Counseling and Group Processes Midterm
Basic Issues In Group Work
"Individuals are wounded in relationships and can heal in relationships" Groups can be a healing force or a force of harm if not effectively facilitated Effective group leaders create a safe space for clients to grow and take risks Groups can provide members with a way to work through relational challenges, provide and give feedback and gain insight to interpersonal dynamics
The Coleadership Model 2
Advantages of Model Reduces chance of burnout- especially helpful with demanding populations Can allow for one leader to focus on reactions of other members- observer role Debrief before and after session is very beneficial- what was objective vs subjective Monitors countertransference and transference Can help multicultural dynamics if coleaders are different
Theories and Techniques Of Group Counseling 2
Alderian Approach- unity of person, individual's subjective perspective and life goals as a means of guiding behavior Therapeutic Goals- fostering social interest and connectedness to others- enhance a sense of belongingness in the group Therapeutic Relationship- cooperation, mutual trust, respect, collaboration and alignment of goals Techniques Providing confrontation and support Assisting group members in searching for new possibilities Offering encouragement and summarizing Interpretation of family and early experiences Lifestyle analysis
Selecting Clients and Composing Groups 3
Almost all clients will fit into SOME group- a more structured, homogeneous group may be more beneficial in many cases Fitting groups to clients vs the other way around Personality and attachment styles/variables can be more predictive of group behavior than diagnosis alone
Theories and Techniques Of Group Counseling 7
Behavior Therapy- identification of specific therapeutic goals by determining present level of functioning Therapeutic Goals- eliminate maladaptive behaviors and replace with constructive patterns Therapeutic relationship- to teach concrete skills through modelling, performance feedback and instructions Techniques Assessment at the beginning of group therapy to determine treatment plan Data collection before, during and after all interventions to determine progress Specific techniques used per treatment plan to help change behavior- evidence based strategies Cultural diversity is considered and treatment plans/goals are individualized per member
Theories and Techniques Of Group Counseling 10
Choice Theory/Reality Therapy- why and how of human behavior- humans motivated to change to get closer to what they want Therapeutic Goals- help people find better ways to meet their needs for survival, love, belonging, power, freedom and fun Therapeutic relationship- caring and acceptance to help members fulfill needs in the real world Techniques Active, directive and didactic W- wants; exploring wants, needs and perceptions; D- direction and doing; E- evaluation of total behavior; P- planning and commitment of realistic plans Creating an action plan Culturally assumes that basic needs of humans is universal
Theories and Techniques Of Group Counseling 8
Cognitive Therapy- people are prone to learning self-defeating thoughts but can unlearn them Therapeutic Goals- change the way clients think Therapeutic relationship- strong alliance and trust building as well as skilled in specific CBT techniques Techniques Identifying automatic thoughts and implementing cognitive restructuring Socratic dialogue/questioning- questions aimed to help clients come to insight on their own Psychoeducation about thought processes Guided discovery-helping members make the connection between thoughts, feelings and behaviors Teaching members how to be their own therapist
The Coleadership Model 1
Common Factors Approach- using common factors of different theoretical approaches to use in group setting Empathic listening, support, warmth, developing a working alliance, opportunity for catharsis, practicing new behaviors, feedback, positive expectations of clients, therapist effects, self reflection, etc. Coleader's working together collaboratively has a positive impact on the group- ensuring they remain on the same team
The Therapists - Basic Tasks 1
Creation and maintenance of a cohesive group Threats- lateness, absences, subgroups, scapegoating, etc.- therapist intervention Building group culture Incorporating therapeutic factors to foster effective group interaction Freedom to comment on immediate feelings about group, members and the therapist Construction of norms- implicitly shaped by group leader Leader moves the group in desirable therapeutic directions Leader models appropriate group behavior
Selecting Clients and Composing Groups 2
Criteria for inclusion Highly motivated for therapy and for group therapy in particular Self-referred Interpersonal challenges- areas they would like to improve Some level of insight into their interpersonal difficulties Impulsive clients and clients with limited accountability can do well due to the nature of the group (i.e. feedback of group members vs just therapist in 1:1)
The Coleadership Model 3
Disadvantages of the Model Problems are likely to occur if coleaders are not meeting regularly/on the same page Competition and rivalry Lack of trust between leaders Joining with members against the other leader Coleaders in a romantic relationship (not recommended) can add dysfunction to the group- working out relationship issues in the group space
Introduction to Group Work: A Multicultural Perspective2
Each person approaches participation in a group from their own unique perspective Important to develop tools as a group leader and a way of being that adequately respects, addresses and explores differences in a therapeutic setting. Be aware of your own personal values, attitudes, biases, assumptions and prejudices General knowledge about the ways diverse backgrounds of members may affect the group process Ability to implement interventions that are appropriate for the life experiences of the members of the group
Ethical and Legal Issues in Group Counseling 3
Ethical concerns in using group techniques Using techniques that a leader is unfamiliar with Using techniques to enhance power Using techniques thats sole purpose is to create intensity between members and with the group Using techniques to pressure members even when they have expressed a desire to not participate Using techniques to alter a group member's personal values or beliefs
Ethical and Legal Issues in Group Counseling 6
Ethical considerations for group members Confidentiality Explanation of expectation and maintenance of confidentiality within the group Explanation of when confidentiality will be breached by leader (this can help ease fears of other members) "Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure information. Counselors hold ongoing discussions with clients as to how, when and with whom information is to be shared." (ACA, 2014) Minors Laws differ from state to state: NY
Ethical and Legal Issues in Group Counseling 5
Ethical considerations for group members Freedom to withdraw from group Explanation of attendance policy and expectations about group process at the beginning of group Information to prematurely leaving the group (i.e. informing group members and leader) Psychological risk for members Explanation of risks involved in growth and how to handle this within the group space Misuse of power, self-disclosure, confidentiality, scapegoating, confrontation
Ethical and Legal Issues in Group Counseling 4
Ethical considerations for group members Informed consent Therapist qualifications, techniques that are used in the group, risks and benefits, etc. Policies regarding appointments, fees and insurance- nature and limitations of confidentiality Involuntary membership- in some cases groups are mandatory Thorough explanation of services and limits of confidentiality Explanation of choices and consequences of lack of compliance
Group Therapy- The Therapeutic Factors 5
Existential Factors Recognizing that life is at times unfair and unjust No escape from life's pain and from death Learning to take ultimate responsibility for the one lives their life No matter how close one is to others, they must still face life alone
Theories and Techniques Of Group Counseling 14
Feminist Therapy- focusses on issues of diversity, sexism and social context of understanding gender issues Therapeutic Goals- empowerment, self-acceptance, self-esteem, joy and self-actualization Therapeutic relationship- empowerment of clients to live according to their own values and honor internal locus of control in defining what is right for them Techniques Gender-role analysis- explores the impact of gender role expectations on members psychological wellbeing Power-analysis- helping members see how unequal accesses to power can influence personal realites Social action- how can members get involved in the community to help empower others
Group Therapy- The Therapeutic Factors 4
Group Cohesiveness Relationship to therapist, to group members and group as a whole Higher "groupness"- greater attendance, participation and mutual support "Relationship is at the heart of effective group therapy" Catharsis Ability to express feelings whether they are positive or negative Being able to say what is bothering you vs holding it in
Group Formation 1
Group Developmental Theory: Five Stages Forming, storming, norming, performing and adjourning Four Stages Engagement- tasks of member engagement and affiliation Differentiation- focus on control, power, status competition and differences Interpersonal work- productive work phase with intimacy and genuine cohesion Termination Groups may visit earlier developmental stages if group members graduate and new ones join Not a rigid timeline for development- groups tend to build upon each stage and may regress if groups integrity is threatened
Introduction to Group Work: A Multicultural Perspective 5
Group counselors can strive to consider(continued): Acknowledge the strengths and limitations in working with individuals from privileged and marginalized groups Inform members about basic values and expectations that are implicit in the group process (such as self disclosure, reflecting on one's life, and taking risks) Strike a balance between learning from each individual about their specific experiences and extending outside of the group to gain information to make them more culturally effective
Introduction to Group Work: A Multicultural Perspective 4
Group counselors can strive to consider: Understand some ways that issues pertaining to gender and sexual orientation can be productively explored within the group Consider the impact of adverse social, environmental, and political factors in problems and designing interventions in a group Awareness of how power, privilege, social group status and oppression influence the process of the group Awareness and knowledgeable in understanding worldviews of group members Respect the roles of family and community hierarchies within a member's culture Respect members' religious and spiritual beliefs and values
Ethical and Legal Issues in Group Counseling 1
Group leaders are expected to practice within the code of ethics of their particular profession and abide by legal standards Failure to exercise due care and act in good faith could lead to civil suit or license revocation Standard of care involves record keeping and consulting when necessary Ethical aspect of working with values "Counselors are aware of-and avoid imposing-their own values, attitudes, beliefs and behaviors." Consultation/additional training can be helpful if conflicting values arise Leaders responsibility to intervene when their is a clash of values or imposition of values among members Recognition of cultural norms of group members which may clash with group norms- create non-threatening way to be involved in group process
Selecting Clients and Composing Groups 1
Heterogeneous Outpatient Therapy Criteria for Exclusion Significant brain injury Paranoid Somatizing Addicted to drugs or alcohol Acutely psychotic Antisocial Little interest in joining the group or the therapeutic process
Theories and Techniques Of Group Counseling 19
How does process commentary help elicit change? Here is what your behavior is like Here is how your behavior makes others feel Here is how your behavior influences the opinions others have of you Here is how your behavior influences your opinion of yourself What does this information help clients to understand? Only I can change the world I have created for myself There is no danger in change To attain what I really want, I must change I can change, I am potent
Introduction to Group Work: A Multicultural Perspective 3
Important to discuss with group members how one's worldview influences beliefs and practices about groups and group process It is necessary to think about how people from other cultures might view group process Group leader engages in an ongoing process of self-reflection and role their professional identity has on group members Group leaders examine beliefs about how people learn and change from both a cultural and theoretical perspective Resistance or reluctance in the group process can be examined to see if it is better explained from a cultural context
Group Therapy- The Therapeutic Factors 1
Installation of hope- belief in the group process, highlighting improvement among group members Universality- knowing one is not alone in their humanness Altruism- members gain through giving Imparting information Didactic instruction- psychoeducation, explanation of the group process Direct advice- advice given amongst group members- can indicate a resistance of more intimate connection Structured groups focus on more direct skills- AA, life skills group, etc.
Theories and Techniques Of Group Counseling 15
Integrative Approach- group counseling based on concepts and techniques drawn from various theoretical approaches Limitations to basing practice off singular theoretical system Allows autonomy for the clinician to adapt a style that feels most authentic to them This can be fostered by trying different techniques and researching different approaches This approach takes time to develop and evolve
Group Therapy- The Therapeutic Factors 3
Interpersonal learning Importance of interpersonal relationships- normalization for group members Transference distortions- deeply stored memories of interactional experiences Interpersonal distortions- self perpetuating and self fulfilling Consensual validation- comparing one's interpersonal evaluation with those of others Corrective emotional experience- can foster the capacity to trust in what people say and do and to engage in the world without excessive vigilance The member's must experience the group as safe and supportive so tensions can be openly expressed Sufficient engagement and honest feedback to permit effective reality testing Group as a social microcosm- outside behavior is present in group and learned behavior in group enhances interpersonal dynamics
Creating the Group
Is the group opened or closed? Size of the group- typically 5-9 Duration and frequency of meetings- typically at least 60 minutes, weekly Brief therapy group- depends on goal of the group to achieve how many sessions are required Pregroup meetings and preparation for group therapy Can be helpful if possible to go over questions, fears, expectations- can also be done as a group in first session if needed
Introduction to Group Work: A Multicultural Perspective 1
Many people seek counseling due to difficulty forming and maintaining intimate relationships Groups can normalize challenges members face and allow them to feel like they are not alone in their difficulties Groups have the ability to create hope that life can be different and prove as a microcosm for how a member operates in the world in real time
Theories and Techniques Of Group Counseling 13
Motivational Interviewing- person centered therapy that is directive but stays in client's frame of reference Therapeutic Goals- explore member's ambivalence, minimize ambivalence and create intrinsic motivation Therapeutic relationship- collaborative partnership- draws on member ideas and references, does not take an expert stance Techniques Being purposeful and to the point to guide group members to positive change All choices rest with the members, not the leader Conversational style that strengthens member's motivation to change
Theories and Techniques Of Group Counseling 12
Narrative Therapy- examining the stories people tell and their meanings- there is no absolute reality Therapeutic Goals- group members to describe their stories with fresh language and different perspective Therapeutic Relationship- therapist seeks to understand the lived experience of each group member and honors that they are the expert on their lives Techniques Externalizing conversations- the person is not the problem, the problem is the problem Questioning with a goal of self-discovery for group members No set agenda Cultural components are taken into account on how these areas have impacted member's story and individualized experience
Theories and Techniques Of Group Counseling 4
Person- Centered Approach- focus on constructive side of human nature and what is right with people- we have the resources to understand and resolve our problems Therapeutic Goals- for members to find their own way and create meaningful goals- self-exploration Therapeutic Relationship- create an accepting and healing environment, non-directive- emphasis on relationship between group members, not therapist Techniques Therapist to share genuine reactions Confront clients in a caring way Be active in the therapeutic process Deep respect for all diversity and value understanding subjective world in accepting and open way
The Group Counselor 1
Personal Characteristics of Effective Group Leader Courage-ability to be vulnerable at times, admit mistakes, imperfections, taking risks Willingness to model desired group behaviors Presence- being affected by other's pain, struggles and joys Goodwill, genuineness and caring Belief in the group process Openness- revealing reactions to members and how you are being affected by them Not revealing intimate details about your personal life
Theories and Techniques Of Group Counseling 18
Process commentary is not usually accepted outside of group therapy space Socialization anxiety- commentary can evoke memories and anxieties associated with parental criticism- can be experienced as judgining, critical and controlling Social norms- unspoken rule to not comment directly on each other's behaviors allows for more autonomy and freedom Fear of retaliation Power maintenance When used in group therapy, allows for members to grow and change through here and now experience
The Group Counselor 2
Professional Skills Active listening- absorbing content, noting gestures, noticing changes in voice or expression and sensing underlying messages Reflecting- conveying the essence of what a person has communicated back to them Clarifying-focusing on key underlying issues and sorting out confusing and conflicting feelings Summarizing- often helpful in deciding where to go next Empathizing- sensing the subjective world of the individual Interpreting- offering possible explanations for certain behaviors and symptoms
The Group Counselor 4
Professional Skills Assessing- appraise certain behavior problems and choose appropriate interventions Modeling Suggesting Initiating- providing direction to members when needed Evaluating- reflecting with the group what is happening within the group Terminating- when a group session should end, when an individual is ready to leave a group and when a group has completed its work
The Group Counselor 5
Professional Skills Facilitating Assisting members to openly express their fears and expectations Actively working to create a climate of safety, acceptance and trust Provide encouragement and support Involving as many members as possible in the group interaction by inviting and sometimes even challenging members to participate Encouraging members to speak directly to one another Helping members overcome barriers to direct communication
The Group Counselor 3
Professional Skills Questioning- what and how questions over why Linking- relating what one person is doing or saying to another group member Confronting- addressing disruptive group behaviors or discrepancies between verbal and non verbal messages Supporting- helpful during crisis but too much can hinder growth in group process/members Blocking- responsibility to block unproductive group behaviors Questioning, probing, gossiping, invading privacy, breaking confidences or defined group rules
Theories and Techniques Of Group Counseling 6
Psychodrama- exploring problems through role playing Therapeutic Goals- facilitate the release of pent-up feelings, provide insight, help group members develop more effective behaviors Therapeutic Relationship- person-centered approach, trust in the relationship and using an active and directive role Techniques Role-playing- direct experience vs just talking about experiences Expressing themselves more fully Exploration of intrinsic and interpersonal problems while receiving constructive feedback Role- reversal- taking on part and perspective of another person
Theories and Techniques Of Group Counseling 1
Psychodynamic- insight, unconscious motivation (as a result of childhood experiences) and reconstruction of personality Therapeutic goals- make the unconscious conscious Therapeutic Relationship- establishing a working relationship in which therapist communicates caring, interest and involvement with members Techniques Free association Dream analysis Analysis of resistance Analysis of transference
Theories and Techniques Of Group Counseling 9
Rational Emotive Behavior Therapy- problems are caused by our perceptions of life situations and our thoughts Therapeutic Goals- eliminate self-defeating outlook on life, reduce unhealthy emotional responses, acquire a more rational and tolerant philosophy Therapeutic Relationship- unconditionally accept group members and teach them unconditionally accept self and others Techniques Help clients critically examine present beliefs and behaviors Connecting how beliefs influence feelings and behaviors Coping self-statements- faulty beliefs can be countered by rational and coping statements
Group Formation 3
Second Stage Conflict, dominance, rebellion Search for control and power and away from acceptance in the group- "storming" Emergence of hostility towards the therapist Ensure you are not putting your own needs over the needs of the group- recipe for failure Can be a valuable modelling opportunity Scapegoating of other member's may occur at this stage Group conflict occurs in the intrinsic process of change- coming together and coming apart and again and again- relational and occurs in psychotherapy
Introduction to Group Work: A Multicultural Perspective 6
Skills and Interventions- Culturally Skilled Group Leaders Familiarize with relevant research on how mental health issues affect diverse populations Actively seek out educational experiences that foster and promote knowledge and skills for facilitating groups across differences Ability to adapt and structure goals and interventions to accommodate cultural differences Flexibility in group facilitation methods and recognition that helping styles may be culture bound Providing psychoeducation on how diverse groups function and best ethical practives Inviting conversations about how culture, stereotypes, discrimination, power, privelege and oppression influence the therapeutic relationship
Ethical and Legal Issues in Group Counseling 2
Social justice approach to group counseling Group leaders find ways to develop groups that promote equity, access, participation and harmony Educating group members of their rights and assisting them in assuming an active role in bringing about social change Promoting discussion about cultural concerns, identity development, privilege and oppression Empowering group members by building on individual strengths of members and the group as a whole Leaders remain sensitive of the dynamics of a group that only includes one representative of a minority culture Leaders strive to establish group norms that facilitate the safety, inclusion and self-disclosure of LGBTQ+ clients
Theories and Techniques Of Group Counseling 11
Solution- Focused Brief Therapy- talking about and creating solutions Therapeutic Goals- emphasizes group members establishing their own goals and preferences Therapeutic relationship- collaborative- creating an environment of understanding and acceptance to allow change to happen Techniques The miracle question Pretherapy change- what have you done since calling for the appointment to help change your problem? Exception question- when did this problem not exist? Scaling- basing problem on scale from 1-10 Summary feedback- pointing out positive change by therapist and group members
Theories and Techniques Of Group Counseling 17
Techniques Process- nature of relationships between interacting individuals- members and therapists Internal psychological worlds of each group member Interpersonal interactions Group as a whole The clinical setting of the group Larger sociocultural/political environment in which the group is embedded Content- the explicit spoken words How and Why of statements and how this impacts interpersonal relationships
Theories and Techniques Of Group Counseling 16
Techniques of Group Therapy Working in the here and now Correlates with improved clinical outcomes Greater emphasis in psychotherapy groups vs structured groups Consists of two symbiotic tiers- working in conjunction with one another Experiencing- feelings towards the other group members, therapist and the group The illumination of process- the making sense aspect of the here and now experience The therapist steers the group to work in the here and now and facilitate the self-reflective loop
Theories and Techniques Of Group Counseling 3
The Existential Approach- we define ourselves by our choices, free will, authors of our lives Therapeutic Goals- members examining how they avoid their freedom and the responsibility that comes with it Therapeutic Relationship- collaborative relationship emphasis on self-discovery and current experiences Techniques Guided by philosophical framework of what it means to be human Envelopes an eclectic approach for therapists to pull from other theories as they see fit Highly applicable when working in multicultural context- universality of being human
Theories and Techniques Of Group Counseling 5
The Gestalt Approach- behavior is understood through the context of ongoing relationship with the present environment Therapeutic Goals- for members to attain great awareness and greater choice Therapeutic Relationship- who the therapist is as a person and the quality of the relationship Techniques Basic work is done by group members- therapist acts as guide/catalyst for experiments within the group Focus on what is happening in the "here and now" Therapist do not impose their own values but get very curious about how cultural backgrounds impact group members in the context of the group
Group Therapy- The Therapeutic Factors 2
The corrective recapitulation of the primary family group- the group as the family allows unresolved family dynamics to emerge- correct and repair Development of socializing techniques- increase in emotional intelligence in senior group members Imitative behavior- group members learn from the therapist and other members Vicarious or spectator therapy- benefit from witnessing the therapy of another group member
Group Formation 2
The first meeting Possibly introduction and methods explained- confidentiality, etc. Often "silence"- which is broken by one member "jumping in" or talking about discomfort in groups An activity (as we viewed in the video) can also be helpful Initial Stage orientation , hesitant participation, search for meaning and dependency Member's try to achieve primary task- purpose of which they joined the group Attending to social relationships in the group to create space or niche for themselve
The Therapists - Basic Tasks 2
Therapeutic Group Norms Self - monitoring- the group begins to assume responsibility for its own functioning Self-disclosure- must occur but each member's own pace Self- disclosure should never be used against a member- therapist should intervene if this occurs Procedural norms- creating the format and flow of the group This varies depending on the type of group- i.e. specialized group vs unstructured therapy group Members as agents of help Support and confrontation- many uncomfortable issues must be broached and explored
Group Formation 4
Third Stage- Development of Cohesiveness In group consciousness, common goals and support Recognition of the group as an entity Trust, self-disclosure Improvement in attendance and commitment
Theories and Techniques Of Group Counseling 21
Useful interpretation techniques Transference Common relational phenomenon with both conscious and unconscious roots Stems from client's fears, wishes and developmental gaps Objectives: Reconfigure a new self view Establish a different relational experience with the therapist than with significant others in the past Translate new understanding of self and other into a new narrative, new behavior and adaptive function Group therapy adds dimension of peer or horizontal transference vs typical vertical transfernce
Theories and Techniques Of Group Counseling 22
Useful interpretation techniques Transference in Group Therapy Adds the dimension of peer or horizontal transference to the more familiar vertical transference (individual therapy) Every client to a greater or lesser degree perceives the therapist incorrectly due to transference distortions "The leader shall have no favorites"- equality Can invoke sibling/family dynamics- trying to receive the validation and favoritism of the leader Money can activate many feelings about the group leader
Theories and Techniques Of Group Counseling 20
Useful interpretations techniques The use of the past If we are fully determined by the past, where comes our ability to change? Behavioral trajectory not only influenced by past but also future and present One also has the ability to reconstitute the past through therapy Group-as-a- whole process commentary When anxiety laden issues arise that are not being addressed Antitherapeutic norms are impeding the group- "taking turns approach" Group flight-regression of group's normal functions
