Introduction
When individuals lose someone close to them, either spouse, friend, or family member, they tend to experience grief. When facing a loss, people manage this traumatic experience in different ways. Some enter into depression, especially children who have not experienced such events. There are two approaches that a therapist can use to help a patient, for example, group or individual sessions. The former is categorized into an open or closed group whereby individuals can be allowed to join the program after it has progressed or are denied permission to do that.
It is important to note that group therapy is appropriate for the selected group of patients in this case. It allows one person to learn from others which can ensure that the healing process is fast. Additionally, the chosen collection of individuals consists of children as well. This means that the adults can offer more support to them and help them cope better since the experiences might be novel to them. The major challenge presented by the use of this technique is the issue of confidentiality. Even though a psychologist is legally and ethically bound to not share information about the clients with a third party, the group members are not. This paper looks at cognitive-behavioral group therapy for bereaved patients.
Needs of the Clients
The cognitive-behavioral group therapy in this discussion is offered to bereaved patients. These are individuals who are in deep sorrow at a loss of a close relative or friend. The number of clients is ten as the group consists of five children and five adults. They can be reassured that their feelings, emotions as well as pain are normal and that all experience loss and grief differently (Berardelli et al., 2018). This group of clients shows various behaviors and emotions, and it can be comforting to them to be guaranteed that the intensity of their sentiments will diminish over time. Some of their needs include a balance between privacy and companionship.
Bereaved patients need a chance to express their grief without feeling embarrassed. Comfortable surroundings are required where the patient can speak about their emotions. Thirdly, they need acknowledgment of the various symptoms that may happen due to intense grieving. These indicators usually resemble physical alterations that happen after or during a severe condition and may consist of loss of appetite, sleep, motivation, and strength and behavioral inconsistencies (Berardelli et al., 2018). The fourth need is support or assistance in becoming socially reactivated. Someone who is dependable and trustworthy has to be close to assist them in social circumstances. Additionally, the active listener would be beneficial in terms of healing since the clients need a chance to re-narrate their encounters.
As hard as grief counseling can be, the level of difficulty increases when handling children and their family members. Special care has to be given when doing this to aid them in grieving in a healthy way. However, there are tips on how to conduct this procedure and make it easier. For instance, answering any question asked by a patient, even the tough ones concerning the issue of death. A therapist ought to offer them honest answers that are proper for both their development and age. It is preferred to use terms such as killed or died rather than passed away or lost.
The other tip is to provide children with choices when possible. They should be allowed to decide how they wish to say goodbye to the individual, permit them to join in the funeral arrangements and the service, as well encouraged to work through grief. Thirdly, the professional needs to speak about and recall the deceased (Butler et al., 2018). This helps them to view grief as a normal part of life and empowers them to focus on good recollections they had with the dead. Someone in the profession of counseling ought to show respect to the variances in grieving styles. A child within the same family may have dissimilar coping methods. It is best or appropriate to allow them to work through it. Lastly, listening without judging them would ensure they heal faster from the situation. The key is to avoid communicating how they need to behave or feel.
Type of Group
Many individuals find it great to be part of both group and personal therapy. Doing this boosts the chances of making valuable and lasting changes for someone. In the event that a person who has been engaging in individual psychotherapy and is not experiencing any progress, joining others may lead to a level of growth. There are two types of groups, including open and closed, and, in this case, whereby there are bereaved patients, the chosen approach is the latter (Ardehali et al., 2020). In this one, every member starts the process toward recovery simultaneously (Ardehali et al., 2020). For instance, they may participate in a twelve-week session together. The format offers varying types of surroundings allowing deeper therapeutic work to happen in contrast to conventional bereavement support groups. It is client-led as well as cost-effective and can be replicated. It is easy to adapt to fit other services’ needs.
A closed group is the most usual type whereby psychoeducational programs are implemented and have been proven to possess particular benefits for implementation. They offer an organized scheme with a set amount of time and sessions, enabling patients to have one experience from start to finish (Do et al., 2021). Such encounter has been discovered to give secure and consistent surroundings for individuals to associate with and feel the support from others. They as well are thought to provide the clients with a greater sense of safety as a result of the stability of the social environment of the group.
The approach allows facilitators to build upon prior weeks and establish trust with members without the disturbance of one entering or leaving on a constant basis. The only disadvantage of this format is being unable to instantly address community needs for intervention and probable retention matters that threaten the process (Do et al., 2021). Accountability is one of the benefits of a closed group intervention. Participants are empowered to share setbacks and successes, and they provide support as well as encouragement.
The closed group format allows an individual to be a part of something greater. While trying to help the bereaved, the person who engages in an intervention can feel as if they are associated with a mission bigger than them (Do et al., 2021). It makes it easy for one client to learn from another since they hear and are able to understand what others underwent in their life. They look objectively at the faults and successes of people within the program.
There are professionals who claim that for bereaved patients, it is important for a therapist to consider advising them to embrace the open group format. This approach is whereby a new member can join regardless of how far the program has reached, and there will be a period of adjustment while familiarizing oneself with the other participants. However, there is a section of researchers who argue that it is not the right path to follow (Do et al., 2021). For instance, it can be a source of instability and unpredictability, lacks intimacy and depth, and it is difficult to balance the instant needs of members.
Inclusion Criteria
To be included in the group therapy aimed at enabling the ten patients to heal, there are certain conditions that someone had to achieve. For instance, the selected individuals were supposed to be between the age of 10 years old and thirty-five years old. Additionally, they had to have a loved one who had recently died. For example, a spouse, child, brother, sister, parent, relative, or friend (Wolgensinger, 2022). Exceptions were made for those who claimed to have lost colleagues at work with whom they had bonded prior to demise. Above all, one was required to have shown symptoms such as loss of appetite, sleep, motivation, and strength, and behavioral inconsistencies mentioned earlier.
For the intensive outpatient program, it would be a single 3-hour session from 9 to 12 noon, Monday through Friday, for five weeks. Regarding the transition part, a two-hour session would be required, between 9 and 11 am, twice weekly for twelve weeks (Wolgensinger, 2022). In the weekly recovery initiative, one would need a 2-hour session, from 9 to 11 am, once every week for 12 weeks. Lastly, for monthly recovery intervention, it would be once a month from 6 to 8 pm for five months.
Confidentiality Issues/Contracts
As the group approach in treatment is gaining popularity, awareness of some ethical dilemmas usually seem to be a risk factor in this format than in individual therapy. Confidentiality refers to an issue that warrants much-needed attention in groups (Ewuoso, 2021). Even though a therapist is ethically and legally bound, no rules exist for a member engaging in therapeutic dialogue (Naidu, 2018). To dispel the fear around the matter, it is assumed that promoting cohesion and trust amongst participants will put them at ease.
Principles of ethics that psychologists adhere to have a responsibility to respect a piece of information’s confidentiality. This notion is based on someone’s right to privacy, whereby it allows a client to establish the level to which data about them and their condition are shared and how that is accomplished. Someone being able to communicate such intimate insight about themselves, they expect that the professional will ensure it remains confidential and used to assure progress in treatment (Ewuoso, 2021). Organizations put in place limits to this to guarantee that the public is secure. Therefore, a person ought to learn about the restrictions before committing to a program.
Even though there are limitations on the data that can be legally and ethically maintained between a clinician and a client, the latter is encouraged to not fear communicating how they feel with a therapist. Generally, unless the professional is mandated by law or given permission by the patient, they cannot disclose any knowledge of the situation learned during any of the sessions. When third parties are available during treatment, they are not held to similar legal and ethical standards. Hence, the capacity to put one at ease regarding ensuring confidentiality presents a bigger problem than in individual treatment.
Although it is assumed that anything shared between a therapist and his or her client should remain confidential, doubts emerge when the patients undergo the process within a group. Complications arise when self-disclosures are heard by multiple participants instead of only the clinician. In the event the members become dependent on one another and are able to form connections, it is impossible to guarantee that the obtained information will remain undisclosed to outer parties. When it is emphasized that people need to convey their experiences, emotions, or feelings, it usually exerts pressure on participants. On the one hand, they are greatly encouraged to share with others in the group. This does not mean that they are sure as to if the listeners will keep the data to themselves. In the early phases of group work, seeming forced to do that can result in a lack of trust. To correct this, it is essential to comprehend the issue of confidentiality, know the restriction, and respect shared information.
Many facilities ensure that members participating in group therapy know and understand the importance of confidentiality in such settings and will dismiss anyone who tries to go against the guideline. Nevertheless, enforcement has been discovered to be hard, as suggested by Ewuoso (2021). The research found that individuals who underwent mental distress due to breaches of this policy felt that the leaders failed to strongly hold accountable those in violation. There exists an uncoded rule that anything discussed in a therapeutic environment will remain confidential and that those in charge will address the matter before the treatment begins.
Nonetheless, participants are not held to similar legal and ethical standards as the therapists. There are possible implications for a clinician who breaches confidentiality when unwarranted. There is no common statute upholding the rights of privacy when another person apart from the client and professional is available even when they are actively engaged in the process. Whereas a psychologist usually reminds the members of the group regularly of the significance of maintaining confidentiality, they are not legally or ethically bound to such conduct. It is viewed often with respect to following that route, as suggested by Koocher (2020). It is necessary when involved in group therapy to have a clear sense of the meaning of discretion and the need to respect disclosures. Having a group leader or psychologist define privacy and explain its implications is proper and necessary but is often enough to guarantee that people assume confidentiality in a group function can be a norm. To address the matter, it has been suggested that members engage in a debate concerning the topic, review the contracts, or use examples to illustrate intentional or unintentional violations.
Cognitive-Behavioral Group Therapy Approach
Cognitive-behavioral group therapy is an approach in counseling whereby behavioral, relational, cognitive, as well as group processes are used to improve the coping capabilities of the clients. It has been concluded by most systematic reviews that this method is effective in helping individuals in situations that may lead to depression. For example, in this case, there are bereaved patients who, if not assisted, might become depressed. The aim or objective of applying this technique is to prevent the negative effects of depression. In many areas, it is recommended that a clinician opts to apply it first.
Delivering the method for depression in the format used in this case is cost-effective as compared to individual treatment. Group therapy sessions may offer more benefits as clients may profit from cohesion as well as normalization impacts. They may as well utilize the group as a platform to engage in behavioral trials, learn from other people, and work as co-psychologists. Some clients do not accept or approve of this type of approach as there is less time dedicated to the healing of one person. There have emerged concerns on whether it is possible to generalize the discoveries from studies.
Using this context, it is easier to differentiate between the effectiveness and efficacy of a treatment method. The latter means the outcome attained in experiments, while the former refers to the results in regular practice. The main objective of the research is to establish an association between a particular technique and results. The participant is usually chosen patient and is treated by a qualified therapist who strictly follows manuals for therapy, receives routine overseeing, and whose adherence is closely supervised. Consistent practice can be characterized by unselected clients, flexible utilization of treatment protocols, and high therapist caseloads. It has been recommended that as a result of harsh exclusion standards, those participating in clinical experiments are not a depiction of people seen in practice which compromises the generalizability of randomized controlled trials. Recent research shows only minor variations in the characteristics between those in RCTs and others in clinical practice, which may be representative of more liberal inclusion criteria in more current RCTs (Ewuoso, 2021). Ethically, it is not feasible to randomize individuals to either active or non-active control conditions.
Multiple researchers have attempted to explore the effectiveness of cognitive-behavioral group therapy for adult depression in regular practice. To define a study’s clinical representatives, Morrison et al. (2019) recommended some standards, including non-university surroundings and referred patients. Others include psychologists with routine caseloads, flexible structure, no training of a therapist for study purposes, or monitoring of the implementation of treatment. In the studies, there were one thousand, eight hundred and eighty patients included in the evaluations. It was found that an average effect magnitude of 1.13 for treatment completers as well as 1.06 for intent-to-treat examination in decreasing depression seriousness (Lazarov et al., 2018). Understanding all this information about the selected approach, it is important to develop sessions or stages a patient will undergo.
There will be five stages as shown below:
- Stage 1
- Session 1 – opening;
- introduction of aims;
- clients introduce themselves;
- forming (i.e., participants look up to the group leader to offer them direction).
- Stage 2
- Session 2 – developing a connection between the therapist and clients;
- storming (i.e., conflict and competition in the relationship between therapist and members begin to develop).
- Stage 3 is defined by cohesion, as suggested by Lazarov et al. (2018).
- Session 3 – the therapist utilizes conflict management strategies to work with the client;
- interventions are implemented to establish connections among participants and between them and the therapist;
- norming (i.e., individuals reach a consensus concerning respect and dynamics and embrace the uniqueness of every one of them).
- Stage 4
- Session 4 – implementing cognitive-behavioral therapy;
- clients make individual contributions to group activities;
- useful examples (one person said…) are introduced to foster communication.
- Session 5 – collecting feedback from the clients;
- addressing the issues;
- providing the clients with comments on how they should address their challenges.
- Stage 5
- Session 6 – adjourning;
- making conclusions;
- commenting on whether the aims have been achieved;
- disengaging from the group.
Conclusion
The paper has looked at cognitive-behavioral group therapy for bereaved patients. The needs of such a group have been explained, for instance, a chance to express their grief without experiencing embarrassment. Most of the time, after an individual loses a loved one, they may feel as if no one is trying to understand them. The pain and the manner in which they may grieve might appear different to another who deals with similar encounters in a varying way. In therapy, the professional attempt to be a great listener and non-judgmental to ensure that the client is willing to express themselves without fear. This is important, particularly for children who do not understand how to behave or how to feel but show signs of grief.
The paper has introduced the concept of group therapy, whereby individuals experiencing similar issues undergo treatment together. In such settings, they can opt for either an open or closed group whereby a new person is allowed or not permitted to join after the method has progressed. In the case of bereaved patients, the latter is better since adding another client not present at the start might lead to distrust or discomfort in the current participants.
Lastly, it is important to note that cognitive-behavioral group therapy refers to an approach in psychotherapy whereby behavioral, relational as well as cognitive processes are used to better the coping capability of a client. Through systematic reviews, experts have concluded that it is effective in assisting people in circumstances that may result in depression. For instance, in the case of bereaved patients, if treatment is not provided early, the symptoms might persist and lead to more severe mental conditions.
References
Ardehali, S. H., Fatemi, A., Rezaei, S. F., Forouzanfar, M. M., & Zolghadr, Z. (2020). The effects of open and closed suction methods on occurrence of ventilator-associated pneumonia; A comparative study. Archives of Academic Emergency Medicine, 8(1). Web.
Berardelli, I., Bloise, M. C., Bologna, M., Conte, A., Pompili, M., Lamis, D. A.,… & Fabbrini, G. (2018). Cognitive-behavioral group therapy versus psychoeducational intervention in Parkinson’s disease. Neuropsychiatric Disease and Treatment, 14, 399. Web.
Butler, R. M., Boden, M. T., Olino, T. M., Morrison, A. S., Goldin, P. R., Gross, J. J., & Heimberg, R. G. (2018). Emotional clarity and attention to emotions in cognitive-behavioral group therapy and mindfulness-based stress reduction for social anxiety disorder. Journal of Anxiety Disorders, 55, 31-38. Web.
Do, A., McGlumphy, E., Shukla, A., Dangda, S., Schuman, J. S., Boland, M. V.,… & Craven, E. R. (2021). Comparison of clinical outcomes with open versus closed conjunctiva implantation of the XEN45 Gel Stent. Ophthalmology Glaucoma, 4(4), 343-349. Web.
Ewuoso, C. (2021). Patient confidentiality, the duty to protect, and psychotherapeutic care: Perspectives from the philosophy of ubuntu. Theoretical Medicine and Bioethics, 42(1), 41-59. Web.
Koocher, G. P. (2020). Privacy, confidentiality, and privilege of health records and psychotherapy notes in custody cases. American Journal of Family Law, 41-50. Web.
Lazarov, A., Marom, S., Yahalom, N., Pine, D. S., Hermesh, H., & Bar-Haim, Y. (2018). Attention bias modification augments cognitive-behavioral group therapy for a social anxiety disorder: A randomized controlled trial. Psychological Medicine, 48(13), 2177-2185.
Morrison, A. S., Mateen, M. A., Brozovich, F. A., Zaki, J., Goldin, P. R., Heimberg, R. G., & Gross, J. J. (2019). Changes in empathy mediate the effects of cognitive-behavioral group therapy but not mindfulness-based stress reduction for social anxiety disorder. Behavior Therapy, 50(6), 1098-1111.
Naidu, T. (2018). To Be or Not to Be…Revealing questions of anonymity and confidentiality. The Palgrave Handbook of Ethics in Critical Research, 241–256.
Wolgensinger, L. (2022). Cognitive-behavioral group therapy for anxiety: Recent developments. Dialogues in Clinical Neuroscience, 17(3), 347-351.