THE IPT GROUP Initial Phase

The tasks of the initial phase of treatment are to refine and consolidate, at a group level, the tasks introduced in the individual pre-group meetings. By helping group members to make preliminary connections between their symptoms and relationship difficulties, the therapist sets in motion a productive momentum. The therapist then amplifies this momentum as members begin to learn to work together as a group. Sessions 1 to 5 represent IPT-G’s initial phase, during which the therapist has the following objectives:

  • • To cultivate positive group norms and group cohesion
  • • To emphasize the commonality of symptoms and how they will be addressed
  • • To educate members about IPT-G theory and their role in treatment
  • • To review the interpersonal inventory of each group member and link his or her symptoms to the interpersonal context
  • • To consolidate the principal problem area and establish a treatment contract.

Session 1: Getting Started

The main objective in this first group meeting is to help members join the group without overdisclosing information. Given the extensive pre-group preparation and

Table 20.4. Summary Checklist for Session i

Therapist Tasks

1. Start and end group on time.

2. Welcome and introduce members.

3. Cultivate positive group norms and cohesion:

4. Reiterate the common diagnosis, and generate the expectation of recovery.

  • • Educate about IPT treatment, group structure, and process issues.
  • • Encourage all members to join in the discussion of interpersonal problem areas and associated target goals, using information gleaned in pre-group interviews.
  • • Begin to facilitate member self-disclosure.

Individual Patient Tasks

1. Introduce self (including details regarding reason for joining group, work stress, activities, significant others).

2. Begin to understand IPT treatment structure and group process.

3. Develop feelings of connection to other members.

4. Reveal and begin to clarify initial target goals.

5. Perceive an expectation of recovery.

Copyright © 2000 Denise E. Wilfley, K. Roy McKenzie, R. Robinson Welch, et al. Reprinted by permission of Basic Books, a member of the Perseus Books Group.

goal formulation in IPT-G, members not uncommonly come “charging out of the gate” during the first session. When this occurs, the therapist should educate the group and encourage members to proceed slowly, assuring them that there will be plenty of time for them to get to know one another. (See Table 20.4 for a summary checklist covering Session 1.)

The following excerpt comes from a first session of IPT-G for depression. The therapist begins by orienting members to the process of sharing a little about themselves and their goals:

therapist: Today you will begin to communicate with people you don’t know and find out what it’s like to be in a group. Talk a little bit about who you are and what brings you here. And then, if you feel like you can, maybe share a little bit about some of the goals that you have set for yourself or some of the things that you think you’re going to be interested in working on over the next twenty weeks. Next session, we will start talking more about the important people in your life and the people that you’re really needing to make changes with. So, that’s how we’ll have things unfold over at least the next couple of sessions. Again, as things come up, and as issues come up with the goals, we’ll want to talk about that with you. Who would like to start?

samantha: I will. My name’s Samantha. I’ve been a secretary for many years. I have a great husband, a terrific little toddler. So, externally, everything just seems great, but I’ve been really depressed. I just got the group goals as I was leaving for tonight’s session. I didn’t really get to look at them, except at the traffic lights.

therapist: One of the things we had talked about being important [in the pregroup interviews] was what other group members have been talking about today, about not feeling validated. And I think that was one of the things you talked about, too. So not being validated by your parents and then not feeling like you’ve been able to let other people give you positive feedback or say good things about you, especially even your husband . . . samantha: Yeah.

therapist: That seemed like a real important connection.

samantha: It was. Just after I had met with you, it was just—I sat out in my car and I cried. I’ve thought about it a lot since I met with you both. It touched on things. And I mean I’ve had therapy for years, and nothing ever struck a chord for me like it did in my session with you both.

therapist: Also, I think you mentioned difficulties in your work situation as well. You find yourself feeling frustrated, not feeling like you have the right to speak up. samantha: Right.

therapist: Right. And I think—Caroline, you had mentioned that, too, not feeling like you had the right to express yourself.

Caroline: For me, it is more with my family, not so much work situations. I don’t want to hurt anyone’s feelings so I tend to keep it to myself. I don’t want to feel like a burden.

therapist: . . . so, feeling it is not okay to share your feelings. samantha: . . . uh, that’s creating a problem more and more within myself and in my relationships.

Caroline: For me too. It is so hard, though, to do that. therapist: Is anyone else connecting with this issue?

Notice how the therapist assists Samantha by bringing in information from the pregroup meetings and guides her to clarify her goals, while encouraging others to join the discussion.

 
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