Group Counseling Midterm Exam

Elements of group process

• group norms

• generating trust and cohesion

• conflict and reluctance

• inter-member feedback

• healing forces within the group

• stages of group development

therapeutic group

• general term for groups whose purpose is:

  • increasing members’ knowledge of themselves/others

  • clarifying the changes members want to make in their lives

  • providing members with the tools needed to make these changes

types of groups

task, psychoeducational, counseling, psychotherapy, and brief

task groups

• aka task facilitation group

• aims to foster accomplishing identified work goals

• common with organizations, community, business, and educational settings (planning, school groups)

• group leaders need skills in: organizational assessment, training, program development, consolation, and program evaluation

  • recognize that process and relationships are central to meeting the goals in this type of group

psychoeducational group

aims to provide members with targeted education on a variety of psychological issues or informational deficits

• increase members’ cognitive, affective, and behavioral skills through a structured set of procedures within and across group meetings

• providing, discussing, and integrating information with the support of planned skill-building exercises

• timeframe dependent on group members

• pros of this group: cost-effective, can address broad range of problems, topics, or skill needs

counseling groups

• aims at preventive and educational purposes

• utilizes methods of interactive feedback within a here-and-now time framework

• address problems of living (career, education, personal, social, developmental concerns) vs. psychological or behavioral disorders

• focus on interpersonal problem-solving strategies that stress conscious thoughts, feelings, and behaviors

• more processing is occurring so group leaders should: structure activities, understand group development stages, model appropriate behavior, and help group members establish personal goals which in turn provides direction for the group as a whole

goals of counseling groups

• develop more positive attitudes and better interpersonal skills

• using group process to facilitate behavior change

• helping members transfer newly acquired skills and behavior learned in the group to everyday life

Psychotherapy groups

• aims at remediation of in-depth psychological problems - reconstructing personality dimensions

• group members have acute or chronic mental health or emotional problems causing impairment, distress, or both

• helps to alleviate symptoms and do deeper work to understand past experiences, and perspectives

brief group therapy

• time-limited, structured group with clear group rules

• lasts 2-3 months and consists of 8 to 12 weekly sessions

• facilitators need training in group processes and brief therapy

• advantages of brief group therapy: well-suited to the needs of both clients and managed care, cost-effective, widely applicable to diverse client populations and problems, and can be used in different settings

multicultural perspective on group work

• culture encompasses the values, beliefs, and behaviors shared by a group of people

• culture is learned in groups

• effective group work involves considering the culture of the participants

• similarities/differences need to be addressed in a group

• advantages of group formats with culturally diverse client populations: members gain much from the power and strength of collective group feedback, can be supportive of one another in patterns that are familiar, seeing other peers gives them hope that change is possible

• disadvantages: reluctant to disclose personal material or to share family conflicts,  see it as shameful even to have personal problems and more shameful to talk to strangers about, Some may be hesitant to join because of their unfamiliarity with how groups work, Others may find that what is expected in a group clashes with their cultural values

goals of multicultural group work

• to promote human development and to enhance interpersonal relationships

• to promote task achievement

• to prevent or identify and remediate mental, emotional, or behavioral disorders and associated distress that interfere with mental health

• to lessen the risk of distress, disability, or loss of human dignity, autonomy, and freedom

multicultural and social justice counseling competencies

• the helping professions continue to emphasize a monocultural approach to training and practice

• referrals based on value conflicts between leaders and members are considered inappropriate and unethical

• achieving cultural competence is a lifelong journey

facilitating difficult conversations about culture and race

• understand your own racial and cultural identity

• recognize and be open about your racial biases

• encourage a discussion about feelings

• pay more attention to the process than to the content of race talk

• encourage and support people who are willing to take the risk of expressing themselves

advantages of the group

• offers support for new behaviors and encourages experimentation

• is a microcosm of the real world allows us to see how we relate to others

• provides an optimal arena for members to discover how they are perceived and experienced by others

• helps members see that they are not alone in their concerns

misconceptions of the group

• groups are suited for everyone

• the main goal of a group is for everyone to achieve closeness

• groups tell people how they should be

• group pressure forces members to lose their sense of identity

• groups are artificial and unreal

five general areas that serve as guidelines for forming a proposal

• rationale

• objectives

• practical considerations

• procedures

• evaluation

practical considerations in forming a group

• group composition

• group size

• frequency and duration of meetings

• length of the group

• place for group sessions

• open versus closed group

questions to consider when thinking about attracting and screening members

• should this person be included in this group at this time with this leader

• what methods of screening will you use

• how can you determine who may or may not benefit from a group

• how might you deal with a candidate who is not appropriate for your group

screening intake for groups

• provide information for the client

  • confirm they are interested in hearing more about the group and specify which one

  • include address, time, day, duration, contact information for facilitators

  • brief overview of what to expect in group (intended to be a safe, intimidation-free space in which clients can share as much or as little as they want)

  • share a few topics you may cover

  • remind them that the group is confidential and free

  • emphasize that we ask members to allow everyone a chance to speak, and to avoid sharing triggering trauma details

• ask the client:

  • why would you like to participate in the support group

  • what would you like to get out of the support group experience

  • do you have any social support

  • how is your current functioning

  • what if any if your experience in mental health treatment/therapy

• tips:

  • do not push them to share

  • be welcoming, supportive, understanding, and advocate for why groups can be so helpful

  • can’t come due to childcare? - ask them if they would come if it was provided

when do we exclude a potential member

• if not ready, or appropriate for the group need to provide the client with information on exclusion

• should be direct, honest, and respectful and provide a rationale

• provide with alternative resources

• no-nos: cannot screen out someone, based on “dislike”, informing the client there is something “wrong” with them

setting up for success (informed consent)

• statement of the goals and purposes of the group

• policies related to entering/exiting the group

• expectations for group participation (voluntary/involuntary membership)

• confidentiality and exceptions

• leader’s theoretical orientation/possible interventions

• documentation procedures/disclosure of information to others

• potential impact of group participation

• risks/benefits of participating in a group

goals of pre-group preparation

• demystifying the therapeutic process is central in preparing members for a group

• describe how group work helps members enhance interpersonal relationships

• encourage members to raise questions about the purpose and goals of the group

• discuss ground rules about confidentiality and subgrouping

• instill faith in group work

• establish some procedures that will facilitate the group process

• anticipate frustrations and disappointments participants are likely to encounter

building evaluation into group work

• federal and state grants typically stipulate measures for accountability

• include in your proposals for groups the procedures you intend to use to evaluate both the individual member outcomes and the outcomes of the group as a unit

• various qualitative methods are appropriate for assessing a group’s movement

co-leader issues on forming a group

• share equal responsibility in forming the group and getting if off to a strong start

• meet in advance to clarify the groups’s purpose, what you hope to accomplish with the time you have, and how you will meet your objectives

• explore your philosophies and leadership styles and develop a strong working relationship

• effective co-leadership requires co-leaders to have a good working relationship

• time spent planning and getting to know one another as co-leaders can greatly influence the success of your work together and start you off in a positive direction

difference between ethical, legal, clinical, and cultural issues

• ethical issues: pertain to the standards that govern the conduct of professional members (standards can be found in the ethics codes of the various professional organizations)

• legal issues: define the minimum standards society will tolerate, which are enforced by the rule of law at the local, state, or federal level

• clinical issues: involve using your professional judgment to act in accordance with ethical and legal mandates

• cultural issues: a person’s ethnic background, gender, sexual orientation, religious affiliation, values, or other differences that affect the way we understand and intervene with clients’ problems

ethical issues in group membership

• competence is one of the major ethical issues in group work

• informed consent

• information to give prospective members: confidentiality, the nature of the group, the goals of the group, the general structure of the sessions, what is expected, what they can expect from you as a leader

• involuntary membership: show them how they could personally benefit from a group, basic information about the group is essential, avoid assuming that involuntary members will not want to change

freedom to withdraw from a group

• procedures for leaving a group need to be explained to all members during the initial group session

• members have a right to leave, but it’s important to inform the leader and members before making their final decision

• leader must intervene if other members use undue pressure to force member to remain in the group

• talk it out with group member

psychological risks for members

• misuse of power

  • leaders need to beware of both the overt and subtle ways in which they utilize their power

  • leaders will use their power to empower the members of their groups by helping them to discover their inner resources and capacities

• self-disclosure

  • an essential aspect of any working group - a means to the end of full self-understanding and should not be promoted in its own right

  • members may have been harmed by self-disclosure in the past, causing hesitation

• confidentiality

  • leaders need to continually emphasize the importance of maintaining confidentiality

• scapegoating

  • members may gang up on this person (scapegoat) making the member the focus of hostile and negative confrontation

  • leader should eliminate the behavior, and explore what is going on with the person doing the scapegoating before focusing on the person being scapegoated

• confrontation

  • valuable and powerful tool in any group, but can become destructive

  • leaders can model the type of confrontation that focuses on specific behaviors and avoids judgments of members

ways to limit psychological risks

• Utilizing contracts or group guidelines 

• Knowing member’s limits 

• Respecting their requests 

• Developing an invitational style as opposed to being pushy or dictatorial 

• Avoid assaultive verbal confrontations 

• Describing behavior rather than making judgments 

• Presenting hunches in attentive way rather than forcing interpretations on members

confidentiality

• foundation of a working group

• leaders need to define the parameters including limitations

• members need to be taught what confidentiality involves

• leaders need to talk to members about the consequences of breaching confidentiality

• leaders need to remind members at various points in a group of the importance of maintaining confidentiality

• leaders must give special consideration to the following:

  • the potential for members to breach confidentiality when they engage in social media

  • the ethical and legal dimensions of confidentiality

  • the multicultural dimensions of confidentiality

  • safeguarding the confidentiality of minors in groups

dealing with conflicts of values

• seek consultation when struggling

• difficulty maintaining objectivity is leader’s problem

• ethical bracketing

social justice approach to group

• groups provide a context for addressing issues of power, privilege, discrimination, and oppression

• group work often provides the potential to further a social justice agenda

• goal: promote the empowerment of people who are marginalized and oppressed in our society

special issues pertaining to sexual orientation

• history of victimization and fear of abandonment

• establish group norms and make interventions that facilitate the safety and inclusion of LGBTQ+ group members

• create a climate that allows for voluntary self-identification and self-disclosure on the part of LGBTQ+ clients

leaders might employ techniques unethically if they

• use techniques with which they are unfamiliar

• use techniques to enhance their power

• use techniques simply to create intensity between members or within the group

• Use techniques to pressure members, even when they have expressed a desire not to participate in an exercise 

• Use techniques to alter a group member’s personal values or beliefs

suggestions for increasing your level of competence

• Participate in continuing education and in personal and professional development activities 

• Seek personal counseling if you recognize problems that could impair your ability to facilitate a group 

• Seek consultation and supervision as needed

what constitutes competence as a group facilitator (ASGW)

• Knowledge competencies: course work is essential 

• Skills competencies: specific group facilitation skills are required for effectively intervening 

• Core specialization in group work: task facilitation groups; psychoeducational groups; counseling groups; psychotherapy groups

benefits of experiential group training

• students need to know they can trust their instructor’s skill, ethics, and professionalism

• participation in experiential groups has many benefits in the areas of personal growth and awareness in addition to offering opportunities for learning about group process

• can provide insight into how future clients may be feeling, the value of working through conflict, and how to facilitate a group and improve their own interpersonal functioning

guidelines for ethical and legal practice

• Take time and care in screening candidates for a group experience

• Demystify the group process (informed consent, confidentiality)

• Strive to develop collaborative relationships with members

• Consult with colleagues or supervisors whenever there is a potential ethical or legal concern

• Incorporate ethical standards in the practice of group work

• Ensure you are documenting your work!

group characteristics at the initial stage

• central process: Members are getting acquainted and learning how the group functions 

• There are periods of silence and awkwardness 

• (varied engagement levels) Members are deciding how much they will disclose and how safe the group is 

• Risk taking is relatively low - exploration is tentative 

• advice-giving: members may offer advice instead of exploring their own issues, which can hinder deeper self-exploration

• Central issues are trust versus mistrust and here-and-now focus versus there-and-then

common fears experienced by group members

• Anxiety over being accepted or rejected and not fitting in 

• Concern about the judgment of others 

• Afraid of appearing stupid 

• Not knowing what is expected 

• Concern over communicating feelings and thoughts effectively

additional concerns for group members

• hidden agenda: an issue that is not openly acknowledged and discussed by group members, which can disrupt the group process

• managing conflict: address head-on

• self-focus versus other focus: can’t work with others not present, how does it impact the person

• here and now focus: how this is impacting you now

• trust versus mistrust: not comfortable but taking risks

creating trust: leader and member risks

• facilitating the group process by sharing personal expectations and by modeling interpersonal honesty, respect, and spontaneity

• establishing trust is a central task for the initial stage of a group

• level of trust depends on attitudes and investment

• touch base with your co-leader

attitudes and actions leading to trust

• Careful attending and genuine listening 

• Understanding nonverbal behavior 

• Empathy 

• Genuineness 

• Self-disclosure 

• Respect 

• Caring confrontation 

• Don’t give advice too early

identifying and clarifying goals

• A major task is assisting members in identifying and clarifying specific goals that are measurable 

• Absence of goals may lead to considerable floundering and aimless sessions 

• Identifying goals is a collaborative process 

• Leaders can assist members in goal setting by using contracts and homework assignments

group process concepts at the initial stage

• Involves the stages groups tend to go through 

• Tension and conflict may build up 

• Includes activities such as establishing norms and group cohesion, learning to work cooperatively, establishing ways of solving problems, and learning to express conflicts openly

group norms

• norms enable a group to attain its goals and can be implicit or explicit

• examples of group norms:

  • Expectations of promptness and regular attendance 

  • Sharing meaningful aspects of themselves 

  • Expectation of giving feedback 

  • Encouraged to support and challenge others 

  • Encouraged to focus on the here and now

group cohesion

• a sense of togetherness, or community within a group and it begins to take shape during the initial stage

• examples:

  • Genuine cohesion 

  • Have struggles with conflict or shared pain 

  • Committed self to risk-taking 

  • There is a sense of safety 

  • Need this for all stages of group

effective therapeutic relationship

• The importance of a positive therapist-client relationship as a contributing factor to positive change in clients 

• Three key constructs that capture the essence of the therapeutic relationship in group treatment: group climate, cohesion, and alliances 

• Aggressive confrontation is the leadership style with the highest risks

helping members get the most from a group experience

• Building trust 

• Express persistent feelings 

• Self-disclosure 

• Participate fully 

• Embrace change 

• Discover new dimensions of yourself 

• Listening 

• Taking in feedback 

• Other suggestions from group members

structure (journal-homework)

• avoid too much structure (not a lecture)

• journaling as an adjunct group session

  • can provide group member journal prompts, sentence completions, reflections of themselves and how they perceive themselves in groups and between group members

• homework during initial stage

  • related more to cognitive behavioral therapy, can be applied to any type of group

  • helps group members to commit to working on problems outside of therapeutic context

leader issues at the initial stage

• think about the following issues: division of responsibility, degree of structuring, opening group sessions, and closing group sessions

personal characteristics of effective group leaders

• courage

• willingness to model

• presence

• belief in group process

• openness

• stamina

• self-awareness

• sense of humor

• inventiveness

group counselor as a professional

• creating a group climate that fosters interpersonal norms such as openness, directness, respect, and concern for one another will lead to therapeutic interactions among members

• leaders’ interpersonal skills, genuineness, empathy, and warmth are significant variables in creating the kind of climate that leads to a successful outcome

developing group leadership skills

• essential to acquire and refine skills

• skills cannot be separated from personality

• learning how to use group skills is an art

• skills are learned through supervised experience, practice, feedback, and participation as a member

group leadership skills

• active listening

• reflecting

• clarifying

• summarizing

• facilitating

• empathizing

• interpreting

• questioning

• confronting

• supporting

• blocking (bombarding, indirect communication, storytelling)

• assessing

• modeling

• suggesting

• initiating

• evaluating

• terminating

advantages of co-leadership

• Decreases the chance of burnout 

• Less overwhelming to respond to the needs of the group 

• Co-leader peer supervision is beneficial 

• Can be helpful in managing countertransference 

• Co-leader can help process members’ reactions to other leader

• If one of the leaders represents a position of power and privilege that may affect members in a particular way, the other leader can help process this, especially if they don’t possess the same social status position 

• If one leader is absent, the group can still meet with the other

disadvantages of co-leadership

• Poor selection of a co-leader or random assignment to another leader 

• Failure of the two leaders to meet regularly 

• Competition and/or rivalry 

• Do not have a relationship built on trust or respect 

• One leader may side with members 

• If in an intimate relationship and try to use group time to deal with their own relationship struggles 

the challenge of combining research and practice

• Allows group practitioners to remain flexible and responsive to new evidence

• Allows group practitioners to critically evaluate new developments in the field of group work

• Process- and outcomes- focused research of groups can help to demonstrate accountability

• Lack of collaboration between researchers and practitioners continues to be a key problem in group work

• Although experimental studies may have internal validity, they may have little practical value to group workers

• Practitioners and researchers need to develop mutual respect for what each can offer and increase their collaboration

characteristics of the transition stage

• Anxiety and defensiveness are common 

• Group members 

  • Test the leader and other members to determine how safe the environment is

  • Struggle between wanting to play it safe and risk getting involved

  • Observe the leader to determine his/her trustworthiness

  • Learn how to express themselves so that others will listen

barometer of trust in a group

• when there is a low level of trust, members may:

  • Members will not initiate work 

  • Show up late, leave early, or miss sessions 

  • Be reluctant to participate to their fear of being confronted 

  • Be unwilling to initiate personally meaningful work 

    • Story telling, excessively quiet, keep reactions to self 

  • Deny that they have any problems or concerns 

  • Subgroup has occurred 

  • Be unwilling to deal with conflict in the group

• when there is a high level of trust, members may:

  • Actively involved in the activities of group

  • Make themselves known to others in personal ways

  • Take risks in and out of group

  • Focus on self

  • Actively working on meaningful personal issues

  • Disclosing persistent feelings (lack of trust)

  • Support and challenge other group members

defensiveness and reluctant behavior

• resistance: Can be viewed as behavior that keeps us from exploring personal conflicts or painful feelings, One way we attempt to protect ourselves from anxiety and can represent a coping strategy that at some point served an adaptive function

• involuntary members: Gives them a sense of control

• our job: Try to understand the meaning of defensive or cautious behavior, Be respectful and patient of members process, Describe what you are seeing, and how it is affecting, and Not to get into a power struggle - go with the negative and try to understand the reasoning for being mandated to join 

common fears emerging at the transition stage

• Self-disclosure 

• Being exposed and vulnerable 

• Rejection

• Being misunderstood or judge 

• Challenged or singled out 

• Losing control 

• Conflict or confrontation 

• Making a fool of oneself 

• Emptiness 

• Being too emotional 

• Taking too much of the group’s time 

guidelines for effective confrontation

• Have a rationale for confronting a person 

• Confront if you care about the other 

• Talk more about yourself than the other person 

• Avoid dogmatic statements, labels, and judgments about the other

• Give others space to reflect on what you say to them

• *When conflict/confrontation is managed, more growth will occur within the group

dealing with difficult behaviors of members

• Avoid responding with sarcasm 

• Encourage members to explore their defensiveness 

• State your observations and hunches in a tentative way 

• Find ways to explore the conflict rather than retreating from it 

• Avoid personalizing members’ reactions 

• Look at ourselves

problematic styles of behaving in a group

• Silence 

• Monopolistic behavior 

• Storytelling (no thoughts or feelings associated, but they are speaking a lot) 

• Questioning 

• Giving advice 

• Dependency 

• Offering pseudo support 

• Hostile behavior 

• Acting superior 

• Socializing 

• Intellectualizing 

• Members becoming assistant leaders

dealing with avoidance by the whole group

• when an entire group chooses not to work and is unwilling to deal with several hidden agendas, it is important to:

  • Address what is going on 

  • Bring to the surface the hidden agendas 

  • Refuse to give up 

  • Not indulge in feelings of frustration and annoyance

dealing with transference and countertransference

• Transference: feelings clients project onto the counselor, which are rooted in the members’ past relationships

• Countertransference: when counselors project their own unresolved conflicts onto the client and can be damaging to members

co-leader issues at the transition stage

• Negative reactions toward one leader

• Challenges to both leaders

• Dealing with problem behaviors

• Dealing with countertransference

member functions versus leader functions in the transition stage

• member functions:

  • Recognize and express persistent reactions; unexpressed feelings may contribute to a climate of distrust

  • Respect their own defenses but work with them

  • Move from dependence to independence

  • Learn how to confront others in a constructive manner

  • Work through conflicts rather than remain silent or form subgroups outside of sessions

• leader functions:

  • Teach members the value of dealing fully with conflict

  • Assist members in recognize their own defensive patterns

  • Teach members to respect anxiety and defensive behavior and to work constructively with attempts at self-protection

  • Model how to deal directly and tactfully with any challenge

  • Encourage members to express reactions that pertain to here-and-now happenings in the sessions

self-focus versus focus on others and here-and-now focus versus then-and-there focus

• self-focus vs. focus on others: Many members initially focus on external situations or others instead of themselves

• here-and-now focus: Emphasizes present interactions within the group, allowing members to explore their interpersonal patterns.

• there-and-then focus: Centers on outside problems and past experiences brought into the session.

stages of building trust in a group

• stage 1: checking out the scene (observe others quietly, internally process)

• stage 2: experimenting with trust (test trust by sharing small things first or waiting for other to open up)

• stage 3: trusting and being trustworthy (proceed cautiously or open up fully once trust is established)

• stage 4: surviving breaches in trust (broken trust may lead to difficulty forgiving or a permanently damaged relationship)