Remember when we were all eager-minded counseling students? We were delighted with the pursuit of self-improvement and strove to be the best versions of new counseling professionals. To that end, we feverishly sought the feedback of our faculty and peers to enhance our basic counseling skills.
So, what happened? Where did that drive go? According to an article by Cheri L. Marmarosh that appeared in the journal Psychotherapy in 2018, eliciting feedback in group settings is not a common practice among therapists. This lapse may be because most group therapy courses do not emphasize the importance of eliciting feedback in group settings. Where does that leave us as practicing clinicians?
Without external sources of feedback, counselors are left with only their clinical judgments for assessing clients’ perceptions of treatment efficacy and satisfaction. Unfortunately, even for experienced practitioners, these judgments may be inaccurate. A counselor’s ability to make accurate judgments may be influenced by several factors, including heuristics, bias and, regrettably, hubris. Some of the more salient factors that influence therapists’ judgment include:
- Availability heuristics
- Representative heuristics
- Fundamental attribution bias
- Confirmation bias
- Leniency bias
- Severity bias
- Illusory correlation
- Primary effects
- Sunk costs
Considering the multitude of variables that influence counselors’ judgment, it is easy to understand why their judgments about clients’ perceptions may be imprecise. If clinical judgments are an unreliable gauge of clients’ perceptions, how might a counselor calculate clients’ respective attitudes toward treatment? Asking directly about clients’ perceptions may be a prudent step in the right direction. In other words, to address the potential shortfall of eliciting feedback from group counseling experiences, it may help to go back to the basics.
Why feedback is important
Facilitating group therapy involves a lot of moving parts. Having more than one client in a clinical space increases the demands on counselors exponentially. Because of that, therapists must be even more diligent and mindful of the treatment they provide and the environment they create in conducting group therapy. Eliciting group feedback can greatly assist therapists in that capacity.
Group feedback can improve treatment outcomes, which may increase the ability of clients to reach their treatment goals. In addition, group feedback contributes to measurable returns by making it easier for therapists to track the efficacy of treatment interventions. Knowing clients’ perceptions provides therapists with concrete data to assess which treatment interventions are working and which are not. Additionally, group feedback provides context as to why certain interventions fail to meet expectations.
Furthermore, owing to the complex variables at play in group settings, attrition rates continue to be an issue throughout the life span of a group. 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. Eliciting group feedback allows therapists to curtail client exodus by identifying group members who may be at risk. In addition, by capturing the factors that influence potential dropouts, therapists are given actionable information that can be used to quickly course-correct and ameliorate those clients’ concerns.
A pleasant byproduct of actuating a client’s feedback is strengthening the therapeutic relationship. When clients see that their feedback has value and their concerns are real and valid, they may be more apt to trust their therapist and feel less stress in the therapeutic environment. That experience decreases dropout rates and increases group cohesion.
Allow clients to do the heavy lifting by supplying the pragmatic insights needed to improve the treatment being provided and enhance the therapeutic environment. While soliciting client feedback requires applied effort on the part of counselors, asking for feedback requires minimal exertion. Furthermore, while this should go without saying, the benefits of group feedback remain absent to therapists who do not ask for their clients’ input.
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. Even more difficult can be the solicitation of the feedback itself.
According to a research study published in the Journal of Applied Psychology by Elad N. Sherf and Elizabeth W. Morrison in 2020, individuals with high self-efficacy tend to underestimate their need for feedback. Sherf and Morrison also argued that individuals who were unable to consider the perspectives of others were less likely to elicit feedback. These findings do not bode well for experienced counselors.
Factoring in the influence that power differentials have on self-efficacy and perspective-taking (the ability to consider others’ perspectives), Sherf and Morrison contended that individuals in high-power positions and with increased self-efficacy were less likely to consider the perspectives of others. While this research study did not relate specifically to the counseling profession, the results are no less dispiriting. Sherf and Morrison’s study helps to demonstrate the importance of self-awareness, the intentionality required for effective group leadership, how vital perspective-taking can be, and the detrimental impacts of hubris.
Asking clients to evaluate their progress in treatment is a crucial element of group feedback. Because counselors’ views of group clients are usually relegated to a 60- to 90-minute weekly snapshot, the ability to evaluate the minutiae of clients’ daily lives and their interpersonal interactions is significantly limited. Client self-evaluation forms allow group clients to provide a more detailed account of their perceptions of progress toward treatment goals as well as any cognitive, behavioral and social changes. Furthermore, self-evaluation provides group clients with a) an element of personal responsibility for their own treatment, b) the opportunity to practice self-reflection skills, c) a simplified way to identify strengths and areas for growth and d) the ability to visualize their progress.
Group client self-evaluation may contain some of the following elements:
- Behavior changes
- Cognitive changes
- Social/interpersonal changes
- Self-awareness/impact on others
- Identification of strengths
- Identification of areas needing improvement
Group facilitator evaluation
Being a group facilitator is a weighty responsibility. As is the case with all client-counselor relationships, an inherent power differential divides the therapeutic space, no matter how egalitarian the therapist’s views. Within the context of group therapy, the disparity in power dynamics is seemingly magnified by the proportion of clients present. Therefore, responsible group therapists might engender meaningful and transparent ways to facilitate accountability to their clients. Eliciting group feedback about their performance as a group therapist is one way to fulfill that objective.
Group facilitator evaluations might include some of the following items:
- Level of preparation
- Ability to provide relevant information
- Ability to support/challenge clients
- Ability to address conflicts/disputes/inappropriate behavior
- Ability to enforce group rules
- Overall client satisfaction of facilitator’s performance
- Ideas for improvement
Group culture and environment evaluation
In many respects, group dynamics can make or break the success of a group. Group cohesion is the most crucial factor contributing to effective outcomes in group settings. Group cohesion depends on clients’ abilities to connect and be vulnerable with the facilitator and other group members. The development of group cohesion is a process that the facilitator must intentionally and conscientiously nurture. Part and parcel of the initiation of group cohesion is the group culture and group environment.
Group culture refers to the behavioral norms, attitudes, values and interactions of the members. While group culture is mainly reliant on the makeup of the individuals within a group, the facilitator can guide group norms. Eliciting client feedback about the group culture allows therapists to be informed of perceived issues within the group dynamic that may have a negative impact on group cohesion.
The physical environment where the group is conducted is also consequential to the formation of group cohesion. Clients are more apt to be open and at ease when they feel safe and unagitated. Because individuals’ preferences vary and what engenders feelings of safety is different from one person to the next, feedback can contribute to a counseling environment that is suitable to most and mitigates situations or irritants that may hinder group cohesion.
While descriptions of effective group settings are outside the purview of this article, Chapter 6 of Scott Simon Fehr’s 2019 text, Introduction to Group Therapy: A Practical Guide, serves as a suitable primer. Group culture and environment evaluations may incorporate some of the following contents:
- Physical environment
- Security and privacy
- Noise contamination/distractions
- Group members’ behavior (e.g., participation, active listening, respect for others’ views, openness to giving/receiving feedback, allowing equal space to share/dominating the conversation, adherence to rules)
- Ideas to improve group environment or group culture
Receiving feedback is truly an exercise of intentionality and self-awareness. Therapists must be open to receiving feedback with a clear mind and thoughtful consideration of the client’s perspective. Once received, feedback should be acknowledged and the client’s perspective validated. The therapist should focus on what was said and not feel the need to respond immediately or take a defensive posture.
Asking open-ended questions can help ensure clarity; once attained, the therapist should convey their understanding to the client. Next, initiate a dialogue with the client to ascertain their perspective on a possible solution or how they may view a practical improvement to their concern. Finally, thank the client for their openness and vulnerability in providing feedback, effectively reinforcing the behavior. Unguarded gratitude also serves to maintain a supportive group environment and provides a foothold to engender group cohesion.
In discussing the importance of feedback in group settings, it would be negligent not to mention the roadblocks that fragile egos can create. As previously identified, feedback can elicit a rather visceral response on the part of the person receiving feedback. Fragile egos add a complexity that can exacerbate that reaction, acting as a catalyst that can transform a well-intended suggestion into a perceived character assassination.
As the recipient of feedback from group clients, counselors may find themselves struggling to hear and embrace that feedback and should stop to consider the why behind their response. Considering the origin of that resistance may elucidate some unresolved personal challenges on the therapist’s part, which may need individual therapy and supervision to address adequately.
The most important aspect of receiving feedback is what you choose to do with it. Feedback is meaningless unless it is put into action. The 2014 ACA Code of Ethics states that counselors must refrain from causing harm to their clients. One could then posit that counselors are duty-bound to consider and execute relevant client feedback.
Consider the following as potential processes for implementing feedback:
1. Develop a plan
- Define the goal
- Outline steps to achieve the goal
- Determine a timeline
- Consult with peers
- Seek supervision
2. Execute the plan
- Identify a time frame to implement
- Stay on task
- Practice intentionally
- Trust the process
- Elicit group feedback
- Consult with peers
- Seek supervision
4. Reflect on the feedback received
- Identify, acknowledge and confront emotions/bias
- Make a note of impacts to self and others
- Consider what was helpful
- Consider what was not helpful
- Take responsibility
5. Seek individual therapy as needed
One of the most vital roles that a counselor facilitates within the therapeutic space is modeling behavior for clients. Within a group setting, counselors must model the appropriate response for receiving feedback. Additionally, implementing feedback openly and transparently, in plain view of group clients, completes a healthy demonstration of receiving feedback. It models not only the behavior but also the intentionality and effort behind the actions.
Make it actionable
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. Even counselors with the best intentions can feel bogged down by the cumbersome process of creating new systems to implement change.
To ease the transition, ready-to-use group feedback forms are provided to help group counselors implement a new framework for facilitating group feedback. (Scan the quick response [QR] code on the left to access the forms.) These forms can be used as-is or may serve as a helpful starting point to build more bespoke forms better suited to your practice. Each of the dedicated feedback forms reflects the above-described categories: client self-evaluation, group facilitator evaluation, and group culture and environment evaluation.
In summation, counselors practicing in group settings limit their success as effective clinicians by failing to elicit and implement group feedback. The sole reliance on clinical judgments to measure client satisfaction in group settings renders counselors vulnerable to myopic interpretations. This article delivers the framework for a conversational agenda among practicing group counselors to address client concerns that may have otherwise been minimized or overlooked.
All counselors have an obligation to commit to excellence in practice. An integral part of that is identifying, validating and actively addressing the needs and concerns of our clients. The therapeutic space is a shared environment. As such, the clients sharing that space should have a voice pertaining to the conservation of the reparative atmosphere. As counselors, it is incumbent upon us to translate that feedback into actionable change to model healthy behaviors and reinforce assertive communication among our clients.
Ashley E. Wadsworth recently completed her doctorate in counselor education and supervision from Capella University. She is a licensed clinical mental health counselor, a licensed clinical addictions specialist associate and a national certified counselor. Having received the President’s Volunteer Service Award in 2017, she is committed to promoting advocacy for the counseling profession and the military community. Contact her at firstname.lastname@example.org.
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