A practitioner's first exposure to group therapy becomes a template from which future practice is derived. In particular, the group format and the degree of structure imposed by the leader on the process are imprinted in the leader's clinical reasoning. Group therapies are commonly categorized as psychodynamic, interpersonal, cognitive, and behavioral. Each of these conceptual frameworks indicates the group's composition, leader role, and intervention principles. By carefully considering the degree of structure imposed, rather than follow implicit knowledge of past experience, the leader can more consciously shape group outcomes.

In this chapter, I propose a rehabilitation model, the functional group (Schwartzberg, Howe, & Barnes, in press), as a theoretical basis for determining the degree of structure as a component of the group design. The assumption underlying the model is that by changing the degree of structure a leader can facilitate outcomes such as group alliances, empathy, and cohesion. The processes used in the group have a direct bearing on the group outcomes and former aims both tacitly perceived and empirically known to be of a value. In a functional group the group and tasks are structured to achieve maximal involvement of members through group-centered action, sponta neous involvement, member support and feedback, maximal sense of individual and group identity, and a "flow experience" where the challenges for action are balanced with the members' capabilities and culturally orientation.

Elements of group structure include the group size, membership, group composition, and degree of process focus (Burlingame, Fuhri-man, & Mosier, 2003). A group's size can range from small (one to four members), medium (five to twelve members), to large (greater than twelve). Group membership may be open for new members or closed. Groups are composed of individuals with heterogeneous or homogeneous traits, needs, and severity of problems. The degree of process focus can range from members being encouraged to interact freely to more leader-centered directed process.

A system for classifying degree of structure in group treatment has been proposed by Burlingame, Fuhriman, and Mosier, 2003. The degree of structure is identified by four types (p. 5):

• Type 1-Guiding force is therapist or manual.

• Type 2-Moving force is the client(s) or group, topic, or content.

• Type 3-Guiding force is the therapist or a specific model of group therapy that structures the treatment. Discussion promotes interactive, responsive group process on client(s) or group-as-whole-reactions, behaviors, feelings, with evidence of here-and-now orientation.

• Type 4-Moving forces are the client(s) or group created by the unique composition of the group. Discussion promotes interactive, responsive group process on client(s) or group-as-whole-reactions, behaviors, feelings, with evidence of here-and-now orientation.

When creating a new group I first assess the members' capability for self-direction around the group's task and then design the group experience to match member ability. I am concerned with a group member's ability to communicate, problem solve, have insight, and generalize from the experience. Upon assessment I rely upon a schema similar to the former classification system to grade the level of expectation and processes.

Degree of Structure in Group Format 203

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