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How important is selection of
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Therefore, is it possible that the
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So, should any patient be sent to
group?
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How effective is group therapy?
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How do group clinicians select their
patients?
nature Central organizing principle consider when the punishments or disadvantages of group membership outweigh the rewards or the anticipated rewards.
What the patient must pay and his/her influence on the group. Patient should also play a role in selection Provide info: expectations, length, objective, rewards.
reported benefits.
If it meets personal needs If they derive satisfaction from the interpersonal interaction If they derive satisfaction from their participating in the group task If they derive satisfaction from group membership
the price High = unable to pay the price, overwhelmed, unable to tolerate
Pts that cant reveal, introspect, care for others and manifest feelings will struggle with this one.
DESELECTION. In others words, the practice of selecting often is deselecting particular pts and including everyone else. Empirical studies and clinical observations due more to provide us with data for exclusion or what doesnt work interpersonally than what works.
question becomes which type of group. Poor candidates for a heterogeneous outpatient therapy group are those with brain damage, paranoid, hypochondriacal, substance abusers, acutely psychotic or sociopaths. But WHY is a better point to focus on. Because eventually they will manifest their inability to relate and will dominate the group, manipulate or be aloof.
1. pts with dx of pending psychotic breakdowns 2. pts that used group for an acute crisis 3. Highly schizoid Dropouts were more socially ineffective. Who this class deals with such clients
Hence studies suggest that drop outs tend to have following characteristics: high denial, high somatization, low motivation, low ses, low social effectiveness, low IQ, psychotic pathology. Reasons for dropping: External factors Group deviancy Problems with intimacy Fear of emotional contagion Inability to share the therapist Complications of concurrent individual therapy Inadequate orientation Complications from subgrouping
babysitting, transportation leading to increases stress. Rationalization as well. Group deviant someone that represents an extreme in at least one dimension- age, economic, education, gender.
They remain as an outsider and slow the group downby remaining on another interpersonal level (avoidance,etc) Lieberman, Yalom and Miles concluded that such pts will not benefit and possible adversely affected According to Schacters study, communication toward a deviant is very high initially then drops off as deviant stands out over time.
Schizoid withdrawal Maladaptive self disclosure Unrealistic demands for instant intimacy
This typically comes from individuals that appear to have permeable ego boundaries (i.e. borderline).
undue self criticism and a degree of sensitivity to the feelings of others seem Pts with significant transference issues Pts attraction to the group and popularity Popularity = self disclosure, introspective and active
Questions to Consider:
Is group behavior predictable?
structured interview in predicting group behavior? What would you focus in order to assess for group behavior?
Questions to Consider:
Is ones behavior relatively consistent in
different groups with similar tasks at hand? If so, how would you as a clincian get your best prediction? Are there any ideal, research based guidelines for the most effective group composition?
Questions to Consider:
Homogenous or Heterogenous? Which do
determine the fate of the group, focusing on certain compositions may allow for a MIX that facilitates this interaction. Screenings:
Toward = conduct with currency of love Against = search for mastery Away = withdrawal in order for withdrawal Personality characteristics: Melnick & Rose study found that social risk taking propensity and self disclosure most important characteristics. Interaction in previous groups = future
assess interpersonal style hx of interpersonal interaction social network participation in organizations relationships etc
interpersonal interview with a psychiatric interview gives enough information to make valid and reliable predictions.
group situation the better. Yaloms example of the group of pts with dx of schizoid personality. P258
Composition of Group
A groups composition influences certain
short term predictable characteristics (e.g. high cohesion, high conflict, high flight, high dependency) which highly predict a groups performance. Two major approaches are:
Heterogeneous approach
Advantageous for long term intensive
interactional Good for ambitious personality change goals Can lead to an isolate p.256 Role heterogeneity (task leader, champion, dependent, moral leader) better for self actualization but can lead to additional conflict
Heterogeneous approach
Social Microcosm Theory
Dissonance Theory
Homogeneous approach
Cohesiveness theory
there is an attraction to the group less conflicts and better attendance good for short term work not enough dissonance so everyone reinforces everyone faster sx relief due to faster support A small amount of research support the cohesiveness theory. This approach allows for factors mentioned above to unfold that directly influence results.
COMPOSITION
Principle
heterogeneity in pts conflict areas and patterns of coping and at the same time striving for homogeneity of the pts degree of vulnerability and capacity to tolerate anxiety The more structure and briefer the group, the less important is composition.