WW.G-KRACHT.

COM

Introduction to group
therapy for patients with
a personality disorder

Drs. M. F. van Vreeswijk

Clinical psychologist/ (group) psychotherapist/
Supervisor/ Personal Therapist CBT/ST society

Goals
• Being aware of individual therapy in a group
or group therapy
• Being aware of different group therapy
settings and formats
• Being aware of the difference between a
training group and a psychotherapy group
• Being aware of the different group therapy
stages
• Being aware of the role of co-therapists
• Knowing some tricks to facilitate a group

Starting a group
1. I will give you two minutes to
consider how you would describe
yourself to those who are now
present (e.g. What is the top 3 of
your schema’s on the YSQ)
2. What do you feel about sharing this
in the chat in Zoom

1
 Research on group therapy
• There is so much which we do not know yet!
• What is the best therapy treatment for PD?
• Is there one therapy treatment for all PD?
• Is a superior therapy for every individual
superior?
• Is group therapy better than individual
therapy or the other way around or a
combination?
• Is outdoor treatment better than day
treatment or clinical treatment?

Starting a group (I)

Start with the following questions:
1. Are you going to give a group training or a
group psychotherapy
2. Are you going to give a long-term or short-
term group therapy
3. Are you going to work with a particular PD
or with heterogenity?

Starting a group (II)

1. Are you going to work in day treatment

or clinic (how do you relate to the
complete treatment program and other
professionals)?
2. Are you record sessions or not?
3. What will you do with patients missing
sessions?

2
 Starting a group (III)
• Best is to do groups for PD with a co-
therapist
• Make sure both of you have seen the patient
together (preferable) before the first group
session
• Explain the group model (see also ST-leaflet)
• Explain the different stages and non-specific
helpfull behaviour in group therapy in simple
wording
• Explain the group rules (see also ST-leaflet)

Starting a group (IV)

• Are you willing to show your own human
being to your co-therapist and the group
when approriate?
• Make sure both therapists have 30 minutes
time off before and after the group
• Realise that when you start as a couple
patient drop out will be likely harder
• Realise that group therapy with PD’s is a
challenge. An interesting journey

Starting a group (V)

• Repeat group rules at beginning of session 1
• Do one or two excersises which are related to
getting to know each other and have a
carefull bit of sharing already
• Give compliments for sharing and say this is
important for the group process.
• Summarize what connects all group
members with eachother despite that there
are also differences (but do not focus YET on
that).

3
 Starting a group (VI)
Ask questions like:
1.Who has noticed some similarities in the
group?
2.Who has recognised something?
3.Who also find it difficult to….?
4.How is it for all of you to be together in this
group?

10

What would be interesting

idea’s to let members get to
know eachother?

11

Differences between group therapy

and training (I)
In a training group:
• Focus is on training a skill (emotion
regulation, assertiveness, problem solving
skills)
• Trainers are “teachers”; theory and practice
• Trainers are more active
• Everybody gets an opportunity to say and do
something; trainers make sure of that
• No intervention on interactions in the group
as long as group climate is safe

12

4
 Differences between group therapy
and training (II)
In a group therapy:
• The group is used as a therapy vehicle
• The group is a mini-society where personality
problems become visible and can be worked
with
• Focus on limited refamilying and reparenting
• Therapists are guiding the process

13

Break out rooms:

A group of 6 patients with personality disorders and 2 co-
therapists (and 1-2 observers). To patients; be nice! NO group
of HELL!

Task co-therapists to stimulate the group to

share about emotions and thoughts
(find out what works for you and what do
you have to learn)
20 minutes for group session and 5 minutes for
reflection in Break out room

14

10 minutes break

15

5
 From start-mid phase (I)
• In the beginning of a group therapy you have
to promote recognition and sharing
• In the beginning: building a feeling of being a
member of the group is important
• In the beginning therapists are more active
• In the beginning therapists show how to
share your emotions and thoughts, ask
questions and empathically confront
eachother
• First 3-5 sessions highest drop out

16

From start-mid phase (II)

• In the beginning: patients are wondering if
they belong in the group
• In the beginning: is this group a safe place?
• In the beginning: patients are longing for
individual contact (in the group)
• In the beginning: patients are looking for what
are the group norms and values

17

From start-mid phase (III)

In the mid-phase:
• The group norms and values are more or less
settled
• The group climate is more or less stable
• In a good functioning group there is a balance
between sharing emotions and thoughts and
empathic confrontation between group
members
• Therapists are less active

18

6
 Imagery exercise:
Being in a group therapy for patients with
personality problems
The mid-phase of the group therapy

19

Co-therapists (I)
• Working with two therapists (co-therapist) in
group therapy with PD is a must
• Meet eachother for half a hour before and
after group
• Share your emotions and thoughts with
eachother (work and private life)
• Do you dare to openly discuss in the group
session
• What do you need from eachother?

20

Co-therapists (II)
• Working together for first time means higher
drop out
• If one therapist focusses on an individual the
other focusses on the group
• Be aware that the two of you are “parents” to
the group
• Be aware of competition between the two of
you

21

7
 Imagery exercise:
Being one of a couple of co-therapists
What do you share and when?
What are you afraid of in doing group
therapy for PD?
What do you need from the other person?

22

Final stages of group therapy (I)

• Old habits die hard!

• Will I be able to function without therapy?
• The process of grieving of letting eachother
go
• Shall we continue to see eachother after the
group?
• Try to reduce irritations between group
members; better to have them irritated at you
• Reduce therapeutic interventions

23

Final stages of group therapy (II)

• One or two follow ups: 1-2 months later

• Follow up sessions are no psychotherapy
sessions!
It is about:
• How have you all been working on your
issues?
• What are you doing well?
• Patients are more quiet (OK!)
• Patients interact with eachother (OK!)

24

8
 Some tips and trics
• If a group is very avoidant; begin session with
an exercise
• If a group is very avoidant; see if you can talk
about agression/ shame

• If a group is very active: slow them down by

focussing on emotions and bodily sensations

• If a group is stuck in their problems: what do

you do well?

25

A caution

Do not give group psychotherapy as long as

you do not have been properly being trained
Know what you not yet can!

26

Q? & A!

27