Group Therapy

Group Therapy
Helping each other heal and grow
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?
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
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.)
What is group therapy?
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.)
Why do we conduct group therapy?
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
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
 Groups offer diversity of perspectives
“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 (group therapy)
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
Who is involved in group therapy?
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)
Group Composition
 Heterogeneous groups
 Homogenous groups
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
Group As a Container
 Ground rules
 Norms
 Group leader facilitation
 “Here and now” interventions
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
Group Evaluation: Outcome measurements are difficult to obtain.
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
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.
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.
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.
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.
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.
Stage 3: Cohesiveness/norming stage
 People know what is expected and act
 Members are sensitive and responsive to one
 Members have developed an emotional
attachment to each other.
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.
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
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
 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
 Individual and cultural differences become more respected and
 Members move from reluctance in hearing feedback to seeking it.
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.
The function of the group therapist
 Emotional Stimulation
Modeling self-disclosure
 Caring
Showing support
Providing praise, warmth, and acceptance
 Meaning Attribution
Explaining and clarifying
 Executive Function
Providing rules and setting limits
Managing time
Commenting on group dynamics
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.
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