Group Therapy: Final Stage

Answer

Group Therapy: Final Stage

All psychotherapies (be they in individual or group settings) must at some point come to an end. The final stage of group therapy, also know n as the termination phase, is  associated with the very process of psychotherapy as well as outcome variable that range from treatment gains consolidation, intense feelings (by both the client and the therapist), and  the client’s readiness for further growth. As the therapeutic relationship comes to an end, various points need to be considered if treatment outcomes are to be optimized and the client prepared for continued development and growth even beyond psychotherapy. This paper discusses the termination stage and considers an appropriate tool for evaluating the group at the end of therapy.

Emphasizing the significance of the termination stage in the entirety of the psychotherapy process and the therapeutic relationship, Bhatia and Gelso (2017) point out three aspects that should be given attention namely the real relationship, the working alliance, and the notion of transference. Here, transference, or  “the patient’s experience and perceptions of the therapist that are shaped by the patient’s own psychological structures and past, involving carryover from and displacement onto the therapist of feelings, attitudes, and behaviors belonging rightfully in earlier significant relationships” gain elevation because they involve the client’s  therapeutic internalization (Bhatia & Gelso, 2017: p. 77). Examining these three aspects, it becomes clear that client and therapist outcomes are equally important. They should be given consideration during the termination stage.

Imperatively, the termination phase should include a review as well as reinforcement of changes (within individuals) that have taken place during the therapy. Additionally, the therapist should be keen on guiding the departing clients to smooth resolutions of relationships among themselves and with the therapist (Corey, 2016). It is also important that each client within the group gets help that would enable him or her to face life challenges in the future by applying the tools, knowledge, and skills acquired during therapy. Groups members including the therapist may encounter various problems during the termination phase, among them being feelings of sadness. A wide body of literature documents loss in the context of the termination phase where, for instance, clients and therapists grieve the loss of each other and the termination of bonds that have been built during the therapy duration (Knox et al.,2011).  On the part of therapists, they are likely to develop anxiety and even fall into depression if their own feelings and experiences of loss are intense. Therapist anxiety is also likely to develop from the therapist’s perception of the sensitivity of clients to loss. Bhatia and Gelso(2017)  illuminate the feeling of loss and sadness during termination by giving examples of research where findings suggested that “more than half of the therapists alluded to feelings of sadness and loss during termination”.

There is also likely to be a challenge in terms of personal conflicts being intertwined with the group therapeutic process. Clients who have made significant progress from the start may realize new levels of intimacy as well as personal contacts that may lead to negative reactions and emotions. Amid these challenges, the therapist should be keen to employ interventions that offer symptomatic relief while also delivering to clients a sense of personal worth and the feeling that their life has moved in the right direction more so in the presence of contextual interpersonal relationships (The American Group Psychotherapy Association, 2007). One intervention in this regard is taking time to disengage and say goodbye to each other, as opposed to ending the therapeutic relationship suddenly. This can be done by setting specific deadlines through which the group works through the process of departure (McKenzie, 2013). Another intervention that would work to address feelings of sadness and loss would be to give gifts and other appropriate physical expressions of appreciation such as hugs, embraces, and handshakes. Positive talk would also help here.

Evaluation

A tool for group therapy evaluation is developed and named the Group Therapy Anticipation and Feedback Tool (GTAFT) (see Appendix 1). Part A should be filled by each client prior to the start of group therapy, or more precisely during the introductory session. Part B is to be filled during the termination stage. Since many baseline factors are not known prior to the group therapy or would require a different assessment approach, the greater part of this evaluation is dependent on part B, which is expected to give insight to the clients’ state before and after the program. Importantly, this tool is intended to give a measure, so each of the responses in part B have been assigned a score/value, the sum of which would be expected to give a reflection of the client’s standing following the group therapy. Extreme positives give a sum score of 20, so a client scoring above 15 would be considered to have benefited optimally from the therapy since that aspect can be determined through perception. Any score above 10 but below 15 would imply the therapy was somehow effective to that particular client while any score below 10 would imply the therapy was not effective (or the client did not benefit).

The scores/values for the various responses are tabulated as follows: