The Wiley-Blackwell Handbook of Group Psychotherapy

Jeffrey L. Kleinberg

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9781119050315, 9780470666319
• eBook ISBN: 9781119979975
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Group Psychotheraphy

"Finally, we have a book about group therapy that answers the question, 'Is there one book that covers the waterfront but is deep enough to provide more than just an overview of models, and can actually help me become a better group therapist?' This is such a book."

International Journal of Group Psychotherapy

"This volume reflects the expansion in the field of psychodynamic group psychotherapy that today incorporates a variety of theoretical perspectives. Leading experts from various countries provide the reader with a clear overview of the different approaches. In addition, there are chapters in this volume that deal with special populations and conditions of treatment. While providing a straightforward introduction to the plethora of material in the field, the volume will also serve as a comprehensive resource for any seasoned group psychotherapist."

Howard D. Kibel, Professor of Psychiatry, New York Medical College and past President of the American Group Psychotherapy Association, USA

The Handbook of Group Psychotherapy is a user-friendly guide to conducting group psychotherapy in various settings and with different populations. It has been designed as a resource for new professionals, including graduate students in mental health, as well as more seasoned clinicians planning to integrate group psychotherapy into their work.

Bringing together pre-eminent group psychotherapists from different theoretical perspectives and countries, the articles in this volume present their approaches to conducting groups with diverse populations in different settings. Written in straight-forward, jargon-free language, the articles directly speak to the needs of the mental health professional planning to begin a group or to strengthen an existing group. Whether combined with a formal class in group techniques, human relations, or group dynamics, or in an institute training group practitioners, or read as part of one's own professional development, this work is likely to advance the reader's clinical competency and strengthen their self-confidence as a leader.

Using a personal style and speaking from years of experience, the contributors provide hands-on suggestions as to how a group leader really works. From determining patient or client needs, developing treatment goals, and constructing a group, to handling emergencies, the contributors address the needs of the new group leader. The articles also address issues of diversity and globalism, as well as trauma and resiliency, making this a truly post-9/11 contribution.

1

Introduction to Group Psychotherapy

Jeffrey L. Kleinberg

Group psychotherapy is widely practised with different populations, in different settings, using different approaches based on different theories of the mind, with different degrees of success. The accent here is on differences. How is a clinician new to this modality to make sense of this diversity and formulate a personal approach to leading a group? One’s group leadership supervision, course work, and conferences, are indispensible for professional development. But what has been lacking is a current, ready-reference that briefs the leader on forming, beginning, and sustaining the treatment in ways that address the therapeutic needs and developmental status of the patients. By ready-reference I mean one that is accessible to the reader who does not want to get bogged down in jargon and a “one-size-fits-all” approach. I believe that our authors – representing the best in the field – have composed a reader-friendly text that “speaks” directly to the needs of current group therapists who want to refresh their leadership approach, to those of individual therapists who wish to expand their practices to include group treatment, and to the concerns of graduate students in mental health and allied fields wishing to learn this modality. Accordingly, an experienced or would-be group leader can turn to just about any chapter and pick up words of wisdom that will come in handy as a group is being put together or is trying to stay on track.

The chapters herein can guide the new practitioner of a group through the phases of selecting members, treatment planning, beginning the group, and developing carefully crafted strategies, reaching treatment goals.

This Handbook presents a variety of theoretical models, conducted in a variety of settings, within diverse cultures – with patients presenting many types of problems and personalities – and using technical approaches relevant to all these factors. My hope is that exposure to many models of thinking and working will help each new group leader find a voice and develop personalized, but informed operating assumptions.

The publication of this Handbook comes at the right time. The context within which groups are conducted has changed from what it was 20 years ago, when the last edition appeared. Today, a greater percentage of groups are taking place in agency, hospitals, schools and other community settings than before when so many groups were held in private offices and were primarily an adjunct to individual treatment. Significantly, groups today are not only geared to those suffering from mental illness, but are also geared towards others finding themselves in stressful circumstances. Group has spread to other nations, and is no longer a Western cultural phenomenon. Groups are used to respond to trauma, ranging from terror attacks to natural disasters. Group strategies are now based on a variety of theories, some of which have come to fruition in the last 20 years, and have arisen in response to emergent cohorts who did not respond to more traditional approaches. New challenges call for newer responses.

There is also a shift in the political and economic climate. There is less money for training. Managed care and the need for evidenced-based treatment modalities put additional strain on the clinician. Now, more than ever, the group therapist needs to be able to state what she does, and why she does it, and at the same time be competitive in the market place for the shrinking available dollars. Group does offer help here in that what we do is cost-effective and can be described in terms that objective observers can understand. Improving interpersonal communication skills, stress reduction, overcoming the effects of trauma, providing peer support, strengthening couple ties, and addressing mood instability can be clearly depicted. Group treatment still complements individual counseling and can enhance its impact, yet even alone, can treat the psychologically impaired or stressed.

What is the Role of Group in a Treatment Plan?

• Group is a platform through which the therapist and the individual can assess deficits in emotional functioning.
• Group experiences can promote insight into what establishes and continues dysfunctional behavior in interpersonal situations, such as family life, intimate relations, work and friendships.
• Group is an arena for patients to experiment with new behavior that could lead to improved relationships.
• Group is a place to get feedback from peers as to how one’s behavior is experienced by others.
• Group is a setting in which distorted perceptions of others can be identified and revised.
• Group enables the patient and therapist to agree on what the barriers are to more satisfying relationships.
• Group interaction provides behavioral samples for measuring the extent to which treatment is progressing, and for making mid-course corrections in the clinical strategy.

Of course these are the potential benefits of group. Unfortunately, too many group patients drop-out before realizing them. My experience as a teacher, supervisor, group leader (and as a group patient!) tells me that we need to be more thoughtful in selecting patients, constructing the group, preparing each potential participant, overcoming barriers, and consolidating gains. While the Handbook is organized by topic, I have created an outline that correlates therapist required knowledge, attitudes and skills with specific sections. Thus, the text can be read in a linear fashion, or by identified need.

The group leader needs to have the relevant clinical skills, knowledge of theory, knowledge of group dynamics, a self-reflective capacity to track and incorporate ongoing emotional responses, and a commitment to continuous professional development.

I am reminded of what Ornstein (1987) said about the four phases of learning to work as an individual therapist. Adapting his formulation to group training, one learns how to feel as a group therapist; how to behave and talk as a group therapist; how to think as a group therapist; and, how to listen as a group therapist.

Leading a group feels different from working as an individual therapist. The novice experiences himself as more exposed, more strongly influenced by the collective needs of his patients, more confused by what is going on and as a cumulative result of these variables, less certain as to how to proceed. These stressors often place roadblocks in the way of training.

Behaving and talking as a group therapist one is directed to the goals of establishing and maintaining an effective working alliance with each patient and the group-as-a-whole. These alliances make the work of therapy possible. Without sufficient safety and tension regulation members can become closed to reflection, and change, and the group could breakdown.

Thinking as a group therapist is based on a set of assumptions as to what would lead to positive change. Specifically, the leader needs to be concerned with what contributes to the development of each patient within the group and what could strengthen the therapeutic climate of the group-as-a-whole. Thinking about groups requires a theoretical base from which clinical strategies can be launched. Theories must explain both individual and group dynamics, and the effects of their interaction. Insights about human behavior, what makes people mentally ill and what makes them better can be drawn from a number of theories. The leader, herself, has the task of integrating these viewpoints until she develops her own therapeutic stance.

If you are like most group therapists, you started out as someone who worked with individuals. In contrast to many professionals, I think leading a group requires skills that are different from one-to-one work. The challenge of a group therapist is to simultaneously track and respond to the individual’s responses, the dyadic relationships as well as the group-as-a-whole dynamics. Since all three domains affect one another, the therapist does indeed act like a conductor – bringing to the fore one or two elements, and focusing the group on a particular part of the process. Which one to spotlight depends very much on where the affect is, where the conflict is or where the action is as a major a common theme is played out. To make the right choice of focus at the right time requires a quick decision within the therapeutic moment – where the biggest gains in understanding and therapeutic change may be found.

The multidimensional arena of group can best be understood through the application of theory drawn from the literature of the various components of the group process – individual, dyadic, group, organizational and cultural dynamics. Adding to the challenge is the likelihood that the therapist will have different, albeit sometimes complementary, reactions to her experience with the different constituencies. The task of the leader, then, is to be able to select what is the figure and what is the ground, and to understand and respond, according to the therapeutic needs at a particular time. Factoring in the role of one’s own emotional reactions in the perception of what is taking place is essential for empathizing with the members and to be objective in the choice of interventions.

From my experience as a clinician, first, and then as a supervisor and trainer, I think it is helpful to break down the job of the group therapist in ways that help her assess what she needs to strengthen her performance. The leader should be able to apply clinical skills, to assess prospective group members, to select who is appropriate for a given group. They must have the ability to develop a treatment plan for each member, compose the group so that the patients can form a therapeutic climate, begin the group, and implement strategies for achieving the goals established for each participant. This array of skills is informed by knowledge of three kinds of theories: personality, developmental (curative), and group dynamics. Integrating and applying these theories to a specific group of patients, with specific needs, in a particular setting is necessary in the design of a treatment strategy. Self-awareness enables the group leader to use her feelings to gain insight into what the members experience and to identify when one’s own issues get in the way of the clinical work. Knowing how one learns, and can learn, to be an effective leader forms a roadmap to leadership development.

This role and task analysis in Table 1.1, serves as the basis for a functional index as an alternative access point to the sections herein. Specifically, this reference list can bring the reader into contact with authors who speak specifically to the skills and knowledge expected of a group leader. In other words, using this functional index enables the learner to create a personalized menu of sections to meet her training needs. (In presenting this table I do not imply that other sections may not be relevant to a particular task or role. Rather, I am pointing to primary resources, but encourage the reader to explore other sections as well in their personal search.)

Table 1.1 Knowledge and skills required of group therapists and sectional references in handbook.

I. Clinical Skills (CS) a. Evaluating prospective group members: Sections 2 and 3. b. Developing a treatment plan: Sections 2 and 3. c. Designing treatment strategies: Sections 1, 2 and 3. d. Deciding optimal group composition: Sections 1, 2, 3, and 4. e. Preparing patients for group: Building working alliances: Sections 1, 2 and 3. f. Preparing group for new members: Strengthening cohesion and empathic attunement: Sections 1, 2, and 3. g. Monitoring tension levels of individual patients and of group-as-a-whole: Sections 1, 2, and 3. h. Managing tension to maintain optimal levels so work can proceed: 1. Responding to empathic failures: Sections 1 and 2....

Table of contents

• Cover
• Title page
• Copyright page
• Contributors
• 1 Introduction to Group Psychotherapy
• Section One: Building the Frame: Theoretical Models
• Section Two: Groups for Adults
• Section Three: Groups for Children
• Section Four: Diversity
• Section Five: Through a Personal Lens
• Author Index
• Subject Index