chapter 10 - in the beginning Flashcards
where does gropu work begin
in pretherapy
what are the pretherapy tasks x4
group selection and composition, propr setting, and client preparation.
does each individual create their individual microcosm in the group
yes
what are the 5 stages of a gropu
forming, storming, norming, performing, and adjourning
what are the 4 stages of anotehr theory of group work
engagement, differentiation, interpersonal work, and termination.
of the 4 stage model theory of group work, about how many sessions does this take
10 sessions
do more sessions mean slower group development
yes, less gropus means faster group development.
describe engagement stage
members make affiliations and relationships with one another
describe differentiation stage of a group
focus on control, power, status, and competition of the group.
describe the interpersonal work stage
long and produtive working stage that has members being intimate, engaged and show genuine cohesion.
describe termintation stage
end of the sessions. it can have grief, lose, relief, letting go, gratitude, etc.
is gropu development stages based on the preceeding stage
yes. so if there are issues in one stage, they will carry into affecting the next stage.
how does gropu maturity affect communication x7
more empathic, more affective than cognitive, more focused on the here and now, and offer constructive feedback, more self disclosing, less leader centered
what is a sign of group immaturity
advice giving
what is a fundamental question that an effective group therapist should be able to answer in regrards the group’s current stage of development
why is this happening in this way at this point.
why call members before the first session
to remind them of group and alleviate any anxities.
what else can you do on the day of the first meeting to alleviate anxiety
greet members at the door or leave signs for them to have direction to the group room.
how shoud you greet the memmebers
warmly and with excitement
what are 2 basic ground rules you should address on day 1
honesty and confidentiality
the first person to speak is most likley to dominate what part of the group stages
the early stages
when do the norms of the group start being shaped
from the very first day by the therapist and the members.
when should you acknowledge tension in the room
from day one as a point ot normalize it.
what are the 2 main parts of the intial stage (forming)
1- figure out how to accomplish the goal of the group
2- create a niche for themselves and the role they play.
wha tmight those with dismissive attachment style do to those that seek engagement
reject them.
what should a therapist watch for in the beginning session x2
the group as a whole and the individual’s subjective experience.
what kind of connection do most seek
intimate one on one relationshipos as well as a connection to the group as a whole.
if a person is fearful of losing themselves within the group identity, what might they value more so
differentation over a sense of belonging.
how does a therapist create the norming from day one
they are the authority figure and they can establish what is to be tolerated and what isnt.
what is the number one way that a therapist is given powers in group work by its members
they see them as a healer, as a omniscient all caring parent or rescuer. this is irrational and untrue.
what is important during these initial discussions (content or process)
process - members are exploring one another in some way and figuring each other out. it doesn’t matter that it is superficial but it does matter that they are engaging.
what do members seek in one another (differences or similarities)
similarities (universality brings relief)
how is direct advice giving beneficial to the group itself
it provides a vehicle for caring for one another to build upon in group cohesion.
does the group need more structure in the beginning or the end
beginning
what is an important feeling to instill during the beginning sesssions by the therapist x3
hope and safety and trust
why would a silent facilitator be a bad idea in the beginning
we are prone to our own anxities in these situations which is normal, subconscious, primoridial and demonstartes why having a facilitator in the beignning is so crucial. this will happen even with the most robust of members.
what is the 2nd stage of the group
storming
what describes the storming stage
focus on orientation, structurue, and meaning as a means of finding out whom is in control of the situation. (storming the ramparts to be in control).
what kind of comments are most common in the storming stage
negative comments and criticism
what happens to social norms in the storming stage
members feel free to give advice but outsid eof the normal social code. they use more “shoulds.” this is done as a means of focusing on a person’s status and position in the group (whom is the strongest)
when are there more covert struggles for power in the group
when new members come in and make a vie for power and not being aware of the order things before their arrival to the group.
why does hostility develop towards the therapist
members have unrealistic and impossible views of the therapist being challenged.
what decreases the hostility towards the therapist
they represent his humanity as well in time.
what 2 ways should a therpaist never respond to hostility with
defensiveness and especially with hostility in return.
what natural forces cause hostility to the therapist to develop x2
humans have a natural tendency to have the ability to depend on someone, and then seek to destroy that dependence (by destroying the authroity figure).
how does a therapist sidestep the natural tendency for people to seek an authority figure
by not being an authority figure - they don’t give answers, and urge the group to explore and develop it’s own resources.
what else brings about resenment towards the therapist (hint: favoritism)
they learn they won’t become the favorite member/child of the therapist.
why might a person seek to be the favorite member/child of the therapist
it’s an interplay between their own sibling rivalry from their past.
what alleviates a member seeking to be the favorite of the group to the therapist
realizing that each person is equal in the eyes of the therapist.
what is there to say of those that are the most profound during the storming stage regarding their reaction formation
very conflicted in their ideas of dependency and have heavy yearnings for dependency
what is a reaction formation
responding to a repressed need with its contrasting form (i.e. seeking others to depend on, but pushing everyone away that might help).
of those most hostile during hte storming stage, what is there to say about their attachment style
avoidant and dismissive attachment style
what assists clients in working through their issues with dependency, fears of rejection, and unresponsiveness as seen in the storming stage?
experience the comfort of belonging and asking for help.
what must first happen to those that are hostile in the storming stage for them to grow and gain insight into their dependency issues?
they must be rebuked by the group and then see the group as something as capable of giving them what they want (trust, acceptance, belonging, protection)
why might a member protect the therapist x2
1- had unreliable care givers in the past and see you as frail (parentification)
2- see this as a point of building an alliance with you against the other members.
we should be aware of any covert signals we might send to rescuers in these situations
why do we use our first names in session
to create a sense of egalantarianism as our titles denote power/authurity.
what qualities make for the worst of responses from the members x3
1- being ambiguous/engimatic.
2- authoritative but provide no strucutre (rule makers)
3- make unrealistic promises to the group.
what is a good way to help us as therapists deal with the storming stage
differentiate between an attack on our selves and an attack on our role in the gropu.
are transferences in sessions linked directly to our behavior
no- it is mostly linked to the perceptions of hte client and their interpretation of those perceptions based on past experiences.
if we have done damage to the group, how should we respond
own it and repair it.
what does owning and repairing the damage in the group by a therapist prove
no one is beyond feedback and that this is a safe space to address anything.
how does countertransference interfere with group work
puts the needs of the therapist ahead of that of the group. it makes the group fail.
why is it best to not be defensivie when facing hostility as a therapist
modeling behavior. shows the attempt to understand and work thgh the attack and shows that aggressiong can be tolerated to some degree.
what happens when aggression to the therapist cannot be expressed in the storming stage
displaced aggression (it has to go somewhere) i.e. scapegoating
what group members are most likely to become scape goats
members that don’t conform to the group.
what do most members do rather than attack the therapist
they attack each other as this is seen as more safe.
how does one assist a member that is scape goated?
humanize them and link them back to the group.
why should we not let the scape goat suffer and be excluded to maintain group cohesion
it’s unethical. and it creates an atmosphere of “first they came for x….now they can come for me….” which breeds more hostility and fear - not cohesion.
what characterizes the 3rd stage (norming) x7
development of cohesion, balance, resonance, safety, more trust and morale, and increased self disclosure
what is the primary focus of this 3rd stage
intimacy (near or far) - fear of being liked or close enough to others.
what kind of affect goes out during the 3rd stage and why
negative affect as a point of preserving group cohesion.
what does it take for a mature working gruop
all affects must be expressed (good and bad and in between) and worked through.
is it normal for even healthy groups to have regression
yes. recrudescence is normal.
what are the 2 stages of cohesion
1- early stage - (group against the world) - full of mutual support.
2- true teamwork - tensions emerge due to struggles with resistances, not for power or dominance in the group. full display of postive and negative affect.
is it a conflict phase necessary for a good outcome
no, but it shows development within the group.
does the group climate questionaire do better at showing individual outcomes or gropu wide outcomes
individual outcome
what 2 characteristics of a termination phase show positive outcome results
high client engagement and low avoidance (Abscences)
is the development of a group linear?
no. it is more like development of tasks similar to the psychosocial stages of Erikson whereas if something is missed in a previous stage, it will cause issies in the next and can be returned to in the previous stage to be addressed more thoroughluy.
what is cyclotherapy of HAMBURG
process of returning to the same issues but from a different perspective with new depths to explore and gain insight from.
what are some anti group forces x4
fear of merging, fear of lose of independence, fear of lose of perceived specialness, fear of rejection, etc.
what builds the initial course of the group
a single member with the loudest interpersonal pathology (most immediate in the group)
what is most likely to happen to groups that don’t start well
they struggle throughout.
why would it be wise to have a new group have a person that has experienced group work before
they have overcome many of their more resistant behaviors and can help move the group along in a healthy way.
what 3 qualities make someone likely to alter a healthy group developmental trend
1- seeks control
2- oversharing/exhibitionism/shock value
3- promiscuous self-disclosure
why would it be beneficial to have someone that is likely to deter the developmental trend in group
give a focus for irritation to bring about affect for the group and make it more exciting for the members.
of those that are early provocateurs of the group claiming to not care of the opinion of the group, what was their actual evaluation of the opinions of others
they cared very much.
if we dread a client’s abscence in group, what does that mean for the group itself
that too much burden is on that person and this undermines therapy.
are all groups the same
no. they have similarities but are all unique.
how does storming appear in more collectivistic societies x4
less conflict, less storming, and more dependent modality. the members spoke less in the beginning in fear it would cut off the speaking of the leader of the group.
what would women groups need for conflict to be experienced
increased safety and intimacy.
what happens to the development of groups less than 10 sessions that are highly structured?
they stay in early engagement trends.
should we use group stages as a template or as an absolute in our work
as a template as being more broad about it as this kind of step by step induction removes the ability to have rael therapist-client engagement. there is less authenticity
how should the journey be in psychotherapy
a shared joureny of discovery.
why might frequent absences side track a group
makes them fearful of group solidarity
what stabilizies with group membership numbers
group solidarity and stability.
why might briefer group sessions have less abscences
more realistic and suited to western thought (solution focused), and leaders are more mindful of the limited amount of time and make moves to make the group cohesive faster.
when do most people drop out - early or late
in the earlier sessions
what prevents drop out
also having individual therapy
what does tardiness and irregular attendance mean
resistance to therapy - if they wanted to be here they would be.
does a really good group have really good attendance
yes
what does irregular attendance lead to for the group
group demoralization - it needs to be addressed and worked through quickly.
what does missing one meeting lead to
missing another - it is a domino effect.
how is group therapy like a team sport
it requires every team member to show up.
do we still charge for missed group sessions
yes. attendance is that important.
what type of abuser is the most resistant to group
men that abuse their partners.
what is one way to increase attendance
a phone call or text before hand.
should we cancel even with low attendance
no. that is the greatest sign that this room is need of help.
should one encourage members to discuss their feelings of abscence/lateness to the perpetrating member
yes. it brings about conflict and resolution in time.
what age bracket tends to appreciate when groups are smaller and more intimate due to missing members
the younger group members.
what does tardiness or being absent relate to in a person on an interpersonal relatioship level
it shows their patterns of relating to others. it has a personal meaning to that member.
should we analyze a person’s lateness/absence or correct for it first
correct for it first through feedback from the group so that the person may grow and understand.
to whom is timing of feedback the most important
to those that have issues with mistrust and vulnerability
why should we insist that a person tell the therapist before hand if they are going to be late?
because the group might speculate as to why they are missing and this cna be struessful (But useful as it shows the group cares) but this can take away from valuble group time together (this is especially the case for early group stages).
any event can be what in the interpersonal mill.
grist or fodder or wheat or something of substance to be of use for therapeutic gains.
why should we avoid cancelling a session at all costs
because it lets the members know that the group is there and is dependable.
even if the group is only 2 people, should we focus on intrapsychic or interpersonal
always interpersonal.
are dropouts necessary for group cohesion
absolutely. as dropping out of members is inevitable.
does having an escape hatch for drop outs provide
there will be mistakes int he prescreen process and this is a decompression mechanism for such as well.
what 3 thigns influence drop out rate
the client, the group, an dthe therapist.
what are the 2 best ways to reduce drop out rates
better selection and pretherapy prep
why would a therapist forewarn a client about possible periods of discouragement in group
so that they can be prepared and feel steadied knowing their therapist has expereince.
why would we ask a client to welcome the discomfort of a group
becuase it means that therapy is hitting on somethign important for them.
when a client says they want to drop out what is common response
the therapist will tell them to come to the next group and bring it to the group so that the group can address it (this never works - UNLESS - the client does it because they think they are worthless and will find they are valued by the group.
what is the dread and hope one might feel comign to gropu
dread of repeating their past poor relationships and the hope that this time things will be different fro them.
what can a therapist provide for a client that is dropping out
individual sessions to address their concerns.
are high sharers or low sharers more of a likely drop put risk?
both are likely to drop out.
if a client discloses too much too early, how can we help them to not lose momentum in the group
show him vertical disclosure vs. horiztonal disclosure.
what is horiztonal disclosure
opening up to how it feels to being open to the group - this prevents a client from over exposing themselves but also doesn’t silence htem.
what does each session of silence produce
subsequently more silence session after sessin.
why would we have someone leave group
due to the fact that they are not goign to be benfit from group and could do so from another form of therapy (individual) so that someone else can come in that would benefit from group instead.
if a client does not respond well to the gropu, what are the 3 possible outcomes
1- they will drop out themelsves. 2- will be harmful to the group3- they will stop gropu work (thus requiring the need to be removed).
what should we expect from the group when we remove a member (one of 2 responses)
a big response from the group. they may fear their own rejection. or they may view us as the responsible mental health advocate. most will lean towards you being an authority figure and fear your rejectin.
how can you lead the group into seeing you as a mental health advocate
by sharing your reasons for throwing out the group member. you must still protect their info at this point but can share your own thoughts.
when is insight and interprtation helpful for a client that is seeking termination
if they are likely to reenter therapy somewhere later on in their life and may help them along their road to wellness.
when should we bring in new members
if the group number goes below 5
when is it best to add new members
durign the first 12 meetings, and after 12-18 meetings (replace graduating members).
when it is best to add new members to the closed gropus
first 3-4 weeks so that they have an adequate stay in the group.
what 3 things make it hard to add new members
1- group in crisis 2- actively in a power struggle 3- in new stage of development (may deter group cohesion with new members added).
when do most groups want new members
when they are stagnant and seek new blood.
what population is most resistant to new members
grief processing.
besides new ideas whta else do new members bring to a group
allows existing people to reevaluate wher ethey are and chang etheir goals thusly.
why would we introduce 2 new group members at a time
saves time and energy in growing the group again, and its easier for the 2 new people as they have someone in their same situation.
is it wise to combine 2 separate gropus that are falling apart
no, one should dissolve them and bring together a whole new group so that old niche lines don’t remain.
