International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Group Therapy Graduate Seminar: A Developmental Perspective Shulamit Geller Ph.D. & Eran Shadach Ph.D. To cite this article: Shulamit Geller Ph.D. & Eran Shadach Ph.D. (2015) Group Therapy Graduate Seminar: A Developmental Perspective, International Journal of Group Psychotherapy, 65:3, 431-444 To link to this article: http://dx.doi.org/10.1521/ijgp.2015.65.3.431
Published online: 24 Aug 2015.
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Article views: 27
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Date: 25 March 2017, At: 15:41
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 65 (3) 2015 GELLER AND SHADACH GROUP THERAPY GRADUATE SEMINAR
Group Therapy Graduate Seminar: A Developmental Perspective SHULAMIT GELLER, PH.D. ERAN SHADACH, PH.D.
ABSTRACT Teaching group therapy is an essential aspect of graduate studies within the helping professions. Existing models discuss four basic elements required for such training: experience, observation, supervised practice, and theory. The present paper offers a model for a group therapy seminar based on these four elements and organized along developmental concepts. Clinical observations of 120 psychology students who participated in the seminar were gathered over a five-year period. Teaching techniques included supervised observation, fishbowl, one-way mirror, and a final paper integrating theory and practice. The seminar enabled students to practice and to theorize about group processes, both as participants and as co-leaders. Seminar outcomes and conclusions are discussed. INTRODUCTION
Although training in group psychotherapy within the helping
professions is an important aspect of graduate studies, its prevalence is limited, as training continues to rely mainly on individual therapy (Ward & Crosby, 2010). Literature on existing group therapy training programs (Stone, 2010) reveals unique and shared Shulamit Geller and Eran Shadach are affiliated with School of Behavioral Sciences at the Academic College of Tel-Aviv-Yaffo in Israel.
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features related to four basic elements: experience, observation, supervised practice, and theory (e.g., Feiner, 1998; Kobos, 2010; Nathan & Poulsen, 2004). The yearly seminar described here implements these four elements within a structured seminar format that enables an integration of personal experience with theoretical conceptualizations (Middleman & Goldberg, 1972). As time is an integral and crucial factor in every group process, and even more so in time-limited groups, developmental theories are an essential component in the training of group psychotherapy (Brabender & Fallon, 2009). Accordingly, the present seminar was designed to train graduate students to think and understand group processes along developmental phases. In short, at the outset of its life, the group is in a “forming” or “engagement” stage, followed by the second stage characterized by “counter-dependency and flight” or a “storming.” The third stage is characterized by “norming” and “intimacy,” while the fourth stage moves on to “performing,” “differentiation,” and “work.” The final stage concerns the issue of termination, whether of individual members or of the group as a whole (American Group Psychotherapy Association [AGPA], 2013; Bakali, Wilberg, Klungsøyr, & Lorentzen, 2013). Methodological Considerations
The current paper is based on clinical observations by the leaders during a five-year period (2007–2012; n = 120) and is formulated and presented as an outline for a group therapy training seminar. FIRST SEMESTER: METHOD
Students’ primary task was to experience and understand the role of a participant in a group (Khaleelee, 2006; Kobos, 2010; Wheelan, Davidson, & Tilin, 2003). Participants
Twenty-four second-year graduate students from the medical, clinical, and rehabilitation psychology programs participated in the seminar every year. Upon commencing the seminar, students had already completed introductory and advanced courses in in-
GROUP THERAPY GRADUATE SEMINAR 433
dividual psychodynamic psychotherapy and had practiced supervised psychotherapy for about six months. Procedure
At the first meeting and after a short introduction, students were divided into two equal groups of 12 students each: a working group (WG) and an observing group (OG) (Kobos, 2010). Group composition was balanced for gender and for program affiliation to achieve maximal in-group heterogeneity (Foulkes & Anthony, 1957/1984). The semester consisted of 14 weekly sessions and each WG was co-led by the seminar lecturers for 7 sessions. Each WG session lasted 60 minutes, applying the fishbowl paradigm (Kane, 1995), while the OG (the remaining 12-student group) was instructed to be attentive to the processes and dynamics of the WG in order to reflect on these aspects after the session (Stiers, 2010). At the conclusion of each session, all participants convened for 30 minutes of supervised discussion (SD), the role of which was to deal with three elements: the experiences and reflections of the observers, those of the WG participants, and the seminar lecturers’ comments and theoretical conceptualizations. After the first seven sessions ended, the WG and OG switched roles, and seminar lecturers conducted the “new” WG for another seven sessions. At the end of the semester, students were required to submit a term paper in which they reported their experience as participants and analyzed the experience conceptually, using relevant theoretical approaches. A short description reflecting the composite experience of the developmental sequence and processes follows. Working Group Overview: Sessions 1–7
Stage 1 (Sessions 1–3). Orientation and dependency themes were raised as participants testified to past experiences in previous groups and repeatedly appealed to the seminar lecturers for concrete and pacifying instructions. Comments of WG members on being observed by the OG may have reflected the group members’ anxiety, as well as their effort to establish the group’s external boundaries (MacKenzie, 1997; Yalom & Leszcz, 2005).
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Stage 2 (Sessions 4–6). Dependence/counter-dependence conflicts were among the most common themes in these sessions (Bennis & Shepard, 1956). Inter-group competition (MacKenzie, 1997), individual struggles to secure a place in the group, and displays of anger towards one another were evident. Termination (Sessions 6–7). In these sessions, the approaching threat of group termination evoked the insecurity of WG members concerning their “birthright,” and fear of losing their “special child” status. Participants addressed these emotions by referring to the group’s progress and to the envy it triggered in the OG. Interpersonally, the group addressed the upcoming end through use of more direct interactions to achieve better closure and to validate their self-concepts (Bennis & Shepard, 1956). Dependency on the seminar lecturers was apparent, its prominence underlining the relatively early developmental stage of the group and the effect of the forced termination. Supervised Discussion Overview
Stage 1 (Sessions 1–3). During the SD, while the WG was occupied with the difficulties of reflecting on the ongoing themes that had emerged in the session, the OG, as outsiders who were instructed to focus on an intellectual task, maintained an illusion of being protected and immune from emotional conflict. However, OG members expressed strong emotions towards the WG in the form of exaggerated sympathy and admiration, or criticism and intrusiveness. These expressions may be understood in various ways: for example, in this particular session, we, the leaders, referred to them as manifestations of rivalry and hidden envy of the WG’s “first child” status. Stage 2 (Sessions 4–6). The growing maturity of the OG was reflected in its enhanced ability to express feelings such as envy and competitiveness toward WG members, and by the increased use of metaphoric and symbolic language. Termination (Sessions 6–7). Due to the forced termination, participants in the SD become more focused on issues related to the upcoming role switch. While OG members expressed their anxiety and their desire to become members of the WG, members of the WG continued with its typical termination themes.
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Interestingly, despite the differences in task and in structure, our impression was that both the WG and the SD followed a similar developmental arc of progress. This may further support the general consensus that groups develop across time (Wheelan et al., 2003). Sessions 8–14. (These sessions are commented on briefly.) Although the new WG needed to work through major developmental themes, members were usually able to express an advanced and open attitude toward the group leaders and their peers. This pattern may be understood as a “shortcut” through the dependency phase that a group typically goes through, but also as an outcome of the genuine developmental progress achieved vicariously during the observation process (Kobos, 2010). The new OG was compelled to adjust to its new observation task and to cope with the loss of its “birthright” (Kreeger, 1992). SECOND SEMESTER: METHOD
Students’ primary task was to experience the role of a group therapist, using twelve task-centered themes that corresponded to the five stages of group development described above. Participants
The participants were the same 24 students as in the first semester. Procedure
The students were divided into two new equal groups of 12 students each: an observing group (OG) and a working group (WG). The WG was comprised of 6 conducting pairs. Each pair was to lead a 60-minute session according to a task-centered theme while OG members were seated behind a one-way mirror (Walker, Alphonse, & Cohen, 1985) accompanied by the seminar lecturers. At the conclusion of each session, all students convened for supervised discussion (SD) to conceptualize and theoretically understand the co-leaders’ work. The discussion typically began with the co-leaders sharing their experiences, followed by com-
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ments and reflections offered by the other students. After the first six sessions, the WG and OG switched roles. The first and final sessions of this semester were conducted by the seminar leaders to address a number of specific subjects. The first meeting was intended to (a) expose students to the experience of being observed and of observing group work behind a one-way mirror and (b) teach students the basic principles of group leading in general, and co-leading in particular, that is, preparing the sessions in advance, content-process differentiation, and working with the here and now (Rutan & Stone, 2001; Yalom & Leszcz, 2005). The purpose of the final session of this semester was to allow students to share their experiences and to allow lecturers to assess students’ progress and satisfaction with the seminar. Upon seminar termination, students were required to submit a paper in which they described their experience as group leaders and their understanding of group processes, using relevant theory. THEMES
The next section introduces the themes’ description following the developmental rationale (e.g., AGPA, 2013; Wheelan et al., 2003). The first three themes—first encounters, parenthood, and authority— correspond to the first stage, and highlight group topics typical of this stage, that is, a group climate of dependency in which members seek the leaders’ guidance in order to identify group norms and boundaries.
First Encounters. This refers to the exploration of group identity, rules, norms, and trust. As the group was led by a pair of novice peer leaders, the issue of whether the leaders could be trusted became salient. Dependency issues were implicitly addressed, either by noting the absence of the seminar lecturers or by expressing relief at their absence. The fact that group members were soon destined to be leaders themselves further enhanced the need to establish norms of conduct between the current and
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the to-be leaders. Finally, the approaching task of leading evoked issues related to personal qualifications and value. Parenthood. Explicit exploration of dependency and of early relations with parental authority figures is the focus of this theme. Members discussed aspects of real parental relations, sharing their own experiences as parents and memories of losing a parent. The interpretations directed attention to the here and now, reflecting the fact that at this stage the co-leaders are the prominent figures towards whom dependency is directed. Authority. This theme encouraged participants to recall past experiences with various authority figures (e.g., teachers and tutors) and enabled them to broaden their understanding of issues of power and control (Bennis & Shepard, 1956). Additionally, this theme stimulated the challenging of the co-leaders’ authority and thus preceded the upcoming second stage of development in which individual needs and preferences come to the fore (Bakali et al., 2013). The next four themes correspond to the second stage, in which aspects of counter-dependency and interpersonal emotional engagement regarding the safety of the group are challenged. Themes like self-esteem, aggression, separation, and competition widen the exploration of exchanges with authority to the peer relations realm (AGPA, 2013; MacKenzie, 1997). Self-esteem. Individual needs and preferences both with regard to authority and to peers characterize this theme. The investigation of commonalities and differences in the group may raise shameful feelings about the self (Wheelan et al., 2003) and therefore may challenge one’s own sense of value. Working with this theme has often involved the need to assert one’s self-value, for example, by competing over who offered the “best understanding” or the “best interpretation.” Aggression. Disagreement among members (Wheelan, 2009) and confrontations with the leaders (AGPA 2013) are both expressed through aggression and are an inevitable part of expressing one’s individuality. Although both direct and indirect aggression towards one another and towards the co-leaders are typical of this stage, in our experience, indirect expressions such as stories of past experiences outside the group, or in the form
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of ignoring one another’s contribution in the group, were more prominent. Separation. Working according to this theme enables individual self-exploration, and it facilitates self-definition and differentiation within group members and between the group and the leader (MacKenzie, 1997). As this session also concluded the work of the first WG (mid-term), narratives concerning the concrete separation came to the fore, and the group became conscious of its shared identity. Competition. This theme invites further exploration of interpersonal differences that usually raises anxiety about the safety of the group (AGPA, 2013). However, as this was the first session of the new WG which typically calls for in-group harmony, the group had to address two developmentally distinct tasks. A possible way of addressing this complexity was to compete with the former group (i.e., stating the present WG’s advantage over it), thus reducing in-group rivalry and enhancing sense of membership. The next four themes—conflicts, intimacy, sibling relations, and leadership—correspond to the third stage of group development. At this stage, a higher degree of consensus is usually achieved concerning the group’s tasks, as well as improved cohesion and openness (AGPA, 2013). Conflicts. Although widely considered an achievement of the second stage, some writers have reported high levels of conflict during later stages as well (e.g., Brossart, Patton, & Wood, 1998). Participants are encouraged to explore and experience contradicting needs and motivations within themselves and between each other. Conflicts in the here and now, such as whether to engage openly with the group or to remain safely in the background, were commonly dealt with by members in an academic manner rather than by actual engagement. Intimacy. As the focus in this stage tends to shift towards greater introspection and personal challenge (MacKenzie, 1997), participants are encouraged to explore meanings, needs, and fears relating to interpersonal functioning. In our experience, this theme was addressed rather openly and emotionally. It is, however, uncertain whether this was the result of a real developmen-
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tal achievement or of the members’ wish to shorten the process needed to accomplish trust and intimacy. The following two themes reflect the increasing productivity and effectiveness characterizing the group during its fourth stage of development (Wheelan, 2009). Sibling Relations. This theme invites members to share and compare relationships with siblings in an open and explicit manner. The intimacy within the group is deepened and expanded, as interactions are experienced in more mature and productive ways, allowing expressions of individual differences and a more open exchange of feedback (AGPA, 2013) Leadership. This theme expresses another advanced link in a presumed circle of development, beginning with dependency, growing to peer relationship, and finally becoming an authority for others. Therefore, it calls for an exploration of the leader’s role. Participants approached this issue in various ways, for example, discussing the disadvantages of leadership, attempting to identify group members with the appropriate leadership valence, and referring to each other’s leadership qualities. The fifth or final stage concerns the issue of termination, whether of individual members or the group as a whole (AGPA, 2013). Endings and Farewells. This final theme is intended to facilitate seminar termination and to promote participants’ exploration of their separation experiences. The narratives that emerged in this session were typical of a termination phase: evaluation of the accomplished work, exchange of personal impressions of self and other, and relief or mourning due to the group’s termination. DISCUSSION
This brief report proposes an outline for an introductory group therapy seminar with a developmental rationale. The discussion begins with course assessment, followed by theoretical and methodological considerations, specific model characteristics, and finally, research limitations. Students’ written assessments showed the seminar to be effective, as it revealed average scores of 6.06 for theoretical contribu-
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tion and 6.41 for general seminar evaluation, on a Likert scale ranging from 1 (low appreciation) to 7 (high appreciation) (see also Nathan & Poulsen, 2004). These findings were further supported by students’ verbal reports on the progress they made in their knowledge and skills, both as participants and as group leaders (see also Sunderji, Malat, & Leszcz, 2013). In conclusion, students evaluated the seminar as effective in training group therapists and therefore as a relevant component of a graduate program. From a theoretical aspect, organizing the seminar along a developmental rationale helped the students experience and conceptualize group developmental stages, and later on enabled them to implement that knowledge as group co-leaders (Ettin, Vaughan, & Fiedler, 1987). In both semesters, we used the SD in order to explain the developmental phases of the group to the students. In addition, during the second semester, the taskcentered themes enabled the co-leaders to use the developmental perspective while practicing group therapy (Ettin et al., 1987). Moreover, in our experience, the themes have also assisted the observers in following the process. Toward termination, even though it was clear that the full developmental sequence had not been completed, we noticed that progress was made: conflicts and avoidance behaviors declined (Bakali et al., 2013; Wheelan et al., 2003), cohesion and relatedness between members tended to increase (MacKenzie, 1997), and the use of symbolic language and metaphors became more prevalent (Berman & Weinberg, 2000). The SD facilitated participants’ learning experience in both semesters, as it encouraged an observing-like mode, allowing participants and observers to re-evaluate emotions and thoughts addressed during the preceding sessions (Stiers, 2010). In regard to the next two elements, that is, the fishbowl and the one-way mirror, the present paper supports existing literature indicating that both provide useful learning experience (Hensley, 2002; Knight et al., 2010). In our experience, the fishbowl is better suited to the first half of the seminar as it facilitates the lecturers’ control over the learning process and promotes shared learning experience. The one-way mirror technique is recommended in the second half, as it modifies group boundaries (Hobbs,
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1988) and fosters support and trust within each group (Walker, Alphonse, & Cohen, 1985), thus enabling the more mature and independent group to work effectively. Finally, as suggested by Yalom & Leszcz (2005), the present experience affirms the idea that practicing co-leading technique enables mutual support for seminar lecturers and for novice leaders alike and improves leaders’ abilities to attend to the group needs (Kivlighan & Miles, 2012). Being primarily an academic seminar, it emphasizes the multiple role relations among the seminar participants and lecturers. Lecturers’ academic evaluative role, and the fact that they often teach some of the participants in other courses, may impede group members’ willingness to be open and trusting (Kobos, 2010). Our experience supports the existence of possible confusion, both for students and lecturers, in matters such as how to understand and to respond to students’ requests inside and outside the sessions (e.g., asking for further reading materials or discussing grades in other courses). However, such multiplicity should not prevent trust development and group cohesiveness as long as the lecturers are careful to respond to participants in accordance with academic rules (e.g., referring the student to the requested readings) while properly addressing the dynamic framework (e.g., interpreting it in the group as a transference manifestation; Hopper, 2007). In this regard, the fact that seminar grades are based solely on the final paper submitted three months after the seminar terminated effectively separated the lecturers’ roles of group leading and of academic evaluation. The most notable limitation of the present outline is the challenge of providing adequate coverage of essential group knowledge and skills in a one-year academic seminar. Moreover, as the present work is based on observations that are subjective in nature, the analysis is susceptible to confirmation biases based on the authors’ pre-existing theoretical and clinical orientations. It is also possible that students’ feedback was biased in such a positive manner (Hensley, 2002). The authors have several suggestions for faculty members who wish to implement such a course in their curriculum. Trainees’ emotional safety may be attended to by putting emphasis on the
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educational rather than the therapeutic aspects of the experience (Kobos, 2010). If possible, didactic teaching of group leading theory within another course is advised (Sunderji et al., 2013). Further research is needed to evaluate, validate, and ensure the quality of this training seminar, as well as to provide educators in the helping professions with means to tailor this type of framework to the requirements of a specific program. REFERENCES American Group Psychotherapy Association (AGPA). (2013). Practice guidelines for group psychotherapy. Retrieved from http://www. agpa.org/guidelines/groupdevelopment.html. Bakali, J. V., Wilberg, T., Klungsרyr, O., & Lorentzen, S. (2013). Development of group climate in short- and long-term psychodynamic group psychotherapy. International Journal of Group Psychotherapy, 63, 366-393. Bennis, W., & Shepard, H. (1956). A theory of group development. Human Relations, 9, 415-437. Berman, A., & Weinberg, H. (1998). The advanced stage in therapy group. International Journal of Group Psychotherapy, 48, 499-518. Brabender, V., & Fallon, A. (2009). Group development in practice: Guidance for clinicians and researchers on stages and dynamics of change. Washington, DC: American Psychological Association. Brossart, D. F., Patton, M. J., & Wood, P. K. (1998). Assessing group process: An illustration using Tuckerized growth curves. Group Dynamics, 2, 3-17. Ettin, M. F., Vaughan, E., & Fiedler, N. (1987). Managing group process in nonprocess groups: Working with the theme-centered psychoeducational group. Group, 11, 177-192. Feiner, S. E. (1998). Course design: An integration of didactic and experiential approaches to graduate training of group therapy. International Journal of Group Psychotherapy, 48, 439-460. Foulkes, S. H., & Anthony, E. J. (1984). Group psychotherapy. London: Marsfield Library (Original work published 1957). Hensley, L.G. (2002). Teaching group process and leadership: The twoway fishbowl model. Journal for Specialists in Group Work, 27, 273286. Hobbs, M. (1988). From behind the scenes: The psychodynamic implications for an analytic psychotherapy group of being observed through a one-way screen. Group Analysis, 21, 235-248.
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Hopper, E. (2007). Theoretical and conceptual notes concerning transference and countertransference processes in groups and by groups, and the social unconscious: Part II. Group Analysis, 40, 29-42. Kane, C. (1995). Fishbowl training in group process. Journal for Specialists in Group Work, 20, 183-188. Khaleelee, O. (2006). Learning from experience and the experience of learning in group relations conferences. In L. D. Brunner, A. Nutkevitch, & M. Sher (Eds.), Group relations conferences (pp. 17-29). London: Karnac. Kivlighan, D. M., & Miles, J. R. (2012). Are two heads better than one? The relationship between number of group leaders and group members, and group climate and group member benefit from therapy. Group Dynamics: Theory, Research, and Practice, 16, 1-13. Knight, E. B., Barth, P. A., Fink, A. H., Cunningham T. J., Vaughn, C. A., & White, R. E. (2010). Baylor College of Medicine group psychotherapy training. Group, 34, 301-308. Kobos, J. (2010). A laboratory learning approach to teaching group psychotherapy. Group, 34, 293-300. Kreeger, L. (1992). Envy preemption in small and large groups. Group Analysis, 25, 391-412. MacKenzie, K. R. (1997). Clinical application of group development ideas. Group Dynamics: Theory, Research, and Practice, 14, 275-287. Middleman, R. R., & Goldberg, G. (1972). The concept of structure in experiential learning. In J. W. Pfeiffer & J. E. Jones (Eds.), The 1972 annual handbook for group facilitators (pp. 1-10). San Diego, CA: Pfeiffer. Nathan, V., & Poulsen, S. (2004). Group-analytic training groups for psychology students: A qualitative study. Group Analysis, 37, 163-177. Rutan, J. S., & Stone, W. N. (2001). Psychodynamic group psychotherapy (3rd ed.). New York: Guilford. Stiers, M. J. (2010). The National Group Psychotherapy Institute: A blending of two educational methods. Group, 34, 329-336. Stone, W. (2010). Introduction to the special issue on training in group psychotherapy. Group, 34, 277-281. Sunderji, N., Malat, J., & Leszcz, M. (2013). Group day: Experiential learning about group psychotherapy for psychiatry residents at university of Toronto. Academic Psychiatry, 37, 352-354. Walker, J. R., Alphonse, A., & Cohen, E. (1985). Group facilitator supervision through a one-way mirror. Journal of Counseling & Development, 63, 578-580. Ward, D., & Crosby, C. (2010). Using an observation model for training group therapists in a community mental health setting. Group, 34, 355-361.
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Wheelan, S. A. (2009). Group size, group development, and group productivity. Small Group Research, 40, 247-262. Wheelan, S. A., Davidson, B., & Tilin, F. (2003). Group development across time: Reality or illusion. Small Group Research, 34, 223-245. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York: Basic Books. Shulamit Geller, Ph.D. School of Behavioral Sciences Academic College of Tel-Aviv-Yaffo 14 Rabenu Yeruham Street Tel-Aviv-Yaffo 68114 Israel E-mail: [email protected]
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Group Therapy Graduate Seminar: A Developmental Perspective Shulamit Geller Ph.D. & Eran Shadach Ph.D. To cite this article: Shulamit Geller Ph.D. & Eran Shadach Ph.D. (2015) Group Therapy Graduate Seminar: A Developmental Perspective, International Journal of Group Psychotherapy, 65:3, 431-444 To link to this article: http://dx.doi.org/10.1521/ijgp.2015.65.3.431
Published online: 24 Aug 2015.
Submit your article to this journal
Article views: 27
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20 Download by: [University of Newcastle, Australia]
Date: 25 March 2017, At: 15:41
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 65 (3) 2015 GELLER AND SHADACH GROUP THERAPY GRADUATE SEMINAR
Group Therapy Graduate Seminar: A Developmental Perspective SHULAMIT GELLER, PH.D. ERAN SHADACH, PH.D.
ABSTRACT Teaching group therapy is an essential aspect of graduate studies within the helping professions. Existing models discuss four basic elements required for such training: experience, observation, supervised practice, and theory. The present paper offers a model for a group therapy seminar based on these four elements and organized along developmental concepts. Clinical observations of 120 psychology students who participated in the seminar were gathered over a five-year period. Teaching techniques included supervised observation, fishbowl, one-way mirror, and a final paper integrating theory and practice. The seminar enabled students to practice and to theorize about group processes, both as participants and as co-leaders. Seminar outcomes and conclusions are discussed. INTRODUCTION
Although training in group psychotherapy within the helping
professions is an important aspect of graduate studies, its prevalence is limited, as training continues to rely mainly on individual therapy (Ward & Crosby, 2010). Literature on existing group therapy training programs (Stone, 2010) reveals unique and shared Shulamit Geller and Eran Shadach are affiliated with School of Behavioral Sciences at the Academic College of Tel-Aviv-Yaffo in Israel.
431
432
GELLER AND SHADACH
features related to four basic elements: experience, observation, supervised practice, and theory (e.g., Feiner, 1998; Kobos, 2010; Nathan & Poulsen, 2004). The yearly seminar described here implements these four elements within a structured seminar format that enables an integration of personal experience with theoretical conceptualizations (Middleman & Goldberg, 1972). As time is an integral and crucial factor in every group process, and even more so in time-limited groups, developmental theories are an essential component in the training of group psychotherapy (Brabender & Fallon, 2009). Accordingly, the present seminar was designed to train graduate students to think and understand group processes along developmental phases. In short, at the outset of its life, the group is in a “forming” or “engagement” stage, followed by the second stage characterized by “counter-dependency and flight” or a “storming.” The third stage is characterized by “norming” and “intimacy,” while the fourth stage moves on to “performing,” “differentiation,” and “work.” The final stage concerns the issue of termination, whether of individual members or of the group as a whole (American Group Psychotherapy Association [AGPA], 2013; Bakali, Wilberg, Klungsøyr, & Lorentzen, 2013). Methodological Considerations
The current paper is based on clinical observations by the leaders during a five-year period (2007–2012; n = 120) and is formulated and presented as an outline for a group therapy training seminar. FIRST SEMESTER: METHOD
Students’ primary task was to experience and understand the role of a participant in a group (Khaleelee, 2006; Kobos, 2010; Wheelan, Davidson, & Tilin, 2003). Participants
Twenty-four second-year graduate students from the medical, clinical, and rehabilitation psychology programs participated in the seminar every year. Upon commencing the seminar, students had already completed introductory and advanced courses in in-
GROUP THERAPY GRADUATE SEMINAR 433
dividual psychodynamic psychotherapy and had practiced supervised psychotherapy for about six months. Procedure
At the first meeting and after a short introduction, students were divided into two equal groups of 12 students each: a working group (WG) and an observing group (OG) (Kobos, 2010). Group composition was balanced for gender and for program affiliation to achieve maximal in-group heterogeneity (Foulkes & Anthony, 1957/1984). The semester consisted of 14 weekly sessions and each WG was co-led by the seminar lecturers for 7 sessions. Each WG session lasted 60 minutes, applying the fishbowl paradigm (Kane, 1995), while the OG (the remaining 12-student group) was instructed to be attentive to the processes and dynamics of the WG in order to reflect on these aspects after the session (Stiers, 2010). At the conclusion of each session, all participants convened for 30 minutes of supervised discussion (SD), the role of which was to deal with three elements: the experiences and reflections of the observers, those of the WG participants, and the seminar lecturers’ comments and theoretical conceptualizations. After the first seven sessions ended, the WG and OG switched roles, and seminar lecturers conducted the “new” WG for another seven sessions. At the end of the semester, students were required to submit a term paper in which they reported their experience as participants and analyzed the experience conceptually, using relevant theoretical approaches. A short description reflecting the composite experience of the developmental sequence and processes follows. Working Group Overview: Sessions 1–7
Stage 1 (Sessions 1–3). Orientation and dependency themes were raised as participants testified to past experiences in previous groups and repeatedly appealed to the seminar lecturers for concrete and pacifying instructions. Comments of WG members on being observed by the OG may have reflected the group members’ anxiety, as well as their effort to establish the group’s external boundaries (MacKenzie, 1997; Yalom & Leszcz, 2005).
434
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Stage 2 (Sessions 4–6). Dependence/counter-dependence conflicts were among the most common themes in these sessions (Bennis & Shepard, 1956). Inter-group competition (MacKenzie, 1997), individual struggles to secure a place in the group, and displays of anger towards one another were evident. Termination (Sessions 6–7). In these sessions, the approaching threat of group termination evoked the insecurity of WG members concerning their “birthright,” and fear of losing their “special child” status. Participants addressed these emotions by referring to the group’s progress and to the envy it triggered in the OG. Interpersonally, the group addressed the upcoming end through use of more direct interactions to achieve better closure and to validate their self-concepts (Bennis & Shepard, 1956). Dependency on the seminar lecturers was apparent, its prominence underlining the relatively early developmental stage of the group and the effect of the forced termination. Supervised Discussion Overview
Stage 1 (Sessions 1–3). During the SD, while the WG was occupied with the difficulties of reflecting on the ongoing themes that had emerged in the session, the OG, as outsiders who were instructed to focus on an intellectual task, maintained an illusion of being protected and immune from emotional conflict. However, OG members expressed strong emotions towards the WG in the form of exaggerated sympathy and admiration, or criticism and intrusiveness. These expressions may be understood in various ways: for example, in this particular session, we, the leaders, referred to them as manifestations of rivalry and hidden envy of the WG’s “first child” status. Stage 2 (Sessions 4–6). The growing maturity of the OG was reflected in its enhanced ability to express feelings such as envy and competitiveness toward WG members, and by the increased use of metaphoric and symbolic language. Termination (Sessions 6–7). Due to the forced termination, participants in the SD become more focused on issues related to the upcoming role switch. While OG members expressed their anxiety and their desire to become members of the WG, members of the WG continued with its typical termination themes.
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Interestingly, despite the differences in task and in structure, our impression was that both the WG and the SD followed a similar developmental arc of progress. This may further support the general consensus that groups develop across time (Wheelan et al., 2003). Sessions 8–14. (These sessions are commented on briefly.) Although the new WG needed to work through major developmental themes, members were usually able to express an advanced and open attitude toward the group leaders and their peers. This pattern may be understood as a “shortcut” through the dependency phase that a group typically goes through, but also as an outcome of the genuine developmental progress achieved vicariously during the observation process (Kobos, 2010). The new OG was compelled to adjust to its new observation task and to cope with the loss of its “birthright” (Kreeger, 1992). SECOND SEMESTER: METHOD
Students’ primary task was to experience the role of a group therapist, using twelve task-centered themes that corresponded to the five stages of group development described above. Participants
The participants were the same 24 students as in the first semester. Procedure
The students were divided into two new equal groups of 12 students each: an observing group (OG) and a working group (WG). The WG was comprised of 6 conducting pairs. Each pair was to lead a 60-minute session according to a task-centered theme while OG members were seated behind a one-way mirror (Walker, Alphonse, & Cohen, 1985) accompanied by the seminar lecturers. At the conclusion of each session, all students convened for supervised discussion (SD) to conceptualize and theoretically understand the co-leaders’ work. The discussion typically began with the co-leaders sharing their experiences, followed by com-
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ments and reflections offered by the other students. After the first six sessions, the WG and OG switched roles. The first and final sessions of this semester were conducted by the seminar leaders to address a number of specific subjects. The first meeting was intended to (a) expose students to the experience of being observed and of observing group work behind a one-way mirror and (b) teach students the basic principles of group leading in general, and co-leading in particular, that is, preparing the sessions in advance, content-process differentiation, and working with the here and now (Rutan & Stone, 2001; Yalom & Leszcz, 2005). The purpose of the final session of this semester was to allow students to share their experiences and to allow lecturers to assess students’ progress and satisfaction with the seminar. Upon seminar termination, students were required to submit a paper in which they described their experience as group leaders and their understanding of group processes, using relevant theory. THEMES
The next section introduces the themes’ description following the developmental rationale (e.g., AGPA, 2013; Wheelan et al., 2003). The first three themes—first encounters, parenthood, and authority— correspond to the first stage, and highlight group topics typical of this stage, that is, a group climate of dependency in which members seek the leaders’ guidance in order to identify group norms and boundaries.
First Encounters. This refers to the exploration of group identity, rules, norms, and trust. As the group was led by a pair of novice peer leaders, the issue of whether the leaders could be trusted became salient. Dependency issues were implicitly addressed, either by noting the absence of the seminar lecturers or by expressing relief at their absence. The fact that group members were soon destined to be leaders themselves further enhanced the need to establish norms of conduct between the current and
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the to-be leaders. Finally, the approaching task of leading evoked issues related to personal qualifications and value. Parenthood. Explicit exploration of dependency and of early relations with parental authority figures is the focus of this theme. Members discussed aspects of real parental relations, sharing their own experiences as parents and memories of losing a parent. The interpretations directed attention to the here and now, reflecting the fact that at this stage the co-leaders are the prominent figures towards whom dependency is directed. Authority. This theme encouraged participants to recall past experiences with various authority figures (e.g., teachers and tutors) and enabled them to broaden their understanding of issues of power and control (Bennis & Shepard, 1956). Additionally, this theme stimulated the challenging of the co-leaders’ authority and thus preceded the upcoming second stage of development in which individual needs and preferences come to the fore (Bakali et al., 2013). The next four themes correspond to the second stage, in which aspects of counter-dependency and interpersonal emotional engagement regarding the safety of the group are challenged. Themes like self-esteem, aggression, separation, and competition widen the exploration of exchanges with authority to the peer relations realm (AGPA, 2013; MacKenzie, 1997). Self-esteem. Individual needs and preferences both with regard to authority and to peers characterize this theme. The investigation of commonalities and differences in the group may raise shameful feelings about the self (Wheelan et al., 2003) and therefore may challenge one’s own sense of value. Working with this theme has often involved the need to assert one’s self-value, for example, by competing over who offered the “best understanding” or the “best interpretation.” Aggression. Disagreement among members (Wheelan, 2009) and confrontations with the leaders (AGPA 2013) are both expressed through aggression and are an inevitable part of expressing one’s individuality. Although both direct and indirect aggression towards one another and towards the co-leaders are typical of this stage, in our experience, indirect expressions such as stories of past experiences outside the group, or in the form
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of ignoring one another’s contribution in the group, were more prominent. Separation. Working according to this theme enables individual self-exploration, and it facilitates self-definition and differentiation within group members and between the group and the leader (MacKenzie, 1997). As this session also concluded the work of the first WG (mid-term), narratives concerning the concrete separation came to the fore, and the group became conscious of its shared identity. Competition. This theme invites further exploration of interpersonal differences that usually raises anxiety about the safety of the group (AGPA, 2013). However, as this was the first session of the new WG which typically calls for in-group harmony, the group had to address two developmentally distinct tasks. A possible way of addressing this complexity was to compete with the former group (i.e., stating the present WG’s advantage over it), thus reducing in-group rivalry and enhancing sense of membership. The next four themes—conflicts, intimacy, sibling relations, and leadership—correspond to the third stage of group development. At this stage, a higher degree of consensus is usually achieved concerning the group’s tasks, as well as improved cohesion and openness (AGPA, 2013). Conflicts. Although widely considered an achievement of the second stage, some writers have reported high levels of conflict during later stages as well (e.g., Brossart, Patton, & Wood, 1998). Participants are encouraged to explore and experience contradicting needs and motivations within themselves and between each other. Conflicts in the here and now, such as whether to engage openly with the group or to remain safely in the background, were commonly dealt with by members in an academic manner rather than by actual engagement. Intimacy. As the focus in this stage tends to shift towards greater introspection and personal challenge (MacKenzie, 1997), participants are encouraged to explore meanings, needs, and fears relating to interpersonal functioning. In our experience, this theme was addressed rather openly and emotionally. It is, however, uncertain whether this was the result of a real developmen-
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tal achievement or of the members’ wish to shorten the process needed to accomplish trust and intimacy. The following two themes reflect the increasing productivity and effectiveness characterizing the group during its fourth stage of development (Wheelan, 2009). Sibling Relations. This theme invites members to share and compare relationships with siblings in an open and explicit manner. The intimacy within the group is deepened and expanded, as interactions are experienced in more mature and productive ways, allowing expressions of individual differences and a more open exchange of feedback (AGPA, 2013) Leadership. This theme expresses another advanced link in a presumed circle of development, beginning with dependency, growing to peer relationship, and finally becoming an authority for others. Therefore, it calls for an exploration of the leader’s role. Participants approached this issue in various ways, for example, discussing the disadvantages of leadership, attempting to identify group members with the appropriate leadership valence, and referring to each other’s leadership qualities. The fifth or final stage concerns the issue of termination, whether of individual members or the group as a whole (AGPA, 2013). Endings and Farewells. This final theme is intended to facilitate seminar termination and to promote participants’ exploration of their separation experiences. The narratives that emerged in this session were typical of a termination phase: evaluation of the accomplished work, exchange of personal impressions of self and other, and relief or mourning due to the group’s termination. DISCUSSION
This brief report proposes an outline for an introductory group therapy seminar with a developmental rationale. The discussion begins with course assessment, followed by theoretical and methodological considerations, specific model characteristics, and finally, research limitations. Students’ written assessments showed the seminar to be effective, as it revealed average scores of 6.06 for theoretical contribu-
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tion and 6.41 for general seminar evaluation, on a Likert scale ranging from 1 (low appreciation) to 7 (high appreciation) (see also Nathan & Poulsen, 2004). These findings were further supported by students’ verbal reports on the progress they made in their knowledge and skills, both as participants and as group leaders (see also Sunderji, Malat, & Leszcz, 2013). In conclusion, students evaluated the seminar as effective in training group therapists and therefore as a relevant component of a graduate program. From a theoretical aspect, organizing the seminar along a developmental rationale helped the students experience and conceptualize group developmental stages, and later on enabled them to implement that knowledge as group co-leaders (Ettin, Vaughan, & Fiedler, 1987). In both semesters, we used the SD in order to explain the developmental phases of the group to the students. In addition, during the second semester, the taskcentered themes enabled the co-leaders to use the developmental perspective while practicing group therapy (Ettin et al., 1987). Moreover, in our experience, the themes have also assisted the observers in following the process. Toward termination, even though it was clear that the full developmental sequence had not been completed, we noticed that progress was made: conflicts and avoidance behaviors declined (Bakali et al., 2013; Wheelan et al., 2003), cohesion and relatedness between members tended to increase (MacKenzie, 1997), and the use of symbolic language and metaphors became more prevalent (Berman & Weinberg, 2000). The SD facilitated participants’ learning experience in both semesters, as it encouraged an observing-like mode, allowing participants and observers to re-evaluate emotions and thoughts addressed during the preceding sessions (Stiers, 2010). In regard to the next two elements, that is, the fishbowl and the one-way mirror, the present paper supports existing literature indicating that both provide useful learning experience (Hensley, 2002; Knight et al., 2010). In our experience, the fishbowl is better suited to the first half of the seminar as it facilitates the lecturers’ control over the learning process and promotes shared learning experience. The one-way mirror technique is recommended in the second half, as it modifies group boundaries (Hobbs,
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1988) and fosters support and trust within each group (Walker, Alphonse, & Cohen, 1985), thus enabling the more mature and independent group to work effectively. Finally, as suggested by Yalom & Leszcz (2005), the present experience affirms the idea that practicing co-leading technique enables mutual support for seminar lecturers and for novice leaders alike and improves leaders’ abilities to attend to the group needs (Kivlighan & Miles, 2012). Being primarily an academic seminar, it emphasizes the multiple role relations among the seminar participants and lecturers. Lecturers’ academic evaluative role, and the fact that they often teach some of the participants in other courses, may impede group members’ willingness to be open and trusting (Kobos, 2010). Our experience supports the existence of possible confusion, both for students and lecturers, in matters such as how to understand and to respond to students’ requests inside and outside the sessions (e.g., asking for further reading materials or discussing grades in other courses). However, such multiplicity should not prevent trust development and group cohesiveness as long as the lecturers are careful to respond to participants in accordance with academic rules (e.g., referring the student to the requested readings) while properly addressing the dynamic framework (e.g., interpreting it in the group as a transference manifestation; Hopper, 2007). In this regard, the fact that seminar grades are based solely on the final paper submitted three months after the seminar terminated effectively separated the lecturers’ roles of group leading and of academic evaluation. The most notable limitation of the present outline is the challenge of providing adequate coverage of essential group knowledge and skills in a one-year academic seminar. Moreover, as the present work is based on observations that are subjective in nature, the analysis is susceptible to confirmation biases based on the authors’ pre-existing theoretical and clinical orientations. It is also possible that students’ feedback was biased in such a positive manner (Hensley, 2002). The authors have several suggestions for faculty members who wish to implement such a course in their curriculum. Trainees’ emotional safety may be attended to by putting emphasis on the
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educational rather than the therapeutic aspects of the experience (Kobos, 2010). If possible, didactic teaching of group leading theory within another course is advised (Sunderji et al., 2013). Further research is needed to evaluate, validate, and ensure the quality of this training seminar, as well as to provide educators in the helping professions with means to tailor this type of framework to the requirements of a specific program. REFERENCES American Group Psychotherapy Association (AGPA). (2013). Practice guidelines for group psychotherapy. Retrieved from http://www. agpa.org/guidelines/groupdevelopment.html. Bakali, J. V., Wilberg, T., Klungsרyr, O., & Lorentzen, S. (2013). Development of group climate in short- and long-term psychodynamic group psychotherapy. International Journal of Group Psychotherapy, 63, 366-393. Bennis, W., & Shepard, H. (1956). A theory of group development. Human Relations, 9, 415-437. Berman, A., & Weinberg, H. (1998). The advanced stage in therapy group. International Journal of Group Psychotherapy, 48, 499-518. Brabender, V., & Fallon, A. (2009). Group development in practice: Guidance for clinicians and researchers on stages and dynamics of change. Washington, DC: American Psychological Association. Brossart, D. F., Patton, M. J., & Wood, P. K. (1998). Assessing group process: An illustration using Tuckerized growth curves. Group Dynamics, 2, 3-17. Ettin, M. F., Vaughan, E., & Fiedler, N. (1987). Managing group process in nonprocess groups: Working with the theme-centered psychoeducational group. Group, 11, 177-192. Feiner, S. E. (1998). Course design: An integration of didactic and experiential approaches to graduate training of group therapy. International Journal of Group Psychotherapy, 48, 439-460. Foulkes, S. H., & Anthony, E. J. (1984). Group psychotherapy. London: Marsfield Library (Original work published 1957). Hensley, L.G. (2002). Teaching group process and leadership: The twoway fishbowl model. Journal for Specialists in Group Work, 27, 273286. Hobbs, M. (1988). From behind the scenes: The psychodynamic implications for an analytic psychotherapy group of being observed through a one-way screen. Group Analysis, 21, 235-248.
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Hopper, E. (2007). Theoretical and conceptual notes concerning transference and countertransference processes in groups and by groups, and the social unconscious: Part II. Group Analysis, 40, 29-42. Kane, C. (1995). Fishbowl training in group process. Journal for Specialists in Group Work, 20, 183-188. Khaleelee, O. (2006). Learning from experience and the experience of learning in group relations conferences. In L. D. Brunner, A. Nutkevitch, & M. Sher (Eds.), Group relations conferences (pp. 17-29). London: Karnac. Kivlighan, D. M., & Miles, J. R. (2012). Are two heads better than one? The relationship between number of group leaders and group members, and group climate and group member benefit from therapy. Group Dynamics: Theory, Research, and Practice, 16, 1-13. Knight, E. B., Barth, P. A., Fink, A. H., Cunningham T. J., Vaughn, C. A., & White, R. E. (2010). Baylor College of Medicine group psychotherapy training. Group, 34, 301-308. Kobos, J. (2010). A laboratory learning approach to teaching group psychotherapy. Group, 34, 293-300. Kreeger, L. (1992). Envy preemption in small and large groups. Group Analysis, 25, 391-412. MacKenzie, K. R. (1997). Clinical application of group development ideas. Group Dynamics: Theory, Research, and Practice, 14, 275-287. Middleman, R. R., & Goldberg, G. (1972). The concept of structure in experiential learning. In J. W. Pfeiffer & J. E. Jones (Eds.), The 1972 annual handbook for group facilitators (pp. 1-10). San Diego, CA: Pfeiffer. Nathan, V., & Poulsen, S. (2004). Group-analytic training groups for psychology students: A qualitative study. Group Analysis, 37, 163-177. Rutan, J. S., & Stone, W. N. (2001). Psychodynamic group psychotherapy (3rd ed.). New York: Guilford. Stiers, M. J. (2010). The National Group Psychotherapy Institute: A blending of two educational methods. Group, 34, 329-336. Stone, W. (2010). Introduction to the special issue on training in group psychotherapy. Group, 34, 277-281. Sunderji, N., Malat, J., & Leszcz, M. (2013). Group day: Experiential learning about group psychotherapy for psychiatry residents at university of Toronto. Academic Psychiatry, 37, 352-354. Walker, J. R., Alphonse, A., & Cohen, E. (1985). Group facilitator supervision through a one-way mirror. Journal of Counseling & Development, 63, 578-580. Ward, D., & Crosby, C. (2010). Using an observation model for training group therapists in a community mental health setting. Group, 34, 355-361.
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Wheelan, S. A. (2009). Group size, group development, and group productivity. Small Group Research, 40, 247-262. Wheelan, S. A., Davidson, B., & Tilin, F. (2003). Group development across time: Reality or illusion. Small Group Research, 34, 223-245. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York: Basic Books. Shulamit Geller, Ph.D. School of Behavioral Sciences Academic College of Tel-Aviv-Yaffo 14 Rabenu Yeruham Street Tel-Aviv-Yaffo 68114 Israel E-mail: [email protected]
