Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: November 2014

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Using Group Therapy to Change Interpersonal Behaviors
Joana Kyei, PsyM

 

It takes people to make people sick, and it takes people to make people well again.

  • Henry Stack Sullivan

 

Human beings are social creatures who begin life in families, and continue to live, work, and play in different groups throughout the lifespan. In the initial familial group, one is introduced to conflict, a ubiquitous phenomenon in every relationship. In the interpersonal realm, conflict usually arises from incompatibilities in people’s needs to be more or less independent than others in their social group, or from competing with others for the same limited resources (e.g. time or social status).

Murray Bowen, a family theorist and therapist, believed that our families remain with us wherever we go. Thus, our understanding of the outcomes of conflict in the family sets the stage for our characteristic ways of managing conflict in subsequent relationships. For example, one person may learn that conflict with a sibling is best resolved when a parental figure settles the dispute. Another may learn that the way to get needs met in the family unit is to stir up conflict, while yet another may learn to negate personal desires that are incompatible with other family members in order to avoid conflict. Subsequently in interacting with others outside of the family, people who experienced adverse conflict outcomes may manage conflict using avoidant or submissive behaviors. People who experienced positive conflict outcomes after involving a parental figure may rely on third parties to resolve conflicts, while those who learnt to create trouble in order to have their needs met may use domineering behaviors in managing conflict.

Although these responses reduce the discomfort associated with alienating others or not having needs met, they also tend to undermine the development of intimate and close relationships. In addition, the inability to handle interpersonal difficulties has been linked to a number of mental health conditions such as anxiety, depression, and borderline and narcissistic personality disorders. Group therapies with interpersonal foci provide active ways of learning how to work through conflicts, and discover more adaptive ways of relating to others. Interpersonal therapy groups are usually time-limited or ongoing in duration, meet on a weekly basis, have five to ten group members, and are led by one or two trained mental health professionals.

How Group Therapy Works

Group therapy provides a nonjudgmental and confidential space to experiment with new behaviors which can then be replicated in relationships outside of the group.  Given that conflict occurs in all groups, group members’ ability to successfully work through discord in the interpersonal therapy group helps people learn that adverse consequences do not always follow disagreements. Conflict in the group may occur for example from two members needing to be listened to at the same time, or from members holding opposing viewpoints on a matter. The group leader’s functions of helping members appreciate the divergent needs or viewpoints of others, helping members feel more confident in communicating their reactions, encouraging members to respect the reactions of others, and assisting members to manage conflict in more adaptive ways, make it safer for group members to engage in more authentic ways.

Many people who experienced rejection or criticism from parental figures after expressing anger in the familial group continue to have difficulty expressing anger toward others. Group therapy is therefore useful in helping members practice expressing negative feelings to people in their lives using group members who most remind them of these people. For example, a group member who has difficulty expressing her anger to an overbearing husband may utilize the facilitated group environment to practice expressing her displeasure to a group member who monopolizes the group.

In interpersonal therapy groups, members learn new methods of communication and interaction by imitating the behaviors of group leader or other group members. Interpersonal learning in groups also occurs through members’ experiences of how their relational styles affect other group members. This provides group members with the opportunity to modify behaviors that impact others negatively, and increase behaviors that lead to intimate connections with others. A group member for example, who was only able to engage others in the family with aggressive or destructive behaviors, will engage similarly in the group by criticizing or antagonizing other members. In these instances, feedback given to the member on how this behavior prevents authentic connection provides an opportunity for that member to engage with others using less abrasive ways. Similarly, providing feedback to a shy group member on the effect of his or her empathy towards other members may improve that member’s self-esteem and autonomy in interpersonal relationships.

Research Findings

Studies evaluating the effectiveness of interpersonal therapy groups indicate that observing the psychological improvements of other members in the group gives members hope that they will similarly improve. The studies also report that group members’ ability to re-live early family conflicts with the group leader and the other members in a safe setting, helps members engage more authentically with others. Furthermore, sharing in the struggles of other group members fosters a sense of belonging in the group, and motivates members to seek a similar sense of belonging with others outside of the interpersonal therapy group.

Finally, in a study which asked group members to describe how group therapy had benefitted them, participants listed the following transformative factors:

  • Discovering and accepting previously unknown or unacceptable parts of myself.
  • Being able to say what was bothering me instead of holding it in.
  • Other members honestly telling me what they think of me.
  • Learning how to express my feelings.
  • The group’s teaching me about the type of impression I make on others.
  • Expressing negative and/or positive feelings toward another member.
  • Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others.
  • Learning how I come across to others.
  • Seeing that others could reveal embarrassing things and take other risks and benefit from it helped me to do the same.
  • Feeling more trustful of groups and of other people.

Resources/ Recommended Readings:

American Group Psychotherapy Association. What is group therapy? http://www.agpa.org/home/developing-healthy-communities/what-is-group-psychotherapy-

Rutan, J. S., Stone, W. N., & Shay, J. J. (2007). Psychodynamic Group Psychotherapy. (4th ed.) New York, NY: Guilford Press.

Yalom, I.D, & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy. (5th ed.) New York, NY: Basic Books

 

 

 

 

 

 

 

 

 

 

 


 

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