Sessions 3-5: The End of the Initial Phase
Sessions 3 to 5 are geared toward preparing members for the next step—the stage in which much of the “work” is done. During this stage, members continue to refine their target goals while beginning to work on them on a daily basis. The expectation is that by Session 5, the majority of group members will have begun addressing one or two target goals.
Since members will know each other better by this time, they will be in a better position to provide meaningful and helpful feedback to each other. At this stage, the therapist encourages members to ask for comments or reactions from other members as a way to help others feel less isolated and to promote reality testing. Some members may interpret the termfeedback as an opportunity to “give advice.” Members should be specifically guided to provide positive feedback, as this is a powerful tool that addresses core self-esteem issues.
During Sessions 3 to 5, it may become evident to the group therapist(s) that certain members are struggling in the tasks of goal setting or daily application. Some members may feel unsure where to begin their endeavors, and feel overwhelmed about how and where to begin. The therapist can help them refine their goals and decide where to begin by encouraging them to choose a specific initial goal, so that they will feel less overwhelmed.
The following excerpt comes from the third session of a group for patients with major depression. In earlier sessions, Mary was active, almost dominating the group as members discussed depression and its effects. In the third session, the therapist effectively brings in other members to address the issue Mary raises and to assist her in thinking about taking steps toward working on it.
mary: Well, this has been a week from hell. My mother called and insisted I go over and help clean her house. Then, my son got the flu, so I had to look after him.
To top it all off, my sister called and wanted me to come over and meet her new boyfriend. By Saturday, I had all I could take. So, I told my husband he would have to look after everything, and I went to bed. therapist: It does sound like it’s been difficult. You had described yourself at the beginning as not being able to set limits due to your depression, and it sounds like that theme was going on this week. Carol, you had said that this was the sort of problem you often encounter. What do you make of what Mary is reporting? carol: Well, I know just what she’s going through. Mary, you just need to get up your courage and learn to say “no.” After our meeting last week, I went home and actually told my husband he has to help out more with the kids. And, you know, he said, “Okay” I almost fell over!
john: I agree, because you don’t have trouble speaking up in here, Mary.
As illustrated here, members often need assistance in learning how to begin to take concrete steps to work on goals. This task will become the primary focus of the intermediate sessions.
While the end of the initial phase in individual IPT is marked by the formulation identifying the patient’s problem area and the focus and goals of treatment, in group IPT-G such tasks are completed prior to beginning group sessions. As such, therapists conducting IPT-G will find that group members are already experiencing a deeper level of affect by the end of the first phase in group IPT, which should be readily apparent during the last session of this phase. This change reveals an awareness of the depth of distress members have been experiencing and provides strong motivation for further work. If all group members have been participating effectively to this point, the therapist may simply acknowledge that the group seems ready to move forward with their work. To gauge this readiness more systematically, group therapists can check with members in Session 5 to ensure that all have made the necessary connections between their symptoms, interpersonal problem areas, and associated target goals. (See Table 20.6 for a summary checklist covering Sessions 3 to 5.)