Chapter 1: The Therapeutic Factors
The relevance of group therapy to therapeutic help is outlined as being highly effective due to its equality in individual therapy in providing help. Therapeutic change is portrayed as a process involving intensive interplay of various elemental factor described as therapeutic factors by the authors, and which revolve around human experiences. The factors identified by the authors include universality, instillation of hope, altruism, imparting information, corrective summary of the key family group, development of techniques for socializing, cohesiveness in the group, behavior imitation, interpersonal learning, catharsis and existential factors.
The concept of universality is described as capable of making clients realize that their problems are not unique to them and can therefore be solved. Instillation of hope is said to be essential in keeping the client on treatment and is further said to be therapeutic on its own. The therapist should take personal initiative in ensuring that the client’s belief on the process and its potential effectiveness is maintained throughout the treatment. Imparting information through the therapist as well as through other group members is also an effective step in achieving group therapy efficiency. It can be done through either didactic instruction or direct advice. The purpose of altruism in group therapy is to show members that gain can only be achieved through giving rather than receiving. In corrective family recapitulation, the group functions as a family unit with different people adopting different figures. Imitative behavior refers to client’s adoption of behavior related to the therapist while socializing techniques foster the development of interpersonal relationships in the group. The other factors all play different but equally important roles in group psychotherapy and affect the effectiveness of the therapeutic process to different degrees.
Chapter 2: Interpersonal Learning
Chapter 2 of the reading focuses on interpersonal learning as a therapeutic factor. The factor of therapeutic interpersonal learning revolves around some concepts, which include the importance of interpersonal creating interpersonal relationships, corrective emotional experience, and the consideration of the group as a microcosm of social interactions. Interpersonal relationships are important in achievement of functional existence. In this respect, a person can only be effectively described by virtue of his/ her personal relationships with others. Besides, interpersonal relations are important since people tend to develop self regard based on the picture they receive from significant people in their lives. The concept of corrective emotional experience on the other hand, leads to the exposure of the client to situations he/ she found difficult to handle in the past. Such incidences are characterized by the client’s depiction of strong negative emotions, unique expression by the client, a fear of anger and the testing of reality. As a social microcosm, the group has the impact of making the members to be themselves while part of the group. The group members each develop their own tiny microcosm, a factor that results in defensive reaction from each member.
It is these social microcosms that the therapist should be able to take advantage of to achieve efficiency in the treatment process. The process of interpersonal learning emanates from a combination of the factors described. For interpersonal learning to be an effective therapeutic process, there must be: a distortion of interpersonal relationships, the evolution of the group into microcosms, awareness of significant features of group members’ interpersonal behavior, the occurrence of the interpersonal sequence, awareness of personal responsibility and acting upon the responsibility, increased understanding of group relationships and movement toward success of the intervention process.
Chapter 3: Group Cohesiveness
The importance of cohesiveness in groups is related to client- therapist relationships in individual therapy and has similar effects. The therapeutic factors in group therapy operate in relation to one another and the impacts of group cohesiveness have the potential of enhancing the impacts of other factors on the effectiveness of therapy. Existing literature evidence shows that group cohesiveness plays an important role in influencing group membership and the impacts of group therapy on the therapeutic process. Since group and individual cohesiveness are interdependent, the magnitude of group cohesiveness can be established by a summation of the attractiveness of the group to the individual members.
The role of group cohesiveness in effective group therapy includes the maintenance of membership and ensuring group attendance, improvement of self and group esteem and being a precondition for the effectiveness of the therapeutic process through acceptance and involvement. It is particularly important in the groups involving individuals who have undergone stigma and exclusion. Individual popularity in the group context can be achieved due to various factors such as willingness to self-disclose and compatibility between group members. This also plays an important role in enhancing cohesiveness within the group. While group cohesiveness has several benefits to the therapeutic process and can be curative in its own self, the lack of cohesiveness can result in interpersonal hostility. This can however be avoided through improved containment of inter-member conflicts. This can be done by encouraging members to bear with each other. To work constructively, the group dynamics must be characterized with intensive interactions and risk taking. In addition, misconceptions about group cohesiveness may result in interference with group tasks, while hostility may advance self-disclosure.
Chapter 5: The Therapist: Basic Tasks
The basic tasks associated with the therapist in group therapy include group creation and maintenance, building the group culture, activation of the here-and -now and shaping the group norms. In creation of the group, the therapist considers factors such as group homogeneity. The group is created as a transitional object, with specific focus on the creation of a physical entity, which may require that the therapist does not focus on meeting everyone’s needs.
In building the group culture, the therapist has the role of shaping the dynamics and energy of the group into a social system that can enhance therapy. Secondly, the group being the agent of change can set the stage for the motion of therapeutic factors. In this role, the therapist has a more indirect responsibility in group therapy than in individual therapy. In the group therapy, the therapist sets up the stage for change while in the individual therapy, the therapist is the direct agent of change. In this role, the therapist is supposed to create a capacity for empathy and to show that he/ she cares, as this is necessary for the client to achieve effective therapy.
The group norms are created from the expectations of group members expectations. Firm expectations make it easier for the therapist to establish group cultures. This can be achieved by first requesting members to talk about their expectations and basing the norms on the stated expectations. The initiation of the here and now comes about interrelated to other therapist tasks and changes with every development in the therapeutic process. Of particular importance is the development of a suitable theoretical model for the accomplishment of the group objectives based on the outlined culture and norms.
Chapter 6: The Therapist: Working in the Here-and- Now
Two important factors are described in the therapist’s work as relating to the here and now. Te first, it the concept of process while the second is the concept of content. Both factors are described as being important in the effectiveness of the group therapy. The process is mainly defined by the group membership while the content can be regulated by the therapist. With regards to the process, focus is maintained on the how, where, why and when a given discourse takes place within the group. On the other hand, the content has to do with the specific composition of the discourse in terms of the information. It is encouraged that as much as focus is trained on the content of communication, it is also necessary to consider the communication process. The process of therapy and communication within the group is described as the power source of the group. The process of working in the here-and -now involves two main stages, which include process experience and process illumination. The tasks associated with the therapist in these stages centre on the moderation of the process.
In the activation of the here-and -now process, the therapist is tasked with the initiation of experience, which may involve the use of the past to determine the challenges of the group therapy dynamics. The moderation of the therapy content is carried out through effective communication of the therapy goals and enlightening the members of specific individual therapy objectives. While the content is important, the process can also play a significant role in determining the effectiveness of the process as well as the purpose of delivering a specific content. Understanding the process may help the group in understanding the content and resolving conflicts amicably without the wastage of much time.
Chapter 7: The Therapist: Transference and Transparency
This chapter discusses how the therapist must be, based on two concepts. The first concept is that of transference, a factor that can be either a tool for effective therapeutic practice or an impediment to effective practice. The concept of transference refers to a situation where attitudes towards the therapist are developed based on the client attitudes towards a specific significant individual in the client’s life. In applying the concept of transference for the purpose of effectiveness, it is necessary that the therapist understands the role of transference in therapy, to remain opaque to the feelings of the client and thus initiate the client’s cloaking of the therapist in transferred attitudes and emotions and to clarify various aspects of the transference. Some therapists describe transference as being ambivalent, capricious, and inappropriate. However, they also support the role played by transference in the analytical treatment of group clients.
Relationship is mentioned as one of the curative factors in-group psychotherapy. The therapist should be engaged and empathic towards the client’s experiences and subjective emotions. However, the degree of disclosure that is necessary is debatable. The problem with this is not in the discussion about the importance of trasference itself but rather in the priority placed upon transference in relation to various other factors.
In transparency, the group therapist is expected to be transparent with regards to information shared with clients. This helps to maintain the trust between the clients and the therapist. It also helps to improve interpersonal relationships between the client and the therapist, which contributes to the process effectiveness. There is however, a limit to what can be disclosed.
Chapter 8: The Selection of Clients
The process of effective group therapy depends on the selection of clients and proper group allocation. The assignment of clients to improper groups may lead to a failure of the process. In assigning clients to groups, the issue of the effectiveness of group therapy arises. Group therapy is said to be as effective as individual therapy. Other benefits associated with group therapy that make it a bit superior to individual therapy include development of social learning, and improved social networks and support. These factors are essential in the achievement of efficiency in therapy. In order to determine which clients are suited to group therapy and who are not, it is necessary to begin with the description of demographic and clinical issues based on variables such as interaction mode, attendance and cohesiveness.
To assign clients to groups, it is common for therapists to define exclusion criteria rather than inclusion criteria as this is easier. For a diverse set up with several groups, a factor that excludes a client from one group may be the same factor that keeps the client in another group. For instance, an interactional dynamic group requires only individuals who are willing to self- examine, disclose, as well as to give and receive members’ feedbacks in terms of his/ her behavior. When clients are assigned to groups to which they are unsuited, they tend to adapt an interpersonal responsibility that may be detrimental to either themselves or others, and may even drop [out of therapy. For instance, sociopaths may not be suited to group therapy as they tend to exhibit behavior that may prove detrimental to themselves and others. Their actions may be dramatic and destructive as they expose their inability to relate to others.
Chapter 9: The Composition of Therapy Groups
The dynamics of group behavior can be predicted based on the composition of the group. While therapeutic factors play an important role in achieving therapeutic effectiveness, the composition of the group also contributes to this effectiveness. Homogeneous groups are significantly more effective than heterogeneous groups. The role of group composition in group therapy can be related to the role of meaningful relationships between the client and the therapist in individual therapy in that the composition of the group influences the nature of relationships that can be created within the group. In addition, similarities between group members also increase chances of effective therapy.
In homogeneous groups, there is significantly less conflict; group cohesiveness is also achieved much easily. Other advantages of homogeneous groups include better attendance, more rapid curative evidence, and they offer more immediate member support. Heterogeneous groups on the other hand, are composed of varied membership with differing demographic features as well as diagnostic capabilities. The heterogeneous groups have different operational diagnostics compared to homogeneous groups. The intensity of conflict in the group cannot possibly override the tolerance of the members’ tolerance for each other and for the group conflict.
The role of group composition in the effectiveness of the therapeutic process is based on the premise that the therapeutic factors such as cohesiveness, interpersonal learning and imparting of information all depend on the group composition. The basic factors that guide the composition of therapy groups include the needs of each member, the specific strategy of therapy and the dynamics of group operation.
Chapter 10: Creation of the Group: Place, Time, Size, Preparation
In the creation of therapeutic groups, several factors are put into consideration. The most important of these factors include the therapeutic factors, the roles of different members in the group, and the time availability for the group sessions. The first issue that is addressed in the group creation process is the concept of group meeting place. In this regards, the meeting place must provide a favorable environment for the therapeutic process. This can boost the effectiveness of the process. The size of the group is also an important factor in the operation and effectiveness of the group. Small groups function better than larger groups.
In the initiation of the group meetings, the availability of time for sessions should be considered too. The group sessions should be not more than two per week and should include all members since each member has a particular role to play within the group. In addition to this, the members should also be made aware of their roles in the group. The sessions should be of approximately 11/2 to 2 hours each and should take a total of 6-12 sessions depending on the specific objectives of the group. Factors such as gender also play a role in-group participation and groups should be made inclusive of all genders.
Preparing for group therapy is an intensive process that involves the consideration of the therapeutic factors in the group. Time should be given for the development of interpersonal relationships within the group before the beginning of therapy sessions. In addition, strategies should be laid down for therapy that addresses the needs of all members. The brief group therapy sessions can help in achieving short-term therapy objectives.
Yalom, I. & Leszcz, M. (2008). The Theory and Practice of Group Psychotherapy 5th Ed. Basic Books.
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