Psychology Support Group Assignment

Jacobs, Schimmel, Masson, & Harvill: Chapter 14

Counseling and Therapy in Groups

Goals of Therapy Groups

Behavioral researchers have identified two types of therapeutic goals for groups:  process goals  and  outcome goals .  Outcome goals are goals that pertain to behavior changes in the member’s life such as obtaining employment, improving an interpersonal relationship, maintaining sobriety, or feeling greater self-esteem. Therapy groups that focus primarily on the members’ concerns are usually much more beneficial than groups that focus primarily on the interactions among the members. Leaders who emphasize outcome goals get members to focus on their issues at a depth level of 6 or below on the depth chart. (To review the depth chart, see  Chapter 7.)

The term  process goals refers to goals that are related to the group process. For example, process goals can be to help members improve their comfort level in the group, to increase their openness in the group, and to learn to confront members in a more productive manner. Some educators teach that the focus of the group should mainly relate to what is happening in the “here and now” and that outside concerns are less important. With this approach, much time is spent on interactions, member feedback, and confrontation. Although focusing on process goals can be a valuable aspect of therapy groups, we feel this should not be the main focus for any therapy group. The focus usually should be on individual concerns and outcome goals.

14-2Establishing Group Size and Membership of Therapy Groups

The ideal therapy group is composed of five to eight members, with the membership remaining constant once the group has begun. In the ideal group, the members attend voluntarily and share at a very personal level. In private practice, college counseling centers, schools, mental health centers, and various other settings, groups can be like this. Unfortunately, in many other settings, groups are not at all like this. We describe the less-than-ideal group to prepare you for what may happen once you start working in the helping field. Less-than-ideal groups are often found in youth crisis centers, drug and alcohol agencies, residential treatment centers, prisons, and psychiatric hospitals. In these settings, leaders may be asked to lead groups with anywhere from 15 to 20 members and with an ever-changing group of members who are forced to attend. The leader regularly has to devote group time to introducing a new member or saying good-bye to a member who is leaving. In very large groups, it is difficult to involve all the members in any discussion or give individual attention to a member. In open-ended groups, sharing is often less personal because members do not feel the sense of cohesion and trust that exists in groups where there are the same five to eight members who want to be in the group.

Large, nonvoluntary groups are difficult to lead and are usually only minimally effective. In a situation where the members are very negative, resistant, or mentally disturbed, or in settings where a large group (12 or more members) is mandated by agency policy, the leader may want to try leading an education or discussion group for all the members and then a smaller therapy group for those who seem to have some commitment to personal change.

14-2aScreening Members

When establishing a therapy group, the leader should screen the members if possible. Screening can eliminate members who do not belong in the group because they are in too much pain, they are too emotionally unbalanced, or they would fit better in a different group than the one being formed.

In many situations, the leader is selecting members from a caseload, or an agency may require all patients to be in groups. Each of these situations leads to the formation of a group of members with very different problems. In such a group, one member may express concerns about keeping employment because of aggressive behavior; another, about her marital troubles; another, about his lack of assertiveness; and another, about anxiety that prevents her from going places more than three miles from home. Screening can be helpful in trying to get the right mix of members. With experience, the skilled leader gets more adept at selecting members for groups. If possible, it is a good strategy to verbalize that the groups are not permanent and that members may be switched to other groups during the first few weeks.

14-2bWhen to Meet

There really is no specific number of times that a therapy group should meet. Some groups meet on a daily basis for 1 hour or more, and others meet once or twice a week for 1 to 3 hours. For different populations and settings, the leader should try various meeting schedules to determine the optimal number of meetings per week or month. In schools, counseling groups usually meet every week or every other week.

14-3The Leader’s Role and Responsibilities in Therapy Groups

The leader is the primary orchestrator of change within a group. The members are very important, but it is the leader who creates the therapeutic climate and is responsible for focusing the group. This does not mean that she does all the talking or counseling, but rather it means the leader is in charge, and has many different responsibilities. We discuss six such responsibilities.

1. Knowing the subject or topic

2. Providing the right atmosphere

3. Directing the focus

4. Being aware of individual members

5. Watching the clock

6. Apportioning the “air time”

7. 14-3aKnowing the Subject or Topic

8. It is the leader’s ethical responsibility to have a good grasp of the issues that may arise in a therapy group. For instance, in an Adult Children of Alcoholics (ACOA) group, the leader would need to know about trust, intimacy, and relationships. Too often, we hear of therapy groups being led by someone who does not know the issues or what to do when important topics are brought up. In groups for depression, eating disorders, sex addiction, or anger management, knowing the issues would enable the leader to introduce topics that are relevant and use exercises that are designed to get members to explore their inner thoughts and feelings.

14-3bProviding the Right Atmosphere

Creating an atmosphere where members feel safe to share their thoughts and feelings is the leader’s responsibility. The members should feel that they will be heard. The leader should create a positive environment in which trust and respect are communicated and modeled. This requires cutting off comments that are negative, hostile, or insensitive. The leader uses certain phrases to remind members they are there to help each other. Some good phrases to use are the following:

· What ideas do you have that might be helpful?

· What is something you can say that may help?

· I appreciate the sharing and caring that you are exhibiting. With these attitudes, I know we can have a good group experience and people can be helped.

· We are here to help and support each other. Does anyone have a suggestion, thought, or reaction that they think may be helpful?

Another consideration regarding the right atmosphere is whether or not a leader should see a member of her group for individual counseling. In most cases, we feel this is not only appropriate, but often very useful, because the leader’s responsibility is to be as helpful as possible. We disagree with some authors’ positions that counseling a group member outside of the group session is detrimental to the performance of the group. We feel this rarely detracts from the atmosphere of the group.

14-3cDirecting the Focus

The therapy group leader should always be aware of the focus and whether it should be held or shifted. If the group is focused on helping a member with a concern, the leader must assess if the concern being discussed has relevance for the other members, and if the members can get involved in helping the member with her problem. For example, in a group for recently divorced women, it would be quite appropriate to discuss such issues as fears about dating or anger at an ex-spouse. However, if a member wanted to discuss the problems she was having with her neighbor over a new fence, the leader would probably want to shift the focus to something more relevant. She would offer to discuss the fence issue with the member after the session or some other time.

14-3dBeing Aware of Individual Members

Another responsibility of the leader is to pay close attention to each person in the group, because at any moment a member may react emotionally to something being discussed. By watching all the members, the leader will observe different reactions and draw out certain members who seem ready to share.

If the group is made up of members with diverse cultural backgrounds, the skilled leader needs to continuously monitor the reactions to the different topics and problems. To completely understand, the leader may need to ask a member how his culture deals with the situation being discussed. This can be valuable in expanding members’ cultural awareness and in understanding the specific members’ reactions. It would be unethical to work intensely with an individual in the group if the leader did not understand that member’s cultural frame of reference. In  Chapter 17 we give an example of making a major mistake in a therapy group because of not understanding the person’s culture.

14-3eWatching the Clock

Another responsibility is making sure that enough time remains in the session to cover an issue adequately. Sometimes leaders make the mistake of introducing a topic or allowing a member to begin discussing a very personal issue with only a few minutes left. For instance, much time would be needed to adequately cover topics such as death or rape.

14-3fApportioning “Air Time”

It is the leader’s responsibility to be aware of the amount of time that each member has had to address problems. Members should not necessarily have equal time, but it is important not to devote an inordinate amount of time to one or two members. If a member seems to need much of the group’s time, it may be best to see that member individually or, in extreme cases, request that the member not remain in the group. The leader must realize that the group should not be dominated by one person’s therapy needs. There will be times where the focus is on one person for 20–30 minutes, which is fine, as long as this person does not have the focus on him week after week. To avoid spending too much time on one person, a leader can find it helpful to reflect on the following questions:

· How long has the group been focused on the member?

· Is the discussion relevant for most of the other members?

· Do members seem annoyed at the amount of time being spent on the person?

· How much time in past sessions has been spent on this person?

· The Process of Therapy in a Group

· 14-4aGetting, Holding, and Deepening the Focus

· Therapy groups differ from other groups in that therapy groups are supposed to move to a deeper personal level. The skilled leader understands the value of trying to deepen the focus. Following are a number of examples that illustrate how the leader can be very instrumental in deepening the focus, which in turn makes the group more personal, more interesting, and more therapeutic.

· Examples

· This group consists of patients at a mental health center. The leader has introduced the topic of guilt for discussion. One member has described how she felt guilty about leaving her dog at home by itself all day; another felt guilty about not going to visit his grandfather more often. Neither of these members seemed too bothered by their guilt, but the leader senses that many of the members are, in fact, very much bothered by their guilt feelings. The leader decides to deepen the focus.

· Leader:

· I guess I am wondering if some of you have some guilt feelings that are hard to live with. That is, do you feel bad about something you did or are doing, and do those actions cause you to think less of yourself? Guilt is often associated with doing something that runs counter to some value or expectation we hold for ourselves. Guilt is often involved with religion and sex. Let me ask this—is there something that you feel guilty about that would be hard to share? I’ll ask you to say yes or no, but you do not have to share what it is.

· Troy:

· No.

· Maria:

· Yes.

· Bob:

· Yes.

· Beth:

· No.

· Cindy:

· Yes.

· Ted:

· Yes.

· Leader:

· What makes it hard to tell?

· Cindy:

· I am afraid of what people would think of me.

· Leader:

· I think that is true for many people. More importantly, though, is how you feel about what you did or what you are doing. How many of you answered yes because of things that you are doing currently?  (Maria, Ted, and Cindy indicate that they did.) Let me ask this question: How can a person quit feeling guilty?

· Ted:

· I don’t see how I cannot feel guilty—it is wrong. I never thought it would go this far. ( Looks down)

· Leader:

· Ted, perhaps if you talk about it, you will see it differently. I urge each of you to talk about what you are feeling guilty about, because there are solutions to guilt. You do not have to continually beat up on yourself. How much longer do you want to punish yourself?

· Ted:

· You’re right about the punishment. I hate it, but I feel so rotten.

· Leader:

· From what you said earlier, Ted, my hunch is that it has to do with your marriage and possibly an affair. Others of you may have guilt over something in your marriage or your past that pertains to sexual issues.

· Ted:

· That’s it—you see, at work …

· In this example, the leader asked members to be more specific. The leader also made some comments and asked thought-provoking questions in order to get members to personalize the discussion. The leader kept exploring the topic until one person was moved enough to want to work on his issue.

·

· The members are all women in an eating disorder group. They are talking about their problems with food.

· Sally:

· When I am bored or upset I eat, and when I start eating I can’t stop.

· Lori:

· That’s true for me. I like all kinds of food, but cookies and candy are my real downfall.

· Sara:

· My downfall is ice cream. My favorite is chocolate chip.

· Najwa:

· Ice cream is one of my downfalls. Let’s list our favorite downfalls.  (Everyone laughs.)

· Leader:

· (In a slow, deliberate voice) Rather than focusing on your downfalls, I’d like each of you to think of how you lose control over your food intake. When does it occur and how do you cause it to occur? Think about that for a minute.  (Pause) Any thoughts?

· In this example, the leader shifted the focus to a new, more personal topic because she saw that the group could get focused on a “surface” topic. As a result of the leader’s question, each member has to think about herself. Too often, leaders get caught up in the flow of the discussion and do not direct the members to more personal and meaningful dialogue.

·

· The group consists of members who all experience frequent panic attacks when they are out in public (agoraphobia). Three different members have been sharing about their intense fear.

· Joe:

· … and as a result of those attacks, I have not been out of the house for longer than 4 hours in the last 5 years. I get out maybe once every 2 months. It’s hell!

· Leader:

· I think Joe is right. It  is hell, and because you are all here for the same reason, I know that most of you feel the same way. One purpose of this group is to help you realize that you are not alone. The other purpose is to reduce your fears. To do this, we have to look at the causes of panic attacks and what can be done about them. I want each of you to think about your panic attacks and the events and thoughts that occur right before they happen. Please comment on your understanding of what happens to you right before the attacks and during the attacks.

· In this example, the leader is introducing a meaningful topic rather than just letting the members relate incidents from their lives. By focusing on what happens right before an attack, the members are more likely to share personal information and to get to pertinent issues.

·

· The members are sharing events of the week without giving much thought to what they are saying.

· Leader:

· I’d like to say something that I think will be helpful to each of you.  (Using a soft, encouraging voice) We have three sessions left, so I want to urge you to really consider what you want to talk about tonight. In the past few weeks, we have discussed a number of personal issues, and I want to encourage you to look into yourself and see if there are other issues that you may need to talk about. What obstacles are in the way of having your life go the way you want it to? Are there some fears or unfinished business from the past that you need to talk about? Really stretch yourself in these last sessions. Are there some things that you would like to bring up in this session?

· Sandi:

· (After about 20 seconds) There is something I would like to bring up. It has to do with me and my appearance….

14-4bObtaining a Contract

The leader always needs to get a “contract” from an individual when the focus is going to be held on her for any length of time. By a  contract , we simply mean that the member agrees to be the focus of the group’s attention. When a leader senses that a member may benefit from being the focus, she might ask:

· Would you like to work on that?

· Would you like to discuss that for a few minutes?

· Would you like to understand that better?

· How can the group be of help to you?

· If we work with you on this issue for 20 minutes, what would be helpful?

The leader needs to be sure that there is a contract, because on many occasions leaders make the mistake of focusing on a person when that person is not ready or willing to work on the issue. Many times a member describes a problem or concern that appears to be severe enough to warrant help from the group. The severity of the problem or the emotional state of a member is not necessarily an indication of a desire to receive help. We have observed leaders who forego getting a contract and dive right into trying to help. As a result, suggestions are often met with a “Yes, but” response. Often this becomes frustrating for the other group members.

There are several reasons why members share their problems but do not really want to work on their problems. First, some members have a history of blaming or externalizing their problems. These individuals have little desire to take charge of their own lives. Second, some members are afraid to commit themselves to a plan of action in front of others. Third, some members tell a story to gain the sympathy of the group or to have others reinforce their position on some issue. The point is that there are many instances where members seemingly in need of help do not want to receive the help of the group.

Group Counseling Skills

Therapy in Groups

Go to video 14.1 and watch the segment where the leader gets a contract and uses a therapeutic round and then engages all the members.

14-4cUse of Theories in Therapy Groups

Knowing and using counseling theories is a must for therapy groups. In the previous chapter we discussed the many different ways to use theories to guide therapeutic work. Because we devoted the previous chapter to the use of theories, we mention it here only as a reminder that no one should lead a counseling group without having at least one theory that he is able to use during the group session.

14-5Techniques for Conducting Therapy in Groups

14-5aTechniques for Engaging the Members

In most situations when the focus is being held on one member, a skilled leader usually involves the other members in an active way. The leader does this because it keeps the members interested, it is therapeutic for members to be helpful to a fellow member, and members often have excellent ideas for the  working member . Described here are a number of techniques that can be used when the group is focused on one member.

Members Ask Questions

Once a member has talked for a few minutes about the specific concern, the leader can use the technique of having the members ask the working member questions.

Leader:

I want you to think of a question that would be helpful for Ralph to answer. Who has one?

Judy:

I do. If your wife lost weight, would you feel more attracted to her?  (Ralph answers.)

Carlos:

Why do you think you can’t develop a long-term relationship with the other woman?  (Ralph answers.)

Sarah:

If you rid yourself of the notion that divorce is wrong, would that help you make a decision?  (Ralph answers.)

Members Guess What the Problem Is

Another way to involve members and cause the working member to stop and think is to have the members guess what the problem is. The leader would use this technique when the working member is being vague or acting confused.

Leader:

I want you each to try to guess what Ralph’s problem is. I am not sure, and I don’t think Ralph is, so perhaps our guessing will help.

Judy:

I think Ralph would really like to be divorced but is afraid of his parents’ disapproval.

Carlos:

I sense that Ralph is afraid to get divorced because he fears he will be left with nothing.

Sarah:

I think Ralph is feeling guilty about the thought of leaving his kids and wife of 15 years.

There are a number of benefits to having members ask questions or guess what the specific concern might be.

· It gets the members involved and prevents them from becoming bored or disinterested.

· It breaks up the member’s storytelling (many times, a working member will ramble without really concentrating on what the specific problem might be).

· It causes the member to think about what she is saying.

· Good questions may be asked.

· The working member gets to hear how he might be feeling. This is especially true if some of the members are very good at pinpointing what the working member is feeling.

· The working member gets to feel understood if the other members are on target.

While the members ask questions or make statements, the leader has time to think about the direction in which he believes the therapy needs to go. It is important that the leader closely monitors the questions and guesses to make sure they are relevant and useful. Sometimes the guesses are projections of how members would feel based on their own values and past experiences.

Members Role-Play the Working Member

A technique that is effective and also causes the members to be involved is to have the members role-play the working member. By  role-playing the working member , we mean that another member acts as the working member. Here is how this may occur.

Leader:

I would like someone to role-play Ralph, using his body language and voice pattern so that Ralph can see how he presents himself in the group. Be sure to speak in the first person singular, just as if you were Ralph. Try to feel what he is feeling based on what you have heard him say.  (After giving the members about a minute to think, the leader begins.) Sarah, you look like you want to give this a try.

Sarah:

I think that Ralph—

Leader:

(Cuts in) Sarah, see if you can speak as if you were Ralph.

Sarah:

(Drops her head, slumps down in her chair, using a weak voice similar to Ralph’s) Okay. I’m Ralph and I’m real confused about what to do. I feel torn. Also, I feel guilty when I think about leaving my family. I’m not sure if this desire for a divorce will pass or not.

Leader:

Are you tired of being so stuck? This has gone on for 2 years.

Sarah:

(In a weak voice with head still down) I just don’t know what to do. I really fear my father’s wrath.

Ralph:

Do I really look that pathetic?

Members:

Yes!

Ralph:

I had no idea that I was acting that way.

Creative Use of Members

There are numerous creative ways that a leader can utilize members to make the counseling more concrete and have more impact. The following techniques are for specific kinds of problems and would be used only if the timing was right and the activity fits the problem being presented.

· Members are asked to stand in front of the working member, who sits on the floor and looks up at the standing members. This activity would be used when a member expresses feelings of “less than” or insignificance in comparison with others. By seeing the other members standing, the seated member experiences visually what he is expressing. This often stimulates further discussion.

· Members can play various ego states of the working member. This technique assumes that the members have been taught the theory of TA. For example, if the working member appears afraid to take risks, the leader might appoint another member to play the working member’s Not-OK Child ego state. In essence, the other members act as different ego states of the member.

· Members are asked to talk about the working member in a kind, caring way while the member listens. (If the leader feels it would be helpful, the member may be told to close his eyes or face away from the group to facilitate listening.) This gives the member a chance to hear how others see him or the problem. To facilitate this, the leader can say, “Jeff, I want you to close your eyes and just listen as we talk about your situation.” (To the others) “What do you think of Jeff’s situation and how he is handling it?”

· If a member does not feel part of the group and the leader senses that the member would like to be but is not trying very hard, the leader may have the group stand in a circle holding hands and have the member walk around the outside of the circle with the option of asking or “fighting” to break into the circle. This can be very effective if the issue is feeling left out or not knowing how to be a productive member of the group. Some on the outside try hard to break into the group while some others need to be coaxed to try to get into the circle.

· An experiential technique could also be used with a member who feels held down by all of his obligations and responsibilities. To help the member experience this, the leader might have the member sit on the floor, with four or five other members holding him down. The leader instructs the member to experience the feeling and then decide on a course of action. Some members do nothing; others fight very hard to break free. The experience usually proves valuable to the member because he gets a sense of how he is handling what he believes is holding him down. This is valuable to the other members because they will reflect on how hard they are fighting to get to where they want to be and also on whether they are holding others back and what is holding them back.  This exercise should be used only by an experienced therapist and must be used with great caution, because it often evokes the emotional release of some deep-seated pain from childhood or former relationships.

· Another effective way for experientially helping a member is to use drama to act out a scene that the member is worried about, such as a job interview or a conversation with parents (members would play the interviewer or parents). The person can get feedback and then try the scene again. In some cases, the leader may get another member to play the working member’s role to give the individual a chance to view how the conversation could be handled more effectively.

· Psychodrama can also be used to explore in action not only historical events but, more importantly, dimensions of psychological events. Psychodramatic enactments are usually quite intense, because they often involve reworking traumatic experiences, memories, or unpleasant or puzzling events. Enactments are conducted using other group members to portray the different people in the protagonist’s (working member’s) life. Psychodrama is a valuable tool for therapy groups, but a detailed discussion is beyond the scope of this book. For a good background in psychodrama, we encourage you to read Blatner’s book  Foundations of Psychodrama: History, Theory, and Practice (Blatner, 2000).

· Another creative way that members can be used to bring about impact when a member is struggling between two positions is to have two members take the working member’s arms to symbolize feelings of being pulled in two directions. The following dialogue illustrates this example.

Dan:

I just feel pulled, you know? A part of me wants to get married because …  (States the reasons). Another part of me doesn’t  (States the reasons). I just can’t seem to make up my mind.

Leader:

Bill, you and Tom stand up. Dan, you stand too. Bill, I want you to stand on one side of Dan and take his arm. In a minute, I want you to tug on his arm, saying all the reasons why Dan wants to marry. Do this as if you were Dan—that is, in the first person. Tom, you get on the other side and pull on the other arm, saying all the reasons why Dan does not want to marry. Okay, begin.

Bill and Tom talk and pull Dan’s arms simultaneously. Thus, Dan feels pulled in both directions. Dan is instructed merely to listen to each side and pay attention to the sensation of feeling pulled. He is also instructed to pay particular attention to whether one side of the issue emerges as more powerful or persuasive than the other side. Note that using such techniques requires that the leader make sure that everyone knows his part. The working member must not experience merely two people pulling on his arms but rather the mental struggle between two sides of an issue. This technique may also seem like a gimmick or a slapstick routine if the leader does not set the tone properly. The leader must explain the purpose of the technique and remain serious about conducting it, even if the members laugh or snicker.

Group Counseling Skills

Therapy in Groups

Go to video 14.2 and watch the segment where the leader engages all the members when working with one member.

14-5bThe Use of Therapeutic Rounds

A therapeutic round differs from the rounds described in  Chapter 9 because in a therapeutic round, the working member is the one completing the round. The following descriptions of therapeutic rounds should clarify this point.

The in-Depth, Stationary Round

This is a round where the working member says something to each member of the group while remaining in his seat.

The first type of  in-depth, stationary round  is one in which the working member makes the same statement to each member. The members serve as a sounding board for the working member by listening as the member repeats a belief that he has.

Example

Ralph has been talking for about 10 minutes and one of his concerns is his parents’ reaction to a divorce.

Leader:

Ralph, I would like you to turn to each member, starting with Sarah on your immediate left, and say, “I’m afraid to get a divorce because of what my parents will think.”

Ralph:

(To Sarah) I’m afraid to get a divorce because of what my parents will think.

Leader:

Now look at Carl and say the same thing. And then repeat it to Judy, Liz, and Asel.

Ralph:

(To Carl) I’m afraid to get a divorce because of what my parents will think.

Ralph:

(Looks at Judy, obviously thinking) I’m afraid to get a divorce because of what my parents will think.

Ralph:

(To Liz) I’m afraid to get a divorce because of well, uh, this is nuts! I have to live my life for me. My parents are not unhappily married, I am!

By saying the same thing over and over, Ralph gets a chance to listen to himself. It is important to note that in this type of round the members do not say anything. They merely act as listeners. By repeating something out loud, to others, a working member is usually able to gain some insight about his thoughts and feelings.

The second type of in-depth, stationary round is one where the working member turns to each member and completes the same sentence stem.

Example

Kara has been talking about how she is not good enough.

Leader:

Kara, let’s clarify what you mean. So far you are being kind of vague. Here’s what I want you to do. I want you to look at each member and start with “I am not good enough because” and then complete the phrase. Start with Marj.

Kara:

(Looking at Marj) I am not good enough because I am not pretty.

Leader:

Now look at Nan and start the same way.

Kara:

(Looking at Nan) I am not good enough because I am not smart.

Kara:

(Looking at Dee) I am not good enough because, uh,  (looks down) my family does not have as much money as most of my friends.  (Tears up)

Leader:

Is that what bothers you the most?

A member doing this type of in-depth, stationary round can be more specific about her concerns. It helps the group to understand her, and it usually helps the member to better understand how she is thinking and feeling. Using the members is more powerful than having her just talk to the group, and also the members feel more involved.

The third type of in-depth, stationary round is one where the working member responds to a repeated question from the other members.

Example

Leader:

I want each of you to ask Charlie the following question: “Charlie, does being gay make you less of a person?”  (Pauses and sees that Bonita is ready) Bonita, you go first and ask Charlie that question. Charlie, you look at Bonita and respond to the question. Then look at the next person.

Bonita:

Charlie, does being gay make you less of a person?

Charlie:

Everybody in my family thinks it does.

Leader:

Look at Meg. Meg, ask Charlie the exact same question.

Meg:

Charlie, does being gay make you less of a person?

Charlie:

I don’t want to think that I am less of a person.

Leader:

Turn to Jenny.

Jenny:

Charlie, does being gay make you less of a person?

Charlie:

(In a very thoughtful voice) I thought I had resolved this, but it is clear to me that I haven’t. I need to get clear as to what I believe.

A fourth type of in-depth, stationary round is one in which each member asks a different question of the working member, using the round format.

Example

Leader:

I want each of you to think of one question that you want to ask Jesse in terms of what he is saying about his guilt. Try to make the question one that will cause him to really think about what he is saying and feeling. Who wants to start with a question? Jesse, make your answers brief. Faith, we’ll start with you.

Faith:

Jesse, do you think you can ever be forgiven for the accident?

Jesse:

No, I don’t ever deserve to be happy given that I killed three people when I was drunk.

Wayne:

Do you think your guilt is helping anyone?

Jesse:

Well, no, but I am not sure what you mean.

Wayne:

What I was …

Leader:

Wayne, hold off. Let’s go on.

Justin:

If you don’t think you can ever get over this, then why are you here and why do you continue to go to church?

Jesse:

(Pauses, head drops) I want to get over this pain.

Justin:

You can if you will let yourself be helped by us and by God.

Anne:

(With a caring but irritated voice) Why do you think you are the only one who has done a bad thing? In our own way, each of us here has plenty to feel guilty about, so why do you think you are so special?

Jesse:

(Somewhat taken aback, with a shaky voice) I just haven’t thought of it the way you are getting me to.  (Tears up)

Often members ask good questions that cause the working member to explore the concern in greater depth. In addition, this allows the other members to be more involved.

The in-Depth, Movement Round

In contrast to the in-depth, stationary round, the  in-depth, movement round  involves the member moving in front of each of the other members, thus intensifying the experience. This kind of round is one of the most powerful techniques for producing intense, in-depth exploration. Moving in front of the other members creates a potent atmosphere that often causes the working member to gain insight. During these rounds, there will be times when the leader will ask the members to sit silently as the person makes the round. Other times, the leader will instruct the members to ask a certain question or to respond in a specific way, such as, “No, it doesn’t mean that.” The role of the members will depend on the content of the specific round and the purpose that it is serving.

Examples

Sherry has been talking about not liking herself but has been vague.

Leader:

Sherry, sit in front of each member and say, “I don’t like myself because….”

Sherry:

(Moves in front of Pam) I don’t like myself because I am fat.

Sherry:

(Moves in front of Kate) I don’t like myself because my teeth are ugly.

Sherry:

(Moves in front of Beth) I don’t like myself because my parents never liked me.  (Starts to cry. Beth starts to reach out and take her hand, but the leader shakes his head no, because he believes Beth would be trying to “rescue” Sherry from her pain.)

Sherry:

(Moves in front of Patty) I don’t like myself, oh, I don’t know if I can say it.  (Cries more and looks down) I don’t like myself because of what my father did to me when I was growing up.

Leader:

(With a warm, caring voice) Was it sexual?

Sherry:

(Sobbing, looking down) Yes!

Leader:

(In a calm, firm voice) Sherry, I want you to look up and see the others’ faces. No one here thinks less of you. Look up—don’t watch that movie that says, “Sherry’s a horrible person.”  (Sherry slowly looks up.)

In this example, the round serves as a way to get the member into her feelings. The leader also used a couple of other skills. First, he continued to push the member even though she had begun to cry. Often in groups when a member cries, the other members and leader make the mistake of rushing to support the member, causing the work to cease. There are times when a person in pain needs to struggle with her pain.

Another skill was having Sherry look up right after she disclosed the sexual abuse. By doing this, the leader did not allow Sherry to reinforce her negative feelings by watching negative images in her mind. Also, by seeing the faces of concerned, caring members, Sherry could experience that they did not think less of her. This latter technique obviously requires that members in the group be empathic and sensitive.

Vicente has been talking about how he feels worthless because he was put up for adoption when he was 4. The leader has been challenging Vicente’s irrational, self-defeating belief and thinks that Vicente may be about to give up this belief.

Leader:

Vicente, I want you to sit in front of each member and answer the question, “How does being adopted make you worthless?” Each of you ask Vicente that question. Vicente, start with Bonnie.  (He moves his chair in front of Bonnie.)

Bonnie:

Vicente, how does being adopted make you worthless?

Vicente:

Well, if they loved me, they would have kept me.

Leader:

Vicente, move to Donna. Donna, ask him the same question, and if he does not answer the question, try to get him to be more specific.

Donna:

Vicente, how does being adopted make you worthless?

Vicente:

If your parents give you away, you are worthless.

Donna:

You said that they gave you away because they just could not handle their own lives and they had no money! Now how does that make you worthless?

Vicente:

I don’t know. I feel it.

Leader:

Go to the next person. Calvin, try to ask something that will challenge Vicente’s thinking.

Calvin:

I don’t believe being adopted makes you less of a person. My closest friend is adopted, and he certainly doesn’t feel worthless, and I don’t think he’s worthless.

Vicente:

Well, uh, maybe I’ve been seeing this all wrong. I think I’m getting the point.

To reiterate, the use of in-depth, movement rounds can be very beneficial when they are used at the right time and with the right kind of problem. A leader should use the in-depth, movement round only when she is trying to get a member in touch with some intense feelings or thoughts.

14-5cSpinning Off

When the focus is being held on one member, the leader should always be thinking about ways to get others involved in either the member’s work or in their own work. To get members involved in their own work, the leader will periodically seek comments from them while putting the working member on “hold.” We call this  spinning off . To do this, the leader might say the following:

Leader:

David, I want you to think about what you have said in the last few minutes while I hear from others.  (Looking at the other members) What has this made you think about in reference to yourself?

This question serves a number of purposes:

· (1)

members get to share what is on their minds (at this time, the leader would not focus on a new person because he has the other member on hold),

· (2)

the leader gains information about how many others are ready or almost ready to work,

· (3)

the sharing can be helpful to the working member, and

· (4)

the working member gets some time to collect his thoughts before the leader comes back to him.

Another way that the leader spins off is by making a few comments to the group about what the working member is saying:

Leader:

Let me comment on what Joe is saying. Joe is talking about his part in weekly fights over household chores. Each of you may want to think about any routine fights that you have and the part that you play in those fights. It is really important that you understand your part in a fight. If you can see how you contribute to any fight, then I think many of you will choose to change. Joe, let’s get back to you.

Spinning off to the members is  essential. By making thought-provoking comments to the members and eliciting their comments about themselves, the leader can cause more members to think about themselves and thus to be ready to share when the current person’s work is completed.

To summarize, in the last few pages, we discussed many ways the leader can involve the members when the focus is being held on an individual.  Too often, leaders just conduct individual counseling and do not take advantage of all the possible ways to involve the members. It is very important to realize that much of the help members receive in a counseling group comes from the sharing, caring, supporting, and challenging that takes place. Also, the leader has a much greater chance of keeping the members’ interest when she involves the other group members while one member is working on a personal issue.

14-5dTechniques for Helping More than One Member at the Same Time

There will be occasions in therapy groups and even sometimes in growth and support groups where two members will need help at the same time, often concerning the same issue. For example, let’s say the members of a therapy group are sharing about guilt. One of the members, Susan, gets in touch with some old feelings of guilt from an abortion. As she begins to talk about her abortion and her sense of guilt, another member, Donna, begins to cry and says that her tears are about an abortion she had 2 years ago. At this point the leader has several options:

· Ask Donna if she can wait until the work is completed with Susan.

· Ask Susan if it is okay to shift to Donna, because her pain seems greater.

· Work with both of them at the same time.

· Ask a co-leader or another member to go to another area of the room or somewhere else with one of the two members.

The first and second options require that the leader hold the focus on one member until her concerns have been alleviated enough to switch the focus to the other. In the preceding example, there may be no need to do this because their problems are similar. However, in an instance in which one person is talking about guilt over an abortion and another brings up guilt over her husband’s suicide, the leader may find it extremely difficult to deal with these issues simultaneously. The skill required in this situation is knowing how to put one member on hold. This is done by being straightforward with the two members and asking if one can wait. If the leader feels both members need immediate attention, she may use the last option, which is to get help from a co-leader or another member.

In many instances, the concerns are so similar that it would save time and benefit the two members for the leader to work with both of them simultaneously. Sometimes the leader may have one or both of the working members complete an in-depth round and then have them talk about each other’s round. Or the leader may have the two members give advice or suggestions to one another. The leader could have the working members complete a sentence stem, such as, “Because I had an abortion, it means I am….” The leader could have the members answer to each other or to the other members. At other times the leader may do an in-depth, stationary round by having the members ask each working member the same question, such as, “Why does having an abortion make you less of a person?” When leaders work with two members simultaneously, each member sees another person in the same situation and most likely identifies with the therapy or recognizes her own faulty thinking by seeing the faulty thinking of the other.

Group Counseling Skills

Therapy in Groups

Go to video 14.3 and watch the segment where the leader works with more than one member.

14-5eTechniques for Working with Individuals Indirectly

At times in therapy groups, the leader will do therapy in an indirect manner with one or more members. Indirect counseling may be helpful for a member who does not feel comfortable being the focus of the group. Let’s assume that Rita had a friend who died tragically 2 years ago. Although Rita has never mentioned this in the group, she did write about it briefly one time in the journal that she leaves at the end of each session. Rita has not participated much verbally and has never been the focus of the group. If the leader does not think Rita wants to work on the issue in the group, he has a couple of options for working with her indirectly.

· He can bring up the issue of death and grieving to get a discussion going and hope that this will be therapeutic and may even prompt Rita to share.

· He can work with another member who has a grief issue, knowing that the work will probably be beneficial to Rita.

If the leader chooses the second option, the group will focus on a member’s pain over a death. While working with that member, the leader would observe any reactions from Rita in hopes that the work will trigger Rita to open up and request help. Or, using dyads, the leader could pair the working member with Rita. Both these methods may be successful in getting the silently working member to share.

If these methods are not successful in drawing out comments from the targeted silent member, the leader should keep in mind that members benefit from hearing others, whether or not they actively discuss their own personal concerns. Hearing the concerns and coping strategies of the other members can help the indirectly working member.

14-6Therapy That Focuses on Process

Throughout this chapter, we have emphasized focusing on individual problems when conducting counseling groups. We do want to mention that there will be many times during a therapy group when focusing on group process will be therapeutic. By focusing on process, we mean focusing on what members are doing or feeling in the group. For instance, a member may constantly try to one-up everything that is said. Feedback from the members can be very therapeutic. Or a member may ramble, and the leader or another member may point this out to the rambler in hopes that the rambler may get some insight on how he comes across to people. Some members can be afraid of what others will think, so the leader may want to focus on this as a topic. Feelings of being one down, not being part of the group, or fear of rejection are all potential material that is therapeutic to discuss. If handled well, the leader can turn conflict or tension among the members into therapeutic gains. The skilled leader always pays attention to process as well as content and will focus on group process when it seems necessary and valuable to do so.

Example

It is the third session of a group of fourth-graders who have trouble making and keeping friends. The leader has observed that Ross has a tendency to interrupt people.

Corey:

My dad is thinking of getting me a 4-wheeler. This means so …

Ross:

( Interrupting) My dad said he’s going to take me to New York this summer. I like….

Leader:

(With a somewhat strong voice) Ross, are you aware you interrupted Corey? Corey, you finish and then I want to focus for a minute on Ross.

Corey:

I was just going to say this means so much to me because it will be something I can do with some of the kids that live by me. I think this will help me get some friends.

Leader:

Corey, that’s great. Keep us posted. Ross, back to you. Are you aware that you interrupt people a lot?

Ross:

(Angrily) I just like to share. Isn’t that what this group is about?

Leader:

(With a nurturing voice) Ross, I’m not trying to pick on you. The purpose of this group is about making friends, and I think your interrupting may hurt you in your effort to make friends. Ross, I’d like you to listen for a minute, okay?  (He nods.) Do any of you think Ross has trouble in this area?

Hans:

I tried to be your friend and you would never let me talk.

Ahmed:

You always butt in here in the group.

Corey:

I don’t think you listen or share very well.

Ross:

At home, I get interrupted all the time by my brother and father.

Leader:

I bet that doesn’t feel good.

Ross:

No, I hate it.

Leader:

You are doing that in here and here at school. I think this is a big reason that people don’t want to be your friend. Will you let us help you with that?

Ross:

How?

Leader:

By letting us point it out to you and you not biting our heads off.  (Ross smiles and nods okay.)

By paying attention to the process (Ross always interrupting), the leader was able to make the group very beneficial for Ross and most likely for others.

14-7Thoughts on Intense Therapy

In this chapter, we have discussed therapy in many ways—from helpful insight to deep therapy. Many counseling groups, such as those in schools, are not aimed at  intense therapy . However, many therapy groups have as their goal deep, personal work; that is, the leader funnels the group to individual work at a level of 5 or below on the depth chart. In these groups, the leader usually directs much of the therapy, because the members are limited in their ability to be helpful. They can share and offer good suggestions or insights, but if the therapeutic process goes deep enough, the members will not know how to be helpful. For instance, in recovery groups from incest, rape, or abuse, we use a variety of techniques, including Gestalt, psychodrama, or in-depth rounds, to get at the deep-seated emotions. We then use REBT, TA, Gestalt, and other theories with some creative techniques to help the client work through the pain. Any leader who is getting members to look at their buried emotions has to know how to help the members get through their pain. Stated another way:  Do not unzip members unless you know how to zip them back up!

If you plan to work in settings where you will be doing some intense group therapy, we strongly suggest that you become knowledgeable and skilled as an individual therapist.  Intense group therapy requires that you have good individual counseling skills. We also suggest that you read some of the literature on psychodrama, because psychodrama includes many skills and techniques that can be used to help members get in touch with some deep-seated issues. It is these skills, coupled with counseling theories and the ideas in this book, that will make you a good group therapist.

14-8Providing Therapy in a Nontherapy Group

At the beginning of this chapter, we mentioned that therapy may take place in nontherapy groups. Quite often in groups in which the purpose is something other than counseling, the opportunity arises to focus on one member’s concern. Topics discussed in a support group or even a discussion or education group can cause members to get in touch with unfinished and/or painful issues.

The first thing that a leader must do when the opportunity for counseling arises in a nontherapy group is to decide if therapy would be appropriate. If the leader decides it is appropriate to focus on one member’s concern (that is, the topic is relevant to the other members and there is enough time), she should ask the member if he desires immediate help. She would also want to ask the other members if they are willing to spend some time focusing on one member’s problem. Once the leader has consent from the members, she will use many of the skills and techniques outlined in this chapter. The following are examples of when it might be appropriate to hold the focus on a member and do some brief therapeutic work in a nontherapy group.

· If a member of an education group for pregnant teenagers starts crying about how she hates being pregnant, the leader might choose to work with her for a few minutes, because, more than likely, others are having similar feelings.

· If a member of an experiential group that is doing the ropes course shares how bad he felt about himself when he was growing up, the leader might decide to funnel the group to a deeper level by focusing on this member.

· If a member of a parenting group discloses that she feels guilty because her baby was the result of an affair that her husband does not know about, the leader might want to take a few minutes and try to be helpful because the topic is guilt, which is something that most people can relate to. Working with the member from a theoretical base could prove to be valuable for all the members.

The benefits of conducting therapy in nontherapy groups are very much the same as for therapy groups. The main difference is that the therapy portion of the group is short-term. The focus is then brought back to the main purpose of the group.

14-9Common Mistakes Made When Leading Therapy Groups

Several errors are common among leaders of therapy groups. These mistakes were discussed earlier in the chapter or in other chapters, but because they are so important, we want to review them briefly.

14-9aAttempting to Conduct Therapy Without a Contract

Many leaders attempt to focus on a member of the group without first getting agreement from that person. The result is that the member resists the leader’s attempt to be helpful; time is wasted; and members become frustrated and even resentful.

14-9bNot Involving the Other Members

One of the most common mistakes made by beginning leaders is to conduct individual counseling with a member without involving the other members. It is a mistake to have members sit and listen while the counselor tries to be helpful to a member unless the leader is very skilled at taking the counseling to a deep level, using theory and a multisensory approach. By using this approach, the other members can relate to their own problems or become very involved in the intense work. Whenever possible, it is best to involve members in some way.

14-9cSpending Too Much Time on One Person

Some leaders make the mistake of spending week after week trying to help one member who is in pain or spending too much of the session on one member. It is important for the leader to realize that some members seek and/or need inordinate attention from the group. The natural tendency of the leader is to focus on those individuals, especially if other members are not as talkative. The skilled leader keeps a mental record of how much time is being spent with the various members and makes sure not to spend too much time with one member.

14-9dSpending Too Little Time on One Person

Many beginning leaders will be hesitant to hold the focus on one member when others also want to share. When this happens, one member shares for a minute or so, then another member, then another member. Sometimes this is helpful and valuable, but at other times this type of sharing is not as personal as when the focus is held on one member. Holding the focus on one member causes him to delve more deeply into his problem, which in turn often causes other members to look more closely at their own concerns.

14-9eFocusing on an Irrelevant Topic

Too often, a leader lets a member ramble on about a personal experience, even if the story has no relevance to the group. The leader might even ask the member questions about the story or have other members ask questions. A similar mistake occurs when two or three members are focused on some irrelevant topic and the leader fails to shift the focus. It is important to realize that if the leader does not cut off irrelevant topics, the session is likely to be much less meaningful for the majority of the members.

14-9fLetting Members Rescue Each Other

If a member begins to cry, it is often a mistake for another member or the entire group to rush immediately to the member’s side, take his hand, and try to comfort him. The leader should discourage this type of behavior when it is antitherapeutic. Many times, the member needs to be with his pain instead of being “rescued” from it. The members should show support, care, and concern but should not rescue. The leader prevents rescuing by saying something like, “Let Mike be with his pain—I think he knows that we care. Mike, do realize that we care and want to help.” As we discussed elsewhere, there are times when supportive touching is quite appropriate and very therapeutic—but leaders need to know the difference.

14-9gLetting the Session Become an Advice-Giving Session

Very often in groups, leaders make the mistake of turning the session into an advice-giving session. That is, a member brings up a problem, and then all the other members try to solve it by giving advice. This is  not what a therapy group is supposed to be. Sometimes advice is given and is helpful, but by and large each member should work on her own concerns with the help of the other members. Advice-giving sessions often occur when the leader does not know theories and thus relies on the members’ advice to be the agent of change.

Group Counseling Skills

Counseling and Therapy Groups

Watch video 17.4—a counseling group for children of divorce. This shows the leader working on the topic of self-blame. The leader uses a variety of skills, techniques, and theories.

Watch video 17.5—an open therapy group. This shows how to lead an open therapy group with a new member joining the group. The leader shows how to manage members with a variety of issues. The leader shows the beginning, middle, and closing phases.

14-10aConcluding Comments

Counseling and therapy groups are different from support and growth groups in that the leader focuses on the members in an in-depth manner. The main purpose of counseling and therapy groups is to help members alleviate personal concerns that interfere with quality living. Many of the techniques discussed for therapy may also be used in nontherapy groups. The approach we have described for leading counseling groups emphasizes the leader as being responsible for the therapy. The leader of a counseling group should be in charge, because she is more knowledgeable about counseling and therapeutic techniques.

When one member is exploring a problem in-depth, the leader can use a variety of skills and techniques. He can use his individual counseling skills to help the member clarify and work through the problem. He can also use the other members to play various roles, or he can use himself to help dramatize the problem. It is the leader’s responsibility to establish a positive tone for the members and to get a contract from a member before focusing intensely on him or her. Once there is an agreement to work on a concern, the leader may need to help the member clarify the problem. Any of a number of techniques can be used, such as having the member engage in a clarifying round or having the other members ask the working member questions. A very valuable technique when working with an individual on a concern is the in-depth, therapeutic stationary or movement round.

When conducting individual therapy in a group, it is important to spin off to the group and hear members’ personal reactions, and get them involved in trying to help the working member. By spinning off and pointing out the themes, the leader keeps members more interested, and this usually causes them to be ready to share when the focus shifts from the working member. We view the leader as the conductor of the group who orchestrates the focus on different members and topics. An excellent book with chapters on many different therapy topics is  Handbook of Group Counseling and Psychotherapy, which is edited by DeLucia-Waack, Gerrrity, Kalodner, and Riva (2003).

Activities

1. Think of five topics that could come up in therapy groups and then think of creative techniques that could be used to introduce and work with each topic. This can be very useful in helping you to develop the ability to think creatively about issues in counseling.

2. Think of three different topics and the different therapeutic rounds that could be used to deepen a member’s work on that issue.

Group Counseling Skills

1. View again video 14.1. Ask yourself the following:

1. How effective was the in-depth round for the working member?

2. How did the round help to engage the other members?

3. Why did the leader go to the members for comments and then come back to Lauren?

4. Why did the leader focus on the topic of forgiveness with the other members?

5. Did the use of props help? If so, how?

2. View again video 14.2. Think about the following:

1. Note how the leader got the other members involved. Why was it important to get the members to comment?

2. Note how the leader used theory in the session.

3. Observe the many ways that the leader involved the other members

4. Was it good that the leader cut off the member’s story when he said, “Stop, Stop,” and then asked the members for comments?

5. Was the round effective when the leader asked all the members, “Is she a terrible mother?”

6. Listen to the narrator’s comments and give thought to what he says in summarizing the session.

3. View again video 14.3 and observe the many different techniques that were used. Also observe closely the different ways the leader handled the three members who had very heavy concerns. Here are some questions to think about:

1. Why did the leader choose to focus briefly on the one member’s issue about voting for herself?

2. What did the leader do to focus on the heavy issues?

3. Was the use of the chair helpful?

4. What did the leader do to keep all the members involved?

4. View again the integrative videos 17.1–17.5. Pay careful attention to all the different techniques that were used by the leaders.