The Selection of Patients
Good group therapy begins with good patient selection. Patients improperly assigned to a therapy group are unlikely to benefit from their therapy experience. Furthermore, an improperly composed group may die stillborn, never having developed into a viable treatment mode for any of its members.
In this chapter I will consider the clinical and research evidence bearing upon selection, as well as how the clinician determines whether a given patient is a suitable candidate for group therapy. The following chapter considers group composition: once it has been decided that a patient is a suitable group therapy candidate, into which specific group should he or she go?
These two chapters focus particularly on patient selection and group composition of a specific type of group therapy: the heterogeneous outpatient group with the ambitious goals of symptomatic relief and characterological change. However, as I shall discuss shortly, many of these general principles have relevance to other types of groups, including the shorter-term problem- oriented group. (Here, as elsewhere in this book, I proceed with the pedagogic strategy of providing the reader with fundamental group therapy principles plus strategies of adapting these strategies to a variety of clinical situations. There is no other reasonable educative strategy. Such a vast number of problem-specific groups exist that one cannot focus separately on selection strategy for each specific one--nor would a teacher wish to. That would result in too narrow and too rigid an education. The graduate of such a curriculum would be unable to adapt to the forms that group therapy may take in future years.)
Let us begin with the most fundamental question in patient selection: Should the patient--indeed, any patient--be sent to group therapy? In other words, how effective is group therapy? This question, often asked by individual therapists and always asked by third-party payers, must be addressed before considering more subtle questions of patient selection.