Person-Centered Group Counseling

1. Jennifer Fortune JR Lee Emily Shields CEP618 April 24, 2013 Person-Centered Group Counseling For Adults with Grief

2. Group Basics • Theme: Helping to console and comfort adults who have lost a spouse or partner recently • Setting: Outpatient community mental health center • Population: Adults of all ethnicities, genders, and races above the age of 40 who have lost their spouse or partner recently. • Males and females will be paired during screening so the group will have the same number of each

3. Rationale • Group counseling has shown efficacy for the older adult population as a means of increasing and strengthening social support. • Increase in bereaved elderly population especially those experiencing loss of a spouse. • In 1998 there was 7.8 million widowed women and 1.5 million widowed men aged 65 and over. • A distinct advantage over individual counseling is the member interaction as a therapeutic tool • Group work enhances one's sense of belonging and affiliation, normalizes emotions associated with grief, provides opportunity to express and integrate experiences, learn coping skills, discover appropriate social roles, and problem solve. • Providing group in an outpatient setting enables us to reach individuals throughout the community to prevent complicated grief reactions while also enhancing social, cognitive, and emotional functioning within an accessible location.

4. Group Formation Recruitment • Word of mouth • Referrals from physicians, social workers, clergy, nurses and other professionals • Flyers and bulletins posted throughout the community in hospital waiting rooms, senior centers, churches, libraries, community centers, and doctor's offices. • Partner with hospice organizations

5. Screening • Interviews will be conducted to select & orientate individuals about the purpose and potential risks and benefits of group. • 6-10 members with 2 facilitators • Loss > than 6 weeks prior to first session • Approximately the same number of men and women to avoid feelings of exclusion and isolation • Include similar types of losses especially those difficult to talk about such as those to suicide and AIDS • Include individuals from different stages of bereavement process • Exclusion criteria includes those with Axis I or II diagnosis or serious pathological or emotional problems, memory function or cognitive problems that inhibit insight or interaction • Assess for abnormal grief reaction • Assessments administered would include the Two Track Bereavement Questionnaire and Grief Support Questionnaire.

6. Theoretical Orientation Person-centered approach Group Setting in Theoretical Context • Focuses on empathy, insight, and relationship-building • Relationship is essential to healing and growth • Meets clients where they are • Employs techniques from other disciplines • Groups reduce the risk of age bias between counselor and client • Provides an opportunity for greater interpersonal connection among members • Mitigates developmental gaps and countertransference

7. Goals • Foster development of new social relationships • Combat isolation • Making genuine connections with others • Assist clients in adapting to the loss • Develop coping strategies • Encourage emotional expression • Adjustment to new or changed roles

8. Cognitive Restructuring • Identifying negative or harmful thoughts and redirecting them • Role playing • Expression of emotions • Unfinished business • Practice new behaviors Treatment Strategies Letter Writing Release of feelings Writing can be easier than speaking Catharsis Keep partner’s memory alive

9. Theoretical Stages Initial Stage Transition Stage Characteristics: anxiety, hesitation, monopolizing Counselor skills: empathy, encouragement, redirection, and blocking Characteristics: resistance, interrupting, conflict, "my loss is bigger than your loss" Counselor skills: keep members focused on the present, encourage respect and trust, and validate everyone's loss as important.

10. Theoretical Stages Working Stage Termination Characteristics: self-disclosure, risk-taking, cohesion, present-focused Counselor skills: Employ interventions, encourage insight and finding meaning in loss Characteristics: anxiety and sadness, translating skills learned in group to life outside, maintaining social connections Counselor skills: encourage members to tie up any unfinished business and continue social connection outside of group

11. Evaluation Follow-up • Members will be contacted via telephone at three months following the final termination session Self Report Survey • Two Track Bereavement Questionnaire • Grief Support Questionnaire Interviewed by a group leader • After the final group session

12. References Altmaier, E.M. (2011). Best practices in counseling grief and loss: Finding benefit from trauma. Journal of Mental Health Counseling, 33(1), 33-45. Capuzzi, D. & Gross, D. (1980). Group work with the elderly: An overview for counselors. Personnel & Guidance Journal, 59(4), 206. Corey, G. (2012). Theory & practice of group counseling. Belmont, CA: Brooks/Cole, Cengage Learning. Henderson, D.A. & Gladding, S.T. (2004). Group counseling with older adults. In DeLucia-Waack, J. L., Gerrity, D. A., Kalodner, C. R., & Riva, M. T. (Eds.). Handbook of group counseling and psychotherapy, 469-478. Thousand Oaks, CA: SAGE Publications, Inc.

13. References Hooyman, N.R. & Kramer, B.J. (2006). Living through loss: Interventions across the lifespan. New York: Columbia University Press. Lattanzi, M. & Hale, M.E. (1984). Giving grief words: Writing during bereavement. Omega, 15(1), 45-52. Mardoyan, J.L. & Weis, D.M. (1981). The efficacy of group counseling with older adults. The Personnel and Guidance Journal, November 1981, 161-163. Post, M. A. Pre and Post Grief Questionnaire. Retrieved from http://www.michellepost.com/index5.html. Rubin S.S., Nadav O.B., Malkinson R., Koren D., Goffer-Shnarch M., & Michaeli E. (2009). The two-track model of bereavement questionnaire (TTBQ): Development and validation of a relation measure. Death Studies, 33(4) 305-33.

14. References Winouker H.R. & Harris, D. (2012). The clinician’s toolbox: Therapeutic modalities and techniques in the context of grief. Principles and practice of grief counseling, 151-179. Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). New York: Springer Publishing Company. Yalom, I. D. (2009) The gift of therapy: An open letter to a new generation of therapists and their patients. New York: Perennial.