Psychotherapy Exam 4

Group Therapy Background

Different type of therapy format

Groups form through identification with others via commonalities that exist among members

Includes individuals experiencing similar difficulties with one or two leaders/therapists

Community-focused

• Increased access to therapy for many members of the community

• Often provides psychoeducation, a place to share suffering, and reductions in loneliness

• Specific group goals vary:

  • From basic survival needs

    • Establishing safety, security, and belonging needs

  • To specific goals

Many, many, many different kinds

• Differ wildly in quality and content

Therapy Formats

Individual therapy

• One-on-one with a therapist

Couples therapy

• Partners with a therapist

Family therapy

• Family with a therapist

Group therapy

• Individuals experiencing similar difficulties with one or two leaders/therapists

Group Therapy Approaches

Specific therapies

• DBT skills groups

• CBT for anxiety groups

Typically, therapist led

Less expensive than individual therapy

Combined therapy

• Client might be in multiple therapy formats

  • e.g., individual & group therapy

Specific topics or areas of distress/impairment

• Exs:

  • Breast cancer support groups

  • Alcoholics anonymous

  • Anger management group

• May or may not be led by a therapist

• May be free/donation based

Personal growth

• Self-help groups

• Meditation/positive thinking groups

Group Focus of Therapy

Variable in length and duration

• 45 minutes – 2 hours

• A few session or perpetually ongoing

• Group size varies

Goals of the individual needs to align with the goals of the group

Benefits of Group Membership Within Therapy

Efficiency

Cost

Mutual social support from people with similar issues

Provides members with richer, broader experiences

Mutual adaptation

• Learning effective social skills (e.g., taking turns talking, active listening, showing empathy) by interacting with other group members

Issues with Group Membership Within Therapy

Dealing with confidentiality

Group leader holds power over many people

• This power must be used carefully and effectively

• The leader should consider how each member’s identity and personal factors will play out in therapy

Group Leadership Dynamics

Leaders play an important role in determining the outcomes for group members

• 4 leadership functions

  1. Executive function

     • Structural activities needed for the group to run

     • Goal setting, recruiting members, guiding members

  2. Caring function

     • Showing affection and protection towards members

  3. Meaning attribution

     • Helping members make sense of their experiences

  4. Emotional stimulation

     • Enhancing members engagement through emotional expression

     • Self-disclosure

       • Careful, recovery focused

Behavior Change

Not an event, but a process

• Slow progress and steps towards a desired goal or outcome

Recognizing and modifying habits or patterns of action

E.g., quitting smoking, changing diet, reducing avoidance behaviors related to psychopathology, adopting new studying skills

Motivation

Internal state that reflects the desire or drive for achieving a goal

Clients vary in their levels of motivation to change behaviors

Stages of Readiness to Change

Transtheoretical model

Clients progress through to 5 steps of behavior change

1. Precontemplation

   • Not ready to think about changing

   • 
     No intention to change behavior in the foreseeable future

2. Contemplation

   • Ready to think about changing

   • Not ready to take action to change behavior

3. Preparation

   • Ready to change in the immediate future, but not fully committed

   • Gathering the energy and resources to take action to change, even some small behavior changes

4. Action

   • Actively trying to change

   • Effective, actual behavior change

5. Maintenance

   • Maintaining change

   • Stabilizing behavior change and avoiding relapse

Transtheoretical Model: Stages of Change

Behavior change is a process and is often not permanent

• Relapse

  • Return to problem behaviors or symptoms after a period of maintenance

  • E.g., returning to smoking, eating a poor diet, elevated anxiety symptoms, not using therapy skills

Progress through the stages is a spiral, not steady steps

Relapse leads to regression to an early stage

• Negative belief about being a failure

Clients recycle through stages before reaching long term maintenance

Change Processes

Are used to promote behavior change

• Activities and experiences that move people into different stages

• Includes behavior change strategies to promote behavior change

Stage: Change Process

Precontemplation: Consciousness Rasing

• Increasing info about self and prob

  • Strats:

    • Eliciting feedback from others

    • Self-observation

Contemplation: Self-reevaluation

• Assessing how one feels and thinks about oneself with respect to a problem

  • Strats:

    • Clarifying personal values

    • Journaling/reflecting on past issues with old habits

Preparation: Self-liberation

• Choosing and committing to act or belief in ability to change

  • Strats:

    • Sharing commitment with others

    • Goal setting for the near future

Action: Stimulus Control

• Avoiding or countering stimuli that elicit problem behaviors

  • Strats:

    • Reminders for new habits

    • Avoiding reminders/high-risk situations for old habits

Maintenance: Contingency Management

• Rewarding oneself or being rewarded by others for making changes

  • Strats:

    • Self-reward

    • Sharing successes with others

Transtheoretical Psychotherapy

Psychotherapy assume clients are ready for behavior change, but most are in earlier stages

• 40-50% precontemplation stage

• 35-40% contemplation stage

• 20% action stage

• Improvement with psychotherapy lowest for clients in the precontemplation/contemplation stages v. preparation/action stages

• Progression in therapy occurs more quickly once clients reach the action stage

  • Goal is to help clients progress into the more advanced stages

Approach to treatment that assess a clients’ readiness to change and matches therapy to their stage of readiness
Therapy matching can occur by:

• Stage matching

• Approach matching

Stage Matching

The therapist matches their interpersonal stance to the client’s stage of change

• Precontemplation

  • Guiding between different choices to grow, identifying how to develop greater independence

• Contemplation

  • Guiding insight on problem behaviors

• Preparation

  • Coaching on how to change

• Action and maintenance

  • Consultation on how to change using advice and support when things are not going smoothly

Psychotherapy Approach Matching

Specific psychotherapy approaches may be more/less useful at specific stages

• Psychodynamic and Cognitive approaches

  • Focused on observing, gaining insight, and identifying values

  • Precontemplation and contemplation stages

• Behavioral approaches

  • Focused on modifying behavior

  • Action and maintenance stages