Transcript Chapter 5: Therapist Basic Tasks

Chapter 5: Therapist
Basic Tasks
The Theory and Practice of Group
Psychotherapy
Irvin Yalom, Ph.D
Basic Tasks
• 1. Creation and maintenance of the group
• 2. Culture Building
• 3. Activation and illumination of the here-and-now
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 everyone’s
needs.
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.
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 member’s 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.
Dimensions of the Leader’s Role
As per Brabender, Fallon, & Smolar (2004);
8 dimensions
– Directive vs.. Nondirective
– Transparency vs.. Opaqueness
– Group as a
whole/subgroup/interpersonal/in
dividual
– Past/resent/Future
– Inside/Outside the group
– Content/ Process
– Understanding/ Corrective
Emotional experience
– Confrontation/exploration vs.
support
Dimensions of the Leader’s 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
Dimensions of the Leader’s 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
Dimensions of the Leader’s Role
As per Brabender, Fallon, & Smolar (2004);
• What if the leader isn’t transparent at all?
Unsafe place
Cold
Little spontaneous interaction
• Therefore, Judicious self disclosure
– Know the intent and its dynamic influence
Dimensions of the Leader’s 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 one’s member’s
issues
Dimensions of the Leader’s Role
As per Brabender, Fallon, & Smolar (2004);
– Past/present/Future
• as related to the group’s 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
Dimensions of the Leader’s 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
Basic Tasks
• Construction of Norms
– Constructed via from expectations for their group and from the
explicit and implicit directions of the leader
– If member’s 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.
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
Basic Tasks
E.G. asking members to mention their opinions on each other’s
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 clinician’s overt
and covert responses act as a reward-punishment.
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 therapist’s 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 don’t understand
how to moderate such behavior.
– The therapist models honest with appropriate restraint.
Basic Tasks
• A leader that presents a infallible doesn’t 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 clinician’s transparency relates to the amount of a clinician’s
disclosure.
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)
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.)