Applying Social Psychology to Research: Group Therapy Facilitation Example PDF

Alysia Robertson (she/her), Final Year PhD Student TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C APPLYING SOCIAL PSYCHOLOGY THEORY TO RESEARCH: A GROUP THERAPY FACILITATION EXAMPLE Lecture Aim Why do I need to learn this? I want to be a clinician! Demonstrate that...

Alysia Robertson (she/her), Final Year PhD Student TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C APPLYING SOCIAL PSYCHOLOGY THEORY TO RESEARCH: A GROUP THERAPY FACILITATION EXAMPLE Lecture Aim Why do I need to learn this? I want to be a clinician! Demonstrate that Social psychology theory can (and does) contribute to applied research Social psychology theory is relevant to clinical contexts Self-categorisation of what? Social identity of who? I will explore this in the context of my PhD research applying identity leadership theory to group therapy facilitation Does this have any relation to the real world? 2 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Lecture Outline 1. 2. 3. Leadership (broad intro) Identity leadership theory (using clinical examples) Group therapy identity leadership research (example of applied social psychology research) 3 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Leadership Is understood in most theories as a process of social influence – Intentional and/or unintentional efforts to change another person's beliefs, attitudes, or behavior. Often studied in organisational, political, sporting domains Is usually associated with words like authority, dominance, power Prevalent idea that we can learn about good leadership from the example of exceptional individual leaders, usually… “great men” 4 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C If that is leadership: why would anyone want to do that in a clinical setting? Influence, coercion, power = not usually associated with our idea of what a therapist does Therapy is client-centred: Seek to reduce power distance between therapist and client But… goal of a therapist: to influence people to change their thoughts, feelings, and behaviours in ways that support their mental health This is leadership! 5 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Zombie leadership Good leadership is not actually about standing out as an exceptional individual or dominating others to be influenced by your vision – Some research at University of Queensland found that narcissism was associated with interest in leadership training programs! Good leadership is a group process and is about being “one of us” and being seen to have the team’s best interests at heart in your decisions – The problem of “Zombie leadership”: dead ideas and myths about effective leadership that walk among us (Haslam et al., 2024 – added to Wattle as optional reading) 6 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C A theory relevant to clinical contexts and addressing myths of leadership: Identity Leadership Theory 7 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Identity leadership theory Leadership is a group-based process of social influence Not about “exceptional individuals” Influence depends on building a sense of “us” as a connected group Influence comes from the group, not the leader’s power/authority (Haslam et al., 2020) Followers must actively choose to and want to follow the leader Not a passive process of influence 8 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C 9 (Robertson et al., 2023) Example of identity leadership in broader clinical context Marcia Linehan – creator of Dialectical Behaviour Therapy DBT is a form of Cognitive Behaviour Therapy designed for people with Borderline Personality Disorder, a condition characterised by unstable moods, behaviours, and relationships (American Psychiatric Association, 2013). Borderline personality disorder is also a condition that Marcia disclosed publicly in 2011 that she herself experiences. 10 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C “Are you one of us?” The patient wanted to know, and her therapist Marsha Linehan had a ready answer… “You mean, have I suffered?” “No, Marsha,” the patient replied... “I mean one of us. Like us. Because if you were, it would give all of us so much hope” 11 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Marcia as an identity leader for people with BPD Prototypicality (being one of us): publicly stating that she understands the unique experience and challenges of people with borderline personality disorder, having been there herself. Entrepreneurship (crafting a sense of us): presenting a hopeful image that people with BPD are able to be successful therapists and researchers (showing the potential for insight, self-regulation, and stability, which counteracts the stereotype about this group). Advancement and impresarioship (being a champion for us and making us matter): creating a new, more effective treatment for the group. Marcia states that she “developed a therapy that provides the things I needed for so many years and never got”. 12 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Group therapy identity leadership research 13 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Prototypicality Being one of us – an important consideration for lived experience debate in clinical psychology People who research, study, or practice in psychology are more likely to have experienced mental ill health in their life: Victor et al. (2022): 82% of ~2000 psychology students, faculty, and clinicians surveyed experienced mental health difficulties in lifetime General population lifetime mental health condition rate is widely agreed to be ~50% (e.g., by World Health Organisation) Note: I had a typo in previous slides – 82%, not 86%, of respondents had experienced mental health difficulties in their lifetime My numbers were mixed up: another study by Bearse et al. (2013) found that 86% of psychologists receive psychotherapy themselves The main idea is that psychology students/clinicians are more likely to experience mental ill health and seek psychological help than the general population! 14 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Study 1 Groups 4 Health for people with elevated social anxiety Groups 4 Health is an example of social psychology theory/research contributing to clinical psychology practice (Haslam et al., 2024) A 5-session social-identity based treatment aimed at enhancing people’s social connections Treatment is highly effective for reducing loneliness and depression Our study also showed it can successfully reduce social anxiety; although we had limited sample size, (N = 33) Results I will present today Some qualitative analysis from interviews with participants of the therapy groups Method used: reflexive thematic analysis (Braun and Clarke, 2019) Theme highlighted the fact that it was useful for therapists to be viewed as “one of us” 15 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Being a postgrad It helped that people facilitating groups were postgraduate ANU students: “Like student identity. I felt similar to them in that way… it would probably weird if they were undergrads…But, like, we were similar enough that they were sort of, you know, plugged into the uni schedule. They remembered being in our academic position so they were able to…empathise, when we were talking about specific experiences. So yeah, I thought that was really helpful.” “[they were] empathetic…And they understood assessment time – so a lot of like that kind of stress, which was really nice…to acknowledge.” 16 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Being socially anxious It helped that facilitators seemed like they understood what it was like to have social anxiety: “‘cause, you know, if, if you are like a perfect human being in front of me, I'll be worried because I have lots of anxiety…And if you look like completely fine, then it will be like… “ugh! Am I… the only one with the problems?”, and stuff like those. But yeah, the fact that they show a little bit level of anxiety, made me feel like, okay… it’s normal to feel anxious.” “I'm not suggesting that like, yes, they definitely had social anxiety, but the way that they behaved made me feel as though we were in an in-group together. Rather than like, I was doing weird things and they were trying to conceal how weird they thought it was.” 17 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Being a facilitator But facilitators needed to remain professional: “they shared their experiences. But I think the, their stories were...I could relate to some of them, but in overall they definitely they were different from my experiences. But I think it's not a negative thing, because they are facilitators. They are not participants.” “I didn't really get to hear much about the personal lives of the facilitators themselves, but that's probably on purpose, because this is therapy for us not for the therapists.” 18 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C So being prototypical is important, but should therapists represent “Who we are now?” (our current identity) or “Who we want to be” (our aspired identity)? 19 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Study 2: Does aspirational prototypicality have positive effects in therapy? (Robertson et al., 2022) Design: N = 112 young women at risk of developing eating disorders Intervention: Body acceptance groups, The Body Project (4 sessions) Predictor: Aspirational prototypicality = the extent that leaders embodied ‘who we want to be’ (i.e., positive body image) Mediator: change across therapy in injunctive norms (approval of dieting) Outcomes: body satisfaction at the end of therapy and intentions to diet in the 3 months after therapy 20 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Results More aspirational prototypicality, better outcomes in therapy (via the change in group approval of dieting – injunctive norms) 21 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Aligns with prior research These findings align with research from a meta-analysis (Steffens et al., 2021) that in organisational contexts, the aspirational type of prototypicality (who we want to be) has more impact on leadership effectiveness compared to averagetype prototypicality (who we are now) 22 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C So being aspirationally prototypical is important, but how can facilitators show clients that they embody our aspired identity (“who we want to be”)? 23 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Study 3/4: Can self-disclosure of lived experience signal aspirational prototypicality? Study 1 N = 160 clients of therapy and 160 therapists (via Prolific) Study 2 N = 175 clients, 177 general population adults Experiment: Group therapy for depression vignette in which therapist discloses Nothing Years of professional experience with depression Years of personal, current experience with depression Years of personal, recovered experience with depression Years of personal, recovered experience with anxiety Average prototypicality Aspirational prototypicality 24 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Findings (averaged across 2 studies) 6 PROTOTYPICALITY 5.5 5 4.5 Aspirational 4 Average 3.5 3 Control Professional Current Recovered Experience Depression Anxiety CONDITION (THERAPIST SELF-DISCLOSURE TYPE) Recovered Depression 1. Recovered depression disclosure signals aspirational prototypicality 2. Any lived experience disclosure signals average prototypicality 25 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Findings 1. Study 1 Recovered depression disclosure significantly indirectly predicted 1. More positive perceptions of therapist 2. Higher ratings of their expertness 3. More positive prognosis for therapy Via both aspirational prototypicality and average prototypicality 2. Current depression and recovered anxiety disclosure indirectly predicted positive perceptions and prognosis only (via average prototypicality only) 3. Professional experience disclosure did not predict any positive outcomes Study 2 26 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C So self-disclosure of lived experience can signal prototypicality, but should therapists go ahead and start doing this? What happens when they do? 27 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Study 5 Goldilocks disclosures: getting selfdisclosure of lived experience “just right” is difficult (Robertson et al., under review) Participants: 160 therapists and clients (same in Study 3) Responded qualitatively to same scenarios and were asked to recount any real instances of therapist self-disclosure they had experienced Reflexive Thematic Analysis used to develop 4 themes 28 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Theme 1: Warm humans versus cold machines Lived experience demonstrates humanity “[a way for therapists to] admit to being human and not some machine made for delivering therapy” (29 years, woman, therapist). “not one book talking to another book, as it were, but one human talking to another” (63 years, man, therapist). But at the expense of professionalism Therapists should be “a mirror, a foil. They should be blank so I can project and work through my issues” (41 years, woman, consumer). 29 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Theme 2: Consumer or therapist? Lived experience helps people to open up “honest”, “truthful”, “open”, “vulnerable”, and “brave” “[being so open shows] a good commitment to honesty, transparency and sincerity which are beneficial within the working relationship” (29 years, woman, therapist). But the therapist has now stepped into the role of the consumer “I would be concerned that sharing my problems and leaning on them emotionally would make [the therapist’s] current episode worse” (33 years, woman, consumer). “It was good at first. It felt friendly but that friendliness soon led me to question the boundaries. Who was the therapist and the client?” (52 years, woman, consumer) 30 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Theme 3: Empathetic but ineffective Having lived experience: A “special” understanding of mental ill health and more empathy But: “incompetent”, requiring “monitoring”, and “not qualified” “I think the therapist needs to focus on their own battles before trying to help others…They would definitely have empathy but possibly no answers or solutions” (48 years, woman, consumer). Having professional experience: “competent” and “able to help” But empathy given is “patronising”; can “only sympathise but not empathise” 31 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C “Just studying depression does not mean you are the best at helping…I think the best way to be an expert in helping others is to have suffered yourself in some way and the understanding gained from that far surpasses just vocational experience. The empathy cannot be matched” 35 years, woman, consumer 32 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Theme 4. Getting disclosures “just right” Once I know you well Something we share Not too much detail Only when you’re better Should come after building relationship with consumer Should be about something relevant Should not take away from consumers’ session to time and be brief Should only be about recovered conditions Gives "insight into how they might react to a selfdisclosure” Normalises: helps consumer to “understand that even people that seem to have a good hold on their mental health can be depressed” Also not too much detail. Can be as simple as using “we” and “us” pronouns Recovery disclosures inspire hope but being currently unwell can be disheartening 33 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Summary Group therapists can improve their effectiveness by engaging in identity leadership It is useful for therapists to be viewed by their clients as “one of us” (e.g., a therapist who understands social anxiety) However, it is most impactful when therapists are viewed as “one of us” in an aspirational sense: embodying “who we want to be”. This leads to better outcomes in therapy. One way that therapists can show that they represent “who we want to be” is by disclosing information about their own mental health journey. However, to truly demonstrate our aspired identity, this disclosure should be of a recovered and relevant mental health experiences (e.g., recovered depression disclosure to a therapy group for depression) By increasing clients’ perceptions that the therapist represents “who we want to be”, therapists’ recovery disclosures lead to them being perceived more positively, viewed as more of an expert, and a better expected prognosis for therapy. However, there are costs and benefits to therapists’ lived experience disclosures and a lot of complexity in getting the disclosure “just right” 34 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Social psychology is relevant to clinical psychology We have used identity leadership theory to explain why therapists disclosing their lived experience has positive effects in therapy We can use identity leadership to demonstrate why recovery disclosures are better: because aspirational prototypicality has more impact on leadership effectiveness 35 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C “It’s possible for students to graduate without knowing anything about group dynamics or group therapy and take a job where they’re running groups. But without training, these students don’t know how to intervene when problems arise among members of the group… They’re just expected to go in and do it…” – Professor Cheri Marmarosh Recent president of the Society of Group Psychology and Group Psychotherapy 36 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Your knowledge provides insight into group and clinical processes My understanding of group processes will make me a better clinician! I am so glad I took PSYC3002 at uni Benefit of social psychology knowledge: can provide therapists with a better understanding of how group processes operate in therapeutic contexts Provides theory to help understand effective practice: “Theory without practice is empty; practice without theory is blind” I wish I knew more about group processes 37 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Take-home messages important for PSYC3002 Social identity processes are relevant to therapeutic contexts as well as typical contexts usually studied in social psychology (politics, organisations, etc.) Identity leadership theory can explain how effective leadership works across a variety of contexts, from politics to therapy Social psychology research can be applied to clinical contexts to provide useful and novel theoretical and practical insights 38 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C Thanks for listening! Thank you to my collaborators Prof Tegan Cruwys, Dr Mark Stevens, Prof Michael Platow, Dr Brett Scholz, Jessica Donaldson, and Dr Anika Quayle Contact me: Alysia Robertson [email protected] TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition). American Psychiatric Association. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806 Haslam, C., Cruwys, T., Haslam, S. A., Bentley, S. V., & Jetten, J. (2024). Groups 4 Health Workbook. Oxford University Press. Haslam, S. A., Alvesson, M., & Reicher, S. D. (2024). Zombie leadership: Dead ideas that still walk among us. The Leadership Quarterly, 101770. https://doi.org/10.1016/j.leaqua.2023.101770 Haslam, S. A., Reicher, S. D., & Platow, M. J. (2020). The new psychology of leadership: Identity, influence and power (2nd ed.). Routledge. Robertson, A. M., Cruwys, T., Stevens, M., & Platow, M. J. (2022). Aspirational leaders help us change: Ingroup prototypicality enables effective group psychotherapy leadership. British Journal of Clinical Psychology, 00, 1–17. https://doi.org/10.1111/bjc.12406 Robertson, A. M., Cruwys, T., Stevens, M., & Platow, M. J. (2023). A social identity approach to facilitating therapy groups. Clinical Psychology: Science and Practice. https://doi.org/10.1037/cps0000178 Steffens, N. K., Munt, K. A., van Knippenberg, D., Platow, M. J., & Haslam, S. A. (2021). Advancing the social identity theory of leadership: A meta-analytic review of leader group prototypicality. Organizational Psychology Review, 11(1), 35–72. https://doi.org/10.1177/2041386620962569 Victor, S. E., Devendorf, A. R., Lewis, S. P., Rottenberg, J., Muehlenkamp, J. J., Stage, D. L., & Miller, R. H. (2022). Only Human: Mental-Health Difficulties Among Clinical, Counseling, and School Psychology Faculty and Trainees. Perspectives on Psychological Science, 17(6), 1576–1590. https://doi.org/10.1177/17456916211071079 40 TEQSA PROVIDER ID: PRV12002 (AUSTRALIAN UNIVERSITY) CRICOS PROVIDER CODE: 00120C