group therapy for people with id/mi robert j. fletcher, dsw, acsw ceo, nadd (national association...
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Group Therapy for People with ID/MI
Robert J. Fletcher, DSW, ACSWCEO, NADD
(National Association for the Dually Diagnosed)
January 24, 2006Phoenix, Arizona
Dr. Fletcher, 2006
Consideration in Forming A Group
Homogeneous vs. Heterogeneous Open vs. Closed Time Limited vs. Ongoing Selecting Members Group Facilitator(s) Size of Group Selecting Members Confidentiality Issues
Dr. Fletcher, 2006
Homogeneous vs. Heterogeneous
Homogeneous Groups Members have similar problem(s) Mutual support based on common problem(s) Group cohesion can develop easily Membership derived from mutual problem(s)
Examples
Women’s Issues & ID Bi-Polar & ID
Substance Abuse & ID Grieving Adults
Adolescents & ID
Dr. Fletcher, 2006
Homogeneous vs. Heterogeneous
Heterogeneous Groups
Members have different problem(s)
Members are at different life stages
Add diversity
Adds depth to the group dynamics
Examples
Adults with ID and MI
Group with sheltered workshop members who
have ID
Dr. Fletcher, 2006
Open vs. Closed Groups
Open Groups Membership changes New members enter as others leave Micro sin of the way life really is New group dynamic with each change in membership
Closed Group Not open to new members Usually runs for a set period of time Provides miniscule of safety and security Promotes group cohesion
Dr. Fletcher, 2006
Time Limited vs. Ongoing
Time Limited Set number of session Clear course of beginning, middle and
termination stages Usually appropriate for homogeneous
Closed Group Not open to new members Usually runs for a set period of time Provides miniscule of safety and security Promotes group cohesion
Dr. Fletcher, 2006
Selecting Members
Homogeneous vs. heterogeneous Location and availability Readiness
Minimum level of interpersonal skills Motivation for treatment Basic ability to relate to and be influence by
others• Goals
– General group goal - Individual goal
• Interview potential group members
Dr. Fletcher, 2006
Group Facilitator(s)
• Facilitates InteractionsEncourages Interaction
• Active Leader• Establishes Ground Rules
• Accepting Individual• Warming, Caring
• Multiple Rules• Therapist Teacher Role Model
• Two Facilitators are the Ideal• One Male/One Female
Dr. Fletcher, 2006
Size of Group
How Large Should a Group Be?
Variables• Depends on Purpose of the Group
• Single Facilitator or two Facilitators
• Six to ten MembersSix for Single FacilitatorTen for ten facilitated group
Dr. Fletcher, 2006
Confidentiality Issues
• What a person reveals in group must not be disclosed outside the group
• Confidentiality must be a ground rule• Members can and should talk about themes/topics with significant others, but members must comply with:
• Preserve anonymity of members when referring to them
• Mask details of what was revealed by making them general rather than specific
• Share their own reaction to what was revealed, not what was already revealed
Dr. Fletcher, 1984
THERAPEUTIC EFFECTSOF
GROUP THERAPY
• HELPS DECREASE FEELINGS OF: INADEQUACY, ISOLATION AND DEFEAT
• PROMOTES PEER SUPPORT
• FOSTERS A SENSE OF SECURITY
• PROMOTES GROUP COHESIVENESS
• ESTABLISHES SENSE OF TRUST
Dr. Fletcher, 1984
THERAPEUTIC EFFECTSOF
GROUP THERAPY
• FOSTERS MEANINGFUL RELATIONSHIPS
• INCREASES RELATIONSHIP SKILLS
• PROMOTES PROBLEM SOLVING SKILLS
• ENABLES LEARNING THROUGH OBSERVATION
Tomasulo, 1998
Typical Model Interactive Model
Blatner, 1973
Group TherapyAction Method Techniques
Founder: Dr. J. Moreno (psychiatrist)
Technique: Psychodrama (Moreno, 1921)
“refers to an enactment involving
problem-solving in terms of one
person’s conflict.”
The drama (problem-solving) may shift among the many facets of one’s life –
Past, present, and future
Blatner, 1973
Group TherapyAction Method Techniques
I. The Protagonist and Double
II. Technique used to explore a problem presented by a group member
I. Protagonist
Person who expresses problem in group
- Interpersonal conflict
- Intrapsychjc conflict
Blatner, 1973
Group TherapyAction Method Techniques
2. Double (alter ego or auxiliary ego)
Person who reflects the feelings/experiences of the protagonist
- Expresses the feelings
of the protagonist
- Approximates the emotional state of
protagonist
Blatner - 1973, Tomasulo - 1998
Group TherapyAction Method Techniques
Five Therapeutic Purposes of the Double:
1. Provides emotional support
2. Gives emotional expression
3. Reorganizes perceptions
4. Promotes empathy
5. Sets the stage for entharsis
Opportunity for change is enhanced if the protagonist feels supported and understood as expressed by the double
Tomasulo, 1998
Group TherapyAction Method Techniques
Choosing the Double:
A. Facilitator can choose
B. Protagonist can choose
C. Group member can volunteer
D. Facilitator can be double
E. Protagonist can double
Razza and Tomasulo, 2005
Group TherapyAction Method Techniques
Processes and Techniques Used in Doubling
•Restarting (to demonstrate understanding of protagonist)
•Speaking the unspoken (to express what protagonist feels but cannot say)
•Exaggerating (to assert loudly what protagonist presents timidly)
•Amplifying (to highlight key parts of protagonist’s statements)
Razza and Tomasulo, 2005
Group TherapyAction Method Techniques
Processes and Techniques Used in Doubling (continued)
•Verbalizing the resistance (to clarify impediments to therapeutic change)
•Clarifying conflict (to voice competing emotions or ambivalence)
•Introducing alternatives (to voice ways to reframe protagonist’s perception of self or situation)
Note: The member doubling checks accuracy of each doubled statement with protagonist; protagonist may repeat key statements.
Tomasulo, 1998
Group TherapyAction Method Techniques
Role of Facilitator
1. Facilitate group interaction
2. Facilitates interaction between protagonist
- asking the double how protagonist feels
- checking with protagonist on expressions from the double
3. Facilitator may need to role model both roles
4. Suggest that “I” statement be used
- I feel ……
Tomasulo, 1998
THE INTERACTIVE BEHAVIORAL MODEL OF GROUP
THERPAY (IBT)
STAGE 1: ORIENTATION
STAGE 2: WARM-UP
STAGE 3: ENANCTMENT
STAGE 4: AFFIRMATION
Tomasulo, 1998
THE INTERACTIVE BEHAVIORAL MODEL OF
GROUP THERPAY (IBT)
STAGE 1
ORIENTATION AND COGNITIVE NETWORKING
OBJECTIVEFACILITATE GROUP INTERACTION
TECHNIQUESPHYSICAL WARM-UP
DISCUSS THEIR MORNINGHAVING MEMBERS REPEAT WHAT WAS SAID
Tomasulo, 1998
THE INTERACTIVE BEHAVIORAL MODEL OF GROUP
THERPAY (IBT)
STAGE 2
WARM-UP FOR ENACTMENT AND SHARING
OBJECTIVEPROMOTE GROUP PROCESS
TECHNIQUESSELF DISCLOSURE AND TAKING TURNS
BRINGING GROUP TOGETHER (GROUPNESS)
MEMBERS ASKING OTHERS TO SPEAK
Tomasulo, 1998
THE INTERACTIVE BEHAVIORAL MODEL OF GROUP
THERPAY (IBT)
STAGE 3ENACTMENT
OBJECTIVEPROBLEM SOLVING AND GROUP INTERACTION
TECHNIQUESACT OF POSSIBLE ROLE PLAYED BY ANOTHER GROUP MEMBER AS HE/SHE GIVES VOICE TO
THE FEELINGS AND THOULGHTS OF ANOTHEREMPY CHAIR
ROLE REVERSAL
Tomasulo, 1998
THE INTERACTIVE BEHAVIORAL MODEL OF GROUP
THERPAY (IBT)
STAGE 4AFFIRMATION
OBJECTIVEVALIDATION OF PARTICIPATION
TECHNIQUESREINFORCEMENT THERAPEUTIC INTERACTIONS
MEMBER ACKNOWLEDGEMENT OF PARTICIPATIONDECOMPRESS FROM GROUP EXPERIENCE AND
SIGNAL CLOSURE OF GROUP SESSION
2006
FOR MORE INFORMATION CONTACT
Dr. Robert J. FletcherNADD (The National Association for the Dually
Diagnosed)132 Fair Street, Kingston, NY 12401Telephone 845 331-4336E-mail rfletcher@thenadd.org
Thank you!
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