Mr. Jayesh Patidar (M.Sc. Nursing)www.drjayeshpatidar.blogspot.com
CONCEPT: Group psychotherapy is a treatment in which carefullyselected people who are emotionally ill meet in a groupguided by a trained therapist, & help one another effectpersonality change. In other word, Group psychotherapy is a treatment ofpsychological problems in which two or more patientsinteract with each other on both an emotional &cognitive levels in the presence of one or morepsychotherapists who serve as catalysts (the person whocan be related to or who can understand the other’spoint of view), facilitators or interpreters.4/24/20132www.drjayeshpatidar.blogspot.com
Count…Three major kinds of groups are: Group Therapy Therapeutic Groups Adjunctive Groups Group Therapy:Group Psychotherapy members gain apersonal insight, improve their interpersonalrelationship, change destructive behavior & make anecessary alteration in their behavior.4/24/20133www.drjayeshpatidar.blogspot.com
Count… Therapeutic Group:It is a group of patients who meet under theleadership of a therapist to work together to improvemental & emotional health.Example; Groups of expectant mothers, people who havejust lost their husband or wife. Group of people with achronic illness.- Therapeutic groups are self-help like Ashiana, Saheli inDelhi, who conduct these groups for drug addicts.4/24/20134www.drjayeshpatidar.blogspot.com
Count… Adjunctive Groups:Adjunctive groups deal with selectedneeds of a group.For Example; for sensory stimulation allow them tohave music therapy, for self-expression arttherapy, for expression of feelings & emotionsthrough dance therapy. These are a few exampleswhich can be used for adjunctive groups4/24/20135www.drjayeshpatidar.blogspot.com
CONTRAINDICATION Antisocial patients Actively suicidal or severely depressedpatients Patients who are delusional & who mayincorporate the group into their delusionalsystem.4/24/20136www.drjayeshpatidar.blogspot.com
GROUP SIZE… Optimal size for group therapy is 8 to 10members.FREQUENCY AND LENGTH OF SESSIONS: Most group psychotherapist conduct groupsessions once a week; each session may last for45 minutes to 1 hour.4/24/20137www.drjayeshpatidar.blogspot.com
Types Of Psychotherapy Groups4/24/2013www.drjayeshpatidar.blogspot.com81. Traditional Groups2. Encounter Group or T. Group3. Homogeneous or heterogeneous groups4. Open or close groups5. Groups for psychosis or neurosis
1. Traditional Groups:4/24/2013www.drjayeshpatidar.blogspot.com9Traditional groups includes mainly the patients with mentalillness & are from the hospital inpatient department. Inthe didactic group therapy, lecture is given to thepatient along with some filmshow, like in the case ofexcessive drinking or use of drugs- Psychodrama is a technique of psychotherapy in which apatient acts out his feelings in front of a group ofpatients. The therapist guides & directs the patient &interprets the actions of the patient. This type of actingout provides an insight into the patient about his faultypatterns of learning which he can eliminate
2. Encounter Group or T. Group:4/24/2013www.drjayeshpatidar.blogspot.com10Encounter group is a form of small group in whichan individual learns how his feelings & behavioraffect him & others. This group is not necessarily agroup of people with mental illness. The individualmay have some coping difficulty which he wouldlike to resolve at the right timeFor Example; a suspicious feeling gradually beingdeveloped about his wife or any other illusions.Theses groups are based on sensitivity training orT-groups.
3. Homogeneous or heterogeneousgroups:4/24/2013www.drjayeshpatidar.blogspot.com11Homogeneous groups are composed of patientsof the same age, race, sex, socioeconomic level& similar category of illness.Heterogeneous groups vary on all theseaspects.
4. Open Groups & Closed Groups:4/24/2013www.drjayeshpatidar.blogspot.com12In open groups members may join & leave thegroup at anytime. Closed groups have aspecific number of people, specific time to start& close the group sessions; the duration is threeto four weeks. Inpatients & outpatients bothare included in this group.Open & closed groups are usedextensively in the hospital.
5. Group According to Mental Illness:4/24/2013www.drjayeshpatidar.blogspot.com13Neurotic group or patientsuffering from psychotic illnesses come underthis category.
APPROACHES TO GROUP THERAPY The therapist’s role is primarily that of a facilitator; heshould provide a safe, comfortable atmosphere for self-disclosure. Focus on the “here and now”. Use any transferences situations to develop insight intotheir problems. Protect members from verbal abuse or fromscapegoating. Whenever appropriate, provide positive reinforcement,this gives ego support & encourages future growth.4/24/201314www.drjayeshpatidar.blogspot.com
Count… Handle circumstantial patients, hallucinating &delusional patients in a manner that protects the self-esteem of the individual & also sets limits on thebehavior so as to protect other group members. Develop ability to recognize when a group member is“fragile”, he should be approached in a gentle,supportive & non-threatening manner. Use silence effectively to encourage introspection &facilitate insight.4/24/201315www.drjayeshpatidar.blogspot.com
Count… Laughter & a moderate amount of joking can act asa safety valve & at times can contribute to groupcohesiveness. Role-playing may help a member develop insightinto the ways in which he related to others.4/24/201316www.drjayeshpatidar.blogspot.com
THERAPEUTIC FACTORS INVOLVED INGROUP THERAPY:1. Sharing experience2. Support to & from group members3. Socialization4. Imitation5. International learning4/24/201317www.drjayeshpatidar.blogspot.com
1. Sharing Experience This helps the patients to realize that they arenot isolated & that others also have similarexperience & problems Hearing from other patients that they haveshared experiences is often more convincing &helpful than reassurance from the therapist.4/24/201318www.drjayeshpatidar.blogspot.com
2. Support to and from group members: Receiving help from other group members canbe supportive to the person helped. The sharing action of being mutuallysupportive is an aspect of the groupcohesiveness that can provide a sense ofbelonging for patients who feel isolated intheir everyday lives.4/24/201319www.drjayeshpatidar.blogspot.com
3. socialization: It is acquisition of social skills (for example,maintaining eye contact) within a groupthrough comments that members provide aboutone another’s deficiencies in social skills. This process can be helped by trying out newways of interacting within the safety of thegroup.4/24/201320www.drjayeshpatidar.blogspot.com
4. Imitation:4/24/2013www.drjayeshpatidar.blogspot.com21 It is learning from observing & adopting the behaviorsof other group members. If the group is run well, patients imitate the adaptivebehaviors of other group members.5. Interpersonal learning: It refers to learning about difficulties in relationships byexamining the interaction of individuals with the othermembers of the group.
STEPS OF GROUP THERAPY4/24/2013www.drjayeshpatidar.blogspot.com221. Selecting group Members2. Developing contact3. Selection of group leaders
1. Selecting group Members:4/24/2013www.drjayeshpatidar.blogspot.com23 It is very important function of a group therapist. She has to decide based on the condition of thepatient who all can be included in the group. A very depressed patient may lead towithdrawal of other members of the group,whereas too many excited patients included inthe group may lead to unsuccessful grouptherapy.
2. Developing Contact:4/24/2013www.drjayeshpatidar.blogspot.com24 The purpose should be made clear to all the members inthe group. Time, length & place of the meeting should beannounced. Starting & ending time & how frequently the groupsessions will be conducted. Attendance of members. Confidentiality to be maintained within the group. Role of the members is; to report punctually, maintainconfidentiality & interact freely.
3. Selection of Group Leaders:4/24/2013www.drjayeshpatidar.blogspot.com25 Role of the therapist – the therapist acts as a facilitator & helper.I. To provide information to the group.II. Allow emotional catharsis.III. Share members’ perception.IV. Share feelings of fear, loneliness & frustration.V. Improve communication skillsVI. Provide a role model.VII. Help to know what is reality.VIII. Set limits for some patients.IX. Make observation of all the non-verbal techniques being used bythe patient.
SOME TECHNIQUES USED IN GROUPTHERAPY:4/24/2013www.drjayeshpatidar.blogspot.com26 Reflecting or rewarding comments of groupmembers Asking for group reaction to one member’sstatement Asking for individual reaction to one member’sstatement Pointing out any shared feelings within the group Summarizing various points at the end of session.