. This review presents three representative studies examining diverse adolescent populations under normal and crisis conditions. All studies employed pre–post experimental-control designs with random assignments when feasible, some including six-month follow-up assessments. Statistical analyses utilized MANOVAs for smaller samples and hierarchical mixed models for larger group numbers, accounting for group-specific effects.

3.1.1. Study 1: Academic Underachievers [20]

Participants: 142 fifth- and sixth-grade students from two schools, identified as underachievers (grades ≤ 50 in language and mathematics). Participants displayed additional dysfunctional behaviors ranging from withdrawal to externalization, affecting relationships, discipline, and mood.

Design: Random assignment to experimental (n = 71) or control (n = 71) conditions. All participants received standard academic support (4 h weekly). Experimental participants additionally attended weekly 50 min group counseling sessions for 15 weeks, facilitated by 2 trained counselors.

Measures: Academic performance (grades and standardized tests in mathematics and language), self-esteem, self-regulation (self-report), and social status (teacher report).

Results: MANOVA revealed significant Group X Time interaction: F(7133) = 32.18, p < 0.001. Experimental participants improved from failing grades to average scores of 75 in both subjects, with 75% showing grade improvement. Significant improvements occurred in self-esteem and self-regulation. Social status showed delayed improvement, becoming significant only at six-month follow-up (M = 61.24, 62.72, and 74.31 for pre-, post- and follow-up, respectively). Control participants showed no significant changes.

Discussion: While psychosocial improvements aligned with expectations, academic gains proved surprising. Four hours of remedial instruction alone produced no change, whereas one hour of group therapy yielded substantial academic improvement, highlighting the mental health-learning nexus and group treatment efficacy. The remarkable results in academic achievement were accompanied by increased self-confidence and self-control, important variables in school functioning. We attribute adolescents’ growth to the intensive support, encouragement, and care provided in these groups, along with self-exploration, insight development, and increased motivation to make necessary changes.

3.1.2. Study 2: Aggressive Youth [21]

Participants: 230 students from 30+ schools, meeting aggressive behavior criteria based on a questionnaire. Thirty teachers enrolled in a graduate education program in one college, attending a mandatory seminar on dealing with disturbing children. They were required to conduct 12 sessions with a small group of children that met the criteria of mild aggression.

Design: Graduate education students selected aggressive students from one class in their school, randomly assigned them to experimental or control conditions, and conducted 15 one-hour session groups following EFT-G training. The teachers received group supervision throughout the treatment process.

Measures: Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) short forms. The two scales are identical; one is self-report, and the other is teacher-report. These are frequently used scales in child and adolescent research.

Results: Mixed model analyses revealed significant Time by Condition interactions for both CBCL [F(2,64.50) = 7.49, p < 0.001] and TRF [F(2,81.69) = 9.32, p < 0.001], with greater gains for treatment children. Clinical severity reductions: CBCL severe level decreased from 24% to 10% (experimental) versus 9% maintained (control); TRF severe level decreased from 30% to 10% (experimental) versus 12.5% maintained (control).

Discussion: Results demonstrate that well trained teachers can effectively facilitate groups producing aggression reduction. These results require caution, as teachers are not typically expected to conduct therapy. However, they can play a role in supporting students in very small groups. If well-trained and supervised throughout the intervention, as these teachers were, using a structured program based on EFT principles, they can be effective. It should be noted, however, that participants in this study were normative students demonstrating only mild levels of aggression.

3.1.3. Study 3: Post-War Trauma [22]

The study was conducted in Israel following the Second Lebanese War (2006). The war took place in northern Israel; people were evacuated from their homes, and many civilians were hit by missiles.

Participants: 104 students (grades 5, 6, and 9) from 18 schools, screening positive for mild or greater trauma symptoms on the Child Post-Traumatic Stress Reaction Index. The study was conducted in Israel following the Second Lebanese War (2006), a month after the war ended.

Design: Random assignment to experimental (n = 98) or control-waitlist (n = 66) conditions. School counselors conducted 10-week emotion-focused groups following specialized training.

Measures: The measures included a post-traumatic symptom questionnaire and a child anxiety scale to study participants’ progress compared to no-treatment children. In addition, we used process variables, including attachment to the group and group cohesion.

Results: Mixed model analyses showed significant Time X Group interactions for PTSD [F(1,223.64) = 4.83, p < 0.05] and anxiety [F(1,246.82) = 10.08, p < 0.01], with better outcomes for treatment children. Clinical severity reductions: PTSD severe level decreased from 47% to 20% (experimental) versus 40% to 37% (control); anxiety severe level decreased from 24% to 3.6% (experimental) versus 9.6% to 4.3% (control). Process Analysis: Anxiety reduction correlated with attachment levels to the therapist and group members and group cohesiveness, indicating the importance of close group relationships for anxiety amelioration.

Discussion: Results of this study point to the efficacy of EFT groups in reducing anxiety and PTSD symptoms in short-term groups, an important outcome in current times. The clinical results are impressive, showing how helpful groups can be for adolescents. Moreover, the process outcomes provide a possible explanation for their efficiency, pointing to relationships as a healing factor.

Groups Compared to Individual Treatment [23]

This study is one of the studies comparing groups to individual treatment, addressing cost-effectiveness.

Participants: 102 aggressive adolescents (grades 5–6) from multiple counseling centers: 26 assigned to individual treatment and 51 to groups, 51 served as control.

Measures: The CBCL (self-report) and TRF (teacher-report) instruments were used to measure the level of child problem behavior.

Results: Significant Time X Format X Treatment effect [F (1,97) = 10.80 and (1,97) = 15.75 For child and teacher report, respectively, p < 0.001, with no Time X Format difference, indicating equivalent efficacy between group and individual modalities. Note that groups treated approximately four times more children with comparable outcomes.

Process measures assessed the progress of children along the process of change, using Prochaska’s four-stage progress: precontemplation (lack of awareness), contemplation (awareness with no motivation to change), preparation (motivation and attempt to change), and action (actual attempts to change behavior). These stages were determined by analyzing participants’ verbal reactions in each of the 10 sessions, based on transcripts of sessions. Results showed that, at the starting point, group participants were more indifferent about their behavior than individual treatment participants. They reached the same level by the second session and progressed in a similar pattern until the 10th session, with 80% of participants reaching a point between the preparation or action stage (see Figure 1).

According to the figure, 80% of participants achieved progress but did not fully reach the action stage. Yet, there was no difference in results between the two treatment formats. This suggests that 10 sessions may not be sufficient to achieve the expected change in either treatment type.

The second process measure focused on therapeutic factors, using four components: emotional awareness, relationship climate, other vs. self-focus, and problem identification change. The only difference revealed was on the emotional awareness component, with higher levels in group treatment.

Discussion: Results indicated general reduction in aggression over time irrespective of format of treatment. Given the high youth aggression prevalence and researchers’ skepticism regarding group treatment for aggressive behaviors, these equivalency findings hold particular significance. Moreover, these studies point to similar patterns of change, indicating that group and individual therapy with children is not that different. The similarity in the pattern of change may be attributed to the very small groups in this study, a necessity when working with aggressive youth. Nevertheless, the groups seem to be efficient, and they are obviously more effective, as they treat 4–5 children compared to individual treatment.

Parent Groups for Adolescent Well-being [24]

Another approach to helping adolescents improve their sense of well-being is to work with their parents. This study examined indirect adolescent benefits through parent group participation.

The Study: Participants: 156 parents of ADHD-diagnosed adolescents from multiple school centers. A randomized design was used to compare parents participating in EFT groups of 12 sessions (n = 78) with waitlist control (n = 78). Parents completed instruments to measure their own growth following treatment and instruments for their children, including child self-efficacy and child problem behavior.

Measures: Self-efficacy and problem behavior (OQ-30), a measure of well-being.

Results: Children of treated parents showed significant improvements in self-efficacy [F(1,144) = 14.92, p < 0.001] and reduced problem behavior [F(1,144) = 14.52, p < 0.001]. Control group children showed no changes.

Discussion: Many adolescents refuse to participate in treatment, including group therapy. Parent treatment represents an alternative pathway for enhancing adolescent well-being using the EFT-G modality.

4. General Discussion and Conclusions

Child and adolescent research on group therapy is quite scarce. We used our own research to highlight some of the research that does exist, showing that group therapy provides an efficient and effective intervention for enhancing adolescent well-being during both normative and crisis periods. The imperative to address adolescent mental health is evident, yet adolescents rarely seek treatment independently. School-based interventions capitalize on the “captive audience” while reducing stigmatization associated with individual counseling. Group participation with similarly struggling peers diminishes isolation and perceived deviance. Furthermore, current counselor-student ratios and limited school psychologist availability render individual therapy provision impossible for meeting contemporary adolescent needs [6].

Current research establishes that groups are efficient, effective, and equivalent to individual treatment for general populations [7]. The present review of studies extends these findings to adolescent populations, demonstrating consistent superiority over no-treatment controls and outcome equivalence with individual therapy. These results validate group intervention efficacy with adolescents. Although groups vary in theoretical orientation, goals, and techniques, they were all found to be efficient and effective. Psychoeducational groups [13] showed impressive changes in adolescents’ behavior. Counseling groups [14] pointed to a reduction in parent–child tension, a topic hardly addressed in schools. Psychotherapy groups—the most frequent in the current review—varied from aggression, PTSD, ADHD, and others [20,21,22], and indicated superior outcomes compared to wait- list children and equal outcomes to individual therapy. In the psychotherapy groups, we used the EFT principles.

The emotion-focused approach represents a relatively novel therapeutic orientation, particularly within group contexts. Participants are expected to talk about their feelings, share private experiences, listen to others, and be empathic and supportive. Working with adolescents in such groups is challenging; they need to trust their peers, use an emotional vocabulary, and possess listening skills, which are often underdeveloped. To facilitate emotional work, we first establish a positive climate, develop helpful group norms, and ensure emotional security. During the working phase, we also use projective techniques from the arts (bibliotherapy, art therapy, phototherapy) to keep adolescents engaged in the therapeutic process [19].

Indeed, the process research consistently identified relationships as the paramount therapeutic element, with cohesiveness correlating directly with outcomes [25]. This finding holds critical implications for therapists, as adolescents’ tendencies toward criticism and cruelty require skillful guidance toward intimacy and friendship development.

The process research also confirms adolescent engagement in psychodynamic processes within these groups. Participants share intimate information, express emotions, explore individual issues on cognitive and affective levels, develop insights, and report behavioral changes [23]. These findings establish both process validity and intervention uniqueness, supporting the conclusion that EFT groups provide safe, effective pathways for enhancing adolescent well-being.

4.1. Limitations

Several limitations constrain generalizability. First, all studies were conducted within one country. Despite population diversity regarding culture and ethnicity, replication across international contexts remains necessary. Additionally, only our own studies were reviewed, which may raise questions about objectivity. More research on adolescent groups is needed. Furthermore, the aim of the study was to illustrate the power of group therapy, so we present a variety of interventions and outcomes, with some statistical details omitted (available in the published papers). This approach keeps the focus on describing sample studies, providing general evidence. Finally, the review includes some older studies (e.g., comparisons between group and individual interventions), which remain important for highlighting the case. More contemporary studies are needed.

Second, the EFT modality requires specialized therapist training. Training deficits represent major barriers to group therapy implementation [6]. EFT groups particularly demand therapist competencies in adolescent engagement, projective method utilization, and psychodynamic skill application. Research demonstrates direct connections between therapeutic activities and outcomes; structured activities increase self-disclosure and therapist self-disclosure predicts improvements across multiple domains [25]. Moreover, results may be related to the unique modality used, but as we did not compare the results to a different modality, we cannot claim superiority of such groups.

Third, adolescent populations present inherent challenges. Their non-normative client status and potential for rejection and defiance require therapists with specific characteristics, including firmness, clear boundaries, and sophisticated resistance management.

4.2. Conclusions

Despite noted limitations, accumulated evidence strongly supports group therapy as a viable intervention for enhancing adolescent well-being across diverse settings. Adolescents worldwide face similar developmental tasks with comparable socioemotional needs for belonging, peer interaction, recognition, respect, and acceptance. Well-facilitated groups address these universal needs effectively.

Moreover, considering the obvious gap between adolescents’ needs and available services, perhaps it is time to expand the therapeutic role’s potential and include well-trained teachers in providing emotional support to students, as shown in our study on aggressive children [21]. In other studies, trained teachers were able to reduce students’ behavior problems just by adding a therapeutic component to their teaching subject [4,13]. However, this is a sensitive and ethical issue; teachers need to know their limits, and ethical principles should be explored before teachers’ involvement is possible.

Finally, parents are an extremely powerful source of support for their adolescent children. Being a parent of an adolescent is very stressful; helping parents in groups appears very worthwhile for their children [24]. This may be another effective way to improve adolescents’ well-being.

4.3. Future Studies

This review indicates that all group interventions used were efficient and effective, but it does not demonstrate that group therapy using the EFT modality is more effective than other types of adolescent groups. To answer this question, a different research design is required, comparing EFT groups to other existing group modalities within a similar population. This presents a significant challenge, as such groups demand intensive training, which is already in short supply. Nevertheless, investigating the unique contribution of EFT groups is important, as adolescents with specific difficulties may require more rigorous interventions. The review also highlights gaps in current knowledge. For example, comparisons with individual treatment are critical, as establishing the relative effectiveness of group therapy could impact the well-being of many adolescents. Additionally, cost-effectiveness analyses should be conducted to further establish the advantages of group therapy. Finally, given that schools appear to be ideal settings for such interventions, future research should explore strategies to implement group therapy successfully in school environments.