Work with Groups
Step Seven: Clinical Group Work
Chapter 16
Group Method
Two Goals
Like the history of social work itself, the
history of group work entails commitment
to two goals:
(1) Individual change (clinical group work)
(chapter 16)
(2) Social change (non-clinical group work)
(chapter 17)
Types of Groups
• Aggregation: a gathering of people in time and
place who have no intent of forming or
maintaining an affiliation. (waiting at a bus stop;
movie audience)
• Natural Groups: Members come together
spontaneously on the basis of naturally occurring
events, interpersonal attraction or the mutually
perceived needs of the members. (the family is a
primary natural group followed by friendship
groups and neighborhood groups)
Types of Groups
Continued
• Formed Groups:
Members (1) come together through some outside
influence or intervention, (2) usually have some
sponsorship (boy/girl scouts, agency auspice),
(3) are convened for a particular purpose and
(4) usually have a professionally trained leader.
• Practitioners work with both natural and formed
groups.
Group Method
Value-Added Skills
• Practitioners, whether in clinical social work or in
policy, advocacy, management or community
practice must acquire additional skills in group
method.
• In addition, competent group work requires
learning two distinct group skill sets; one for
clinical group work (this chapter) and another for
policy, advocacy, management and community
practice (Chapter 18).
Paradox of Group
Constructive-Destructive Forces
• There is universal ambivalence toward groups
whether they are used in clinical or non-clinical
settings.
• It is impossible to have any kind of group without
the occurrence of contradictory process such as
individuality/belonging; attachment/alienation;
progression/regression.
• Constructive and destructive forces co-exist in
any form of group life.
Inevitable Group Tensions
The following inevitable group tensions occur
whether in clinical or non-clinical groups:
(1) Competition, (2) Rivalry, (3) Envy
(4) Dominance, (5) Submission, (6) Criticism
(7) Group pressure, (8) Scapegoating
(9) Hostility, and (10) Rejection
Types of Clinical Groups
Historical Perspective
• Settlement House Movement: group program
activities and skill training. Members socialize and
improve their lives.
• Recreation Movement: pursuit of leisure activities
to encourage constructive use of time and to create
a sense of community.
• Progressive Education: small groups are used to
solve shared problems and to foster mutual aid
Types of Clinical Groups
Historical Perspective
• Therapy-Mental Health and Child
Guidance Movement: group healing for
those in emotional pain. Foulkes is credited
with fathering the group analytic method
• Residential living and treatment facilities:
recognition of the dynamics of group living;
effort to create a therapeutic social milieu;
manage negative group dynamics.
Professionalization
Historical Perspective
• Grace Coyle (1948) established group work as a
method within social work
• National Association for the Study of Group Work
(NASGW, 1936) transformed into American
Association of Group Workers (AAGW): began
group journal.
• NASW (1955) Merger of AAGW with National
Association of Social Workers
• AASWG (1979) Association for the Advancement
of Social Work Practice with Groups; effort to
revitalize group work
Merger: Gains and Losses
Professionalization
• Group work gained professional status following
its merger with NASW, however, its significance
as a method was overrun by the sheer number of
caseworkers in the profession.
• Group Works’ tilt toward professionalization led
to a tilt toward clinical group work
• Its standing as a significant model of nonclinical practice in policy, advocacy, management
and community practice was lost.
• Group method was further eroded with the move
toward generalist practice.
Definition
• Group method is one clinical method choice
among several clinical method options
(individual and family methods).
• Clinical group work is defined as goaldirected activity with small groups aimed at
meeting the social and emotional needs of
individual members and the group as a
whole.
Clinical Group Method
Goals
To promote, enhance, or restore individual:
(1) mental health
(2) social functioning
Not all clinical group work is group psychotherapy but all clinical group work serves
therapeutic goals
Groups in Clinical Practice
Typology: Therapeutic Groups
• Recreational groups: Activities, fun, sport
• Skill acquisition: budgeting, cooking, car repair,
sewing, life skills
• Play groups: developmental skills; interpersonal
skills, taking turns, listening, sharing
• Self enhancement: dance, drama, poetry, music,
art, book discussion
• Social Milieu: Residential living
Groups in Clinical Practice
Typology:Psychotherapy Groups
Analytic Groups
• Psychodrama
• Sociodrama
• Play therapy
• Psycho-education
• Mutual Aid
• Ego Supportive
Groups in Clinical Practice
Typology:Psychotherapy Groups
Social Microcosm
• Groups focused on social identity
• Groups focused on socialization to societal
norms; conformity to law and order
Optimism
The Group’s Potential
• Foulkes, Yalom, and Schulman are
optimistic about the groups’ potential to
bring about healing through its curative
properties.
• These scholar-practitioners admonish group
therapists to “trust the group”
• Therapists are taught to rely on the creative
properties of groups.
Caution:The Anti-Group:
Destructive Properties of Groups
• In contrast to Foulkes’ optimism, Nitsun cautions
practitioners about the anti-group.
• Nitsun identifies 10 aspects of group life that
cause anti-group sentiments among group
members:
(1) the group is a collection of strangers
(2) the group is unstructured
(3) members “create” the group; worker is not
always in control of the group’s process
Anti-Group Sentiments
Continued
(4) it is a public arena –
(5) it is a plural entity
(6) it is a complex experience
(7) it creates interpersonal tension
(8) it is unpredictable
(9) it fluctuates in its progress
(10) it is an incomplete experience
Anti-Group Dynamics in the
Analytic Group
• According to Nitsun (1996) the paradox of group
life deepens when groups are used as a method of
therapy.
• The therapy group is exaggerated by the paradox
of group life generally and specifically by the
conditions members bring to the group.
• Groups can become pathological, mobilizing
aggressive and destructive forces (Nitsun 1996;
Bion, 1961).
Anti-Group Dynamics in the
Analytic Group
• According to Bion, neurotic and psychotic
conditions are in essence group disruptive.
• According to Knopka, groups possess destructive
power even when they are composed of healthy,
rational, well-meaning individuals
• Otherwise good people harm other good people
when the destructive forces of group life are not
properly managed.
Empirical Studies
10 Properties Common to All Groups
Empirical studies about how groups work have
identified 10 properties common to all groups.
All group workers must take into account the
following properties of group: (1) size (2)
purpose, (3) composition, (4) open or closed
membership, (5) degree of desired cohesion,
(6) group stages, (7) group structure,
(8) interaction and communication patterns,
(9) curative factors and (10) anti-group sentiments
and forces.
Group Property
Size
• Size refers to the optimum number of
members needed to form a group to
accomplish purpose-driven goals.
• The optimal size for achieving clinical goals
is 5-10 members.
• Size must allow for absences and attrition.
Group Property
Composition
• Group composition affects group dynamics and
ultimately the effectiveness and efficacy of
outcome.
• The group worker must weigh the value of
homogeneity and heterogeneity on numerous
composition variables e.g. gender, age, diagnoses,
severity of condition, tension needed for change,
compatibility or incompatibility of members,. etc.
• Example: Yalom’s in-patient groups are
heterogeneous on diagnoses; homogeneous on
level of functioning, capacity for insight, attention
span (1 hr.) not disruptive, able to talk.
Group Property
Stranger Composition
• Stranger composition is the sine qua non of the
therapy group.
• Nitsun notes that the psychological challenges of
belonging to a group may be greater than
commonly recognized.
• Group life often re-evokes and recreates feared
interpersonal situations.
• Groups can lack containment and protection;
members fear breach of confidentiality and
exposure to a wider community.
Group Property
Socio-Demographic Composition
• Workers must take into account sociodemographic variables such as race, gender, class,
ethnicity, religious affiliation, sexual orientation.
• How syntonic or dystonic members should be on
these socio-demographic variables depends on the
purpose of group.
• If the difference is too great, subgroups may form,
creating greater intolerance and blocking change.
• If there is not enough difference the tension
needed for change will be absent.
Group Property
Open or Closed Membership
• Open: anyone welcome, at any time
• Closed: no new members once formed.
• Whether membership should be open or
closed depends on the purpose of the group
and the degree of cohesion sought.
• Analytic groups: closed membership- trust
is needed for self-disclosure.
• Recreation or skill training groups: open
Group Property
Cohesion
• The degree of cohesion depends on the
goal of the group. The goal may be:
• To break down cohesion when groups act
cohesively to achieve destructive ends e.g.
gangs
• To foster cohesion where no camaraderie
exists and when worker wants group to
foster group identity and sense of belonging
Group Property
Typology of Group Stages
• Every group and every session passes through
identifiable stages. See exhibit 16.3
• Failure to recognize and work with group stages
can lead to therapeutic errors and missteps.
• Tuckman’s stages are: forming, norming,
storming, performing and ending.
• Bion’s stages are: dependency, independence
(fight/flight), interdependence (pairing), work,
ending
• Generic stages are : beginnings, middles, & ends.
Group Property
Structure: Subgroups
• Like other systems, groups have a structure.
• Groups have the following structural forms: the
individual member, sub groups, and the group as a
whole.
• Subgroups (cliques) may come in pairs, triads for
foursomes; leaders and followers.
• In-group/outgroup: Sub groups have boundaries
that include and exclude other group members.
• Ingroup/outgroup dynamics are destructive to
individual members and to the group as a whole.
Group Property
Structure: Roles
• A role structures interaction
• The role a member plays may interfere with
individual change and may block the work of the
group as a whole. See exhibit 16.4
• Schulman identifies the following roles that occur
in groups: (1) gatekeeper, (2) deviant, (3)
scapegoat, (4) internal leader, (5) quiet member,
(6) defensive member-denial.(7) monopolizer.
• Cliques and roles are structural formations.
Group Property:
Norms –Patterns of Interaction
• Communication and interaction patterns establish
group norms.
• Norms may be explicit or implicit.
• Explicit norms: day and time of meeting; length
of meeting (1.5 hr.); duration of group (brief-12
weeks); use of talk or activity.
• Implicit norms: Is it safe to trust? To take a risk?
To be angry? To miss a session? To cry?
• Norms: sabotage or support the work of the group
Group Property
Communication Patterns
• Often groups begin by using a maypole or round
robin pattern of communication where each
member, in turn, directs some communication to
the leader.
• Eventually the communication patterns become
dynamic and implicit.
• A sociogram captures implicit group
communication & interaction patterns; who
initiates an exchange, how frequently and to
whom it is directed.
Group Property
Communication
• What is communicated may be expressed verbally
or nonverbally.
• Members communicate through words, feelings
(tears, laughter,) and behavior (who sits where,
who comes in first, leaves last).
• Members communicate “near” problems-and
introduce problems as the session ends; doorknob.
• Non-problems: Themes are discussed rather than
the specific problem of a specific individual.
Group Property
Yalom: Curative Factors
Groups possess curative factors: (1) hope,
(2) universality, (3) imparting information,
(4) altruism, (5) corrective recapitulation of
the primary family group, (6) imitative
learning, (7) interpersonal learning,
(8) group cohesion, (9) catharsis, and
(10 ) existential factors.
Group Property
Shulman: Mutual Aid
Mutual Aid consists of: (1) sharing data,
(2) the dialectic process, (3) discussing taboo
areas, (4) all-in-the-same-boat, (5) mutual
support, (6) mutual demand, (7) developing a
universal perspective, (8) individual problem
solving, (9) rehearsal, and (10) strength-in
numbers
Group Property
Nitsun: The Anti-Group
• Analytic therapy groups contain destructive forces
which the group therapist must manage.
• The anti-group challenges the optimistic
perception of the therapy group as a healing
medium.
• When therapy groups fail to develop as
therapeutic entities, such groups may act
pathologically.
• The flip side of Yalom’s core curative factor,
“interpersonal learning” is “interpersonal threat”.
Group Property
Anti-Group Phenomenon
•
•
•
•
•
•
Rise of anger and hostility in the group
A high drop out rate
Excessive member absences
A state of tense, negative impasse
Abrupt ending of the group
Nitsun remains skeptical about the ability of the
group, or its leader, to control the group’s own
destructive process once unleashed.
Group Property
Reparation and Transformation
• Foulkes believes that reparation & transformation
lie in confrontation of anxiety about
destructiveness.
• Confrontation awakens the urge to repair.
• Containment, if not resolution, of group
destructive forces relieves some anxiety.
• Brief and short term models of group therapy
appear to minimize the likelihood that destructive
forces will be unleashed.
Theories that Inform
Group Work Practice.
The major theories that inform analytic
group therapy are borrowed from:
(1) Psychology, psychodynamic theorypersonality; Ego identity; Ego strength
(2) Sociology, symbolic-interaction theory
and socialization theory – definition of
self; social identity.
Analytic Groups
Psychodynamic Theory
• The purpose of analytic groups is to change
individual maladaptive patterns of communication
and interpersonal interactions thought to originate
in childhood. “There and then” plays out in the the
“here and now” of current relationships.
• An individual’s maladaptive patterns are reenacted and corrected through the medium of the
group. Recapitulations lead to diagnostic
hypotheses and corrective interventions.
Analytic Groups
Psychodynamic Theory
• Individuals in analytic group therapy benefit
from insight (interpretation) and from
experiencing self-others correctively in the
interactive group moment
• Group members and the therapist substitute
for the individual’s family and those in the
client’s current interactive environment.
Analytic Groups
Psychodrama: Moreno
• Referred to as the theater of spontaneity; an off
shoot of psychodynamic theory.
• Enactment of problem scenes in the client’s life
are followed by corrective scenes.
• The client plays both the protagonist and
antagonist to view the problem from different
perspectives. Other group members may stand in
for significant others in the client’s life
• Other members recognize self in other and gain
insight and healing vicariously.
Analytic Groups
Gestalt Therapy: Perls
• Perls rejects analytic orthodoxy.
• The hot seat is used to focus on one member
• The worker follows the unfolding of the member’s
experience but does not direct it as in sociodrama.
• The emphasis in Gestalt therapy is on the client’s
moment to moment awareness and feeling state.
• Observers are thought to benefit vicariously.
Analytic Groups
Sociological Theories
• The group is a social microcosm of an individual’s
environment of socialization.
• Group dynamics reflect experiential learning
about social self related to culture, ethnicity, race,
religion, sexual orientation, gender, socioeconomic class and handicapping condition.
• Issues of poor self-esteem, identity, social status,
and stigma arise through group dynamics and are
the focus of attention.
Analytical Groups
Sociological Theories
• When sociological theories are used, it is
hypothesized that how an individual feels, thinks,
and behaves is the result of socialization to status
(structure-function theory) and reference group
membership (symbolic interaction theory).
• When psychological theories are used, causality
is attributed to childhood and current interpersonal
maladaptive patterns of interpersonal relationship.
Managing Destructive Group
Behavior
• Managing the Anti-Group: Caution is warranted
when the destructive forces of group life are
unleashed. It is difficult to transform such forces
once they have developed.
• Transference- Counter-Transference:
Groups trigger multiple transferences and
counter-transferences. This is potentially helpful
and harmful depending on the worker’s skill
• Analytic group therapist: Need additional training
beyond that offered in most schools of social
work.
Group Method
Rules of Thumb
• Group method is not appropriate for all clients.
• The clinician must be able to predict and balance
the needs, strengths, and vulnerabilities of
members, when composing a group, in a manner
that will benefit each member and the group as a
whole.
• A worker should not knowingly compose a group
that will lead to dynamics that she/he is unable to
manage.
Group Method
Contra-Indications
• No one should be forced to participate in a group
against their will; this includes non-clinical school
and work groups.
• Analytic group method is contra-indicated for
those individuals who are non-verbal, unable to
take into account the viewpoint of another, or who
may be secondarily traumatized by their
participation .
• Group is not an appropriate method for those who
have a cultural norm against self-disclosure.
Group Method
Contra-Indications
• Group is not an appropriate method for
those who are highly vulnerable to the
aggressiveness of others or those, who are
themselves, highly aggressive.
Group Method
Missteps
 It is a misstep to allow a member to leave the
group in a vulnerable state because of the group’s
process.
• The worker should not leave unchecked, the
attack of one member or the group on another,
negative ingroup/outgroup dynamics, individual
acting out, or a member’s negative reaction to
group process.
• The practitioner is obligated to intervene in
negative group dynamics.
Group Method
Sample Process Recording
• See exhibit 16.6 –Process Recording of a boys’
recreational group- constructive use of time
• See exhibit 16.7 on the decision schema for
choosing group method as a clinical intervention.
• See chapter 17 for the use of group method in
policy, advocacy, management and community
practice.