Three approaches to qualitative content analysis. Communicate plans and time increments, and then try to stick with the time frame. Keys to great group therapy Group culture refers to the behavioral norms, attitudes, values and interactions of the members. Consideration of pathological narcissism in group psychotherapy is complex and nuanced. 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. (Karlie, SUD Intensive Clinic). Encouraging Participation in Group Counseling One form of departure (reported by eight clinicians, including five New Day clinicians) was through impromptu accommodations, with clinicians changing course based on what is happening in the current session. Osilla KC, Alexis J, V N, Pedersen ER, Houck JM, D'Amico EJ. One clinician was especially blunt about the lack of quality control efforts in the clinic: What do I think that this place does to ensure that group sessions are high in quality? This research could form the foundation of group MI training efforts, but at the current time we are unaware of research that has examined best practices for MI supervision and training focused specifically on group therapy (but see Osilla et al., 2015, for a study with implications for group MI training). Clinicians reported challenges and complexities with group facilitation. Participants were reimbursed $30 per hour for the interview, and $15 for completing a survey that included demographic information. Contact her at. Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. While group culture is mainly reliant on the makeup of the individuals within a group, the facilitator can guide group norms. 102 Citations 13 Altmetric Metrics Abstract Focus group methodology generates distinct ethical challenges that do not correspond fully to those raised by one-to-one interviews. These vignettes suggest that clinicians attempt to check the pulse of entire groupswhere the group is atand adjust accordingly. Your email address will not be published. Finally, clinicians reported several ways in which flexible group facilitation sometimes required departing from planned material. and self-efficacy should be a key element in interventions to elicit a process of empowerment that may improve recovery and well-being. (Morgan, Recovery Services). You can be expressive with your emotions. Typically, groups meet for an hour or two each week. 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 manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. 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). Theory and practice of group psychotherapy. Group therapy can alleviate feelings of isolation and Carroll KM, Rounsaville BJ. Declaration of Conflicting Interests. 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? Bethesda, MD 20894, Web Policies (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. The three participating clinics (identified here by pseudonyms) were diverse in their operational structures, treatment philosophies, interventions, and types of clientele. 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. Select one of the group therapy video demonstrations In group sessions, therapists adopt culturally responsive practices to build alliance and show support and empathy as the client negotiates recovery challenges. On the other hand, however, it is possible for SUD group clinicians to overemphasize the importance of flexibility. If they remember next week what we talked about, that's a good indicator, too, of how engaged they were. While the word feedback often evokes a visceral response in the person receiving that feedback, it is critical that counselors provide effective treatment to clients in group settings. Hogue A, Henderson CE, Ozechowski TJ, Robbins MS. Knudsen HK, Ducharme LJ, Roman PM. And then I was on my own. 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. In a recent survey of group therapy SUD specialty clinicians in the United States, 69% reported that all of their facilitated groups were open-enrolling groups, with only 10% reporting that none of their groups were open (Author, 2017). 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. Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al.Zweben A. In contrast to individual therapy, clinicians discussed unique challenges with group therapy in terms of group dynamics. Evidence base on outpatient behavioral treatments for adolescent substance use: Updates and recommendations 20072013. If clinical judgments are an unreliable gauge of clients perceptions, how might a counselor calculate clients respective attitudes toward treatment? Although most clinicians endorsed the use of MI (especially for New Day and SUD Intensive Clinic), six expressed difficulties with facilitating MI in groups, in terms of limited experience or difficulty balancing the needs of individuals with groups. engagement of participants in group therapy. I don't think any one thing is going to work 100% for 100% of people. So, what happened? Some part of their mind, it will stick at some point. Second, direct observation of treatment, which was not feasible for this exploratory study, would help to provide a fuller picture of group therapy facilitation, especially in ways that might not match respondents' accounts. 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. Moreover, clinicians may have widely varying sensibilities about when and whether to deviate. Eliciting patient-important outcomes through group - SpringerOpen In particular, effective group therapy facilitation requires greater knowledge about and experience with process beyond mastery of content (American Group Psychotherapy Association, 2007). Finally, thank the client for their openness and vulnerability in providing feedback, effectively reinforcing the behavior. Remember when we were all eager-minded counseling students? Within a group setting, counselors must model the appropriate response for receiving feedback. In other words, to address the potential shortfall of eliciting feedback from group counseling experiences, it may help to go back to the basics. First, consistency of coding was facilitated through the use of NVivo qualitative data analysis software (version 10), used to code textual material and interpret hierarchical relationships between identified themes. 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. (Karlie, SUD Intensive Clinic). the contents by NLM or the National Institutes of Health. (Rosemary, Recovery Services). And especially reviewing that whole disease concept with them. Facilitating group therapy involves a lot of moving parts. This chapter discusses methods for preparing group members for group psychotherapy to help insure full and fulfilling participation in therapy. Second, Recovery Services had a five-week intensive outpatient program as well as standard weekly outpatient groups. Imagine you are leading your own group session. How would you As stated at the beginning of this article, the benefits of group feedback remain absent to therapists who do not ask for their clients input. One clinician had some satisfaction even if clients could only mimic content. Rogers explains, "People are just as wonderful as sunsets if you let them be. Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior. Even counselors with the best intentions can feel bogged down by the cumbersome process of creating new systems to implement change. 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. 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. Evidence-based treatments (EBTs) often are not utilized in treatment settings or lag years behind in their uptake, resulting in clients receiving compromised or potentially harmful care (Carroll & Rounsaville, 2007; Manuel et al., 2011). (Rosemary, Recovery Services). Eliciting group feedback can greatly assist therapists in that capacity. Envision - a method of identifying areas for future development so that goals can be achieved. Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. The 2014 ACA Code of Ethics states that counselors must refrain from causing harm to their clients. A randomized controlled trial of a group motivational interviewing intervention for adolescents with a first time alcohol or drug offense. Inclusion in an NLM database does not imply endorsement of, or agreement with, We interviewed clinicians concerning complexities of group therapy facilitation. Keys to great group therapy. We were delighted with the pursuit of self-improvement and strove to be the best versions of new counseling professionals. Eliciting group feedback about their performance as a group therapist is one way to fulfill that objective. In contrast, active skills practice was reported to be infrequent, primarily limited to mindfulness exercises in some group sessions at New Day and SUD Intensive Clinic, and minimal role playing at SUD Intensive Clinic; these skills were especially utilized in groups based on CBT and third-wave behavioral principles. In particular, because learning through observation is effective only to the extent that the observed therapy is high in quality, clinics would benefit from having clinicians' readiness for group therapy be based on mastered competences rather than mere experience. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. The publisher's final edited version of this article is available at. People that maybe do not feel as open or willing to share in front of other people can just sit sort of in the shadows. At your first group session, prepare clients for the realities and responsibilities of being a group member. For example, it is simpler to teach about CBT principles than to facilitate active practice of these principles in the group itself (e.g., through role playing), especially in large groups. And so again, it's meeting the clients where they are at. PDF Engagement in Group Therapy for Aphasia - COE 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). In this regard, several clinicians expressed concern that rigidity with manualized treatments could impede potential benefits from the group milieu. Tackle teens` resistance to group engagement. How to effectively manage the talkative and silent members of a group . Summarize the management of internal issues that disrupt group therapy sessions. It models not only the behavior but also the intentionality and effort behind the actions. Connors GJ, DiClemente CC, Velasquez MM, Donovan DM. How do clinicians balance treatment structure (including use of treatment manuals) with group process? Let's get somebody else's input. Not that it's not important, but I can kind of see people zoning out. This approach is especially necessary for rural and low-income areas where clinics are often understaffed and have a high volume of patients. Data saturation was repeatedly assessed throughout this process and was generally reached for the major themes reported in this article. In: Wagner CC, Ingersoll KS, editors. Group size generally ranged from 8-12 clients. And so I'll have to kind of, OK, OK, thanks! Because these EBTs are designed and evaluated for use with individual clientsand thus lack explicit consideration of group processclinicians may be prone to simply port content into group format. I agree to keep secret the names of other members of the group and what is said in the group. Group feedback can improve treatment outcomes, which may increase the ability of clients to reach their treatment goals. How would you elicit participation in your group? How to Run a Successful Group Therapy Session - Valant This study consists of interviews with 13 clinicians from three SUD specialty outpatient clinics located in the same metropolitan area in the Midwestern U.S. An integral part of that is identifying, validating and actively addressing the needs and concerns of our clients. 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). Play and Social Participation Listen Play is an important occupation of children. Principle Two. An underappreciated aspect of this research-practice gap is a mismatch in treatment modality: Whereas clinical trials have focused primarily on individual therapy, most SUD specialty treatment is provided in group format (Author, in press). 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. Occasional experiential activities were reported, such as hands-on activities, team-building exercises, or interactive gameseven then, the predominant goal was typically education. A final implication for group facilitation pertains to clinicians' reliance on didactic education within groups. An official website of the United States government. Open-enrolling groups and limited training were factors in reported challenges. Strategies for Group Success | U-M Counseling and Psychological Services Lay out your attendance policy clearly. Inside rehab: The surprising truth about addiction treatment--and how to get help that works. 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. Group therapy for substance use disorders: A motivational cognitive-behavioral approach. Nothing. Third, clinicians relied heavily on didactic educational groups, perhaps reflective of a narrow range of therapy options. A survey and cluster analysis. We were delighted with the pursuit of self-improvement and strove to be the best versions of new counseling professionals. According to an, Identification of areas needing improvement, Ability to address conflicts/disputes/inappropriate behavior, Overall client satisfaction of facilitators performance. 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. To elicit more information from youth, therefore, interviews were conducted with youth and parent(s) together. Ten take home lessons from the first 10 years of the CTN and 10 recommendations for the future. The https:// ensures that you are connecting to the How would you elicit participation in your group? Encourage even quiet learners to accept leadership positions that can help them serve God. And I think it is easier in that way to become disengaged and sort of just like mind drift off. The response vaguely or inaccurately describes anticipated findings in different phases of group therapy, or is missing. Psychotherapy: Understanding group therapy These vignettes suggest that educational approaches may limit clinicians' abilities for facilitating relevant and engaging group sessions. 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]. Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM. I felt unprepared. (2019, April 1). Lash SJ, Timko C, Curran GM, McKay JR, Burden JL. Part and parcel of the initiation of group cohesion is the group culture and group environment. 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. Group therapy is frequently more effective than individual therapy in helping people acquire new ways of thinking, feeling,and behaving. 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. The sample was diverse in gender (67% women), age (range from 25-65 years; mean of 39 years), years providing SUD services (range from 1-45 years; mean of 10 years), and personal recovery status (31% endorsed). Implementing evidence-based psychosocial treatment in specialty substance use disorder care. Finally, we adhered to a 32-item checklist for reporting information from qualitative studies (Tong, Sainsbury, & Craig, 2007).