Enhancing Group Counseling and Therapy Skills | Part 1

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you I'd like to welcome everybody to group therapy which is a product of treatment improvement protocol 41. Today we're going to be going over chapters one and two. Tip 41 they actually did make into an in service which is what I loosely based the next sets of presentations on. And we're going to talk about some of the different ways you can use group and make it beneficial and and helpful and hopefully easier than some other ways of approaching treatment. So in the first part of today's presentation, the goal is to provide an overview of group therapy which is used in substance abuse and mental health treatment. And like I said, I'm loosely basing it on it. But a lot of times the groups that we're doing in substance abuse are the same ones we're doing in mental health. We're going to discuss the uses of group therapy in treatment, define five therapy models, explain the advantages of group therapy, and modify group therapy to treat and address substance abuse issues. So group therapy is awesome because it supports members in times of pain and trouble. It's something that we can make available. The community mental health center that I worked at before and if you've worked in community mental health or even private mental health, maybe a lot of times there are waiting lists to get into iop, to get into php, to get into residential, to get into detox. So one of the things that we started instituting was an intervention level psychoeducational group. So we were able to sort of keep a tab on on people who were on our waiting list. They got on the waiting list and they started coming to these groups that provided them tools, provided them skills. We weren't treating any particular issue. We were really focusing more on life skills, distress tolerance, emotion regulation, all that other DBT kind of stuff in order to help them get through. But it was also enabling us to provide them some hope and keep their motivation going. Group therapy can enrich members with insight and guidance, I found. And one of the reasons I love doing groups so much is because you can ask a question to a group of 10 people and get eight or 10 different answers to it. And the cool thing about that is that each person has their own blind spots. So what they might not have thought about before might still be germane to them and somebody else puts it out there. So when you start putting asking questions and putting the answers on the board or using the flip chart papers and having stations around the room that people go and contribute to the group process. You start getting a lot more feedback from individuals and they're going to come up with ideas and suggestions and thoughts that not only each other had never had. So they're going to enrich each other's lives. But they teach me something every single time. So I loved doing, still do love doing group. And it's a natural ally with addiction treatment or treatment in general. Group therapy enables us to provide a basic framework of information to people in a cost effective manner. You know, there are a lot of things like emotion regulation, distress tolerance, self esteem skills, effective interpersonal communication, relationship skills, self esteem, I may have already said that, that we give to all of our clients, whether it's substance abuse or mental health. And everybody who's coming through the program has this curriculum, if you will, to go through now. It's going to apply a little bit differently to each one. And they're going to take the stuff they get from those groups and they're going to be able to take it back to their individual therap and say this is what I learned in group. If it is just a group process, then they're going to be able to talk among each other and come up with their own ideas. But iop, PHP and residential all have an individual counseling component. If you're doing an intervention level group of 0.05 on the ASAM if you will, you may not have that individual therapy component. So you want to make sure that when you provide members with information and you help them start gaining insight, that you tie it up in a nice little bow at the end and help them apply it. So what did you get out of today's group that could have been helpful last week and how could you have used it? And then go back around the room and say from whatever you got from today's group or what's a morsel you got from today's group that you're going to use next week and how do you expect to do that? So I encourage them to take one or two morsels and figure out how they can use that in their particular life. Little bit of a sidetrack here. In support groups, if somebody is going to celebrate recovery or 12 step group or even a depression or anxiety management group, I encourage them when they walk out of group to be able to answer the question, what was in that group for me? What can I take away from that? Now it may be, I know What I don't want to do, or it may be, that was a great idea that so and so had. But I want them to answer that question every time, not just walk out a group and go, well, that was a good group. Why? Why was it a good group? What did you get out of it? Group therapy, as opposed to self help groups and support groups, if you will, has trained leaders. So you do have a lot more ability to facilitate what's going on and kind of point people in directions that you want them to go. Whereas support groups may have facilitators, but they don't have the training that clinicians do. And group therapy produces healing and recovery from substance abuse and mental health issues. You see a lot of people gain hope. You see a lot of people gain optimism. You see a lot of people learn tools from one another and nobody can con a con, if you will. And I had to figure out a way to say that a little bit nicer than the way I usually do. But when people are in recovery and you can even think about it with your teenagers, if you've been around them or if you have them, teenagers hear what their parents say and they're like, yeah, okay, whatever, old fuddy duddy. But when their parents, when their peers say it, it carries a lot more weight. So sometimes the hope and faith and tools and stuff, stuff that they hear from their cohort has more impact than what we say if we've created a good, supportive, healthy, nurturing environment. So group therapy has a lot of power to it because it's basically like having a bunch of co therapists and the ability to control it a little bit more than in group therapy. You can address factors associated with addiction or these factors by themselves, such as depression, anxiety, anger, shame, temporary cognitive impairment, character pathology, I.e. personality disorders, medication management and pain management. So let's go through these a little bit. Depression groups are wonderful. Now we're going to talk about different types of groups and there's everything from the traditional therapy group where people are sitting in a circle and, or however, usually in a circle and sharing what's going on in their particular situation, all the way to psychoeducational and skills skills groups where we're providing them the tools to understand what's going on and the tools to deal with what they're experiencing. And you know, with depression, one of the groups I'm going to do in depression, well, any of these is to talk about what is it, what causes it, where did it come from, how is it impacting you? And have People start figuring out what that means to them, and then we're going to start talking probably in the next group about what are some ways we can start addressing this and what has worked for you? What. What has worked in the past and what things might you want to try? Temporary cognitive impairment can be addressed in group in the sense that we can provide some life skills coaching we can provide in early recovery and substance abuse, for example. A lot of people come to our groups, or at least where I used to work, they would get out of detox, and they weren't fully detoxed yet. They had two days under them, and the drug was out of their system for the most part, you know, except for like marijuana or benzos. But they were still not on their A game. So getting them to just get there on time, be prepared, pay attention, and process what's going on was huge. We didn't expect to make huge therapeutic gains. But what I wanted was somebody to be able to basically dress up and show up, if you will. Character pathology can be addressed in groups. One of the basic. One of the reasons that Marsha Linehan created dialectical behavior therapy was to address borderline personality disorder. And DBT is very strong on skills groups, now has the individual components and coaching components as well. But she uses the skills groups in order to help people with character pathologies. Borderline personality disorder, among other things, start learning about, what are these symptoms, what do they mean, what does it look like and how can I deal with them? And then they personalize it in their individual sessions. Medication management is huge for me. Whether it's somebody who's on antidepressants or somebody who's on methadone, I really don't care. But I think it's really important for people when they start taking medication, especially psychotropic medication, whether it's addiction or mental depression, anxiety, to be able to go in to a group and talk with others who've been on similar medications, understand the side effects, understand that it gets better, understand what they've done that's helped them deal with the side effects. For example, a lot of my clients used to be on Seroquel. And Seroquel is extremely sedating. So a lot of them found that they needed to take it at night. But I had a small group of people who, when they took it at night, you know, they would go to sleep at like 11, get up at 6:30, and they were still groggy as all get out from the Seroquel, and among themselves, they started talking about, okay, so I need to take it at seven every night in order for it to be out of my system so I can function the next morning. And they worked it out by talking about how long before it starts sedating you and how long do the sedating effects last. But it helped clients stay more compliant with their medication because a lot of times, and not to knock psychiatrists or doctors, but the ones that I've had experience with, for the most part, I've had a couple really awesome attendings. They don't have the patience, they don't have the time in their schedule to hear all of the issues and help the client brainstorm. And a lot of times they don't think to share with the patient. These are the most common side effects that people tell me they experience. Yes, they get the handout from the pharmacist that's like six pages long in eight point font of all the potential side effects. But what really do people feel like when they start taking this? Zoloft is another one. You know, that's one that's really commonly prescribed. And a lot of patients feel kind of like they've got the flu. They feel real dizzy for the first two, three days and then that wears off. If they understand that if they have a place where they can go and talk about the side effects and talk about how to deal with some of the side effects, it helps. And this is also a place where they can talk about things like weight gain and fatigue and lethargy. And how do you deal with this when you're on this particular medication? It doesn't have to be facilitated by a nurse or a doctor. Obviously that's more helpful if it's facilitated by a clinician. What we want to do is encourage patients to become aware of what their potential obstacles are to maintain to remaining med compliant, identify some ways to address it, some interventions that might be effective, and then go talk to their doctor. So they are armed with knowledge when they go see their psychiatrist and say, I'm having these problems. And it also gives them a chance to talk to other people and understand what it actually looks like if the medication is working for them and gives them hope if they have to change 2, 3, 4 times to find the right medication. So medication management obviously is a group that I think is really important if you've got clients that are medicated. Pain management is another one. Pain can cause depression and anxiety. Your body perceives pain as a stressor. So anybody who has pain may experience negative affect, especially if it goes on for a while. So helping them Figure out ways to deal with the pain, ways to deal with breakthrough pain. If you're dealing with somebody who's in recovery, then you're also dealing with the issue of pain management without narcotics. So pain management groups can be helpful for teaching stress management skills, progressive muscular relaxation and sharing non pharmacological interventions that they can discuss with their doctor such as massage, physical therapy, acupuncture, yada yada. It also is a place that people get hope. Again, this is going to keep coming up with group therapy hope because they hear other people's stories and yeah, I hear that after John's accident, he was in agony for six months and he was able to get through it. So they can share and support one another. Groups provide positive peer support for abstinence from substances or addictive behaviors. Remember, we wanted check our clients, assess our clients to make sure they're not engaging in addictive behaviors like Internet gaming, pornography, gambling, food and eating addiction, anything like that. But it also provides positive peer support for positive action in any direction. So if it's growth goals, if it's depression goals, the group is there to cheer you on. They're also there to notice when you're starting to lose your motivation and point it out and help you increase that motivation. Groups reduce isolation. So if you're dealing with someone who's got empty nest syndrome, someone who's got depression, someone who's got an addiction, it helps them understand that they're not the only one dealing with that. And they can share and support enabling the members to witness the recovery or transformation of their fellow group members and see how other people deal with similar problems. Because we all, I mean there's what, 12 people in class today. So if I throw out any problem, I'm probably going to get at least eight or nine different suggestions for how to deal with it. And that's cool. But that's the awesome part about group too, because they can share with each other. What do you do when you can't get to sleep at night? What do you do when the anxiety is so oppressive that you feel like you can't breathe? Groups provide information to clients who are new to the recovery process so they know what to expect. They're not going to be giddy as all get out 24 hours, seven days a week, 365 days a year, probably ever, because that's not reality. But it helps them learn what the recovery trajectory looks like, helps them accept the fact that there are going to be bad days, and it helps them see how they can Be empowered in the process. It provides feedback on group members values and abilities. They're going to hone in on their own values. And I encourage in my groups and obviously from a multicultural perspective, I think it's vital that we encourage members to explore their own values and accept or reject them as they are. And it's not for me to say whether your values are right or wrong, but I want you to know what your values are and make sure that they're yours. Not something that came from the media or something that just kind of popped into your head and you don't know where it came from that you don't agree with. And sometimes that'll come up, especially as it pertains to medication use or controlled drinking or anything like that. But it also provides feedback on their abilities. And this is where I really focus more than values. What is it that you have done already? What are your strengths? If you went three hours yesterday without being depressed and crying, that is really awesome. What did you do? How did you do it? How were you able to do that? And I want to highlight that ability so we can build on it. We want to highlight the exceptions to the problems and offer sort of a family like experience where people get a sense of belonging and support. When groups are run well, even if their skills are psychoeducational groups, when a group member leaves, drops out, relapses, whatever happens, they just, if they suddenly leave, it affects the entire group. When you've got a well run group and a group member graduates or completes treatment, there's still a whole process and sort of a grieving process as that person leaves, the family launches out of the nest. Whatever you want to say, we. The way I've always run groups and the way I was taught was we always celebrate that at the end of somebody's treatment experience. After the last group that that person attends, we have a little bit, a little pizza party or something in order to celebrate. Let people say their goodbyes and have a good sense of closure. A lot of our clients did not have good family experiences. So we want them to have the experience of being supported, being able to have different opinions and disagree with others, but be respected and being able to be cared about. And groups encourage, coach, support and reinforce what they're doing. Well, we don't have to focus on what they're doing wrong. You know, obviously we can talk about that in individual or you know, it may become germane to group, but what we want to do is reinforce what they're doing right. From a management Perspective groups allow a single treatment professional to help a number of clients at the same time. Like I said, there are a core set of groups, educational modules, if you will, that I think all clients need to be exposed to. So group is a great way to do it instead of saying the same thing six times a day to each one of your clients. Having a group available with the advent of media and Internet, just like we're doing right now, Web chat, web groups, you can do some skills based groups. You know, if they're not treatment, you don't have as many issues with confidentiality. But you can also have videos online that you have them watch, learn from, complete a worksheet and then come and participate in a one hour group instead of maybe having to sit through the whole lesson, which is an hour or so, and then participate in the group. So there are a lot of different things that you can do using group techniques in order to reach a bunch of people with one treatment provider in the same hour. Basically, groups add needed structure and discipline because generally the group leader has a certain goal for the group or has a certain style of managing the group. So it can help sort of add a rhythm, if you will, to the group process. Now if we're talking traditional therapy groups, you're going to be sort of like the parent that controls the rhythm of the family. If you're talking skills or psychoed groups, you're going to be setting more of a tone of like the teacher and creating a learning experience. But it adds the structure so people feel safe. They know what they can share, what they're, what's too much sharing or what's inappropriate sharing. And it helps people also learn to bite their tongue, wait their turn. All those other things that can be really helpful in life. They instill hope and a sense that if that person can make it, so can I. So they see people doing a little bit better. Yeah, they also see some people doing a little bit worse sometimes. But that's the, that's an opportunity for them to be able to reach out and provide support. And that helps the person providing support as much as it helps the person receiving it. I truly believe that most people get a sense of contentment, if you will, by being able to reach out and help someone that they are concerned about. It provides support and encouragement to one another outside the group setting. Now this gets a little dicey depending on your groups and your agency philosophy. In reality, in substance abuse groups, the people that are in your group are probably going to be going to the same support group meetings so telling them not to ever contact each other outside of group is unrealistic. They're going to see each other in the community. So it's important to help them understand how to set boundaries and what's okay behavior and what's not okay behavior between group members, other groups, other facilities are less stringent on that and actually encourage the clients to reach out to one another outside of the group setting. So depending on the group, the issue, your agency, all that kind of stuff, there's going to be more or less sharing. What I want to see especially is if you have, for example, an iop, it's three hours, so you're going to have three groups with breaks. I want to see people talking outside a group. I want to see people sharing, not just all sitting in there going, when do we get out of here? I want them to develop relationships and learn how to effectively communicate. So group therapy is not individual therapy done with an audience. It is not a mutual support group. It's designed to help people develop and practice knowledge and skills. In a microcosm, you're creating a mini family or a mini community. It aids patients in learning how to develop healthy, supportive relationships and also how to terminate relationships. Because sometimes when people graduate, they move on. It doesn't necessarily mean that they're going to continue to interact with the clients in the group. All right, so the second half of this class, we're going to look at the group therapy models used in treatment, explain the stages of change, and discuss three specialized group therapy modules that may be used. So stages of change. I've gone over this before for the new people. I'll go over it again real quick. Think about getting into a pool in the summer. It's hot. It's like 90 degrees. You are sweating bullets. Pre contemplation, you're still laying on the lawn chair going, I ain't hot yet. No, I'm not anywhere near hot enough to go near that pool. Contemplation. You're starting to get. Get hot and sweaty, and you're looking at the pool going, you know, that might actually be a nice change. Preparation. You move to the side of the pool and you're dangling your feet in the water, trying to figure out if you're ready to take the plunge because it's cold. I mean, compared to the 90, 90 to 5 degrees that is outside and you know, your 98.6 body temperature, water's cold. So you're preparing action is when you jump in, you're like, I can't take it anymore. I'm too hot. Jump in the pool. Now if that pool is too cold, if it's too painful to stay in there because you're just like, oh, you may jump back out again and back into preparation or further back. If you get in there and get moving and get your body temperature back up, that's sort of basically like treatment and you're getting the swing of things, then you just want to maintain so you don't get cold again. And recurrence obviously is when you get out, you get hot again and go through this process again. So pre contemplation. I ain't got a problem. Contemplation, yeah, I'm a little uncomfortable, but I'm not ready to do anything yet. Preparation, I'm starting to get ready to make a change because this is uncomfortable, but I'm not there yet. Action. I'm on it. And maintenance is keeping your gains and maintaining a steady state. So variable factors for groups, the group leader, group or leader focus. So if you're focusing on part of it is your training, you know, if you are more Rogerian client centered in your training versus cognitive, behavioral versus DBT versus act, whatever your theoretical underpinnings are what you choose to focus on in that particular group. Because there's a lot of stuff we can focus on, whether it's cognitive, physical, emotional, we want to. Another thing that affects it is the specificity of the group agenda. If you're going to have a group and it's on self esteem, well that's not real specific. So we could go 16 different ways till Sunday. If you're looking at self esteem and disarming the internal critic, now that's much more specific for that group. So that's going to really affect what that group looks like for that session or that set of sessions, how similar or different your group members are. If they have a lot of different experiences, you're going to have a different experience as a group leader than if you have a lot of people who have the same experiences. Open ended or determinate duration of treatment. If you've got a group that somebody can join and if they want to stay for 104 weeks, they can stay for 104 weeks. That's up to them versus a group that is 16 weeks long, that's also going to affect how your group goes, what you cover, how connected group members become. I use 104 weeks just to sort of overemphasize. I hope nobody stays in group for 104 weeks. But the level of leader activity I have Seen groups where leaders will throw out a discussion and they're like, okay, topic for today is what do you think about it? And let the group facilitate, sort of self facilitate with a little bit of nudging here and there versus other groups where the leader is very involved and goes around and goes, okay, Sam, what do you think about this? Sally, what do you think about it? And that affects how people react and what they expect. It doesn't necessarily affect what they get out of it, but these are variables which could affect how someone meshes with the group. Not everybody is going to like a real open ended, loosey goosey group. I don't, you know, I'm real structured, so I prefer to be in groups where I know what the agenda is, what we're going to do. My groups, we start out with a review from the last group, that's the first five minutes and check in with everybody. Next five minutes we do a 15 to 20 minute psychoed piece. And then the last, you know, 30 minutes of group I spend going around the room and having people tell me, what is it that you got out of this, what do you think you could, how do you think you could use this next week, etc. And really applying it to what they know. So that's how my groups go. So they're really very structured. Obviously you've got to be able to drop back and punt if a client is in crisis or something really strikes a nerve with them. You know, you might have to change up a little bit. But overall you're sort of setting the tone for what's going to happen in group, the duration of treatment and length of each session. You're going to cover a lot more in a three hour IOP session. And treatment is five days a week for 12 weeks. Then you're going to cover in a treatment program that's one hour a week for eight weeks. Just knowing what you're going to try to cover will affect the depth or the breadth of what you go through. The arrangement of the room also affects how the people interact. If you have them set up in theater style or classroom style, people interact differently than if they're all sitting around in a circle. And if you ever want to experiment with that, it is interesting to notice how much differently people interact and how much more they seem to participate when they're sitting sort of in a circle versus when they're in theater style and they feel like they can hide and the characteristics of the individuals. Sometimes you're going to have people who are really enthusiastic and Chatty. Sometimes you're going to have people who are not. And it could be for a whole host of reasons. It could be a bad fit, it could be they're involuntary. It could be they just got out of detox. It could be that they're all just at that level of clinical depression, that they're having a hard time staying with the group. And it's up to us to adjust in order to try to meet the needs of as many people in group as possible. Now, while I'm saying this, they didn't really say the size of group here. The recommended size of group is 8 to 12 people. If you're dealing with adolescents or people with severe and persistent mental illness, it's more along the lines of 812 for your average group, 15 for psychoeducational and skills groups. Any more than 15, you're really doing a class and not a group. Psychoed groups assist individuals in every stage of change. Pre contemplation, contemplation, yada yada. It helps clients learn about their disorders, their treatment or intervention options, and other resources that might be available to them, such as assistance with prescriptions or physical therapy or whatever other wraparound services we often call it might be available. And they can also be used to provide family members with an understanding of the person in recovery. So family ed groups can be really awesome because then you get to understand and hear what the family thinks is going on and expects is going to happen in treatment and what they're seeing and hearing, and you can normalize for them what's actually going on with the client. So somebody recovering from clinical depression or somebody with bipolar disorder, you know, this is what recovery looks like. This is what living with the disorder looks like. This is what being on this medication looks like. I've had a lot of patients because I deal with mainly co occurring. I've had a lot of patients who have bipolar disorder and, you know, some sort of substance abuse issue. They start taking Seroquel because that seemed to be the drug of choice for our prescribing at that particular time. And they would start acting all groggy and the family would freak out going, you're using again. And so family education groups were a great time for us to educate not only about the disorder, but also about treatment, medications, side effects, and how to interact with the loved one to be as most as supportive as possible. Psychoed groups educate about a disorder or teach a skill or tool and work to engage the clients in the discussion. I don't want to stand up there and lecture, I want them to be able to throw out ideas. So if I say, you know, what is it that you do when you're struggling with somebody because they just grate on your every last nerve, or what are some things you do to solve that problem or to deal with it? I don't want to just tell them everything. I want to do something more Socratic and encourage them to tell me how they work with it. And if they come up with something that's not quite on point as far as being the most effective or healthiest approach, then we'll talk about it and we'll say, well, I'm sure that's worked for you. I'm wondering if, you know, if there's a kinder, gentler way to do it or, you know, kind of massage it a little bit to morph it into something that is useful. We want to prompt clients to relate what they learn to their own issues, including their disorders. You know, how do you. How does this relate to your depression, but also your goals, your challenges, and your successes. Psychoed groups are highly structured and follow a manual or create curriculum. And it doesn't have to be a manualized curriculum that you buy from somewhere. You can create your own curriculum, but you teach the same thing, and it's sequential. And it follows a teach, apply, practice method. So you teach a skill, you have them talk about how they would apply it, how that might apply to them, and then you have them practice it in role plays or imagining how they might use it next week. Basic teaching skills are required for psychoed groups, though, which requires that you understand the basic components of learning. And I call these the 3C's capture, which is how you get the knowledge. I mean, you got to get it into your brain somehow. I am a visual kinesthetic learner. I learned virtually nothing from sitting in lecture classes. I'm off in La La land in about 30 seconds. I know this about myself, so I need to have material that I can see, which is why I do PowerPoints here. Some of y' all might not even be looking at the screen. You may be off doing something else and listening to me. More power to you. However you get the information in your brain is great. Global and sequential. Some people are global. They need the big picture. When they're doing a puzzle, they want to see the box first in order to do the frame and then fit all the pieces in. Sequential. People don't want the box. That's cheating. They look for pieces and put them together and then try to figure out how all the pieces go together to make a hole, and then they're, voila, there's a hole. In order to appeal to both of those at the beginning of group, give an overview of what you're going to cover in group and if you can, sort of a written agenda. It's not always practical. I always tried to put it up on the whiteboard. We always had issues with how many copies we were allowed to make and stuff. So in the interest of saving trees, try to give them some sort of an agenda so they know what the progress is or what they can expect from group. Talk about it so people can hear it. Apply it through role plays. Having them apply it to themselves. Make them manipulate that information in their mind and provide visual representations, like bullet points, of what you're going over. If you can't, if copies, again are an issue, have them bring a notebook and write on a whiteboard so they can see it. So you're presenting information as many ways as possible. Conceptualization is relating the information to building blocks. So if you're teaching a unit on cognitive distortions, then you're going to talk about maybe using extreme words, all or nothing talk. So I might say, tell me about a time that you've said something like, you always do this, and then we're going to talk about how to change that and how, you know, thinking about things that way might be contributing to some of their distress. And then caring. This is the biggest one, which is again why I have clients, when they leave a group, ask themselves, what could I get out of that? Why was that important to me? If they're not motivated to remember it, they're not going to think back to high school biology or College Humanities. Archaeology 101. For me, I learned what I needed to learn for as long as I need to learn it to pass the test. And then I forgot it all because I didn't care about it. So we want them to care or they're not going to remember. So get it in their heads. Help them relate it to something they know and make them care about it. Make them figure out why it's important to them. Foster an environment that supports participation. Encourage participants to take responsibility for their own learning. Use a variety of learning methods that require sensory experiences, which means talking about it, you know, talking about it, listening to it, and maybe drawing. Art therapy. Try to incorporate as many senses as possible. I always find that role plays are a big hit. You can also break up concepts and have. Break up your group into smaller groups and have each of the Smaller groups reteach a concept to make sure that they understand it and be mindful of cognitive impairments. So if you've got someone who is impaired in some way, make sure that you have some sort of method to ensure that that person is keeping up with the rest of the group. If it's a diverse group. Skills development Cultivate the necessary skills to prevent a relapse, depression, anxiety, addiction, achieve an acceptable quality of life. Part of skills groups assume that the clients lack needed skills, such as coping skills, interpersonal skills, communication skills, hence the term skills group. So we want to allow clients to practice skills in groups. Psychoed groups provide the knowledge. And if you remember, in basic treatment planning, it's knowledge, skills, then abilities. So you know it, you learn how to use the skill. And then an ability is the ability to put those skills into practice. So we want them to be able to practice these skills in a safe microcosm. You want to focus on skills directly related to recovery and those to thrive in general. Think about Maslow's hierarchy. They need to get those biological needs met. They need food, shelter, medication, pain management, health, safety and safety from themselves, and love and belonging. So we want to help them make sure they're getting those, not just focusing specifically on depression or anxiety. Skills development groups have a limited number of sessions and a limited number of participants, so everybody can practice. We don't want a big auditorium. We want that 8 to 15 number ideally, and they're used to strengthen behavioral and cognitive resources. Skills groups focus on developing an information base on which decisions can be made and actions can be taken. So when they're thinking, when they practice the pause, and they're trying to decide, okay, what is the best reaction to this current situation? That's when skills kick in and they've got a menu of skills to choose from. Cognitive behavioral groups conceptualize dependence on substances as a learned behavior that's subject to modifications through various interventions, which is a bunch of garbledygook for CBT. Groups really look at using as a triggered behavior in response to pain. You want the pain to go away, and your drug of choice does that. The same is true for self injury or a variety of other symptoms that we see in our patients. So we want to look at what's triggering those and how can we. What are they trying to meet? What need are they trying to meet with that behavior? And how can we help them meet that otherwise? Sorry, my nose is really itchy Today. Work to change learned behavior by changing thinking patterns, beliefs and perceptions and include psychological elements like thoughts, beliefs, decisions, opinions and assumptions. CBT groups develop social networks that support abstinence so the person with dependence becomes aware of behaviors that may lead to relapse and develop strategies to continue in recovery. Now that's for addictions groups for anxiety and depression. The same is true. We want them to have social networks of other people who experience the same diagnosis, if you will, so they can become aware of relapse warning signs when they're starting to become impatient, they're not sleeping as much, whatever their relapse warning signs are for their condition, disorder, whatever you want to call it, so they can develop strategies to stay happy and healthy. Educational devices used in CBT groups include worksheets, role plays and videos and encompass a variety of approaches that focus on changing the way we think and the behavior that flows from it. Like I cannot stand feeling this way can be changed to I really don't like feeling this way, but I know it will change in the next moment. CBT techniques teach group members about self destructive behavior and thinking that lead to maladaptive behavior. We really look at those unhelpful cognitions and the effects of them. How does that impact you in your relationships, the way you perceive the world and your general sense of empowerment and happiness. They focus on problem solving and short and long term goal setting, which a lot of people don't know how to do. Imagine how much better and more empowered people feel when they figure out hey, I know how to do that. I know how to see a problem, develop a plan and solve the problem. And they help clients monitor feelings and behavior, particularly those associated with their diagnosis. Support groups are useful for apprehensive clients who are looking for a safe environment and they bolster members efforts to develop and strengthen their ability to manage thinking and emotions and interpersonal skills. Support groups don't have a trained facilitator necessarily so they're not necessarily, how do I want to say this? They're only as effective as as the effectiveness of the group leader and the health of the group leader. Support groups address pragmatic concerns and generally improve members self esteem and self confidence. They're often open ended with changing members. Encourage discussion about members current situations and recent problems so we're less focused on education and skill building and more focused on what's going on with you today. And they provide peer feedback and require members are accountable to one another. Support groups vary with group goals and member needs and include facilitating discussion among members, maintaining appropriate group boundaries which can be a little difficult especially with untrained there's no trained facilitators there. These groups can help the whole group work through obstacles and conflicts. So if you've got people that are arguing within the group, remember this is a microcosm. This is a little family. Whether it's a support group or any other kind of group, these people meet every week and there are going to be conflicts. So we want to help people work through these and develop acceptance and regard for one another. Support groups ensure that interpersonal struggles among group members do not hinder groups development. So if you've got a relationship budding between two people, not unheard of, or if you've got a huge conflict getting ready to happen between two people, you want to make sure that doesn't interfere with the group process. So you may need to handle that outside of group or, you know, figure out how to address it. Interpersonal process groups recognize that conflicting forces in the mind, some of which may be outside of one's awareness, determine a person's behavior, whether it's helpful or unhelpful. So interpersonal process groups really help people identify the developmental influences and other things that have gotten them to where they are, that influence how they act and react the way they do currently, and bring a lot of stuff into awareness like, oh, that makes sense that I react that way because that's how my mom used to react, or when I did that when I was a kid, I got in trouble for it, or whatever the case may be. Interpersonal process groups delve into major developmental issues, searching for patterns that contribute to the problem or interfere with recovery. Abandonment issues is one that comes up a lot. Looking at the family of origin, their coping skills, we want to learn, what did you learn when you were growing up that you are using now, and how effective is that for you? These groups use psychodynamics, or the way people function psychologically, to promote change and healing and rely on the here and now interactions of members. So we're really focusing on all this stuff that made you who you are and gave you the tools that you have right now. How's that working for you? So there are multiple types of groups that are available to assist clients in achieving their goals. We view current coping skills as creative adaptations to what they've learned and ways to get their needs met. They may not be the healthiest coping skills, but they are serving a purpose. So we want to look at the way clients are coping, acting, interacting, just look at their behaviors and ask ourselves, what's the benefit to that? What's motivating that? Because we always choose the behavior that seems, and I emphasize the word seems to have the most reward to it based on reward and effort. Groups help strengthen the healthy skills, but they also help point out some of the unhealthy ones. And again, a lot of times it has more oomph to it if it comes from a peer as opposed to if it comes from a therapist. Skills required to facilitate groups overlap significantly. A lot of my psychoed groups are also kind of skills groups. I kind of do a psychoed skills blend when I do groups. That's my style though. And it's important for the group facilitator to figure out his or her own style because you're going to set the tone for your group. Not everybody is going to thrive in your group, just like not everybody is going to mesh with you as an individual therapist. But knowing your style and being confident is one of the first steps to having a really strong group experience. Types of groups include psychoeducational, which provides your knowledge, and classroom type format. Skills development provides takes that information, that knowledge, and helps people translate it into skills. Okay, now I know what an unhelpful thought or a cognitive distortion is. What do I do about it? Skills group is the what do I do about it? And let's practice it. So when I have this thought, what can I do? Cognitive behavioral groups really kind of integrate those, but focus strongly on what's going on with the individual and the thoughts. If you think of the ABCs, the automatic beliefs that may be perpetuating or maintaining the unpleasant consequences, and support groups are those groups that are not facilitated by a trained facilitator or by a clinical facilitator. Some groups, like Smart Recovery, the facilitators are trained, but they're not necessarily clinicians and group members are accountable to one another more so than accountable to a group leader. Start group by telling people what they're going to learn and do and why it's useful to them. Make them care, give them that global perspective of what's going to happen, and then go through the information step by step or sequentially so all of your learners are getting as much as possible. Provide an overview of what you're talking about. Have written material. Like I said, if copies are a big issue where you come from, it's not unheard of. Or if you just don't like making lots of Xerox copies, write it on a whiteboard and encourage clients to bring a notebook and write it down. Clients will actually remember things better if they have to write it down because they're going to paraphrase it, which is a form of kinesthetic learning, before they write it down, most likely because they want to write down as little as possible. Discuss the material and apply it. Ask for their input. How do you deal with this? What do you think about this option? How could you use this? How could you have used this last week? And what do you think you might how do you think you might use it next week and give me an example of what that would look like. You can also have them role play. Maybe they're having a particular somebody in the group is having a particular issue with a supervisor or a roommate. You may choose to role play that in group and have them apply a skill that you're talking about. Have each group member close by identifying one thing they got out of group and how they are going to use it in their recovery plan. Again, this brings it back to caring, has them kind of tie it up into a neat bow and be able to walk out with one tool. Give them too many tools in one group and they're going to walk out and none of them are going to get used. You give them one tool and they walk out. They may try to use it throughout the week and then next week in group you can ask them how did it go? If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. 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