Expanding the Support System: Evidenced-Based Group Therapy Practices

Expanding the Support System: Evidenced-Based Group Therapy Practices

    Expanding the Support System: Evidenced-Based Group Therapy Practices

    Group therapy  is  a  relatively recently accepted, widely  practiced method of  working  with  patients.  Prior  to  World  War  II,  there  were  only  a  few physicians  that  practiced  group  therapy  in  favor  of  the  more  traditional emphasis of the development of  the  doctor-patient  relationship. As soldiers returned from the war, it was evident  that  there  would  be  an  overwhelming  need  for  mental  health services.  Group  therapy  was  born  of  this  need,  wherein  psychiatrists would  treat  soldiers  in  groups  to  maximize  the  services  that  one psychiatrist could provide. As this practice advanced, it was clear that group therapy was an effective method for treating individuals who had similar challenges.
    Today,  group  therapy  has  grown  to  include  treatment  options  for everything  from  eating  disorders  to  social  anxiety  and  substance  abuse. Although the benefits of group therapy can be promising, therapists who choose  this  modality  must  be  aware  that  this  type  of  therapy  has  its limitations.  Therapists  who choose  group  therapy  instead  of  individual  therapy  for  specific  client profiles  must  consider  the  characteristics  of  the  group  in  order  to determine  the  likelihood  of  treatment  success. 
    An analysis of 125 studies discovered that group treatment dropout rates were approximately 47%. Recent analyses have shown  similar  results.  In  one  analysis,  over  699 studies were reviewed, and the results indicated that although more clients remained in group therapy, the dropout rate is approximately 1 in 5. Studies also  indicate  that  the increasing  use  of evidence-based practices in  group therapy  can  have  an  impact  not  only  on  client  retention,  but  also  on  the long-term effectiveness of treatment, even for group members who do not follow the program to completion.

    Client Characteristics to Consider 

    It  is  necessary  to  consider  several  characteristics  of  clients  in  order  to determine  who  is  likely  to  be  a  successful  candidate  for  this  type  of intervention.  When  examining  client  demographics,  factors  such  as  age, education,  socioeconomic  status,  diagnosis,  and  treatment  expectations can all have substantial impacts on the outcome of treatment. 

    Age 

    Studies  show  that  age  can  be  a  predicting  factor  in  the  success  rate  of group therapy. The younger the client, the more likely they are to drop out of treatment or, at the very least,  decide not to follow through with all treatment stages.  

    Education and Socioeconomic 

    Status Individuals  who  have  lower  levels  of  education  are  less  likely  to  follow through  with  group  treatment.  Level  of  education  oftentimes  correlates with socioeconomic status; therefore, studies suggest that individuals who have a high school diploma or who have dropped out of school, along with income  in  or  around  the  poverty  level,  are  less  likely  to  continue participating in group treatment.

    Diagnosis 

    While group therapy may be effective for a multitude of diagnoses, there are a few that remain challenging for group therapy treatment; specifically, substance abuse disorders, antisocial personality disorder, and borderline personality  disorder  have  been  cited  as  the  most  difficult  disorders  to experience  successful  treatment  through  the  group  therapy  method.  Substance  abuse  disorders  often  occur simultaneously with trauma-related disorders, and it can often be difficult to treat both with the same level of efficacy (mental health counseling programs). 
    Studies show that substance abuse disorders are a major factor in group therapy  dropout  rates  due  to  the  likelihood  of  relapse.  There  are  some  programs  that  have  shown  promise  in reducing the number of dropouts, as well as strengthening the outcome of treatment  in  those  individuals  who  have  left  therapy  before  program completion;  however,  these  factors  are  dependent  upon  the  individual patient.  Another diagnosis that is difficult to effectively treat in group therapy is borderline  personality  disorder  (BPD).  Patients  who  are  diagnosed  with this  disorder  can  be  especially  difficult  to  treat  due  to  the  nature  of  the disorder  which  is  characterized  by  impairments  in  empathy,  intimacy, self-direction,  and  self-image,  as  well  as  emotional  liability,  anxiety,  and separation insecurity. In patients with BPD, higher levels of aggression, impulsivity, and manipulation have been  reported  as  being  present  during  group  therapy.
    Similar to BPD, antisocial personality disorder can be extremely difficult to  treat  in  a  group  setting.  Like  BPD,  patients  who  are  diagnosed  with antisocial  personality  disorder  are  characterized  by  a  lack  of  empathy, difficulties  with  intimate  relationships,  and  impairments  in  self-functioning. However, clients with this disorder often experience hostility toward  others,  deceitfulness,  and  risk-taking  behavior. This  can  make it extremely  challenging to work with these individuals within the group setting. Even if treatment is marginally successful for patients with antisocial personality disorder (as well as other disorders), the ever-changing nature of some group therapy sessions can prove to be detrimental to treatment efficacy (accredited mental health counseling programs).

    Treatment Expectations 

    For  patients  who  have  not  completely  bought  into  the  idea  of  group therapy, treatment can  have varied effects. Studies  have suggested that a patient’s attitude toward treatment and the belief that the modality can be successful  has  a  substantial  impact  on  whether  or  not  the  treatment  is indeed  successful. Similarly, for patients who felt that the therapist’s role was the  most  important in determining success of treatment, the  percentage of  success  rates  was  higher  than  in  individuals  who  felt  they  could discontinue therapy without completion and still be successful. 
    While this is not an exhaustive list of client characteristics to consider, it is  important  to  examine  the  client’s  full  profile  when  determining  the likelihood of success with the group therapy method. It is also necessary to note that the above-mentioned traits  may not have a negative impact in group  therapy  for  certain  individuals.  It  is  best  to  consider  each  client individually when determining their fitness for this modality. 
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