Chapter 12:​ Treatment Groups​

Leader should have training in

• Assessing human behavior and problems.

• Therapeutic intervention approaches (e.g., reality therapy, behavior therapy, rational therapy, feminist intervention).

• Specialized techniques (e.g., assertiveness training, relaxation techniques).

• Interviewing and counseling.

• Group dynamics (e.g., cohesion, task/social-emotional roles, leadership styles).

Preparation and Homework​

• Extensive preparation​:

  -Planning for a new group​

  -Planning for each meeting​

• Study the literature​

• Establish group purpose and goals​

• Anticipate members’ needs and expectations​

• Visualize the session​

Key planning questions for a new group:

• What are the overall purpose and goals?

• How can goals be accomplished?

• Characteristics and individual needs of members?

• Resources members need to address problems.

• First meeting format: ice-breakers, refreshments, seating arrangement, atmosphere.

• Members’ expectations and your role as the leader.

Gather information about group members:

• Number of members.

• Member characteristics (age, problems, socioeconomic status, backgrounds).

• Knowledge level about group issues.

• Personal goals and agendas.

• Motivation level (voluntary vs. involuntary members).

• Underlying value systems (consider diversity but avoid stereotypes).

Relaxing Before Starting a Session

• Some anxiety is useful; mental alertness​

• High level of anxiety reduces effectiveness​

• Reduce high anxiety levels using relaxation techniques.​

Cues Upon Entering the Meeting Room​

• Be on time or early​

• Opportunity to scan setting for possible needs​

• Opportunity to observe moods and obtain information regarding interests of group​

Seating Arrangements​

• Can have an effect on group cohesion and morale​

• A circle is ideal for eye contact, generating discussion, and encouraging equal status​

Introductions​

• Leader introduction – summarize credentials​

• Icebreakers are useful for introducing group members​

• Good to have members state their expectations of the group during first group session​

• Factual information is often used to begin a session​

Clarifying Roles​

• Leader must have a clear understanding of his/her roles and responsibilities​

• Present self as knowledgeable​

• Be prepared to provide explanations​

• Remember that leadership is shared​

Building Rapport​

• Attempt to establish a non-threatening atmosphere​

• Be genuine and calm; do not express shock​

• Set a tone of caring​

• Avoid emotional outbursts​

• View members as equals​

• Use a shared vocabulary​

• Keep confidences​

Exploring Problems in Depth​

Prior to exploring alternative solutions, explore:​

• Extent of the problem​

• How long the problem has existed​

• Causes​

• Individual perceptions​

• Physical and mental capacity to cope with the problem​

• strengths​

Exploring Alternative Solutions​

• Ask participant an open-ended question such as, “Have you thought about ways to resolve this?”​

• Examine merits and shortcomings of each alternative​

• Ask group to suggest alternatives​

• Therapist suggestions​

• Weigh the pros and cons​

• Self-determination​

• Formulate a contract​

• Role playing is a useful group technique​

Exploring Alternative Solutions​

• Ask participant an open-ended question such as, “Have you thought about ways to resolve this?”​

• Examine merits and shortcomings of each alternative​

• Ask group to suggest alternatives​

• Therapist suggestions​

• Weigh the pros and cons​

• Self-determination​

• Formulate a contract​

• Role playing is a useful group technique

If the facilitator selects an alternative:

• The alternative may not work, leading to blame and damaging the relationship.

• If successful, the member might become dependent on the facilitator for future decisions

Stages of Group Development​

• As discussed in earlier chapters, groups have stages of development. It is important for leader to be aware of these stages.​

• Garland, Jones, and Kolodny Model ​

  -Preaffiliation​

  -Power and control​

  -Intimacy​

  -Differentiation​

  -Separation​

Preaffiliation:

• Members are ambivalent and guarded, testing if they want to belong.

• Leader should create an attractive and supportive environment, using ice-breakers and building trust.

• Ends when members feel safe and see the rewards of participation.

Power and Control:

• Group dynamics emerge, with alliances, communication patterns, and subgroups forming.

• Power struggles arise as members vie for control and rewards from the group.

• Anxiety and testing of limits by members; dropout rates often highest.

• Leader’s role: normalize struggles, provide emotional support, problem-solve, and help establish norms.

• Ends when members trust the leader to maintain a safe balance of shared power and control.

Intimacy:

• Group feels like a family, with open expression of feelings and personal issues.

• “Sibling rivalries” and deeper emotional connections may surface.

• The group is seen as a space for growth and change, with increased cohesiveness.

Differentiation:

• Members experiment with new behaviors and share leadership.

• Roles become more functional, and power struggles are minimized.

• Decision-making becomes more objective and rational, akin to a functioning family where members are more independent.

Separation:

• Group goals are achieved, and members have learned new functional behaviors.

• Termination is bittersweet, with some members reluctant to leave.

• Leader’s role: help members evaluate the group’s merits, address fears about the group ending, and prepare them for future challenges.

Ending a Session​

• Plan for ending at the beginning of session​

• Shortly before end of session, inform the group that time is almost up​

• Summarize​

• Clarify actions to be taken​

• Relaxation exercises are useful​

• Be sure to leave enough time​

Ending a Group​

• May evoke powerful emotions such as:​

  -Loss​

  -Guilt​

• Disappointment​

• Allow members to:​

  -Ventilate and work through emotions​

  -Develop a game plan​

• Seek feedback for improving future groups​

Other Issues Explored​

• Co-facilitating groups​

• Legal safeguards for group facilitators​

• Setting professional boundaries with clients​

• Therapeutic factors​