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Chapter: Essentials of Psychiatry: Group Psychotherapy

Group Psychotherapy: Group Development

The basic science informing group treatment is group develop-ment and dynamics.

Group Development and Group Dynamics


The basic science informing group treatment is group develop-ment and dynamics. Understanding of these concepts provides a foundation for the therapist’s integration of individual, interper-sonal and intrapsychic dynamics with those of group member-ship (Table 67.1).



Group Development


The seminal work of Bennis and Shepard (1956) produced a spate of studies demonstrating that groups have a natural developmen-tal sequence. Groups must accomplish certain tasks as they move from a collection of individuals to a functioning and working or-ganization. In this discussion, the focus is on developmental se-quences in groups conducted along psychodynamic principles


Initial (Engagement, Orientation) Phase


Individuals entering a psychotherapy group are faced with two ma-jor tasks: they have to decide how they will use the treatment to accomplish their goals and simultaneously they have to determine the limits of emotional safety. Members turn to the therapist in hope of gaining information on how to proceed. They anticipate that the leader, a person they already know and who fulfills a traditional role, will provide guidance and smooth the way in getting to know the strangers in the room. In the main, these “dependency” strivings are frustrated. Members tentatively reveal themselves to others. Gradu-ally, unwritten and primarily unconscious rules (norms) develop, which help contain anxiety and set standards for acceptable behav-ior. Therapists help shape behavior by providing information on how to proceed and by clarifying (interpreting) underlying anxieties. Common themes and concerns may be highlighted, which serve to diminish members’ sense of isolation and enhance cohesion.


Reactive (Power, Differentiation) Phase


Many groups move into this phase by rebelliously rejecting their leader. This may be followed by a relatively short-lived sense of well-being and harmony. However, norms are often experienced as restrictive and members may begin to feel as though they are controlled by the group (group tyranny). In response, they assert individuality and demonstrate their own power. Struggles be-tween members emerge, and angry exchanges are not uncommon. Usual norms against expression of intense intragroup affects are tested and modified in accordance with members’ personal ca-pacities. Some members may threaten to quit, or they remain si-lent during this phase as they grapple with their ability to tolerate conflict. The therapist assists in helping members understand and tolerate responses to intense feelings and differences.


Mature (Working) Phase


In this phase, groups have developed considerable cohesion. Members can tolerate differences and they can contain anxi-ety and allow conflicts to emerge without having to interrupt exchanges. They have learned to provide and receive feedback from others without undue defensiveness. A considerable por-tion of the group transactions is focused on the here and now, and exchanges are appreciated as containing both reactions to the present and vestiges from prior relationships (transferences). Members attempt to understand one another at both surface and in-depth levels. The therapist no longer is the sole expert, and members are valued for their emotional and cognitive unique-ness. Therapists continue to help patients understand their in-group reactions and assist in broadening their perspectives to include the sources (genetic) of their feelings and their manifesta-tions in their outside world.


Termination Phase


Ending treatment is the final stage. It is filled with mixed feelings: those of success and looking to the future and those surrounding separations (Schermer and Klein, 1996). Often there is a regres-sion as anxieties over departing are addressed. This provides an additional opportunity to explore the problems that emerge. Members respond with pleasure at seeing someone “graduate”, but they also experience loss of a valued contributor to the work and envy over a colleague’s achievement. A successful termina-tion also offers hope for those who remain. The therapist monitors the dynamic forces and enables members to say their farewells within a context of therapeutic accomplishments and continuing psychological work. In the process, remaining members experi-ence and integrate their responses to the departure.




Groups do not uniformly traverse these developmental phases, and they undergo shifts to earlier stages under stress, such as vacations or change in membership. A considerable amount of therapeutic work takes place at each developmental level. For in-stance, a group of individuals experiencing problems with basic trust may spend a good deal of time in an initial stage, where these feelings may be explored. Patients who need to address competitive feelings may alternate between the reactive and the working phases. Understanding group development provides a framework for therapists to appreciate the forces that have an im-pact on members’ feelings and behavior.


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