Group Therapy

1. Group Therapy Helping each other heal and grow

2. This lecture: • History of group therapy • What is group therapy? • Why do we conduct group therapy? • Who is involved in group therapy? • How is group therapy conducted?

3. History of Group Therapy (in the U.S.) • Before 1900’s • Large groups (e.g., immigrants, poor, etc.) • Hull House • Groups for people with tuberculosis (1905) • Moreno (1921) – Theater of Spontaneity (psychodrama) • AA founded in 1930’s • Introduced in the 1940s, though Alfred Adler (“Collective Counseling”) and a few others • Early efforts similar to today’s group guidance and psychoeducational groups • WWII and its effects led to popularization of group therapy

4. History of Group Therapy (cont.) • The 1960’s Human Potential Movement • Founded on belief that most people only use a small percentage of their capabilities but that within a group experience, they can recognize their full potential. • Started proliferation of personal growth groups • Gestalt groups • T-Groups: Individuals come together to learn how to work in a group and to effect interpersonal change. • Encounter Groups: Designed to help normal individuals remove blocks that inhibit their functioning • Marathon Groups: An intensified encounter group that meets for a long period of time (e.g. 8 hours or a whole weekend.)

5. What is group therapy?

6. Types of Groups • Task Groups: A group that comes together to perform a task that has a concrete goal (e.g. community organizations, committees, planning groups, task force). • Guidance/Psychoeducational Group: Preventative and educational groups that help group members learn information about a particular topic or issue and might also help group members cope with that same issue (e.g. transition group to prepare students to enter high school etc.) • Counseling/Interpersonal Problem-Solving Groups: These groups help participants resolve problems of living through interpersonal support and problem solving. • Psychotherapy Groups: These groups focus on personality reconstruction or remediation of deep-seated psychological problems. • Support Groups: These deal with special populations and deal with specific issues and offer support, comfort, and connectedness to others. • Self-help Groups: These have no formal or trained group leader. (e.g. Alcoholics Anonymous or Gamblers Anonymous.)

7. Why do we conduct group therapy?

8. Therapeutic Forces In Groups (Yalom) • Instillation of Hope • Universality • Imparting of Information • Group Cohesiveness (belonging) • Catharsis • Support • Feedback and Confrontation • Existential Factors (risk, responsibility) • Interpersonal Learning (modeling, vicarious learning) • Group as a microcosm (e.g., social contact, roles) • Simulation of primary family • Altruism • Corrective emotional experience • Development of social skills

9. Advantages of groups • Groups provide a social atmosphere that is similar to the real world • Groups provide more opportunity for social learning • Participants can more easily learn interpersonal skills • Members can practice new interpersonal skills on each other • Particularly developmentally appropriate for adolescents • Groups are cost effective • Groups provide commonality (e.g. “I’m not the only one with this problem”) • Group experiences help members become aware of how others view them and what impact their behavior has on others • Group dynamics can replicate family of origin dynamics and thus help group members work out old family issues • A group member makes public statements regarding change and thus is more likely to follow through with stated behavior • Members receive feedback/support/challenge that encourage or facilitate change • Groups offer diversity of perspectives

10. “What I got out of group therapy” “What I got out of group therapy: I was treated with respect, listened to, not judged. I was able to say in "public" what my symptoms were and how I felt. I met other people who had what I had which relieved the feeling of isolation. I learned from the other members of the group what worked for them and copied the skills that worked for me. I got encouragement from the others when I wanted to die. I got compliments when I did well or said something they liked. I had a chance to give and get feedback. I got to hear myself think out loud as I vocally processed what I was dealing with, thus getting it clearer in my own mind." From Wikipedia.org (group therapy)

11. Disadvantages of groups • Not everyone can be in a group (e.g., issues, interpersonal skills) • Confidentiality more difficult to maintain • Harder to build trust and safety • Group leaders are not always properly trained • Not enough time to deal with each person thoroughly • Group leaders have less control than in individual therapy • There are concerns with conformity and peer pressure • Scapegoating may occur • A disruptive person can cause more harm • Casualties are more likely to occur

12. Who is involved in group therapy?

13. Inclusion/Exclusion Criteria • Who benefits? • Depends on the group • Almost anyone can benefit from group • People who have the most difficult time in relationships are those who might most benefit from group therapy • Usually form a group by creating exclusion criteria • Possible reasons for exclusion • Acute situational crisis • Deeply depressed suicidal clients • Members who are unable to attend regularly • Clients with Antisocial Personality Disorder (unless the group is specifically designed for them)

14. Group Composition • Heterogeneous groups • Homogenous groups

15. How do we conduct group therapy? “He drew a circle that shut me out;Heretic, Rebel, a thing to flout.But Love and I had the Wit to Win.We drew a circle that took him in” – Edwin Markham

16. Group As a Container • Ground rules • Norms • Group leader facilitation • “Here and now” interventions

17. Concerns in Group Work • Participant Selection: Screening is needed with counseling and psychotherapy groups. Some people are not well suited for group work. • Group Size: Varies from 3-4 members to several hundred depending upon the group (e.g. psychotherapeutic or task group). Group counseling and psychotherapy generally work best with 6-8 members. • Length and Duration of Sessions: Individual sessions are usually 50 minutes, group sessions range from 1-2 hours. Session duration can be only once or in some cases might last for years (e.g. open-ended psychotherapy group). • Group structure can be open (allows members to enter and leave the group as needed) and closed (only the group members who started at the beginning are in the group at the end). • Ethics: Confidentiality is hard to guarantee due to the number of participants. • Group Evaluation: Outcome measurements are difficult to obtain.

18. Group Development • Development occurs in an orderly fashion through stages • Stages are completed in sequence • Knowledge of developmental stages allows one to predict behavior • Development can be facilitated

19. Stages of groups • Stage One (Orientation/Forming): Group members orient to group and each other. • Stage Two (Transition/Storming): Anxiety, ambiguity, and conflict become prevalent as group members struggle to define themselves and group norms. • Stage Three (Cohesiveness/Norming): A therapeutic alliance forms between group members. • Stage Four (Working/Performing): Group members experiment with new ideas, behaviors or ways of thinking. Egalitarianism develops. • Stage Five (Adjourning/Terminating): The group disbands.

20. Stage 1: Orientation/Forming Stage • Members lean on the group leader for guidance. Group rules and norms are discussed. • Members are guarded because trust has not yet been built. • Members may also be defensive and resistant because they are unsure. • Member roles are explored. • Members may come forth with hidden agendas • Group leaders do a lot of guiding at this stage. • Group leaders model communication and behavior that they want the group to follow.

21. Moving from the Orientation/Forming stage: • Members are ready to move to the next stage when: • they have internalized the ground rules and are following them. • they have developed some trust with one another. • the group feels safe to group members. • members treat each other with respect and caring.

22. Stage 2: Storming/Transition Stage • Conflict is common. • Members begin to test the group and seek power and greater self-disclosure. • Other members may attempt to block increased self-disclosure due to feelings of threat or feeling uncomfortable. • Members may act tentatively and experimentally, testing others reactions. • Group leaders model appropriate self-disclosure. • Group leaders facilitate responses that are genuine, concrete and suitable to the present level of disclosure.

23. Moving from the Storming/Transition stage • Members are ready to move to the next stage when: • Members feel closer to one another. • Trust and risk taking behaviors have increased. • Members show care-taking behavior toward one another.

24. Stage 3: Cohesiveness/norming stage • People know what is expected and act accordingly. • Members are sensitive and responsive to one another. • Members have developed an emotional attachment to each other.

25. Stage 4: Working/performing stage • Group leaders are less active and members more active. • Group leaders model appropriate ways to confront others. • Members make a commitment to change and act on that commitment.

26. Stage 5: Termination or Disengagement Stage • Disengagement usually begins a few sessions before the ending of the group. • Self-disclosure and risk taking taper off. • Grief and loss issues are common. • Feelings of ambivalence about the group ending are also common. • Group counselors reinforce the growth made in the group and encourage members to continue to maintain progress. • Counselors make any necessary referrals

27. Group Development Over Time • Group becomes less leader centered and more member centered. • Self-disclosure moves from being centered on impersonal events or feelings located in the past to more personal and present centered. • Conflicts are handled less by avoidance and more by acknowledgment. • Norms change from those that have been more imposed by the leader to those collaborated on by the group and these norms reflect the culture of the group. • Boundaries between members move from being rigid to being more flexible. • Individual and cultural differences become more respected and valued. • Members move from reluctance in hearing feedback to seeking it.

28. Purposes of therapist intervention • To help build an atmosphere of trust and safety. • To prevent or cut off abuse and/or hostility. • To enforce rules and norms. • To redirect focus. • To provide feedback. • To get a member’s input, reaction or feedback. • To draw connections between members or point out themes. • To correct irrational or faulty thinking. • To empower participants. • To offer support when needed. • To reinforce helpful contributions. • To encourage constructive risk taking • To provide structure when it is needed. • To stop unproductive gripe sessions. • To confront incongruence or inconsistencies. • To bring closure to a topic or a session.

29. The function of the group therapist • Emotional Stimulation • Challenging • Confronting • Modeling self-disclosure • Caring • Showing support • Providing praise, warmth, and acceptance • Meaning Attribution • Explaining and clarifying • Interpreting • Linking • Executive Function • Providing rules and setting limits • Managing time • Commenting on group dynamics

30. Benefits of having co-therapists • More expertise. • Allows for division of labor (e.g. one leader can concentrate on content and the other leader can look at process variables). • Group members receive more individual attention. • Two leaders can model communication and conflict resolution. • Two leaders provide diversity in theoretical orientation, interpersonal style, and cultural resources.

31. Limitations/dangers of co-therapists • If two leaders do not get along, it can be detrimental and even harmful to group • Co-leaders might develop competition between themselves and this too is not good for the group • If co-leaders have different skill levels, one might try to lead the other. This can lead to coalitions with other group members or even in the marginalization of the more inexperienced leader • Group members might feel ganged up on if both leaders become adamant in getting across a therapeutic message • Groups with two leaders can more easily become over structured