Reboo Code

Tuesday, July 14, 2009

Group Therapy Process by Tony Astro


Many studies confirm that optimism or positive anticipation are therapeutic and results to positive outcomes. When a client sees a group member who is a fellow alcoholic and has not drink for months and has better his life, client associates himself to his fellow group mate instilling hope. The inspiration provided to participants by their peers results in substantial improvements in medical outcomes, reduces health care costs, promotes the individual’s sense of self-efficacy, and often makes group interventions superior to individual therapies (Fawzy, Fawzy and Wheeler, 1996).


Kindness or willingness to help gives a sense of satisfaction in many normal individuals. The gratification of being part of a team and sharing the ability to help or giving out aid based on experience like prior drug addiction and what helps is satisfying to the client.

In a group setting there are many opportunities for the client with similar experience to share each other similar experiences and with pride gives information to fellow, for instance, one who has the same drug dependence / addiction with someone who was going through or has gone through. Being called selfish because of not sharing your experience is not healthy for an individual and this kind of self-sacrifice of being transparent helps in a group setting.

Group therapy is unique in being the only therapy that offers clients the opportunity to be of benefit to others (Yalom, 2005). It also encourages role versatility, requiring clients to shift between roles of help receivers and help providers (Holmes and Kivlighan, 2000).


Everyone needs a connection with someone at any point of life. During military deployment, many Sailors suffer from some type of stress because of lack of interaction with others, particularly with family and even fellow personnel due to highly stress environment. The feeling of isolation does not help a client if there is a need arise.
The theory of interpersonal relationships has become so much an integral part of the fabric of psychiatric thought that needs no further underscoring; people need people – for initial and continued survival, for socialization, for the pursuit of satisfaction (Yalom, 2005).

On a group therapy, there is 100% opportunity to interact with someone no matter what personality or issues of the client. A diverse group or a set of people with the same background or issues will set the tone of how the group will get along and interpersonal relationship will play a big role in having a successful group therapy.


If there is lack of confidence in a group and especially with the leader, the interaction and dynamics to get a therapy will not be successful. In order to be a thriving group, 3 out of the 15 Therapeutic Forces should be present:

1. Clarity of purpose for the leader and the members.
2. The leader’s attitude.
3. Level of trust among members.


Without a comprehensible goal and rationale of why the group exists – there will be no direction and majority of the 15 Therapeutic Forces will not be possible. For instance, a leader might say the group is educational but spend most of the time doing therapy, or the leader might say the group is for support but spend the majority of the time focusing on one person or on one topic that is not relevant for most of the members (Jacobs, Masson & Harvill, 2008).

There should be a clear objective and presented to the group members or clients step by step until it is comprehended.


The leader who facilitates the group has direct key to the success of the group because he or she has the capacity to implement any or all of the 15 therapeutic forces that may influence the outcome of the therapy. No matter how small or big the group or how long the session is or even how high the level of trust among the members are – the leader has the full control of the group.
If the group contains hostile, nonvoluntary members, the leader should try to find a way to get theses members involved; however, if the members are completely resistant and negative, the leader may need to remove them from the group (Jacobs, Masson & Harvill, 2008).


Once trust is lost, there is no looking back. There is always at the back of a person's mind that the issues or something else may not be resolve because an expectation or confidence was no longer there and leader has to resolve this fast.

Problems of trust often occur when members have very different points of view and if the group consists of members who do not like each other, the leader can try to change this by bringing it up in the group or by meeting with some members privately to see if their differences can be resolved (Jacobs, Masson & Harvill, 2008).

Each Factor theory from Yalom and 15 Forces from Jacob, Masson and Harvill has an important key to all group therapy and can be be applied on a case by case and the importance of one does not mean that one factor is not important.


Holmes, S. & Kivlighan, D. (2000). Comparison of Therapeutic Factors in group and Individual Treatment Processes,” Journal of Counseling Psychology: pages 447-48.

Jacobs, E., Masson, R. L., & Harvill, R. L. (2008). Group Counseling: Strategies and Skills. New York: Brooks Cole.

Yalom, I. D. & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy. New York: Basic Books.

Tuesday, July 7, 2009


Psychodynamic Approach is to tap into unconscious feelings that are causing the difficulty or disorder of the patient. It is a protracted and responsibility of the therapist to undertake analysis about 4 times a week in a long time. The importance of easing the pain and focus on current situation is the goal of the counselor for the patient.

Adlerian Approach, unlike Psychodynamic Approach has a social component that involves our family including birth order where the theory is the oldest children tend to be power seeking and organized and youngest may become dependent on others. The Adlerian theory is a cognitive, goal oriented process that is interested in a person’s beliefs and perceptions, as well as the effects that person’s behavior has on others (Capuzzi, 2003).

Both approaches seek to further the development of personality and express the impulses. Psychodynamic help the patient to become more fully aware of his inner conflict through his subconscious and history while Adlerian is into development of the superiority of a person from inferiority complex.

It is vital that counselors must define the abnormal behavior and then present a description of the most common disorders through psychopathology. According to Hobson, there are new lines of evidence to suggest that psychodynamic approaches, including those of Freud and Klein that hypothesize mental representations of internal figures who are experienced in different ways, may have importance for understanding personality disorder (Hobson. 2000). Engaging in self-diagnosis without the view of psychopathology or using resources like Diagnostic and Statistical Manual (DSM) may not detect the actual cause and effect of patient’s abnormalities.

In order to recognize a patient’s problem’s the counselor must understand the dynamics and culture of his or her family. Depending on personality disorder, community and school, as a unit must be factored in. According to Irvin Yalom (1995), therapeutic experience is divided into eleven factors as follows:
1. Instillation of hope
2. Universality
3. Imparting information
4. Altruism
5. Corrective recapitulation of the primary family group
6. Development of socializing techniques
7. Imitative behavior
8. Interpersonal learning
9. Group cohesiveness
10. Catharsis
11. Existential factors

Every group of the individual patient has some information that will bring light to the therapy. Group therapy can also aid other participants through offering of words of comfort with the same situation.

Capuzzi, D. & Gross, D.R. (2003). Counseling and Psychotherapy: Theories and Inerventions (3rd Ed.). Upper Saddle River, NJ: Prentice Hall.

Hobson, P (2000). Psychodynamics and developmental psychopathology, Psychiatry, Volume 4, Issue 5, Pages 21-24. Retrieved on January 18, 2009 from

Yalom, I (1995). Theory and practice of group psychotherapy, (4th ed.). New York: Basic Books

Monday, July 6, 2009


Counselors should be aware of the difference in counseling on every stage level of clients but the main and common need is empathizing with them. Perhaps the most important distinction between the child and the adult clients is that children with difficulties rarely seek help themselves. Rather, they are typically referred for help by concerned others, usually the child’s family or teachers (Elliott, 1998).

Both child and adolescent need specific directions during counseling and if a child has difficulty or rarely seeking help themselves, adolescents has challenge on its own. Adolescence is a time of physiological, cognitive and psychological changes and adolescents need time to understand and integrate all the enormous changes taking place in the period between childhood and adulthood (Bor, 2002).

So, the key is how we communicate and pattern the language towards the level or current stage of our client. For instance, we communicate playfully with a child but doing this with an adolescent maybe affront to a teen client.

Counselors reflect the content of a client’s communications in order to convey an understanding of material explicitly expressed. With adult clients, this translates into reflecting the verbal message communicated. Because children’s content may be expressed in actions or play, the counselor working with children must add behavioral tracking to his or her repertoire (van Velsor, 2004).


For instance, Romeo (16 years old, Asian-American with Filipino accent) and Jules (4 years old, Hindu with dark skin complexion) are both suffering from mild depression due to divorce of their parents and racial discrimination or being outcast by their peers due to their obvious ethnic difference. As counselor, we convey our condolences to them more descriptively yet sensitively to Jules. We acknowledge and impart the same message both on empathetic tone and attentive yet more ingenuous and trusting with Jules either through story or maybe one of Jules favorite toy or animation. In case of Romeo, using a Lego toy may not be effective but treating Romeo as an adult maybe more appropriate.

Counselors can enhance their skill with children by adapting their use of microskills. Useful changes include the addition of behavioral tracking to counselor skill repertoires
and attention to the feelings communicated through the characters in children’s play (van Velsor, 2004, p 217).


Romeo and Jules perhaps are suffering from low self-esteem and they need to be recognized. The divorce maybe the main reason for their counseling but underlying their pain is their suffering from ethnic confusion. As counselors, culture should always be part of every session. A clear, strong sense of ethnic identity is often associated with high levels of self-esteem and psychological functioning. Our task as therapists is to be vigilant for the signs of distress influenced by struggles with racism and ethnic identity. Giving these sometimes silent struggles a voice in adolescent therapy when they are evident to us and, to a large extent, to the adolescent initiates an inquiry that can be instructive and emancipative (Zayas, 2001)


Bor, R. (2002). Counseling in Schools. London, GBR: Sage Publications Ltd, p 22. Retrieved January 8, 2009, from

Elliott, J. (1998). Children in Difficulty : A Guide to Understanding and Helping.
Florence, KY, USA: Routledge, 1998. p 10. Retrieved January 8, 2009, from

Luis H Zayas (2001). Incorporating struggles with racism and ethnic identity in therapy with adolescents. Clinical Social Work Journal, 29(4), 361-373. Retrieved January 8, 2009, from ProQuest Psychology Journals database. (Document ID: 95852058).

van Velsor, P. (2004). Revisiting Basic Counseling Skills With Children. Journal of Counseling & Development, 82(3), 313-318. Retrieved January 8, 2009, from Academic Search Premier database.

Why it is important to consider the individual, family, community, cultural, school, and societal factors when counseling children and adolescents.


The individuality, family, community, cultural background, school and other societal factors must be deliberated when counseling children and adolescent. Social ecology provides a framework for viewing difficult issues involving individual and family adjustment to societal change, including adjustments faced by individuals who have developmental disabilities and their families (Berry, 1995).


Bronfenbrenner’s theory is levels of environment that has effect on a child’s growth. There are five the levels or structure of environments:

1. Microsystem - Consisting of the child’s most immediate environment (physically, socially and psychologically), this core entity stands as the child’s venue for initially learning about the world (Swick and Williams, 2006). The child’s family has foremost influence on his development from his birth towards nurturing of their parents and siblings where they build their most trust. They way how his parents nurtured the child through their parent’s belief and culture have effect on child’s development.

2. Exosystems are the contexts we experience vicariously and yet they have a direct impact on us. They can be empowering (as a high quality child-care program is for the entire family) or they can be degrading (as excessive stress at work is on the total family ecology) (Swick and Williams, 2006). These are factors outside of child’s family and yet they are surrounded and influence indirectly with (work environment of parents) or without social interaction (child care). A child who has a janitor as his father’s (or parent's) job has a different influence with another child who has a Chief Executive Officer father (or parent)

3. Macrosystem - The larger systems of cultural beliefs, societal values, political trends, and ‘‘community happenings’’ act as a powerful source of energy in our lives. The macrosystems we live in influence what, how, when and where we carry out our relations (Bronfenbrenner, 2005). The society (media, country’s culture, education and neighborhood) brings out how a child perceive himself and how he can relate to all his surroundings and in the long run connect with the norms of a certain social order (populace).

4. Mesosytems connects any of these levels such as when a family member joins a certain religious group and eventually affecting the child’s environment. For instance, a child is affected by what his church or religious Sunday school teacher tells him to believe or do.

5. Chronosystems is the long-standing evolution on a combination of all these structure of environment and their family history. A good example of these is the unexpected death in a family.


Counselors should understand the situations and environment when counseling children and adolescents sequentially to relate with them and eventually find the proper and necessary treatment. A child with a microsystem of good and religious upbringing at the early age of five who lives in a small populated area in a state of Nebraska and move to an environment with macrosystem of foreign speakers (in a case of a military family moving overseas) will have a chronosystems of different expectations and finally reach his teen years (age 15) dwelling in a populated area of Tokyo with a neighborhood of local gangs (or peer pressures) in Japan.

The child’s development will be different from someone who is his neighbor with the same religious and family background in Nebraska the whole entire time (15 years).

The counselor must communicate and established an understanding to view the child’s transition or 5 levels of structure of environment as a factor and relate to each level and be aware then empathize with the child or adolescent’s history.


Berry, J. (1995, March). Families and Deinstitutionalization: An Application of
Bronfenbrenner's Social Ecology Model. Journal of Counseling & Development, 73(4), 379-383. Retrieved January 5, 2009, from SocINDEX with Full Text database.

Bronfenbrenner, U. (1974). Developmental Research, Public Policy, and the Ecology of Childhood. Child Development, pp. 1,5. Retrieved January 5, 2009, doi:10.1111/1467-8624.ep12265367

Bronfenbrenner, U. (2005). Making human beings human: Bioecological Perspectives on human development. Thousand Oaks, CA: Sage.

Swick, K., & Williams, R. (2006, April). An Analysis of Bronfenbrenner’s Bio-Ecological Perspective for Early Childhood Educators: Implications for Working with Families Experiencing Stress. Early Childhood Education Journal, 33(5), 371-378. Retrieved January 5, 2009, doi:10.1007/s10643-006-0078-y