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Week 4: Personality Disorders
Lecture 7: Group therapy
Learning goals
To compare and distinguish between group training vs. group therapy
To identify key components of group therapy including:
o The 12 therapeutic principles as identified by Yalom
o Stages of group development
o Process variables that predict outcome
o Group member variables that predict outcome
o Pro/Cons of homogeneous vs heterogeneous groups
To reflect on the effectiveness of group therapy
To apply knowledge of group therapy to clinical examples
Warming up exercise
I will give you two minutes to consider how you would describe yourself to those who are now present (e.g.
What is the top 3 of your schemas on the YSQ)
What do you feel about sharing this in the chat in Zoom. Keep this in mind when you are giving group
therapy!
Research on group therapy
There is so much which we do not know yet!
What is the best therapy treatment for PD?
Is there one therapy treatment for all PD?
Is a superior therapy for every individual superior?
Is group therapy better than individual therapy or the other way around or a combination?
Is outdoor treatment better than day treatment or clinical treatment?
E.g. is group therapy more effective than individual therapy? A study suggests that combined group therapy
and individual therapy with very severe (e.g. self-damaging behavior, very impulsive) PDs is more effective.
Also discussion about outpatient versus inpatient treatment, but we don’t know yet what works best for
whom. Very important that the whole team is participating during an inpatient treatment.
Advice for starting with a group: don’t do this for PDs after just getting your degree. PDs are very difficult to
treat, especially in a group for an inexperienced therapist.
Starting a group
Start with the following questions:
o Are you going to give a group training or a group psychotherapy
o Are you going to give a long-term or short-term group therapy
o Are you going to work with a particular PD or with heterogeneity? The lecturer prefers to work with
patients with different PDs, because it is a better representation of society. Also, people with the
same PDs tend to cluster with each other in groups and reinforcing their behavior, thoughts, etc.
o Are you going to work in day treatment or clinic (how do you relate to the complete treatment
program and other professionals)?
o Are you going to record sessions or not? You can use this if a patient missed a session. It can also
be a mirror for patients who feel isolated or paranoid about what really happened. Did something
really happen or did you think it happened?
o What will you do with patients missing sessions?
Best is to do groups for PD with a co-therapist
Make sure both of you have seen the patient together (preferable) before the first group session
Explain the group model (see also ST-leaflet)
Explain the different stages and non-specific helpful behaviour in group therapy in simple wording
Explain the group rules (see also ST-leaflet)
Are you willing to show your own human being to your co-therapist and the group when appropriate?
Make sure both therapists have 30 minutes time off before and after the group
Realize that when you start as a couple patient drop out will be likely harder. Also patients with PDs are more
likely to drop out. The lecturer starts with groups of 8-10 people.
Realize that group therapy with PD’s is a challenge. An interesting journey
Repeat group rules at beginning of session 1
, 2
Do one or two exercises which are related to getting to know each other and have a careful bit of sharing
already
Give compliments for sharing and say this is important for the group process.
Summarize what connects all group members with each other despite that there are also differences (but do
not focus YET on that).
Ask questions like:
o Who has noticed some similarities in the group?
o Who has recognized something?
o Who also find it difficult to….?
o How is it for all of you to be together in this group?
What would be interesting ideas to let members get to know each other?
Voorbeelden: speeddaten, steek je hand op als…., twee waarheden en een leugen, het opnoemen van
overeenkomsten en je voorstellen aan de hand van je sleutels.
Differences between group therapy and training
In a training group:
o Focus is on training a skill (emotion regulation, assertiveness, problem solving skills)
o Trainers are “teachers”; theory and practice
o Trainers are more active
o Everybody gets an opportunity to say and do something; trainers make sure of that
o No intervention on interactions in the group as long as group climate is safe
In a group therapy:
o The group is used as a therapy vehicle
o The group is a mini society where personality problems become visible and can be worked with
o Focus on limited refamilying and reparenting
o Therapists are guiding the process
From start-mid phase
In the beginning of a group therapy you have to promote recognition and sharing
In the beginning: building a feeling of being a member of the group is important
In the beginning therapists are more active
In the beginning therapists show how to share your emotions and thoughts, ask questions and empathically
confront each other
First 3-5 sessions highest drop out
In the beginning: patients are wondering if they belong in the group
In the beginning: is this group a safe place?
In the beginning: patients are longing for individual contact (in the group)
In the beginning: patients are looking for what are the group norms and values
In the mid-phase
o The group norms and values are more or less settled
o The group climate is more or less stable
o In a good functioning group there is a balance between sharing emotions and thoughts and
empathic confrontation between group members
o Therapists are less active
Co-therapists
Working with two therapists (co-therapist) in group therapy with PD is a must
Meet each other for half an hour before and after group
Share your emotions and thoughts with each other (work and private life)
Do you dare to openly discuss in the group session
What do you need from each other?
Working together for first time means higher drop out
If one therapist focusses on an individual the other focusses on the group
Be aware that the two of you are “parents” to the group
Be aware of competition between the two of you
Final stages of group therapy
Old habits die hard!
Week 4: Personality Disorders
Lecture 7: Group therapy
Learning goals
To compare and distinguish between group training vs. group therapy
To identify key components of group therapy including:
o The 12 therapeutic principles as identified by Yalom
o Stages of group development
o Process variables that predict outcome
o Group member variables that predict outcome
o Pro/Cons of homogeneous vs heterogeneous groups
To reflect on the effectiveness of group therapy
To apply knowledge of group therapy to clinical examples
Warming up exercise
I will give you two minutes to consider how you would describe yourself to those who are now present (e.g.
What is the top 3 of your schemas on the YSQ)
What do you feel about sharing this in the chat in Zoom. Keep this in mind when you are giving group
therapy!
Research on group therapy
There is so much which we do not know yet!
What is the best therapy treatment for PD?
Is there one therapy treatment for all PD?
Is a superior therapy for every individual superior?
Is group therapy better than individual therapy or the other way around or a combination?
Is outdoor treatment better than day treatment or clinical treatment?
E.g. is group therapy more effective than individual therapy? A study suggests that combined group therapy
and individual therapy with very severe (e.g. self-damaging behavior, very impulsive) PDs is more effective.
Also discussion about outpatient versus inpatient treatment, but we don’t know yet what works best for
whom. Very important that the whole team is participating during an inpatient treatment.
Advice for starting with a group: don’t do this for PDs after just getting your degree. PDs are very difficult to
treat, especially in a group for an inexperienced therapist.
Starting a group
Start with the following questions:
o Are you going to give a group training or a group psychotherapy
o Are you going to give a long-term or short-term group therapy
o Are you going to work with a particular PD or with heterogeneity? The lecturer prefers to work with
patients with different PDs, because it is a better representation of society. Also, people with the
same PDs tend to cluster with each other in groups and reinforcing their behavior, thoughts, etc.
o Are you going to work in day treatment or clinic (how do you relate to the complete treatment
program and other professionals)?
o Are you going to record sessions or not? You can use this if a patient missed a session. It can also
be a mirror for patients who feel isolated or paranoid about what really happened. Did something
really happen or did you think it happened?
o What will you do with patients missing sessions?
Best is to do groups for PD with a co-therapist
Make sure both of you have seen the patient together (preferable) before the first group session
Explain the group model (see also ST-leaflet)
Explain the different stages and non-specific helpful behaviour in group therapy in simple wording
Explain the group rules (see also ST-leaflet)
Are you willing to show your own human being to your co-therapist and the group when appropriate?
Make sure both therapists have 30 minutes time off before and after the group
Realize that when you start as a couple patient drop out will be likely harder. Also patients with PDs are more
likely to drop out. The lecturer starts with groups of 8-10 people.
Realize that group therapy with PD’s is a challenge. An interesting journey
Repeat group rules at beginning of session 1
, 2
Do one or two exercises which are related to getting to know each other and have a careful bit of sharing
already
Give compliments for sharing and say this is important for the group process.
Summarize what connects all group members with each other despite that there are also differences (but do
not focus YET on that).
Ask questions like:
o Who has noticed some similarities in the group?
o Who has recognized something?
o Who also find it difficult to….?
o How is it for all of you to be together in this group?
What would be interesting ideas to let members get to know each other?
Voorbeelden: speeddaten, steek je hand op als…., twee waarheden en een leugen, het opnoemen van
overeenkomsten en je voorstellen aan de hand van je sleutels.
Differences between group therapy and training
In a training group:
o Focus is on training a skill (emotion regulation, assertiveness, problem solving skills)
o Trainers are “teachers”; theory and practice
o Trainers are more active
o Everybody gets an opportunity to say and do something; trainers make sure of that
o No intervention on interactions in the group as long as group climate is safe
In a group therapy:
o The group is used as a therapy vehicle
o The group is a mini society where personality problems become visible and can be worked with
o Focus on limited refamilying and reparenting
o Therapists are guiding the process
From start-mid phase
In the beginning of a group therapy you have to promote recognition and sharing
In the beginning: building a feeling of being a member of the group is important
In the beginning therapists are more active
In the beginning therapists show how to share your emotions and thoughts, ask questions and empathically
confront each other
First 3-5 sessions highest drop out
In the beginning: patients are wondering if they belong in the group
In the beginning: is this group a safe place?
In the beginning: patients are longing for individual contact (in the group)
In the beginning: patients are looking for what are the group norms and values
In the mid-phase
o The group norms and values are more or less settled
o The group climate is more or less stable
o In a good functioning group there is a balance between sharing emotions and thoughts and
empathic confrontation between group members
o Therapists are less active
Co-therapists
Working with two therapists (co-therapist) in group therapy with PD is a must
Meet each other for half an hour before and after group
Share your emotions and thoughts with each other (work and private life)
Do you dare to openly discuss in the group session
What do you need from each other?
Working together for first time means higher drop out
If one therapist focusses on an individual the other focusses on the group
Be aware that the two of you are “parents” to the group
Be aware of competition between the two of you
Final stages of group therapy
Old habits die hard!
