Group counseling: theory, practice, and applications

Group counseling offers tremendous benefits to clients like Maria when offered as stand-alone interventions or in conjunction with other forms of therapeutic techniques. However, there are major differences between different types, styles, and forms of group counseling. The different types of group counseling include encounter groups, psychoeducational groups, counseling groups, therapy groups, and self-help or support groups. Research has highlighted the efficacy of multiple group therapies specifically for client populations who have endured intimate partner violence or domestic abuse (Sax, 2012). Participation in all types of groups can help Maria to rebuild trust in intimate relationships, while releasing her emotional dependency on her abusive partner. Role playing and other group activities can help Maria build specific communication and behavioral skills, while also reframing her relationship and redeveloping identity and sense of self. Thesis: While all group types increase members’ self-awareness, helping Maria to build the self-confidence she needs to make necessary changes in her life, a psychoeducational group would be recommended in Maria’s case because of its strong emphasis on structure and the potential to integrate cognitive-behavioral techniques.
Psychoeducational groups offer an ideal structure for guiding clients like Maria, who “knows very little about the cycle of domestic violence,” according to the description of her in the case study. Maria’s lack of understanding might preclude her from making necessary changes to her behavior, attitudes, or cognitions. Therefore, a first step in the group therapy process for Maria would be to help her understand what domestic violence is, within a nonjudgmental and supportive environment. As Steckl (2014) points out, “people that attend psychoeducational groups are often high-functioning but have an information deficit in a certain area,” (p. 1). A psychoeducational group would offer Maria the information she needs to overcome her cognitive deficits. Moreover, Maria has claimed that she has few choices in life, indicating a lack of awareness of what she is capable of doing on her own. A psychoeducational group would help Maria to see how remaining in a dysfunctional or abusive relationship prevents her from exploring other options or reaching her highest potential.
If Maria were to participate in a psychoeducational group, she could also benefit from support groups. Support groups might offer Maria “a greater sense of belonging and decreased distress,” (Sullivan, 2012, p. 8). Maria has, after all, expressed a sense of feeling lonely. Her loneliness might cause her to cling to her partner, if she believes that she has no friends or alternatives for emotional intimacy and belonging. However, Maria needs more than just emotional support. Maria would benefit from a supportive psychoeducational group because the client does need to experience fundamental cognitive and behavioral changes. Psychoeducation helps all members of the group reach an understanding about IPV as it affects them, not in a detached or academic way. By listening to other members of the group and their experiences, Maria can see domestic violence from a detached perspective. Gaining a new viewpoint on her own situation, listening to other members of the group can motivate Maria to apply what she learns to her own situation. A support group alone might offer temporary emotional solace and a sense of not being so alone, but Maria needs more than just emotional platitudes. The client needs the courage and wherewithal to set boundaries for herself, and to extricate herself from the abusive situation.
Self-awareness is a goal of all group therapies, and especially in encounter groups. While encounter groups might be helpful, like support groups, they do not necessarily offer the focus or structure that Maria needs to make important and immediate behavioral change. Some of the elements central to encounter groups, such as emotional catharsis leading to feelings of increased connectedness, can be loosely and occasionally incorporated into a psychoeducational group by a skilled facilitator (Sullivan, 2012). As Sax (2012) points out, psychoeducational groups are superior to other types of groups for addressing the complex clusters of issues related to intimate partner violence because they ultimately focus on cognitive-behavioral principles. A psychoeducational group can, for example, help Maria be aware of her own issues and potential mood disorders, leading her to seek further treatment. If Maria were diagnosed with a mood disorder, then a therapy group might be useful. At the moment, a therapy group is not recommended because the emphasis in Maria’s treatment should be on behavioral change.
Like psychoeducational groups, counseling groups can help otherwise fully functioning individuals to achieve growth through self-awareness (Steckl, 2014). Counseling groups can help Maria cope with the feelings she experiences during separation from her partner, but would not necessarily encourage Maria to take the practical steps to leave her partner in the first place. Therefore, a psychoeducational group would be a recommended first step in Maria’s therapeutic intervention. As leader or facilitator of Maria’s group, I would prepare by first exploring the local, community, state, and federal resources and organizations available. The psychoeducational group is the ideal setting in which to offer concrete information for people like Maria: women who might not know that there are alternatives to remaining with an abusive partner. If Maria is afraid to leave her partner for financial reasons, then as facilitator, I would ensure that the client knew about shelters, job placement, and career building opportunities. If, on the other hand, psychological issues were causing Maria to remain in the relationship, I would gather and offer information about specific techniques or steps Maria can take to cultivate the courage to make changes. Mindfulness meditation, for example, could be integrated into Maria’s psychoeducational plan of action.
Groups develop through stages including forming, storming, norming, performing, and adjourning. During the critical forming stage, the facilitator plays an active role in setting the tone for the group and establishing ground rules and structure. During the forming stage, the facilitator outlines the goals of the group, and each member of the group has the opportunity to develop personal goals too. The forming stage is not time for getting too deep emotionally, because it is important to develop trust and solidarity first. The second stage of the group, the storming stage, is when the different personalities and their differences in communication styles might bring conflicts to the surface. During this stage, clients might voice their judgments and opinions of others, leading to interpersonal conflict and the eruption of uncomfortable emotions. As group leader or facilitator, I would need to maintain harmony without sacrificing the potential benefits of allowing members to voice their concerns or be truthful to one another. In fact, all clients can benefit from the frankness and authenticity with which members of the group share their opinions. The goal for Maria is to help her develop the cognitive and behavioral shifts to create a new life without her partner. As she cannot yet envision how she can or will achieve this goal, other members often group might offer her solutions that she might resist or rebel against vehemently at first. If Maria is willing to change in earnest, and devoted to self-awareness, she and the other members of the group can move beyond the storming stage to the norming stage.
The norming stage potentially creates stagnation and complacency, which is why as the facilitator I would need to offer specific tasks and exercises. Sax (2012) presents specific cognitive behavioral techniques and tools, which have been proven in the literature. Cognitive behavioral techniques offer a level of specificity during the psychoeducational process. For example, Sax (2012) suggests exercises that encourage group members like Maria to identify maladaptive coping mechanisms, and to brainstorm solutions that involve changing the ways she deals with stress or uncomfortable emotions. The norming stage usually entails harmonious flow between members, who have developed sufficient trust to share their feelings without feeling threatened.
The performing phase of the psychoeducational group is the cornerstone of the healing process for Maria. It is during the performing stage that members of the group start to take action. The actions each person takes will differ, depending on their specific situations. For example, Maria might need to perform differently by asserting herself better and resisting passive aggression in all her relationships. Alternatively, Maria might need to take action by looking for a new apartment or living arrangement. The type of performance needs to be bolstered by feedback in the group, as well as by self-awareness that leads to meaningful and long-term change. When the group reaches the final, adjourning stage, the facilitator wants to know that each member is prepared to take what they have learned in the psychoeducational sessions and continue on the path towards growth and self-improvement. The lessons learned in the group do not stop after adjournment. On the contrary, Maria would want a plan of action for her future, which might include a three year, five year, and ten year plan of action.
Psychoeducational groups can be helpful in providing specific information about domestic violence. Although circumstances will vary, domestic violence does follow patterns that transcend individual and cultural differences. Issues related to gender, power, control, and manipulation need to be addressed frankly and substantiated by evidence-based practice. A psychoeducational group is therefore recommended for Maria, to help her develop and achieve specific personal goals.



References

Sax, K. (2012). Intimate partner violence. The Group Psychologist 49(2012). Retrieved online: http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2012/11/partner-violence.aspx
Steckl, C. (2014). Which type of therapeutic group is right for you? Mental Help. Retrieved online: https://www.mentalhelp.net/blogs/which-type-of-therapeutic-group-is-right-for-you/
Sullivan, C.M. (2012). Support groups for women with abusive partners. NRCDV. Retrieved online: http://www.dvevidenceproject.org/wp-content/themes/DVEProject/files/research/DVSupportGroupResearchSummary10-2012.pdf