Elements of Successful Group Interventions

Elements of Successful Group Interventions
Michele Aluoch, LPCC River of Life Professional Counseling LLC

Group Therapy An evolving culture
1. Treatment of individuals who share their psychotherapy 2. Treatment of groups so they mange cooperatively Rather than therapist centered is group centered The group is the common ground The whole can be worked on by highlighting any part of it

Homogeneous Versus Heterogeneous
Types of Groups Homogeneous Versus Heterogeneous Homogeneous- One type of sex, age, issue, demographic, treatment approach Heterogeneous- Varied in background What might be some pros and cons?

Types of Groups Who is likely to benefit from this therapy?
What will happen if I blend by sexes, diagnosis, or other variables?

Open versus Closed Groups
Types of Groups Open versus Closed Groups Open Ended- ongoing where new participants are allowed to join as well as old participants leave with flexiblity Closed group=- time limited with a commitment of regular attendees

Types of Groups Group Psychotherapy Clinical practice
A type of psychotherapy By a specifically trained licensed counselor or social worker, psychologist, psychiatrist or nursing staff With members characterized by previous clinical assessment results Goal= repairing pathology

Types of Groups Therapeutic Groups Led by human services personnel
Not necessarily trained In a hospital , community mental health center, or rehabilitation or activities venue Goal= remediation, achievement of improved functioning

Types of Groups Self Help Groups
Voluntarily face to face groups of people with similar struggles Goals: help members control a common problem, advice on coping strategies, enhancement of self esteem E.g, AA, Al-aon, Gamblers Anonymous, weight loss groups, divorce care groups

Task Group Wadsworth, J. (2008).
Accomplishing certain goals (planning groups, treatment conferences, community organizations, study circles, task forces) Courses in: organizational development, management, consultation, theory and practice of task/work facilitation

Psycho-educational Group Wadsworth, J. (2008)
Imparting and discussing and integrating information (workshops- stress management, support groups Courses in: Organizational development, school and community counseling, health promotion, theory and practice of group counseling

Counseling Group Wadsworth, J. (2008).
Addressing relationship issues(Career counseling, victims of abuse) Courses in: human development, health promotion, theory and practice of group counseling

Psychotherapy Group Wadsworth, J. (2008).
Remediating psychological problems eating disorders, sexual disorders depression, anxiety, etc.) Course in: human development, assessment and treatment of mental health disorders

General Group Guidelines
Few, clear 8-12 participants 1- 1 ½ hours each weekly Homogenous or heterogeneous? Open ended versus closed group? Location Expectations Confidentiality Sharing communication

Getting Group Referrals
Rare to get enough referrals and a specific type of referrals on your own Many wrong referrals which can lead to dropouts Collateral referral sources Method for referring is important Plan for more referrals than needed because of screening and dropouts

Cost Cost effective compared to individual psychotherapy
$60-$120 for one 45 minute session versus $40 for 90 minutes. $40 X 10 = 40

Screening Potential Members
Hearing what the patient’s goals are- where he/she believes life is at versus where he/she would like to be Identification of any disqualifying factors Discussion of resistance or ambivalence about being in a group Exploration of other group experiences role played scenario Ability to follow through with time and obligations Responses to interpersonal problems Rationale for joining the group- other mandated/suggested vs. wanting to be there

Degree of ego when people have strong opinions Willingness for consents with other professionals Interactions with others in group situations? Any significant issues? Thorough assessment Comprehensive

Three key Elements: 1. Expectancy- “Working in a group will really help me.” 2. Participation- “I like to share my feelings with others.” 3. Domineering- “I argue for arguments sake.” Discuss the potential for each of these for that person in group

Say “No” To People with poor cognitive abilities
People with little insight Those who do not want to self reflect Those unmotivated for change Defensive Guarded Instigators

Say “Yes” To Those who want change Those goal minded Action oriented
Those who ware wiling to learn Those who respect interpersonal interactions Those who would benefit from supportive role models for imitative behavior Those who will do the work of therapy Those who will allow themselves to be challenged

Exercise: Screening Potential Members
A dual diagnosed multi-substance using antisocial personality with a history of three assaults and combative style A highly dependent woman who needs excessive reassurance for all her decision making and lacks assertiveness skills and a mind of her own A young man who has been unable to keep a job and make a living for himself A woman grieving a recent diagnosis of terminal cancer A middle aged female who has been taught to hold emotions in al her life yet has so much bottled up anger and resentment inside

A professional career gentleman who is very wealthy and has things in life generally go his way until his recent DUI when his alcohol abuse had been discovered by the public A nurse who became shaky on the job and was losing her ability to maintain professionalism because life stresses had mounted up too much A court mandated woman who just wants to get the requirements over with in the stupid system A man who tends to isolate himself and withdraw and lacks social skills for interpersonal relationships

A homeless woman who lacks transportation but is highly motivated to get her life back on track as it once was years ago A young adult man whose parents are wiling to pay whatever it costs for him to go through a program so he does not waste his life away A verbally argumentative woman who becomes manic and talks loud and nonstop A woman who is recently widowed who sits most of the day and cries A man who hears voices and believes he can hear the thoughts of the people on TV, the animals and nature around him A woman who has frequent command hallucinations to rid the world of all tall people, rich people, and people trying to poison her food

Informed Consent 1. enhances the patient’s autonomy
2. decreases the risks of regression 3. shifts responsibility to a collaborative arrangement 4. increases practitioner’s accountability Open discussion of pros and cons Automatic part of prep process

Informed Consent Receptionist given Vs. Therapist given Discussed
Preferably: 1. in person 2. directly given to the client one on one 3. with room for discussion 4. personalized and evolving

Informed Consent The Nature of the Group
Purposes and goals of the group, individual versus group goals Obligations of the member and leader Agreement to follow group rules Regular attendance and notice of cancellations Compliance with homework Cost and method of payment Session time, length and number of sessions How to be reached outside session time

Informed Consent Therapist Qualities
Credentials, experience, personal characteristics Treatment Risks and Benefits Giving and receiving feedback Dealing with emotional reactions

Questions Re. Group Therapy
How does group therapy work? How does group therapy compare to other types of therapies? What are the risks? How many clients improve after group therapy? Do any clients get wore? How log will it take? What if therapy isn’t working?

Alternatives What other types of therapies are out there? How do they work? What are the risks and benefits of these alternatives to group therapy? What about medication options and treatments? Which therapies are most effective for my issues?

Appointments What times and dates are the groups? How often are groups? How much do they cost? How is payment made? Insurance ? Our of pocket? Who can I talk to between appointments? What if the weather is bad or I need to cancel?

Confidentiality How do you keep group records? How are records protected? Who has access to my info.?

Money What is your fee? How do I pay? What about missed sessions? Do I need to pay for phone calls? Letters? E mails? What are your policies about raising fees? If I lose my source of income do you offer a sliding scale?

Insurance What info. Are you required to tell my insurance company? What if I get new insurance you do not accept? What if I lose my insurance? How would therapy be different if I choose to pay versus go insurance? General What is your training? Licensure?

Five Group Stages 1) Dependency- Also called forming 2) Conflict- Also called storming 3) Cohesion/We-ness 4) Work/Performance 5) Adjourning/Termination

Stage One: Dependency Forming Pre-affiliation with the group
Anxiety, caution, dependency Desire to flee Leader: primarily an educator What do you want? Why are you here? Expectations? Locus of control-blaming others/complaining or learning to manage what is within

Stage One: Dependency Membership- who is in and out
Time starting and ending, vacations Subject matter sharing Affective expression guidelines Sharing when anxiety level is becoming too much

Stage Two: Conflict Struggles begin to erupt Power and control issues
The group as a whole The subgroups The outsiders Therapist- primarily reaffirming the groups; purpose and setting ground rules and expectations

Stage Three: Cohesion Becoming coherent around a set of rules and norms Building trust and openness Communication is more free Feedback becoming more open with guidelines

Stage Four: Work/Performance
Open exchange and feedback May move back and forth at this point Expect fluctuations Emotions and catharsis higher Opportunity for disllusionment and depression

Stage Five: Termination
Separation from the group Chance to generalize skills on own outside the group Fears about resurgence of presenting problems Gift giving, sharing food, positive affirmations Plans for ongoing maintainence of therapeutic gains

Record Keeping General goals and observations of group as whole
Also specific observations and goals for each participant- separate files for each Required for accountability standard of care as well as third part payers, and employers, continuity of care if release of information

Group Therapeutic Factors
Universality Altruism Installation of Hope Imparting of Information Corrective recapitulation of the primary family experience Development of socializing techniques

Group Therapeutic Factors
Imitative behavior Cohesiveness Existential factors Catharsis Interpersonal Learning Self understanding

Universality All group members have shared experiences
We are in this together Leads to validation and acceptance decreases stigma and isolation

Universality A connection
Healing is possible because it happened for someone else.

Exercise Kay states that “it is clear I am not like the rest of you. You have not at all gone through the level of hard times I have. My mom abandoned me at birth and I had no home. I never had any support system. Everything I’ve had I’ve struggled for. I had to protect myself, take care of myself, look out for number one. Seems none of you would now what it is like walking the street even as a 6 and 8 year old trying to scavage for my own food, having nowhere to do homework because drug dealers are in and out of the house, and daily having everyone stare at you because you are different. You all at least get sleep- I never know when the next gunshot is coming and if I’m safe.”

Exercise Bob states that he struggles being in a group with ‘you people’. He comments that “you don’t know the stress of heading a top company and managing and administrating anything because you can’t’ even manage your own lives. Whatever homelessness, lack of jobs, and life issues he believes are the other group members’ faults because they have not had the determination and resolve to do more and be proactive in their own lives.

Altruism By helping each other group members gain a sense of internal satisfaction. Providing assistance and insight to others Improved other’s self esteem- “I’m worth helping.”

Altruism Annette asks if she can offer some help about an idea that has worked for her regarding dealing with relatives. She wants to demonstrate how it is done to Carol. Gene states that he can connect some of the group members with referrals and phone numbers to a local employment agency that will give them on the job skills and training if they need a job. “They have helped me so much,” he says.

Installation of Hope Believing there are positive outcomes possible
Belief plus agency Anticipating an improved state Possibility thinking, options Concrete ways of achieving goals An optimistic attitude Hearing about others who have overcome problems Sense of “f they could do it, I can too”

Installation of Hope Related to self efficacy
Related to ability to effectively problem solve Related to motivation- willingness to give and receive honest feedback, to experiment with new outcomes, and set reasonable goals A common therapeutic factor Cultivated by self, therapist, and group Cultivated through active involvement

Instillation of Hope An opportunity to witness change in others
Being celebrated for steps made Tied to meaning making: 1. life has a meaning, 2. decreased depression and anxiety Tied to creativity (foods , hobbies, leisure, self care)

Instillation of Hope Three task or Goals Related To Hope:
Comprehending the environment Managing the environment Pursuing meaningful ends Bricklayer metaphor- one goal produces another and more hope

Imparting of Information
Providing psycho-educational info. regarding disorders, dynamics, techniques Therapist is expert with the information Knowledge to build applications on About diagnosis, how issues affect relationships, treatment approaches, Examples: how life might change after a loss or trauma How to ask for what’s needed, how to develop new skills, how to do daily tasks with a disability in a wheelchair, how to have hope filled proactive behaviors when you have a terminal illness, how to be accountable when you are tempted to slip into toxic behaviors

Imparting of Information
Reflecting on what has been learned in a given group Tying together these and learning experiences Finding success out of what felt like stuckness or failure

Corrective recapitulation of the primary family experience
People ted to if in a therapeutic situation long enough act out significant life interpersonal themes and problems Another opportunity for working through Family is represented symbolically Family= first group Power to change is in the interchanges

Corrective recapitulation of the primary family experience
Processing times in which members relate to other members as if they were a part of their families Processing bringing past family dynamics into the present Identifying old dysfunctional family of origin messages Developing alternatives

Exercise James screams at another group member stating “Did I ask you for your opinion? I dolt need a father! Never had one anyway and don’t want one now!” Lucy cries stating “you’ll leave me too just like they all did. Mom chose her life over me when she put me up for adoption. Wait until you find something else to do too.” Nikki exclaims, “why try and solve problems anyway. The same things happen. It was just like when I grew up. Dad hit the bottle and hid at the bar. Mom kept quiet and dove into household chores. But no one talked. No one dare say how messed up the home was.”

Development of socializing techniques
Meeting new people Dealing with different people Entering into the group Dealing with feeling as if you are an outsider Giving/receiving feedback Socialization cues Communication means (verbal and nonverbal)

Development of socializing techniques
Breaking through isolation to connect with others in meaningful ways

Exercise John admits, “we always stuck to our own kind of people from our neighborhood. Have seen more types of people in this group then I ever saw I all my years growing up. “ Bonnie says even those she is 55 years she “is not sure how to begin communicating her feelings to other because he is so fearful of rejection. Dave, the tough 40 year old man, finally breaks down. “I never learned how to love someone. I just screamed louder or hit someone. Now I want to show my wife I love her but where do I begin? I hear you guys talking and I don’t know what love is.”

Imitative Behavior Observing and trying new things
Safe, vulnerable setting Skill acquisition is often more successful when done by observing and imitating peers than therapist Building desire to succeed and master issues Therapist and members role played and offered real life alternatives to member destructive behaviors

Cohesiveness Somewhere I belong
Even when I am gone a bit I fit back in Apace to identify with Finding commonalities in the midst of perceived differences A sense of bounding Working together toward perceived goals Engagement Mutual acceptance

Cohesiveness Support Affiliation with the group
Attraction within the group Belief that there is meaning in relating to the group Feeling accepted as I am Belonging Sense of team spirit

Cohesiveness A subjective experience of the relationship between self and others Identification-methods: 1. Agreeing among themselves on something 2. Rallying against a leader or member or issue 3. Ignoring a leader, member, or issue Cannot occur without a therapeutic alliance in place

Example: Cohesiveness
Mary had a tendency to wear her feelings on her sleeve. It was apparent to all the others that she felt injustice as all the private practice patients seem to have a closeness with each other and the group leader that she felt she and the other “outsiders” could never have . She began frequently asking about the differences between the interactions of the “favored clients” of the therapist and the outsiders.

Existential Factors Building a sense of self responsibility
Shifting from an external to internal locus of control Issues like meaning, life, death Who am I? Where do I exist in the world? How do I matter?

Catharsis A place to feel Dealing with emotional distress
A place to deal with defenses. Hopes, fears What to communicate or not communicate and when Helping each other mobilize inner resources attendees may not realize they have

Catharsis Insights may be accompanied by resurfacing of old psychological wounds The group provides context for feelings expressions Being able to show how I really feel Getting things off my chest

Exercise “No one has ever let me be myself. For the first time I feel like I can share what is going on inside me. No judgment. This group is not like the cold hearted world out there, “ states Jen. “Feelings are worthless,” retorts Jeff. “They don’t do anything good. Like dad said you juts need to buck up and act tough. Be a real man.”

Interpersonal Learning
Observations of others Direct feedback Indirect responses Suggestions Role modeling Teaching by leader Groups within groups

Interpersonal Learning
Taking advantage of naturally occurring incidents Creating teachable moments

Self understanding Past cycles What works and what doesn’t work
New alternative options Why I did what I did Why others might have done what they did Humility

New Factors in the Literature

Multicultural Diversity, Divergence Hornsey, M.J., Dwyer, L., Oei, T.P.S., &Dingle, G.A. (April 2005). Argument: cohesiveness is too general a concept Cohesiveness is not well operationally defined Need for personal expression, dissent, challenge are more important in the working phases of groups

Multicultural Diversity, Divergence Fambrogh, M.J., & Comerford, S.A. (Sept. 2006)
Allows for more heterogeneity American society being pluralistic does not do well with the traditional group tx model Should not be greatest good but each finding goodness of fit One size does not fit all The majority may not really represent the whole as used to be thought The traditional model works when norms are clear, reinforced and rewarded by the power bearing majority

Multicultural Diversity, Divergence Fambrogh, M.J., & Comerford, S.A. (Sept. 2006); Rubenfeld, S. (October 2001). Allows for norms to evolve and be altered There is no status quo Goals are relative to individual circumstances Multiple meaning making possibilities Inequalities and social injustices can be acknowledged rather than ignored Multiple perspectives are good

Multicultural Diversity, Divergence Fambrogh, M.J., & Comerford, S.A. (Sept. 2006)
Traditional Contextual Seeks Cohesion, agreement, sameness, identification Respect for differences, diversity Truth Whatever the group majority says it perceives Evolving respective to the individual and interpersonal dynamics Approach Don’t rock the boat, share within boundaries Respect all realities Timing Process is more important than timing Interpersonal context, time frames are critical Philosophy Idealism Pragmatism

Contextualism Actions and events interact in a context
Everything is constantly changing It is not possible to get perfect agreement and cohesion from all Group change is also cummulative

Which model do you prefer?
Traditional model? OR New Divergent Contextual model?

Authenticity Versus Sincerity
Approaching truth with wisdom What I do with when I become self aware Generally censored Expresses Love Sincerity Desires growth of the person and group Willingness to deal with the breakdown of safe ideas to share what’s in one’s heart Expresses passion

Facilitative Encourage group sharing of information (as opposed to didactic) Finding out hat the group specifically needs and tailoring to that Accepting Nonjudgmental Empathic (not necessarily agreeing)

Courage Affirming the members decision to face possible issues without any guarantees of outcomes Willingness to participate in potentially uncomfortable therapy Willingness to do something difficult even without constant recognition Speaking about certain issues Broaching new solutions Being around different diverse people Trying new techniques Taking a risk

Individuality Maintaining self Multiculturalism Diversity factors
R religious/spiritual E economic class S sexual identity P psychological development E ethnic/racial identity C chronological issues T trauma and threats to well being F family issues U unique physical issues L language and location or residence issues

Challenging/Confronting
Can serve to correct imbalances Ca be therapeutic Helps to encourage and influence different ways of building and maintaining change

Building Attachments Insecure or anxious attachments- fears of rejection or abandonment Going between desire to be close and desire to reject or push away Believe others are inconsistent and unreliable Avoidant attachment- act like they don’t need others, are independent, and others are untrustworthy, irrelevant, or too needy Building cohesiveness can assist in building healthy attachments Especially important for the therapist to assess herself or himself

Group Therapy Skills Active listening Linking Blocking Summarizing

Group Problem Resolution
People who talk too much People who don’t talk Members who arrive late or leave early Change of therapist Scapegoating

Talk too Much Slowing things down Acknowledge their input Redirect
Return to group standards and boundaries

Talk Too Little Invite input and exploration Direct inquiries
Roundtable method Return to value of group as a whole

Silence in Group Could be resistance or defense mechanism
Not always bad May be a learned behavior Silence is communication May be a cover for hostility May be an uncertainty of how to react or what is okay to say or not Can be a reaction to group changes- breaks, changes in leaders, newcomers, changes in group stage, etc. Can occur when fears o risks are present- “What if I reveal myself?”

Silence in Group Can be a reaction to seeing group members reprimanded for sharing too much Can be an attempt at punishing the leader

Example Anna often spoke up throughout group of her feelings of being unloved, unwanted, and unappreciated in life by others. When the therapist tried to include everyone in discussions she began voicing how her urgent and valuable comments were passed by. ‘I am just a victim as usual. No one wants to hear me. Everyone matters more than me.”

Arrive Late/Leave Early
Emphasize group norms, rules, and boundaries Is this representing something? What is the message behind this? Can be used as a n example for a general issue

Scapegoating A means for the group to blame rather than heading issues head on A defense mechanism, projection Frequently someone who may be influential to the group Should be used therapeutically

Psychodynamic Group Processing
Who am I? Who would I like to be? Who should the others be like? How should the others perceive me?

Newcomers Stressful because challenges the security, cohesion, predictability the group has already achieved May challenge the group expectancies Can offer new perspective Can be a good source for new observations and input Uncertainty who and what and when confrontations and comments can occur Old timers see newcomers as upsetting to cohesion already established in the group Minority influence can occur with consent and done properly

Newcomers Debate and uprising may signal the desire to work through tension NOTE: People can be silent in one on one and outspoken in groups or vice versa Doe the therapist confront tensions with newcomers or not?

Example: Newcomers Two new people joined a group in addition to those who had already been coming. Ground rules and procedures had long been in effect. With the new attendees there appeared to be regression to former group stages. One of the new group members began arriving late, complained about being hungry and the group time, and frequently had negative comments and “suggestions” about nearly everything in the group. He demanded that the leader reconsider the timing of the group and the way it normally was constructed in terms of time management

Chaos Theory Groups move back and forth from disequilibrium to balance
Any change can set a group off balance Any change can make members reassess The heart of a group: how do we stay the same while changing?” Therapist’s role- containing the group when chaos is being sorted through

The Seven Resiliencies Laursen, E.K., & Oliver, V. (Spring 2003)
Reframing problems as strengths 1. insight-asking touch questions 2. independence- being your own person 3. relationships- connecting with people who matter 4. initiative-taking charge 5. creativity-using imagination 6. humor- finding what’s funny 7. morality- doing the right thing

Strengths-based Mental Health Descriptions Laursen, E.K., & Oliver, V. (Spring 2003)
Major Depression- sadness regarding a series of events Oppositional Defaint Disorder- standing up for yourself when you believe you a re being violated Anger- a feeling of anger that is at times justified but you forget to control in a way that is acceptable to others Bipolar- Moodswings that keep you from being calm, organized, and collected Adjustment disorder- Being comfortable with your current situation that makes it difficult for you to adjust to the new thing

Group Process Process Here and now experience
How the group is functioning at a given moment In relationships and interactions among group members with each other and with the group leader A systems perspective Process involves doing something about which participants might have been hesitant or frightened before

Group Process Brown, N.W. (April 2003).
What is the group doing to promote safety? How is the group establishing norms? What is the group’s reaction to authority? What threatens the group? How does the group mange uncomfortable emotions? How are important feelings expressed or ignored? How is the group managing its work? What personal feelings or reactions am I having? How much is from the group versus from my past? Is the group stuck or forward moving?

Key Aspects For Successful Group Therapy
Presence in the here and now Comfort with affect in the room- cerate safety, invite strong feelings, and place high priority on sharing feelings Empathic connection Facing shame without defenses or withdrawal Earning different communication styles Developing alternatives to goal achievement Improving interpersonal skills

Group Competencies LaRocque, S.E
Comprehensive understanding of stages of groups Therapeutic factors which influence change in groups Therapeutic techniques for groups Ways of collaborating between therapist and group members Participation/attendance in a group Hands- on group facilitation Estimated 4-6 month timeline Positioning as participant observers in groups

Group Competencies LaRocque, S.E
Identification of and skills for working with therapeutic factors like universality, cohesiveness, the stages of development, and corrective relational experiences Assisting group members in affirming, empathizing, confronting, and influencing one another Translating theory into techniques

Teaching Group Counseling Skills (Furr, S.R., & Barrett, B., 2000)
Four essential areas of preparation: 1. Theory 2. Opportunity to observe groups and learn and practice group skills 3. Participating in an experiential group 4. Practice leading or co-leading a group

Students select a group topic weekly Each week a new step is introduced and the student assignment for that week is to complete that step Teacher lectures and demonstrates that step Class size is 20 with 10 in each group

Group Training- Three Phase Model
First phase- 45 minutes, senior co-leader and leader and the outer circle of staff observers A communication boundary between the inner and outer circles. Patients work on their issues with the co-leaders. Second phase- 15 minutes, the inner circle of staff observers, the senior leader, and the co-leader reacting to the discussion in the first phase, and the outer circle of patients who are now observing. There is a communication boundary between the inner and outer circles.

Third phase- 15 minutes, Patients, staff observers, and the two coleaders all talk together and process their intrapsychic , interpersonal, and group as a whole reactions to the discussion in phases one and two. Staff shared thoughts and feelings while patients observed.

Initial phase: Group one: Are we safe? Are there boundaries? Group two: Who would the leaders favor? Group three: Everyone processed about being new and worrying about their roles

Reactive phase- testing how far they can talk about emotions and issues, dealing with issues of control and power, disappointments and hurts, coping with pain Group One: Competition between leaders Group two: There was a discussion about how uncomfortable staff felt. Group three: The co-leaders discussed patients who were unable to continue with the group to the next phase

Work phase: Goal directedness, cooperating on activities Group one: moving the group to a neutral position Group two: Co-leaders demonstrated that it was possible for people to work together in spite of their differences, which became more apparent as the group matured Group three: Patients were particularly interested in how the two co-leaders could feel and express anger with one another and still work together

Termination Phase: Group One: Patients were sad about terminating and talked about missing each other. Group Two: Staff talked about missing each other. Group Three: All participants integrated what they had learned.

Leader Skills Facilitating Managing conflict
Four Categories of Awareness: 1. Split awareness- Paying attention to what is going on in the foreground while maintaining an awareness of background process 2. Dual awareness- Tracking the external processes while keeping in tune with the internal processes in reaction to what is occurring as well as input for the group 3. Role awareness- Noticing roles as they emerge and the effects of these roles 4. Self reflective awareness- Notice, evaluate, and comment on inner experiences with members as they occur

Leader Skills Principles of group dynamics
Group leadership styles and approaches Group process Group therapy types of groups Prepare standards for group leaders Apply ethical and legal issues for groups Use multicultural principles Apply theories of group counseling Apply group counseling methods

Activity Groups Cowls, J., & Hale, S. (January 2005).
Trends toward lesser hospital stays and insurance approving lesser stays and treatment days in general Move towards more activity groups and psycho-educational groups Activity groups-Crafts, cooking, arts, decorating, exercise, wellness Psycho-educational groups- social skills, conflict resolution, communication skills

Activity Groups Cowls, J., & Hale, S. (January 2005)
Why do clients attend groups while they are in the hospital? What do they value in these groups? When in the course of a client’s recovery are they ready to process and utilize information form these groups? Less threatening Easier to attend Metaphorical Produce insight Easier to get at defense mechanisms

Activity Groups Cowls, J., & Hale, S. (January 2005)
Can be more effective at developing interpersonal skills with certain mental health populations Thinking outside the box Can develop awareness and insight quicker and members are more wiling to acknowledge Includes: visual arts, music, media, and others symbolic representations E.g. Color your World- pick colors that represent feelings or meanings, draw lines and symbols, share story

Draw Your Solution A problem I am currently facing
Steps to Get to the Solution What the Solution Would Look Like If It was Solved

Demonstration Groups Gans, J.S., Rutan, J.S., & Lape, E. (2002).
Used for training group professionals Mental health professionals (between 6-8) who volunteer to be members of a group to be held by a senior group therapist in front of an observing group of students, peers, and colleagues Once or a few limited times in workshop setting Opportunity to be led by a senior group therapist Improved self confidence in competencies

Demonstration Groups Gans, J.S., Rutan, J.S., & Lape, E. (2002)
The Physical Setting Should have microphones and ability to hear various dynamics of each group discussion and training The group agreements

Demonstration Groups Gans, J.S., Rutan, J.S., & Lape, E. (2002).
Three Parts of the Didactic Section: 1. Discussion by the leader of themes and significant affective moments, salient group dynamics, leader interventions, and theory 2. Response to questions or comments from the observer group 3. Processing what the observer group is experiencing: What did they identify with?, Perceptions of the leader’s work? What would they do differently? Themes they became aware of? Most compelling moments for group members?

CBT Groups Look at classical and operant conditioning principles
Focus on the antecedents and consequences in terms of what they are doing to keep behaviors going. Change by changing toxic thoughts and problematic behavior Stop reinforcing the problem and reinforce what’s healthy Group may challenge thoughts and behaviors which are unhealthy

CBT Groups Where is the evidence? Where is the logic?
What do you have to lose? What do you have to gain? What would be the one thing that could happen? What can you learn from that experience? Goal= max beh. Change Guide group interactions to enhance awareness of thoughts, beliefs, behaviors and emotions

Writing Groups Leader with both clinical and writing skills
Not about the quality of the writing style How to assemble language to share experiences with others Writing makes the individualistic world of the person shareable with others Facing anxieties, exercising concerns, giving feedback, hearing advice, sharing differing worldviews

Writing Groups Gives a chance for the group therapist to process what the member is looking for Empathy? Agreement? Support Listening? Encouragement? No Criticism or correction? Themes can be assigned (controlling person, family/parenting, abuse/trauma, sibling rivalry, something I’m afraid of

Affective Biblotherapy Groups Schechtman, Z. , & Nir-Shfrir, R. (Jan
Increase ability to be vulnerable and catharsis in group Self administration function Allows for insight without embarrassment An indirect method May include books, films, short stories, poetry A method of role modeling and identification of restorative narrative and alternatives

Inpatient Hospital Groups Burlingame, G. M. , Earnshaw, D. , Barlow, S
Inpatient Hospital Groups Burlingame, G.M., Earnshaw, D., Barlow, S.H., Richardson, E.J., Donnell, A.J., & Villani, J. (October 2002). Identify types of groups for populations served (psychotherapy, psycho-educational, skill-based, counseling, activities) Should be part of a systems wide approach Overall hospital staff should enhance group competencies Ceo, Administration to highlight the importance of groups Key personnel on units selected as “group champions” to attend annual and specialized trainings

Inpatient Hospital Groups Burlingame, G. M. , Earnshaw, D. , Barlow, S
Inpatient Hospital Groups Burlingame, G.M., Earnshaw, D., Barlow, S.H., Richardson, E.J., Donnell, A.J., & Villani, J. (October 2002). Establish hospital wide standards of care for group programs On units establish structure which allows for an incorporates groups Weekly meetings on units with group coordinators Groups multidimensional- cognitive affective, and behavioral components Most hospital staff have little or no group clinical training so workshops need to be held regularly for building competency

Considerations With Older Adults Saiger, G. M. (Summer 2001)
Mobility Issues Health concerns Accomodations needed Which subgroup?: medical, managed care, activities program, group home, retirement village, mental health Forgetfulness, dementia issues Speed Preoccupations: body functions, health, death, repetitive stressors

Termination Should be processed from beginning on Factors: Unemployed
Unmarried Childless Lower income Criminal History Witnessed trauma More severe psychopathology Alcohol/substance problems Social isolation

Scenarios In Group Therapy
For Discussion

A person likes to talk about his or her problems but does not seem to be mindful and respectful of the needs of the other group members Some group members have begun dating and developing romantic feelings for each other as they have identified over common issues Subgroups are developing in the group which are at odds with each other A group member comments about you (the leader) liking certain people more than others because you set boundaries.

It is challenging to get any group work done because a member keeps trying to derail the conversation A member has a strong emotional reaction and begins crying uncontrollably A member has a strong reaction and begins yelling uncontrollably A member admits to the group some trauma previously hidden A member tells the group that he will be quitting because the group is not helpful

A member becomes defensive and insulted over something that was misperceived A member expresses a need to be vulnerable and share a deep issue and realization they have never shared with anyone but they are afraid of the group’s reaction The group becomes more social and chatty when they are supposed to be working on a task or issue Members of the group perceive that you (the leader) tend to give nonverbal attention and more talk time to your “favorite” group members.

Your colleague would like to lead a group. She is very excited about learning some new techniques in grad school but has never tried these techniques out. Eager to try something new she sets up a group using the newly learned techniques. What do you say or do about this? How would you describe here level of competency? Your work setting does not want to pay the independently licensed people more to lead the therapy groups so they use some paraprofessionals and lay people with some basic training to do a mixture of therapy, education, and activities groups.

Bibliography Alexander, P.C., Morris, E., Tracy, A., & Frye, A. (2010). Stages of change and the group treatment of batterers: A randomized clinical trial. Violence and Victims, 25(5), Bernard, H., Burlingsham, G., Flores, P., Greene, L, Joyce, A., Kobos, J.C., Leszcz, M., Seamands, M.R.R., Piper, W.E., McEneaney, A.M.S., & Fierman, D. (October 2008). Clinical practice guidelines for group psychotherapy. International journal of group psychotherapy, 58(4), Barnes, K. L. (September 2004) Applying self efficacy theory to counselor training and supervision: A comparison of two approaches. Counselor Education and Supervision, 44, Billow, R.M. (January 2010). Models of therapeutic engagement part two: Sincerity and authenticity. International Journal of Group Psychotherapy, 60(1),

Bibliography Billow, R.M. (January 2003). Bonding in group: The therapist’s contribution. International Journal of Group Psychotherapy, 53(1), Brown, N.W. (April 2003). Conceptualizing process. International Journal of Group Psychotherapy, 53(2), Buchele, B. (October 2000). Life’s many pieces: The identity of the group psychotherapist. International Journal of Group Psychotherapy, 50(4), Bullock, A., & Bannigan, K. ( ). Effectiveness of activity-based group work in community mental helath: a systematic review. The American Journal of Occupational Therapy, Burlingame, G.M., Earnshaw, D., Barlow, S.H., Richardson, E.J., Donnell, A.J., & Villani, J. (October 2002). A systematic program to enhance clinician group skills in an inpatient psychiatric hospital. International Journal of Group Psychotherapy. 52(4),

Bibliography Chamodraka, M. (2008). Hope development is psychotherapy: A grounded theory analysis of client experiences. Department of Educational and Counseling Psychology, McGill University, Montreal, CA. Cini, M. A. (Spring 2001). Group newcomers: From disruption to innovation. Group Facilitation, 3-13. Clark, A. (Summer 2002). Scapegoating: Dynamics and interventions in group counseling. Journal of Counseling and Development, 80(3), Cohen, A. (July 2004). A process-oriented approach to learning process-oriented counselling skills in groups. Canadian Journal of Counselling, 38(3), Counselman, E.F. (April 2008). Why study group therapy? International Journal of Group Psychotherapy, 58(2), Cowls, J., & Hale, S. (January 2005). It’s the activity that counts: What clients value in psycho-educational groups. The Canadian Journal of Occupational Therapy, 72(3),

Bibliography Daly, J.E., & Pelowski, S. (2000). Predictors of dropout among men who batter: A review of studies with implications for research and practice. Violence and Victims, 15(2), Dierick, P., & Lietaer, G. (April 2008). Client perception of therapeutic factors in group psychotherapy and growth groups: An empirically-based hierarchical model. International Journal of Group Psychotherapy, 58(2), Elfant, A.B. (January 2000). Discussion of “group therapy program development.” International Journal of Group Psychotherapy, 50(1), Ettin, M.F. (April 2000). From identified patient to identifiable group: The alchemy of the group as a whole. International Journal of Group Psychotherapy, 50(2), Ettin, M.F. (October 2001). Working through a psychotherapy groups’ political cultures. International Journal of Group Psychotherapy, 53(4),

Bibliography Fallon, A. (Oct. 2006). Informed consent in the practice of group psychotherapy. International Journal of Group Psychotherapy, 56(4), Fambrogh, M.J., & Comerford, S.A. (Sept. 2006). The changing epistemological assumptions of group therapy. The Journal of Applied Behavioral Science, 42(3), Feldman, D.B. & Snyder, C.R. (May 2005). Hope and the meaningful life: Theoretical and empirical associations between goal-directed thinking and life meaning. Journal of Social and Clinical Psychology, 24(3), Fuhriman, A., & Burlingame, G.M. (2001). Group psychotherapy training and effectiveness. International Journal of Group Psychotherapy , 51(3), Furr, S.R., & Barret, B. (Dec. 2000). Teaching group counseling skills: problems and solutions. Counselor Education and Supervision, 40(2),

Bibliography Gagerman, J.R. (fall 2004). The search for fuller mutuality and self experiences in a women’s psychotherapy group. Clinical Social Work Journal, 32(3), Gans, J.S., & Counselman, E.F. (April 2010). Patient selection for psychodynamic group psychotherapy: practical and dynamic considerations. International Journal of Group Psychotherapy, 50(1), Gans, J.S., & Counselman, E.F. (January 2000). Silence in Group Psychotherapy: A powerful communication. International Journal of Group Psychotherapy, 50(1), Gans, J.S., Rutan, J.S., & Lape, E. (2002). The demonstration group: a tool for observing of group processes and leadership style. International Journal of Group Psychotherapy, 52(2), Gans, J.S. (October 2005). A plea for greater recognition and appreciation for our group members’ courage. International Journal of Group Psychotherapy, 55(4),

Bibliography Gladding, S.T. (April 1994). Effective group counseling. Eric Digest #EDO-CG Gonzalez, J.M., & Prihoda, T.J. (2007). A case study for psychodynamic group psychotherapy for bipolar disorder Greggio, S. P. (Summer 2007). Biblical metaphors for corrective emotional relationships in group work. Journal of Psychology and Theology, 35(2), Grossmark, R. (2007) The edge of chaos: enactment, disruption, and emergence in group psychotherapy. Psychoanalytic Dialogues, 17(4), Grundy, D. (April 2007). What is a writing group?: Dilemma of the leader. International Journal of Group Psychotherapy, 57(2),

Bibliography Gutteling, B.M., Montagne, B., Nijs, M., Van Den Bosch, W. (2012). Dialetical behavior therapy: Is outpatient group psychotherapy as effective alternative to individual psychotherapy? Preliminary conclusions. Comprehensive Psychiatry, 53, Hornsey, M.J., Dwyer, L., Oei, T.P.S., &Dingle, G.A. (April 2005). Group processes and outcomes in group psychotherapy: Is it time to let go of “cohesiveness?” International Journal of Group Psychotherapy , 59(2), Horowitz, R. (2012). The contours of identity: Relational dynamics in the psychotherapy of long-term mental illness. Clinical Social Work Journal, 40, Joyce, A.S., Piper, W.E., & Ogrodnizuk, J.S. (July 2007). Therapeutic alliance and cohesion variables as predictors of outcome in short-term psychotherapy. International Journal of Group Psychotherapy, 57(2), Kivlighan, D.M. (October 2008). Comments on the practice guidelines for group psychotherapy”: Evidence, gaps in the literature, and resistence. International Journal of Group Psychotherapy. 58(4),

Bibliography Krogel, J., & Beecher, M.E., Presnell, J., Burlingame, G., & Simonsen, C. (October 2009). The group selection qustionaire: A qualitative analysis of potential group members. International Journal of Group Psychotherapy, 59(4), LaRocque, S.E. The social work student as a participant observer in group therapy training. Reflections, 18(2), Lanza, M. L., & Witkower, A. (Oct. 2010) Concentric interactive group model: A unique experience for patients and staff. Perspectives in Psychiatric Care, 46(4), Large, T.R. (October 2005). Resistance in long-term cancer support groups. International Journal of Group Psychotherapy, 55(4), Laursen, E.K., & Oliver, V. (Spring 2003). Recasting problems as potentials in group work. Reclaiming Children and Youth, 12(1), Leszcz, M. (July 2004). Reflections on the abuse of power, control, and status in group therapy and group therapy training. International Journal of Group Psychotherapy, 54(3),

Bibliography Markus, H.E. & Abernathy, A.D. (April 2001). Joining with resistance: Addressing reluctance to engage I group therapy training. International Journal of Group Psychotherapy. 51(2), r Marmarosh, C.L., Franz, V.A., Majors, R.C., Rahimi, A.M., Ronquillo, J.G., Somberg, R.J., Swope, J.S., and Zimmer, K. (July 2006). Therapists’ group attachments and their expectations of patient’s attitudes about group therapy. International Journal of Group Psychotherapy, 56(3), Mishna, F., & Muskat, B. (October 2004). “I’m not the only one!”: Group therapy with older children and adolescents who have learning disabilities. International Journal of Group Psychotherapy , 54(4), Newsome, D.W., Henderson, D.A., and Veach, L.J. (Fall 2005). Using expressive arts in group supervision to enhance awareness and foster cohesion. Journal of Humanistic Counseling, Education, and development, 44(2), Oel, T. P.S., & Browne, A. (2006). Components of group processes: Have they contributed to the outcome of mood and anxiety disorder patients in a group cognitive-behaviour therapy program? American Journal of Psychotherapy, 60(1),

Bibliography Osborn, C.J., Daninhirsch, C.L., & Page, B.J. (Spring 2003). Experiential training in group counseling: humanistic processes in practice. Journal of Humanistic Counseling, Education, and Development, 42(1), Pepper, R.S. (April 2002). Emotional incest in group psychotherapy. International Journal of Group Psychotherapy, 52(2), Person, E.S. (Jan. 2004). When the weak confront the strong: How groups affect change. International Journal of Group Psychotherapy, 54(1), Petrocelli, J.V. (Winter 2002). Processes and stages of change: counseling with the transtheoretical model of change. Journal of Counseling and Development, 80(1), Phan, L.T., Rivera, E.T., Volker, M.A., & Garrett, M.T. (Oct. 2004). Measuring group dynamics: An exploratory trial. Canadian Journal of Counselling, 38(4), Reeve, J. (February 2006). Group psychotherapy with children on the inpatient unit: The MEGA group model. Journal of Child and Adolescent Psychiatric Nursing, 19(1), 3-12.

Bibliography Rowswarski, T.E., Dunn, J.P. (January 2009). The role of help and hope in prevention and early intervention with suicidal adolescents: Implications for mental health counselors. Journal of Mental Health Counseling, 31(1), Rubenfeld, S. (October 2001). Group therapy and complexity theory. International Journal of Group Psychotherapy, 51(4), Saiger, G. M. (Summer 2001). Group psychotherapy with older adults. Psychiatry, 64(2), Scharwachter, P. (Januray 2008). Three applications of functional analysis with group dynamic cognitive-behavioral group therapy. International Journal of Group Psychotherapy International Journal of Group Psychotherapy, 58(1), Schechtman, Z., Hiradin, A. & Zina, S. (Spring 2003). The impact of culture on group behavior: a comparison of three ethnic groups. Journal of Counseling and Development, 81(2),

Bibliography Schechtman, Z., & Mor, M. (April 2010). Groups for children and adolescents with trauma-related symptoms: Outcomes ad processes. International Journal of Group Psychotherapy, 60(2), Schechtman, Z., & Nir-Shfrir, R. (Jan. 2008). The effect of affect bibliotherapy on client’s functioning in group therapy. International Journal of Group Psychotherapy, 58(1), Scheidlinger, S. (2004). Group psychotherapy and related helping groups today: An overview. American Journal of Psychotherapy, 58(3), Sparrow, Dr. Scott, UTAP Dept. of Ed. Psychology, Scenarios in Group Therapy, Calling For Intervention-EPSY 6365. Thompson, D.A., & McRae, M.B. (October 2001). The need to belong: A theory of the therapeutic function of the black church tradition. Counseling and Value, 46, Tschuschke, V., & Greene, l.R. (Oct. 2002). Group therapist’s training: What predicts learning? International Journal of Group Psychotherapy, 52(4),

Bibliography Valore, T.G. (Summer 2002). Sharing adventure: The group is important. Reclaiming Children and Youth, 11(2), Verhofstadt-Deneve, L.M. (2012). Subgroup conflics? Try the psychodramatic “double triad method.” International Journal of Group Psychotherapy, 62(2), Vernon, A. (April 2002). Experiencing loss: practical guidelines for group cousneling. Counseling and Human Development, 34(8), 1-16. Wadsworth, J. (2008). The group experience. Rehabilittion education, 22(3-4), Wright, F. (April 2004). Being seen, moved, disrupted, and reconfigured: Group leadership from a relational perspective. International Journal of Group Psychotherapy International Journal of Group Psychotherapy, 54(2),

Bibliography Yildirim, T. (2012). The unheard voice in group counseling: Quietness. Educational Sciences; Theory and Practice, 12(1),

Elements of Successful Group Interventions

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