Term Paper on "Group Psychotherapy"

Term Paper 10 pages (2702 words) Sources: 5

[EXCERPT] . . . .

Psychotherapy

Group psychotherapy also referred to as "group therapy" is when one or more psychotherapists treat a small number of patients together as a group. The term "group psychotherapy" can refer to any kind of group environment, whether it is an interpersonal type of therapy or cognitive behavioral therapy -- among other types of therapy not mentioned. The whole point of group therapy is that the group context is a group process, employed as a way to change or develop, explore and examine, the interpersonal relationships within that specific group. There are broad concepts of group therapy that can include any therapeutic process in a group -- such as support discussions and training groups, as well as skill training groups -- among others. Group therapy models vary significantly as well as do the approaches used in group therapy. There may be open or closed groups, open-ended -- i.e., without a time limitation, or differences in frequency. There may also be groups that take place in an inpatient setting. Bion (1991) notes that in individual therapy, neurosis is seen as the problem of the individual; however, in the group, it must be seen as a problem of the collective group. This is probably the biggest distinguishing factor of group therapy vs. individual therapy.

W.R. Bion, a psychoanalytic theorist, spent much of his work focusing on the dynamics of a group. Some of his important ideas include the "container" and the "contained"; mental processes as influenced by trauma; and the role of the leader and savior in group dynamics. He came up with an abstract model of psychic functioning (the "grid") that was founded on algebraic principles, and studied the behavior of individuals in groups and the emotions of the individuals that came from those group interactions. During the Second World War, Bion brought together groups of soldiers, working as a group to rehabilitate them, making the healing process a group challenge. He recognized that transference happens not only between group members and the therapist but also among group members.

Bion says that the term 'group therapy' can have two distinct meanings: it can refer to the treatment of a number of individuals assembled for specific therapeutic sessions, or it can refer to a planned endeavor to develop in a group the forces that lead to smoothly running co-operative activity (Bion 1991). The therapy of individuals who have come together in group settings is normally in the nature of explanation of neurotic trouble, with reassurance; and sometimes it turns mainly on the catharsis of public confession (1991). "The therapy of groups is likely to turn on the acquisition of knowledge and experience of the factors which make for a good group spirit" (1991).

Bion (1991) offers an elaborate description of the psychology of groups and the unconscious forces that obstruct effective group functioning. His approach is also known as the Tavistock approach. It is a useful model for understanding group-as-a-whole dynamics.

Bion's whole idea of group therapy is that an amassed cluster of individuals becomes a group when interaction between the members occurs, when their common relationship develops and when a common group mission becomes apparent. According to Bion's idea of group therapy, there are different elements that can produce a group -- including such elements like an external threat, a collective threat, regressive behavior, or some kind of need to satisfy security or safety, dependency or even affection. Groups emerge when the members are made aware of their commonality. They then became a collective force in search of one common goal that is individual as well as collective. When this aggregate turns into a group, the group then is able to work as a system -- as a whole that can be greater than the sum of its parts -- and the main task of the group becomes survival. Though the task is often hidden, group survival can turn into a latent motivating force for each individual member of the group, providing the framework for the exploration of group behavior. Kosters, Burlingame, Nachtigall and Strauss (2005) note that inpatient group therapy is also very effective -- especially when it comes to patients with emotional or mood disorders.

Bion's theory was that groups, not unlike dreams, have an apparent, overt element as well as a hidden, covert element to them. The apparent element is the work group, a certain degree of performance at which members consciously pursue agreed-on goals and they work toward completing those goals as a group. Group members may have hidden agendas, however, and they depend on internal and external controls to keep those hidden agendas from coming out and interfering with the group task that has been created. They can bring all of their illogical thinking together and combine all of their skills in order to solve whatever problems they need to solve as well as make decisions that need to be made.

Bion believed that groups do not always function in a rational or productive way. He also thought that individual group members aren't always necessarily aware of the internal and external controls they depend on to keep the border line between their stated intentions and their hidden agendas. The collective hidden agendas of the members of a group make up the hidden element of group life, the basic assumption group. In contrast with a rational group, the group is made up of unconscious wishes, doubts, projections and urges; they are focused inward.

Bion insisted that as the group becomes a whole, frame of mind increases. At any time during the group experience, a group possesses one of three basic assumptions, and they can stray from the beliefs of the other members. The basic assumption of dependence comes from the group's anxiety and its need to depend on someone who is there to protect the group's needs as well as satisfy those needs. Technically, a sort of helplessness characterizes the feeling of dependence. Once a group feels dependences, it can interrupt the task of the group. The group leader must then find a way to interpret the helpless feelings in order for effective group work to take place. Collective belief in some kind of enemy that can be dealt with either with an attack or retreat technique is the basic assumption of fight-or-flight. Fight-or-flight is basically characterized by feelings of fear and even aggressiveness. The basic assumption of "pairing" defines the idea that some event in the future or some person will come in and then solve all of the problems. Pairing is characterized by feelings of anticipation and hope that things will turn out well in the end.

Yalom (2005) notes that Bion focused more on the individual group and that member's relationship to the group culture. The word "valency" was developed to describe a member's attraction to a certain group culture. "This attraction, analogous to tropism in plants, is a force that leads a member into being the chief spokesperson or a participant or a major revel in one of the basic assumption cultures" (2005). He also notes that Bion's perspective on group therapy more leader-centered.

Bion believed thus that there were two types of groups: the basic assumption group and the work group. The basic assumption group is formed by the unconscious of each member of the group, and the assumption play out without the cooperation (or knowledge even) of the individual members. The dependent group wants a leader who is powerful, the fight-flight group needs to have an enemy and needs the leader to come up with some sort of defense, and the pairing group looks ahead to some desired and promised way of being in the future. (The concept of the pairing group is a metaphor: two group members come together and they created a "child" -- and that child becomes the savior of the group). New ideas (the contained) always have the power to upset a basic assumption group (the container) in a process called "catastrophic change." A basic assumption group is hostile, in a sense, resisting change and growth. They often use communication as a way to lash out rather than as a way to come up with new ideas together.

All three basic assumption states are oriented toward the issue of leadership. Each type of group searches for a leader -- one who will meet its needs. The basic assumption dependency group attempts in various ways to coax or coerce the professional leader to guide them; the flight-fight group searches for a member who will lead them in this direction; the pairing group optimistically pairs and waits, hopeful that a leader will emerge from the offspring of the pair (Yalom 2005).

Change is a huge process and it comes through "an intricate interplay of human experiences," what Yalom (2005) refers to as "therapeutic factors" (2005). For Yalom (2005), the therapeutic experience is divided into eleven primary factors: 1) instillation of hope; 2) universality; 3) imparting information; 4) altruism; 5) the corrective recapitulation of the primary family group; 6) development… READ MORE

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