Definition

Group therapy is a form of psychotherapy in which a small, carefully selected group of

individuals meets regularly with a therapist.

Purpose
The purpose of group therapy is to assist each individual in emotional growth and
personal problem solving.

Description
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.
Unlike the simple two-person relationship between patient and therapist in individual
therapy, group therapy offers multiple relationships to assist the individual in growth and
problem solving. The noted psychiatrist Dr. Irvin D. Yalom in his book The Theory and
Practice of Group Therapy identified 11 "curative factors" that are the "primary agents of
change" in group therapy.

Instillation of hope
All patients come into therapy hoping to decrease their suffering and improve their lives.
Because each member in a therapy group is inevitably at a different point on the coping
continuum and grows at a different rate, watching others cope with and overcome
similar problems successfully instills hope and inspiration. New members or those in
despair may be particularly encouraged by others' positive outcomes.

Universality
A common feeling among group therapy members, especially when a group is just
starting, is that of being isolated, unique, and apart from others. Many who enter group
therapy have great difficulty sustaining interpersonal relationships, and feel unlikable
and unlovable. Group therapy provides a powerful antidote to these feelings. For many,
it may be the first time they feel understood and similar to others. Enormous relief often
accompanies the recognition that they are not alone; this is a special benefit of group
therapy.

Information giving
An essential component of many therapy groups is increasing members' knowledge and
understanding of a common problem. Explicit instruction about the nature of their
shared illness, such as bipolar disorders , depression, panic disorders, or bulimia, is
often a key part of the therapy. Most patients leave the group far more knowledgeable
about their specific condition than when they entered. This makes them increasingly
able to help others with the same or similar problems.

Altruism
Group therapy offers its members a unique opportunity: the chance to help others.
Often patients with psychiatric problems believe they have very little to offer others
because they have needed so much help themselves; this can make them feel
inadequate. The process of helping others is a powerful therapeutic tool that greatly
enhances members' self-esteem and feeling of self-worth.

Corrective recapitulation of the primary family

Many people who enter group therapy had troubled family lives during their formative
years. The group becomes a substitute family that resembles—and improves upon—the
family of origin in significant ways. Like a family, a therapy group consists of a leader (or
coleaders), an authority figure that evokes feelings similar to those felt toward parents.
Other group members substitute for siblings, vying for attention and affection from the
leader/parent, and forming subgroups and coalitions with other members. This recasting
of the family of origin gives members a chance to correct dysfunctional interpersonal
relationships in a way that can have a powerful therapeutic impact.

Improved social skills

According to Yalom, social learning, or the development of basic social skills, is a
therapeutic factor that occurs in all therapy groups. Some groups place considerable
emphasis on improving social skills, for example, with adolescents preparing to leave a
psychiatric hospital, or among bereaved or divorced members seeking to date again.
Group members offer feedback to one another about the appropriateness of the others'
behavior. While this may be painful, the directness and honesty with which it is offered
can provide much-needed behavioral correction and thus improve relationships both
within and outside the group.

Imitative behavior
Research shows that therapists exert a powerful influence on the communication
patterns of group members by modeling certain behaviors. For example, therapists
model active listening, giving nonjudgmental feedback, and offering support. Over time,
members pick up these behaviors and incorporate them. This earns them increasingly
positive feedback from others, enhancing their self-esteem and emotional growth.

Interpersonal learning
Human beings are social animals, born ready to connect. Our lives are characterized by
intense and persistent relationships, and much of our self-esteem is developed via
feedback and reflection from important others. Yet we all develop distortions in the way
we see others, and these distortions can damage even our most important
relationships. Therapy groups provide an opportunity for members to improve their
ability to relate to others and live far more satisfying lives because of it.

Group cohesiveness
Belonging, acceptance, and approval are among the most important and universal of
human needs. Fitting in with our peers as children and adolescents, pledging a sorority
or fraternity as young adults, and joining a church or other social group as adults all
fulfill these basic human needs. Many people with emotional problems, however, have
not experienced success as group members. For them, group therapy may make them
feel truly accepted and valued for the first time. This can be a powerful healing factor as
individuals replace their feelings of isolation and separateness with a sense of
belonging.

Catharsis
Catharsis is a powerful emotional experience—the release of conscious or unconscious
feelings—followed by a feeling of great relief. Catharsis is a factor in most therapies,
including group therapy. It is a type of emotional learning, as opposed to intellectual
understanding, that can lead to immediate and long-lasting change. While catharsis
cannot be forced, a group environment provides ample opportunity for members to have
these powerful experiences.

Existential factors
Existential factors are certain realities of life including death, isolation, freedom, and
meaninglessness. Becoming aware of these realities can lead to anxiety. The trust and
openness that develops among members of a therapy group, however, permits
exploration of these fundamental issues, and can help members develop an acceptance
of difficult realities.

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.
In 1905, a Boston physician named Joseph Pratt formed groups of impoverished
patients suffering from a common illness—tuberculosis. Pratt believed that these
patients could provide mutual support and assistance. Like settlement houses, his early
groups were another forerunner of group therapy.
Some early psychoanalysts, especially Alfred Adler, a student of Sigmund Freud,
believed that many individual problems were social in origin. In the 1930s Adler
encouraged his patients to meet in groups to provide mutual support. At around the
same time, social work groups began forming in mental hospitals, child guidance clinics,
prisons, and public assistance agencies. A contemporary descendant of these groups is
today's support group, in which people with a common problem come together, without
a leader or therapist, to help each other solve a common problem. Groups such
as Alcoholics Anonymous, Narcotics Anonymous, and

Group therapy offers multiple relationships to assist an individual in growth and problem solving. In
group therapy sessions, members are encouraged to discuss the issues that brought them into therapy
openly and honestly. The therapist works to create an atmosphere of trust and acceptance that
encourages members to support one another.
Richard T. Nowitz. Photo Researchers, Inc. Reproduced by permission.)

Survivors of Incest all have their roots in this early social work movement.

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.
Behavior therapies focus on how a problem behavior originated, and on the
environmental factors that maintain it. Individuals are encouraged to become self-
analytical, looking at events occurring before, during, and after the problem behavior
takes place. Strategies are then developed and employed to replace the problem
behavior with new, more adaptive behaviors.
An important offshoot of behavior therapy is cognitive-behavioral therapy , developed
in the 1960s and 1970s, which is the predominant behavioral approach used today. It
emphasizes the examination of thoughts with the goal of changing them to more rational
and less inflammatory ones. Albert Ellis, a psychologist who believed that we cause our
own unhappiness by our interpretations of events, rather than by the events
themselves, is a major figure in cognitive-behavior therapy. By changing what we tell
ourselves, Ellis believes we can reduce the strength of our emotional reactions, as well.

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.
In group therapy sessions, members are encouraged to discuss the issues that brought
them into therapy openly and honestly. The therapist works to create an atmosphere of
trust and acceptance that encourages members to support one another. Ground rules
may be set at the beginning, such as maintaining confidentiality of group discussions,
and restricting social contact among members outside the group.
The therapist facilitates the group process, that is, the effective functioning of the group,
and guides individuals in self-discovery. Depending upon the group's goals and the
therapist's orientation, sessions may be either highly structured or fluid and relatively
undirected. Typically, the leader steers a middle course, providing direction when the
group gets off track, yet letting members set their own agenda. The therapist may guide
the group by reinforcing the positive behaviors they engage in. For example, if one
member shows empathy and supportive listening to another, the therapist might
compliment that member and explain the value of that behavior to the group. In almost
all group therapy situations, the therapist will emphasize the commonalities among
members to instill a sense of group identity.
Self-help or support groups like Alcoholics Anonymous and Weight Watchers fall
outside of the psychotherapy realm. These groups offer many of the same benefits,
including social support, the opportunity to identify with others, and the sense of
belonging that makes group therapy effective for many. Self-help groups also meet to
share their common concern and help one another cope. These groups, however, are
typically leaderless or run by a member who takes on the leader role for one or more
meetings. Sometimes self-help groups can be an adjunct to psychotherapy groups.

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.

Results
Studies have shown that both group and individual psychotherapy benefit about 85% of
the patients who participate in them. Ideally, patients leave with a better understanding
and acceptance of themselves, and stronger interpersonal and coping skills. Some
individuals continue in therapy after the group disbands, either individually or in another
group setting.
See also Abuse ; Addiction ; Alcohol and related disorders ; Amphetamines and related
disorders ; Anxiety and anxiety disorders ; Bulimia nervosa ; Cannabis and related
disorders ; Cocaine and related disorders ; Cognitive-behavioral
therapy ; ; Modeling ; Nicotine and related disorders ; Obesity ; Opioids and related
disorders ;Peer groups ; ; Rational emotive therapy ; Reinforcement ; Self-help
groups ; Social skills training ; Substance abuse and related disorders ; Support groups

Resources
BOOKS
Hales, Dianne and Robert E. Hales. Caring for the Mind: A Comprehensive Guide to
Mental Health. New York: Bantam Books, 1995.
Kaplan, Harold I. and Benjamin J. Sadock. Synopsis of Psychiatry. 8th edition.
Baltimore: Lippincott Williams and Wilkins, 1998.
Panman, Richard and Sandra Panman. "Group Counseling and Therapy." In The
Counseling Sourcebook: A Practical Reference on Contemporary Issues, edited by
Judah L. Ronch, William Van Ornum, and Nicholas C Stilwell. New York: Crossroad,
2001.
Yalom, Irvin D. The Theory and Practice of Group Psychotherapy. 4th edition. Basic
Books, New York, NY, 1995.

ORGANIZATIONS
American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888)
357-7924. <http://www.psych.org> .
American Psychological Association (APA). 750 First Street NE, Washington, DC
20002-4242. (202) 336-5700.
National Institute of Mental Health. 6001 Executive Boulevard, Room 8184, MC 9663,
Bethesda, MD 20892-9663. (301) 443-4513. <http://www.nimh.nih.gov> .
Barbara S. Sternberg, Ph.D.

Read more: http://www.minddisorders.com/Flu-Inv/Group-therapy.html#ixzz5ZRhUY0pv
Occupational Therapy Group, Philadelphia Hospital for Mental Diseases, Thirty-fourth and Pine ...

MENTAL HEALTH CARE IN THE 1950'S AND 1960'S

JULIANNA TIDWELL, BECKY TULLBERG, ALLISON MARTI, TORI DETLEFS

Introduction:
     In the 1960’s, the estimated amount of people in mental hospitals in the United
States was around 565,000, but today has dropped to less than 40,000
(Abderholden). Mental institutions were not a place many people wanted to be.
Many patients in mental institutions during the 1950’s and 1960’s were people who
had disorders that couldn't be controlled at the time like bipolar-ism. Patients were
referred to by others as lunatics. The conditions of these institutions were horrible;
beds were cramped together and the sanitary level was unimaginable. The patients
were treated inhumanely. Many doctors had no remorse towards the patients and
their conditions/state of mind. However, in the 1950’s and 1960’s, many new drugs
and treatments were introduced and were tested on many patients. These
treatments consisted of electroshock therapy and lobotomy. Many drugs were also
tested to help with symptoms of other disorders. Mental health care in the 1950’s
and 1960’s taught us a lot about people with mental disorders and gave us basic
knowledge about how to treat them today. 

History of Psychiatric Hospitals

The history of psychiatric hospitals was once tied tightly to that of all American hospitals.
Those who supported the creation of the first early-eighteenth-century public and private
hospitals recognized that one important mission would be the care and treatment of those
with severe symptoms of mental illnesses. Like most physically sick men and women, such
individuals remained with their families and received treatment in their homes. Their
communities showed significant tolerance for what they saw as strange thoughts and
behaviors.  But some such individuals seemed too violent or disruptive to remain at home or
in their communities. In East Coast cities, both public almshouses and private hospitals set
aside separate wards for the mentally ill. Private hospitals, in fact, depended on the money
paid by wealthier families to care for their mentally ill husbands, wives, sons, and daughters
to support their main charitable mission of caring for the physically sick poor.  

But the opening decades of the nineteenth-century brought to the United States new
European ideas about the care and treatment of the mentally ill. These ideas, soon to be
called “moral treatment,” promised a cure for mental illnesses to those who sought
treatment in a very new kind of institution—an “asylum.” The moral treatment of the insane
was built on the assumption that those suffering from mental illness could find their way to
recovery and an eventual cure if treated kindly and in ways that appealed to the parts of
their minds that remained rational. It repudiated the use of harsh restraints and long periods
of isolation that had been used to manage the most destructive behaviors of mentally ill
individuals. It depended instead on specially constructed hospitals that provided quiet,
secluded, and peaceful country settings; opportunities for meaningful work and recreation; a
system of privileges and rewards for rational behaviors; and gentler kinds of restraints used
for shorter periods.

Many of the more prestigious private hospitals tried to implement some parts of moral
treatment on the wards that held mentally ill patients. But the Friends Asylum, established
by Philadelphia’s Quaker community in 1814, was the first institution specially built to
implement the full program of moral treatment. The Friends Asylum remained unique in that
it was run by a lay staff rather than by medical men and women. The private institutions that
quickly followed, by contrast, chose physicians as administrators. But they all chose quiet
and secluded sites for these new hospitals to which they would transfer their insane
patients. Massachusetts General Hospital built the McLean Hospital outside of Boston in
1811; the New York Hospital built the Bloomingdale Insane Asylum in Morningside Heights
in upper Manhattan in 1816; and the Pennsylvania Hospital established the Institute of the
Pennsylvania Hospital across the river from the city in 1841. Thomas Kirkbride, the
influential medical superintendent of the Institute of the Pennsylvania Hospital, developed
what quickly became known as the “Kirkbride Plan” for how hospitals devoted to moral
treatment should be built and organized. This plan, the prototype for many future private
and public insane asylums, called for no more than 250 patients living in a building with a
central core and long, rambling wings arranged to provide sunshine and fresh air as well as
privacy and comfort.