Group therapy involves a small, carefully selected group of individuals meeting regularly with a therapist to assist with emotional growth and problem solving. There are various approaches to group therapy, including psychodynamic, phenomenological, gestalt, transactional analysis, and behavioral. Key components of group therapy include developing group cohesion, members helping and learning from one another, and curative factors such as universality, altruism, and interpersonal learning. The history and procedures of group therapy are outlined.

1. GROUP THERAPY:GROUP THERAPY:
METHODS ANDMETHODS AND
PROCEDURESPROCEDURES
Lecture 35Lecture 35

2.  DEFINITION:DEFINITION:
Group therapy is a form ofGroup therapy is a form of psychotherapypsychotherapy inin
which a small, carefully selected group ofwhich a small, carefully selected group of
individuals meets regularly with a therapist.individuals meets regularly with a therapist.
 PURPOSE:PURPOSE:
The purpose of group therapy is to assist eachThe purpose of group therapy is to assist each
individual in emotional growth and personalindividual in emotional growth and personal
problem solvingproblem solving

3. People may choose group therapy forPeople may choose group therapy for
several reasons.several reasons.
 First, group therapy is usually less expensiveFirst, group therapy is usually less expensive
than individual therapy, because groupthan individual therapy, because group
members share the cost.members share the cost.
 Aside from cost and efficiency advantages,Aside from cost and efficiency advantages,
group therapy allows people to hear and seegroup therapy allows people to hear and see
how others deal with their problems.how others deal with their problems.
 In addition, group members receive vitalIn addition, group members receive vital
support and encouragement from others in thesupport and encouragement from others in the
group. They can try out new ways of behavinggroup. They can try out new ways of behaving
in a safe, supportive environment and learnin a safe, supportive environment and learn
how others perceive them.how others perceive them.

4. The noted psychiatrist Dr. Irvin D. Yalom in hisThe noted psychiatrist Dr. Irvin D. Yalom in his
bookbook The Theory and Practice of Group TherapyThe Theory and Practice of Group Therapy
identified 11 "curative factors" that are theidentified 11 "curative factors" that are the
"primary agents of change" in group therapy."primary agents of change" in group therapy.
 INSTILLATION OF HOPE:-INSTILLATION OF HOPE:-All patients come intoAll patients come into
therapy hoping to decrease their suffering andtherapy hoping to decrease their suffering and
improve their lives.improve their lives.
 UNIVERSALITY: -UNIVERSALITY: - A common feeling among groupA common feeling among group
therapy members, especially when a group is justtherapy members, especially when a group is just
starting, is that of being isolated, unique, and apartstarting, is that of being isolated, unique, and apart
from others. Many who enter group therapy have greatfrom others. Many who enter group therapy have great
difficulty sustaining interpersonal relationships, anddifficulty sustaining interpersonal relationships, and
feel unlikable and unlovablefeel unlikable and unlovable

5.  INFORMATION GIVING:-INFORMATION GIVING:-An essential component ofAn essential component of
many therapy groups is increasing members'many therapy groups is increasing members'
knowledge and understanding of a common problem.knowledge and understanding of a common problem.
 ALTRUISMALTRUISM:-:-Group therapy offers its members aGroup therapy offers its members a
unique opportunity: the chance to help others.unique opportunity: the chance to help others.
 CORRECTIVE RECAPUTALATION OF THECORRECTIVE RECAPUTALATION OF THE
PRIMARY FAMILY:-PRIMARY FAMILY:-Many people who enter groupMany people who enter group
therapy had troubled family lives during their formativetherapy had troubled family lives during their formative
years. The group becomes a substitute family thatyears. The group becomes a substitute family that
resembles—and improves upon—the family of originresembles—and improves upon—the family of origin
in significant ways.in significant ways.

6.  IMPROVED SOCIAL SKILLS:-IMPROVED SOCIAL SKILLS:-According toAccording to
Yalom, social learning, or the development ofYalom, social learning, or the development of
basic social skills, is a therapeutic factor thatbasic social skills, is a therapeutic factor that
occurs in all therapy groups.occurs in all therapy groups.
 IMITATIVE BEHAVIORIMITATIVE BEHAVIOR:-:-Research shows thatResearch shows that
therapists exert a powerful influence on thetherapists exert a powerful influence on the
communication patterns of group members bycommunication patterns of group members by
modeling certain behaviors.modeling certain behaviors.
 INTERPERSONAL LEARNINGINTERPERSONAL LEARNING:-:-TherapyTherapy
groups provide an opportunity for members togroups provide an opportunity for members to
improve their ability to relate to others and liveimprove their ability to relate to others and live
far more satisfying lives because of it.far more satisfying lives because of it.

7.  GROUP COHESIVENESSGROUP COHESIVENESS:-:-Belonging, acceptance, andBelonging, acceptance, and
approval are among the most important and universal ofapproval are among the most important and universal of
human needs.human needs.
 CATHARSISCATHARSIS:-:-Catharsis is a powerful emotionalCatharsis is a powerful emotional
experience—the release of conscious or unconsciousexperience—the release of conscious or unconscious
feelings—followed by a feeling of great relief. Catharsisfeelings—followed by a feeling of great relief. Catharsis
is a factor in most therapies, including group therapy.is a factor in most therapies, including group therapy.
 EXISTENTIAL FACTORS:-EXISTENTIAL FACTORS:-Existential factors are certainExistential factors are certain
realities of life including death, isolation, freedom, andrealities of life including death, isolation, freedom, and
meaninglessness. Becoming aware of these realitiesmeaninglessness. Becoming aware of these realities
can lead to anxiety. The trust and openness thatcan lead to anxiety. The trust and openness that
develops among members of a therapy group, however,develops among members of a therapy group, however,
permits exploration of these fundamental issues, andpermits exploration of these fundamental issues, and
can help members develop an acceptance of difficultcan help members develop an acceptance of difficult
realities.realities.

8. HISTORY OF GROUP THERAPYHISTORY OF GROUP THERAPY
 For many years, group therapy was practicedFor many years, group therapy was practiced
as a method of choice by only a handful ofas a method of choice by only a handful of
dedicated therapists.dedicated therapists.
 Others used it primarily because their caseloadOthers used it primarily because their caseload
was so heavy that group therapy was the onlywas so heavy that group therapy was the only
means by which they could deal with themeans by which they could deal with the
overload.overload.
 Still other therapists used group therapy as aStill other therapists used group therapy as a
supplementary techniquesupplementary technique

9.  One of the earliest formal uses of groupOne of the earliest formal uses of group
methods was Joseph H. Pratt's work withmethods was Joseph H. Pratt's work with
tubercular patients in 1905.tubercular patients in 1905.
 A major figure in the group movement was J. L.A major figure in the group movement was J. L.
Moreno, who began to develop some groupMoreno, who began to develop some group
methods in Vienna inmethods in Vienna in thethe early 1900s and, inearly 1900s and, in
1925, introduced his psychodrama to the1925, introduced his psychodrama to the
United StatesUnited States
 Moreno also used the termMoreno also used the term group therapygroup therapy..
 Trigant Burrow was a psychoanalyst who usedTrigant Burrow was a psychoanalyst who used
the related termthe related term groupgroup analysis to describe hisanalysis to describe his
procedures (Rosenbaum, 1965).procedures (Rosenbaum, 1965).

10.  In the 1930s, Slavson encouraged adolescentIn the 1930s, Slavson encouraged adolescent
patients to work through their problems withpatients to work through their problems with
controlled play.controlled play.
 As was true for clinical psychology generally, itAs was true for clinical psychology generally, it
was the aftermath of World War II that reallywas the aftermath of World War II that really
brought group methods to center stage.brought group methods to center stage.
 The large number of war veterans sharplyThe large number of war veterans sharply
increased the demand for coun­seling andincreased the demand for coun­seling and
therapytherapy

11. APPROACHES TO GROUP THERAPYAPPROACHES TO GROUP THERAPY
 PSYCHODYNAMIC THERAPIES:-PSYCHODYNAMIC THERAPIES:-
o Psychodynamic theory was conceived byPsychodynamic theory was conceived by
Sigmund Freud, the father ofSigmund Freud, the father of psychoanalysis.psychoanalysis.
o Freud believed that unconscious psychologicalFreud believed that unconscious psychological
forces determine thoughts, feelings, andforces determine thoughts, feelings, and
behaviors.behaviors.
o By analyzing the interactions among groupBy analyzing the interactions among group
members, psychodynamic therapies focus onmembers, psychodynamic therapies focus on
helping individuals become aware of theirhelping individuals become aware of their
unconscious needs and motivations as well asunconscious needs and motivations as well as
the concerns common to all group members.the concerns common to all group members.

12.  PHENOMENOLOGICAL THERAPIES:-PHENOMENOLOGICAL THERAPIES:-
o PsychodramaPsychodrama——developed by Jacob Moreno,developed by Jacob Moreno,
an Austrian psychiatrist, this techniquean Austrian psychiatrist, this technique
encourages members to play the parts ofencourages members to play the parts of
significant individuals in their lives to help themsignificant individuals in their lives to help them
solve interpersonal conflicts.solve interpersonal conflicts.
o Psychodrama brings the conflict into thePsychodrama brings the conflict into the
present, emphasizing dramatic action as a waypresent, emphasizing dramatic action as a way
of helping group members solve their problems.of helping group members solve their problems.
o Catharsis, the therapeutic release of emotionsCatharsis, the therapeutic release of emotions
followed by relief, plays a prominent rolefollowed by relief, plays a prominent role

13. o Person-centered therapyPerson-centered therapy——a therapeutica therapeutic
approach developed by theapproach developed by the psychologistpsychologist CarlCarl
Rogers.Rogers.
o Rather than viewing the therapist as expert,Rather than viewing the therapist as expert,
Rogers believed that the client's own driveRogers believed that the client's own drive
toward growth and development is the mosttoward growth and development is the most
important healing factor.important healing factor.
o The therapist empathizes with the client'sThe therapist empathizes with the client's
feelings and perceptions, helping him or herfeelings and perceptions, helping him or her
gain insight and plan constructive action.gain insight and plan constructive action.
o Rogers'sRogers's person-centered therapyperson-centered therapy becamebecame
the basis for the intensive group experiencethe basis for the intensive group experience
known as the encounter group,known as the encounter group,

14. Gestalt therapyGestalt therapy——
 In the 1940s Fritz Perls challengedIn the 1940s Fritz Perls challenged
psychoanalytic theory and practice with thispsychoanalytic theory and practice with this
approach.approach.
 Members take turns being in the "hot seat,"Members take turns being in the "hot seat,"
an empty chair used to represent peoplean empty chair used to represent people
with whom the person is experiencingwith whom the person is experiencing
conflicts.conflicts.
 The therapist encourages the client toThe therapist encourages the client to
become aware of feelings and impulsesbecome aware of feelings and impulses
previously denied.previously denied.

15. TRANSACTIONAL ANALYSIS:TRANSACTIONAL ANALYSIS:
 Eric Berne (1961) was the developer of and theEric Berne (1961) was the developer of and the
dynamic force behinddynamic force behind transactional analysistransactional analysis
(TA).(TA).
 TA is essentially a process in which theTA is essentially a process in which the
interactions among the various aspects of theinteractions among the various aspects of the
people in the group are analyzed.people in the group are analyzed.
 Analyses often focus on three chief: “egoAnalyses often focus on three chief: “ego
states” within each person:.states” within each person:.
 Child egoChild ego state, thestate, the Parent egoParent ego state, and the:state, and the:
Adult egoAdult ego state.state.

16.  Depending on how a person was raised, he or she willDepending on how a person was raised, he or she will
manifest various aspects of positive and negativemanifest various aspects of positive and negative
characteristics.characteristics.
 The therapist might then point out how each person isThe therapist might then point out how each person is
playing negative roles (Child, Adult, or Parent).playing negative roles (Child, Adult, or Parent).
 Repeated analyses of the interactions among groupRepeated analyses of the interactions among group
members reveal the ego states that they typicallymembers reveal the ego states that they typically
employ. These analyses lead the patients towardemploy. These analyses lead the patients toward
more rational, appropriate ways of thinking that aremore rational, appropriate ways of thinking that are
closer to the Adult ego state (positive).closer to the Adult ego state (positive).
 A transactional analysis involves the determination ofA transactional analysis involves the determination of
which ego states are operative in a given transactionwhich ego states are operative in a given transaction
between peoplebetween people

17.  Another aspect of TA is the emphasis on gamesAnother aspect of TA is the emphasis on games
(Berne, 1964).(Berne, 1964).
 TA tends to be a swift-moving, action-ori-entedTA tends to be a swift-moving, action-ori-ented
approach.approach.
 There is an emphasis on the present, a sense ofThere is an emphasis on the present, a sense of
grappling with immediate problems that makes itgrappling with immediate problems that makes it
attractive to many patients and therapists.attractive to many patients and therapists.
 TA has an aura of responsi-bility, of learning how toTA has an aura of responsi-bility, of learning how to
choose between op-tions and this can be a desirablechoose between op-tions and this can be a desirable
alternative to more traditional forms of group therapyalternative to more traditional forms of group therapy

18.  BEHAVIOR THERAPIES:-BEHAVIOR THERAPIES:-
 The emergence of behavior therapies in the 1950sThe emergence of behavior therapies in the 1950s
represented a radical departure from psychoanalysis.represented a radical departure from psychoanalysis.
 Behavior therapies focus on how a problem behaviorBehavior therapies focus on how a problem behavior
originated, and on the environmental factors thatoriginated, and on the environmental factors that
maintain it. Individuals are encouraged to becomemaintain it. Individuals are encouraged to become
self-analytical, looking at events occurring before,self-analytical, looking at events occurring before,
during, and after the problem behavior takes place.during, and after the problem behavior takes place.
 An important offshoot of behavior therapy isAn important offshoot of behavior therapy is
cognitive-behavioral therapycognitive-behavioral therapy, developed in the, developed in the
1960s and 1970s, It emphasizes the examination of1960s and 1970s, It emphasizes the examination of
thoughts with the goal of changing them to morethoughts with the goal of changing them to more
rational and less inflammatory ones.rational and less inflammatory ones.

19.  TIME LIMITED GROUP THERAPY:-TIME LIMITED GROUP THERAPY:-
 These groups typically meet on a weekly basisThese groups typically meet on a weekly basis
for a predetermined number of sessions.for a predetermined number of sessions.
 As described by Budman and Gurman (1988),As described by Budman and Gurman (1988),
time-limited groups are characterized by fourtime-limited groups are characterized by four
central features:central features:
 Pregroup preparation and screeningPregroup preparation and screening..
 Establishing and maintaining a workingEstablishing and maintaining a working
focusfocus in the groupin the group
 Group cohesionGroup cohesion..
 Reactions to time limitsReactions to time limits..

20. METHODS AND PROCEDURES OF GROUPMETHODS AND PROCEDURES OF GROUP
THERAPYTHERAPY
 WHO BELONGS IN A THERAPY GROUP?WHO BELONGS IN A THERAPY GROUP?
Individuals that share a common problem or concernIndividuals that share a common problem or concern
are often placed in therapy groups where they canare often placed in therapy groups where they can
share their mutual struggles and feelings.share their mutual struggles and feelings.
 HOW ARE THERAPY GROUPS CONSTRUCTED?HOW ARE THERAPY GROUPS CONSTRUCTED?
Therapy groups may be homogeneous orTherapy groups may be homogeneous or
heterogeneous. Homogeneous groups, describedheterogeneous. Homogeneous groups, described
above, have members with similar diagnosticabove, have members with similar diagnostic
backgrounds, Heterogeneous groups contain a mix ofbackgrounds, Heterogeneous groups contain a mix of
individuals with different emotional problems. Theindividuals with different emotional problems. The
number of group members typically ranges from five tonumber of group members typically ranges from five to
12.12.

21.  HOW DO THERAPY GROUP WORKS?HOW DO THERAPY GROUP WORKS?
 The number of sessions in group therapyThe number of sessions in group therapy
depends upon the group's makeup, goals, anddepends upon the group's makeup, goals, and
settingsetting
 In group therapy sessions, members areIn group therapy sessions, members are
encouraged to discuss the issues that broughtencouraged to discuss the issues that brought
them into therapy openly and honestly.them into therapy openly and honestly.
 The therapist facilitates the group process, thatThe therapist facilitates the group process, that
is, the effective functioning of the group, andis, the effective functioning of the group, and
guides individuals in self-discovery.guides individuals in self-discovery.
 Self-help groupsSelf-help groups also meet to share theiralso meet to share their
common concern and help one another copecommon concern and help one another cope

22.  HOW ARE PATEINTS REFERRED FORHOW ARE PATEINTS REFERRED FOR
THERAPY GROUP?THERAPY GROUP?
 Individuals are typically referred for groupIndividuals are typically referred for group
therapy by a psychologist or psychiatrist.therapy by a psychologist or psychiatrist.
 Before a person begins in a therapy group, theBefore a person begins in a therapy group, the
leader interviews the individual to ensure aleader interviews the individual to ensure a
good fit between their needs and the group's.good fit between their needs and the group's.
 The individual may be given some preliminaryThe individual may be given some preliminary
information before sessions begin, such asinformation before sessions begin, such as
guidelines and ground rules, and informationguidelines and ground rules, and information
about the problem on which the group isabout the problem on which the group is
focused.focused.

23.  WHEN DO THERAPY GROUPS END?WHEN DO THERAPY GROUPS END?
 Therapy groups end in a variety of ways.Therapy groups end in a variety of ways.
Some, such as those in drug rehabilitationSome, such as those in drug rehabilitation
programs and psychiatric hospitals, may beprograms and psychiatric hospitals, may be
ongoing, with patients coming and going asongoing, with patients coming and going as
they leave the facility.they leave the facility.
 Others may have an end date set from theOthers may have an end date set from the
outset.outset.
 Still others may continue until the group and/orStill others may continue until the group and/or
the therapist believe the group goals have beenthe therapist believe the group goals have been
met.met.
 Working through termination phase is anWorking through termination phase is an
important part of the treatment process.important part of the treatment process.

24. WHO DROPS OUT OF THERAPY GROUPS?WHO DROPS OUT OF THERAPY GROUPS?
 Individuals who are emotionally fragile orIndividuals who are emotionally fragile or
unable to tolerate aggressive or hostileunable to tolerate aggressive or hostile
comments from other members are at risk ofcomments from other members are at risk of
dropping out, as are those who have troubledropping out, as are those who have trouble
communicating in a group setting.communicating in a group setting.
 The group can be injured by the prematureThe group can be injured by the premature
departure of any of its members.departure of any of its members.

25. RESULTSRESULTS
 Studies have shown that both group andStudies have shown that both group and
individual psychotherapy benefit about 85% ofindividual psychotherapy benefit about 85% of
the patients who participate in them.the patients who participate in them.
 Ideally, patients leave with a betterIdeally, patients leave with a better
understanding and acceptance of themselves,understanding and acceptance of themselves,
and stronger interpersonal and coping skills.and stronger interpersonal and coping skills.
 Some individuals continue in therapy after theSome individuals continue in therapy after the
group disbands, either individually or in anothergroup disbands, either individually or in another
group setting.group setting.

26. ConclusionConclusion

27.  THE FUTURE OF GROUP THERAPY:-THE FUTURE OF GROUP THERAPY:-
 clients and therapists alike tend to view groupclients and therapists alike tend to view group
therapy as a second-choice form of treatment.therapy as a second-choice form of treatment.
 Fewer clients are referred for group therapy asFewer clients are referred for group therapy as
compared with other forms of treatment, andcompared with other forms of treatment, and
even those who are referred may not followeven those who are referred may not follow
through and join a group.through and join a group.
 Managed behavioral health care is likely toManaged behavioral health care is likely to
make group therapy a more viable option in themake group therapy a more viable option in the
future.future.

28.  Group therapy is attractive to therapists andGroup therapy is attractive to therapists and
managed care organizations because it canmanaged care organizations because it can
save staff time.save staff time.
 Group therapists need to better educate theGroup therapists need to better educate the
public and health care professionals about thispublic and health care professionals about this
mode of treatment.mode of treatment.