Topic 1: Group Basics, Dynamics, Processes, & Leadership Styles {by 9/10}

There are three readings due this week – Bieling et al. Chapters 1 & 2 and Yalom Chapter 5.  Address the following two discussion points: (1) Bieling et al. discuss some of the similarities and differences in group therapeutic factors between Yalom and CBT. Discuss what you think are some important universal group therapeutic factors regardless of theoretical orientation (Yalom/CBT); and then what are some factors that may be unique to CBT (or at least a stronger emphasis). (2) Based on Yalom’s reading, what did you take away as important therapist skills in the creation and maintenance of groups (e.g., culture building, norms, etc.)? Be sure to support both of your responses using the readings (i.e., not anecdotal opinions).  Your original post should be posted by the beginning of class 9/10.  Have your two replies no later than 9/12.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

22 Comments (+add yours?)

  1. Gil
    Sep 07, 2014 @ 13:35:52

    Many of the universal principles present in various schools of therapy overlap and connect with one another. Yalom and Bieling list instillation of hope, universality, and group cohesiveness as three key factors in guiding a successful group. Yalom seems to embrace certain aspects of various orientations in his support of the here-and-now and transference. First, encountering others with similar issues can help address feelings of isolation and help foster self-acceptance. The connection, acceptance, and trust among group members allow the group processes to take place. Therefore, when someone in the group begins to see benefits, the others often feel increased hope in their own situations and will model the successful behavior of the member. The universality prompts cohesiveness and the cohesiveness can inspire acceptance and encouragement to produce hope. Although, different orientations may provide different labels for these effects, the underlying factors are similar.

    Those from a CBT orientation will augment this instillation of hope through providing research to show the efficacy of group CBT. However, a main difference related to CBT is the added structure of the session plan to focus on specific principles and techniques pertaining to CBT. This direction provides the group with a deliberate sequence of steps designed in a way that the new techniques build upon the previous sessions. The group process can help augment these techniques. For example, Socratic questioning and other member perspectives can help reality test cognitive distortions. Various assumptions can be tested from these alternative perspectives or from taking action to test these assumptions, especially through exposure. The cheerleading and observational learning can increase the success of the exposure. Bandura pointed out that perceived similarity to others helps support modeling for encountering exposures. The CBT group offers these tangible skills and direction to help measure objective progress and keep the group more focused and directive in moving toward improvement.

    Yalom supports the therapist being the most effective for the group using indirect an indirect approach. He sees the main factors of change coming from the group processes. Therefore, the therapist’s main job is to support an environment where these group processes flourish. The power differential, lack of therapist disclosure, and perceived non-similarity between the members and the therapist can create barriers to effective communication and openness. Therefore, the therapist’s modeling of concern, acceptance, genuineness, and empathy to affect the members’ behavior is more important for change. The therapist can help create the culture of the group to guide behavior. However, before these in group processes take place, the therapist must select group members that are appropriate for the group and who will help group cohesiveness. Finally, the therapist understands the mechanisms of change and will help draw this information from other group members. Feedback and self-disclosure are vital to group progress, but some group members will let their fears of confrontation, evaluation, or norms stand in the way of their contribution. Questions to elicit the thoughts of others and reinforcement upon self-disclosure can increase these helpful behaviors.

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  2. Sarah-Eve
    Sep 07, 2014 @ 15:30:04

    1) According to Yalom (1995), there are nine relevant therapeutic factors that groups offer: instillation of hope, universality, imparting information, altruism, corrective capitulation of the family group and interpersonal learning, socialization techniques, imitative behavior, group cohesion, and catharsis. Bieling et al. (2006), defines important aspects to the CBT process as: optimism, inclusion, group learning, shifting self-focus, group cohesiveness, modification of maladaptive relational patterns, and emotional processing in group settings.
    One similarity is group cohesiveness, which is important to facilitating cognitive and behavioral changes. Yalom and Bieling share similarities in some of their important therapeutic factors. For example, instillation of hope and optimism are extremely similar. Emphasizing positive outcomes and providing an atmosphere promoting hope is vital. Universality and inclusion are also similar; the group promotes awareness of shared issues and allows for individuals to feel a sense of belonging. Group learning also encompasses a few aspects of Yalom’s therapeutic factors, it indicates that the group provides the opportunity for learning on many levels (e.g., psychoeducation, feedback/advice from others, and alternative perspectives), this type of learning may also promote corrective social learning experiences or modification of maladaptive relational patterns. Socializing techniques (i.e., development of basic skills) and imitative behavior (i.e., learning from the observation of others) are similar to group learning. Shifting self-focus and altruism refer to the opportunity of group provides members to help others through support, self-disclosure, and reassurance.
    Corrective recapitulation of the primary family group may not be as relevant to CBT because its focus is more on the “here and now” rather than on attachment. Psychotherapy is more likely to work through early developmental experiences, while CBT may address origin of issues, but will not delve into re-experiencing or interpreting these occurrences. According the Yalom, the therapeutic factors are necessary, but not sufficient for successful groups and the main focus is on group process. CBT agrees with this and adds that the group process should be structured and progress through specific stages.
    2) Yalom (1995) explains that there are three fundamental tasks of a therapist (creation and maintenance of the group, building a group culture, and activation and illumination of the here and now). In creating and maintaining a group, there are many important skills in which a therapist may rely on. The therapist must start off as the unifying force for the group members and deter anything that may potentially threaten the group’s cohesion; tardiness, absence, cliques, scapegoating, etc. The therapist shapes the therapeutic social system unwritten codes/rules/norms that guide the group culture. Norms, or behavioral rules, may involve what is the correct amount of self-disclosure, the appropriate amount of help from group members, and how safe others are in the group to confront members. These norms are typically expressed indirectly, such as the promotion of spontaneity of expression between group members, and are a result of group members’ and the therapist’s expectations of the group. Other norms may be explicitly shaped through the directions of the therapist and other influential group members. Often, social reinforcement shapes norms. Reinforcement from the therapist and group members influence the types of behaviors produced and encouraged in group. Not only does the therapist reinforce behaviors, but they may model them to the group as well, teaching the group members norms through vicarious learning.

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  3. Richard Hisman
    Sep 09, 2014 @ 10:37:51

    1. What are the elements of group therapy that are universal? Regardless of orientation Bieling and Yalom posit that optimism is an essential component of any therapy group. Through expectation and knowledge of prior effectiveness of the therapy type, can greatly increase the effectiveness of any group being formed. Inclusion of its members is a key component in group cohesion, which is another factor that crosses orientation boundaries. All participants in a group must seek self-disclosure in order for the group to acknowledge that they are not alone. Others suffer from the same maladies. Psycho-education is paramount in all orientations to ensure that the direction and skill sets necessary for recovery are clearly delineated.
    Differences begin right away when analyzing CBT group approaches. Most psychoanalytical groups can be open ended, ongoing that add to and subtract members as therapies are completed and started. CBT groups tend to be closed ended specific length of time groups. Membership in a group does not change unless a member needs to be dropped for a specific reason. Group learning follows a very specific line in which homework, skill sets, and exposure are the key elements. This structure is unlike the process group style Yalom describes where the group as a whole directly influences the direction of the therapy. In CBT the empirically driven therapy models guide the direction and clients influence the speed. Group structure can be subtlety influenced as well.
    Formation of a group in CBT requires that the clients be as similar as possible. An optimum group would all have the same axis I diagnosis and the same or no comorbidity factors. While this not likely to happen it is optimum. One last split occurs in inclusion, whereby a shift from individual emphasis or self-focus to helping the others in the group. It puts more value on altruism than an individual’s self-centrism.
    2. Yalom positioned that a therapist needed to be “a gate keeper” for the group. That stability of the group was directly tied to stability of its membership. The insight to recognize threats to group cohesiveness was a skill that is paramount in a successful therapist. In order to facilitate this stability, norms had to be set. The ability of the therapist to be the technical expert and initial key model of these normative rules were vital to instilling in the group the norms that were to be expected. The therapist needs to then be able to instill the importance of the group through one’s ability subtly encourage or acknowledge positive interactions. At times when the group stalls it may be necessary for the therapist to self-disclose or provide an example to the group in order to restart the dialogue.
    This will also be a modeling of behavior to the group and establish that all can contribute. Culture building and group dynamics round out the effective therapist. By virtue of one’s honesty and spontaneity the therapist will build upon the interaction of the group. It is essential that the therapist eventually become the shaper of the group social structure. The group clients begin to interact with each other moving the group, directing the change. The therapist is now is ensuring that negative factors do not destabilize the group.

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    • Gil
      Sep 10, 2014 @ 18:20:31

      I wonder about the effects for having an open vs. closed group. It seems that an open group might make it more difficult for members to feel the same cohesiveness that a closed group might garner. The closed group might keep members together for better or for worse. It’s possible that being refined to a group pushes members to work through differences. Sometimes being stuck in a situation brings adaptation to the situation. However, the open group has the possible benefit of spreading the growth of the group to more individuals. The norms and expectations of the group have already been set, so new members have multiple models to follow in order to embrace the group standards. Finally, the open group and timeline make missing a group or two more forgiving. The linear nature of the CBT group make an absence possibly harmful to the individual who might have benefited from the particular topic.

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    • Sarah-Eve
      Sep 11, 2014 @ 09:25:34

      Though process groups focus on self-disclosure more often, it is also a vital component in CBT oriented groups. Self-disclosure promotes many other factors, for example, it can aid in the feeling of inclusion or universality. It also ties into shifting focus from the self and altruism, when a group member is able to successfully support the individual who is disclosing such personal information. These feelings of belonging and helping aid in promoting group cohesion. The therapist acting as a “gate keeper” also helps to promote group cohesion and instill specific norms within the group in order to encourage appropriate behavior. The following of these “rules” can also affect group cohesion. An individual who actively breaks these norms sets themselves apart from others and influences the sense of belonging and oneness of the group.

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  4. Paige Hartmann
    Sep 09, 2014 @ 10:56:47

    Bieling et al. focus on the similarities and differences in group therapeutic factors between Yalom and CBT. However, despite theoretical orientation, there are important universal therapeutic factors necessary for group therapy. I believe that the instillation of hope and universality play an important role within group therapy. In order for group members to be motivated to change, they need to be provided with hope and the understanding that they are not alone in their struggles. Additionally, imparting of information/psychoeducation is another important therapeutic factor within a group setting. Providing an explanation or model of the group members’ condition and struggles is necessary in order for the participants to gain understanding of their situation. Socializing techniques are also important because it allows the participants to develop better social skills as well as practice these new skills with one another. Lastly, group cohesion is an essential therapeutic factor that promotes trust and support among participants within a group setting. When the level of group cohesion is high, participants will feel more comfortable disclosing their struggles and emotions with one another. The therapeutic factors that would be unique to CBT include the modification of maladaptive relational patterns and emotional processing within the group setting. Although Yalom discusses socializing techniques, within a CBT group the focus would consist of modifying maladaptive appraisals. This would be achieved through utilizing CBT techniques such as identifying core beliefs, role play, and exposure. Additionally, emotional processing within the group would focus in the moment on automatic thoughts and beliefs of the participants.

    Based on Yalom’s reading, one of the first important therapist skills in the creation and maintenance of groups is recognizing that the group members are the agent of change. It is essential for the therapist to develop a group culture that provides effective interactions between group members. This can be achieved through the development of norms within the group that provide expectations of the members and directions from the group therapist. Yalom discusses that the group therapist can shape the norms of the group through the role of the technical expert or the model setting participant. The technical expert role provides a more direct way of shaping the norms of a group through explicit directions and reinforcing strategies. The model-setting participant role shapes the norms for the group through the group therapist’s behavior and functions as an example. The participants will be able to change their behavior based upon observing the group therapist’s adaptive behavior.

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    • Gil
      Sep 10, 2014 @ 18:30:07

      It’s interesting that Yalom designates the other group members as the primary agents of change. They have not been trained to use empathy, validation, and warmth that therapists should have learned. However, it seems that genuiness is the key factor that makes the other group member’s input so valuable. Clients can always suspect a therapist of having ulterior motives, being manipulative, and having too much of a power difference. I might feel shaped when a therapist gives me a compliment, but truly accept the compliment when it comes from a peer. The defenses present against a therapist may not be as high against other members. It also might be the case that the group members identify more with each other and feel more understood by someone who is actually experiencing the same issues. When someone without depression tells someone to just snap out of it or cheer up, there is most likely a lot of defensiveness because the person with depression correctly accuses the person of not understanding the situation. Finally, perceived similarity can be important in increasing observational learning to spread successes.

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    • Richard Hisman
      Sep 11, 2014 @ 10:31:25

      One thing I picked up first in Yalom and then Bieling, was the necessity of the therapist to keep accurate records of where a group is and what has been previously worked on. This enables smooth transitions from meeting to meeting. It seems pretty simple, but as I am finding out in other courses, it is not uncommon for inexperienced and even experienced therapist to “get lazy” so to speak and confuse clients. In a group setting this would seem even easier to do. I am not currently on internship, for those who are, approximately how many groups do your supervisors supervise in a given week? Do they also handle individual therapy while performing groups?

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    • Robert
      Sep 13, 2014 @ 15:34:13

      I agree that the group members are the agent of change with the therapist providing the framework for the group interactions, but is not the main force behind them. Research indicates that group members valued each other’s feedback more than the therapist’s, and viewed each other as the agent of change rather than the therapist. Feedback, whether it be positive or negative, from a fellow group member who suffers from the same disorder usually appears more meaningful compared to a therapist who is a paid expert who may or may not have had the disorder. This is not to underestimate the importance of the role the therapist has of helping to create an environment where member feedback can be therapeutically beneficial as opposed to detrimental that can occur in real life or is often parodied in popular culture (e.g. the movie, Anger Management).

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  5. Robert
    Sep 09, 2014 @ 22:50:18

    1. Group cohesion with its culture of trust and support from group members is one essential therapeutic factor regardless of theoretical orientation. A lack of cohesion impedes progress towards clinical goals and influences member drop out. Universality is another group therapeutic factor that is especially relevant to group therapy. It is one thing for people to be told others suffer from the same specific disorder they have, but it’s quite another for them to meet and get to know other sufferers. CBT may more strongly emphasize socializing techniques and imitative behavior as members can model for each other how to successfully overcome difficulties. This also extends to homework tasks, with the therapist’s reinforcement of its completion supporting the desire of other members to imitate accomplishing it.
    2. I took away from Yalom’s reading the importance of the therapist to establish a group culture of support, self-disclosure, cohesion, norms, and effective boundaries of confrontation. The therapist establishes a focus on the here-and-now in the group process and on group members as facilitators of change. Positive change for group members occurs in the context of group members feeling safe in self-disclosing and appropriately challenging each other. The therapist assumes a role similar to that of a conductor in guiding the action but is not the main force behind it. Yet, the therapist plays a crucial role in group therapy, especially in the beginning, to ensure the best outcomes for the group. Like all forms of communication, it is just as important for what the therapist doesn’t do as well as what the therapist does that influences the group.

    Reply

    • Sarah-Eve
      Sep 11, 2014 @ 09:17:59

      Establishing the here-and-now in group process, while promoting group members as facilitators of change, is such an important part of group therapy. Individual therapy neither promotes the same sense of camaraderie, nor provides such diverse feedback and reactions as do groups. Receiving feedback, observing reactions, and witnessing progress in other individuals who are both similar and dissimilar promotes stronger responses within a group member. The main role of the therapist is to guide the group’s interactions, rather than providing the actual advice. Though the therapist often imparts information through psychoeducation, education and knowledge may also be spurred on by group members. It is very rare that I don’t come out of a group feeling as if I have learned nothing new.

      Reply

    • Paige Hartmann
      Sep 12, 2014 @ 10:42:50

      Robert, I liked your discussion regarding the therapist’s role within a group therapy setting. It is important for the therapist to establish the group culture as well as have an awareness that the group members are the agents of change. You bring up a valid point regarding the influence that the therapist has over the group setting. The therapist should have self-awareness because what the therapist doesn’t do will impact the group just as much as what the therapist does do. As a beginning therapist I think this is an important factor we must really consider when starting to run our own groups.

      Reply

  6. Sarah Gagne
    Sep 10, 2014 @ 00:04:02

    Despite theoretical orientation, most clinicians can agree upon common factors that will increase the efficacy of group therapy. Without group cohesion, or a therapeutic alliance, very little therapeutic value can be gained from session. Group members should feel confident that the environment is safe and non-judgmental. Group cohesion can be achieved in part by understanding the universality of experiences in group therapy. Group members are able, sometimes for the first time, to openly disclose in a confidential environment and will often find that they are not alone in their illnesses and share similar experiences. Imparting information can be translated to psychoeducation and the facilitation of group based learning. Group members can provide personal accounts of how specific techniques have worked for them in similar situations, or facilitators can provide case studies of clinical examples and explain models of change. Installation of hope may occur as a result of hearing success stories, and group members may feel they are capable of the same processes of change.

    Therapists must understand the importance of the group process and the interpersonal alliance. Yalom emphasizes the importance of identifying the group as the agent of change rather than the therapist, which is seen in individual therapy. The therapist’s main goal is to create an environment, or culture, in which group members are able to function within a set of social norms that will lead to the maintenance of the therapeutic factors. For example, universality is far less likely to be achieved if the therapist takes control of the group with only case studies and does not allow clients to share their own experiences. Group members should eventually effectively interact with each other as they would with peers in the “real world.”

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    • Michelle
      Sep 11, 2014 @ 20:25:53

      Sarah, as group therapy begins, and progresses, and members learn about each other’s struggles, experiences, and traumas… I agree that it helps to formulate the group cohesion that can be so vital to the individual successes of each member of the group. You brought up the point of confidentiality. I’m so glad that you did- and I wonder what everyone’s opinion of having a group confidentiality agreement is, as a group begins. I would think that some members might feel safer to reveal, if they believe that other members will keep what is said within the group. For open groups (probably wouldn’t be CBT-based), I would think that it could even be helpful if the existing members explain the confidentiality practices when the new group member joins.

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  7. Jessica
    Sep 10, 2014 @ 00:15:56

    I think the universal factors for group therapy regardless of theoretical orientation are 1) instillation of hope 2) universality 3) imparting of information and 4) group cohesion. All groups, from AA to Weight Watchers to Gestalt to CBT involve these aspects. Hope is a particularly strong predictor of change, for without it even the best interventions delivered in the best possible way will usually fall on deaf ears. Universality is a strong appeal of groups, of knowing one is not alone. Imparting information occurs invariably, albeit in many different ways (It might be explicitly didactic in nature, and/or it may be advice from other members) and with widely varying content depending on the group. Group cohesiveness is what draws the group together and keeps it going, based on many complex factors such as acceptance, trust, and support.
    In CBT, these factors are very important, though imparting information may be more important in a CBT group than in a humanistic group that won’t offer it’s participants a theoretical model for their disorder and ways to change, backed by research. Yet this factor is not as important in CBT group as it is for some support groups that are mainly designed to teach members skills or information with little reference to the individual’s behavior, cognitions and emotions occurring in the here-and-now. Thus since CBT involves a delicate balance of imparting information and giving all members a chance to talk, and ideally begin to impart therapeutically useful information to each other, leadership skills and structure is important. The leader has to structure the group, pay attention to group process, and encourage others to offer each other feedback and support. Socializing techniques and imitative behavior are likely more directly addressed and encouraged in CBT than some other groups. For example CBT groups often assign homework and addressing the group’s compliance or non-compliance to the homework would bring to light one aspect of the group’s norms and imitative behavior.
    There is a lot I learned from Yalom in this chapter, one of the most important things I learned are that a leader influences group norms just as much by inactivity as he/she does by activity. For example, not addressing that someone is late makes it seem ok to arrive late and undermines the importance of the group. The therapist should endeavor to make all the members “mini-therapists” by picking up the therapist’s evaluative function as they observe and learn skills of offering feedback and appropriate suggestions over time. I also agreed strongly with Yalom’s statement “I believe that it is important to articulate how much the group matters to you” (p. 136). If the counselor views both the treatment and the clients) as important and valuable and communicates this to the client(s) then so will the clients view the treatment and themselves as important and valuable. This can be communicated by explicitly stating it but also by other ways: arriving on time, being well-prepared and remembering and giving thought to what people have said in previous groups indicates that the group is important to the therapist.

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    • Richard Hisman
      Sep 11, 2014 @ 10:12:40

      I believe one aspect that has been under-discussed at this point is why and what are the leadership qualities and why do these qualities work? It is probably the single biggest factor for a client when exploring his or her willingness to enter a group. Is the individual therapist able to instill confidence that this is worth his or her effort. Too strong of a character and individuals will avoid the group due to feeling inferior and to weak the individuals will not see any point in entering a group run by that therapist. I bring this up, because all of us including myself, discussed the installation of hope. During initial interviews this will be a key component. A common misconception of individuals in the military is, you give orders and people follow them. That does not work for long. The installment of confidence in individuals that you will guide them, keep them safe, care for them, and respect them are but some of the aspects that earn that trust. The same would be true of individuals entering therapy either group or individual.

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      • Michelle
        Sep 11, 2014 @ 20:16:29

        Richard, I agree that it’s vital that group members feel free and comfortable enough to share intimate details of their life, in order for them to open up, share, and then in turn learn from each other and the leader. The leader had great influence over this- I would agree. Right from the start of group, the therapist models warmth, acceptance, and regard, which in turn should promote group members to act in the same manner, thus facilitating a group where there is mutual respect, warmth, and empathy.
        You had responded to the readings by indicating that you see installation of hope as highly valuable. Both Yalom’s work and CBT agree that it’s a vital factor to the eventual chances of success, and I too would agree. Possibly, one benefit of group therapy is the members being able to see each other’s struggles, and then successes and victories. Through Universality, they can then seen the modeled successes, and feel an even greater sense of hope.

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  8. Michelle
    Sep 10, 2014 @ 13:46:40

    Yalom asserts that there are eleven primary therapeutic factors. These factors direct attention to the group itself, rather than focusing on the applied mode of therapeutic intervention, such as CBT. Burlingame et. al. respond to Yalom’s theory by asserting the value of the various modalities that have proven successful for use within the group domain. For instance, Burlingame et. al. suggest that there are several major contributing factors, one of which is referred to as the “formal change theory.” This factor identifies the mode of treatment used in the group therapy environment, and asserts the importance of interventions and techniques employed. His theory aligns with Yaloms’, by acknowledging the importance of group process, which includes the relationships between group members, the particular personality traits that each member brings to the group, and by group factors such as length and number of sessions.
    Both Yalom and CBT assert that instillation of hope and universality are important. Within the CBT model, however, it seems to me that these factors are viewed more in terms of the value that they bring to the structured CBT framework, so that they support methods and interventions that are a part of this particular treatment modality. Imparting information and altruism are also common factors that both Yalom and CBT agree are important. Because CBT is more focused on current affect, behavior, and cognitions, it doesn’t particularly address corrective recapitulation. However, identified problematic core beliefs may surface, and the formation of them briefly explored. Rather though, than focusing on early familial issues, CBT focuses more on how those circumstances and environment shaped the identified core belief.
    I personally see most, if not all, of the therapeutic factors as important. Creating an environment that is accepting and open is critical, and hearing that other members have had success in varying ways and amounts can become an encouragement. So, installation of hope is high on my list of important factors (CBT seems to agree). Altruism allows the participant to try out their own ideas in a safe place, and to gain self efficacy from those experiences. Finally, it’s helpful to know that one is not alone in their struggles, and that others experience similar struggles. Universality seems to me to be a factor that can help to act not only as a way to encourage openness, but also as a glue, that holds the group together.
    CBT is a modality that welcomes the client as a partner in the therapeutic process. Thus, information sharing is a factor that seems to be a major focus of CBT. The interesting issue proposed by Yalom, CBT, and this class, is how and for what purpose information is shared within the group, namely, the process of doing so.
    The CBT leader must first have a solid understanding of CBT technique and interventions, which can be used to promote progress. Leaders have the important task of ensuring that the group supports the techniques of CBT, by using the group itself to do so (process factors). The CBT therapist should be able to offer positive feedback in a way that engages the group to encourage their members, while also modeling and imparting information. While members share, the CBT therapist actively addresses what in shared in a way that is consistent with the group’s goals. Just as in an individual session, the therapist directs the structure of the group, by reviewing homework, and offering opportunities for role play, exposure, and reinforcement.

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    • Paige Hartmann
      Sep 12, 2014 @ 10:59:09

      Michelle, I liked your discussion of the therapist’s role in a CBT group and the importance of the group to be structured following the CBT framework. It is essential that the therapist has the group support CBT techniques as well as ensuring that the therapist offers positive feedback to the group members. The CBT therapist plays an active role within the group and it is important for the therapist to implement the structural elements of the group.

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    • Angela Vizzo
      Sep 12, 2014 @ 20:31:15

      Michelle, I totally agree with you that instillation of hope is extremely important in group therapy, regardless of the theoretical orientation. It is one of the advantages to group that cannot be gained through individual therapy, or at least not as well as in group therapy. I believe that if an individual gains nothing else through group therapy, but they have gained hope that the therapy can be considered a success.

      Reply

  9. Angela Vizzo
    Sep 10, 2014 @ 15:48:47

    There are many universal group therapeutic factors despite the different orientations that the group may be conducted in. In particular, psychoeducation, universality, and social skills seem to be especially universal. Yalom refers to psychoeducation as imparting didactic information, but no matter what it is called it would be important to any therapy group. This may include explaining the disorder to the clients including common presentations, symptoms, and causal factors as well as explaining how the group will function such as the interventions that will be used and why they may be helpful. Explaining these things will help the group members feel more at ease and increase group cohesiveness. Universality is another group therapy factor that would be present in all groups as the clients will see that they are not alone in the disorder or problem that they are facing. The details and specifics of their individual experiences may differ but the overall themes presented in those situations would be present amongst all the members. It is also notable that, sharing these experiences and hearing others’ stories can help alleviate hopelessness. Finally, in any group the acquisition of social skills would be necessary as the members need to know how to interact with each other and would be taught the appropriate ways to do so either through implicit or explicit instruction.

    Differences in CBT-specific therapy groups include the structure of the groups as there is a lesson plan and specific goals that need to be accomplished in each session, which may not be as strongly emphasized in groups of other theoretical orientations. CBT groups also tend to be closed groups with a set end time, and careful selection of the members. Therefore, these groups tend to be less diverse as patients as controlled for having interfering diagnoses, the appropriate cognitive level the learn the necessary skills, and that they are at the appropriate stage of change. Finally, the leader is more of a teacher/guider than a member in CBT groups as there is a clear separation that is emphasized.

    Important therapist skills in the creation and maintenance of groups include conveying warmth and empathy to the clients and encouraging and facilitating group cohesiveness as well as encouraging interactions between members that lead to therapeutic change. This encouragement can be done through modeling and constructing group norms and culture; which can be either implicit or explicit.

    Reply

    • Robert
      Sep 13, 2014 @ 14:06:34

      Angela, that is a nice summary of the differences that CBT-specific groups may present. Just like a teacher in a classroom, a CBT group therapist would prefer to have clients who want to focus on a particular disorder or subject and have group members be cognitively similar to each other to limit the possibility of clients falling behind or finding group therapy as unchallenging. However, given CBT group therapy more stringent guidelines for forming groups, I wonder if that may limit its ability to form groups for clients with less common disorders?

      Reply

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Adam M. Volungis, PhD, LMHC

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