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 GroupWadsworth, 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 GroupWadsworth, 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 GroupWadsworth, J. (2008). • Addressing relationship issues(Career counseling, victims of abuse) • Courses in: human development, health promotion, theory and practice of group counseling
Psychotherapy GroupWadsworth, 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
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 • 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
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 • 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 • 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 acceptancedecreases 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”