Blood from a Stone: A Rough Guide for Group Therapy Implementation in Community Mental Healthcare.

Despite its demonstrated efficacy, group therapy remains underutilized in community mental health centers (CMHCs), where structural barriers and a chronic shortfall of funds impede implementation. This article examines the disconnect between academic research and the financial, organizational, and policy constraints that shape care in safety-net settings. Drawing from direct experience at a CMHC serving marginalized populations, we offer a financial analysis that illustrates how current reimbursement models create steep challenges for sustaining group therapy. Guided by domain theory, we present practice-based strategies-including standardized group formats, continuity-focused structures, and clinician cross-training-that respond to barriers across service, management, and policy domains. Rather than proposing one-size-fits-all solutions, we share adaptable frameworks rooted in the realities of CMHC work. We argue for a more context-sensitive approach to implementation-one that takes seriously the questions of access, sustainability, and equity that define group work in underresourced settings.