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Group Therapy Approaches

Group Therapy Approaches

Group Therapy Approaches

QUESTION
This week’s assignment includes two parts.

Part 1: For the first part of this assignment you will choose two approaches that you are familiar with or one that is new to you. The approach must come from material in this course (Corey, 2016; Yalom, 2005) and include the following:

Psychoanalytic, Adlerian, Psychodrama;
Existential, Gestalt, and Person-Centered Therapy; and/or
Rational emotive, reality therapy, and solution-focused brief therapy.
You will then, write a paper that examines the following of each approach:

(1) key concepts of your selected approach,

(2) the role of the group leader,

(3) role of group members,

(4) key developmental tasks and therapeutic goals,

(5) techniques and methods, and

(6) stages in the evolution of this kind of group.

Then, evaluate both approaches by comparing and contrasting their usefulness and their relationship to a particular topic in group therapy (e.g., trauma, interpersonal skills, intimacy, and partner relationships).

You will also present recent evidence on the efficacy of such groups by integrating the research of at least 10 studies published in peer-reviewed journals in the past five years.

Incorporate your instructor’s feedback from Week 4’s Outline Assignment (consider the areas and approaches you reviewed during Weeks 5-8), and then prepare a final draft of your paper.

Part 2: For the second part of this assignment, you will provide a reflection of your course experiences. In particular, reflect upon your learning experiences for the past 8 weeks, and then consider the following:

What was new information for you in review of each week’s exploration of group therapy and its processes?
What was familiar to you around the weekly topics?
What did you enjoy the most and why (if at all)?
What did you enjoy the least and why (if at all)?
What did you find surprising, even challenging to existing perspective you may have held about group therapy (if at all)?
How do you envision your clinical group therapy work from here?
Please note, using the first-person perspective for this portion of the assignment is accepted.

Length: Part 1: 12 pages; Part 2: 2 pages, not including the title and reference pages

References: Include a minimum of 10 scholarly resources for Part 1.
Group Therapy Approaches

ANSWER
Group Therapy Approaches

Student Name
Professor
Institution
Course Title
05/12/2020

Group Therapy Approaches
The past century has seen increased research and development of psychotherapy resulting in better therapeutic methodologies that have improved patient health and overall cost of care for patients with mental issues. A report indicated that 792 people live with mental health disorders, approximately 10.7% of the global population. The same report indicates that mental health disorders are among the most underreported diseases statistically. This indicates that the data is probably very high (Walker et al., 2015). The identification and development of methodologies like group therapy have helped in the management of the conditions. Group therapy is well defined as a field of psychotherapy involving one or two qualified therapists meeting an average of eight students to discuss issues concerning them, hence providing viable and practical solutions for the eventual restoration of health. Group therapy increases self-awareness and individual acceptance of criticism, educational promotion from others, induction, and acceptance of the change. Since its discovery in the 20th century by H.Pratt, Trigant Burrow, and Paul Shilder, group therapy has been utilized to manage patients with issues like smoking cessation, depression, dialectical behavioral therapy, obsessive-compulsive disorders (Yalom and Leszcz, 2020). The key reasons for the growth of group therapy utilization include its principles of universality, altruism, instillation of hope, ability to impact information through relating experiences and recovery processes, catharsis, and cohesiveness.
Similarly, compared to individual therapy, group therapy’s overall cost tends to be almost a third of individual therapy, making it more cost-effective. Another key advantage of group therapy is the support network and sounding board that helps in problem-solving. Diversity is also key in the methodologies since one tends to learn different approaches used by the available members. Unlike individual therapy that only equips the patient with the therapeutics of treating the mental illness, group therapy helps individuals develop skills like communication, problem-solving, socialization, and openness (Brabender et al., 2004). This paper aims at the analysis of two psychotherapeutic approaches-psychodynamic and reality therapy- and later give a comparison of the two concerning their usefulness and relationship while being utilized in group therapy conditions.
Psychodynamic Group Therapy
1. Key Concepts of Psychodynamic Theory.
Psychodynamic therapy puts a lot of emphasis on the patient’s unconscious processes as they manifest in the person’s current behavior. The methodology stems from the fact that the unconscious mind enormously influences individual thoughts and behaviors. Exploring early childhood experiences helps determine the progressive effect on individuals’ development and contributions to current concerns. This technique is among the best in treating mental illnesses due to its ability to state and identify objectives and goals (Hofmann, 2016). This technique is quite similar to psychoanalytical therapy developed by Sigmund Freud with minor time limits and intensiveness, where psychodynamic therapy is less intensive and briefer. Psychodynamic therapy uses existing data through behavioral analysis and data obtained in therapy to identify the relationship between conscious and unconscious motivation. Despite there being limited quantitative and experimental research data in its efficacy, the technique has attained global acceptance and utility in treating conditions like phobia, depression, and anxiety disorders (Smith, 2018). Modernization of this technique has seen the utilization of a pair of chairs instead of the celebrated couch and one-on-one communication between the therapist and the client. The technique’s purpose involves the induction of self-awareness to the client and fostering personal conceptualization of their thoughts, emotions, and beliefs concerning their childhood experiences. In the process, the therapist can help the client identify and examine unresolved conflicts and occurrences in the past. The theory assumes that the client can only do the self-awareness process by digging deep into the unconscious mind. This is the only way to resolve existing chronic problems before catharsis (Fonagy, 2015).
Though originating from the same source as psychoanalytic therapy, psychodynamic therapy displays a balanced relationship between the client and the therapist. The therapists never act over powerful or too informed. The therapist only helps the patient in digging deeper into the unconscious mind. Similarly, the fewer sessions in psychodynamics and reduced overall timeline of the therapy help in reducing the cost of therapy (Hofmann, 2016).
2. Role of The Group Leader
The leader always acts as a guide to the patient in revelation unconscious mind by encouraging the clients to freely communicate their feelings and identify recurrent patterns in their life, i.e., behaviors, thoughts, and emotions. By aiding n the identification of these patterns, they can now help the patient determine their significance and ultimate effects on the clients. Pattern identifications are done through extensive probing of the client’s childhood by observing the client’s interactions (Tschuschke et al., 2019). Observations of the client interaction in the session are critical since the approach considers that the same interactions happen in real life, especially in childhood moments like parents. Other than observation, the leader also gives professional advice to the client based on the findings. Simply put leader plays the role of helping the patient connect past experiences with current problems while utilizing personal internal resources to handle the problems (Bradender et al., 2004).
3. Role of Group Members
The group members in a group psychodynamic therapy play a huge role in enhancing recovery and the induction of varied skills. First, the confidentiality of information is necessary. This is always assured by the fact that all of them tend to have the same mental conditions. Group members also encourage others to be social with extensive openness, thus aid in the self-awareness process. Altruism is a role required by each member since the goal is to recover each individual no matter the duration.
Similarly, every member is required to be corporative. The members learn from their childhood experiences and learn how to avoid behaviors considered unhelpful or destructive to them by listening to their colleagues. This is considered as a corrective recapitulation of each participant. The members also have the responsibility of promoting cohesiveness among each other as well as shows personal responsibility to their lives in an existential manner (Suazek et al., 2015).
Group Therapy Approaches
4. Key Developmental Tasks and Therapeutic Goals
Psychodynamic theory has seen rapid changes since its formulation. As mentioned earlier, Sigmund Freud played a vital role in its development when he published data on psychoanalytic therapy. Continuous research has seen its modification and efficient utilization for maximum delivery of care to the patient. Despite being underutilized and facing extreme competition from other therapeutical methodologies, psychoanalytic has been accepted globally and provided astonishing results to many patients. In the early days of its development, psychoanalytic did not give equal autonomy to the clients and the leader. The leader had a lot of power and was not to face the clients while conducting the sessions. This was seen to be so irrelevant. Its elimination allowed the leader to only act as a guide in the revelation of the patient’s unconscious mind in solving the current problem and a source of advice to the clients while observing current behavior during sessions. The introduction of face to face sessions made it possible to incorporate the approach into group therapy. This enhances the social impact and team mentality of the clients and a learning growth curve that reduces overall recovery time and impacts more skills to the clients.
Similarly, with the increasing economy and the need to reduce the overall cost of care, the timeline of therapy and number of sessions were reduced drastically. This reduces the overall cost of therapy. However, the duration depends on the mental illness of the patient and the recovery rate. Some group therapy sessions can go on for longer durations, e.g., in patients with alcohol use disorder or smoking cessation (Fonagy, 2015).
According to Sigmund Freud in his psychoanalytic approach, the human consciousness is divided into three awareness levels: the conscious, preconscious, and unconscious, which overlap with his idea of individuality id, ego, and superego. This perspective has led to the development of different psychology fields, including developmental, social, neuropsychology, and cognitive psychology. Psychodynamic therapy greatly utilizes psychoanalytic and talk therapy aspects to examine maladaptive functions that occurred in a client’s early childhood (Smith, 2018).
Carl Jung also played a great role in developing psychodynamic therapy through the modification of Freud’s approach. He introduced the key concepts of archetype, individuation, and collective unconsciousness in his approach. The approach focuses less on the clients’ childhood development and existing misunderstanding of the id and superego. Instead, he focused on the overall integration of different segments of the clients. He ended up classifying individual behaviors based on two general attitudes, i.e., either introverted or extroverted, and used four functions in classification; thinking, feeling, and intuiting. Other key contributors to the development of psychodynamic theory include Alfred Adler and Erik Erikson. The approach has currently seen the inclusion of the object relation theory that indicates that early relationships always determine later life relationships (Brabender et al., 2004).
The goal of psychodynamic therapy usually includes assisting the patient in the revelation of the unconscious, i.e.self-awareness. It also helps them in going through developmental stages that made them remain fixated or were unresolved. It also helps in the reconstruction of the client’s basic personality. Through all these activities, the client ends up attaining intellectual awareness and adjusts to day to day demands, including work, intimacy, and society.
5. Techniques and Methods In Psychodynamic Therapy
Unlike other approaches, psychodynamic therapy puts less consideration into group activities and exercises. However, five key techniques are critical in deep digging into the unconscious mind of the client. First is the utilization of the Psychodynamic Diagnostic Manual, often referred to as the psychologist’s Bible. This helps in the evaluation of the patient’s behavior during sessions. This manual was developed after a disagreement among psychologists that the old manual, Diagnostic, and Statistical Manual, only focused on observable symptoms while omitting subjective symptoms during diagnosis. The new manual is seen to be quite vital in providing an advanced diagnosis in therapeutic sessions. Secondly, the Rorschach Inkblots are also used in the diagnosis and discussion of symptoms. This technique is quite valuable in patients with thinking disorders since their degree of interpretation of the images usually varies from healthy individuals. Thirdly, the Freudian slip is also used, though not frequently(Brabender et al., 2004). The accidental slip of the tongue in Freudian slip provides extensive insight into the person’s social life and past experiences. It is considered that a slip is usually a part of the unconscious mind resurfacing with an indication of unresolved issues. Fourthly, free association is among the most effective and commonly used techniques. In this technique, the therapist shares a list of words, and the client is required to respond immediately with anything that crosses their mind. Through this exercise, information is gathered on the underlying connections and associations lying in the unconscious mind. Lastly is the dream analysis technique introduced by Sigmund Freud. Here the patient’s dream is discussed in details, thus derive meaning from the dreams (Caligor et al., 2018).
6. Stages in The Evolution of The Group
The group usually evolves from fear of sharing information to openness and eventual treatment. The group leader’s evaluation is majorly guided and assisted by enacting efficient leadership skills and assuring the clients of confidentiality of information. As each member begins to open up, the others also get the courage to reveal and express their unconscious mind. Through testimonies of treatment and recovery process by colleagues, the others also feel motivated to continue with the sessions and learn from their early childhood experiences. The social aspect of group therapy enables self-awareness among each member.
Reality therapy
1. Key Concepts Of Reality Therapy.
William Glasser first developed reality therapy from the theory of control. The therapy focuses on helping people control the world around them in a manner that allows them to satisfy their needs. The approach focuses on the current happenings (here and now) of the patient and how to create a better future without focusing on past occurrences. The client is made to fully understand their future needs and whether what they are doing currently is helping them achieve their future desires. Most therapists consider reality therapy a cognitive behavioral approach to therapy (Brabender et al., 2004). Unlike the psychodynamic therapy approach, the reality therapy approach indicates that people act consciously without instinct or the unconscious mind. Growth forces in each individual drive people’s desires. According to the theory, there exist two phases of child development. The first is when the child is aged between 2 and 5 years, where the child learns socialization and how to handle frustration and disappointment. If the children fail to attain parental support and guidance in this phase, they develop a failure identity. The second phase is when the child is aged 5 to 10 years. This is usually the early school years, and any child with the existing social and academic problem also develops a failure identity. However, reality therapy demonstrates that learning is a lifelong process, and one can decide to change their identity at any given time. The technique fully utilizes the control theory, which contains three significant parts; Behaviour, Control (includes a comparison of the image produced by personal behavior and the desired image), and Perception (development of the client’s image)(Robey et al., 2017)
According to reality therapy, all humans are self-determining and can change based on their desires. Individuals’ choices determine their behaviors and eventual outcome in life, and these choices can be modified once someone focuses on their future needs. The most patient usually tries to relate their past occurrences to their current state in defensive modes. However, these techniques try to eliminate these past experiences by allowing them to only focus on the current issues and the future (Robey et al., 2017).
2. Role of The Group Leader.
When this approach is used in group therapy, the group leader acts as the teacher and the model to the group members allowing them to reveal their current behaviors and identify their desires, hence forming their behaviors to suit their futuristic needs. The group leader is also responsible for creating an enabling environment that demonstrates acceptance and warmth by helping the group change their thoughts and actions. The group leader usually controls the session by focusing on modifying specific behaviors that need to be changed and how to change them.
The group leader always works on establishing an empathetic and trusting alliance among the group members. The leaders also promote discussion of the client’s current behavior and discourage excuses for bad behaviors. In the process, the group members get assisted in the exploration of different perceptions. The leaders help the group members set up plans and goals that are realistic and continuously help them evaluate their commitments to the plans. The leader often encourages the members to continue making changes even at the end of the groups (Brabender et al., 2004).
3. Role of Group Members
The group members are always charged with the responsibility of being open and sincere as possible. They need to understand that the treatment’s overall benefits come back to them, and they have persona responsibility for change. They are also needed to utilize each resource available, including their colleagues, to find solutions. A learning mindset is also essential and the ability to stick to the action plans. Similarly, they must note that the information shared is confidential and should only be used for change. Each member is considered as a family member s such respect is necessary. The clients need o look forward to changing their behavior and should never give up in their quest for change.
4. Key Developmental Tasks and Therapeutic Goals
The therapy begins by first having the leader and clients develop a relationship that will make it easier to share information. This is part of the creation of an enabling environment before diagnosis. The next task involves the identification of the present behavior of each client. This process is usually as specific as possible, and the patient is guided at revealing the behavior they consider unacceptable to them but still part of their lives. The next task is evaluating the client’s behavior through in-depth analysis and assistance of the leader and other group members. This is followed by developing a plan of action intended to change the behavior towards the desired future. In each step, everything is done with client autonomy. The clients then give a sincere commitment to the plan while eliminating any excuses. The commitment excludes any sort of punishment but allows reasonable consequences. The group leader also indicates that they won’t give up on the group members until they fully recover(Skovholt, 2012).
Reality therapy helps the clients to understand their current behavior and opt for change based on their desires. In the process, the clients can meet their needs for love, fun, survival, power, freedom, and belonging. It also strengthens the clients psychologically and instills personal responsibility in them. The clients are put in a self-evaluation position, learning to plan, learning to commit to plans, and becoming more effective in meeting personal needs. In the process, clients can forget the past and focus on the present and its impact on the future.
5. Techniques and Methods
Four techniques are used in this approach. The first is the use of humor in the sessions to identify unusual behaviors without affecting the patients’ emotions. This helps in creating a friendly environment as well as building relationships. Second is the utilization of confrontation, which makes the group members accept responsibility for their behavior. Acceptance is the foundation of this approach, and without it, no change can happen. Thirdly, an eight-step technique is utilized to cover all the tasks; relationship establishment, present behavior identification, and analysis, behavioral evaluation, planning for change, commitment from clients, denial of excuses, giving room for excuses while excluding punishments, and finally sticking with the patient to the end. The last technique lies in the group leader and requires them to never give up on the clients(Brabender, 2004).
6. Stages in The Evolution of The Group on Reality Therapy
The group is built on the foundation of acceptance and analysis of present behavior. The primary aspect that enhances sincerity and acceptance is the existence of a relationship. Once each participant of the group gets well related to each other, it becomes easy for them to share their present behaviors. The establishment of a viable plan is also critical once the behaviors have been identified. This involves joint work from the leader and group members. The plan needs to be polite and realistic, as well as achievable. The leader needs to ensure that the clients commit to the actionable plan, and he/she should work with the group in all the processes of the plan as they learn from each step (Pick, 2015). The eventual outcome is recovery. However, the leader needs to continue encouraging the clients to utilize the plan and incorporate the change into their daily lives.
Comparing and contrasting usefulness of psychodynamic and reality therapy in the management of depression
Both techniques provide a useful solution in the recovery of patients with depression. Most of the goals are similar in that they tend t instill long-term positive change in the clients. When used in group therapy, they tend to enhance the members’ learning by listening to different experiences and knowing what to do if they encounter such situations in life. When used in group therapy, the two approaches tend to be cost-effective and allow patients’ recovery at different times, depending on their conceptualization abilities. However, Reality Therapy disregards the conscious mind aspect indicates that it is ineffective at the management of some conditions like depression. Solving a problem by identifying the root cause is necessary since this eliminates the chances of recurrence. This is what makes the psychodynamic approach more significant. Reality therapy is more suitable for patients who reject therapy due to its simplicity and reduced timelines.
Conclusion
Group therapy is quite beneficial in the management of the different mental condition. However, the outcome is dependent on the approaches utilized. However, the overall benefits of group therapy surpass that of individual therapy. It is critical to identify the class of patients to be handled in a group before selecting a desirable approach. In all approaches, the role of the group leader and the group members appear to be similar. This indicates that the approach utilized never affects active participants’ roles.

References
Brabender, V., Fallon, A., & Smolar, A. I. (2004). Essentials of group therapy. Hoboken, N.J: Wiley.
Caligor, E., Kernberg, O. F., Clarkin, J. F., & Yeomans, F. E. (2018). Psychodynamic therapy for personality pathology: Treating self and interpersonal functioning. American Psychiatric Pub.
Fonagy P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 137– 150. https://doi.org/10.1002/wps.20235
Haverkampf, C. J. (2017). CBT and Psychodynamic Psychotherapy-A Comparison. J Psychiatry Psychotherapy Communication, 6(2), 61-68
Hofmann S. G. (2016). Psychodynamic therapy: a poorly defined concept with questionable evidence. Evidence-based mental health, 19(2), 63. https://doi.org/10.1136/eb-2015- 102211
Pick, D. (2015). Psychoanalysis: a Very Short Introduction. Oxford University Press.
Robey, P.A., Wubbolding, R.E., & Malters, M. (2017). A Comparison of Choice Theory and Reality Therapy to Adlerian Individual Psychology. The Journal of Individual Psychology 73(4), 283-294. doi:10.1353/jip.2017.0024.
Skovholt, T. M. (2012). Becoming a therapist: On the path to mastery. Hoboken, N.J: John Wiley and Sons.
Smith, E. (2018). Why Should We Care? Psychodynamic Theory and Practice in Counselor Preparation. The Journal of Counselor Preparation and Supervision. 11(1).
Suszek, H., Holas, P., Wyrzykowski, T., Lorentzen, S., & Kokoszka, A. (2015). Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial. Trials, 16(1), 1-12.
Tschuschke, V., & Flatten, G. (2019). Effect of group leaders on doctors’ learning in Balint groups. The International Journal of Psychiatry in Medicine, 54(2), 83-96., DOI: 10.1080/11038128.2018.1551419
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502
Yalom, I. D., & Leszcz, M. (2020). The theory and practice of group psychotherapy.

Group Therapy Approaches

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