Facilitating Open Ended Groups
Dr. Dawn-Elise Snipes compares closed, open-ended, and single-session therapeutic groups, showing how open-ended groups admit members rapidly but require facilitators to compress group development phases each week. She walks through session structure: orientation, check-ins, topic tied to members' challenges, multisensory teaching, role-plays, and application planning, with rotating 12-16 topic curricula and activities like collages and board games.
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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 today's presentation on facilitating open ended groups. I am Dr. Donnelly Snipes. During this presentation we're going to define closed, open and single session groups. Real quick just to kind of hit the highlights. We'll explore the benefits and challenges for each. Again, hitting the highlights because most of us in our careers are going to end up doing a little bit of all three Will identify the developmental phases for open groups which are relatively similar to closed groups, just a lot faster and discuss necessary skills for managing open ended groups. So closed groups are those which begin with a group of people and don't add anybody else. So like a 12 week anxiety management group, it starts on June 1st, it runs for 12 weeks. Once it's starting, nobody enters and ideally nobody drops out and then the next group starts 12 weeks later. A single session group is a standalone group in which participants are not expected to return. A lot of these things can be like your four hour workshops, your intensives if you will. It is a group in which all of the phases of development and progress are supposed to take place in that one day. Open groups are those which don't have a set number of sessions and participants regularly rotate in and out. I worked in community behavioral health for many, many, many, many years and we had open groups. Our residential facility, we had four groups a day, every single day and as new people came onto the unit, they would join the group. There was no closed group where you couldn't access it until a certain date. We had to become very adept at being able to facilitate these types of groups. So in especially in settings or in long term care settings, this is going to be the norm. The other place where we see a lot of open groups is in support group sort of settings where you've got people who will rotate in and rotate out. Very rarely are your support groups a 12 week and done sort of thing. Some people stay on for a year or two years or more in the case of for example 12 step groups and other people come, they get what they need in four, six weeks and they're out. The benefits of closed groups participants all begin at the same time and learn the same material. So you can go through a curriculum just like you're teaching a class and you can build off of what you did last week when everybody begins together. The developmental Process occurs in a predictable way. You have your forming, Norming and performing forming. People are kind of jockeying for power, figuring out, you know, who has the power in the group and how everybody fits together. Norming is when you're obviously setting group norms. Everybody's kind of settled in and they're. The group machine, if you will, is starting to. Starting to function and get warmed up and get ready to go and then performing. The group machine is functioning at full capacity. Participants in closed groups often form more intimate bonds because they're there, you know, that first week, maybe the first couple of weeks they're getting to know each other, but by the sixth week they are really familiar with each other and it's the same group of people. So there's not a building of trust that has to take place. The drawbacks to closed groups, as people leave, there's no replacement. So if you start out with 12 and you have four people drop out, then you have those four seats that are not billable. If you want to look at it from a financial perspective, there's often a waiting period for people to get into groups, which is not ideal for emergent issues. If you've got somebody with major clinical depression and you want to get them enrolled in groups and the next closed group doesn't open for six weeks, well, they need something before that. And in a lot of agencies, because of capacity issues, we use open groups, as if you will, placeholders to provide services to people until an individual therapist slot opens up. So closed groups can be challenging from that perspective too. If you really need to get somebody in and if you don't have enough people to make a group, you know, you have three people when it's time for the group to start, you may not think it's financially feasible to facilitate that group for 12 weeks. And enclosed groups, generally when people drop out, they can't return. So if they leave after the third week, they're not going to be able to come back. In the eighth or ninth week, they're going to have to start over again. Single session groups can be really, really useful. If you do, for example, a four or eight hour intensive, you can take multiple breaks, give people time to apply the material, but you don't have to expect them to come back. Single session groups use a brief intervention model during a longer session and think of them as like menus. If you're looking at a menu and maybe Dr. Jane has single session groups every single Saturday. Each group is a standalone thing, it's an a la carte group. And you're going to go there and you're going to learn a skill or a tool. So Sally may be looking at Dr. Jane's menu and go, well, I want to go to that one, that one and this one, six weeks from now and that's fine. They're single session groups. Sally's going to get whatever she needs by selecting from the items that she's interested in. Single session groups don't require the participant to return for follow up. So you're providing the information and taking them from knowledge to implementation, ideally in that session. The drawbacks, it requires the full development of the group in one session. So it can be really intense in terms of the energy required by the facilitator. It typically does not help participants translate knowledge into long term practice. Generally they're getting some ideas, they're talking about how they might implement it, but they're not being able to come back a week from now or a month from now and say, okay, I tried these techniques and this is how it went and how should I tweak it a little bit to work for me. Typically, single session groups tend to be much more psycho educational in nature. You're not typically going to have people come in and start sharing their deepest, darkest secrets or really doing in depth intensive work during a single session group. But it serves a purpose. It serves that what we call an intervention level. If you're familiar with the ASAM intervention level treatment, if you will, and it can provide some actual therapeutic treatment if you want to get into teaching more skills and applying some of those skills, self esteem, for example, you can really do a lot of really great work even in a single session group. Open ended groups are available on demand for emergent concerns. John comes to the clinic today, he has his assessment and we determine that he has major clinical depression. He would benefit from groups. So bada Bing, John can enroll in a group and we can get him started tomorrow or Thursday. Open ended groups often meet the guidelines for co occurring disorder treatment of episodic care. We believe with people with co occurring disorders and even those without co occurring disorders, that treatment is often more beneficial. If it's episodic, that people come in, they get what they need, they reach a plateau, if you will, and then they leave treatment. You know, eight to 12 weeks is often a good estimation. Then they leave treatment for a while, they're doing okay, they're holding their own, then maybe they come back to learn more, or maybe something takes a turn and life changes, their needs change and open ended groups are there Whenever they need to come back, they're there and it provides a gentle transition back into care. Instead of having to start with a whole new group, with brand new people, you can come back. And ideally, at least the facilitator is still the same. But generally some of the participants are also the same. The drawbacks to open ended groups, there's a certain amount of forming and norming each time a new member arrives or joins. Now, just because it's an open ended group doesn't mean you're going to have new people every single week. But when new members do arrive, there's a certain amount of stuff that a facilitator has to do and we'll get there. It's harder to develop a deep level of trust when clients rotate in and out or relatively frequently. You're going to get a certain amount of trust, but it may not be as intense. When working in residential treatment, we would have process oriented therapy groups and we would have people talking about, you know, trauma therapy groups that were open ended groups. These people were sharing what they felt comfortable sharing in these therapeutic groups that were with people who were in their therapeutic milieu, who were living in the house with them for that 30, 60, 90 days. Did they go as deep as they would in a closed group? I don't know, you know, I have no idea. But we were able to make significant process progress. For example, in our women's issues group, that was always a wildly popular group. It requires clinical clinicians to be highly structured, able to foster cohesion between old and new members when new members come in. And we're going to talk about how to do that as we get in there. But the facilitator needs to be able to welcome them in so there's not this uncomfortable feeling here like who is this person? It's an outsider and have to go through the whole forming, storming and norming process all over again. Facilitators must be able to develop a clear and specific purpose for each group. Open ended groups, similar to single session groups need to basically be able to stand alone. We need to be able to have people come in who weren't here for the previous eight weeks and understand and get something out of what's going on. And one of the most challenging for some people is that facilitators must thoroughly research expected needs to be able to make this facilitation happen on the fly. And which means you have to have a certain amount of knowledge and that'll become clear again as we go through how to do this. So facilitator planning. When you're in the forming stages of an open ended group, facilitators need to plan ahead of time, divide the topic into standalone groups, so someone who wasn't there last week can still benefit from this week. If you're talking about distress tolerance and they have no understanding of what mindfulness is, you can still benefit from learning about distress tolerance even if you don't know what mindfulness is. Now, a lot of times, at least in the facilities that I've worked in, we had a pretty standard rotation. So people would go through an entire curriculum, if you will, during their stay with us. So we had 12 weeks and we would have 12 sessions. If somebody came in at session number four, then you know, they would go four through 12 and then they would end with sessions one, two, three and four, but they would still get all 12 sessions and still benefit from all 12 sessions. If you're considering a cyclic rotation, another thing you can do is every eight to 16 sessions, you know, depending on how much you want to go into, you can present slightly different information. There is not when you start really doing a good group, especially if you've got 8, 10, 12 people in the group, there's not a lot of time to go over a whole bunch of information. If you're going to make it a therapeutic interactive group, you can lecture at people for an hour and go over a bunch of material, but they're not going to likely get that information and be able to take it and apply it and use it. So if you're going to help them move from knowledge acquisition to application, then you're going to have to make it smaller. So for example, if you're teaching sleep and nutritional interventions, you might just focus on in one group on sleep hygiene. And then the next time you go through the series, you might focus on something else that has to do with sleep. Might not seem ideal, but it is beneficial for those people who choose to stay in the group for, you know, 6, 12, 18 months. Each time they go through a topic, they're learning something new. They're not hearing the same thing over and over again. So for example, one set of groups I do breaks down going over depression, depression causes and consequences. The next week is sleep and nutritional interventions. Then understanding chronic pain and its impact on depression, mindfulness, distress tolerance, embracing dialectics and making lemonade, problem solving, attachment and boundaries starting to form those healthy relationships for support, relationship synergy, appreciating individual differences and reducing interpersonal stress. Ten is unhelpful thoughts, cognitive distortions and cognitive processing. Lots of stuff you can go over in there. I mean cognitive distortions, there's 12 common ones. So even if you do one or two every cycle then it's going to take a while to get through all of them. Week 11 is silencing the inner critic. Week 12 is developing psychological flexibility. 13 Improving self esteem and self efficacy. 14 what you see is how you feel, addressing the environment and making it a positive, relaxing, safe feeling environment. Grief, trauma and depression and anger, anxiety and depression. Looking at the connections and you know, addressing triggers for anger and anxiety which may be maintaining people's sense of helplessness and hopelessness. So there's a lot of stuff you can go through and I would be foolhardy to think that I could teach everything people need to know about all of these things in 16 sessions. So it's a matter of breaking it down and figuring out exactly what you're going to cover that week and sticking with it. And Lisa points out and it's true when in open ended groups and we're getting ready to get there, older members can buddy up or facilitate sharing by new members. So you actually don't have a as awkward if you will of a get up and going process. People hit the ground running if you will. Still in the forming stage you have it's ideal if you can have a pre group orientation. During this pre group orientation for the person who hasn't joined the group yet, explain the expectations and rules for the group attendance policies, how to withdraw if they decide they don't want to come anymore or if they're done. Participation what's expected. Not everybody's going to be comfortable coming in and sharing right away. And many people what they know about group therapy is what they've seen from the media and that's not real reflective of most groups. Tell them what it's like in your group, what they can expect and any reasons for discharge things reasons why they may be kicked out of the group for lack of a better word. If they show up under the influence of substances, will they be discharged? Will they, you know, what are the consequences of doing that? Review what will be covered in group for the person you theoretically already got the structure set out. So give them that syllabus if you will of what's going to be covered each week just so they know, so they're aware. Provide any introductory information such as handouts and videos that you think they might need or benefit from going into it. This that's step is completely optional but sometimes if you're doing A particular type of group, you might want people to have some foundational knowledge to get them up to speed. It depends on the population you're working with and whether they would even use this information before coming to group. And have each person in pre group orientation develop personal goals for group. What do you hope to get out of this group? Have them go in there with these goals in mind because that's going to help motivate them and help focus their attention to how can I apply this information before group starts? Ideally, buddy up new members with an existing member. It doesn't have to be somebody that shares the same goal or whatever, but we have an idea about who might be a good buddy for whom when. If you've got people who've been in your group for a while and that helps ease the transition so the person's not sitting there going, well, I want to say something, but do I raise my hand? Do I speak out? How do I do this? They have a comrade in arms, if you will, in the first session and with open ended groups because people can rotate in and out as with any group really, we really want to think of it as could this be the only session if this person doesn't come back, are they going to have a tool, are they going to have a nugget that they were able to use by the time they get finished with group? So in this first session we want to create cohesion and we want to help people start feeling comfortable with what's going on. So the new person will introduce themselves and identify what they hope to get out of group. That goal that they identified in pre orientation. Alright? So they're going to share that with the group. Depending on how many new people this could take 5 to 10 minutes max. Have current members share if they have similar goals. So for example, Tom might be a new member and say, I am so tired of being tired and depressed all the time. I just want to find a way to get some pleasure back in my life. Okay, Jim, who has been coming to the group for a while, responds, I hear you, Tom. We when I joined the group, life almost didn't seem worth living. But each week I learned more about the reasons I feel this way and small changes I've made have made a big difference. So now Tom has some hope and he also has some camaraderie. He feels like, okay, somebody might understand where I'm coming from. Then go around the group and have members share. Once you've done this introductory thing and had people share, if they have similar goals to the new person then go around the group and have each person share how they're doing that day, including the new person. One way they dealt with their issue. We'll use the depression in this example. One way they've dealt with their depression since the last group and one challenge they've experienced since the last group, if any. So you're going to go around the room, and it's really important that group members know this is not the time that we're going to go deep into stuff. We're going to spend about one to two minutes per person. And so you want to keep it brief. Just tell me what's going on. Answer the question and figure out what's going on. One of the things I used to like to do, especially in my bigger groups, because sometimes we would have groups that were more like 15, 18. They were kind of pushing the limits of usefulness on the whiteboard. As people would mention the tools they used, I would write those up on the board. And as they mentioned the challenges they had, I would write those up on the board so we could see connections. You know, maybe Sally and Tom were both having difficulty with hypersomnia over the week. Okay. Both people were having a challenge with that. So we can identify that as a common challenge. And the next step, we want to have people start seeing how all this pulls together. But during this first step, and this is when we move into storming. So the new people have introduced themselves. The older people have said, yeah, I hear you. You know, I've experienced something similar. Everybody shared their challenges over the week. So we're all kind of putting our cards on the table. Storming may happen during this time. Existing members typically take a facilitative lead to help empower new members to take full advantage of the group. They will model how much to share. They tend to model asking questions and participation. You know, we don't want existing members falling asleep over in the corner. We want to make sure that we hold a consistent set of expectations for group. However, as facilitators with all groups, we need to ensure that one person doesn't dominate the group and decide to make it their individual therapy session. That just happens to have 15 other people in the room during this first session. You know, we've heard about their challenges and things that they've experienced over the week. Present the topic for the day and link it to people's tools and challenges. So, for example, you hear from your group that several people were having problems with anhedonia or lack of pleasure. Couple people were having Problems with sleeping, too much. And pretty much everybody talked about low motivation. Okay, so those are three challenges that are common among the group. Now today's topic is distress tolerance. And this is where facilitation on the fly comes in. And you've got to forgive my phrase, but you got to be able to pull something out of your butt. Do it on the fly. You can't say, okay, let me go research that. You need to be able to tie it together and bring it together. So you need to know going into it, how does distress tolerance relate to depression and depression recovery? So you start talking and you review how dopamine, serotonin and norepinephrine are impacted by stress, which can impact people's ability to feel pleasure, their libido, their ability to sleep, sleep, appetite and motivation. So we want to start talking and reminding people that stress can lead people to be revved up for too long and it can be exhausting and that can contribute to depression and it can also disrupt the balance of those neurotransmitters. So when people aren't feeling pleasure and symptoms of depression, lack of pleasure, sleep disturbances, appetite disturbances, low motivation, you know, we want to tie it all together and help them see how stress or distress can contribute to anhedonia, hypersomnia and motivation or lack of motivation. So now they understand, okay, distress tolerance. Maybe there's something in here that I can use this week to start addressing this challenge, the next step, we're moving on to the performing stage that we've already gone through. Forming, norming, forming, storming, norming, and now we're in performing, which is the final stage of development. And hopefully, you know, you've gotten here in the first 20 minutes or so, so you want to provide a useful nugget. You've listened to what people had to say, you've tied it together, you've shared, tied together commonalities between people's struggles. You've tied together their challenges with today's topic. Now we're going to start talking about the topic. And this is where in the performing phase, you want to provide this useful nugget, something that they can take and actually use to address their issue. You want to use as many multi sensory techniques and approaches as possible because number one, the more senses we use when we learn, the more likely we are to remember it, the stronger the memory pathways are. Number two, you're going to have in group multiple different types of learners. Providing as much multi sensory information as possible is really helpful. So talking about things, obviously that's typical Group that lecture discussion format. But not everybody is an auditory learner. So write things on the whiteboard. I'm a visual learner, so I naturally write a lot of stuff down so people can see connections and I can draw lines and make connections so it's visual for them. You can provide handouts so they can read it or even use charts or graphs. And we're going to get into that. But you want to provide this information and teach the technique using multi sensory approaches, encouraging them to roleplay it, to maybe break out into groups. And each group tries to teach a different aspect of it. There are a lot of different ways you can gamify it. Gamify. It's huge and it can be really fun. We want people to understand the technique, understand what it is and be able to articulate what it is, how it helps and how to use it. And then the last 30 minutes of group this is a 90 minute group. Have participants discuss how the new technique or information could have helped them address their challenge from the past week. So go around and say, okay, how could distress tolerance, these techniques that we learned today, how could those have helped you with maybe addressing your lack of pleasure? And maybe they reflect back and they realize that they were focused a lot on worrying about something that was happening at work or in their relationship or whatever it is, and that took a lot of their energy. So distress tolerance techniques would maybe would have helped them use that energy towards something that helped them feel happier. Motivation. How could distress tolerance help you with your motivation? When we're in distress, we are not feeling as empowered as we could be. We are feeling, you know, anxious, angry, stressed out, whatever the word you want to use. But that energy could be used to solve a goal. There's a lot of different ways that people could see or figure out how using distress tolerance techniques and reducing their distress could have helped them have more energy, more motivation and more pleasure. And then have them talk about how they can foresee remembering to use it and using it in the upcoming week. So generally you can go around and say, how might you use distress tolerance in the upcoming week to help you not use a bunch of excess energy stuck fighting with your distress? And then say, okay, great ideas about how you could use it. Now how are you going to remember to use it? And that differs for different people. Some people will have an app on their phone. Some people will have a bracelet that, you know, one of those little rubber, not rubber bands like the snappy kind, but the little rubber bracelets that you can get something that reminds them to use their distress tolerance techniques. Have them brainstorm ways they can remember and how will it help them achieve their overall goal for the group? If you use these distress tolerance techniques over the next week and you start using them regularly, how will it help you have more pleasure in life? For example, you want to tie it to their proximal challenges and their proximal goals as well as their long term goals. Make sure they can articulate how they would apply it. Give a specific example of how they could have used it last week to reduce their distress or how they can use it, something they expect to be distressful in the upcoming week. Give an example of how they can use it and exactly what they will do. Other ways of organizing groups. You can do it by symptoms if you want to, instead of doing it by interventions or topics. Maybe you have one group on anhedonia and you have another group on appetite disturbances and another group on sleep disturbances by the symptoms of the diagnosable condition. If you want to use a self help book, you can do it by book chapters. So each week maybe you go over a different chapter. Toxic Parents is one that I've used. Surviving the Borderline Parent Self esteem by Matthew McKay, a beginner's guide. There's lots of great books out there that you read and you're like, oh, if my clients could read this, they would get so much out of it. But getting clients to actually read it, apply it and do it on their own may not happen. So sometimes you can use it and you can have clients get the book and. Or your facility provides the book for all the clients and you can go through the book together in order to help them go through it granularly and apply it to their particular situation. Another way you can do it is by current events. I lacked a better term for that. So for example, dealing with depression during the holidays, you know, you're going to have preparing for the holidays, dealing with triggers in the, in the stores. If you're getting ready for Christmas, for example, I mean, they start getting out Christmas stuff in September now. So if Christmas is a triggering time for you, which it is for a lot of people, when you start seeing all that stuff, how do you handle it? What techniques can you use to deal with it when it comes time to, you know, people want to invite you over to their house or to go to parties, how do you handle that? How do you handle your emotions during that period of time? Do you have other ways, you know, and I'm putting this out there to you, do you have Other ways that you organize your open ended groups. While you guys are thinking about that, another group that I've done and one of my favorite books of all time for dealing with grief and trauma is Crisis Promoting Resilience and Resolution in Troubled Times by Linus Ecterling and Associates. It is an excellent, excellent crisis intervention and sort of trauma oriented group. I really enjoy reading that book and we used it as a textbook for one of my classes in graduate school and I still have it today. So I would strongly recommend if you work with clients who have crisis issues, it's worth the read. It's not a huge book, golly, maybe a half an inch thick. Really great book. Anyhow, basically going through the highlights of what he talks about in that group and this book is way too clinical for clients to go through. It's something that you would want to use to structure your group. You're not going to want to give it to clients and go read this along with me. But he goes through a lot of really awesome suggestions and provides awesome prompts to use with people. So an eight week group for grief, impact of grief and trauma. What to expect and how it makes sense from a behavioral, emotional, physical, interpersonal, cognitive and spiritual standpoint. Understanding how grief impacts us in each one of those ways and how it makes sense from a survival perspective. Because a lot of times once people understand that their symptoms make sense, it's like, I have no idea why this is happening. They have this epiphany. It's like, oh, okay, I get it. You know, don't like it, but I get it. Then they can start addressing it. The second week is getting support or love as he calls it, luv from others and yourself. Learning how to listen, understand and validating. And he talks about getting it from others, but I add on getting it from yourself in teaching people to become mindful and aware and understand themselves and validate their own feelings. Highlight resilience in people. And he has a lot of great techniques for highlighting resilience and helping people highlight resilience and identify ways that they have overcome other challenges and the strengths that they do have down in there in that toolbox somewhere. Help them make meaning from what happened. Transforming crisis into an opportunity. Managing emotions by promoting feelings of resolve and confidence. Visioning possibilities, creative coping to deal with what's going on, taking action. And I pretty sure that in this book is where I got the activity that I've talked about a bunch when working with people who've undergone some sort of trauma or crisis, asking them, okay, you know you're writing your book. That was a chapter, now that chapter is closing. So how is the next chapter going to open up? What's that going to look like? What are the characters going to do? We want to have, you know, how does this play out into the storyline and then taking action, encouraging people to take that next step, not just talk about what could be or what resources they have, but using them and making a difference and making a change. Other ways people have proposed in the chat room for arranging groups by different issues that brought them in. You can, if people are brought in because of divorce or if they're brought in through the child advocacy system or they're brought in from substance use, you know, you can have channels for that or you can split groups into types of losses. Suicide, loss of a parent, loss of a child. Those can all be very different types of loss that people experience. You can also do some by age or activity you want. Obviously you don't want to have 6 and 10 year olds in group with 16 and 18 year olds. That's cognitively, they're not even on the same plane. So you want to divide them by groups. That's a really good point. And you can also have groups based on learning style. Lisa points out. You can have writing groups for those who are more visual learners. You can have art therapy groups. You can have movement groups for people who are more into maybe psychodrama and experiential activities. So there's a lot of different ways you can do it because not everybody, like I said, not everybody is going to learn the same way. Now if you don't have the ability to break things into different groups, you might be able to have different subgroups within your group. So for example, you're talking about distress tolerance activities and you have a subgroup of people who want to make a collage or whatever. I'm not super good with art therapy, so we do a lot of collages because that's about the extent of my knowledge. But they can do that. Or you can have them another group that writes down narratively how they're going to use the distress tolerance or maybe a story about using one of those techniques. And then you can have another group that creates a skit and demonstrates how to use that particular distress tolerance technique. So within the same group you can appeal to different types of learners. If you don't have the luxury of being able to have multiple groups to meet the different needs of the different learners. Multi sensory techniques. I kept referring to them. Let's talk about what they are visual. Visual learners tend to get information by taking it through their eyes or whiteboards. We like to write a lot of stuff down. I worked with one client and this wasn't in group, but I worked with one client who had bipolar disorder. And when she was in a manic phase, her mind just raced. And so we had difficulty keeping her focused during a session. So what we started doing, as things came up, we would write them on the whiteboard so she could be calm and confident that we wouldn't forget about them. And then we would come back to the topic we were talking about. And then we would go over to those other topics once we finish the topic at hand. Sometimes a whiteboard helps people see things and think about things. Graphs or drawings. Obviously graphs are great. You know, they're pictorial. They can give you an idea of how much energy, what percent of the pie are you using on worry each week? Or you can do drawings of different things that can help people envision what they need to do. Handouts are obviously great, and a lot of times you can get handouts offline for free from the National Institute of Health or samhsa. Use analogy examples that people can understand the visual connection between a is to be. Art therapy can be really great for people, especially if you're good with art therapy and you can have some really creative activities that people can do that can help them internalize what they're talking about. And note taking if all else fails. If you are largely doing a lecture type group, encouraging people to take notes so they're writing it down and they can go back and review their notes later. For your auditory learners, if you can tape record the lecture part of the class, you're obviously not going to record stuff where other people are sharing. You're going to record your narrative about teaching whatever the topic was. But if you can record that, or if the person can record that, then they can go back and listen to it later. Discussion is useful for auditory learners because they hear and they remember what they hear really well. Kinesthetic or manipulative learners. And generally we think of kinesthetic as actually having to do something physical and tangible. When we're talking about psychology, not so much. We want people to be able to manipulate the information and apply it to different situations. So you can have people break up into groups and teach an aspect. So if you're teaching distress tolerance techniques, you can give each group, each subgroup of your group a distress tolerance technique and have those people teach the rest of the group about that particular technique. When I Started teaching many moons ago. I learned very quickly that I didn't know what I didn't know until I started trying to teach it. And then I realized where all the gaps were. I'd be sitting there going, oh, I'm not really sure the answer to that. Okay, I don't know the answer to that either. I feel like I'm an idiot. And obviously I wouldn't say that. But we want to help people realize once they start teaching it, then as facilitators, if they start to falter, we realize, okay, there's a gap in their knowledge. Then we can help them bridge that gap in their knowledge so they have the full picture. Have them apply it to situations they've experienced before, situations they expect to experience, or hypothetical situations. Once they start applying, instead of just talking about it, because I can talk about things and say, okay, if I want to do this thing on the computer, I've got to do step A, step B, step C, yada yada, all right, Seems simple enough. And then I sit down at the computer and I start kind of stuttering and I get all confused. By applying it, people are taking that knowledge and moving it to application. And there is actually a pretty big gap there. Making sure that they can translate that knowledge into actually doing it and feel comfortable doing it. You can role play. When people role play, obviously they're manipulating the information. They're taking this tool that you taught them and they are applying it to a hypothetical situation in a role play. Board games can help people manipulate information. Now, depending on what you're teaching, some games may be more or less appropriate. Board games can be helpful, especially for rote memorization type things. Jeopardy is the same way. You're not going to get really in depth with a lot of these kinds of things unless you're far more creative than I am. Jenga is another one of those kinesthetic, manipulative sort of things. I like Jenga because Jenga is built on stability. And when you pull out the wrong block, then there's not enough stability to hold the tower up. And if we think of the Jenga tower as our mental health, then if you pull out the wrong block, or if it doesn't have enough support in a particular area, the block, the tower crumbles. Ball toss is another one that can be interesting. You can put, for example, we'll stick with distress tolerance techniques since that's what we've been talking about. You can write all the different distress tolerance techniques on a ball. Your accept and improves activities, comparisons, contributions and the rest of them that are escaping me at the moment. And you pass the ball around, it's one of those big beach balls. And whoever catches the ball, they look down and whatever distress tolerance technique they see is they've got to give an example of that distress tolerance technique and how they could use it, and then they pass the ball to somebody else. So this is a little bit more fun than just going around the circle. There are a lot of things like this that you can do. Don't be afraid to do something that sounds a little juvenile, because sometimes it's fun to be juvenile. Sometimes it's fun to have a balloon toss in your group and, you know, try to keep a balloon from hitting the ground or, you know, pass around the beach ball instead of just routinely going around the circle. Sometimes you can also do the clapping game that you used to do when you were, I don't know, seven, eight, nine. And you go around the circle, and each person, you start with the letter A. And the person who has the letter A has to identify distress tolerance technique that they could use that begins with A, what kind of activity they could do, art. And then the next person would have the letter B. So identify a distress tolerance activity that they could use that begins with the letter B. And this encourages brainstorming for the particular, specific activities that a person might be interested in doing. Because with excepts, you know, the A stands for activities. Well, the activities that people are going to do to manage their distress are going to vary. You know, each person in this group today probably has different things that they do when they get distressed. So having people start brainstorming what might be something that they could do. And it's fun. It's not super stressful to do something like that when you're helping people get hold of the topic. Now, remember, this is during that 20 minutes where you're teaching the topic. You haven't started applying it yet. You're getting them, their brain juices flowing and really getting them to embrace that topic in their mind. Other adult learning tips. And this is true for everybody, but especially for high school and older. And I know high schoolers are adolescents, not adults, but by the time they get to high school, they start asking that question, why in the world do I have to learn this? Why do I care? Well, that's one of the main components to learning. Learning is how you acquire the information. Do you get it through your eyes, your ears, or kinesthetically how you conceptualize the information? Do you do it top down, bottom up? Do you need the big picture first. And then attitudinal or caring is what I call. So I have three Cs. Why do I care about this? Because if we don't care about it, we're not going to be motivated to remember it. So our brain chemicals associated with memory aren't going to be as robust. We want to make people care about what we're teaching. So in the beginning, which is why at the beginning we have people state how they're doing and what a challenge has been for them over the week. And then we present the topic and help them see how this topic that we're talking about today can help them deal with some of the challenges and help them achieve the goals they want to. In group, we're helping them see how what we're talking about is going to benefit them, make it relevant to their lives. If you're talking to a bunch of 8 year olds, you know, don't talk about going to work because that's not relevant to them. Talk about going to school or recess or whatever it is that's relevant to them. Use culturally appropriate examples. If you're working with a group that happens to be really into cars, for example, well then use car metaphors. If you're working with a group that is really into sports, use sports metaphors. Use things that are appropriate to them. And one thing that a lot of us, most of those we know, one thing that a lot of us fail to take into consideration is thinking breaks. Reflective learners take in information and we take it in and we take it in and we take it in, then we need to digest it and then we have an aha moment. Active learners take digest and aha all kind of at the same time as they go. Reflective learners need thinking breaks. It doesn't have to be a long break. So every 10 or 15 minutes you can have people pause and reflect and they can either take notes or you can give them something to think about. But give the reflective learners two to three minutes to kind of catch up and have that mini aha moment, like, oh, this makes sense now. Open ended groups are the norm in most agencies. The biggest challenges with open ended groups are structuring sessions. So prior knowledge isn't necessary and participants have access to all the information if they stay for the full course of the group, whether it's 8, 12 or 16 weeks. Facilitating progression beyond superficial awareness can be a challenge. It doesn't have to be, you know, as we talked about, the people who've been in the group often, if you will, pull the new people out of their shell pretty quickly and share a certain level of intimacy. Does it get as in depth and intimate as closed groups? Not necessarily, but that doesn't mean it can't. With the right facilitator in the right setting. Developing cohesion among members is a challenge if you're not used to it, because again, you have to develop that cohesion really quickly in the first 10 to 20 minutes of the group. And tying participants current challenges to the planned topic. That whole facilitation on the fly, if you will, can be really challenging, especially for new clinicians who don't have the breadth of knowledge that those of us who've been doing this for, you know, two decades have. The biggest benefits to open ended groups are episodic flexibility, rapid admission, and when new people come in, you actually can get some new perspectives, which we really didn't talk about a lot. But you might get somebody who comes in and they're like, well, why wouldn't you try this? And everybody in the group is like, oh, well, none of us ever thought of that. So there's a lot of benefit, if you will, to fresh eyes, if you will, in groups, people closed and open people do tend to hold each other accountable for their behavior in group, but also for trying and implementing new techniques and things. And they, they tend to be more encouraging and saying, okay, so you tried that, it didn't seem to work. You know, let's brainstorm why that didn't happen. That's what we used to do in our aftercare groups. We would talk about things that people did in order to maintain their sobriety over the week and challenges they faced or little hiccups they had. And we would talk about how, you know, what may have happened, why that didn't work as well as they had hoped, and what they could do differently the next time that would make it more effective for them. And that's the time when, which is one of the reasons I love open ended groups versus single session groups. Because you have the ability to help people over the course of a few weeks as they try new techniques, help them individualize those techniques for their own temperament and learning and situation. Are there any questions, Referring to Pat's question, how insurance works with these. Insurance works the same with open ended groups as it does with all the other groups. Generally you will get a certain number of approved sessions and if the person wants to continue coming after those approved sessions are up, then you need to get another approval and continue to do the reassessments just like you would for intensive, outpatient or anything else. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand CEUs for this podcast is@allce.com podcastceus that's allceus.com podcastceus to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com sponsor thank you.
