Clinical Psychology

Spring 2015Kyle Stephenson

Overview – Day 12

•Group therapy▫Approaches▫Potential active ingredients

•Family therapy▫Goals and principles

•Couples therapy▫Common factors▫Empirically-based interventions

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

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

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

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

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

•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

•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

Group Therapy

•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

Overview – Day 12

•Group therapy▫Approaches▫Potential active ingredients

•Family therapy▫Goals and principles

•Couples therapy▫Common factors▫Empirically-based interventions

Family Therapy•Background

▫Rooted in social work▫Influencing individuals through the whole

family unit; one person’s problem affects all members and vise versa

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.

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

Overview – Day 12

•Group therapy▫Approaches▫Potential active ingredients

•Family therapy▫Goals and principles

•Couples therapy▫Common factors▫Empirically-based interventions

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

Empirically-based couple therapies•Traditional behavioral couples therapy

(TBCT)•Integrative behavioral couples therapy

(IBCT)•Emotion focused couples therapy (EFT)•Insight oriented couples therapy (IOCT)

Couples Therapy Examples

•EFT•Probably TBCT

•Communication handout▫Common component of almost all couple

therapy

Efficacy

Efficacy

•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

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