Group Counseling & Counseling @ Different Settings

Definition

Group therapy is a form of psychotherapy in which a small, carefully selected group of individuals meets regularly with a therapist.

PURPOSE:

The purpose of group therapy is to assist each individual in emotional growth and personal problem solving.

Description

Group therapy encompasses many different kinds of groups with varying theoretical orientations that exist for varying purposes. All therapy groups exist to help individuals grow emotionally and solve personal problems. All utilize the power of the group, as well as the therapist who leads it, in this process.

Unlike the simple two-person relationship between patient and therapist in individual therapy, group therapy offers multiple relationships to assist the individual in growth and problem solving. The noted psychiatrist Dr. Irvin D. Yalom in his book The Theory and Practice of Group Therapy identified 11 "curative factors" that are the "primary agents of change" in group therapy.

Instillation of hope

All patients come into therapy hoping to decrease their suffering and improve their lives. Because each member in a therapy group is inevitably at a different point on the coping continuum and grows at a different rate, watching others cope with and overcome similar problems successfully instills hope and inspiration. New members or those in despair may be particularly encouraged by others' positive outcomes.

Universality

A common feeling among group therapy members, especially when a group is just starting, is that of being isolated, unique, and apart from others. Many who enter group therapy have great difficulty sustaining interpersonal relationships, and feel unlikable and unlovable. Group therapy provides a powerful antidote to these feelings. For many, it may be the first time they feel understood and similar to others. Enormous relief often accompanies the recognition that they are not alone; this is a special benefit of group therapy.

Information giving

An essential component of many therapy groups is increasing members' knowledge and understanding of a common problem. Explicit instruction about the nature of their shared illness, such as bipolar disorders , depression, panic disorders, or bulimia, is often a key part of the therapy. Most patients leave the group far more knowledgeable about their specific condition than when they entered. This makes them increasingly able to help others with the same or similar problems.

Altruism

Group therapy offers its members a unique opportunity: the chance to help others. Often patients with psychiatric problems believe they have very little to offer others because they have needed so much help themselves; this can make them feel inadequate. The process of helping others is a powerful therapeutic tool that greatly enhances members' self-esteem and feeling of self-worth.

Corrective recapitulation of the primary family

Many people who enter group therapy had troubled family lives during their formative years. The group becomes a substitute family that resembles—and improves upon—the family of origin in significant ways. Like a family, a therapy group consists of a leader (or coleaders), an authority figure that evokes feelings similar to those felt toward parents. Other group members substitute for siblings, vying for attention and affection from the leader/parent, and forming subgroups and coalitions with other members. This recasting of the family of origin gives members a chance to correct dysfunctional interpersonal relationships in a way that can have a powerful therapeutic impact.

Improved social skills

According to Yalom, social learning, or the development of basic social skills, is a therapeutic factor that occurs in all therapy groups. Some groups place considerable emphasis on improving social skills, for example, with adolescents preparing to leave a psychiatric hospital, or among bereaved or divorced members seeking to date again. Group members offer feedback to one another about the appropriateness of the others' behavior. While this may be painful, the directness and honesty with which it is offered can provide much-needed behavioral correction and thus improve relationships both within and outside the group.

Imitative behavior

Research shows that therapists exert a powerful influence on the communication patterns of group members by modeling certain behaviors. For example, therapists model active listening, giving nonjudgmental feedback, and offering support. Over time, members pick up these behaviors and incorporate them. This earns them increasingly positive feedback from others, enhancing their self-esteem and emotional growth.

Interpersonal learning

Human beings are social animals, born ready to connect. Our lives are characterized by intense and persistent relationships, and much of our self-esteem is developed via feedback and reflection from important others. Yet we all develop distortions in the way we see others, and these distortions can damage even our most important relationships. Therapy groups provide an opportunity for members to improve their ability to relate to others and live far more satisfying lives because of it.

Group cohesiveness

Belonging, acceptance, and approval are among the most important and universal of human needs. Fitting in with our peers as children and adolescents, pledging a sorority or fraternity as young adults, and joining a church or other social group as adults all fulfill these basic human needs. Many people with emotional problems, however, have not experienced success as group members. For them, group therapy may make them feel truly accepted and valued for the first time. This can be a powerful healing factor as individuals replace their feelings of isolation and separateness with a sense of belonging.

Catharsis

Catharsis is a powerful emotional experience—the release of conscious or unconscious feelings—followed by a feeling of great relief. Catharsis is a factor in most therapies, including group therapy. It is a type of emotional learning, as opposed to intellectual understanding, that can lead to immediate and long-lasting change. While catharsis cannot be forced, a group environment provides ample opportunity for members to have these powerful experiences.

Existential factors

Existential factors are certain realities of life including death, isolation, freedom, and meaninglessness. Becoming aware of these realities can lead to anxiety. The trust and openness that develops among members of a therapy group, however, permits exploration of these fundamental issues, and can help members develop an acceptance of difficult realities.

History of group therapy

Group therapy in the United States can be traced back to the late nineteenth and early twentieth centuries, when millions of immigrants moved to American shores. Most of these immigrants settled in large cities, and organizations such as Hull House in Chicago were founded to assist them adjust to life in the United States. Known as settlement houses, these agencies helped immigrant groups lobby for better housing, working conditions, and recreational facilities. These early social work groups valued group participation, the democratic process, and personal growth.

In 1905, a Boston physician named Joseph Pratt formed groups of impoverished patients suffering from a common illness—tuberculosis. Pratt believed that these patients could provide mutual support and assistance. Like settlement houses, his early groups were another forerunner of group therapy.

Some early psychoanalysts, especially Alfred Adler, a student of Sigmund Freud, believed that many individual problems were social in origin. In the 1930s Adler encouraged his patients to meet in groups to provide mutual support. At around the same time, social work groups began forming in mental hospitals, child guidance clinics, prisons, and public assistance agencies. A contemporary descendant of these groups is today's support group, in which people with a common problem come together, without a leader or therapist, to help each other solve a common problem. Groups such as Alcoholics Anonymous, Narcotics Anonymous, etc.

Types of therapy groups

PSYCHODYNAMIC THERAPIES. Psychodynamic theory was conceived by Sigmund Freud, the father of psychoanalysis . Freud believed that unconscious psychological forces determine thoughts, feelings, and behaviors. By analyzing the interactions among group members, psychodynamic therapies focus on helping individuals become aware of their unconscious needs and motivations as well as the concerns common to all group members. Issues of authority (the relationship to the therapist) and affection (the relationships among group members) provide rich sources of material that the therapist can use to help group members understand their relationships and themselves.

PHENOMENOLOGICAL THERAPIES. Until the 1940s virtually all psychotherapy was based on psychoanalytic principles. Several group therapy approaches were developed by psychoanalytically trained therapists looking to expand their focus beyond the unconscious to the interpretations individuals place on their experiences. Underlying this focus is the belief that human beings are capable of consciously controlling their behavior and taking responsibility for their decisions. Some phenomenological therapies include:

• Psychodrama— developed by Jacob Moreno, an Austrian psychiatrist, this technique encourages members to play the parts of significant individuals in their lives to help them solve interpersonal conflicts. Psychodrama brings the conflict into the present, emphasizing dramatic action as a way of helping group members solve their problems. Catharsis, the therapeutic release of emotions followed by relief, plays a prominent role. This approach is particularly useful for people who find it difficult to express their feelings in words.
• Person-centered therapy— a therapeutic approach developed by the psychologist Carl Rogers. Rather than viewing the therapist as expert, Rogers believed that the client's own drive toward growth and development is the most important healing factor. The therapist empathizes with the client's feelings and perceptions, helping him or her gain insight and plan constructive action. Rogers's person-centered therapy became the basis for the intensive group experience known as the encounter group, in which the leader helps members discuss their feelings about one another and, through the group process, grow as individuals. Rogers emphasized honest feedback and the awareness, expression, and acceptance of feelings. He believed that a trusting and cohesive atmosphere is fundamental to the therapeutic effect of the group.
• Gestalt therapy— In the 1940s Fritz Perls challenged psychoanalytic theory and practice with this approach. Members take turns being in the "hot seat," an empty chair used to represent people with whom the person is experiencing conflicts. The therapist encourages the client to become aware of feelings and impulses previously denied.

BEHAVIOR THERAPIES. Behavior therapies comprise a number of techniques based upon a common theoretical belief: maladaptive behaviors develop according to the same principles that govern all learning. As a result, they can be unlearned, and new, more adaptive behaviors learned in their place. The emergence of behavior therapies in the 1950s represented a radical departure from psychoanalysis.

Behavior therapies focus on how a problem behavior originated, and on the environmental factors that maintain it. Individuals are encouraged to become self-analytical, looking at events occurring before, during, and after the problem behavior takes place. Strategies are then developed and employed to replace the problem behavior with new, more adaptive behaviors.

An important offshoot of behavior therapy is cognitive-behavioral therapy , developed in the 1960s and 1970s, which is the predominant behavioral approach used today. It emphasizes the examination of thoughts with the goal of changing them to more rational and less inflammatory ones. Albert Ellis, a psychologist who believed that we cause our own unhappiness by our interpretations of events, rather than by the events themselves, is a major figure in cognitive-behavior therapy. By changing what we tell ourselves, Ellis believes we can reduce the strength of our emotional reactions, as well.

Who belongs in a therapy group?

Individuals that share a common problem or concern are often placed in therapy groups where they can share their mutual struggles and feelings. Groups for bulimic individuals, victims of sexual abuse , adult children of alcoholics, and recovering drug addicts are some types of common therapy groups.

Individuals that are suicidal, homicidal, psychotic, or in the midst of a major life crisis are not typically placed in group therapy until their behavior and emotional states have stabilized. People with organic brain injury and other cognitive impairments may also be poor candidates for group therapy, as are patients with sociopathic traits, who show little ability to empathize with others.

How are therapy groups constructed?

Therapy groups may be homogeneous or heterogeneous. Homogeneous groups, described above, have members with similar diagnostic backgrounds (for example, they may all suffer from depression). Heterogeneous groups contain a mix of individuals with different emotional problems. The number of group members typically ranges from five to 12.

How do therapy groups work?

The number of sessions in group therapy depends upon the group's makeup, goals, and setting. Some are time limited, with a predetermined number of sessions known to all members at the beginning. Others are indeterminate, and the group and/or therapist determines when the group is ready to disband. Membership may be closed or open to new members. The therapeutic approach used depends on both the focus of the group and the therapist's orientation.

In group therapy sessions, members are encouraged to discuss the issues that brought them into therapy openly and honestly. The therapist works to create an atmosphere of trust and acceptance that encourages members to support one another. Ground rules may be set at the beginning, such as maintaining confidentiality of group discussions, and restricting social contact among members outside the group.

The therapist facilitates the group process, that is, the effective functioning of the group, and guides individuals in self-discovery. Depending upon the group's goals and the therapist's orientation, sessions may be either highly structured or fluid and relatively undirected. Typically, the leader steers a middle course, providing direction when the group gets off track, yet letting members set their own agenda. The therapist may guide the group by reinforcing the positive behaviors they engage in. For example, if one member shows empathy and supportive listening to another, the therapist might compliment that member and explain the value of that behavior to the group. In almost all group therapy situations, the therapist will emphasize the commonalities among members to instill a sense of group identity.

Self-help or support groups like Alcoholics Anonymous and Weight Watchers fall outside of the psychotherapy realm. These groups offer many of the same benefits, including social support, the opportunity to identify with others, and the sense of belonging that makes group therapy effective for many. Self-help groups also meet to share their common concern and help one another cope. These groups, however, are typically leaderless or run by a member who takes on the leader role for one or more meetings. Sometimes self-help groups can be an adjunct to psychotherapy groups.

How are patients referred for group therapy?

Individuals are typically referred for group therapy by a psychologist or psychiatrist. Some may participate in both individual and group therapy. Before a person begins in a therapy group, the leader interviews the individual to ensure a good fit between their needs and the group's. The individual may be given some preliminary information before sessions begin, such as guidelines and ground rules, and information about the problem on which the group is focused.

How do therapy groups end?

Therapy groups end in a variety of ways. Some, such as those in drug rehabilitation programs and psychiatric hospitals, may be ongoing, with patients coming and going as they leave the facility. Others may have an end date set from the outset. Still others may continue until the group and/or the therapist believe the group goals have been met.

The termination of a long-term therapy group may cause feelings of grief , loss, abandonment, anger, or rejection in some members. The therapist attempts to deal with these feelings and foster a sense of closure by encouraging exploration of feelings and use of newly acquired coping techniques for handling them. Working through this termination phase is an important part of the treatment process.

Who drops out of group therapy?

Individuals who are emotionally fragile or unable to tolerate aggressive or hostile comments from other members are at risk of dropping out, as are those who have trouble communicating in a group setting. If the therapist does not support them and help reduce their sense of isolation and aloneness, they may drop out and feel like failures. The group can be injured by the premature departure of any of its members, and it is up to the therapist to minimize the likelihood of this occurrence by careful selection and management of the group process.

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Group counseling is a form of therapy, which posits that people benefit from shared experiences. Usually group counseling is focused on a particular issue, for example obsessive-compulsive disorder or anger management. While a therapist usually manages group counseling, contributions from other members in the group are considered valuable since all in the group share similar issues.

One of the main principals behind group counseling is the idea that dealing with specific issues may cause isolation, and a feeling that one is alone in facing one’s problems. Group counseling attempts to counteract this isolation by assembling people with similar issues to enforce that difficulties are not singular to one person. Additionally, knowing other people with similar troubles can be comforting to each individual, who may not have access in their own family and friends to people with the same problem.

Group counseling may be highly organized, with people doing specific activities together and then sharing the results. Alternately, it may be more freeform, where people share current issues related to the group’s purpose. One person’s verbal contributions to a group might be discussed, validated, and provoke problem solving by other group members in a session. It might also be an entry into a discussion regarding a certain aspect of an illness or condition that is then primarily led by the therapist.

Group counseling may also embrace different psychological schools of thought. For example a Jungian-oriented group dealing with depression might evaluate symbols in dreams that could shed insight on each member’s condition. A Gestalt-oriented group might be encouraged to question a person’s motives and evaluate both verbal and body language. Confrontation in Gestalt therapy is considered a vital part of healing.

Some forms of group counseling take place in psychiatric hospitals. The success of such therapy often depends upon the diversity of people’s conditions. Other group counseling is more like A.A. meetings and may not be counselor directed, but may merely be a group of people meeting to help find their way out of addiction.

Many large therapy businesses now offer group therapy as an alternative to private therapy. Such groups might address subjects like living with anxiety, parenting the special needs child, living with grief, or living with depression. Some people find the group counseling experience a better alternative than private therapy because it tends to cost less. Frequently group counseling is covered by insurance, and many groups offer sliding scale fees for those without insurance.

Length of group therapy also varies. Group counseling may take place for a defined period of time. Conversely, it may be open-ended, allowing people to drop in as needed. Usually more freeform groups are open to drop-ins, and may last for an indefinite period of time. More organized groups may last for a certain period of time, and require materials, study books, or the like. These groups may require a time commitment and a payment upfront or registration.

Not all group counseling efforts are completely successful. Occasionally, group therapy suffers if a group is too large or small. Group therapy may also become problematic when one person appears to monopolize the group. Usually group counseling works best when an experienced counselor can redirect a person who is sharing too much, and allow equal time for people to share their ideas, problems or opinions.

People may vary in their need for therapy, and generally those who monopolize a group should not be despised but should be redirected to private counseling, where the person is the sole focus of attention. After some time in private sessions, a person may feel less need to monopolize a group counseling session.

ADVANTAGES OF GROUP THERAPY:

When an individual first seeks professional help to deal with an emotional or psychological issue, counseling sessions are usually one-on-one with a trained psychotherapist or psychologist. As these sessions progress and the client becomes more comfortable, however, some counselors may introduce the idea of group therapy. Group therapy often consists of a small group of clients, usually no more than 10 to 15 in number, who are selected specifically for their varied viewpoints and experiences. Therapists hope that the social interaction and dynamics of group therapy sessions will provide each individual client with much-needed perspective on his or own circumstances.

One advantage of group therapy is the diversity of opinions. The relationship between an individual client and a therapist can become very insular. Thoughts expressed in these sessions are not often challenged by the therapist, only examined more closely. In a group therapy session, however, each participant is free to challenge or critique another participant's statements, within certain boundaries. An experienced addict in recovery, for instance, may recognize another addict's denial and persuade him or her to face reality. By encouraging diverse opinions, group therapy can effectively motivate each participant towards more honest interaction with others.

Another advantage of group therapy is the social interaction between different ages, cultures and sexes. Many group therapy leaders insist on a form of anonymity and discretion outside of sessions, so each participant is free to assign their own 'identifiers' to other participants. One may represent an oppressive parent, while another may be seen as a spouse. This diversity is helpful for those suffering from social anxiety disorders or self-esteem issues. For example, while in group therapy sessions, a young man suffering from social anxiety disorder may learn how he is perceived by an attractive female, an older parental figure and a male his own age. When participants start to reconcile their irrational beliefs with reality, true emotional healing can begin.

Some participants in group therapy sessions may feel an improved sense of purpose or structure. By attending regularly scheduled meetings, some who suffer from social disorders may feel a sense of belonging. A participant who felt especially needy or helpless one week could become a confident group leader the next week. Participants can use their own strengths to bolster each other during times of crisis. Many people in counseling for anger management or social maladjustment disorders often benefit from group therapy, because they can see others who are facing the same difficulties.

While group therapy may not be an ideal arrangement for all who seek personal counseling, these sessions have proven effective for most participants. Group therapy sessions generally last a few months to a few years, and participation is almost always voluntary. A number of recovery groups, such as Alcoholics Anonymous, use group therapy techniques to help addicts find strength in numbers and realize that they are not alone in the world.

TYPES OF GROUP COUNSELING:

1. Task Groups: A group that comes together to perform a task that has a concrete goal (e.g. community organizations, committees, planning groups, task force).

2. Guidance/Psychoeducational Group: Preventative and educational groups that help group members learn information about a particular topic or issue and might also help group members cope with that same issue (e.g. support group for a suicide, transition group to prepare students to enter high school etc.)

3. Counseling/Interpersonal Problem-Solving Groups: These groups help participants resolve problems of living through interpersonal support and problem solving.

4. Psychotherapy Groups: These groups focus on personality reconstruction or remediation of deep-seated psychological problems.

5. Support Groups: These deal with special populations and deal with specific issues and offer support, comfort, and connectedness to others.

6. Self-help Groups: These have no formal or trained group leader. (e.g. Alcoholics Anonymous or Gamblers Anonymous.)

Advantages of Groups

• It provides a social atmosphere that is similar to the real world.
• Members can test out and practice new behaviors.
• Members can practice new interpersonal skills.
• They are cost effective.
• Groups help members see that they are not the only one who has that particular problem or issue.
• Groups provide members with support.

Disadvantages of Groups

• Less individualized attention from the counselor.
• Confidentiality is more difficult to maintain.
• There are concerns with conformity and peer pressure.
• Not everyone can be in a group (e.g. those with issues too severe or those with poor interpersonal skills.)
• Scapegoating may occur.
• Group leaders are not always properly trained.

Stages of Groups

· Stage One (Orientation/Forming): Group members become oriented to the group and to each other.

· Stage Two (Transition/Storming): Anxiety and ambiguity become prevalent as group members struggle to define themselves and group norms. This stage is often characterized by conflict.

· Stage Three (Cohesiveness/Norming): A therapeutic alliance forms between group members. Trust between members has been established.

· Stage Four (Working/Performing): Group members experiment with new ideas, behaviors or ways of thinking. Egalitarianism develops.

· Stage Five (Adjourning/Terminating): This is the time when the group disbands.

COUNSELING IN DIFFERENT SETTINGS:

FAMILY COUNSELING:

Family counseling is a type of psychotherapy that may have one or more objectives. Family counseling may help to promote better relationships and understanding within a family. It may be incident specific, as for example family counseling during a divorce, or the approaching death of a family member. Alternately family counseling may address the needs of the family when one family member suffers from a mental or physical illness that alters his or her behavior or habits in negative ways.

Family counseling often occurs with all members of the family unit present. This may not always be the case. A family member who suffers from alcoholism or drug addiction might not attend sessions, and might actually be the reason why other family members seek out family counseling.

Part of the goal of the therapist is to observe interactions between family members. Another part is to observe the perception of non-interacting family members. Thus if two family members get into an argument in a session, the therapist might want to know how the other family members are dealing with the disagreement or the way in which the two fighting members comport themselves.

In addition to observation, the therapist often helps the family reflect on better ways of communicating with each other. So family counseling may in part be instruction and encouragement. In fact, family counseling often teaches family members new and more positive ways to communicate to replace old, negative communication patterns.

Observations may also be used to point out how poor communication, especially when particularly filled with strife, affects the behavior and happiness of children. Children benefit from the safe forum of a session. They may get to for discuss the things they don’t like about behavior of caregivers and/or siblings. Such discussion might not be permitted in the home setting.

As in group counseling, the therapist also acts as moderator in family counseling. He or she attempts to ensure that each family member gets fair time for expressing concerns and contributing to the conversation as to how the family can do better. Sometimes the therapist may identify one or more family members who need more than the family counseling model, and might benefit from individual therapy. The personal issues of one member of a family may affect all other family members.

The therapist may identify that the family cannot progress to a better relationship format without some individuals receiving more help, and possibly medication. A family member with a bipolar chemistry may want to be a better parent, but may be physically unable to change radical mood swings without a combination of individual therapy and medication.

Family counseling may not take a long time to complete. Often families benefit from four to five sessions. Sometimes families require more help and might need 20-30 sessions to resolve significant or ongoing family issues.

For families, family counseling often helps because it involves a disinterested third party who does not favor any one member of the family. This is generally why a therapist for one family member will not agree to be a family counselor for the client’s family. Display of partiality can render family counseling ineffective.

SCHOOL COUNSELING:

· Academic development

· Career development

· Personal/Social development (Student Perspective)

School counselors, referred to as “guidance counselors” in the past, help every student improve academic achievement, personal and social development, and career planning. School counselors in the 21st century are highly trained educators in pre K—12 settings who uphold ethical and professional standards to design, implement and manage comprehensive, developmental, results-based school counseling programs that promote and enhance student success.

What Do School Counselors Do?

School counselors address the academic and developmental needs of all students, not just those in need, by collaborating with students, parents, school staff and the community.

School counseling programs exhibit the following characteristics:

Foundational mission and goals:

School counselors design, implement, and maintain guidance programs that align with the educational mission and philosophies of their schools and school districts. These programs help every student develop competencies in academic achievement, personal and social development, and career planning.

Delivery methods:

School counselors follow a comprehensive guidance curriculum to work with students in individual, small group and classroom settings. School counselors help students create an academic plan for their education to prepare for successful careers after graduation and help students develop the necessary skills, such as organizational, time management, and study skills. They also help students overcome obstacles that may form barriers to learning by helping students respond to issues such as divorce or death in their family, as well as developmental issues typical in childhood and adolescence.

Program management:

School counselors manage their programs just as teachers manage their curriculum.

They collaborate with administrators and other educators to ensure that the school counseling program helps fulfill the mission of the school by setting annual goals and putting mechanisms in place to facilitate the successful and effective delivery of the school counseling program.

Accountability:

School counselors hold their programs accountable for student achievement by monitoring student progress to ensure that the school counseling program meets its desired goals and objectives. School counselors collect, analyze and present statistics about grades, test scores, attendance and disciplinary records, and other information to make data based and data-driven decisions about the school counseling program.

“The responsibilities of school counselors have increased tremendously over the years. School counselors are an integral part of the whole school community working to help children, teachers and other school personnel and parents. School counselors help children face challenges, tough classes, peer pressure, friendship problems, depression and more – all that can be roadblocks to future success.”

-- Angela Reformato, a school counselor in New York