GROUP PSYCHOTHERAPY

INTRODUCTION

Foulkes (1975) referred to group therapy as “ hall of mirrors “ in which people can see
themselves reflected in others. Group therapy is a powerful therapeutic tool to help the
patients, correct maladaptive personal behaviors and to enhance a patient’s ability to
function as a contributing member of the community. The experience of being in a group
does not deny the uniqueness of each person. Rather, it allows people to directly
experience their talents and possibilities through the eyes and personal experience of
others. By using a variety of technical maneuvers and theoretical constructs, the leader
directs group members’ interactions to bring about changes. The principles of group
psychotherapy have also been applied with success in the fields of business and
education in the form of training.

DEFINITION

Group therapy is a method of therapeutic intervention based on the exploration and

analysis of both internal (emotional) and external (environmental) conflicts and the
group process.
[LEGO, 1996]

Group therapy is an identifiable system consisting of at least 3 people who share a

common goal.
[NUDELMAN, 1986]

Group therapy is a “hall of mirrors” in which people can see themselves reflected in
others.
[FOULKES, 1975]

1
HISTORY

Group psychotherapy, as a recognized form of psychological treatment, traces its origin

to the early 1900’s. in 1907, Joseph Pratt, an internist in Boston, developed a psycho
educational method for teaching patients with TB about their disease and improving their
morale. He used a combination of lecture and informal group discussion. The success of
his group treatment approach inspired Pratt and others to use a group format to treat
other chronic diseases such as diabetes. Later, Pratt expanded its use to the treatment of
neurotic disorders. The idea of sharing a “common bond in a common disease”, which
Pratt advocated at the turn of the century, serves as the basis for many contemporary
support and mutual help groups. The notion of combining psycho education with
informal group discussion is used increasingly with patients and families because of the
benefit of combining didactic information with individuals’ experiences.

Samuel R Slavson, considered the father of group psychotherapy in America, worked

with, inner- city children and adolescence. He found that a group format using a
combination of games, tools and food to engage children in actively communicating with
each other, encouraged co- operative behaviors among children who otherwise might not
talk to each other. This work laid the ground work for group activity therapy, in which
arts and crafts help children experience and direct their energies in productive way.

CHARACTERISTICS OF AN EFFECTIVE GROUP

• Goals are clearly identified and collaborately developed.

• Open, goal directed communication of feelings and ideas is encouraged.
• Power is equally shared and rotates among members, depending on ability and
group needs.
• Decision making is flexible and adapted to the group needs.
• Controversy is viewed as healthy because it builds member involvement and
creates stronger solutions.

2
• A healthy balance exist between task and maintenance role functioning.
• Individual contributions are acknowledged and respected.
• Diversity is encouraged. Interpersonal effectiveness, innovation and problem
solving adequacy are evident.

PURPOSES OF GROUP THERAPY

• Psycho educational purpose of some groups is to help patients and families

better understand the disease process, treatment and modifiable risk factors
• To help patients to understand and modify maladaptive patterns of relating to
others.
• Strengthen healthy patterns of behavior and to help patients learn new,
better ways of relating.
• Self help and mutual aid groups frequently do not have a professional
leader. Their purpose is to provide patients and families having similar health
concerns a place to share their experiences, derive comfort , share information and
exchange practical advice.

ELEMENTS / CURATIVE FACTORS

Certain essential elements are common to all types of group therapy. Yalom (2005)
has identified eleven essential elements of group therapy. This include

1. Instillation Of Hope: It is the first and often most important factor. People
participating in the group experience initially feel demoralized and helpless. So
providing them with hope is therefore a most worthwhile achievement. Client
should be encouraged to believe that they can find help and support in the
group and that it is realistic to expect that problem will eventually be resolved.
2. Universality: It can be defined as the sense of realizing that one is not
completely alone in any situation. Group members can identify this factor as a

3
 major reason for seeking group therapy. During the sessions, members are
encouraged to express complex, often very negative feelings in the hope that
they will experience understanding and support from others with similar
thoughts and feelings.
3. Imparting Of Information: This includes both didactic instructions and direct
advice, and refers to the imparting of specific educational information plus the
sharing of advice and guidance among members. The transmission of this
information also indicates to each member the other’s concern and trust.
4. Altruism: It is the personalized help that one group member extends to
another. Clients have the experience of learning to help others, and in the
process they begin to feel better about themselves. Both the group therapist and
the members can offer invaluable support, insight and reassurance while
allowing themselves to gain self knowledge and growth.
5. Corrective Recapitulation Of The Primary Family Group: This allows
members in the group to correct some of the perceptions and feelings
associated with unsatisfactory experiences they have had with their family. The
participants receive feedback as they discuss and relieve early familial conflicts
and experience corrective responses. Family roles are explored, and members
are encouraged to resolve unresolved family business.
6. Development of Socializing Techniques: It is essential in the group as
members are given the opportunity to learn and test new social skills. Members
also receive information about maladaptive social behaviors.
7. Imitative Behaviour: It refers to the process in which members observe and
model their behaviors after one another. Imitation is an acknowledged
therapeutic force; a healthy group environment provides valuable opportunities
for experimenting with desired changes and behaviors.
8. Inter Personal learning: This includes the gaining of insight, the development
of an understanding of a transference relationship, the experience of correcting
emotional thoughts and behaviors and the importance of learning about oneself
in relation to oneself.

4
 9. Group Cohesiveness: It is the development of strong sense of group
membership and alliance. The concept of cohesiveness refers to the degree to
which a group functions as a supportive problem solving unit. Ideally, each
member feels acceptance and approval from all others in the group. This factor
is essential in ensuring optimal individual and group growth.
10. Catharsis: It is similar to group cohesiveness and involves members relating to
one another through the verbal expression of positive and negative feelings.
11. Existential Factors: These factors are consistently operating in the group and
help to make up the final component. These intangible issues encourage each
group member to accept the motivating that he or she is ultimately responsible
for his or her life choices and actions.

TYPES OF GROUP THERAPY:

SUPPORTIVE ANALYTICALLY PSYCHOANLYSIS TRASACTIONAL BEHAVIOURAL

PARAMETERS GROUP ORIENTED OF GROUPS GROUP THERAPY GROUP
THERAPY GROUP THERAPY THERAPY
1-3 times a 1-5 times a 1-3 times a 1-3 times a
FERGUENCY Once a week week week week week
Upto 6 Up to 6
DURATION 1-3+years 1-3+years 1-3 years
months months
Phobias,
PRIMARY Psychotic & Anxiety & Anxiety & Psychotic & passivity,
INDICATIOS
anxiety personality personality anxiety sexual
disorders disorders disorders disorders problems
INDIVIDUAL
SCREENING Usually Always Always Usually Usually
INTERVIEW
Present & past Primarily past
Primarily life situations, life Primarily intra Specific
COMMUNICATION
environmental Intra group & experiences& group relations symptoms
CONTENT

factors extra group intra group without focus

relations relations on causality

TRANSFERANCE Positive Positive Positive
transference Positive & Transference relationships relationships
negative

5
 encouraged transference neurosis fostered, fostered, no
to promote evoked and evoked and negative examination
improved analyzed analyzed feelings of
functioning analyzed transference
Always
DREAMS Not analyzed Analyzed Analyzed
analyzed & Not used
frequently encouraged rarely
Intra group
dependence Intra group Intra group Intra group Intra group

encouraged, dependence dependence not dependence dependence

DEPENDACE
members encouraged, encouraged, encouraged, not

relay on dependence on dependence on dependence on encouraged,

leader to leader variable leader variable leader not reliance on

great extend encouraged leader is high

Strengthen Challenge Challenge Challenge Create new

existing defenses, defenses, defenses, defenses,
THRAPIST’S
ACTIVITY defenses, active, give passive, give active, give active and
active, give advice or no advice or personal directive
advice personal personal response, rather
response response than advice
MAJOR GROUP Transference,
PROCESSESS Univeralization, Cohesion, Cohesion,
ventilation, Abreaction,
reality testing transference, catharses, reality testing reinforcement,
reality testing reality testing conditioning
SOCIALIZATION Generally
OUT OF GROUP Encouraged Discouraged Variable Discouraged
discouraged
Moderate Extensive Alteration of Relief of
Improved reconstruction reconstruction behaviour through
specific
GOALS
adaptation to mechanism of
of personality of personality psychiatric
conscious control
environment dynamics dynamics symptoms

TYPES OF THERAPY GROUPS

6
The functions of a group vary depending on the reason the group was formed. Clark
identifies three types of groups in which nurses most often participate: task, teaching &
supporting or therapeutic groups, self help groups
1. TASK GROUPS
The function of a task group is to accomplish a specific outcome or task. The
focus is in solving problems and making decisions to achieve this outcome. Often
a deadline is placed on completion of task, and such importance is placed on a
satisfactory outcome, that conflict within the group maybe smoothed over or
ignored to focus on the priority at hand.
2. TEACHING GROUPS
Teaching, or educational groups exist to convey knowledge and information to a
number of individuals. Nurse can be involved in teaching groups of many
varieties such as medication education, child birth education, breast self
education and effective parenting classes. These groups usually have a set time
frame or set number of meetings. Members learn from each other as well as from
the designated instructor. The objective of teaching group is verbalization or
demonstration by the learner of the material presented by the end of the
designated period.
3. SUPPORTIVE OR THERAPEUTIC GROUPS
The primary concern of support group is to prevent future upsets by teaching
participants effective ways dealing with emotional stress arising from situational
or developmental crises
4. SELF HELP GROUPS
An additional type group in which, nurses may or may not be involved is the self
help group. It allows clients to talk about their fears and relieve feelings of
isolation while receiving comfort and advice from others undergoing similar
experiences. Eg. Alcoholic anonymous, narcotic anonymous, over eaters
anonymous, women’s groups and men’s group.

CONCEPTS IN GROUP DYNAMICS:

7
Patient Selection:
Member selection is based on a patient’s treatment need capacity to contribute to
group goals. Group members do not know each other before entering the group,
and it is best not to include people in the same group who socialize with each
other. It is not possible to have full control over patient selection, particularly in
inpatient or partial hospitalization settings, but the therapist should carefully
consider the rationale for including patients who are actively psychotic,
uncontrolled manic, paranoid or hostile even in inpatient setting. These
individuals cannot benefit from the group when their symptoms are intense and
they will disrupt the group even with the most skilled leadership.
Functional Similarity:
Group members should have enough in common with each other to feel
interpersonally comfortable in the group and it is referred as the functional
capacity. This means that group members should have sufficient levels of
functional ability and social recognizability to allow them in meaningful
conversation. Significant differences in educational level, life experiences or
developmental levels can be barriers to full participation. When group members
feel uncomfortable, they are not as likely to talk with each other. The leader
should avoid including members who are the only ones with permanent
characteristics such as different race, gender, education or age than the other
members.
MacKenzie referred to this as the “ Noah’s Arch” phenomenon. That is, a
therapy group ideally should have at least two members with similar
characteristics. Pairing members in this way precludes the creation of a group
social isolate. For eg: it would not be appropriate to place a single adolescent girl
in a group of adolescent boys.

Capacity to contribute:

8
Group members must be able to both contribute to group goals and derive benefit
from this treatment modality. Usually, patients with more than mild cognitive
disorders, anti social behaviors, strong hostility or paranoid symptoms do not
profit from group intervention. First, their symptoms disrupt the group
functioning. Second, their pathologies interfere with their own ability to derive
benefit because their symptoms preclude the necessary co – operation with other
members. They should be included only after their symptoms are under sufficient
control that they gain some benefit from group membership. All group members
need to be able to contribute in a meaningful way to the functioning of the group
as a whole.
Matching individual need with membership:
Another factor to consider with group composition is the issue of homogenous
compared with heterogeneous group membership. Homogenous group include
patients with same diagnosis, similar age group and same gender. They are
particularly useful in treating disorders in which denial plays a role, for example,
addiction or eating disorders. Heterogeneous groups draw their membership from
a variety of diagnoses. These groups are composed of men and women, rather
than being single gender and prospective members can run the age gamut of
adulthood. The advantage of a heterogeneous group is that the rich complexity of
its membership can provide several different ways of approaching interpersonal
relationships. The format works well with patients experiencing relationship
difficulties.
Choosing open or closed groups:
Another decision is whether to have open or closed membership. Open groups
are those in which group membership changes frequently. This type of group is
found in inpatient settings that depend on member residency and in many mutual
help and support groups. Closed groups are those in which group membership
does not change for the life of the group or only for a clearly understood reason.
Members often must meet certain criteria for acceptance, such as a diagnosis or a
particular therapeutic issue. Foe example, alcoholic anonymous is open only to

9
people with a drug problem .psychotherapy group can share characteristics of
both open and
closed membership. They are open in that as one member leaves the group,
another fills the empty slot, but they have a closed membership in that members
cannot arbitrarily enter the group simply because they have similar interests or
problems.
Group size:
Psycho educational groups can consist of 10-15 members. In psycho educational
groups, the members discuss a particular topic such as medication, prevention or
symptom management of a mental disorder, but the process does not allow
individual to address personal psychological issues unrelated to the discussion
topic. Most insight oriented therapy groups limit membership to six to eight. This
size not only allows for a variety of interpretations but also permits sufficient
interpersonal space for intimate sharing. Therapy group needs to have at least
five members. With fewer than five members, the group is likely to produce an
emotional intensity or to form sub groups, both of which are difficult to regulate.
Time boundaries:
Time boundaries in group therapy are extremely important. Most group therapy
sessions last 75 – 90 minutes. Therapy sessions should begin and end on time.
Attention to time boundaries respects the need of individuals to have lives
outside the group and firmly integrates the group as a set pattern in the patient’s
life.
Inpatient versus outpatient groups:
Inpatient groups differ from outpatient groups in several ways. Group
membership in the inpatient groups depends on the particular patient population.
Because of short stays, the focus of group may be on spotting mal adaptive
behaviors that can be worked on in outpatient therapy and stabilizing symptoms
enough to permit discharge. The content and process of inpatient therapy is more
superficial than in outpatient settings. With inpatient therapy, the therapist takes a
much more active role, clarifies more often and directs the process of establishing
appropriate norms.

10
PHASES OF GROUP DEVELOPMENT:

The phases of group development are sequential and overlapping, beginning with
planning, which takes place before the group starts and ending with termination and
referrals if needed. Tuckman 1965 describe the phases of group development as forming,
storming, norming, performing and adjourning.

 Pre Interactive Phase :

The leader’s first task is to establish suitable foundation for the group selecting an
appropriate time and place for the group sessions and clearing these arrangements
with other staff members. Psychotherapy groups must take place in a quite, well
ventilated room where the group is not disturbed and the chairs should be arranged
so that all group members face each other. The initial assessment interview takes
place as an individual session before the first group session. Assessment interviews
provide the therapist with an important opportunity to evaluate motivation and
personal commitment. Another important goal of the pre group assessment interview
is to make entry into the group easier. People may have preconceptions about the
therapy that the therapist can dispel. During this initial discussion, the patient begins
to experience the “person” of the leader. Experiencing the group leader as a human
being and a consistent member of the group beforehand often reduces the patient’s
anxiety about joining the group. During the pre group assessment interview, the
therapist can provide necessary information about the group purpose, format and
expectations and the patient can ask questions that may make the difference between
whether he or she rejects or accepts group membership.

 Forming Phase:
The forming phase of group therapy is the orientation phase in which group members
begin to know each other. The therapist can begin the group with a self introduction
and ask the members to say their names and tell the group something about

11
themselves. The manner in which the individuals express themselves and the type of
information they choose to share provide important data that can be used later, in the
working phase. However, the therapist needs to make sure that members do not
prematurely disclose lengthy intimate details about themselves because premature
sharing can lead to intense discomfort when the shares reflects on it, resulting in
unanticipated termination.
Acceptance, inclusion and trust are primary values held by members in beginning
group meetings. Initially, group communication tends to be tentative, polite and
guarded, as members explore their values and ideas with each other. They need to
know that other group members, including the leader, will respect their contribution
and will not make them look foolish to their peers. Finding that other members have
had similar experiences and related feelings help strengthen initial emotional
bonding among group members. The group leader encourages the development of
universality by linking member contributions together, pointing out similarities, and
stressing the importance of group members as therapists for each other.
When the group begins to meet, the leader plays an important role in establishing the
group structure. A standard first meeting format is to (1) identify the group‘s purpose
and goals; (2) name fundamental structural norms such as expected attendance,
confidentiality, and what to do incase of absence; and (3) explain how the group will
function. A general statement about the nature of work (i.e., that the group provides a
place where members can discuss serious personal issues and receive personal
feedback from each other) establishes the task of the group as serious. If members
have never been in group therapy before, the therapist briefly educates them as to
their roles as members.

 Storming Phase:
The storming phase of group development signals movement beyond the initial
hesitancy and fear about being in the group. It can appear as a subtle questioning of
appropriateness of time or group objectives. This opens the door to exploration of
stronger feelings, hidden agendas and open conflicts as members struggle with issues
of power and control. Although uncomfortable, this phase of group development is

12
absolutely essential because it sets the foundation for the development of the group
specific norm that will guide the group in the working phase. This phase usually does
not last long. Establishing trust remains a central task for this phase of group
development. During this phase, the therapist acts as a gatekeeper by helping
individual group members identify but move beyond their personal agendas and
engage in their group dialogues. During this phase group members begin to engage
with each other at deeper level and to reveal more of their issues while asking for a
similar commitment from others.

 Norming Phase:
During this phase, the group develops norms- behavioral standards and basic
operating procedures- that provide structural boundaries and guidelines for behaviors
that will or will not be tolerated. Some behaviors as classified as universal norms
because they are standards found in all psychotherapy groups. These are
predetermined norms, voiced during the opening session, that include regular
attendance, confidentiality and the expectation of verbal contributions. Other
standards are group specific norms, which emerge from the need of group members
to facilitate goal achievement. For eg, group specific norms for a chronic
schizophrenic therapy group might include specific basic group behaviors such as
talking one at a time, not leaving the room during the session, refraining from violent
behaviors towards other group members and refraining from obscene language.
Specific norm in a drug abuse group would be to remain drug free during the group
session.
The group pressure on members who do not confirm to expected norms helps
reinforce bonding. Because norm violation by one member affects the entire group,
the leader must always address norm violations as being significant.

 Performing/Working Phase:
Once the ground rules for operating the group are in place, members actively engage
in working on group determined agendas. The performing phase is characterized by
cohesion and productivity and the most in depth work of the group takes place during

13
this phase. Self disclosure is more spontaneous and honest in the performing phase.
Members know what to expect from each other. In the process of working through
differences, a genuine respect for other members has developed, members trust the
comments of others and the sense of belonging is at its highest peak. Here, group
members experience the altruism of helping others, interpersonal learning, self
understanding, and recapitulation of the family.
Throughout the performing phase, the therapist’s primary function is to facilitate
movement towards the group goals by providing an accepting interpersonal
environment in which group members feel supported in exploring difficult issues.
Group members take responsibility for leadership activities and, in essence, become
therapist for each other.

 Adjourning (termination) phase:

Good endings are as important as good beginnings in group life. The adjourning
phase of group relationships occur in a variety of ways: members leave, the group
disbands, or a member is asked not to return for violating the group contract. Most
often, individual group members leave a psychotherapy group because their work is
finished or because they are discharged from the hospital or treatment program.
Preparation for voluntary endings in an outpatient group can begin with a non
established in the first meeting or during the initial interview when the therapist asks
each group member to tell the group of impending departure one weak and to return
the next to say goodbye. Terminations are important both for the group as a whole
and for the patient. Sufficient time for effective goodbye should be provided during
each patient’s last session. Ask the patient to tell the group what has been helpful and
to say something to each group member.
If the group as a whole is ending the therapist can help the group summarize the goal
achievement and gain closure on any unresolved issues. Providing feedback about
positive goal achievement individually and collectively is important to individual
members and the group as a whole.

14
INDIVIDUAL FUNCTIONS WITH IN A GROUP:

 Roles involving task functions:

Initiator: proposes new ideas, directions, tasks, methods.

Elaborator: expand son existing suggestions and develops the group’s plans further.
Evaluator: critically evaluates ideas, proposals, and plans, examining the
practicality of proposals and the effectiveness of procedures.
Co–ordinator: helps to pull together ideas and themes to clarify suggestions that
have been made and to help various subgroups work more effectively together
towards their common goals.

 Roles involving group maintenance functions:

Encourager: Offers praise to and agrees with other members; communicates

acceptance of others and their ideas and an openness to differences within the group .
Harmonizer: mediates conflicts and disagreements that crop up, trying to relieve or
reduce tension within the group.
Compromiser: seeks a position between contending sides; seeks a compromise that
all parties can accept.

 Roles involving primarily personal, individualistic functions:

Aggressor: Acts negatively, with hostility toward other members; criticizes others’
contributions; attacks the group and its members.
Recognition-seeker: calls attention to own activities; boasts; redirects things
towards self.

15
 Help-seeker or confessor: uses the group as a vehicle either to gain sympathy or to
achieve personal insight and self-satisfaction without consideration for others or the
group as a whole.
Dominator: asserts authority and seeks to manipulate others so as to be in control of
everything that happens.

HOW GROUP THERAPY WORKS?

Display of inter personal pathology


Feed back and self observation

Sharing reactions

Examining the results of sharing reactions

Understanding ones’ opinion of self

Developing a sense of responsibility

Realizing ones’ power to effect change

High affect potentiate change

16
COMMON PROBLEMS AFFECTING GROUP THERAPY AND PROCESS AND
ASSOCIATED NURSING INTERVENTIONS:

SL. GROUP PROBLEM NURSING INTERVENTION

NO

1. Fear of authority resulting in • Use non verbal and verbal

timid,agreesive, hostile or communication techniques, listen to
withdrawn behavior and encourage client to share and
explore feelings
• Respond in an understanding manner
when the client expresses feelings
(even when they are hostile).
• Reassure client that nurse-therapist
will not respond punitively to the
expression of feelings.

2. Initial anxiety in a group,

• Give “strokes” for positive interactions
displayed by silence, fidgeting,
• Help client establish a role in the
nervous movement and selective
group, one related to the client’s skills
hearing.
• Share with client that discomfort in the
initial state of group development is
common.
• Meet client’s dependency needs.

3. Hidden Agenda
• Identify the source of individual and
group anxiety causing the hidden

17
 agenda.
• Explore the hidden agenda with the
group and its meaning and effect on
the group’s functioning.

4. Sub grouping • Establish clarifying goals and purpose

of the group (thereby lessoning the
group’s anxiety an aiding in
elimination of subgroups.

• Direct subgroup interest towards the

goals of the group, thereby lessoning
subgroup pre occupation with outside
themes

5. Deviant behavior- behavior that

• Identify deviant behavior and discuss it
needs personal need and
with the client.
undermines the group

• Identify sources of discomfort in the

environment that affects the client.

• Explore with the client whether he or

she identifies the behavior as deviant.

• Help members of the group identify

deviant behavior.

• Help the client explore how this

behavior affects his or her relationship

18

6. Resistance to therapy(eg.
Grunting, moaning, staring into
space, over responding to
situations, changing the subject,
absence from group).
in the group.
• Use group pressure to help the deviant
member change or conform to group
norms.
• Explore resistant behavior with the
client.
• Confront the client with his or her
behavior, using an understanding
approach.
• Help the client identify what he or she
has accomplished while a member of
the group.
• Help the client work through feeling of
loss during termination. (ie feelings of
anger, euphoria, depression, rejection).
• Help the client express both positive
and negative feelings about the group
and evaluate the group experience
realistically. Plan a termination activity
that allows expression of group
members’ feelings.
• Lesson intensity of group interaction
as group nears termination.
19
NURSES’ RESPONSIBILITY IN GROUP THERAPY

The primary role of the nurse – therapist in group therapy is to guide individuals through
a problem solving process by anticipating and responding to the needs and concerns of
the group members. The nurse therapist has both task and maintenance role functions.
Group task functions are concerned with the practical issues of leading a group, where
as group maintenance functions focus on less tangible group process.

ADVANTAGES:

1. More clients can be treated in a group, making the method cost effective.
2. Members benefit by hearing others discuss similar problems; feelings of
isolation, alienation, and uniqueness.
3. It provides the client opportunity to explore their specific styles of
communication in a safe atmosphere where they can receive feedback and
undergo changes.
4. Members learn multiple ways of solving a problem from others and group
exploration may help them to discover new ways of solving problems.
5. Members learn about the functional roles of individuals in the group. Sometimes
a member shares the responsibility as a co-therapist.
6. The group provides for its members’ understanding, confrontation and
identification with more than one person. The member gains a reference group.

DISADVANTAGES:

1. A member’s privacy may be violated, such as when a conversation is shared

outside the group. This behaviour obstructs confidentiality and hampers complete
and honest participation.
2. Clients may experience difficulty exposing themselves to a group or believe that
they lack the skill to communicate effectively. Some clients may use these factors

20
 as resistance; others may be reluctant to expose themselves because they do not
want to change.
3. Group therapy is not helpful if the therapist conducts the group as if it is an
individual therapy. Such a therapist may see dynamics and group process as
incidental or antagonistic to the therapeutic process. The effective group leader
must be skilled in techniques and interventions that foster group interaction and
shape group behaviour and growth.

CONCLUSION
Purpose of group therapy is to intervene in mentally disorder behaviour, thinking
and feeling. Group therapy offers multiple stimuli to reveal examine and resolve
distortion in interpersonal relationship. The purpose of the group is related to goals and
expected outcomes. The group therapist focuses on the process of interpersonal learning
and change.

21
 BIBLIOGRAPHY

1) Benner, Carson, Verna. Mental health nursing: The nurse patient journey. 2nd
ed. Philadelphia: W B Saunders Company; 2000. Page no. 354 – 362.
2) Taylor M, Cecelia. Essentials of psychiatric nursing. 14 th ed. Philadelphia:
Mosby publishers; 2001.Page no. 468 – 476.
3) Rebraca L, Shives. Basic concepts of psychiatric mental health nursing.7 th ed.
Philadelphia: Lippincott publishers; 2000. Page no.206 – 211.
4) Benjamine J S , Virginea A S . Synopsis of psychiatry. 10 th ed. Philadelphia:
Lippincott publishers; 2001. Page no. 934 – 940.
5) Townsend M C. Psychiatric mental health nursing. 5th ed. New Delhi: J P
Publishers; 2004. Page no. 151 – 157.
6) Mohr K W. Psychiatric Mental Health Nursing. 6 th ed. Philadelphia: Lippincott
Publishers; 2006. Page no: 198 – 205.
7) Johnson D P, Penn D L, Bauer D J, Meyer P, Evans E. Predictor of the
therapeutic alliance in group therapy for individuals with treatment resistant
auditory hallucinations. British journal of clinical psychology. 2008; 47: 171 –
183.

22