IB Psychology: Group Therapy



Group therapy

Why was it designed originally? A cost-saving measure; in institutional settings where many people needed psychological treatment and there were too few psychologists to provide the treatment. However, in conducting research on the effectiveness of these therapy groups, psychologists discovered that the group experience benefited people in many ways that were not always addressed in individual psychotherapy. Likewise, it was also discovered that some people did not benefit from group therapy.

History of group psychotherapy The founders of group psychotherapy in the USA included Pratt, Burrow, Moreno and Yalom.

In the UK group psychotherapy initially developed independently, with pioneers Foulkes and Bion using group therapy as an approach to treating combat fatigue in the Second World War

Foulkes and Bion were psychoanalysts and incorporated psychoanalysis into group therapy by recognising that transference can arise not only between group members and the therapist but also among group members. Bion has been criticised for his technical approach which had an exclusive focus on analysis of whole-group processes to the exclusion of any exploration of individual group members' issues. Bion's approach is similar to Social Therapy developed in the US in the 70s by Holzman and Newman; here practitioners relate to the group, not its individuals, as the fundamental unit of development. The task of the group is to "build the group" rather than focus on problem solving or "fixing" individuals.

How many people usually take part in group therapy? Anywhere between 6 and 12 members, plus one or two psychologists/facilitators.

What does it involve? Group therapy is very diverse; psychologists have different theoretical training and use group therapy for many different problems and concerns. The therapist works to help the group to establish a safe environment where members build trust and empathy so they can to talk personally and honestly; trust allows individuals to feel free to care about other people and confidentiality is central to the establishment of trust.

There are various ways in which group therapy can differ, e.g. time limited or ongoing, set focus or more general support, skills focused or condition focused.

Therapy can be ongoing or for a specific number of sessions. Ongoing groups continues indefinitely; members complete treatment and leave, new members join along the way as places arise whereas time limited groups run for a set number of sessions, the programme has a beginning, middle and end, and new members cannot join after first few sessions.

Group focus can be very diverse from very general goals related to improving overall life satisfaction and effective life functioning, especially in the area of interpersonal relationships. These groups tend to be heterogeneous; members with varying backgrounds and psychological issues; the leader will choose members who may complement each others’ needs and might work well to help each together. Other groups are "focused" or "topical" therapy groups: Members have similar problems. Some groups focus less on diagnoses and the individuals’ backgrounds and more on specific skills which the person wishes to enhance or behaviours they wish to change, e.g. improving coping skills, stress management, parenting, assertiveness, anger management, mindfulness, relaxation training, social skills training

Different forms of individual therapy such as cognitive behavioural therapy or Interpersonal therapy can also be provided to small groups. However, group therapy also refers to psychodynamic group therapy where the group context and group process is explicitly utilised as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Other, more specialised forms of group therapy would include non-verbal expressive therapies such as dance or music therapy.

In time limited therapy how many sessions are there usually? Between 8-20 sessions; duration is based on purpose and group needs.

How does group therapy compare with individual therapy?

• Members learn that they are not alone in experiencing psychological adjustment problems and can gain support from others

• Members can experiment with trying to relate to and interact with people differently in a safe environment, with a psychologist present to assist as needed.

• Member can learn from the experiences of others with similar problems and gain a sense of hope when they see members at further along in the healing process; members help each other to see alternatives and resolve problems

• Members gain a better understanding of how different people view the world and interact with others 

• Members are encouraged to give feedback to others, i.e. expressing feelings about what others says or do.

• Interaction highly encouraged; provides opportunities for the individual to try out new ways of behaving

Yalom developed a set of therapeutic factors which derived from extensive self-report research with users of group therapy.

Universality : The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member's sense of isolation, validate their experiences, and raise self-esteem

Altruism: The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self esteem and help develop more adaptive coping styles and interpersonal skills.

Instillation of hope: In a mixed group that has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems with which they are still struggling.

Imparting information: While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group. For example, about their treatment or about access to services.

Corrective recapitulation of the primary family experience: Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference specific to group psychotherapy. The therapist's interpretations can help group members gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships

Development of socializing techniques: The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal behaviour and improving their social skills

Imitative behaviour: One way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others

Cohesiveness: It has been suggested that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.

Existential factors: Learning that one has to take responsibility for one's own life and the consequences of one's decisions

Catharsis: Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt

Interpersonal learning: Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member's behaviour and impact on others

Self-understanding: This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into one's problems and the unconscious motivations that underlie one's behaviour

Settings: Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit. In addition to classical "talking" therapy, group therapy in an institutional setting can also include group-based expressive therapies such as drama therapy, psychodrama, art therapy, and non-verbal types of therapy such as music therapy.

Some more specific forms of group therapy

Therapeutic communities and milieu therapy The total environment or milieu is regarded as the medium of therapy, all interactions and activities regarded as potentially therapeutic and are subject to exploration and interpretation, and are explored in daily or weekly community meetings[14]

Projective therapy: Has reportedly been effective with psychotic adolescents and recovering addicts. Therpay uses a text such as a novel or film to provides a safe focus for discussion of a plotline, and the motivation of both the characters but also the author. The group members may then explore their own repressed and suppressed emotions or thoughts through talking about the book/film.

Research on effectiveness

Use the info below in conjunction with the info in Crane and Law et al.

• A meta-analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect sizes, (Callahan, 2004)

• Good evidence for effectiveness with chronic traumatic stress in war veterans, (Kanas, 2005)

• Less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes. Kanas et al suggest that poor outcomes might reflect a need for additional support for some patients, in addition to the group therapy. Eclectic approach may be important here. (Kanas, 2006)

• Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups. However, long-term intensive interactional group psychotherapy assumes diverse and diagnostically heterogeneous group membership, and an open-ended time scale for therapy. Good outcomes have also been demonstrated for this form of group therapy, (Lorentzen, et al 2002)

• Group Therapy has been shown to be as or more effective than individual therapy for higher functioning adults, (Gardenswartz, 2009). Clinical cases have shown that the combination of both individual and group therapy is most beneficial for such clients. (the "multiplicative" effect).

• Eisler et al (2000) showed that two different forms of family therapy work in the treatment of adolescent anorexia nervosa: "Conjoint family therapy", in which the parents and child are seen together by the same therapist and “Separated family therapy" (SFT) in which parents and child attend therapy separately with different therapists

• le Grange & Eisler (2009) showed that the Maudsley approach to family therapy achieved recovery rates of up to 90% at a four to five year follow-up

• The success of family therapy fits with aetiological theories such as Minuchin's family systems theory which emphasise the importance of family relationships and interaction styles in the development of anorexia nervosa

• Tucker & Oei (2006), in a review of 36 studies, found group CBT to be more cost-effective than individual CBT in the treatment of depression

Discuss:

1. Can you think of 6 examples of very specific focus groups, i.e. where members have homogenous psychological issues and backgrounds?

2. Can you think of 6 specific skills areas that group therapy might focus on?

For next couple of question, think about theories and concepts from the SCLOA, CLOA and BLOA...

3. What benefits might group therapy provide in comparison with individual therapy? Try and come up with 10! At least 1 should be from the perspective of the organisation that is providing therapy and one from the perspective of the therapist, the rest should be seen from the perspective of group members themselves.

4. Think of one reason why ongoing treatment groups might be more effective than time limited groups and one reason why they might be less effective?

5. In general, what might the disadvantages be of group therapy?

6. What factors can you think of that might mean some groups are more effective than others?

7. How might group therapy be effective for people with depression and anorexia nervosa?

8. Why might group therapy be ineffective for individuals with either of these diagnoses?

9. How might cultural differences affect the success/failure of group therapy? Think about each of the cultural dimensions studied in the SCLOA: individualist/collectivist cultures, power-distance dimension, uncertainty avoidance dimension, Confucian dynamism, masculinity-femininity dimension.

10. Design a study to measure the effectiveness of group therapy for depression and/or anorexia nervosa? Write down your aim, hypothesis, method, design, IV and DV, controls, ethics, participants and sampling technique, materials and procedure. What problems might arise in your study and would these affect your results?

With regard to cultural considerations in treatment, make notes on...

Treating specific disorders with group therapy

Look at the research studies in Crane (p.177 -178) and Law et al (p173-174 and 179) and complete the table, describing the studies that support each claim, focusing on findings and conclusions. As you read and make notes on each study, also complete two evaluation points for each study.

| |Depression |Eating disorders |

|Group therapy is effective | | |

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|Group therapy is more effective than | | |

|individual therapy | | |

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|Group therapy and individual therapy are | | |

|equally effective | | |

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|Individual therapy is more effective than | | |

|group therapy | | |

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|Evaluation points for studies mentioned | | |

|above: | | |

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Homework:

Examine the use of group therapy in treating psychological disorders (22)

You may wish to research further to find out more about some of the US and UK pioneers in group therapy mentioned in this handout.

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What do we already know?

Mutlaq and Chaleby (1995) (p.168 Crane)

What is meant by indigenous healing practices?

Give specific examples of indigenous healing practices in Malaysian and Chinese culture:

Why do you think it would be important for clinical psychological services to include indigenous healing practitioners?

Outline Miller’s (2000) approach which centres on the whole community as the unit of development.

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