Groups and Group Therapy

Group therapy is a popular mode of therapy for both therapists and clients. Group therapy is a highly effective form of psychotherapy that is based on interdependence and interaction among the group members who mutually disclose personal material (Lasky & Riva, 2006). Group psychotherapy began in the late 1800’s/early 1900’s when Joseph Pratt, a Boston physician, recognised the positive effects on tuberculosis patients who did not have access to sanatoria (Laski & Riva, 2006). Because their recovery required strict hygienic regimens in their impoverished homes, he used regular group meetings to educate his patients on how to combat the diseases. 

Other psychiatrists were influenced by this method. For example one psychotherapist, Cody Marsh, even included dance classes in his hospital (Brabender, Fallon & Smolar, 2004; Laski & Riva, 2006). The role of the charismatic leader and the dynamics of group relationships were recognised by Freud later.

Group therapy received increased attention during World War II when many therapists were initially exposed to group work during their military experience. Theorists from England and the US applied psychoanalytic and other interpersonal theory to group therapy concepts. The social revolutions in the 1960s resulted in the beginning of sensitivity training experiences (T groups), and a variety of personal growth groups.
 
The emergence of transactional analysis, gestalt theory, bioenergetics, and existential models for group therapy; along with many additional innovative variations, have also enriched the group therapy fields over the decades (Jose, 2010).
 
In Britain and America during the second world war, an appreciation of group psychotherapy lead to a wide range of innovations, including the use of a group approach in the selection and allocation of work responsibilities, studies of group morale and in the integration of psychiatric knowledge in the management of large groups through the role of the command psychiatrist.
 
Definition of a group
 
A group is a collection of individuals whose association is founded on commonalities of interest, norms and values. Membership in the group may be by chance, by choice or by circumstances. The group can either be open (i.e. admitting new members at any time) or closed (i.e. not admitting new members after the first session).
 
Definitions of Group Therapy
 
Below is a list of key aspects that different schools of psychotherapy have used to define the qualities of group therapy. 

  • Group therapy is a type of psychotherapeutic care in which several clients meet with one or more therapists at the same time. The client’s form a support group for each other as well as receiving expert care and advice. The group therapy model is particularly appropriate for mental health issues that are support intensive, for example anxiety; but is not well suited for the treatment of some other psychiatric disorders, for example schizophrenia.
     
  • Group therapy is a type of psychoanalysis in which clients analyse each other with the assistance of one or more psychotherapists, as in an “encounter group”.
     
  • Group therapy is a form of psychotherapy that involves sessions guided by a therapist and attended by several clients who confront their personal problems together. The interaction among clients is considered to be an integral part of the therapeutic process. 
     
  • Group therapy is a form of psychosocial treatment where a small group of clients meet regularly to talk, interact, and discuss problems with each other and the group leader (therapist).

Characteristics of a group

  • Size of the group 
  •  Homogeneity (similar issues) or heterogeneity (variety of issues) of the members
  • Stability of the group
  • Climate of the group (warm, cold, friendly, aloof)
  • Degree of cohesiveness
  • Conformity to norms
  • Degree of agreement with the leader and the groups norms
  • Ability to deal with members infractions
  • Goal directness and task orientation of the group’s work
  • Homogeneous versus heterogeneous groups

Some therapists believe that a group should be as heterogeneous as possible to ensure maximum interaction. Heterogeneity refers to the diversity of clients within the group and can include different diagnostic categories and behavioural patterns, and clients from different races, social levels, educational and backgrounds. The assumption is that groups composed of participants from a diversity of backgrounds (heterogeneous) can enrich the psychotherapeutic experience and interpersonal interaction for each member (Gladding, 2003).
 
Homogeneous groups are composed of members based on similarities rather than diversity. Similarities could be on such things as issues/disorders being faced (e.g. drug abuse, depression, etc), gender, ethnicity, sexual orientation etc. Some have suggested that the homogeneous psychotherapy group is most suitable for children and adolescents (Gladding, 2003).
 
Goals of Group Therapy
 
Behavioural therapists have identified two primary goals of group therapy. These are process goals and outcome goals. Process goals refer to goals that are related to the group process. For example, process goals can be to help members improve their comfort level in the group, to increase openness in the group, and to learn to confront members in a more productive manner (Jacobs, Masson & Harvill, 2006).
 
Outcome goals on the other hand are goals that affect the behaviour changes in the member’s life such as obtaining employment, improving interpersonal relationships and successfully addressing whatever issues that the member presented with for group therapy. Therapy groups that focus primarily on the members concerns are usually more beneficial than those that focus on the interactions of the group members (Jacobs, Masson & Harvill, 2006). However, for the more robust effectiveness of any group therapy, the therapist should focus on both process and outcome goals.
 
Models of Group Therapy
 
Interpersonal Group Therapy
 
The focus in this form of group therapy is based on the premise of interpersonal learning being a primary mechanism of change. The group provides the antidotes to maladaptive interpersonal beliefs and behaviours through feedback from others and encouragement to experiment with healthier alternative behaviours, first within the group and then outside the group.
 
The shared examination of inter group transference reactions allows members to replace processes of relating that have a historical origin in the ‘there and then’ (the dynamic past) with those more appropriate to the ‘here and now’ (dynamic present).
 
The Tavistock Model
 
According to this model, the culture and climate of a group is governed by primitive unconscious anxieties that ultimately can impede the group’s capacity for rational work. This is a therapist centred approach with the focus on techniques that enforce a series of interactions to reduce the complexity and the constraints of the group work.
 
The Group Analytic Model
 
Group Analysis is a method of group psychotherapy that combines psychoanalytic insights with an understanding of social and interpersonal functioning. It has a specific focus on the relationships between the individual group members. Deriving from psychoanalysis, Group Analysis also draws on a range of other psychotherapeutic traditions and approaches. This includes systems theory other psychotherapies, developmental psychology and social psychology. From this emerges what some group therapists consider a powerful psychotherapeutic technique.
 
The assumption of this model is that deep lasting change can occur within a carefully formed group whose combined membership reflects the wider norms of society. A stimulating interaction between group members becomes the focus of treatment and therapeutic work by building an understanding of group interactions, conversations and events to facilitate a powerful way each group member learns about themselves (Aviv, 2010).

Related Readings: Therapeutic and Counselling Groups
 
References

  • Aviv, A. (2010). Where intersubjectivity and group analysis meet. International Journal of Group Psychotherapy, 60, 91-109.
  • Brabender, V. A., Fallon, A. E., & Smolar, A. I. (2004). Essentials of group therapy. Hoboken, NJ: John Wiley & Sons.
  • Gladding. G.T. (2003) Group Work: A Counselling Speciality (4th ed). New Jersey: Prentice Hall.
  • Jacobs, E., Masson, R.L. & Harvill, R.L. (2006). Group Counselling: Strategies and Skills. Belmont, CA: Thompson Brooks/Cole.
  • Jose, J. (2010). Group therapy. Psychiatric Nursing. Retrieved from http://www.nursingplanet.com/ on 5th August 2010.
  • Lasky, G.B. & Riva, M.T. (2006). Confidentiality and Privileged communication in psychotherapy. International Journal of Group Psychotherapy, 56, 455-476.

Source: www.mentalhealthacademy.com.au