Group Therapy--Initial Stage Of A Group

Front 1

Initial Stage of a Group

Back 1

1. Orientation and Exploration

--Members getting to know one another, learning how group process works, establishing group norms (bx), etc.

--Leader should respond to member's participation in early discussions with openness and acceptance; members may fear being shut down during discussions.

--Members of minority or ethnic background may be reluctant to speak or disclose their emotions. Leader should discuss cultural conditioning and discuss member's fear of talking about (blank) subject.

2. Goal is to have members identify their fears and begin to explore them. Building trust is key.

--Icebreaker: have members work in pairs, then later have them join groups of 4. Discuss expectations, fears, reservations, become acquainted with one another.

Front 2

Common difficulties that arise in initial stage of group work

Back 2

• Hidden agendas--An issue that is not openly acknowledged and discussed and a common form of resistance in groups. Ex: rumor in group, dislike of someone in group, etc. --Leads to group members becoming closed, cautious, and defensive instead of being open. --Leader should guide conversation to discussion of the issue (pink elephant in the room) to make group progress.
• Addressing conflict early--leader should teach appropriate and effective confrontation techniques to talk about issues that arise between members and find a resolution.
  
• Self-Focus vs Focus on Others--the tendency to talk about others and to focus on people and situations outside the group.

--Leader should focus on steering member back to discussing their reactions to situations/people rather than focusing on others.

• Here-and-Now Focus vs There-and-Then Focus--ask members to make connections between personal problems they are facing in their world and their experience in the group (combination of here-and-now and there-and-then). Delineates how interactions in group environment is reflected in personal lives.
  

--Here-and-now: experiential and relationship-oriented approaches; Present-centered: cognitive behavioral approaches; There-and-then: psychodynamic (centered on the past)

• Trust vs Mistrust--in order to make progress as a group, members must trust one another or else problems will grow.
  

Front 3

Ways to create trust in initial stage

Back 3

1) Modeling--model appropriate behavior; practice active listening; listen with respect and do not react defensively; self-disclose when appropriate

2) Attending and listening--listen to what is said by the speaker; pay attention to verbal/nonverbal behavior; ask appropriate questions; encourage speaker to explore conflict; stay present with the group.

3) Understanding nonverbal bx--you may observe discrepancies between statements made during session and how member expresses self through nonverbal behavior.

--Address this issue by describing the behavior and then asking the member to provide meaning to the behavior.

--"I notice that you are smiling, yet you are talking of difficult memories, and there are tears in your eyes. Are you aware of that?"

--"You say that no one listening to you but you are speaking softly to the group."

-- You can also ask clients to pay attention to what they are experiencing physically as they speak. "What area of your body are you most aware of at this moment?"-->connect to feelings and explore the emotions.

4) Empathy--teach members of group how to respond to one another with empathy.

--Point out counterproductive behaviors they may be doing during responses--not responding to others at all, questioning inappropriately, telling others how they should be, responding with critical judgments, being defensive.

5) Genuineness--As a leader you do not pretend to be accepting when you internally do not accept the client's behavior. Do not try to win approval from members and do not hide behind your professional role as a leader. Provide honest responses.

6) Self-disclosure--decide when it is appropriate to reveal information about yourself. Will information help progress in group work or be irrelevant? Keep in mind, some cultures expect to know some personal information or else will not partake in session.

7) Respect--do not provide critical judgements, label clients; you should express warmth and support, be genuine, and recognize the right of others to be different.

8) Caring confrontation--teach members how to broach difficult subjects or issues with other group members in a caring and honest manner. Do not allow verbal abuse, attacking comments, or aggressive confrontations.

Front 4

Common mistakes leaders make (lack of attending and listening skills)

Back 4

• Not focusing on what the speaker is saying; instead planning on what to say next.
  
• Asking too many closed questions that probe for irrelevant and detailed information
• Doing too much talking and not enough listening
• Giving advice too quickly; should encourage the speaker to explore a struggle.
  
• Paying attention to explicit statements and not paying attention to nonverbal behavior.
  
• Engaging in selective listening (hearing only what one wants to hear).
  
• Failing to ask people to give voice to what their body is experiencing.
  

Front 5

identifying & clarifying goals

Back 5

• A major task during the initial stage in which leaders assist members in formulating goals that will influence their participation; there are both individual and group goals
• Make sure goals are measurable.
  
• Contracts may be used--identify goals client want to work on and the behaviors they want to change
• Assign homework
  

Front 6

Questions that may help clients identify their goals for counseling

Back 6

• In what ways might I feel and behave differently if my life were as I want it to be?
  
• What steps can I take to help bring about these desired changes in my emotions and in my behaviors?
• What internal and external barriers exist that interfere with reaching my goals?
  
• What support systems can I use in reaching my goals?
  

Front 7

Group Process

Back 7

The stages groups go through, each characterized by certain feelings and behaviors. It includes activities, such as:

• Establishing group norms and group cohesion
• Learning to work cooperatively
• Establishing ways of solving problems
• Learning to express conflict openly.
  

Front 8

Group norms

Back 8

• Shared beliefs about expected behaviors aimed at making groups function effectively; can be implicitly (unstated) or explicitly stated

Implicit Norms: behaviors members take on in the group based on behavior they assume to be acceptable.

--Ex: leader curses, so members begin to curse in session

Explicit Norms: standards of behavior that are expected at group sessions. (see pg. 187). These norms are maintained throughout the life of the group and should be created collaboratively between all members.

--Members are expected to attend regularly and show up on time.

--Members are expected to give feedback to one another.

--Members are expected to focus on here-and-now interactions within the group.

Front 9

Group cohesion

Back 9

• A sense of togetherness, or community, within a group.
  
• Members have incentives for remaining in the group and share a feeling of belonging and relatedness.
  
• Usually occurs after group has struggled through a conflict together and have committed to taking significant risks. . It results after members have committed to actively participate and contribute to establishing a safe and accepting climate.

Front 10

3 Key Constructs for Effective Therapeutic Relationship in Group Treatment

Back 10

• group climate
  
• cohesion
• alliances
  

Front 11

Support vs Confrontation

Back 11

• Maintain appropriate balance between support and confrontation.
  
• Leaders should avoid highly confrontational interventions until they have established a relationship based on trust with members of group.
  

Front 12

Leader guidelines for members

Back 12

• Learn to help establish trust

--members should verbalize their fears, concerns, here-and-now reactions during early sessions.

• Express persistent feelings
  

--"If you are feeling detached and alone, let it be known." "If you are experiencing chronic anger or irritation towards others in the group, don't keep these feelings for yourself."

• Beware of misusing jargon

--people may not know certain terms "relate to", "get closer", "connect with"; may use "they" or "you", or "people" when really talking about themselves

• Decide for yourself how much to disclose
• Be an active participant, not an observer

--encourage members to share; if they feel they have nothing to share, then have them share their reactions to others' stories.

• Expect some disruption in your life

--family and friends may not react well to the changes you undergo as you complete group counseling; relationships may change

• Expect to discover positive aspects about yourself

--by working through the pain, members may discover inner strength, inner creativity, etc.

• Listen closely and discriminatingly
  

--Really listen to what members are saying in session. before speaking, let it sink in and note how it is affecting them.

• Pay attention to consistent feedback

--If several people have provided similar feedback, maybe take the chance to consider its validity.

• Do not categorize yourself

--do not apply labels to members or self; look at how the roles have worked for them in the past and how it is working in current situations; work to change the label/life narrative

Front 13

Recommendations

Back 13

• Avoid too much structuring and teaching--fosters too much dependence on the leader and not enough independence among group members
  
• Suggest journal writing as an adjunct to group sessions. Can share journal excerpts in session.
  
• Provide home assignments (example appropriate for initial session is incomplete sentence assignments) (see p. 203)
  

Front 14

Guidelines for assigning homework

Back 14

1. provide a rationale for activity

2. provide clients with a choice of homework activities or options

3. ask clients how confident they are that they will be able to complete the assignment

4. be sure to discuss the extent of homework completion and outcomes at next session

5. assess and record client's weekly performance of homework for monitoring progress

Front 15

Leader issues at initial stage

Back 15

• Division of responsibility--equal between co-leaders

• Degree of structuring (need balance, esp. in beginning)

--encourage members to assume increasing responsibility in group; should not depend on leader to provide structure for sessions.

--Leader should structure the group in a fashion that facilitates each member's autonomous functioning.

--Depending in the group, certain topics should be discussed in each session. But, if conflicts occur between members, the issue should be discussed and resolved before resuming discussion of selected topic.

• Opening and closing group sessions

-- have members "check-in" with each other in a warm-up activity before each session

Front 16

Suggestions for opening sessions ("checking-in")

Back 16

• Quick go-around, brief opportunity to share what they have done since the previous session (e.g., journal writing, completion of homework assignments).
• Discuss afterthoughts/unresolved feelings about the previous session; let group know that you have been thinking during the week about how the group is progressing; introduce any new members

Front 17

Suggestions for closing sessions

Back 17

• Brief checkout process with each member (last 10 minutes)
  
• Members should be encouraged to reflect on what they liked/did not like about the session, talk about what they would like to do outside of group during the week, and give some indication of how they experienced the session.
  
• Weekly groups: summarize what occurred in that session

Guidelines:

• Members can leave session with unanswered questions (something to "chew on"/to be answered in next week's session)
• Members should make a statement concerning their level of investment in the session (involved, uninvolved, excited, etc. )
• Members can share what they are learning about themselves through their relationships with other members.
  
• Bring up other topics, questions, or problems they would like to explore in the next session.
• Give feedback to one another.
• Remind participants of members who will be leaving. Provide time for other members to react to the transition of termination.