UTPA Department of Social Work

1
UTPADepartment of Social Work

• Social Work License Exam Preparation Workshop
• April 19, 24 26, 2008

2

• Group Therapy and Family Couple Theory
  Therapy
• April 26, 2008
• 830am 1015am
• Alonzo Cavazos, Ed.D., LCSW, LPC
• (presentation adapted from Middleton Mather,
  2000
• www.licenseprep.com

3
Group therapy

• Definition of group work
• Goal-directed activity with small treatment and
  task groups aimed at meeting socioemotional needs
  and accomplishing tasks. This activity is
  directed to individual members of a group and to
  the group as a whole within a system of service
  delivery Roseland Rivas, 2005.

4
Conceptual Categories for Groups

• 1. Three models of social group work
• social goals model (citizen education groups
• remedial model (therapy groups)
• reciprocal model (mutual aid groups)
• (Whitaker, J. K., 1980)
• 2. Task vs. treatment groups

5
Social Goals Model

• Purpose To raise social consciousness, social
  responsibility, informed citizenry, and to inform
  political and social action.
• Used in settlement houses and neighborhood
  centers
• Group worker as role model/enabler

6
Remedial Model

• Purpose To restore/rehabilitate individuals
  exhibiting dysfunctional behavior
• Group worker is change agent therapy involves
  assessment and interventions to assist group
  members to achieve treatment goals.
• Used in clinical outpatient/inpatient settings.

7
Reciprocal Model

• Purpose To provide mutual aid to group members
  in achieving optimum adaptation, socialization
• Group worker functions as mediator between
  members, groups, and society to assist all
  concerned in getting their needs met.
• Can be used in clinical inpatient/outpatient
  settings and in neighborhood, community centers.

8
Task vs. treatment groups

• Task groups
• Goal to accomplish a specific task
• General Characteristics
• The standard for success is the accomplishment
  of specific task(s)
• Communication focuses on the task at hand
• Low self-disclosure
• Important that members have the requisite
  interest, knowledge base, and skills to achieve
  the purpose of the group.

9
Treatment groups

• Goal to increase the ability of members to meet
  their socioemotional needs
• General Characteristics
• open communication is encouraged among members
• the roles of group members naturally evolve
• high disclosure, particularly for long-term
  groups
• confidentiality expected
• success is defined as the achievement of
  individual and group goals.

10
Group Composition caveats

• In general, homogeneous (similar) groups tend to
  gel faster, become more cohesive, offer more
  immediate support to group members, have better
  attendance and less conflict, and provide more
  symptomatic relief they can however, remain
  superficial and are less effective for altering
  character structure.
• Group therapy is not indicated for children
  younger than 8.

11
Group Composition caveats(continued)

• In general, inclusion of both genders in groups
  for children is not recommended some adolescents
  can handle mixed groups mixed groups have the
  most lasting effect for adults.
• Glaver and Gavin maintain that a group that is
  too homogeneous, in terms of undesirable
  characteristics (deviant behavior), will
  reinforce these behaviors.
• Group size for treatment groups (7 -10)

12
Open vs. closed groups

• Closed groups are most effective for short-term,
  task-oriented therapy, and for groups conducted
  in inpatient settings.
• Open groups offer members fresh input and allow
  them to benefit from the success of graduates but
  can often impede the development of trust,
  acceptance, and cohesiveness.

13
Group Stages

• Prescreening (ensure best fit for group)
• First stage (orientation, norming, search for
  meaning, dependency)
• Second stage conflict dominance (storming)
• Third stage development of cohesion
• Forth stage working stage (performing)
• Fifth stage disengagement/termination

14
Types of Treatment Groups

• Support group (e.g. single fathers)
• Educational group (group to educate adolescents
  at AIDS)
• Growth Group (marriage enrichment group)
• Therapy Group (group for adults molested as
  children)
• Socialization Group

15
Therapeutic Factors (Irvin D. Yalom)

• Instillation of Hope
• Universality (We are in the same boat)
• Imparting of information
• Altruism (unselfishness)
• The Corrective Recapitulation of the Primary
  Family Group
• Socialization Skills

16
Therapeutic Factors (Yalom)

• Imitative Behavior
• Interpersonal Learning
• Group Cohesiveness
• Catharsis (open expression of strong emotional
  feelings)
• Existential factors
• Recognizing that life is at times unfair.
• Recognizing no escape from pain, suffering
  death
• Can get close, but still have to face life alone.
• Having ultimate responsibilities for ones life.

17
Test Question

• Yalom believes that the use of individual therapy
  with group therapy
• Brings about changes sooner
• Works together for more significant change
• Is not effective
• Can be effective if the therapist is the same for
  both

18
Test Answer

• Yalom believes that the use of individual therapy
  with group therapy
• Brings about changes sooner
• Works together for more significant change
• Is not effective
• Can be effective if the therapist is the same for
  both
• Other theorists believe differently if the
  therapist is same for both.

19
Test Question

• As a social worker in a child abuse center, you
  create a group for abusive parents. During the
  first session, one of the parents becomes angry
  and starts to argue with another parent. You
  should handle this situation by
• Asking the parent to explain what caused her
  anger
• Having the parents work through the disagreement
  in an appropriate manner
• Insisting the parent stop arguing
• Allowing the parent to vent her anger

20
Test Answer

• b -- Having the parents work through the
  disagreement in an appropriate manner.
• Rationale What created the anger is not nearly
  as important as learning to resolve conflicts in
  appropriate ways.

21
Test Question

• A teenage drug abuse group becomes hostile, and
  the social worker fears that violence will break
  out. It is important for the social worker to
  first
• Try to de-escalate the group
• Ask the two most difficult members to leave
• Call for help
• End the group

22
Test Answer

• a -- try to de-escalate the group
• Rationale This question asks what the social
  worker should do first. If the fails, then the
  worker may have to terminate the group or call
  for help.

23
Test Question

• There are many different types of groups that
  social workers lead. The type of group most
  associated with self-improvement and
  opportunities to expand self-awareness is
• The therapeutic group
• The socialization group
• The growth group
• The recreational group

24
Test Answer

• There are many different types of groups that
  social workers lead. The type of group most
  associated with self-improvement and
  opportunities to expand self-awareness is
• The therapeutic group
• The socialization group
• The growth group
• The recreational group

25
Test Question

• While holding a first session of a group for
  newly divorced clients, a woman begins discussing
  her anger with men in general. One man in the
  group begins to appear uncomfortable, while
  another starts to argue with the woman. What is
  the most likely reason for the mens responses?
• Transference
• Interpersonal conflict
• Projection
• Complimentary Ego-states

26
Test Answer

• Transference

27
Test Question

• A member of the group comes in late. The leader
  confronts her for coming in late. The group
  argues with the leader for confronting the
  member. This is an example of
• Scapegoating
• Cohesion
• Resistance
• Universality

28
Test Answer

• b - cohesion

29
Family Therapy Key Points

• Focuses on the whole system of individuals,
  interpersonal patterns, communication patterns
• Seeks to clarify roles and reciprocal obligations
  and encourage more adaptable behaviors among the
  family members
• Variations in techniques practiced by proponents
  of different family therapy orientations.

30
Family Therapy Models

• Family Systems theory (Murray Bowen)
• Communications/Experiential Family Therapy
  (Mental Research Institute)
• Virginia Satir
• Structural Family Theory (Salvadore Minuchin)
• Strategic Family Therapy (Jay Haley)
• Milan Systemic Therapy (Mara Selvini Palazzoli)

31
Family Systems theory (Murray Bowen)

• The goal of therapy - differentiation of self
  for all family members.
• Therapy often involves work with one family
  member, the premise being that when one member
  changes, the other will follow.
• Each member is helped to take responsibility for
  his/her own role in the problem (s).
• Communication is directed to the therapist.
• Reduction of anxiety is critical for success

32
Bowenian Theory

• interlocking concepts
• differentiation of self
• undifferentiated family ego mass (fused
  identities)
• triangles
• nuclear family emotional processes (emotional
  forces)
• emotional cutoff (severing ties with parents)
• sibling position
• family projection process (next slide)
• multigenerational transmission process

33
Bowenian Theory

• family projection process the process through
  which parents transmit their lack of
  differentiation unto their offspring.
• multigenerational transmission process has
  reference to the transmission, through the
  generations, of the familys emotional process.

34
Test question

• A family therapist who deals with separation from
  family of origin is generally using
• Bowen
• Jackson
• Satir
• Milan

35
Test Question

• During the initial family therapy session, the
  parents of a17-year-old boy complain about the
  activities he engages in without their
  permission. These activities include failing to
  maintain curfew hours, engaging in smoking and
  drinking, and telling his parents to stuff it.
  The parents are concerned about this behavior,
  and the father keeps referring to his own such
  thoughtlessness at the same age when his father
  was angry with him. The family therapist would
  describe this as
• Delinquent behaviors
• Scapegoating
• Family of origin issues
• Potential signs of deviant behaviors

36
Test Answer

• c - Family of origin issues
• The father appears to be responding to his sons
  behavior from the context of his own experience
  as a child in his parents home.

37
Test Question

• If you utilize Bowens brand of therapy, it would
  be important to
• Discuss transference
• Coach clients
• Give directives
• Teach the power of touch

38
Test Answer

• b coach clients (which is major component of
  Bowens work)

39
Communications/Experiential Family Therapy

• Theorists Gregory Bateson, Don Jackson, Virginia
  Satir, Jay Haley.
• Primary purpose of symptoms is the maintenance of
  homeostasis in the family.
• Pathological families are seen as being stuck in
  strong dysfunctional communication patterns and
  who view any change as a threat to the integrity
  of the system.
• Goal of therapy alter the interactional patterns
  that the maintain the presenting symptoms.

40
Communications/Experiential Family Therapy

• 2 levels of communication (report content
  (manifest) command level (latent)
• For example Have dinner ready by 6pm.
• Command level metacommunication or a covert
  message (I am the boss)
• 2 types of relationships
• Symmetrical egalitarian
• Complementary relationships that involve a fit
  between different roles

41
Communications/Experiential Family Therapy

• Principle of equifinality same results in
  therapy can be obtained via different means.
• Circular model of causality behaviors of
  different subsystems reciprocally impact each
  other.
• Dysfunctional communication (some examples)
• Blaming, mind reading, incomplete sentences,
• disqualification of the communication of another
  member, and over generaliziang

42
Test Question

• All of the following are circular models of
  causality except
• Blaming and criticizing
• Mind reading
• Over generalizing
• Scapegoating

43
Test Answer

• d scapegoating
• This is an information question that uses
• except one of the following

44
Test Question

• During a family therapy session, the teenage
  daughter begins accusing her mother of being
  abusive and of neglecting her needs. The mother
  responds very passively and does not defend
  herself, while the father attempts to take
  control of the session. The social worker needs
  to examine the family situation for
• Sexual abuse
• Individuation issues
• Triangulation
• Substance abuse

45
Test Answer

• a sexual abuse
• In situation involving incestuous sexual abuse,
  fathers are often highly controlling and the
  mothers are often passive.

46
Virginia Satir

• Satir assisted each family member to become as
  whole as possible through deliberate efforts to
  build self-esteem/self-worth and through the
  correction of dysfunctional communication
  patterns.

47
Virginia Satir (continued)

• Five Styles (poses) of Communication
• Placater agrees, apologizes, tries to please
• Blamer accuses, criticizes, and dominates
• Super-reasonable calm, cool, emotionally
  detached
• Irrelevant seeks to distract
• Congruent communicator sends clear, straight
  messages, is genuine

48
Test Question

• During a session with a family of 2 parents 5
  kids, the youngest child spends a lot to time
  trying to get the mothers attention. The mother
  tends to get distracted when the therapist asks
  her questions about her relationship with her
  husband. Which role is the youngest playing?
• Scapegoat
• Distractor
• Support
• Surrogate Partner

49
Structural Family Theory (Salvadore Minuchin)

• Theory premise all families have an underlying
  organization (structure), which may be adaptive
  or maladaptive.
• Important concepts (some examples)
• subsystems
• alignments (coalitions between subsystems)
• power hierarchies (distribution of power)
• interpersonal boundaries
• Disengagement
• Enmeshment

50
Structural Family Theory

• Treatment techniques
• Joining therapists entrance into the familys
  interactional system by 1) forming strong bonds,
  2) acknowledging the various perspectives, 3)
  accommodating the familys organization and
  patterns.
• Enactment
• Reframing redefining the familys perspective
  on the problem

51
Scenario

• During a family session, the husband begins to
  criticize the wife over her reluctance to
  exercise with him during the morning as she used
  to do. The youngest son begins to move his chair
  closer to the mother as this exchange occurs. You
  comment on the sons movement of the chair
  between the husband and wife and explain how the
  chair is like a fence.

52
Test Question

• Structural family therapy is most likely the type
  of a family therapy being used because
• Structure was the focus of the intervention
• It is the most empirically tested of the family
  therapies
• The therapist shares his observations with the
  family
• The therapist doesnt confront the husband about
  his criticism

53
Test Answer

• Structural family therapy is most likely the type
  of a family therapy being used because
• Structure was the focus of the intervention
• The therapist focuses on interpersonal boundaries
  and alignments.

54
Test Question

• Your fist step in dealing with the issue raised
  in the above scenario would be to
• Explain the structural emphasis
• Provide a directive
• Place the son in another chair
• Discuss the metaphor with the parents

55
Test Answer

• c - place the son in another chair

56
Test Question

• The childs reaction may also reflect on the ___
  of the family.
• Rules
• Subsystems
• Individuation
• Secrets

57
Test Answer

• b subsystems ( mother/son, husband/wife, or
  father/son)

58
Test Question

• A structural family therapists initial action is
  to
• Diagnose the family
• Direct the family
• Join with the family
• Interpret the family issues

59
Test Question

• Structural family therapy is
• Effective with all ethnic groups
• Based on the work of Minuchin
• Not effective with African Americans
• Based on the work of Haley

60
Strategic Family Therapy (Jay Haley)

• Emphasis change techniques over theory.
• Distinguishing Characteristics
• Rapid change
• Uses resistance of family members in the service
  of change
• Communication is seen as defining relationships
  (every relationship involves a struggle for power
  as to who defines the relationship).
• Symptoms are tactics to control
• Finding alternative ways of defining
  relationships.

61
Strategic Family Therapy

• Techniques
• therapist takes charge role
• directives (therapist tells family members
  precisely what tasks she/he wants them to
  perform.
• Paradoxical directives (for example
  prescribing symptoms asking members to resist
  certain things.
• Ordeals (making the clients symptoms too much
  trouble for the client to continuing having
  them)
• Restraining (warning the family about changes)
• Reframing (offering more favorable explanation)

62
Milan Systemic Therapy (Mara Selvini Palazzoli)

• Is a form of strategic therapy which focuses on
  the struggle for power and the protective role of
  symptoms.
• Techniques
• Hypothesizing about the presenting problem
  (pre-session)
• Neutrality (avoidance of allying with family
  members
• Rituals engaging family members in repetitious
  behavior designed to counter dysfunctional family
  rules

63
Milan Systemic Therapy (continued)

• Paradoxical prescription/directive prescribing
  the problem behavior
• Positive connotation (reframing)
• Circular questions (members are asked q questions
  that assist them to think in relational terms and
  that help them to try to understand the
  perspectives of other members).

64
Milan Systemic Therapy (continued)

• Therapy Stages
• Pre-session (formulate hypothesis(es)
• Session (modify hypothesis based on information
  gained in the interview)
• Intersession (decided on the intervention)
• Intervention (implement the intervention)
• Post-session (discuss familys response and plan
  for next session)

65
Definitions

• Open system family accepts information from
  external systems. Closed system the opposite
• Homeostasis the balanced state systems seek to
  maintain.
• Negative feedback loop input that maintains the
  status quo of a system.
• Positive feedback loop input that forces a
  system to change.
• Multifinality the same beginning point may lead
  to different results.
• Equifinality different beginning points may
  lead to the result.

66
Test Question

• A technique to describe family structure and
  relationships is
• Genogram
• Sculpting
• Fishbowl
• Psychodrama

67
Test Answer

• A technique to describe family structure and
  relationships is
• Genogram
• Sculpting
• Fishbowl
• Psychodrama

68
Test Question

• Healthy family boundaries are
• rigid
• cohesive
• semi-permeable
• normal

69
Test Question

• Healthy family boundaries are
• rigid
• cohesive
• semi-permeable
• normal

70
Test Question

• Family therapy is contraindicated when
• Family members are grossly deceitful and
  destructive to one another.
• There is evidence of consistent violation of
  generational boundaries.
• Family myths and secrets appear to be the
  family style.
• The identified client is resistant and
  unmotivated.

71
Test Answer

• Family therapy is contraindicated when
• Family members are grossly deceitful and
  destructive to one another.
• There is evidence of consistent violation of
  generational boundaries.
• Family myths and secrets appear to be the
  family style.
• The identified client is resistant and
  unmotivated.