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Therapy groups evolve and change over time. Group dynamics reflect both personal and group development. Knowledge on how groups proceed and the stages of group therapy will help in formulating strategic interventions for mental health conditions.
5 stages of group therapy
Tuckman’s model of group development suggests that there are 5 stages to group development in group therapy. The five stages are explained below:
Stage 1: Forming
In the forming stage, group members look up to the therapist or group leader for direction. Participants usually behave well and may experience some anxiety, and uncertainty about the group.
Acceptance is desired by group members and each individual wants to know if the group is a safe space before they start sharing about the challenges that they are facing.
First impressions are made and serious topics and feelings are usually not talked about at this stage. Group members are tentative in self-disclosure.
The therapist’s role at this stage is to educate and clarify the purpose of group therapy. Additionally, the therapist will also aim to enable each participant to identify personal goals as well as common challenges of the group.
The group is ready for stage 2 when group members risk the possibility of conflict by getting into more ‘threatening’ topics.
Typical behaviors in the Forming stage include:
- Getting acquainted and comfortable with group members.
- Group members are polite.
- Higher need for approval.
- Group members are guarded.
- Personal feelings are kept hidden.
- Group tends to be dominated by individuals who are more verbal.
- Group members ask for information from each other and give information about themselves.
- Low ability to accomplish group tasks.
Stage 2: Storming
In the storming stage, competition and conflict in the relationship between group members and therapist start to develop. Conflicts start to arise when individuals have to adjust their ideas, attitudes, feelings and beliefs to suit the group.
Differences between group members can generate discomfort with some members trying to dominate while others remain passive. The storming stage is important as genuine cohesion and cooperation can only be achieved when the group works through conflicts and tensions.
During this stage, the therapist works to encourage group cohesion while reassuring and affirming the purpose of group therapy and goals that are to be achieved.
The therapist also facilitates conflict resolution among group members by encouraging participants to listen, understand, accept and respect each other.
Typical behaviors in the storming stage include:
- Subgroups and/or individuals attempting to influence ideas and values.
- Competition for recognition and attention.
- Conflict and confrontation among group members.
- Emotional reactions to tasks or opinions of others.
- Unsolicited comments and opinions may be given.
Stage 3: Norming
The third stage is characterised by cohesion. Group members reach a consensus about group dynamics and respect and appreciate the unique qualities of each individual in the group.
Contributions of group members are acknowledged and issues that arise are solved together. Group members are also able to change preconceived ideas about others when facts are presented. Subgroups or cliques decrease as members are more trusting towards each other.
As group members begin to feel a sense of belonging, they start to share their feelings and ideas as well as solicit and give feedback to each other. Trust between group members results in openness and group tasks are accomplished well together.
Each individual starts to feel good about being a part of the group.
The role of the therapist in this stage is to facilitate and provide feedback and encourage healthy problem solving strategies.
Typical behaviors that can be observed in the norming stage include:
- Confrontation of issues, rather than people.
- Group cohesion.
- The disappearance of subgroups and cliques.
- Active listening among group members.
- Risky issues are brought up in meetings.
- Group members move from blame to responsibility.
- Quieter people start to contribute more.
- Acceptance of alternative viewpoints.
Stage 4: Performing
The performing stage is characterized by group members working together independently with roles and group dynamics adjusting to meet the needs of both individuals and the group as a whole. There is an acceptance for individual differences and group members are self-assured.
During this stage, group members feel accepted and the sense of belonging enables high group morale and loyalty. Group productivity is high and there is support for new ideas when it comes to problem-solving.
During this stage, the therapist focuses on facilitating empathy between group members and if needed, assists the group in acknowledging and accepting individual differences.
Typical behaviors in this stage include:
- Group members relate to each other with respect, honesty and authenticity.
- A sense of security results in sharing and accepting new ideas and opinions.
- Individual differences are met with integrity and unity.
- Group members are committed to working towards common goals.
- Diversity is welcomed and respected.
Stage 5: Adjourning
In this final stage, group members disengage from the group relationships.
Participation and achievement of group members is recognized and members are given the chance to say their goodbyes to each other. Group members may experience anxiety, anger, sadness and even upheaval, especially if the group has been a significant source of psychological support.
During this stage, the therapist helps group members to express their feelings as well as attend to any unfinished businesses before bringing the group to a conclusion. There may also be a review or a progress evaluation of group members.
Follow up treatment may be required by some group members and it is the therapist’s role to assess it accordingly.
Typical behaviors that can be seen in the final stage include:
- Apprehension over the potential loss of friendships and support
- A sense of achievement when group goals have been accomplished.
- Evaluation of progress and reports.
- Saying goodbye.
Group therapy can be very effective for mental health conditions such as depression, anxiety, as well as substance use disorders. If you are considering group therapy, do discuss with your mental health practitioner one of the different types of group therapies to find one that will be able to properly address your struggles.
The article is a part of our comprehensive series on “What is group therapy and what to expect?”