This article delivers the framework for a conversational agenda among practicing group counselors to address client concerns that may have otherwise been minimized or overlooked. I think [clients] would enjoy it more, instead of necessarily just sitting there and just talking again and again about the negative consequences of their substance use. On one hand, a high degree of flexibility may be warranted for using EBTs in groups, both for addressing the complex nature of addiction as well as for capitalizing on unique benefits of group therapy. To that end, we feverishly sought the feedback of our faculty and peers to enhance our basic counseling skills. Bethesda, MD 20894, Web Policies Narcissistic personality disorder is perhaps the most heterogeneous of all personality disorders in terms of presentation and psychosocial functioning (Caligor et al., 2015). Select one of the group therapy video demonstrations What do you see as the benefits and challenges of group therapy? Several processes were used to ensure rigor of data analysis. And it's like, OK, well, you are going to learn about Bill Wilson. But if you don't care who Bill Wilson is, then what is the point? However, even in the absence of innovative group therapy protocols, clinicians and administrators could make efforts for incorporating more skills practice and interaction within group sessions (see Wenzel et al., 2012). Procedures and guidelines for group therapy - APA Divisions Interviews were audio recorded and transcribed verbatim according to conventional transcription standards. Required fields are marked *. Methods Fifty-two predominately African American adults patients with moderately to poorly controlled Diabetes Mellitus participated in three separate group brainstorming sessions as part of a PCORI-funded group concept mapping study examining comparing methods for the elicitation of patient important outcomes (PIOs). An official website of the United States government. And I think it is easier in that way to become disengaged and sort of just like mind drift off. Use time wisely. How do clinicians balance treatment structure (including use of treatment manuals) with group process? You have people that are not willing to speak up, won't give you eye contact, maybe just sort of nod their head. Group size may be a barrier in this regard; for non-educational groups, a group size of five to eight clients has been recommended as optimal, in light of research indicating that group interaction markedly drops with groups of nine clients or more (Yalom & Leszcz, 2005). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. What practices are most likely to be used? Miller WR, Forcehimes AA, Zweben A, McLellan AT. This dynamic reportedly resulted in more quiet or withdrawn clients receiving considerably less attention and care than they would have through individual therapy. Although estimates in the literature vary, some suggest that group attrition rates are as high as 40% to 60%, with the early stages of a group being the most vulnerable to this phenomenon. Although it may appear to be a simple, obvious concept, engagement is, in fact, Exploring the use of activity-based group therapy in increasing self The sole reliance on clinical judgments to measure client satisfaction in group settings renders counselors vulnerable to myopic interpretations. FOIA Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior. Lash SJ, Timko C, Curran GM, McKay JR, Burden JL. These and other related questions relative to group therapy facilitation are the focus of this exploratory qualitative study. Even more difficult can be the solicitation of the feedback itself. Keys to great group therapy Bamatter W, Carroll KM, Aez LM, Paris M, Ball SA, Nich C, et al.Martino S. Informal discussions in substance abuse treatment sessions with Spanish-speaking clients. Meeting people where they are at and meeting the needs of the group, I think, sometimes is compromised by doing manualized [therapy]. (Meagan, SUD Intensive Clinic). When clients see that their feedback has value and their concerns are real and valid, they may be more apt to trust their therapist and feel less stress in the therapeutic environment. So I'm going to try to use whatever I think might work. In addition, a practice reported across clinics was having each group member introduce themselves when new members were in attendance. What group therapy techniques were demonstrated How well do you.docx However, the majority of adolescents fulfilling the criteria for mental health disorders do not receive treatment, and half of those who do get treatment drop out. In contrast to individual therapy, clinicians discussed unique challenges with group therapy in terms of group dynamics. This paper explores, in both conceptual and practical terms, three key issues: consent; confidentiality and anonymity; and risk of harm. (Lina, New Day). This vignette implies the importance of not only discovering from practice what works, but also learning from clients what they want. In this regard, several clinicians reported the importance of promoting the group's autonomy in influencing the direction of groups, especially as clients progress in their recovery. Previous researchers have discussed the problem of assuming that groups can be readily facilitated by clinicians without specific training in group therapy (American Group Psychotherapy Association, 2007; Center for Substance Abuse Treatment, 2005; Sobell & Sobell, 2011; Yalom & Leszcz, 2005). Journal of the American Medical Association. Three approaches to qualitative content analysis. Finally, clinicians reported several ways in which flexible group facilitation sometimes required departing from planned material. Facilitating group therapy involves a lot of moving parts. A final implication for group facilitation pertains to clinicians' reliance on didactic education within groups. Miller WR, Wilbourne PL. You can be expressive with your emotions. This begs the question of what differentiates helpful from unhelpful treatment processes from the perspective of young clients. Support your reasoning with at least three peer- reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Online role-playing games as group therapy during the COVID-19 pandemic, The power of virtual group therapy during a time of quarantine, Facilitating support groups for caregivers, Developing competence to address undue police violence, Advocacy Update: Tips for effective advocacy, Conceptualizing and assessing race-based traumatic stress, From the President: Creating change within the profession, Group members behavior (e.g., participation, active listening, respect for others views, openness to giving/receiving feedback, allowing equal space to share/dominating the conversation, adherence to rules). Implementation of evidence-based substance use disorder continuing care interventions. Federal government websites often end in .gov or .mil. There are a couple people that I've been working with recently in there that I think have probably 9 to 12 months [of sobriety]. A critical challenge for group therapy facilitation was limited clinician experience and training with groups, along with limited organizational efforts to ensure quality control. Nothing. While descriptions of effective group settings are outside the purview of this article, Chapter 6 of Scott Simon Fehrs 2019 text, Ideas to improve group environment or group culture, The most important aspect of receiving feedback is what you choose to do with it. Clinicians emphasized the importance of having considerable flexibility in facilitating groups, which has implications for incorporating EBTs or manualized interventions. Furthermore, they should develop shared goals for group therapy. The implication here is that clients are best helped when they understand the theoretical models that are being utilized and they are able to describe or at least label those models. Each of the dedicated feedback forms reflects the above-described categories: client self-evaluation, group facilitator evaluation, and group culture and environment evaluation. (Alex, New Day). Participants are identified by pseudonyms, along with their respective clinics. The difficulty of navigating differing and shifting stages of change also pertained to clinicians' reported difficulties with utilizing MI principles in groups. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback. This finding converges with implementation research demonstrating that clinicians are more likely to sustainably use EBTs when sufficient flexibility is built into treatment manuals or protocols (see, e.g., Palinkas et al., 2008). Ashley E. Wadsworth recently completed her doctorate in counselor education and supervision from Capella University. The meta-analysis of clinical judgment project: Fifty-six years of accumulated research on clinical versus statistical prediction. Group interventions are used as an alternative, or in addition to, interventions delivered to individuals in healthcare [6, 7] and involve an intervention delivered to small groups of people by one or more group leaders rather than to individuals; this includes activity, support, problem solving/educational and psychodynamic groups, but does not includes task . In addition to cost considerations, a meta-analysis of 24 studies suggested that group therapy is generally equally effective as individual therapy for SUD treatment (Weiss et al., 2004; see also Sobell & Sobell, 2011). Careers, Unable to load your collection due to an error. (Rosemary, Recovery Services), Sometimes there is a guy that's been in the Friday group that tends to kind of go off on weird tangents. To that end, we feverishly sought the feedback of our faculty and peers to enhance our basic counseling skills. (Taylor, New Day). Nonetheless, this focus is clearly a mismatch for SUD specialty treatment settings. The more you become involved in the group, the more likely you are to benefit. Eliciting group feedback allows therapists to curtail client exodus by identifying group members who may be at risk. The predominant role of didactic education was also implicitly communicated by participants in the interviews. These skills include building group cohesion, managing confrontation and conflict, redirecting clients who monopolize group discussion or stray off topic, managing unhelpful advice given from one member to another, and eliciting client participation rather than lecturing (American Group Psychotherapy Association, 2007; Center for Substance Abuse Treatment, 2005; Sobell & Sobell, 2011; Yalom & Leszcz, 2005). National Library of Medicine aDepartment of Psychology, University of Michigan, 530 Church St., Ann Arbor, Michigan, USA, 48109. ; In spite of increased attention to research-based interventions for substance use disorders (SUDs), a formidable research-practice gap impedes the implementation of evidence-based treatments (EBTs). The key principles of cognitive behavioural therapy This approach makes sense for a developmental training process but only if observed clinicians and supervisors are themselves skilled in group facilitation. Eliciting group feedback about their performance as a group therapist is one way to fulfill that objective. Still, it should be noted that open groups have clinical (not just economic) advantages, in terms of new clients with urgent needs being able to initiate treatment more rapidly. Completely. Given limitations in clinicians' experience and skill with group therapy delivery, combined with complexities of and limited resources for group facilitation, it is perhaps not surprising that participants reported frequent utilization of educational groups, whether through lectures, didactic presentations, worksheets, or videos. While group culture is mainly reliant on the makeup of the individuals within a group, the facilitator can guide group norms. Group therapy provides a solution to this problem by allowing for the treatment of multiple individuals simultaneously. Lay out your attendance policy clearly. Mental health problems start early in life. They'll figure out a way and say, This will work, or This won't work. And it has to be up to them. All Rights Reserved. In terms of varying levels of group engagement (discussed by 12 participants), a common problem was groups consisting of both over-engaged and under-engaged clients. The person that wrote [a treatment manual] doesn't know the people in front of me. Empower - a process of encouragement in which clients are urged to try out their identified strengths and refine their usage. Glasner-Edwards S, Rawson R. Evidence-based practices in addiction treatment: Review and recommendations for public policy. Clinicians also expressed that flexibility was important in order to promote group engagement and build group cohesion. I think I observed five or six groups and then a therapist observed me do one group. and transmitted securely. (Alex, New Day) Other clinicians described the importance of this flexibility, using phrases such as doing my little twists and turns (Brett, Recovery Services) or putting my own spin on the material (Karlie, SUD Intensive Clinic). substance use disorder treatment, group therapy, evidence-based practice, qualitative inquiry. First, clinicians' reported experiences at the three clinics for this study may have limited generalizability to other SUD treatment clinics and clinicians. In spite of the high prevalence of group therapy for SUDs in real world settings, research efforts have focused primarily on individual therapy. In discussing the importance of feedback in group settings, it would be negligent not to mention the roadblocks that fragile egos can create. The second clinic, Recovery Services, was operated by a state medical school, and included an intensive outpatient track and a standard outpatient track; its treatment approach was eclectic, with therapeutic orientations varying per clinician. Weiss RD, Jaffee WB, de Menil VP, Cogley CB. Some group SUD treatment studies, particularly for motivational interviewing (MI) and cognitive behavioral therapy (CBT), have been conducted (Crits-Christoph et al., 2013; D'Amico, Houck, Tucker, Ewing, & Pedersen, 2017; Hogue, Henderson, Ozechowski, & Robbins, 2014; Santa Ana, Wulfert, & Nietert, 2007; Watkins et al., 2011). (2019, April 1). Third, SUD Intensive Clinic had a four-week intensive outpatient curriculum, in which clients met three times weekly for 3-4 50-minute sessions of group therapy; the curriculum consisted of 40 unique sessions, each of which was manualized and adapted from EBT protocolswith a focus on CBT and motivational enhancement therapy. With good group skills sometimes. Wells EA, Saxon AJ, Calsyn DA, Jackson TR, Donovan DM. Gifford EV, Tavakoli S, Weingardt KR, Finney JW, Pierson HM, Rosen CS, et al.Curran GM. Group cohesion depends on clients abilities to connect and be vulnerable with the facilitator and other group members. Preparing members to fully participate in group therapy. Group cohesion is the most crucial factor contributing to effective outcomes in group settings. These findings do not bode well for experienced counselors. The Assignment In a 3- to 4-page paper, identify the video you selected and address the following: What group therapy techniques were demonstrated? Clinicians also discussed problems with the inflexibility of some manualized/structured therapies in the context of group therapy. Identified reasons for this gap include organizational barriers (Carroll et al., 2011; Carroll & Rounsaville, 2007), the complexity of SUD treatment (Aarons, Miller, Green, Perrott, & Bradway, 2012; Lash, Timko, Curran, McKay, & Burden, 2011; Wells, Saxon, Calsyn, Jackson, & Donovan, 2010), and clinician attitudes (Knudsen, Ducharme, & Roman, 2007; Manuel et al., 2011). As discussed above, clinical researchers have generally resisted conducting clinical research in group format, due to less experimental control and statistical complexities inherent in group designs. 2023, American Counseling Association. Importantly, most clinicians expressed positive attitudes towards EBTs or manualized therapies (especially to guide new clinicians) but only if sufficient flexibility is permitted. To compensate, for this study care was taken to elicit detailed accounts of group therapy facilitation, including in-depth discussion of a recent session the clinician facilitated. This lapse may be because most group therapy courses do not emphasize the importance of eliciting feedback in group settings. Clinicians emphasized the importance of having flexibility in facilitating groups, through built-in group processes and clinicians' own adaptions and accommodations; this flexibility was especially emphasized for the use of EBTs or manualized interventions. Why such a reliance on education? Inclusion in an NLM database does not imply endorsement of, or agreement with, I think it is easier for me in a session to say, So, I hear that you are really on the fence about twelve-step programming; I have some information about that, would it be OK for me to share it? Than for me to be in a group and ask for permission. One clinician had some satisfaction even if clients could only mimic content. These included a range of processes across clinics, including educational topics, skills training, experiential activities, group discussions, and homework assignments. Communication: Ultimately, you control what, when, and how much you talk about in group counseling. Services were reimbursed through sliding-scale payments, government contracts, and donations; more than half of clients were court-ordered. In addition, by capturing the factors that influence potential dropouts, therapists are given actionable information that can be used to quickly course-correct and ameliorate those clients concerns. For at least three clinicians at New Day and Recovery Services, a focus on education appeared to stem from a belief in the necessity of promoting a disease model of addiction. As the recipient of feedback from group clients, counselors may find themselves struggling to hear and embrace that feedback and should stop to consider the why behind their response. Clinical versus actuarial judgment. Group interventions in healthcare. Typically, groups meet for an hour or two each week. So, what happened? Declaration of Conflicting Interests. A vision of the next generation of behavioral therapies research in the addictions. It is the most widely researched and . Connors GJ, DiClemente CC, Velasquez MM, Donovan DM. Additionally, implementing feedback openly and transparently, in plain view of group clients, completes a healthy demonstration of receiving feedback. These vignettes suggest that clinicians attempt to check the pulse of entire groupswhere the group is atand adjust accordingly. Hogue A, Henderson CE, Ozechowski TJ, Robbins MS. This process necessarily involved seeking regular feedback from group members. Care was taken to provide vignettes that are most exemplary and illustrative of the presented themes, while also being balanced among the three clinics and 13 participants. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Substance abuse treatment: Group therapy. Such a mismatch has clinical implications, in that clinical skills required for quality group facilitation are not obviously transferable from individual service delivery. To run a successful therapy group, you and the other members of the group share responsibility to create a positive atmosphere. As such, the clients sharing that space should have a voice pertaining to the conservation of the reparative atmosphere. Although each clinic operated within organizations that offered a range of SUD services (including residential programs, housing, and detoxification), this study is limited in scope to the specialty adult outpatient services of the specific clinics. To be sure, making clinical decisions on the status of an entire group (e.g., group cohesion) would be consistent with a systems approach to treatment that typically underlies group therapy theory (American Group Psychotherapy Association, 2007); however, in the case of short-term open-enrolling groups (where membership is constantly in flux), clinicians may have difficulty knowing how much to emphasize group-level appraisals versus the individual needs of group members who are most at risk. Group Therapy: Definition, Types, Techniques, and Efficacy - Verywell Mind government site. Participants varied in whether they were concerned about the amount of education in groups. However, as described elsewhere (Author, in press), the three clinics have many commonalities with what is known about SUD specialty clinics nationally (with one notable difference being that the majority of clinicians in this study are social workers, whereas addiction counselors/therapists are more predominant nationally).
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