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Group Therapy (TIP 41)
Leadership Skills & Common Errors
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
~ Discuss the characteristics of group leaders.
~ Describe concepts and techniques for conducting substance abuse treatment group therapy.
~ How much leadership to exercise
~ How to structure the group
~ When to intervene
~ How to effect a successful intervention
~ How to manage the group’s collective anxiety
~ How to resolve other issues
Personal Qualities of Leaders
~ Active listening
~ Firm identity
~ Communicates respect and acceptance
~ Is knowledgeable
~ Tells less; listens more
~ Gently persuades
~ Provides support
~ Leaders vary therapeutic styles to meet the needs of clients.
~ Leaders model behavior.
~ Leaders are sensitive to ethical issues:
•Overriding group agreement
•Informing clients of options
•Acting in each client’s best interest
Leading Groups (cont.)
~ Leaders improve motivation when:
~ Members are engaged at the appropriate stage of change.
~ Members receive support for change efforts.
~ The leader explores choices and consequences with members.
~ The leader communicates care and concern for members.
~ The leader points out members’ competencies.
~ Positive changes are noted in and encouraged by the group.
Leading Groups (cont.)
~ Leaders work with, not against, resistance.
~ Leaders protect against boundary violations.
~ Leaders maintain a safe, therapeutic setting:
•Emotional aspects of safety
•Boundaries and physical contact
~ Leaders help cool down affect.
~ Leaders encourage communication within the group.
~ Connect with other people.
~ Discover connections between substance use or mood issue and thoughts and feelings.
~ Understand attempts to regulate feelings and relationships.
~ Build coping skills.
~ Perceive the effect of mental illness or addictive behaviors on life.
~ Notice inconsistencies among thoughts, feelings, and behavior.
Avoid a Leader-Centered Group
~ Build skills in members; avoid doing for the group what it can do for itself.
~ Encourage group members to learn the skills necessary to support and encourage one another.
~ Refrain from overresponsibility for clients. Clients should be allowed to struggle with what is facing them.
~ Can have an adverse effect on the therapeutic alliance and process.
~ Can point out inconsistencies such as disconnects between behaviors and stated goals.
~ Can help clients see and accept reality, so they can change accordingly.
Transference & Countertransference
~ Transference. Clients project parts of important past relationships into present relationships.
~ Countertransference. The other person projects emotional response to a group member’s transference:
~ Feelings of having been there
~ Feelings of helplessness when the leader/other person is more invested in the treatment than the client is are
~ Feelings of incompetence because of unfamiliarity with culture and jargon
~ Resistance arises to protect the client from the pain of change.
~ Resistance is an opportunity to understand something important for the client or the group.
~ Resistance indicates the proposed solutions are less rewarding/appealing than the old behaviors or there is a fear that they will be
~ Efforts need to be made to understand the problem.
~ Strict adherence to confidentiality regulations builds trust.
~ Leaders should explain how information from sources may and may not be used in group.
~ Violations of confidentiality should be managed in the same way as other boundary violations.
~ Professionals in the healthcare network need to be aware of the role of group therapy and how it integrates with the multidisciplinary team
~ Clinicians should coordinate the treatment plan, keeping important interpersonal issues alive in both settings.
~ Medication knowledge base. Leaders should be aware of medication needs of clients, the types of medications prescribed, and side effects.
~ Conflict is normal, healthy, and unavoidable.
~ Major Tasks
~ Handling anger
~ Developing empathy
~ Managing emotions
~ Disagreeing respectfully
~ The leader facilitates to call attention to subtle, unhealthful patterns.
~ Conflicts that appear to scapegoat a group member may be
~ Misplaced anger that a member feels toward the leader (sometimes it IS you)
~ A transference issue.
~ Subgroups inevitably will form.
~ Subgroups can provoke anxiety, especially when a therapy group comprises individuals acquainted before becoming group members.
~ Subgroups are not always negative.
Responding to Disruptive Behavior
~ Clients who cannot stop talking
~ Stop and summarize
~ Discuss outside of group
~ Explore motivations
~ Clients who interrupt (Talking stick)
~ Clients who flee a session (Co-facilitator or back-up plan)
Contraindications for Continuation
~ Sometimes, clients are unable to participate in ways consistent with group agreements.
~ Removing someone from group is serious
~ The leader makes the decision to remove an individual from the group.
~ Members are allotted time to work through their responses.
Managing Common Problems
~ Coming late or missing sessions
~ Tuning out
~ Participating only around the issues of others
~ Fear of losing control
~ Fragile clients with psychological emergencies
~ Anxiety and resistance after self-disclosure
~ Impatience with clients’ slow pace of dealing with changes
~ Inability to drop the mask of professionalism
~ Failure to recognize countertransference issues
~ Not clarifying group rules
~ Conducting individual therapy rather than using the entire group effectively
~ Failure to integrate new members effectively into the group
Staff Development Methods
~ Theories and techniques
~ Traditional psychodynamic methods, cognitive–behavioral modes, systems theory
~ Sitting in on groups, studying tapes, watching groups
~ Experiential learning
~ Participating in a training group, being a member of a personal therapy group
~ Ongoing training with groups under the supervision of an experienced leader
~ Essential leader skills include:
~ Group training.
~ Cultural competence.
~ Awareness of co-occurring disorders
~ Knowledge of signs of intoxication and withdrawal
~ Supervisory alliance is required to teach skills needed to lead groups and ensure that the group accomplishes its purposes.
Assessment of Leader Skills
~ Clinical skills
~ Selecting prospective group members
~ Designing treatment strategies
~ Planning and managing termination
~ Comprehensive knowledge of co-occurring disorders
~ Knowledge of the preferred theoretical approach
~ Knowledge of the institution’s preferred theoretical approaches
Assessment of Leader Skills (cont.)
~ Diagnostic skills for determining co-occurring disorders
~ Capacity for self-reflection, recognizing one’s vulnerability and ability to monitor reactions
~ Consultation skills, the ability to consult with referring therapist, provide feedback, and coordinate both individual and group treatment
~ Capacity to be supervised, including openness in supervision, setting goals for training, and discussing one’s learning style and preferences
~ Leading group is very different than individual therapy.
~ Group dynamics can give insight into how the client reacts in social situations outside of group
~ Group facilitators have an obligation to continue to enhance their skills