how to elicit participation in group therapy

In contrast to individual therapy, clinicians discussed unique challenges with group therapy in terms of group dynamics. How would you elicit participation in your group? Flexible, individualized treatment also was discussed through various, albeit limited, ways in which one-on-one encounters with clients intersected with group therapy. The importance of flexible group facilitation was evident from clinicians stressing the importance of incorporating multiple topics and activities, in order to reach the most individuals. Group size ranged from 5 to over 20 clients, with most groups having between 12-18 clients. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Stay in the loop! In particular, effective group therapy facilitation requires greater knowledge about and experience with process beyond mastery of content (American Group Psychotherapy Association, 2007). In most cases, interviews were completed in one visit (two participants required two visits). What is Client Engagement in Therapy and How to Apply It? As previously identified, feedback can elicit a rather visceral response on the part of the person receiving feedback. Finally, thank the client for their openness and vulnerability in providing feedback, effectively reinforcing the behavior. Structure is really good, but I think there's got to be some flexibility in there too. The therapist's posture towards group members must be one of unconditional positive regard --that is, accepting people as they are, including their group contribution and their choices inside and outside of group. I felt unprepared. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. 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. In discussing the importance of feedback in group settings, it would be negligent not to mention the roadblocks that fragile egos can create. The Assignment In a 3- to 4-page paper, identify the video you selected and address the following: What group therapy techniques were demonstrated? They'll figure out a way and say, This will work, or This won't work. And it has to be up to them. Study results from the Clinical Trials Network's first 10 years: Where do they lead? SUD Intensive Clinic's manualized protocol allowed for this process in the most systematic way, in terms of each session being adapted to stand on its own, with the first 5 minutes (of 50-minute sessions) being devoted to briefly summarizing the therapy's theoretical model (e.g., by briefly reviewing at the start of CBT sessions the interdependent roles of thoughts, feelings, behavior, and environment). The response vaguely or inaccurately describes anticipated findings in different phases of group therapy, or is missing. I don't think any one thing is going to work 100% for 100% of people. However, the vast majority of EBTs and major treatment research studies have been designed for individual treatment modalities (Anton et al., 2006; Connors, DiClemente, Velasquez, & Donovan, 2013; Sobell & Sobell, 2011; Weiss et al., 2004). Interviews were audio recorded and transcribed verbatim according to conventional transcription standards. Having received the Presidents Volunteer Service Award in 2017, she is committed to promoting advocacy for the counseling profession and the military community. As a library, NLM provides access to scientific literature. Furthermore, they should develop shared goals for group therapy. Semi-structured interviews were conducted with 13 group clinicians from among three outpatient SUD specialty clinicsdiverse in their operational structures, treatment philosophies, clientele, and serviceslocated in the same Midwestern U.S. metropolitan area. So I think to me that is why [education] is so helpful, especially when we are describing what is wrong, why they have this problem. Clients are more apt to be open and at ease when they feel safe and unagitated. The https:// ensures that you are connecting to the On the other hand, however, it is possible for SUD group clinicians to overemphasize the importance of flexibility. This chapter discusses methods for preparing group members for group psychotherapy to help insure full and fulfilling participation in 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. Group cohesion depends on clients abilities to connect and be vulnerable with the facilitator and other group members. Because of that, therapists must be even more diligent and mindful of the treatment they provide and the environment they create in conducting group therapy. Where did that drive go? Asking open-ended questions can help ensure clarity; once attained, the therapist should convey their understanding to the client. Facilitating group therapy involves a lot of moving parts. The most frequently reported intersection was ad-hoc one-on-one conversations with the group facilitator (usually immediately after sessions), when clients had individualized needs that were difficult to address in group format. If clinical judgments are an unreliable gauge of clients perceptions, how might a counselor calculate clients respective attitudes toward treatment? These included a range of processes across clinics, including educational topics, skills training, experiential activities, group discussions, and homework assignments. Therapists must be open to receiving feedback with a clear mind and thoughtful consideration of the clients perspective. Group therapy provides a solution to this problem by allowing for the treatment of multiple individuals simultaneously. Glasner-Edwards S, Rawson R. Evidence-based practices in addiction treatment: Review and recommendations for public policy. In addition, certain enduring financial and clinical factors within SUD specialty treatment may further complicate the implementation and use of existing EBTs. Confirmation bias Leniency bias Severity bias Illusory correlation Primary effects Sunk costs Overconfidence Considering the multitude of variables that influence counselors' judgment, it is easy to understand why their judgments about clients' perceptions may be imprecise. As presented above, although clinician participants emphasized the importance of having flexibility in group therapy facilitation, several challenges and obstacles were evident in offering this in group format. Finally, an educational approach may be assumed to be the natural adaptation of existing EBTs for SUDs. Baldwin SA, Murray DM, Shadish WR. And what seems to work is here are all these strangers in the worst positions they are in in their lives, but they start helping each other. An official website of the United States government. Inclusion criteria included being a full- or part-time licensed provider who has facilitated outpatient group therapy for SUDs in the past two years; physicians and non-licensed trainees were excluded, in order to ensure that participants were fully trained to provide psychosocial therapies. For this study we aimed to narrow this gap, by exploring through in-depth interviews clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. Empirically supported treatments or Type I errors? If we were just to kind of follow CBT or do a manualized treatment, there would be no time creating this thing that happens amongst people. Although patients were strongly encouraged to attend group therapy, participation was voluntary. Support your reasoning with at least three peer- reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Finally, we adhered to a 32-item checklist for reporting information from qualitative studies (Tong, Sainsbury, & Craig, 2007). In this regard, several clinicians expressed concern that rigidity with manualized treatments could impede potential benefits from the group milieu. Third, clinicians relied heavily on didactic educational groups, perhaps reflective of a narrow range of therapy options. The 2014 ACA Code of Ethics states that counselors must refrain from causing harm to their clients. And so I'll have to kind of, OK, OK, thanks! Make sure groups and leaders know what you expect from them. Some might propose that the burden is on clinicians to adapt existing EBTs into group formats. At any rate, remarkably little research exists concerning what SUD clinicians do in group therapy, and thus the extent to which a treatment modality mismatch is a barrier in EBT implementation is unknown. Additionally, group feedback provides context as to why certain interventions fail to meet expectations. 1. After full review, this study was designated as exempt from oversight by the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board. Where does that leave us as practicing clinicians? This exploration may be helpful in bridging the gap between research and practice, by informing researchers about clinical complexities that may be neglected in SUD treatment research focusing on individual interventions. Required fields are marked *. The predominant role of didactic education was also implicitly communicated by participants in the interviews. In this study, we interviewed 12 young people who entered . A first step, then, would be to explore clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. So I'm going to try to use whatever I think might work. Clinicians at the SUD Intensive Clinic did report some attempts to link group homework assignments with case management sessions (e.g., suggesting for clients to discuss group assignments with their case managers) but acknowledged that these efforts were idiosyncratic and with limited success. 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. Clinicians discussed several challenges and barriers with providing group therapy in SUD treatment. How would you elicit participation in your group? (Rosemary, Recovery Services). In certain ways, this flexibility was embedded into clinics' existing group programming; in other ways, clinicians needed to make adaptations and accommodations based on individual and group needs. Imagine you are leading your own group session. How would you Group therapy involves one or more psychologists who lead a group of roughly five to 15 patients. To this end, we encourage researchers and clinicians to develop and make widely accessible EBTs that can be flexibly utilized in open groups. Procedures and guidelines for group therapy - APA Divisions Enter your email address to subscribe and receive an email anytime a new article is posted at CT Online. Cognitive behavioural therapy (CBT) explores the links between thoughts, emotions and behaviour. Evidence base on outpatient behavioral treatments for adolescent substance use: Updates and recommendations 20072013. Implementation of evidence-based substance use disorder continuing care interventions. (32%, n = 6) also mentioned that during their participation in the family therapy sessions they learned an appreciation for spending time with . Definitions and Theories At the most basic level, group therapy is: "a form of psychotherapy that involves one or more therapists working with several people at the same time (Cherry, 2017)." 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. Weiss RD, Jaffee WB, de Menil VP, Cogley CB. Group culture refers to the behavioral norms, attitudes, values and interactions of the members. Assuming that group therapy will remain a major aspect of SUD specialty treatment for the foreseeable future, it would behoove researchers, clinicians, and administrators to more explicitly and comprehensively address these challenges. Ashley E. Wadsworth recently completed her doctorate in counselor education and supervision from Capella University. We were delighted with the pursuit of self-improvement and strove to be the best versions of new counseling professionals. Group therapy for substance use disorders: A motivational cognitive-behavioral approach. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. Group client self-evaluation may contain some of the following elements: Being a group facilitator is a weighty responsibility. And one of the common things that they identify is having the ability to take it in a direction or subject where they need to address something at that time. Provide clear instructions to groups and group leaders. But my supervisor has never sat in my group. Factoring in the influence that power differentials have on self-efficacy and perspective-taking (the ability to consider others perspectives), Sherf and Morrison contended that individuals in high-power positions and with increased self-efficacy were less likely to consider the perspectives of others. Miller WR, Forcehimes AA, Zweben A, McLellan AT. 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). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. The meta-analysis of clinical judgment project: Fifty-six years of accumulated research on clinical versus statistical prediction. Second, we adhered to a 15-point checklist for content analysis (see Braun & Clarke, 2006), including guidelines such as, Themes have been checked against each other and back to the original data set, and, All relevant extracts for each theme have been collated (p. 96). I have led adolescent therapy groups for years, and have grown accustomed to hearing phrases such as, "I don't need to be here," "This is stupid," and "Let's get this over with.". Morgan-Lopez AA, Fals-Stewart W. Analyzing data from open enrollment groups: Current considerations and future directions. What practices are most likely to be used? What do you see as the benefits and challenges of group therapy? Practice Guidelines for Group Psychotherapy - AGPA How well do you believe these techniques were demonstrated? Results have implications for evidence-based treatment implementation efforts. This article was written during the second author's tenure as the Katz Family Endowed Chair in Native American Studies at Montana State University in Bozeman, MT; additionally, the second author received fellowship support from the John Simon Guggenheim Memorial Foundation. ; The corrective recapitulation of the primary family group: The therapy group is much like a family in some ways.Within the group, each member can explore how . Having more than one client in a clinical space increases the demands on counselors exponentially. Several participants, especially clinicians from New Day and SUD Intensive Clinic, had minimal group therapy training and experience at the time they were hired. As counselors, it is incumbent upon us to translate that feedback into actionable change to model healthy behaviors and reinforce assertive communication among our clients. Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. So just trying to find information that is relevant to everybody has been challenging. This may be concerning, given that SUD treatment limited to didactic education is generally ineffective (see Gifford et al., 2012; Power, Nishimi, & Kizer, 2005). 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). Participants also were asked about their SUD treatment background and experience (5 items; e.g., What brought you to working here at [Name of Clinic]?); details about a specific group they have facilitated recently (7 items; e.g., What are the major processes, activities, and/or tasks of this group?); and their SUD group facilitation practices generally (5 items; e.g., How can you tell when you've had a very successful group session?). Group members often work on their relationships . It is the most widely researched and . This study aims to narrow this research-practice gap by exploring clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. Two other clinics were considered for inclusion; one declined participation (due to being in the midst of a major overhaul of its programming) and the other was not selected because of costly and lengthy internal institutional review requirements for interviewing its staff. However, in recent years there has been a burst of research on facilitating MI in groups in a variety of contexts, including SUD treatment settings (Crits-Christoph et al., 2013; D'Amico et al., 2017; D'Amico, Hunter, Miles, Ewing, & Osilla, 2013; Santa Ana et al., 2007; Wagner & Ingersoll, 2012). Clinicians stressed the importance of finding a middle ground between standardization and individualized care. Recruitment consisted of visiting staff meetings and/or email solicitations; clinicians were free to decline participation without knowledge of or reprisal from their employers. Evolve - a means of summarizing gains and generalizing strengths beyond therapy. Experience with group process might also be enhanced through discussion or, better yet, role play during clinical meetings and/or between co-facilitators. Motivational interviewing groups for dually diagnosed patients. In some cases this process involved co-facilitation or being observed by a supervisor, particularly for clinicians who initially were student trainees at the clinics. Participating clinics were selected on the basis of being among the largest and most visible outpatient SUD treatment facilities in the metropolitan area. PDF Engagement in Group Therapy for Aphasia - COE In order to provide individualized and engaging care, clinicians universally expressed the necessity of being flexible in their group therapy facilitation. According to this same clinician, socialization through education was viewed as important not only through learning theoretical content but through the use of specific terminology: Hearing them actually use the buzzwords, it is just so exciting! (Karlie, SUD Intensive Clinic). Hogue A, Henderson CE, Ozechowski TJ, Robbins MS. Teenagers are one of the toughest crowds in therapy. 8600 Rockville Pike And I think it is easier in that way to become disengaged and sort of just like mind drift off. This lapse may be because most group therapy courses do not emphasize the importance of eliciting feedback in group settings. Tackle teens` resistance to group engagement. However, clinicians also had challenges with group therapy facilitation, as evidenced by their reported difficulty in managing complex group dynamics, their limited group therapy experience and training, and their reliance on educational groups. To run a successful therapy group, you and the other members of the group share responsibility to create a positive atmosphere. Knudsen HK, Ducharme LJ, Roman PM. The three participating clinics (identified here by pseudonyms) were diverse in their operational structures, treatment philosophies, interventions, and types of clientele. Therefore, responsible group therapists might engender meaningful and transparent ways to facilitate accountability to their clients. 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). So we are basically telling them in those education pieces how to not use, what to do instead. The most important aspect of receiving feedback is what you choose to do with it. We recommend, then, that considerably greater attention be given to training and quality control for SUD group therapy by researchers, administrators, and clinicians. Clinicians' reliance on didactic education is likely not idiosyncratic to this study, as other observers have critiqued the tendency for SUD groups to be more like classes than therapy (see, e.g., Center for Substance Abuse Treatment, 2005; Sobell & Sobell, 2011; Wenzel et al., 2012). Additionally, implementing feedback openly and transparently, in plain view of group clients, completes a healthy demonstration of receiving feedback. Moreover, greater training, supervision, and resources clearly are needed for clinicians in delivering EBTs in group format. In this section, we discuss these themes and their implications for bridging the gap between research and practice, including general recommendations for researchers, clinicians, and administrators. It is a directive, time-limited, structured approach used to treat a variety of mental health disorders. Explain that group treatment revolves . There is strong consensus that pre-group preparation can be profoundly beneficial, not only for prospective members but also for the group as a whole. Encourage even quiet learners to accept leadership positions that can help them serve God. Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence. Many groups are designed to target a specific problem, such as depression, obesity, panic . The first clinic, New Day, was part of a large non-profit SUD treatment organization, with a primary focus on twelve-step principles and community reintegration. While descriptions of effective group settings are outside the purview of this article, Chapter 6 of Scott Simon Fehrs 2019 text, Introduction to Group Therapy: A Practical Guide, serves as a suitable primer. 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. 2. Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. How would you elicit participation in your group? What would you This tension raises the importance of the development of group-based decision-making guidelines for knowing when to deviate and why. WK3 Assignment: Analyzing Group Techniques. As a service to our customers we are providing this early version of the manuscript. Some part of their mind, it will stick at some point. A lot of [the curriculum] is psychoeducational stuff. 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. Wenzel A, Liese BS, Beck AT, Friedman-Wheeler DG. Implementing evidence-based psychosocial treatment in specialty substance use disorder care. I only did seven months of SUD groups in my internship and so, I had minimal experience there. Group Therapy Article 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. I think I observed five or six groups and then a therapist observed me do one group. Fragile egos add a complexity that can exacerbate that reaction, acting as a catalyst that can transform a well-intended suggestion into a perceived character assassination. I understand that everything said in group is confidential. The following results include a presentation of major interpretive themeslimited to those that cut across the three clinicsas a result of systematic coding and thematic content analysis of qualitative data. These recommendations are primarily geared for open groups, in light of the prevalence of open groups as well as the practical barriers in providing closed groups within SUD specialty clinics. What group therapy techniques were demonstrated How well do you.docx This process necessarily involved seeking regular feedback from group members. (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. Might apply it at some point. pixelheadphoto digitalskillet/Shutterstock.com. D'Amico EJ, Hunter SB, Miles JNV, Ewing BA, Osilla KC. 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. This work was supported by the National Institutes of Health (T32 DA007267; T32 AA007455) and the University of Michigan (Rackham Graduate Student Research Award, Edward S. Bordin Graduate Research Fund, Psychology Dissertation/Thesis Grant, and Undergraduate Research Opportunity Program). Client engagement was discussed extensively in terms of limitations of manualized or more structured therapies in the context of group therapy. Finally, clinicians reported several ways in which flexible group facilitation sometimes required departing from planned material. Importantly, most clinicians expressed positive attitudes towards EBTs or manualized therapies (especially to guide new clinicians) but only if sufficient flexibility is permitted. As discussed above, group therapy skills are not automatically transferrable from clinicians trained to work with individualsa realization that dawned on several clinicians from this study as they began facilitating groups. The primary measure consisted of a 32-item semi-structured interview (1.5-2 hours) with each participant, completed between October 2013 and June 2014. Feedback is meaningless unless it is put into action. Carroll KM, Ball SA, Jackson R, Martino S, Petry NM, Stitzer ML, et al.Weiss RD. The interview protocol was piloted with a volunteer student clinician. Nothing. The publisher's final edited version of this article is available at. Sherf and Morrison also argued that individuals who were unable to consider the perspectives of others were less likely to elicit feedback. Distribute cards in advance for written anonymous input. Counseling Today reviews unsolicited articles written by American Counseling Association members. Without external sources of feedback, counselors are left with only their clinical judgments for assessing clients perceptions of treatment efficacy and satisfaction. 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 first author contacted the clinical directors of the three clinics, and each director agreed for clinicians to be recruited. In group sessions, therapists adopt culturally responsive practices to build alliance and show support and empathy as the client negotiates recovery challenges. The third clinic, SUD Intensive Clinic, was an intensive outpatient clinic operating within a U.S. Veterans Affairs medical center; its treatment approach was predominantly rooted in CBT and MI. A major conclusion from this study concerns the wide chasm between real-world group facilitation and the use of EBTs or manualized therapies. 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? I would say groups are my weakest point. According to previous surveys, group therapy is offered by over 90% of SUD treatment facilities (Crits-Christoph, Johnson, Connolly Gibbons, & Gallop, 2013; Weiss, Jaffee, de Menil, & Cogley, 2004) and for many organizations it is the overwhelming focus (Fletcher, 2013). Inasmuch as clinician-observed groups are educational, clinicians may assume that this is simply the way that groups are run; moreover, lecturing to clients likely requires considerably less skill than orchestrating discussion with diverse clients with varying levels of motivation, drawing out the music from the group (see Sobell & Sobell, 2011, p. 191). Completely. Clinicians from each clinic reported that their clinics would like to begin instituting formal outcome monitoring but that they had not yet done so.
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