A social identity approach to facilitating therapy groups

Abstract

Increasing demand for mental health services, coupled with a lack of therapists and funding to deliver them, underscores the need for effective and cost-efficient mental health interventions. Group therapy offers a potential solution because it is as effective as individual therapy, with the cost-saving advantage that multiple clients can be treated simultaneously by the same clinician. A problem with existing group therapy research and practice, however, is that group therapy facilitators are often (mis)conceptualised as relatively uninfluential and passive providers of treatment. This has led to a lack of theoretically driven research on effective facilitation. In this thesis, I propose that group facilitators should be reconceptualised as leaders who play an important role in determining the success of therapy. In line with this proposition, this thesis uses identity leadership theory as a framework to develop and test strategies for improving therapist effectiveness. This aim is achieved through a conceptual paper and four empirical papers. First, the conceptual paper outlines the theoretical basis for group therapy identity leadership and its hypothesised benefits. Second, a large corpus of data drawn from a group therapy trial (client end-of-session questionnaires, interviews, and video-recorded sessions) is used to catalogue and provide initial validation for a set of behaviours that constitute identity leadership in group therapy. Third, a longitudinal study with participants drawn from body acceptance groups demonstrates that when facilitators are perceived as aspirationally prototypical (embodying "who we want to be") by clients, positive changes occur in group norms around dieting and therapeutic outcomes. Fourth, in line with a growing movement advocating for the voices of people with lived experience of mental ill-health in healthcare provision, two experimental studies demonstrate that therapist self-disclosure of recovered and relevant mental health conditions enhances perceptions of aspirational prototypicality, which improves perceptions of the therapist and expectations for prognosis. Finally, a qualitative study examining real-world experiences of therapist lived experience disclosures highlights the nuances and complexity in clients' and therapists' experiences of these disclosures, triangulating the finding that effective disclosures must be recovered and relevant. This thesis extends identity leadership theory into a group therapy context. It also contributes to clinical theory and practice by documenting diverse group therapy identity leadership behaviours and providing evidence for their positive impact. Overall, this thesis provides a strong case for the necessity and value of conceptualising facilitators as identity leaders. Show more