Chapter 5: Therapist Basic Tasks

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Chapter 5 Therapist Basic Tasks

• The Theory and Practice of Group Psychotherapy
• Irvin Yalom, Ph.D

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Basic Tasks

• 1. Creation and maintenance of the group
• 2. Culture Building
• 3. Activation and illumination of the here-and-now

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Basic Tasks

• Creation and Maintenance of the Group
• Transitional object ????
• You need to create a physical entity
• Occasionally, you may need to focus on not
  meeting everyones needs.

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Basic Tasks

• Culture Building
• Shaping the energy/dynamics into a therapeutic
  social system.
• The group that is the agent of change.
• They set the therapeutic factors in motion.
• The group therapist functions far more
  indirectly, than individual therapist in which
  the clinician is the agent of change.
• Like the game of chess, therapist sets up the
  situation.

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Basic Tasks

• In this process it is important to demonstrate
• Capacity for empathy and caring (Rogers, 1957
  Traux Carkhuff,1967)
• In Lieberman, Yalom Miles (1973) work with
  encounter groups, they found that the members
  perception of the leader as genuinely concerned
  and caring was the most important factor.
• It contributes to the culture of a safe place.
• Self Reflection in order to manage adverse
  reactions to the group.

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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)
8 dimensions

• Directive vs.. Nondirective
• Transparency vs.. Opaqueness
• Group as a whole/subgroup/interpersonal/individual
  
• Past/resent/Future

• Inside/Outside the group
• Content/ Process
• Understanding/ Corrective Emotional experience
• Confrontation/exploration vs. support

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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• Directive vs. Nondirective
• Self explanatory
• Nondirective allows for the members to take on
  greater responsibility
• Focus on each other instead of the leader as the
  transitional object
• Allows leader to see their natural (supposedly)
  form of relating
• Directive
• Efficient use of time
• Insures greater participation by more members
• Keeps group on track but possibly influencing too
  much

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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• Transparency vs. Opaqueness
• The extent the leader shares information about
  themselves
• What might you expect if a therapist is
  completely transparent?

No boundaries Loss of the dual role of a leader
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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• What if the leader isnt transparent at all?
• Therefore, Judicious self disclosure
• Know the intent and its dynamic influence

Unsafe place Cold Little spontaneous interaction
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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• Group as a whole/subgroup/interpersonal/individual
  
• Represents the different layers or degree upon
  which a leader can intervene
• Group level focus members responding to the
  same stimuli
• Subgroup level focus - two members form alliances
  and explore the differences or focus on conflict
  resolutions between subgroups
• Individual level focus the group is directed to
  examine ones members issues

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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• Past/present/Future
• as related to the groups life
• Inside/Outside the group
• Now this one can combine with the above to create
  a matrix
• Content/ Process
• The communication dynamics between members
• NOTE As you focus on the process of an
  individual, he/she may feel more vulnerable
  because you are often addressing more unconscious
  material

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Dimensions of the Leaders Role As per
Brabender, Fallon, Smolar (2004)

• Understanding/ Corrective Emotional experience
• Increase understanding via providing insight
  which suggests that there is a conflict to be
  addressed
• Or provide the basic foundation that they may
  have not had in their previous relationships a
  corrective experience suggesting that there is a
  lack of something
• Confrontation/exploration vs. support
• Raise the level of emotional stimulation
• Or consolidate the gains acquired through support

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Basic Tasks

• Construction of Norms
• Constructed via from expectations for their group
  and from the explicit and implicit directions of
  the leader
• If members expectations are not firm, then the
  leader has even more opportunity to design a
  group culture.
• The leader cannot not influence norms.
• What one does not do is often as important as
  what one does do.

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Basic Tasks

• Norms are shaped both the expectations of the
  members and by behavior of the therapist.
• The leader shape norms via
• The technical expert role
• The model setting participant
• -The technical expert understands the dynamics
  and is able to explain to the group and reinforce
  appropriately.
• Page 113 good examples

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Basic Tasks

• E.G. asking members to mention their opinions on
  each others comments.
• Hence, this role includes significant social
  reinforcement persuasion.
• Among certain theoretical frameworks or
  clinicians, this is a controversial issue.
• Consider this, that it tends to be inevitable
  that a clinicians overt and covert responses act
  as a reward-punishment.

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Basic Tasks

• The model setting participant
• Bandura has demonstrated in studies that
  individuals may be influenced to engage in more
  adaptive or less adaptive behaviors through
  observing and assuming the therapists behavior.
• A clinician model the difference of their a self
  esteem and public esteem. Therefore, they
  demonstrate how the integrity of their self
  esteem is not threatened but rather can be
  improved.
• Appropriate disclosure can also be modeled.
  Sometimes pts dont understand how to moderate
  such behavior.
• The therapist models honest with appropriate
  restraint.

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Basic Tasks

• A leader that presents a infallible doesnt allow
  for members to present their flaws and encourages
  a norm of being always being right.
• NOTE A patient issue with you may related to
  his/her past but may have some validity to it in
  your reality. In other words, check its validity
  within and through ???______ validation.
• For example an overly cautious leader may lead
  to a guarded and lifeless group. How does this
  work in the individual therapy format.
• A clinicians transparency relates to the amount
  of a clinicians disclosure.

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Basic Tasks

• Therapeutic Norms
• Self Monitoring group
• They are the main event instead of waiting on you
• Self Disclosure
• There is a subjective aspect of disclosure.
• What you consider superficial may be profound to
  another.
• The other issue is when to disclose avoiding
  premature.
• Vertical vs. horizontal disclosure
  (metadisclosure)

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Basic Tasks

• Be aware not to have a pt punished for
  disclosure.
• Procedural norms
• The patterns of behavior in the group may not be
  appropriate. (i.e. An appropriate one is checking
  in at the beginning but inappropriate one would
  be to continue the session in a sequential
  method.)