Group Counseling

By: Christy Hicks, CADC/CSW

Regional TEAP Specialist

Why use group therapy?

• Engages therapeutic forces– Affiliation– Support– Peer confrontation– Bonding– Lack of isolation– Examples of recovery and positive

activities– Social skills training– Encouragement

What skills you need to lead any group?

• Educator/Facilitator needs to be warm, and show genuineness, and positive regard for others

• Good knowledge of materials to present• Have knowledge of group process and how our

students interact within a group• Know how group dynamics influence and individual’s

behavior in group• Basic teaching skills: organizing, planning, delivery• All groups must be effective, meaningful, and

promotes learning• All people learn differently. What does that mean?

What skills you need to lead any group?

• Active Listening• Clarifying• Supporting• Reflecting• Attending• Confronting• Terminating

What do we need to watch for in group situations?

• Conflict between group members• Encouraging withdrawn group members to be

more active• Make sure all group members have a chance

to participate• Unpleasant experiences: mocking others or

their ideas, insensitivity, or laughing.• Avoiding leader-centered group• Transference and countertransference• Confidentiality

Some Group Basic Models• Psychoeducational groups• Skills development• Cognitive behavioral groups• Support groups• Interpersonal process groups• Relapse prevention groups• Communal- and culturally-specific groups• Expressive groups• Groups focused on specific problems

Psychoeducational Groups• Designed to educate clients about substance abuse, and

related behaviors and consequences• Specific topics presented by lectures, videos, audio, etc.• Direct application to our clients life to instill self-

awareness, suggest options for growth and change, identify community resources that can assist, develop a understanding of the process of recovery

• Expansion of awareness about behavioral, medical, psychological consequences of substance abuse to become recovery ready

• Must be supervised throughout the process

Psychoeducational Groups• Most helpful in:

– Learning about their disorder– Recognize road blocks– Help family members understand substance

abuse behavior– Help students lean about resources (anger

management, relaxation, nutrition, and medical needs)

– Highly structured (manual or pre-planned curriculum)

– Leader/instructor takes active role

Skills Development Group• Cognitive-behavioral orientation, but

other forms of treatment can be used. Incorporates psycho-educational groups but should focus on the primary focus skills development.– Develop coping skills training– Avoid triggers to use drugs/alcohol– Cope with urges to use drugs/alcohol– Manage anger– Solve problems– Relaxation

Skills Development Group• Group size is important (no more that

15). Why??? Needs to be small enough for the group to practice skills

• Demonstrate the skills the students can learn

• Model skills• Sometimes a group may need to be

lead by someone trained in meditation, or other special skills

Cognitive-Behavioral Groups

• Cognitive restructuring is the basic method of change. Change learned behaviors by changed thinking patterns, belief, assumptions, and precipitations.

• Identify stimuli associated with addictive behaviors• Avoid that stimuli• Development of enhanced contingency management

strategies• Response and desensitization• I’m a failure/ I’m different• I’m not strong enough to quit/ I’m loveable• I’m a bad person/ I’m a good friend• Changing such cognitions and beliefs assist students to

be more productive.

Cognitive-Behavioral Groups

• Must be structured• Goal orientated • Deal with issues immediately• Problem-solving skills groups help build skills

and resources• Things to think about:

– # of sessions– Male/ female groups– Where the student is in the change process– Mandatory vs. non-mandatory groups

Cognitive-Behavioral Groups

• You must know about CBT to effectively lead this type of group

• Can be directive or non directive• Active or non-active groups• Confrontational or non-confrontational• Engagement is the key to access• Teaching group members about self-destructive behavior• Focus on problem solving and short/long-term goal

setting• Help student monitor their feelings and behaviors• Fosters open and honest communication• Leader active but not directive

Support Groups• Groups show unconditional acceptance, inward

reflection, open and honest interpersonal interaction, and commitment to change.

• Helps with dependence when though they don’t know the root cause.

• Groups can be peer generated or peer leaders• Increases self-esteem• Increase self confidence• Decrease anxiety• Provides positive reinforcement to students• Understand commonality• Less directive

Interpersonal Process Group

• Focuses on healing by changing basic interpersonal or within self psychological dynamics.

• Experiences affects future• Sometimes perceptions distort reality• Psychological and cognitive processes outside

awareness and influence behavior• Behaviors are chosen to adapt to situations

and protect students from harm• Attention is paid more to the group than to

each individual student

Relapse Prevention Groups

• Maintaining abstinence or recover from relapse. Relapse prevention helps to maintain sobriety by providing students will skills and knowledge to anticipate identify and mange high-risk situations that lead to substance use stabilization.

• Focuses on activities, problem solving, and skill building• Supportive relationship building• Targeting high risk students • Relapse needs to be handled in a non judgmental way• Understand the wide range of consequences for relapse:

criminal justice, child protection, job, school, family, relationships, etc.

Communal and Culturally Specific Groups

• Risk factors• Specific cultural healing practices• Cultural prohibitions patterns

Expressive Groups• Assists students to express feeling and

thoughts that are difficult with spoken work alone.– Art– Music– Drama– Psychodrama– Games– Play– Dance– Free movement– Poetry

Groups Focused on Specific Problems

• Works specifically on one problem.– Shyness– Loss of a loved one– Substance abuse – Smoking– Eating

• Short highly structured groups, effective coping skills until substance abuse treatment is initiated.

How to be a great group leader?

• Our students are from a broad and diverse population, ages, ethnic groups, co-occurring conditions and histories.

• In substance abuse treatment you use the same type of skills, qualities, styles, and approaches needed in any type of therapeutic treatment group.

How to be an great group leader?

• Personal Qualities:– Communication skills– Responsive and affirming– Safe and supportive– How to manage the group’s anxiety– When you need to intervene

• Consistency:– Security– Boundaries

How to be a great group leader?

• Active Listening:– Verbal– Non-verbal

• Firm Identity• Confidence• Spontaneity• Integrity• Trust• Humor

How to be a great group leader?

• Empathy: Ability to identify someone else feelings, while remaining aware that others’ feelings are not your own.

• How do we project empathy?– Communicates respect for and acceptance of students and

their feelings– Encourages a non-judgmental, collaborative relationship– Is supportive and knowledgeable– Sincerely complements rather then denigrates or

diminishes another person– Tells less and listens more– Gently persuades, while understanding that the decision to

change is the students– Provides support throughout the recovery process– As a leader you should be able to model empathic

interaction to the students

Leaders Improve Motivation by:

• Overcoming resistance• Defending limits• Maintaining safe therapeutic settings• Helping cool down affect• Encouraging communication within the

group

Confidentiality and 42 CFR Part 2 Confidentiality of Alcohol and Drug Abuse

Patient Records• Confidentiality is both and ethical and legal

issue. Guarantees strict confidentiality of information about all people receiving substance abuse prevention and/or treatment services. Clients should be fully informed regarding issues of confidentiality, and group leaders should do all they can to build respect for confidentiality and anonymity within groups.

Confidentiality and 42 CFR Part 2 Confidentiality of Alcohol and Drug Abuse

Patient Records• Six limited conditions• Release of information• Threatens imminent harm him or herself• Threatened imminent harm to someone else• Emergency medical emergency care• Suspected of child neglect and/or abuse• Direct court order

Management of the Group• Handling conflict in group• Subgroup management• Responding to disruptive behaviors

– Students who cannot stop talking– Students who interrupt– Students who flee

• Contraindications for continued participation in group

• Coming late or missing sessions• Silence

Group Management

• Tuning out• Participating only around the

issues of others• Fear of losing control• Fragile clients with psychological

emergencies• Anxiety and resistance after self-

disclosure

Group Rules• Here are some typical group rules:

1. Be on Time

2. Come clean and sober

3. No cell phones

4. Only one person talks at a time

5. What's said in group stays in group

6. Respect others opinions

7. Say "Thank You“

8. Offer feedback to your group members

9. No disruptive language

10. Speak the truth

Group Rules• Group has to be a safe place for

members to come and work on their issues. Certain rules have to be put into place to help establish the space effectively.

• Some group leaders have a copy of group rules for each group member to sign and have opportunity to ask questions about the rules prior to group attendance.

Questions??????