Yalom Chapter 2; Corey Chapter 2 and 3

Interpersonal Learning

"Ones interpersonal beliefs express themselves in behaviors that have a predictable impact on others." "Psychiatric treatment should be directed toward the correction of interpersonal distortion." Goal shift: from symptoms to interpersonal. Accordingly, psychiatric treatment should be directed toward the correction of interpersonal distortions, thus enabling the individual to lead a more abundant life, to participate collaboratively with others, to obtain interpersonal satisfactions in the context of realistic, mutually satisfying interpersonal relationships: "One achieves mental health to the extent that one becomes aware of one's interpersonal relationships." Their initial goal, relief of suffering, is modified and eventually replaced by new goals, usually interpersonal in nature. For example, goals may change from wanting relief from anxiety or depression to wanting to learn to communicate with others, to be more trusting and honest with others, to learn to love. The goal shift from relief of suffering to change in interpersonal functioning is an essential early step in the dynamic therapeutic process. It is important in the thinking of the therapist as well. Therapists cannot, for example, treat depression per se: depression offers no effective therapeutic handhold, no rationale for examining interpersonal relationships, which, as I hope to demonstrate, is the key to the therapeutic power of the therapy group. It is necessary, first, to translate depression into interpersonal terms and then to treat the underlying interpersonal pathology. Thus, the therapist translates depression into its interpersonal issues—for example, passive dependency, isolation, obsequiousness, inability to express anger, hypersensitivity to separation The theory of interpersonal relationships has become so much an integral part of the fabric of psychiatric thought that it needs no further underscoring. People need people—for initial and continued survival, for socialization, for the pursuit of satisfaction. No one—not the dying, not the outcast, not the mighty—transcends the need for human contact. Many of the issues that I have raised have a vital bearing on the therapeutic process in group therapy: the concept that mental illness emanates from disturbed interpersonal relationships, the role of consensual validation in the modification of interpersonal distortions, the definition of the therapeutic process as an adaptive modification of interpersonal relationships, and the enduring nature and potency of the human being's social needs.

THE IMPORTANCE OF INTERPERSONAL RELATIONSHIPS

"The need to belong is a powerful, fundamental and pervasive motivation." Risk factors associated with loneliness Social connection has a positive impact (Sullivan) "The self may be said to be made up of reflected appraisals....the personality is almost entirely the product of interaction with significant human beings." There is, for example, persuasive evidence that the rate for virtually every major cause of death is significantly higher for the lonely, the single, the divorced, and the widowed.6 Social isolation is as much a risk factor for early mortality as obvious physical risk factors such as smoking and obesity.7 The inverse is also true: social connection and integration have a positive impact on the course of serious illnesses such as cancer and AIDS. Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings.

Pregroup Disclosures

A clear statement regarding the purpose of the group A description of the group format, procedures, and ground rules An initial interview to determine whether this particular group with this particular leader is at this time appropriate to their needs An opportunity to seek information about the group, to pose questions, and to explore concerns A discussion of ways the group process may or may not be congruent with the cultural beliefs and values of group members A statement describing the education, training, and qualifications of the group leader Information concerning fees and expenses including fees for a follow-up session, should there be one; also, information about length of the group, frequency and duration of meetings, group goals, and techniques being employed Information about the psychological risks involved in participating in a group Knowledge of the circumstances in which confidentiality must be broken because of legal, ethical, or professional reasons Clarification of what services can and cannot be provided within the group Help from the group leader in developing personal goals A clear understanding of the division of responsibility between leader and participants A discussion of the rights and responsibilities of group members Clients' Rights During the Group Here is a list of what members have a right to expect during the course of the group: Guidance concerning what is expected of them Notice of any research involving the group and of any audio- or videotaping of group sessions Assistance from the group leader in translating group learning into action in everyday life Opportunities to discuss what one has learned in the group and to bring some closure to the group experience so participants are not left with unnecessary unfinished business A consultation with the group leader should a crisis arise as a direct result of participation in the group, or a referral to other sources of help if further help is not available from the group leader The exercise of reasonable safeguards on the leader's part to minimize the potential risks of the group; respect for member privacy with regard to what the person will reveal as well as to the degree of disclosure Observance of confidentiality on the part of the leader and other group members Freedom from having values imposed by the leader or other members The right to be treated as an individual and accorded dignity and respect It is critical that group leaders stress that participation in groups carries certain responsibilities as well as rights. These responsibilities include attending regularly, being prompt, taking risks, being willing to talk about oneself, giving others feedback, maintaining confidentiality, and defining one's personal goals for group participation.

Portrait of Highly Effective Therapists

A drive to master, yet a sense of never arriving An ability to deeply enter the world of another without losing a sense of self The ability to provide an emotionally safe environment for clients while challenging them The ability to draw on their therapeutic power to help others while maintaining a sense of humility Integration of their personal and professional selves with clear boundaries between each dimension The ability to give of self to others while being able to nurture and take care of themselves The ability to accept feedback about themselves without becoming destabilized by this feedback

THE GROUP AS SOCIAL MICROCOSM

A freely interactive group, with few structural restrictions, will, in time, develop into a social microcosm of the participant members. Given enough time, group members will begin to be themselves: they will interact with the group members as they interact with others in their social sphere, will create in the group the same interpersonal universe they have always inhabited. There is no need for them to describe or give a detailed history of their pathology: they will sooner or later enact it before the other group members' eyes. Don't allow problem solving/history taking...instead, allow an "unfolding in the here and now of the group." "What would it be like to live with Linda all the time instead of an hour and a half a week?"

Belief in the Group Process and Enthusiasm

A leader's lack of enthusiasm is generally reflected in members' lack of excitement about coming to group sessions and in members' inability to do significant work. The enthusiasm group leaders bring to their groups can have an infectious quality. If leaders radiate life, the chances are slim that they will consistently be leading "stale groups." Leaders need to show that they enjoy their work and like being with their groups.

parataxic distortion

A parataxic distortion occurs in an interpersonal situation when one person relates to another not on the basis of the realistic attributes of the other but on the basis of a personification existing chiefly in the former's own fantasy. Although parataxic distortion is similar to the concept of transference, it differs in two important ways. First, the scope is broader: it refers not only to an individual's distorted view of the therapist but to all interpersonal relationships (including, of course, distorted relationships among group members). Second, the theory of origin is broader: parataxic distortion is constituted not only of the simple transferring onto contemporary relationships of attitudes toward real-life figures of the past but also of the distortion of interpersonal reality in response to intrapersonal needs. Interpersonal (that is, parataxic) distortions tend to be self-perpetuating. For example, an individual with a derogatory, debased self-image may, through selective inattention or projection, incorrectly perceive another to be harsh and rejecting. Moreover, the process compounds itself because that individual may then gradually develop mannerisms and behavioral traits—for example, servility, defensive antagonism, or condescension—that eventually will cause others to become, in reality, harsh and rejecting. This sequence is commonly referred to as a "self-fulfilling prophecy"—the individual anticipates that others will respond in a certain manner and then unwittingly behaves in a manner that brings that to pass.

Giving Feedback

A skilled group leader gives specific and honest feedback based on his or her observation of and reaction to the members' behaviors and encourages the members to give feedback to one another. One of the great advantages of groups is that participants can tell each other their reactions to what they observe. The purpose of feedback is to provide a realistic assessment of how a person appears to others. The skill involved in productive feedback relates to the ability to present the feedback so that it is acceptable and worthy of serious consideration. Feedback that is specific and descriptive rather than global and judgmental is the most helpful.

Overview of Group Leadership Skills

Active Listening Reflecting Clarification Summarizing Facilitating Empathizing Interpreting Questioning Initiating Setting goals Evaluating Giving feedback Suggesting Protecting Disclosing oneself Modeling Linking Blocking Terminating Linking Confronting Supporting Blocking Assessing Modeling Suggesting Initiating Evaluating Terminating

Active Listening

Active listening involves paying total attention to the speaker and being sensitive to what is being communicated at both the verbal and nonverbal levels. Being a skilled group leader entails picking up the subtle cues provided by members through their style of speech, body posture, gestures, voice quality, and mannerisms. Not only do group leaders need to listen well to members, it is important that leaders teach members how to listen actively to one another.

Becoming a Diversity-Competent Group Leader

Address the following three areas of the multicultural counseling competencies: Beliefs and attitudes Knowledge Skills and intervention strategies Become aware of your biases and values Try to understand the world from the member's vantage point Gain a knowledge of the dynamics of oppression, racism, discrimination, and stereotyping Study the traditions and values of the members of your group Learn general knowledge, but avoid stereotyping Be open to learning from your members Recognize that diversity can enhance the group process

Skills for Closing Group Sessions

Allow time for closure Encourage members to evaluate their own progress Close a session without closing the issues raised during the session Make summary comments Teach members how to integrate what they have learned for themselves Encourage members to offer feedback to each other Discuss homework assignments Before closing a session, it is essential to allow time for integrating what has occurred, for reflecting on what has been experienced, for talking about what the participants may do between now and the next session, and for summarizing. The leader may also find it useful to check with the group around the midpoint of the session and say something like this: "I'm aware that we still have an hour left before we close today. I want to see if there are any matters you want to bring up before we close"; or this: "I'd like each of you to give me an idea of how you feel about this session. So far, have you gotten what you wanted from it?" Although these assessments in the middle of a session don't have to be made routinely, doing so from time to time can encourage members to evaluate their progress. If members are not satisfied with either their own participation or what is going on in the session, there is still time to change the course of the group before it ends. The leader can do a great deal to guide participants into reflecting on the time limitations of their group and on whether they are satisfied with their participation. Members also need guidance in appraising how fully their goals are being achieved and how effectively the group is operating. If this periodic appraisal is done well, members have a chance to formulate plans for changes in the group's direction before it is too late. Consequently, it is less likely they will leave the group feeling that they didn't get what they had hoped for when they joined. Group leaders should strive to close the session without closing the issues raised during the session. It may not be therapeutic to wrap up a concern or solve a problem too quickly. t is good for people to leave a session with unanswered questions, as this can motivate them to think more about their concerns and to come up with some tentative solutions on their own. Leaders need to learn the delicate balance between bringing temporary closure to a topic at the end of a session and closing the exploration of an area of personal concern completely. Summarizing can be effective at the end of each session. It is helpful to ask members to summarize both the group process and their own progress toward their goals. Participants can be asked to tell the group how they perceived the session, to offer comments and feedback to other members, and to make a statement about their level of investment in the session. By doing this regularly, members share in the responsibility of deciding what they will do to change the group's direction if they are not satisfied with it. It is helpful to focus on positive feedback too. Individuals who get involved should be recognized and supported for their efforts by both the leader and other participants. Members can report on their homework assignments, in which they tried to put into practice some of their new insights, and they can make plans for applying what they have learned to problem situations outside the group. Participants can be asked whether there are any topics or problems they would like to put on the agenda for the next session. Doing this can add to a sense of ownership and responsibility for and to the group and to the members' own change process. Group leaders may want to express their own reactions to the session and make some observations. These reactions and comments about the direction of the group can be very useful in stimulating thought and action on the part of the members. In a group with changing membership, it is good to remind members a week before that certain members will be leaving the group. Those who are terminating need to talk about what they have gotten from the group and what it is like for them to be leaving. Other members will most likely want to give feedback to the terminating member.

Religious and Spiritual Values in Group Counseling

Almost all survey participants found it appropriate to discuss both spiritual and religious topics when group members brought up these concerns, but they did not introduce these topics or ask group members about their spiritual or religious background and beliefs. In addition, counselors were twice as likely to comment on the therapeutic value of spiritual discussions over religious discussions. Addressing spiritual and religious values in group counseling encompasses particularly sensitive, controversial, and complex concerns. It is critical to be aware of and to understand your own spiritual or religious attitudes, beliefs, values, and experiences if you hope to facilitate an exploration of these issues with members of your group. Religious and spiritual values are a basic aspect of the lives of some group members, and clients may feel that their needs are not being met if their religious or spiritual concerns are ignored. In this area, the group members should set the agenda.

Self-Disclosure

Although what to reveal and when are factors in determining the appropriateness of self-disclosure, the issue centers on how much to reveal. It is not uncommon to err on either extreme, disclosing too little or disclosing too much. If you try very hard to maintain stereotyped role expectations and keep yourself mysterious by hiding behind your professional facade, you can lose your personal identity in the group and allow very little of yourself to be known. In addition to being unwilling to share your personal life, you may also be hesitant to disclose how you feel in the group or how you are affected by certain members. As a way of avoiding sharing your own reactions to what is occurring within the group, you might limit your interventions to detached observations. Such "professional" aloofness may be expressed by too frequently making interpretations and suggestions, asking questions rather than making personal statements, acting as a mere coordinator, and providing one structured exercise after another to keep the group going. In my opinion, the most productive form of sharing is disclosure that is related to what is going on in the group. Considering the reasons for your disclosures, the readiness of the members, the impact your sharing of intimate details is likely to have on them, and the degree to which your disclosures are relevant to the here-and-now process of the group should go hand-in-hand with self-disclosure.

Practice-Based Evidence in Group Work

An alternative to EBP is PBE: It involves systematically gathering and using formal client feedback to inform, guide, and evaluate treatment PBE can help therapists assess the value of a group for its members throughout the life of the group It aids in evaluation of the group experience during the termination phase

Socializing Among Group Members

An issue to consider is whether socializing among group members hinders or facilitates the group process. This concern can become an ethical issue if members are forming cliques and gossiping about others in the group or if they are banding together and talking about matters that are best explored in the group sessions. If hidden agendas develop through various subgroups within the group, it is likely that the progress of the group will come to an abrupt halt. This is especially true when some participants discuss issues relevant to the group but avoid bringing up the same issues in the group itself. As Yalom (2005) explains, "It is not the subgrouping per se that is destructive to the group, but the conspiracy of silence that generally surrounds it". One of the best ways for the group leader to prevent inappropriate and counterproductive socialization among group members is to bring this issue up for discussion. It is especially timely to explore the negative impact of forming cliques when the group seems to be stuck and is getting nowhere or when it appears that members are not talking about their reactions to one another. The members can be taught that what they do not say in the group itself might very well prevent their group from attaining any level of cohesion or achieving its goals.

Appropriate and Facilitative Self-Disclosure

Appropriate, facilitative self-disclosure is an essential aspect of the art of group leading. It is not necessary to disclose details of your past or of your personal life to make yourself known as a person or to empathize with the participants. A few words can convey a great deal, and nonverbal messages—a touch, a look, a gesture—can express feelings of identification and understanding. Appropriate disclosure does not take the focus away from the client and is never a contrived technique to get group members to open up. At times, a group therapist's self-disclosure involves communicating his or her observations and personal reactions to an individual member or to what is happening in the group at a given point in time. When done in a sensitive and caring manner, this can be a powerful way to model giving interpersonal feedback in the group, and it can have a therapeutic impact. Therapists need to monitor the frequency and purpose of their disclosures. Therapists might consider disclosing for the purpose of normalizing experiences, modeling, strengthening the therapeutic alliance, validating reality, or offering alternative ways to think or act. Therapists should avoid self-disclosure that is used to meet their own needs, takes the focus off the client's experiencing, interferes with the flow of the session, burdens the client, blurs the boundaries in the relationship, or contaminates the transference. It is important for therapists to observe how clients react to the disclosures, to ask clients how they react to sharing personal material, and to decide how to intervene next. Different clients react differently to therapist disclosure, so it is important to determine what clients need from the therapist.

The Right to Confidentiality

As a leader, you are required to keep the confidences of group members, but you have the added responsibility of impressing on the members the necessity of maintaining the confidential nature of whatever is revealed in the group. This matter bears reinforcement along the way, from the initial screening interview to the final group session. Confidentiality is often on the minds of people when they join a group, so it is timely to fully explore this issue. A good practice is to remind participants from time to time of the danger of inadvertently revealing confidences. As a group leader, you cannot guarantee confidentiality in a group setting because you cannot control absolutely what the members do or do not keep private. Members have a right to know that absolute confidentiality in groups is difficult and at times even unrealistic (Lasky & Riva, 2006). However, you can discuss the matter, express your convictions about the importance of maintaining confidentiality, and have members sign contracts agreeing to it. Your own modeling and the importance that you place on maintaining confidentiality will be crucial in setting norms for members to follow

Skills for Opening Group Sessions

Ask members to briefly check in and comment on what they want to explore Be attentive to unresolved issues from prior sessions Ask members to report their progress or difficulties during the week With members, create an agenda for each session Consider using structured exercises to open sessions If you are facilitating an "open group," ask experienced members to share with newcomers what the group has meant to them have newcomers share their hopes and anxieties pertaining to the group In addition to facilitating member involvement in opening a session, group leaders may want to make some observations about the previous meeting or relate some thoughts that have occurred to them since the group last met. One way to open a group session is through the use of a structured exercise that assists members in identifying the concerns they want to explore. Depending on how, when, and why they are used, structured exercises can enhance interaction and provide a focus for work, or they can promote member dependence on the leader for continuing to provide direction.

Professional Training Standards for Group Counselors

At a minimum, one group course should be included in a training program, and it should be structured to help students acquire the basic knowledge and skills needed to facilitate a group. All study participants reported some personal or professional progress as a result of their experience in a group. Areas of benefit included interpersonal learning, knowledge about group process, self-awareness, empathy for future clients, and opportunities to learn by observing group process in action. The participants' confidence in facilitating a group increased after having experience as a group member, and they believed their participation assisted them in developing their own personal leadership style.

The Impact of the Leader's Values on the Group

Be aware of how your values influence your group interventions Assist members in finding answers that are most congruent with their own values Use "ethical bracketing" to keep your personal values separate from your work with group members Find ways to manage value conflicts between you and the members Recognize that much of group members' exploration involves clarifying their values Monitor any members who may attempt to impose their values on other members The purpose of the group is to help members clarify their beliefs and examine options that are most congruent with their own value system. Group counseling is not a forum in which leaders impose their worldview on the members; it is a way to assist members in exploring their own cultural values and beliefs. Kocet and Herlihy (2014) describe this process as ethical bracketing, the "intentional setting aside of the counselor's personal values in order to provide ethical and appropriate counseling to all clients, especially those whose worldviews, values, belief systems, and decisions differ significantly from those of the counselor".

The Ethics of Group Leaders' Actions

Being a group practitioner demands sensitivity to the needs of the members of your group and to the impact your values and techniques can have on them. It also demands an awareness of community standards of practice, the policies of the agency where you work, and the state laws that govern group counseling.

Presence

Being emotionally present means being moved by the joy and pain that others experience. If leaders recognize and give expression to their own emotions, they can become more emotionally involved with others. Presence also has to do with "being there" for the members, which involves genuine caring and a willingness to enter their psychological world. Being present means that leaders are not fragmented when they come to a group session and that they are not preoccupied with other matters.

Critical incidents: Negative affect

But the evocation and expression of raw affect is not sufficient: it has to be transformed into a corrective emotional experience. For that to occur two conditions are required: (1) the members must experience the group as sufficiently safe and supportive so that these tensions may be openly expressed; (2) there must be sufficient engagement and honest feedback to permit effective reality testing. 1.The client expressed strong negative affect. 2. This expression was a unique or novel experience for the client. 3. The client had always dreaded the expression of anger. Yet no catastrophe ensued: no one left or died; the roof did not collapse. 4. Reality testing ensued. The client realized either that the anger expressed was inappropriate in intensity or direction or that prior avoidance of affect expression had been irrational. The client may or may not have gained some insight, that is, learned the reasons accounting either for the inappropriate affect or for the prior avoidance of affect experience or expression. 5. The client was enabled to interact more freely and to explore interpersonal relationships more deeply.

Self-Exploration Groups for Group Leaders

By experiencing your own cautiousness, resistances, fears, and uncomfortable moments in a group, by being confronted, and by struggling with your problems in a group context, you can experience what is needed to build a trusting and cohesive group. In addition to helping you recognize and explore personal conflicts and increase self-understanding, a personal growth group can be a powerful teaching tool. Some of the benefits of participating in a therapeutic group that he suggests are experiencing the power of a group, learning what self-disclosure is about, coming to appreciate the difficulties involved in self-sharing, learning on an emotional level what one knows intellectually, and becoming aware of one's dependency on the leader's power and knowledge.

Don't Overwhelm Yourself!

By systematically learning certain principles and practicing certain skills, you can expect to gradually refine your leadership style and gain the confidence you need to use these skills effectively. Participating in a group as a member is the optimal way of developing these skills, for you can learn a lot by observing experienced people. Of course, you also need to practice these skills by leading groups under supervision. Feedback from group members, your coleader, and your supervisor is essential to the refinement of your leadership skills.

Personal Characteristics of the Effective Group Leader

Courage Willingness to model Presence Goodwill, genuineness and caring Belief in Group Process Openness Nondefensiveness in Coping with Criticism Aware of Own Culture Willingness to Seek New Experience Personal Power Stamina Self Awareness Sense of Humor Inventiveness Personal Dedication-Commitment The challenge is for you to take an honest look at your personal qualities and make an assessment of your ability as a person to inspire others. Your own commitment to living up to your potential is a key tool. Experiencing your own therapy (either individually or in groups) is one way to remain open to looking at the direction of your life. It is certainly not a matter of being the perfectly integrated group leader who has "arrived."

Transcending Cultural Encapsulation

Cultural encapsulation is a potential trap that all group counselors are vulnerable to falling into. If you accept the idea that certain cultural values are supreme, you limit yourself by refusing to consider alternatives. If you possess cultural tunnel vision, you are likely to misinterpret patterns of behavior displayed by group members who are culturally different from you. Unless you understand the values of other cultures, you are likely to misunderstand these clients. It is essential that you avoid perceiving individuals as simply belonging to a group. Indeed, the differences between individuals within a group are often greater than the differences among the various groups e culturally encapsulated counselor as one who has substituted stereotypes for the real world, who disregards cultural variations among clients, and who dogmatizes technique-oriented definitions of counseling and therapy. Such individuals, who operate within a monocultural framework, maintain a cocoon by evading reality and depending entirely on their own internalized value assumptions about what is good for society and the individual. The central point is that if the group experience is largely the product of values that are alien to certain group members, it is easy to see that such members will not embrace the group. Group counselors who practice exclusively with a Western perspective are likely to meet with a considerable amount of resistance from clients with a non-Western worldview. Culturally sensitive group practice can occur only when leaders are willing to reveal the underlying values of the group process and determine whether these values are congruent with the cultural values of the members

Determining One's Own Level of Competence

Different groups require different leader qualities. For example, you may be fully competent to lead a group of relatively well-adjusted adults or of adults in crisis situations yet not be competent to lead a group of seriously disturbed people. Generally, however, those who seek to become group practitioners find that formal education, even at the master's or doctoral level, does not give them the practical grounding they require to effectively lead groups. Practitioners often find it necessary to take a variety of specialized group therapy training workshops to gain experience. Remain current and increase your knowledge and skill competencies through activities such as continuing education, professional supervision, and participation in personal and professional development activities. Utilize consultation and/or supervision to ensure effective practice regarding ethical concerns that interfere with effective functioning as a group leader. Be open to getting professional assistance for personal problems or conflicts of your own that may impair your professional judgment or work performance.

Courage

Effective group leaders show courage in their interactions with group members and do not hide behind their special role as counselors. They show courage by taking risks in the group and admitting mistakes, by being vulnerable, by being willing to challenge members in respectful ways, by acting on intuitions and beliefs, by discussing with the group their thoughts and feelings about the group process, and by being willing to share their power with group members. Leaders can model important lessons to members by being themselves and not getting lost in pretenses. When members push themselves to leave familiar and secure patterns, they often report being anxious and scared.

Special Skills for Opening and Closing Group Sessions

Effectively opening and closing each session ensures continuity from meeting to meeting. Continuity makes it more likely that participants will think about what occurred in the group when they are outside of it, and they will be more likely to try to apply what they have learned to their everyday lives. Together with encouragement and direction from the leader, effective summarizing and evaluation facilitate the members' task of assessing their own level of participation at each session.

The Issue of Psychological Risks in Groups

Ethical practice demands that group practitioners inform prospective participants of the potential risks involved in the group experience. The nature of these risks—which include life changes that cause disruption, hostile and destructive confrontations, scapegoating, and harmful socializing among members—and what the leader can do about them are the subject of this section. It is unrealistic to expect that a group will not involve risk, for all meaningful learning in life involves taking some kind of risk. It is the ethical responsibility of the group leader to ensure that prospective group members are aware of the potential negative outcomes that are associated with various risks and to take every precaution against them. A minimal expectation is that group leaders discuss with members the advantages and disadvantages of a given group, that they prepare the members to deal with any problems that might grow out of the group experience, and that they be alert to the fears and reservations that members might have. Group leaders must take precautionary measures to reduce unnecessary psychological risks by knowing members' limits, respecting their requests, developing an invitational style as opposed to an aggressive or dictatorial style, avoiding abrasive confrontations, describing behavior rather than making judgments, and presenting hunches in a tentative way. Members should be made aware of the possibility that participating in a group (or any other therapeutic endeavor) may disrupt their lives. Occasionally an individual member may be singled out as the scapegoat of the group. Other group members may "gang up" on this person, blaming him or her for problems of the group. Clearly, the group leader must take firm steps to deal with such occurrences. Confrontation, a valuable and powerful tool in any group, can be misused, especially when it is employed to destructively attack another. Intrusive interventions, overly confrontive leader tactics, and pushing members beyond their limits often produce negative outcomes. If safety is lacking in a group, members who have been subjected to social injustices may be revictimized when they explore their experiences in the group. One way to minimize psychological risks in groups is to use a contract in which the leader specifies his or her responsibilities and the members specify their commitment by stating what they are willing to explore and do in the group. If safety is lacking in a group, members who have been subjected to social injustices may be revictimized when they explore their experiences in the group. One way to minimize psychological risks in groups is to use a contract in which the leader specifies his or her responsibilities and the members specify their commitment by stating what they are willing to explore and do in the group. Another safeguard against unnecessary risk is the ability of leaders to recognize the boundaries of their competence and to restrict themselves to working only with those groups for which their training and experience have properly prepared them.

Evaluating

Evaluating is an ongoing process that continues for the duration of a group. After each session, the leader assesses what is happening in the group as a whole and within individual members. Leaders teach participants how to evaluate themselves and how to appraise the movement and direction of their group.

Facilitating

Facilitating is aimed at enhancing the group experience and enabling the members to reach their goals. Facilitation skills involve opening up clear and direct communication among the participants and helping them assume increasing responsibility for the direction of the group.

Becoming Aware of Your Cultural Values

For Johnson and her colleagues, one goal of multicultural group counseling is to provide new levels of communication among members. This can be instrumental in assisting members in challenging their stereotypes by providing accurate information about individuals. Another goal of a diverse group is to promote understanding, acceptance, and trust among members of various cultural groups. For group leaders to facilitate this understanding and acceptance in a diverse group, it is essential that they be aware of their biases and that they have challenged their stereotypes. Social justice issues often surface when working with people from culturally diverse backgrounds (MacNair-Semands, 2007). Individuals can be invited to talk about their pain from the social injustices they have encountered.

Social Media in Group Work: Confidentiality and Privacy Considerations

Group counselors must address the parameters of online behavior through informed consent and should establish ground rules regarding members' commitment to avoid posting pictures, comments, or any type of confidential information about other members online. Developing these rules needs to be part of the discussion about norms governing the group. Educate members to share their experience with others outside the group by talking about their own experience, reactions, and insights rather than telling stories about other members or mentioning others in the group by name. Confidentiality and privacy considerations: There is an increased risk of breach of confidentiality when members of a counseling group engage in social media Ground rules regarding members' online behavior need to be part of informed consent

Confidentiality With Minors

Group leaders must also be careful in how they talk about the children to teachers and administrators. Those who do groups with children need to explain what will be kept confidential and what may need to be shared with school personnel. This also applies to talking with parents. It is a good practice to require written permission from parents before allowing a minor to enter a group. It is useful to have this permission include a brief statement concerning the purpose of the group, along with comments regarding the importance of confidentiality as a prerequisite to accomplishing such purposes, and your intention not to violate any confidences. t is important to work cooperatively with parents and guardians as well as to enlist the trust of the young people. It is also useful to teach minors, in terms that they are capable of understanding, about the nature, purposes, and limitations of confidentiality.

Stamina

Group leaders need stamina and the ability to withstand pressure to remain vitalized throughout the course of a group. Leaders of very challenging groups are bound to feel their energy being drained, and unrealistically high expectations can affect stamina. It is crucial for group leaders to be aware of their own energy level and to have sources other than the group for psychological nourishment.

Terminating

Group leaders need to learn when and how to terminate their work with individuals as well as groups. The skills required in closing a group session or ending a group successfully include providing members with suggestions for applying what they've learned in the group to their daily lives, preparing the participants to deal with the problems they may encounter outside of the group, providing for some type of evaluation and follow-up, suggesting sources of further help, and being available for individual consultation should the need arise.

Personal Counseling for Group Leaders

I believe that extensive self-exploration is necessary for trainees to identify countertransference feelings, to recognize blind spots and biases, and to use their personal attributes effectively in their group work. To me it makes sense that group leaders need to demonstrate the courage and willingness to do for themselves what they expect members in their groups to do—expand their awareness of self and the effect of that self on others. Increasing self-awareness is a major reason to seek out personal counseling. In leading a group, you will encounter many instances of transferences, both among members and toward you. Transference refers to the unconscious process whereby members project onto you, the group leader, past feelings or attitudes that they had toward significant people in their lives. Of course, you can easily become entangled in your own feelings of countertransference, which often involves both conscious and unconscious emotional responses to group members. Through being a client yourself, you can gain an experiential frame of reference to view yourself as you are. This experience will increase your compassion for your clients and help you learn ways of intervening that you can use in the groups you facilitate.

OVERVIEW

I. Psychological symptomatology emanates from disturbed interpersonal relationships. The task of psychotherapy is to help the client learn how to develop distortion-free, gratifying interpersonal relationships. II. The psychotherapy group, provided its development is unhampered by severe structural restrictions, evolves into a social microcosm, a miniaturized representation of each member's social universe. III. The group members, through feedback from others, self-reflection, and self-observation, become aware of significant aspects of their interpersonal behavior: their strengths, their limitations, their interpersonal distortions, and the maladaptive behavior that elicits unwanted responses from other people. The client, who will often have had a series of disastrous relationships and subsequently suffered rejection, has failed to learn from these experiences because others, sensing the person's general insecurity and abiding by the rules of etiquette governing normal social interaction, have not communicated the reasons for rejection. Therefore, and this is important, clients have never learned to discriminate between objectionable aspects of their behavior and a self-concept as a totally unacceptable person. The therapy group, with its encouragement of accurate feedback, makes such discrimination possible. IV. In the therapy group, a regular interpersonal sequence occurs: a. Pathology display: the member displays his or her behavior. b. Through feedback and self-observation, clients 1. become better witnesses of their own behavior; 2. appreciate the impact of that behavior on a. the feelings of others; b. the opinions that others have of them; c. the opinions they have of themselves. V. The client who has become fully aware of this sequence also becomes aware of personal responsibility for it: each individual is the author of his or her own interpersonal world. VI. Individuals who fully accept personal responsibility for the shaping of their interpersonal world may then begin to grapple with the corollary of this discovery: if they created their social-relational world, then they have the power to change it. VII. The depth and meaningfulness of these understandings understandings are directly proportional to the amount of affect associated with the sequence. The more real and the more emotional an experience, the more potent is its impact; the more distant and intellectualized the experience, the less effective is the learning. VIII. As a result of this group therapy sequence, the client gradually changes by risking new ways of being with others. The likelihood that change will occur is a function of a. The client's motivation for change and the amount of personal discomfort and dissatisfaction with current modes of behavior; b. The client's involvement in the group—that is, how much the client allows the group to matter; c. The rigidity of the client's character structure and interpersonal style. IX. Once change, even modest change, occurs, the client appreciates that some feared calamity, which had hitherto prevented such behavior, has been irrational and can be disconfirmed; the change in behavior has not resulted in such calamities as death, destruction, abandonment, derision, or engulfment. X. The social microcosm concept is bidirectional: not only does outside behavior become manifest in the group, but behavior learned in the group is eventually carried over into the client's social environment, and alterations appear in clients' interpersonal behavior outside the group. XI. Gradually an adaptive spiral is set in motion, at first inside and then outside the group. As a client's interpersonal distortions diminish, his or her ability to form rewarding relationships is enhanced. Social anxiety decreases; self-esteem rises; the need for self-concealment diminishes. Behavior change is an essentialessential component of effective group therapy, as even small changes elicit positive responses from others, who show more approval and acceptance of the client, which further increases self-esteem and encourages further change.49 Eventually the adaptive spiral achieves such autonomy and efficacy that professional therapy is no longer necessary.

A Basic Right: Informed Consent

If basic information about the group is discussed at the initial session, the participants are likely to be far more cooperative and active. A leader who does this as a matter of policy demonstrates honesty and respect for group members and fosters the trust necessary for members to be open and active. Such a leader has obtained the informed consent of the participants. Informed consent is a process that begins with presenting basic information about group treatment to potential group members to enable them to make better decisions about whether or not to enter and how to participate in a group It is a good policy to provide a professional disclosure statement to group members that includes written information on a variety of topics pertaining to the nature of the group, including therapists' qualifications, techniques often used in the group, the rights and obligations of group members, and the risks and benefits of participating in the group.

Modeling

If leaders value honesty, respect, openness, risk taking, and assertiveness, they can foster these qualities in the members by demonstrating them in the group. From a leader who shows respect by really listening and empathizing, members learn a direct and powerful lesson in how respect is shown behaviorally. In short, one of the best ways to teach more effective skills of interpersonal relating is by direct example.

RECOGNITION OF BEHAVIORAL PATTERNS IN THE SOCIAL MICROCOSM

If therapists are to turn the social microcosm to therapeutic use, they must first learn to identify the group members' recurrent maladaptive interpersonal patterns. Some of this can be elicited from the other group members reactions to the client Must be collective, multiple, repetitive The emotional response of any single member is not sufficient; therapists need confirmatory evidence. They look for repetitive patterns over time and for multiple responses—that is, the reactions of several other members (referred to as consensual validation) to the individual. Ultimately therapists rely on the most valuable evidence of all: their own emotional responses. Therapists must be able to attend to their own reactions to the client, an essential skill in all relational models. None of this is meant to imply that therapists should not take seriously the responses and feedback of all clients, including those who are highly disturbed. Even the most exaggerated, irrational responses contain a core of reality. Furthermore, the disturbed client may be a valuable, accurate source of feedback at other times: no individual is highly conflicted in every area. And, of course, an idiosyncratic response may contain much information about the respondent.

Restating

In a sense, restating (or paraphrasing) is an extension of listening. It means recasting what someone said into different words so that the meaning is clearer to both the speaker and the group. Effective restating zeroes in on the core of a person's message, bringing it into sharper focus and eliminating ambiguity. The value of accurate and concise restating is twofold: it tells the participants that they are being listened to, and it helps them see more clearly the issues they are struggling with and their own feelings and thoughts about these issues

Special Problems and Issues for Beginning Group Leaders

Initial anxiety Realistic versus unrealistic anxiety Self-disclosure How much or how little to disclose Appropriate and facilitative self-disclosure

Insight

Insight defies precise description; it is not a unitary concept. I prefer to employ it in the general sense of "sighting inward"—a process encompassing clarification, explanation, and derepression. Insight occurs when one discovers something important about oneself—about one's behavior, one's motivational system, or one's unconscious. In the group therapy process, clients may obtain insight on at least four different levels: 1. Clients may gain a more objective perspective on their interpersonal presentation. They may for the first time learn how they are seen by other people: as tense, warm, aloof, seductive, bitter, arrogant, pompous, obsequious, and so on. 2. Clients may gain some understanding into their more complex interactional patterns of behavior. Any of a vast number of patterns may become clear to them: for example, that they exploit others, court constant admiration, seduce and then reject or withdraw, compete relentlessly, plead for love, or relate only to the therapist or either the male or female members. 3. The third level may be termed motivational insight. Clients may learn why they do what they do to and with other people. A common form this type of insight assumes is learning that one behaves in certain ways because of the belief that different behavior would bring about some catastrophe: one might be humiliated, scorned, destroyed, or abandoned. Aloof, detached clients, for example, may understand that they shun closeness because of fears of being engulfed and losing themselves; competitive, vindictive, controlling clients may understand that they are frightened of their deep, insatiable cravings for nurturance; timid, obsequious individuals may dread the eruption of their repressed, destructive rage. 4. A fourth level of insight, genetic insight, attempts to help clients understand how they got to be the way they are. Through an exploration of the impact of early family and environmental experiences, the client understands the genesis of current patterns of behavior.

Clarifying

It involves responding to confusing and unclear aspects of a message by focusing on underlying issues and helping the person sort out conflicting feelings. Members often say that they have ambivalent feelings or are feeling many things at once; clarification can help sort out these feelings so that members can focus more sharply on what they are actually experiencing. The same procedure applies to thinking. In clarifying, the group leader stays within the individual's frame of reference while at the same time helping the group member put things into perspective; this, in turn, may lead to a deeper level of self-exploration on the part of the member.

Initial Anxiety

It is essential for group counselors to identify and examine their internal dialogue. Even the most effective group leaders may find themselves slipping into distorted ways of thinking and engaging in negative thinking. It is not easy to erase self-defeating thought patterns, yet it is possible to question the assumptions we make and the conclusions we form. As cognitive therapy teaches us, by being willing to continually challenge our core beliefs, we can avoid being controlled by negative internal dialogues. Beginning leaders are encouraged to recognize that their doubts and concerns are normal. Moderate anxiety is beneficial because it can lead to honest self-appraisal. Anxiety can be counterproductive, however, if it begins to feed on itself and is allowed to freeze us into inactivity. It is a good practice for beginning leaders to voice their questions and concerns and to explore them in the course of the training sessions. Exploring their concerns with peers and a supervisor can help beginning leaders distinguish between realistic and unrealistic anxiety and thus defuse unwarranted and counterproductive anxiety.

Critique of EBP

It is mechanistic and does not consider the relational dimensions of therapy It may not adequately capture the complexity of human change Third-party payers could use research findings solely as cost-containment measures rather than to improve services

Inventiveness and Creativity

Leaders should avoid getting trapped in ritualized techniques and programmed presentations. It may not be easy to approach each group with new ideas. Inventive and creative leaders are open to new experiences and to worldviews that differ from their own. One of the main advantages of group work is that it offers many opportunities for being inventive.

The Freedom to Leave a Group

Leaders should be clear about their policies pertaining to attendance, commitment to remaining in a group for a predetermined number of sessions, and leaving a particular session if they do not like what is going on in the group. For one thing, it can be deleterious to members to leave without having been able to discuss what they considered threatening or negative in the experience. If they leave without discussing their intended departure, they are likely to be left with unfinished business, and so are the remaining members. A member's dropping out may damage the cohesion and trust in a group; the remaining members may think that they in some way "caused" the departure. It is a good practice to tell members that if they are even thinking of withdrawing they should bring the matter up for exploration in a session. Ideally, both the group leader and the members will work cooperatively to determine the degree to which a group experience is productive or counterproductive. If, at a mutually agreed-upon time, members still choose not to participate in a group, I believe they should be allowed to drop out without being subjected to pressure by the leader and other members to remain.

Freedom From Coercion and Undue Pressure

Members can reasonably expect to be respected by the group and not to be subjected to coercion and undue group pressure. However, some degree of group pressure is inevitable, and it is even therapeutic in many instances. People in a group are challenged to examine their self-defeating beliefs and behaviors and are encouraged to recognize what they are doing and determine whether they want to remain the way they are. Further, in a counseling group, there is pressure in sessions to speak up, to make personal disclosures, to take certain risks, to share one's reactions to the here-and-now events within the group, and to be honest with the group.

Issues in Involuntary Groups

Much effort needs to be directed toward fully informing involuntary members of the nature and goals of the group, the procedures to be used, their rights and responsibilities, the limits of confidentiality, and what effect their level of participation in the group will have on critical decisions about them outside of the group. Group leaders can inform members that it is their choice of how they will use the time in the group. The members can be encouraged to explore their fears and reluctance to fully participate in the group, as well as the consequences of not participating in the group.

THE SOCIAL MICROCOSM: A DYNAMIC INTERACTION

Not only does the small group provide a social microcosm in which the maladaptive behavior of members is clearly displayed, but it also becomes a laboratory in which is demonstrated, often with great clarity, the meaning and the dynamics of the behavior. The therapist sees not only the behavior but also the events triggering it and sometimes, more important, the anticipated and real responses of others. Members are less likely to attack and blame one another if they can look beyond surface behavior and become sensitive to one another's internal experiences and underlying intentions.† Thus empathy is a critical element in the successful group. Both the underlying meaning of the individual's behavior and the impact of that behavior on others need to be revealed and processed if the members are to arrive at an empathic understanding of one another.

Setting Goals

Note that group leaders do not set goals for members; they help group members select and clarify their own specific goals. Although goal setting is especially important during the initial stages of a group, throughout the group's life leaders need to encourage participants to take another look at their goals, to modify them if necessary, and to determine how effectively they are accomplishing them. Leaders who do not develop the intervention skills of challenging members to formulate concrete goals often find that their groups are characterized by aimless and unproductive sessions.

Developing Your Group Leadership Style

One determinant is whether you lead short- or long-term groups Develop a style that fits your personality and expresses your uniqueness Your theoretical stance should be closely related to your values, beliefs, and personal characteristics One determinant of your leadership style is whether you lead short- or long-term groups. As a group leader, your role in short-term groups is quite different from the leadership role in long-term therapy groups. Most likely you will be expected to set up and conduct a variety of short-term groups, which means you will need to be active, directive, conscious of time limitations, and concerned with assisting members in identifying specific problem areas dealing with their current life situation. In conducting short-term groups the leader needs to pay particular attention to pregroup screening and preparation of potential members prior to the group; maintain a focus on a particular set of themes during the sessions; strive to develop group cohesion quickly; remind members of the time limits on the group's duration; and do follow-up work once the group ends. One way to build a foundation for a personal leadership style is to know the diverse range of theories of group counseling and their implications for styles of leading If your theoretical perspective causes you to ignore all others, you may force your clients to fit its confines instead of using it to understand them. If you embrace a theory in its entirety, the theory may not serve the diverse needs of your group. Most therapists today base their practice on some form of psychotherapeutic integration, or adopt an eclectic orientation, rather than identifying with a single theoretical orientation

Sincerity and Authenticity

One of the leader's most important qualities is a sincere interest in the well-being and growth of others. Because sincerity involves being direct, it can also involve telling members what may be difficult for them to hear. Authenticity is a form of sincerity. Authentic group leaders do not live by pretenses and do not hide behind defenses or facades. Authenticity entails the willingness to appropriately disclose oneself and share feelings and reactions to what is going on in the group.

Linking

One way of promoting interaction among the members is to look for themes that emerge in a group and then to connect the work that members do to these themes. This is a most important skill to teach in a group and to foster involvement on the part of many members. Group leaders with an interactional bias—that is, those who develop the norm of member-to-member rather than leader-to-member communication—rely a great deal on linking. They encourage members to address others in the group directly rather than looking at the leader and talking about others who are present. Members often have shared concerns, and through effective linking they can be helped to work through their problems. By being alert for common concerns, the leader can promote interaction and increase the level of group cohesion. Through linking several members together, the leader is also teaching members how to take responsibility for involving themselves in the work of others. When members learn how to bring themselves into group interactions, they become more independent of the leader and are also likely to feel a greater sense of belongingness by being connected to others.

Personal Power

Personal power involves self-confidence and an awareness of one's influence on others. If group leaders do not feel a sense of power in their own lives (or if they do not feel in control of their destiny), it is difficult for them to facilitate members' movement toward empowerment. Truly powerful leaders use the effect they have on group participants to encourage members to get in contact with their own unused power, not to foster their dependency. Group leaders promote a sense of empowerment by encouraging group members to become client colleagues.

Liability and Malpractice

Practitioners are subject to civil penalties if they fail to do right or if they actively do wrong to another. If group members can prove that personal injury or psychological harm was caused by a leader's failure to render proper service, either through negligence or ignorance, the leader is open to a malpractice suit. Negligence consists of departing from the standard and commonly accepted practices of others in the profession. Practitioners involved in a malpractice action may need to justify the techniques they use. If their therapeutic interventions are consistent with those of other members of their profession in their community, they are on much firmer ground than if they employ uncommon techniques. Those leaders who work with groups of children and adolescents, especially, must know the law as it pertains to matters of confidentiality, parental consent, the right to treatment or to refuse treatment, informed consent, and other legal rights of clients The best way to protect yourself from a malpractice suit is to take preventive measures, which means not practicing outside the boundaries of your competence. Following the spirit of the ethics codes of your professional organization is also important. The key to avoiding a malpractice suit is maintaining reasonable, ordinary, and prudent practices. Be willing to devote the time it takes to adequately screen, select, and prepare the members of your group. Develop written informed consent procedures at the outset of a group. Give the potential members of your groups enough information to make informed choices about group participation. Do not mystify the group process. Provide an atmosphere of respect for diversity within the group. Become aware of local and state laws that limit your practice, as well as the policies of the agency for which you work. Inform members about these policies and about legal limitations (such as exemptions to confidentiality, mandatory reporting, and the like). Emphasize the importance of maintaining confidentiality before the group begins and at various times during the life of a group. If social media is part of group work, establish with members the importance of maintaining boundaries, confidentiality, and privacy of others in the group. Restrict your practice to client populations for which you are prepared by virtue of your education, training, and experience. Be alert for symptoms of psychological debilitation in group members, which may indicate that their participation should be discontinued. Be able to put such clients in contact with appropriate referral resources. Do not promise the members of your group anything that you cannot deliver. Help them realize that their degree of effort and commitment will be key factors in determining the outcomes of the group experience. In working with minors, secure the written permission of their parents, even if this is not required by state law. Consult with colleagues or supervisors whenever there is an ethical or legal concern. Document the nature of these consultations. Make it a practice to assess the general progress of a group, and teach members how to evaluate their progress toward their personal goals; keep adequate clinical records on this progress. Learn how to assess and intervene in cases in which clients pose a threat to themselves or others. Avoid blending professional relationships with social ones. Avoid engaging in sexual relationships with either current or former group members. Remain alert to ways in which your personal reactions might inhibit the group process, and monitor your countertransference. Avoid using the group you are leading as a place where you work on personal problems. Continue to read the research, and use group interventions and techniques that are supported by research as well as by community practice. Have a theoretical orientation that serves as a guide to your practice. Be able to describe the purpose of the techniques you use in your groups.

Reflecting Feelings

Reflecting feelings is the skill of responding to the essence of what a person has communicated. The purpose is to let members know that they are being heard and understood. Although reflection entails mirroring certain feelings that the person has expressed, it is not merely a bouncing-back process. Reflection is dependent on attention, interest, understanding, and respect for the person. When reflection is done well, it fosters further contact and involvement; feeling understood and achieving a clearer grasp of one's feelings are very reinforcing and stimulate the person to seek greater self-awareness.

The Role of Research in the Practice of Group Work

Research can help group workers to identify specific factors that contribute to successful outcomes Accountability is stressed in all settings; thus, familiarity with research and evaluation practices is essential Collaboration between practitioners and researchers can benefit both parties and the group work field A community-based research paradigm has been proposed A shift from process research to outcome studies has occurred Applied research can help you identify factors that interfere with group effectiveness as well as confirm the efficacy of your interventions. Clinical work can be greatly aided by research findings and can inform research Some practical considerations that can limit practitioners' active participation in research include the constant pressure to meet clinical demands, a lack of time, a lack of financial remuneration for doing research, and a lack of the skills and knowledge required to conduct research

Confronting

Skilled group counselors confront behavior inconsistencies in a way that gives the person ample opportunity to consider what is being said. Skillful confrontation specifies the behavior or the discrepancies between verbal and nonverbal messages that are being challenged so that no labeling can possibly occur.

Uses and Misuses of Group Techniques

Some of the ways in which leaders can practice unprofessionally are using techniques with which they are unfamiliar, using techniques in a mechanical way, using techniques to serve their own hidden agenda or to enhance their power, or using specific techniques to pressure members. Leaders should avoid pushing members to "get into their emotions." Some group leaders measure the efficacy of their group by the level of catharsis, and group leaders who need to see members experience intense emotions can exploit the group members. This expression of emotion can sometimes reveal the leader's needs rather than the needs of the members. Techniques are aimed at fostering the client's self-exploration and self-understanding. At their best, they are invented in each unique client situation, and they are a collaborative effort between the leader and members. Techniques assist the group member in experimenting with some form of new behavior. It is critical that techniques be introduced in a timely and sensitive manner, with respect for the client, and that they be abandoned if they are not working. Leaders can respect the cultural values of members and at the same time encourage them to think about how these values and their upbringing have a continuing effect on their behavior. In some cases members will decide to modify certain behaviors because the personal price of retaining a value is too high. In other cases they will decide that they are not interested in changing certain cultural values or behaviors.

Blocking

Sometimes a leader must intervene to stop counterproductive behaviors within the group. Blocking is a skill that requires sensitivity, directness, and the ability to stop the activity without attacking the person. The attention should be on the specific behavior and not on the character of the person, and labeling should be avoided. When members judge or criticize others, pressure others to take a specific course of action or to express feelings in a group, or habitually ask questions of others, the group leader may need to block this behavior. Other behaviors that group leaders need to watch for and block when necessary include making excuses to justify failure to make changes, breaking confidences, invading a member's privacy, perpetually giving advice, storytelling, gossiping, offering support inappropriately, and making inaccurate or inappropriate interpretations.

Commitment to Self-Care

Staying alive both personally and professionally is not something that happens automatically; it is the result of a commitment to acquiring habits of thinking and action that promote wellness.

Suggesting

Suggestion is a form of intervention designed to help participants develop an alternative course of thinking or action. It can take many forms, a few of which are giving information and advice, giving "homework assignments," asking members to think of experiments they might try inside and outside of the group, and encouraging members to look at a situation from a different perspective. Giving information and providing appropriate suggestions for alternative plans of action can hasten the progress members make in a group. Suggestions need not always come from the leader; members can make suggestions for others to consider, especially at a later stage of the group. The overuse of persuasion, suggestions, and advice entails some dangers. One is that members can be led to believe that simple solutions exist for complex problems. Another is that members may remain dependent on other people to suggest what they should do in the face of future problems instead of learning how to solve their own problems.

Supporting

Supporting means providing group members with encouragement and reinforcement, especially when they are disclosing personal information, exploring painful feelings, or taking risks. A leader can provide support by being fully present at the appropriate time. This full presence requires a combination of skills: listening actively to what is being said and what is being conveyed nonverbally, being psychologically present with the client, and responding in a way that encourages the client to continue working and to move forward.

The Corrective Emotional Experience

The basic principle of treatment, he stated, "is to expose the patient, under more favorable circumstances, to emotional situations that he could not handle in the past. The patient, in order to be helped, must undergo a corrective emotional experience suitable to repair the traumatic influence of previous experience." Change both at the behavioral level and at the deeper level of internalized images of past relationships does not occur primarily through interpretation and insight but through meaningful here-and-now relational experience that disconfirms the client's pathogenic beliefs. When the therapy group focuses on the here-and-now, it increases in power and effectiveness. But if the here-and-now focus (that is, a focus on what is happening in this room in the immediate present) is to be therapeutic, it must have two components: the group members must experience one another with as much spontaneity and honesty as possible, and they must also reflect back on that experience. This reflecting back, this self-reflective loop, is crucial if an emotional experience is to be transformed into a therapeutic one. Although emotional experiences (expression and experiencing of strong affect, self-disclosure, giving and receiving feedback) were considered extremely important, they did not distinguish successful from unsuccessful group members. In other words, the members who were unchanged or even had a destructive experience were as likely as successful members to value highly the emotional incidents of the group. What types of experiences did differentiate the successful from the unsuccessful members? There was clear evidence that a cognitive component was essential; some type of cognitive map was needed, some intellectual system that framed the experience and made sense of the emotions evoked in the group.

Exceptions to Confidentiality

The client poses a danger to others or self A minor, elder, or dependent adult is victim of abuse or neglect The client needs to be hospitalized The information is made an issue in a court action The client requests a release of record It is a good policy for group workers to give a written statement to each member setting forth the limitations of confidentiality and spelling out specific situations that would require breaching confidences. Such straightforwardness with members from the outset does a great deal to create trust because members then know where they stand. Of course, it is imperative that those who lead groups become familiar with the state laws that have an impact on their practice. Generally speaking, you will find that you have a better chance of gaining the cooperation of group members if you are candid about a situation rather than hiding your disclosures and thereby putting yourself in the position of violating their confidences.

Empathizing

The core of the skill of empathy lies in the leader's ability to sensitively grasp the subjective world of the participant and yet retain his or her own separateness. To empathize effectively, a leader needs to care for the group members. One form of empathizing is for leaders to demonstrate cultural empathy, which is the ability to assume the worldview of others

Evidence-Based Practice in Group Work

The current trend is to promote specific interventions for specific problems based on empirically supported treatments EBP should incorporate three pillars: Best available evidence Clinician expertise Client characteristics

Interpreting

The leader interprets when he or she offers possible explanations for a participant's thoughts, feelings, or behavior. By offering tentative hypotheses concerning certain patterns of behavior, interpreting helps the individual see new perspectives and alternatives.

The Group Leader as a Person

The most important instrument you have is YOU Model effective behavior rather than merely describe it Strive to live a growth-oriented life Live the way you encourage group members to live Seek new experiences To inspire others to break away from deadening ways of being, leaders need to be willing to seek new experiences themselves. In short, group leaders become an influential force in a group when they are able to model effective behavior rather than merely describe it. The issue is not whether leaders have personal problems but whether they are willing to make a serious attempt to live the way they encourage members to live. More important than being a finished product is the willingness to continually examine whether one's life reflects life-giving values. The key to success as a group leader is a commitment to the never-ending journey toward becoming a more effective human being.

Critical incidents: Positive affect

The second most common type of critical incident my clients describe also involves strong affect—but, in these instances, positive affect. For example, a schizoid client described an incident in which he ran after and comforted a distressed group member who had bolted from the room; later he spoke of how profoundly he was affected by learning learning that he could care for and help someone else. Others spoke of discovering their aliveness or of feeling in touch with themselves. These incidents had in common the following characteristics: 1. The client expressed strong positive affect—an unusual occurrence. 2. The feared catastrophe did not occur—derision, rejection, engulfment, the destruction of others. 3. The client discovered a previously unknown part of the self and thus was enabled to relate to others in a new fashion.

Summarizing

The skill of pulling together the important elements of a group interaction or part of a session is known as summarizing. This ability is particularly useful when making a transition from one topic to another. Rather than merely proceeding from issue to issue, identifying common elements can increase learning and maintain continuity. One of the leader's functions is to help members reflect on and make sense of what has occurred in their group. Summarizing encourages participants to think about what they have learned and experienced in a session and about ways of applying it to their everyday lives. At the end of the session, group leaders may offer their own brief summary or ask each member in turn to summarize what has taken place, what the highlights of the session were, and how each member responded to the interaction.

Participation in Experiential Training Workshops

The trainees can also learn a great deal about their response to feedback, their competitiveness, their need for approval, their concerns over being competent, and their power struggles. In working with both university students learning about group approaches and with professionals who want to upgrade their group skills, I have found an intensive weekend or weeklong workshop to be an effective format.

Questioning

There are several problems with the ineffective use of questioning. Members feel as if they have been subjected to the "third degree." The questioner probes for personal information while remaining safe and anonymous behind the interrogation. Also, a low-level questioning style on the leader's part provides a poor model for the members, who soon begin to imitate the leader's ineffective questioning style when they deal with one another.

Initiating

These skills include using catalysts to get members to focus on meaningful work, knowing how to employ various techniques that promote deeper self-exploration, and providing links for various themes being explored in the group. Whereas appropriate leader direction can give the group a focus and keep it moving, too much direction can lead to passivity on the part of members. Initiating is a key skill in structuring a group session and in working with the group as a whole.

Willingness to Challenge Oneself

This essential characteristic includes awareness not only of one's needs and motivations but also of personal conflicts and problems, of defenses and weak spots, of areas of unfinished business, and of the potential influence of all of these on the group process. Leaders who are self-aware are able to work therapeutically with the transferences that emerge within the group setting, both toward themselves and toward other members. Furthermore, group leaders are aware of their own vulnerabilities, especially their potential countertransferences, and take responsibility for their own reactions.

Sense of Identity

This means knowing what you value and living by these standards, not by what others expect. It means being aware of your own strengths, limitations, needs, fears, motivations, and goals. It means knowing what you are capable of becoming, what you want from life, and how you are going to get what you want. Being aware of your cultural heritage, your ethnicity, and your sexual and gender identities are vital components of this sense of identity.

Transference.

Transference is a specific form of interpersonal perceptual distortion. In individual psychotherapy, the recognition and the working through of this distortion is of paramount importance. In group therapy, working through interpersonal distortions is, as we have seen, of no less importance; however, the range and variety of distortions are considerably greater. Working through the transference—that is, the distortion in the relationship to the therapist—now becomes only one of a series of distortions to be examined in the therapy process. For many clients, perhaps for the majority, it is the most important relationship to work through, because the therapist is the personification of parental images, of teachers, of authority, of established tradition, of incorporated values. But most clients are also conflicted in other interpersonal domains: for example, power, assertiveness, anger, competitiveness with peers, intimacy, sexuality, generosity, greed, envy. Considerable research emphasizes the importance many group members place on working through relationships with other members rather than with the leader.50 To take one example, a team of researchers asked members, in a twelve-month follow-up of a short-term crisis group, to indicate the source of the help each had received. Forty-two percent felt that the group members and not the therapist had been helpful, and 28 percent responded that both had been helpful. Only 5 percent said that the therapist alone was a major contributor to change.

Disclosing Oneself

When leaders reveal personal information, they usually have an impact on the group. The skill consists of knowing what, when, how, and how much to reveal. If the leader shares appropriately, the effects on the group are likely to be positive. If the leader shares too much too soon, the effects are likely to be adverse because the members may not be able yet to handle such disclosure.

Protecting

Without assuming a parental attitude toward the group, leaders need to be able to safeguard members from unnecessary psychological or physical risks associated with being in a group.

Critical incidents: Self disclosure

second. Clients recall an incident, usually involving self-disclosure, that plunged them into greater involvement with the group. For example, a previously withdrawn, reticent man who had missed a couple of meetings disclosed to the group how desperately he wanted to hear the group members say that they had missed him during his absence. Others, too, in one fashion or another, openly asked the group for help. To summarize, the corrective emotional experience in group therapy has several components: 1. A strong expression of emotion, which is interpersonally directed and constitutes a risk taken by the client. 2. A group supportive enough to permit this risk taking. 3. Reality testing, which allows the individual to examine the incident with the aid of consensual validation from the other members. 4. A recognition of the inappropriateness of certain interpersonal feelings and behavior or of the inappropriateness of avoiding certain interpersonal behavior. 5. The ultimate facilitation of the individual's ability to interact with others more deeply and honestly.