Group Dynamics

exploring member's and leader's expectations, members are informed on CBT (informed consent): collaborative empiricism, time-limited, quick accomplishment of goals, use of techniques. Begin to establish trust, cohesion, and a climate of safety. Begin groups with a review or summary of the session.

Initial Stage of CBT

Individual Goals

Integrating polarities within oneself Enriching and expanding awareness Achieving contact with self and others Learning to provide self-support instead of looking to others for this support Defining one's boundaries with clarity Translating insights into action Being willing to learn about oneself by engaging in creative experiments Learning to flow smoothly through the awareness-excitment-contact cycle without serious blockage

Empathy

The capacity to see the world of another by assuming the internal frame of reference of that person. Fosters client self-exploration, dissolves alienation.

Awareness leads group members to discover how they are functioning in the world. Attention to behavior and member's movement, posture, language patterns, voice, gestures, and interactions with others is important.

The core of the Gestalt methodology is awareness, or recognizing what one is thinking, feeling, sensing, and doing. How does the Gestalt group leader see this awareness as a crucial and basic part of the therapeutic process?

Choosing for oneself

To grow as an individual and become who we are we choose how to live in the present moment and take responsibility for that choice.

Focus on self-control and independence of individuals. Groups designed for stress management training, social skills training, and self-directed behavior change. Targets problematic behaviors and maladaptive cognitions.

What are the areas of focus in this approach to groups?

This anxiety must be worked through in therapy. Anxiety is brought about in therapy because the clients are growing in awareness and working to give up ways of being that are familiar.

What are the implications of anxiety for group work?

If you do not have awareness, you can't fully accept your own struggles, so self-awareness is to help live in the present moment, come to terms with what is going on in one''s self, choosing how to live in the moment, and taking responsibility for the choice.

What are the implications of the concept of self-awareness for group practice? Why are the developments important and how do they benefit the group?

Primarily: to create an accepting and healing climate in the group where members will interact in increasingly authentic and honest ways.

What are the role and functions of the group facilitator according to person-centered model?

To provide a context that enables members to increase their awareness of what they are experiencing and the quality of the contact they are making with others

What are the therapeutic goals of the Gestalt group?

Assessment and evaluation continue, along with collecting data on participation, member satisfaction, attendance, and completion of assignments. Individuals monitor their behaviors.

Working Stage of CBT

Language Usage

"it," "you," "can't" statements, "oughts" & "shoulds": "It" used instead of "I" is a way of depersonalizing language and maintaining distance from the experience. "You" talk detaches the person from whatever they may be feeling. To have member's take responsibility for what they are saying, have them use "I". "I can't" instead of "I won't", change this to help them own and accept their power by taking responsibility for their decisions. "Shoulds" and "Oughts" go along with feelings of powerlessness, these can be changed to "I have to" or "I choose to".

Mindfulness-based stress reduction

8-10 week group program applying mindfulness techniques to coping with stress and promoting physical and psychological health. Use sitting meditation and mindful yoga to cultivate mindfulness.

Unconditional Positive Regard (acceptance)

Acceptance of and caring for group members. This reduces client defensiveness and enables openness and client's ability to become more involved.

reenacting family relationships

Advantages of a group format over an individual analysis that utilizes psychoanalytic concepts and techniques

1) to help clients become more present to both themselves and others; 2) to assist clients in identifying ways they block themselves from fuller presence; 3) to challenge people to assume responsibility for designing their present life; and 4) to encourage individuals to choose more expanded ways of being in their daily life.

Aims of Existential Groups

- individuals reclaim or acquire a sense of power, empowerment - flexible therapeutic style suitable for variety of groups - focus on spirituality and meaning of life

Assets for Existential

- fresh and creative perspectives - healthy expression of immediate emotions and re-experiencing old emotions - experiential learning - focus on physical body brings rich clues to life

Assets of Gestalt

- members assume responsibility for determining their own level of responsibility - truly listening and deeply understanding - members find their own answers - helps with a wide range of problems - function better interpersonally

Assets of Person-Centered

Problem Solving

CB strategy that teaches individuals or groups to systematically work through steps in analyzing a problem.

cognitive restructuring

Cognitive restructuring is important because clients often reveal a lot of negative self-talk and and defeating thoughts. Cognitive restructuring is the process of identifying and evaluating one's cognitions, understanding both the negative behavioral impact of certain thoughts, and learning to replace these cognitions with more realistic, appropriate, and adaptive thoughts. Members are often asked to self-identify these cognitions, as earlier in the group, they should be taught how to differentiate between self-enhancing and self-defeating thoughts. Other members of the group can offer feedback to the findings of individuals.

the dialogue approach:

Contacting parts of our nature that we work hard at keeping secret from both ourselves and others. Getting interjections out in the open. Purpose: bringing to the surface inner conflicts we might have. Heighten awareness of introjections and projections.

Uniquely, it relies on the principles and procedures of the scientific method, and these experimentally derived principles of learning are systematically applied to help people change maladaptive behaviors. 1) conducting a behavior assessment 2) precisely spelling out collaborative treatment goals 3) formulating a specific treatment procedure appropriate to a particular problem 4) objectively evaluating the outcomes of therapy.

Describe the unique characteristics of cognitive behavior therapy in groups.

The leader's inability to have unconditional positive regard, lack of empathic understanding, or genuine authenticity: interferes with setting up the atmosphere, conditions that enable people to grow. People not feeling the need to change. No connection between group members and the leader. Lack of willingness to receive what the leader and other members are offering/resistance. Lack of attending and empathy. Lack of belief in the therapeutic process. Absence of counselor self-disclosure.

Discuss barriers that can interfere with the effectiveness of person-centered therapy.

Similar to Existential focusing on the full awareness, the individual will be able to tap into things of the past because the present can be resulting from past. But it is important to look at the now to bring up past and future rather than just focusing on past and future.

Discuss the concept of the "here and now" as it relates to Gestalt therapy. How does this approach deal with both the past and the future? In what ways can focusing on the present moment bring more vitality to a group?

Enter into a group to make contact. Before something happens, unhealthy contact will lead to stepping back before the business is finished.

Discuss the concept of unfinished business from the Gestalt viewpoint.

Death is essential to the discovery of meaning and purpose of life; life has meaning because it must end. How we live determines the quality and meaningfulness of life. Death awareness is an awakening experience that can be a useful catalyst for making significant life changes. We can turn our fear of death into a positive force when we accept the reality of our mortality.

Discuss the existential view of death as a significant variable in living fully. How are death and meaning in life related concepts?

With choices, people can self-direct their own destiny and assume control of their life. They also learn how their own behavior affects others.

Discuss the implications of the concepts of self-determination and personal responsibility for group counseling.

Therapists maximize the member's capacity to transform themselves. Therapy is a partnership and a shared venture between the therapist and the client. They focus on the person-to-person relationship. They must bring in their own subjectivity and must demonstrate presence.

Discuss the role of the existential group leader. How would you describe the therapist's relationship with group members?

analytic dream work

Dreams are the "royal road to the unconscious." They express unconscious needs, conflict, wishes, fears, and repressed experiences. After exploring the various facets and possible meanings of a dream in a supportive group, members may be more willing to accept themselves and explore other unresolved problems that elicit feelings of guilt and shame. Manifest and Latent content. Analyzing dreams should occur throughout the group process. Members are encouraged to interpret and to free-associate with one another's dreams. Leader must have a nonjudgmental attitude.

Leader is primarily concerned with having members transfer the changes they have exhibited in the group to their everyday environment. Members rehearse and practice. Feedback from group along with coaching. Preparation for generalization and maintenance of change. Developing a specific plan of action for outside of group. Preparing members for set backs. Reviewing group experience and its meaning. Self-responsibility is emphasized. Short and long-term follow-up interviews are scheduled. Knowing members will be accountable for their changes motivates them to maintain new skills. Can address relapse prevention.

Final Stage of CBT

Leaders need to be skilled in drawing on a wide variety of brief interventions aimed at efficiently and effectively solving problems and assisting members in developing new skills. Leaders model active participation and collaboration. Provide reinforcement of behaviors.

Function of CBT leader

Use 1) direct experiencing and experimenting 2) direct contact and personal presence 3) attention to what and how 4) here-and-now focus.

Functions of Gestalt leader

The rationale on concrete goals and overt behavior is that, in evaluating behavior, the client would become aware of specific behavior they wanted to change in themselves. It is important to be able to objectively determine whether or not the goals were met.

Give a rationale for the focus on concrete goals and overt behavior in a behavioral group. Why are specific goals needed?

Members are often asked to self-identify these cognitions, as earlier in the group, they should be taught how to differentiate between self-enhancing and self-defeating thoughts. Other members of the group can offer feedback to the findings of individuals. Beliefs are worked in with the hope that behavior will change in the theory that our thoughts are causally linked to our behavior and emotions, so the route to changing behavior and emotion is to change negative or self-defeating cognitions.

How are beliefs worked in with the hope that behaviors will change?

leader should enlist the cooperation of members by starting with the client's immediate problems as they are manifested through resistive behaviors, which should not be viewed as something to overcome. Should not be labeled as resistance to the client.

How do group analysts deal with resistance?

Anxiety provides potentially instructive signals that can assist individuals to live more authentically. It is the unavoidable product of being confronted with the givens of existence: death, freedom, existential isolation, and meaninglessness. It is the basic unease that we experience when we become aware of our vulnerability and our inevitable death. It is a part of the human condition, but a failure to move through anxiety results in neurotic anxiety.

How does the existential group leader view anxiety?

The past is used as a tool to understand the present and future. If members are stuck on recollecting useless details of their past, then it inhibits growth.

How is the past dealt with in the analytic group?

To address this theme, encourage group members to ask themselves honestly how they feel about the quality of their life. By reflecting on unfinished business, participants may come to realize that they are not living the life they would like to live, and maybe identify reasons for unsatisfactory existence.

How might an existential practitioner focus on this reality within group counseling?

In each interaction, the member should try to fully immerse into the interaction to work things out. Boundaries should be relatively fluid to enter in and withdraw from experiences. Withdrawal should hopefully happen after the business is finished. Gestalt doesn't want members to get caught up into intellectualizing, trying to figure out things with thoughts and ideas. Gestalt wants the sensory contact.

How would a Gestalt group leader attempt to work with unfinished business in a group?

Even with close friendships, we are ultimately alone — only we can give a sense of meaning to our lives, decide how we will live, find our own answers, and decide whether we will be or not be. We enter and leave the world alone. We must manage the tension between our wish for relatedness with others and the reality of our aloneness. We must stand alone before we can stand meaningfully with others. Solitude is something we can choose for ourselves. We depend on interpersonal relationships, we have a desire for meaningful connections, but unless we can find our own strength within ourselves, we cannot have nourishing relationships with others based on fulfillment rather than deprivation.

How would an existential practitioner view the idea of being alone? How does this create tension with relatedness?

Challenge for therapists is to not directly change group participants, but to engage participants and assist them in developing their own awareness of how they are in the present moment.

Implications of Gestalt approach

In group, members have the opportunity to relate with others in meaningful ways and to find reward and nourishment in the relationships they develop, but they also learn that it is not in others that they find the answers to their questions. Relationships in group should be fostered to teach people how to relate with others outside group. Group shows the individual that they are not alone in their struggles.

In what way might such a practitioner work with these experiences in a group?

Countertransference

Leader projecting strong emotional responses in an upsetting/bothersome way toward the group. May come from insecurities, unresolved things in the leader's life. Can be from other members as members can have transference on other members.

- abstract and difficult to apply - not particularly relevant for people not interested in examining basic assumptions - role of consultant leader rather than "sub parent"

Liabilities of Existential

- elicits emotions - more focus on feelings than cognitive factors - misuse of power by therapist - requires a lot of knowledge, training, skill, experience, and judgment from therapist

Limitations of Gestalt

- lack of structure

Limitations of Person-Centered

Transference

May occur toward the leader or toward other members. Members have strong emotional responses projected towards the leader or other members.

Making the rounds

Member goes around to each group member and says something that he or she usually does not communicate verbally. Purpose: to help a member recognize a hidden fear.

Exaggeration Technique

Members repeat and intensify a particular behavior for the purpose of bring out-of-awareness emotional process to awareness. Purpose: becoming more aware of the subtle signals and cues we send through body language.

Dream Work

Members tell their dream as if it were happening in the present. Purpose: To become aware of the existential messages dreams provide. Helps to extend one's sense of diversity, broadening the experience of self, and centers themselves in the world.

Displacement

Person is putting their feelings on something other than the cause/target of them.

Build a relationship, be more genuine, be more human in relationships, more in line with how other therapeutic approaches build relationships Not just concerned about what a person is bringing up, but also about what I am seeing/picking up (as the leader) Looking more at person to person interaction, the leader isn't the expert with all the answers being totally anonymous Gives support when doing so is therapeutics. Helps members face and deal with resistances within themselves and in the group as a whole. Assists members to gain an awareness of the subtle aspects of behavior through questions and interpretations.

Primary roles and functions of the leader of the contemporary analytic group?

Focus on conscious awareness, contact, and experimentation and encourage members to heighten their awareness and attend to their contact styles. The therapist models the process of useful interactions by disclosing his/her own awareness and experience. Sharing personal reactions to what is going on in group. Connects members with one another and finds ways of involving the group as a whole. Promotes a nurturing environment.

Role of the Gestalt group leader.

Within group, there are more times to see when you are falling short in being authentic. Anxiety may come from having the existential guilt. There are more opportunities to test this. Group gives more opportunity for awareness, as the awareness of the guilt forms, the person will be able to observe how they can improve themselves.

The existential practitioner speaks about the concept of authentic identity. Discuss this concept and how falling short of it is related to existential guilt. How do you see this as a significant concept for the practice of group work?

Projection

The person describes their personal situation as being what is going on with another.

Some knowledge can be gained through the transference and countertransference if it is discussed in group and handled in the group setting to help members understand what is occurring. Transference reflects the patterning of old experiences and earlier acquired distortions as they emerge in present relationships. These can be okay and beneficial if it is open for resolution.

The role of countertransference and transference

Defense Mechanisms

Unconscious ways to deal with reality by distorting it. Protecting ourselves from experiencing anxiety. Includes: Repression, Denial, Regression, Projection, Displacement, Reaction Formation, and Rationalization.

Freedom and responsibility

We are free to choose among alternatives and therefore responsible for directing our life and shaping our destiny. 1) the freedom to become within the context of natural and self-imposed limitations; 2) the capacity to reflect on the meaning of choices; and 3) the capacity to act on the choices we make.

Creates authenticity. Brings about awareness and change. It awakens unfinished business and can bring closure to it. It encourages others to get involved by expressing their reactions.

What are some advantages of the Gestalt emphasis on re-experiencing past traumas as though they were occurring in the present?

Apprehension about joining a group, some to participation in the group process, and some to the desire of leaving group.

What are some forms that resistance takes?

Restructuring the client's character and personality system. Achieved by making unconscious conflicts conscious and examining them. Mainly done through family reenactment.

What is the goal(s) of the analytic group?

In a Gestalt group, members are discouraged from asking questions. Questions direct attention to other people and can easily put others on the defensive. Also, questions often demand that those being questioned reveal themselves whereas those who ask questions remain safe behind their interrogation. Group members are encouraged to make a direct statement to the person and share your own motivation for your question, instead of asking a question. Group members should especially avoid "why" questions because they lead to a chain of "why/because" exchanges. They are encouraged to try "how" and "what" questions instead. Group members should also practice making "I" statements. By doing so, they take responsibility for their position, their opinions, and their preferences.

What is the position of the Gestalt leader in using questions?

Leaders have the role of teacher and encourage members to learn and practice social skills in the group that they can apply to everyday life. Leaders must assume an active, directive, and supportive role and apply their knowledge to resolve problems. They are skilled technicians with human qualities.

What is the role of a cognitive behaviorally oriented group leader?

Anxiety

a feeling of dread and impending doom that results from repressed feelings, memories, desires, and experiences bubbling to the surface of awareness. It is triggered by something in the environment or within the individual. It stems from the threat of unconscious material breaking through the wall of repression.

Mindfulness-based CT

aimed primarily at treating depression. 8 weeks, integrates C.T. and mindfulness-based stress reduction procedures. Clients are asked to "just notice" thoughts and emotions as they rise. The open and nonjudgmental posture regarding negative thinking, emotions, and bodily states are used to help clients realize their thoughts are not facts. Aims at changing clients' awareness of and relation to their negative thoughts.

Reinforcement

an event that strengthens the tendency for a response to be repeated.

"It is based on the assumption that we are best understood in relation to our environment." Gestalt therapy is existential, focuses on here-and-now Awareness, choice, and responsibility are cornerstones of the practice Interpersonal contact and awareness Phenomenological: emphasizes how we see the world, how we contribute to creating our experience, and how we organize our world and ourselves Experimental: members come to grips with what and how they are thinking, feeling, and doing Individuals can self regulate, especially if they are fully aware of what is happening in and around them.

assumptions underlying the Gestalt

Mindfulness

becoming increasingly observant and aware of external and internal stimuli in the present moment and adopting an open attitude toward accepting what is rather than judging the current situation.

Reaction Formation

behaving in a manner that is opposite to one's real feelings. Being sweet when angry.

Modeling

clients learn through observation and imitation of both the leader and other members.

Phenomenological approach

each person has a unique understanding of the world from their experiences. The group leader will strive to understand reality from the client's perspective. The group leader will emphasize the uniqueness of clients.

Denial

effort to suppress unpleasant reality. "closing our eyes" to the existence of anxiety-producing reality.

Repression

excluding from consciousness threatening or painful thoughts and desires.

Attending

full presence to the individual, hearing what they are saying and intertwining this with non-verbals, reading in between the lines. A here-and-now full presence. You can't be genuine, truly listening when you aren't attending.

Self-awareness

he greater our awareness, the greater our possibilities for freedom. Regardless of how great the forces victimizing us are, we have the capacity to know that we are being victimized, which allows us to take a stand on this situation. Through self-awareness we come to recognize the responsibility association with the freedom to choose and to act

Emphasizes helping clients explore and understand existential concerns and how these concerns affect their life. Looks at freedom and responsibility, existential isolation, meaninglessness, and death.

how does an existential practitioner view group counseling?

Actualization tendency

human beings strive to grow, not just for stability: there is an innate drive for one to understand personal potential.

Resistance

individual's reluctance to bring into conscious awareness threatening unconscious material that has been previously repressed or denied. Anything that prevents members from dealing with unconscious material and thus keeps the group from making progress.

Belief that humans are free self determining being

individuals may be influenced by their past and environment, but they have a role in who and what they become through their choices there should be concern and respect for the subjective experience of each person. Should try to empathize with each group members worldview.

interpretation

is a proposal of meaning aimed at helping group members gain self-understanding. It is presented as a tentative hypotheses. It will deal with material that is close to the member's awareness so the member will be ready and able to incorporate it. It should begin from the surface and go as deep as the member can emotionally tolerate, and it is best to point out a form of defense or resistance before interpreting the feeling or conflict that lies underneath it. Anyone can provide interpretation so long as it is given in an appropriate manner. All members have their freedom to share and discuss.

Free association

is when members say whatever is on their mind without any hesitancy. In the designated moment it is uncensored talk and members are able to respond to each other's free associations. It can be immediate reactions and interpretations of whatever discussion is occurring. Dream analysis and free association, what is brought to mind is shared about what is going on. This occurs in much deeper group therapy to uncover what has been going on over time.

Coaching

leader gives general principles for performing desired behavior effectively.

Group Member Goals

learning how to ask clearly and directly for what they want or need learning how to deal effectively with interpersonal conflicts being direct with each other and speaking in the first person finding ways to challenge members to grow while respecting their needs for space and boundaries creating a community that is based on trust that allows for a level of deep and meaningful work learning how to give each other feedback learning not to give advice using the resources within the group rather than relying on the group leader as the director

Rehearsal

members say out loud what they are thinking silently. Purpose: to bring into sharper awareness a process that is typically done without awareness; members become more aware of how they strive to please others, of the degree to which they want to be accepted and approved, and of the extent of their efforts to avoid alienating others.

provide for reenacting past unfinished events, especially when other members stimulate such intense feelings in an individual that he or she "sees" in them some significant figure such as a father, mother, sibling, life partner, spouse, ex-lover, or boss.

multiple transferences

Importance of self awareness

people who are self aware can make more life affirming decisions. The Group Leader will have to be aware in order to model this to his or her group members. The group leader will need to be open to self awareness. Group work will focus on working towards self awareness

Paradoxical Theory of Change

personal change tends to occur when we become aware of what we are as opposed to trying to become what we are not. Accepting who we are. Equal attention to process and content.

Behavior Rehearsal

practicing in a group session a new behavior that will be used in everyday situations.

Feedback

praise and encouragement.

Cognitive Restructuring

process of identifying and evaluation one's cognitions, understanding the negative behavioral impact of certain thoughts, and learning to replace these cognitions with more realistic appropriate and adaptive thoughts. Problem Solving:

Homework

putting into action what members explore during a group session.

Acceptance

receiving one's present experience without judgment or preference, but with curiosity and kindness, and striving for full awareness of the present moment.

Dialectical BT

recognized for borderline personality disorder. Integrates cognitive behavioral concepts with mindfulness training. Emphasizes the importance of the psychotherapeutic relationship, validation of the client, and the etiologic importance of the client having experiences an "invalidating environment" as a child. Focuses on accepting the present as it is and uses mindfulness.

Awareness

requires self-knowledge, responsibility for choices, contact with the environment, immersion in current experience, self-acceptance, and the ability to make contact. Clients find within themselves the resources to solve their problems and to discover conditions that will make change possible.

Regression

returning to a less mature developmental level in the face of severe stress or crisis.

The first 6 years of one's life is seen as the roots of present conflicts. Although past development is irreversible, to change the effects of these events, one must look back at their past and recognize how their early development affects them.

the role and influence of the past as a key factor of present development

Genuineness (congruence)

the state of authenticity that results from a deep exploration of self and a willingness to accept the truths of this exploration. Lends credibility to empathy and positive regard.

Unconscious

thoughts, feelings, motives, impulses, and events that are kept out of our awareness as a protection against anxiety. What we do in everyday life is motivated by our unconscious. In a group setting, understanding one's unconscious will help them make sense of interactions in a group.

Rationalization

when one tries to justify their behavior by assigning logical and admirable motives to it.