Session of a Group You Are Leading

¶ … session of a group you are leading and members are giving each other feedback. One member, Jody, an Indonesian woman, says to another member "You know, there are negative feelings that I have been holding onto for weeks -- and before it's too late I think I am going to have to tell you what I've been feeling about you!"

What intervention would you make at this point? Would you encourage or discourage Jody from directing her negative feelings?

The group leader has a responsibility to create and maintain a safe environment where members can interact positively and productively to maximize their health outcomes. Negative confrontations at any of the four stages of group development ruin the calm environment that had already been created, creating room for defensiveness and scapegoating that could turn ugly if left unchecked (Corey, 2012). Based on this, I would intervene by discouraging Jody from voicing out her negative feelings. For instance, I would intercept the impending exchange through a remark such as "Jody, I am wondering how useful it would be for you to continue with this discussion right now…" (Center for Substance Abuse and Treatment, 20045, n.pag). This would give the member time to regulate their emotion and consider the appropriateness of their impending statement(s) at that particular point in time.

There is the risk, however, that in so doing, the leader may fall out with Jody, who may think that the leader is taking the other member's side and is trying to prevent her/him from owning up to his/her wrongdoings. To prevent this, the leader needs to make it clear that they are not intentionally refusing to listen to Jody's views; rather, they are trying to avoid a situation where members push other members away, and the group loses grip on its overall purpose (Center for Substance Abuse and Treatment, 2005). He could point this out, for instance, through a statement such as "my asking you to stop Jody does not in any way mean that I am reluctant to hear you; it's not that at all. It's just that at this point, I am concerned that you might disclose or share more information than you may want to share." This would prevent a situation where Jody feels like she is being pushed away, but at the same time, it would give her the confidence that at least, her opinion matters (Center for Substance Abuse and Treatment, 2005).

There are several reasons why it would be more advantageous to discourage Jody from voicing out her negative comments. To begin with, Jody's comments, if allowed, could create room for scapegoating against the other member, especially if there are other members in the group who share the same opinion as Jody and have not found the confidence to voice the same out. Moreover, this being the final session, and with the participants expected to move their own thereafter, there is the danger that such negative comments could impede on the affected member's willingness or readiness to carry on with what has been learnt in the group. This would make the entire process useless for that particular member. It would be safer, therefore, for the leader to encourage Jody to meet the member with whom she has issues privately and discuss the same with her; after all, the information could help the member be a better participant in other groups in future.

What to say to the group beforehand to lessen the danger of this type of confrontation occurring

As already mentioned, confrontations such as these can be detrimental to group success. To minimize their risk of occurrence, the leader could make it a norm for participants to look out for each other, and never say or do anything that is likely to push other members away (Corey, 2012). In the first session, for instance, as the leader lays out the rules and norms that would govern the group throughout its term, he/she could encourage the participants to always live by the 'do (say) unto others what you would want done (said) to you' principle. In Jody's case, therefore, the overriding principle would be that if you do not wish for your negative side to be aired out in public by another participant, then do not do it to your colleague. Basically, the rule would help avert this, and any other such situations from disrupting the unity and cohesiveness of the group.

Part Two: Case Seven

At the last meeting of a group, Ned, a Native-American man, seems convinced that he will not be able to maintain the interpersonal skills he has acquired in his group. He says "It's easy to get close to people in this group, but that just isn't the way it is in the world. People are supposed to be caring and accepting in group, but in the world most people don't really care. I can't even get close to my son. He doesn't understand this group talk!"

What would you want to say to Ned? Specifically, how would you prepare members for setbacks?

Lapses can be expected for patients who have just completed psychological treatment. Often times, patients are exposed to pressures to return to their pre-treatment tendencies. In this case, for instance, Ned runs a substantially high risk of relapse (returning to the pre-treatment interpersonal communication tendencies); he does not seem to see the value of the therapy that he has just completed in his daily life. He is angry, for instance, about the fact that despite attending the group sessions, he still is not able to communicate and build a relationship with his son. This frustration, if left unchecked, could end up being a trigger for his return to pre-treatment tendencies. Having identified that, the group leader needs to be keen to equip Ned with the relevant strategies and coping mechanisms that would prevent the same from happening. There are a number of possible interventions that he/she could use in this case. The basis of these interventions is to show Ned that the risk of relapse is real, but so are the consequences (Center for Substance Abuse and Treatment, 2006). The therapist needs to explain to Ned that the choice of whether or not to return to the pre-treatment tendencies is theirs solely, but the long-term rewards of maintaining the acquired tendencies far outweigh the immediate benefits of compromise (Center for Substance Abuse and Treatment, 2006). The therapist must be keen, however, not to take too much control of the client's life at this stage, because the final stage is mainly the responsibility of the client -- to test how well they are able to apply the lessons and skills learnt in the group in the context of their own lives.

The first possible intervention at this point is to educate Ned on among other things, the cues to relapse, how relapse could ruin relationships (including that with his son even further), and the resources or support systems that he could use to avert the possible risk of relapse (Center for Substance Abuse and Treatment, 2006). Secondly, the leader could move to help Ned develop an effective prevention plan outlining appropriate coping strategies including joining support group meetings, identifying the good aspects of post-treatment life, and calling the group leader or any other group members regularly if they feel like they are on the verge of relapse (Center for Substance Abuse and Treatment, 2006). Moreover, the group leader could prepare Ned by having them sign a behavioral contract spelling out the post-treatment expectations, rewards to be offered if these expectations are met, and the possible consequences of failing to stick to the contract (Center for Substance Abuse and Treatment, 2006). This would help make real the possibility of relapse, while still keeping the client prepared for the potential consequences of any such happening.

Helping Ned see the important lessons he learnt in the group

As already mentioned, the risk of falling back into one's pre-treatment tendencies is dependent partly on how much they value the lessons learnt in the therapeutic setting. Therapists can, therefore, minimize the risk of relapse by ensuring that clients recognize the importance of the skills and lessons they learn. Therapeutic storytelling is one way through which the therapist could help Ned see value and begin to appreciate the value of the skills and lessons learnt in the group. For instance, he could use specific cases of people, particularly Native Americans, who rose to fame and power as a result of their strong communication skills. These cases would go a long way in giving Ned a reason to hold on to the lessons and skills learnt in the group when faced with potential triggers. Further, it would show that the world, which Ned tends to think, is not concerned about whether or not an individual went through all the trouble of seeking therapeutic help just to be a better person, after all treasures people who can communicate strongly.

Part Three: Essay

Children and adolescents today are an at-risk population owing to lifestyle factors and changing family dynamics. Traditionally, women stayed in the home as men went out to fend for the family. However, with more women now climbing the career ladder and pursuing higher education as an empowerment tool, this is no longer the case in most families. Most families today are led by working parents, and it is commonplace for children to be separated from their biological parents by work-related commitments. For this reason, parents are playing a less significant role in their children's lives, and this leaves the children exposed to peer influences and self-esteem issues. Lifestyle disorders such as obesity are common now more than ever before; and children affected by such disorders become vulnerable to mental disorders such as depression when they are unable to fit into their peer groups or when other children pick at them, and the parents are not available to provide relevant support. These emerging dynamics all point to the need to increase counseling services for children and adolescents. The type of counseling offered will, however, depend on the age and the specific treatment needs of individual patients. Literature has shown group psychotherapy to be appropriate for this population given that it helps children build self-esteem, and at the same time, connect with and learn from their peers. The subsequent sections outline the best practices for designing such groups (with different populations) so that they are able to yield maximum treatment outcomes for children.

Groups for children who have been abused

Children who have been victims of abuse will demonstrate a range of thoughts and feelings related to anger, guilt, shame, loss, sadness, powerlessness, vulnerability, anxiety, fear and hostility (Corey, Corey & Corey, 2008). As such, they may be struggling with such issues as poor self-image, trust and self-esteem issues, and depression. The therapy sessions in such cases ought, therefore, to be focused on rebuilding the child's trust and self-image and reestablishing their interpersonal relationship skills (Corey et al., 2008). Corey and her colleagues propose a number of best practices for structuring group therapy to ensure that it effectively restores the aforementioned aspects of the child's life to normalcy. First, it is prudent that the therapist conduct a pre-group screening to assess the potential children's readiness for counseling and therapy (Corey et al., 2008). Readiness is affected by among other things, the amount of time that has lapsed since the abuse, the level of trauma suffered, and whether or not the child has received any form of individual or family counseling. The authors suggest that if the latter is the case, the therapist obtain clinical case notes from the family or individual therapist to assist in the assessment for readiness (Corey et al., 2008). It is paramount that prior to doing this, the therapist obtain consent from the child's parents, guardians and teachers so that there is no breach of privacy.

Another fundamental best practice has to do with the composition of the group -- it is important that group members are of the same age, gender, and physical size so that participants are not intimidated by each other and the environment is safe for everyone to participate (Corey et al., 2012). It is also recommended that the group members have suffered the same kind of abuse so that children are not re-traumatized by others' experiences.

The setting is also crucial -- success is highly dependent on the effectiveness of the setting used. For very young children, such sessions work best if conducted in a playroom, because then, children are able to relate to 'get their mind off things' through games or relevant toys when overwhelmed (Corey, Corey & Corey, 2008). For adolescents, a playroom may not be necessary; however, the setting should be one that allows participants to free themselves of their anger and frustration through shouting, hitting and banging of things and so on.

Finally, it is recommended that the group sessions be divided into three -- a warm-up section (when members check-in with each other and reflect about their experiences from the last meeting); a work session (which involves open discussions, role-playing, storytelling and free play); and the wrap-up section (where participants share their reactions about the session with each other) (Corey et al., 2008).

A group for elementary school children of divorce and changing families

Children who have been victims of divorce or broken families face a number of mental problems that include feeling responsible for the family problems being experienced, loneliness, and the issue of divided loyalties. In this case, it is prudent that the therapist conducts a needs assessment to determine which of these themes each individual child is struggling with (Corey, Corey & Corey, 2012). This they could do by visiting the classroom, talking to the children themselves, or talking with people close to the children such as friends, teachers, and family. This would help them know exactly what to focus on in their group sessions. It is also prudent to obtain parental consent and make the rules and norms of the group clear to participants. The authors recommend that the therapist make the teacher an integral part of the counseling process, obtaining feedback from her on the child's tendencies in class. This could help in effective monitoring of the child's progress.

Moreover, the number of sessions should be enough to enable the group realize its objectives. It is recommended that the sessions be conducted for a period of 30 minutes, once every week, for a period of not less than six weeks (Corey et al., 2008). Moreover, the sessions should not interfere with classroom activities. For convenience purposes, they could be conducted during lunch hour (Corey et al., 2008).

In regard to the actual program design, it is important that the therapist devise games or platforms that allow the children to express how they feel about their family situation, what they would love to see happen between their parents (for instance, whether they would love for them to get back together), how they feel about spending time with their non-custodial parent, what they would love their parents and stepparents to know, and so on. It is also important that the therapist allow the children to anonymously ask questions that they may not feel comfortable sharing in the group setting.

A school counseling group for 6 to 11-year-olds

Just like is the case with the two groups discussed earlier, therapists dealing with this population need to ensure that they incorporate parents and teachers into their programs as sources of feedback on the children's progress (Corey, Corey & Corey, 2008). For this particular group, the best setting for the therapeutic sessions would be a playroom. The therapist should avail therapeutic toys or make use of games that allow the children to talk loudly, touch, explore, and shout if they are frustrated or angry (Corey et al., 2008).

Moreover, to increase efficiency, the sessions should not be based on counseling alone; rather, they should be geared at providing additional assistance to children to improve their overall well-being. For instance, the therapist ought to look out for evidence of malnourishment, abuse, academic difficulty, and so on and come up with ways of addressing the same so that the counseling process is beneficial to the person as a whole. Moreover, the therapist should be keen to ensure that participation is voluntary, and that each child has some time to meet privately with the therapist to discuss things that they perhaps are not comfortable airing out.