Group Counseling Final (ch. 9-17)
Screening therapy groups
- eliminate if in too much pain, too emotionally unbalanced, or better fit for another group
When therapy groups meet
- some meet 1 hour/day, others meet 1-2xs/wk for 1-3 hours... depends on populations and settings.
Designated number round
1-10 round to encourage members to think more specifically about a topic. (10 being very comfortable with topic in group, how much you liked the article this week, how you'd rate X issue, how you'd rate your current X)
Ideal therapy group size
5-8 (consistent) members
Exercise
An activity that the group does for a specific purpose. Plays an important role in making a group meaningful and interesting. Important for leaders to adapt exercises for the needs of the group and age level, cultural background, etc Can be used at any time during a group session.
The designated word or round phrase
Leader asks 1-3 possible choices when responding to a question or issue - y/n, very helpful/helpful/not helpful, here/getting there/not here.
Middle stage - assessing the benefits
Many ways to do this: - conduct a 1-10 round on how valuable the group has been - comment round - review previously discussed topics to eval group effectiveness so far - writing for 5-10 points on gains - assign out-of-group projects to bring back to group or email
Word or phrase round
Members are asked to respond with only one word or short phrase because the leader wants to keep comments brief. Ex. in a word or phrase, how are you feeling about X, how would you describe X
Most important stage of a group
Middle / working stage -- members work, learn, and derive max benefit from being in a group.
According to Yalom, structured exercises were first made for what kind of groups in the 1950s?
T-groups
Adlerian Therapy
- Adler - belief that human behavior can be controlled by instincts and formed by family/social interactions in childhood (i.e., birth order, learning value); private logic. - ALL behavior is purposeful... understanding it can help us change it! - guiding fictions are false beliefs learned as a child currently directing our lives - mistaken goals are goals we have based on faulty logic
Dealing with silence
- Can be both productive (when members are processing) and non-productive (members are confused, fearful of talking, or bored - Watch member's body language to tell the difference - If productive, give 1-2 mins or break the silence ("many of you seem to be deep in thought...") - If nonproductive, break silence in 15-20 seconds
Transactional Analysis
- Eric Berne - a visual theory, easy for members to understanding - Ego states (parent - critical/nurturing, adult, child - ok/not ok -- learned through childhood messages) - key is to help members get the "adult perspective" - can have members act out family scenes and stop throughout asking "What ego state are they in right now?"
Gestalt Therapy
- Fritz and Lisa Perls - existential approach; here and now - focuses on creating an environment where clients get "in touch" with unfinished business, re-experiencing, and integrating such experiences into curren awareness - goal is integration and movement toward independence, maturity, and self-actualization - concepts: hot seat, empty chair, guided fantasies - may produce intense emotions
Dealing with sexual feelings
- Sometimes members can and will be sexually attracted - Members may try to impress, hold back, or become jealous/angry/hurt - Some leaders set rules, others talk about how it may arise - to help: talk privately, address as a group, ask couple to drop out if interfering -- don't ignore.
Dealing with crying
- Tears can well up > sobbing; range of emotions reflected in tears. - leader should always be sure the member wants to work on the problem and that there is enough time to deal with the emotions - distinguish between genuine struggle and member who wants to be rescued
Reality Therapy
- William Glasser - Proposes that human beings are responsible for making choices about behavior and that such choices are intended to meet five basic human needs: survival, love/belonging, power, freedom, and fun. - choice theory - focus on relationships and satisfaction of human needs - believes "symptoms" such as nonclinical depression/anger are behaviors intended to control others/the environment. - focus not on past but leader plays active role to help members develop more positive plans of action - Use WDEP in group: want, doing, eval, and plan.
Military groups
- active duty military, veterans, and families - issues with daily living stress (ex. childcare, reintegration, career) or experiences in combat (ex. PTSD, hypervigilance, TBI) - screen for purpose of group, level of functioning - 4-6 members, 8-12 for war processing; 1-2 hours with breaks.. 2-3 or 8-12 weeks (depends) - counselor skills: knowledge of military culture/deployment/reintegration, military experience, handle intense emotions/flashbacks, trauma
Groups with teens
- ages 12-19 - can help with identity issues, sexual concerns, problems with peers/parents/school - ex. pregnant teens, drug users, runaways, parents of divorce/abuse - both voluntary/non - various settings/types - be aware of teens who sign up just to get out of class or be with friends (screen 1:1!) - 6-8 ideal size, 10-12 in psychoeducational - length: 40-90 mins / 1 session up to 1 year - leader skills: take charge, use structure, and make it interesting - keep confidentiality in mind
Middle stage - screening out members
- asking members to leave should only be done after numerous attempts to help the difficult member become a cooperative group member - maybe ask group members if its a good idea
Multicultural issues in groups
- be prepared for group differences that cause tension - some groups focus on specific cultural issues
Groups with addictions
- can be support/educational, voluntary/non - ex. overeating/not eating, shopping, gambling, sex, drugs, alcohol (AA) - screen for commitment to change - 6-10 members but to 30-40; usually lasts 1 hour but up to 2 hours with a therapist - counselor skills: dealing with anger (many non-voluntary), use of multisensory, handling confrontation, planning, cutting off, and patience
Formats for closing a session
- choice depends on type of group - rounds (in a sentence or two...) - dyads - written - summarize (member OR leader can)
Closing skills and techniques
- clarity of purpose (session is ending, no new topics) - cutting off ("let's discuss that next session") - tying together (patterns, issues, people) - drawing out - wishes ("my wish for you is...") - acknowledging a new member ("new member, I hope this has been interesting and even helpful. Was it?) - acknowledging a member who is leaving (5-10 mins... how they were different first session > wishes) - cautioning this warmth experience may not happen as quickly or at all in outside groups/relationships - prepare for challenges outside of group - prepare to handle criticism
Middle stage - assessing member participation
- consider each member's style of participation (no correct way) - to gain more participation, leader can change tone, mention observation, shift focus
Middle stage - planning and assessment
- decide how much planning is needed based on purpose of group, personalities/needs of group, and levels of trust/commitment - plans made before group ever made may need shifting throughout... just because it worked for past groups doesn't mean it will work for future
The closing stage
- depends on kind of group, purpose, number of sessions, and members' needs. - the greater the number of sessions, the more personal the sharing, the longer the closing stage.
Middle stage - assessing members' trust level/group cohesion
- did the group truly go through storming stage? - if low, bring up topic of trust or do a trust exercise
Therapeutic rounds
- differs in that the WORKING member is the one completing the round - in-depth stationary round (ex. same statement of belief said to every member to get a chance to listen to themselves) - in-depth movement round (ex. saying statements but moving in front of one another) - often involves SPINNING OFF to bring the group into the process with questions/observations
Closing phase
- every session should have a closing phase at the end of a session - for 1-hour sessions, 3-5 mins is enough; 2-3 hour sessions may require 5-10 mins - "Because there only are a few mins left in today's session, let's review what we've gone over... I think we're at a good stopping point, so let's spend the next few summarizing today's session and then we'll briefly talk about next week's session"
Middle stage - assessing how much to focus on content/process
- find a proper balance of content/process - not focusing on process can lead to superficiality/negative experiences
Solution-Focused Therapy
- focuses on client's strengths and solutions/coping - brief, good for schools - exceptions to problems, miracle question, scaling questions, coping questions, - avoid insight into the problem
Groups with chronic diseases or disabilities
- formed on a community basis, hospitals, or rehabs - important for pain or long-term management, emotional support - best to group based on one particular illness or disability - can be open/closed - 6-8 members, 1.5-2 hours per week - counselor skills: dealing with powerful feelings, getting members to focus on other aspects of life, letting members be experts, cutting off, being knowledgeable, and understanding the psychological ramifications of being in a residential treatment center.
Introducing an exercise
- give clear instructions/purpose - set the right tone - gain the cooperation of members - optional participation - don't imply where it's gonna go, let members decide - avoid lengthy intro - give a time limit - don't assume people did homework
Groups with adult children of alcoholics (ACOA)
- leaderless/ leader-led, support groups or therapy groups - screen for readiness, functioning - 8-12 members, 2 hour sessions, 8-15 weeks - counselor skills: knowledge, prepared to deal with emotional pain, Gestalt, TA, psychodrama
Techniques for more than one member in therapy groups
- likely to happen during topics - if someone is uncomfortable being the focus, shift the relevant topic to everyone, work in dyads, etc.
Techniques for conducting therapy groups
- members ask questions - members guess what the problem is - members role-play the working members - creative use of members (ex. playing ego states, enactments)
Groups with sexual abuse survivors
- mental health centers, abuse shelters, and drug/alcohol centers - most likely benefit from support or therapy groups... validates experiences and cuts through the veil of secrecy - screen for group maturity level (min. age 12?); recommended individual therapy first - 3-6 members; 2-2.5 hours per session... 6-8 weeks - counselor skills: knowledge of abuse, worked through issues of transference
Groups for divorced people
- mental health centers, churches - recovery (6-8 weeks), starting over groups (several months), or parenting - can be opened or closed - screen for individuals in so much pain that they might not be ready for group counseling - 3-8 members, 1.5-2 hour sessions - counselor skills: knowledge, REBT/CBT
Dealing with mutually hostile members
- mutual member dislike may manifest in arguments, disagreements, and silence - sometimes because of something that happened before/outside of group (SCREEN!) - leader may want to address in group or outside - goal is to get members not to let their dislike for another completely interfere with their benefiting from the group experience - get a commitment from each member to resolve the issue - dyads and group exercises can help
Groups with older clients
- needs are diverse... lowered self-esteem, alienation, fewer social contacts, fear of death, preoccupation with the past - task, support, and education groups - community centers, min. care residences, nursing homes, and institutions (screen for cognitive functioning) - 1-1.5 hours per session - counselor skills: providing info, making things happen, working through personal issues, developing/maintaining social contacts, explore new goals in life... patience, energy, and knowledge of certain issues.
Asking a member to leave
- not a regular occurence - can happen for several reasons: negative, hostile, resistant, distruptive, needs are contrary to the purpose of the group - ask to leave by talking 1:1,
Middle stage - assessing member's interest and commitment
- observe absences/late arrivals, ongoing disinterest - if so: end the group, change the format, bring up new issues, meet with specific members
Dealing with prejudiced, narrow-minded, or insensitive members
- one who tries to act as a moralist/preacher - leader may politely ask the member to try to understand that others have different views - may need to ask the member to leave the group if they are not open to different viewpoints
Purpose and goals of closing stage
- pull together significant ideas, decisions, and personal changes experienced by the members during the group. - progress, goals, accomplishments - some focus on group dynamics but mostly on individual
Groups with children
- under 12 - mostly in schools - is effective - mostly for family issues, values, self-concept, social and academic skills - under 7, mostly play time with some processing - confidentiality can be limited with parents - referrals: teachers can be useful; kids should know first session is screening to know they like being in a group/how they do - 4-6 ideal group size; 3 is better for ADHD or more severe - 30-mins - Session lengths vary and attend to school calendar - leader-oriented rather than facilitator - use multi-sensory approach - cut off and hold focus on any given topic - use enthusiastic voice - usually don't keep focus on one person at a time; depth usually goes to 6-7 with individual follow-up
Groups with couples
- usually a mental health center, treatment center, or church - usually enrichment, support, or therapy groups - ex. communication, living with X differences, surviving the loss of X - 5-12 members - weekend retreats or weekly sessions up to 2-3 hours - should be co-led - complex and usually difficult - leader should: understand the kinds of problems that may arise, counseling theories, use of drama/psychodrama, and special needs (ex. gay and lesbian)
Past/present-oriented exercises
- usually more productive to focus in the present about how the past impacts members because members cannot change their past but they can change they they are affected by it
Exercise-specific considerations
- written/craft: provide materials THEN explain - movement: have members move THEN explain - reading: facedown first - fantasy: speak slowly, encourage closed eyes but open is okay, leader keeps eyes open - feedback: give members space to think first
Middle stage - dealing with confidentiality
1 - talk to member who breached confidentiality to get some idea of what happened and why 2 - get a sense of how other members feel 3 - consult with supervision/colleagues 4 - turn the situation into a learning experience 5 - be mindful of agency policy
7 reasons for using exercises in a group
1. COMFORT - increase comfort among members Ex. writing exercises 2. GATHERING INFO - 3. DISCUSSION + FOCUS - helpful for different cultures 4. SHIFT FOCUS - 5. DEEPEN FOCUS - 6. EXPERIENTIAL LEARNING - acting out 7. FUN + RELAXATION - loosen up, becoming more present
8 uses of dyads
1. COMFORT - individual connections 2. WARMING/ENERGY - esp. beginning sessions 3. PROCESS - helpful after new info/activities 4. CLOSING TOPIC - ending a discussion 5. PAIRING MEMBERS - choosing specific members 6. LEADER-MEMBER INTERACTION - clarity/encouragement 7. CHANGING FORMAT - prevent restlessness 8. TIME FOR LEADER TO THINK - groups can be unpredictable!
Middle stage - leadership tactics
1. EDUCATION: good balance of information + discussion 2. TASK: generate options to move toward decision/resolution
Conducting an exercise
1. INSTRUCTIONS: make sure members take focused/follow-through 2. NOT SHARE: allow members to not share 3. EMO. REACTIONS: focus on 1 member, dyads, acknowledge + continue, allow member space, or pull aside on break 4. CHANGE/STOP: intensity, appropriateness, relevance of topic 5. TIME: inform time before, during 6. LEADER: monitor as non-participant, do not participate if too much focus is on leader/unfinished business; could build leader buy-in/manage effect/need for feedback/manage a difficult member/odd # of members
6 roles and responsibilities of a therapy group leader
1. KNOWLEDGE: of topic, ethical responsibility 2. ATMOSPHERE: provide right environment for trust 3. FOCUS: aware of holding, shifting 4. AWARENESS: of reactions, emotions, dynamics, culture 5. TIMING: watching the clock, room for enough time to discuss deeper topics 6. "AIR TIME": do not focus only on 1-2 members
2 ways to pair members for dyads
1. MEMBERS CHOOSE - be careful of favorites/excluding 2. LEADERS CHOOSE - by seating, by similarities/differences
Middle stage - leadership skills + techniques
1. PROGRESS REPORTS: what happened between sessions -- 5-10 mins. 2. TOPICS: new topics when group wanes -- shifting focus 3. THOUGHTS: stimulate new perspectives/thoughts w/questions 4. FORMAT: see if group wants a change in format if bored 5. STYLE: have members do more of the cutting off, drawing out, generating topics vs. a more active role 6. STRUCTURE: extending meeting, changing day, sub-groups, divide time in half 7. VOICE: exergize and change the "tone" of the group 8. MATERIALS/ASSIGNMENTS: to build outside change 9. 1:1: to get an idea of how member is doing 10. ENDING: inform members group is ending at least 3-5 weeks in advance
7 stages of closing stage
1. REVIEW/SUMMARIZE GROUP EXPERIENCE: usually best to allow members to share what stood out to them. 2. ASSESS MEMBER GROWTH/CHANGE 3. FINISH BUSINESS: questions, negative feelings about one another, unresolved personal issues ("I urge you not to leave thinking "I wish I would have done this or that") 4. APPLY CHANGE TO LIFE 5. FEEDBACK 6. GOODBYES: normalize sad feelings 7. CONT. PROBLEM RESOLUTION: provide referral sources
Exercises to use during the closing stage
1. ROUNDS: 1-10 satisfaction, sentence about the experience, word or phrase about how you feel this is ending. 2. WISHES 3. REUNION FANTASY: to project into the future 4. WRITING 5. FLIPCHART/HANDOUTS
6 aspects of rounds
1. SET UP - when's it useful? does everyone understand? 2. START - switch up who goes first/last 3. STOPPING - for info mini lectures, if crying 4. HESITANCY - skip or come back, don't force 5. PROCESS - why'd they answer the round that way? Pair up members according to how they answered, focus on one member in need, follow-up for further clarification (ex. y/n round) 6. OVERUSING - can be come boring
5 considerations during closing stage
1. STRONG EMOTIONS: guard against ending with! Members should see ending as a new beginning and leave on a high. 2. EXIT INTERVIEWS: 3. FOLLOW-UP: reunions usually not recommended; ex. members write themselves letters to read in several weeks/months (great idea!) 4. EVALUATION: 5. PARTY: depends on group, may or may not be appropriate
6 considerations for dyads
1. TIME - 2-10 mins, give time warnings 2. CLEAR INSTRUCTIONS - 3. STAY ON TASK - purpose beforehand helps 4. LEADER'S ROLE - may or may not participate, floating, time warnings 5. PHYSICAL ARRANGEMENT - maybe move to other parts of building for longer dyads 6. TRIADS - more ideas, but people may hide/not contribute
8 uses of rounds
1. TRUST - get to know all members, linking 2. FOCUS - on issue/topic (comment, word, or #) 3. INFO + ENERGY - to know what members know 4. SHIFT FOCUS - to all members (cutting off) 5. DRAWING OUT - quiet members 6. DEEPENING - delving deeper into thoughts/feelings/topic 7. PROCESS EXERCISES - 8. SUMMARIZE - closing
Middle stage - common leadership mistakes
1. UNDER/OVER LEADING: 2. WARM-UP TOO LONG: 3. SHIFTING FOCUS TOO MUCH: 4. FOCUSING TOO LONG ON ONE MEMBER: 5. FOCUSING ONLY ON 1-2 MEMBERS: 6. PLANNING 1-2 EXERCISES: 7. FAILING TO PROCESS: 8. UNINTERESTING SPEAKERS:
14 kinds of exercises
1. WRITTEN - versatile; lists, fill-in, completion, checking boxes 2. MOVEMENT - changing seats, milling, values continuum, goals walk, how far you've come, sculpt your feelings, family sculpture, group sculpture, home spot, personal space, become a statue, trust 3. DYADS/TRIADS - I have to/I choose to 4. ROUNDS 5. CREATIVE PROPS - rubber bands, cups, small chair, beer bottle, 6. ARTS/CRAFTS 7. FANTASY - ex. growth groups briefcase 8. READING - Gestalt prayer 9. FEEDBACK - first impressions, strength bombardment, wishes 10. TRUST - trust fall, blind trust walk 11. EXPERIENTIAL 12. MORAL DILEMMA 13. GROUP-DECISION 14. TOUCHING - consider appropriateness...
Common mistakes when leading therapy groups
1. attempting to conduct therapy w/o a contract 2. not involving other members 3. spending too much time on one person 4. spending too little time on one person 5. focusing on an irrelevant topic 6. letting members rescue each other 7. letting the session be an advice-giving session
3 kinds of rounds
1. designated word, phrase, or number 2. the word or phrase round 3. the comment round
Goals of therapy groups
1. process goals: goals related to the group process. 2. outcome goals: goals that pertain to behavior changes in the member's life (depth level 6 or below)
3 purposes and goals of the closing phase
1. summarizing and highlighting the main points 2. reinforcing commitments made by individual members (HW) 3. checking for unfinished business from the session
Transtheoretical Model
5 stages of change: 1. precontemplation - no desire to change (ex. mandated) 2. contemplation - aware of problems but no commitment to change 3. preparation - intention to change + small steps toward change 4. action - make changes; progress reports 5. maintenance - maintaining change - esp. important for growth, counseling, therapy groups - increase internal motivation to change behavior - goal-oriented behavioral changes
Dyads
An activity where members pair up and discuss issues or complete a task
Member who tries to "get the leader"
Attempts to sabotage what the leader says/does; disagrees, not following instructions, asking unanswerable questions, whispering/distracting... often because the member feels irritated/embarrassed by some experience with the leader (e.g., putting member on the spot, cutting off, failing to come back to them, not being skilled enough as a leader, being boring, etc. To help: pull aside and ask about directly, group feedback
The rescuing member
Attempts to smooth over negative feelings experienced by another member; prevents others from problem-solving... To help: educate on rescuing to the group, interrupt, model behavior as leader...
CBT
Based on the principle that thoughts > feelings. Includes rational emotive, relational behavioral, rational living, cognitive, and DBT. Ellis (REBT) and Beck (Cognitive Therapy).
The chronic talker
Characteristized by persistent rambling and repetition, makes members tune out, lose interest, get frustrated. 3 types: 1. nervous member - talks to alleviate anxiety 2. rambler - talkative person who tells long stories 3. show-off - insecure, wants to impress others To help: dyads (talk to member about talkativeness), address the group and hope they hear the message, seek feedback from the whole group ("anyone here want to give another member feedback?"), avoid eye contact, written feedback
Closing phase vs. closing stage
Closing PHASE is a period of a session when the leader wraps things up. Closing STAGE is the last session or few sessions.
The negative member
Constantly complains about the group/disagrees with other members; works against leader's positive tone. To help: talk to member 1:1, identify positive members to talk more in group, avoid eye contact to not draw out... avoid confronting in group!
The distracter
Either seeking attention or avoiding looking at self; tries to get the group off task with unrelated discussion; usually found in non-voluntary groups... To help: talk with the member and then ignore comments/behaviors to minimize distractions.
The resistant member
Often non-voluntary; sometimes helpful to have them express anger; essential for leader to pay attention to what is being worked through in resistance/if the member is resisting group process or personal change... To help: let the member share feelings in group, talk to them in dyad/after a session to work through resistance.
REBT
Rational emotive behavior therapy - Ellis - excellent for groups because its easy to learn - A (activating event) + B (beliefs) = C (consequences) - teach in session with the real group member problem or asking "where do feelings come from?" and use whiteboard/hand out with ABC model - rational/irrational thoughts - ex. "using the ABC model, what do you hear as X's activating event?"
Processing an exercise
The most important phase of any exercise... - to stimulate sharing - go deeper - improve group process - give enough space/time for processing - assess feelings, thoughts, insights, applicability - hear from all members first
The dominator
Tries to rule the group, wants to be in control... To help: usually needs to be pulled aside and can either be a helper/special role or will need to be removed from the group.
Comment round
Used when the leader wants members to say more than just a few words. Ex. brief progress reports on the week, which action should we take, what's hardest about X briefly.
Obtaining a contract in therapy groups
member agrees to be the focus of the group's attention -- would you like to work on that?
