Exam 3: Group therapy and research in counseling psychology Flashcards
group
two or more individuals who are connected to one another by a particular social relationship
group therapy
psychotherapy in which one or more therapists treat a group of clients together as a group
types of groups
- support group
- psychoeducation group
- process groups
support groups
focuses on providing support for specific issues and offering comfort and connectedness to others ⇒ focus on the clients supporting and validating one another
psychoeducation groups
focuses on providing information about particular topics and developing skills ⇒ more information based, less personal sharing, less self disclosure
- May feel like a presentation/lecture rather than therapy
process groups
focuses on the process of being in the group, guiding the clients to note how they interact with other group members and how that mirrors their lived experiences ⇒ attention is paid to feelings, thoughts, and experiences that arise in there group
- There will be opportunities to explore the meaning of these behaviors
who benefits from group therapy? (2)
- People who have difficult time in relationships may benefit significantly from a process groups ⇒ interpersonal process group
- Almost anyone can benefit from a group
Note: Usually form a group by creating exclusion criteria
reasons for group exclusion (4)
- Acute situational crisis ⇒ if you are in your own crisis it is difficult to help others
- May need to do crisis or individual counseling first - Suicidal clients ⇒ these clients usually need more focused attention to themselves to make sure they are safe
- Members who are unable to attend regularly ⇒ especially true for process group interpersonal connections
- It can disrupt the dynamic of the group - Clients with antisocial personality disorder ⇒ unlikely they will support others
- these patients often wouldn’t seek therapy as they don’t see themselves as having problems but in reality have more difficulty (less empathy and may hurt others )
- May be better for individual therapy
considerations for groups (4)
- group size
- duration of sessions
- group structure
- ethics
group size considerations
varies from 3 to several hundred group members depending on the type of group
- process groups usually work best with 6-8 members ⇒ enough to share but not too many to have anxiety about sharing
- Several hundred is usually the psychoeducation groups
duration of session considerations
groups sessions usually range from 1-2 hours ⇒ depending on how often they meet as well
group structure considerations (2)
- Open: allowing members to enter and leave the group as needed
- Typically psychoeducation group - Closed: only the group members who started at the beginning are in the group at the end
- Process groups shouldn’t have new members added because they will be behind
ethics considerations
confidentiality cannot be guaranteed ⇒ everyone will agree about this at beginning but this works as an honor system and you cannot monitor that
therapists role in group therapy (3)
- express concern, acceptance, genuineness, and empathy toward all group members
- facilitate dialogue
- Serve as a role model of how to give and receive feedback to group members
→ In psychoeducational groups, instructors often instruct, educate and give examples
process group components (4)
- who communicates, how long, how often, to who, who interrupts, are there patterns related to gender/age/race?
- what roles conflict on the surface (what, who, resolution)
- what is the emotional content of the discussion
- what are some of the unstated assumptions underlying the discussion
techniques of group therapy (3)
- Creation and maintenance of the group
- group screening interview - Culture building
- Norms of process
- Therapist models desired behavior - Using the here and now (often immediacy technique)
- Process illumination
- Self reflect
process illumination
help group members figure out what’s going on inside of them
who created the group stages in 1965?
Tuckman
- Originally 4 stages and later added a 5th to address termination
Tuchman’s stages
- forming
- storming
- norming
- performing
- adjourning
forming stage
orientation stage
- Typically polite, limited interactions
- Members are getting to know their role
- Greater dependency on therapist
therapist role in forming (2)
provide structure and direction
storming stage
conflict stage ⇒ challenging but healthy
- Ideas are criticized and challenged; coalitions begin to form
- Members may be judgemental of one another
- Power struggle among members
therapist role in storming
distinguish between an attack on your person and an attack on your role/ideas ⇒ therapist models ways of providing feedback
- Unpleasant stage for most therapists
- Maintain safety for people and show they are valued but practice confrontation
norming stage
structure stage
- Agreement on procedures
- “We” feeling among group members
- Cohesion
concerns for group members during norming
- Not being liked
- Not being close enough with others
therapist role in norming
foster group cohesion so group can be optimally effective
performing stage
work stage
- High task orientation
- Emphasize performance and cooperation
- Full expression of positive and negative emotions
- Most productive therapy at this stage
therapist role in performing
look out for subgrouping, conflict, and self disclosure
therapeutic considerations in performing (3)
- Subgrouping: inevitable in all groups; often disruptive in therapy groups if kept secret
- Conflict: cannot and should not be eliminated from group
- Self-disclosure: essential for therapeutic benefit; member must reveal personal information for group therapy to be useful
adjourning stage
dissolution/termination
- Completion of tasks; increased independence and emotionality
- Termination
therapist role in adjourning
assist in termination process and guide client conclusions
Yaloms therapeutic factors (11)
- Hope
- Universality
- Imparting information
- Altruism ⇒ give help and get help
- Corrective emotional experiences
- Development of social skills ⇒ groups give people a chance to practice social skills
- Imitative behavior
- Interpersonal learning ⇒ getting feedback on how others perceive you
- Group cohesiveness
- Catharsis
- Existential factors
hope
having hope or expectation that it will work is positively related with good outcomes in therapy
universality
pain can be a universal experience and we will always have some discomfort in life that we don’t talk about with one another very often
- In group therapy you realize you are not alone
imparting information
the clients receive and impart information with other group members with gives you the experience of altruism
corrective emotional experiences
roles in group may influence others behavior to solve problems so that people don’t have to take on certain roles and receive help instead of be the leader
imitative behavior
observational learning for behaviors others in the group do
group cohesiveness
can give you a sense of belonging and connection amongst similar goals
catharsis
process of working through emotions and expressing them
existential factors
chance for individuals to address meaninglessness and isolation in their lives
advantages of groups (6)
- Group dynamics can replicate dynamics outside the group and thus help group members work out those issues
- Accountability
- Skill building
- Members receive feedback/suport/challenge that encourage or facilitate change
- Groups offer diversity of perspectives
- Cost effective
disadvantages of group (6)
- Not everyone can be in a group
- Confidentiality is more difficult to maintain
- Can be harder to build trust and safety
- Group leaders are not always properly trained
- Group leaders have less control than in individual therapy
- Concerns regarding what a disruptive person could do
components of being a scientist practitioner (4)
- Conducting research
- Being a good consumer of research
- Applying research findings to practice
- Approaching clients with a scientific mindset
how is research generated? (5)
- Identify a research hypothesis or aim
- Choose an appropriate experimental method
- Conduct research
- Analyze the data
- Publish your research findings
theory
Make a hypothesis and then test it to see if it is supported
- With lots of supporting evidence you have a theory
can theories be proven?
theories can never be proven true or false because there will always be new evidence to change the current theory
why do we care about research? (3)
- it helps us answer questions
- ethical considerations
- Protect client welfare and safety and public trust - practical considerations
- Many different stakeholders ⇒ clients, clinicians, insurance companies, mental health agencies, taxpayers, governments, researchers pushing for evidence based treatment/practice
2 type of research psychotherapy? What are the differences?
- outcome research
- does it work and what specifically works? - process research
- when, why, and how it works based on components and who does it work for?
what are the 2 types of research that can be done with outcome research?
- Single group design
- Randomized control trials (RCTs)
Single group design
test treatment effectiveness by looking at an outcome variable before and after treatment ⇒ is there significant change
- Assess pre and post therapy but also outcomes at other time points
Randomized control trials (RCTs)
test treatment effectiveness by comparing one or more groups against a control
- Two or more groups ⇒ individuals randomly assigned to a group
- Are the groups scores on the DV significantly different from one another at post treatment?
considerations for RCT’s (6)
- Define the inclusion and exclusion criteria ⇒ establish whether a treatment works for a specific population or disorder with a strict diagnosis
- Even with people who have a specific diagnosis there is a lot of heterogeneity
- Recruitment issues ⇒ need a large enough sample size for evidence
- Must define the control group
- Must operationalize the therapy
- Therapist related factors ⇒ carried out by humans which is why it can get messy
what causes heterogeneity in RCTs? (4)
- How long they have the disorder
- Family history
- Previous treatment, therapy, medication, both
- Comorbid disorders
comorbid disorders
people with certain diagnosis may have other diagnosis too
blinding
how you make sure the participants don’t know what group they are in
placebo effect
show improvements because they think they are getting better when they actually are not
Supportive therapy/treatment as usual
provide educational evidence for therapy or continue with treatments they are already doing ⇒ can still show placebo
Pure control
no intervention
Wait list control
receive intervention after the study
Manualized therapy
specific protocol explaining how to carry out the therapy
- part of operationalizing the therapy
therapist related factors (2)
- Therapist effects
- Therapist adherence
Therapist effects
some individual therapist may be more effective than others
Therapist adherence
therapist may differ in how closely they follow the manualized treatment
Process research
when, why, and how it works based on components and who does it work for
components of process research (2)
- moderation
- mediation
moderation
third variable that affects the direction or strength of association between 2 variables
- When or who does treatment work
- What makes it more effective for some patients than others ⇒ strength + direction
mediation
3rd variable accounting for association between 2 variables
- How or why does effects occur
open science
a scholarly movement dedicated to the core principles and behaviors of making research transparent, credible, reproducible, and accessible
key components of open science (2)
- Preregistration
- Open data, protocols, materials, and code
preregistration
Require researchers to register their study’s hypothesis, methods, and analysis plans before conducting the research ⇒ reduces data manipulation
