Group Radical Openness (GRO) is a structured group therapy intervention that we initially developed for a psychiatric population (Booth & Egan, 2023). Research has shown that it is a valuable and significant intervention (Egan et al., 2021; Egan et al., 2025; Johnstone et al., 2024; Twomey et al., 2026; Twomey & Nelson-Sisinni, 2026). Over the last two years, we have pioneered an adaptation of this therapy in the Irish Prison Service (IPS). It is aimed at incarcerated people who fit a profile of what is termed “overcontrol”. This paper outlines the development of GRO, key features of overcontrol, how GRO has been implemented in prisons, and how its application has resulted in a new model called Forensic GRO.
Background To Group Radical Openness (GRO)
The journey to GRO started in St. Patrick’s Mental Health Services in Dublin, Ireland. We were running a Dialectical Behaviour Therapy (DBT) group for service users who experienced a range of difficulties and were self-harming. Many benefited from the intervention, but there were some individuals who were not making progress. It became apparent that, although they presented with some similar symptoms, their difficulties had very different underpinnings. In contrast to the majority of the group who were impulsive and emotionally dysregulated, this subgroup was highly controlled. We set out to learn more about overcontrol and its associated mental health costs.
Features of Overcontrol
Our early research highlighted three key patterns in those with disorders of overcontrol. First, they tended to be distant in relationships. This is not to say that they were solitary figures, but they were challenged by real intimacy, and it was often partners or colleagues who grew to find this intolerable. In some cases, their vigilance to threat impacted their signalling to others who found them unwelcoming, cold or even hostile. The prioritisation of protection over connection left them feeling lonely, adrift and fearful of getting close to others.
Second, they were likely to be rigid in their ways of coping. Strict rules and harsh unrelenting standards made life hard for themselves and others. Certain ways of protection, adaptive in early life, were now costly and often shameful. Play and spontaneity proved hard to access and they experienced regret over lost opportunities in life.
Third, they viewed emotions as a liability, either suppressing them or not acknowledging them at all. They resorted to caring for or appeasing others, rather than expressing their full range of emotions. While one or two emotions may have been accessible, others had been shut out for so long that they felt inaccessible. This inhibition or suppression meant that on an infrequent basis, bottled-up emotion could come bursting out. These outbursts were much more intense than warranted by the situation and often resulted in further incentive to suppress emotion. Together with self-harm, these outbursts (sometimes labelled emotional leakage or emotional overflow) were the main reason there could be confusion between undercontrol and overcontrol and why careful clinical assessment is required.
The GRO Treatment Model
Our initial therapeutic efforts were similar to Radical Openness Dialectical Behaviour Therapy (RO DBT; Lynch, 2018a, 2018b). We thought that teaching skills to upregulate emotion and improve social signalling would work for our overcontrolled population. However, as our work progressed, we felt that a lack of skills was not the fundamental problem and this led us to develop our own model. Central to the GRO model is the belief that the best place to risk being more open to connection, more flexible in how to approach life, and more willing to experience emotions is in the company of like-minded others. Not only are participants having the experience of being in a social group, but they are with others who share their learning history and mixed feelings about giving up strategies that, to some degree, have served them well. The course content is one element of the therapy but the connection, the common humanity, and the shared experiences play an integral role. In the manual (Booth & Egan, 2023) and five subsequent research papers, this approach is being extensively explored and evaluated. Participants of GRO have consistently highlighted how helpful and healing the social connection of the group has been and how much it reduced their overcontrolled coping and improved their lives outside the group.
Forensic GRO
Let’s consider a particular client profile.
“Jack” was a model citizen, a hard-working, honest family man, well respected in his community. Seemingly out of the blue, he murdered his wife. During his detention, he has been a model prisoner. There have been no disciplinary reports on his record and prison staff often remark on how hard he works. His crime was an apparent aberration. It is hard to plan an intervention for Jack, harder still to know if it might be having an impact.
When psychologists in the IPS read about GRO, they felt that it would be a very good fit for someone like Jack. He displayed many of the key traits of overcontrol. He had difficulty getting close to others, his rigidity and inflexible standards made him an unwelcome work colleague and, though he could express anger and frustration with others, for the most part he was closed to emotional expression. The murder of his wife fitted with the understanding of emotional overflow.
As our work progressed, we also felt that this therapy would suit incarcerated people who became overcontrolled as a result of their offence and subsequent length of time in prison. They too had shut out connection, become rigid, and suppressed emotions as a means to survive prison life.
Just as we had found with a psychiatric population, once we started to look, there were far more incarcerated people who fit these profiles than we had imagined. Much of the style and content of Forensic GRO remains the same as in the original model. The group fosters self-awareness. It helps participants to understand that their overcontrolled strategies were learned and often adaptive. The group builds a sense of belonging; they have the opportunity to regulate others and be regulated by them. They become invested in each other’s journeys. But we have made some adaptations. With our psychiatric population, there has been a cost (a breakdown, the loss of a key relationship, a serious suicide attempt, a hospital admission) that motivates them to consider their overcontrol. With those in prison it takes more time for them to see their overcontrol and they are likely to feel it has been necessary to help them cope with a long sentence. It requires a slower approach for them to realise that their overcontrol may have been a key element in their offending, and that it may not serve them well after release. In place of generalising what is happening in the GRO group to life outside (which is often not practical in prison), time is spent being more radically open in the group. A further adaptation of Forensic GRO is a key exercise requiring participants to be more radically open about their offence in front of the group.
Current Implementation of Forensic Gro and Next Steps
We have trained many practitioners in the Irish Prison Service and elsewhere. To date, we have delivered GRO groups in four Irish prisons and there has been a GRO group running in the UK (in HMP Frankland) for three years. The 27-session programme has up to now been aimed at those nearing the end of a life sentence, but is being broadened to other categories of incarcerated people, including individuals serving sentences for sexual offences. The programme has been very well received by both the psychologists and those taking part. Now that Forensic GRO has been created, formal data will be gathered and analysed. Informal qualitative data is already showing great promise and many points of interest.
Dr Richard Booth, Consultant Psychologist.
Dr Rachel Egan, Principal Clinical Psychologist at Saint Patrick’s Mental Health Services.
Correspondence is welcome at info@groupradicalopenness.com
References available upon request.
