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Group Therapy 

Definition

Group therapy is a form of psychosocial treatment where a small group of patients meet regularly to talk, interact, and discuss problems with each other and the group leader (therapist).

Purpose

Group therapy attempts to give individuals a safe and comfortable place where they can work out problems and emotional issues. 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 group therapy experience.

Precautions

Patients who are suicidal, homicidal, psychotic, or in the midst of a major acute 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 (like patients with organic brain disease or a traumatic brain injury) may also be unsuitable for group therapy intervention. Some patients with sociopathic traits are not suitable for most groups.

Description

A psychologist, psychiatrist, social worker, or other healthcare professional typically arranges and conducts group therapy sessions. In some therapy groups, two co-therapists share the responsibility of group leadership. Patients are selected on the basis of what they might gain from group therapy interaction and what they can contribute to the group as a whole.

Therapy groups may be homogeneous or heterogeneous. Homogeneous groups have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups have a mix of individuals with different emotional 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 number of sessions in group therapy depends on the makeup, goals, and setting of the group. For example, a therapy group that is part of a substance abuse program to rehabilitate inpatients would be called short-term group therapy. This term is used because, as patients, the group members will only be in the hospital for a relatively short period of time. Long-term therapy groups may meet for six months, a year, or longer. The therapeutic approach used in therapy 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 therapy session, group members are encouraged to openly and honestly discuss the issues that brought them to therapy. They try to help other group members by offering their own suggestions, insights, and empathy regarding their problems. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have some 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. Depending on the goals of the group and the training and style of the therapist, he or she may lead the group interaction or allow the group to take their own direction. Typically, the group leader does some of both, providing direction when the group gets off track while letting them set their own agenda. The therapist may guide the group by simply reinforcing the positive behaviors they engage in. For example, if a group member shows empathy to another member, or offers a constructive suggestion, the therapist will point this out and explain the value of these actions to the group. In almost all group therapy situations, the therapist will attempt to emphasize the common traits among group members so that members can gain a sense of group identity. Group members realize that others share the same issues they do.

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 group therapy patient gains a certain sense of identity and social acceptance from their membership in the group. Suddenly, they are not alone. They are surrounded by others who have the same anxieties and emotional issues that they have. Seeing how others deal with these issues may give them new solutions to their problems. Feedback from group members also offers them a unique insight into their own behavior, and the group provides a safe forum in which to practice new behaviors. Lastly, by helping others in the group work through their problems, group therapy members can gain more self-esteem. Group therapy may also simulate family experiences of patients and will allow family dynamic issues to emerge.

Self-help groups like Alcoholics Anonymous and Weight Watchers fall outside of the psychotherapy realm. These self-help groups do offer many of the same benefits of social support, identity, and belonging that make group therapy effective for many. Self-help group members meet to discuss a common area of concern (like 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.

Preparation

Patients are typically referred for group therapy by a psychologist or psychiatrist. Some patients may need individual therapy first. Before group sessions begin, the therapist leading the session may conduct a short intake interview with the patient to determine if the group is right for the patient. This interview will also allow the therapist to determine if the addition of the patient will benefit the group. The patient may be given some preliminary information on the group before sessions begin. This may include guidelines for success (like being open, listening to others, taking risks), rules of the group (like maintaining confidentiality), and educational information on what group therapy is about.

Aftercare

The end of long-term group therapy may cause feelings of grief, loss, abandonment, anger, or rejection in some members. The group therapist will attempt to foster 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.

Risks

Some very fragile patients may not be able to tolerate aggressive or hostile comments from group members. 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.

Normal results

Studies have shown that both group and individual psychotherapy benefit about 85% of the patients that participate in them. Optimally, patients gain a better understanding of themselves, and perhaps a stronger set of interpersonal and coping skills through the group therapy process. Some patients may continue therapy after group therapy ends, either individually or in another group setting.

Resources

Organizations

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

American Psychological Association (APA). 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. ttp://www.apa.org.

Key terms

Cognitive-behavioral — A therapy technique that focuses on changing beliefs, images, and thoughts in order to change maladjusted behaviors.

Gestalt — A humanistic therapy technique that focuses on gaining an awareness of emotions and behaviors in the present rather than in the past.

Psychodynamic — A therapy technique that assumes improper or unwanted behavior is caused by unconscious, internal conflicts and focuses on gaining insight into these motivations.

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therapy /ther·a·py/ (-pe) the treatment of disease; see also treatment.

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ablation therapy  the destruction of small areas of myocardial tissue, usually by application of electrical or chemical energy, in the treatment of some tachyarrhythmias.

adjuvant therapy  the use of chemotherapy or radiotherapy in addition to surgical resection in the treatment of cancer.

antiplatelet therapy  the use of platelet-modifying agents to inhibit platelet adhesion or aggregation and so prevent thrombosis, alter the course of atherosclerosis, or prolong vascular graft patency.

art therapy  the use of art, the creative process, and patient response to the products created for the treatment of psychiatric and psychologic conditions and for rehabilitation.

aversion therapy , aversive therapy that using aversive conditioning to reduce or eliminate undesirable behavior or symptoms; sometimes used synonymously with aversive conditioning.

behavior therapy  a therapeutic approach that focuses on modifying the patient's observable behavior, rather than on the conflicts and unconscious processes presumed to underlie the behavior.

biological therapy  treatment of disease by injection of substances that produce a biological reaction in the organism.

chelation therapy  the use of a chelating agent to remove toxic metals from the body, used in the treatment of heavy metal poisoning. In complementary medicine, also used for the treatment of atherosclerosis and other disorders.

cognitive therapy , cognitive-behavioral therapy that based on the theory that emotional problems result from distorted attitudes and ways of thinking that can be corrected, the therapist guiding the patient to do so.

convulsive therapy  treatment of mental disorders, primarily depression, by induction of convulsions; now it is virtually always by electric shock (electroconvulsive t.) .

couples therapy  marital t.

dance therapy  the therapeutic use of movement to further the emotional, social, cognitive, and physical integration of the individual in the treatment of a variety of social, emotional, cognitive, and physical disorders.

electroconvulsive therapy  (ECT) a treatment for mental disorders, primarily depression, in which convulsions and loss of consciousness are induced by application of brief pulses of low-voltage alternating current to the brain via scalp electrodes.

electroshock therapy  (EST) electroconvulsive t.

endocrine therapy  treatment of disease by the use of hormones.

estrogen replacement therapy  administration of an estrogen to treat estrogen deficiency, as that following menopause; in women with a uterus, a progestational agent is usually included to prevent endometrial hyperplasia.

enzyme therapy  in complementary medicine, the oral administration of proteolytic enzymes to improve immune system function; used for a wide variety of disorders and as adjunctive therapy in cancer treatment.

family therapy  group therapy of the members of a family, exploring and improving family relationships and processes and thus the mental health of the collective unit and of individual members.

fibrinolytic therapy  the use of fibrinolytic agents (e.g., prourokinase) to lyse thrombi in patients with acute peripheral arterial occlusion, deep venous thrombosis, pulmonary embolism, or acute myocardial infarction.

gene therapy  manipulation of the genome of an individual to prevent, mask, or lessen the effects of a genetic disorder.

group therapy  psychotherapy carried out regularly with a group of patients under the guidance of a group leader, usually a therapist.

highly active antiretroviral therapy  (HAART) the aggressive use of extremely potent antiretroviral agents in the treatment of human immunodeficiency virus infection.

hormonal therapy , hormone therapy endocrine t.

hormone replacement therapy  the administration of hormones to correct a deficiency, such as postmenopausal estrogen replacement ttherapy.

immunosuppressive therapy  treatment with agents, such as x-rays, corticosteroids, or cytotoxic chemicals, that suppress the immune response to antigen(s); used in conditions such as organ transplantation, autoimmune disease, allergy, multiple myeloma, and chronic nephritis.

inhalation therapy  former name for respiratory care (2).

light therapy 

1. phototherapy (def. 1).

2. photodynamic t.

marital therapy  a type of family therapy aimed at understanding and treating one or both members of a couple in the context of a distressed relationship, but not necessarily addressing the discordant relationship itself; sometimes used more restrictively as a synonym of marriage therapy .

marriage therapy  a subset of marital therapy (q.v.) that focuses specifically on the bond of marriage between two people, enhancing and preserving it.

massage therapy  the manipulation of the soft tissues of the body for the purpose of normalizing them, thereby enhancing health and healing.

milieu therapy  treatment, usually in a psychiatric hospital, that emphasizes the provision of an environment and activities appropriate to the patient's emotional and interpersonal needs.

music therapy  the use of music to effect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems.

occupational therapy  the therapeutic use of self-care, work, and play activities to increase function, enhance development, and prevent disabilities.

oral rehydration therapy  (ORT) oral administration of a solution of electrolytes and carbohydrates in the treatment of dehydration.

orthomolecular therapy  treatment of disease based on the theory that restoration of optimal concentrations of substances normally present in the body, such as vitamins, trace elements, and amino acids, will effect a cure.

photodynamic therapy  intravenous administration of hematoporphyrin derivative, which concentrates selectively in metabolically active tumor tissue, followed by exposure of the tumor tissue to red laser light to produce cytotoxic free radicals that destroy hematoporphyrin-containing tissue.

physical therapy 

1. treatment by physical means.

2. the health profession concerned with the promotion of health, the prevention of disability, and the evaluation and rehabilitation of patients disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiologic measures.

poetry therapy  a form of bibliotherapy in which a selected poem, which may be created by the patient, is used to evoke feelings and responses for discussion in a therapeutic setting.

PUVA therapy  a form of photochemotherapy for skin disorders such as psoriasis and vitiligo; oral psoralen administration is followed two hours later by exposure to ultraviolet light.

radiation therapy  radiotherapy.

relaxation therapy  any of a number of techniques for inducing the relaxation response, used for the reduction of stress; useful in the management of a wide variety of chronic illnesses caused or exacerbated by stress.

replacement therapy 

1. treatment to replace deficiencies in body products by administration of natural or synthetic substitutes.

2. treatment that replaces or compensates for a nonfunctioning organ, e.g., hemodialysis.

respiratory therapy  see under care.

substitution therapy  the administration of a hormone to compensate for glandular deficiency.

thrombolytic therapy  fibrinolytic t.

thyroid replacement therapy  treatment with a preparation of a thyroid hormone.

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group therapy

n.

A form of psychotherapy that involves sessions guided by a therapist and attended by several clients who confront their personal problems together. The interaction among clients is considered to be an integral part of the therapy.

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group therapy,

the application of psychotherapeutic techniques within a group of people (usually 10 or fewer) who experience similar difficulties. Generally a group leader directs the discussion of problems in an attempt to promote individual psychologic growth and favorable personality change. The procedure provides opportunities for treating a greater number of people in a shorter time than would be possible with individual therapy, and it is used in clinics, in institutions, and in private practice. Group therapy has been found to be particularly effective in the treatment of various addictions. A kind of group therapy is psychodrama. See also Gestalt therapy, psychotherapy, self-help group, transactional analysis.

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group therapy

Group psychotherapy Psychiatry The regular treatment of a small–2 to 20–group of people with a similar mental issue; GT techniques are as varied as the methods used in psychoanalysis, and tend to be therapist-specific. See Psychotherapy.