ch15

• Group Therapy


  Historically applied when heavy caseloads exist or as a supplemental technique, spiked with veterans post World War II
• Group Therapy Approaches


  • Psychoanalytic
  • Psychodrama
  • Transactional Analysis (TA)
  • Gestalt
  • Behavioral
• Psychoanalytic Group Therapy


  Free association, transference, interpretation of resistance, group as a vehicle, increased anxiety tolerance
• Psychodrama


  Form of role playing, seeks catharsis, done in a theatrical play format
• Transactional Analysis (TA)


  Interactions among people of the group analyzed, 3 ego states (child, parent, adult), emphasis on games, lacking research
• Gestalt Group Therapy


  Residential seminars, retreats, workshops, focus on 1 member at a time, "hot seat" approach, lacking research
• Behavioral Group Therapy


  Efficiency over group dynamic, reinforcement & problem solving, therapist in didactic role, time-limited, research supported
• Group Therapy Arrangements


  • 5-10 members
  • 90 minute to 2 hour sessions
  • Weekly
  • Can be mixed gender or separated
  • One or more therapists
  • Open vs. closed groups
  • Group confidentiality
• Curative Factors in Group Therapy

  • Imparting information
  • Instilling hope
  • Universality
  • Altruism
  • Interpersonal learning
  • Imitative behavior
  • Corrective recapitulation
  • Catharsis
  • Group cohesiveness
• Group therapy is more efficient & economical, more effective than no treatment, but not shown to be superior to other treatments and needs further research
• Group therapy is facing increasing demand, influence of managed care, and as an alternative to inpatient treatment
• Family Therapy


  Rooted in social work, influencing individuals through the whole family unit, one person's problem affects all members
• Double Bind Concept


  A case in which an individual is told two contradictory messages by an important figure in his or her life such that every response he or she makes with regard to that figure is wrong
• Influence of schizophrenia studies: identified pathologic families
• Communication in Family Therapy

  Pathology is failure of communication, general systems theory: the family is a system, and pathology is reduced by altering the way the system functions, focus on "unbalanced" state
• Family therapy involves multiple professions/practitioners, need for consensus of credentials for expert family therapists, many theories and techniques used
• Goals of Family Therapy

  Improve communication, de-emphasize problems of individuals, treat and view family as a whole
• Characteristics of Family Therapy

  • Important for therapist to learn the family's idiosyncratic subculture and frame of reference, therapist remains detached and does not favor certain family members or factions, family history and assessment crucial
• Approaches in Family Therapy

  • Conjoint family therapy
  • Concurrent
  • Collaborative
  • Behavioral
  • Multisystemic Therapy (MST)
• Conjoint Family Therapy


  Entire family seen at once, therapist as relatively non-directive, resource provider, observer, teacher
• Forms of Communication in Family Therapy

  • Placating
  • Blaming
  • Super reasonable
  • Irrelevant
  • Congruent
• Concurrent Family Therapy


  One therapist, family meets with therapist in individual sessions, same goals as conjoint
• Collaborative Family Therapy


  Multiple therapists, family seen individually, by different therapists, therapists discuss family as a whole
• Behavioral Family Therapy


  Focus on reinforcement contingencies and skills training, full behavioral analysis of family problems, inducing family to provide correct reinforcement, similar to a CBT approach
• Multisystemic Therapy (MST)


  Intervention for juvenile offenders, family = most important link in changing youth behavior, problems arise from multiple factors, treatment delivered in home/school/community, 24/7 therapist access, low caseloads, MST therapists work in a team, employ evidence based techniques, track & log outcomes
• Applying Family Therapy


  • Most often begun when adolescent is principal patient
  • Family crisis
  • Value conflicts
  • Cost-benefit considerations
• Couples Therapy


  Form of family therapy, wide range of theoretical approaches, high rate of growth since 1960s
• Behavioral Marital Therapy (BMT)

  Application of reinforcement principles, contingency contracting, support-understanding technique, problem-solving techniques
• Emotionally Focused Therapy (EFT)

  Brief treatment, changes negative emotional interactional styles, establish more secure attachment, 9 step process
• Family therapy and couples therapy are highly complex and harder to evaluate empirically, requiring self reporting, ratings by others, and observational ratings
• Family therapy has relatively few well controlled studies, but eclectic and behavioral family therapy are most effective, especially with OCD & schizophrenia
• Couples therapy has even fewer studies, but BMT is effective for lower distress, and EFT is effective for higher distress cases