Group Therapy (Chapter 1-5)

Front 1

Therapeutic Group

Back 1

• Purpose: increase member's knowledge of themselves and others, to help members clarify the changes they most want to make in their lives, to provide members with tools they need to make these changes, and to support their changes.
  
• receive honest feedback from support groups members on behavioral changes. Members learn how their behavior affects others.
  
• 4 types of groups: task, psycho-educational, counseling, psychotherapy
  

Front 2

Task Groups (task facilitation groups)

Back 2

• Focus in on the application of group dynamic processes and principles to improve practice and to foster accomplishment of identified work goals.
• Commonly used at: task forces, committee, planning groups, staff development groups, treatment conferences, community organizations, social action groups, discussion groups, study circles, learning groups, etc.

Front 3

Psychoeducational Groups

Back 3

• Goal is to ameliorate educational deficits and psychological problems. Goal is to provide members increased awareness of a life problem and tools to better cope with it.
  
• Provide, discuss, and integrate factual information in group sessions. Utilize planned skill-building exercises.
  
• examples: parenting effectiveness training, assertiveness skills group, substance abuse prevention group, stress management, anger management
• Sessions: 2x/week for 4-15 weeks, 30-45 minutes
  
• focus on developing cognitive, affective, and behavioral skills
• effective for use with children and adolescents; community and school settings
  

• 1st session: ask members to complete a questionnaire on how well they are coping with the area of concern
• Utilize: Structured exercises, readings, homework assignments, contracts.
  
• Last session: complete another questionnaire to assess progress.
  

Front 4

Counseling Groups

Back 4

• Help members resolve usual, yet difficult, problems of living. Deal with conscious problems; oriented toward the resolution of short-term issues. Members are usually well-functioning.
  
• May help members resolve problems in living or dealing with developmental concerns.
• Does not deal with major personality changes and is not concerned with tx of severe psychological /behavioral disorders
• Settings: school, college, university counseling centers, churches, community mental health clinics and agencies.
  
• Focus on interpersonal process and problem-solving strategies that stress conscious thoughts , feelings, and behavior.
• Interactive feedback and uses the here-and-now time frame. Growth model.
  
• Identify personal strengths (resources) and barriers that prevent optimal development. Construct methods to deal with barriers by providing tools to cope with current and future problems.
  
• leaders should have received 45-60 hours of supervision

• main goals:

1. help people develop more positive attitudes and better interpersonal skills
2. use the group process to facilitate behavior change
3. help members transfer newly acquired skills and behavior learned in the group to everyday life.
   

Front 5

Psychotherapy Groups

Back 5

• Help individual group members remediate psychological or interpersonal problems of living. Group members often have acute or chronic mental or emotional problems that are accompanied by marked distress, impairment in functioning, or both.
  
• Goal is to aid each individual in reconstructing major personality behaviors.
  
• Settings: community mental health agencies
  
• Examples: group therapy for sex offenders, group therapy for domestic violence offenders, bereavement groups

Front 6

Brief Group Therapy (BGT)

Back 6

• Refers to groups that are time-limited, structured, last 2-3 months, and 8-12 weekly sessions.
  
• There are clear-ground rules (critical) and leaders provide structure to the group therapy process.
  
• BGT is popular in school and community settings--cheaper and more effective treatment. This is also the preferred treatment for managed care.
  
• It is essential for group leaders to be trained in group process and brief therapy

1. set clear and realistic tx goals
2. establish a clear focus within the group structure
3. therapist maintains an active role in session
4. accomplish goals within time frame.
   

Front 7

Culture

Back 7

encompasses the values, beliefs, and behaviors shared by a group of people

Front 8

Basic Assumptions about multiculturalism

Back 8

1. culture is best defined broadly rather than narrowly

2. all counseling occurs in a multicultural context

3. culture includes both objective symbols and subjective perspectives

4. cultural similarities and differences are equally important

5. a multicultural perspective is relevant to all aspects of counseling practice

6. muliticulturalism needs to be understood as a continuous theme in all fields of counseling

7. multiculturalism can be the basis for people to disagree without one person being "right" and the other being "wrong"

Front 9

Multicultural competency

Back 9

Includes: 1) beliefs and attitudes, 2) knowledge, 3) skills and intervention strategies

Front 10

How the group leader's level of cultural awareness affects group therapy

Back 10

1. Be aware of your personal cultural values and personal assumptions/biases/prejudices.
   
2. Have a general knowledge about the ways diverse backgrounds of members may affect the group process.
   
3. Be able to implement interventions that are appropriate for the life experience of the members of the group.
   

• Find ways to respect, address, and explore differences in the group in an effective manner.
  
• It is important to discuss with group members how your worldview influences your beliefs and practices about groups and group processes.
  
• Recognize your privilege and the power of your professional role in the group. "Lean into your discomfort."
• remember: Everyone does not view the world as you do.
  

Front 11

Personal characteristics of an effective group leader

Back 11

• Courage--counselor is willing to be vulnerable, admit mistakes/imperfections; able to confront others but stay present to work through the conflicts; able to act on beliefs and hunches;able to examine own life; able to be direct and honest in a caring an respectful way.
  
• Willingness to Model--model positive behavior in session; show what is expected of members in session;engage in honest, appropriate and timely self-disclosure .
  
• Presence--fully immerse yourself in the moment in session (emotions--pain, struggle, joys); be attentive to the feelings that are expressed and empathize, but do not let it overwhelm you. Show that you truly understand what they are experiencing.
  
• Goodwill, genuineness, and caring--sincere interest in the welfare of members in the group; involves respecting, trusting, and valuing others.
  *Be aware of the kind of people you are drawn to and what kind you find challenging. *give warmth, concern, and support when you genuinely feel it towards a person.
  
• Belief in Group Process--be enthusiastic about group work and be confident about the therapeutic process---> this encourages the members to believe in the process and better outcomes.
  
• Openness--reveal enough of yourself to give participants a sense of who you are as a person. You can self-disclose by sharing your perceptions and personal reactions to their statements/progress.
  
• Nondefensivness in coping with criticism--there will be times when members will openly criticize you as the leader--explore with the group the feelings behind criticisms. Model effective and non-aggressive ways to express thoughts and feelings. Can also tell the member your reactions (to verbal abuse, etc.) and let them know how you are affected by their confrontation.
  
• Becoming aware of subtle culture issues-- be aware cultural issues that affect the dynamics of a group session. Always address racist remarks/discriminatory comments about others in session--don't let it slide because those are opportunities for learning and leader facilitation.
  
• Being able to identify with a client's pain--reflect on your own issues and work though the issues in therapy to better serve a group facilitator. Avoid countertransference with self-reflection.
  
• Personal Power--be confident in your skills a group leader--this sense of positivity/competence will empower group members to believe in themselves. Recognize and accept your weaknesses as a person and be able to show these qualities to group members (congruence).
  
• Stamina--be conscious of your energy levels as you contnue your work as a group faciliatator. Recognize the signs of burnout and find ways to take care of yourself. Examine your expectations of members (are they unrealistic?) and adjust your perspective of the situation.
  
• Commitment to self-care--listen to your body and take care of yourself. Do things that make you happy or else the stress from work will leech into therapy sessions.
  
• Self-awareness--become aware of your personal characteristics; solve previously unresolved problems. be aware of why you chose to lead groups. Does group facilitation meet a personal need?
  
• Sense of humor--be careful how you joke around with members. what you think is funny may not always come across as funny to others.
  
• Inventiveness--ability to be spontaneous and approach each group with fresh ideas. tap into member's creativity (personal strengths).
  
• Personal dedication and commitment--convey acceptance and commitment to members when they show both good and bad behavior (support). Have humility--you do not know everything; read journals, books, attend conferences/workshops to keep up to date.
  

Front 12

Professional characteristics of an effective group counselor

Back 12

1. active listening
2. reflecting
3. clarifying
4. summarizing
5. facilitating
6. empathizing
7. interpreting
8. questioning
9. linking
10. confronting
11. supporting
12. blocking
13. assessing
14. modeling
15. suggesting
16. initiating
17. evaluating
18. terminating

Front 13

What is one of the most significant variables influencing the group's success or failure?

Back 13

who the counselor is as a person

Front 14

What NOT to do when sharing co-leadership in group session

Back 14

• not sitting across from one another and making continuous eye contact with co-leader
• having a plan or goal for the group but not communicating that to the co-leader
• taking too much personal space or being competitive with their co-leader.
  
• asserting power over their co-leader in covert and overt ways.
  
• trying to be right as a leader at the expense of making the co-leader wrong
• taking turns leading rather than co-facilitating or adding to one another's interventions.
  
• remaining quiet and letting the co-leader do most of the work.
  

Front 15

Common difficulties between co-leaders

Back 15

• interpersonal conflicts
• competition between leaders
• over-dependence on the co-leader
• unresolved conflicts between the co-leaders.
  

**address issues and resolve conflicts immediately; if not, this will ruin the relationship and will not provide effective facilitation of the group.

**be aware of your personal issues that could lead to competitiveness, performance anxiety, power and control struggles

Front 16

CA Statute on treatment for minors

Back 16

• Minors who are 12 years of age or older are allowed to receive counseling if the practitioner determines that the minor is mature enough to participate intelligently in outpatient treatment or mental health counseling.
  
• The statute requires parental (guardian) involvement in the treatment of the minor, unless the therapist finds, after consulting with the minor, that this involvement would be inappropriate under the circumstances.
  
• Therapist keeps record of: when they made attempts to contact parents (or guardians), whether the attempts were successful/unsuccessful, and why contact with the parent was deemed inappropriate.
  

Front 17

minors in group session

Back 17

• Before a minor enters a group, the counselor must notify parents or guardians that their children are participating in group counseling.
  
• Always obtain written permission (private practice, school-based counseling, etc. ).
  
• Provide: Brief description of the purpose of the group, the importance of confidentiality as a prerequisite to accomplishing these purposes, and the counselor's intention not to violate any confidence.
  
• Counselor can tell parent the purpose of the group and provide general feedback about progress of sessions, but cannot break minor's confidence about what is revealed in sessions. can provide feedback in a session involving parents (one or or both), the child, and group leader.
  

Front 18

Techniques

Back 18

leader interventions aimed at facilitating movement within a group

Front 19

Technical Eclecticism

Back 19

tends to focus on differences, includes aspects from many approaches, and is a collection of techniques; not advisable - integration preferred

Front 20

Theoretical integration

Back 20

a conceptual or theoretical creation beyond a mere blending of techniques; synthesis of two or more theoretical approaches thought to be better than restricting practice to single theory

Front 21

Cognitive Domain

Back 21

Focus is on thinking or thought processes; one of 3 domains thought to be the basis for a powerful and comprehensive approach to counseling practice

Front 22

Affective Domain

Back 22

focus is on the feelings; one of three domains that form basis for a powerful and comprehensive approach to practice

Front 23

Behavioral Domain

Back 23

focus is on action; one of three domains that form basis for a powerful and comprehensive approach to practice

Front 24

Theory

Back 24

a general framework that helps you make sense of the many facets of group process, provides you with a map of giving direction to what you do and say in the group, and helps you think about the possible results of your interventions

Front 25

informed consent

Back 25

1) info on the nature, purposes, and goals of the group

2) confidentiality and exceptions to confidentiality

3) leader's theoretical orientation

4) group services that can be provided

5) the role and responsibility of group members and leaders

6) qualifications of the leader

Front 26

psychological risks

Back 26

involvement in group has the potential to bring about life changes. There are also risks in terms of self disclosure, maintaining confidentiality, scapegoating, and confrontation.

Front 27

main issue with confidentiality in group setting

Back 27

the fact that confidentiality cannot be guaranteed is clearly communicated to group members

Front 28

privileged communication

Back 28

Professionals cannot break confidence of clients unless:

1) clients are likely to do serious harm to themselves/others/property

2) abuses of children or elderly is suspected

3) they are ordered by court to provide information (Arkansas one of the exceptions)

4) they are supervisees in a supervisory relationship

5) the clients give specific written permission

Front 29

other ethical issues

Back 29

values and working with diversity, technology, competence, legal liability and malpractice

Front 30

liability & malpractice

Back 30

counselors who fail to exercise due care and act in good faith are liable to a civil suit

Front 31

The Group Process

Back 31

• Pregroup stage
• Initial stage
• Transition stage
• Working stage
• Final stage
  

Front 32

Pregroup Stage

Back 32

All the factors involved in the formation of a group:

• proposal for a group
• attracting members
• screening and selecting members
  
• orientation process

Front 33

Initial Stage

Back 33

• A time of orientation and exploration; members tend to present dimensions of themselves they consider to be "socially acceptable"
• At this stage members bring their expectations, concerns, and anxiety about the group into session. Members are getting to know one another, testing boundaries, developing "norms" for the group, identifying personal goals, etc.
  

Front 34

Transition Stage

Back 34

• Counselor's task is to help members learn how to begin working on the concerns that brought them to the group
• Members learn to monitor thoughts, feelings, reactions, actions and to express them verbally.
  
• Counselor/leader helps members recognize and accept fears and defensiveness; help them work through their anxieties and any reluctance they may be experiencing.
  

Front 35

Working Stage

Back 35

• Characterized by productiveness; this is marked by a deeper level of exploration.
  
• Mutuality and self-exploration increase and group focuses on making behavioral changes

**Some groups may never reach this stage

Front 36

Final Stage

Back 36

• Time to further identify what was learned and to decide how this new learning can become part of daily living
• Focus is on conceptualization and bringing closure to the group experience

*Group gets ready for termination

Front 37

Basis of a proposal

Back 37

Present a proposal to school or community administrators for approval of group organization. make sure you meet following points:

1) Rationale: Do you have a clear and convincing rationale for your group? Are you able to answer questions that might be raised about the need for the group?

2) Objectives: Can you clearly state what you most want to attain and how you go about doing so? Are your objectives specific, measurable, and attainable within the specified time?

3) Practical considerations: Is the membership defined? Are meeting times, frequency of meetings and duration of the group reasonable?

4) Procedures: Have you selected specific procedures to meet the stated objectives? Are the procedures appropriate and realistic for the given population?

5) Evaluation: Does your proposal contain strategies for evaluating how well the stated objectives were met? Are your evaluation methods objective, practical, and relevant?

*note 13 sample proposals for schools and community settings--see chapter 10 and 11

Front 38

Attracting and Screening Members

Back 38

Announce and recruit potential members for a group--contact people personally or ask agency colleagues for recommendations.

Provide the following information in writing to potential members:

• Professional disclosure statement
• A statement of the goals and purpose of the group
• Policies concerning entering and exiting the group
• Expectations for group participation, including voluntary and involuntary membership
• Policies and procedures governing mandated groups (where relevant)
• Role expectations of members and leader(s)
  
• The rights and responsibilities of both group members and the group leader
• Documentation procedures and disclosure of information to others
• Implications of out-of-group contact or involvement among members
• Education, training, and qualifications of the group leader
• Fees and time parameters
• A realistic statement of what services can and cannot be provided within a particular group structure.
  
• Potential impacts of group particiaption
  

Front 39

Screening Members

Back 39

The goal of screening is to prevent potential harm to clients: Should this particular person be included in this particular group at this time with this group leader?

Front 40

Practical considerations in forming a group

Back 40

1. Group composition

--should be homogeneous group (to accomplish specific goals and purpose in group sessions)

2. Group size (how many)

--depends on age of clients, experience of the leader, type of group, an problems to be explored. Young kids--3 to 4 people in group; teens and adults--6 to 8 people in group.

3. Frequency and duration of meetings (how often)

--Kids/Teens: length of 1 class period for group session is optimal; can meet frequently for shorter amounts of time (short attention spans)

--Adults: 2 hour weekly session

--Inpatient low-functioning group: 45 min/day

Higher functioning inpatient group: 90 min several times a week

4. Length of a group (how long)

--Kids/Teens: length of school session (semester = 16 weeks)

--groups in general should have a schedule; should not be ongoing with no end or else promotes dependency.

5. Place for group members (where)

--comfortable, clean sitting area; sit in a circle with co-leaders sitting across from one another.

6. Open vs closed groups (what)

--Open groups: As members leave, new members are admitted, and the group continues.

--Pro: members interact with more people, just like in daily life; Con: lack of cohesion in group due to influx of new members.

--Should provide a video to new members covering group rules and then review ground rules during intake interview.

--Closed groups: have a time limitation; group meet for a predetermined # of sessions. Members are expected to remain in group until termination and new members are not added.

Front 41

Pre-group preparation

Back 41

Pre-group preparation:

• Involves setting expectations, establishing group rules/procedures, role reparation, and skill building.
  
• Positive correlation with early therapeutic processes and later client improvement.
• Positive association with cohesion, members' satisfaction, and comfort with the group.
  
• Increases attendance, self-disclosure, and group cohesion.
  

• Standard practice for short-term therapy groups.
  

• Pre-group preparation session decreases anxiety because members have a better understanding of goals to be accomplished, what is expected of them during sessions, and how they should behave.

Front 42

Pregroup session

Back 42

• Leader(s) should explore members expectations, clarify group goals and objectives, explain the group process, and answer member's questions.
• Members should become acquainted with one another.
  

Front 43

Establishing Basic Ground Rules

Back 43

• Group leader can explain policies and procedures in nonauthoritarian manner OR have members establish their own procedures that will help them accomplish group goals.
  
• Leader should explain limits of confidentiality, attendance, being on time, parental consent, dual relationships, rights and responsibilities

Front 44

Integration of evaluations into group work

(evaluation research)

Back 44

Ask members to fill out evaluation forms to measure:

• Individual member outcomes
• Group outcomes (as a unit)
  

Front 45

Co-leadership

Back 45

Talk about any issues that may interfere with progress in facilitation of group sessions:

• Theoretical orientations/group work experience; cultural/ethnic backgrounds; differences in personality that may interfere or issues that may causes negativity in sessions; personal strengths and weaknesses; ethical perspectives
• Also talk about how you will handle conflict and disagreements as a team during sessions. Discuss how each can provide support for one another in group sessions.