A STUDY OF ATTITUDES ABOUT INDIVIDUAL AND

GROUP THERAPY

IN CLINICAL AND NON-CLINICAL POPULATIONS

[contd....]

RATIONALE AND AIM

A review of the literature has pointed that there is no evidence that one modality is more effective then the other.

The debate about the effectiveness of psychotherapy is not resolved the same as the debate about the effectiveness of individual therapy compared to group therapy.

Theoretical observations were made to try to assess which client is more suitable to which form of therapy but in reality clients are referred to what is available in their area or to what economically is more effective.

The theoretical explanations about the importance of group therapy are valid but in reality clients and therapists have the tendency to work individually.

The aim of this research is to check the expectations and perceptions of different subjects according to their therapy experience (group and / or individual therapy) or lack of experience and the influence of different modalities of therapy on clients' attitudes towards therapy.

The problem that therapists have that they never ask the consumer what he/ she really wants.

Maybe it is time to ask the client, who is on the receiving end of the therapy what his /her needs are from therapy? As the counsellors and the psychotherapists work according to different theoretical orientations it is time to understand what is the client’s perception of therapy, what are his /her needs, thoughts, feelings?

This research will check the attitudes towards individual and group therapy from the point of view of the client, taking the clients’ expectations and perceptions in consideration, and may suggest some guidelines when deciding about the process of group therapy. Who to treat and how and in what kind of therapy.

HYPOTHESES

Considering the above considerations the following hypotheses were developed:

METHOD

A self completion questionnaire was designed specifically for the study. The questionnaire measured attitudes towards group and individual therapy. Subjects who had experienced either group or individual therapy or both or no therapy at all, responded to statements using a 4-point scale:

* Strongly agree

* Mildly agree

* Mildly disagree

* Strongly disagree

The questionnaire aimed to identify the relationship between type (s) of therapy experienced and attitude towards those therapies.

Subjects

A total of 81 subjects was sampled. The sample was obtained by sending the questionnaires to therapists practising individual and/or group therapy and requesting that the questionnaires were distributed to clients. The questionnaires were also sent also to Alternative Healing centres to be completed by clients that did not experience any therapy at all.

• Two hundred questionnaires were distributed of which 81% (40%) were completed.
• Of the 81 respondents 9 (11.1%) were male and 72 (88.9%) female.
• Ages ranged from 19 to 60 years with a mean of 42.9 (standard deviation = 9.17).
• Thirty-seven (45.7%) reported having both individual and group therapy.
• Twenty-six (21%) had individual therapy only.
• Seven (5.67%) had group therapy only.
• Eleven (8.91%) subjects reported having no therapy at all.
• Sixty-three (54%) subjects had individual therapy, number of sessions Mean =98.246.
• Forty four (35.64%) subjects had group therapy, number of sessions Mean =36.068
• The number of individual sessions Mean =50 was twice as much as group therapy sessions
• Mean =25.
• Fifty-seven (89.1%) subjects had individual therapy first.
• Seven (8.6%) subjects had group therapy first.
• Seventy-two (88.9%) subjects would have preferred to have individual therapy at present.
• Seven (8.6%) subjects would have preferred to have group therapy at present.
• Two (2.5%) subjects did not have any preference at all.

QUESTIONNAIRE DEVELOPMENT.

The questionnaire was developed to assess client views of individual and group therapy.

The items were generated on the basis of a review of the literature, case study, discussion with colleagues, and my own experience.

A number of items were suggested by certain instruments employed by Yolanda Sanchez Slocum (1987).

The items were divided into 2 groups:

1) items about individual therapy; positive and negative,

2) items about group therapy; positive and negative.

In phrasing the items an effort was made to word items positively and negatively with respect to desirability. The items were randomly ordered and structured such that subjects responded on a 4 point, agree-disagree format. Slocum (1987) in her questionnaire had five points that the middle one was the no-opinion middle point, this point was not included in the questionnaire as the questionnaire was given to subjects that never experienced any form of therapy. The no-opinion point gave the opportunity for those who did not have any experience of therapy not to make a statement. It was of interest to know what would be the empirical attitudes of those who have never experienced therapy. This was done to avoid the opportunity to escape from making a statement on the basis that they did not have any experience in that kind of therapy.

Apart from the quantitative questions, a number of qualitative questions were designed.

The questionnaire also included a question like:

"From which therapy have you benefited or will you benefit the most and why?"

The questionnaire consists of 30 items reflecting attitudes, feelings and thoughts about group therapy.

RELIABILITY TEST

Reliability was established using Cronbach’s alpha.

The reliability was established following the main administration of the questionnaires.

The two groups of statements relating to individual and group therapy had an Alpha smaller than 0.6.

Individual therapy had Alpha=.5482

Group therapy had Alpha=.4376

As a result 5 items that had shown weak reliability were removed.

Those statements were:

• -In individual therapy I might become dependent on my therapist.
• -Individual therapy might be too intense for me.
• -Group therapy is more effective than individual therapy.
• -Being in a group of people who have emotional problems will make me feel worse.
• -In group therapy I can be quiet.

Following this reliability was once again established that individual therapy items had an Alpha=.8548

And group therapy items had an Alpha=.7031

Although considering the statements relating to Individual therapy; items 7 and 11 have shown the lowest reliability, and it seems that there was not a wide consensus regarding those statements.

The statements were:

7. In individual therapy I can explore my issues deeper than in group therapy. Alpha=.4215

11. In individual therapy I feel more protected. Alpha=.5894

23. In Individual therapy I am pressurized to talk all the time. Alpha=.2358

Considering the statements relating to group therapy; items 2, 3 and 29 have shown the lowest reliability, and it seems that there was not a wide consensus regarding those statements.

The statements were:

2. Group therapy reflects reality better than individual therapy. Alpha=.1400

3. In group therapy I tend to be more passive than in individual therapy. Alpha=.1568

29. I have found group therapy more beneficial than individual therapy. Alpha=.0747

The reliability test has shown that the statements about individual therapy and the subjects' responses were more reliable then those of the group therapy.

PROCEDURE

200 questionnaires were issued to local counsellors and psychotherapists and Alternative centres in Colchester area. The counsellor and psychotherapists were chosen among those who work in private practice and their clients have made the choice to take part in individual therapy or group therapy settings.

Each practitioner was issued with number of questionnaires and S.A.E's and a personal letter (see appendix A) was sent to them and to the subjects who agreed to answer the questionnaire promising confidentiality.

RESULTS

Participants' responses to each of the questions were determined.

89% preferred to have individual therapy at the moment.

Table 1: The four experimental conditions,

The subjects were allocated to four experimental conditions.

The four conditions represent two conditions for each of two variables:

Positive and negative attitudes towards individual therapy.

Positive and negative attitudes towards group therapy.

INDIVIDUAL THERAPY QUESTIONS

The following statements were taken into consideration checking attitudes towards individual therapy : 1 - 5 - 7 - 11 - 18 - 20 - 28 - 30 - 23. (See appendix B)

Attitudes toward Individual therapy revealed that:

Total mean :

21.44

(55 subjects)

GROUP THERAPY

Taking the 34 subjects that have responded ‘yes’ to group therapy, their mean score is 21.59, comparing to the 21 subjects that have responded ‘no’ to group therapy, their mean score is 21.19. There was no significant difference in the mean score between the two responses.

INDIVIDUAL THERAPY

Taking the 40 subjects that have responded ‘yes’ to Individual therapy, their mean score is 21.55, comparing to the 15 subjects that have responded ‘no’ to Individual therapy, their mean score is 21.19. There was no significant difference in the mean score between the two responses.

2 X 2 TABLE:

In considering the 4 conditions. the following means were obtained:

Table 2: Subjects’ mean responses towards individual therapy statements.

Group 1. Represent subjects that had individual and group therapy.

Group 2. Represent subjects that had individual therapy only.

Group 3. Represent subjects that had group therapy only.

Group 4. Represent subjects that did not have any therapy.

The lower the mean the more favourable the attitude towards individual therapy is.

Subjects that did not had any therapy at all (group 4) had the most favourable attitude towards individual therapy, while subjects that had group therapy only (group 3) had the less favourable attitude.

Subjects that had individual and group therapy (group 1) had a more favourable attitude then subjects that had individual therapy only (group 2).

The difference between the mean score of the group that had group therapy only and the group that had no therapy at all is significant. (Group 3 26.40 - Group 4 18.50)

The results do not show any significant difference between the groups.

A 2-way ANOVA was carried out on the individual questions considering those who had had individual therapy and those who had had group therapy. The following effects were found:

Table 3: Analysis of variance

INDIVIDUAL Source of Variation Sum of squares DF MEAN F Significance of F Main Effects 2.906 2 1.453 .073 .930 GROUP 1.012 1 1.012 .051 .823 INDIVIDUAL .852 1 .852 .043 .837 2-way interaction 273.065 1 273.065 13.632 .001 GROUP-INDIVIDUAL 273.065 1 273.065 13.632 .001 Explained 275.971 3 91.990 4.593 .006 Residual 1021.556 51 20.031 Total 1297.527 54 24.028

From the above table it can be seen that the only significant effect was the interaction between group and individual [F=13.632 (1,51) p=0.001]

Figure 1: Interaction for individual therapy items

The following graph demonstrates the differences between the variables and the significance of the interaction between them.

This graph shows that the gap between subjects that had individual therapy only and those who had individual and group therapy (left side of the graph) is smaller than those who had group therapy only and those who did not had any therapy (right side of the graph).

The lower the value on the chart reflects the most favourable attitude towards Individual therapy.

GROUP THERAPY QUESTIONS

The following statements were taken in consideration checking attitudes towards Group therapy : 2 - 6 - 10 - 16 - 19 - 21 - 26 - 29 - 3 - 4 - 8 - 12 - 13 - 17 - 25 - 27. (See appendix B)

Attitudes towards group therapy have revealed that:

Total mean:

44.14

(51 subjects)

GROUP THERAPY

Taking the 26 subjects that have responded ‘yes’ to group therapy, their mean score is 43.50, comparing to the 25 subjects that have responded ‘no’ to group therapy, their mean score is 44.80. There was no significant difference in the mean score between the two responses.

INDIVIDUAL THERAPY

Taking the 37 subjects that have responded ‘yes’ to Individual therapy, their mean score is 42.55, comparing to the 14 subjects that have responded ‘no’ to Individual therapy, their mean score is 48.50 There was a significant difference in the mean score between the two responses.

2 X 2 TABLE:

Table 4: Subjects’ mean responses towards group therapy statements

Group 1. Represent subjects that had individual and group therapy.

Group 2. Represent subjects that had individual therapy only.

Group 3. Represent subjects that had group therapy only.

Group 4. Represent subjects that did not have any therapy.

The lower the mean, the more favourable the attitude towards group therapy is.

Subjects that had individual therapy (group 2 42.07) had the most favourable attitude towards group therapy, while subjects that had no therapy experience (group 4 48.90) had the less favourable attitude.

Subjects that had individual and group therapy (group 1 42.77) had a more favourable attitude then subjects that had group therapy only (group 3 47.50).

The results show a significant difference between the groups.

Table 6: Analysis of variance

INDIVIDUAL
Source of Variation	Sum of squares	DF	MEAN	F	Significance of F
Main Effects	367.744	2	183.872	5.267	.009
GROUP	.448	1	.448	.013	.910
INDIVIDUAL	346.205	1	346.205	9.918	.003
2-way interaction	9.598	1	9.598	275	.602
GROUP-INDIVIDUAL	9.958	1	9.958	275	.602
Explained	377.342	3	125.781	3.603	.020
Residual	1640.697	47	34.908
Total	2018.039	50	40.361

This analysis shows that there is a significant difference between attitudes of the two groups, subjects that had individual therapy have a more favourable approach towards group therapy.

F 9.918 (1, 47) (p=.003)

Meaning that there is less than 5% probability that it was due to chance or error.

On the 2-way interaction, there was no significance difference or interval between subjects that had individual therapy or group therapy.

Figure 2: Interaction for group therapy items

The following graph demonstrates the differences between the variables and the significance of the interaction between them.

The graph shows that the gap between subjects that had individual therapy only and those who had individual and group (left side of figure) is only slightly smaller than those who had group therapy only and those who did not had any therapy. (Right side of figure.)

On the other hand there is a significant difference between subjects that had individual therapy experience and individual plus group therapy experience, which their attitudes towards group therapy are much more favorable then those who did not have any therapy experience or those who had group therapy experience only.

The lower the value on the chart reflects the most favourable attitude towards group therapy.

Trying to check the impact that those therapies had or will have on the different groups I have produced the following graph.

Figure 3: Comparing subjects’ attitudes towards group therapy and individual therapy

As there was a different number of statements regarding individual and group therapy due to the reliability analysis in which some of the statements had to be put out, for that reason the impact of different experiences on the different groups cannot be measured exactly.

Putting it visually on the graph shows that:

Subjects that had individual and group experience had a closely similar attitude towards both therapies, were more favourable then subjects that had group therapy only, who has a closely negative attitude to both therapies.

Subjects that had Individual therapy only had a little more favourable attitude towards Group therapy then towards individual therapy, while subjects that didn't had any therapy had the most positive attitude towards individual therapy then all the other groups and the most negative attitude towards group the therapy then all the other groups.

The following table will demonstrate it:

Table 7: Order of preferences of attitudes towards individual and group therapy

Group & Individual	2	2
Individual only	1	3
Group only	3	4
No therapy experience	4	1

Group 1 - Subjects that had individual and group therapy experience had the same attitude for individual and group therapy. Although their attitudes were not the most favourable.

Group 2 - Subjects that had individual therapy only had the most favourable attitude towards group therapy.

Group 3- Subjects that had group therapy experience only had the least favourable attitude towards individual therapy.

Group 4 - Subjects that didn’t had any therapy experience had the highest score regarding individual therapy and the lower score for group therapy.

THE QUALITATIVE RESEARCH

Additionally to the quantitative research the subjects were asked to answer the question: "From which therapy have you or will you benefited the most and why?

The intention here was to give the subjects the opportunity to explain and describe their experience in their own words. The statements in the quantitative research might reflect my subjective thoughts about both therapies and restrict the subjects to answer according to the narrow criteria of the research while the open ended question gave the freedom to express their thoughts and feelings more freely.

Eight statements from eight subjects were chosen. These statements were the most interesting ones and they reflect the common attitude that subjects had regarding group therapy.

Subject 1:

The silence of the group leader reminded me of my father and so I suppose there was some transference going on there and that was why I felt so angry with him. I really feel that if a therapist is going to use the 'silent approach' as I call it then they ought to explain that to their client before they start, the main benefit I received from group therapy was that I found that other people's experiences were very similar to mine and that proved to me that I could not be inventing my symptoms.

The main disadvantage of group therapy for me is that I found that after a while I began to get better but that I tended to behave in a way appropriate to the group. That is to say, I would behave normally at work or with friends, but when I entered a therapeutic situation where you were expected to be 'sick' to some degree, I changed my behaviour to meet that expectation. I did not really do it consciously but I realised it later when I analysed it. I think that the group therapy encourages that behaviour, because of the combination of group conformity and role playing.

Subject 2:

In a group therapy situation I did not know what to expect, the long moments of silence made me anxious.

Subject 3:

In my experience group therapy can be abused by those who lead it if they choose to discriminate against some members of the group in order to raise the confidence of others in the group.

Subject 4:

Individual therapy helped me sort through personal problem, group therapy helped me with feelings and understanding that others have similar experiences.

Subject 5:

I have benefited the most from individual therapy because the counsellor understands some of the problems that I discussed, although was judgmental on others.

The group experience was frustrating because no one spoke, and no-one wanted to reveal anything.

Subject 6:

I have benefited mostly from individual therapy, because I was able to go in my own pace, sometimes the work I have done in individual therapy has enabled me to not only cope with a group but to, progress a long way in a group. has also helped the other way. Something has triggered in a group that I have then been able to work through individually.

Subject 7:

In the group therapy I felt lost and left behind.

Subject 8:

I benefited from both kinds of therapies in different ways.

It was good for me that I had individual therapy for about two and half years before I started group therapy. In my individual therapy I learnt to acknowledge my needs and to look after

myself. I got a much better and healthier sense of my true self. It made me strong enough to face working with a group.

My work in the group expanded my horizon enormously. I could interact with different kinds of people in a protected environment. It helped me to get rid of fears and prejudices.

I learnt to stand up for myself and the respect and affection I got from people in the group improved my self confidence.

I also learnt to accept other people's support, while before group therapy I was very fixed on my therapist's support and felt more dependent on her.

I found the combination of the two therapies most helpful.

Individual therapy focused me on the relationship with myself while group therapy focused more on the outside world.

The main problem of the subjects that have experienced group therapy is the lack of understanding about the aims of such therapy, subjects that had previous individual therapy experience were more aware and ready for the group experience and could understand how the two therapies compliment each other.

DISCUSSION.

Checking the attitudes towards individual and group therapy from the point of view of the client and comparing their responses towards each therapy, this research aimed to suggest some guidelines about taking those factors in consideration when deciding about the process of group therapy. Who to treat and how and in what kind of therapy?

The results of the investigation indicate that there exist major differences between attitudes towards individual or group therapy. These results tend to indicate that there exist unfavorable attitudes towards group therapy.

Checking the results of the research in light of the hypotheses:

Hypothesis 1 stated that individual therapy would be preferred over group therapy. Indeed 89% preferred to have individual therapy at present.

From the statements that were given to the participants it was shown that there was a vast agreement that individual therapy is safer than group therapy. (Statement 1).

One more reason that individual therapy was more popular is that a good number of subjects endorsed the notion that group therapy is diluted therapy because the therapist has to be shared with other group members.

It is interesting to point out that participants that did not have any therapy at all had the most favorable attitude towards individual therapy. (See table 7) Their attitude was more favorable then those who had individual therapy experience. In the latter group this is probably due to unfulfilled expectations as a result of individual therapy experience.

This result is similar to the study of Slocum (1987) who showed that group therapy is not as effective as individual therapy.

The results show that participants that had individual therapy, had the most favorable attitude towards group therapy, while participants that had both therapies have slightly less favorable attitude towards group therapy. (Hypothesis-2)

These facts might reflect that the expectations of the participants from group therapy were not fulfilled and that subjects that had individual therapy experience were more prepared for a group experience.

Participants that had no therapy experience favoured individual therapy (Hypothesis-3). On the other hand they had the less favourable attitude towards group therapy. It is probably because that this group is not ready for group therapy and that individual therapy should precede group therapy. While participants that had group therapy only had the lowest score for group therapy and a low score for individual therapy and that suggests that those participants might not come back to therapy due to negative experience. (Hypothesis - 4)

Hypothesis -5 stated that group therapy would be preferred over individual therapy by participants that had individual and group therapy experience but it is interesting to point out that participants that had individual and group therapy experience did not favoured group therapy more than participants that had individual therapy only. This might suggest that:

* Participants that had individual and group therapy experience probably experienced unfulfilled expectations in their group therapy.

* Participants that had individual therapy experience are more ready for the group experience.

Yalom (1966) points out that there is a major unfulfilled expectation that clients bring to the group therapy situation.

Further support for this observation is obtained from Yalom's (1966) study of group therapy dropouts, in which he found that an important factor resulting in premature termination for a number of clients who had initially requested individual therapy but who had, nevertheless, been assigned to a group, was their "inability to share the doctor." Apparently, these clients had experienced positive outcomes as a result of their involvement in individual therapy and anticipated the progress in a group would be minimal or at best limited because the focus of attention had to be shared.

Subjects that had group therapy only (group 3) had the most unfavorable attitude to individual therapy and group therapy (see table 7). It is consistent with Slocum’s (1987) findings that group therapy can be detrimental. As mentioned in Stone’s and Rutan’s (1982) research that clients that had group therapy only tend to drop out more (50%) then clients that have experienced both therapies. (16%).

The unfavorable attitudes towards group therapy suggest that individuals anticipate that they will have decreased control over their behavior in a group. They may be pressurized to behave in ways that are uncharacteristic or unacceptable to them. (Statements 23 & 27) Such perceptions would create a great deal of anxiety, particularly for potential clients who typically fear self-disclosure, intimacy, and loss of control. Slocum (1987) is right to say that: it is precisely this population that would benefit the most from a group experience. (P. 49) But it is precisely this population who has to growth through individual therapy experience before being ready for the group experience.

It is suggested from the research results that clients that have experienced individual therapy have a most positive attitude towards group therapy because they have the awareness to see that group therapy is a natural progression of individual therapy. On the other hand clients that have experienced both therapies favour individual therapy more then group therapy due to the unfulfilled expectations.

The reliability test have shown that certain statements were not perceived clearly by the participants as positive or negative, e.g. Statement 9, In individual therapy I might become dependant on my therapist. Maybe dependency this is what clients need in the beginning of their therapy process. Perceiving this statement as a negative might be a judgment of what we think is good for the client. There were also few statements that were included in the analysis but have shown the lowest reliability. E.g. Statement 23, In individual therapy I am pressurized to talk all the time. Statement 7, In individual therapy I can explore my issues deeper or statement 11, In individual therapy I feel more protected..

Those statements have shown that there was not a wide consensus. This is probably due to different therapy experiences by different participants which were factor of the theoretical approach of the therapist and the significance of the therapeutic relationship. These factors were not taken into consideration in this research.

The interesting fact is that the experience of clients that had individual therapy only did not improve their attitudes towards individual therapy and they have scored the third place on their positive attitudes towards that kind of therapy. Also clients that had group therapy only scored the third place on their positive attitudes towards that group therapy.

Although the subjects that had individual therapy only had the most favourable attitude towards group therapy, subjects that had group therapy only had a destructive experience and have the less favourable attitudes towards individual and group therapy. (See table 7).

It seems that clients that had individual therapy are better prepared for group therapy then clients that had group therapy only. Individual therapy should precede group therapy. It is not recommended to start a therapy experience with group therapy.

Group psychotherapy is portrayed in the media and film industry as an experience for socially undesirable or deviant individuals with who the average person does not wish to identify. (Slocum 1987).

Slocum (1987) in her study about the group therapy survey found that the non-clinical population (subjects that did not had a therapy experience) expressed more positive attitude towards group therapy then the clinical population. Her explanation to this phenomenon is that the clinical population, as a whole, may experience greater anxiety at the prospect of participating in a group; in other words, their level of social anxiety may be higher than those subjects not seeking counselling, which is inconsistent with group 4 (subjects that had no therapy experience which on the one hand had the most favorable attitude towards individual therapy and the less favorable attitude towards group therapy.)

On the other hand in this research it was suggested that subjects that have experienced individual therapy have a more positive attitude towards group therapy then subjects that did not experience any therapy at all.

The assumption in this research is that the clinical population i.e. subjects that had group therapy experience without individual therapy experience had been negatively affected by this mode of therapy, but on the other hand the non clinical population i.e. subjects that didn't had any therapy at all expressed the less favourable attitude towards group therapy.

The observed relationship between previous individual and group therapy and more accurate expectations, despite being weak, does suggest that unfavourable attitudes are at least partially associated with a lack of information about the process of psychotherapy, in general, and group therapy in particular.

Jones & Crandall (1985) differentiate a therapy group from most other groups. The individual who joins probably never anticipated joining such a group, has little knowledge of such groups, and will have to be convinced by someone else, usually a therapist that joining such a group will be in his or her best interest. Persuading an individual to join an established therapy group may be especially difficult. The newcomer will be at a distinctive disadvantage and will have to contend with a group in which he or she is the only stranger.

This may create more anxiety and resistance than in a situation where everyone enters the group at the same time. The newcomer has to contend with the issue of acceptance by individuals who have had an intense personal involvement. He or she also generally has no idea, or only a vague idea of what occurs in a therapy group, of the goals of the group, and of his or her role in the group. It will be argued that the better these issues are managed prior to the newcomer's entry into the group, the greater the probability that the individual will remain and derive full benefit from the group.

Mullan and Rosenbaum point out:

The individual therapy patient is not ready for the group psychotherapeutic experience for he has no idea of group. (1962 p.410)

Yalom (1966 p.410) says that a frequent complaint of group therapy dropouts is the apparent formlessness and purposelessness of the meetings. His examination for reasons of premature termination from group therapy serves to underscore the importance of some type of preparation.

The unfavorable attitude towards group therapy shown by subjects that had group therapy only or did not have any therapy at all, corresponds to Yalom’s study (1966) of nine therapy groups for six months. His conclusion was that inadequate orientation to therapy was the primary or a contributing factor for termination in many of the cases.

It also corresponds to Kupst and Schulman’s (1979) work that demonstrated that premature termination was one effect of the discrepancy between what clients expect and what they obtained.

Goldstein (1962) also examined client-therapist expectancies of therapy with an emphasis on the mutuality and reciprocity of the expectational process and concluded that:

Not only do participant prognostic expectancies significantly influence treatment outcome, but, in addition, therapist-patient role expectations appear to have a decisive effect on the therapeutic relationship - the major vehicle influencing patient improvement in psychotherapy. (Goldstein 1962 p.70)

A review of the literature with respect to the effects of disconfirmed client role expectations in psychotherapy (Duckro et al. 1976) found the evidence mixed with regard to the outcomes in individual psychotherapy. However, existing evidence on groups suggests that expectations are important. It can be argued that the group process is more complex and the effects of disconfirmed expectations may play a more important role. In essence, the individual has many more roles to play in a group than in individual therapy.

The qualitative research demonstrates that the clients were uncomfortable with the silent approach of the therapist in the group therapy. (Subject 1 & 2). Clients will favour some kind of explanation about the aims and objectives of group therapy. It is also important to point out that some participants state that they had benefited from group therapy but they always add that it came as a result of their individual therapy experience. (Subjects 6 & 8).

The importance of correcting misconceptions and providing a set of accurate, positive expectancies prior to entering treatment is highlighted by the impact of erroneous beliefs and unfavourable attitudes on attrition and outcomes as suggested by the studies reviewed later.

To respond to these problems, several approaches to pre-group orientation have been developed. These include two distinct processes - preparation and integration.

These include written instruction, role induction training social learning techniques. Jones & Crandall (1985) have found that in general, prepared clients had better attendance records and were judged by their therapist to manifest better client role behavior during the first session than a control group.

One possible cause for newcomers leaving the group early, according to Jones & Crandall (1985), is the social anxiety of the individual. Although there is apparently no literature related to developing social skills to help clients integrate into therapy groups, the methods mentioned above provide the individual with some idea of how he or she is expected to behave in the group. But those expectations reflect the therapist's needs more the clients' needs. Clients whose expectations are divergent from the therapist's, may be labeled as 'resistant' or 'unsuitable' for therapy by the therapist. Goldstein (1971) suggests that this labeling process serves to hide therapist's feelings of inadequacy and their dislike of the client.

Slocum (1987) claims the all the above procedures have proven to be generally successful, the interview method holds greater promise in that expectations can be examined on an individual basis and corrected immediately.

The results of this research can be administered on an individual basis prior to intake or the preparatory interview to illuminate those areas or issues requiring special consideration and to assess the level of motivation, attraction to, and faith in group.

During the preparatory interview these issues can be clarified and a positive attitude to group increased by helping the client to understand, specifically, how his or her particular problems can be dealt with and how relief can be obtained through participation in a therapy group.

Rabbi (1970) claims that this orientation technique can highlight any specific resistances and personality or psychodanamic factors that may impede progress or lead to premature termination potential problems can be anticipated and discussed during the interview itself.

It should be pointed out that some therapists would oppose the preparation of clients. They argue that ambiguity of both patient and therapist role expectations are desirable in early phases of the group. Thus, in psychoanalytic groups, the argument is essentially that the development and eventual resolution of the therapist-client relationship, that is, the transference, is the key curative factor in therapy. These therapists argue that one should seek to enhance the development of transference. Ambiguity and the absence of cognitive anchoring facilitate a regressive reaction to the therapist and help create an atmosphere favourable to the development of transference. (Horwitz 1964) (Wolf 1963)

The question is what is the extend of the dropout of psychoanalytical groups that do not prepare their clients for the group experience in comparison with other therapy groups. But the most important questions are:

* What was the impact on the individual that have dropped out of such a group?

* What damage it has done to his or her self-esteem and the ability to integrate into society?.

Mayerson (1984) says that in group therapy, as opposed to individual therapy, the issue of setting accurate client expectations regarding the therapy process and appropriate role behaviors is especially convincing for several reasons. In individual therapy the therapist's necessary part of the interpersonal process imparts to him a good deal of control over the nature of the interactions. In contrast, group therapies usually consist of many client-client interactions, and consequently, much more of the control over the nature of the interactions in the hands of the clients themselves.

Usually 'appropriate' group member expectations and behaviours are developed during the course of therapy. For example therapists often model these behaviours and "try to reinforce them when others exhibit them." (Myerson 1984 p.192.) The result is that some members develop, at different rates, into 'good's group members, while others can have difficulty in recognising what the 'appropriate' behaviours are and in becoming motivated to enact them.

FUTURE RESEARCH

The outcomes of this research may be distorted by several factors.

The statements regarding individual therapy were not equal to the statements regarding group therapy this made the task of adequately comparing the four group experiences or expectations nearly impossible.

The lower number of subjects that had group therapy experience only could also contribute to the distortion of the results.

A lot of the questionnaires that were distributed among subjects that had no therapy experience were not returned, those subjects could not relate to hypothetical statements.

For future research it will be valuable to check how a dropout of such a client from group therapy or his or her experience of such therapy has affected his or her presenting problem.

As Yalom (1975) stated when discussing group therapy dropouts:

it is up to the therapist to make the experience as constructive as possible, such patients ordinarily are considerably demoralised and tend to view the group experience as "one more failure" (p.367)

Would those subjects ever return to therapy? Was there any damage done? Can it be corrected?

Another area for research would be to check the differences between the attitudes of therapists and clients towards group therapy, and the differences between the expectations of those two groups.

The main question for future research should be:

To what extent clients and therapist see individual therapy and group therapy as opposites?

To what extent the theoretical orientations of various therapists, practising individual and group therapy, took clients' perception and expectations into consideration?

GENERAL CONCLUSION

The results of this project support the hypothesis that participants prefer individual therapy over group therapy.

It is also clear that participants that had individual therapy experience prior to group therapy will have a favourable attitude towards group therapy.

There were few limitations related to statistical analysis. In the case of dependent measures derived from individuals as opposed to groups, there is the issue of interdependence of scores. That is within a therapy group, any particular individual's experience or response may be influenced by the group experience.

Another limitation was that individual therapy and group therapy was used in their wide meaning without distinguishing between different types of therapists, clients, age groups, homogeneous or heterogeneous composition of groups.

The importance of this project is to raise the awareness to clients' perceptions of individual and group therapy and expectations of those modes of therapy. It is also important to understand the impact of those therapies on the clients. Subjects that had group therapy only had a negative attitude to individual therapy as well as to group therapy.

It is important to note that the referral process itself is critical in creating a favourable set of expectations about group and needs to be handled with greater sensitivity. A referral to group therapy is actually a violation of an expectancy: Clients for the most part, expect to be seen for individual therapy when they seek help. This violation can generate disappointment and anger, particularly if the relevance of group therapy is obscured. In addition, clients frequently perceive the referral to group as a rejection by the therapist, especially in the absence of an adequate rationale for the referral.

 

Unfortunately, a therapy group often serves as a dumping ground for clients who are undesirable and who may be difficult to engage in the therapeutic process. (Slocum 1987 p.52)

An illegitimate referral (Klein, 1983) is not only a disservice to the client, but ultimately, to the group itself. The therapist's attitude toward group therapy, as he is making the referral, is extremely important in generating positive expectations.

Referring therapists who have unfavorable or unsupportive attitudes about group therapy may subtly communicate them to prospective group clients. It is unreasonable to expect that clients who are already apprehensive and skeptical about group therapy will not detect the covert message.

Client satisfaction should be measured according to:

-perceived benefit,

-degree of comfort,

-attraction to therapists and other group members,

-number of therapy session completed.

Scientifically measuring process and outcome is not the answer. The most important thing is the client's perception of success.

In many ways it is reassuring with regard to the question of deciding whom to treat and how. Nevertheless, it still remains somewhat unclear whether this similarity merely represents our biased, universal expectations about who will do best or, in fact, represents a similar reality. (Fuhirman & Burlingame 1990 p.15)

It is more important to adjust the therapist's theoretical orientation to the expectations and perceptions of the clients then to adjust the clients' behaviour to the theoretical orientation of the therapist.

Ward (1992) claims that counselling theoreticians and counsellors' educators have been mostly interested in emphasising the establishment of facilitative counselling conditions and the application of facilitative therapeutic techniques and strategies in order to bring about human growth and change. They have therefore been less interested in the process of reducing and eliminating the feeling of loss and termination. Therefore termination of the individual therapy process with adequate preparation for group therapy will reduce the negative effects of premature termination of therapy.

Therapy is a process of change, the therapy should begin where the client is, and most clients are a result of a dysfunctional family this was their first group experience. They need to re-establish that primal parental bond (individual therapy) and then gradually introduces into that family the other family member when the client is ready to share a parent with his siblings.

The exit from that family into the larger world will represent the resolution of the therapy and integration into the world being able to create ones own support system.

Therapists must be alert to the individual needs of their clients. The analysis of the client problem should be not only done through the therapist theoretical orientation but also according to the needs and expectations of the clients.

The therapist is there for his or her client, it is time to create a synthesis between the therapist's theory and the client's perception and needs.

The therapy setting in usually, a one to one setting in which the client explores his/her personal and social problems in a safe environment that is isolated from the reality of the outside world. It can be suggested from the literature that there is a tendency of Counsellors and Psychotherapists to work in a one to one setting, and this tendency is shared also by clients who prefer to work in private settings. Clients will probably prefer individual therapy over group therapy, by regressing to their primal interaction between a child and a parent.

I think each one of us as part of two simultaneous contexts, an inner world with its internalised situations and relationships and an outer world of actual events and interchange. These two contexts are not separable; there is a constant interflow and interaction between them which describes technically with terms like projection, introjection, identification

I believe that the 'inner world is more suitable for individual therapy, and the 'outer world' for group work. We are always inhabitants of both worlds simultaneously.

Metaphorically it can be compared to the process of a client starting with individual therapy and ending with group therapy to the process of the growth of a child that initially finds it safer to bond just with his/her mother and gradually he/she integrates into an and wider social group.

The primal transference of the infant to his mother by early libidinal bonds that replaces primary narcissism and provides the foundation for the infant to become aware of the dramatic persons of his unfolding life.

It is the end-phase of group therapy that displays its limitations most conspicuously. Each group member who exhibits separation anxiety, depressive emotions, and multiform idiosyncratic fantasies because of the momentous impact of the group's impending dissolution will have much less time for consideration of termination than would be his lot in prolonged individual analysis.

It thus becomes apparent that therapy in a group can profitably complement individual therapy, as long as clients’ needs, expectations and perceptions were taken into account and incorporated into the theoretical orientation and / or process of therapy that will affect the outcome.

What clinical educators must not convey is a rigid certainty in either our techniques or in our underlying assumptions about therapeutic change; the field is far too primitive for disciples of unwavering faith. (Yalom 1970 p. 533)

REFERENCES

Abse, W. (1983). Some complementary functions of Group-Analytic Psychotherapy and individual psychoanalysis. In: Pines, M. The Evolution of Group Analysis. London: Routledge & Kegan. 17-28.

Balint, G.R. (1972). Fair shares and mutual concern. International Journal of Psychoanalysis, 52, 61-65.

Bion, W.R. (1961). Experiences in Groups. London & New York: Tavistock Rutledge.

Bloch, S. (1982). What is Psychotherapy?. Oxford: Oxford University Press.

Breen, D. (1977). Some differences between group and individual therapy in connection with the therapist’s pregnancy. International Journal of Group Psychotherapy, 27, 499-506.

Broomfield, R. & Pfeifer, G. (1988). Combining group and individual psychotherapy, Impact on the individual treatment. Journal of The Academy of Child and Adolescent Psychiatry, 27(2) 220-225.

Budman, S.H. et al. (1988). Comparative outcome in time-limited individual and group psychotherapy. International Journal of Group Psychotherapy, January 1, 38-44.

Caligor, J. Fieldsteel, N. Brok, A.J. (1984). Individual and Group Psychotherapy. New York: Basic Books, Inc.

Cohn, H. W. (1986). The double context: On combining individual and group therapy. Group Analysis, 19, 327-339.

Dryden, W. & Aveline, M. (1988). Group Therapy in Britain. Milton Keynes: Open University Press.

Ducro, P. Beal, D. & Geage, C. (1979). Research on the effects of discomfirmed role expectations in psychotherapy: A critical review. Psychological Bulletine, 86, 260-275.

Fenchel, G. H. (1990). The janus face in group psychotherapy. Group, 14 (4), 195-204

Fiumara, R. (1976). Therapeutic group analysis and analytical psychology. Journal of Analytical Psychology, 21, 1-12.

Fordham, M. (1986). Jungian Psychotherapy. GB: Marsfield.

Fuhriman, A. & Burlingham, G. M. (1990). A comparative analysis of individual and group process variables. The Counselling Psychologist, 18,(1), 6-63.

Gans, J. (1990). Broaching and exploring the question of combined group and individual therapy. International Journal of Group Psychotherapy. 40 (2).

Garfield, L. (1980). Psychotherapy, An Eclectic Approach. London:

Green, J. & D’Olivera (1982). Learning to Use Statistical Tests in Psychology. Milton Keynes: Open University Press.

Goldstein, A. P. (1971). Psychotherapeutic Attraction. New York: Pergamon Press.

Jones, A. & Crandall, R. (1985). Preparing newcomers to enhance assimilation into groups. A group example. Small Group Behaviour, 16,(1), 31-57.

Hariman, J. (1984). Does Psychotherapy Help?. Engalnd: C. Thomas, Publishers.

Hill, C. E. (1990). Is individual therapy process really different from group therapy process?. The Counselling Psychologist, 18, January, 1 26-130.

Horwitz, L. (1964). Transference in training groups and therapy groups. International Journal of Psychotherapy, 14, 202-213.

Kertsh, R. Goren, Y. Wasserman, A. (1987). Change patterns of borderline patients in individual and group therapy. International Journal of Group Psychotherapy, 37, January, (1).

Klein, R. H. (1983). Some problems of referral for outpatients group psychotherapy. International Journal of Group Psychotherapy, 33, 229-241.

Kupst, M. J. & Shulman, J. L. (1979). Comparing professional and lay expectations of psychotherapy. Psychotherapy Research and Practice, 16, 237-243.

Levine, B. (1979). Group Psychotherapy: Practice and Development. Engelwood, Cliffs.

Mayerson, N. H. (1984). Preparing clients for group therapy: A critical review and theoretical formulation. Clinical Psychology Review, 4, 191-213.

Mullan, H. & Rosenbaum, M. (1962). Group Psychotherapy. New York: Free Press.

Piper, W.E. Debane, E. G. Bienvenu, J. P. (1984). A comparative study of four forms of psychotherapy. Journal of Consulting and Clinical Psychology, 52, (2), 268-279.

Rabin, H. M. (1970). Preparing patients for group psychotherapy. International Journal of Group Psychotherapy, 20, 135-145.

Rogers, C. (1961). A Therapist’s View of Psychotherapy. On Becoming A Person. GB: Redwood Burn Limited.

Rogers, C. (1989). Client Centered Therapy. London: Constable.

Rutan, J. S. & Alonso, A. (1982). Group therapy, individual therapy, or both?. International Journal of Group Psychotherapy, 32, (3), 267-285.

Rush, A. & Watkins, J. T. (1981). Group versus individual cognitive therapy: A pilot study. Cognitive Therapy Research, 5, 95-103.

Shaw, M. (1976). Group Dynamics: The Psychology of Small Group Behaviour. New York: McGraw-Hill.

Slocum, Y. (1987). A survey of expectations about group therapy among clinical and nonclinical populations. International Journal of Group Psychotherapy, 37, (1), 39-54.

Slavinska -Holy, et Al. (1983). Combining individual & homogeneous group psychotherapies for borderline conditions. International Journal of Group Psychotherapy, 33, (3), 297-312.

Stone, W. N. & Rutan, J. S. (1984). Duration of treatment in group psychotherapy. International Journal of Group Psychotherapy, 34, (1).

Stiles, B. W. (1986). Are All Psychotherapies Equivalent?. American Psychologist.

Solomon, S. D. (1982). Individual versus group therapy: Current status in the treatment of alcoholism. Advances in Alcohol and Substance Abuse, 2, (1), 69-86.

Toseland, R. W. & Siporin, M. (1986). When to recommend group treatment: A review of the clinical and the research literature. International Journal of Group Psychotherapy, 36,(2).

Ward, D. E. (1992). Termination of individual counselling: Concepts and strategies. Key issues For Counselling in Action. London: Sage Publications.

Webster-Straton, C. (1984). Randomized trial of two parent-training programs for families with conduct-disordered children. Journal of Consulting and Clinical Psychology, 52, (4), 666-678.

Wierzbicki, M. & Bartlett, T. (1987). The efficacy of group and individual cognitive therapy for mild depression. Cognitive Therapy Research, 11, (3), 337-342.

Wolf, A. & Schwartz, E. (1962). Psychoanalysis in Groups. New York: Grune & Straton.

Wolf, A. (1963). The psychoanalysis of groups. In Rosenbaum, M. & Berger, M. Eds. Group Psychotherapy and Group Function. New York: Basic Press.

Yalom, I. D. (1966). A study of group therapy dropouts. Archives of General Psychiatry, 14, 393-414.

Yalom, I. D.