Focused Brief Group Therapy
Focused Brief Group Therapy is utilized across the USA, China and Singapore and is recognized for its innovations in treating interpersonal distress in a brief time frame. It is used in practice settings ranging from university counseling centers in the USA to hospital settings across Asia. The book, Focused Brief Group Therapy: An integrative approach to reducing interpersonal distress comes out via APA Press in late 2023 along with an accompanying video.
What is FBGT?
Focused Brief Group Therapy is a semi-structured, integrative process group approach to achieving client outcomes in less than eight sessions. It involves utilizing the principles of Yalom's integrative interpersonal approach but using a series of techniques to activate the mechanisms of change in a far shorter time period.
It is a theoretically integrative approach, organizing mechanisms of change in stepwise fashion so that the group leader can integrate the science and art of therapy into a thoughtful and person-centered approach that allows for multicultural sensitivity and responsiveness. It blends principles and techniques from Yalom and Leszcz’s (2020) interpersonal process model wtih interpersonal circumplex theory (Kiesler, 1996; Horowitz & Strack, 2011), the use of measurement- based care (Lewis, 2019), behavioral activation (Stein et al, 2021) and multiculturally responsive therapy (Owen, et al., 2011).
FBGT was designed and refined over a six-year process at Wright State University's Counseling and Wellness Services to achieve measurable outcomes in less than eight sessions. Rather than beginning in a lab under tightly controlled conditions, it was developed in a real world, naturalistic setting - a counseling center. As groups were running, research findings and clinical learnings were integrated to constantly improve and tweak the approach. When groups or individuals did not achieve hoped for results, the research data, clinical judgment of the therapists, client feedback and supervisor were integrated to refine and improve the model. Multiple dissertations and research projects took place, exploring different facets of FBGT and these were also used to improve the model.
From the beginning, it was based on the best available research on group therapy, Best Practices guidelines and the leading writers on brief group therapy.
Support for the Approach
Early effectiveness studies conducted in a naturalistic setting showed promising outcomes across a wide range of constructs. Studies by Rotsinger-Stemen ((2013) showed significant gains over wait list and comparative or superior outcomes to individual therapy for depression, social anxiety, hostility and interpersonal distress. Allison (2015) found statistically significant change for every interpersonal sub-type score that was the focus of change. It features in the Sage Encyclopedia of Theories in Counseling and Psychotherapy, as well as in Yalom & Leszcz's classic text, Theory and Practice of Group Psychotherapy (6th edition).
Whittingham, M. (in press). Focused Brief Group Therapy: An integrative approach to reducing interpersonal distress. APA Press.
Whittingham, M. (2018). Innovations in group assessment: How focused brief group therapy integrates formal measures to enhance treatment preparation, process, and outcomes. Psychotherapy, 55(2), 186.
The following is an interview Dr. Whittingham conducted with The Atlanta Group Psychotherapy Society in preparation for a Fall workshop on FBGT. It is reproduced from the AGPS newsletter with their permission.
Interview with Martyn Whittingham
In preparation for our upcoming fall workshop, our AGPS president Bob Fredrick, LCSW interviewed presenter Martyn Whittingham, Ph.D., CGP about our workshop topic: Focused Brief Group Therapy.
Bob Fredrick (BF): How is your approach to groups relevant to both the clinician doing short-term groups and the clinician who is conducting long-term psychotherapy groups? Also, what are the similarities and differences between Focused Brief Group Therapy (FBGT) and long term group psychotherapy?
Martyn Whittingham (MW): FBGT is as a brief, semi-structured process group approach. It integrates Evidence Based principles and Practice Based Evidence (evidence used in real time to enhance therapy) to sharpen and focus interventions. It also allows the therapist to prevent group “failure to launch” and “failure to thrive” by anticipating member self-sabotage and problematic group dynamics at the screening stage. FBGT also predicts into group dynamics, co-leadership dynamics, transference / counter-transference and change pathways. Although designed as a short-term approach, its utility extends to longer treatment approaches, albeit in modiﬁed form.
Similarities to long-term approaches include a use of the here-and-now, focus on process, and activation of insight using experience as a modality of change. The differences are that insight is achieved rapidly during screening. This insight is then transformed into group goals and behavioral activation during the here and now is emphasized. The approach has been described by a previous workshop participant as “turbocharged Yalom”.
BF: What is your experience with using FBGT in institutional settings such as prisons and state-run mental health facilities?
MW: FBGT was developed in a university counseling center but was designed to be an effective method of achieving measurable improvement in interpersonal ﬂexibility. In the university counseling center, research showed gains in depression, social anxiety, interpersonal ﬂexibility, and hostility in less than eight sessions. Any agency that is looking for rapid clinical gains and sees interpersonal ﬂexibility as etiological for its patients might ﬁnd the approach useful. The approach would be more useful for those in intensive outpatient and partial hospitalization than inpatient, since those in acute settings are likely to beneﬁt more from approaches that downregulate. This approach is more suited to settings where clients are stabilized and able to engage in approaches geared to interpersonal learning and personal growth.
Since FBGT also relies on process and outcome measures as part of routine clinical practice, this enables those utilizing the approach to understand the impact of the approach in real time and to make adaptations as necessary.
BF: Would you discuss the term ‘interpersonal circumplex’ and its relevance to FBGT?
MW: The interpersonal circumplex is the most empirically validated measure of interpersonal functioning in psychology. It has two main axes – agency (sometimes referred to as power) and afﬁliation (sometimes referred to as communion). Arranged around a circular structure, each interpersonal type is related orthogonally. So, dominance is directly opposite to submission, focused on the needs of self is directly opposite to focused on the needs of others and so on.
FBGT utilizes the Inventory of Interpersonal Problems (IIP-32; Horowitz, Alden, Wiggins, & Pincus, 2000) to help the client determine the impact and focus of their highest area of speciﬁc interpersonal distress. Goals are then collaboratively established and the clients are invited to act them out in the here and now during the group. The circumplex is also used in a myriad of other ways, ranging from understanding group dynamics through to preventing premature group dropout and self-sabotage.
BF: Would you give us some idea of the types of issues group members address in FBGT?
MW: FBGT is designed to target and impact the speciﬁc interpersonal distress that underpins diagnostic symptomology. So while a client might identify depression and anxiety as the symptoms they are seeking to remit, FBGT targets interpersonal etiology, such as client self-identiﬁed social inhibition or being overly focused on the need to dominate. The approach validates their basic personality makeup but invites the client to consider if becoming slightly more interpersonally ﬂexible might help them better meet their own life goals and needs.
Horowitz, L.M., Alden, L.E., Wiggins, J.S., & Pincus, A.L. (2000). Inventory of Interpersonal Problems Manual. Odessa, FL: Mindgarden
Presentations and Workshops on FBGT
Dr. Whitingham has given presentations and workshops on FBGT regionally, nationally, and internationally, including by invitation from the Yalom Institute / China Institute of Psychology. See workshops page.
Rotsinger-Stemen, S., & Whittingham, M. (2013). Focused Brief Group Therapy: An effectiveness study. Poster Presentation at APA National Convention, Hawaii.
Sobon, M., & Whittingham, M. (2013). Assessing change patterns of the overly accommodating subtype within Focused Brief Group Therapy. Poster presentation at APA National Convention, Hawaii.
Greening, K., Whittingham, M., & Yutrzenka, D. (2012, August). Assessing Change Patterns for the Intrusively/Needy Subtype Within Focused Brief Group Therapy: A Mixed Methods Approach. Poster presented at the American Psychological Association Annual Convention, Orlando, FL.