Practice Guidelines for Group Psychotherapy
Group
Development
Like all groups, therapeutic
groups change and evolve over time (Arrow et al., 2004; Worchel & Coutant,
2001). Knowledge of group development can help the group therapist discern if
member behaviors reflect personal and individual or group developmental issues.
Furthermore, an appreciation of how members cope in the face of group
developmental issues can aid the therapist in formulating specific interventions
that are specific to the developmental stage of the group.
Questions about group
development began to crystallize after LeBon (1910) and Freud (1959/1922)
theorized about the dynamics associated with groups engaged in a shared task.
Since then, a plethora of models depicting how “groups become groups” have
entered the literature. These models generally share the view that development
occurs in a systematic fashion, advancing through phases or stages. For example,
Bennis and Shepard (1956) outlined a model that included only two stages,
dependence and interdependence, whereas Beck (1974) delineated a model
comprising nine stages. The models differ in terms of whether the developmental
process is seen to be linear (stages occur progressively in an invariant
succession), recurrently cyclical (the group may repeat certain stages—or deal
with particular issues—at certain intervals or under certain conditions), or a
composite of linear and cyclical patterns (Mann et al., 1967). For example,
cohesion and relatedness between members tends to increase in a progressive,
linear fashion (MacKenzie, 1994), whereas conflict and resolution processes may
recur in a fairly regular cycle (Worchel, 1994). Bion’s (1961) well-known
depiction of “basic assumption” groups (dependency, fight-flight, pairing, and
working) represents a form of cyclic developmental model.
The diversity of developmental
models also reflects different types, structures and composition of group
therapy approaches. When implementing an outpatient group, the leader
establishes certain parameters, including whether the group will be open or
closed, time-limited or open-ended, as well as session frequency and duration.
Each of these variables influences group development. For example, open groups
which continually add and lose new members on an ongoing basis, such as a
community- based support group, may not develop through certain stages in the
same way as a closed, insight-oriented, interpersonal group. That is, certain
stages may be truncated or simply not emerge. In similar fashion, an open-ended
group with a fixed membership will be more likely to manifest cyclical patterns
of development than a time-limited, fixed membership group. There is also
evidence that groups of different compositions, for example, homogeneous and
heterogeneous with regard to member gender, may vary in terms of the durations
of each developmental stage (Verdi & Wheelan, 1992).
Models of Group Development:
Assumptions.
MacKenzie (1994) addressed four assumptions underpinning most models of group
development. The first assumption is that groups develop in a regular and
observable pattern, allowing for predictions of near-future patterns of group
behavior. Understanding the group’s developmental status may inform the
therapist about the maturity of member-member interactions. However, these
observations do not allow for the prediction of long-term outcome. The second
assumption asserts that the same developmental features will be evident in all
treatment groups that develop in a normative fashion. This may be true for
groups with a similar structure, format, and membership composition. However,
different clinical contexts and group characteristics will impact group
development (Arrow et al., 2004). For example, while most models posit the
emergence of conflict in a second stage, Schiller (1995) noted that for groups
composed exclusively of women, conflict emerges much later and only after
sufficient safety and trust has been established.
The third
assumption notes that development is epigenetic, with later developmental stages
being contingent on the successful negotiation of earlier developmental crises.
This invariant stage progression is unlikely; however, if it is considered that
groups occasionally undergo abrupt changes, as may occur in the case of an
unexpected departure or death of a member. Consequently, development may tend in
certain groups to be discontinuous rather than graduated and incremental. It was
noted earlier that most if not all models posit one or more periods of crisis or
conflict during the life of a group, variably defined as “resistance” (Klein,
1972) or “storming”(Tuckman, 1965). The emergence of chaos theory to describe
self-organizing systems has led some theorists to argue that each group
developmental stage involves the transition through a growth crisis (Garland et
al., 1973). The fourth assumption of most models is that over time, groups will
manifest increased interactional complexity but may, on occasion, exhibit
regression and reversibility, recycling back to earlier stages of development.
This assumption refers to the natural maturation that occurs in a group that
meets for a sufficient period of time. The issue of reversibility, however, is
controversial. Though a group may recycle through certain issues or conflicts
addressed earlier in its development, it will do so with the skills and
experience derived from moving through that earlier developmental stage (Brabender,
1997).
Developmental Stages.
Despite variation in the number and naming of stages put forward by the various
models of group development, commonalities can be discerned (Wheelan et al.,
2003). A general description of a five-stage sequence follows, with reference to
the models of Tuckman (1965), Garland et al., (1973), and Wheelan et al.,
(2003).
1. At the outset of its
life, the group is in a “forming” (Tuckman, 1965) or “preaffiliation” (Garland
et al., 1973) stage. The focus is on issues of “dependency and inclusion” (Wheelan
et al., 2003). The members will experience anxiety, seek guidance from the
group leader(s) on appropriate behaviors, and engage in tentative
self-disclosures and sharing.
2. Once established, the
group will enter a stage characterized by “counterdependency and flight” (Wheelan
et al., 2003), or a “storming” stage (Tuckman, 1965) defined by struggles around
the issues of “power and control” (Garland et al., 1973). Competition and
conflict among the members, anxiety about the safety of the group and the
authority of the leader are common concerns at this stage. Confrontations of the
leader reinforce member solidarity and openness. Many theories of group
development hold that these struggles over authority and status are essential
for the emergence of genuine cohesion and cooperation.
3. In a third stage of
“norming” (Tuckman, 1965) or “intimacy” (Garland et al., 1973), a consensus on
the group tasks and a working process emerge. The group begins to demonstrate
“trust and structure” (Wheelan 2005), cohesion and openness.
4. A fourth stage of
“performing” (Tuckman, 1965), “differentiation” (Garland et al., 1973), or
“work” (Wheelan et al., 2003) is characterized by a mature and productive group
process and the expression of individual differences. The group has the capacity
for focusing on the task of therapeutic work and the members engage in an open
exchange of feedback. If the group has a time-limited format or certain members
prepare to “graduate” during this stage, elements of disillusionment and
disappointment can emerge.
5. The final stage concerns
the issue of termination, whether of individual members or the group as a whole.
Concerns associated with “adjourning” (Tuckman, 1965) and “separation” (Garland
et al., 1973) prompt the emergence of painful affects and oscillations between
conflict and defensiveness and mature work. The members’ appreciation for each
other and the group experience, along with efforts at preparing for a future
independent of group participation, also characterize termination sessions.
Studies of group development
are generally consistent with the Tuckman (1965) model (Kivlighan, McGovern, &
Corrazini, 1984; Maples, 1988; Stiles et al., 1982; Verdi & Wheelan, 1992;
Wheelan & Hochberger, 1996). MacKenzie’s (1994, 1997) four-stage model
(engagement, differentiation, interpersonal work, and termination) combines the
norming and performing stages identified by Tuckman (1965), arguing that in
therapeutic groups, normative development and a focus on individual adjustment
tend to emerge together. Further detail on each of the five stages described
above, with attention to the leader’s role and recommended interventions are
offered below.
Forming/Preaffiliation.
Members’ behavior will be marked by an approach-avoidance stance regarding close
involvement, and interactions marked by intimacy will be rare. The members will
allude to anxiety, ambivalence and uncertainty about the group. Dependence on
the leader(s) will be high, alternating with a climate of “flight” from the
group situation. Self-disclosure and sharing of therapy goals will eventually
emerge, but tentatively. The leader’s stance is primarily educative. The leader
clarifies the group’s purpose and the therapist’s role, and offers guidelines
for the operation of the group and member participation. Strategically, the
leader allows for regulation of interpersonal distance but invites trust,
assists the members to identify personal goals, and identifies commonalities
between the members. This allows the group interaction to become more structured
and predictable.
Storming/Power and Control.
The members now begin to engage emotionally. The leader’s authority and the
safety of the group as a “container” are challenged. Subgroups may emerge as
members attempt to establish a status hierarchy. Conflict and the expression of
negative feelings of hostility and anger are common. The leader’s tasks are to
ensure that the group passes safely and successfully through this stage and that
a good working alliance begins to emerge amongst the members. The therapist
works to reaffirm the group’s purpose and the members’ common goals. Ground
rules and expectations are reinforced. The therapist encourages group cohesion
and interpersonal learning among the members. Strategically, the leader elicits
the expression of negative affect and assists members to identify and resolve
conflict to demonstrate the embryonic group’s potential. Behavior that is
incongruent with the group purpose is confronted if necessary. The leader avoids
labeling individuals in terms of specific roles or rigidly identifying with
member subgroups.
Norming/Intimacy.
If the group successively negotiates the conflicts of the preceding stage,
member trust, commitment, and willingness to cooperate will increase. Norms for
group behavior become more firmly established. With this structure, the group is
characterized by freer communication and feedback and greater cohesion and
openness. Leadership functions become shared by the members; the leader is able
to assume a more peripheral and less active role. Strategically, the leader’s
interventions aim to maintain a balance between support and confrontation. The
leader’s primary tasks are to facilitate the working process regarding feedback,
promote insight, and encourage problem-solving in an ongoing manner. A
“derailment” of the group process during this stage may suggest that the group
members are revisiting a previous developmental issue.
Performing/Differentiation.
The group has achieved maturity and functions as a creative system of mutual
aid. There is a clearer recognition among the members of the group’s strengths
and limitations. The process is marked by the open expression and acceptance of
interdependence and differences between individuals. The finite nature of a
given member’s tenure in the group, or the life of the group itself, may be
addressed productively by working through ambivalence or defensively through
avoidance or the re-emergence of subgroups. The leader’s focus is on letting the
group run itself. At an intervention level, the leader facilitates
member-member empathy and assists the members to acknowledge and amplify
individual differences. Interventions addressing both member- and group-level
issues can be utilized.
Adjourning/Separation.
With an ending in sight, the group experiences an upheaval of sadness, anxiety
and anger. The member(s) may experience the ending of therapy as a profound
relationship loss, especially if the group has become a source of psychological
support. Members may experience a resurgence of presenting problems or symptoms.
Defensive efforts at denial or flight will alternate with periods of productive
work. Additionally, the members will demonstrate a future orientation and plans
for continuing the therapeutic process or maintaining gains. Expressions of both
sadness and appreciation are common at this stage. The leader’s primary task is
to assist with the expression of feelings and attention to unfinished business.
The leader facilitates a systematic review and evaluation of the group’s
progress, encourages planning for the post-group period, and facilitates
involvement in the process of saying goodbye. The latter activity is a critical
task—unless the termination is properly managed, the gains achieved during
treatment can evaporate (Quintana, 1993).
Summary
1. There is strong
consensus for a five-stage model of group development.
2. The first or forming
stage addresses issue of dependency and inclusion. The
leader aims to educate the
members (group purpose, norms, and roles of participants),
invite trust and highlight
commonalities.
3. The second or storming
stage is concerned with issues of power or status and the
resolution of the associated
conflicts. The leader aims to promote a safe and
successful resolution of
conflict, encourage group cohesion, and facilitate
interpersonal learning.
4. The third or norming
stage reflects the establishment of trust and a functional
group structure (norms). The
leader aims to facilitate an early working process;
interventions reflect a balance
of support and confrontation.
5. The fourth or performing
stage is characterized by a mature, productive group
process and the expression of
individual differences. The leader’s aim is to allow the
group to function at an
optimally productive level, and to highlight the individuality of
the members.
6. The final or termination
stage involves a focus on separation issues, a review of
the group experience, and
preparation for the ending of the group. The leader aims to
encourage the expression of
feelings associated with saying goodbye, and to facilitate
attention to unfinished
business in the group.
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©2007 American
Group Psychotherapy Association
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