Counseling Today, Cover Stories

Group effort

By Laurie Meyers May 25, 2015

When a client seeks help, often the focused, tailored nature of individual counseling is exactly what he or she needs. But sometimes there is a particular alchemy in a group.

Many clients benefit from group counseling, either in addition to or instead of individual treatment. Why is that? The counselors to whom we spoke pointed to one element in particular: peer power.

Jonathan J. Orr, president of the Association for Specialists in Group Work (ASGW), a division of the American Counseling Association, thinks that group counseling is always a better alternative than individual counseling. “If you think about it,” he says, “groups are the natural setting for us as Group_Brandinghumans. We are social beings by nature, interactive by nature, and group counseling most closely approximates how we live our lives.”

From Orr’s perspective, it is the intense individual counseling setting — in which clients share everything with a single person — that is more artificial, demanding a kind of forced intimacy. People are not naturally inclined to reveal all of themselves to just one person, he contends. But in a group, clients can choose what to reveal and can also listen and learn from what others share. It also tends to be easier to discuss problems with people who have experienced similar difficulties, Orr concludes.

The groups described in this article focus on specific client populations that counselors determined would benefit most from the group process. These group leaders emphasize that although proper facilitation skills are crucial to the success of the group, many of the most important contributions — and changes — are the result of the participants’ interactions.

Ex-offenders in need of job assistance

When people are released from prison in North Carolina, they are offered services such as substance abuse counseling, help finding affordable housing and money management courses. But one type of service is not offered to these individuals trying to reintegrate into society — a service that ACA member Mark B. Scholl believes is absolutely essential: career development.

Scholl began offering group counseling in career development to ex-offenders this past fall. At the time, he was a counselor educator at East Carolina University in Greenville, and the impetus for forming the groups came from a graduate student who was also a probation officer. The student explained that ex-offenders were not receiving any career guidance and asked Scholl if he could work with them on career development and related career entry skills.

“It just seemed like such a glaring omission when you think about becoming reintegrated into society,” says Scholl, who is also a member of the National Career Development Association, a division of ACA. “What individuals need to feel like they are reintegrated … is a purpose, and work fulfills that purpose for many of us. One of the most important indicators of desistance” — or not repeating the criminal behavior — “is having employment.”

Given those circumstances, Scholl and his student set up a career program for ex-offenders in Beaufort County. The program, designed by Scholl, is promoted by the North Carolina Department of Public Safety, which oversees the state’s probation and parole officers. Scholl also sends fliers to local mental health agencies. The program is open to both men and women, and the length of the participants’ criminal histories varies, he says. Typically, group members have been convicted of substance-related offenses, such as possessing or selling drugs, or other nonviolent offenses. But a few applicants have convictions for weapons charges or other violent offenses. Although this will limit their employment choices, it does not disqualify them from joining the group, Scholl says. However, the group does require that participants be clean and sober, take any mandated psychotropic medications, speak and write English fluently and be either unemployed or underemployed.

Scholl set up a second program in Forsyth County after moving from East Carolina to Wake Forest University. He and his co-facilitators, all of whom do the work pro bono, work with one group of ex-offenders at a time in each program. The groups are small, typically having four to six members apiece. Depending on the group members’ progress, there are six to eight sessions, each of which lasts for two hours. The group meets every three to four weeks and spends one to two sessions on each of the four topic areas: assessment, résumé writing, interviewing skills and job search strategies.

The program starts with a skills assessment. Facilitators and group members work together to identify experiences that can be translated into viable job skills. Scholl and the facilitators emphasize that skills are anything a group member is good at and may even include abilities that the person used in his or her criminal activities.

“You might be really good with numbers, or you might be really good at selling things,” he explains to participants. “You might have been selling things that were against the law, like drugs or stolen merchandise, but you still have those transferable skills and … those are valuable.”

Everyone in the group gets a transferable skills list, Scholl says. “[It] is very comprehensive. It includes different categories of skills like communicating, influencing and organizing, and under each of those categories, there are about 20 transferable skills,” he explains. “Because they’re transferable skills, [it doesn’t] require formal training or education to have them or to claim them.”

For instance, “communication” can include skills such as being a good listener, being good at explaining things or giving directions, being good at persuading and selling or even, in certain contexts, arguing or debating, Scholl says.

Everyone in the group picks three skills and then shares them with the facilitators and group members. These transferable skills will help the participants craft their résumés and also come into play as they learn about the interviewing process.

Scholl and the other facilitators give the group members sample résumés and a list of action verbs to use — for example, coordinate, sell, order, supervise, facilitate, interview — when writing their own résumé lines.

The group facilitators discourage ex-offenders from listing jobs that they held in prison on their résumés but stress that in addition to past paid work, participants can include volunteer work in churches and in the community. Skills that group members gained in prison or while engaged in criminal activity can be listed under the “professional skills” section of the résumé, Scholl says. The facilitators then edit and provide feedback on the group members’ résumés.

The next step in the group program is perhaps the most delicate and difficult: interviewing. Scholl describes the group’s counseling approach as postmodern, and that approach especially comes into play at this point.

“We emphasize that [they] are active meaning-makers,” he says. “Part of the postmodern tradition is that we all have that capacity to construct meaning for ourselves. So, for example, one thing we practice is self-disclosing your criminal record in a way that’s as positive as possible. You make the part where you talk about your mistake and your bad choice brief and concise, and you own that you are fully responsible. But you quickly move on to emphasizing that you’re not letting it [the mistake] define you as a person.”

Group members can then delineate the steps they have taken to improve themselves. By presenting their pasts in this way, they become the authors of their past experiences, Scholl explains.

Group members also prepare for interviews by constructing narratives around their strengths and what they can contribute to a company. Facilitators teach participants to use the acronym STAR (situation, task, action, result) to build these narratives, Scholl says.

For example, if wanting to demonstrate a strength such as sales or planning skills, the group member might tell a story about a time in high school when he or she was asked to sell magazine subscriptions door to door (situation and task) and made a plan to go to 10 houses each day after school for a week (action). As a result, the group member sold 35 magazine subscriptions and raised X number of dollars toward the purchase of uniforms for the high school band (result).

Another application of STAR could be a story about when the group member worked in a laundry setting (without emphasizing that it was the prison laundry) with a co-worker who wasn’t pulling his or her weight. The group member reasoned with the co-worker and, as a result, the team member’s work improved, Scholl says.

Group members write their STAR narratives and break up into pairs to role-play, taking turns being the interviewer and the interviewee, Scholl explains. They then give each other feedback on how to make their stories more compelling or clearer, asking questions such as “Why was this a strength?” or “What was the outcome?” Participants then reassemble to get feedback from the facilitators and other members of the group.

Scholl and his facilitators emphasize the importance of the STAR narratives to the group members. “We talk about … when you are interviewing for a job, things like your GPA or how much money you made in your last position, that’s not the kind of thing that makes you a memorable applicant,” Scholl says. “It’s the stories you tell. If 150 people apply [for a job], the one or ones with the most compelling stories are going to be unforgettable.”

The last stage of the group program involves job search strategies, which includes information about the importance of the informational interview, how to conduct an informational interview and how to approach someone for such an interview, Scholl says. But the strongest emphasis during this portion of the group is on self-presentation, including grooming and hygiene, he says. The facilitators also stress to group members the importance of being polite and friendly to everyone they encounter, because they never know when they might re-encounter someone in the job search, Scholl says.

Scholl acknowledges that he doesn’t possess much hard data on the overall efficacy of the group. But he says he can point to tangible products such as résumés — many group participants now have one for the first time. He and his facilitators also have anecdotal evidence, such as hearing that “Doug” got a job last week or “Mike” is going back to get his two-year degree so he can acquire the training necessary to work in a field in which he has a strong interest. Former group members also come back to sessions to share what they got out of the program.

“We recently had a woman come back to say that she was going to get her four-year degree,” Scholl recounts. Although the woman had been sober for several years prior to participating in the career group, she also credited the group with helping her maintain her sobriety.

For Scholl, this demonstrates why the value of group counseling goes beyond its curriculum or resources. The true value is in group members experiencing mutual support. “I think there is so much power in the ability to role-play with a peer and to view the group as an alliance of peers that can bring information, ideas and support,” he says.

When the caregivers need care

Laura Kestemberg is the director and associate dean of the newly established clinical mental health counseling master’s program at Molloy College in Rockville Centre, New York. For the past few years, she has been researching stress in parents of children with autism. Along with fellow ACA member Laura DeGennaro, Kestemberg joined Molloy’s initiative to launch an interdisciplinary autism center.

As Kestemberg and DeGennaro, the clinical director and clinical coordinator, respectively, of the proposed autism center, worked with these children, they identified another group that needed help — the children’s parents. The social and behavioral impairments that accompany autism cause challenges that permeate almost every aspect of a family’s life, Kestemberg notes. “Parents [of children with autism] feel very isolated and ashamed and that it’s just them,” she explains. “Sometimes it’s been them [alone] battling with the school system or battling with providers.”

Parents of children with autism often experience a lack of social support, Kestemberg says. It’s not uncommon for friends and family members to pull away, and even if they don’t, it’s difficult for them to truly understand what the family is going through. But parents of other children with autism do understand, Kestemberg says, which makes a group counseling approach particularly helpful for them. In addition, group counseling has been shown to be very powerful for populations experiencing high levels of stress.

Both Kestemberg and DeGennaro had previously worked with parents of children with disabilities. “So we decided to put our heads together and try to have a clinical intervention for the parents,” Kestemberg says. They approached John Carpente, executive director of the proposed autism center and director of the Rebecca Center for Music Therapy at Molloy College, about providing this clinical resource for parents and collecting data on parenting stress.

As they were developing the group, Kestemberg and DeGennaro assumed they would run across other groups that focused on supporting the parents of children with autism, but that wasn’t the case. “We found that there were a lot of advocacy groups and a lot of parent training groups,” Kestemberg says. In training groups, counselors help parents learn to manage the child’s acting-out behaviors or show parents how to help the child manage in the school setting. “But it’s always about the child,” Kestemberg stresses. “We wanted … to do something where they could come to a group and [we could] say, ‘We’re going to talk about you — the parents, not your child. And we’re going to provide you with the strategies to help reduce your stressors.’”

Kestemberg and DeGennaro struggled with determining when to hold the group. They finally decided on the summer, when most children were still in summer camps, during the middle of the day. Evening groups were too difficult to coordinate because many of the parents didn’t have good child care options, and Kestemberg and DeGennaro didn’t yet possess the resources to offer child care while the group met.

Participants were recruited from the Rebecca Center and other local organizations that provide services to children with autism. Kestemberg and DeGennaro conducted a telephone intake interview with each parent. Although they wanted the group to include fathers, the mothers had greater availability. They ended up with a group of five women who met for 90-minute sessions 10 times throughout the summer of 2014.

Kestemberg and DeGennaro started each session by going around the circle and asking each woman to update the group on the most important things that had happened during the past week. At first, the women were more likely to bring up problems their children were having. “We tried to steer them toward what was going on with them or how what was going on with their child affected them,” Kestemberg says.

At first, it was difficult for some of the group members to open up. “The mindset was, ‘If I let a little bit out, I just won’t stop crying,’ or … ‘I’ll have so much anger that I’ll blow people away,’” Kestemberg recalls.

Little by little, as Kestemberg and DeGennaro reassured the members that the group represented a safe place with others who were going through the same challenges, the women began to share. They talked about very painful topics, such as deciding whether to have another child, feeling alone in their marriages or yelling at their offspring and how ashamed they felt about doing that in the face of the child’s disability. “And other women in the group would say, ‘You know, I’ve done that too,’ or ‘I also think my marriage isn’t going so well,’” Kestemberg says.

As the women shared, an important concept became evident to each group member: “You are not alone.” In turn, this helped the group work toward the goals that Kestemberg and DeGennaro had set for the parents, which included:

  • Feeling more empowered
  • Decreasing their feelings of guilt
  • Decreasing their stress levels
  • Becoming more aware of their own needs
  • Learning to use more positive coping strategies

The experiences the women shared weren’t just helpful emotionally but practically as well, Kestemberg says. For example, one mother expressed concern about going in front of a school district special education committee to talk about her child. These meetings involve educators, service providers and parents getting together to decide how best to meet the needs of the child. However, the gatherings can be emotionally charged because these parents often feel like it is a struggle to obtain the proper services for their children. Going in front of the committees, they feel the burden of having their facts straight and presenting a compelling case concerning why their requests for their children are valid.

In the case of this mother, the other group members suggested role-playing to help her prepare. Several of the other mothers had already gone through similar hearings, Kestemberg explains.

Another common experience the women reported was feeling like they had to gird themselves before entering the house upon returning home. “A lot of our moms … said, ‘I’m so stressed that I can’t go right into my house. I sit in my car, have a cup of coffee, listen to the radio or do what I have to do before I have to face the chaos of what’s going on in the house,’” Kestemberg reports.

To help them cope with these overwhelming moments, DeGennaro and Kestemberg taught the mothers mindfulness techniques such as meditation, deep breathing, observing thoughts, mindful eating and walking, body scans and guided imagery. They also closed each session with a GROUP THERAPYmeditation or relaxation exercise and asked group members to practice the mindfulness techniques themselves as homework. Kestemberg and DeGennaro also informed the mothers about mobile apps for relaxation such as Stress Tracker, Breathe2Relax, MindShift and Take a Break! Guided Meditations for Stress Relief.

But so much of the benefit from the group came from what its members gave to each other, like offering to role-play, Kestemberg says. “[The group] was much more powerful than meeting with a therapist or mental health care provider one-on-one because they were with other moms who had gone through it,” she emphasizes.

The group ended up being a mix of mothers with children who were very young and newly diagnosed with autism and mothers whose children were as old as 18. Kestemberg and DeGennaro initially thought it would be best to separate participants by age or level of severity of diagnosis, but because the total number of recruits ended up being so small, there was a need to combine them. This was a serendipitous necessity because it allowed the mothers with children who were newly diagnosed to see that there were other mothers who had “survived” and flourished throughout the school years.

These shared experiences resulted in a strong bond forming among the group members. The mothers would email each other between sessions to trade resources or just to offer support.

Kestemberg and DeGennaro conducted both pre-group and post-group parental stress assessments but did not find a significant decrease. However, they think that the mothers’ experience of opening up and actually acknowledging what they were going through may partly account for the results. Acknowledging the strain may have changed the way they reported their stress levels, DeGennaro explains.

This was only a pilot study, but DeGennaro and Kestemberg already have a waiting list for this summer’s groups. They intend to increase the number of sessions and plan to measure participants’ coping styles and levels of loneliness, anxiety, depression, subjective well-being and hope.

Helping kids at risk of dropping out

How can schools help students who are struggling academically and at risk of falling behind or even dropping out? When ACA and ASGW member Jonathan Ohrt was an assistant professor in the counseling and higher education department at the University of North Texas (UNT) in the Dallas-Fort Worth area, he worked with groups of students to teach them skills that could help them succeed. UNT had an agreement with two area middle schools to work with students the schools deemed to be at risk for dropping out. Students qualified as at risk using a combination of teacher recommendations and items from the Texas Education Agency’s at-risk factors, which include not maintaining an average of 70 in two or more subjects in the previous or current school year and having multiple suspensions.

Ohrt and his team had researched which elements were most predictive of students’ academic success or failure. Although GPAs and test scores typically receive the lion’s share of attention, Ohrt found that social and emotional factors played larger roles. Armed with these findings, Ohrt decided to use the Student Success Skills (SSS) curriculum (designed by counselor educators, researchers and ACA members Greg Brigman and Linda Webb) because it has shown success with factors such as goal setting, self-regulation, academic self-efficacy and engagement. The curriculum also focuses on factors such as social skills, overall health and well-being, and physical activity. Although the curriculum features elements of psychoeducation, Ohrt believes the practical elements of goal setting and peer support are most crucial to group members’ success.

Ohrt and his co-facilitators led three different groups, each containing six to eight students, at the two middle schools. The groups ran for eight weeks with one 40-minute session per week.

The first session was spent on introductions, with the students getting to know one another and the facilitators. The second session was psychoeducational in nature, with the leaders talking about the life skills that are related to being successful, such as goal setting, progress monitoring, memory skills, managing attention and managing anger. The SSS curriculum includes worksheets that explain the life skills areas, and the facilitators went over these with the students to help them identify areas they needed to work on.

After that, the students set goals and worked on maintaining them, which provided the focus for sessions three through seven. The group leaders helped the students visualize setting and achieving goals. “Talk to the students about what their goal might look like and what the concrete steps are,” Ohrt advises. “As a group leader, you need to be able to visualize what would help them succeed [and] what is going on that is causing them not to succeed.”

Ohrt likes to use solution-focused counseling during this process, prompting group members with questions such as, “Did you have a time when you were doing well in school? What was going well? What changed?” He adds, however, that implementing solution-focused counseling isn’t a requirement for leading such a group. Counselors can use their preferred theoretical orientation to help group members visualize their goals.

Generally, Ohrt says, each group member chooses just one goal on which to focus because making small, specific adjustments over time tends to be the most sustainable path to success. Typical goals include:

  • I’m going to complete my homework on time more often
  • I’m going to spend X number of hours preparing for my math tests
  • I’m going to focus on paying more attention in class
  • I’m going to work on controlling my anger

The students paired off at the beginning of each session and talked about the progress they had made with their goals. Then the entire group convened again, with each student again sharing his or her progress. If certain group members were having difficulties with their particular goals, the other students often shared what had worked — or what hadn’t worked — for them. If no one offered a possible solution, Ohrt or the other facilitators spurred discussion by asking questions such as “Has anyone struggled with that?” or “Have any of you heard something else that another student did that you might want to try?”

Session eight, the final session, served as a general wrapup of the group, with students talking about what they had learned and how they had progressed.

Ohrt and his team tested for three elements both before and after the groups: self-regulation, perceived academic efficacy and self-esteem. The results showed that although the students’ self-esteem had not improved, they had made strides in both their self-efficacy and self-regulation. When the team repeated the testing two months after the groups concluded, however, it found that the students had gone backward a bit on their improvements. Ohrt thinks that holding brief booster sessions every few months after a group ends might help to maintain the students’ gains.

Ohrt is now working as an assistant professor of educational studies at the University of South Carolina, where he is supervising graduate students leading similar groups in several area schools.

 

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To contact the individuals interviewed for this article, email:

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

1 Comment

  1. Lisa Mardis

    We are looking for a licensed counselor to volunteer some of their time for a group counseling session or sessions for individuals suffering from a rare disorder called trimethylaminuria. Many have been abused, harrassed, and discriminated against just like me. Many have now displayed suicidal thoughts and depression. I have this disorder and started a text group, private facebook group, website. Thank you so much as I do not know how to handle thid, and they do not trust anyone outside the group.

    Reply

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