Group Therapy

Helping each other heal and grow

This lecture:

 What is group therapy?

 Why do we conduct group therapy?

 Who is involved in group therapy?

 How is group therapy conducted?

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
 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
 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
change
 Groups offer diversity of perspectives
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
 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
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
 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.

 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

accordingly.
 Members are sensitive and responsive to one
another.
 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
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.
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
 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
 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 structured
CBT with
Conversion
Disorder
Conversion Disorder
Conversion disorder is a psychological condition that
causes symptoms that appear to be neurological, such as
paralysis, speech impairment, or tremors.
What Causes It?
 While the specific cause of conversion disorder is still
being studied, researchers think it develops as a way for
your brain to deal with emotional strife. It’s almost
always triggered by stressful situations and other
mental disorders. And the symptoms usually develop
suddenly.
 Women are more likely to have it than men. It also
happens more often to people with a history of
emotional trauma, and in those who have a hard time
talking about their feelings.
 Sometimes, physical symptoms might help resolve some
sort of internal conflict. For example, if you’re
struggling with the desire to hurt someone, conversion
disorder may cause you to develop paralysis, making it
impossible to act on that desire.
Symptoms
Conversion disorder symptoms most
commonly look like issues involving your 
nervous system (brain, spinal cord, or other
nerves). These include:
 Uncontrollable movements
 Tunnel vision or blindness
 Loss of smell or speech
 Numbness or paralysis
How Is It Diagnosed?

The symptoms must meet the standards set by the

American Psychiatric Association:
They affect your movement or senses, and you can’t
control them.
They can be related to a stressful event.
You’re not faking them.
They can’t be explained by any other condition, 
medication, or behavior.
They cause you stress in social and work settings.
They aren’t caused by another mental health problem.
CBT Techniques
Psychoeducation
 The family and patient need to have an understanding of
disorder within a neurobehavioral model
 A review of the risks and benefit of CBT

Daily Thought Record

 Make four columns
 First column includes date and time
 Second column mention the event and situation
 Third column includes the thought
 Forth column is about emotional response towards that
event
Cont..

SUDS (subjective unit of distress)

 Rating system for amount of symptom
 Usually use a 0-10 scale
Used during exercises as a way to monitor
response – ask for SUDS rating at beginning of
exercise then wait for value to decrease to
normal levels
Cont..

ABC Model
same as earlier
Triple Column Technique
make three columns
 First for negative thoughts
 Second for cognitive error
 Third for positive thought
Cont..
Problem Solving
Steps of P.S
 List out all your problems
 Pick one problem which you think, you wanted
to solve
 Find all possible solutions
 Pick the best solution
 Implementation
 If you fail than pick another solution and implement it
 Give reward for your attempt
Cont..
 Pleasure and Mastery Chart
I Want – They Want Assessment
 Positive events of the week
 Support Gait Intervention
 Behavioral Experiments
 Stretching of Muscles
 Stress Management
Cont..
 Extinction
 General Mobility
 Practicing Acceptance
 Imagery
 Double Standard Technique
 PMR
 Sleep Hygiene