Group and Family Therapy

Group and family therapy modalities are essential components of clinical social work practice. The ASWB exam tests your understanding of group development stages, facilitation skills, therapeutic factors, and major family therapy models.

Tuckman's Stages of Group Development

Bruce Tuckman identified five stages that groups typically move through:

Therapeutic Factors in Group Therapy (Yalom)

Irvin Yalom identified therapeutic factors unique to group therapy:

• Universality: Discovering that others share similar struggles ("I'm not the only one")
• Altruism: Helping others in the group, which builds self-esteem
• Instillation of hope: Seeing others improve gives hope for one's own recovery
• Imparting information: Learning from the therapist and other group members
• Corrective recapitulation of the family group: Reliving and reworking family dynamics in the group setting
• Socializing techniques: Learning social skills through group interaction
• Imitative behavior: Modeling positive behaviors observed in other members
• Interpersonal learning: Gaining insight into relationship patterns through group feedback
• Group cohesiveness: The sense of belonging and being valued by the group
• Catharsis: Emotional release through expressing feelings in a safe environment
• Existential factors: Confronting fundamental questions about life, meaning, and responsibility

Group Facilitation Skills

Effective group leaders must manage several common group dynamics:

• Monopolizing: One member dominates the conversation. Intervention: Redirect by inviting others to share; set time limits.
• Scapegoating: The group blames one member for its problems. Intervention: Protect the scapegoated member; explore the group's projections.
• Subgrouping: Cliques form within the group. Intervention: Address in the full group; rearrange seating; use structured exercises.
• Silence: Members are reluctant to speak. Intervention: Normalize silence; use structured prompts; explore what the silence means.
• Resistance: Members resist engaging in the process. Intervention: Explore ambivalence; avoid power struggles; use motivational approaches.

Family Therapy Models

Social workers must understand the major approaches to family therapy and when to apply them.

Structural Family Therapy (Salvador Minuchin)

Structural family therapy views problems as arising from dysfunctional family structures — specifically, problems with boundaries, hierarchies, and subsystems.

Key Concepts:

• Subsystems: Family members form subsystems (parental subsystem, sibling subsystem, spousal subsystem). Each subsystem has its own roles and functions.
• Boundaries: Rules that define who participates in each subsystem and how.
  • Clear (flexible) boundaries: Healthy; allow appropriate interaction between subsystems
  • Enmeshed (diffuse) boundaries: Too permeable; family members are overly involved in each other's lives, poor differentiation
  • Disengaged (rigid) boundaries: Too impermeable; family members are emotionally disconnected, lack support
• Hierarchy: A healthy family has a clear parental hierarchy where parents hold authority over children
• Joining: The therapist enters the family system and adapts to its style to gain trust
• Enactment: Having the family interact during the session to observe patterns directly
• Restructuring: Actively intervening to change boundaries, hierarchies, and subsystem interactions

Strategic Family Therapy (Jay Haley, Cloe Madanes)

Strategic family therapy focuses on changing specific interaction patterns that maintain the problem. The therapist takes a directive, problem-solving approach.

Key Techniques:

• Directives: The therapist assigns specific tasks or homework to change behavioral patterns
• Reframing: Presenting a problem in a new light to change how the family perceives it
• Paradoxical interventions: Prescribing the symptom or suggesting the family resist change, which often motivates the opposite response
• Communication patterns: Identifying and interrupting dysfunctional communication cycles

Bowenian Family Therapy

Murray Bowen's approach was discussed in Chapter 1 but is applied therapeutically through:

• Genograms: Multigenerational family diagrams that map relationships, patterns, and significant events across at least three generations
• Coaching: Helping individuals differentiate from their family of origin
• De-triangulation: Helping individuals step out of triangulated relationships
• Working with the most motivated family member: Unlike structural therapy, Bowen often works with individuals to change the family system

Couples Therapy

Common approaches to couples therapy include:

• Emotionally Focused Therapy (EFT) (Sue Johnson): Based on attachment theory; helps couples identify negative interaction cycles and develop secure emotional bonds
• Gottman Method: Based on decades of couples research; focuses on building friendship, managing conflict, and creating shared meaning. Identifies "Four Horsemen" of relationship failure: criticism, contempt, defensiveness, and stonewalling.

Psychoeducation Groups

Psychoeducation groups provide structured information and skill-building for specific conditions. They are commonly used for:

• Families of individuals with schizophrenia or bipolar disorder
• Parenting skills training
• Chronic disease management (diabetes, heart disease)
• Caregiver support
• Substance use recovery support