Section 5: Therapeutic Groups

What is a group?

Broadly speaking, a group consists of three or more persons who influence each other and are influenced by others. Beyond this, little else about groups is accepted as consensus.

How extensively is group therapy used?

Group therapy has been recognized as a therapeutic procedure for many years. Groups of all varieties are now available to cater to those seeking help for serious psychological problems, to those experiencing situational crises and to healthy individuals who wish to expand their self-awareness and increase their level of interpersonal functioning.

What are some of the possible group variables?

1. Setting
2. Group size
3. Group composition
4. Membership selection
5. Group content
6. Group goals
7. Duration of the group
8. Group norms
9. Group dynamics
10. Therapeutic factors
11. Leadership style
12. Frame of reference
13. Group cohesion

Based on various combinations of these variables there are five types of groups:

1. Therapy groups
2. Training groups
3. Guidance groups
4. Counseling groups
5. Encounter or sensitivity groups

What is terminology used regarding groups?

The group content refers to what the group discusses, while the group process refers to how the discussion is conducted. To be an effective group member or leader, one must be able to both participate in the discussion and observe what is going on. Group cohesion refers to the interacting forces that keep the group together. Group cohesiveness can be evaluated by such factors as whether or not members attend regularly, whether they are punctual and the level of trust and mutual support that members express toward each other. Group norms are closely related to group cohesiveness and refer to the formal and informal rules that govern what is considered to be appropriate behavior within the group. It is important that groups establish their formal norms at the outset of the group experience. Group goals refers to the desired achievements of the group. Group dynamics refers to the interaction among members of a group, each of whom is dependent on the other. The group is capable of exerting pressure on a person to change their behavior, but that person also influences the group.

How is a group established?

1. Decide on the type of group to be set up;

2. Substantiate that there is a need for such a group;

3. Decide on the goals of the group;

4. Choose an appropriate setting for the group to meet. The place chosen should be safe, private, consistently available, comfortable and contain adequate furniture;

5. Identify a suitable group leader (that person may change as the group evolves);

6. Establish formal norms for the group, e.g., group size, group composition, eligibility for group membership, times, duration and frequency of meetings, life span of the group, protocol for admitting new members to the group, unacceptable behaviors of group members and the consequences of such behaviors, etc.;

7. Select and orient potential group members (usually the responsibility of the group leader);

8. Hold the first group meeting.

What are the stages of group development?

Formative Stages of a Group(months)	1. Search for meaning
	2. Conflict, dominance and rebellion
	3. Development of group cohesiveness
Advanced Stages of a Group(months to years)	4. Further group development with possible issues of sub-grouping, of a group conflict and self-disclosure
	5. Termination

When is group therapy contraindicated?

1. When the person is not motivated to participate in the group;

2. When the person is in a state of crisis and other members of the group are not;

3. When the person is deeply depressed and/or suicidal or homicidal;

4. When confidentiality is essential;

5. When the person has an unusual fear of speaking;

6. When the person's interpersonal skills are very poor;

7. When the person has very limited awareness of his or her own feelings, motivations and behaviors;

8. When deviant sexual behavior is involved;

9. When the person's need for attention is too great to be managed in a group;

10. When the person is acutely manic or psychotic.

What are the benefits of groups?

Yalom (1995) notes that the group process provides numerous healing factors intrinsic to the group itself. Some of the benefits of the group process are:

1. Generation of feelings of hope and optimism;
2. A sense of safety, comfort and support;
3. Identification of common goals and issues;
4. Exchange of useful constructive information;
5. Interpersonal learning and imitative behavior;
6. Recapturing the nurturing role of the primary family group;
7. Opportunity for verbalization and catharsis;
8. Encouragement and empowerment of participants;
9. Reduction of the sense of isolation and uniqueness;
10. Self-understanding and normalization of one's experiences;
11. Reduction of shame, guilt and stigmatization;
12. Enhancement of one's interpersonal and socializing skills;
13. An awareness of existential factors;
14. Unselfish regard for the well-being of others;
15. Prompt and direct feedback about one's behavior.

What are the limitations of therapeutic groups?

1. Some persons need individual help before they can function in or conform to a group.

2. The group can become caught up with "group process issues" and not spend enough time addressing individual concerns.

3. Some persons may find it difficult to be open and honest in a group setting.

4. Some clients and counselors expect too much from the group experience.

5. The counselor's role is very diffuse and therefore more complex since he/she must be able to simultaneously focus on the concerns of each client, respond to the interactions among group members and observe the dynamics of the group. For that reason, some persons may benefit at the expense of others from the group.

6. There is always the danger of breaches of confidentiality.

7. Pressure to conform to group norms can cause group members to inappropriately substitute the group's norms for their own.

8. Some clients fail to use knowledge gained during the group experience to improve their functioning in daily interactions.

9. Some clients misuse the understanding and acceptance of the group experience by venting their problems to the group without making any attempts to change their behaviors.

10. There is always the danger of psychological damage to group participants if the group's leadership is inadequate.

What are effective group leadership strategies?

1. To listen and observe;

2. To use effective communication techniques;

3. To be warm, caring, empathetic and genuine;

4. To afford each group member non-judgmental respect;

5. To give and encourage feedback which should be descriptive and not evaluative;

6. To gently confront discrepancies and disruptive behavior;

7. To use open-ended questions and leads, encouraging members to gain insight into their feelings and the sources of these feelings;

8. To be able to summarize and reframe problems in a more positive light;

9. To stay focused on the matter at hand, i.e., to be concrete;

10. To link the commonalities of the experience among group members so as to encourage member-to-member communication and dispel feelings of uniqueness;

11. To model desired behaviors;

12. To effectively manage transference issues and problem group members.

What are some of the more difficult character types to have in a group?

1. The monopolist
2. The acting-out, angry or disruptive person
3. The silent or withdrawn person
4. The psychopath
5. The critic
6. The insensitive or crude individual
7. The narcissist
8. The help-rejecting complainer
9. The borderline
10. The psychotic person

End of Section Quiz

Please circle the correct answer.

1.	Poor group leadership can be harmful to participants in a group.	T	F
2.	Group leaders need to be concrete.	T	F
3.	Narcissists are difficult to manage in a group.	T	F
4.	Group dynamics refer to what the group discusses.	T	F
5.	Formal group norms can be established as the group evolves.	T	F
6.	Persons in a state of crisis are usually managed in groups.	T	F
7.	The group experience provides an opportunity for verbalization and catharsis.	T	F
8.	Group leaders must always be male.	T	F
9.	Some persons may not benefit from a group experience.	T	F
10.	Group cohesion refers to the interacting forces that keep the group together.	T	F

Note: Answers to questions are on Appendix 2. Quiz Answers.

NOTES

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