Adressing Key Components of Effective Group Therapy



Addressing Key Components of Effective Group TherapyLacey HastingsStenberg CollegeWorking in GroupsDebbie McCreedyAbstractThe use of group therapy is on the rise, and some could say this is because group therapy is just as, if not more effective than individual therapy (Burlingame, Fuhriman, & Johnson, 2004; as cited in Corey 2008). Group therapy allows for a different kind of experience, where members can interact with one another, learn from each other, and improve interpersonal functioning. Group therapy is also a very meticulous process, dependent on particular therapeutic factors, environments, behaviors and dynamics. Literature shows that members need to prepared for this experience, they need to be informed of the process and nature, they need to have expectations, and fears addressed, and they need to be prepared for what is expected of them(Yalom & Leszcz, 2005). This preparation influences participation, attendance, and the overall experience of the member (CSAT, 2005); thus directly influences the effectiveness of group therapy. In addition, for members to have an effective group therapy experience, to partake in meaningful group work, they need to experience cohesion in the group(Marmarosh & Horn, 2011). When members are part of a cohesive group, they feel accepted and supported, and they are more likely to self-disclosure, open up, explore and learn. This is pivotal for meaningful group work, and for members to experience effective group therapy. There also needs to be a focus on interpersonal communication and interpersonal interactions in group work, as this is how we meet basic human needs, and interpersonal relationships are directly connected with mental health(Lipsitz & Markowirz, 2013). When members relate, interact, learn and explore with other members, interpersonal learning takes place, which results in personal growth and ultimately change; thus rendering the therapeutic experience more effective. There are many important therapeutic factors and preconditions for group therapy, however proper preparation, group cohesiveness and interpersonal learning, are of uttermost importance for effective group therapy. Addressing Key Components of Effective Group TherapyGroup therapy is a very powerful experience, a highly effective form of therapy and research confirms its power to provide a ‘meaningful benefit’ (Yalom & Leszcz, 2005). It has been noted through the literature that group therapy is just as, if not more, effective than individual therapy in treating a range of psychological problems (Burlingame, Fuhriman, & Johnson, 2004a, 2004b; Fuhriman & Burlingame, 1999; Markus & King, 2003; Piper & Ogrodniczuk, 2004; Corey 2008). This effectiveness can be explained in many ways, can stem from many things, and the benefits of group therapy are numerous. With group therapy, members can “not only gain insight but practice new skills both within the group and in their everyday interactions outside the group”, and benefit immensely from the feedback and interactions with group members and therapists (Corey, 2008). Thus group therapy is effective and beneficial for numerous intrapersonal and interpersonal issues that come along with so many psychological problems; it is an effective treatment for helping people change, learn and grow (Corey & Corey, 2010). However, group therapy is very precise, a very strategic and fragile process, requiring specific therapeutic factors, conditions, and dynamics. For group therapy to be effective, certain things need to take place, the group needs to interact in certain ways, and the group leader needs to fulfill certain roles and certain skills. The writer beliefs that for group therapy to be effective, clients need to be properly prepared for the experience, there needs to be group cohesiveness and interpersonal learning needs to take place. The writer will prove this by exploring these concepts and reviewing the literature. Pre- Group PreparationSince the dynamics and the ‘work’ of group therapy is so particular, and this particularity is how group therapy becomes effective and how meaningful benefit takes place, clients need to be prepared for this powerful and challenging experience. Preparing a client means getting them ready, educating them about group therapy, discussing the purpose and the expectations, addressing any concerns, and discussing any group agreements or ground rules (CSAT, 2005; Puskar, 2012). This includes clarifying any misconceptions, fears and expectations, and generating “realistic and positive expectations about the group therapy” (Yalom & Leszcz, 2005). It includes providing clients with a base, with ‘group norms’ in which promote effective group participation (Yalom & Leszcz, 2005). Clients need to know what is expected of them, they need to know realistically what to expect and what goals to focus on, and they need to be aware of the hard work and the benefits of group therapy, as all of this will influence how they participate and what they get out of the experience (CSAT, 2005). Individuals often have predetermined ideas and misconceptions about group therapy, these can come from previous experiences or others experience, either way they can affect how members participate, what they put into the group experience, and whether they terminate prematurely (Puskar, 2012; Yalom & Leszcz, 2005). Individuals may have false ideas of what the group experience will entail; they may have unrealistic fears, or negative misconceptions of the quality of group therapy. Which is why these ideas, these fears and misconceptions need to be addressed and clarified, and appropriate and accurate information needs to be given. Without preparation for group therapy, clients can be left in the dark, left with uncertainty, and anxiety, and can grow ‘unnecessarily discouraged’, and potentially terminate group therapy (Yalom & Leszcz, 2005). However with appropriate preparation, with the clarification of goals, behaviors, process and expectations, uncertainty and anxiety can be reduced (Yalom & Leszcz, 2005). Misconceptions, and fears can be challenged, and clients can be provided with appropriate information and expectations, so they can understand and be familiar with the process, so they know what to expect, and can participate accordingly. Thus with pre-group preparation individuals can be given the information and the tools they need to benefit from group therapy, and have an effective group therapy experience. Research shows that preparing clients for group therapy improves attendance, participation, and group cohesion; individuals who are prepared report less anxiety, show motivation to change and are more likely to achieve their goals in therapy (Yalom & Leszvz, 2005). Research confirms the value of preparation for group therapy, and as Yalom (2005) States, “There is highly persuasive evidence that pre-group preparation expedites the course of group therapy” (p.294).Group CohesivenessGroup cohesiveness can be described as a mechanism or a force that keeps members connected to the group (Festinger, Schachter & Back, 1950; 1992; Lewin, 1947; as cited in Marmarosh & Horn, 2011). It can be described as a sense of ‘we-ness’, or a “feeling of being a part of something bigger than oneself” (Marmarosh & Horn, 2011). This feeling or this ‘force’ is one of the most important therapeutic factors for group therapy (Yallom & Leszcz; as cited in Marmarosh & Horn, 2011). Cohesion is said to be the ‘glue’ that holds the group together (Marmarosh & Horn, 2011).With group cohesiveness members feel connected, they feel accepted and can identify with the group (Marmarosh & Horn, 2011). Cohesiveness alters self-esteem through this acceptance and empathy, and self-esteem is important for change and growth throughout group therapy (Yalom, 1995; as cited in Marmarosh, Holtz & Schottenbauer, 2005). Cohesion allows members to engage in necessary self-disclosure and personal exploration- important therapeutic factors for effective group therapy (Yalom, 1995; as cited in Marmarosh, Holtz & Schottenbauer, 2005).And this allows member to open up, to gain insight, and to learn and grow interpersonally (Yalom & Leszcz, 2005). Thus group cohesion allows for the necessary ‘therapeutic environment’ for group work, the necessary condition for ‘meaningful group work’ (Yalom 2005; as cited in Marmarosh & Horn, 2011). It allows for a safe environment, an environment where members can feel supported, understood and accepted, where they can share, disclose and explore. With a cohesive group they can have the environment they need to facilitate this necessary group work, and thus get the most out of their group therapy experience. Cohesion can also be looked at as a ‘prerequisite for change’(Marmarosh & Horn, 2011), by allowing members to feel comfortable, and have the self-esteem and support to self-disclose, explore and to participate In group work, this is allowing for growth, learning, progress and change; i.e. effective group work.Research shows that as cohesion levels increase, client outcomes improve and psychological symptoms decrease (Burlingame, McClendon & Alonso, 2011). As cohesion predicts process, and in turn, eventual group outcomes (Burlingame, Fuhriman, & Johnson, 2001). Thus cohesion is a ‘mediator of outcome’ for group therapy (Marmarosh & Horn, 2011).Group cohesion can be compared to the therapeutic alliance in individual therapy, in group therapy cohesion is the therapeutic relationship (Burlingame, Fuhriman, & Johnson, 2001). Thus without cohesion, without that sense of 'we-ness', the group remains detached, they become “frozen behind their defenses” and their work is superficial (Corey, 1995; as cited in Marmarosh & Horn, 2011). They don’t have that support, acceptance, and connection that is necessary for meaningful group work, thus without a cohesive group, members don’t have that environment that is needed for effective group work.Interpersonal LearningInterpersonal communication is central to our everyday life’s, to our everyday interactions (Wood, 2010). We communicate to “develop identities, establish and build relationships, coordinate efforts with others, have impact on issues that matter to us, and work out problems and possibilities” (Wood, 2010). Interpersonal communication is the ‘lifeblood’ of meaningful relationships in personal, social, and professional contexts (Wood, 2010) and as Sullivan proposed, mental health depends on healthy, intimate connections with other people (As cited in Lipsitz & Markowitz, 2013). When looking at Maslow’s Hierarchical of Needs , interpersonal communication is a primary way in which to meet these basic needs. Such as belonging needs, we communicate interpersonally to meet these belonging needs, the need to fit in, to socialize, to be accepted and for affirmation (Wood, 2010). As well as self-esteem needs, which involves valuing and respecting ourselves and being valued and respected by others; through interpersonal communication we figure out who we are and who we can be (Wood, 2010). Through interpersonal communication we also meet the human need of self-actualization, the need to become our fullest self’s, to learn, grow and change (Wood, 2010). Interpersonal communication fosters this personal growth.Individuals with psychological problems often have difficulties in interpersonal functioning and with interpersonal communication (Lipsitz & Markowitz, 2013) and psychological symptomology is said to “emanate from disturbed interpersonal relationships” (Yalom & Leszcz, 2005). And since interpersonal communication is a primary way to meet human needs, is a central part of daily life and directly related to mental health, interpersonal learning is pivotal in group therapy, and improving interpersonal functioning is a universal goal of psychotherapy (Lipsitz & Markowitz, 2013). The interpersonal aspects of the group in a group therapy setting are the dynamics between the group members, the emotional reactions, the closeness, assertiveness and boundaries (Earley, 2013). Through interpersonal interactions, members come to understand differences and similarities, which foster personal growth (Wood, 2010). Interpersonal interaction stimulates reactions and transferences, that are the ‘lifeblood’ of therapy, and this allows for experimenting, exploring and healing responses (Earley, 2013). Through relating and interacting individuals can learn about themselves, they can become aware of interpersonal tendencies and modify them (Lipsitz & Markowitz, 2013). Group members can learn from one another, they can make social connections, work through emotions and behaviors and ultimately learn to better understand and manage these emotions and interpersonal encounters more generally (Lipsitz & Markowitz, 2013). With working through interpersonal issues in the group setting, one’s social supports can be enhanced, interpersonal stress can be decreased, emotional processing facilitated, and interpersonal skills improved (Lipsitz & Markowirz, 2013). Thus with interpersonal learning, comes the real ‘work’ of group therapy, the meaningful and effective work, the learning, growing and changing. Without working on interpersonal communication, and interpersonal issues, without interpersonal learning, there is little room for change, as this interpersonal, here and now learning, is the key to insight, understanding and change (Yalom & Leszcz, 2005) and thus the key to effective group therapy. SummaryGroup therapy is proven to be effective; it can be a powerful, meaningful experience with deep interpersonal/intrapersonal benefits. However it requires appropriate therapeutic factors, and the right therapeutic environment. In order for individuals to benefit from this powerful experience, they need to be prepared for it, they need to be aware of the therapeutic factors, be prepared for the ‘meaningful’ work that will take place, and be prepared for what is expected of them. This preparation influences the quality and the outcome of the group work, and influences the attendance and termination of group members; critical to effective therapy. Individuals need to feel that they are in a cohesive group, they need to feel accepted, supported, and feel that ‘we-ness’, this enables them to open up and participate in meaningful work, and to get the most out of their group therapy experience. And for group therapy to be truly effective, meaningful and powerful there needs to be deep interpersonal learning, as improving interpersonal functioning is a main focus, is directly related to mental health, and allows members to reach their basic human needs, and allows for healing, learning and growing. Thus the writer concludes that for group therapy to be truly effective, members need to be appropriately prepared, have cohesion within the group, and experience forms of interpersonal learning. ReferencesBurlingame, G. M., McClendon, D. T., & Alonso, J. (2011). Cohesion in group therapy. Psychotherapy, 48(1), 34. Retrieved from: for Substance Abuse Treatment. (CSAT). (2005). 4 Group Development and Phase‐Specific Tasks. (Treatment Improvement Protocol (TIP) Series, No. 41.) Retrieved from: , G. (2011). Theory and practice of group counseling. Cengage Learning. Retrieved from: , M., Corey, G., & Corey, C. (2013). Groups: Process and practice. Cengage Learning. Retrieved from:, J. (2013). Interactive Group Therapy: Integrating, Interpersonal, Action-Orientated and Psychodynamic Approaches. Routledge. Retrieved from: , J. D., & Markowitz, J. C. (2013). Mechanisms of change in interpersonal therapy (IPT). Clinical psychology review, 33(8), 1134-1147. Retrieved from: , C., Holtz, A., & Schottenbauer, M. (2005). Group Cohesiveness, Group-Derived Collective Self-Esteem, Group-Derived Hope, and the Well-Being of Group Therapy Members. Group Dynamics: Theory, Research, and Practice, 9(1), 32. Retrieved from: , C. Horn, S, T. (2011). Cohesion in Counselling and Psychotherapy Groups in: Conyne, R. K. (Eds).The Oxford Handbook of Group Counseling.(pp.137-158). Oxford University Press. Puskar, K. (2012). Understanding Content and Process: Guidelines for Group Leaders. Perspectives In Psychiatric Care, 48(4), 225-229. Retrieved from: , J. (2012). Interpersonal communication: Everyday encounters. Cengage Learning. Retrieved from: , I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). Cambridge, MA: Basic Books. ................
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