First, group membership commonly ends the sense of isolation many clients feel. It is difficult to maintain the feeling that you are the only person experiencing a particular problem when you are surrounded by other individuals who are dealing with similar issues. One of the potentially therapeutic factors in group treatment is the interaction with others who share common concerns (Yalom in 1985 referred to this as "universality"). Listening to others who describe and solve problems brings hope to the client that his or her problems are also manageable, which Yalom in 1985 also stated is a curative factor. These group phenomena are supported by the therapists who continuously permit members to help each other and create other conditions that increase the cohesion and work focus of the group. Helping others, a form of altruism and group cohesion, has also been described as curative factors by Yalom in 1985.
The group provides the client with a source of feedback about those behaviors that are irritating or acceptable to others and about those cognitions that can be viewed as distorted, self-defeating, and/or stress eliciting. As a result the group contributes to improved self-assessment for the individual client.
Another reason for using groups is the frequent and varied opportunity for mutual reinforcement. We have noted that clients find reinforcement from other group members more powerful than reinforcement from a single therapist. Reinforcement is a highly valued commodity in interpersonal relationships. As clients increase the frequency of reinforcing others, they note that they are reciprocally reinforced by others, and mutual liking increases. Each client is given the chance to learn or to improve his or her ability to mediate rewards for others in social interactive situations (with acquaintances, friends, family members, acquaintances in other groups, with other group members, etc.). The group therapist can create situations in which each client has frequent opportunity, instructions, and rewards for rein forcing others in the group. Special group exercises have been designed to train clients in mutual reinforcement, and extragroup tasks (homework assignments) are used to encourage clients, deficient in reinforcement skills, to practice them in the real world. The completion of these tasks is monitored by other group members.
In groups, a client must learn to deal with the idiosyncrasies of other individuals. Clients must wait while other people explain their problem. They must learn to tolerate what they perceive to be inadequate or even inane advice. Clients may be required to tolerate major differences with other group members and in some cases to deal with them. They must learn how to offer other clients critical feedback and advice in a tactful and helpful manner. By helping others, clients are likely to practice a set of strategies for helping themselves and learn a model of helping others that can be applied outside of the group. In this way they are likely to improve their relationships with others.
Therapy groups simulate the real world of natural friendship groups more accurately than does individual therapy if the therapist permits and even encourages such simulation. Individual therapy consists solely of a high-status therapist and a low-status client. Due to the greater similarity of the group to other social situations in the real world, the group setting facilitates transfer of newly learned behavior from the therapeutic setting to the community.
Groups create the opportunity for the group therapist to use an abundance of therapeutic procedures that are either unavailable or less efficient in individual treatment. Among these procedures are the "buddy system," numerous group exercises (see, e.g., Rose's work in 1998), multiple modeling, group feedback, group brain-storming, and mutual reinforcement. Groups also provide each client with a large number of models, role-players for overt and covert behavioral rehearsal, manpower for behavior monitoring, and partners for use in a "buddy system." By simulating the social world, the group provides a natural laboratory for learning, discussion, behavioral testing, and leadership skill development. All of these acquired skills are essential to form good social relationships in any setting.
In the process of interaction in therapy groups, norms (informal agreements among members as to preferred modes of action and interaction in the group) often arise, which serve to control the behavior of individual members. If these norms are introduced and effectively maintained by the group therapist, they serve as powerful therapeutic tools. The group, through group discussion of the implication of nonconformity to the norms, pressures deviant members to conform to such norms as attending regularly, mutual reinforcement of assignment completion, self-disclosing, analyzing problems systematically, and assisting peers with their problems. Of course, if the group therapist is not careful, antithera-peutic norms also can be generated such as members coming regularly late, or having group members inappropriately or prematurely confronting one another.
In addition to modifying the norms of the group, the group therapist can facilitate the attainment of both individual and group therapy goals by such procedures as modifying the cohesiveness of the group, the status pattern, or the communication structure in the group. Group problems are also dealt with and resolved when they arise. Much of the power of group therapy to facilitate the achievement of therapy goals is lost if negative group attributes are permitted to fester.
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