Therapy
Group Psychotherapy
Lori Pantaleao, Ph.D., LMFT, LMHC, CAP, CTP
Summer 2026
Week 4 - Chapter 3
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The Mask We Wear
Outside of the Mask
What people typically see.
Inside of the Mask
What people may not see.
Outside of the Mask
“What people typically see.” Examples:
Strong
Funny
Organized
Leader
Calm
Successful
Inside of the Mask
“What people may not see.” Examples:
Anxiety
Fear of failure
Loneliness
Self-doubt
Pressure
3
Small Group Discussion
Prompt: Share only what feels emotionally safe.
Discuss:
What was easy to write?
What was difficult?
What surprised you?
Encourage active listening only — no fixing or advice.
4
What was easy to write?
What was difficult?
What surprised you?
Large Group Discussion
Processing Questions
What was it like to share?
What emotions came up?
What increased or decreased safety?
How does this relate to clients entering group therapy?
Which stage of group development did we experience today?
What therapeutic factors were present?
What role did vulnerability play in cohesion?
“What interventions did the facilitators naturally use?”
“Where did you notice resistance?”
“How might this activity need to be modified for adolescents, trauma groups, or substance abuse groups?”
5
What was it like to share?
What emotions came up?
What increased or decreased safety?
How does this relate to clients entering group therapy?
Which stage of group development did we experience today?
Where did you notice resistance?
What role did vulnerability play in cohesion?
Group psychotherapy is powerful because healing occurs not only through insight, but through human connection, shared experience, and corrective relational interactions in real time.
6
The write-up… What else would you add?
Activity: The Mask We Wear
Focus: Group cohesion, vulnerability, interpersonal awareness, and therapeutic process.
Time: 35–45 minutes
Materials:
Blank paper plates/face template/regular paper
Markers/colored pencils
Tape/popsicle sticks
Optional music in the background
7
Key Terms & Definitions
Key Concepts
Group psychotherapy provides:
Support
Universality
Interpersonal learning
Corrective emotional experiences
Opportunity for feedback
Increased self-awareness
Discussion Points
Many clients feel isolated before entering group.
Hearing “me too” can reduce shame.
Groups become a “social microcosm.”
Members often recreate relational patterns seen outside the group.
Clinical Example
A member who interrupts others in group may also struggle relationally outside of group settings.
Group allows real-time processing of those interactions.
8
Best Hopes — Clients’ desired outcomes for therapy.
Pre‑Session Change — Improvements occurring before the first meeting.
Goal Negotiation — Aligning diverse member goals.
Early Alliance — Initial trust and rapport.
Tuckman's 5 Stages of Team Development (Forming, Storming, Norming, Performing, Re-forming)
Initial Stage
Characteristics
Anxiety
Testing safety
Dependence on leader
Superficial conversation
Fear of judgment
Leader Tasks
Establish norms
Encourage participation
Model empathy
Clarify confidentiality
Talking Point
“The beginning stage is often less about deep disclosure and more about determining whether the group is emotionally safe.”
Transition Stage
Characteristics
Resistance
Conflict
Power struggles
Silence
Fear of vulnerability
Common Group Behaviors
Challenging leader
Side conversations
Intellectualizing
Avoidance
Leader Tasks
Normalize resistance
Address conflict directly
Encourage authentic communication
Maintain structure without becoming controlling
Teaching Point
Conflict in group is not failure.
Productive conflict often deepens cohesion.
Working Stage
Characteristics
Increased trust
Vulnerability
Cohesion
Feedback between members
Emotional risk-taking
Therapeutic Factors Become Stronger
Catharsis
Interpersonal learning
Instillation of hope
Talking Point
“The most therapeutic groups are not conflict-free groups. They are groups where conflict can be processed safely.”
Final Stage / Termination
Themes
Loss
Reflection
Celebration
Anxiety about ending
Leader Responsibilities
Process unfinished feelings
Encourage transfer of learning outside group
Reflect on growth
Clinical Reflection
Group endings often mirror attachment experiences.
9
5 Stages of Team Development
Initial Stage
Anxiety
Testing safety
Dependence on the leader
Superficial conversation
Fear of judgment
Leader Tasks
Establish norms
Encourage participation
Model empathy
Clarify confidentiality
The beginning stage is often less about deep disclosure and more about determining whether the group is emotionally safe.
Transition Stage
Resistance
Conflict
Power struggles
Silence
Fear of vulnerability
Common Group Behaviors
Challenging leader
Side conversations
Intellectualizing
Avoidance
Leader Tasks
Normalize resistance
Address conflict directly
Encourage authentic communication
Maintain structure without becoming controlling
Conflict in a group is not failure. Productive conflict often deepens cohesion.
Working Stage
Increased trust
Vulnerability
Cohesion
Feedback between members
Emotional risk-taking
Therapeutic Factors Become Stronger
Catharsis
Interpersonal learning
Instillation of hope
The most therapeutic groups are not conflict-free groups. They are groups where conflict can be processed safely.
Final Stage / Termination
Loss
Reflection
Celebration
Anxiety about ending
Leader Responsibilities
Process unfinished feelings
Encourage transfer of learning outside group
Reflect on growth
Group endings often mirror attachment experiences.
Opening the First Session
Welcome, purpose, and structure.
Introduce solution‑focused philosophy.
Beginning the Group Process with a New Conversation
Belonging brings a sense of importance, acceptance, support and validity in our lives
SFBT group facilitators bring the focus in abilities not deficits
Partnerships form and engagement in a discovery of new perspectives is elicited
Imagine engaging with others where support is given, and all ideas validate and bring new exciting changes
Now remember, you believe people are competent and you provide an atmosphere where they can experience competency and solve their own problems
The power of silence, take notes about what you are observing and listen for: strengths or skills/probable abilities the person is exhibiting that could help resolve their problem, with busy schedules how have them managed to set aside time to attend group- TAKE A BACK SEAT- watch, write strengths, observe how the group moves out of their problem
Share your observations at the end of each session
Major Categories of Group Discussion
Health and Wellness
Sleep patterns
Exercise
Nutrition
Medication education
Recognizing warning signs
Personal Control
Anger management
Stress management
Personal hygiene
Impulse control
Cognitive Behavioral Therapy (CBT) or Rational Behavioral Therapy (RBT)
Relationships
Assertiveness
Boundaries
Conflict management
Major Categories of Group Discussion, cont’d
Grief, loss, and forgiveness
Parenting skills
Values and Beliefs
Goal setting
Values
Beliefs
Goals
Safety Planning
Warning signs for recidivism
Identifying supports
Discharge/Safety planning
Mental Health Systems
How to talk to your doctor
How to get the support you need
Chemical Dependency
12 steps / Alcoholics Anonymous or Narcotics Anonymous
Dual diagnosis (co-morbidity of multiple mental health conditions)
Eliciting Best Hopes
“What are your best hopes for our time together?”
“How will you know this group is useful?”
Identifying Pre‑Session Change
“What’s already better since you decided to join?”
Facilitating the Group: First Meeting
First meeting
set the mood for focusing on solutions,
introduce yourself and
Tell us a little about how come you are joining us today?
Suggest goal setting
What will be going on in the future that will tell you and each of us that things are better for you?
Search for exceptions
Let's talk about those times before the problem started to interfere with your life. What were you doing to keep them away?
Encourage motivation
When the problem that brought you to the group is less what will you get to do more of? Is there someone in the group whom you might like to encourage to do something different?
Assist group members with task development
as we stop today, I would like each of you to watch your day-to-day activities closely and notice when your situation is not bothering you as often
Facilitating the Group: Second Meeting
Second group meeting:
Who would like to start our time together telling us what's better since the last time we met?
Let’s suppose more of that happens or in spite of things being rough, you managed to come back to group, what do you all think that says about this member?
You have experienced challenging events, I am not surprised that your progress is taking more time, I would not be surprised if your change is slow and steady, we will be here for you as your process continues
Building Cohesion Early
Normalize diverse goals.
Highlight shared themes.
The First Step Map
Each participant draws a simple map showing where they are now and the first small step toward their preferred future.
Members share maps in small groups.
Group identifies common first steps to build early momentum.
Developmental Adaptations
Children
Use drawings to express best hopes.
Keep goals simple and concrete.
Adolescents
Use peer‑based activities to build cohesion.
Adults
Focus on practical, measurable goals.
Older Adults
Emphasize dignity, autonomy, and life experience.
Case Vignette
A member reports feeling worse before the first session. Students explore how to use pre‑session change questions to uncover unnoticed strengths.
Discussion
Why is the first session so critical in SFBT?
How do you handle conflicting goals in a group?
Video- Self of the Therapist/Group Leader
GRIT- The power of passion and perseverance https://youtu.be/H14bBuluwB8
Assessment
Define pre‑session change.
1
Explain how best hopes shape group direction.
2
Describe two strategies for early alliance‑building.
3
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