CSL 6805.01

Chapters 10, 11, 12 &13

Agenda

• Chapters 10, 11, 12, 13• Experiential Group Exercises:

Questioning – Compare Person-Centered Approach with Gestalt Approach; Dreams – Compare Psychoanalytic Approach with Gestalt Approach; Transactional Analysis

Course Competencies

• Defining the origins of group counseling, including the leaders and time frames

• Applying specific theories of practice to group counseling

• Applying group dynamics and processes• Modeling appropriate group techniques for use

in schools, community, and organizational settings

• Providing and synthesizing the exchange of feedback between self and other leaders and group members

Person Centered Group Approach

Carl Rogers (1902-1987)

Person-Centered Group Approach

• The Person-Centered Approach Challenges:– The assumption that “the group leader knows best”– The validity of advice, suggestion, persuasion,

teaching, diagnosis, and interpretation– The belief that group members cannot understand

and resolve their own problems without active and directive intervention of the leader

– The focus on problems over persons– The necessity of using techniques to get or keep a

group moving

Humanism

• Overlaps with Existentialism, but focuses on human capacities aimed at growth:– Love, freedom, choice, creativity, purpose,

relatedness, meaning, values, self-actualization, autonomy, responsibility

• Carl Rogers, Rollo May, Abraham Maslow, Clark Moustakas, Sidney Jourard, Fritz Perls, James Bugental

Humanism – Key Concepts

• Self-awareness – people who are self-aware can make more life-affirming choices.

• Phenomenological approach – understand reality from client’s perspective

• Self-actualization - Innate process by which a person tends to grow spiritually and realize potential

• Self-determining – although influenced by past, individuals determine who they become through choice

• Respect for subjective experience of each person – that people are capable of acting in responsible and caring ways in interpersonal relationships

Person-Centered Approach [PCA]

PCA in group practice emphasizes:– Therapy as a shared journey– The person’s innate striving for self-actualization– The personal characteristics of the facilitator and the

quality of the therapeutic relationships within the group

– The facilitator’s creation of a permissive, “growth promoting” climate

– People are capable of self-directed growth if the core conditions are present

– Trust in the group process: Members can be trusted to move in a constructive direction

Person Centered Approach

• In nondirective counseling the therapist’s realness and empathy are emphasized, and the therapeutic relationship rather than the therapist’s techniques are viewed as the central factor in facilitating change.

• Basic trust in the client’s ability to move forward if conditions fostering growth are present

Therapeutic Conditions for Growth

• Congruence—genuineness or realness– The greater the extent to which facilitators are real, the

more members will change and grow• Unconditional positive regard and acceptance

– Caring not contaminated by judgment– An attitude of receptiveness toward the subjective and

experiential world of the members• Empathy

– This is the ability to deeply grasp the member’s subjective world

– Facilitator’s attitudes are more important than knowledge

Congruence & Genuineness

• Therapist is real, genuine, integrated & authentic during therapy; human being struggling for realness

• Therapist has no false front; match of inner & outer expression of experience

• Therapist can openly express feelings, thoughts, reactions & attitudes present in relationships with client

Unconditional Positive Regard

• Therapist communicates deep & genuine caring for client as a person

• Caring is unconditional-no evaluation or judgment of client’s feelings, thoughts or behaviors

• Caring does not come from need of reciprocal caring of therapist by client

• Acceptance & recognition of client’s right to have own beliefs & feelings

Accurate Empathic Understanding

• Therapist understands client’s experience & feelings as revealed in interaction

• Therapist tries to sense client’s subjective experience in here and now

• Sense the other’s feelings as if my own• Capable of reflecting the experience of client

back to client-encourages client to be more reflective

• Encourages client’s own understanding & clarification of beliefs and worldviews

Six Core Conditions

Necessary and sufficient for personality changes to occur

1. Two persons are in psychological contact

2. The first, the client, is experiencing incongruency

3. The second person, the therapist, is congruent or integrated in the relationship

4. The therapist experiences unconditional positive regard or real caring for the client

5. The therapist experiences empathy for the client’s internal frame of reference and endeavors to communicate this to the client

6. The communication to the client is, to a minimal degree, achieved

Process of Therapy1. Client’s communications about externals & not self2. Client describes feelings but not recognize or “own” them

personally3. Client talks about self as an object in terms of past

experiences4. Client experiences feelings in present-just describes them with

distrust & fear5. Client experiences & expresses feelings freely in present-

feelings bubble up6. Client accepts own feelings in immediacy & richness7. Client trusts new experiences & relates to others openly &

freely

The Group Counselor

• Focuses on the quality of the therapeutic relationship• Understands that the presence of facilitator is of the utmost

importance• More concerned about personal qualities rather than

techniques of leading a group• Serves as a model of a human being struggling toward greater

realness• Is genuine, integrated, and authentic, without a false front• Can openly express feelings and attitudes that are present in

the relationship with the group members• Understands the role of group counselor is that of a facilitator

—using self as an instrument of change

Techniques

• Listening• Accepting• Respecting• Understanding• Responding

Person-Centered Expressive Arts

• Natalie Rogers• Principles of expressive arts therapy

– Expressive arts as a multimodal approach to integrating mind, body, emotions, and spiritual inner resources through art forms

– All people have the ability to be creative– The creative process is healing

• Conditions that foster creativity– Openness to experience– Internal locus of evaluation

• Some guidelines for creative expression in groups– Important to offer stimulating and challenging experiences– Essential to create a nonjudgmental and supportive climate– The facilitator’s “way of being” is more important than techniques

used in expressive arts therapy

Evaluation of PCA in Groups

• Contributions and strengths of the approach– A good foundation for the initial stage of most groups– Value is placed on empathy and respect for members– Values and principles of PCA can be incorporated into many

other approaches– This approach places prime emphasis on the group counselor

as a person – The philosophy can be a basic part of working with culturally

diverse client populations

• Limitations of the approach– Many leaders want and need more structure than this

approach allows

Gestalt Therapy

• Fritz Perls (1893-1970) Germany

• Married Laura Perls in 1930

• US in 1946• Founded New York

Institute of Gestalt Therapy

Therapeutic Goals in Groups

• Existential and Phenomenological—it is grounded in the member’s “here and now” experience– Emphasizes how each member views the world

• Initial goal is for group members to gain awareness of what they are experiencing and doing now– Promotes direct experiencing rather than the

abstractness of talking about situations– Rather than talk about a childhood trauma, the group

participant is encouraged to become the hurt child– As members acquire present-centered awareness,

significant unfinished business emerges– Awareness is seen as curative and growth-producing

Continuum of Awareness

• Awareness involves staying with the moment-to-moment flow of experiencing

• By staying with present-centered awareness, members discover how they function in the world

• Group leaders ask “what” and “how” questions– What are you experiencing now?– How are you experiencing your anxiety in

your body?

Four Major Principles of Gestalt Therapy

• Holism-interested in the whole person-emphasis on integration-thoughts, feelings, behaviors, body, & dreams

• Field Theory-organism must be seen in its environment or its context as part of a constantly changing field; everything is relational, in flux, interrelated & in process

• Figure Formation Process-tracks how some aspect of the environmental field emerges from the background and becomes a focal point of the individual’s attention

• Organismic self-regulation-restore equilibrium or contribute to growth & change

The Here-and-Now

• Our “power is in the present”– Nothing exists except the “now”– The past is gone and the future has not yet arrived– The past is important, but only as it is related to present

functioning– A here-and-now focus brings vitality to a group

• For many people the power of the present is lost– They may focus on their past mistakes or engage in

endless resolutions and plans for the future– The challenge is to come into closer contact with

ongoing experiencing from moment to moment

Unfinished Business

• Feelings about the past are unexpressed– These feelings are associated with distinct

memories and fantasies– Feelings not fully experienced linger in the

background and interfere with effective contact and functioning

• Result:– Preoccupation, compulsive behavior, wariness,

oppressive energy, and self-defeating behavior– Unfinished business needs to be addressed so that

we can move toward health and integration

Contact and Disturbances to Contact

• CONTACT – interacting with nature and with other people without losing one’s individuality

• DISTURBANCES TO CONTACT – the defenses we develop to prevent us from experiencing the present fully– Gestalt therapist focuses on disturbances to

contact– Five contact boundary disturbances:

• Introjection• Projection• Retroflection• Confluence• Deflection

Introjection-channel of resistance

• Tendency to uncritically accept others’ beliefs and standards without assimilating them to make them congruent with who we are

• Passively incorporate what the environment provides, spending little time on becoming clear about what we need or want

Projection -channel of resistance

• Disown aspects of self by assigning them to environment

• Trouble distinguishing between inside & outside world

• Disown attributes of self that are inconsistent with self-image & put onto other people

• To avoid taking responsibility for our own feelings & person who we really are

• Keeps us powerless to initiate change

Deflection -channel of resistance

• Process of distraction-keep difficult to sustain sense of contact with reality

• Overuse of humor, abstract generalizations & questions rather than statements-results in emotional depletion

• Diminished emotional experience-by speaking through and for others

Confluence-channel of resistance

• Blurring differentiation between self & environment

• In relationships, it is a need to fit in, an absence of conflict, a belief all people feel & think same way

• High need for acceptance, approval• Stay safe, never express own feelings

Energy and Blocks to Energy

• Unexpressed emotions create a blockage in the body• Energy

– In a Gestalt group, the focus is on energy—within individuals and with the group as a whole

– Gestalt leaders pay attention to where energy is located, how it is used, and how it can be blocked

• Blocks to energy– These blocks manifest themselves in the body in

various ways– Members may not be aware of their energy or

where it is located– Experiments can be designed to assist members in

becoming aware of the ways they may be blocking their energy

Role of Gestalt Leader

• Gestalt leaders encourage members to heighten their awareness

• Gestalt leaders focus on contact, awareness, and experimentation

• Gestalt leaders take an active role in creating experiments to assist members in gaining awareness

• Main role of leader is to create a safe climate that allows members to feel free in trying out new ways of being and behaving

• Central role of the relationship:– Contemporary Gestalt practice emphasizes a

dialogic relationship (attitude)– Emphasis is on presence, authentic dialogue,

gentleness, and self-expression by the leader

Client’s Process in Gestalt Work

• Discovery - Surprises for client– new realizations about self– novel view about old situations– new look at significant other

• Accommodation– recognition they have a choice– try new behaviors in safety of group– expand awareness in real world

• Assimilation– Learning to influence environment– Deal with surprises encountered daily– Confidence to improve and improvise

Paying Attention to Language

• To encourage self-awareness:• Change “It” talk to “I”-Ex. “I am frightened”, instead of

“It’s frightening”.• Change “You” talk to “I” talk to take responsibility for

feelings, opinions, etc. – “You feel hurt” to “I feel hurt” • Questions can put other members on the defensive.• Pay attention to qualifiers such as “but” because they

diminish the power of statements.• Substitute “won’t” for “can’t” to be more honest and take

responsibility.• Leaders should not challenge members’ language in the

early stages when developing trust and safety.

Therapeutic Experiments

– Not a technique or exercise that is prescribed to bring about an action

– Phenomenologically based and evolve out of what is occurring within members in the present moment

– Members are encouraged to try new behaviors and pay attention to what they are experiencing

– A creative happening, rather than a group exercise that the leaders might prepare prior to a group meeting

Experiments

• Internal dialogue exercise• Making the rounds• Rehearsal exercise• Exaggeration exercise• Staying with the feelings

Internal Dialogues

• Fantasy dialogues promote awareness–Dialogues between opposing sides of

self–Dialogues with a parent or significant

other–Can use the “empty chair” technique

Making the Rounds

• In a group, go up to each person in the group and speak to or do something with each one

• Goal: confronting, take risks, disclose self, try new behaviors to grow and change

Rehearsal Exercise

• Behavioral rehearsal: role playing a planned for new behavior with a person or people in client’s environment

• To reduce stage fright, anxiety or fear “not do the role right”

• Encourages spontaneity and willingness to experiment with new behaviors

Exaggeration Exercise

• Exaggerate movement or gesture repeatedly to intensify feelings attached to behavior to make inner meaning clearer

• Trembling hands or feet, slouched posture, bent shoulders, clenched fists, tight frowning, facial grimacing, crossed arms

Staying with the Feelings

• Keep client from escaping from – Fearful stimuli– Avoiding unpleasant feelings

• Encourage to go deeper into feelings or behavior which they wish to avoid (“How are you…”)

• Facing, confronting & experiencing feelings-to unblock and make way for new levels of growth-takes courage & pain

• Leader avoids telling members the meaning of their gestures, postures, and body symptoms, so that members are more able to stay with what they are experiencing and eventually find their own meaning.

Dream Work in Groups

• Principles of Gestalt dream work– Dreams contain an existential message– Dreams are not interpreted by the leader– Members discover their own meaning of their dreams

• Guidelines for working with a dream in a group– Relive the dream as though it were happening now– Members asked what interests them about the dream– Members are encouraged to become different parts of the

dream– Create dialogue between the various aspects of the dream– Members suggest what they think a dream might be telling

them– Other members can share with the person working with the

dream how they are affected

Evaluation

• Strengths– Integrates theory, practice, research– Shown to benefit clients with various

disorders• Limitations

– Inept therapists may use powerful interventions to stir up emotions and not sufficiently help clients to work through and obtain closure.

Transactional Analysis

• Eric Berne (1910-1970) Canada/Us– TA evolved out of Berne’s dissatisfaction

with psychoanalysis

• Mary & Robert Goulding– Redecision therapy – combination of TA,

Gestalt, psychodrama, behavior therapy

Transactional Analysis

• Transactional Analysis (TA) is an interactional and contractual approach to groups

• TA is basically a psychoeducational approach to group work

• TA is grounded on the assumption that people make present decisions based on their early experiences

• Redecision therapy is a form of TA that assists group members in taking charge of their lives by deciding how they will change

• The practice of TA is ideally suited to group work• Basic assumption of TA is that we are in charge of what

we do, of the ways we think, and of how we feel

Key Concepts of TA

• People have a basic trio of Parent, Adult, and Child (P-A-C) ego states

• Need for strokes• Injunctions and counterinjunctions• Decisions and redecisions• Games• Basic psychological life positions

Ego States

TA Ego States or Personality Aspects

Parent Adult Child

The Ego States

• Members are taught how to recognize in which ego state they are functioning at any given time– The Parent ego state

• This ego state contains the values, morals, core beliefs, and behaviors incorporated from parents

• This ego state can be expressed in critical or nurturing behavior

– The Adult ego state• This ego state is the objective part of personality and functions as

a data processor

– The Child ego state• This ego state consists of feelings, impulses, and spontaneous

actions

Ego States

act and feel much as those who raised us.

Parent

Controlling Parent…

follows rules, accepts slogans, holds opinions without thinking first of facts.

Nurturing Parent…

Supportive and protective toward others, offers help and guidance.

Ego States

Ways of Acting in the Parent Ego State

… a frown or stern look.…tone of voice.… pointing of the index finger.… arms folded as to say “what are you doing?”… uses phrases like; “you should,” “you ought to,”

“that is right!”… words such as; sympathizing, punishing.

moralizing, judging, giving orders, criticizing.

Ego States

what we were when we were young.Child

Natural Child…

Open to life, spontaneous, filled with the sense of wonder and delight, self centered, aggressive, rebellious, does not consider the consequences of feeling or actions.

Adapted Child…

Polite, sociable, recognizes the rights of others, adapts behavior to suit them, can resent the rights/demands of others, complies grudgingly, feels unsure about themselves, procrastinates .

Ego States

Ways of Behaving in the Child Ego State

… smiling, laughing, having fun.…tone of voice.… crying, having tantrums, getting into trouble.… childlike facial expressions.… uses words/phrases like; “Wow!,” “Gosh!,” “I

wish,” “I feel.”

Ego States

looks at the facts and reasons - the computer in us.Adult

… figures things out logically.

… takes responsibility for thoughts, feelings and actions.

… solves problems and makes decisions.

Ego States

Ways of Behaving in the Adult Ego State

… straight forward facial expression.…active listener, eyes blink every 3 to 5 seconds

showing attention.… speaks of probabilities.… uses phrases like; “In my opinion,” “Based on

what I have observed,” “So far the facts seem to indicate.”

TA Group

• Members recognize in which of the ego states they are functioning at any given time

• Goal is to decide whether that state or another state is more appropriate

• Member decides if change is warranted

The Need for Strokes

• A transaction is a basic unit of communication, consisting of an exchange of strokes between 2 people

• People need to receive physical and psychological strokes to develop a sense of trust in the world– Positive strokes express warmth, affection, approval,

and appreciation– Negative strokes can be given to set limits: “Stop it right

there!”• When group members understand how strokes

(exchanges) affect their behavior, they can choose the kinds of exchanges they want– Members sometimes have a difficult time in asking for or

receiving positive strokes

Injunctions

• Injunctions are messages (many nonverbally) issued from the parent’s own Child Ego state when the parent feels threatened by a child’s behavior.– Some examples of injunctions which are expressions of

disappointment, frustration, anxiety, unhappiness:• “Don’t be”

• “Don’t be close”

• “Don’t think”

• “Don’t feel”

• In TA groups members explore the “dos” and “don’ts” by which they were trained to live– Once members identify the messages they have

internalized, they can critically examine them to decide if they want to continue living by them

Counterinjunctions

• Messages issued from the parent’s Parent Ego state – Convey the shoulds, oughts & dos of

parental expectations– “Be perfect”, “Try hard”, “Be strong”, “Please

me”• Like injunctions, group members become

aware of these shoulds, oughts, & dos and determine whether they are willing to continue living by them.

Decisions and Redecisions

• Group work may address the decisions made in response to parental injunctions and counterinjunctions.

• TA group members learn to relive these early decisions and make new ones.

Decisions and Redecisions

• Early decisions– Based on injunctions, we make early decisions– Early decisions had a purpose at one time, yet they may not

be functional as we become adults– TA groups allow members to examine early decisions

• Making new decisions– An assumption in TA is that whatever we decided can be

redecided– Redecision is done emotionally, not just cognitively– Members can create a new ending to scenes where early

decisions were made• New endings can result in a new beginning• New beginnings allow members to think, feel, and act in

revitalized ways

Decisions and Redecisions

• Group leaders assist a member to return to some critical point in childhood.

• The group member re-experiences the scene, reliving it in the here-and-now, but with a different outcome.

• After experiencing a redecision in the old scene, they design experiments to practice new behaviors to support the redecision.

Games We Play

• Games—an ongoing series of transactions that ends with a negative payoff

• Games are designed to prevent intimacy• The process of game playing:

– We receive strokes– We maintain and defend our early decisions; find

evidence to support our view of the world– Rackets—unpleasant feelings people experience after a

game; learned in childhood & maladaptive in adulthood– Members can identify the games they played as children

and the games they currently play– In a group, members can become aware of games they

play and decide if they want to live more honestly and authentically

Basic Life Positions

• TA identifies four basic psychological life positions that determine how people feel about themselves and how they relate to others:– I’m OK—You’re OK: generally game free– I’m OK—You’re not OK: position of people

who project problems on others– I’m not OK—You’re OK: powerless position– I’m not OK—You’re not OK: futility &

despair, unable to cope in the real world

Life Script

• A life script is a plan for life– A personal life script is an unconscious plan made in

childhood– A life script is blueprint that tells us where we are

going• Script analysis

– In TA groups the members become aware of how they acquired their life script

– Members can learn how to free themselves of self-defeating patterns

– Group members act out portions of their life script, learn about the injunctions they accepted as children, the decisions they made in response, & the games and rackets they currently use to keep the early decisions alive.

Roles of the Group Leader

• Explains key concepts of TA• Creates a climate that assists members

in gaining awareness• Challenges members to discover and

experiment with change• Facilitates the members in fulfilling their

contracts• Focus is between group leader and

group member, rather than interactions between group members

The Therapeutic Contract

• Contracts: The Structure of the Therapeutic Relationship– TA is a contractual form of group therapy– Members must have the capacity and willingness to

understand and design a therapeutic contract– Contracts allow members to specify their goals– Contracts assist members in identifying how they will be

different as a result of their participation in group– Members learn that therapy is a shared venture– A well-stated contract provide a basis for members to

determine if they are getting what they want from the group experience

– Contracts are not rigid and are open to revision

Evaluation of TA

• Strengths– Emphasis on contracts encourage the members’

empowerment and responsibility for change.– Brief therapy

• Limitations– Requires extensive training to use the psychodrama

techniques– As a cognitive approach, feelings are usually not

explored; genuine contact between group leader and members may not be achieved

Cognitive Behavioral Approaches

• A set of clinical procedures relying on experimental findings of psychological research– Based on principles of learning that are

systematically applied• Treatment goals are specific and measurable

– Focusing on the member’s current problems• To help people change maladaptive to adaptive

behaviors

– The therapy is largely educational—teaching group members skills of self-management

Key Names in Behavioral Therapy

• Arnold Lazarus-role of therapeutic change-brief, efficient & effective psychotherapy-Multimodal Therapy

• Albert Bandura-introduced cognition as focus of behavior therapy

• Albert Ellis-Rational Emotive Therapy• Aaron Beck-Cognitive therapy for

depression• Donald Meichenbaum-treatments for

stress inoculation & self-instructional training

Cognitive Behavioral Leaders• Cognitive behavioral group leaders:

– Use brief, active, directive, collaborative psychoeducational model of therapy

– Assume that most problematic behaviors, cognitions, and emotions have been learned and can be modified by new learning

– Assume that change can occur without insight into underlying dynamics

– Follow the progress of group members by collecting data before, during, and after all interventions

• Orientation of the cognitive behavioral leader:– May develop strategies from diverse theoretical

viewpoints– Is both a clinician and scientist who tests the efficacy of

techniques – Systematically adheres to specification and

measurement

Unique Characteristics of CBTDifferent from other group approaches, CBT relies on the scientific

method1. Behavioral assessment

▪ Involves a set of procedures used to get information that will guide the development of a treatment plan

2. Precise therapeutic goals▪ CBT focuses concretely on specific target areas of change▪ Identifying goals determines direction of therapeutic

movement3. Treatment plan

▪ Treatment plan is based on specified goals▪ Members are expected to take an active role with tasks

4. Objective evaluation ▪ Emphasis is on evaluating effectiveness of techniques used ▪ Evaluation is an ongoing process

Role of CBT Group Leader

• CBT groups have a detailed, concrete, problem-oriented structure

• Leaders use short-term interventions• Leaders need to be skilled in brief interventions• CBT leader assumes the role of teacher and

encourager• Some specific educational and therapeutic functions:

– They draw on a wide array of techniques to help members reach goals

– They model appropriate behaviors– They model active participation and collaboration– They provide reinforcement to members for new

learning– They help members develop a plan for change

Therapeutic Techniques

• Reinforcement—specified event that strengthens the tendency for a response to be repeated (Ex. Praise)

• Contingency contracts—behaviors to be performed are spelled out; time period; reinforcement; records

• Modeling—clients learn through observation and imitation of leader & members (Ex. Role-play)

• Behavior rehearsal—practicing a new behavior in a session

• Coaching-coach sits behind member who is rehearsing• Homework—affords members opportunities to practice

new skills in between sessions

Therapeutic Techniques

• Feedback-fellow group members can provide reactions with praise & encouragement

• Cognitive restructuring—identifying and evaluating one’s cognitions and learning to replace negative cognitions with constructive cognitions

• Problem Solving- goal is to identify the most effective solution to a problem and provide training in cognitive & behavioral skills so group member can apply them

• Buddy System-members assist each other in designing homework tasks and monitoring their completion

Social Skills Training Groups

• Social skills training deals with one’s ability to interact effectively with others in various social situations

• Social skills training includes these strategies: psychoeducation, modeling, behavior rehearsal, role playing, and feedback

• Three formats of social skills training:– Sheldon Rose model of structuring social skills training

• Members role-play problem situations & assign themselves homework– Social effectiveness training (SET)

• A treatment program aimed at reducing social anxiety and improving interpersonal skills; utilize modeling, behavioral rehearsal; reinforcement

– Assertion training• Groups that increase members’ behavioral repertoire so they can make

the choice of being assertive or not; express themselves in a way that reflects sensitivity to feelings and rights of others

Cognitive Therapy Groups

• Aaron Beck• Cognitive therapy (CT) is an insight-focused therapy• CT can be applied to a wide range of groups• Emphasizes changing negative thoughts and maladaptive

beliefs• Theoretical assumptions of CT

– People’s internal communication is accessible to introspection

– Clients’ beliefs have highly personal meanings– These meanings can be discovered by the client rather

than being taught or interpreted by the therapist

Theory, Goals & Principles of CT

• Basic theory:– To understand the nature of an emotional episode or

disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts

• Goals:– To change the way clients think by using their automatic

thoughts to reach the core schemata and begin to introduce the idea of schema restructuring

• Principles:– Automatic thoughts: personalized notions that are triggered

by particular stimuli that lead to emotional responses

Focus of Cognitive Therapy Group

• Emphasis is on the present and approach is time limited• Group sessions focused on current problems• Past can be brought into group session when this is relevant

to understanding and resolving present problems• Members identify self-defeating beliefs• They learn to refute core beliefs and faulty thinking

– Empirically test beliefs with Socratic dialogue, carry out homework assignments, gather data on assumptions, keep record of activities, form alternative interpretations

– Ex. “Where is the evidence for _____________?”

• CT in groups is task oriented• Members learn that most effective way to change

dysfunctional emotions and behaviors is to modify inaccurate thinking

Stress Management Training in Groups

• Donald Meichenbaum• Stress inoculation training (SIT) involves:

– A combination of information giving, Socratic discussion, cognitive restructuring, problem solving, relaxation training, behavior rehearsal, self-monitoring, self-instruction, and self-reinforcement

• Premise:– As a prerequisite to behavior change, clients must notice

how they think, feel, and behave, and what impact they have on others

• Basic assumption:– Distressing emotions and stress are typically the result of

maladaptive thoughts

Stress Inoculation Training (SIT)

• Three-stage model

1. Conceptual-educational: clients participate in assessment process, goals setting & self-monitoring process

2. Skills acquisition: clients learn & rehearse coping strategies (relaxation training, cognitive restructuring (Beck’s CT), problem solving, time management)

3. Application: transfer & maintenance of change – monitor homework, training is relapse prevention

Multimodal Group Therapy

• Arnold Lazarus• Stresses therapeutic flexibility and versatility since

each client is unique• Lazarus calls for technical eclecticism

– Drawing techniques from a variety of theoretical models without embracing any of the models

• Multimodal therapy begins with a comprehensive assessment of all modalities– Employs the BASIC I.D. assessment structure– Lends itself to brief treatment based on assessment

• Multimodal therapists operate on premise that breadth is more important than depth

BASIC I.D.

• 7 areas of personality functioning which must be accounted for in a complete assessment and treatment program:– B=Behavior– A=Affective Response– S=Sensations– I=Images– C=Cognitions– I=Interpersonal Relations– D=Drugs, Biological Functions, Nutrition,

Exercise

Principles of Multimodal Therapy

1. Humans act & interact across seven areas of BASIC I.D.

2. These modalities are interconnected & must be treated as an interactive system

3. Accurate evaluation(diagnosis)is best accomplished by systematically assessing the 7 modalities & their interaction

4. Comprehensive approach to treatment involves specific correction of significant problems across the BASIC I.D.

Multimodal Group Therapy

• Technical Eclecticism– Draws on strategies from a variety of

approaches without having to embrace any of the diverse theoretical positions

– Requires breadth, depth, & specificity– The larger the leader’s repertoire of

methods, the more likely it is that therapy will be effective

Mindfulness and Acceptance

• Mindfulness and acceptance-based cognitive behavior therapy– Represents the new wave in CBT– In mindfulness practice, clients train themselves to focus on present

experience– Acceptance is a process of receiving present experience without

judgment, but with curiosity and striving for full awareness of the present moment

• Major approaches of this recent development of CBT– Dialectical behavior therapy: aimed at helping clients to accept their

emotions while changing the emotional experience– Mindfulness-based stress reduction: meditation, yoga– Mindfulness-based cognitive therapy: clients suffering from

depression become aware of thoughts and feelings– Acceptance and commitment therapy: involves fully accepting

present experience and mindfully letting go of obstacles

Evaluation of Cognitive Behavioral Approaches to Group

• Strengths– Emphasis on education and prevention– Research exists that determine its efficacy– Demonstrated effective for a variety of

issues and a variety of individuals– Wide range of techniques

• Limitations– Leaders need a wide repertoire of skills– Too much structure can prevent individuals

from meeting their needs