Intermediate Phase

The bulk of work on problem areas occurs during the intermediate phase. To help members reach their goals, the therapist introduces the IPT strategies specific to each problem area (Table 20.7). The therapist promotes the work of the intermediate phase by keeping the group on task, guiding members to:

  • • Maintain a focus on discussing issues related to their problem areas
  • • Increase self-disclosure
  • • Connect to and learn from other group members
  • • Express their emotional reactions primarily in relation to addressing their target goals and interacting with the therapist and with other members
  • • Implement changes based on problem areas in outside circumstances and in the group
  • • Remain motivated to continue in current group treatment, despite concerns about upcoming treatment termination and associated feelings of loss and fear

Table 20.6. Summary Checklist for Sessions 3T05

Therapist Tasks

1. Start and end group on time.

2. Ensure that members have a clear understanding of IPT rationale and roles of

the therapist and members.

3. Cultivate positive groups norms:

  • • Maximize member self-disclosure, and heighten awareness of feeling states.
  • • Keep group member discussions centered on current problem areas.
  • • Continue to assist members in making connections between target goals and difficulties managing relationships.
  • • Encourage members to discuss problems, changes, and successes in applying target goals.

4. Work with members who are struggling to make connections, and encourage them to note the efforts of others as a way to assist them in pushing their work forward.

5. Prepare members to enter the work stage.

Individual Patient Tasks

1. Deepen feelings of connection to other members.

2. Continue to learn how to use group structure and process to work on target goals.

3. Continue to make connections among target goals, difficulties in interpersonal relationships, and symptoms.

4. Modify target goals.

5. Begin applying target goals to daily life outside of group.

6. Share problems, changes, and successes in applying target goals.

7. Solidify goals.

8. Discuss feelings regarding the end of the initial phase.

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.

Grief

A cohesive group can powerfully support a member working through grief issues. The group can validate the member’s feelings and question unrealistic, guilty ideas or distortions that may accompany the disclosure of details of the event. The diversity of grief experiences among members of a typical group provides a rich source of consolation, reassurance, and corrective reorientation. One group member might tell another, “I know just what you were experiencing. I thought I’d never get over it, but I finally did and found some peace about the whole situation. Just keep at it.” Group members can provide such genuinely constructive comments with great expertise. Since death is a universal experience, the group can usually address the related issues with an immediate understanding that is less easily achieved in the other problem areas.

Table 20.7. Interpersonal Problem Area Goals and Strategies

Goals

Strategies

Grief

  • 1. Facilitate the mourning process.
  • 2. Help the patient re-establish interest and relationships to substitute for what was lost.
  • 1. Reconstruct the patient’s relationships with the deceased.
  • 2. Describe the sequence and consequences of events just prior to, during, and after the death.
  • 3. Explore associated feelings (negative and positive).
  • 4. Help the patient consider ways of becoming re-involved with others.

Interpersonal role disputes

  • 1. Identify the dispute.
  • 2. Help the patient choose a plan of action.
  • 3. Modify the patient’s expectations or faulty communications to bring about a satisfactory resolution.
  • 1. Determine the stage of the dispute.
  • 2. Understand how nonreciprocal role expectations relate to the dispute.

Role transitions

  • 1. Help the patient to mourn and accept the loss of the old role.
  • 2. Help the patient to regard the new role as more positive.
  • 3. Help the patient to restore self-esteem by developing a sense of mastery regarding demands of new roles.
  • 1. Review positive and negative aspects of old and new roles.
  • 2. Explore feelings about what is lost.
  • 3. Explore feelings about the change itself.
  • 4. Explore opportunities that the new role brings.
  • 5. Realistically evaluate what is lost.
  • 6. Encourage appropriate release of affect.
  • 7. Encourage development of a social support system and of any new skills called for in the new role.

Interpersonal

deficits

  • 1. Reduce the patient’s social isolation.
  • 2. Encourage formation of new relationships.
  • 1. Review the patient’s past significant relationships, including negative and positive aspects.
  • 2. Explore the repetitive patterns in these relationships.
  • 3. Discuss the patient’s positive and negative reactions toward both the therapists and the group members, and seek parallels in other relationships.
 
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