Group therapy M.A. Fourth Semester

MODELS OF GROUP THERAPY there are generally two forms of group therapy in which some focus on the individual patients while others focus on group process.
On the other hand, there are other methods which are in effect adaptations of individual therapy, in this sense group therapy is essentially multiple- individual therapy.
in terms of approaches they will be called :
Intrapersonalist
Transactionalist( or interpersonalist)
Integralist

Intrapersonalist- Intrapersonalist therapists work in the psychoanalytic mode where they encourage association, delve into personal histories, and interpret transference reactions.
Transactionalist- they tend to focus on interpersonal relationships between subgroups. The interrelationships among patients and the therapist are viewed as having therapeutic potential. they stress the attractiveness of being a group member- as a factor in alternating individual behavior. Most group therapist fall within this broad class.
Integralist- They hold the view that a person’s problem may lie in his inability to mesh with others in effective solving of group problems.<br>

PROCESS OF GROUP THERAPY FORMAL ARRANGEMENTS-
Groups generally consist of six to ten participants, with eight being an optimal number.
Sessions can be one and one- half to two hours long, often scheduled in evening.
Meeting may held once or twice weekly.
Participants are seated in an open circle, so that all members can see each other.
many group therapist work alone, but sometimes a co-therapist is also present there.
Male- female co -therapists are also used where the focus is on marital problem, as in couple group therapy.
Groups may either be closed, holding only those who started initially, or open, admitting new members after the beginning of sessions.

COMPOSITION OF THE GROUP-
Usually groups are heterogeneous , members participating are having a variety of occupations, with varied educational levels, moderate range of age difference, and varying degree of sophistication.
Sometimes homogeneous groups are arranged (for example, drug addicts, stutterers or hospitalized patients with same diagnosis).<br>

Continue…. Sometimes certain classes of patients are less fit for outpatient – group meetings, these included brain- damaged, extremely narcissistic or paranoid, sociopathic, hypocondriacal or suicidal, or gross psychotic.
Homogenous groups are often formed precisely to work in their area of common concern.

THE ROLE OF THE THERAPIST-
In the individual therapeutic format the therapist is the sole & the direct agent of change; in the group therapeutic format he functions far more indirectly.
The therapist’s role is essentially to guide or to facilitate, keeping the group on course , encouraging interaction and self- exploration.
Therapist is probably most active during the early group sessions, helping the strangers develop some sense of group culture and cohesiveness, defining the rules.
The therapist must be aware of resistances, cliques, alliances and coalitions among some members, scapegoating etc.. , and the effect taking place on each group member.<br>

The unique advantages OF GROUP THERAPY The following advantages of group therapy distinguish it from individual therapy are:
Greater sense of reality: A group manifest everyday reality more closely than does in the situation of individual therapy. The group allow the therapist to see the patient’s actual behavior and the way of interaction with people.
Reduction of social isolation: Each members has an opportunity to become aware about his or her problems and learning that they are not unique. Group discussions provides relief when each members learns he or she is not alone in fearing death. the patient is encouraged to give up feelings of isolation & self- consciousness and develop a greater sense of hope.
Group acceptance and support: Group cohesiveness leads to increased acceptance, trust, caring, and support of one another.
Imitation of successful coping style: Each patient is encouraged to apply new coping techniques by imitating other members. new members have an opportunity to observe older members and their more successful ways of coping with problems.
Opportunity for feedback: The group situation demands the open expression of feelings, both positive and negative, directed toward other members who evoke love, frustration, tears, rage and so on. The members has a chance to practice new behaviors.<br>

conti,…… Opportunity for altruism: Self- esteem is increased by helping others. In group therapy, empathy, warmth, acceptance, support, genuineness may be received and given by any group members.
Increased sensitivity: Insight and understanding of human motives and behavior are developed in many patients both during and after group therapy. they are likely to be more attuned to their own feelings.
Corrective “family” experience: Participants in groups regard themselves as members of a family. Such a setting may provide an opportunity to live early family experiences that may still disturb or disrupt the individual’s present functioning.
Hope: In group therapy, the change-supporting factor develops from observing positive changes occurring in others, and holds out hope for one’s own chances of recovery, and change.<br>

Varieties of group therapy PSYCHOANALYTIC GROUP THERAPY
PSYCHODRAMA
BEHAVIOUR-THERAPY GROUPS
SENSITIVITY TRAINING GROUPS (T – GROUPS)
ENCOUNTER GROUPS
MARATHON GROUPS
GESTALT GROUPS
TRANSACTIONAL ANALYSIS GROUPS
SYNANON GAMES
BIOENERGETIC GROUP THERAPY<br>

Psychoanalytic group therapy Wolf ( 1975) and Slavson (1964) have been translated The classical psychoanalytic concepts for group setting.
Wolf conceptualizes group as a re-creation of the primary family, encouraged his patients to work through their unresolved conflicts in this simulated family situation.
Group members are asked to engage in free associations about one another and to report their dreams.
Resistances and transference feelings ( developed toward all members, not the analyst alone) are analyzed, usually by other members of group.
Interpretations by the analyst are kept minimum.
Wolf hold the view that group support helps each member to tolerate anxiety better, permitting a deeper analytic experience.
Slavson’s major thrust with a group is to aid each member to gain insight and self understanding.<br>

psychodrama developed by Jacob Moreno, in the 1920, psychodrama involves role- playing procedures in group setting.
It encourage catharsis, spontaneity, and self- understanding among the participants.
Moreno believed that recreating the various interpersonal situations in the therapeutic process where patient enmeshed in ( with mother, father, siblings, child, boss or others) that may have led to his or her present psychological difficulties.
He as therapist/ director, used a stage in which the patient could act out his/her significant life events in front of an audience.
various people represented key persons (called, “auxiliary egos”) in patient life.
At certain junctures, the director might instruct the patient to reserve roles with one of the players so that the patient could gain greater awareness of how another person saw him or her.<br>

Conti…….. Psychodrama generally takes place in front of audience , that provide acceptance & understanding
According to Moreno , acting out rather than talking out feelings leads to greater catharsis & helps free the patient’s creativity.
Psychodrama emphasis on both verbal and non- verbal techniques.<br>

Behaviour-THERAPY GROUPS In this approach, many people with the alike problem behaviors can be treated simultaneously
Lazarus (1981) has been leader in this field.
Behavior- therapy groups are of three types: Systematic desensitization groups, behavioral practice groups, and specific behavioral control groups.
Desensitization groups include people with similar fears who learn relaxation methods together before starting, separately but simultaneously, to work on a standardized anxiety hierarchy.
in Assertion- training groups, members practice by role- playing scenes with one another, such groups usually involve direct teaching by a therapist regarding problems caused by nonassertiveness.<br>

T-GROUPS “ Sensitivity training group”, T-group is a learning laboratory for adequately functioning people.
It was developed to gain greater self awareness, to increase sensitivity to feelings, thoughts & motives of others, to become more honest and authentic and to learn techniques for giving & receiving feedback and resolving interpersonal conflicts..
Group is fascilitated by a trainer who imposes no structure or agenda rather helps group to choose its own goals and directions & learn from its own experiences.
GOAL-
Open previously closed areas of thoughts & feelings.
Allowing the participant to experience deeper personal feelings & closer relationships with others after the laboratory experience is over.

The following are some typical T- group exercises designed for trust building, gaining feedback from others, & develop strong feelings within the group:
Mindmiling: Participants with eyes closed, mill around the room for some time. They do not speaks but only try to experience the group through the sense of touch and smell.<br>

CONTI…….. Eyeball to eyeball: members in pair stare into each other’s eyes for one or two minutes, without speaking or moving,
Strength bombardment: Each group member, told something nice about himself or herself by every other member. Also, each member may be urged to say good things about himself or herself.
Metaphorical descriptions: Each member moves around the group & stops at each other member. Looking at the other member, the participants describe the other in metaphorical terms such as “ mashed potato” or “scary baboon”
Trusting the group: Each person stands in the center of the circle formed by other members. With eyes closed, they allow themselves to fall and other members of the group catch them.
Breaking in: The group forms a circle in which they interlocked their arms together. one member is outside the group circle and tries to physically break the circle and become a part of it. Those in the circle hardly try to keep intruder out. A reverse of the procedure occurs when someone is trapped inside the circle and try to get out.
Who am I: each member must complete the phrase “ I am……” for a period up to one minute.<br>

ENCOUNTER GROUPS The “ open encounter “ method was developed by Schutz (1973).
The “basic encounter” by Rogers (1970).
Both of them facilitated personal growth by “unfreezing& encouraging” people to develop spontaneity.
According to Bebout (1978), “ direct experiential contact” makes them powerful change agents.
Members psychologically “touch” one another, getting spontaneity, a loss of self- consciousness, a mutual attention, unity of feelings and action.
ASSUMPTIONS:
A therapist can develop, a psychological climate of safety in which freedom of expression & reduction of defensiveness begins to occur.
Immediate feeling reaction of each member towards others and towards himself , likely to be expressed.
Mutual trust develops- mutual freedom to express real feelings.
Each members move toward greater acceptance of his total wellbeing- emotional, intellectual and physical
With this newly acquired freedom and improved communication, new ideas, new concepts, new directions emerged.<br>

Marathon groups It is continuous, time- extended, intense encounters, of 24 hours to full weekend, with minimal timeout for eating and sleeping.
Stoller (1968) calls the process “accelerated interaction”.
Bach (1966) adapted the technique to his own clinical practice, coining the term ‘ marathon group therapy’.
brief naps are allowed/ sleep break scheduled, all in the same big room, foods are there.
a “ pressure cooker” environment is generated.
Much of the period is full of crises, of dramatic & frightening activities; tears and threats are common, intense anger and verbal abuse. May be seen.
Heightened sense of intimacy & deeply felt positive feelings among participants emerged as sessions coming towards end. The final phase sometimes been called the “ love feast “.
Members experience more deeply their relatedness to each other.<br>

GESTALT GROUPS Gestalt therapy methods in encounter groups has gained increasing popularity.
It was developed by Fritz Perls.
It focuses on becoming people to be aware and take responsibility for their action in the here- and –now.
Leaders and participant engage in role-playing.
Person is expected to be aware of his sensations, feelings, and acts in the now.
He/She should put aside conceptualized accounts of his own thoughts, expectations and plans.
The participant interact with an imagined person as if that person or part is in a nearby empty chair.
Portions of dream have to be acted out.<br>

Transactional analysis groups Created in 50s by the psychiatrist Eric Berne.
became popular through his book Games People Play (Berne, 1964).
it focuses more on the patients gaining understanding rather than emotional release, achieving greater insight & awareness of his/her faulty transactions with others.
The term ‘ transactional’ refers to the relations between ego states ( those related to roles of child, adult, or parent) within the same person rather than transaction among people.
According to Berne , each person has three ego states : Child, Adult, and Parent.
An ego state is a consistent pattern of feelings and experiences that corresponds to a specific pattern of behavior.
The Child ego states remains from the patient’s childhood , reproduce in his /her behavior the reactive pattern of childhood.
The Adult ego state is related with collecting & processing data and planning actions.
The Parent ego states are learned from parental figures and reproduce the feelings and behavioural responses from that figures.<br>

Conti…….. Berne has conceptualised four life- positions :
I’m OK – You’re OK
I’m OK – You’re not OK
I’m not OK – You’re OK
I’m not OK – You’re not OK
The first life positions reflects self – acceptance and acceptance of others.
Paranoid and other highly suspicious person are likely adopt the second life positions.
Depressed persons are committed to third life positions.
Schizophrenia are apt to take fourth life position, rejecting themselves and all others.<br>

SYNANON GAMES Synanon games is significantly different from other encounter techniques.
It emphasis on the open, direct, and uninhibited expression of anger and hostility, stopping only at the beginning of overt violence.
An essential part of the program at Synanon, a self- help organization for former drug addicts.
The games consist of leaderless group encounters, of about 3 hours.
In that situation persons are singled out in turn for intense verbal assault.
Game is seen as a way of discharge of the participants hostile feelings rather than in more indirect & potentially dangerous ways.<br>

BIOENERGETIC GROUP THERAPY It is rooted in the psychoanalytic tradition and developed by Wilhelm Reich.
Physical approach to group therapy and neo- Reichian in nature.
This therapy focuses on the expression of feelings through body movements, postures, musculature and types of breathing ( Lowen,1969).
Participants are encouraged to make physical as well as psychological contact with one another in order that the body as a whole available for self- expression.<br>

Consulted books Goldenberg, H.(1982). Contemporary Clinical Psychology, Brooks/Cole pub. Co.
Korchin, j. (1979). Modern Clinical Psychology. New York: Harper Collins
Nietzel, Michael T., Bernstein, Douglas A., Kramer, Geoffrey P., & Milich, Richard (2003). Introduction to Clinical Psychology, (6th ed.), Upper Saddle River: Prentice Hall.
Wolman, B.B.(1984) Handbook of Clinical Psychology, New York: Wiley & Sons.<br>