GROUP THERAPY

GROUP THERAPY

INTRODUCTION
Group psychotherapy is a treatment of psychological problems in which two or more patients interact with
each other on both an emotional and cognitive levels in the presence of one or more therapists who serve as
catalysts facilitators or interpreters. Group therapy is the treatment of multiple patients at once by one or
more healthcare providers. It can be used to treat a variety of conditions including but not limited to
emotional trauma, anxiety, depression, post-traumatic stress disorder (PTSD), and attention deficit
hyperactivity disorder (ADHD). This activity outlines the principles of group therapy and explains the role
of the interprofessional team in evaluating, treating, and improving care for patients who undergo group
therapy. Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists
treat a small group of clients together as a group . Group therapy is sometimes used alone, but it is also
commonly integrated into a comprehensive treatment plan that also includes individual therapy. Group
therapy is a form of psychotherapy that involves one or more therapists working with several people at the
same time. This type of therapy is widely available at a variety of locations including private therapeutic
practices, hospitals, mental health clinics, and community centers.
Definition :-
according to kapoor Bimla
Group psychotherapy is a treatment in which carefully selected people who are emotionally ill meet in a
group guided by a trained therapist, and help one another effect personality change.

Goals:-
 Alleviating intra psychic stress.
 Reducing anxiety.
 Providing clients with opportunities to modify and test new behaviors in controlled setting.
 Helping him to develop a sense of self-identity.

Types of group therapy:-

1. Group therapy:- Is a treatment method in which clients meet at planned times with a qualified
therapist to focus on becoming self aware and self understanding improving IPR, making behavioral
changes or all three.

2. Therapeutic therapy:-It deals with emotional stress from physical illness, normal growth and
developmental crisis or social maladjustment.

 To prevent health problems.

 To educate / develop group members potentials.
 To enhance quality of life.
3. Adjunctive groups:- It deals with selected need of individual such as cognitive stimulation,
sensory stimulation, orientation to reality and socialization.
Selection:-
 Homogeneous groups .
  Adolescents and patients with personality disorders.
 Families and couples where the system needs change Contraindications.
 Antisocial patients .
 Actively suicidal or severely depressed patients.
 Patients who are delusional and who may incorporate the group into their delusional system.

Group Size -
Optimal size for group therapy is 8 to 10members
Frequency and Length of Sessions:-
Most group psychotherapists conduct group sessions once a week; each session may last for 45minutes to
1hour.
Why do we conduct group therapy:-
Therapeutic Forces In Groups (Yalom)
a) Instillation of Hope
b) Universality
c) Imparting of Information
d) Group Cohesiveness (belonging)
e) Catharsis
f) Support
g) Feedback and Confrontation
h) Existential Factors (risk, responsibility)
i) Interpersonal Learning (modeling, vicarious learning)
j) Group as a microcosm (e.g., social contact, roles)
k) Simulation of primary family
l) Altruism
m) Corrective emotional experience
n) 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 Groups provide commonality (e.g. “I’m not the only oneare cost effective with this
problem”)
 Group experiences help members become aware of how others view them and what impact their
behavior has on others
 Group dynamics c
 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 therapy:.
1. Confidentiality more difficult to maintain
2. Harder to build trust and safety.
3. Group leaders are not always properly trained.
4. Not enough time to deal with each person thoroughly.
5. Group leaders have less control than in individual therapy .
6. There are concerns with conformity and peer pressure .
7. Scapegoating may occur.
8. A disruptive person can cause more harm .
9. 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)
 Heterogeneous groups.
 Homogenous groups.
 Ground rules.
 Norms.
 Group leader facilitation .

Concerns in Group Work :-

1. Participant Selection: Screening is needed with counseling and psychotherapy groups. Some
people are not well suited for group work.
2. 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.
3. 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)
 4. 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).
5. Ethics: Confidentiality is hard to guarantee due to the number of participants.
6. 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 :-
1. Stage One (Orientation/Forming): Group members orient to group and each other.
2. Stage Two (Transition/Storming): Anxiety, ambiguity, and conflict become prevalent as group
members struggle to define themselves and group norms.
3. Stage Three (Cohesiveness/Norming): A therapeutic alliance Stage Four (Working/Performing):
Group membersforms between group members. experiment with new ideas, behaviors or ways of
thinking. Egalitarianism develops
4. 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 :-

a) Group leaders are less active and members more active.
b) Group leaders model appropriate ways to confront others.
c) Members make a commitment to change and act on that commitment.

Stage 5: Termination or Disengagement Stage

a. Disengagement usually begins a few sessions before the ending of the group
b. Self-disclosure and risk taking taper off.
c. Grief and loss issues are common.

d. Feelings of ambivalence about the group ending are also common.

e. Group counselors reinforce the growth made in the group and encourage members to continue to
maintain progress.
f. 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
 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:-
o More expertise
o Allows for division of labor (e.g. one leader can concentrate on content and the other leader can
look at process variables).
o Group members receive more individual attention.
o Two leaders can model communication and conflict resolution.
o Two leaders provide diversity in theoretical orientation, interpersonal style, and cultural resources.
Limitations/dangers of co-therapists:-
a) If two leaders do not get along, it can be detrimental and even harmful to group
b) Co-leaders might develop competition between themselves and this too is not good for the group
c) 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
 d) Group members might feel ganged up on if both leaders become adamant in getting across a
therapeutic message
e) Groups with two leaders can more easily become over structured
Approaches to Group Therapy:-
 The therapist's role is primarily that of a facilitator; he should provide a safe, comfortable
atmosphere for self-disclosure.
 Focus on the "here and now" .
 Use any transference situations to develop insight into their problems.
 Protect members from verbal abuse or from scape goating.
 Whenever appropriate, provide positive reinforcement, this gives ego support and encourages future
growth Therapeutic Modalities in Psychiatry 191
 Handle circumstantial patients, hallucinating and delusional patients in a manner that protects the
self-esteem of the individual and also sets limits on the behavior so as to protect other group
members.
 Develop ability to recognize when a group member is" fragile";he should be approached in a gentle,
supportive and non-threatening manner.
 Use silence effectively to encourage introspection and facilitate insight.
 Laughter and a moderate amount of joking can act as a safety valve and at times can contribute to
group cohesiveness.
 Role-playing may help a member develop insight into the ways in which he relates to others.
Therapeutic Factors Involved in Group Therapy:-
These involve sharing experiences, support to and from group members, socialization, imitation and
interpersonal learning.
Sharing experience:
This helps the patients to realize that they are not isolated and that others also have similar
experiences and problems. Hearing from other patients that they have shared experiences is often
more convincing and helpful than reassurance from the therapist.
Support to and from group members:
Receiving help from other group members can be supportive to the person helped. The sharing action
of being mutually supporting is an aspect of group cohesiveness that can provide a sense of
belonging for patients who feel isolated in their everyday lives.
Socialization:
It is acquisition of social skills (for e.g. maintaining eye contact) within a group through comments
that members provide about one another's deficiencies in social skills. This process can be helped by
trying out new ways of interacting within the safety of the group.
Imitation:
It is learning from observing and adapting the behaviors of other group
Interpersonal learning:
It refers to learning about difficulties in relationships by examining the interaction ofindividuals with
the other members of the group.

 Reflecting or rewarding comments of group members

 Asking for group reaction to one member's statement
 Asking for individual reaction one member's statement
 Pointing out any shared feelings within the group
 Summarizing various points at the end of session
Role Of Nurse
1. Lead various types of therapeutic groups such as client education, assertiveness training, support ,
parent and transition to discharge groups among others.
2. Problem solving, decision making,thus enabling him to re-enter the society's mainstream with a
greater degree of confidence.
3. maintain good interpersonal relationship .
4. work with coordination for better care out come.
5. documentation