ALL INDIA INSTITUTE OF MEDICAL

SCIENCES, RISHIKESH
CENTRE OF EXCELLENCE IN NURSING
EDUCATION AND RESEARCH [CENER]

Seminar on: Group Therapy

Presented to Presented by
Dr. Rajesh Kumar Ms Preeti Malik
Associate Professor MSc [N] 1st Year
College of Nursing College of Nursing
AIIMS , Rishikesh AIIMS , Rishikesh

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 INDEX
S no. Content Page no.

1. Introduction of group therapy. 3

2. Approaches of group therapy 3

3 Indications 3-4

4 Contraindications 4

5 Types of group therapy 4-5

6 Principles of group therapy 5-6

7 Mechanism of change in group therapy 6-9

7 Benefits 10

8 Role of nurse 11

9. Research article 12

10. Reference 12

INTRODUCTION

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Group psychotherapy involves a professionally trained leader who organizes and leads a
group to achieve individual and collective therapeutic goals. These groups provide mutual
support, Countering isolation, and disseminating accurate information about shared
conditions. Effective for medical illnesses, substance abuse, and severe psychiatric
conditions, group psychotherapy involves members working together to effect personality
change under the guidance of a therapist using various techniques and theoretical
frameworks.
Indications
 Schizophrenia
 Affective disorders
 Anxiety disorders
 Phobic disorders
 Personality disorder
 Disorders of impulse control
 Sexual disorders
 Psychotic disorders in adolescence
.
Contraindications
 Severe mental health disorders (e.g., severe personality disorders, psychosis, acute
mania, or severe depression)
 Active substance abuse or addiction
 Extreme social anxiety or agoraphobia
 Inability to maintain confidentiality or trust issues
 Severe emotional instability or acute crises (e.g., suicidal ideation or self-harm)
 Lack of motivation or willingness to participate (e.g., non-voluntary participants)
 Dangerous or disruptive behavior (e.g., violence, aggression, or manipulative
behavior)
 Severe cognitive impairments (e.g., dementia or significant developmental delays)
 Absence of adequate support systems (e.g., needing intensive, individualized care)
 Cultural or religious barriers that prevent participation in the group setting
expression of feelings.

Group Dynamics
Group size: Groups generally consist of 5-10 members.

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Frequency: There is a preference for weekly 1-2 hours sessions
Patient composition: Groups can be homogeneous or heterogeneous, with many therapists
favouring heterogeneity for maximum inter- action. Age, sex, race, and social levels vary to
create a diverse dynamics.
Patient Selection
The suitability for group therapy is determined through psychiatric history, and mental status
examination. a screening interview, group size , frequency of sessions patient
composition ,and confidentiality are considered.
Approaches of Group Therapy
* Psychoanalytic group therapy: Based on psychoanalytic principles
* Transactional group therapy: Developed by Eric Berne, focusing on interactions among
group members
* Behavioral group therapy: Utilizes conditioning techniques from learning theory
* Gestalt group therapy: Created by Frederick Perls, enabling emotional expression and
abreaction
* Patient centered group therapy: Developed by Carl Rogers, based on non judgemental

Types of Group Therapy

Group therapy can be categorized into different types depending on the mental health
condition it is intended to treat as well as the clinical method used during the therapy. The
most common types of group therapy include:
 Cognitive behavioral groups, which center on identifying and changing inaccurate
or distorted thinking patterns, emotional responses, and behaviors

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  Interpersonal groups, which focus on interpersonal relationships and social
interactions, including how much support you have from others and the impact these
relationships have on mental health
 Psychoeducational groups, which focus on educating clients about their disorders and
ways of coping; often based on the principles of cognitive behavior therapy (CBT)
 Skills development groups, which focus on improving social skills in people with
mental disorders or developmental disabilities
 Support groups, which provide a wide range of benefits for people with a variety of
mental health conditions as well as their loved ones.
Broad Principles of conducting group therapy
Certain broad principles underlie the conduct of group therapy. These include:
 Planned Group Formation
 Specific Objectives
 Purposeful Worker - Group Relationship
 Continuous Individualization
 Guided group Interaction
 Democratic Group self-determination
 Flexible Functional Organization
 Progressive Programme Experiences
 Resource Utilization
 Evaluation

Therapeutic principles of Group Therapy

Why are therapeutic groups helpful?

Yalom and Leszcz (2005) have described 11 techniques that individuals can achieve through
interpersonal inter- actions within the group, some of which are present in most groups in
varying degrees:

1. The Instillation of Hope. By observing the progress of others in the group with similar
problems, a group member garners hope that his or her problems can also be resolved

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2. Universality. Through universality, individuals come to realize that they are not alone in
the problems, thoughts, and feelings they are experiencing. Anxiety is relieved by the support
and understanding of others in the group who share similar (universal) experiences.

3. The Imparting of Information. Knowledge is gained through formal instruction as well

as the sharing of advice and suggestions among group members.

4. Altruism. Altruism is assimilated by group members through mutual sharing and concern
for each other. Providing assistance and support to others creates a positive self-image and
promotes self-growth.

5. The Corrective Recapitulation of the Primary Family Group. Group members are able
to re experience early family conflicts that remain un resolved. Attempts at resolution are
promoted through feedback and exploration.

6. The Development of Socializing Techniques. Through interaction with and feedback

from other members within the group, individuals are able to correct maladaptive social
behaviors and learn and develop new social skills.

7. Imitative Behavior. In this setting, one who has mastered a particular psychosocial skill or
developmental task can be a valuable role model for others. Individuals may imitate selected
behaviors that they wish to develop in themselves.

8. Interpersonal Learning. The group offers many and varied opportunities for interacting
with other people. Insight is gained regarding how one per ceives and is being perceived by
others.

9. Group Cohesiveness. Members develop a sense of belonging that separates the individual
("I am") from the group ("we are"). Out of this alliance emerges a common feeling that both
individual members and the total group are of value to each other.
10. Catharsis. Within the group, members are able to express both positive and negative
feelings perhaps feelings that have never been expressed before-in a nonthreatening
atmosphere. This catharsis, or open expression of feelings, is beneficial for the individual
within the group.

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11. Existential Factors. The group is able to help in dividual members take direction of their
own lives and to accept responsibility for the quality of their existence.

It may be helpful for a group leader to explain these curative factors to members of the group.
Positive responses are experienced by individuals who understand and are able to recognize
curative factors as they occur within the group.

Mechanisms of change in group therapy

Mechanisms of change in dialectical behavior therapy (DBT) skills group and positive
psychotherapy (PPT) group intervention, two treatments that have previously been shown to
be effective at reducing symptoms of BPD and depression over a 12-week treatment protocol.
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based
on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience
emotions very intensely.
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand
how thoughts affect emotions and behaviors.
“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the
reality of their lives and their behaviors, as well as helping them learn to change their lives,
including their unhelpful behaviors.
Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American
psychologist.
DBT has proven to be effective for treating and managing a wide range of mental health
conditions, including:
 Borderline personality disorder (BPD).
 Self-harm.
 Suicidal behavior.
 Post-traumatic stress disorder (PTSD).
 Substance use disorder.
 Eating disorders, specifically binge eating disorder and bulimia.
 Depression.
 Anxiety.

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The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in
general, DBT involves these four types of sessions:
 DBT pre-assessment.
 Individual therapy.
 Skills training in groups.
 Telephone crisis coaching.
Positive Psychotherapy (PPT)
Positive psychotherapy (PPT) is a relatively new therapeutic approach, influenced by both the
humanistic and psychodynamic approaches to diagnosis and treatment. Its core focus is on
moving away from what’s ‘wrong’ with an individual and toward what’s good and positive.
Seligman, Rashid, and Parks (2006, p. 774) offer the following definition for PPT concerning
depression:
Positive psychotherapy (PPT) contrasts with standard interventions for depression by
increasing positive emotion, engagement, and meaning rather than directly targeting
depressive symptoms.
While the emphasis is on positivity and positive outcomes, the overall theory of PPT also
asserts that three core principles need to be addressed to allow this to happen (Dobiała &
Winkler, 2016):
1. Hope: This principle encourages focus on the overall positivity of humanity. Negative
experiences are to be seen as having a higher purpose with a positive reframing.
Therapists encourage clients to explore any disruptions to a sense of wellbeing and
reframe them as signals that there is an imbalance that requires addressing.
2. Balance: This principle examines how we experience discontent and the coping
methods we use to address it. According to PPT, negative symptoms arise when these
coping methods aren’t working and areas of our life are out of balance, with
discontent impacting how we think and feel. Peseschkian (1979) ascertained there are
four key areas where we experience imbalance: body/sense, achievement/activities,
contact/environment, and fantasy/future. These are the areas PPT focuses on when
exploring and addressing the principle of balance.
3. Consultation: This principle sets out the five stages of therapy that must be worked
through to achieve a positive outcome:
1. Observation: The individual provides an account of the issues, challenges, or
situations that are upsetting them and those that are making them happy.
2. Inventory: The therapist and individual work together to explore and highlight
the correlation between negative feelings/symptoms and the individual’s true
capabilities.

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 3. Situational support: The individual is asked to focus on their positive traits
and those of the people around them who significantly offer them support.
4. Verbalization: The individual is encouraged to talk openly about any negative
feelings, challenges, or symptoms.
5. Development of goals: The individual is invited to turn their focus to the
future, set positive goals, and envision the positive feelings they want to
cultivate, connecting these with their unique strengths.

Benefits of Group Therapy

There are several advantages of group therapy.
Support, Safety and Encouragement
Group therapy allows people to receive the support and encouragement of the other members
of the group. People participating in the group can see that others are going through the same
thing, which can help them feel less alone. The setting allows people to practice behaviours
and actions within the safety and security of the group.
Role Modelling
Group members can serve as role models for other members of the group. By observing
someone successfully coping with a problem, other members of the group can see that there
is hope for recovery. As each person progresses, they can, in turn, serve as a role model and
support figure for others. This can help foster feelings of success and accomplishment.
Insight on Social Skills
By working with a group, the therapist can see first-hand how each person responds to other
people and behaves in social situations. Using this information, the therapist can provide
valuable feedback to each client.
Affordability
Group therapy is often very affordable. Instead of focusing on just one client at a time, the
therapist can devote their time to a much larger group of people, which reduces the cost for
participants.

Role of the Nurse

The nurse facilitates rather than directs, creating a conducive environment for self-discovery
and change. Nurses play pivotal roles in this setting, utilizing their clinical skills, empathy,
and holistic understanding of patient care to facilitate therapeutic processes. Their roles and
functions in group therapy are multifaceted, encompassing facilitator, educator, advocate, and
observer.

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Facilitator
As facilitators, nurses are responsible for guiding group sessions, ensuring that discussions
remain productive and focused. They create a safe and supportive environment in which
participants feel comfortable sharing experiences and emotions.
Educator
In their educator role, nurses provide valuable information relevant to the group's therapeutic
objectives. This can include teaching coping strategies, stress management techniques, and
information about specific health conditions.
Advocate
Nurses serve as advocates for group members, ensuring that their needs and concerns are
heard and addressed. They provide support gate the healthcare system and access necessary
resources. Advocacy also involves respecting each member's confidentiality and promoting a
non- judgmental atmosphere in which everyone's voice is valued. Nurses might also intervene
on behalf of the group or individual members to address issues that hinder progress or well-
being
Observer and Evaluator
An essential function of nurses in group therapy is to observe and evaluate the group's
dynamics and individual behaviours. Through keen observation, nurses can identify patterns,
progress, and potential areas of concern.
This allows them to tailor interventions to meet the specific needs of the group and its
members, They continuously assess the effectiveness of the therapy sessions and make
necessary adjustments to enhance therapeutic outcomes.
Emotional Support Provider
Nurses offer emo- tonal support by building trusting relationships with group members. Their
empathetic presence helps individuals feel understood and cared for, which can be
particularly comforting during challenging discussions. They listen actively, validate motions,
and provide reassurance, contributing to the overall therapeutic atmosphere. By being a
Consistent source of support, nurses help individual navigate their emotional landscapes and
build resilience.
Coordinator and Organizer
Nurses often take the tole of coordinators, organizing group therapy sessions, managing
logistics, and ensuring that all necessary materials and resources are available. They schedule
sessions, communicate with group members about upcoming meetings, and handle any
administrative tasks related to the therapy group. Their organizational skills ensure that the
group runs smoothly and that participants can focus on their therapeutic work without
distractions.

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CONCLUSION
Group therapy is a form of psychotherapy that typically involves a small group of people to
help them cope with their problems and reach goals. Group therapy is often used in hospitals
and mental health settings to provide support for those who are recovering from an illness or
experiencing hardships.

RESEARCH ARTICLE
Reasons for Suggesting Group Psychotherapy to Patients
There are many psychotherapy varieties, but all are delivered through two predominant
modalities—individual and group. This article outlines differences between individual and
group treatment and the advantages and disadvantages of each.
As a result, many people seek psychotherapy to help build and sustain more intimate and
healthier relationships, a goal for which group therapy is well suited. As relationships develop
in group psychotherapy, group members demonstrate the assets and liabilities of their
relational styles. Their defenses against intimacy become apparent. For these reasons, group
therapy is the treatment of choice for many people. The interpersonal nature of group
psychotherapy provides an opportunity to recognize interpersonal behavior patterns and thus
may provide tools to allow for more intimate relationships. When meeting a new patient, the
therapist seeks not only the theoretical treatment that might be most amenable to the patient’s
individual needs but also the form of therapy that might work best. The aim of this article is
to examine the unique features of group therapy and of the patients this modality may
especially help.

REFERENCE

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3. Group Therapy: How It Works, What It Helps, and More. (2023, November 21).
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4. Ezhumalai, Sinu; Muralidhar, D; Dhanasekarapandian, R; Nikketha, Bala Shanti.
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5. Uliaszek AA, Hamdullahpur K, Chugani CD, Tayyab Rashid. Mechanisms of change
in group therapy for treatment-seeking university students. Behav Res Ther. 2018
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