GROUP THERAPY QUIZ TWO

Two tiers for the therapist to work in the here and now

•Members live in the here and now, developing strong feelings toward other group members, the therapist, and members as a whole

-its a major disclosure for the group and makes members more intensely involved

•Illumination of Process: group examines itself and its own transactions

•This allows group members to have a cognitive framework, keeping that group experience going even when they’re not in group→ learning transference can transfer beyond group

what happen to group if one of the tiers that the therapist has to work on is not present

•If the group only experiences the here-and-now without the examination process the group is intense, rewarding to some, but members have no frame of reference to generalize the experience outside that one time

•If the group is only examining process, then it loses meaning and becomes aloof and sterile

•Therefore, it’s a good idea to make it obvious to the group that you’re switching gears from the here and now to process

•EX. Maybe group members have been interacting and engaged in building relationships for the first 30 min., thus a therapist might say “Ok it’s been 30 minutes let’s switch gears, what does everyone think about group today?”

the nature of relationships between interacting individuals; what relationship are forming in the group

process

the importance of Process in groups

•It answers the question implicitly “What do these  explicit words and style of participants reveal about the interpersonal relationships of the participants?”

•Therefore, therapists are listening to the ‘how and ‘why’ content of what people are saying in group

•If unsure what to say in order to bring out Process, you might go ‘How are each of you experiencing the group so far?’

•Therapist might also ask ‘who is speaking, who is being spoken to, what is being said, and what is not being said’

•EX. Therapists look at how people say something, why they’re saying it, why do individuals sit in certain places, why they don’t sit in certain places, how the individuals are approaching each other in group

group process

•Sometime the message is verbal and behavioral messages are usually between more than 2 people

Relationships form between a member and the group

Relationships form in subgroups

Relationships form between the leader and other members

socialization in group process

•This fear of judgment comes from parental messages; this fear is resolved in group when they receive healthy positive feedback from group, having the stance of ‘not everyone is going to judge me’

•In healthy group process, social norms get developed and immediate behaviors get addressed

•Process commentary; might think that it undermines the authority structure in other groups that aren’t group therapy groups

therapist tasks in the here and now

In the activating phase (first stage of here-and-now focus): steers the focus away from outside material to the groups relationships with each other

•In the second stage –> Process Illumination, the therapist is an observer-participant. 

•They makes observations, connects events, and maintains the group goals going

•The therapist is responsible for the group culture, supporting and sustaining the group and pushing it forward: When someone else takes up this role it can become dangerous psychologically, thus the therapist is the one who speaks the unspeakable

•The group is an ahistorical approach: the past group experiences from the previous groups is used for the help it offers to help explain the here and now; the past is used to help the group understand the here and now

techniques of the here and now activation

•Therapist needs to think here and now (allows you to steer in that direction): have to ask the question ‘how can I make this issue come to life in the here and now’

•When thinking here and now, you’re continually moving the group from the outside to the inside: Move the group from a focus form the outside world to the inside; you’re essentially bringing an outside  issue into the group

•EX. If a client came in expressing anger about an issue relating to their SO, you as the therapist could ask the question “If you were to be angry with another person in group the way that you are angry with your SO who would it be?”

•Be mindful in the very beginning in how you arrange the environment in group

•Therapists may have to respectfully interrupt outside content in order to bring the group back to the here and now

techniques of process illumination

Clients recognize the interactions with others

Clients appreciate the impact of this behavior on others and how it influences other’s opinions of them and then how their opinions impact their own self-regard

Client evaluate whether they are satisfied with their own interpersonal styles: they’re able to see their behavior, reflect to see if they’re satisfied with it and think if they want to change it

Clients exercise the will to choose they don’t have to change if they don’t want to

techniques to bring out process of illumination

•Recognize process: answering ‘Why is this coming out in group  at this particular time and way’

•Recognize that to some degree tensions are going to exist in every therapy group: Therapist examines everyone’s feelings, thoughts, fears, and wishes; most common group tensions including the struggle for dominance or status in the group

•Common technique: Recognizing that there can be a primary task and secondary gratification, and when secondary gratification isn’t met it causes  members to drop out

•Therapists need to  help the client identify their primary tasks and how to accomplish it

•As the group goes on, therapist needs to understand that resistance can occur

resistance to change in group therapy

•people come into a group with a primary task of wanting to change, yet at the same time experience a fear of change

•be shown in numerous ways, such as representing oneself falsely in group, refusing to get help, wanting to be revealed, admired, or loved

→Resistance can obstruct therapeutic work, thus therapists have to continually remind members the primary reason they’re seeking therapy

process illumination comments

•It’s important to help clients accept process illuminating comments→ this refocuses everyone in group to become aware of the here and now

•EX. You might go ‘We’re halfway through our time today, I wonder how each other is feeling about the meeting so far’; helps clients process an orientation

•Might also go ‘I’m not sure what is occurring, but I am seeing something unusual in group’

what do to when group enters a ‘heated’ moment

•  When group members are in heated discussion and throw truths at each other, it is not productive for the therapist to do the same, it only aids the aggressor→ they must neutralize defensiveness of combatants first

•Neutralizing meaning that you are helping the sole member and everyone else in the group as well; not necessarily picking sides because if you do it could ruin rapport

the importance of process commentary in group

Process commentary allows for process illumination which leads to change

  How does the therapist help foster change in group?

•Commentary that follows the sequence:

§  Here is what your behavior is like

§  Here is how your behavior makes others feel

§  Here is how your behavior influences the opinions other have of you

§  Here is how your behavior influences your opinion of yourself

during process commentary, the client with significant pathology may resist change, thus therapist must help them understand

1.Only I can change the world I created for myself: no one else can change it

2.There is no danger in change, rather it is safe

3.To attain what I want I must change

4.I can change: maybe they don’t have the belief they can thus you might need to help them see they can change

the use of the past in group

•The past visits the group process

•You use the past in being able to gain insight about the here and now

• The past plays a role in the working through process but it is implicitly stated 

what is transference

•Transference: attitudes towards the therapist that are transferred from earlier attitudes towards important figures in a client’s life

•Coined by Freud

•Stems from one’s fears, wishes, and developmental gaps

•Can be a hindrance to the group goals and individual growth

•Establish different relationships experience with a therapist and significant others in the past through thistransferense

•Translate of the self and others into a new narrative, new behaviors, and adaptive functions

forms of transference

•Vertical Transference: clients experiencing transference towards the leader

•Peer Transference: clients experiencing transference towards their peers

•Individual Transference: only transference towards the therapist

the curative factor in therapy is

•the relationship between the therapist and client which requires the client and therapist to engage authentically

→requires therapist to attend to the client’s internal emotional and subjective experience.

•Not a good idea for the therapist to react when the client reacts; then the therapist would be re-creating the client’s past relationship

transference distortions

client perceiving the therapist incorrectly to some degree

^Attitudes towards the therapist are transferred from early attitudes towards important figures of a client’s life

transference in group therapy

•Transference can hinder goals and individual groups: Therapist needs to recognize this transference and appreciate it, because it naturally occurs→ If therapist ignores it, it will not help change take place

•Therapist can get an idea about the type of transference occurring by looking at the seating choices→ EX. does the client always sit next to the therapist

•Transference involves powerful unrealistic feelings that group members have towards the therapist→These feelings can prevent accurate interpretations of the leaders

consensual validations

The therapist encourages a client to validate his impressions against those of the other participants

how the group resolves transference distortions through consensual validations and transparency

§Everyone in group expresses their view of the therapist; they each have a different view of the leader

§The client either is in consensus with the others, revealing a global group force or they are perceiving the therapist accurately

§If there is no consensus, then the client perception is unrealistic and therefore can be helped by the group to see this internal distortion going on

therapist transparency

•Gradually revealing more and more of yourself as a group as a therapist

→ therapist presenting themselves as human among the group; helps the client overcome this distortion view of the therapist

Group leader needs to be guided by one basic question, which is

‘What must I do to ensure the success of this group?’ → should have this question in mind regarding client selection

guideline for exclusion criteria

-We can predict clients will fail in group if they are unable to participate in the primary task of the group

-Majority of the time, therapist are thinking ‘Who am I not going to include in group’

-Consider our clients’ expectations: if they expect to not improve in group chances are they will not

^^Building a therapeutic alliance increases the chances of them to remain in group therapy

what are the reasons a client might not be picked by the therapist to join group

Logistical Reasons: our client comes to us and states that their work schedule interferes with group time

Intellectual Level of our Individuals: if one is dealing with a heterogenous process focused group, you want to make sure that their intellectual abilities don’t interfere with their ability to participate; it’d be better for them to be in a more structured group

Psychological or Interpersonal Reasons: make decisions based on an individual level, not based on diagnosis per say→ Individuals with bipolar disorder are very effective in group, because their of their interpersonal issues they need to work on→ many are quite insightful in groups for the most part

When would you include a person with narcissistic traits in group? Would you consider clients in an acute process for group?

If they actively want to better themselves personally; depends on their level of awareness of narcissistic traits

No for acute crisis, because you would need to address the crisis first , and group might not be the right time for this

traits clients need to possess in order to be chosen for group

´Possess the capacity to examine their interpersonal behaviors

´Engage in self disclosure

´Being able to Reflect on themselves: Reflect on both themselves, others, and on the group as a whole

´Need to be able to receive feedback(CRITICAL)

´Need to engage with other group members

Group and Dropping Out

´You want to predict clients that are going to drop out to reduce the percentage of drop-outs: if you have too many that drop out then the group will fall apart

´EX. If you have 8 people in the group, and 50% drop out you’d have 4 people in the group-> Four people doesn’t make a group; instead, the therapist is; it becomes ‘brief individual therapy’ with the members now

´It is better to add new members than to be in the ‘start together and finish together’ mindset

´Anticipating life changes and having discussion when having premature sessions about clients plans for the near future→Could adversely affect the group cohesion, messing up the group as a whole

difference of setting and dropping out rates

´Research also shows that in private practice setting the drop out rate is lower than in group setting: setting where people are paying a fee

´You have to pay, actively seeking and wanting to be there

´30-35% for private practice drop out rate ;50% for university setting for drop out rate

Nine major reasons for dropping out of group therapy( factors we should look out for)

1.External factors: such as logical reasoning(schedule conflicts) and external stress

2.Group deviancy: behavior deviates from group norms and inhibits participation→those who are different from group

3.Intimacy problems: withdrawal, maladaptive self-disclosure, unrealistic demands

4.Fear of emotional contagion: upset by hearing problems of others

5.Inability to share the therapist: some individuals might want all the attention on them

6.Complications of concurrent individual and group therapy at the same time: clients may say something in individual and not group

7.Early provocateurs

8.Inadequate orientation to therapy: we didn’t prepare them enough for what to expect in group

9.Complications arising from subgrouping: going to happen regardless, thus we must do our best to prevent them from occurring frequently

Complications arising from subgrouping in group therapy

-Secrets: trust issues; affects with the group cohesion

-Can be limiting the type of feedback you receive bc they might get perspectives from those they choose to hang around

-People get stuck in their comfort zone in group: people might sit in the same place, they don’t get to know everyone in the group

criteria for including clients in group therapy

´  Can the client profit from participation

´  Primary is motivation levels

´  Willingness to take responsibility for personal limitations: If they’re not willing, scapegoating or attempts to blame certain individuals may occur

´  Impulsive individuals who have difficulty controlling immediate actions can work well in group: Don’t exclude people with pathologies because essentially that is what they’re in group for, to work on those pathologies

´  How will the client effect the other clients: Many times a client can provide better feedback than the therapist; they see it from a different perspective

´Therapist personal feelings towards the client must also be considered: As a therapist we’re human, this we might have personal feelings with the members in the group

´ Include clients if its going to help meet their personal needs→ If not, then they probably might not work out in the group

what are the first steps in creating a group

šCreating a circle-> like physically; has to be no obstacles 

šRemoving empty chairs: Don’t let people move the chairs away from the group-> others members might start doing the same

šConsent form process with group: can’t completely promise it because we can’t control what goes outside of group

šA group should start with 9-10 people: this is because you should expect people to drop out

šIdeal amount of group time is 80-90 minutes for the duration of the group

Ideal to have groups to meet twice a week: With 2x week there’s more things you can work on

rule of thumb for the number of members in group

šStart with 9-10 people and if you have a 30% drop out rate then you’d have 6-7 people(still good)

šIf you get down to 3-4 members this is when you need to start adding new members

šGroups can range from 5-9 members  (typically pretty good size for group)

As soon as a member drops out, replace the person that dropped out as soon as possible

what is a brief therapy group

= Brief Therapy Groups: Widely used therapy format

šRange from 16-25 sessions: can also range from 50-60 sessions

šMinimum number of session one should have is 12: Research has shown that if you have 12 session then 50% of the people improve 

the shortest group life span that can achieve a specialized goal

brief group

common factors in brief group therapy

šEfficiency: more efficient

šStays in the Present: more present focused

šGoal Obtainment: People know it’s short, thus really focus on obtaining their goals

šAlways temporal restriction: clients are aware of this restriction, know they’re limited to their time thus engage more quickly in self disclosure

šClients are quicker to transfer learning: begin to practice pretty quickly what they learn in group therapy 

šFocuses on the here and now on interpersonal instead of extra personal issues

clients and their recreational relationships in group

Clients will recreate their typical relationship interaction within the group

šWhat one sees in a group context gives us a good idea of how the client interacts with people outside of group-> group is a social microcosm

šClient is recreating in relationships that they have outside of group

šBecause of this, the first step you do in group is make them create a circle

the importance of diversity in group therapy

šIf you have a group where all the members are too similar to each other, then they’re not going to learn from a variety of perspectives→ Need to have a blending of members

šEX. if everyone has a secure attachment style then they’re not going to be able to learn from others that have different attachments styles 

what is a good predictor of member’s behavior in group therapy

š  Personality and  attachment styles are more important predictors of group behavior than diagnostics

šDiagnoses don’t provide success or lack of success in groups ; its more about peoples’ interaction styles and their relationships with others  that are good predictors of  success in groups

how can we predict a member’s behavior before we integrate them into group

šGood Idea in Clinical Interview: ask the client about their prior group experience

šIf they had any group experience in the past, how it went, what did they like or dislike about it

šCould give you information about their triggers, what groups they might work well/not work well in

→Best way to predict group is the interpersonal interview, but also observing how they’re interacting with you, the therapist, during the interview

differences between homogeneity and heterogeneity in group

šAge: if you have a variety of ages, it’s a positive thing for heterogeneity; you actually want to make sure of this→ If you do this, you don’t want to have six people in their 20s and one in their 80s

šKEY IN GROUP: group should be homo with regards to ego strengths, intellectual capacity, psychological mindfulness , cognitive ability; There should be heterogeneous regarding personal concerns, such as attachment styles, areas of conflict

šConflict: If everyone has the same type of conflict, there’s no resolution and members cannot grow

šDisadvantages: If groups are too homo then the group becomes stagnates and cannot move forward  due to lack of perspectives

Groups needs to have a variety of cultures, gender diversity, and races in groups: groups should mirror society, which gives therapists a good idea of whom to include in group; you should have a variety of cultures and opinions

cohesiveness in groups

šResearch supports that the creation of interpersonally compatible groups create greater cohesion

šCohesive groups are not free of conflict: conflict is normal and essential-> will and should occur→ members are able to tolerate it because they know each other; you work through the conflict

šIf there’s cohesion, then in spit of the conflict, members will remain attracted to the group; they’ll look forward to going→ Especially if there’s something not yet resolved; they become eager to return to resolve the conflict

will be the key to forming the group composition; how compatible is everyone interpersonally

interpersonal compatibility

is recommended as the primary guideline in the composition of therapy

cohesiveness

initial formative stage of group

šfilling out for members; there’s a lot of people pleasing

šCommon use of stereotype statements: “I think everyone is doing a great job here”

šEveryone is overall nice to each other; Important for people to not stay in this initial stage

šPeople are typically engaged and trying to affiliate; engagement is not as much in a deeper level as the later stages in group 

initial stages of group

šDuring the initial stage of group, participants are going to be hesitant about self disclosing: Because of this, it’s important for the therapist to continue pre-group discussions, especially discussions  about hope and distillation of group→this is important in the beginning of group

šHaving a hetero group with beginner and senior members is helpful to instill that hope

šHesitancy is important among everyone in group: Can come in form of a question like “How is this going to help me” or “What does all of this have to do with solving my problems”

šMembers initially want to depend on leader but we have to help them not to depend on them rather rely on the group members : Dependency is more evident if  early group is puzzled or unclear-> may more likely rely on leader

šIn beginning stages, clients are seeking advice from members, but it’s so much of gaining answers but more of an interactional strategy: Members also do not know how to effectively give or ask for feedback, thus they may have learned that the way to do this is to ask for advice 

How many group sessions is the initial stage?

Every group is different and at some point you’ll see your group transition to the second stage of group

second stage of group

šWhich members will lead and which will follow “top or bottom”:Stage where there’s conflict occurring in group→Individuals are preoccupied with dominance, control, and power

šHierarchy of Control emerges during this stage: you can see the microsome of groups occurring; similar to the hierarchy we see in social groups

šHostility towards therapist is inevitable and hopefully occurs: If not occurring maybe the therapist is sending an aloof or frail  demeanor, thus no conflict

šWhen client has conflict with therapist, it’s important for them to not get defensive: KEY is for the therapist has to understand that it is not about them, it’s part of the formative stages of group

šRebellion might occur: challenges occur through normal change process as members adjust to find their place in the social microcosm; as the therapist you have to teach them how to resolve conflicts effectively

hostility towards the therapist in group

šdies down as the members discover the therapist’s humanity

šAlso as the members learns ‘therapist really cares about me’ the hostility decreases

šThis hostility could be due to transference, and need to realize this as the therapist and not fall into countertransference

šThis stage is difficult but essential for therapist

šEssential for therapist to receive majority of hostility bc if not then the other members of group are the ones receiving this hostility

what is scapegoating

blaming another member for issues that are occurring in group; putting the responsibility on another person

the third stage of group

šWhen people have worked through their conflicts and the group has formed a cohesive

šThey’re working and supporting together; further trust has been developed between members and leader

šStage were members feel safe about stating the real reason they came to therapy: Other members might start opening up too-> self disclosure leads to other self disclosure

šEveryone in this stage is receiving mutual support from each other

what can threaten cohesiveness in group

šTurnover(drop out rates) can threaten cohesiveness: when drop out occurs it leaves an empty space that can threaten group development

šShort-term groups tend to have lower turnover

šOne way to reduce this is at least spending a session processing the loss of the group member before replacing the member; by doing this the members learn that no one is replaceable

šWe should replace members early on, but consider having a session before doing so

Clients can be removed from group but must be processed with the group, paying attention to confidentiality, and  without public humiliation

attendance and group

šBeing on time should be stressed in pre-group meetings and throughout

šWhen there’s a lot of absences then members aren’t fully able to process issues and poor benefit from group participation

šAttendance at 2 meetings establishes commitment