yalom - chapter 15 - specialized therapy groups Flashcards
what kind of group is considered the most fundamental and the one upon which all other groups are based
interpersonal outpatient group therapy
what are the 4 steps to making a specialized clinical group
1- assess the clinical situation. 2- formulate clinical goals. 3- change techniques to fit the new group with the new goals. 4- evaluate how well this work for the group at hand.
what are intrinsic factors
things built into the clinical situation (location, policies, etc.). things the therapist cannot change
what are extrinsic factors
things the therapist can change
what should the goals be
relief of symptoms and change character structure
what are 2 features fo the goals
they need to be appropriate to the group and acheiveable within the time frame.
what is disciplined experimentation
it is the art of changing the goals and the techniques in a mindful way to benefit the client.
what do we focus on acute inpatient group therapy
setting is really hard for group to work so it requires alot of change to techniques.
what is the big difference for group for inpatient vs. outpaitent
inpatient is contained in a closed off world. so what happens in group can spread to the entire ward.
why is group so hard for inpatient situations x5
rapid client turn over, different psychopathologies, time limitations, group boundaries, and group leader challenges
what are the 6 goals of inpatient group
1- engage clients into the process. 2- show that talking therapy helps. 3- assist in identification of an issue. 4- decrease isolation 5- give opportunities for clients to help each other 6- reduce tensions and hospital related anxiety
due to inpatient groups being so unstable and always changing, what 2 things are required for each session to be effective
efficiency and activity
what is the major goal of inpatient group therapy
have the client engage in therapeutic processes to be continued after discharge.
what are things that need to be well managed in terms of working with clients that are in acute inpatient group
being efficient and active in session as there may be only one session you have per client.
what is direct support x5
using engagement, empathy, listening, understanding, acceptance (this can be vebal or nonverbal)
what is indirect support
support of the client by having a cohesive group.
what should we support immediately
positive acts of adaptation from the clients
whom is normally in the best possible situation to accept criticism
the therapist.
what are 2 things that are detrimental in inpatient group over outpatient group
intensification of affection or hostility
wht is mirrorign
seeing the aspect of yourself in another (especially negative aspects) and disliking that person for that aspect.
how do you overcome mirroring x2
1- have clients deflect the conflict by discussing the ways in which they resemble one another. 2- role switching (demonstrate the other person’s POV)
what makes inpatient group so ineffective
lack of here and now.
what is the worst thing the group can provide another member in the group
by providing advice (then and there focus - here and now focus is as effective inpatient and it is outpatient
what 3 things are the here and now synonymous
conflict, confrontation and critical feedback.
why is conflict important in these situations
it shows interpersonal skills
what ist he key role of hte the therapist in the inpatient setting
creating group cohesion by providing active structure for the group
what is the best physical set up for an inpatient group room x3
appropriate sized room with a closed door and comfortable seating.
how should an inpatient group be ran regarding its time constraints
it should be punctual and uninterrupted. (many members get removed due to various reasons and group should be held as a sacred time to be effective).
when it comes to the group, how should it be referred to in terms of possessiveness
as “their” group or the group belongs to you the client not you the therapist.
how should we approach those that may become fearful and wish to bolt from the room
to admit the hope that they will stay for the whole meeting but acknowleding their anxiety about being able to leave the group. they cannot be physically stopped but reframe why staying might be helpful or offering the chance to only observe
how can we address challenging situations by those in psychosis that deteriorate group efforts
acknowledge our own discomfort at having to set hard boundaries but is done so to protect the integrity fo the group as a whole.
2 ways to provide structure to a gropu
use a consistent and explicit sequence (only for inpatient)
what are 4 steps to provide a consistent and explicit sequence
1- first few minutes is used to provide the structure for the session. 2- define the task (what are we doing today) 3- fill the task (involve as much of the group as possible in completing the task of the group. 4- summarize (spend the last few minutes summarizing the group experience using the self-reflective loop of the here and now to clarify what was seen in the group today).
what does the golden rule say about structure in a group session
too much or too little structure stops growth
why must structure be so apparent in inpatient gropu
so that the group is encouraged to maintain autonomous functioning
what is the ideal number of sessions per week for inpatient
3-5 times per week
what is the ideal amount of time per session for in patient
60-75 minutes
what is the ideal schedule for a session for inpatient
orientation and prep -3-5 minutes
personal agenda setting - 20-35 minutes
agenda filling - 20-25 minutes
summary- 10 minutes
what should be discussed during orietnation and prep of an inpatient gropu x4
introduce the ground rules, clear display of the purpose of the group, outline of basic procedure and sequence of the meeting
what is done during the personal agenda setting section for inpatient
establishing interpersonal issues - must be realistic and doable for a singule session and done so in the here and now.
what are the 3 parts of the personal agenda for a person in inpatient
1- acknowledge wish to change. 2- a wish to change in an interpersonal orientation. 3- is able to be seen in the here and now.
is the personal agenda related to why the person is currently hospitalized
no
what should we do if a client’s personal agenda deals with expressing their ange
we do not want them to express anger with each other so we have them focus on “young anger”
what is young anger
anger that is the beginning levels of old anger (being frustrated or irritated or minor annoynaces)
is the personal agenda therapeutic
yes, as it allows them to be autonomous and discover something for themselves
what should the aim be regarding hte group fro the therapist when it comes to filling the agenda of the individuals
turnign the group session into the most possible good for the most possible people in the groupl
what is the ideal size for inpatient group
6
how do groups take to being observed
by making this apparent it works better for them especially getting feedback from them
what are the 3 kinds of groups for those that are medically ill
1- emotionally based coping (social support and emotional venting), 2- probleming solving (cognitive and behavioral strategies, psychoeducation, stress reduction) 3- meaning based coping (increased existential awareness and aligning life priorities to find purpose)
are medically ill groups homogenous or hetereogenous
homogenous based on illness
what do medically ill groups not focus on x2
interpersonal learning and the here and now.
what 7 factors do medically ill groups focus on
1- universality
2- self disclosure
3- cohesion
4- instill hope
5- modeling
6- imparting info
7- existential factors
does theory really make the therapist effective
no.
does CBT in group focus on the gropu or the individual
it helps the individual working in an cbt format not the actual therapy factors in group
what 2 core beliefs did CBT in groups show
relationship and competence (am i worth loving)
what type of CBT for groups has a higher drop out rate
exposure based group treatment
what are the 3 basic features of a cbt group q
brief, homogenous, and time limited (8-20 sessions at about 2-3 hours per each session)
what are 3 structures in group CBT
STRUCUTRE, focus, and learning cognitive and behavioral skills
what is cold processing
processing done outside of session
what is hot processingq
prcoessing done in session
what are 11 things that would be addressed using CBT in group
1- recording automatic thoughs.
2- challenge those automatic thoughts
3- monitor mood
4- create an arousal hierarchy - (ranking situation from 1-10)
5- monitor activity (track time and energy spent)
6- problem solve
7- psychoeducation
8- learn relaxation techniques
9- risk appraisal (what bothers me and what can i do about it)
10- use guided imagery for exposure therpay
11- relapse prevention
how does interpersonal therapy identity the issue at hand
due to interpersonal relationsihps
what does interpersonal therapy work well in
multicultural situations
what does interpersonal theroy not use as therapeutic factors x2
here and now and social micorocosm. thus, less conflict.
what are 2 key features of self help groups
1- use leadsership and develop cohesion
what therapeutic factor is not used in self help gropus
interpersonal learning
what direction of expertise do self help groups emphasize
internal (the self) thus they are the providers and the consumers as they are all the expert on the matter
