Group Modality

A group refers to a collection of individuals with a common objective that they wish to accomplish together. It could also mean two or more people gathered with a common purpose or interest in a cognitive, affective and social interchange in single or repeated encounters sufficient for participants to develop impressions of one another. Norms are set and collective functioning and goals are developed for their collective activity. A sense of cohesion is developed and they consider themselves distinct from other collectives. (Hartford, 1972).

Human beings are social beings who can use others as mirrors to their own experiences, feelings or behavior. Groups can influence behavior as they create their own styles or specific culture. Family, peers and teachers shape our goals, values, perceptions of life and sense of self. They can enhance or instill new beliefs. They increase one’s self-awareness, change attitudes as well as interpersonal competence. (Toseland W. & Rivas F, 2001)

Group influence is affected by the amount of attachment one has to the other members, values and norms in the group status of the group, rewards and sanctions for conformity and nonconformity and the importance of the group to the member. (Hartford, 1972).

Therapy groups are organized for the purpose of correcting specific behavioral or emotional disorder that impedes a person’s function. In a group therapy, focus is given to unconscious factors, one’s past and personality change (Seligman M. & Marshak E,  1990)

Group formation ensures that goals are set through interactions. The leader considers the needs of each member and integrates them. Service goals, individual goals may be exposed or internalized and considered secret while others may be unconscious, for instance seeking acceptance. All members create goals.

In today’s world individualism is emphasized and groups are important in helping to build relationships group therapy is important on issues like intimacy and people affect each others behavior over time. (Rutan S. & Stone N, 2001)

Specific and clearly defined purpose increases their self-awareness and can identify external distortions causing destructions in their lives.

There are various mechanisms of change in the group context. Members can use imitation where they observe how others react, solve problems and use new styles and then incorporate them. Identification, which entails taking aspects of others to change ones perceptions and group’s cohesiveness. Members could see aspects in fellow members, which they may not be aware of. Internalization deals with a shift in the psychic structure to produce a detailed examination and reexamination of emotional interactions. It is facilitated by confrontation, clarification, interpretation and a sense of belonging. (Felix F. & Laroca D, 1986).

Through repeated experience one learns all that is expected of them. Interpretation should not be made absolute but should be posed to them for further contemplation.

Phases of group treatment.

In the engagement stage bonding is based on common experience and understanding. It begins at a superficial level where there is anxiety for some members but after bonding is accomplished feelings of interconnectedness develop. Anxiety is reduced through self-disclosure and commitment.

The differentiation stage entails the movement to a sense of self where people attempt to demonstrate their own identity. There is more tension in this phase and the need to cooperatively explore each member differences arises. Support and constructive confrontation as the group grows to maturity is important.

The interpersonal or work stage increases focus on individual members. Self-exploration and self-revelation are more common and members explore themselves more deeply. Consequently bonding intensifies.

In the termination stage disengagement is delicate and if this stage is not executed it may undo much of the work accomplished in a group.

According toHartford’s Group Phases include the Pregroup Phases when the idea to start a group is birthed. It could be Private where an idea exists in the mind of the organizer and it determines the potential composition of the group. There is no blueprint for the group yet

It becomes Public when decision to have group is disseminated. Flyers can be used or contacting agencies to refer clients. In notify candidates one finds out why people want to join and allow prospects to decide if group would benefit them.

Decisions are made on time, location and size.

The Convening stage is the beginning of group formation and leaders meet with potential members to discuss their expectations. An assessment of whether people think their expectations will be met is done. Leaders can observe interactions between members.

In the group formation phase people must be significant to one another and discern common purposes or goals as a group. Collectivity is highly enhanced. Time duration for this may vary.

The Phase of integration, disintegration or reintegration is around the third or fourth meeting. Negative social and emotional behavior rises and conflicts may appear.

Original leadership roles may shift as people become more comfortable with themselves.

Members try to establish their identities

Termination Phases.

In pretermination stage people prepare for the end. Evaluation of group accomplishments is done. Work is done through difficulties as members face the realization of the end. Parties could be organized for the last session. Some members may reduce their interactions at this point by showing up late, not showing up at all, or by decreasing their involvement in the group

Separation and anxiety increase as members find themselves wondering why they did not perform, as they ought. They may blame others for not participating. Things to be examined include the meaning of the group to each member, relation to group purposes, meaning of the worker and group aspects.

According to Rutan’s Group Phases include the formative Phase where members struggle to create a group that feels safe enough for them to participate in the therapeutic process. They fear being controlled and engulfed and dependency on the group is observed.

There is a struggle with autonomy and acceptance and it is a period of regression

How they handle this can tell the therapist a lot about past and current relationships and defenses typically used by each member. Advice giving is offered. Stories brought up in the group in this phase symbolize feelings members have in the group. Transition into second phase occurs when trust and acceptance is felt by members

In the reactive Phase individuality of each member becomes apparent.

There is a power struggle as members try to free themselves from the control they feel the group has over them. They try to figure out how to maintain their identity while belonging to the group. Norms are tested and hostility increases.

As the group development commences members tend to lose their identity to conform to the before becoming autonomous to step back into self and learn to relate to others.

Mature Phase entails the group working together towards set goals

Feelings can be expressed openly or confidently and members can assume a variety of roles. Conflicts and different points of view can be tolerated

Members become aware of patterns by reflecting on similar experiences in the group. The leader is no longer seen as omnipotent as members have a more realistic view of him or her.

The Termination stage escalates at half waypoint where members contemplate of the group coming to an end

Definition of group treatment as a modality.

Group therapy plays an important role in the treatment of eating disorders at all levels of care: in initial psycho education, as an adjunct to in-hospital management, in outpatient treatment, or as the central modality in a day hospital program. Group therapy offers the patient acceptance and reinforcement by peers in a treatment setting that is both effective and time-efficient for the clinician

Group work is characterized by diversity, which spans from client populations, client problems, and social work settings (Fink A, 1978).  Groups change with the needs of the times. In a group, members get support and acceptance.  Clients with eating disorders face rejection but group therapy provides them with support. In a positive group setting, members provide acceptance while supporting and encouraging necessary changes.  Here members learn of trust, compassion and empathy.  Interpersonal relationships enhance communication in groups

In a group, members get support and acceptance.  Clients with eating disorders face rejection but group therapy provides them with support. In a positive group setting, members provide acceptance while supporting and encouraging necessary changes.  Here members learn of trust, compassion and empathy.  Interpersonal relationships enhance communication in groups

Group therapy enables clients to gain a more realistic view of situations through group experience.  Universality is a key element in group therapy.  It is a tremendous relief to know there are others like you.  Groups show clients they are not alone as they share feelings and experiences.  All group members are unique.  Clients all have different views and different levels of comprehension.  .  In eating disorder groups the common trait of having an eating disorder is the desire to be special and unique.  The eating disorder itself makes group members feel special.  In a group, members share interests and they share burdens.

In eating disorder groups, anorexics have poorer outcomes then bulimics.  Anorexics tend to be more rigid, withdrawn, anxious, and have extreme difficulty in identifying and expressing feelings.

Groups could be segregated or homogeneous or mixed heterogeneous groups.  Segregated or homogeneous groups have with people with the same disorder.  Segregating enhances similarities among members and they relate to each other easily.  Experts feel it is best not to mix groups.  Heterogeneous or mixed groups can be therapeutic.  In anorexic groups members are egocentric, hypersensitive and anxiety may be high making group interaction impossible.  Anorexics may be competitive.  Each wants to have been the one to eat the least, weigh the least, and be the best anorexic.  Mixed groups might sometimes be a better alternative. (Bryant-Jeffries Richard, 2006)

Mixed or Heterogeneous Groups Anorexic, bulemic and binge eating groups are prevalent especially in inpatient treatments facilities.  All clients have the common characteristics of self-destructive relationships with food and their bodies.  Combining disorders can be difficult for the leader, but if the group works well benefits are remarkable.  Hearing the painful journey of an anorexic can be helpful for the treatment of a bulemic or vice versa.  Clients within the group look at each other’s strengths and weaknesses and see themselves in each other. A support group usually doesn’t provide therapy, however, provides education and support. (Carolyn C, 1999)

The Role of the Leader in the Group Milieu

The leader in a group has diverse roles to play. He or she encourages members to interact and is viewed as an expert, authority figure and change agent who assesses members’ problems and develops goals. He or she should treat each member in a unique manner. The role of the leader is predominant and there is need to conceptualize the leadership role. (Harper-Giuffre H. & Mackenzie R, 1992).  Group development is a priority and it requires all members to participate. Determining emerging roles and exploiting them is necessary for group development. People with positive view of relationships will be important. Confrontation may be appropriate in the differentiation stage. Interpretation should not be done at this stage and leaders should look for themes of commonality. (Harper-Giuffre H. & Mackenzie R, 1992).

Leaders play the role of facilitating the process by which members test themselves and establish their roles while participating in direction of the group. Roles taken may be an initiator, antagonist, clown, synthesizer, mediator, supporter, helper, teacher and attacker


Role of the Client in the Group Milieu

During Individuation members become increasingly receptive to psychological exploration that may be intense and painful but will end up being extremely satisfying.

There is need to realize the connections between psychological events and eating behavior. (Harper-Giuffre H. & Mackenzie R, 1992).  

During Intimacy members become aware of roles played in the group that mirror outside relationships and experience with new behaviors learned in the group.

(Harper-Giuffre H. & Mackenzie R, 1992). During Mutuality members experience and acknowledge that they can be important to someone else and accept responsibility for their interactions with others. The meaning of closeness is explored.

Members should participate in group discussion and agree to rules created either by leader or group as a whole. Contracts could be suggested when working with groups that have an eating disorder. Members may agree to maintain a certain weight while in the group and there is need to bond with therapist as well as group members.



















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HartfordE.  1972. Groups in social work.ColumbiaUniversityPress. New York,NY

Seligman M. & Marshak E.  1990. Group Psychotherapy Interventions with Special Populations. Allyn & Bacon Needham Heights,MA

Rutan S. & Stone N. 2001. Psychodynamic group psychotherapy 3rd Ed. TheGuilford Press.New York,NY

Felix F. & Laroca D. 1986. Eating Disorders: Effective Care and Treatment Ishiyaku Euro America, Inc. Tokyo,Japan.

Bryant-Jeffries Richard. 2006. Counseling for eating disorders in women: person-centered dialogues.OxfordSeattle: Volume: xiii, 173.

Costin Carolyn. 1999. The eating disorder source book: a comprehensive guide to the causes, treatments and prevention of eating disorders, 2nd Edition.Los Angeles,CA,LowellHouse

Arthur Fink.1978. The Field of Social Work, 7th Edition. NY by Holt, Rinehart & Winston