DiscoverCounselor Toolbox PodcastGroup Therapy Leadership Skills and Common Errors
Group Therapy Leadership Skills and Common Errors

Group Therapy Leadership Skills and Common Errors

Update: 2019-06-061
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Group Therapy (TIP 41)

Chapter 6&7

Leadership Skills & Common Errors

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs


Purchase CEUs for this podcast at: https://www.allceus.com/member/cart/index/product/id/1111/c/


Objectives

~ Discuss the characteristics of group leaders.

~ Describe concepts and techniques for conducting substance abuse treatment group therapy.

Leaders Choose

~ 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

~ Constancy

~ Active listening

~ Firm identity

~ Confidence

~ Spontaneity

~ Integrity

~ Trust

~ Humor


~ Empathy

~ Communicates respect and acceptance

~ Encourages

~ Is knowledgeable

~ Compliments

~ Tells less; listens more

~ Gently persuades

~ Provides support

Leading Groups

~ 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

•Preventing enmeshment

•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

•Substance use

•Boundaries and physical contact

~ Leaders help cool down affect.

~ Leaders encourage communication within the group.

Interventions

~ 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.

Confrontation

~ 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

~ 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.

Confidentiality

~ 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.

Integrating Care

~ 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.

Handling Conflict

~ Conflict is normal, healthy, and unavoidable.

~ Major Tasks

~ Handling anger

~ Developing empathy

~ Managing emotions

~ Disagreeing respectfully

Handling Conflict

~ 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.

Subgroup Management

~ 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

~ Silence

~ Tuning out

~ Participating only around the issues of others

~ Fear of losing control

~ Fragile clients with psychological emergencies

~ Anxiety and resistance after self-disclosure

Common Errors

~ 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

~ Observation

~ Sitting in on groups, studying tapes, watching groups

~ Experiential learning

~ Participating in a training group, being a member of a personal therapy group

~ Supervision

~ Ongoing training with groups under the supervision of an experienced leader

Supervision

~ 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


Summary

~ 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

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Group Therapy Leadership Skills and Common Errors

Group Therapy Leadership Skills and Common Errors

Dr. Dawn-Elise Snipes