Competency 8: Intervention

Question 1

Interpersonal learning in group therapy

Question 2

Cohesion in group therapy

Answer 2

Cohesiveness is the group therapy analog to relationship in individual therapy
However, this is a broad concept encompassing an individual’s:
Relationship to the therapist
Relationship to other group members
Relationship to the group as a whole
Groups differ in their amount of “we-ness” or togetherness
Groups with more solidarity will defend the group against internal and external threats
Groups with more cohesion have higher rates of:
Attendance
Participation
Mutual support
Cohesion can fluctuate greatly throughout the course of a group
Early cohesion is essential for the group to be able to navigate more challenging work that comes later as more conflict and discomfort emerges.
Cohesion is also a precondition for other therapeutic factors to function optimally.
The need of belonging is innate in all humans
Many clients in the group setting have interrupted interpersonal skills and limited acceptance in their intimate relationships
Being accepted in a group challenges clients’ beliefs that they are unacceptable or unlovable
Members can see that they can generate cohesion with others and bring about durable relationships
Members of a Cohesive Group tend to:
Participate more readily in group
Self-disclose more
Protect the group norms and exert more pressure on those deviating from the norms
Be less susceptible to disruption as a group when a member terminates membership
Experience greater ownership of the group therapy process

Question 3

Instillation of hope as a therapeutic factor

Answer 3

Hope is required to get the client engaged in group so other therapeutic factors will tack effect
Therapists must capitalize on this to increase clients’ confidence in the group – and this starts with the therapist believing in the efficacy of the group
Therapy groups can often contain individuals at different points in their treatment
Interactions between individuals allow for opportunities to witness and see growth – which in turn – provides hope
Hope is flexible and can redefine itself in the group parameters (i.e., hope for different things can change and shift during the group process)

Question 4

Catharsis in group therapy

Answer 4

Group treatment provides members with an opportunity to ventilate. Through venting their feelings, fears, past traumatic events, and concerns, members gain a release of anxiety or tension, which often improves functioning. In groups, strong expression of emotions almost always enhances the development of group cohesiveness.

Question 5

Fundamental definition of Motivational Interviewing

Question 6

Difference between transference and counter-transference

Question 7

Cognitive model of depression

Question 8

Counseling style that leads to increase dropout rate

Question 9

Cognitive therapy’s effectiveness

Question 10

Core beliefs

Question 11

Operant conditioning

Question 12

Homework and behavioral activation

Question 13

Structuring Cognitive Behavior therapy sessions

Question 14

Automatic thoughts and CBT

Question 15

Motivational interviewing and supporting client self confidence

Question 16

Principles of Motivational Interviewing

Question 17

Functional analysis in behavioral activation

Question 18

Simple activation

Question 19

Transtheoretical model of change

Question 20

Cognitive theory

Question 21

Compensatory strategy

Question 22

Motivation to change in MI

Question 23

The concept of relapse

Question 24

Purpose of motivational interviewing

Question 25

Conceptualizing client problems in behavioral activation

Question 26

CBT and the therapeutic alliance

Question 27

Transference

Question 28

Countertransference

Question 29

Therapeutic Factors (all of them)

Answer 29

Instillation of Hope
Universality
Imparting Information
Altruism
The Corrective Recapitulation of the Primary Family Group
Development of Socializing Techniques
Imitative Behavior
Interpersonal Learning
Group Cohesiveness
Catharsis
Existential Factors

Question 30

Public esteem vs self esteem

Answer 30

Public esteem involves members ranking one another on several variables
Members’ ability to face their own deficiencies increases their public esteem
Group members considered most popular typically have better therapy outcomes.
Three variables that correlate with popularity and better outcomes are:
Previous self-disclosure
Interpersonal compatibility
Other sociometric measures
Ex: members chosen as friends outside the group

Question 31

Working in the Here and Now

Answer 31

Process:
Nature of the relationship between interacting individual group members and the therapist
The content = the subject matter
The process includes how, why, when, and who – the here and the now
The process begins with the therapist reflection of underlying issues
The process is the power of the group
Outside of group work – processing in this way is often considered taboo due to:
Socialization anxiety
Social norms
Fear of retaliation
Power maintenance
Focus is directed toward the immediate needs of the group
Questions to assess the process focus include:
“How are each of you experiencing the meeting so far?”
“You look like you are having some reaction to this”
The therapist moves the group away from the ”then-and-there” and outside materials
Therapists help set norms and reinforce:
Interpersonal confrontation
Emotional expression
Self—monitoring
The group as a source of information
This is done by activation and process illumination
The therapist should think in the “here-and-now” by relating any issues that arise back to the group’s primary task
Move focus from the outside to inside, abstract to specific, general to personal
Encourage responses from others – request and offer feedback
Encourage direct speech

Question 32

Types of problem members according to Yalom

Answer 32

Client who monopolizes
Client who is silent
Client who is “boring”
Client who is considered a “help-rejecting complainer”
Client who is psychotic or bipolar
Client who is characterologically difficult
Client with schizoid disorder
Client with borderline personality disorder
Client who is narcissistic

Question 33

Vertical Disclosure

Answer 33

Vertical disclosure is when a person self-discloses some content about themselves (such as an act they did) and goes deeper and deeper in the way of details.

Question 34

Horizontal disclosure

Answer 34

Horizontal disclosure is a meta-disclosure; when a person discloses about their disclosure (how it felt to disclose, why they felt comfortable or uncomfortable in disclosing, etc.).

Question 35

Construction of Norms

Question 36

Client who monopolizes (Yalom)

Answer 36

Talks a lot!
Shares things that may or may not be relevant to the group
May interrogate other group members
May share bizarre and puzzling information
May share information about or create a crisis for the group to focus on

Question 37

Client who is silent (Yalom)

Answer 37

It is possible for vicarious learning to take place for the silent client as he/she identifies with active members who have similar problems, but this is not the ideal method for change. The research shows that, in general, the more active and influential the member becomes in group, the more likely he or she is to benefit.
The silent client is problematic because he or she rarely benefits in a significant way from the group.
Why silent? (1) Dread self-disclosure, (2) Lack assertiveness skills, (3) waiting to be rescued, (4) difficulty with being vulnerable, (5) threatened by a specific group member…. And many other reasons!

Question 38

Client who is “boring” (Yalom)

Answer 38

In general, the boring client is “the one who is massively inhibited, who lacks spontaneity, who never takes risks.” These clients provide safe and predictable information, avoid aggression, and are often critical of themselves. Sometimes these clients lack the ability to identify and communicate feelings.
Group therapy is an excellent fit for these clients and is often more effective than individual therapy alone because modeling, support, and the opportunity to experience with feelings is beneficial. It can also help to increase emotional awareness and expression.

Question 39

Client who is considered a “help-rejecting complainer” (Yalom)

Answer 39

Behavior pattern: Directly or indirectly REQUEST HELP from the group by sharing problems or complains and then REJECT ANY HELP that the group offers
These problems are often presented as not having a solution
Often, this client will want the therapist’s opinion and ignore the group’s reaction to them
This client will view himself or herself as more in need of help than the other group members – thus, they dislike another group member having the attention of the therapist
Problems may be exaggerated
Self-focused

Question 40

Client who is psychotic or bipolar (Yalom)

Answer 40

Expect that bipolar patients can be referred to therapy groups – it is commonplace to do so because it helps to address the interpersonal conflicts common to those with this diagnosis. Actively psychotic patients are typically referred to a higher level of care than an outpatient therapy group.
When the psychosis presents is important – group members are more likely to be tolerant and effective helpers when the psychotic client has already occupied a central, valued role in the group.
When psychosis presents early in group and is unanticipated, it always creates substantial problems for group because it diverts energy from developing the group cohesion that is essential in the early stages of group development.

Question 41

Client who is characterologically difficult (Yalom)

Answer 41

These are clients who have a personality disorder diagnosis
Common problems related to regulation of affect, in interpersonal engagement, and in sense of self
Lack internal soothing skills, difficulty with ambivalent feelings and interpersonal reactions – often “black and white, good and bad, loving and hating” (the world is split in a dualistic fashion)
Rage, vulnerability to abandonment, projecting, lack of insight into the way their behavior affects others
Troubled interpersonal relationships – both inside and outside of group
Often a history of trauma

Question 42

Client with schizoid disorder (Yalom)

Answer 42

Emotionally blocked, isolated, and distant
“Cannot feel, cannot love, cannot play, cannot cry”
Like the avoidant (silent) client – the difference is that the silent client can engage when trust is earned, and they are assured that rejection by the group will not happen; the schizoid client does not necessarily have this ability
Group sessions often confirm for the schizoid patient that “the nature and intensity of their emotional experience differs considerably from that of other members”
This feeling of emotional isolation will be conveyed to the other group members

Question 43

Client with borderline personality disorder (Yalom)

Answer 43

Often highly unstable, sometimes develop psychosis to varying degrees
Instability in interpersonal relationships, self=image, affects, control over impulses
Instability of mood, thought, and interpersonal development
Often group therapy is recommended for these clients because they are so difficult to treat in individual therapy due to an inability to tolerate intimacy in individual settings
Benefits include a secure place for reality-testing, opportunity to develop trust in the group, opportunity to correct distorted views of self and others, gain the chance to develop intimacy in an environment where they can “check out” at times
Separation anxiety and fear of abandonment are common features
Defenses include splitting, projective identification, devaluation and flight
Can help to keep the group together – this is an asset to the therapy group

Question 44

Client who is narcissistic (Yalom)

Answer 44

Represent a range and dimension of concerns – it can be helpful to think of these as traits and features rather than in a formal diagnosis of Narcissistic Personality Disorder
Grandiose sense of self-importance
Preoccupation with fantasies of unlimited success, power, love, or brilliance
Belief that he or she is special and can be understood only by other special, high-status people
Need for excessive admiration
Sense of entitlement
Interpersonally exploitative behavior
Lack of empathy
Often envious of others
Arrogant, haughty behaviors or attitudes