on practical considerations. Some therapists feel
strongly that a heterogeneous group is best—
one that includes women and men with a variety
of problems, backgrounds, and personalities. Other
therapists feel that homogeneous groups are best—
groups composed, for example, exclusively of
alcoholics or patients with phobias. They believe
that homogeneity makes for greater efficiency,
quicker understanding, and mutual acceptance
(e.g., Budman & Gurman, 1988). In institutional
settings with large numbers of patients, it is rela-
tively easy to establish homogeneous groups. In
private practice, however, the therapist may have
no alternative except to use heterogeneous groups.
Most therapists agree that certain kinds of patients
must generally be excluded. These include those
with severe cognitive limitations, the grossly
psychotic, and persons who are especially prone
to disrupt the group process (e.g., those who
monopolize group discussions or are extremely
antagonistic).
In some instances, the therapist sees all group
members concurrently on an individual basis. In
others, the therapist sees the patients only at
group therapy meetings. At times, some therapists
like to use a cotherapist (often a therapist of the
opposite sex who will add another dimension to
such processes as transference). Some groups meet
occasionally without a therapist. Whatever the
exact format, the role of the group leader is critical.
In some groups, there are prohibitions against
extracurricular fraternizing; other therapists feel
that such prohibitions are unrealistic. Open groups
admit a new member whenever someone leaves theBOX15-1 Focus on Clinical Applications: Time-Effective Group Psychotherapy for Patients
with Personality DisordersBudman et al. (1996) discussed how group psychother-
apy can be particularly effective and useful for a group
of patients that are often seen as among the most
difficult to treat—those with Axis II personality disor-
ders. With these patients, group therapy offers special
advantages:
■ The patients’social/interpersonal behavior can be
directly observed (e.g., being hostile and critical of
others);
■ Group members can provide on-the-spot feedback
regarding the adaptive and maladaptive aspects
of a patient’s interpersonal behavior (e.g.,“When
you said that I don’t know what I am talking
about, I felt hurt and angry at you.”)
■ Patients have a chance to modify their interper-
sonal behavior in a group setting;
■ Peer pressure may encourage the individual group
member to decrease problematic behaviors (e.g.,
verbally lashing out at others) and to increase more
adaptive responses (e.g., telling another member
that she or he felt hurt by a particular comment); and
■ The group essentially serves as“a social microcosm
of the‘real-world’.”(Budman et al., 1996, p. 331)
A number of other features are noteworthy.
Budman et al.’s (1996) time-effective grouppsychotherapy (a) has an interpersonal focus;
(b) requires the therapist/leader to actively facilitate
the group process (e.g.,“jump-starting”the group,
setting limits on actions that are destructive to the
group); (c) is time limited to encourage change; (d)
encourages patient responsibility, goal-setting, and
monitoring of progress toward the goals; (e) uses
homework assignments to encourage change; and (f)
utilizes session summaries to tie together group
process, recurring themes, and individual progress.
Group members are evaluated for appropriate-
ness based on an extensive screening (via an individual
session with the group leader) and a pregroup work-
shop in which all prospective members meet to intro-
duce themselves, to complete small-group tasks (e.g.,
role-play problematic interpersonal behaviors and then
alternative behaviors), and to complete a whole-group
exercise (e.g., planning a party). In this way, the group
leader can assess each prospective member’s appropri-
ateness for the group—does he respond well to limit-
setting? Does she use feedback appropriately? Is he
able to engage with other group members?
Budman et al. (1996) report that such a treat-
mentislikelytoleadtobetteraffectivecontrol,
the development of better coping skills, and
improved interpersonal behavior in patients with
personality disorders.438 CHAPTER 15