Behavioral Group Work

Description of the Strategy

Group therapy is a way of working with more than one client at a time in which all the members help one another to establish and achieve treatment goals. In behavioral group therapy (BGT), the major means of intervention are operant, problem solving, or cognitive, and the group is used as an additional tool to enhance effectiveness of these interventions to achieve treatment goals. In this entry, we focus on the benefits of the group and specifically how it is used in assessment, treatment, and generalization planning for adult clients. We also describe how these groups are organized.

Behavioral groups vary considerably. There are groups, not unlike individual therapy, that aim to improve social skills and coping with stress, reduce anxiety and depression, eliminate panic responses, reduce frequency of bulimic behavior, promote weight loss, resolve phobic disorders, ameliorate agoraphobia, manage chronic pain, improve general social functioning, increase abstention from risky sexual activity, and reduce frequency of drug and alcohol abuse. Most of these strategies are supported by empirical research. Groups range in size from 5 to 15 members, although for adults, the norm is 8. They range in duration from 6 to 20 sessions depending on complexity of the presenting problems. Most sessions last from 1½ to 2 hours. There are either one or two [Page 115]therapists. Most groups are closed and time limited. Using similar methods, therapists also organize closed groups in institutions.

Usually, clients in group therapy have shared individual goals in one or several of the above areas. The role of the group is to help members to formulate more specific subgoals and with the help of the therapist and group members to design interventions to achieve those goals.

There are many advantages to treatment in groups. First, because the clients are surrounded by other individuals who are dealing with similar issues, group membership commonly ends the sense of isolation experienced by many clients. The group provides the client with a source of feedback about behaviors that are irritating or acceptable to others and about cognitions that can be viewed as distorted or stress eliciting. We have noted that clients find reinforcement from other group members more powerful than from the group therapist alone. As clients increase frequency of reinforcing others, they note that they are reciprocally reinforced, and group cohesion increases. In groups, clients must learn to deal with the idiosyncrasies of other individuals. They must learn how to offer each other critical feedback and advice in a tactful and helpful manner, both of which are relationship-building skills.

Of course, groups are not without disadvantages. A relevant limitation to be concerned with is that it is more difficult to individualize each client in the group than in one-to-one therapy. Another threat to individualization is the fact that in order for everyone to have a chance to participate actively in every session, limits must be placed on clients who talk more than their share. Confidentiality is more difficult to maintain in groups than in the therapeutic dyad. Confidentiality and consequences of breaches need to be dealt with by the group therapist in pregroup screening and early in treatment.

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