Counseling Today, Cover Stories

Strength in numbers

Lynne Shallcross September 22, 2010

“Your father’s a jerk.”

In many elementary schools, such a comment might be rewarded with a swift trip to the principal’s office. But in Janice DeLucia-Waack’s group for children of divorced parents, the statement stood as nothing short of a breakthrough.

DeLucia-Waack, associate professor and program director of school counseling in the Department of Counseling, School and Educational Psychology at the University of Buffalo, SUNY, had played a song called “Is It My Fault?” for her group of second-graders. When the song was finished, she asked the kids whether any of them thought their parents’ divorce was their fault.

One hand shot up. “I know it’s my fault,” the little boy said. “My father tells me it is every Friday when he picks me up from school.” Before DeLucia-Waack could swallow the lump in her throat, one of the other group members spoke up with unabashed honesty. “Your father’s a jerk,” the boy’s peer told him. “When you get in the car on Friday, you tell him big people don’t get divorced because of little kids.”

Realizing he was the only one who had responded to his peer’s painful admission, the group member caught himself and said, “Well, that’s my opinion. Everyone else should give their advice, too.” After the other kids in the group added their own words of advice, the boy who felt at fault for his parents’ divorce practiced a few phrases out loud to say to his father.

The following week, the boy reported back to the group. No, he hadn’t told his dad he was a jerk, but he had conveyed the message loud and clear. “When you say that to me, it makes me feel really bad,” the boy told his father. “And I’d like you not to say that to me anymore.”

It was a poignant moment exemplifying the power of groups, says DeLucia-Waack, a member of the American Counseling Association and a past president of the Association for Specialists in Group Work, a division of ACA. “I could say to this kid 10 times, ‘It’s not your fault,’ but the other kids told him, and they told him clearly — ‘You need to say something to your dad.’”

Clear data exist that groups are more effective than individual therapy for children and adolescents, according to DeLucia-Waack, who consults for school districts across New York state on how to lead psychoeducational groups, among other things. In these psychoeducational groups, kids learn skills such as anger management, stress management, coping, communication, problem solving and conflict resolution. “We’re teaching a set of skills that they’re going to need for the rest of their lives,” DeLucia-Waack says.

Although the research differs on group effectiveness for adults depending on the type of group and intervention, many practitioners agree that group work is a valuable tool. ACA member Michael Kahn regularly runs personal growth groups that incorporate film out of his private practice in Charlotte, N.C. At the first meeting, he asks each group member to bring in and share with the other members a movie clip that resonates with the individual in some way. Throughout succeeding group meetings, Kahn assigns particular movies to watch, and group members discuss aspects of these films. Kahn says he looks for movies that have multiple story lines and an array of characters, such as Dead Poets Society or Fried Green Tomatoes, so there’s a good chance that some part of the story or characters will resonate with clients.

Kahn, who also uses film in workshops he offers for other therapists on ethics, grief and self-care, recalls one group member who watched a movie and returned to tell the group she hated it but couldn’t figure out why. After the group discussion, she realized the film spoke to an experience she’d had as a teenager that she’d never shared with anyone. Films often provide a certain level of safety that allows clients to share, Kahn says, because when clients talk about a movie, they are in some ways “removed” from themselves. But at the same time, he says, the right movie can effectively address issues in clients’ lives. “Film just has a way of winding its way past some of the defenses we have set up as individuals and can bring up other things [clients] were pushing away or things they didn’t know were there.”

In Medford, Ore., Jeff Borchers coleads groups through an employee assistance program (EAP) at Asante Health System. An ACA member who also maintains a private practice in Medford, Borchers says his groups are composed mainly of overworked nurses. “Nursing is the place where the rubber meets the road,” he says. “[Nurses are in] extremely stressful positions, and every year, they’re asked to do more with less.” Borchers’ groups, which average about 12 members, are heavily focused on psychoeducation and conflict management.

Many times, Borchers says, the groups are convened over a clash of new versus old — new nurses who are feeling overwhelmed reacting to more experienced nurses who have been on the job for many years and might be case-hardened and gruff in their personal skills. The nursing profession has changed quite a bit through the years, Borchers says, focusing more on quality patient care at the interpersonal level, which involves a more respectful way of communicating.

“There can be a lot of tears and heartache over that,” Borchers says. “Older nurses came up in a completely different environment. It’s a clash of cultures and a clash of generations. The way to resolve it ultimately comes down to empowering the younger nurses to be able to speak up and take a stand when they feel they need to and educating the older nurses on a different style of communicating.”

You are not alone

In addition to psychoeducational groups such as Borchers’ and DeLucia-Waack’s, ASGW identifies three other types of groups: task groups, counseling groups and psychotherapy groups. No matter the group’s purpose and nature, counselor practitioners agree the benefits can be wide ranging.

In addition to his film group, Kahn runs a group called Empty Arms at a local agency for parents who have experienced a miscarriage, a stillbirth or the death of an infant. Groups often focus on topics such as anger, relationships with friends, thoughts of having another child and spirituality. Kahn says the biggest benefit the group provides is a safe place where members will be understood. “They’re with a group of people who get it, who understand what this loss means, who understand that it is a loss,” he says. “They don’t have to explain themselves or defend themselves.”

The group can be especially helpful to those dealing with miscarriage, which parts of society don’t view as a legitimate loss, Kahn says. As an added benefit, group members can see what other mothers and fathers are going through, giving each individual a better perspective on what his or her own spouse might be experiencing. “To be around other folks who are experiencing the same thing gives them so much relief,” Kahn says.

Larry Tyson, associate professor and program coordinator of the University of Alabama at Birmingham Counselor Education Program, agrees that groups are effective in defraying feelings of isolation. “It allows clients to realize that they obviously are not alone in their situation or their dilemma. They are able to listen to people who have similar issues and struggles, as well as similar successes or possible successes.” Tyson, a member of ACA, says groups have the added advantage of offering multiple perspectives rather than the sole perspective of the counselor provided in individual counseling.

Another welcome by-product of group work is the confidence clients can gain from helping their fellow group members, Tyson adds. “It can allow people to serve as models for other folks who might not be at the same place that an individual is. They can share their experiences with other people. They can talk about the struggles or the successes they have had. So just as for the person who’s hearing this, for the person who’s talking about it and sharing, it allows them to acquire a sense of enhanced esteem. It gives them increased awareness of their own self and possibilities because they’ve been down that road.”

Loriann Oberlin, who works in private practice in North Potomac, Md., has experience running various types of groups, including groups for high school girls, women and elementary and middle school children, as well as separation and divorce groups for adults and children. “For children or teens trying to connect in a world where they may feel on the outside looking in, group therapy allows them that chance to feel accepted and understood and to make social mistakes but to also have thoughtful corrections and chances for a ‘redo,’” says Oberlin, an ACA member. “Adults, after working for a while with a therapist, may wish to move beyond one-on-one counseling and solicit peer feedback and connections. They usually feel good as well when they contribute to the group’s process and know they’ve helped a member in some particular way.”

Oberlin points to Irvin Yalom’s therapeutic factors of group therapy, which, she says, explain the benefits that group work can offer. Among these are improved social skills (group members hear feedback on how they come across to others) and instillation of hope (members find through group peers that there is hope for their situation). Another factor, Oberlin says, is universality, or the feeling that “we’re all in this together.” The information-giving aspect of groups helps clients learn from one another, while the altruism factor offers each person a chance to help their peers within the group.

Borchers, who has also been exposed to the positive power of groups during his three decades as a karate instructor, has witnessed powerful transformations at the group level that he doubts would have transpired in a one-on-one setting with a client and a counselor. For one thing, there’s safety in groups, he says, because clients can “lay low” if they feel it necessary. But groups also offer the added benefit of multiple perspectives and life experiences, allowing a client to share what he or she is going through and to hear varied feedback. “To have it come from a group, particularly someone who’s struggling with the same issues you are, that power can’t be duplicated in individual therapy,” Borchers says.

Shedding light on challenges

Oberlin has found group therapy to be particularly beneficial for children and teens with social skills deficits, learning challenges, slow processing speeds, attentional concerns, anxiety or mild to moderate mood disorders, as well as those going through situational stressors, such as their parents’ divorce.

“For adults,” she says, “[groups] can help through a situational stressor such as divorce or life transitions, as well as lack of connection, low self-esteem and for obtaining skill sets — dealing with difficult people, learning to be assertive, overcoming anxiety and sadness.”

Tyson agrees that group work has an array of benefits for diverse client populations, ranging from elementary school students to inpatient residential treatment clients. But it’s crucial, he emphasizes, that the therapist consider the emotional stability and cognitive ability of each potential member of the group. “Good group therapists know that evaluating and screening potential members is always helpful.”

Even group work proponents question the effectiveness of groups with clients in crisis. “If [clients] are needing the focus to be very much on them because they’re in a place of crisis or their needs are such that they would have a difficult time having the spotlight focused on other folks, then individual [therapy] would probably be the right way to go,” Kahn says. DeLucia-Waack, an ACA fellow, agrees. Anyone who is actively in crisis or suicidal is not a good candidate for group work, she says, adding that clients must have the capacity for introspection to be in a group.

For all its benefits, experts acknowledge that group work also poses some challenges. One of the toughest might come at the start — finding enough clients to put a group together. Sometimes, Kahn says, fellow therapists might overlook groups as a resource and refer their clients elsewhere, so it’s up to counselors who lead groups to keep their work in front of their peers. Social/professional networking sites such as LinkedIn are one possible way to let colleagues know about the groups you offer, he says.

Getting clients to show up is a challenge shared by individual and group therapists, Tyson says. Of course, a no-show in group work affects not just the individual client but fellow group members. If a client is habitually late or misses multiple sessions yet maintains he or she is committed to the group, Tyson suggests that confrontation at the group level can be helpful. Tyson says he would ask the group’s members whether they think the client is committed to the group in light of that individual’s actions. Let the group, rather than the therapist, confront the client, he advises.

“For me, one of the challenges — though I try to head it off with a good discussion and handout about groups beforehand — occurs when parents of group members, or even adult group members themselves, decide they will no longer be in group and they don’t wish to plan their last day in group,” Oberlin says. “Instead, they make the decision and sometimes inform the leader the same day as members.” That doesn’t allow for proper termination, she says.

Although many clients and parents of clients respect the rules Oberlin sets out at the beginning of the group, some don’t. “It can come across negatively to terminate abruptly,” she says. “These clients don’t recognize how such a quick decision impacts others. In one case, a girl came back to group the next week in tears because she really felt connected and understood by this person [who left the group suddenly]. It was all so quick and should have been planned better for all concerned.”

Clients’ individual issues can also pose challenges when putting people together in a group setting, Tyson says. That’s why it’s extremely important for the group leader to understand what each client is bringing to the table, he says. For instance, if a client is particularly manipulative in a one-on-one setting with a counselor, the counselor can confront the client about it and they can examine the issue together. But if that client enters a group setting, the manipulation can affect everyone. “Everything is multiplied by the number of people you have in the room,” Tyson says. Rather than the group leader intervening in a circumstance such as this, Tyson recommends letting group members talk about what’s impeding their progress and encouraging everyone to participate in overcoming the problem.

In school settings, time is of the essence and can therefore be a hurdle to effective group work, DeLucia-Waack says, adding that it is essential to have teachers, principals and other school personnel who are flexible. Educating people about the benefits of group work is another challenge, DeLucia-Waack says. “Sometimes people feel like it’s second-rate therapy,” she says. Clients themselves might question why they are being put into a group when a counselor could work with them one-on-one and give their issue undivided attention. “You have to do a lot of education for people as to why, sometimes, groups are even more effective,” she says.

Getting started

Tyson, who coedited Critical Incidents in Group Counseling, published by ACA in 2004, remembers having a strong interest in groups almost from the outset. “I noticed that about myself early in my career, that while I liked individual counseling, I was also fascinated with how people interacted in a group.” He believes that possessing a high level of interest is crucial to being an effective group leader. Although counselor educators can teach students group skills, he advises counselors-in-training and established practitioners to make sure their heart is in group counseling before following that path.

For counselors innately interested in group work, Tyson says the first step is educating themselves. He says running successful groups requires a specific skill set in terms of theoretical orientation, techniques used in a group setting, expected outcomes and the skills required to address the specific issues that clients bring with them to group. “Being a group therapist requires a whole different set of skills — some complementary to individual but [others] additional to individual. You just can’t go out and do group therapy.” The difference between individual and group counseling, Tyson says, is related to managing a set of individuals who might have a common issue but also possess different methods of processing information, sharing thoughts and feelings, and accepting feedback.

Borchers agrees. “The skill set for group work includes, among other things, a subset of what I’d call leadership and team-building skills. That’s because I believe the therapeutic alliance, once made, is often best spent in motivating clients toward change. In individual counseling, it’s usually the therapist’s job alone to provide that kind of incentive. But in groups, there’s always the possibility that motivation comes from another elsewhere in the group. I believe Yalom suggests that we facilitators look for a natural leader to emerge — one who allies with the therapist. Whether this happens or not, our job is to prepare the seedbed for unexpected growth, however chaotic it may appear at first.”

ASGW President Bogusia Skudrzyk, associate professor in the Fairfield University Counselor Education Department, likens the skills needed to lead a group to those needed to lead an orchestra. “Perhaps as group leaders, we are somewhat like conductors who facilitate the rhythm and the beat, as it is up to each group member to give voice to their experiences,” she says. “So, just because someone knows how to play an instrument very well does not mean that he or she can immediately become a conductor. The ‘how’ of group work is equally important to what happens and what we need to know and do.”

At times, counselors might be thrown into the deep end with group work before they’re ready, Tyson says. “What I have found as a counselor educator and as a practitioner is that there are a lot of people who maybe only have one group class and are called upon in their work environment to lead groups. I’m not convinced that’s what you need. People who lead groups and want to do it well have to really work at becoming a good group facilitator. And that requires more than just one course in your master’s degree.”

Tyson remembers an instance in which one of his school counseling interns told him that another intern on the same project site from another university was running a group for children who were displaying self-injurious behavior. “The issue, to me, was how competent are you to run that kind of group?” he says. “Not just in group counseling techniques, but what do you know about that group? Do you feel trained to understand the psychology of that group of people? Being competent about your techniques and the population you’re serving is very important. If you’re not competent, try not to run the group until you become competent.”

Tyson and DeLucia-Waack agree that ASGW is a particularly helpful resource for counselors interested in or already doing group work. DeLucia-Waack points to three sets of standards — training standards, diversity-competency standards and best practices — available as free downloads on the ASGW website at asgw.org. ASGW has also worked with ACA to produce activity books, DVDs and other literature to help counselors, says DeLucia-Waack, who coedited the revised edition of Group Work Experts Share Their Favorite Activities: A Guide to Choosing, Planning, Conducting and Processing as well as School Counselors Share Their Favorite Group Activities: A Guide to Choosing, Planning, Conducting and Processing.

Counselors should also take continuing education classes and workshops and consistently reflect on their progress, Tyson says. In addition, many ACA members and other professionals in the field are highly acclaimed group therapists, Tyson says, so it would pay for counselors interested in group work to identify those experts and read their work. Then, he says, counselors should secure supervision. “Find someone you can talk to who is an experienced group leader and whom you can relate to,” he says. Another helpful tactic, DeLucia-Waack says, is for newer group counselors to colead groups with more experienced professionals.

Nothing can replace the value of practice and supervision when it comes to group work, Tyson says. “You have to get on the bike and do it. You’ve got to practice. You’re going to mess up, but you still have to get on the bike again.” Getting past the initial hesitancy to lead a group is a big step, he says, and that is exactly where supervision comes in, because the relationship allows a new group counselor to talk with an expert about what goes on in the group.

“Let the challenges be your teacher,” Skudrzyk says. “And find a mentor. Someone who is wise, honest and has an open heart, preferably through group work mentoring, too, so that we can keep learning about how we need to keep on changing without ever giving up who we are.”

Effective group leadership

The first piece of advice DeLucia-Waack gives to counselors who are ready to lead groups: Be yourself. “If you’re not genuine, particularly with adolescents, they won’t believe you and they won’t engage with you.” DeLucia-Waack remembers showing her true colors and singing along to some of the songs that were being played during a group session for fifth-graders. The verdict on her vocal skills? The kids laughed at her.

Instead of feeling embarrassed or choosing to suppress her singing, DeLucia-Waack remained open and genuine with the group members, telling them that she really enjoyed singing even though she was bad at it. What resulted was a great conversation about various things the kids didn’t think they could do well but wanted to do regardless. “Those are kind of teachable moments in that way,” she says.

Oberlin says counselors should understand up front that group work is time-intensive. It goes well beyond getting a group together, putting a board game in front of group members and seeing where it all leads, she cautions. “It’s not for someone who doesn’t wish to put planning into it. And, of course, there are progress notes for each individual and claims if you submit to insurance. There’s much time spent organizing, with phone calls to establish a group and extra work if you must cancel or call it off.”

Being even-keeled is another quality that helps in leading a group, Borchers says. “Staying centered and calm is a crucial ingredient to this work, particularly if you’re new to it.”

But there’s no substitute for being prepared, he says, both emotionally and for your clients in their environment. For example, when running EAP groups, Borchers says it’s imperative that he knows who the group members are and what they do in their jobs, the stressors present in their workplace and the specialized language they use in their jobs. “Groups have the ability to set their own pace, so you don’t want to be behind the eight ball on what’s going on,” he says. “If you can’t follow the thread of an argument, you can’t offer much in the way of a resolution.”

Although many counselors might have learned from counseling models not to provide too much structure for clients, DeLucia-Waack believes it’s important to have adequate structure in group work. This allows clients to feel safe and see how groups work while still giving them room to progress, she says.

All of DeLucia-Waack’s groups have an opening segment, a working session and a closing. Groups start at the same time each session so clients will learn quickly that if they’re late, they’ll miss something, she says. Having the closing is helpful because group members learn not to introduce new issues shortly before a group meeting is set to end. That’s part of providing a sense of safety for clients, DeLucia-Waack explains, because they know no one will say something provocative at the very end of the group and get out the door before it can be addressed.

Having an impact

Looking back, Tyson says, “I wish I had realized earlier in my career the power that comes from people being in groups — the power in terms of what they can learn.” After the initial nervousness wears off for clients in a group setting, they share more and risk more, he says. As they receive input from their fellow group members, they go out and try those new ways of thinking or acting in the world. Then they often come back and talk about that experience within the group. “That, to me, is growth, and as a therapist, that’s huge,” Tyson says. “That’s what I wish I had learned earlier on — the power that groups can give people and the impact a group can have.”

Kahn says he loves to see the community created among group members as they learn from one another, reach out to one another and lean on one another. For counselors wondering what kind of impact their group is having on members, Kahn recommends scanning the parking lot after a meeting. It’s a great sign, he says, to look out his window after a session and to see clients chatting with one another in the parking lot instead of hopping in their cars immediately and speeding away. Kahn and one of his colleagues have coined the phrase “parking lot moments” to describe what happens if a group is really clicking.

“To me, it means that the support, the bonding and the community that you’re hoping is being created as a therapist has legs,” Kahn says. “Rather than them all leaving the group and getting in their cars and going off to their separate worlds, the fact that they’re continuing to connect outside the group [is evidence of] the strengthening of the community.”

Just because a community is being formed doesn’t mean that all the clients’ problems are being resolved, Kahn says. But simply feeling less isolated can be a big win for many clients, he says. “To know that they’re starting to reach out to folks who were strangers just a few weeks ago is really powerful and rewarding as a therapist.”

As Kahn and his colleague say to each other, when it comes to group therapy, “The more parking lot moments, the better.”

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org

Group work resources

All of the following books and DVDs can be ordered directly through the American Counseling Association’s online bookstore at counseling.org/publications or by calling 800.422.2648 ext. 222.

  • Group Microskills: Culture-Centered Group Process and Strategies (order #72872), by Allen E. Ivey, Paul B. Pedersen and Mary Bradford Ivey, provides a foundation for training culturally competent group leaders ($49).
  • Critical Incidents in Group Counseling (order #72812), edited by Lawrence E. Tyson, Rachelle Pérusse and Jim Whitledge, provides a means to explore the difficult decisions that group leaders face and the learning opportunities they create for further discussion ($29.95 for ACA members; $44.95 for nonmembers).

The following resources are produced by the Association for Specialists in Group Work, a division of ACA:

  • Group Work Experts Share Their Favorite Multicultural Activities: A Guide to Diversity-Competent Choosing, Planning, Conducting and Processing (order #72891), edited by Carmen F. Salazar, features contributions from experts in group work, multiculturalism and social justice ($35 for ACA members; $45 for nonmembers).
  • School Counselors Share Their Favorite Group Activities: A Guide to Choosing, Planning, Conducting and Processing (order #72885), edited by Louisa L. Foss, Judy Green, Kelly Wolfe-Stiltner and Janice L. DeLucia-Waack, offers 67 group activities for working with children and adolescents in schools ($35 for ACA members; $45 for nonmembers).
  • Group Work Experts Share Their Favorite Activities: A Guide to Choosing, Planning, Conducting and Processing, revised edition (order #78070), edited by Janice DeLucia-Waack, Karen H. Bridbord, Jennifer Sue Kleiner and Amy G. Nitza, presents more than 50 creative group activities ($35 for ACA members; $45 for nonmembers).
  • Celebrating Cultural Diversity: A Group for Fifth-Graders (order #78215), presented by Sheri Bauman and Sam Steen, is a DVD with a complete recording of a six-session counseling group with fifth-grade students ($199).
  • Leading Groups With Adolescents (order #78208), presented by Janice DeLucia-Waack, Allen Segrist and Arthur M. Horne, is a DVD showing nationally recognized group experts working with high school students ($199).
  • Group Work: Leading in the Here and Now (order #79816), presented by Peg Carroll, is a DVD demonstrating how group members learn to participate in the “here and now process” ($150).
  • Developmental Aspects of Group Counseling: Process, Leadership and Supervision (order #79817), presented by Rex Stockton, is a DVD presenting three easy-to-teach segments on the most critical areas in group counseling ($150).

In addition, membership in ASGW offers a wide range of other resources and benefits, including the Journal for Specialists in Group Work. For more information, visit asgw.org.