Creating the Group Part 2

now we're going to spend a little bit of time talking about preparing clients for therapy and pre-group meetings one of the first problems you're going to face is that different clients are going to be ready for group therapy at different points so if you have a group in a month or two and one client is ready and perhaps you gain a few clients along the way until at the point where you're going to start group therapy you have enough people for a group you have to keep those people who signed on first engaged you don't

want them dropping out of group before the group's even stepping out of group before the groups even started and so therapists might want to meet periodically with potential clients during the weeks leading up to the group to keep those clients engaged during that time therapists can accomplish a number of tasks one is to start building a therapeutic relationship which hopefully will transfer over into the group therapy sessions and form the basis of group cohesion as we've talked about before during the pre-group sessions the therapist and client can further clarify the client's problems and clarify their

goals readers might also want to take the time to clarify some misconceptions about group therapy many clients whether they talk about it or not may have misconceptions about group therapy some common misconceptions about group therapy include group therapy being somewhat wild and unpredictable and unpredictable and involving a loss of personal control and having to engage in self-disclosure against one's will some people will think that group therapy isn't as effective as individual therapy because members of the group have to split their time with one therapist it involves a greater risk for rejection and feelings of shame

and some people think that group therapy is ineffective because it might not seem logical that interpersonal learning is going to be effective in a group made up of people with relationship problems another common fear is the lack of confidence is the lack of confidentiality that people in the group will share personal information with individuals outside of the group now there might be a number of reasons for these misconceptions about group therapy one is that many of the clients who are coming to therapy may have been involved throughout their lives in natural groups that really weren't

helpful and so the groups that they belong to throughout their lives have been part of the problem and not part of the solution and so they might be naturally skeptical that going to group therapy is going to be helpful additionally sometimes people have misconceptions about group therapy because of how the media is about group therapy because of how the media portrays group therapy for example if you've ever seen the movie one flew over the cuckoo's nest you may remember the group therapy leader who is very cold and demanding therapists will also want to anticipate some

problems that may arise over the course of group therapy entities to prevent these problems from having a negative effect on the group one potential problem may occur when clients don't understand how their goals are going to match with group goals when we think about group goals we think about things like interpersonal learning and cohesion and universality and things like that and things like that but that's not necessarily what an individual client is defining as their problem clients might be coming to group therapy for problems like anxiety or an ailment from which they're suffering and so

the therapist can plan ahead and help the client understand how will help the client meet their individual goals we've talked about many times the problem of attrition and clients dropping out of group prematurely and so group therapists will also want to address this potential problem in pre-group meetings it might help for the therapist to compare the group to to a sports team and talk about the importance of all the members of the team showing up like in sports when one member of the team doesn't show up to practice or to a game that can have

an effect on the whole group another potential problem that may come up during group therapy is that clients might be looking for some relief from group therapy but oftentimes the real benefit of group therapy is evident over long periods of time and so the therapist might want to prepare a client for that for the idea that the effectiveness of group therapy occurs over many weeks and months and sometimes years and months and sometimes years we've also alluded to the phenomena that sometimes members of the group might create their own subgroups or they might socialize outside

of group therapy we'll cover this in more detail during another lecture but it's just important to note that this is another problem that's might anticipate before therapy groups start and as a result group therapists might start preventative measures during pre-group meetings let's talk a little bit more about the process of preparing clients for group therapy many clients will come to clients will come to group therapy with a biological model of mental disorders a model wherein mental illness is diagnosed and then medication provided and perhaps some individual therapy and so it's important for a group therapist

to present an interpersonal mental illness as well and highlight problems with establishing maintaining and navigating relationships in this context group therapy makes a lot of sense as a treatment modality that is group therapy provides a social laboratory for people to be honest with each other and explore elements of relationships that can't be explored given the structure of our society and so group therapists will find it helpful to advise clients to be honest and direct and at times it may be painful to be honest and direct and to express positive or negative feelings but group members

need to resist the urge to withdraw and let other people do the work some clients will still be skeptical about the effectiveness of group therapy and so in pre-group meetings it might be helpful to encourage members and to get them to commit to attending at least can really get a feel for the process of group therapy and have a chance to see for themselves whether or not it can be effective in their lives pre-group meetings should also cover elements of confidentiality and it will be important for the therapist to let the client know that the

therapist can't keep everything keep everything confidential the therapist has to report situations in which the client is harmful to self or others along these lines of confidentiality it's important for therapists to gain formal consent to discuss the client's personal issues in the group even during sessions when it isn't there however therapists need to be careful not to reveal information that the therapist gained during a pre-group meeting with the rest of the group without the client's permission it will also be important for group therapists in pre-group meetings to discuss the topic of sub grouping of sub

grouping and clients meeting together outside of group therapy clients will naturally want to meet with each other outside of therapy because for many of the clients it will be the first time that they've ever really made meaningful connections with other people and in this case it's especially important for therapists to tell the clients why they shouldn't meet with other clients outside of group therapy as opposed to just setting a rule group therapists might explain to clients that the purpose of group therapy is to teach one how to develop intimate relationships but it does not provide

the intimate relationships themselves they've learned how to form intimate relationships in group therapy it's really the client's responsibility to apply that knowledge to form their own intimate relationships outside of the group but occasionally clients will meet outside of the group if you're dealing with kids in a k-12 school setting a 12 school setting they're going to have classes together and they're going to be social events at school that they might have together additionally if you're dealing with an adult outpatient group they might meet by chance at the supermarket or they might decide on their own

that they want to meet outside of group regardless of the situation it's a meet outside of group either by chance or by design that they share the important elements of their meeting with the group remember one of the effective elements of group therapy is the openness and honesty and if you create a situation where people keep secrets from each other that really under mother that really undermines one of the fundamental processes of group therapy and so one of the reasons that meeting outside of group can be really detrimental to the group therapy process is that

group members can develop a loyalty to each other and may feel as though they're betraying a friend if they reveal what happened outside of group therapy to group thus meeting outside of group is really discouraged because it can really fundamentally undermine important group processes pre-group meetings should also be used to acquire informed consent from clients and that process entails being very frank with clients and talking to them about not only the treatment benefits but also of course side effects costs and alternatives so that clients can really make informed decisions about whether or not they want

to participate in group therapy versus other modalities of treatment as other modalities of treatment oftentimes you'll find that informed consent is simply handed to a client on a sheet of paper for them to sign but a group therapist can use this as an opportunity not just to fulfill an ethical requirement but also to build relationship with just handing them a piece of paper and asking them to sign it but having a frank discussion about all of these benefits and costs of therapy can be part of the process of creating a good therapeutic trusting relationship one

final note about pre-group meetings is the necessity is the necessity to keep continued contact with prospective clients before the group starts it's likely that one pre-group meeting isn't going to be enough to adequately prepare a client for therapy partially because they're going to forget a lot of the information group meeting and so having some form of following up with the client until the group starts is going to be important and there are a variety of mediums through which this might take place for example some therapists will give their clients written documents like flyers to continually

provide them with information about actually start the group other therapists might present clients with a video tape of group meetings perhaps a video that's been professionally prepared specifically to prepare clients for group therapy other therapists might invite clients for pre-group might invite clients for pre-group sessions in which they provide some training on a particular desired behavior for example there might be a pre-group training on the here and now there might be a pre-group training on expressing feelings or self-disclosure or any one of those topics of disclosure or any one of those topics on which a

therapist might want to train a potential client there is a fair amount of research that suggests that pre-group meetings have a very beneficial impact on the course of group therapy and on outcomes after group therapy i won't go in this is a good place to stop for the day