Group Therapy: Stages and Process Group Therapy

Group Therapy: Stages and Process

Group therapy has become a popular method for treating a wide range of addictions, disorders, and grief processes. As Corey and Corey (1997) state: "Groups provide a natural laboratory that demonstrates to people that they are not alone and that there is hope for creating a different life" (p. 5) Other benefits of group therapy include information-sharing, a sense of belonging, catharsis, emotional support, progress through confrontation, and development of altruism and social skills (University of Illinois at Urbana Psychology Dept, 2010) There are many variations of group therapy, including multi-family, Adlerian, support, self-help, and counseling or psychotherapy (University of Illinois at Urbana Psychology Dept, 2010). Most therapeutic group programs involve 3 major stages: initial, transition, and working (Corey & Corey, 1997), or the 5 stage version: forming, storming, norming, performing, and terminating (University of Illinois at Urbana Psychology Dept, 2010).

In the initial stage of the 3 step process, group members get to know one another, and are apt to develop either an "in or out" feeling (Bandy, 2010). This possibility of developing feelings of alienation makes it critical for leaders to "maintain a basic posture of concern, acceptance, genuineness and empathy toward the group members" (Bandy, 2010, slide 5). Guidelines and normative behaviors are discussed, and group and individual goals are set (Brodsky, 1999). It's also important for group leaders at this stage to meet with each member individually to feel them out for any personality disorders or behaviors that may cause disruption and hinder group progress. This stage corresponds to the "forming" stage in the 5 step model, and is also known as the orientation and exploration phase (University of Illinois at Urbana Psychology Dept, 2010).

In the transition or storming stage, conflicts and tensions arise as members begin to test one another and work to define their place in the group. In addition, members "feel out" others for abilities, capabilities, and limits. Emotion may run high as feelings of "anxiety, defensiveness, and resistance are displayed" (Brodsky, 1999, p. 1). During this phase, tensions also play out as members begin to transition from a preoccupation with group acceptance and approval to concern with "dominance, control, and power" (Bandy, 2010, slide 12)

The next stage or stages are the norming and working/performing phases, when trust and bonding is established between group members as a result of the making it through the "storming" (University of Illinois at Urbana Psychology Dept, 2010). This trust allows the real therapeutic work to begin as members feel safe and secure enough to open up more fully (Brodsky, 1999). Group cohesiveness develops as members unite around a common goal and develop positive group spirit based on principles of "cooperation, mutual support, group integration, we-consciousness unity, support and freedom of communication as well as the establishment of intimacy and trust between peers" (Bandy, 2010, slide 17). In addition, the working/performing stage is the time for group members to "experiment with new ideas, behaviors or ways of thinking; and egalitarianism develops" (University of Illinois at Urbana Psychology Dept, 2010, p. 19). While members at this stage may have a "rosy glow" of high hopes and a strong sense of cohesion, progress cannot be made unless members remain open to expressing difficult feelings and honestly addressing the conflicts that will naturally arise (Bandy, 2010).

Finally, the group undergoes a termination stage to ease the process of separation. This stage only applies to time-limit groups, but members of open-ended groups will also have to deal with the loss of members. By this time, strong bonds and friendships have formed, so disbanding may be stressful. Group members are given time to gradually "close up" again; at the same time, counselors encourage a positive outlook based on progress already made and plans for future maintenance and improvement (University of Illinois at Urbana Psychology Dept, 2010). The termination stage involves reinforcement of lessons learned and progress made, guidance from the leader in terms of gaining "closure" in relationships, and help from leaders and other members in preparing for issues that may arise once treatment is over. In addition, proper leadership at this stage can facilitate the cementing of individual triumphs and an internalization of the entire process and experience. It is also critical that group members leave the process with a sense of accomplishment and optimism for the future (Brodsky, 1999); this can occur only after any unresolved or underlying conflicts are brought to the surface and dealt with.

The termination stage may also need to be considered from different angles, such as: was the time boundary sufficient? Do individuals feel free to express their ambivalence about leaving and feel empowered to leave on their own terms? How best to deal with the situation when the leader or therapist himself must make a premature departure? Researchers have found that the termination stage deserves more attention than it often receives (Sonstegard & al, 2004).

All the stages of group therapy are critical to the therapeutic process and somewhat mimic the stages of a friendship or partnership (Brodsky, 1999). Upon meeting, group members are ambivalent and excited at the same time about meeting new people. The new "friends" then deepen their relationship by working through conflicts, differences, and the accompanying tension as identities and boundaries are formed, and power struggles take place. Once this happens, a sense of trust and safety develops which allows the relationship to proceed to the deepest level of sharing and therapeutic catharsis; the new "friends" feel comfortable sharing their innermost feelings and experiences without fear of rejection. Also like a friendship, separation anxiety and grief are common emotions experienced when it's time to end the relationship or move on.

The Transition Stage -- How it Works