WEEK 13 o As with individual approaches to

treatment, much of the work in

I. Group Therapy group therapy began from a
psychoanalytic tradition, most
a. A Historical Perspective forms of psychoanalytic group
therapy are basically
· One of the earliest formal uses of group psychoanalytic therapy carried
methods was Joseph H. Pratt’s work with out in a group setting.
tubercular patients in 1905.
o Although there are obvious
· This was an inspirational approach that differences from individual
used lectures and group discussion to help lift psychotherapy (e.g., multiple
the spirits of depressed patients and promote transference effects, modified
their cooperation with the medical regimen. therapist–patient transference,
and influences from one
· A major figure in the group movement member to another), the focus is
was J. L. Moreno, who began to develop still on phenomena such as free
some group methods in Vienna in the early association, transference,
1900s and, in 1925, introduced his interpretation of resistance, and
psychodrama to the United States. Moreno working through.
also used the term group therapy.
o Although one can hardly argue
· Trigant Burrow was a psychoanalyst that group processes do not
who used the related term group analysis to exist, their role is viewed as
describe his procedures. secondary to that of individual
processes.
· In the 1930s, Slavson encouraged
adolescent patients to work through their o Typically, these groups consist
problems with controlled play. His procedures of eight to ten members (equal
were based on psychoanalytic concepts. numbers of men and women)
These and other figures have been identified who meet for 90 minutes three
as pioneers of the group movement. times a week. Sometimes the
group meets once or twice a
· As was true for clinical psychology week without the therapist to
generally, it was the aftermath of World War II facilitate the working through of
that really brought group methods to center transference relationships.
stage.
o Patients often free-associate to
· As we have observed before, the large their feelings about other
number of war veterans sharply increased the members, report dreams, and
demand for counseling and therapy. The analyze resistance and
limitations of the existing agency and hospital transference feelings toward
facilities made it necessary to use group both the therapist and other
methods to cope with the immediate demand. group members.

- Psychodrama

· It involves a patient, a stage on which

b. Approaches to Group Therapy the drama is played, a director or therapist,
“auxiliary egos” (other patients, therapeutic
· Psychoanalytic Group Therapy aides, and others), and an audience.

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· The director assigns the patient a role, just passive observers; they may
and the supporting cast is made up of the be called on to say how they
auxiliary egos. The audience can provide regard the person in the hot
acceptance and understanding and may even seat.
participate contemporaneously.
o At times, there are bits of role-
- Transactional Analysis playing, the reporting of dreams,
and dialogues between patients.
· TA is essentially a process in which the But regardless of whether a
interactions among the various aspects of the member is an observer or in the
people in the group are analyzed. Analyses hot seat, there tends to be
often focus on three chief “ego states” within intense involvement in the
each person: the Child ego state, the Parent proceedings.
ego state, and the Adult ego state.
· Behavior Therapy Groups
· Each state is composed of positive and
negative features. The positive Child is o Group behavior therapy, a fairly
spontaneous, uninhibited, and creative. The popular mode of group therapy
negative Child is fearful, overly emotional, or in contemporary clinical
full of guilt. psychology, seems to have
grown out of considerations of
· On the positive side, the Parent state efficiency rather than a primary
may be characterized as supportive, loving, or decision to focus on the
understanding. The negative Parent is dynamics of group interactions.
punishing and quick to condemn.
o It is entirely feasible to conduct
· The Adult ego state is less oriented desensitization sessions, model
toward feelings and emotions and is more interpersonal skills, or use
involved with logic, planning, or information cognitive restructuring
gathering. But the Adult can be reasonable interventions in a group setting.
(positive) or nonspontaneous (negative). For example, it is possible to
teach patients in a group setting
· Gestalt Group Therapy how to relax, and it is equally
possible to establish common
o Gestalt therapy focuses on anxiety hierarchies
leading the patient to an simultaneously with several
awareness of the “now” and an patients.
appreciation of one’s being in
the world. In group therapy, this o Where such procedures are
is achieved by concentrating on feasible, it is certainly efficient to
one member at a time. use them. In contrast to other
group therapy approaches, the
o The therapist focuses on the therapist in group behavioral
patient, while the other group therapy often plays a very
members serve as observers. active, almost didactic role,
This has been dubbed the “hot providing lessons, skills training,
seat” approach. and homework assignments.

o Patients are asked to

experience their feelings and
behavior—to lose their minds
and find their senses. Other c. The Curative Factors
members of the group are not
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· Imparting information. Group members · In general, research on group therapy
can receive advice and guidance not just from has not advanced much beyond answering
the therapist but also from other group the general question of overall effectiveness.
members. However, some believe that evidence is
mounting to show the differential effectiveness
· Instilling hope. Observing others who of certain group models of treatment in
have successfully grappled with problems different psychological disorders.
helps to instill hope—a necessary ingredient
for any successful therapy experience. · Although theorists such as Yalom have
proposed a variety of “curative factors” or
· Universality. Listening to others, one other variables that may influence outcome in
discovers that he or she has the same group treatment (e.g., group leadership style,
problems, fears, and concerns. Knowing that the necessity of pre-group training), relatively
one is not alone can be highly rewarding. few studies have been conducted that
critically examine the effect of these factors.
· Altruism. In the beginning, a group The studies that have been completed are
member often feels useless and demoralized. plagued with a number of conceptual and
As it becomes apparent that one can help methodological problems.
others in the group, a feeling of greater self-
value and competence emerges.

· Interpersonal learning. Interacting with III. The Future of Group Therapy

others in the group can teach one about
interpersonal relationships, social skills, · Group therapy is attractive to therapists
sensitivity to others, resolution of conflicts, and managed care organizations because it
and so on. can save staff time (and ultimately money) in
the care of less severely disturbed patients
· Imitative behavior. Watching and and it offers an alternative to inpatient
listening to others can lead to the modeling of treatment in some cases.
more useful behaviors. Group members learn
from one another. · However, to take advantage of these
opportunities, group therapists need to better
· Corrective recapitulation of the primary educate the public and health care
family. The group context can help clients professionals about this mode of treatment,
understand and the effects of past family aggressively lobby governments and
experiences can be dissolved by learning that managed behavioral health care companies to
maladaptive coping methods will not work in financially support group therapy as a service,
the present group situation. and better educate themselves about
managed care and the health care needs that
· Catharsis. Learning how to express remain unfulfilled.
feelings about others in the group in an
honest, open way builds a capacity for mutual
trust and understanding.
IV. Family Therapy
· Group cohesiveness. Group members
become a tightly knit little group that a. The Development of Family Therapy
enhances self-esteem through group
acceptance. · Fruzzetti and Jacobson (1991) trace the
origins of family therapy to the 19th-century
social work movement. However, family
therapy did not immediately gain prominence.
II. Does Group Therapy Work? It was not until the mid-20th century that

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family therapy became a popular form of · There is no clear, consensual definition
treatment. of what constitutes family therapy. Indeed,
there is not even a consensus on who should
· Some of the delay had to do with the conduct it. The general procedures of family
long-standing dominance of psychoanalysis. therapy are carried on by psychologists,
The perspectives of behaviorism and psychiatrists, social workers, counselors, and
humanism paved the way for an alternative others.
treatment like family therapy to become a
viable option for clinicians. · Family therapists and counselors are
trained in several different programs, including
· The problems of individuals were clinical psychology, counseling psychology,
conceptualized in systemic terms, as a psychiatry, social work, family and child
manifestation of some type of family development, and education.
dysfunction. This new perspective on clinical
problems was most evident in some of the · The Goals
conceptualizations of severe mental disorders
such as schizophrenia. o Most family therapists share the
primary goal of improving
communication within the family
and deemphasize the problems
of the individual in favor of
b. The Concept of Communication treating the problems of the
family as a whole.
· From the time of its origins in the work
on schizophrenia, family therapy has · Some General Characteristics
emphasized communication. Pathology has
typically been seen as a failure of o Certain aspects of family therapy
communication among family members. This differentiate it from the
communication focus can be seen in what customary individual therapy.
many regards as the central concept in family For example, family members
therapy—general systems theory. have a shared frame of
reference, a common history,
· Family therapy deals with the and a shared language of
relationship between the individual family connotations that may be foreign
member and the family system. The family is to the therapist.
conceived of as a system, which family
therapy seeks to alter in some important way. o The therapist has to learn the
Many conceptualize the family as constantly family roles and something
striving to maintain a homeostasis. about the family’s idiosyncratic
subculture.
· One person’s behaviors (e.g., a child’s
developmental delays) may shift attention o This information is used to
away from a conflictual marital relationship. enhance communication or to
Sometimes the family successfully adapts to confront family members. At the
their particular pattern of interaction within this same time, the therapist must
system. remain detached and not
become overly identified with
one faction of the family at the
expense of another.

c. Forms and Methods o This can be a difficult and

delicate task because family
members will often attempt to
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 use the therapist in their power · In some instances, the therapist may
struggles or in their defenses conduct traditional psychotherapy with the
against open communication. principal patient but also occasionally see
other members of the family.
· Conjoint Family Therapy
· As a matter of fact, it is perhaps
o In conjoint family therapy, the unfortunate that the last variation is not used
entire family is seen at the same more often as a part of traditional
time by one therapist. In some psychotherapy.
varieties of this approach, the
therapist plays a rather passive, · Because it is often the case that an
nondirective role. individual patient’s problems can be
understood better and dealt with better in
o In other varieties, the therapist is collaboration with significant others in the
an active force, directing the patient’s life, the use of such arrangements
conversation, assigning tasks to should facilitate the therapeutic process.
various family members,
imparting direct instruction
regarding human relations, and
so on.
b. Collaborative Family Therapy
o In conjoint and other forms of
family therapy, there are five · In collaborative family therapy, each
basic modes of communication: family member sees a different therapist. The
therapists then get together to discuss their
- placating (always agreeing, no matter what patients and the family as a whole.
is going on)
· As we saw earlier, the use of this
- blaming (a person’s way of showing how approach with child patients was one of the
much he or she can criticize another and thus factors that stimulated the early growth of
throw his or her weight around) family therapy.

- super-reasonable (especially characteristic · In a variation of this general approach,

of teachers, whose words may come out co-therapists are sometimes assigned to work
“super-reasonable” but may bear no with the same family. That is, two or more
relationship to how they feel) therapists meet with the family unit.

- irrelevant (the words are completely

unrelated to what is going on)

- congruent (the words relate to what is real). c. Behavioral Approaches to Family

Therapy

· The role of the therapist is to generate

V. Other Varieties of Family a behavioral analysis of family problems.
Therapy
· This analysis helps identify the
a. Concurrent Family Therapy behaviors whose frequency should be
increased or decreased as well as the
· In concurrent family therapy, one rewards that are maintaining undesirable
therapist sees all family members, but in behaviors or that will enhance desired
individual sessions. The overall goals are the behaviors.
same as those in conjoint therapy.
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· Behavioral family therapy then · In some instances, it quickly becomes
becomes a process of inducing family clear that a given family member is so
members to dispense the appropriate social disturbed, so uncooperative, or so disruptive
reinforcements to one another for the desired that the entire process of family therapy would
behaviors. be poisoned by his or her presence.

VII. Couples Therapy

d. Multisystemic Therapy
· Although we use the term couples
· MST sees the family as the most therapy, this approach is not limited to married
important link in changing problematic couples and can be provided to unmarried
behavior, and this approach is characterized couples, same-sex couples, and others.
by several key components:
· There are many issues that bring
(a) treatment is delivered in the person’s couples in to consult with a clinician. In one
home, school, or other community locations sense, couples therapy can be construed as a
(b) MST therapists are available for form of family therapy.
consultation 24 hours a day, 7 days a week.
· For example, when a husband and wife
(c) the caseloads of MST therapists are kept are seen together and the focus of treatment
intentionally low (4 to 6 families) in order to is on the marital relationship rather than on
provide intensive services to each family. the problems of the individuals, a form of
family therapy seems to be involved.
(d) MST therapists serve on a team in order to
provide continuity of services and to be
available for back-up should the need arise.
a. Behavioral Marital Therapy

VI. When to Conduct Family

Therapy? · A major component of his treatment
was a technique called contingency
· Sometimes, family crises, such as the contracting; spouses were trained to modify
death of a family member, propel the entire their own behavior to effect a specific desired
family unit into pathology almost as one. In change in their mate’s behavior.
some families, there are conflicts over values.
· Over the years, BMT has broadened to
· For example, an adolescent who include a number of additional techniques.
begins to take drugs or becomes totally Support understanding techniques aim to
absorbed in a cult or a different religion may increase positive behaviors emitted by
disrupt the entire family by seeming to partners, increase collaboration within the
undermine its values. In such instances, couple, and increase positive feelings in each
family therapy may be a logical recourse. partner.

· However, family therapy is not a cure- · For example, each partner generates a
all, and it is not always appropriate. list of behaviors that, if produced by his or her
Sometimes a family is so disrupted that such mate, will bring pleasure. Next, each partner
intervention would clearly be doomed to fail. It agrees to perform three of the behaviors from
is also possible that one or more family her or his partner’s list before the next
members will refuse to cooperate. session.

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· Problem-solving techniques involve families of patients with
training couples in positive communication schizophrenia appear
skills so that effective decision making and efficacious in reducing relapse
negotiating are possible. rates for the disorder. Relapse
rates for patients with
· For example, couples are given a list of schizophrenia typically range
basic rules of positive communication skills between 50% and 75%, but the
and then “practice” these skills within the relapse rates for patients whose
session. families received treatment were
typically 35% or less.
· The clinician intervenes if she or he
thinks it will be helpful (e.g., clarifying the · Couples Therapy. Baucom et al. (1998)
appropriate communication skills, modeling provide additional information on the efficacy
alternative ways to communicate that are of different forms of couples therapy.
more positive).
o They concur that behavioral
marital therapy (BMT) is
efficacious, noting that data
suggest that between one-third
b. Emotionally Focused Couples Therapy and two-thirds of the couples
who receive BMT are likely to be
· Emotionally focused couples therapy similar to non-distressed couples
(EFT) is a brief treatment that seeks to (based on their scores on
change partners’ problematic interactional outcome measures of
styles and emotional responses so that a relationship functioning) by the
stronger and more secure emotional bond can end of treatment.
be established.
o In addition, Baucom et al. (1998)
· This treatment approach assumes that report that the available
negative affect and associated destructive evidence suggests that
interactional styles create marital distress. emotionally focused couples
Further, it is believed that a more secure therapy (EFT) is an effective
attachment to one’s partner is necessary to form of treatment, especially
stabilize a dyadic relationship. with mildly to moderately
distressed couples, and that
EFT was superior to BMT in at
least one study (Johnson &
VIII. Do Family Therapy and Greenberg, 1985). Finally,
Couples Therapy Work? Baucom et al. note that
cognitive, cognitive-behavioral,
· Family Therapy. Despite the popularity and insight-oriented forms of
of family therapy in clinical practice, relatively couples therapy appear
few well controlled empirical studies have promising in their effects to date
been conducted to evaluate its effectiveness. and should be investigated
further.
o Family therapy has also been
shown efficacious for a second
psychological disorder,
schizophrenia. Baucom et al.
report that behavioral,
supportive, and family systems
forms of family therapy provided
for at least 9 months to the
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