Therapists know better than anyone that therapy is a powerful space for healing, but it was never meant to be the only space.

Especially for clients whose distress is shaped by disconnection, the 50-minute hour can only go so far. It can offer safety, reflection, and regulation, but for those living in social isolation, what happens between sessions may matter just as much as what happens within them. Loneliness is not only painful – it’s physically and psychologically dangerous. And for too many of our clients, it’s become a way of life.

According to the U.S. Surgeon General’s 2023 Advisory on the Healing Effects of Social Connection, lack of social connection and feelings of isolation increase the risk of premature death by 29%, a risk factor greater than smoking or obesity. The mental health field has been quick to respond to loneliness as a public health issue for the general population. But the same crisis is unfolding in our therapy rooms.

If therapy is one secure base, then our work also includes helping clients build others: friendships, community, belonging. It means recognizing when healing can’t be contained in a room, and instead must be carried into the real world.

Why Connection Falters for So Many Clients

By the time many clients arrive in therapy, disconnection may have already become a central feature of their distress. This may show up as social withdrawal, shame, emotional flatness, or a deeply internalized belief that they are “too much” or “not enough” for others. There can many roots to this kind of loneliness, for example:

• Neurodivergence that creates sensory or communication barriers
• Social anxiety that turns every interaction into a perceived performance
• Trauma histories that make closeness feel unsafe
• Disruption of third spaces like religious communities, libraries, coffee shops, or clubs
• COVID-19 pandemic-related social regression or avoidance
• Marginalization, including racism, transphobia, or ableism in community spaces

In a report published in the Journal of Clinical and Diagnostic Research, researchers found that loneliness can lead to various psychiatric disorders like depression, substance use, sleep problems, and personality disorders – especially among adolescents and young adults. For some clients, loneliness predates their mental health symptoms. For others, it’s a consequence of them. Either way, isolation becomes a feedback loop: the more disconnected we feel, the harder it is to reconnect.

Why Support Groups Work (And Why We May Underuse Them)

Support groups can be seen as an optional or informal adjunct to therapy: nice, if accessible, but not essential. But that framing misses the real therapeutic power these groups can hold, particularly for clients struggling with loneliness, grief, identity rupture, or post-crisis rebuilding.

Research consistently shows that support groups are not just a “bonus” to individual therapy—they can be a transformative part of treatment. A 2022 meta-analysis in Cambridge University’s publication, Psychological Medicine found that peer-led support groups led to significant reductions in anxiety, depression, and perceived isolation, particularly for marginalized or underserved populations. 

Unlike individual therapy, which focuses on internal exploration, support groups offer relational learning: the chance to be witnessed, to practice vulnerability, and to feel normalized through shared experience. For clients who struggle with shame, abandonment fears, or attachment injuries, this type of group belonging can be uniquely healing.

And yet, it can be common to under-refer to support groups. Sometimes it’s because of uncertainty around group quality. Sometimes it’s due to assumptions that group therapy must be professionally led, tightly structured, or manualized to be “real” treatment. And sometimes it’s just habit—we’re trained to think in terms of the one-on-one hour.

But in a world where so many clients are suffering from a poverty of connection, support groups deserve to be taken seriously as evidence-based, community-based interventions.

What Makes Support Groups Therapeutically Valuable:

• Peer modeling: Clients see others with similar struggles making progress, which reduces shame and increases self-efficacy.
• Witnessing without fixing: A space to be seen and heard, without having to perform or explain.
• Shared language and lived experience: Especially powerful in identity-affirming groups (e.g., LGBTQ+ clients, new parents, people in recovery).
• Co-regulation: The group becomes a space where nervous systems learn safety in connection.
• Structure and continuity: Weekly or biweekly sessions offer rhythm, accountability, and low-pressure social contact.

For clients leaving intensive treatment (like inpatient or IOP), or those with chronic conditions (grief, illness, trauma histories), support groups can be the difference between maintenance and relapse—between insight and loneliness.

Of course, not all groups are appropriate for all clients. Some may need more structure than peer-led spaces provide, or may struggle with emotional safety in groups due to complex trauma. But these concerns can be discussed openly and collaboratively in session, with preparation, role-play, and skill-building to help clients participate meaningfully and safely.

Most importantly, therapists can reframe group participation not as an afterthought—but as a core part of recovery.

How to Help Clients Build Real-World Connection

Support groups are one part of the solution, but helping clients build connections often requires more individualized support. There are clinical strategies that help clients move toward a meaningful community in ways that feel safe, incremental, and self-directed. For example:

1. Assess and Name the Need

Include social health as part of your assessment process. Ask, “Who are your people?” or “Where do you feel most known?” Normalize the desire for friendship, companionship, and trust as a mental health need, not a luxury.

2. Include Connection Goals in Treatment Planning

For clients dealing with depression, trauma, or relational loss, create gentle but actionable goals. For example:

• Reach out to one friend per week
• Attend a community event, group, or spiritual gathering
• Join a book club or skill-share group
• Frame these goals as nervous system practice—not social performance.

3. Coach Clients Through Early Discomfort

For many clients, social reentry comes with fear, shame, or exhaustion. Help them prepare with scripts, plan regulation strategies, and develop compassionate expectations. Make it okay to leave early or try again later.

4. Use Imaginal Rehearsal or Role-Play

Practice initiating a conversation. Validate that social muscles atrophy with time – and that practice matters. Offer feedback, not judgment.

5. Build a “Social Care Plan” for Transitions

When clients are graduating from therapy, navigating grief, or entering new phases of life, help them name and claim their sources of connection. List who they can call. Identify structured ways to stay engaged. Keep it simple and real.

Beyond the Hour, Toward Belonging

Therapy is sacred space, but healing rarely stops at the office door. For many clients, especially those facing chronic disconnection, what they do between sessions may matter more than what they say within them.

Helping clients find their people – whether through support groups, community centers, faith spaces, or informal gatherings – is not a fringe benefit. It’s a clinically sound, ethically grounded act of care. 

We cannot change the loneliness epidemic alone. But we can offer clients maps, pathways, and language to help them begin.

Therapy is a foundation, but thriving happens in community.