1 UTPA Department of Social Work Social Work License Exam Preparation Workshop April 21, 26, & 28, 2007

2 Group Therapy and Family & Couple Theory & Therapy April 28, :30am – 10:15am Alonzo Cavazos, Ed.D., LCSW, LPC (presentation adapted from Middleton & Mather,

3 Group therapy Definition of group work “Goal-directed activity with small treatment and task groups aimed at meeting socioemotional needs and accomplishing tasks. This activity is directed to individual members of a group and to the group as a whole within a system of service delivery – Roseland & Rivas, 2005.

4 Two Conceptualizations of Major Types of Groups 1.Three models of social group work  social goals model (citizen education groups  remedial model (therapy groups)  reciprocal model (mutual aid groups) 2.Task vs. treatment groups

5 Social Goals Model Purpose: To raise social consciousness, social responsibility, informed citizenry, and to inform political and social action. Used in settlement houses and neighborhood centers Group worker as role model/enabler

6 Remedial Model Purpose: To restore/rehabilitate individuals exhibiting dysfunctional behavior Group worker is change agent – therapy involves assessment and interventions to assist group members to achieve treatment goals. Used in clinical outpatient/inpatient settings.

7 Reciprocal Model Purpose: To provide mutual aid to group members in achieving optimum adaptation, socialization Group worker functions as mediator between members, groups, and society to assist all concerned in getting their needs met. Can be used in clinical inpatient/outpatient settings and in neighborhood, community centers.

8 Task vs. treatment groups Task groups Goal: to accomplish a specific task General Characteristics:  The standard for success is the accomplishment of the task  Communication focuses on the task at hand  Low self-disclosure  Important that members have the requisite interest, knowledge base, and skills to achieve the purpose of the group.

9 Treatment groups Goal: to increase the ability of members to meet their socioemotional needs General Characteristics  open communication is encouraged among members  the roles of group members naturally evolve  high disclosure  confidentiality expected  success is defined as the achievement of individual and group goals.

10 Group Composition – caveats In general, homogeneous groups tend to gel faster, become more cohesive, offer more immediate support to group members, have better attendance and less conflict, and provide more symptomatic relief; they can however, remain superficial and are ineffective for altering character structure. Group therapy is not indicated for children younger than 8.

11 Group Composition – caveats (continued) In general, inclusion of both genders in groups for children is not recommended; some adolescents can handle mixed groups; mixed groups have the most lasting effect for adults. Glaver and Gavin maintain that a group that is too homogeneous, in terms of undesirable characteristics (deviant behavior), will reinforce these behaviors. Group size – for treatment groups (7 -10)

12 Open vs. closed groups Closed groups are most effective for short- term, task-oriented therapy, and for groups conducted in inpatient settings. Open groups offer members fresh input and allow them to benefit from the success of graduates but can often impede the development of trust, acceptance, and cohesiveness.

13 Group Stages Prescreening (ensure best fit for group) First stage (orientation, norming, search for meaning, dependency) Second stage – conflict dominance (storming) Third stage – development of cohesion Forth stage – working stage (performing) Fifth stage – disengagement/termination

14 Types of Treatment Groups Support group (e.g. single fathers) Educational group (group to educate adolescents at AIDS) Growth Group (marriage enrichment group) Therapy Group (group for adults molested as children) Socialization Group

15 Therapeutic Factors (Irvin D. Yalom) 1.Instillation of Hope 2.Universality (“We are in the same boat”) 3.Imparting of information 4.Altruism (unselfishness) 5.The Corrective Recapitulation of the Primary Family Group 6.Socialization Skills

16 Therapeutic Factors (Yalom) Imitative Behavior Interpersonal Learning Group Cohesiveness Catharsis (open expression of strong emotional feelings) Existential factors –Recognizing that life is at times unfair. –Recognizing – no escape from pain, suffering & death –Can get close, but still have to face life alone. –Having ultimate responsibilities for one’s life.

17 Test Question Yalom believes that the use of individual therapy with group therapy a.Brings about changes sooner b.Works together for more significant change c.Is not effective d.Can be effective if the therapist is the same for both

18 Test Answer Yalom believes that the use of individual therapy with group therapy a.Brings about changes sooner b.Works together for more significant change c.Is not effective d.Can be effective if the therapist is the same for both Other theorists believe differently if the therapist is same for both.

19 Test Question As a social worker in a child abuse center, you create a group for abusive parents. During the first session, one of the parents becomes angry and starts to argue with another parent. You should handle this situation by a.Asking the parent to explain what caused her anger b.Having the parents work through the disagreement in an appropriate manner c.Insisting the parent stop arguing d.Allowing the parent to vent her anger

20 Test Answer “b” -- Having the parents work through the disagreement in an appropriate manner. Rationale: What created the anger is not nearly as important as learning to resolve conflicts in appropriate ways.

21 Test Question A teenage drug abuse group becomes hostile, and the social worker fears that violence will break out. It is important for the social worker to first a.Try to de-escalate the group b.Ask the two most difficult members to leave c.Call for help d.End the group

22 Test Answer “a” -- try to de-escalate the group Rationale: This question asks what the social worker should do first. If the fails, then the worker may have to terminate the group or call for help.

23 Test Question There are many different types of groups that social workers lead. The type of group most associated with self- improvement and opportunities to expand self-awareness is a.The therapeutic group b.The socialization group c.The growth group d.The recreational group

24 Test Answer There are many different types of groups that social workers lead. The type of group most associated with self- improvement and opportunities to expand self-awareness is a.The therapeutic group b.The socialization group c.The growth group d.The recreational group

25 Test Question While holding a first session of a group for newly divorced clients, a woman begins discussing her anger with men in general. One man in the group begins to appear uncomfortable, while another starts to argue with the woman. What is the most likely reason for the men’s responses? a.Transference b.Interpersonal conflict c.Projection d.Complimentary Ego-states

26 Test Answer a.Transference

27 Test Question A member of the group comes in late. The leader confronts her for coming in late. The group argues with the leader for confronting the member. This is an example of: a.Scapegoating b.Cohesion c.Resistance d.Universality

28 Test Answer “b” - cohesion

29 Family Therapy: Key Points Focuses on the whole system of individuals, interpersonal patterns, & communication patterns Seeks to clarify roles and reciprocal obligations and encourage more adaptable behaviors among the family members Variations in techniques practiced by proponents of different family therapy orientations.

30 Family Therapy Models 1.Family Systems theory (Murray Bowen) 2.Communications/Experiential Family Therapy (Mental Research Institute) 3.Virginia Satir 4.Structural Family Theory (Salvadore Minuchin) 5.Strategic Family Therapy (Jay Haley) 6.Milan Systemic Therapy (Mara Selvini Palazzoli)

31 Family Systems theory (Murray Bowen) The goal of therapy - differentiation of self for all family members. Therapy often involves work with one family member, the premise being that when one member changes, the other will follow. Each member is helped to take responsibility for his/her own role in the problem (s). Communication is directed to the therapist. Reduction of anxiety is critical for success

32 Bowenian Theory interlocking concepts  differentiation of self  undifferentiated family ego mass (fused identities)  triangles  nuclear family emotional processes (emotional forces)  emotional cutoff (severing ties with parents)  sibling position  family projection process (next slide)  multigenerational transmission process

33 Bowenian Theory  family projection process – the process through which parents transmit their lack of differentiation unto their offspring.  multigenerational transmission process – has reference to the transmission, through the generations, of the family’s emotional process.

34 Test question A family therapist who deals with separation from family of origin is generally using a.Bowen b.Jackson c.Satir d.Milan

35 Test Question During the initial family therapy session, the parents of a17- year-old boy complain about the activities he engages in without their permission. These activities include failing to maintain curfew hours, engaging in smoking and drinking, and telling his parents to “stuff it.” The parents are concerned about this behavior, and the father keeps referring to his own such “thoughtlessness” at the same age when his father was angry with him. The family therapist would describe this as a.Delinquent behaviors b.Scapegoating c.Family of origin issues d.Potential signs of deviant behaviors

36 Test Answer “c” - Family of origin issues The father appears to be responding to his son’s behavior from the context of his own experience as a child in his parents’ home.

37 Test Question If you utilize Bowen’s brand of therapy, it would be important to a.Discuss transference b.Coach clients c.Give directives d.Teach the power of touch

38 Test Answer ‘b” – coach clients (which is major component of Bowen’s work)

39 Communications/Experiential Family Therapy Theorists: Gregory Bateson, Don Jackson, Virginia Satir, & Jay Haley. Primary purpose of symptoms is the maintenance of homeostasis in the family. Pathological families are seen as being stuck in strong dysfunctional communication patterns and who view any change as a threat to the integrity of the system. Goal of therapy: alter the interactional patterns that the maintain the presenting symptoms.

40 Communications/Experiential Family Therapy 2 levels of communication (report & content (manifest) & command level (latent) –For example: Have dinner ready by 6pm. –Command level: metacommunication or a covert message (I am the boss) 2 types of relationships Symmetrical – egalitarian Complementary – relationships that involve a fit between different roles

41 Communications/Experiential Family Therapy Principle of equifinality – same results in therapy can be obtained via different means. Circular model of causality – behaviors of different subsystems reciprocally impact each other. Dysfunctional communication (some examples) –Blaming, mind reading, incomplete sentences, disqualification of the communication of another member, and over generaliziang

42 Test Question All of the following are circular models of causality except a.Blaming and criticizing b.Mind reading c.Over generalizing d.Scapegoating

43 Test Answer “d” – scapegoating This is an information question that uses except one of the following

44 Test Question During a family therapy session, the teenage daughter begins accusing her mother of being abusive and of neglecting her needs. The mother responds very passively and does not defend herself, while the father attempts to take control of the session. The social worker needs to examine the family situation for a.Sexual abuse b.Individuation issues c.Triangulation d.Substance abuse

45 Test Answer “a” sexual abuse In situation involving incestuous sexual abuse, fathers are often highly controlling and the mothers are often passive.

46 Virginia Satir Satir assisted each family member to become as whole as possible through deliberate efforts to build self-esteem/self- worth and through the correction of dysfunctional communication patterns.

47 Virginia Satir (continued) Five Styles (poses) of Communication  Placater – agrees, apologizes, tries to please  Blamer – accuses, criticizes, and dominates  Super-reasonable – calm, cool, emotionally detached  Irrelevant – seeks to distract  Congruent communicator – sends clear, straight messages, & is genuine

48 Test Question During a session with a family of 2 parents & 5 kids, the youngest child spends a lot to time trying to get the mother’s attention. The mother tends to get distracted when the therapist asks her questions about her relationship with her husband. Which role is the youngest playing? Scapegoat Distractor Support Surrogate Partner

49 Structural Family Theory (Salvadore Minuchin) Theory premise – all families have an underlying organization (structure), which may be adaptive or maladaptive. Important concepts (some examples)  subsystems  alignments (coalitions between subsystems)  power hierarchies (distribution of power)  interpersonal boundaries  Disengagement  Enmeshment

50 Structural Family Theory Treatment techniques Joining – therapist’s entrance into the family’s interactional system by 1) forming strong bonds, 2) acknowledging the various perspectives, 3) accommodating the family’s organization and patterns. Enactment Reframing – redefining the family’s perspective on the problem

51 Scenario During a family session, the husband begins to criticize the wife over her reluctance to exercise with him during the morning as she used to do. The youngest son begins to move his chair closer to the mother as this exchange occurs. You comment on the son’s movement of the chair between the husband and wife and explain how the chair is like a fence.

52 Test Question Structural family therapy is most likely the type of a family therapy being used because a.Structure was the focus of the intervention b.It is the most empirically tested of the family therapies c.The therapist shares his observations with the family d.The therapist doesn’t confront the husband about his criticism

53 Test Answer Structural family therapy is most likely the type of a family therapy being used because a.Structure was the focus of the intervention The therapist focuses on interpersonal boundaries and alignments.

54 Test Question Your fist step in dealing with the issue raised in the above scenario would be to a.Explain the structural emphasis b.Provide a directive c.Place the son in another chair d.Discuss the metaphor with the parents

55 Test Answer “c” - place the son in another chair

56 Test Question The child’s reaction may also reflect on the ___ of the family. a.Rules b.Subsystems c.Individuation d.Secrets

57 Test Answer “b” – subsystems ( mother/son, husband/wife, or father/son)

58 Test Question A structural family therapist’s initial action is to a.Diagnose the family b.Direct the family c.Join with the family d.Interpret the family issues

59 Test Question Structural family therapy is a.Effective with all ethnic groups b.Based on the work of Minuchin c.Not effective with African Americans d.Based on the work of Haley

60 Strategic Family Therapy (Jay Haley) Emphasis – change techniques over theory. Distinguishing Characteristics  Rapid change  Uses resistance of family members in the service of change  Communication is seen as defining relationships (every relationship involves a struggle for power as to who defines the relationship).  Symptoms are tactics to control  Finding alternative ways of defining relationships.

61 Strategic Family Therapy Techniques  therapist takes charge role  directives (therapist tells family members precisely what tasks she/he wants them to perform.  Paradoxical directives (for example: prescribing symptoms – asking members to resist certain things.  Ordeals (making the client’s symptoms too much trouble for the client to continuing having them)  Restraining (warning the family about changes)  Reframing (offering more favorable explanation)

62 Milan Systemic Therapy (Mara Selvini Palazzoli) Is a form of strategic therapy which focuses on the struggle for power and the protective role of symptoms. Techniques Hypothesizing about the presenting problem (pre- session) Neutrality (avoidance of allying with family members Rituals – engaging family members in repetitious behavior designed to counter dysfunctional family rules

63 Milan Systemic Therapy (continued) Paradoxical prescription/directive – prescribing the problem behavior Positive connotation (reframing) Circular questions (members are asked q questions that assist them to think in relational terms and that help them to try to understand the perspectives of other members).

64 Milan Systemic Therapy (continued) Therapy Stages 1.Pre-session (formulate hypothesis(es) 2.Session (modify hypothesis based on information gained in the interview) 3.Intersession (decided on the intervention) 4.Intervention (implement the intervention) 5.Post-session (discuss family’s response and plan for next session)

65 Definitions Open system – family accepts information from external systems. Closed system – the opposite Homeostasis – the balanced state systems seek to maintain. Negative feedback loop – input that maintains the status quo of a system. Positive feedback loop – input that forces a system to change. Multifinality – the same beginning point may lead to different results. Equifinality – different beginning points may lead to the result.

66 Test Question A technique to describe family structure and relationships is: a.Genogram b.Sculpting c.Fishbowl d.Psychodrama

67 Test Answer A technique to describe family structure and relationships is: a.Genogram b.Sculpting c.Fishbowl d.Psychodrama

68 Test Question Healthy family boundaries are: a.rigid b.cohesive c.semi-permeable d.normal

69 Test Question Healthy family boundaries are: a.rigid b.cohesive c.semi-permeable d.normal

70 Test Question Family therapy is contraindicated when: a.Family members are grossly deceitful and destructive to one another. b.There is evidence of consistent violation of generational boundaries. c.Family myths and secrets appear to be the family style. d.The identified client is resistant and unmotivated.

71 Test Answer Family therapy is contraindicated when: a.Family members are grossly deceitful and destructive to one another. b.There is evidence of consistent violation of generational boundaries. c.Family myths and secrets appear to be the family style. d.The identified client is resistant and unmotivated.