GROUP THERAPY

Group therapy may utilize psychoanalytic

,supportive, transactional or behavioral
approaches. over the years many types of
group therapies have emerged like self
help groups(alcoholics anonymous for
alcoholics, weight watchers for obese)
transactional analysis groups,
psychodrama and the like.
Group therapy sessions are held once or
twice a week ,with each sessions lasting
1-2 hours and the patient usually sit in
circle. In group therapy approximately
6-10 individuals meet face-to-face with a
trained group therapist. During the
group meeting time, members decide
what they want to talk about.
DEFINATION:
IT is a form of treatment in which
carefully selected, emotionally ill
persons are placed into groups ,guided
by a trained therapist for the purpose of
changing the maladaptive behavior of
the individual member.
PURPOSES:
To intervene in psychopathology.
To reveal ,examine and resolve
distortions in interpersonal
relationships.
To improve the skill of relating to
others.
To learn coping styles.
THERAPEUTIC FUNCTIONS OF GROUP
THERAPHY:
1 . imparting of information:
Psycho education /health education information
that are structured and planned are given through
lecture method in the group.
2. Instillation of hope: Helps the client
maintain faith in the therapeutic modality. The
client is optimistic he believes he will get better.
3.Universality: Client learns that others in the
group have problems ,thought and feelings similar
4.Altruism:
Is the process of client s’ aiding or helping
each other. The act of giving to others
becomes therapeutic for the giver, which
increases the self esteem of the giver.
5.Correctives recapitulation of the
primary family group:
Means that the client is influenced in
therapy group by his history.
6. DEVELOPMENT OF SOCIALIZING
TECHNIQUES:
Role play and feedback in group therapy helps to
develop social skills.

7.IMITATIVE BEHAVIOR:
The client identifies with the healthier aspects of
the other members and the leader and gains
growth imitation.
 
8. INTERPERSONAL LEARNING:
The client learns to profit from the
therapeutic use of anxiety when anxiety is
minimized the client relates more openly he
learns to trust, to expose himself ,to give of
himself ,to expect from others ,to test
reality ,and therefore to experience growth .
 
9.GROUP COHESIVENESS:
Relates to bonding the feeling of “we
instead of “I” .cohesiveness is
demonstrated through attendance and
ability of the group to communicate
positive and negative expressions to
each other without the group
disintegrating.
 
10. CATHARSIS:
IS The expression of feelings deep emotions and
anxiety provoking problems in the group . this
enables the client to find a practical solution.
 
11. EXISTENTIAL FACTORS:
The group is able to help individual members take
directions of their own lives and to accept
responsibility for the quality of their existence.
SETTINGS:
Group therapy can form part of the therapeutic
milieu of a psychiatric in-patient unit or ambulatory
psychiatric Partial hospitalization (also known as
Day Hospital treatment) .In addition to classical
"talking" therapy, group therapy in an institutional
setting can also include group-based
expressive therapies such as drama therapy,
psychodrama, art therapy, and non-verbal types of
therapy such as music therapy
A form of group therapy has been
reported to be effective in psychotic
adolescents and recovering addicts.
Patient groups read a novel or
collectively view a film. They then
participate collectively in the discussion
of plot, character motivation and
author motivation.
Physical Conditions That
Influence Group Dynamics:
Seating : the physical conditions
for the group should be set up so
that there is no barriers between
the members.
Size: various authors suggested
different range of size as ideal group
interactions: 4to 7 (Huber 1996) 2
to 15 (Sampson & marthas 1990)
and 4 to 12 (clark 1994) . group size
does not make a difference in the
interaction among members.
Membership: whether the group is
open ended or close ended is another
condition that influence the dynamics
of the group process. Open ended
groups are those in which members
leave and others join at any time while
the group exists.
Closed groups are fixed frame. All
members join at the time of group
organized and terminate at the end
of designated time period. These
groups are composed of individual
with common issues or problems
they wish to address.
Dealing with challenging group
behaviors: problematic behaviors
occur in all groups. They can be
challenging to the most experienced
group leaders and frustrating to new
leader . in dealing with any problematic
behaviors the leader must remember to
support the integrity of the individual
members and the group as whole.
Monopolizer: some people monopolize
group by talking others. It causes
anxiety among the members.
 Yes , but: some people agree with
suggestions from others but they add
,yes but”and give several reasons so
leader must avoid problem solving for
the member and encourage the person
to develop his or her own solutions.
Disliked member: in some group members
dislikes one particular member so in this
situation leader must move the member to
better match group.
The silent member: the member who
does not participate in group discussion the
leader must respect the person silent nature
and get to know the member and
understand the meaning of the silence
before encouraging interactions.
Group conflict; groups experienced
conflict. The leader must decide it
is a natural part or addressing any
issues. Member to member conflict
can be handled but leader to
member conflict is more
complicated.
Why is group therapy helpful?
1. When people come into a group and interact freely
with other group members, they usually recreate those
difficulties that brought them to group therapy in the
first place. Under the direction of the group therapist,
the group is able to give support, offer alternatives, and
comfort members in such a way that these difficulties
become resolved and alternative behaviors are learned.
2. The group also allows a person to develop new ways
of relating to people.
3. During group therapy, people begin to see that
they are not alone and that there is hope and help.
It is comforting to hear that other people have a
similar difficulty, or have already worked through a
problem that deeply disturbs another group
member.
4. Another reason for the success of group therapy
is that people feel free to care about each other
because of the climate of trust in a group.
 TYPES OF GROUP THERAPY:
TASK GROUPS : Task groups are
designed to accomplish a particular task.
The emphasis of these groups is on decision
making and problem solving . they often
have specific goals to accomplish and a
deadline for completion of the work.
SELF HELP GROUP:
Groups organized around a common
experience are labeled self –help
group.eg alcoholics anonymous,
smoking cessation group and numerous
groups related to specific health
problems .
EDUCATIONAL GROUPS:
The goal of teaching group is to
provide information.eg child birth
preparation ,patient education
groups, medication groups and
psychoeducation group.
SUPPORTIVE THERAPY GROUP:
The primary goal of supportive therapy
group is to help the members cope with life
stress.
PSYCHOTHERAPY GROUP:
The goal of psychotherapy group is the
treatment of emotional ,cognitive , or
behavioral dysfunction.
 BRIEF THERAPY GROUP:
The purpose of brief therapy group is to focus on the
actions participants can take to improve their
current situation.
 INTENSIVE PROBLEM –SOLVING GROUPS:
These are designed for 6to 10 patients each working
on the identification and resolution of specific target
problems ,goals, and problem solving strategies
related to an individual treatment plan.
MULTIDISCIPLINARY TEAM: Nurses are
often members of multidisciplinary teams
consisting of psychiatrists psychologist, social
worker. ACTIVITY GROUPS:
It is designed to enhance the psychological and
emotional well being of patients . task include
drawing ,exercise to music, arts and crafts,
reviewing current events.
PEER SUPPORT GROUPS:
Is effective way of professional to share the
stress and problems related to their work.
group purposes may include case
consultation ,sharing information, about
educational opportunities providing
information about management skills, and
decreasing professional isolation.
ACCORDING TO THE PURPOSES:
  PSYCHOANALYTIC GROUP
THERAPY:
Group communication is focused on the
here level of unconscious ,semiconscious
and conscious material the group focuses on
interpretation of dreams ,free association,
and other latent content produced in the
group.
TRANSACTIONAL A NALYSIS:
The three ego states of the individual the parent ,the
child ,and the adult –are examined in TA group.
 RATIONAL EMOTIVE THERAPY :
It aims to maximize a person rational thinking.
GESTALT THERAPY:
It emphasizes self expression, self exploration, and
self awareness in the patient .clients and therapist
focus on the every day problem and try to solve
them.
INTERPERSONAL GROUP
THERAPY:
It explore the members anxiety and
stress and their effects on the individual .
PSYCHODRAMA GROUP:
It explore the truth through dramatic
methods.
ENCOUNTER GROUPS:
It aims at the bringing personal change as a result of
deeply felt experiences.
T –GROUPS:
The goal is to verify experimentally the T- group
method . this involves the study of groups norms ,
roles , communication distortions, and the effect of
authority on behavior patterns personality and
coping mechanisms.
COMMUNITY SUPPORT
GROUPS:
Provides identification ,clarification
,understanding ,role modeling ,feelings
of togetherness, and group cohesion.
They help prevent the individual
member from feeling lonely and
isolated.
MARATHON GROUP:
The term Marathon group refers to the
amount of concentrated time the
participants spend together as a group.

 PHASES OF GROUP DEVELOPMENT

:
PHASE : 1 INTIAL PHASE:
Group activities:
The leader and member works together to
establish the rules that will govern the group .
Leader expectations:
The leader is expected to orient members to
specific group processes, encourages members to
participant without disclosing too much too soon ,
promote environment of trust and ensure that
rules established by the group do not interfere with
fulfillment of the goals.
 
Member behavior:
In phase 1 ,members have not yet established trust
and will respond to this lack of trust by being overly
polite.

PHASE 2 MIDDLE OR WORKING PHASE:

 
Group activity:
During the working phase ,cohesiveness has been
established has been established with in the group.
Leader expectations:
The role of leader diminished and become more
one of facilitator during the working phase.
Member behavior:
At this point trust has been established among the
members. They turn more often to each other and
less often to the leader for guidance . they accept
criticism from each other using it in a constructive
manner to create change.
PHASE 3 FINAL OR TERMINATION
PHASE:
Group activity:
The longer a group has been in existence ,the
more difficult termination is likely to be for the
members.
 Leader expectations:
In the termination phase the leader encourages
the group members to reminisce about what has
occurred within the group to review the
goals and discuss the actual outcomes and to
encourage members to provide feedback to
each other about individual progress within
the group. The leader encourages members
to discuss feelings of loss associated with
termination of the group.
MEMBERS ROLES:
BENNE AND SHEATES IDENTIFIES
THREE MAJOR types of roles of individual
play within membership of the group. These
are
Complete the task of the group.
Maintain or enhance group processes.
Fulfill personal or individual needs.
PREPARATION : The patient is
prepared for the group therapy sessions by
explaining the processes to which the patient
will exposed ,emphasizing the need to be
open and honest with co- patient and
finally ,alerting the patient to the possibility
that he may likely be questioned by group
members explicitly share his problem to
develop self knowledge about illness.
CRITERIA OF PATIENT TO BE INCLUDED
IN GROUP THERAPY:
Ability to communicate .
Willingness to share his problems with others.
Motivation to change.
Patient with authority anxiety .
Patient using defense mechanism of projection,
repression, denial, suppression, transference
reactions.
FACTORS CONTRIBUTING TO GROUP
THERAPY:
Faith in the treatment procedure.
Universality (similar problems are seen in the
others)
Direct guidance for the problem.
Altruism (patient offer each other support
,reassurance, suggestion, and insight)
Development of socializing skills.
Imitative behavior (imitation of a healthy
behavior ,especially therapist is identified as a role
model and patients imitates the therapist.)
Catharsis (ventilation of emotion)
Conflict resolutions.
Acceptance of the reality
Group cohesiveness(attractiveness that members
have for their group and for other members )
Interpersonal learning.
THERAPEUTIC TECHNIQUES USED IN
GROUP THERAPY:
Approval: -
condoning or encouraging an attitude ,feeling or
action.
Acceptance :-
An attitude or a relationship that recognizes the
worth of a person without imply either approval of
particular behavior or personal affection.
Clarification:-
Restatement by another in what is hoped to be
clearer terms of the substance of what the client has
said.
Exploration :-
A shift from considering one aspect of a situation to
considering other.
Identification:-
Delineating specific factors for the purposes of
understanding or clarifying.
Interpretation:-
Finding or explaining the meaning or significance of
the information.
Information giving:-
Stating facts about a problem.
Encouraging expression of feelings or ideas:-
Indication in some way that it is permissible or
desirable to talk about feelings or ideas.
Reassurance :-
Offering the client confidence of a favorable outcome
through suggestion, through persuasive arguments
or through comparing similar cases.
 support :-
giving comfort ,approval or acceptance.
 Intervention:-
An action that directs or influences the client
behavior.
Understanding:-
Indicating verbally or nonverbally that you know or
comprehened what the client is communicating and
what he is feeling.
Reflection:-
Repeating back to the client what he has said
mirroring his statements.
Listening :-
Concentrating on the clients communication without
interruption.
Teaching:-
Helping the client learn specifies in relation
to events and behavior.
Silence:-
The use of no verbal or spoken words.
Structuring:-
Shaping the content of the group meetings.
Limit –setting:-
Deciding how far group members and the group may
go before the therapist ceases or restricts to a point
,the behavior ,activity , or verbal expression of
members.
Transference and counter transference:-
Transference occurs when the client attributes
characteristics and the behavior of the family
member to the therapist
And counter transference occurs when
therapist responds in a negative
manner to the client transference.
Themes:- The area of discussion that
recur or relate one group session to
another and then explore the meaning
of these themes.
ADVANTAGES OF GROUP THERAPY:

Members profit by hearing other members

discuss their problems. This discussion decreases
the members feeling of isolation alienation, and
uniqueness, and encourages him to share his
feeling and problems.
 
opportunity to explore specific styles of
communication in a safe atmosphere , where they
can receive feedback and can undergo change.
 learns multiple way of solving problems
from other group members and group
exploration helps them to discover new ways
of solving problems.
 The group provides for its members
understanding ,confronting and
identification, with more then one
individual.
Group therapy allows people to
receive the support and
encouragement of the other
members of the group.
Group members can serve as role
models to other members of the
group.
Group therapy is very cost effective.
Group therapy offers a safe
haven.

By working in a group, the

therapist can see first-hand how
each person responds to other
people and behaves in social
situations.
DISADVANTAGES:
Individual privacy is destroyed.
Resistance and reluctant to
change.
Therapist at times dominant or as
if he is giving individual therapy.
 
NURSES’ ROLES IN GROUP
THERAPY:
Nurses explore the use of groups as a
teaching method , a therapeutic method ,a
therapeutic tool with clients and a form of
peer group supervision. Nurses participates
as a leader in many formal and informal
group therapies.
Leader roles are :
1. group task roles.
2. group building and maintenance
role.
3. individual roles.
Group task roles:
To identify group problems and select methods to
solve those problems.
Suggests new ideas.
Seeks clarification.
Ask for opinion to what the group is undertaking.
Gives information shares experiences in relation to
the group problems.
 
Give opinion by stating ideas and values about group
suggestions.
Clarifies how ideas can work.
Orients the group on target by defining where the
group is in relationship to its goal.
Evaluates the accomplishment of the group in
relation to its task.
Motivates the group to greater productivity .
Record the productive discussion.
Group building and maintenance
roles:
To strength , regulate and perpetuate the
group members to function as whole group.

Encourage and accepts the contributions of

others.
Reconciles differences between group
members.
Admits error to maintain group harmony.
Keeps communication open and provides
encouraging remarks.
Sets group goals and evaluate the
functioning of the group.
Observes the group discussion , gives
feedback and interprets.
Assumes more of an audience role but gives
the feeling of being with group.
Individual role:
To meet the needs of the group members it
hampers group functioning that need to be
aware of Expresses aggressions, which
deflates the status of individual and group
accomplishment.
Resists progress by arguing or disagreeing
beyond reason.
Calls attention to himself/ herself through
boasting and pointing out achievements.
Give self confession by expressing feelings and
ideology not related to the group but uses the
group as audience.
Demonstrate individuals lack of involvement.
Asserts authority superiority in manipulating the
group.
Seeks helps from group.
Tries to have own biases and prejudices.
 
Basic roles of nurses:
Determine setting and size of the group.
Choose frequency and length of group
sessions.
Select a therapist for the group.
Formulates policy on group therapy with
other therapeutic modalities.
Formulating appropriate goals.
Selecting patients who can perform the group task.
Preparing patients who can perform group task.
Preparing patients for group therapy.
Explaining group members to maintain
confidentiality of group discussion.
Identify and resolve common problems.
Fix up time for the subsequent sessions.
Maintain attendance of group members.
Arrange for guard ship during session for
uninterrupted discussions.
Maintain strict discipline and confidentiality over
the informations that are discussed in the session.
Assists the group members for progressing and
completing the task home assignments.
Monitor the group members behavioral changes
prior to and after group therapy sessions.
Thank you