Group Psychotherapy

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GROUP PSYCHOTHERAPYINTRODUCTIONFoulkes (1975) referred to group therapy as hall of mirrors in which people can see themselves reflected in others. Group therapy is a powerful therapeutic tool to help the patients, correct maladaptive personal behaviors and to enhance a patients ability to function as a contributing member of the community. The experience of being in a group does not deny the uniqueness of each person. Rather, it allows people to directly experience their talents and possibilities through the eyes and personal experience of others. By using a variety of technical maneuvers and theoretical constructs, the leader directs group members interactions to bring about changes. The principles of group psychotherapy have also been applied with success in the fields of business and education in the form of training.

DEFINITIONGroup therapy is a method of therapeutic intervention based on the exploration and analysis of both internal (emotional) and external (environmental) conflicts and the group process. [LEGO, 1996] Group therapy is an identifiable system consisting of at least 3 people who share a common goal. [NUDELMAN, 1986]

Group therapy is a hall of mirrors in which people can see themselves reflected in others. [FOULKES, 1975] 1

HISTORYGroup psychotherapy, as a recognized form of psychological treatment, traces its origin to the early 1900s. in 1907, Joseph Pratt, an internist in Boston, developed a psycho educational method for teaching patients with TB about their disease and improving their morale. He used a combination of lecture and informal group discussion. The success of his group treatment approach inspired Pratt and others to use a group format to treat other chronic diseases such as diabetes. Later, Pratt expanded its use to the treatment of neurotic disorders. The idea of sharing a common bond in a common disease, which Pratt advocated at the turn of the century, serves as the basis for many contemporary support and mutual help groups. The notion of combining psycho education with informal group discussion is used increasingly with patients and families because of the benefit of combining didactic information with individuals experiences. Samuel R Slavson, considered the father of group psychotherapy in America, worked with, inner- city children and adolescence. He found that a group format using a combination of games, tools and food to engage children in actively communicating with each other, encouraged co- operative behaviors among children who otherwise might not talk to each other. This work laid the ground work for group activity therapy, in which arts and crafts help children experience and direct their energies in productive way.

CHARACTERISTICS OF AN EFFECTIVE GROUP Goals are clearly identified and collaborately developed. Open, goal directed communication of feelings and ideas is encouraged. Power is equally shared and rotates among members, depending on ability and group needs. Decision making is flexible and adapted to the group needs. Controversy is viewed as healthy because it builds member involvement and creates stronger solutions. 2

A healthy balance exist between task and maintenance role functioning. Individual contributions are acknowledged and respected. Diversity is encouraged. Interpersonal effectiveness, innovation and problem solving adequacy are evident.

PURPOSES OF GROUP THERAPY Psycho educational purpose of some groups is to help patients and families

better understand the disease process, treatment and modifiable risk factors To help patients to understand and modify maladaptive patterns of relating to others. Strengthen healthy patterns of behavior and to help patients learn new, better ways of relating. Self help and mutual aid groups frequently do not have a professional

leader. Their purpose is to provide patients and families having similar health concerns a place to share their experiences, derive comfort , share information and exchange practical advice.

ELEMENTS / CURATIVE FACTORSCertain essential elements are common to all types of group therapy. Yalom (2005) has identified eleven essential elements of group therapy. This include 1. Instillation Of Hope: It is the first and often most important factor. People participating in the group experience initially feel demoralized and helpless. So providing them with hope is therefore a most worthwhile achievement. Client should be encouraged to believe that they can find help and support in the group and that it is realistic to expect that problem will eventually be resolved. 2. Universality: It can be defined as the sense of realizing that one is not completely alone in any situation. Group members can identify this factor as a 3

major reason for seeking group therapy. During the sessions, members are encouraged to express complex, often very negative feelings in the hope that they will experience understanding and support from others with similar thoughts and feelings. 3. Imparting Of Information: This includes both didactic instructions and direct advice, and refers to the imparting of specific educational information plus the sharing of advice and guidance among members. The transmission of this information also indicates to each member the others concern and trust. 4. Altruism: It is the personalized help that one group member extends to another. Clients have the experience of learning to help others, and in the process they begin to feel better about themselves. Both the group therapist and the members can offer invaluable support, insight and reassurance while allowing themselves to gain self knowledge and growth. 5. Corrective Recapitulation Of The Primary Family Group: This allows members in the group to correct some of the perceptions and feelings associated with unsatisfactory experiences they have had with their family. The participants receive feedback as they discuss and relieve early familial conflicts and experience corrective responses. Family roles are explored, and members are encouraged to resolve unresolved family business. 6. Development of Socializing Techniques: It is essential in the group as members are given the opportunity to learn and test new social skills. Members also receive information about maladaptive social behaviors. 7. Imitative Behaviour: It refers to the process in which members observe and model their behaviors after one another. Imitation is an acknowledged therapeutic force; a healthy group environment provides valuable opportunities for experimenting with desired changes and behaviors. 8. Inter Personal learning: This includes the gaining of insight, the development of an understanding of a transference relationship, the experience of correcting emotional thoughts and behaviors and the importance of learning about oneself in relation to oneself.

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9. Group Cohesiveness: It is the development of strong sense of group membership and alliance. The concept of cohesiveness refers to the degree to which a group functions as a supportive problem solving unit. Ideally, each member feels acceptance and approval from all others in the group. This factor is essential in ensuring optimal individual and group growth. 10. Catharsis: It is similar to group cohesiveness and involves members relating to one another through the verbal expression of positive and negative feelings. 11. Existential Factors: These factors are consistently operating in the group and help to make up the final component. These intangible issues encourage each group member to accept the motivating that he or she is ultimately responsible for his or her life choices and actions.

TYPES OF GROUP THERAPY:SUPPORTIVE PARAMETERS GROUP THERAPY FERGUENCY ANALYTICALLY ORIENTED GROUP THERAPY PSYCHOANLYSIS OF GROUPS TRASACTIONAL GROUP THERAPY BEHAVIOURAL GROUP THERAPY

1-3 times a Once a week Upto 6DURATION

1-5 times a week 1-3+years Anxiety & personality disorders Always Primarily past life experiences& intra group relations

1-3 times a week 1-3 years Psychotic & anxiety disorders Usually

1-3 times a week Up to 6 months Phobias, passivity, sexual problems Usually Specific symptoms without focus on causality

week 1-3+years Anxiety & personality disorders Always Present & past

months Psychotic & anxiety disorders

PRIMARY INDICATIOS

INDIVIDUAL SCREENING INTERVIEW

Usually

COMMUNICATION CONTENT

Primarilyenvironmental

life situations, Intra group & extra group relations

Primarily intra group relations

factorsTRANSFERANCE

Positive transference Positive & negative Transference

Positive relationships

Positive relationships

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encouraged to promote improved functioning

transference evoked and analyzed

neurosis evoked and analyzed Always

fostered, negative feelings analyzed

fostered, no examination of transference Not used

DREAMS

Not analyzed Intra group dependence encouraged,

Analyzed frequently Intra group dependence encouraged, dependence on leader variable

analyzed & encouraged Intra group dependence not encouraged, dependence on leader variable

Analyzed rarely Intra group dependence encouraged, dependence on leader not encouraged

Intra group dependence not encouraged, reliance on leader is high Create new defenses, active and directive

DEPENDACE

members relay on leader to great extend Strengthen

Challenge defenses, active, give advice or personal response

Challenge defenses, passive, give no advice or personal response Transference, ventilation, catharses, reality testing Discouraged Extensive reconstruction of personality dynamics

Challenge defenses, active, give personal response, rather than advice Ab