Background This study sought to evaluate the clinical effectiveness and practical viability of groups loosely based on cognitive behaviour therapy (CBT) principles for older frail residents of an aged‐care facility with anxiety and/or depressive symptoms. Methods Six residents (mean age 88 years) participated in 8 weekly sessions of group psychotherapy. All had multiple physical comorbidities and loss of physical independence; one participant had a diagnosis of dementia. Results After the program, two participants significantly improved on the Beck Depression Inventory II, while one worsened slightly. Despite difficulties with recruitment, participants were highly engaged and managed group processes, such as confidentiality and turn taking, well. Participants highly valued the program. The trial revealed a number of challenges to group therapy for this population. Clinically, participants had difficulties with goal setting and refused formal homework tasks. Facilitators modified sessions to flow with the group and used experiences raised by participants to illustrate conceptual and practical lessons. Logistical issues also emerged, and we make a number of suggestions for future practice. Conclusions Despite challenges unique to running psychological therapy groups in residential aged‐care facilities, this pilot shows it is possible to work around them and that frail old residents can contribute to, and potentially benefit from, the process of group therapy.