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Group therapy
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Introduction

• Group therapy or group psycho therapy is a less
  time consuming procedure in which usually 8-10
  people can be treated at one time.
• Joseph Pratt first used this in 1905.

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• Group therapy may be utilize psycho analytic,
  supportive, transactional or behavioral
  approaches.
• The sessions are held once or twice a week, with
  each session lasting 1-2 hours, the patients
  usually sit in a circle.

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Definition

• Group therapy or group psychotherapy is a form of
  treatment in which carefully selected,
  emotionally ill patients are placed into group,
  guided by a trained therapist for the purpose of
  changing the maladaptive behavior of the
  individual member.

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Purposes

• To intervene in psychopathology
• To reveal, examine and resolve distortions in
  interpersonal relationships
• To improve the skill of relating to others
• To learn coping styles

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Therapeutic functions of Group therapy (Yalom)

• Imparting of information
• Instillation of hope
• Universality
• Altruism
• Corrective recapitulation of the Primary Family
  Group.

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Contd

• Development of socializing techniques
• Imitative behavior
• Interpersonal learning
• Group cohesiveness
• Catharsis

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Types of group therapy

• 1. According to size
• A. Small
• B. Large
• 2. According to diagnosis of clients
• A. Homogeneous group
• B. Heterogeneous group

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• 3. According to nature of group
• A. Primary group
• B. Secondary group
• 4. According to purpose
• A. Psychoanalytic group therapy
• B. Transactional Analysis
• C. Rational- emotive therapy

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• D. Gestalt therapy
• E. Interpersonal Group therapy
• F. Psycho drama group
• G. Encounter Groups
• H. T- groups
• I. Community support groups
• J. Marathon groups

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Psychoanalytic group psychotherapy

• Group communication is focused on the three
  levels of unconscious, semiconscious and
  conscious material.
• The group focuses on interpretation of dreams,
  free association, and other latent content
  product in the group. The therapist turns these
  experiences into conscious, healthy learning
  experiences for the client.

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Transactional analysis

• The three ego stages of the individual- the
  parent, the child, the adult-are examined in TA
  group.

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Rational emotive therapy

• It aims to maximize a persons rational thinking

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Gestalt therapy

• It emphasizes on self-
  expression, self- exploration and self awareness
  in the patient. Clients and therapist focus on
  every day problems and try to solve them

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Interpersonal group therapy

• It explores the members
  anxiety and stress and their effects on the
  individual. It is believed that anxiety from
  interpersonal relationships is reduced or
  relieved through interpersonal support.

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Psychodrama group

• During psychodrama, the client produces a topic
  to be explored. The therapist directs the subject
  through role playing of scenes related to the
  topic and incorporates the use of therapeutic
  ideas in the action.
• A catharsis occurs for the subject and also for
  the audience.

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Encounter groups

• It aims at bringing personal change as a result
  of deeply felt experiences.

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T- groups

• The goal is to verify experimentally the T-group
  method. This involves the study of group norms,
  roles, communication distortions, and the effect
  of authority on behavior patterns personality and
  coping mechanisms.
• Group members receive feedback by exposing
  themselves to others in the group, and they also
  experiment with new and more productive behavior.

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Community support groups

• It provides identification, clarification,
  understanding, role modeling, feeling of
  togetherness, and group cohesion.
• They help individual member from being lonely and
  depressed.
• They help the members decrease levels of stress
  and increase levels of self-acceptance. The
  members develop new or more effective patterns of
  behavior.

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Marathon groups

• The term marathon group refers to the amount of
  concentrated time the participants spend together
  as a group. These sessions may last from 12 hrs
  to 2,3 or more days, allowing short periods away
  from the group for sleeping and eating.
• These groups have a clearly stated goal of
  personal change or growth of the participants.
• Size of group 8-10 members, duration of each
  session is 1-2 hrs, frequently everyday or 3 days
  in a week.

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Stages of group therapy

• Initial stage
• Involvement among members is superficial
• Members are becoming acquainted with each other
• They search for similarity between themselves and
  other group members
• Some amount of structuring of group norms, roles
  and responsibilities take place

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• Working Stage
• Members get into Work accomplished
• Freely approach each other, discuss their
  problems and attempt to solve their problems.
• Conflict and cooperation surface during the work
  group.

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• Termination stage
• . Evaluating and summarizing the group experience
• . Exploring positive and negative feelings about
  group experiences.
• . Evaluation of the goals been achieved

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Criteria of patients to be included in group
therapy

• Ability to communicate
• Willingness to share his problems with others
• Motivation to change
• Patients with authority anxiety
• Patients using defense mechanism of projections,
  repression, denial, suppression, transference
  reactions.

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Factors contributing to group therapy

• Faith in the treatment procedure
• Universality of problems
• Direct guidance for the problem
• Altruism
• Development of socializing skills

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• Imitative behavior
• Catharsis
• Conflict resolution
• Acceptance of reality
• Group cohesiveness
• Interpersonal learning

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Therapeutic interventions/techniques in the
group therapy

• Approval
• Acceptance
• Clarification
• Exploration
• Identification
• Interpretation
• Information giving

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• Encouraging expression of feelings or ideas
• Reassurance
• Support
• Understanding
• Reflection
• Listening
• Teaching
• silence

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• Structuring
• Limit setting
• Transference and counter transference
• Themes

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Advantages of group therapy

• Cost effective
• Decreases the feeling of isolation, uniqueness
• Enhances problem sharing
• Opportunity to explore specific styles of
  communication in a safe atmosphere
• Lear multiple ways of solving problems from other
  group members
• Learn socialization skills
• Group provides for its members understanding,
  confrontation and identification with more than
  one individual.

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Disadvantages

• Individual privacy is destroyed
• Resistance and reluctant to change
• Therapist at times dominates in the therapy
  session

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Nurses roles in group therapy

• Group task role
• Aim is to identify group problems
  and select methods to solve those problems.
• Seeks clarification
• Suggests or proposes new ideas
• Asks for opinions or values pertinent to what the
  group is undertaking
• Gives information, offers facts or generalization0

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• Gives his/her opinion by stating his/her ideas
  and values about group suggestions
• Elaborates the meaning of suggestions offered to
  the group
• Coordinates shows or clarifies how ideas can work
• Orients the group on target by defining where the
  group is in relationship to its goal.
• Evaluates the accomplishment of the group in
  relation to its task
• Motivates the group to greater productivity
• Records the productive discussions

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• Group building and maintenance roles
• Aim- to strength, regulate and perpetuate the
  group members to function as whole group
• Encourages and accepts the contribution of others
• Reconciles differences between group members
• Admits his/others error to maintain group harmony
• Keeps communication open and provides encouraging
  remarks
• Sets group goals and evaluate the group
  functioning
• Observe group discussion, gives feed back and
  interprets

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• Individual role
• Aim meet the needs of the group member and not
  the group. This hampers group functioning, we
  need to be aware of
• Expresses aggression, which deflates the status
  of individual and group accomplishment
• Resists progress by arguing or disagreeing beyond
  reason
• Calls attention to himself/ herself through
  boasting and pointing out his achievements.

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• Gives self confession by expressing his/her
  feelings and ideology not related to the group,
  but uses the group audience
• Demonstrates his/her lack of involvement
• Asserts his or her authority and superiority in
  manipulating the group or certain members of the
  group.
• Seeks help or tries to elicit sympathy from the
  group
• Tries to have his/her own biases and prejudices.
• Individually oriented behavior

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• Some basic roles of nurses
• Determine setting and size of the group
• Choose frequency and length of group sessions
• Select a therapist/ co therapist for group
• Formulate policy on group therapy with other
  therapeutic modalities
• Formulating appropriate goals

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• Selecting patients who can perform the group
• Preparing patients for group therapy
• Build the culture of the group explicitly and
  implicitly
• Explaining the group members to maintain the
  confidentiality of the group activities.
• Identify and resolve the petty problems of the
  group

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• Fix up time for the subsequent sessions
• Maintain attendance group members
• Obtain written informed consent from the group
  members
• Maintain strict discipline and confidentiality
• Document all the sessions
• Monitor the group members behavioral changes

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