Group Problem Management Plus (GROUP PM+): Strengthening Social Support (Session 4)
Strengthening Social Support (Session 4)
Session Overview
Objective: To review previously learned strategies (Managing Stress, Managing Problems, Get Going, Keep Doing) and introduce the final PM+ strategy: Strengthening Social Support.
Session Plan:
- Review Managing Stress practice.
- Review Managing Problems and Get Going, Keep Doing.
- Introduce Strengthening Social Support to improve social support.
- Practice Managing Stress to end the session.
Review: Managing Stress (10 minutes)
Refer to a case example (picture 21).
Invite participants to share their experiences practicing Managing Stress during the past week.
This discussion can occur in a large group, small groups, or pairs.
Encourage sharing on:
- How they practiced Managing Stress.
- What happened when they practiced it.
Address any difficulties participants had.
- Utilize helpful hints for Managing Stress (Appendix E).
- Encourage group members to suggest solutions to problems that arise.
Review: Managing Problems (20 minutes)
Materials: Managing Problems poster (Appendix F), Participant handout (optional): Managing Problems (Appendix G)
Refer to a case example (picture 22).
- Encourage participants to think of potential solutions for the case example’s new problem.
- Possible solutions:
- Practicing slow breathing before sleep.
- Listening to relaxing music.
- Reading a book or reciting a story.
Review Managing Problems home practice.
Invite participants to share their experiences completing their Managing Problems action plan during the week.
- Educate participants about possible home practice experiences:
- Successfully completed action plan.
- Tried but unsuccessful action plan.
- Unable to do action plan.
- Emphasize that all experiences are okay and important to share.
- Highlight the learning opportunity from unsuccessful experiences.
- Educate participants about possible home practice experiences:
Review each participant’s action plan in the larger group, if possible.
- Ask who solved their problem by completing the action plan.
- Ask those who completed their action plan to share what happened, keeping stories brief.
Respond to and manage difficulties in completing action plans.
Refer to Helpful Hints for Managing Problems (Appendix E).
Emphasize that problems are normal and learning opportunities.
Encourage sharing of difficulties and group problem-solving.
Small groups continue Managing Problems.
Options:
- A. Two groups
- B. Pairs
Display the Managing Problems poster.
A. Split into two groups:
- Designate areas for each group to avoid disturbing each other.
- If possible, have one facilitator per group.
- For large groups, divide into smaller groups of 3-4.
- Group 1: Continues managing the same problem.
- Group 2: Starts managing a new problem.
B. Split into pairs:
- Pair participants whose action plan was or wasn’t discussed.
- Pair participants with similar problems.
- Facilitators support all participants.
Lead each group/pair:
- Group 1 (same problem):
- Review steps 2 & 3 (problem, definition).
- Participants state their problem aloud.
- Ensure participants are happy with their responses.
- Check that problems are still solvable.
- Start Step 4 (solutions):
- One participant shares their problem.
- Participant recalls previous solutions and brainstorms new ones.
- Group suggests more solutions.
- Continue with Step 5 (best solutions):
- Participant chooses the most helpful and practical solutions.
- Step 6 (action plan):
- Develop an action plan for the next week.
- Use the Managing Problems handout to record the plan.
- Detail the first step to carry out the solution.
- Imagine completing the solution and describe each step.
- Group 2 (new problem):
- Go through Managing Problems from the beginning.
- Step 1: Review and add to the list of problems.
- Step 2: Participants choose a problem and define it specifically.
- Document the problem.
- Work on one participant’s problem as a group.
- Step 4: Brainstorm possible solutions.
- Confirm the next step with participants to reinforce understanding.
- Step 5: Participant chooses the most helpful and practical solutions.
- Step 6: Develop an action plan for the week ahead, recording it on the handout.
- Detail the first step to carry out the solution.
- Imagine completing the solution and describe each step.
- Group 1 (same problem):
Review: Get Going, Keep Doing (20 minutes)
Materials: Inactivity Cycle poster (Appendix F), Participant handouts (optional): Get Going, Keep Doing (Appendix G)
Refer to case example pictures 23 and 24.
Review Get Going, Keep Doing home practice.
Invite participants to share their experiences completing their activity during the week.
Ask who started or completed their action plan.
Ask those who completed their activity to share what happened, briefly.
Respond to and manage any difficulties participants had.
See Helpful Hints for Get Going, Keep Doing (Appendix E).
Ensure participants with difficulties have a clear new action plan.
Ask participants to share what they will try differently this week, focusing on a smaller first step or a new activity.
Record new plans for review in the next session or have participants complete the handout.
Encourage those who completed activities to continue, and to introduce new pleasant activities if confident.
Introduce Get Going, Keep Doing for task-oriented activity.
Large group discussion, following the structure from Session 3.
Explain the shift to tasks and chores.
Key points:
Remind participants that Get Going, Keep Doing helps to start being active again.
Explain that low mood often reduces motivation for chores, work, self-care, and other tasks.
Stress that activity with these tasks improves mood through a sense of achievement.
Participants will choose one task-oriented activity to restart.
Large group discussion
Help participants select a chore, self-care, or work activity.
Invite suggestions, allowing time for thought and offering support to those unsure.
Prompt questions:
"Is there one thing that is not too hard that you could do around the house, for your family or yourself or to do with work?"
"Is there anything you would like to do that others have already mentioned?"
"Tell me what you used to do a year ago."
If a participant remains stuck, solicit examples from other participants and revisit the person at the end.
Examples: cleaning a small area, washing clothes, collecting wood/water/fuel, washing oneself, cooking, washing dishes, going to work, helping a relative.
Note: The chosen activity can be completed during the group time (e.g., clearing cups).
Recommend starting with easier activities.
Ask participants to list steps involved in completing the activity, such as getting up on time, getting dressed, organizing childcare or transport.
Acknowledge that work-related tasks might be too difficult initially and suggest an easier alternative.
Suggest simple tasks that can be done at home without many resources or assistance.
- Examples: washing some laundry, sweeping an area in the kitchen, cleaning the kitchen bench.
Help participants break down the activity into manageable steps.
- Use one participant’s activity to demonstrate.
- Participants break down their own activities.
- Record action plans on the Get Going, Keep Doing handout.
Prompt questions:
"Sit quietly and imagine when you last did this activity. Can you tell me in as much detail as you can all the things you did, and I will write these down. These will be the steps you need to take to complete the activity."
"What are the material things you will need in order to complete the activity/task?"
Break: Summarize the session so far: reviewed Managing Stress, Managing Problems and Get Going, Keep Doing.
Strengthening Social Support – Education and Case Example (20 minutes)
Materials: Four Strategies poster (Appendix F), Participant handouts (optional): Strengthening Social Support (Appendix G)
Purpose:
- Good support helps people cope in adversity.
- Support can prevent stress and depression.
- Support can help manage practical problems.
- Support makes people feel less alone.
Steps:
Give a brief definition:
- Point out the strategy on the Four Strategies poster.
- Explain that it's about connecting with others for support to manage problems.
Refer to case example pictures 25 and 26.
Introduce Strengthening Social Support as the final strategy.
Refer to previous discussions where social support was relevant.
Encourage a discussion about what social support is and how it helps.
Prompt questions:
"When you think about social support, what comes to mind (what do you think of)?"
"Would anyone like to share a time that they received support from someone or an organization (give name of a local organization) to deal with a problem? And did it help? How so?"
"What has been people’s experience coming to this group and sharing their problems with others? Have people found it helpful? How so?"
"How did Ezria/Ben say that seeking support has helped her/him in the past?"
"Are there other ways you think that strengthening social support might help people affected by adversity? How do you think it might help you?"
Key points:
Forms of social support:
Listening, validating concerns and emotions, showing care.
Connecting with agencies for information and support.
Getting help with tasks.
Spending time together without discussing problems.
Helping others while caring for oneself.
People feel more confident and hopeful with support.
Problems feel more manageable.
Sharing problems reduces burden.
Hearing others' problems reduces feelings of isolation.
Share a relevant local saying or proverb.
Discuss obstacles to strengthening social support
Explain that seeking support can be difficult for various reasons.
Refer to case example picture 27.
Ask about Ezria’s/Ben’s difficulties.
Invite participants to share personal difficulties.
- Suggested questions: "What has made it hard for you to get support from others in the past? What do you think might make it hard for you to strengthen your social supports this week?"
Give examples of obstacles:
Personal feelings: shame, embarrassment, low mood, anxiety, worry.
Negative expectations: it won’t work, it’s pointless, I’ll burden others.
Isolation: lack of available support people.
Difficulties trusting others (especially after trauma).
Suggested script for participants unsure about strengthening social supports:
Acknowledge concerns about burdening others.
Explain that sharing problems and asking for help are often reciprocal.
Discuss perspective gained from hearing others’ difficulties.
For those with trust issues, offer further discussion about finding someone to trust.
Refer to case example picture 27 to illustrate how obstacles can be overcome.
Strengthening Social Support – Participant Support (25 minutes)
Inform participants that the next segment focuses on planning for strengthened social support.
Refer to case example pictures 28 and 29.
Large group discussion
Invite participants to choose a way to strengthen their support in the next week.
Remind of different approaches (from “Key points to include” box).
Suggested questions: "Does anyone have an idea of how they would like to strengthen their social support? Is there a social support you had in the past that you could start to strengthen again? Is there someone or an organization you could get support from?"
Help participants to plan specific actions.
Discuss actions for different support types:
Start with those seeking support through talking to someone.
Then discuss plans for those seeking organizational support.
Finally, discuss asking for practical help.
Break down plans into small, manageable steps.
Suggested questions: "What would be the first step to strengthening your social support? Imagine you are completing this action right now. Tell me in as much detail as you can everything you would do in order to carry it out."
Rehearsing (role-playing) what to do
Participants pair up and practice what they will say to the person or organization.
If time is limited, encourage participants who are comfortable to meet outside the group to practice.
Stress that confidence increases the likelihood of success.
Role-play examples:
- Talking about a practical problem and feelings.
- Talking about being involved in the program.
- Talking about a specific problem.
- Asking to meet with someone.
- Asking for help with a practical problem.
Help participants schedule steps to complete the social support activity
Discuss what, when, and how (be specific).
Write down the plans for review in the next session (or use the handout).
Discuss reminders to complete steps, as with Managing Problems and Get Going, Keep Doing.
Managing Stress (5 minutes)
Remind participants of the strategy’s usefulness in relaxing the body and reducing stress.
Lead the group in Managing Stress
Relax the body (move limbs, rock head, roll shoulders).
Breathe from the stomach (imagine a balloon).
Count three seconds for in-breath and three seconds for out-breath, for one minute.
Stop counting and encourage self-counting or following a rhythm (e.g., clock ticking).
Continue for at least three minutes.
Ending the Session (10 minutes)
Give a summary:
Reviewed Managing Stress (mention specific problems).
Reviewed Managing Problems (mention specific problems).
Reviewed Get Going, Keep Doing (mention specific problems).
Learned how to apply Get Going, Keep Doing to start doing tasks again.
Learned how to strengthen social supports.
Ask participants to name one helpful thing from the session.
Remind participants to practice Managing Stress regularly.
Remind them to complete their action plans for Managing Problems, Get Going, Keep Doing, and Strengthening Social Support, for review next session.
Remind participants of the next session – time and location – and tell them the topics that will be discussed (i.e. reviewing the strategies and preparing for the future).