I’m not sure what the power of group work is all about, but I do know that group counseling offers intense experiences for those who engage the dynamic of group psychotherapy. Because of the intensity that crescendos at times in group therapy, this approach is not for everyone. I do believe that group therapists should interview possible candidates for group work, assessing whether or not each individual is a good fit for group dynamics. There is not a hard cut method to eliminate all possible problematic clients, but at least a meeting one-on-one with potential members before the group is established gives therapists a possible look at any interpersonal concerns that could disrupt good group interaction.
Group counseling can be designed to help various individuals who experience a wide array of concerns. I have in mind three types of group work I would like to offer clients. I will label each type as follows: 1) interpersonal dynamics and personal growth; 2) group dynamics for social anxiety; and 3) group dynamics for values exploration. I will provide a short discussion of each of these group topics respectively. First, I will offer some thoughts on face-to-face meetings with clients previous to their beginning group therapy along with some ideas about assessing prospective group members as to whether or not group counseling would be a good path for them.
Assessing Clients for Group Counseling Fit
Although the diagnostics that revolve around personality disorders are controversial at times, I do think descriptions of potential interpersonal dynamics that the DSM-V offers associated with personality disorders can be helpful in determining the potential fit for prospective members for group counseling. The emotional dysregulation that accompanies those who are diagnosed as Borderline does not bode well for process oriented group therapies. The group skills work that DBT offers these clients is the best pathway for them until they can better regulate their emotions and then pursue process work in therapy if they so choose. Obviously therapists would want to rule out potential members who evidence antisocial or narcissistic tendencies. Dependent personality disorders can also prove problematic where interpersonal relating is key to group work. Those people who might be considered by some as fragile, not open to others’ feedback, and lack the ability to be self-critical would be better served by individual therapy until they are ready for group dynamics.
Those individuals who experience psychoses, intense anxiety disorders, severe depression, and struggles with eating disorders may not be ready for group work as well. On the other hand, group work can be helpful for these individuals if they engage group therapies that specifically deal with these particular diagnostics. I don’t believe a diagnosis of these disorders should automatically rule out one’s ability to engage group work.
The face-to-face interview for potential group members should focus on several interpersonal dynamics. How well does an individual articulate his desire for wanting to engage group counseling? Does the interviewee appear open and honest about her needs? Is the individual self-critical about areas where he wants to pursue personal growth? If someone merely wants to meet people, then he or she should pursue social networks rather than group counseling. Group settings are not the place to find someone to date. Even those who have experienced therapy in the past, and group therapy in particular, may be too therapy savvy, looking for a place to show off their therapy know-how rather than legitimately seeking group counseling because they believe it might help them.
There are many other things to think about regarding the pre-group therapy interview. At the same time, as a therapist, one doesn’t want to overthink the assessment. After all, individuals are unique in their interpersonal strengths and those areas where they think they need improvement. I simply want to see how a person engages conversation with me in a way that I would feel he or she would be interesting to work with in a group dynamic. Group counseling involves a context where people can be glaringly honest with one another. So individuals need to possess somewhat of a strong ego at the outset while simultaneously possessing the willingness to open themselves to possible areas of growth and improvement.
Types of Group Counseling
There are countless foci out there around which group therapists shape their work. Therapists might shape the group work they do according to a particular diagnostic, such as Major Depression or Social Anxiety. Therapists also can work with particular populations of individuals. Group work can be designed for those who have reached retirement age, those who have recently gone through a divorce, and those who are facing some type of bereavement and grief. Therapists usually design group counseling around those areas in which they are interested and experienced. I have in mind three types of group counseling that I would like to offer clients: 1) Interpersonal dynamics and personal growth groups; 2) group dynamics for those who experience social anxiety; and 3) group dynamics for values exploration. I would structure each of these types of groups so that they contain no more than eight members, and the time limit of each group would entail eight weeks. Hence, these are not long-term groups in my mind, but they are long enough for people to accomplish some specific goals.
Interpersonal Dynamic and Personal Growth Groups
What immediately comes to mind when one thinks about this type of group work is the old encounter groups associated with Carl Rogers. Others might be more familiar with Irvin Yalom and the type of group work he designs. Although influenced both by Rogers and Yalom in my reading and study of their work, I would add some structure and get some idea of specific goals that people have for wanting to engage this type of group. Interpersonal growth groups allow people to interact in ways that they discover things about themselves and others, mostly derived from how they relate to members in the group. Historically these types of groups can be ongoing for quite some time, and they can either be closed or open-ended groups, the latter allowing for the introduction of new members from time to time. These types of groups allow people to work out some of their concerns revolving around interpersonal relationships, be they intimate, family, or close friendships. It is the type of group counseling that calls on people to learn more about themselves as they engage others. Thereby they also may learn how to better relate to others. Interpersonal interaction, giving and receiving feedback from others, and honing a self-critical eye about how and what one wants to change in his or her life form the core work of this type of group. The eight-week time limit that I would place on these groups make them quite different from the old encounter groups developed by Rogers and the interpersonal psychotherapy groups that Yalom led. The tasks of the therapists is simply to facilitate interpersonal interaction among group members.
Group Dynamics for Social Anxiety
Over the years that I have worked as a private practitioner therapist, I have worked with numerous individuals who experience social anxiety. It appears more prevalent in society than people would anticipate. Cognitive Behavioral therapists have worked with all anxiety disorders in terms of what they call exposure therapy. Clients confront the very objects or situations that cause anxiety to overtake them. If an individual experiences intense anxiety when driving over bridges, and thereby becomes unable to do so, then therapy proceeds in working with the person to do just that, drive over bridges. Such exposure work may entail flooding, whereby the person jumps headlong into the pool of anxiety that threatens him. If clients are not willing to engage flooding, therapists and clients strategize some step-by-step process through which clients can at their own pace approach angst producing situation. The first approach is called flooding, and the latter approach is called systematic desensitization. For those individuals who experience social anxiety, the group itself is the exposure treatment because those who are socially anxious seek to avoid social situations, especially those social contexts where they do not know people. Group work is ready made for the type of exposure that might help clients face and deal with their social fears. Those who are socially anxious excessively fear negative evaluation from others, so the interpersonal dynamics in this type of group will become important in helping individual members receive feedback about how others perceive them. Obviously such interpersonal dynamics can be risky, and one of the major tasks for the therapists is to squelch any dialogue that approaches verbal attacks and abusive words hurled from one member to others.
Group Dynamics for Values Exploration
Values exploration has become an important component in various types of therapy from a variety of modalities ranging from existential work to Acceptance and Commitment Therapy (ACT). The work entails the search that individuals carry out regarding what they believe to be their core values that guide how they want to live out their lives. In most ways, we are doing just that all the time, but we may not be aware of the core value off which we are operating. As well, we may claim to hold a particular core value, but we have never thought it through as to why it is a core value. Moreover, we may sense that there are too many times that we act in ways that are not in alignment with what we claim to value. Work around such experiences may involve trying to uncover why we are failing to live in alignment with our core values, or as important, therapeutic work may lead us to question do we in fact believe what we claim to believe. Alignment between what we claim to value and how we act in our lives is one of the major goals of values exploration. Values exploration is premised on the notion that a life of fulfillment is based on such alignment. Although we are never perfect in this alignment, for many people it is a worthy goal to pursue. The notion that the good life entails the fact that we say what we mean, and mean what we say is a strong value that pulls at many people. Moreover, we hope to claim that we act in ways that we claim to believe. As described here, this type of group work entails an overall specific regimen that then allows individuals to establish goals for their lives based on what they conclude in terms of their search for core values. The tasks of the therapist may be more structured than the other two types of groups, specifically in the beginning when group members are seeking to decide what they believe their core values to be. Many therapists utilize Q-sorts to engage clients in the work of values exploration.
The above descriptions of the three types of group work that interest me are necessarily short, and their discussions in no way tap all the concerns that therapists face in designing group work. The general concerns for therapists who lead groups are always present. I purposely didn’t discuss those because this particular blog is not an introduction to group therapy. Rules for group dynamics, methods and techniques, and group leadership or facilitator style always remain important reflections for therapists who want to engage group work. Single leader/facilitator versus co-leaders/facilitators is also an important position that group therapists want to consider.
As I stated above, I determined these three types of groups based on my interests. I also think that, for whatever reasons in the evolving process of therapy, these topical themes appear to be ones that are popular in today’s therapeutic world. People still want to learn how to develop interpersonal relationship skills. Devastation and avoidance of life fulfillment due to social anxiety is a constant reminder of how prevalent this concern is in today’s social climate. And values exploration has become a hot topic along with the practice of mindfulness. For these reasons, it is important that as therapists we shape well-articulated reasons for how we work with these concerns. Likewise, it is important that we find ways that generate good outcome when it comes to this type of work. Popularity can indeed breed onslaughts of mountebankery. I believe group therapy designed around these concerns can and will generate good therapeutic outcome. Like any other type of work in the therapeutic world, we should attend to the research and work of other therapists. Also, we must possess the attitude that we want to assess as best we can the outcome of our work. That’s easier said than done many times.
John V. Jones, Jr., Ph.D., LPC-S/September 14th, 2018