chapter 28 group therapy Flashcards
Transactional Group therapy
Eric Berne:
emphasis on here and now interactions
Gestalt group therapy
Fredrick Perls:
enables patients to abreact and express themselves fully
Client centered group therapy
Carl Rogers:
Nonjudgemental expression of feelings among group members.
Which patients prefer group therapy, and who are more anxious about it?
those with authority anxiety will feel more comfortable in a group
those with peer anxiety (e.g. borderline and schizoid) may be anxious in a group setting
types of group therapy- frequency:
supportive analytically oriented psychoanalysis transactional behavioral
supportive- once a week
psychanalysis of group- 1-5/w
analytically oriented, transactional and behavioral- 1-3/w
types of group therapy- duration:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive and behvioral- up to 6 months
* psychoanalysis, psychoanalytically oriented and transactional- 1-3+ yrs.
types of group therapy- primary indications:
supportive analytically oriented psychoanalysis transactional behavioral
- suportive and transactional- psychotic and anxiety disorder.
- psychoanalysis- anxiety and personality disorders
- psychoanalytically oriented- anxiety, personality dis and borderline states
- behavioral- phobias, passivity and sexual problems
types of group therapy- communication content:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive- primarily environmental factors
- analytically oriented- present and past life situations, intragroup and extragroup relationships
- psychoanalysis- primarily past life experiences intragroup relationships
- transactional- primarily intragroup relationshp, rarely history, here and now stressed
- behavioral- specific symptoms without focus on causality
types of group therapy- transference:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive- positive transference encouraged to promote improved functioning
- analytically oriented- positive and negative transference evoked and analyzed
- psychoanalysis- transference neurosis evoked and analyzed
- transactional- positive relationships fostered, negative feeings analyzed
- behvioral- positive relationship fostered, no examination of transference
types of group therapy- dreams:
supportive analytically oriented psychoanalysis transactional behavioral
- supporitve and behaviral- not used
- transactional- rarely
- analytically oriented-frequently
- psychoanalysis- encouraged, and allways used.
types of group therapy- dependance:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive,analytically oriented and transactional: intragroup dependence encouraged.
- in behavioral and psychoanalysis: intragroup dependence not encouraged.
- supportive and behavioral: reliance on leader is high
- transactional: dependence on leader not encouraged
- in psychoanalysis and analytically oriented: dependence on leader variable
types of group therapy- therapist activity:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive- active, gives advice, stregthens defences
- analytically oriented- challanges defenses, active, gives advice and personal response
- psychoanalysis- challanges defenses, no advice or personal response
- transactional- challenges defenses, active, gives personal response rather than advice
- behavioral- creates new defenses, active and directive
types of group therapy- intepretation:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive- no unconscious interpretation
- analytically oriented- unconscious interpretations
- psychoanalysis- extensive interpretation
- transaction- interpretation of current behaviral patterns in the here and now
- in behavioal- not used
types of group therapy- major group processes:
supportive analytically oriented psychoanalysis transactional behavioral
- all but behvioral- reality testing.
- in supportive- universalization
- analytically oriented- cohesion, transference
- psychoanalysis- transference, ventilation, catharsis
- transactional- abreatcion
- behvaioral- cohesion, reinforcement, conditioning.
types of group therapy- socialization outside group:
supportive analytically oriented psychoanalysis transactional behavioral
- encouraged only in supportive.
- in transactional- variable.
- behaviors, psychonalysis and analytically oriented- discouraged
types of group therapy- goals:
supportive analytically oriented psychoanalysis transactional behavioral
- supportive- increased adaptation to environment
- analytically oriented- moderate reconstruction of personality
- psychoanalysis- extensive reconstruction of personality
- transctional- alteration of behavior through mechanism of coscious control
- behavioral- relief of specific symptoms.
therapists role in group therapy
- determine size of group, frequency, patient composition
- confidentiality
- set goals
- preparation of patients
- determine group processes
grup therapy- special considerations and contraindications
1) antisocial- unless a group of antisocials
2) depression-do better after establishing trusting relationship with therapist
3) manic- under psychopharmacological control
4) exclude delusional, as can incoporate group in their delusional system
5) aggressive
advantages for preparation before goup therapy
- patients continue longer
* less anxiety if well prepared
size of group
can vary between 3-15, but optimal usually 8-10
what are alternate group sessions?
groups meet twice a week, once with therapist and once without
What are marathon group therapies
group meets continuously for 12 to 72 hours.
pros and cons of marathon group therapy
pros:
- enforced interactional proximity
- sleep deprivation breaks ego defences, releases affective processes, and promotes open communication.
cons:
dangerous for those with weak ego - e.g. schizophrenia and borderline.
ages in group therapy
adults: all ages. Helps with developing and reliving interpersonal situations such as parent-child, brother- sister etc.
children and adolescents: persons their own age group.
open vs closed groups
open- in and out, not a set amount and composition of patients.
role of therapist in group therapy
mainly facilitative.
ideally the members themselves are primary source for cure and change.
inpatient ve outpatients group
sometimes bigger group, high turnover
therapeutic factors: sharing information, universalization and catharsis.
- discuss conflicts between patients and with staff
- inerpersonal and socail skills
- adaptations to hospital
insight: more in outpatient(because long term)
self help group
homogenous
emphasize cohesion
combined individual and group therapy
- this is a particular modality- not augmentation!
- not attending sessions should be analyzed.
- same therapist for group and individual.
- usually8-10 patients.
- provides additional transferentail reactions for corrective emotional experiences.
- less dropout rate
- appears to resolve problems more quickly
structured interactional group psychotherapy
type of combined therapy.
each weekly session focuses on a different group member
psychodrama- role
- Director- most active of all group modalities
- Protagonist- the patient in conflict.
- Auxiliary ego- another group member who represents someone in the protagonist’s experience
- group- some participants, some observers. benefit from identifying with events.
- spontaneity, especially of protagonist.
confidentiallity in group therapy
therapist is obligated to confidentiallity, but members are not (but should be encouraged).
abreaction
emotional and cognitive reliving of repressed material, usually leading to insight
altruism
freud believed it to be a major factor in group cohesion and community feeling.
catharsis
expression of ideas, thoughts and reperssed material with accompanied emotional response leading to a state of relief.
What is the most important factor for positive therapeutic effects in group therapy?
cohesion, the sense of “we-ness”, the sense that the group is working together to a common goal.
consensual validation and observation
Harry Stack Sullivan (and Trigant Burrow):
confirmation of reality and correcting interpersonal distortions by comparing conceptualizations with other group members
identification
Unconscious incoporation of characteristics and qualities of another person or object into ego system
contagion
expression of emotion by one member stimulates awareness of same emtion by another member
imitation
conscious (as opposed to identification) modeling of one’s behavior after another (role modeling), spectator therapy (patients learn from each other)
insight
conscious awareness and understanding of one’s own dynamics.
emothional insight higher level than intellectual insight- leading to change
univesalization
you’re not alone!
