July 15, 2026
14 min read
By Albert Wong, PhD · Clinical Psychologist
The short answer
To start a therapy group: pick a focused population and format, screen every member individually, cap the group at 6–10, run a signed group agreement covering member confidentiality before the first session, and price per member per session ($40–75 private pay is typical). The business case is strong — a 8-person group at $50 earns $400/hour — but the operational rules are strict: each member gets their own chart, their own note, and their own bill, and you only ever bill members who actually attended.
A quick disambiguation, because the internet muddles this constantly: this is a guide to running therapy groups — one clinician, several unrelated clients, one shared hour. It is not about building a group practice (hiring other therapists). If you want that, read our guide to making your first hire instead.
Here's what I believe about groups, plainly: they're the most underused format in private practice, and the reasons therapists don't run them have almost nothing to do with therapy. The evidence is solid across anxiety, depression, grief, substance use, and process work. Group gives clients the one thing individual therapy structurally can't — being witnessed by people walking the same road. And the economics are the best in the business. What stops most of us is never the clinical skill. It's the logistics: the screening, the paperwork, the billing that multiplies by eight. The logistics are learnable. Here's all of it, start to finish.
"Process group, Tuesdays" fills slowly. "Anxiety skills for new parents," "grief group for adult children who lost a parent," "men's process group, 30s–40s" fill faster, because a prospective member can recognize themselves in one sentence. The focus also determines the format: skills-based groups (CBT, DBT-informed) run well as closed, time-limited cohorts of 8–12 weeks; process groups run well as open, ongoing groups with a stable core.
A 20–30 minute individual screening call before admitting anyone is the single highest-value habit in group work. You're checking three things: fit with the group's focus, capacity to tolerate group process (acute crisis, active psychosis, and unmanaged substance use are usually referrals to individual work first), and composition — one member who dominates or scapegoats can sink a young group. Screening is also billable in many cases as an intake evaluation, and it's where you walk through the group agreement (below) one-on-one.
Unlike your legal duty of confidentiality, group members are not bound by law to protect each other's privacy — their commitment comes from a signed agreement, and everyone should understand that this is a personal commitment, not a legal guarantee. A solid group agreement covers:
Collect the signature before the first session, during screening. If you run groups by video, the telehealth-specific clauses belong in the same document.
| Model | Typical range | Your hour, 8 members |
|---|---|---|
| Private pay, per session | $40–75 per member | $320–600 |
| Insurance (CPT 90853) | ≈$33 Medicare; commercial often 1.5–2× | $260–530 |
Compare that with one $150 individual session in the same hour. Groups also make therapy accessible to clients who can't afford your individual rate — the rare pricing decision that's good for the client and the practice. For insurance groups, read the complete 90853 billing guide first — the code is billed per participant, one unit per member per day, and several plans require prior authorization for group therapy.
This is also where your practice software earns its keep or fails you: some platforms charge extra for group scheduling (SimplePractice prices group appointments as a $20/month add-on on its mid tier — see the full pricing breakdown), and many can't do per-member attendance, per-member billing, and per-member notes without manual duplication. Practice Harbor treats groups as first-class: roster scheduling, per-member attendance that drives per-member billing automatically, one note per attendee, and group telehealth included on every paid plan.
Roster scheduling, per-member attendance and billing, one note per attendee, and group telehealth — included, not an add-on. Free for pre-licensed clinicians, $19/mo licensed.
Six to ten members is the working range for most therapy groups. Below five, a single absence deflates the session; above ten, quieter members stop participating — and Medicare caps CPT 90853 group psychotherapy at 10 participants. Many clinicians aim to launch at 5–6 committed members and grow to 8.
Typical private-pay group therapy fees are $40–75 per member per session, which makes an 8-person group earn $320–600 per clinical hour. Insurance groups billed under CPT 90853 reimburse roughly $33 per member under Medicare in 2026, with commercial payers often paying 1.5–2 times that.
Not by law. The therapist is legally and ethically bound to confidentiality, but group members are not — their commitment comes from a signed group agreement covering member confidentiality, no recording, and attendance expectations. Every member should sign it before the first session, and members should understand it is a personal commitment rather than a legal guarantee.
Yes. Every attendee must receive an individual note in their own chart; a single group note naming all members violates HIPAA. The standard pattern is a reusable group summary (theme, interventions, group dynamics) plus an individualized section per member, written so no other member is identifiable.