Interactive Group Therapy

Integrating, Interpersonal, Action-Orientated and Psychodynamic Approaches

Jay Earley

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135826758
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Interactive Group Therapy is a complete guide to group psychotherapy based on the author's unique integrated approach. Dr. Earley integrates from interpersonal group therapy a focus on the feeling reactions and relationships among group members, from psychodynamic approaches, an appreciation of unconscious processes and childhood origins, and from Gestalt therapy, the importance of awareness, contact, and experimentation. The book develops an action-oriented leadership style for group-centered groups and a new interpersonal understanding of the therapeutic change process in group therapy, leading to an approach that has impressive depth and creativity. It covers both short-term and long-term groups, making it a valuable book for those interested in brief therapies.The primary focus of Interactive Group Therapy is to provide practical guidelines for leading groups. It offers detailed suggestions for structuring groups, creating a therapeutic group climate, promoting interpersonal work, and helping group members develop awareness and responsibility. It discusses how to handle conflict, foster therapeutic change, work with difficult clients, adopt the best leadership attitude, understand group process, and a host of other clinical issues. In addition to rich clinical examples and case histories, this book also presents transcripts of group sessions, annotated to illustrate both theory and technique. The author's thorough presentation of his approach, its theoretical underpinnings, and its application to actual groups make this a valuable resource for graduate students in the mental health professions and psychotherapists of all levels of experience.

1

CHAPTER

Introduction

Group Therapy

Let’s begin with an overall look at the field of group psychotherapy. Originally a mere offshoot of individual therapy, group therapy was long considered a second-rate form of treatment. Over the years, increasingly sophisticated forms of group therapy have emerged that take advantage of the unique features of the group setting. As a consequence, group therapy has become a powerful treatment modality in its own right. Rather than simply being a more cost-efficient way to provide therapy, group therapy provides many therapeutic advantages over the individual setting.

Group therapy is effective for the entire range of psychological issues and is the treatment of choice for certain problems and clients. It is also useful when combined with individual therapy, either at the same time or in sequence. In addition, groups provide clients with a different kind of growth experience than other modes of therapy, helping them especially to develop interpersonal and group capacities. Of course, individual therapy also has advantages over group therapy. The optimal treatment for a particular client depends on her presenting problem, her personality structure, and her therapeutic goals.

Recent surveys of the research literature on psychotherapy outcome (Dies, 1986; Kaul & Bednar, 1986; Orlinsky & Howard, 1986) indicate widespread endorsement of group therapy as a clearly effective mode of psychotherapy. Moreover, when comparing group and individual psychotherapy, researchers (Orlinsky & Howard, 1986; Toseland & Siporin, 1986) have found that group therapy is generally as effective if not more effective than individual therapy. Given the much greater cost of individual therapy, this conclusion has important implications.

Increasing Importance of Group Therapy. Today group therapy is becoming increasingly prevalent because of managed care’s push toward reducing the cost of treatment. Groups are being used more frequently in institutional settings because they are more cost effective. In private practice, clients are often not covered for the full course of therapy they need, and therefore they are turning to groups because they are more affordable.

The Need for Training. As group therapy becomes more widely used, there is a greater need for group therapy education and training. Frequently therapists tell me that they have been given three groups to lead at the clinic, even though they have no training other than a single graduate course in group therapy. It is important for therapists to receive substantial training in group therapy, perhaps even as much as they receive in individual therapy. This should include at least a year program including theory and technique, a personal group experience, and a practicum, along with supervision of a group the trainee is leading. If not provided in graduate school, psychotherapists should seek this at postgraduate training institutes. This book is appropriate for use in such a training program.

General Purpose and Problem-Focused Groups. Therapy groups can be divided into two general categories—general purpose groups and problem-focused groups. Problem-focused groups (McKay & Paley, 1992) tend to be oriented toward specific populations and issues such as bereavement, anxiety, sexual abuse, AIDS, substance abuse, and assertiveness. Usually these groups are structured or use a support-group format. In either case, they aim at helping people through a crisis, improving coping, teaching social skills, or alleviating symptoms. They are often time-limited because they focus on goals such as the above that can reasonably be accomplished in a short time, usually 10 to 30 sessions. Self-help groups are an important and widely used type of problem-focused group, though they can’t be considered psychotherapy groups.

General purpose groups accept people with a variety of presenting problems. Instead of focusing on a specific issue, these groups work on all the different behavioral and psychodynamic issues that arise in the course of the group and interpersonal process. In addition to the above-mentioned goals, many general purpose groups aim to help clients make deeper changes in their character structure and therefore they need to operate for a longer time, often 1 to 3 years or more. However, they can also be time-limited, and some therapists have reported success with shorter general purpose groups of 20–30 sessions (MacKenzie, 1990).

The approach presented in this book is oriented toward general purpose outpatient groups for adults. It targets both short-term symptom alleviation and problem resolution, and also long-term characterological transformation. At various points the book discusses how to integrate this approach with other group modalities such as supportive work, psychodrama (Moreno, 1959), structured exercises (Earley, 1990), and individual work in the group setting (R. L. Harman, 1984). Chapter 28 explores how this approach can be modified for problem-focused groups and other populations and settings.

Introduction to This Approach

In keeping with the interpersonal nature of the approach presented in this book, the group work focuses primarily on the relationships among the group members and what is currently happening within the group. The group becomes a microcosm for each member’s life (Yalom, 1995), and any interpersonal problems she has will most likely occur sooner or later with someone in the group. Thus, rather than just talking about the problems in their lives, members live them out in the group. This gives them a chance to get feedback on the way they affect others, to become aware of their feelings and motivations, and to experiment with new, healthier behavior.

One common type of interaction involves a dialogue between two members. One person might say, “John, I’d like to talk to you. You know, last week when you confronted Sarah, I felt annoyed at you (or I admired you, or I was intimidated by you).” If John were receptive, he might respond by saying, “Gee, what was it that made you feel that way?” Then the two members would have a dialogue. If there was conflict, they would try to resolve it. If they were confused about what was happening between them, they would attempt to clarify the precise nature of their interaction. If they felt good about each other, they might work on connecting more deeply.

The leader facilitates this process, helping them to be more aware of what they are feeling in the moment, especially in response to what the other person just said, and helping them to improve their communication skills (e.g., assertiveness and sensitivity to others). The leader is particularly interested in helping members to become aware of their interpersonal patterns, such as neediness, avoidance of intimacy, defiance of authority, codependence, etc. For each pattern, the client learns to be aware of when it happens in group, what she¹ is feeling at the time, the underlying motivation, its childhood origin, and the role it plays in her life. Then the client can work on healing the pain that underlies the pattern and experimenting with healthier behavior in the group.

In other common types of group work, one client might explore his feelings about being in the group or the group-as-a-whole might explore an issue that is affecting everyone. The interpersonal work for each client changes over time. When a person first joins a group, he will be working on the way he relates to people whom he is just getting to know. Once someone has been in the group for a year or more, he will have a chance to develop close connections with some other group members, and therefore he will begin to deal with intimacy issues.

Clients develop multiple transferences with the leader, other members, and the group-as-a-whole that provide the raw material for exploring interpersonal defenses and their childhood origins. Ultimately, these relationships also serve as a vehicle for healing these wounds and developing healthy ways of relating.

Basic Concepts

I will now present some basic concepts that are used throughout the book in understanding intrapsychic process and therapeutic change.

Core Issues

A core issue is a structure in the psyche based on past events that influences, often unconsciously, the way people see and feel about themselves, relate to others, and act in the world. Core issues are a way of coding memory so that it can be used in future interactions with people. A core issue is the internal basis for a transference reaction. It usually consists of a self-representation and representation of another. These representations involve more than just beliefs and images; they also include emotion, perception, motivation, body sensation, expression, and action. Core issues are similar to object relations (Kernberg, 1975) and to the concept of schemas used in cognitive therapy (Safran & Segal, 1990). They won’t be discussed in more detail in this book because the primary focus here is the practice of group therapy.

Let’s look at an example of a core issue. If a girl, Marcy, was consistently rejected by her father, she might develop a core issue with an internal representation of the self as needy and unlovable, and a representation of the other as desirable and rejecting. This core issue would likely influence her self-esteem and the way she relates to men. A core issue may be activated all the time or it may operate only under certain conditions. For example, Marcy might feel unlovable all the time, or she might feel that way only when relating to a man she is attracted to. A core issue can be activated by a type of person (e.g., men), a perception about a person (e.g., an attractive man), a situation (e.g., a social situation), an action of the other (e.g., he acts rejecting) or an action of the person (e.g., Marcy reaches out to a man).

Healthy Capacities

Human beings have the potential for a variety of healthy capacities,² such as assertiveness, intimacy, autonomy, and empathy. These capacities are present to a certain extent in young children, but most capacities develop during childhood (and to a lesser extent also during later life). For optimal development of these capacities, a child requires appropriate parenting and other influences (from siblings, relatives, peers, teachers, and the culture at large).

Each capacity includes both behavioral ability and inner experience. The behavioral aspect has to do with the person’s capacity to act in a healthy way in the world. For example, the behavioral aspect of assertiveness is the ability to act assertively—to ask for what one wants, to set limits, to stand up for oneself. The experiential aspect has to do with the person’s inner experience or sense of self. In the case of assertiveness, the experiential aspect involves feeling powerful, entitled to take care of oneself, and confident about self-assertion.

When a core issue is activated, it blocks a healthy capacity (or capacities). In other words, it interferes with a person’s ability to use the capacity. (When talking about children, it can mean interfering with the child’s development of the capacity.) Thus, just like a core issue, a healthy capacity may be available only under certain conditions. For example, Marcy might feel valuable only when she is relating to women.

At any given moment, a person’s behavior often stems from a combination of healthy capacities core issues.

Basic Needs and Capacities

I have found it helpful to identify four basic interpersonal needs that are central to human motivation: connectedness, safety, autonomy, and value. These needs are crucial to the healthy development of children and also influence adult behavior. If a basic need is not met adequately in a person’s early years, there will be a deficiency in the corresponding healthy capacity, resulting in pain and perhaps difficulty in functioning. For example, if a person’s need for connectedness—love, caring, nurturing—is not met during childhood, she is likely to feel unlovable, isolated, empty, needy, or fragmented. People react intensely to deprivation of basic needs; they are often driven either to defend against the pain or compensate for the deficiency.

Each basic need has a corresponding healthy capacity, called by the same name, which is simultaneously the capacity to get that need met and to feel confident and deserving in that area. I call these the basic capacities. For example, the capacity for connectedness means that a person can reach out to form healthy relationships, and also that she feels connected to others and to herself. Basic needs operate all through a person’s life even though they are more critical during childhood. Even if a basic need was met during childhood, the person will still have that need as an adult, but the need will be mild, adult, and appropriate, and the person will have the behavioral ability to get it met in most circumstances. To the extent that the need was not met adequately during childhood, the need will be more intense, infantile, and inappropriate, and the person will have less in the way of behavioral skills to get it met.

A person needs to feel safe from attack, intrusion, control, excessive judgment, or exploitation. A person with a good sense of safety trusts that others will respect her boundaries and therefore can allow herself to be vulnerable when this is appropriate, but she is able to protect herself from violation if necessary. She is able to mobilize aggression and stand up to anyone who threatens her safety.

A person who has the capacity for autonomy feels free to be himself and to take power and initiative in the world without being unduly influenced by others’ desires. Therefore he can freely cooperate with others when appropriate, but he can also assert himself and stand up to others if that is called for.

A person who has an inner sense of value feels positively about herself and valuable as a person.³ To the extent that the need for value was met during childhood by appropriate mirroring and appreciation and a person has developed a sense of value, she has high self-esteem, confidence in herself, resiliency in the face of failure, and the ability for constructive self-criticism (Kohut, 1971, 1977). Even though a child needs appropriate responses from others for value to develop in early years, once value is developed in an adult, it tends to be largely self-sustaining.

¹I have decided to deal with the problem o...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• CONTENTS
• Preface
• Acknowledgments
• Chapter 1 Introduction
• I. THE THERAPEUTIC CHANGE PROCESS
• II. CREATING A THERAPEUTIC GROUP CULTURE
• III. FACILITATING THE PROCESS
• IV. GROUP-RELATED ISSUES
• V. SPECIAL ISSUES
• Glossary
• Appendix
• References
• Index