101 Interventions in Group Therapy

Scott Simon Fehr

• Publisher: Routledge
• Year: 2016
• eBook ISBN: 9781317328810
• Edition: 2
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This newly revised and expanded second edition of 101 Interventions in Group Therapy offers practitioners exactly what they are looking for: effective interventions in a clear and reader-friendly format. This comprehensive guide provides 101 short chapters by leading practitioners explaining step-by-step exactly what to do to when challenging situations arise in group therapy. Featuring a wide selection of all new interventions with an added focus on working with diverse populations, this comprehensive volume is an invaluable resource for both early career practitioners as well as seasoned group leaders looking to expand their collection of therapeutic tools.

1	On Second Thought Demonstrating Different Levels of Perception Toby Berman

Introduction

How Perceived Individual Differences can Bring us Closer Together

It is truly amazing that people ever really understand each other. We all come from different histories and experiences, although some may seem comparable, besides we all have a different understanding of the use of language plus we differentiate in the personal understanding of the continuum of known vocabulary. These obvious separations in fact do just that. They separate individuals from each other. In order to bring people together in a healthy environment, we as therapists need to demonstrate that no matter what the differences may be we are all very much alike. We have the same hopes, dreams and concerns that generally the person next to us, whether in the street, bus, plane etc. is experiencing.

Another separation that keeps people apart is their cautiousness with perceived differences. This person may be of a different color, race, education, religion, finance or just plain physical appearance. This felt separation is simply a component of judgment. Most people prefer the ease of comfort within their homogenous population. The judgment being if you are not like me, you and I will not develop an interpersonal relationship or friendship. So how do we alleviate this historical judgment and the inhibition of moving out of one’s comfort zone which in fact may have been handed down from generation to generation? We show that individual differences can truly be a remarkable component to being human with a profound opportunity of expanding our world.

Intervention

This intervention is really quite simple. We need to first show a group of people that part of what separates them is their different levels of perception of the same event. What is wonderful about the intervention is that there is no wrong or right answer thus eliminating competition and the fear of failure and not appearing intelligent thus demonstrating the uniqueness of each individual.

Procedure

1.  Simply find a few sentences that can be interpreted multiple ways.

2.  Write them on a board or hand out a sheet of paper with the sentences printed out.

3.  Ask the clients what these sentences mean and reiterate there is no wrong or right answer.

Examples

1.  He is a fine man. (What does that mean?)

2.  My father was very strict. (What does that mean?)

3.  Love is elusive. (What does that mean?)

As seen these sentences are generally not threatening sentences and can be interpreted in multiple ways. For example with sentence number 1, I have gotten responses such as “He is upstanding; He is responsible; He takes care of his family; He has a great ass, etc.” For sentence number 2, I have gotten “He was very rigid; He was controlling; He made rules that had to be followed; He made me take out the garbage once a week, etc.” For sentence number 3, I have gotten responses such as “I can never find love; Love requires a lot of work; People often say they love you but do not mean it; Love does not exist, etc.”

With the many responses gathered from groups of people, it is interesting to observe two or more people from different cultures, races and education respond similarly and to watch the faces of these individuals hear what they interpreted said by someone whom they believed to be so very different than themselves. There are also those interpretations that are so foreign to the other members in the group that they become thoughtful and admiring by saying, “I would never have thought that.”

These individual different interpretations begin to implement curiosity of the group members. They begin to want to learn more about the other people in their group. Interestingly, they start to seek components of each other’s personalities that are similar to theirs. It is not uncommon for a straight guy to say to a gay guy, “You know I am having that same kind of issue with my wife that you are having with your partner,” or an African American woman saying to a Caucasian woman, “Honey we are married to the same guy.”

What is so remarkable about this intervention is the ultimate closeness that develops from people who, at one time, would never have even spoken to one another.

Client Responses

Most of the clients with whom we used this intervention very much enjoy it. It is not uncommon for them to ask if I have any more sentences that they can play with while they are in group together. It is also to be noted that many of the clients wish to develop, over time, more personal relationships with each other, i.e. having their respective families meet or go for coffee after group. Unlike a typical process group where we discourage outside socialization, in this particular group we encourage it as it builds bonds. Like a process group, we request that what is disclosed outside of the group during these events be brought back into the group for further discussion and in fact creates a role model or template for others to follow.

Conclusion and Contraindications

Individual differences make the world we live in interesting and unique. If used appropriately this intervention can not only show our differences but also our sameness. It would appear that it is easier to harm someone who is not like ourselves and yet with others like ourselves, in many cases, an inhibition curtails the action.

There have not been any experienced contraindications for the clients with this intervention. The only contraindication that may be found is within the therapist. If he or she lacks the sensitivity to the nuances of the responses, the therapist will miss many opportunities to provide a developing bond for the group members.

Toby Berman, Psy.D., is on staff at Mount Sinai Hospital in Miami Beach, Florida. Dr. Berman practices group and individual psychotherapy as well as psychological testing. She has written chapters and articles in many books and journals.

2	Collateral Damage Joseph Shay

Theoretical Considerations

None of us wants to admit we cannot keep everyone safe in the room at all times. Readers, however, know there are unavoidable moments in group therapy that can be damaging to members. Given this reality, perhaps there are skillful ways to intervene to mitigate the damage.

My emphasis here is on what I call “collateral damage to another group member’s process.” By this I mean that the “damaging” member is actually engaged in acting out the very issues that brought him or her to group originally and is therefore engaged in a necessary reenactment which will thereby allow reflection and growth to occur. But progress for one group member may come at the expense of another.

Consider this clinical example familiar to readers (cf. Nitsun, 1996; Rutan, Stone, and Shay, 2014, chapter 14.) The group therapist asks Claire, a young woman in her first group session, “What are you feeling right now?” Claire replies, “I feel that people don’t really want me here and that everyone is judging me which is what I always felt when I entered a new school when I was little.” She continues, tearfully, “My parents never helped me integrate into the new school either.” Bob, another group member, says Claire is whining and he assumes that she contributed to her lack of integration by her attitude. Claire, taken aback, exclaims, “What? What are you talking about?” The therapist asks Claire how she feels right now. Claire replies, “I feel misunderstood. I feel rejected. I feel unsafe.” Bob says, “My parents never helped me adjust to school and I never complained. I got bullied by other kids and my father said, ‘Deal with it, Bob.’ I never whined.” The group and the therapist know that Bob is so flooded by his history that his comments are infused with projection and transference and the attendant bitterness and rage. But Claire does not know this and she flees the room. The group is stunned.

For Bob, the resurgence and working through of such early wounds is essential to his ultimate progress. But his reactions—until they are understood and worked through—have the potential of damaging any member on the receiving end of his projections, in this case the new member, Claire. When members are so activated in the recipient role that they cannot tolerate their own affects, let alone begin to reflect on the experience, they have experienced damage, if temporary, in the group as a collateral effect of another member’s necessary and inevitable group process.

Description of Group

This situation can occur in any group whether long-term, short-term, or theme-centered, that allows unstructured cross-talk and promotes open exchanges that can become affectively charged.

Intervention

The example above is a situation I have faced in different variations. The intervention described here was used in a long-term open-ended coed group, with the intervention made about three months into the life of the group.

In this group of eight, ages 25 to 50, members have begun to engage in deeper levels of sharing about their earlier lives and about their feelings in the room toward other group members. They are aware of the repetition in the group of childhood experiences and out-of-group interactions. Through exploration of these, the group is learning two things: first, the group is a petri dish for the appearance of earlier life experiences and second, the intensity of affect in the present is a marker that the affect is almost certainly fueled by experiences from the past.

Claire does return to the group session the day she flees but says, “I don’t want to talk about this anymore,” and for that moment, I agree. There are allusions to the experience in subsequent sessions. Three months later a similar situation arises.

Bob again accuses Claire of moaning and failing to admit fault, not realizing he is identifying with his aggressor father. Claire begins to weep and look toward the door. My intervention here is expressed in one paragraph though in actuality it is often broken into more bite-size comments across a session or several sessions. Rarely do I speak at such length but do so here for the sake of illustration.

In this intervention, because I am making a larger point to the group, I do not name Bob and Claire but I could just as easily have named them directly. The intervention has four parts: recognizing the process as having distortions within it; naming the potential benefit of the process; validating the feeling of being damaged during it; and expressing hope and belief that the group can tolerate and benefit from it.

Taken as a whole, I say, “There are a lot of really powerful feelings in the room, some of which did not originate here. That’s how group therapy is and what I tried to explain when I met with each of you before you came to group. I know this is hard. Remember, it’s the very intensity of the feeling that can give you evidence that something else is at work here, before any of you met each other. The beauty of group therapy is that you can get in touch with powerful feelings and express them but that doesn’t mean that the comments that come from those feelings are accurate about the person they are expressed to. They may be or they may not be.

“This can be a very painful part of group because a comment can come your way that really hurts you, and you can even feel damaged by it because it hits you in a vulnerable spot. But our goal together is to reflect on what gets activated in us so we can learn from it. As I’ve expressed before, group therapy is about action and reflection, and that action can sometimes feel painful to you before the reflection happens. The group is strong enough, and I am hopeful that each of you is strong enough, to be able to tolerate this process and to return each week to understand what happened.”

General Client Responses

In one such circumstance, a member who had been the one attacked replied, “Well, that sucks,” suggesting the intervention was not helpful to her. Another rejoined, however, “Remember what we’ve been learning; it’s not really about you. You don’t have to own that.” When group members really inhabit this idea—i.e., own what’s yours and reject what’s not yours—they are actually freed to own parts of the truth embedded in another member’s distortion of them.

Conclusion

There is a deeply human wish on the part of all group therapists to shield wounded individuals from further wounds. Group therapy is not the place for that, however, because as safe as we wish it to be, it is in the very re-experiencing of these wounds that corrective experiences and healing can occur. Generally speaking, group members in successful groups learn that experiencing pain in group interactions is part of, not a failure of, the healing process. To prepare them for that in the screening phase makes it less likely they will be damaged by it.

Possible Contraindications

This type of intervention is rarely contraindicated except when, in the working through of the process, the member who is “damaging” feels too shamed by the suggestion of distortion or projection, or the member who is “damaged” feels too invalidated by the implication that his or her feelings are overpersonalized.

References

Nitsun, M. (1996). The anti-group: Destructive forces in the group and their creative potential. London: Routledge.

Rutan, J. S., Stone, W. N., & Shay, J. J. (2014). Psychodynamic group Psychotherapy (5th ed.). New York: Guilford.

Joseph Shay, PhD, CGP, FAGPA, a psychologist in private practice in Cambridge, MA, has an affiliate position at the Harvard Medical School in the Department of Psychiatry, supervises at McLean and Massachusetts General Hospitals, and is on the faculty of the Psychoanalytic Couple and Family Institute of New England, the Northeaster...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Editor
• Foreword by J. Scott Rutan
• Preface
• 1 On Second Thought: Demonstrating Different Levels of Perception
• 2 Collateral Damage
• 3 Lesbians Grieving Heterosexual Privilege by Creating a Loss Totem
• 4 A Culture of Nice in a Women’s Group: It’s Nice to be Nice
• 5 Countertransference in Groups With Severely Ill Inpatients
• 6 The Use of Primal Scream to Facilitate Release in the African-American Male: Pain Demands to be Heard
• 7 Hiring a Group Coordinator Can Develop a Group Program
• 8 Who Owes You an Apology?
• 9 Not Just Talk: A Group Therapy Model Integrating Action Theory and Techniques
• 10 Anger: A Historical Account and an Ah Ha Moment
• 11 Battling the Alien: Working Through Self-Hatred in Group Therapy
• 12 A Ritual for Termination
• 13 Setting Group Culture Development in Motion
• 14 Only the Lonely: Trauma and Group Identity
• 15 The Efficacy of Wedding Cognitive Behavior and Psychoanalytic Psychotherapies in Group Psychotherapy for Incarcerated Male Population
• 16 Sparking Connection: Increasing Awareness, Engagement and Relatedness
• 17 Intercultural Group Therapy: Global Nomads, Expats and Lovepats
• 18 Back to the Future: Attending to Detrimental Family Loyalties
• 19 The Undecided: Helping Clients Make Decisions
• 20 Degree of Action and Structure in Format to Facilitate Group Cohesion
• 21 Attuning to Micro-Expressions in Group: A Relational Technique
• 22 The Group Therapist in the Making
• 23 Grounding: Coming into the “Here and Now” by Using Our Bodily Sensations
• 24 Post Traumatic Stress Disorder with Combat Veterans Using Cognitive Behavioral Group Therapy
• 25 The Group Sandwich Model for International Conflict Dialog Using Large Groups as a Social Developmental Space
• 26 A Five-Stage Technique to Enhance Termination in Group Therapy 8
• 27 Mindfulness Practice: Interventions for Working with Young Children in Groups
• 28 A Relaxed Approach to Treating Phobia
• 29 Building a Pathway to Success
• 30 Urge and Creativity in the Group Matrix: Applying Art Therapy Within Group Therapy
• 31 “I Am Positive There is More to Me Than HIV”
• 32 From Time to Time
• 33 Applying Expressive Therapies to Accelerate Cognitive Insight in Organizations
• 34 Treating Depression with a Dose of Anxiety
• 35 The Burden of Being Beautiful … Is 40 the End of the Road?
• 36 Transforming Failures Into Honey
• 37 Humility in the Face of a Mistake
• 38 Promoting Communication and Interaction in a Group of Sub-Saharan Africa Immigrant Women
• 39 Letting Go of the Myth of Closure: One Practitioner’s View
• 40 The Shielded Name Tent
• 41 Corrective Experiences in Intensive Group Psychotherapy
• 42 Mother-Daughter Interaction Through the Group’s “Hall of Mirrors”
• 43 Improving Emotional Processing With Group Psychotherapy
• 44 Who’s Responsible? Accepting and Integrating One is Not Always the Victim
• 45 Hot Air Balloon
• 46 Long-term Intergenerational Women’s Psychotherapy Groups
• 47 The Evolution of Gay Group Therapy
• 48 Group Therapy for Therapists
• 49 Refilling and Repairing Your Glass: Insightful Exercise for Dually Diagnosed Clients
• 50 Am I Modeling or Muddling? Cranking Up a New Group
• 51 Fireball
• 52 A Chair is Not a Chair is Not a Chair
• 53 The Masks We Wear
• 54 Animal Assisted Therapy With a Group of Young Children With Social Problems
• 55 “Am I My Mother’s Daughter?” Eliciting Self-Awareness in the Transmission of Gender Roles Through Family Role Models
• 56 Living with Dying: How to Keep the Group Alive When the Members are Dying
• 57 Bringing a New Member Into Group: Marking a New Place in the Cycle
• 58 The Crystal and the Stone: Use of Transitional Objects in Groups
• 59 You Can Teach an Old Dog New Tricks!
• 60 Using Dreams in Group Therapy
• 61 The Group Therapist as Storyteller
• 62 Using Primary Language to Access Primary Affect
• 63 “What’s so Funny?” The Group Leader’s Use of Humor in Adolescent Groups
• 64 Using Grammar to Increase Immediacy and Affect
• 65 Group as a Place to Practice New Behaviors
• 66 Counterresistance: Its Manifestation and Impact on Group Intervention and Management
• 67 “When Boundaries Breathe”
• 68 “What Do You Mean I Should Tell Her What I Think About Her?” Psychoeducation About Interpersonal Processes
• 69 Advice Giving
• 70 Bridging as a Tool to Avoid Scapegoating
• 71 The “I’s” Have It!
• 72 Women’s Empowerment Group Using Art Therapy
• 73 From Silence to Frenzy: Resistance in the Face of Shame
• 74 “After The Group has Ended”: Imagery to Vivify Termination
• 75 Diminishing Dissociative Experiences for War Veterans in Group Therapy
• 76 I am Part of the Group Matrix
• 77 To Err is Human: Turning Our Mistakes Into Useful Interventions
• 78 The Ability to Verbalize One’s Needs Clearly in a Geriatric Population
• 79 Norm Repair
• 80 Alchemy and Transformation: The Disturber in Group
• 81 Family Member Association
• 82 Building Self-Esteem Using Assertiveness Training and Props
• 83 Group Supervision Horseback Riding Workshop for Increasing Self-Awareness
• 84 Poetry as a Projective Technique and Springboard for Dialogue in Group Therapy
• 85 Unexpected Consequences: Maintaining the Boundaries in a Therapy Group for Older Adults
• 86 Creative Use of the Group Contract in Long-Term Psychotherapy Groups
• 87 An Angry Outburst: Responding to Aggression
• 88 A Difficult Session
• 89 The Nine Basic Steps for a Successful Group
• 90 Stress Inoculation Training for Trauma and Stress-Related Disorders
• 91 Using Metaphors and Stories to Resolve Impasses and Bridge Resistance
• 92 Therapist Self-Disclosure as an Intervention Toward Normalizing and Eliciting Hope
• 93 Directed Eye Contact: Nonverbal Communication as a Group Strengthening Tool
• 94 “Remember Be Here Now”
• 95 Changing Chairs: Experiential Exercise for Exploration of Interpersonal Boundaries
• 96 Surfing an Unexpected Group’s Tide
• 97 Mindfulness in Group Therapy
• 98 Trauma Therapy as a Community Enterprise
• 99 Dealing with Anger in Two Different Phases of Group Psychotherapy
• 100 The Fee: A Clinical Tool in Group Therapy
• 101 Installation of Hope in Bereavement Groups for the Elderly
• Index