An outline of group therapy (focus on depression)

Understanding depression, 12 or 24 sessions of integrative group therapy, 2 therapists with 6-8 members, 1.5-2 hours, online counselling skype therapy (exercises)

session 1- Introductions by therapists and members. Framework issues, encouraging openness, trust and mutual respect and support. Previous experience of therapy and expectations. Encouraging commitment and attendance. Exploring how depression might be understood by members, no right/wrongs in terms of therapist’s expectations. Introduction of key areas relating to how depression can be made sense of. [30 min exercise: large sheets labelled: ‘thoughts’ ‘emotion’ ‘body’ ‘relationships’ ‘behaviour’, placed on the floor with large detachable paper arrows that can be moved between the sheets to show connections. Looking at individual ways of how depression is maintained, bad cycles]. Introducing the idea of a journal as homework and during therapy

2- How is depression understood? Looking at individual stories and ways of making sense of depression. Feedback from week 1 and understanding that has potentially emerged. Looking at depression and identity – feelings around having feeling of depression, stigmas, labels, roles etc. Does depression constitute the ‘whole’ of oneself and one’s life? Even if it feels like this does that mean it’s true? [15 min exercise: members talking in pairs on depression and identity, how do they perceive themselves? How do they think the world sees them? How do they perceive each other in the pairs? Note the patterns and differences – Discussion follows]

3 – Early relationships – How do members relate their depression to the families and circumstances they grew up in? [Exercise with genorgams so members can present their relational understanding of current and previous family systems]. Exploring feelings, thoughts and behaviours around this. Similarities and differences to the way they grew up and how they behave now by acting out or reacting. Introduction of the idea of life’s givens, choice and responsibility [eg ‘I cannot change the family I was born in but I have a choice in reframing the way I currently relate to them and to distressing memories by understanding more about myself and about them’]

4- Current lifestyles. Looking at how depressive lifestyle patterns are maintained or continued from family, how depression might feel like overshadowing life. Trying to clarify depressive from non-depressive patterns and triggers. What helps and what makes one more depressed? [15 min exercise: talking in pairs on this subject, group discussion follows] Looking again at how depression is made sense of, is it ‘all’ of one, is it their ‘core self’? Is there such an idea or self can be seen as a more fluid process. Looking at meanings or lack of meaning around depression, how humans need to have purpose and meaning in life in order to maintain wellbeing. Assignment for the next 4 weeks and reporting back: members are invited to make small experiments, behavioural changes and discuss back. Highlighting the therapeutic value of doing safe experiments within a safe process in order to break patterns.

5- Negative thought and feelings. Looking at automatic negative thinking and ways that can be dealt with. How thinking relate to feelings and behaviour. [Exercise: role play with a member presenting ‘negative thinking’]. The importance of being able to ‘stay’ with some negative feeling in order to make sense, exploring the fears and anxiety when one stays with negative feeling. Introducing mindfulness. How we might have understandable negative feelings when faced with trauma etc. Clarifying anxiety, excitement, fear: the exciting and insecure anxiety when one takes a chance in life versus the fearful clinical anxiety and depression when one is withdrawn from life. Finishing with mindfulness meditation [10 min] – online counselling, skype therapy

6- Assumptions and beliefs. Start with mindfulness meditation [10 min- ask group if they wish to start every session alike?]. Looking at underlying assumptions and core beliefs, linking with family dynamics, patterns. How external relations have been internalised? What sort of parenting you received and what sort of a ‘parent’ and ‘child’ do you carry inside you now [Transactional Analysis] Exercise: talk in pairs

another 6 or 12 sessions to follow


by Leo Dolias