1. Clinical Psychology Spring 2015 Kyle Stephenson

2. Overview – Day 12 Group therapy ▫Approaches ▫Potential active ingredients Family therapy ▫Goals and principles Couples therapy ▫Common factors ▫Empirically-based interventions

3. Group Therapy Historically, was applied: ▫When heavy caseloads existed ▫As a supplement to individual therapy Use became more widespread with veterans post World War II ▫More patients than could be handled using individual therapy

4. Group Therapy Approaches Psychoanalytic: pretty similar to individual. Group processes seen as secondary to individual insight Same tools and ideas ▫Free association ▫Transference ▫Interpretation of resistance Group seen as a vehicle  Possibly increased anxiety tolerance through “leaning” on group

5. Group Therapy Approaches Transactional Analysis (TA): interactions among people of the group analyzed ▫3 ego states  Child  Parent  Adult  Each has positive & negative aspects that patients can exhibit ▫Emphasis on games: Behaviors used to avoid getting close to others ▫Lack of research

6. Group Therapy Approaches Behavioral ▫Efficiency is main consideration, rather than group dynamic ▫Reinforcement & problem solving ▫Therapist often in didactic role ▫Time-limited ▫More research support than other types of group therapies

7. Group Therapy Approaches Mindfulness ▫Mindfulness meditation is typically considered more of a practice than a therapy per se ▫Sessions are typically a mixture of didactic and experiential practice ▫Many forms:  MBSR  Loving-kindness  MBCT

8. Common characteristics ▫5-10 members ▫90 minute to 2 hour sessions ▫Weekly Can be mixed gender or separated One or more therapists ▫Can also be gender diverse Open vs. closed groups Group confidentiality Group Therapy Arrangements

9. Potential active ingredients (Yalom) ▫Imparting information – what’s worked for you? ▫Instilling hope – I can survive this ▫Universality / normalization – not just me ▫Altruism – I get to help others ▫Interpersonal learning – Improve skills ▫Corrective recapitulation – learn that ineffective methods of interaction don’t work ▫Catharsis – learning how to express feelings ▫Group cohesiveness – feel like you belong Group Therapy

10. Does it work? ▫More efficient & economical than individual therapy ▫More effective than no treatment ▫Not shown to be superior to individual therapy, but little evidence that it’s any less effective ▫However, limited research overall

11. Overview – Day 12 Group therapy ▫Approaches ▫Potential active ingredients Family therapy ▫Goals and principles Couples therapy ▫Common factors ▫Empirically-based interventions

12. Family Therapy Background ▫Rooted in social work ▫Influencing individuals through the whole family unit; one person’s problem affects all members and vise versa

13. Family Therapy Primary focus: Communication ▫Pathology in family system is conceptualized as failure of communication ▫General systems theory:  The family is a system, and pathology is reduced by altering the way the system functions ▫Important aspects of system:  Interconnected  Certain “homeostasis” points, some more satisfying than others.

14. Family Therapy Goals ▫Improve communication ▫De-emphasize problems of individuals ▫Treat and view family as a whole Methods ▫Important for therapist to learn the family’s idiosyncratic subculture ▫Therapist remains “detached” and does not favor certain family members or factions ▫Family history and assessment crucial Overview and sample

15. Overview – Day 12 Group therapy ▫Approaches ▫Potential active ingredients Family therapy ▫Goals and principles Couples therapy ▫Common factors ▫Empirically-based interventions

16. Couples Therapy Goal: increase relationship satisfaction ▫Ideally increase stability as well, but not primary goal Common factors: ▫Shift conceptualization ▫Modify dysfunctional behavior ▫Elicit avoided emotions ▫Foster productive communication ▫Emphasize strengths / encourage positive behavior

17. Empirically-based couple therapies Traditional behavioral couples therapy (TBCT) Integrative behavioral couples therapy (IBCT) Emotion focused couples therapy (EFT) Insight oriented couples therapy (IOCT)

18. Couples Therapy Examples EFT Probably TBCT Communication handout ▫Common component of almost all couple therapy

19. Efficacy

20. TBCT: 50-60% of couples benefit ▫But effects relatively unstable IBCT: 70% of couples benefit ▫Effects seem slightly more stable than TBCT ▫Small number, but extremely high-quality studies EFT: up to 70% of couples benefit ▫But less research than TBCT or IBCT IOCT: 43% of couples benefited ▫Only a single study

21. Take-Home Group, family, and couples therapies all acknowledge the importance of interpersonal interactions in shaping our mental health Group therapy is often conducted primarily for convenience and interventions often look similar to individual therapies Family and couples therapy have unique aspects of treatment Limited evidence supports efficacy of group therapy and strong evidence supports couples therapy; there is less evidence regarding family therapy