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Group Intervention

Midterm Study Stack

What is parataxic distortion and how is it different from transference? -Tendency of individuals to distort their perceptions of others. -Scope and the theory of origin are broader (all interactions and not only past relationship transference, also distortion based on interpersonal needs)
What is consensual validation and how does it help with parataxic distortion? Comparing our evaluatinos with others. Helpful with group b/c many people, many perspectives. Helps a person identify the distortions they are making.
Define Corrective Emotional Experience Exposure under more favorable circumstances to emotional situations that one could not handle in the past
What are the key components of Corrective Emotional Experience? 1. Expression of emotion 2. Reality testing through consensual validation
What are the 2 conditions necessary for Corrective Emotional Experience to occur? 1. Group must be seen as safe and supportive in order to freely express 2. There must be sufficient engagement and honest feedback to permit reality testing
Define here-and-now Members live in the here-and-now. Immediate events in group take precedence over any outside or past events. -Must experience each other with as much spontaneity and honesty as possible.
What is the purpose of the self-reflective loop? Transforms emotional response into therapeutic experience
Define social microcosm and identify how it is important to therapeutic work Group members will begin to interact with each other as they interact with others in their social sphere. Individual pathologies will present themselves and issues needing work can be addressed through feedback & self-reflecting loop.
What is the difference between group "rules" and group "norms"? Examples Rules= explicitly laid out by leader, not to be broken (payment, attendance, confidentiality, etc.) -Norms= preferred/prohibited general behavior guidelines, can be explicit or implicit, conscious or unconscious (personal attacks, expressing)
What are some characteristics that make for good group composition? -similar level of functioning/ego strength -similar willingness to take responsibility for their work -not too many difficult clients per group -no previous outside relationship
How does the length of group (short vs long-term) affect goal setting? -Short term: specific and achievable goals to allow for appropriate expectations (get through crisis, reduce intensity of specific symptom) -Long-term: aim for fundamental character change (alter fundamental core issues, develop healthy new capacities)
What are some exclusion criteria? -Unable or unwilling to examine their behaviors, self-disclose, and give and receive feedback. -brain-damaged, paranoid, addiction, sociopathic -currently in crisis -low motivation -inability to tolerate confrontation -can't regularly attend
What is the #1 most important inclusion criteria? Motivation for change
What are the 5 predictors of success according to Yalom? 1. Pt's attraction to group and popularity 2. Values personal change 3. Views self as lacking in understanding of one's own and others' feelings 4. High and clear expectations for group 5. Willing to take interpersonal risks
Identified Patient (potential pros and cons) -Works extensively on their issues or problems in group -Harmful: prevents others from working on their own issues and will then feel they are the only one with problems
Caretaker (potential pros and cons) Caring and nurturing toward members who are in pain Pros: promotes safety and vulnerability in the group Cons: Moving too quickly to offer gratification before exploration
Scapegoat- what is it and what purpose does it serve? What are the dangers, how to deal with a scapegoat? -Ostracized by the other group members -Serves a defensive function; target of aggression and judgment -explore cause of alienation, focus on group/help them identify with scapegoat explain role, ask the group what they are getting out of this
Social Leader (potential pros and cons) -Express warmth and caring towards one another and become interested in each other as people -smooth over conflict -initiate get togethers -Community rather than therapy -Problematic if it gets in the way of therapeutic exploration
Aggressive Memeber (potential pros and cons) Often initiates the conflict stage of group development -functional if others explore their aggression -non-therapeutic if they are the only one doing the confronting -Truth teller? will always say what they see in group even when not appropriate
Emotional Member Feels emotions deeply -could cause others to do the same OR NOT
Deviant and Structural role Tends to challenge or break the group norms -can expand rigid norms or cause consistent conflict and scapegoating Called the "task leader" in social psych, includes group leader and member-therapist
Risk-taker, Norm-setter, and attractive member -Experimenting with new behavior -Most influence in determining group norms -Members want to connect with because of liking, respect, or sexual attraction
How might you work with rigid roles within the group? Explore: how do they benefit from this role? Why do they want to avoid doing the opposite? Why do other group members avoid taking this role? How does it benefit from assigning someone to a non-therapeutic role (scapegoat)?
What is cohesiveness and what variables are associated with it? The therapeutic relationship with other members, the therapist, and the group as a whole. -try harder to influence -+ receptive to " " -+ willing to listen & accept -+ security & relief -+ participation -+ self-disclosure -protect group norms
What is the difference between self-esteem and public esteem. How do discrepancies between the two play out in group? -individual's evaluation of what he/she is worth vs. groups evaluation -Discrepancies lead to dissonance -If neg. pt can misperceive/deny and devalue group OR pt can rise to the occasion and change behavior or attitudes
Therpeutic factors 1-5 1. Instillation of Hope 2. Universality 3. Imparting Information 4. Altruism 5. Corrective Recapitulation of Family Unit
Therapeutic factors 6-11 6. Development of Socializing Techniques 7. Imitative Behavior 8. Interpersonal Learning 9. Group Cohesiveness 10. Catharsis 11. Existential Factors
Instillation of Hope -Therapists must believe in themselves and in efficacy of the group -Help clients understand how group can help (preparation) -Testimonials (leaders are previous members, group veteran)
Universality -Pts become isolated as they suffer and feel that they are unique and have unacceptable probs that others can't tolerate, relate to, or accept -Disconfirming this: freedom from stigma, shame, and self-blame -Identification of common human conditions
Imparting Information -Information can be didactic instruction, advice, suggestions, or direct guidance from therapist or other members -Advice is least effective form of direct suggestion -Alternative suggestion about how to achieve goal was most effective
Altruism -The act of giving is as important and powerful as receiving in a group -realizing one has something to offer and is needed and useful and we must care for those we wish to receive care from -meaning comes from stepping outside of self
Corrective Recapitulation of Family Unit -Within the group, members repeat the experience they have had with a primary family unit -Key is to relive these conflicts CORRECTLY -roles become more flexible, investigation of relationship occurs, trying out new behaviors
Development of Socializing Techniques -Development of social skills is important and inherent part of dealing with problems -Allows members to learn how they contribute to own isolation -Identify discrepancies between intent and actual impact on others
Imitative Behavior -Vicarious learning: members can benefit from observing therapy of others with similar problems -May "try on" new behaviors of other members (facilitates exploration of new behaviors, see what fits and what doesn't)
The Initial Stage "The cocktail party" -Orientation, search for structure/goals, dependent on leader/concern for boundaries -IN vs. OUT: sizing each other up and look for roles -confusion, restricted communication -Search for similarities -Giving/seeking advice
The Second Stage "Storming Stage" -Conflict, dominance, rebellion -TOP vs. BOTTOM -social pecking order emerges -negative comments/criticism more frequent -Hostility towards leader, disappointed -Conflict about change
The Third Stage "Honeymoon Phase" -Development of cohesiveness -NEAR vs. FAR: anxiety about not being liked, not close enough to others, or too close -Increased safety -Attendance improves -Struggles no longer with each other, with own issues and resistances
How can a leader work to construct group norms early in the group? -Technical expert role: explicit instruction and subtle reinforcing techniques (exercises to increase engagement, nod or smile, shift posture) -Model setting participant: teaching by example (interpersonal honesty and spontaneity w/responsible restraint)
Identify the therapeutic norms Yalom identifies and understand why they are important -Procedural norms (checking in, not sequential) -Importance of group to its members (reinforce) -Members as agents of help (members can provide help too) -Support and Confrontation (permit conflict after firm foundations of safety/support established)
How are therapeutic norms different from regular social norms? Therapeutic group norms encourage overly personal, emotional discussion and social norms discourage it.
How can we as a group leader help encourage clients to be vulnerable? (6 ways) -respond positively to it -show interest in it -explicitly encourage it -express appreciation for it -challenge a patient who undermines it -model it (through caring and protectiveness, minimal self-disclosure)
When and how do we need to step in to protect a client that has made him/herself vulnerable? -Intervene when: person is being attacked when vulnerable/ganged up on, person can't handle it. When unsure, ask them.
Identify and describe the 2 steps necessary for successful group work in the here-and-now 1.Experiencing component: focus on current moment, feedback, catharsis, meaningful self-disclosure, and development of socializing techniques. 2.Illumination of the Process: must examine experiences/transactions, focus on understand them
What is the difference between content and process? Content: consists of explicit words spoken Process: focus on metacommunication, the HOW and WHY
Why is process commentary primarily the reponsibility of the therapist? -Group members don't allow each other to take this role -Members are often too involved in interaction to separate selves from it
What kinds of questions or things to you look for and ask when examining the process? -WHY THAT statement at THAT time to THAT person? -Triggers -Non-verbal data (who sits where, who sits by the door, who looks at who while speaking, how quickly do people enter, who leaves coats on, etc...)
What are some statements you might make or things you might do to focus your group on here-and-now process? -"How are each of you experiencing the meeting so far?" -"You look like you are having some reaction to this." -work in small groups, have clients look/speak directly to each other, use conditionals (if...)teach to avoid global questions (am I boring?)
What are some reasons we don't generally do process commentary in everyday life? -This process is experienced as critical and controlling -If it occurred all the time society would become intolerably self conscious -Fear of retaliation from intrusiveness -Undermines arbitrary authority structure (equalizing power)
What are some ways we can recognize process? (list of 7 things) 1.Use own reaction as process data 2.Reaction memb elicits from others 3.Attend to what's omitted 4.How does group respond when memb absent? 5.verb/nonverb incongruent? 6.response disproportionate to stimuli? 7.response off target, make no sense?
What is the 4-step sequence of recognitions that helps clients transform dissatisfaction into change? 1. Here is what your behavior looks like. 2. Here is how your behavior makes others feel. 3. Here is how your behavior influences the opinions others have of you. 4.Here is how your behavior influences the opinion you have of yourself.
If you have to choose between making a group-as-a-whole vs an individualized comment, what should you do and why? Functioning of the group always takes precedence over narrower interpersonal issues
Define transference Attitudes toward the therapist that are "transferred" from earlier attitudes toward important figures in the client's life.
What are some unrealistic roles clients might cast you in? -Superhuman: therapist comments carry too much weight, everything you say or do is seen as purposeful, all progress attributed to you, believe you predict & control all events in group. -Mind Reader: blurred ego boundaries, expect to sense needs
What are some reasons clients may see therapists unrealistically? (3 points) 1.True transference or displacement from prior object 2.Conflicted attitudes toward authority (dependency, distrust, rebellion, etc..) that become personified in therapist 3.Tendency to imbue therapist with superhuman features as shield against anxiety
Identify and be able to explain the 2 major approaches to resolving transference? 1. Consensual Validation: encourage clients to validate impressions of therapist against others'. 2.Increased Transparency: Share your feelings/response, gradually reveal more of self, therapist is real person.
How is judicious therapist self-disclosure beneficial to the group? Defining characteristic of interpersonal model, it facilitates greater openness between group members, promotes group autonomy and cohesiveness
What are the 3 things to do as a therapist when receiving negative feedback? 1.Take it seriously, listen to it, and respond. Respect the client and let their feedback matter. 2.Obtain consensual validation. If reality, confirm it. 3.Check your internal experience, does feedback fit/click?
How would you respond to a client asking you personal questions? (what to take into consideration before responding, what questions would you ask yourself, what are the options and potential consequences (positive and negative) of how you would respond?) -Understand why/purpose of question and self-disclosure. -What is the process behind the content? -Is there therapeutic intent? -Is countertransference influencing you? -What is the anticipated impact?
What is the danger of countertransference when it comes to therapist self-disclosure? That a therapist will self-disclose too much because of influence of countertransference.
What does Yalom mean when he says each member MUST be a problem? The success of therapy depends on each individual's encountering and then mastering basic life problems in the here-and-now of the group.
The Monopolist (describe and how to intervene) -Talks constantly to avoid silence (anxiety) -Consider both M and group allowing it (why?) M: want to hear more, not less: more genuine. Become aware of interpersonal impact, lack of empathy. Members respond, guide M to reflect
The Silent Client (describe and how to intervene) Dread of self-disclosure snowballing, maintain distance, fear of inadequacy, force others, -Silence is still a behavior, explore it, don't pressure. Comment on non-verbal behavior, reinforce all activity.
The Boring Client (describe and how to intervene) Dependency leads to compliance to reduce risk of rejection, may confuse assertion with aggression -counter boredom with curiosity (what's missing that makes them boring, when am I most/least bored? -Remove obstacles to free expression
The Help-Rejecting Complainer (describe and how to intervene) -Request help then reject it -Take pride in insolubility of problems -Appear self-centered -Focus on feedback from group, see lack of empathy and impact on others (lack on interest in their probs) -Listen, agree it sucks, don't offer advice/help fix
The Psychotic or Bipolar Client (describe and how to intervene) Early in group, gets in the way, scares people. -Sometimes appropriate for therapist to take action, sometimes better to allow group to come to decisions for action. -Group safety first!
Schizoid Client (describe and how to intervene) -Emotionally blocked, isolated, distant -Seek therapy because "something's missing" -Other members may "sledgehammer" -Differentiate among members, grasp the tiniest feeling of anything and describe in detail -Interpret body language, tie to emotion
Borderline Client (describe and how to intervene) More disorganized that neurotic clients but more integrated than psychotic clients. -Very sensitive to threatened separation -Instability of mood, thought, and interpersonal involvement -Best in homogeneous groups, co therapist recommended
Narcissistic Client (describe and how to intervene) -May have negative response to crucial therapeutic factors like cohesiveness and universality -May do work but not interested in others' -Overly sensitive to criticism -Must have strong rapport/relationship before any criticism will be heard
Which type of problem group memeber do you anticipate would be the msot difficult for you to deal with and why? Schizoid: I think it would be difficult to build rapport, lack of feedback, difficult to connect. It would be frustrating!
What are some of the values of defenses? -serves to ward off unbearable pain that could not be assimilated when young -when young, helped deal with harmful interactions -In unsafe situations, defenses may be healthy -personal strengths (wit, control/assertiveness, etc..)
What is the difference between a defense and resistance? -Defense: internal psychodynamics; any behavior or internal process that attempts to avoid experiencing or activating a core issue -Resistance: person's response to therapy; any behavior that doesn't cooperate with the therapy process or therapist
What are the 3 components of a healthy alliance? 1.Trust and safety so client can take risks and be vulnerable 2.belief that therapist cares and is genuinely interested in helping 3.belief in therapist's competence
How can you work to rebuild a disrupted alliance? -focus on repairing alliance instead of therapeutic change -acknowledge therapist role in reaction -slowly and gently help client understand their reactions to you -make it clear you value the relationship & want to restore it(what can each of you do?)
When receiving negative feedback or even an attack, what is the msot important thing(s) for therapist to do first? Hear the client out, encourage them to explore their feelings fully while also monitoring yourself for defensiveness
What should you do if someone makes a valid challenge toward you? Acknowledge the mistake
What is countertransference? What are the two types? Therapist's emotional reactions to client that may be problematic/get in the way of therapy -Personal: reaction that comes from personal issues of therapist -Elicited: reaction that is elicited by client
What is our job as therapist in dealing with each type of countertransference? 1.Use awareness of own reaction to learn more about client's behavior patterns and how they affect others 2.Work through own reaction so in better position to help client
What is the first step in dealing with transference/countertransference? Recognizing it
When you find yourself angry at a client, what does Yalom suggest a therapist focus on instead? The underlying pain of the client, what drives their behavior
Define Group Role A function that needs to be performed for that group. Can help or harm the group
The Member-Therapist Helps members seem themselves clearly, perceive what is going on beneath the surface psychologically, and understand its meaning and childhood roots -problematic when member takes on this role to avoid looking at his/herself
Which group role would be the most difficult for you to work with and why? Aggressive member: May want to intervene when not necessary, fear for group safety, constant confrontation is stressful, may be difficult to address/work on own issues, power struggle.
Created by: klthomas0123