group therapy seminar 08-04-13

8/22/2019 Group Therapy Seminar 08-04-13

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GROUP THERAPY

Department of Clinical Psychology

Institute of Psychiatry, Kolkata

Presentee:

Priya Puri

Chairperson:

Ms. Rudrani Chatterjee

Date:08-04-13


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It is in the shelter of each otherthat the people live

~ Irish Proverb~


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a group is defined as two or more people who interact and

influence one another (Shaw, 1981).


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intended to help people who would like to improve their

ability to cope with difficulties and problems in their lives

focuses on interpersonal interactions

Aims to help with solving the emotional difficulties

encourages the personal development

Members feel that (s) he is not alone with her/his problem and

that there are others who feel the same


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The group can become a source of support and strength in

times of stress

Feedback from the group can make one become aware of

maladaptive patterns of behaviour, and thus change ones pointof view and help one adopt more constructive and effective

reactions.


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GROUP THERAPYv/s

INDIVIDUAL THERAPY


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Group therapy usually costs much less as compared to

individual therapy

meeting other people with problems can give a wider

perspective ofones own problems

Listening to other people helps one understand that one can

view and handle problems in more than one way.

Other people can give encouragement and emotional support:

"We are all in the same boat."


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Group therapy is useful in treating problems involving

communication with other people

Problem of confidentiality of secrets

In group therapy the therapist needs to cater to each member

of the group, while in individual therapy the therapist gets

more time to handle an individuals particular problems


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HISTORICALBACKGROUND


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Development of group psychotherapy can be seen in four

phases

currently group therapy is in its fourth phase.

The four phases of group therapy:

The first phase was ushered by World War II and the

enormous amount of psychological carnage that emerged

from it.

second phase of group therapy's development was the

community mental health movement in the late 1960s and

1970s


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The four phases of group therapy:

third phase came in the 1990s which was the age of health

care reform

fourth phase of group therapy came in the first decade of

this century and it was ushered by a rise in terrorism andnatural calamities to address the issues of psychological

trauma


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Important contributors to the field of group therapy:

Joseph Pratt (1905)

Edward W. Lazell (1921)

Jacob Moreno, the founder of psychodrama

Trigant Burrow 1928,

Samuel Slavson

Maxwell Jonesstherapeutic community

Kurt Lewins field theory

Nathan Ackerman


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INDICATIONSFOR INCLUSION


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Slavson (1955) sets four general criteria for inclusion into

groups:

The patient must have experienced minimal satisfaction in

his/her primary relations

A minimal degree of sexual disturbance

A moderate ego-strength

A minimal super-ego development


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Other indicators:

Motivation and preparation (Berne,1966)

people who define their problems as interpersonal

(Friedman,1976)

willing to become susceptible to influences of the group

willing to be of help to others.

Relatedness and reality contact (Mullan and

Rosenbaum,1962)

Ability to withstand frustration (Horowitz, 1976)

ability to maintain tolerance for others (Corsini, 1957)


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THERAPEUTIC FACTORSIN GROUP THERAPY


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Sadock (1989) delineated 20 therapeutic factors for group

therapy:

1. Abreaction

2. Acceptance

3. Altruism

4. Catharsis

5. Cohesion

6. Consensual validation


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7. Contagion

8. Corrective familial experience

9. Empathy

10. Identification

11. Imitation

12. Insight

13. Inspiration

14. Interaction


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15. Interpretation

16. Learning

17. Reality testing

18. Transference

19. Universalization

20. Ventilation


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TYPES OF GROUPS


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Jacobs et al. (2010) have categorised groups into 7 types that

are as follows:

Education groups

Discussion groups

Task groups

Growth and experiential groups

Counselling and therapy groups

Support groups

Self-help groups


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STAGES OFGROUP THERAPY


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The beginning stage:

the time period used for introductions and for discussion of

such topics as the purpose of the group, what to expect,

fears, group rules, comfort levels, and the content of the

group.

In this stage, members are checking out other members and

their own level of comfort with sharing in the group.

members determine the focus of the group

May take more than two sessions to feel enough trust and

comfort


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The middle, or working, stage:

the members focus on the purpose.

learn new material, thoroughly discuss various topics,

complete tasks, or engage in personal sharing and

therapeutic work. This stage is the core of the group process

it is the time when members benefit from being in a group


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The closing, or ending, stage

devoted to terminating the group

members share what they have learned, how they have

changed, and how they plan to use what they have learned.

May be an emotional experience

Most groups need only one session for this stage


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APPLICATION OFTHEORETICAL MODELS


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Cognitive Behaviour Therapy:

efficient form of treatment for a wide range of specific

problems for diverse client populations (Bieling, McCabe, &

Antony, 2006).

emphasizes the interaction of thoughts, feelings, and

behaviours.

The most direct way to change dysfunctional emotions and

behaviours is to modify inaccurate and dysfunctional

thinking.


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sound therapeutic relationship that emphasizes collaboration

and active participation is the foundation for effective

practice

The cognitive therapist teaches group members how to

identify these distorted and dysfunctional cognitions through

a process of evaluation.

group leader assists members in forming hypotheses and

testing their assumptions, which is known as collaborative

empiricism.


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learn to engage in more realistic thinking

trained to test these automatic thoughts against reality.

therapeutic goals that guide group interventions include

providing symptom relief, assisting members in resolving their

most pressing problems, and teaching them relapse prevention

strategies.


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Rational Emotive Behaviour Therapy:

founded by Albert Ellis

Ellis developed an ABC model of understanding feelings

and behaviours.

The theory is based on the premise that thoughts cause

feelings,

the leader helps members to focus on changing their

feelings by looking at what they are telling themselves


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Steps of REBT in group set-up:

Clarifying the event, person, or situation (A)

Clarifying the feelings and/or behaviour (C)

Clarifying the negative self-talk (B)

Changing the feelings by changing the self-talk


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Transactional analysis:

developed by Eric Berne

everyone has three ego states: the Parent, Adult, and Child

developed as a result of childhood messages.

The key in TA is to help members get an Adult perspectiveon situations that tend to be negative or volatile.


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Dialectical Behaviour Therapy:

originally developed by Marsha M. Linehan, to treat people

with borderline personality disorder(BPD).

Combines standard cognitive behavioural techniques

for emotion regulation and reality-testing with concepts ofdistress tolerance, acceptance, and mindful awareness.


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For DBT in group settings the group ordinarily meets once

weekly for two to two-and-a-half hours and learns to use

specific skills that are broken down into four skill modules:

core mindfulness

interpersonal effectiveness

emotion regulation

distress tolerance.


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COMMON MISTAKESMADE WHEN

LEADING THERAPY GROUPS


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Attempting to Conduct Therapy Without a Contract

Not Involving the Other Members

Spending Too Much Time on One Person

Spending Too Little Time on One Person

Focusing on an Irrelevant Topic

Letting Members Rescue Each Other

Letting the Session Become an Advice-Giving Session


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DEALING WITH PROBLEMSITUATIONS IN GROUPS


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The chronic talker:

leader could attempt to speak to the member about histalkativeness.

other strategy involves seeking feedback from the members.

Another method could be to ask a question to the group and

encouraging members who have not spoken yet to speak up.


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The resistant member:

May have negative expectations about the effectiveness of a

group

believe that the group will not be helpful, and therefore, they

refuse to participate cooperatively

Leader should let the member share his feelings in the group

or to talk to him in a dyad or after the session and try to help

him work through his resistance.

Do not to spend too much time with the resistant member if

it takes productive time away from the other group

members.


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The member who tries to get the leader:

This occurs when a member attempts to sabotage what the

leader is saying or doing in the group.

Leader should try to understand why the member has

targeted him.

talk to the member at the end of the session

the leader might be able to gain some insight from talking to

other members.


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Dealing with crying:

important to take into consideration when a member is

crying is whether the crying is a result of some struggle or

painful event or is an attempt to gain sympathy.

Members may reach out and touch the person who is crying.

it is appropriate to ask a member not to touch or hug another

member

shift the focus away from that member and then seek

him/her out after the group.


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CLINICAL APPLICATIONS OFGROUP THERAPY


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Groups for Mood Disorder:

When one looks at the interpersonal sphere of depressed and

bipolar patients, one sees that their histories are riddled with

interpersonal problems.

depressed patients are invariably withdrawn from socialcontact and/or show signs of irritability as a prominent

symptom.

Bauer and McBride (2003) created a life goals group

program for bipolar disorder


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Groups for personality disorders:

personality disorders owing to the predominant affective

disturbance and disturbance in the interpersonal sphere seen

in PDs.

In a group set-up, the therapist has more leverage to induce

change in maladaptive behaviour, negative attitudinal

stances, and interpersonal deficits.

DBT can be used in group set-ups for borderline personality

disorders.


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Groups for Anxiety Disorders:

The CBT group aims to empower patients to engage with

their anxieties by supplying them with a set of anxiety-

reducing skills.

The advantages of a CBT group are having greater

opportunities for role modelling, practicing new behaviours

in vivo before testing them out in the world outside

getting peer feedback from others with similar anxieties

enjoying the positive reinforcement that comes from many

people, not just the therapist, which serves to reinforce new

habits and thought patterns.


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Group therapy for substance dependence:

Velasquez, et al (2001) posit a comprehensive 29-session

group treatment model based on the transtheoretical model

of behaviour change (TTM).

The five distinct Stages of Change: Precontemplation,

Contemplation,Preparation,Action,Maintenance.

The 29 sessions are divided into two sequences: the first 14

meetings are devoted to the Precontemplation,

Contemplation and Preparation (P/C/P) stages while the

final 15 meetings focus on Action and Maintenance (A/M).


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Precontemplative/Contemplative/Preparation:

Consciousness Raising

Self-re-evaluation

Decisional Balance

Environmental Re-evaluation

Efficacy

Self-liberation


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Action/Maintenance

Stimulus Control

Counter-conditioning

Reinforcement Management

Social Liberation

Helping Relationships


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Parent training groups for behaviour management:

focuses on helping the parent help a child learn new

behaviours that he is having difficult time learning

focus on helping parents reduce and eliminate undesirable or

challenging behaviours in the child


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Parent training programs are based on the following

principles:

Behaviours are learned.

These behaviours become habits and they keep happening

because of the way parents and children interact with each

other.

Behaviours and habits can be changed by changing the

way parents respond to the childs behaviours.


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Parental training groups are usually of two types:

Parent support group

Special training groups

The goal of parent training groups is to make the parentsexperts and this cannot happen unless parents devote enough

time to practicing the skills at home.


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GROUP THERAPYININDIAN SCENARIO


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Very few studies based on group psychotherapy in India

A study by Bhaduri et al. (1967) suggested a positive relation

between group therapy activities and intellectual, emotional

and behavioural improvement of maladjusted adolescents.

Bastani in 1974 conducted a study on group psychotherapy

with 6 male exhibitionists. The study suggested that a group

setting offered the male exhibitionists opportunities for

support, introspection, coping adaptively with the environmentand a realistic relation with an interested group of peers and an

accepting therapist.


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Ismail Shihabuddeen and Gopinath (2005) conducted a

study to assess the perceived benefits and difficulties of group

meetings among caregivers of persons with Schizophrenia and

Bipolar Mood Disorder. The study revealed that the group

meeting led to effective monitoring of the functioning of

individuals, a reduction in the subjective family burden and

family distress, a better support system with adequate coping

skills and good compliance with the treatment programme.


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EVIDENCE BASED STUDIES


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Hovland et al. (2012) conducted a study to compare physical

exercise in groups to group cognitive behaviour therapy for

the treatment of panic disorder and found that Group CBT is

more effective than group physical exercise as treatment of

panic disorder, both immediately following treatment and at

follow-up assessments.


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A study conducted by Andion et al. (2012) to examine

the efficacy of Individual DBT in 37 BPD patients, compared

with combined individual/Group DBT in 14 BPD patients.

Significant improvements on the outcome measures were

observed across both versions of DBT treatment, particularly

at the 18-month follow-up assessment but, no significantdifferences were observed between Individual DBT and

Combined individual/Group DBT on any of the post-treatment

evaluations.


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In a study by Lecomte et al. (2012) intended to see whether

effects of Group CBT for early psychosis lasted even after one

year, it was found that there were Significant improvements at

12 months for social support and insight. Negative symptoms

remained low, whereas positive symptoms went back to pre-

therapy levels.


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A study by Huntley, Araya, and Salisbury (2012) revealed

that Group CBT confers benefit for individuals who are

clinically depressed over that of usual care alone. Individually

delivered CBT is more effective than group CBT immediately

following treatment but after 3 months there is no evidence of

difference.


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A study by Klein, Skinner and Hawley (2012) evaluated the

feasibility of group-based DBT for binge eating within the

context of an operating community clinic. Positive outcomes

included significant improvement in both binge eating and

secondary outcomes with the Eating Disorder Inventory

subscales of Bulimia, Ineffectiveness, Perfectionism and

Interpersonal Distrust.


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CONCLUSION


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Group psychotherapy is suitable for a large variety of

problems and difficulties, beginning with people who would

like to develop their interpersonal skills and ending with

people with emotional problems like anxiety, depression, etc.

It aims at helping individuals with solving the emotional

difficulties

encourages the personal development of the participants in the

group.


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But, as compared to other modes of therapy it is a relatively

underexplored area.

More research needs to be done in this area especially in a

collectivistic and developing country like India.


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group therapy seminar 08-04-13

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