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
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?
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 (workshopsstress 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
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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
Screening Potential
Members
• 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
Screening Potential
Members
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
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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
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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
Exercise: Screening
Potential Members
• 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
Exercise: Screening
Potential Members
• 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
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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
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?
Questions Re. Group
Therapy
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?
Questions Re. Group
Therapy
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?
Questions Re. Group
Therapy
Confidentiality
• How do you keep group records?
• How are records protected?
• Who has access to my info.?
Questions Re. Group
Therapy
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?
Questions Re. Group
Therapy
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
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Forming
Pre-affiliation with the group
Anxiety, caution, dependency
Desire to flee
Leader: primarily an educator
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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
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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
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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
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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
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Group Therapeutic
Factors
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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”
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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)
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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
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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
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Cohesiveness
• A subjective experience of the relationship
between self and others
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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
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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
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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
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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
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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
Evolving respective to
majority says it perceives 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
Authenticity• 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
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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
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Active listening
Linking
Blocking
Summarizing
Group Problem
Resolution
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People who talk too much
People who don’t talk
Members who arrive late or leave early
Change of therapist
Scapegoating
Talk too Much
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Slowing things down
Acknowledge their input
Redirect
Return to group standards and
boundaries
Talk Too Little
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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?”
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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
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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
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
• 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.
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
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.
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
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
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
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
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
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
Teaching Group Counseling Skills
(Furr, S.R., & Barrett, B., 2000)
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 psychoeducational 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. 2008)
• 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.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.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
Scenarios In Group Therapy
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.
Scenarios In Group Therapy
• 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
Scenarios In Group Therapy
• 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.
Scenarios In Group Therapy
• 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.
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