Running head: ADDRESSING KEY COMPONENTS OF EFFECTIVE GROUP
Addressing Key Components of Effective Group Therapy
Lacey Hastings
Stenberg College
Working in Groups
Debbie McCreedy
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ADDRESSING KEY COMPONENTS OF EFFECTIVE GROUP
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Abstract
The use of group therapy is on the rise, and some could say this is because group therapy is just
as, if not more effective than individual therapy (Burlingame, Fuhriman, & Johnson, 2004; as
cited in Corey 2008). Group therapy allows for a different kind of experience, where members
can interact with one another, learn from each other, and improve interpersonal functioning.
Group therapy is also a very meticulous process, dependent on particular therapeutic factors,
environments, behaviors and dynamics. Literature shows that members need to prepared for this
experience, they need to be informed of the process and nature, they need to have expectations,
and fears addressed, and they need to be prepared for what is expected of them(Yalom & Leszcz,
2005). This preparation influences participation, attendance, and the overall experience of the
member (CSAT, 2005); thus directly influences the effectiveness of group therapy. In addition,
for members to have an effective group therapy experience, to partake in meaningful group
work, they need to experience cohesion in the group(Marmarosh & Horn, 2011). When members
are part of a cohesive group, they feel accepted and supported, and they are more likely to selfdisclosure, open up, explore and learn. This is pivotal for meaningful group work, and for
members to experience effective group therapy. There also needs to be a focus on interpersonal
communication and interpersonal interactions in group work, as this is how we meet basic
human needs, and interpersonal relationships are directly connected with mental health(Lipsitz &
Markowirz, 2013). When members relate, interact, learn and explore with other members,
interpersonal learning takes place, which results in personal growth and ultimately change; thus
rendering the therapeutic experience more effective. There are many important therapeutic
factors and preconditions for group therapy, however proper preparation, group cohesiveness and
interpersonal learning, are of uttermost importance for effective group therapy.
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Addressing Key Components of Effective Group Therapy
Group therapy is a very powerful experience, a highly effective form of therapy and
research confirms its power to provide a ‘meaningful benefit’ (Yalom & Leszcz, 2005). It has
been noted through the literature that group therapy is just as, if not more, effective than
individual therapy in treating a range of psychological problems (Burlingame, Fuhriman, &
Johnson, 2004a, 2004b; Fuhriman & Burlingame, 1999; Markus & King, 2003; Piper &
Ogrodniczuk, 2004; Corey 2008). This effectiveness can be explained in many ways, can stem
from many things, and the benefits of group therapy are numerous. With group therapy,
members can “not only gain insight but practice new skills both within the group and in their
everyday interactions outside the group”, and benefit immensely from the feedback and
interactions with group members and therapists (Corey, 2008). Thus group therapy is effective
and beneficial for numerous intrapersonal and interpersonal issues that come along with so many
psychological problems; it is an effective treatment for helping people change, learn and grow
(Corey & Corey, 2010). However, group therapy is very precise, a very strategic and fragile
process, requiring specific therapeutic factors, conditions, and dynamics. For group therapy to be
effective, certain things need to take place, the group needs to interact in certain ways, and the
group leader needs to fulfill certain roles and certain skills. The writer beliefs that for group
therapy to be effective, clients need to be properly prepared for the experience, there needs to be
group cohesiveness and interpersonal learning needs to take place. The writer will prove this by
exploring these concepts and reviewing the literature.
ADRESSING KEY COMPONENTS OF EFFECTIVE GROUP
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Pre- Group Preparation
Since the dynamics and the ‘work’ of group therapy is so particular, and this particularity
is how group therapy becomes effective and how meaningful benefit takes place, clients need to
be prepared for this powerful and challenging experience. Preparing a client means getting them
ready, educating them about group therapy, discussing the purpose and the expectations,
addressing any concerns, and discussing any group agreements or ground rules (CSAT, 2005;
Puskar, 2012). This includes clarifying any misconceptions, fears and expectations, and
generating “realistic and positive expectations about the group therapy” (Yalom & Leszcz,
2005). It includes providing clients with a base, with ‘group norms’ in which promote effective
group participation (Yalom & Leszcz, 2005). Clients need to know what is expected of them,
they need to know realistically what to expect and what goals to focus on, and they need to be
aware of the hard work and the benefits of group therapy, as all of this will influence how they
participate and what they get out of the experience (CSAT, 2005).
Individuals often have predetermined ideas and misconceptions about group therapy,
these can come from previous experiences or others experience, either way they can affect how
members participate, what they put into the group experience, and whether they terminate
prematurely (Puskar, 2012; Yalom & Leszcz, 2005). Individuals may have false ideas of what
the group experience will entail; they may have unrealistic fears, or negative misconceptions of
the quality of group therapy. Which is why these ideas, these fears and misconceptions need to
be addressed and clarified, and appropriate and accurate information needs to be given.
Without preparation for group therapy, clients can be left in the dark, left with
uncertainty, and anxiety, and can grow ‘unnecessarily discouraged’, and potentially terminate
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group therapy (Yalom & Leszcz, 2005). However with appropriate preparation, with the
clarification of goals, behaviors, process and expectations, uncertainty and anxiety can be
reduced (Yalom & Leszcz, 2005). Misconceptions, and fears can be challenged, and clients can
be provided with appropriate information and expectations, so they can understand and be
familiar with the process, so they know what to expect, and can participate accordingly. Thus
with pre-group preparation individuals can be given the information and the tools they need to
benefit from group therapy, and have an effective group therapy experience.
Research shows that preparing clients for group therapy improves attendance,
participation, and group cohesion; individuals who are prepared report less anxiety, show
motivation to change and are more likely to achieve their goals in therapy (Yalom & Leszvz,
2005). Research confirms the value of preparation for group therapy, and as Yalom (2005)
States, “There is highly persuasive evidence that pre-group preparation expedites the course of
group therapy” (p.294).
Group Cohesiveness
Group cohesiveness can be described as a mechanism or a force that keeps members
connected to the group (Festinger, Schachter & Back, 1950; 1992; Lewin, 1947; as cited in
Marmarosh & Horn, 2011). It can be described as a sense of ‘we-ness’, or a “feeling of being a
part of something bigger than oneself” (Marmarosh & Horn, 2011). This feeling or this ‘force’ is
one of the most important therapeutic factors for group therapy (Yallom & Leszcz; as cited in
Marmarosh & Horn, 2011). Cohesion is said to be the ‘glue’ that holds the group together
(Marmarosh & Horn, 2011).
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With group cohesiveness members feel connected, they feel accepted and can identify
with the group (Marmarosh & Horn, 2011). Cohesiveness alters self-esteem through this
acceptance and empathy, and self-esteem is important for change and growth throughout group
therapy (Yalom, 1995; as cited in Marmarosh, Holtz & Schottenbauer, 2005). Cohesion allows
members to engage in necessary self-disclosure and personal exploration- important therapeutic
factors for effective group therapy (Yalom, 1995; as cited in Marmarosh, Holtz & Schottenbauer,
2005).And this allows member to open up, to gain insight, and to learn and grow interpersonally
(Yalom & Leszcz, 2005). Thus group cohesion allows for the necessary ‘therapeutic
environment’ for group work, the necessary condition for ‘meaningful group work’ (Yalom
2005; as cited in Marmarosh & Horn, 2011). It allows for a safe environment, an environment
where members can feel supported, understood and accepted, where they can share, disclose and
explore. With a cohesive group they can have the environment they need to facilitate this
necessary group work, and thus get the most out of their group therapy experience. Cohesion can
also be looked at as a ‘prerequisite for change’(Marmarosh & Horn, 2011), by allowing members
to feel comfortable, and have the self-esteem and support to self-disclose, explore and to
participate In group work, this is allowing for growth, learning, progress and change; i.e.
effective group work.
Research shows that as cohesion levels increase, client outcomes improve and
psychological symptoms decrease (Burlingame, McClendon & Alonso, 2011). As cohesion
predicts process, and in turn, eventual group outcomes (Burlingame, Fuhriman, & Johnson,
2001). Thus cohesion is a ‘mediator of outcome’ for group therapy (Marmarosh & Horn, 2011).
Group cohesion can be compared to the therapeutic alliance in individual therapy, in
group therapy cohesion is the therapeutic relationship (Burlingame, Fuhriman, & Johnson,
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2001). Thus without cohesion, without that sense of 'we-ness', the group remains detached, they
become “frozen behind their defenses” and their work is superficial (Corey, 1995; as cited in
Marmarosh & Horn, 2011). They don’t have that support, acceptance, and connection that is
necessary for meaningful group work, thus without a cohesive group, members don’t have that
environment that is needed for effective group work.
Interpersonal Learning
Interpersonal communication is central to our everyday life’s, to our everyday
interactions (Wood, 2010). We communicate to “develop identities, establish and build
relationships, coordinate efforts with others, have impact on issues that matter to us, and work
out problems and possibilities” (Wood, 2010). Interpersonal communication is the ‘lifeblood’
of meaningful relationships in personal, social, and professional contexts (Wood, 2010) and as
Sullivan proposed, mental health depends on healthy, intimate connections with other people (As
cited in Lipsitz & Markowitz, 2013). When looking at Maslow’s Hierarchical of Needs ,
interpersonal communication is a primary way in which to meet these basic needs. Such as
belonging needs, we communicate interpersonally to meet these belonging needs, the need to fit
in, to socialize, to be accepted and for affirmation (Wood, 2010). As well as self-esteem needs,
which involves valuing and respecting ourselves and being valued and respected by others;
through interpersonal communication we figure out who we are and who we can be (Wood,
2010). Through interpersonal communication we also meet the human need of self-actualization,
the need to become our fullest self’s, to learn, grow and change (Wood, 2010). Interpersonal
communication fosters this personal growth.
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Individuals with psychological problems often have difficulties in interpersonal
functioning and with interpersonal communication (Lipsitz & Markowitz, 2013) and
psychological symptomology is said to “emanate from disturbed interpersonal relationships”
(Yalom & Leszcz, 2005). And since interpersonal communication is a primary way to meet
human needs, is a central part of daily life and directly related to mental health, interpersonal
learning is pivotal in group therapy, and improving interpersonal functioning is a universal goal
of psychotherapy (Lipsitz & Markowitz, 2013).
The interpersonal aspects of the group in a group therapy setting are the dynamics
between the group members, the emotional reactions, the closeness, assertiveness and boundaries
(Earley, 2013). Through interpersonal interactions, members come to understand differences and
similarities, which foster personal growth (Wood, 2010). Interpersonal interaction stimulates
reactions and transferences, that are the ‘lifeblood’ of therapy, and this allows for experimenting,
exploring and healing responses (Earley, 2013). Through relating and interacting individuals can
learn about themselves, they can become aware of interpersonal tendencies and modify them
(Lipsitz & Markowitz, 2013). Group members can learn from one another, they can make social
connections, work through emotions and behaviors and ultimately learn to better understand and
manage these emotions and interpersonal encounters more generally (Lipsitz & Markowitz,
2013). With working through interpersonal issues in the group setting, one’s social supports can
be enhanced, interpersonal stress can be decreased, emotional processing facilitated, and
interpersonal skills improved (Lipsitz & Markowirz, 2013). Thus with interpersonal learning,
comes the real ‘work’ of group therapy, the meaningful and effective work, the learning,
growing and changing.
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Without working on interpersonal communication, and interpersonal issues, without
interpersonal learning, there is little room for change, as this interpersonal, here and now
learning, is the key to insight, understanding and change (Yalom & Leszcz, 2005) and thus the
key to effective group therapy.
Summary
Group therapy is proven to be effective; it can be a powerful, meaningful experience with
deep interpersonal/intrapersonal benefits. However it requires appropriate therapeutic factors,
and the right therapeutic environment. In order for individuals to benefit from this powerful
experience, they need to be prepared for it, they need to be aware of the therapeutic factors, be
prepared for the ‘meaningful’ work that will take place, and be prepared for what is expected of
them. This preparation influences the quality and the outcome of the group work, and influences
the attendance and termination of group members; critical to effective therapy. Individuals need
to feel that they are in a cohesive group, they need to feel accepted, supported, and feel that ‘weness’, this enables them to open up and participate in meaningful work, and to get the most out of
their group therapy experience. And for group therapy to be truly effective, meaningful and
powerful there needs to be deep interpersonal learning, as improving interpersonal functioning is
a main focus, is directly related to mental health, and allows members to reach their basic human
needs, and allows for healing, learning and growing. Thus the writer concludes that for group
therapy to be truly effective, members need to be appropriately prepared, have cohesion within
the group, and experience forms of interpersonal learning.
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