group therapy

Definition

Group therapy is a form of psychosocial treatment where a small group of patients meet regularly to talk, interact, and discuss problems with each other and the group leader (therapist).

Description

A psychologist, psychiatrist, social worker, or other healthcare professional typically arranges and conducts group therapy sessions. In some therapy groups, two cotherapists share the responsibility of group leadership. Patients are selected on the basis of what they might gain from group therapy interaction and what they can contribute to the group as a whole.

Therapy groups may be homogeneous or heterogeneous. Homogeneous groups have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups have a mix of individuals with different emotional issues. The number of group members varies widely, but is typically no more than 12. Groups may be time limited (with a predetermined number of sessions) or indefinite (where the group determines when therapy ends). Membership may be closed or open to new members once sessions begin.

The number of sessions in group therapy depends on the makeup, goals, and setting of the group. For example, a therapy group that is part of a substance abuse program to rehabilitate inpatients would be called short-term group therapy. This term is used because, as patients, the group members will only be in the hospital for a relatively short period of time. Long-term therapy groups may meet for six months, a year, or longer. The therapeutic approach used in therapy depends on the focus of the group and the psychological training of the therapist. Some common techniques include psychodynamic, cognitive-behavioral, and Gestalt therapy.

In a group therapy session, group members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding their problems. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have some basic ground rules that are usually discussed during the first session. Patients are asked not to share what goes on in therapy sessions with anyone outside of the group. This protects the confidentiality of the other members. They may also be asked not to see other group members socially outside of therapy because of the harmful effect it might have on the dynamics of the group.

The therapist's main task is to guide the group in self-discovery. Depending on the goals of the group and the training and style of the therapist, he or she may lead the group interaction or allow the group to take their own direction. Typically, the group leader does some of both, providing direction when the group gets off track while letting them set their own agenda. The therapist may guide the group by simply reinforcing the positive behaviors they engage in. For example, if a group member shows empathy to another member, or offers a constructive suggestion, the therapist will point this out and explain the value of these actions to the group. In almost all group therapy situations, the therapist will attempt to emphasize the common traits among group members so that members can gain a sense of group identity. Group members realize that others share the same issues they do.

The main benefit group therapy may have over individual psychotherapy is that some patients behave and react more like themselves in a group setting than they would one-on-one with a therapist. The group therapy patient gains a certain sense of identity and social acceptance from their membership in the group. Suddenly, they are not alone. They are surrounded by others who have the same anxieties and emotional issues that they have. Seeing how others deal with these issues may give them new solutions to their problems. Feedback from group members also offers them a unique insight into their own behavior, and the group provides a safe forum in which to practice new behaviors. Lastly, by helping others in the group work through their problems, group therapy members can gain more self-esteem. Group therapy may also simulate family experiences of patients and will allow family dynamic issues to emerge.

Self-help groups like Alcoholics Anonymous and Weight Watchers fall outside of the psychotherapy realm. These self-help groups do offer many of the same benefits of social support, identity, and belonging that make group therapy effective for many. Self-help group members meet to discuss a common area of concern (like alcoholism, eating disorders, bereavement, parenting). Group sessions are not run by a therapist, but by a nonprofessional leader, group member, or the group as a whole. Self-help groups are sometimes used in addition to psychotherapy or regular group therapy.

— Paula Anne Ford-Martin

For more information on group therapy, visit Britannica.com.

The notion of group psychotherapies encompasses a considerable number of techniques and different theoretical points of view. Strictly speaking, group psychotherapy is a method for treating psychopathology and its concomitant suffering by means of the specific action of the group's processes on the individuals who comprise it. There is also a model of group psychotherapy that seeks to treat the group as a specific whole. To accomplish its therapeutic aims and bring about the corresponding changes in personality, group psychotherapy mobilizes in the participants the psychological exploration and work that ensues necessarily as a result of the development of intersubjective and transsubjective links. Various appropriate mechanisms are directed toward this end.

This method of psychotherapy is probably the oldest form of mental and psychosomatic care. Treatment regimens practiced in the Asclepion at Pergamon (Bergama) included group sessions of dream interpretation, as the ancient writings of Aelius Aristides reveal. However, the term "group psychotherapy" is recent: It was introduced by Jacob Moreno around 1930. Various attempts had been made prior to that, from Franz von Mesmer's tub to the explorations of J. H. Pratt (1905) or Trigant Burrow (1914). On the eve and at the beginning of the Second World War, Kurt Lewin and his collaborators developed the basics of group dynamics, based on Gestalt theory, observations of experimental groups, and group training programs. Siegmund Foulkes and Wilfred R. Bion established the groundwork for group analysis and psychoanalytic group psychotherapy. During the 1950s and 1960s this trend saw a remarkable upsurge in the United States, Latin America (Enrique Pichon-Rivière, José Bleger), and in Europe, notably in Great Britain, France, and Italy.

There is considerable variation among the theories, practical techniques, and goals of group psychotherapies, but a certain number of characteristics are common to all its forms. The group is composed of a relatively small number of participants (from three to about a dozen) who come together for a limited time. The restricted size of the group enables each of its participants to perceive and enter into relationship with each of the others; the time limitation, whether or not it is predetermined (long-term groups, short-term therapies, groups that gradually become more open), makes it possible to work with the resistance effects provoked by the group's institutionalization.

Several combinable classification criteria can be used to distinguish different types of groups: mono-therapy or cotherapy groups; groups centered on the group or on the individual; on speech or on nonverbal modes of expression (ergotherapies, art therapies, writing, music); on psychodramatic role-playing or on the body (bioenergy, primal scream, relaxation); on family relations (psychoanalytic and systemic family therapies); on instituted groups (therapy groups within institutions, therapeutic communities). Regardless of the form of communication used to put the therapeutic processes into play (words, screams, improvised or scripted role-playing, sculpting, painting, music, puppets), each theory has its own way of assessing the therapy's processes and effects.

According to the psychoanalytic conception, the group constitutes a staging ground for the externalization, figuration, and contention of pathogenic representations that are unacceptable in the intrapsychic space; it is a mechanism for linking and dynamic transformation of the formations and processes that cannot be internally bound without this detour through the work of intersubjectivity. Groups result in specific modes of transference and resistance. Interpreting these produces a reorganization of the psyche in its encounter with the object-based reality of others, with the prohibitions and founding statements of psychic life and of intersubjectivity. For its members, the group constitutes a powerful identificatory anaclisis; it generates creativity and the capacity for symbolization between intrapsychic and bodily reality and intersubjective and social reality. However, numerous clinical, methodological, and theoretical problems have yet to be worked out. Group psychotherapies are not a panacea. They require a personal demand and personal training; their effectiveness depends on the specific indications, limits, and principles involved.

Bibliography

Bion, Wilfred Ruprecht. (1965). Transformations: Change from learning to growth. London: Tavistock Publications.

Bleandonu, Gérard. (1991). Les groupes thérapeutiques familiaux et institutionnels. Paris: Presses Universitaires de France.

Foulkes, Siegmund Heinrich. (1964). Therapeutic group analysis. New York: International Universities Press.

Moreno, Jacob L. (1966). The international handbook of group psychotherapy. New York: Philosophical Library.

Schneider, Pierre-Bernard. (1965-1972). Pratique de la psychothérapie de groupe. Paris: Presses Universitaires de France.

Further Reading

Brown, Dennis, and Zinkin, Louis. (Eds.) (1994). The psyche and the social world: Developments in group-analytic theory. London/New York: Routledge.

—RENÉ KAËS

Any form of psychotherapy involving a group of patients, rather than a one-on-one session between a patient and a therapist. (See encounter group).

Patients during a group psychotherapy.

Redirected from Group-Trerapy(band)

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Cognitive behavioural therapy or Interpersonal therapy, but it is usually applied 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. The broader concept of group therapy can be taken to include any helping process that takes place in a group, including support groups, skills training groups (such as anger management, mindfulness, relaxation training or social skills training), and psycho-education groups. The differences between psychodynamic groups, activity groups, support groups, problem-solving and psycoeducational groups are discussed by Montgomery (2002).^[1]. Other, more specialised forms of group therapy would include non-verbal expressive therapies such as dance therapy, music therapy or the TaKeTiNa Rhythm Process.

Contents 1 History of group psychotherapy 2 Therapeutic principles 3 Settings 4 Research on effectiveness 5 See also 6 Notes 7 External links

History of group psychotherapy

The founders of group psychotherapy in the USA were Joseph H. Pratt, Trigant Burrow and Paul Schilder. All three of them were active and working at the East Coast in first half of the 20th century. After World War II group psychotherapy was further developed by Jacob L. Moreno, Samuel Slavson, Hyman Spotnitz, Irvin Yalom, and Lou Ormont. Yalom's approach to group therapy has been very influential not only in the USA but across the world, through his classic text "The Theory and Practice of Group Psychotherapy".^[2] Moreno developed a specific and highly structured form of group therapy known as Psychodrama.

In the United Kingdom group psychotherapy initially developed independently, with pioneers S. H. Foulkes and Wilfred Bion using group therapy as an approach to treating combat fatigue in the Second World War.^[3] 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. Furthermore the psychoanalytic concept of the unconscious was extended with a recognition of a group unconscious, in which the unconscious processes of group members could be acted out in the form of irrational processes in group sessions. Foulkes developed the model known as Group Analysis and the Institute of Group Analysis, while Bion was influential in the development of group therapy at the Tavistock Clinic. Bion has been criticised, for example by Yalom,^[4] 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. Despite this, his recognition of group defences in the "Basic Assumption Group", has been highly influential.^[5][6]

Bion's approach is comparable to Social Therapy, first developed in the United States in the late 1970s by Lois Holzman and Fred Newman, which is a group therapy in which 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.

Therapeutic principles

Yalom's therapeutic factors (originally termed curative factors but re-named therapeutic factors in the 5th edition of 'The Theory and Practice of Group Psychotherapy'^[7] are derived from extensive self-report research with users of group therapy^[8][9]

• 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^[10] 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 the genesis of 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 ^[11][12] or ambulatory psychiatric Partial hospitalization (also known as Day Hospital treatment).^[13] 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. Group psychotherapy is a key component of Milieu Therapy in a Therapeutic Community. 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]

A form of group therapy has been reported to be effective in psychotic adolescents and recovering addicts.^[15] Projective group therapy uses an outside text such as a novel or motion picture to provide a "stable delusion" for the former cohort and a safe focus for repressed and suppressed emotions or thoughts in the latter. Patient groups read a novel or collectively view a film. They then participate collectively in the discussion of plot, character motivation and author motivation. In the case of films, sound track,cinematography and background are also discussed and processed. Under the guidance of the therapist, defense mechanisms are bypassed by the use of signifiers and semiotic processes. The focus remains on the text rather than on personal issues.^[16]

Research on effectiveness

There is clear evidence for the effectiveness of group psychotherapy for depression: a meta-analysis of 48 studies showed an overall effect size of 1.03, which is clinically highly significant.^[17] Similarly, a meta-analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect sizes ^[18], and there is also good evidence for effectiveness with chronic traumatic stress in war veterans.^[19] There is less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes.^[20] The authors comment that these poor outcomes might reflect a need for additional support for some patients, in addition to the group therapy. This is borne out by the impressive results obtained using Mentalization based treatment, a model that combines dynamic group psychotherapy with individual psychotherapy and case management.^[21] Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups. However, long-term intensive interactional group psychotherapy ^[22] 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. ^[23]

See also

Self Help Groups Twelve-step program Expressive therapy Drama therapy Family therapy

Play therapy Psychotherapy Social Therapy Systemic Constellations

Notes

1. ^ Montgomery C (2002) Role of dynamic group therapy in psychiatry Advances in Psychiatric Treatment, 8(1): 34-41
2. ^ Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy, 5th edition, Basic Books
3. ^ T Harrison and D Clarke (1992)The Northfield experiments.British Journal of Psychiatry 160: 698-708 (http://bjp.rcpsych.org/cgi/content/abstract/160/5/698)
4. ^ ^ Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy, 5th edition, Basic Books, p.193
5. ^ Bion (1962) Experiences in groups and other papers http://www.pep-web.org/document.php?id=PAQ.033.0441A
6. ^ Billow R (2005). Bion Today. International Journal of Group Psychotherapy 55 (4) 613-23
7. ^ Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy, 5th edition, Basic Books, Preface p. xii
8. ^ Butler T and Fuhriman A(1983) Curative Factors in Group Therapy: A Review of the Recent Literature. Small Group Research, 14: 131-142
9. ^ See also the American Group Psychotherapy Association http://www.agpa.org/guidelines/factorsandmechanisms.html
10. ^ Joyce A, Piper W, Ogrodniczuk J (2007). Therapeutic Alliance and Cohesion Variables as Predictors of Outcome in Short-Term Group Psychotherapy. International Journal of Group Psychotherapy 57 (3),269-97
11. ^ Yalom (1983) Inpatient Group Psychotherapy
12. ^ see for example http://psychiatry.stanford.edu/medservices/in.html
13. ^ Ogrodniczuk J & Steinberg P (2005) A Renewed Interest in Day Treatment. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 50(1)
14. ^ See for example Campling & Haigh (1988) Therapeutic Communities: Past present and future. Jessica Kingsley,Publishers, London; De Leon (2000) The Therapeutic Community, Springer
15. ^ AJ Giannini. Use of fiction in therapy. Psychiatric Times.18(12)33-34,2001.
16. ^ AJ Giannini. Tangential symbols. Journal of Clinical Pharmacology.33:1134-1139,1993. PMID 7510314
17. ^ McDermut W et al. (2001) The Efficacy of Group Psychotherapy for Depression: A Meta-analysis and Review of the Empirical Research. Clinical Psychology: Science and Practice, 8, 98-116
18. ^ Callahan, K (2004) A review of interpersonal-psychodynamic group psychotherapy outcomes for adult survivors of childhood sexual abuse. International Journal of Group Psychotherapy, 54 (4): 491-519
19. ^ Kanas, N (2005) Group Therapy for Patients with Chronic Trauma-Related Stress Disorders. International Journal of Group Psychotherapy, 55 (1), 161-6
20. ^ Kanas, N (2006) Long-Term Psychodynamic Group Therapy for Patients with Personality Disorders. International Journal of Group Psychotherapy 56 (2), 245-51
21. ^ Bateman A (2008) 8-Year Follow-Up of Patients Treated for Borderline Personality Disorder. American Journal of Psychiatry, 165 (5)
22. ^ Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy, 5th edition, Basic Books p. 272
23. ^ Lorentzen S, Bogwald K, Hoglend P. (2002) Change during and after long-term analytic group psychotherapy. International Journal of Group Psychotherapy. 52 (3), 419-30

External links

• FindGroupTherapy.Com - Directory site for United States therapy groups
• Directory site for UK groups
• American Group Psychotherapy Association
• Contents of International Journal of Group Psychotherapy 1969-Present
• Bibliography of ther group therapy literature

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