Group psychotherapy

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Group psychotherapy 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 explictly 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-solvong and psycoeducational groups are discussed by Momtgomery (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 Information for patients / users 1.1 The benefits of group therapy 1.2 How to find group therapy 1.3 What is expected of you in a therapy group 2 History of group psychotherapy 3 Therapeutic principles 4 Settings 5 Research on effectiveness 6 See Also 7 Notes 8 External links

[edit] Information for patients / users

[edit] The benefits of group therapy

Quoted with permission is the report of one client:

What I got out of group therapy: I was treated with respect, listened to, not judged. I was able to say in "public" what my symptoms were and how I felt. I met other people who had what I had which relieved the feeling of isolation. I learned from the other members of the group what worked for them and copied the skills that worked for me. I got encouragement from the others when I wanted to die. I got compliments when I did well or said something they liked. I had a chance to give and get feedback. I got to hear myself think out loud as I vocally processed what I was dealing with, thus getting it clearer in my own mind.

In group therapy the interactions between the members of the group and the therapists become the material with which the therapy is conducted, alongside past experiences and experiences outside the therapeutic group. These interactions are not necessarily as positive as reported as above, as the problems which the client experiences in daily life will also show up in his or her interactions in the group. Nevertheless, this allows such problems to be worked through in a therapeutic setting, generating experiences which may be translated to "real life." Group therapy is not based on a single psychotherapeutic theory, but takes from many what works.

Some of the many benefits of group therapy:

• Exploring issues in a social context more accurately reflects real life.
• Group therapy provides an opportunity to observe and reflect on your own and others' social skills.
• Group therapy provides an opportunity to benefit both through active participation and through observation.
• Group therapy offers an opportunity to give and get immediate feedback about concerns, issues and problems affecting one's life.
• Group therapy members benefit by working through personal issues in a supportive, confidential environment and by helping others to work through theirs.

[edit] How to find group therapy

Depending on where you live, you might be able to access group therapy therough a public mental health service or through a private practitioner. You can ask your individual therpist, psychiatrist or case manager for further information or to make a referral. Alternatively you can contact a training institute such as the Institute of Group Analysis in the UK or the American Group Psychotherapy Associaltion in the USA, who will have information about group therapy providers. Training institutes can sometimes offer reduced fee therapy with supervised trainee therapists.

[edit] What is expected of you in a therapy group

This can vary according to the therpists approach. In general, however, you would be expected to make a commitment to attend a certain minimum number of sessions, and you would be expected to attend regularly once a week (or twice a week in some instances). Group sessions typically run for 90 minutes. There are not many rules for group members, but group members are expected to respect the confidentiality of fellow patients, and not have relationsips with other members outside the group. You can participate in your own way at your own pace, but it is generally helpful to share your own thoughts, feelings and experiences, and to take an active interest in other members. The group therapist will usually encourage your participation, and comment on interactions and relationships in the group sessions. If you find something difficult or unpleasant in a group session you should do your best to talk openly about it in the group, because wotking through these challenges is a big part of the therapy process. [1]

[edit] 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 influenial 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 indvidual 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 1970's 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.

[edit] 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 experiencesand 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 which has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems that they are still struggling with.

• 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 procsss which 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 unconsciuously repeating unhelpful past interactive patterns in present day relationships.

• Development of socialising 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 sociual skills is through a modelling 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 responsibiliuty for one's own life and the consequences of one's decisions.

• Catharsis

Catharisis 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 which underlie one's behaviour.

[edit] Settings

Group therapy can form part of the therapeutic milieu of a psychiatric in-patient unit ^{[11] [12]}or ambulatory psychiatric Partial Hospitalisation (also known as Day Hospital treatment).^[13] In addition to classical "talking" therapy, group therpy 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 exporation and interpretation, and are explored in daily or weekly community meetings^[14]

[edit] 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.^[15] Similarly, a meta-analysis of five studies of group psychotherapy for adult sexual abuse survivors showed moderate to strong effect sizes ^[16], and there is also good evidence for effectiveness with chronic traumatic stress in war veterans.^[17] There is less robust evidence of good outcomes for patients with borderline personality disorder, with some studies showing only small to moderate effect sizes.^[18] 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 which combines dynamic group psychotherapy with individual psychotherapy and case management. ^[19] Most outcome research is carried out using time-limited therapy with diagnostically homogenous groups, however long-term intensive interactional group psychotherapy ^[20]assumes diverse and diagnostically heterogenous group membership, and an open-ended time scale for therapy. Good outcomes have also been demonstrated for this form of group therapy. ^[21]

[edit] See Also

• Self Help Groups
• Emotions Anonymous
• Expressive therapy
• Drama therapy
• Family therapy
• GROW
• Physical Therapy
• Play therapy
• Theraplay
• Social Therapy
• Systemic Constellations
• Recovery, Inc.

[edit] Notes

[edit] External links

• Useful directory site for UK groups -for specific needs
• Useful site about group psychotherapy and shame, with extensive links to other group therapy sites
• East Side Institute for Group and Short Term Psychotherapy
• American Group Psychotherapy Association
• Useful information about Lou Ormont's Method of Modern Group Analysis
• Contents of International Journal of Group Psychotherapy 1969-Present
• A good bibliography of ther group therapy literature