Cognitive group therapy

In the initial stage of group development, members begin to develop their relationship with one another and learn what is expected of them. Group members rely on safe, patterned behaviour and look to the group leader for guidance and direction. Group members have a desire for acceptance by the group and a need to be known that the group is safe (Corey, 1995). They set about gathering impressions and data about the similarities and differences among them and forming preferences for future subgrouping.

Rules of behaviour seem to be to keep things simple and to avoid controversy. Serious topics and feelings are avoided. The major task functions also concern orientation. Members attempt to become oriented to the tasks as well as to one another. Discussion centers around defining the scope of the task, how to approach it, and similar concerns. To grow from this stage to the next, each member must relinquish the comfort of non-threatening topics and risk the possibility of conflict.

The next stage, which is called the transition stage, is characterized by competition and conflict in the personal-relations dimension an organization in the task-functions dimension. As the group members attempt to organize for the task, conflict inevitably results in their personal relations. Although conflicts may or may not surface as group issues, they do exist. Questions will arise about who is going to be responsible for what, what the rules are, what the reward system is, and what criteria for evaluation are. These reflect conflicts over leadership, structure, power, and authority. There may be wide swings in members’ behaviour based on emerging issues of competition and hostilities.

Because of the discomfort generated during this stage, some members may remain completely silent while others attempt to dominate. It is important to work through the conflict at this time and to establish clear goals. It is necessary for there to be discussion so everyone feels heard and can come to an agreement on the direction the group is to move in (Corey, 1995). In the working stage, interpersonal relations are characterized by cohesion. Group members are engaged in active acknowledgment of all members’ contributions, community building and maintenance, and solving of group issues.

Members are willing to change their preconceived ideas or opinions on the basis of facts presented by other members, and they actively ask questions of one another. When members begin to know-and identify with one another, the level of trust in their personal relations contributes to the development of group cohesion (Corey, 1995).

It is during this stage of development (assuming the group gets this far) that people begin to experience a sense of group belonging and a feeling of relief as a result of resolving interpersonal conflicts. The major task function of stage three is the data flow between group members: They share feelings and ideas, solicit and give feedback to one another, and explore actions related to the task. Creativity is high. If this stage of data flow and cohesion is attained by the group members, their interactions are characterized by openness and sharing of information on both a personal and task level.

They feel good about being part of an effective group. The major drawback of this stage is that members may begin to fear the inevitable future break-up of the group hence they may resist change of any sort. If group members are able to evolve to stage four, their capacity, range, and depth of personal relations expand to true interdependence. In this stage, people can work independently, in subgroups, or as a total unit with equal facility. Their roles and authorities dynamically adjust to the changing needs of the group and individuals.

Stage four is marked by interdependence in personal relations and problem solving in the realm of task functions. By now, the group should be most productive. Individual members have become self-assuring, and the need for group approval is past. Members are both highly task oriented and highly people oriented. There is unity: group identity is complete, group morale is high, and group loyalty is intense. The task function becomes genuine problem solving, leading toward optimal solutions and optimum group development. There is support for experimentation in solving problems and an emphasis on achievement.

The overall goal is productivity through problem solving and work. The final stage, consolidation, involves the termination of task behaviours and disengagement from relationships. A planned conclusion usually includes recognition for participation and achievement and an opportunity for members to say personal goodbyes (Corey, 1995). Concluding a group can create some apprehension – in effect, a minor crisis. The termination of the group is a regressive movement from giving up control to giving up inclusion in the group. The group will find that it can celebrate its accomplishments and that members will be learning new skills and sharing roles.

QUESTION 2In the initial stage of group development, the leader should be inclusive and empowering. He/she should make sure that everyone connected to the group is involved Corey, 1995). Inclusive leadership should be modelled and diverse members and talents should be sought out. Common purposes and targets of change should be identified and the environment should be one that fosters trust and builds commitment to the group. In the transitional stage, the leader should be ethical and open to other people’s ideas.

He/she should allow for differences of opinion to be discussed and conflict should be handled directly and civilly. Every attempt should be made to keep everyone focused on the purpose of the group and the topic of conflict (Corey, 1995). Personal attacks should be avoided and biases that may be blocking progress or preventing another member to be treated fairly should be examined. New members should feel welcomed, informed, and involved by stage three; the working stage. The leader should continue to clarify his/her expectations of individuals in the group and engage in collaboration and teamwork (Corey, 1995).

Finally, the in the consolidation stage, accomplishments should be celebrated and renewal in relationships should be sought. Members of the group should be encouraged and empowered to learn new skills and to share roles that keep things fresh and exciting (Corey, 1995). At this point, leadership is viewed as shared and cliques have hopefully dissolved.

QUESTION 3An increasingly important form of group therapy for addiction is based on the principles of cognitive therapy. Cognitive therapy addiction groups address understanding and changing cognitive processes about addiction (Liese et al., 2002). Cognitive processes include myriad mental activities, which interact with affective, environmental, physiological and developmental processes resulting in addictive behaviour.

The working of the cognitive model is reviewed in each group session by the group facilitator focusing on its relationship to the difficulties and addictive processes of members. Group facilitators take an active role in modeling or suggesting goals for members. Group members learn how maladaptive thinking leads to addiction; in cognitive therapy addiction groups, the focus is on helping members control their thought processes and addictive behaviours.

Helping members refrain from addictive behaviour and cope more effectively are the goals of cognitive therapy addiction groups. Group members are taught specific coping skills in areas such as affect regulation, the development of relationships and crisis management by carrying out homework assignments to achieve specific goals.

With assistance, members visualize the future and identify resources. It is suggested that members attend sessions at least weekly and are encouraged to attend even after extended periods of abstinence (Liese and Najavits, 1997). Members of cognitive therapy addiction groups vary in their readiness to change; therefore, a familiarity with the transtheoretical model of change (Prochaska and DiClemente, 1992) and the principles of motivational interviewing (Miller and Rollnick, 1991) is helpful.

A harm-reduction approach may be necessary on the road to achieving abstinence even though that may be the long-term goal of cognitive therapy addiction groups. Participants will meet with other members to plan his/her goals for the week. The clients are encouraged to take as much responsibility as they are able in determining their own goals. They will be given suggestions from their counsellor regarding what the team believes would be helpful goals for them. This will be their opportunity to discuss these goals with other participants and describe their feelings about them. The members may also use this time to negotiate and revise goals.

Each member will be asked to “check-in” about how they are doing, both positives and negatives. Also, any requests for changes in a treatment plan or schedule will be made during this meeting. The group will encourage participants to develop skills in helping each other in the therapy process (Corey, 1995). In a cognitive group therapy session, group members are encouraged to openly and honestly discuss the issues that brought them to therapy.

They try to help other group members by offering their own suggestions, insights, and empathy regarding their problems. There are no definite rules for group therapy, only that members participate to the best of their ability. However, most therapy groups do have some basic ground rules that are usually discussed during the first session. Clients are asked not to share what goes on in therapy sessions with anyone outside of the group. This protects the confidentiality of the other members.

They may also be asked not to see other group members socially outside of therapy because of the harmful effect it might have on the dynamics of the group. The counsellor’s main task is to guide the group in self-discovery. Depending on the goals of the group and the training and style of the counsellor, he/she may lead the group interaction or allow the group to take their own direction.

Typically, the group leader does some of both, providing direction when the group gets off track while letting them set their own agenda. The counsellor may guide the group by simply reinforcing the positive behaviours they engage in. For example, if a group member shows empathy to another member, or offers a constructive suggestion, the counsellor will point this out and explain the value of these actions to the group. In almost all group therapy situations, the counsellor will attempt to emphasize the common traits among group members so that members can gain a sense of group identity.

Group members realize that others share the same issues they do. The main benefit cognitive group therapy may have over individual psychotherapy is that some clients behave and react more like themselves in a group setting than they would one-on-one with a counsellor. The cognitive group therapy client gains a certain sense of identity and social acceptance from their membership in the group. Suddenly, they are not alone.

They are surrounded by others who have the same anxieties and emotional issues that they have. Seeing how others deal with these issues may give them new solutions to their problems. Feedback from group members also offers them a unique insight into their own behaviour, and the group provides a safe forum in which to practice new behaviours. Lastly, by helping others in the group work through their problems, group therapy members can gain more self-esteem. Group therapy may also simulate family experiences of clients and will allow family dynamic issues to emerge. BIBLIOGRAPHY

Corey, G. (1995). Theory and Practice of Group Counselling. Brooks/Cole. Liese, B., Navajits, L. (1997). Cognitive and Behavioural Therapies. Baltimore: Williams & Wilkins. Liese, B., Beck, A., Seaton, K. (2002). The Cognitive Therapy Addictions Group. New York: Haworth Medical Press. Miller, W., Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behaviour. New York: Guilford Press. Prochaska, J., DiClemente, C. (1992). Handbook of Therapy Integration. New York: BasicBooks.