TOPIC 2: THEORETICAL ORIENTATIONS AND AN OVERVIEW OF VARIOUS TYPES OF GROUP

INTRODUCTION
Group Therapy is a type of therapy where a small group of individuals (6-12 members) meet with a trained group therapist for the purpose of personal growth and healing. Members agree to maintain confidentiality to not discuss any group content outside the group. During sessions, members decide what they want to talk about, and while openness is encouraged, no one is forced to reveal information that they choose to keep private. Through interacting with others in the group, members learn and understand more about themselves and their effect on others through the feedback they receive, and thereby can improve their interpersonal relationships.

 Group therapy encompasses many different kinds of groups with varying theoretical orientations that exist for varying purposes. All therapy groups exist to help individuals grow emotionally and solve personal problems. All utilize the power of the group, as well as the therapist who leads it, in this process.

 Group therapy approaches include behavior therapy, psychoanalytic therapy, sensitivity training, or Gestalt psychology (see psychotherapy). The composition of groups varies as well, with family therapy and marriage counseling common forms in recent years. Peer group therapy usually consists of a group of individuals who have similar problems, and can be mediated by a psychoanalyst or by the members themselves.

HISTORY OF GROUP THERAPY

Group therapy in the United States can be traced back to the late nineteenth and early twentieth centuries, when millions of immigrants moved to American shores. Most of these immigrants settled in large cities, and organizations such as Hull House in Chicago were founded to assist them adjust to life in the United States. Known as settlement houses, these agencies helped immigrant groups lobby for better housing, working conditions, and recreational facilities. These early social work groups valued group participation, the democratic process, and personal growth.

TYPES OF THERAPY GROUPS

PSYCHODYNAMIC THERAPIES.
Psychodynamic theory was conceived by Sigmund Freud, the father of psychoanalysis . Freud believed that unconscious psychological forces determine thoughts, feelings, and behaviors. By analyzing the interactions among group members, psychodynamic therapies focus on helping individuals become aware of their unconscious needs and motivations as well as the concerns common to all group members. Issues of authority (the relationship to the therapist) and affection (the relationships among group members) provide rich sources of material that the therapist can use to help group members understand their relationships and themselves.

PHENOMENOLOGICAL THERAPIES.
Until the 1940s virtually all psychotherapy was based on psychoanalytic principles. Several group therapy approaches were developed by psychoanalytically trained therapists looking to expand their focus beyond the unconscious to the interpretations individuals place on their experiences. Underlying this focus is the belief that human beings are capable of consciously controlling their behavior and taking responsibility for their decisions. Some phenomenological therapies include:

PSYCHODRAMA
Developed by Jacob Moreno, an Austrian psychiatrist, this technique encourages members to play the parts of significant individuals in their lives to help them solve interpersonal conflicts. Psychodrama brings the conflict into the present, emphasizing dramatic action as a way of helping group members solve their problems. Catharsis, the therapeutic release of emotions followed by relief, plays a prominent role. This approach is particularly useful for people who find it difficult to express their feelings in words.

PERSON-CENTERED THERAPY
a therapeutic approach developed by the psychologist Carl Rogers. Rather than viewing the therapist as expert, Rogers believed that the client's own drive toward growth and development is the most important healing factor. The therapist empathizes with the client's feelings and perceptions, helping him or her gain insight and plan constructive action. Rogers's person-centered therapy became the basis for the intensive group experience known as the encounter group, in which the leader helps members discuss their feelings about one another and, through the group process, grow as individuals. Rogers emphasized honest feedback and the awareness, expression, and acceptance of feelings. He believed that a trusting and cohesive atmosphere is fundamental to the therapeutic effect of the group.

GESTALT THERAPY
In the 1940s Fritz Perls challenged psychoanalytic theory and practice with this approach. Members take turns being in the "hot seat," an empty chair used to represent people with whom the person is experiencing conflicts. The therapist encourages the client to become aware of feelings and impulses previously denied.

BEHAVIOR THERAPIES.
Behavior therapies comprise a number of techniques based upon a common theoretical belief: maladaptive behaviors develop according to the same principles that govern all learning. As a result, they can be unlearned, and new, more adaptive behaviors learned in their place. The emergence of behavior therapies in the 1950s represented a radical departure from psychoanalysis.

COGNITIVE BEHAVIORAL Therapy

has been demonstrated by many research studies to be the most effective approach to therapy for a variety of psychological problems. The therapy relationship is collaborative and goal-oriented, and the focus on thoughts, beliefs, assumptions and behaviors is key. In CBT, the goal is for a person to develop more realistic and rational perspectives, and make healthier behavioral choices, as well as to feel relief from negative emotional states. Specific techniques, strategies and methods are used to help people to improve their mood, relationships and work performance. A CBT approach may be used in individual therapy, couples counseling and group therapy.

SCHEMA THERAPY
is similar to cognitive therapy in that the focus is on correcting problems in a persons habitual patterns of thinking and feeling, and corresponding difficulties in his or her behavioral coping style. The focus is on identifying and understanding, and then challenging and overcoming the long-standing maladaptive patterns in thinking, feeling and behavior that create obstacles for a person in getting needs met and attaining life goals. As with standard CBT, the goal is for the person to feel better and enjoy greater life satisfaction

WHO BELONGS IN A THERAPY GROUP?

Individuals that share a common problem or concern are often placed in therapy groups where they can share their mutual struggles and feelings. Groups for bulimic individuals, victims of sexual abuse , adult children of alcoholics, and recovering drug addicts are some types of common therapy groups. Individuals that are suicidal, homicidal, psychotic, or in the midst of a major life crisis are not typically placed in group therapy until their behavior and emotional states have stabilized. People with organic brain injury and other cognitive impairments may also be poor candidates for group therapy, as are patients with sociopathic traits, who show little ability to empathize with others.

HOW ARE THERAPY GROUPS CONSTRUCTED?

Therapy groups may be homogeneous or heterogeneous. Homogeneous groups, described above, have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups contain a mix of individuals with different emotional problems. The number of group members typically ranges from five to 12.

HOW DO THERAPY GROUPS WORK?

The number of sessions in group therapy depends upon the group's makeup, goals, and setting. Some are time limited, with a predetermined number of sessions known to all members at the beginning. Others are indeterminate, and the group and/or therapist determines when the group is ready to disband. Membership may be closed or open to new members. The therapeutic approach used depends on both the focus of the group and the therapist's orientation.

HOW ARE PATIENTS REFERRED FOR GROUP THERAPY?

Individuals are typically referred for group therapy by a psychologist or psychiatrist. Some may participate in both individual and group therapy. Before a person begins in a therapy group, the leader interviews the individual to ensure a good fit between their needs and the group's. The individual may be given some preliminary information before sessions begin, such as guidelines and ground rules, and information about the problem on which the group is focused.

HOW DO THERAPY GROUPS END?

Therapy groups end in a variety of ways. Some, such as those in drug rehabilitation programs and psychiatric hospitals, may be ongoing, with patients coming and going as they leave the facility. Others may have an end date set from the outset. Still others may continue until the group and/or the therapist believe the group goals have been met. The termination of a long-term therapy group may cause feelings of grief , loss, abandonment, anger, or rejection in some members. The therapist attempts to deal with these feelings and foster a sense of closure by encouraging exploration of feelings and use of newly acquired coping techniques for handling them. Working through this termination phase is an important part of the treatment process.

WHO DROPS OUT OF GROUP THERAPY?

Individuals who are emotionally fragile or unable to tolerate aggressive or hostile comments from other members are at risk of dropping out, as are those who have trouble communicating in a group setting. If the therapist does not support them and help reduce their sense of isolation and aloneness, they may drop out and feel like failures. The group can be injured by the premature departure of any of its members, and it is up to the therapist to minimize the likelihood of this occurrence by careful selection and management of the group process.