Group Therapy
Group therapy gives individuals a safe and comfortable place where they can work out problems and emotional issues with others. It takes place in small groups of patients that meet regularly to talk, interact, and discuss problems with each other and the group leader (therapist). Patients gain insight into their own thoughts and behavior, and offer suggestions and support to others. In addition, patients who have a difficult time with interpersonal relationships can benefit from the social interactions that are a basic part of the therapy.
Patients are typically referred for group therapy by a psychologist or psychiatrist. Some patients may need individual therapy first. Group therapy sessions are usually arranged and conducted by a psychologist, psychiatrist, social worker, or other healthcare professional. In some groups, two co-therapists share the leadership responsibility. Patients are selected based on what they might gain from group interaction and what they can contribute.
Therapy group members may have similar diagnostic backgrounds (for example, they may all suffer from depression), or they may be dealing with a variety of issues. The number of group members varies widely, but is typically no more than 12. Groups may be time-limited (with a predetermined number of sessions) or indefinite (where the group determines when therapy ends). Membership may be closed or open to new members once sessions begin.
The therapeutic approach depends on the focus of the group and the psychological training of the therapist. Some common techniques include psychodynamic, cognitive-behavioral, and Gestalt therapy.
In a group session, members are encouraged to openly and honestly discuss the issues that brought them to therapy. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have basic ground rules that are usually discussed during the first session. Patients are asked not to share what goes on in therapy sessions with anyone outside of the group. This protects the confidentiality of the other members. They may also be asked not to see other group members socially outside of therapy, because of the harmful effect it might have on the dynamics of the group.
The therapist's main task is to guide the group in self-discovery. He or she may lead the group interaction or allow the group to take its own direction. Typically, the leader does some of both, providing direction when the group gets off track while letting members set their own agenda. The therapist may simply reinforce positive behavior (such as empathy or constructive suggestions) within the group. In almost all group therapy situations, the therapist will emphasize the common traits among members so they gain a sense of group identity.
The main benefit group therapy may have over individual psychotherapy is that some patients behave and react more like themselves in a group setting than they would one-on-one with a therapist. The patient gains a sense of identity and social acceptance from membership in the group. Seeing how others deal with these issues may suggest new solutions to their problems. Feedback from group members offers unique insights into one's own behavior, and the group provides a safe forum in which to practice new behaviors. By helping others work through their problems, members can gain self-esteem. Group therapy may also simulate family experiences, allowing family dynamic issues to emerge.
The end of long-term group therapy may cause feelings of grief, loss, abandonment, anger, or rejection in some members. The group therapist will try to create a sense of closure by encouraging members to explore their feelings and use newly acquired coping techniques to deal with them. Working through this termination phase of group therapy is an important part of the treatment process.
Patients who have trouble communicating in group situations may be at risk for dropping out of group therapy. If no one comments on their silence or makes an attempt to interact with them, they may begin to feel even more isolated and alone instead of identifying with the group. Therefore, the therapist usually attempts to encourage silent members to participate early on in treatment.
Patients who are suicidal, homicidal, psychotic, or in the midst of a major crisis are typically not referred for group therapy until their behavior and emotional state have stabilized. Depending on their level of functioning, cognitively impaired patients (such as patients with organic brain disease or a traumatic brain injury) may also be unsuitable for group therapy. Some very fragile patients may not be able to tolerate aggressive or hostile comments from group members. Some patients with sociopathic traits are not suitable for most groups.
Both group and individual psychotherapy benefit about 85% of the patients who participate in them. Optimally, patients gain a better understanding of themselves, and perhaps a stronger set of interpersonal and coping skills. Some patients may continue therapy after group therapy ends, either individually or in another group setting.
Self-help groups like Alcoholics Anonymous and Weight Watchers offer many of the same benefits of social support, identity, and belonging, but are considered outside of the psychotherapy realm. These self-help groups meet to discuss a common area of concern (such as alcoholism, eating disorders, bereavement, parenting). Group sessions are not run by a therapist, but by a nonprofessional leader, group member, or the group as a whole. Self-help groups are sometimes used in addition to psychotherapy or regular group therapy.
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