Foundations of Treatment 139
stepfather angry, at least until the adults have more practice working out their
diffi culties. Paradoxical intention is generally only used with families who have not
otherwise made changes suggested by the therapist.
Note that systems therapy originated with therapists who worked almost ex-clusively with families. This history has caused systems therapy to be confused with
family therapy. The two are not the same: Some systems therapists use a systems
approach to treat only one individual, whereas some family therapists use a psycho-
dynamic or behavioral approach rather than a systems approach.
Group Therapy
Ingroup therapy, a number of patients (typically 6–8) with similar needs meet to-
gether with one or two therapists. This form of therapy can occur in a single ses-
sion, in sessions that continue over years, or within some specifi ed time limit (such
as 12 weeks). Like family therapy, group therapy can be rooted in any of a variety
of theoretical orientations, such as psychodynamic or cognitive-behavioral. If the
therapist has a cognitive- behavioral orientation, participants in the group are likely
to be assigned homework between sessions and will then discuss their homework in
the group. Some therapy groups are restricted to people who have a specifi c prob-
lem or disorder (such as people with depression), and the group offers members
psychoeducation, emotional support, or training in CBT techniques. Other therapy
groups (which may be psychodynamic in approach) are open to people who are
united simply by their desire to understand their relationships and to develop better
ways to interact with others—romantic partners, colleagues, or other people in their
lives. A psychodynamic therapist might use transference, resistance, and interpreta-
tion to help members learn about themselves and change the ways that they relate
to others. In groups in which the goal is to improve interpersonal interactions, the
group itself can be a forum for experimenting with new ways of interacting.
The most appropriate type of group therapy for Leon might well be one that tar-geted his social phobia. Just being in a group with strangers would, in and of itself,
be exposure treatment for him; moreover, he might feel less alone and ashamed
when hearing about other group members’ similar problems and struggles.
Beyond information and support, group therapy provides interaction withothers who share similar problems and goals. Hearing members talk about expe-
riences that are similar to their own can help patients understand their own experi-
ences more clearly and think about them in a different way. For instance, if Leon
were in group therapy, after hearing about other members’ experiences, he might
feel less anxious being around them and realize that, just as he wasn’t judging the
other group members, they probably were not judging him. In turn, he might then
feel more willing to be with other people. Whether group therapy helps people ex-
plore their relationships or develop skills for cognitive restructuring of automatic
negative thoughts, being with other members who are struggling with the same is-
sues decreases the sense of hopelessness, isolation, and shame that some patients
feel about their problem or disorder.
Community-Based Treatment
Treatment most often occurs within a patient’s community—his or her neighbor-
hood, town, or city. Most people seeking mental health care receive outpatient
treatment—treatment that does not involve an overnight stay in a hospital.
Outpatient treatment may occur in a therapist’s private offi ce, a community mental
health center or mental health clinic, an outpatient unit of a hospital, or, for those
seeking pastoral counseling, within their church, synagogue, or mosque. For some
people with severe symptoms, outpatient treatment consisting of weekly sessions of
up to 1 hour may not be adequate, and more intensive treatment may be needed or
desired. Intensive treatment may take place in a hospital, clinic, or mental health
facility and may last for several hours each day or evening to 24 hours a day.
Group therapy
The form of treatment in which several
patients with similar needs meet together
with one or two therapists.Outpatient treatment
Treatment that does not involve an overnight
stay in a hospital.