NNNC6062 PSYCHOTHERAPY II

MASTER IN CLINICAL PSYCHOLOGY, SEMESTER 2, 2024-2025

24TH MARCH, 2025 (MONDAY)

SECOND LECTURE: 8 TO 10:15AM

AT BSJ03 (ARAS BAWAH BLOK J)’

SECOND LECTURE: TOPIC 2

SUPPORT GROUP, SELF-HELP GROUP AND
GROUP PSYCHOTHERAPY WITH VARIOUS
APPROACHES AND POPULATIONS
SUPPORT GROUPS AND
SELF-HELP GROUPS

• Support groups are organised by an established, professional helping

organisation or individual.
• Self-help groups in the truest sense are those originate
spontaneously and stress their autonomy and internal group
resources.
SELF-HELP GROUPS

• Self-help groups usually develop spontaneously, center on a single

topic, and are led by a layperson with little formal group training but
with experience in the stressful event that brought the group
together.
• Can be either short or long term.
 SUPPORT GROUPS

• Focus on a particular concern or problem too, but established professional

helping organizations or individuals organize them.
• Some support groups charge fees; others do not.
• Like self-help groups, support groups center around topics that are
physical, emotional, or social.
• Lieberman (1994) sees self-help and support groups as healthy for the
general public.
• Corey (2008) thinks support groups and self-help groups are
complementary to other mental health services.
THEORETICAL EXPLANATION

• Our world – relational world.

• Mental health – promoted through deep, meaningful, and lasting
connections with others.
• Most of our patients/clients’ problems come from feelings of
isolation, low self-esteem, and difficulties with relationships.
• Support and therapy groups offer them a safety net and an
opportunity to develop close connections with others in a
confidential environment – with proper boundary maintenance,
good leadership skills, appropriate client/patient selection and
preparation, an awareness of group development and group
dynamics – groups can be therapeutic.
• A support group focuses on coping strategies and emotional re-enforcement.
Compared to an on-going, process- oriented therapy group emphasises personal
growth and interpersonal learning.
• Social support group has been proven to be an important component of coping
when people face stressful situations (Cohen and Wills, 1985,; Leavy, 1983).
• High functioning patients who experience an acute, unexpected event would
benefit from a support group.
• By and large these patients function well in the world: they have strong
relationships with others, have meaningful work, and are able to manage normal
amounts of stress, but under acute distress due to changing circumstances have
trouble coping or feel isolated.
• They often want to be in a group with others who are experiencing similar
circumstances.
• The purpose of the themed or diagnosis-centered support group is to provide
symptom relief and emotional support as patients develop coping skills, build
an extended social network, and strengthen their resilience so they can return
to their normal level of functioning.
• All support groups bring together people with the same problem or concern.
• Homogeneous groups are more advantageous for short-term and support
groups because they “… gel more rapidly than heterogeneous groups, have a
better attendance rate, are more cohesive, offer more immediate support,
have less conflict, and provide more rapid relief of symptoms” (Salvendy, 1993,
p. 76).
• Some support groups are unstructured groups – provide a supportive
environment for patients to share their experiences and provide empathic
connections to one another.
• Other more structured groups offer information about the condition, teach
coping strategies such as cognitive reframing, mindfulness, meditation, stress
management techniques, and visualization exercises, and encourage the
development of a support network.
• Therapeutic factors in support groups include supportive help-giving
comments, personal disclosure, information sharing, positive interaction, and
empathy (Abramowitz and Coursey, 1989; Kurtz, 1997; Toseland, Rossiter,
Peak, and Smith, 1990).
• While support groups may be therapeutic, unlike therapy groups, their goal is
not promote change of enduring personality characteristics.
WHY SUPPORT?
• Psychological support.
• Social support.
• For mental and physical health.
• Social support has been defined as the presence of others, or the resources
provided by them, prior to, during and following a stressful event (Ganster
and Victor, 1988).
SOCIAL SUPPORT – THE ELEMENTS

• Ogden (2004) – meaning of social support with four elements assumed:

1. Interactions leading to an increase in self-esteem (through contact with
others);
2. Support through the provision of information;
3. Social companionship; and
4. Instrumental support (actual physical help).
WHY GROUPS?

• The group experience – direct personal experiences that can be extremely

valuable in terms of personal development or personal support and, further,
that such experiences are hard to come by other than through the group
process.
• The support group is about mutual help.
THE CONTENTS OF SUPPORT GROUPS

In practicable terms, some important skills in support group:

• Learning to focus on exchanges related to issues of personal relevance
rather than social rituals and “pastimes”;
• Learning to confront “difficult” issues rather than denying these or
retreating behind superficiality;
• Developing the skill of reflective, feeling-based self-disclosure;
• Learning to use the responses, feedback and challenges of other group
members to develop self-awareness;
• Assisting other members with these tasks;
• Learning to receive and give support.
OTHER TYPES OF GROUP WORK

• Assessment groups;
• Support and maintenance groups – the helping group;
• Change or therapy groups;
• Education, information and training group;
• Collective change groups.
IS IT ALL ROSES OR CAN GROUPS DO
HARM?

• Groups do not always go well.

• Despite careful selection some members may prove to be unsuited.
• Outside influences may interferer.
• Leaders make mistakes.
• In specific circumstances there is a risk of harm.
• Do group leaders need training? -- think.
THE PRACTICALITIES OF STARTING A
SUPPORT GROUP
• Time issues for support groups – Who decides on timing?; Frequency of
meetings; How long should support groups meetings be?; What “start-up”
format and timing should support groups have?; How many meetings, and over
what period of time?
• Venues for support groups
• Membership of support groups – Size of the group; Composition; Open versus
closed membership for support groups
• The what, how and when of the first session – Managing the first few minutes of
the first session; Setting going “group business”
• The first hour of the first meeting – The enthusiastic client/patient support
group; The strained staff support group
• Ending the first meeting
… AND THE PROCESSES CONTINUE …

• The middle stages of a support group

• Ending a support group

SELF-HELP GROUPS

• One device for continuing the life of a group is conversion into a self-help
format.
• Self-help groups, as the name suggests, function without a formal leader.
• Further your understanding and thoughts on self-help groups. Some
readings links:
ONLINE RESOURCES TO REFER
• “What is a Self-Help Group?”
• [Link]

• “What Is a Self-Help Group? Types, Examples, Benefits”

• [Link]

• “Self-help groups”
• [Link]

• “Self-help groups”
• [Link]
BASIC CONCEPTS OF GROUPS

• Stages of group development

• The role of the leader
• Patient/Client selection and preparation
• Beginnings and endings
• Resistance
• Countertransference
• Difficult patients/clients and groups
• Training and supervision
• Other considerations
READINGS

• Leading a support group: A practical guide by Keith Nichols and John Jenkinson. Open University Press.
2006.
• The Wiley-Blackwell handbook of group psychotherapy. Edited by Jeffrey L. Kleinberg. Wiley-Blackwell,
John Wiley & Sons, Ltd.. 2012.
TYPES OF GROUP AND GROUP BASED ON
VARIOUS APPROACHES …
• Encounter groups
• T-group
• Group based on different orientation:
-- Psychoanalytic approach
-- Adlerian group
-- Psychodrama
-- Existential approach
-- Person-centered approach
-- Gestalt therapy in groups
-- Transactional analysis in groups
-- Cognitive behavioural approaches to groups
-- Rational emotive behaviour therapy in groups
-- Reality therapy in groups
-- Solution-focused brief therapy in groups
and so on …
Do explore yourself how these different types and orientations of
group will be unique.
ENCOUNTER GROUPS

• Sources:

• “Group Therapy and the Encounter Group”

[Link]

• “What is an Encounter Group?”

[Link]

and many online resources – explore and search yourself and READ.
ENCOUNTER GROUPS
• In the 1970s and 1980s, there was a great deal of interest in encounter and
sensitivity training groups.
• In such forums, a group of people, usually no fewer than 7 and rarely more
than 20, get together with the aim of shedding their ordinarily polite social
masks and expressing their real feelings.
• The group usually emphasizes verbal interaction, games, and other activities
that encourage open displays of approval, criticism, affection, dislike, and
even anger and tears, rather than the tact and inhibition of emotional
expression that ordinarily govern our social behavior.
• The assumption in these groups is similar to that of person-centered therapy:
the individual will grow in a positive way by resisting social restrictions and by
interacting with others honestly and openly. Sensitivity training groups
originally tended to be less extreme than encounter groups, although the
distinction between the two is thin, and the terms are often used
interchangeably.
• The sensitivity training group (T-group) grew out of conferences on small-group
dynamics held at the National Training Laboratory in Bethel, Maine, in 1947.
• Originally, T-groups were designed to help executives and managers become
more sensitive or aware of the needs of their employees. The emphasis has
shifted toward individual growth in healthy people.
• Carl Rogers is credited with starting some of the first T-groups when he trained
counselors at the University of Chicago in the mid-1940s.
• Encounter groups most often have a leader experienced at getting people to
open up. The group may meet for several hours a week over some period of
months, or it may meet as a marathon group for 24 continuous hours or more,
with individuals dropping out for naps. It is thought that the intensity and
prolonged time of the marathon group will break down social resistance faster,
and accomplish as much as groups whose meetings are interspersed over longer
periods of time.
• The goals of encounter groups include examining one's behavior and values,
learning about people in general, becoming more successful in interpersonal
relationships, and developing conflict resolution skills.
• Related to encounter groups are groups that are designed especially for
assertiveness training.
• These groups help individuals stand up for their rights without violating the
rights of others. Typically, a group of about a dozen people role-play in various
situations that require an assertive response. Feedback and encouragement are
provided by the therapist, until individuals feel comfortable being assertive
(Carson & Colleagues, 1996).
• Most people in encounter groups do not consider themselves involved in
psychotherapy. Rather it is thought that anyone can benefit from the experience
in encounters where there is complete candor--something very rare in our world.
• Some psychologists are concerned that these group experiences may trigger
serious disturbances in some of the more troubled patients who participate in
them. The success of these groups depends to a large degree on the skills of the
leader and the personalities of the people involved. Be cautious and ascertain if
the leader is properly trained and well respected before joining such a group.
READING

Carl Rogers on Encounter Groups Hardcover – June 1, 1970

by Carl R. Rogers (Author)

• [Link]
T-GROUP
Source: [Link]

• A T-group or training group (sometimes also referred to as sensitivity-training

group, human relations training group or encounter group) is a form of group
training where participants themselves (typically, between eight and 15 people)
learn about themselves (and about small group processes in general) through
their interaction with each other. They use feedback, problem solving, and role
play to gain insights into themselves, others, and groups.
• A T-group meeting does not have an explicit agenda, structure, or expressed goal.
Under the guidance of a facilitator, the participants are encouraged to share
emotional reactions (for example, anger, fear, warmth, or envy) that arise in
response to their fellow participants' actions and statements. The emphasis is on
sharing emotions, as opposed to judgments or conclusions. In this way, T-group
participants can learn how their words and actions trigger emotional responses in
the people they communicate with.
THEORETICAL EXAMPLES ON GROUP PSYCHOTHERAPY FROM A PSYCHOTHERAPEUTIC PERSPECTIVE …

GROUP APPLICATION FROM CBT PERSPECTIVE:

USING GROUP PROCESS IN CBT GROUP TREATMENT – SOME EFFECTS

• Optimism – positive expectations and associated feelings of hopefulness toward recovery

• Inclusion – not isolated
• Group-based learning – from therapist and advice and feedback from other group members,
and observational learning
• Shifting self-focus – Benefit of being able to help other group
members is an important aspect of the group experience
• Modification of maladaptive relational patterns – corrective
social learning experience for maladaptive interpersonal
patterns
• Group cohesiveness – conditions that hold group members
within the group – increase participation etc.
• Emotional processing in the group setting – open expression
and processing of emotion
THE PSYCHOANALYTIC APPROACH TO GROUPS

• Goal of the analytic group – restructuring the client’s character and

personality system – specifically, psychoanalytic groups reenact the family of
origin in a symbolic way via the group so that the historical past of each group
member is replaced in the group’s presence.
• Mullan and Rosenbaum (1978) – process of re-creating one’s family as the
“regressive-reconstructive” approach to psychoanalytic group therapy – this
term refers to a regression into each member’s past to achieve the
therapeutic goal of personality reconstruction, which is characterised by
social awareness and the ability to be creatively involved in life.
TIME-LIMITED PSYCHODYNAMIC GROUPS
• “Time-limited” is not the same as “short-term”.
• “Time-effective” treatment.
• “Time-managed” group psychotherapy.
• Goals – must be clear, as precise as possible. But with sufficient flexibility –
for individual variation.
• Particular advantages in working with grief. Grief – an affect that is aroused
in a group that ends according to the calendar rather than when “the work is
finished”, since grief is a response to an ending that comes “too soon”.
• Other: To examine difficulties in relationships. Choosing members with
careful evaluations – to examine transferences in the here-and-now
interactions. Patients should have sufficient ego strength to be able to deeply
engage and also process their experiences.
READING

• “Psychodynamic group psychotherapy” by J. Scott Rutan and Walter N. Stone.

Third Edition. Guildford Press. 2001.
SOLUTION-FOCUSED BRIEF THERAPY IN GROUPS

The process of the solution-focused group – steps in the change process:

Setting the tone for the group – facilitators sets the mood for focusing on
solutions from the beginning.
Beginning to set goals – the group leader works with members in developing
well-formed goals as soon as possible.
Searching for exceptions to the problem – the facilitator asks members about
times when their problems were not present or when the problems were less
severe.
Encouraging motivation – “In this group session, who did you notice
who became less preoccupied with the problem and appeared to be
more problem free?”
Assisting group members with task development – at the end of each
solution-building conversation, the leader offers members summary
feedback, provides encouragement, and suggest what they might
observe or do before the next session to further solve their problems.
The next group session – at the next group session the leader might ask,
“Who wants to begin today by telling us what has gone better for you
since our last meeting?
 … AND SO ON …

• … and explore yourself other types and approaches of groups – how they are
conducted and how the processes look like
MORE READINGS

• “Group works leadership: An introduction for helpers” by Robert K. Conyne.

SAGE Publications, Inc.. 2014.
• “Groups: Process and practice” (Eight edition) by Marianne Schneider Corey,
Gerald Corey and Cindy Corey. Brooks/Cole. Cengage Learning. 2010.
GROUP PSYCHOTHERAPY
WITH CHILDREN AND
ADOLESCENTS
• Group therapy provides children with a setting where they
can talk, play and do things – “endless worlds” of relational
possibilities – with each of the other members individually,
in pairs or a group-as-a-whole, and with the group leader.
• Children’s perceptions of self and other are rooted in their
actual experiences.
• Sullivan (1953) discussed the widening scope of social-
interpersonal awareness as a result of exposure to group
life outside the home, as well as the subsequent
establishment of in-groups and out-groups in childhood
society, ideas later echoed by Erikson (1959).
• The importance of children’s group life, of organized games (Bettelheim,
1987; Sutton-Smith, 1986) and of manual activities for the expression of
emotion, identity formation and for learning spatial skills have all been noted
in the literature.
• “The group format is equal in effectiveness and efficacy to individual
treatment and superior in cost-effectiveness” (Shechtman and Mor, 2010).
CLASSIFICATION OF CHILDREN’S GROUP

• Psychoeducational groups
• Support group
• Clinical group psychotherapy – entails a trained mental health practitioner
who is working with a carefully balanced group – with each group member
being assessed and judged suitable for the particular group.
• Whereas in psychoeducational and support groups – may be little screening
and assessment process, as these groups tend to be aimed at prevention,
education and do not necessarily have the explicit goal of reducing symptoms.
CURATIVE FACTORS IN GROUP

• Yalom and Leszcz (2005) have described several curative factors in group
experience: installation of hope; universality; imparting information;
altruism; corrective recapitulation of the family experience; interpersonal
learning; group cohesion; catharsis; existential factors; development of
socializing techniques; imitative behaviour.
• Not all of these factors apply equally to children’s groups.
• Shechtman and Gluk (2005) found that the three most relevant therapeutic
factors for children to be group cohesion, catharsis and social techniques.
• For other children, especially those from abusive families, the corrective
experience of being in a family-like group can be extremely powerful. (This
may coincide with fantasies about the leader, or leaders, as parent figures.)
DEVELOPMENTAL CONSIDERATIONS

• In determining the structure of the group as well as the “goodness of fit”

factors, such as each child’s age, gender, developmental level and diagnosis
must be considered (Schamess, 1986).
• For the pre-school child, play groups are a developmentally comfortable and
syntonic modality.
• Pre-schoolers also relate with ease in co-educational groups and generally
speaking, accept the authority of adults of either sex.
• As children enter elementary school, their verbalization skills continue to
develop, as do their abilities for reflection and self-awareness.
• The group becomes a major source of support and self-esteem enhancement.

• Games, sports, crafts and other creative and competitive efforts become the
building blocks for a sense of identity (Bettelheim, 1987, Erikson, 1959).
• In organizing a group for children according to
developmental needs, it is necessary to consider the
following:
1. A safe physical environment that facilitates peer
interaction.
2. Furnishing and play material that are developmentally
appropriate.
3. Clearly defined therapist/leader ratios to help the group
members individually, and the group-as-a-whole, to
master specific developmental tasks.
THE SCREENING INTERVIEW

• A screening appointment with each child and the family can help determine
the suitability of the match of group with child.
• This initial interview also allows the therapist to balance the prospective
group (Slavson, 1950).
• Balancing entails careful consideration of who the group members should be,
based on developmental factors and presenting difficulties as well as race,
ethnicity, gender, sophistication levels, etc.
• Some degree of homogeneity is essential to the group.
• Attention to the group’s make-up helps to maximize the group’s therapeutic
potential and effect.
• For example, placing an anxious, inhibited nine year old girl into a group for
eleven and twelve year old boys with ADHD is a recipe for disaster!
• The screening interview also creates the opportunity to begin to establish a
treatment alliance – with the family as well.
STRUCTURING THE GROUP
• Location and furnishings of the groups.
• Small, crowded room may precipitate frustration, especially for
those children at a developmental level which necessitates space
in which they can move around freely.
• Too large room may be too expansive and encourage frenzied
activity.
• A room with plush carpeting, expensive furnishings or video
equipment invites trouble.
• Location – running a group for very active, loud, expressive boys
near the clinic administrator’s office is sure to bring some degree
of anger (and institutional scapegoating) directed at the group
and leaders.
 THE CHILD GROUP THERAPY
LEADER
• Positive attributes of the therapist with who works with children:
Self-respect;
Self-awareness;
Open-mindedness;
Cultural and gender sensitivity;
Respect for the child and family;
Empathy;
Flexibility and tolerance of ambiguity
(Sheppard, 2008)
• Other important characteristics include a willingness to play,
perhaps based in part on an ability to use regression in the
service of the ego (Kris, 1952).
• Such an ability to play, as described by Winnicott (1971), also
includes the capacity to understand verbal and non-verbal
material.
• The leader must be able to focus on the relationships in
group (and in children’s group, they are plentiful and
manifold!), supporting and facilitating communication among
members.
STAGES OF GROUP DEVELOPMENT

First stage – Pre-affiliation

• Anxiety of each child member has about fitting in.
• There may be much fluidity of roles and themes, making it a good time to add
new members, if necessary.
• The therapist may be directly challenged, and the leader’s ability to contain
and set limits is crucial to maintaining a sense of safety within the group.
Working stage
• As the group’s cohesion builds, intimacy deepens.
• There may be noticeable personal involvement of group members with each
other.
• In this working stage, children may more readily ask for and give help to each
other.
Termination stage
• Members consolidate what learning and gains they have made.
• There is sadness as they mourn the loss of the group.
• Short-term groups undergo similar developmental stages.
• The time-limited nature of short-term groups forces the leaders to pay even
closer attention to group selection and composition as well as the
establishment of focused, achievable goals.
• A focus on adaptation and mastery becomes essential.
 SOME COMMON PROBLEM
BEHAVIOURS

• Scapegoating – a phenomenon as old as human history – in inevitable part of

group process.
• To offer “psychological first-aid” to the victim – measure of support and trust
that the leader will ensure that the group is safe.
• Emotional contagion (Redl, 1966).
• There is an acute conflict area in the group (feelings about mothers,
deprivation, nurturance), a high degree of emotional liability, and an initiator
with high status in the group (the boy who began laughing).
• Stopping the emotionally contagious behaviour depends on identifying the
initiator and the issue/conflict area so it can be addressed.
ETHICAL CONCERNS IN GROUP

• Confidentiality.
• Rules and boundaries – safe and maximises the possibility of trust in group.
TEXTBOOK READING

• Read the relevant chapters in the main reference “Counselling children” by Geldard, Geldard and Yin
Foo, on this topic – for examples, Chapter 10 and 18, and other readings.
READINGS

• Kleinberg, J. L. (2012). The Wiley-Blackwell handbook of group psychotherapy.

Wiley-Blackwell.

• Geldard K., Geldard, D. (2008). Counselling children: A practical introduction

(3rd ed.). Sage Publications Ltd.. (and also the latest fourth edition.)

• Bromfield, R. (2007). Doing child and adolescent psychotherapy: Adapting

psychodynamic treatment to contemporary practice (2nd ed.). John Wiley &
Sons, Inc..