Group

Question 1

Group Stages

Answer 1

o	Forming (orientation) “childhood” 
o	Storming (conflict) “adolescence” 
o	Norming (structure, roles established) “young adulthood” 
o	Performing (work) “adulthood” 
o	Adjourning (conclusion) “maturity”

Question 2

Group Basics

Answer 2

o In or out
o Top or bottom
o Near or far

Question 3

Therapeutic Factors in Group

Answer 3

1. Instillation of hope→ demoralized, Ego strength factor
2. Universality
3. Imparting of information
4. Altruism
5. Corrective recapitulation of family
6. Development of socializing techniques
7. Imitative behavior
8. Interpersonal learning
9. Group cohesiveness
10. Catharsis
11. Existential factors

Question 4

Prepare for Group

Answer 4

o Opt people out of group v opt in
o Consider task, open/closed/duration/frequency/size
o Screening interview (prepare, pretrain, expectations)
o 6-8 ideal size
o publicize, word of mouth, professional networking
o develop rational
o theoretical format, applicable
o practical considerations (logistics)
o pretrain and select members and leaders

Question 5

Group Composition

Answer 5

o Exclude brain damage, hypochondriac, psychotic, deviant, low psych mindedness, paranoid, CD, sociopath, in crisis
o Homogeneity →cohesiveness but lacks conflict, stress
• Social microcosm theory=hetero
• Dissonance theory=hetero
• Cohesiveness=homo
• Rule of thumb: hetero= conflict, homo= ego strength
• When doubt, don’t let them in

Question 6

Nine Rules for Drop-Outs

Answer 6

External factors, 
deviancy, 
problems of intimacy, 
fear of emotional contagion, 
inability to share therapist, 
complications of concurrent individ/group therapies, 
early provocateurs, 
inadequate orientation to therapy, 
complications arising from subgrouping

Question 7

3 Core Activities for Effective Groups

Answer 7

o Accomplish goals
o Maintain good working relationship among members
o Developing and adapting to changing conditions in way that improve its effectiveness

Question 8

Characteristics of Effective Groups

Answer 8

o Goals are clarified, meet individual, groups goals, cooperative structured
o two-way communication, open, accurate expression of ideas, feelings is emphasized
o participation, leadership distributed
o goal accomplishment, internal maintenance, developmental change underscored
o contract built to fulfill goals, needs
o power equalized, shared
o decision-making procedures match situation,
o consensus, involvement and discussions encouraged
o conflict is positive to involvement
o cohesion, inclusion, affection, acceptance, support, trust, individuality
o problem-solving high
o goal accomplishment, internal maintenance, development considered important
o interpersonal effectiveness, self-actualization, innovation encouraged

Question 9

Characteristics of Ineffective Groups

Answer 9

o Imposed goals, competitively structured
o One-way communication, only ideas expressed, feelings suppressed/ignored
o leadership delegated, based on authority,
o membership unequal, only goal accomplishment is emphasized
o position determined influence, power, obedience,
o decisions made by highest authority, little discussion,
o member involvement minimal
o conflict ignored, denied, avoided, suppressed
o functions of members emphasized, cohesion ignored
o force, conformity, low problem solving, authoritarian
o obsessive order

Question 10

Hazards of Groups

Answer 10

o	Groupthink
o	Conformity
o	bystander effect
o	Deindividuation
o	Obedience of Group Members
o	Power tactics

Question 11

Groupthink

Answer 11

• Conformity→irrational decisions
• Cohesion gone bad
• Reach consensus without critical evaluation

Question 12

Conformity

Answer 12

• Modify judgments so that they match those of others in group
• Asch situation—ignore reality and give incorrect answer to conform
• 1/3 will let group make mistake

Question 13

Bystander effect

Answer 13

• presence of others discourages individual from intervening in emergency situation
• each person added to group, individuals feel less inclined to take action

Question 14

Deindividuation

Answer 14

Members more likely to act impulsively, commit crimes, perform antisocial acts bc presence of crowd conceals identity; e.g. riots

Question 15

Group member obedience

Answer 15

• Milgrim experiment

* People comply to authority

Question 16

Power tactics

Answer 16

Strategies used to influence others, usually to gain particular advantage
• Used when people need to poke into actions
• Assertive, non-assertive/passive, aggressive
• check-in v step-in
• “can we have a re-do?”, “get out of the limbic system”
• Soft, hard, compliant tactics

Question 17

Soft [Power] Tactics

Answer 17

• Exploiting relationship between influencer and targer to extract compliant
• e.g. threaten people with expulsion from group, public embarrassment

Question 18

Hard [Power] Tactics

Answer 18

More coercive, direct, harsh, bullying, punishment

Question 19

Compliant [Power] Tactics

Answer 19

• Foot in door: preface a major request with minor one so that few people would refuse to comply
• Door in face: large request made knowing it will be refused so that smaller request is agreeable
• Low-ball technique: offers services at bargain price in order to first attract buyer, adds additional expenses to make purchase less of bargain that thought
• Ingratiation: get others to like you and comply with requests

Question 20

Specialized Therapy Groups

Answer 20

Adapt what is known about fundamental group theory to the special needs of specialized groups

Question 21

Modify Group for Specialized Clinical Situation

Answer 21

o Assess the clinical situation: Identify limiting factors
o Formulate appropriate clinical goals
o Modify traditional technique

Question 22

Modify Group for Specialized Clinical Situation: Assess Clinical SItuation

Answer 22

Identify limiting factors
• Intrinsic limiting factors: situations in clinical setting that cannot be changed
• Extrinsic limiting factors: situations in clinical setting that are tradition, policy or arbitrary
• Therapists have power or flexibility to enact change

Question 23

Modify Group for Specialized Clinical Situation: Formulate appropriate clinical goals

Answer 23

• Create goals that are
• Appropriate to the clinical situation
• Achieveable to the time grame allowed
• Tailored to the clientele
• Focused to produce a successful experience
• Goals shouldbe clear to therapist and clinets
• Therapists: explain how group will help achieve goals
• Clear, appropriate goals; most important step take in therapeutic work

Question 24

Modify Group for Specialized Clinical Situation: Modify Traditional Technique

Answer 24

• Retain basic principle of therapeutic factors
• Determine which therapeutic facots will be emphasized the most to achieve the goals
• Adjust to the clinical situation and the population of the participants by adapting the group techniques in order to achieve the goals

Question 25

The Acute Inpatient Therapy Group

Answer 25

Radical modifcations required (half inpatients involved)
o assessment setting (Intrinsic factors, clinet turnover, heterogeneity, time, boundaries, more directive leader)
o Formulation of Goals→more realistic/shorter/achieveable
• Six achievable goals:
1. Engaging the patient in the therapeutic process
2. Demonstrating that talking helps
3. Problem spotting
4. Decreasing isolation
5. Being helpful to others
6. Alleviating hospital-related anxiety
o Intrinsic Facots with inpatient groups
• Rapid client turnover
• Short term duration of participation
• Revolving door of incoming and outgoing challenges stability, consistency
• Heterogeneity of Pathology
• Individuals may be at different stages of change
• Diversity in capacity for or attitude toward therapy
• Individuals in gurp vary in length of time they’ve been living with mental illness
• Time
• General no time to meet with clinet prior to group
• Difficult to work on integration or termination of members
• Group Boundaries
• Blurred boundaries, confidentiality difficult
• Confidentiality usually encompasses whole unit out of necessity
• Formulation of Goals: Inpatient Groups: 6 Goals
• Engaging patient in therapeutic process→POSITIVE experience with therapy, maybe use it after discharge
o Receiving support, encouragement in group setting, increases likelihood paitents will continue group work in different setting after discharge
• Demonstrating that talking helps
o Inpaitent groups can introduce cohesiveness and universality
o Clients can share experiences, listen to others, realize they are not alone; altruism!
• Problem solving
o Help clinets identify areas that may need work in individual therapy (e.g. realtionships issues observed in groups)
• Decreasing isolation
o Patients can us communcaiton skills gainedin group to reestablish connections outside of hosptital
o Decreases in isolation inreases one’s ability to build relationships with others in clinical setting, utilize other therapeutic resources
• Being helpful to others
o Clients who help others with encouragement, support, ideas can boost their own snse of self-worth by feeling valuable to grup memebrs
o Do NOT encourage conflict in these groups
o Tamp down conflict
• Alleviating hospital-related anxiety
o Group members can talk about hospital related issues such as behavior of others on unit or staff tensions
o Indiviuals can learn that others may share these concern
o Modification of Technique
• Devise a clinical strategy and technique
• Therapists time frame
• Expect shortened time frame
• Life of group is single session, compositions always different
• Make most out of each session
• Efficacy and activity
• Therapists must be more active in engaging clients
• Round of “agendas”
• Support
• Therapists should offer support more quickly, directly, increases safety in group
o Openly comment on group members efforst, intentions, strengths, etc
o Reinforce how client communicating adaptively
o Invite memebrs to support each other, ask how group can help
o Allow group memebrs to control how much share
o Directly support members by positive comments on behavior, compliment attempts to communication, stay the session, pay attention, support other members
• The here-and-now
• Encourage positive relationship, communication skills
• Communicate needs, get closer to others, express positive feelings, more self-aware, listen, offer support
• Structure
• Provides safety to have clear, firm understanding of what to expect
• Modes of structure
• Spatial and temporal
o Spatial: physical arrangement for room, e.g. circle of chares
o Temporal: start and end on time
• Encounrage memebrs to stay entire session
• Ask staff to help disorganized memebers to find room on tim
• Allow anxious members to observe if they feel like leaving
• Therapist style \
o Take more active, firm, decisive role for reassurance
o Redirect often
• Inpatient groups don’t have enough time to process difficult events, long discussions, stories from indiviauls taking too much time
• Consistent group session protocol
o Structure each session the same way so mambers know what to expect
• Disadvantages of structure
• Hamper group effectiveness—flexibility within structure
• Yalom’s Working Model for Inpatient Group Session Protocol
• Orientation and Preparation
o Intro statement: describe time and duration of meeting, ground rules
o Describe purpose of group, work on relationships, communication
o Describe procedure and sequence of sssion
• Personal Agenda Setting
o Create task members have to think of osething to change in relation to others
o Guide members to think about how can apply their desires to here and now
• Feel closer to people—who could you feel closer to in group?
o Be facilitative, persistent, inventive, direct to make agenda setting work
• Agenda filling
o It as many agenda together as possible, customize to provide greatet good for greatest number of patients
o Conduct group by directing each member to try to touch on several agendas
• End-of-Meeting Review
o Focus on review and evaluation of session
o Break review into two parts
• 1: therapists, co, observers discuss observations
• 2: members joind, discuss
o provides modeling, transparency, reflection, point out future directions, wrap up loose ends
• In patient
• Not light fire but may need to address to get past it