Basic methods and applications Basic methods

In Fig I we have used two simple factors—therapeutic goals and group leadership—to provide a simple classification of the many different methods in use.

Fig. 1 A simple classification of group methods

Therapeutic goals

Groups will be more or less specific in their therapeutic goals. For example, those catering for a homogeneous population with a commonly defined problem whose solution provides the basis for entry to the group, such as overcoming drink or drug dependence, are classified here with specific goals. Groups that provide group-analytic or psychoanalytic psychotherapy, whether run according to the interpersonal, Tavistock or group-analytic models, are classified here with non-specific goals. There is a wide range of variation between these extremes and within each of these psychodynamic models.

Leadership

The more directed the group experience is by the leader, the more prominent he or she becomes as the group's 'model object'. The less directed the group experience is by the leader, the more scope there is for the emergence of unconscious dynamics and for attention to transference and countertransference. In this case therapy progresses through the development of relationships. The higher the relative level of leadership activity, the more likely it is that group members are being offered a technique or skill in the setting of a group. The lower this level, the stronger will be the relational content of the therapy in which the therapist's principal skills have to do with fostering relationships rather than advancing on them with 'a method'.

Using these two basic indicators—specificity of goals and levels of leadership activity—the four quadrants in Fig 1 provide a simple way of 'placing' the different group therapies.

Goal-specific therapy with a high level of leader activity: quadrant 1

In many drug and alcohol dependency regimes, participants are required to fulfil obligations tied to each stage of treatment in a structured programme. They move forward when stage-specific obligations are fulfilled. As the novice moves up he or she becomes a trainer to the newcomers with the therapist(s) directing the process in active terms. Cognitive therapy given in a group setting uses the group as an assembly who learn from and discuss with the expert. Dependency on a shared and valued leader and attention to group dynamics amplify the learning and some group cohesion develops, but this is not the primary focus of the therapy.

Goal-directed therapy with lower level of leader activity: quadrant 2

Problem-solving or psychoeducational groups for homogeneous populations, such as those set up for eating disorders or offenders, which are run along analytic lines, can be placed in this category. Although there are clear and directed goals, the leader's level of activity is confined to facilitating, linking, or enabling, followed by analysis and interpretation. Group discussion and cohesion amplify the affective experience and enhance the learning.

Non-specific goals with high level of leader activity: quadrant 3

In psychodrama groups, leadership is explicitly vested in the psychodrama director. The needs and goals of group members are diffuse and often diverse, and, in psychiatric practice, will have to do with relief from mental suffering. The psychodrama director can draw on many techniques. Affective arousal can be high, and so the power of sharing through discussion, and through the sympathy and empathy of group members towards one another, become powerful therapeutic tools. Strong conflict arousal and its subsequent resolution is similarly therapeutic.

Systems-centred therapy (as developed by Agazarian(7)) similarly provides a high level of leadership activity for groups that have non-specific goals. Short-term dynamic groups are frequently constituted with non-specific goals, but are run over 10 or 20 sessions by leaders who maintain a high level of involvement and direction, often demarcated according to the different stages of the group's progress.

Non-specific goals with low level of leader activity: quadrant 4

The goals of group-analytic or psychoanalytic group therapy are most frequently diffuse and non-specific, involving relief from symptoms and other forms of suffering, personal growth, and psychological change. Three main schools are considered in this chapter—interpersonal (Yalom and colleagues), Tavistock (Bion or group-as-a-whole), and group-analytic. They share non-specific goals and have low levels of leader activity, but differ from one another in how the leadership role and function are understood and discharged. They share assumptions about the importance of unconscious individual and group dynamics and look to the group for its transformational potential. Their differences affect the way in which transference and countertransference are understood and worked with. A comparative appraisal of these models is given later in this chapter.

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