Tuesday, June 1, 2010

Group Psychotherapy

PSYCHOANALYSIS

Though we are interested to see the historical antecedents of current behavior, we need to weave back and forth between the past and present. (Locke, 1961)

Analyzing all the following things in a group can be called Psychoanalytic Group Therapy.
Ø        Influence of the Past
Ø        The Unconscious
Ø        Anxiety
Ø        Ego-Defense Mechanisms
Ø        Resistance
Ø        Transference
Ø        Countertransference
Ø        Interpretation
Ø        Dream Analysis

Therapeutic Techniques and Procedures in Group Settings
1.      Free Association
2.      Interpretation
3.      Dream Analysis
4.      Insight and working through


Free Association
Communicating whatever comes to mind regardless of how painful, illogical or irrelevant it may seem
·        Free Floating Discussion: Group discussion left open to whatever participants may bring up rather than revolving around an established theme.
·        Go- around Technique: Each Participant goes around to each of the other member and says the first thing that comes to the mind about the person

Interpretation
·        Interpreting free associations, dreams, resistances and transference feelings.
·        Well timed and accurate interpretations help clients to gain insights
·        Interpretations can better be presented in the form of Hypotheses.
·        Should begin from the surface and can go deeper.
·        It’s best to point out a form of Defense or resistance before interpretation.
·        Encourage the members of the group to make interpretations.

Dream Analysis
·        The Royal Road to the Unconscious.
·        Can be shared in the Groups to investigate the unresolved problems behind it.
·        Members are encouraged to do free association and then interpretations.
·        Analyzing Manifest Content and Latent Content


Insight and working through
·        Insight - Awareness of the causes of one’s present difficulties.
·        Cognitive and Emotional Awareness of the connection of the past experience to the present problems.
·        Newer Connections are formed and new perspective to life starts
·        Working Through involves repeating interpretations and overcoming resistance thereby, dissolve the dysfunctional patterns that originated in Childhood and make choices based on the new insights.
·        It is a Long Commitment



TRANSACTIONAL ANALYSIS

Awareness is an important first step in the process of changing our ways of thinking, feeling and behaving. It helps to redecide our lives. Thus it’s known as redecisional Therapy. Berne believed that group therapy yielded information about one’s personal plan for life much more quickly than individual therapy.

Making aware the members of the group about the following concepts of TA
  • The ego status: Parent, Adult and Child Ego status – Structure of our personality
  • The need for strokes
  • Injunctions and Counterinjunctions
  • Decisions and Redecisions: Relieving our decisions from Parental Injunctions and Counterinjunctions.
  • Life Scripts: I’m OK-You’re OK, I’m OK-You’re not OK, I’m not OK-You’re not OK & I’m not OK-You’re not OK.
  • Games: According to Berne, collection of games originates from three positions: Persecutor, rescuer and Victim. e.g. “Yes, but”, “Kick me” and “Look what you have made me to do”
  • Rackets e.g.

Therapeutic Techniques and Procedures in Group Settings
A group leader has to teach Structural Analysis, Script Analysis and Game analysis. Berne suggested that the group leader’s role is to observe and analysis of Transactions of each member in the group. A group leader is a catalyst and so group members do most of the work.

Taking the group members into the journey of understanding that they can redecide their lives, TA provides 3 stages where the above stated concepts are introduced step by step.

The initial Stage: Establishing good contacts and Trust among one another. To a large extent, the outcomes of Group Therapy depend on the quality of relationships the group leader is able to establish with the members and on the leader’s competence. Inquiry about the members’ actual contract to change is the next step like “What are going to change about yourself today?”


The Working Stage: Exploring the rackets the members use to justify their life scripts and ultimately, their decisions. The aim is to expose the rackets and have them take responsibility for them. E.g. Anger racket- beginning with recent events.
Changing the perspectives of “not taking responsibilities for behavior, thinking and feelings” and challenging when they use “cop-out language”, such as  “can’t”, “perhaps”, “if I weren’t for” and ”try”

The Final stage: Once the re-decision is made from the child ego state, group members are encouraged to tell a new story replacing the old story, and they typically receive verbal and non-verbal stroking to support their new decisions. The focus is on challenging members to transfer their changes from therapy situation to their daily life.

REALITY THERAPY

The Philosophy behind reality therapy is “Choice Theory”

William Glasser believes that we can only control what we are presently doing. We may be the product of our past, but we are not victims of our past unless we so choose.

Key Concepts:

ü     Human needs and Purposeful behavior: We are born with internal purposes; specifically, five genetically encoded needs: Survival, Love and Belonging Power, Freedom and fun.


ü      Existential/Phenomenological Orientation: We perceive the world in the context of our own needs, not as it really is.

ü      External Control Psychology: Common psychology of the world is that almost all people to attempt to control other people.

ü      Internal Control Psychology: People have the choice to attempt controlling oneslef. A shift from External Control to Internal Control has to take place.

ü      Quality World:        We keep close track of anything we do that feels very good and to store this knowledge in a special place in our brain called our quality world.

ü      Total Behavior: Inseparable but Distinct Components-Acting, Thinking, Feeling and the Physiology. We can indirectly choose many feelings and some of our physiology through directly choosing Acting & Thinking.

Therapeutic Techniques and Procedures in Group Settings
Teaching them the Choice Theory is a part of Therapy.

The WDEP System

W=Wants: Members explore what they want, what they have and what they are not getting. (Discovering Quality World)
D= Doing & Direction: After exploring Quality World, they are asked to look at their current behavior to determine if what they are getting them what they want. The Group Therapists helps to describe their total behavior.
S=Self-evaluation: Evaluation of total behavior takes place to find the determinants of the failures and what changes can be undertaken to promote success.
P=Planning: Short-term goals, how to be responsible for the goals and the ways to achieve them are planned.

SOLUTION FOCUSED BRIEF THERAPY

SFBT is a future-focused and goal oriented therapeutic approach. This approach shifts the focus from problem solving to a complete focus on solutions.

Key Concepts:
ü      Positive Orientation: The optimistic assumption that people are resilient, resourceful and competent and have the ability to construct solutions that can change their lives. Emphasis is on existing positive dimensions.

ü      Focus on solutions, Not problems: Avoiding the focus on the past in favor of both present and future. Little interest is in dealing with present problem and exploring past issues.

ü      Looking for what is working: Individuals bring their stories and some justify their belief that life can’t be changed or worse that life is moving from their goals. Therapists assist the client to pay attention to the exceptions. A key concept is “Once you know what works, do more of it”

Therapeutic Techniques and Procedures in Group Settings
Pre-Therapy Change: When client comes to meet the therapist for the first time, asking “What have you done since you called for the appointment that has made a difference in your problem?” This addresses the changes before the initial session
Questioning: Group Leaders do not raise questions for which they know the answer. By questioning, leaders help the members to identify the exceptions and realize the resilience and competency of theirs.
Exception Questions: SFBT is based on the notion that there were times when the problems they identify were o problematic. These times are called exceptions. This will make the members to thin problems are not all-powerful and existed forever.

The Miracle Question:
Many members come with a "Problem-oriented" frame of mind. Even the few solutions they have considered are wrapped in the power of the problem orientation. So a miracle Question which is generally presented as follows," If a miracle happened and the problem you have was solved overnight, how would you know it was solved and what would be different?" It encourages the members to visualize and dream.

Scaling Questions:
They are used when changes in human experiences are not easily observed such as feelings, moods or communication. For example, a group member reporting feelings. For example, "on a scale of zero to ten, rate your feeling of anxiety about the event." This technique can be applied to tap clients' self esteem, pre-session change, willingness to work hard and desire to solve the problems.

Formula First Session Talk:
FFST is a form of home work a group leader might give members to complete first and second session. The leader might say, "Between now and the next time we meet, I would like for each of you to observe so that you can describe all of us next time, what happens in your family, life, relationships and marriage that you want to continue to have happen". In the next sessions, members are asked what they observed and what they would like to have in the future. They can also respond to each other's observations as group colleagues.

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