RELEVANCE OF GROUP

PSYCHOTHERAPY

Mr. Mahesh Tripathi

Lecturer , IMH,

Sweekaar Academy of Rehabilitation Sciences

 INTRODUCTION
Human beings live in groups. All individuals participate daily in

numerous small and large groups, from families and friends, cliques

and clubs, to work groups and political organizations. Likewise his

problems are usually reflected in group behavior. Group are able to

provide powerful support and encouragement as well as a vivid setting

in which problems based on such distorting effects can be explored

and treated.
• Groups can be used at both the outer
supportive levels and the deeper
explorative levels in psychotherapy.

• Group forces may be used to bring

about therapeutic behavior and
personality changes in individuals.
 Definition
Group Psychotherapy is a type of psychological treatment

involving several patients participating together in the presence of one or

more psychotherapists who facilitate both emotional and rational

cognitive interaction to effect uniquely targeted changes in the

maladaptive behaviour of the individual patient in his or her everyday

interpersonal exchanges. Psychotherapy involves using psychological

methods to treat mental or emotional problems.

Six to ten people meet face-to-face with one or
more trained group therapists
 Talk about what is troubling them.
 Members also give feedback to each other by
expressing their own feelings about what someone
says or does.
 This interaction gives group members an
opportunity to try out new ways of behaving and to
learn more about the way they interact with others.
It is a safe environment in which members work to establish
a level of trust that allows them to talk personally and
honestly.
Group members make a commitment to the group and are
instructed that the content of the group sessions are
confidential.
It is not appropriate for group members to disclose events
of the group to an outside person.
 Evolution of group psychotherapy
History of group therapy starts with Joseph H. Pratt, who offered

inspirational lectures to his patients with tuberculosis. “He adapted a

“classroom method” and called “it thought control”. Inspired frorm his

approach many doctors adapted the methods to treat their patients

(Pratt, 1970).

J. L. Moreno (1917-1918) made experiment with creative drama with

children and applied the group therapy with war neurotics.

Freud Sigmund (1921) speculated on group dynamics in his

paper “Group Psychology and the Analysis of the Ego”.

J. L. Moreno (1932) first coined the terms “group therapy”

and “group psychotherapy” at a conferences of the American

Psychiatric Association in Philadelphia, after doing basic

research on prison populations (Sadock & Sadock 2005).

 Why is group therapy helpful?
1. When people come into a group and interact freely with other group
members, they usually recreate those difficulties that brought them
to group therapy in the first place and encourage them to learn
alternative behaviors.
2. The group also allows a person to develop new ways of relating to
people.
3. During group therapy, people begin to see that they are not alone
and that there is hope and help.
4. Another reason for the success of group therapy is that people feel
free to care about each other because of the climate of trust in a
group.
5. As the group members begin to feel more comfortable, they will be
able to speak freely.

6. The psychological safety of the group will allow the expression of

those feelings which are often difficult to express outside of
group.

7. Members will begin to ask for the support they need.

8. They will be encouraged to tell people what they expect of them.

9. Group therapy offers an opportunity to give and get immediate

feedback about concerns, issues and problems affecting one's
life.
 AIMS

 Help patients to identify maladaptive behaviors.

 Solve emotional difficulties through feedback and thus improve

one's ability to cope with difficult problems.

 Provide a supportive surrounding for the participants.

 Precautions
• Patients who are suicidal, homicidal, psychotic, or in the midst
of a major acute crisis are typically not referred for group
therapy until their behavior and emotional state have stabilized.

• Depending on their level of functioning, cognitively impaired

patients (like patients with organic brain disease or a traumatic
brain injury) may also be unsuitable for group therapy
intervention.

• Some patients with sociopath traits are not suitable for most
group therapy.
 AFTERCARE
• The end of long-term group therapy may cause feelings of grief, loss,

abandonment, anger, or rejection in some members.

• The group therapist will attempt to foster a sense of closure by

encouraging members to explore their feelings and use newly acquired

coping techniques to deal with them.

• Working through this termination phase of group therapy is an

important part of the treatment process.

 Risks
• Some very fragile patients may not be able to tolerate aggressive or

hostile comments from group members.

• Patients who have trouble in communicating in group situations may

be at risk for dropping out of group therapy.

• If no one comments on their silence or makes an attempt to interact

with them, they may begin to feel even more isolated and alone instead

of identifying with the group.

• Therefore, the therapist usually attempts to encourage silent members

to participate early on in treatment.

 Group Size
• If a group has to function adequately without lacking its dynamics, it

should consists of approximately 10 members, which considered to be

either too large nor small (Walsh & Golins, 1976).

• If the groups are adjusted according to its attrition and addition, the

optimal group size may vacillate in 6 to 16.

• It is the dynamics rather than the actual number of members in a

group, which is most likely to affect psychosocial outcomes.

 Composition of group
• Heterogeneous vs. homogeneous
• The former deals with varied problems’ and the latter with a single
problem.
• Most of the groups are said to be heterogeneous is one or in other way
like differences in age, sex, ethnicity, economic conditions etc. from
similar diseases like depression, substance abuse etc, which will
create rapid group induction, as all of the members are from common
set of life issues, and are less ambiguous among members, as they
know why they are selected in a particular group.
• Most of the short- term groups are fine examples of such homogenous
groups.
Heterogeneous groups are Homogenous groups
indicated when: indicated when;
• Patients have important problems in
• Patients share the same
current interpersonal relationships,
• Get locked in to regressive problem,
transference ,
• See their symptoms as a
• Are excessively intellectual,
problem,
• Cannot tolerate dyadic intimacy,
• Elicit harmful counter transference • Do not have a sustaining
responses in individual therapists,
social network.
• Open to others and willing to share.
 Time Factors
Duration of therapy means the length that each session takes and the

group experience over the course of time.

 Usually a time period of 90 minutes is advised (Spitz, 1999).

There are some non-psychotherapeutic groups that adepts

psychotherapeutic techniques, extend from 3 hours to throughout a

weekend session and is said to be ‘marathon’ groups But these groups

have lesser effect on its members (Spitz 1999).

• Usually the group psychotherapy
session is conducted twice in a week
and the number of session will vary
between short term to long term and
model to model.
 Group Memberships

Group membership refers to the fact that whether the group is closed
(fixed) or open.
In the closed group membership the members are fixed usually as in the
short-term group, which focuses on such clinical factor like symptoms
removal, acquisition skills, common life cycle issues or developmental
issues. In such groups the drop outs are not replaced.
In open group, if some members are dropping out or leaving the group
after successful completion, they will be replaced by a new member
with similar sort of problems (S).
 Therapeutic Factors

Group therapy relies on certain therapeutic factors which come in

to action when group grows and develops. Most of the

concepts of these therapeutic factors are evolved from the

psychodynamic principles and some of these principles are

said to be model specific (Sadock & Sadock 2005).

 Abreaction: A process by which repressed materials particularly a painful

experience or conflict is brought back to consciousness, not only recalls but

relieves the materials which is accompanied by the appropriate emotional

response.

 Acceptance: The feeling of being accepted by other members of the groups.

 Altruism: The act of one member’s being of help to another, putting another

person’s need before one’s own and learning that there is value in giving to

others.

Catharsis : The expression of ideas, thoughts, and suppressed materials

that is accompanied by an emotional response that produces a state of relief in

the patients.
 Cohesion : The sense that the group is working together towards a

common goal; also referred to as a sense of “we-ness”

• Consensus: Confirmation of reality by comparing one’s own

conceptualizations with validation those of other group members;

interpersonal distortions are hereby corrected.

• Contagion: The process in which the expression of emotion by one

member stimulates the awareness of a similar emotion in another

member.
Familial experiences: The group recreates the family of origin for some

members who can work and experience through original conflicts

psychologically through group interaction (e.g. sibling rivalry, anger, toward

parents).

Empathy: A capacity put oneself into the psychological frame of reference of

another group member thereby understand his or her thinking, feeling or

behavior.

Identification: An unconscious defense mechanism in which a person

incorporates the characteristics and qualities of another person or object into

his or her ego system.

Imitation: The modeling of one’s behavior after that of another ( also

called role modeling); also known as spectators therapy, as one patient

learn from another..

Insight: Conscious awareness and understanding of one’s own

psychodynamics and symptoms of maladaptive behavior. Most therapists

distinguish two types: (1) Intellectual insight – Knowledge and awareness

without any changes in maladaptive behavior and (2) Emotional insight-

awareness and understanding leading to positive changes in personality

and behavior.

Inspiration: The ability to recognize that one has the capacity to

overcome problems; also known as instillation of hope.

 Interaction: The free and open exchange of ideas and feeling among

group members.

 Interpretation: The process during which the group leader formulates

the meaning or significance of a patient’s resistances, defenses and

symbols

 Learning: Patients acquire knowledge about new areas, such as social

skills and sexual behavior they receive advice, obtain guidance,

attempt to influence, and are influenced by other group members.

Reality Testing: Ability of a person to evaluate objectively the world

outside the self; includes the capacity to perceive oneself and other

group members accurately.

 Transferences: Projection of feelings, thoughts and wishes onto the

therapist, who has come to represent an object from the patients past.

Patients in group may also direct such feelings toward one another, a

process called multiple transferences.

Universalization: The awareness of patients that they are not alone in

having problems, others share similar complaints or difficulties in

learning.

Ventilation: The expression of suppressed feelings, ideas, or events to

other group members.

 PREPARATION FOR GROUP PSYCHOTHERAPY
Initial Interview:
This is done to know:
• whether the candidates are fit into a group situation
• how he will collaborate with others
• how he will be benefited from the group
Process:
•collect information regarding the person’s current and previous
level of interpersonal functioning.
•gather information regarding the
•person’s family history,
• peer relationship
•group history
Another important aim of initial interwiew is to formulate a diagnostic
and treatment plan and to arrive at a diagnosis of the member.
Selections of the Patients

Therapist should take prime responsibilities to select appropriate

candidates. Most of the time the false selection of members will sometime
affects the dynamics or cohesion of a therapeutic group (Piper and
McCallum 1994). Traditionally the selection of patients based on inclusion
and exclusion criteria. More scientifically refined recent trend is to select
patients based on an inclusion criteria, they are.

•The chief complaint being interpersonal component.

•Motivation for a change
•Ability to perform group task
•Able to empathize with others
•Knowing the purpose of selection
•Committed to the rules
•Self reflective
•Reasonably realistic set of expectations
• Exclusion criteria which were adapted
during 1960s are as follows:
– Acute psychotic
– Psychopathic personalities
– Acute depressive patients
– Active suicidal or homicidal ideas
– Hallucinatory patients
– Patients with marked paranoid tendencies
– Other language speaking children
– Acute crisis situation and
– Organic complaints.
Pre Group Orientation

After including the members through the procedures mentioned

above the next task is to provide the members a pre group orientation.

Pre group orientation program reduces the anxiety of members, goals

about what they are going to do and how they have to behave in a group,

therapeutic route and there by make the clients “ready to work” (Spitz

1996). There are many ways of preparing orientation according to Piper et

al (1982), which ranges from informal way of discussion with patients to a

more structured level like using videotapes distribution of handouts

regarding the rules and roles.

Therapists in the Group
The therapist should maintain a transparency.

The therapist must be aware about the advantages, disadvantages and

dynamics of leadership, as well as the considerations regarding

individual and group psychotherapy.

Leaders who are not satisfactory in making their relationship in their

lives are poor candidates for group treatments.

As the group further develops there might be a heightening of emotions

like emotional contagion, scapegoat, nonverbal communication etc.

Leader should inform to his clients regarding the confidentiality and

there by seek trust with his/her group members.

Initial Session
In the first session the therapist should attend the group only after
all the group members are arrived.
But at the same time he/she should take special attention to start
the session on time.
The initial session will start with the leader addressing the
members by introducing him/her and disseminating the basic group
ground rules.
 He will ask the clients to introduce themselves and how they will
be referring their fellow group members, usually using first name of

the clients is the prescribed strategy(Sprits,1999).

 GROUP DEVELOPMENT
• Four of the most common models of groups
development:

Tubbs’s (1995)

Fisher's (1970)

Tuckman's(1965)

Pool's (1989)
Model Stages Description

Tubbs’s Orientation Knowing each other, start to talk about the problem, and
(1995) examine the limitations and opportunities of the
project.

Conflict It allows the group to evaluate ideas and it helps the group
avoid conformity and groupthink

Consensus Conflict ends this stage, when group member’s

compromise, select ideas, and agree on alternatives.

Closure The final result is announced and group members reaffirm

their support of the decision
 Model Stages Description

Fisher's Orientation Primary tension stage, the awkward feeling

(1970) members may have before rules and expectations
are established. They feel comfortable by better
understanding.

Conflict Secondary tension as group members will disagree

with each other and debate ideas. Conflict is
good; because it helps the group achieves positive
results.

Emergence During this phase the outcome of the group's task

and its social. structure become apparent.

Reinforcement Group members bolster their final decision by using

supportive verbal and nonverbal communication.
Tuckman's(1965) Forming As in the Fisher's model the group members
learn about each other and the task at hand.

Storming Group members become comfortable; they will

engage each other in arguments and for
status in the group. These activities mark the
storming phase.

Norming Members establish implicit or explicit rules

about how they will achieve their goal.

Performing During the performing phase the groups reach a

conclusion and implement the conclusion

Adjourning This phase is considered to be as the group

project ends, the group disbands in the
adjournment phase.
Pool's (1989) Task Track According to this model the task track
concerns the process by which the group
accomplishes its goals.

Topic Track In the topic track situation the group members

will discuss about a specific item the group
at the time.

Relation Track It concerns with the interpersonal

relationships. At times, the group may stop
its work on the task and work instead on its
relationships.

Break points Breakpoints occur when a group switches from

one track to another. Shifts in the
conversation, adjournment, or
postponement are examples of breakpoints.
 Termination of Group Psychotherapy
 can occur at any stage of the group development.
 directly related to the type, length or the kind of the group therapy.
 Termination can occur in any forms they are:
1) Pre mature termination, is characterized by the irregularity
in attendance, not being punctual.
2) Forced or enforced, is characterized by the members feeling
that he is causing problem to his fellow group members or
other members are causing problem to the individual
members which will sometimes force the member to
terminate the treatment.
3) circumstantial termination occurs when a member become
unable to continue the treatment due to some
circumstantial factors like getting ill, transferred to other
place and so on.
 Forms of group psychotherapy
• Psychoanalytic group therapy
• Interpersonal group therapy
• Tavistok model
• Analytic model
• Client centered group therapy
• Gestalt group therapy
• Behavioral group therapy
• Cognitive group therpy
• Group based forms of group therapy.
• Psychodrama
• Transactional analysis
Psychoanalytic Groups

Psychoanalysts assume that groups develop a transference relationship

with the therapist and a sibling transference with group members. The

therapist interprets both transference relationships. Patients free-

associate to each other and report dreams, and both therapist and group

members interpret the dreams and the resistances. Group members

reinforce the analyst's interpretations of individuals by agreeing with the

interpretation and citing examples of it from the group's interactions.

Structure
• Relatively unstructured :
– Therapist does not suggest exercises
for the group to engage in.
– Therapist does not set specific goals
for the group members to attain,
• But Structured activities, such as dream analysis and
analysis of transferential relationships in the group is
essential.
Role of Therapist or Leader
• To offer interpretations
• To confront resistance.
• To make sure that the group does not evolve to
become a "dysfunctional family”.
 Theoretical basis

• Interpersonal group therapy

• Tavistok model
• Analytic model
 Interpersonal group therapy
Members are encouraged to explore their thoughts and feeling
and there by correct their emotional experiences.

In this the therapist :

•Plays a passive role
•Help his clients to minimize the impact
of group transferences tension
•Will encourage the connection to be made
from the past and the principle of 'here and now'
and between behaviors occurring outside
and within the group.
•Takes special care to be transparent
towards his clients (Yalom 1970).
 The Tavistock Model
Bion developed Tavistock model. According to him, every group operates in
two levels:
• ‘ Work group ‘.
• ‘ Basic assumptions’.

The work group:

Emphasis that the group members work collectively to attain a common

group task constantly by a cluster of primitive defenses against psychotic
anxieties, which emerges in all members when they are being in a group.
He called these cluster of defenses as basic assumptions, which consists of
dependency, fight or flight and pairing (Bion 1948).
Basic assumptions :
• Dependency: This defense is against depressive
anxieties and is operative when group members
behave as if the group analyst had the power,
ability and knowledge to satisfy their needs.
• Fight or flight: Starts operating when the group
members behave as if there is some external
threat, the response to which can result in a fight
or flight situations.
• Pairing: Operates when two members pair up and
become involved in long and intense discussions
 Analytical Model
Foulkes formulated this model placing importance in three concepts:
• Location
• Communication
• Matrix.

Location :
He theorized that the individual's disturbance are a product of
incompatibility between the individual and his or her original group, i.e.
family.
Communication:
He stated that "Mental sickness has a disturbance of integration within the
community at its very roots - a disturbance of communication."
Matrix:
• He conceived the concept of matrix as a complex
unconscious network of interactions between individuals,
subgroups and the group as a whole.
• In one level the communication that takes place within a
group is found to be meaningful and in the other the matrix has
a more elusive and less definable function of receiving,
containing and transforming each individual's contributions in a
manner that is both integrating and ultimately results in healing.
• The group analyst is known as conductor, without taking a
non intrusive attitude he/she will point out the conflicts and
encourage a free floating interaction.
 Client-Centered Therapy
The goal of a client-centered group is to provide a
warm, supportive, and empathic emotional context
within which individuals can explore their
relationships with themselves and with each other.
Individuals are thought to learn through the process
of opening up to others, confronting each other's
misperceptions, and learning to trust themselves in
the context of others. The client-centered therapist
helps this process by tuning in to each party and
empathically helping them.
Structure:
• Relatively unstructured.
• Agenda and exercises are not typically used.
• Since learning is thought to occur through the process of the group itself, it is
important to allow that process to occur naturally, rather than trying to "force" it
through structured exercises. Through the process of communicating within a
"safe" group climate, members gradually struggle with themselves and come to
tune in to their feelings.

Role of Therapist or Leader:

•Not a leader in a traditional sense and may initially start the group off (and
provide a little bit of structure) by making a few general comments about what
she/he hopes will happen in the group.
•The therapist tries to relate as an equal in the group, self-disclosing and
sharing her own feelings and reactions, but always trying to do so in a
facilitative, effectively communicative way.
 Gestalt Groups therapy
• Fritz Perls formulated this.
• Gestalt groups could not be said to be "proper groups" at all.
• Perls's primary method was to work with individuals only in a
group format. Perls would have an individual come up and sit
on the "hot seat" and work in front of the group.
• The goal of a gestalt group is to help individuals be fully present
in the moment; to be able to make full, open contact with the
self and with others; and to take responsibility for themselves.

Structure
• Gestalt groups are unstructured. utilize structured exercises
Role of leader:
• Gestalt leaders do not come in with preset formats or agendas for
how the group should operate.
• However, gestalt therapists often utilize unstructured exercises to
facilitate the learning-exploration process. These exercises are
introduced spontaneously by the gestalt therapist in a given
moment.

The existential group therapy

The existential group therapy targets in present and its
concerned with the issues related to the individuals existence.
The main focus of exploration is related to death, meaning of
one's life, life beyond death etc. This therapy helps its
members to develop better communication, better self
expression and personal growth.
 Behavioral group therapy
Focus on the learning of new skills and the
unlearning of old, dysfunctional behavior.
Techniques used are
• Exposure methods,
• Skills training,
• Parent training,
• Stress inoculation training,
• Coping skill training.
(Rose, 1989).
Structure :
Highly structured.

Role of Therapist or Leader :

•Like that of a teacher

• The therapist provides structured activities for learning, conducts

discussions to foster that learning, gives feedback, may engage in role

playing, gives lectures and demonstrations, and so on. The behavior

therapist might share feelings and reactions in order to model how clients

can effectively self-disclose using "I" statements.

 Cognitive group therapy
• Focus on confronting and dealing with clients' dysfunctional cognitions.
Cognitive therapists give homework assignments and then explore clients'
reactions to those homework assignments in terms of their dysfunctional
cognitions.
Structure
• Typically structured to pursue specific goals for specific clients.
• The approach is flexible, but businesslike.
• Clients are encouraged to set goals for themselves, and structured exercises
are utilized to help them achieve those goals.
• These exercises can include
– assertion training
– training in other coping skills,
– structured homework assignments
– In the group itself, clients learn to confront their own and their fellow
group members' dysfunctional cognitions.
Role of Therapist or Leader

•Is more like that of a teacher or a coach.

•The therapist models:

•The skills of challenging dysfunctional thinking,

• Facilitates individuals' confronting their own

dysfunctional thinking,

• Encourages other members of the group to learn how to

challenge dysfunctional thinking.

Theoretical Basis
1) scientific
2) Structured
3) The therapist play an active role in group situations
(Sarason and Sarason 2000).
4) The basic assumption of the behavioral technique is that
most problematic behaviors, cognitions and emotions
have been learned and can be modified by the method of
relearning.
Group-Based Forms of Group Therapy

• Psychodrama
• Transactional analysis
 Psychodrama

•Psychodrama was developed by J. L. Moreno (1934)

•It stresses insight and catharsis through the acting process.
•Clients act out scenes of conflict from their childhood or present life.
Group members help each other by acting the necessary parts in an
individual's scene.
•However, in contrast to gestalt, the client's role would often then be
taken by another group member. This way, the client can gain insight
into how she appears to others.
Structure
•Highly structured.
•Phases are:
• Warm-up phase : Clients talk about any problems that have been
bothering them recently, and it is often from this discussion that a client is
selected to work on his or her problem.
•Actual phase : Then that client is placed in a structured situation, such as
having a dialogue with the person or persons involved. Other members of
the group are utilized to either play the other roles, such as other members
of the client's family, or to play alter egos. The therapist directs the
encounter, pausing it at various times to restructure the interaction to
highlight and explore certain issues.
Role of Therapist or Leader
•Role of "director."
•He structures the action, assigns roles, and decides at various points if other
members of the group are to be called in to play new roles.
 Transactional Analysis
• Eric Berne (1964, 1966) developed transactional analysis (TA) in the 1950s.
• It has a strong interpersonal basis
• TA analyzes the transactions between people rather than the inner conflicts
of the individual. The therapist interprets the client's way of interacting with
other people in order to clarify these early experiences and the effect they
have on current relationships. Berne named his three "ego-states" or parts
of the personality:
• Child
• Adult
• Parent
• Each ego-state is appropriate to certain types of relationships.
• Also discussed the concept of games and lifescript.
• Child : similar to the id, and it contains the childish and
childlike impulses and ways of behaving. The Child is
immature, dependent, demanding, and helpless
(childish), but it is also playful, creative, and genuine
(childlike).
• Adult : similar to the ego, is rational, independent, and
responsible, but also unfeeling and perhaps not much
fun
• Parent : similar to the superego, can be nurturing,
caring, and helpful, but also domineering, guilt inducing,
critical, and controlling.
• Each ego-state is appropriate to certain types of
relationships.
• Games :
•Orderly transactions with rules that conceal ulterior motives.
•Berne (1966) described the rules of several such games
and the ways therapists can intervene with game players.
The life script :
•Berne believed that based on early life experiences, people
"unconsciously" write a script for themselves to play all their lives.
•Abused children see themselves as victims and compose a life script with
themselves in the permanent role of victim. Berne believed that if clients
become aware of their scripts and roles, they could rewrite them. He also
believed that people's favorite fairy tale from childhood was an indication of
their life script.
•TA therapist interprets the client behaviour in terms of the client's
transactions in the Child, Adult, and Parent ego-states. Most interpretations
are of interactions between group members.
Special uses of group
psychotherapy
•In children
•In adolescents
•In elderly
 In children….
• Different models of therapy:
– Psycho ananalytic groups - interpretation of
parental transference to the therapists or sibling
issues between the children may be made
– Behaviour therapy- small groups of anxious,
socially inhibited children may be taught assertive
sociable behaviour.
– Group therapy is most often group play therapy
 Group play therapy
• Play is used as a structure for talking,
exploring, and learning.
• Play may be used to help children learn
how to solve problem
• A range of toys and materials are also
used here
• A reduction of shame and guilt, and ability
to practice problem solving and coping
behaviour with peers and adults.
 Used with children who have
• Suffered specific traumatic experience
• Parents who are undergoing a divorce
children are encouraged to talk about and
share their feelings. This allows them to
explore
• Their fears
• Their guilt
• Practical concerns
• Dysfunctional beliefs
• Children also learn they are not alone in their
feelings.
 In adolescents…..
• Exquisite sensitivity to what others think makes
it difficult for adolescents to open up and self-
disclose.
• It makes it difficult for adolescents to engage in
exercises, such as role playing, where they
might worry about appearing "silly."
• Adolescents who are referred for therapy are
often there against their will and are motivated to
act in a rebellious manner toward the therapist.
• This may be exacerbated in a group of
adolescents, where no adolescent may want to
appear to be a "wimp" who is conforming to what
the authority figures want.
 In elderly….

• Insight oriented therapy

• Supportive psychotherapy
Tross and June E. Bllum(1988)
• Insight oriented therapy • Supportive psychotherapy
includes: – Resocialization Group
Therapy
– psychoanalytic group – Art therapy
therapy – Cognitive Behavioral Group
– Psychodrama and Life Therapy
Review Group Therapy – Social Skills Training group
– Remotivation Therapy
• working through of • Deals with current stresses
emotional conflicts that and relationship.
have persisted
throughout a life time
 Group psychotherapy in anxiety and mood
disorders
Anxiety disorder: Mood disorder:
• Group in-vivo exposure • Imagery techniques
• Role playing
• Relearning
• Working through of grief
• No contraindications to reactions
treatment of the anxiety • Reconceptualise the meaning
disorders with some of the traumatic events
form of group • Contraindicated for patients
with manic episodes, suicidal
psychotherapy
or homicidal patient
 Group psychotherapy for
personality disorders
• Poor responders to group therapy.
• If a therapist is successful in motivating
them, it remains a fact that they can gain
some insight into their asocial
characteristics and may try to change to
some extent.
• Borderline personality disorder perceive each
other as offensive, angry, unpredictable, fear-
inducing and disloyal.
• Schizoid personality disorder appear to be
remote, detached and uninterested in their
social surroundings. They appear to live in
dream world; they seem to be' unmotivated and'
passive. they do not show interest in
participating in group situation
• These patients do not show interest in
participating in group situation
 Group psychotherapy for
substance abuse problems
Alcoholics Anonymous is one of the most
successful methods for the following
reasons:
– More cost-efficient
– Powerful learning effects in groups.
– overcoming denial
– Improving self awareness.
– Easier to see things in others before one sees
them
In this intervention, a group of people who are involved in the
alcoholic's life are brought together. This group, which may consist of
his wife, children, boss, friends, and so on. The group gives him
concrete feedback on incident after incident in which his drinking has
negatively affected their lives. The alcoholic, now is made vividly
aware. Here, he is confronted with an irrefutable pattern of evidence.
Often, after such an intervention, the alcoholic is willing to enter a
treatment program.
A word of caution:

The coaching by the therapist is done so that the feedback is given in

as loving and nonjudgmental a form as possible
Benefits of group therapy:

Become aware of one's problem and to accept its existence.

Efforts are made to explore the underlying feelings

Childhood roots of the problem are explored and discussed.

Develop and identify more positive values and goals.

 To develop better coping skills

 Group psychotherapy with the
chronically mentally ill
Techniques can be explored across three levels:
• Insight-oriented therapies help members gain an
understanding of their maladaptive internal and
external responses. Transferences in the group are
group are explored.
• Social skills training include role playing, the practice
of self-assertion, and problem solving.
• Supportive therapies provide sense of belonging,
decrease isolation, and strengthen coping and
problem-solving capacities in the external world.
Positive transferences are encouraged.
 Group psychotherapy
for eating Disorders
The groups for eating disorders work similar to
substance abuse groups. The following
components are included:
• Educational component: Members are given
information on diet, eating, and health.
• Coping skills are taught : challenging
dysfunctional cognitions when one is feeling
depressed or lonely, dealing with stress. This
will help bulimic clients avoid using food as a
way of coping.
• Helping the client "get a life“ : Focus
clients on positive, productive activities to
make their lives more meaningful.
• Helping to learn to base their self-esteem
on things other than their appearance, and
the link between self-esteem and body
image are explored.
• Focus clients away from talking about
food and eating.
 Group psychotherapy for
Impulse-control disorders
• Patients with impulse control disorders are best
treated in homogeneous groups with the primary
focus on controlling the symptom of the maladaptive
behavior.
• The patient’s explosive, overly physical, or verbal
aggressiveness threatens the sense of security
within the group and interferes with ongoing work.
• External controls usually have to be provided to
treat impulsive patients.
 Group psychotherapy for
schizophrenia
• Study findings suggest that nondirective approach
and emphasis on insight often created intolerable
anxiety for psychotic patients.

• The importance of belongingness (group

cohesiveness), therapist effectiveness and clarity of
focus and the value of patient’s learning from each
other through their interactions in the group are very
important.
(Gerome Frank, 1955).
• Activity group psychotherapy helps in decreasing social isolation and
improving the chance for discharge in chronically regressed hospitalized
schizophrenia patients·
(John Beard et aI, 1958).
• Slavson (1961) described’ some dangers of Psychoanalytic
exploratory group psychotherapy and said that reality oriented
discussion might be more therapeutic.

• M.Horowitz and P.Weisberg (1966) described the value of directive

techniques in inpatient schizophrenic groups that actively encouraged
group cohesiveness and patient participation and discouraged self
inflecting responses.
 CONCLUSION
Group therapy may be one of the waves of the future. Most
psychological problems are interpersonal, not just
intrapsychic, so group therapy may be a superior form of
treatment. It is clearly more economical than individual
therapy. Greater number of people can be treated in less
time with fewer therapists. As therapy and self help groups
can be effective, they also have the potential to be harmful.
Charismatic group leaders can create group climates in
which those who do not conform are criticized and
ostracized in ways that are psychologically harmful.
Pressures toward uniformity, implicit group norms of which
group is not explicitly aware, and other factors can push
groups in dysfunctional directions. Groups create their own
‘realities,’ which can then get imposed on individual
members to their detriment, often in the guise of ‘helping
them face up to themselves.