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Chapter 35. Group Therapy

Paul D. Cox, M.D.; Sophia Vinogradov, M.D.; Irvin D. Yalom, M.D.
DOI: 10.1176/appi.books.9781585623402.334425

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Excerpt

Interpersonal relationships are of crucial importance to human psychological development (Siegel 1999). There are many psychiatric and therapeutic implications to this simple premise. Personality and patterns of behavior can be seen as the result of early interactions with other significant human beings. Modern schools of dynamic psychotherapy underscore the link between psychopathology and distorted interpersonal relationships and emphasize that psychiatric treatment must be directed toward understanding and correcting these distortions. Although this can of course take place in the context of the therapist–patient dyad, it is self-evident that a group of people can serve as an immensely specific therapeutic tool. In such a group setting, patients are provided with a varied array of interpersonal relationships that, with proper guidance, will permit them to identify, explore, and alter maladaptive interpersonal behavior.

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FIGURE 35–1. Learning from behavioral patterns in the social microcosm of the therapy.

FIGURE 35–2. Group development and therapeutic factors.

FIGURE 35–3. Common problems in group therapy.

FIGURE 35–4. Schematic representation of the here-and-now technique in group therapy.

FIGURE 35–5. Creation of a treatment group.
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TABLE 35–1. Scope of current group therapy practice
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TABLE 35–2. General membership criteria for group therapy
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TABLE 35–3. Yalom's inventory of the therapeutic factors in group therapy
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TABLE 35–4. Group cohesiveness
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TABLE 35–5. The therapist's basic tasks in group therapy
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TABLE 35–6. Co-leading group psychotherapy
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TABLE 35–7. Rationales behind group therapy preparation
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TABLE 35–8. Qualities of self-disclosure in the group
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TABLE 35–9. Benefits of weekly written summary of group therapy session
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TABLE 35–11. Modifications of basic techniques for acute inpatient therapy groups
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TABLE 35–10. Goals for acute inpatient therapy groups
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TABLE 35–12. Essentials for starting a group program and seamless integration with other clinical services
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The goals of a treatment group should inform the therapist's techniques and theoretical approach and the group's structure.

Group cohesiveness refers to the affinity that members have for their group and for the other members. A cohesive group is ready to perform the group task.

One of the therapist's essential tasks is to prepare the patient for group therapy by demystifying the group and establishing a therapeutic alliance.

The leader must establish behavioral norms that will guide the interactions of the newly formed group; the members themselves will be important agents of change, and a "culture"—a set of unwritten rules or norms that determine the acceptable behavioral procedures of the group—should be shaped to create an atmosphere maximally conducive to effective group interaction and to the development of the various therapeutic factors.

Cliques forming within a group (subgrouping) and conflict between members are examples of dynamics that, if mismanaged, are destructive in the earliest stages of group development but are important therapeutic opportunities when thoughtfully negotiated in later stages.

By directly focusing on the here and now, de-emphasizing history and life outside the group, the leader solicits and engages the active participation of all the members and maximizes the power and efficiency of the group.

Phrases like "in-group analogue" and "social microcosm" are useful for explaining a here-and-now focus and should be explained repeatedly prior to referral, during referral, and after referral in pregroup preparation.

Group process provides additional information above and beyond content. The content consists of the actual words spoken and the substantive issues addressed. The process of the discussion is entirely different and refers to how this content was expressed and what it reveals about the nature of the relationship of the individuals holding the discussion.

Group therapy coordination is an essential function. Group program coordinators perform or oversee the many essential executive, clerical, and educational tasks necessary to develop, enlarge, and maintain a group program.

The key question is: "How we can prepare everyone to benefit from some form of group treatment?"

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Which historical figure is associated with the Tavistock model of group behavior?
2.
Four interrelated dimensions have been used to categorize therapy groups. Which of the following is not one of these basic dimensions?
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Various inclusion and exclusion criteria have been proposed for different types of groups. However, among all therapy groups, there is one underlying principle for group membership. This principle is
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