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christian counseling today
Vol. 20 no. 4
T
group treatment for anger, violence, abuse, addiction, and
parenting problems. In addition, groups can enhance your
reputation. Promoting research validated groups communi-
cates a high value for excellence in service delivery and sets
you apart from your competition.
Groups can also provide win-win collaboration with
other treatment providers. We promise practitioners outside
of our practice that we will not solicit for, nor provide upon
client request, any other treatment than the group in which
they participate. We have several practices, both private and
publicly funded, that refer regularly to our groups. Low or no
cost support groups provide a great entry point to introduce
people to your practice. Satisfied clients are typically your best
referral source.
n
Group therapy provides a great context for
training and collaboration.
I train pre and post-graduate
students. As co-therapists, a more experienced counselor
works side-by-side with a less experienced counselor. This
elevates the student to peer status and increases competence
and confidence. It is also much more dynamic than case
presentation supervision.
n
Group therapy provides steady revenue at afford-
able rates for clients.
Counseling and psychotherapy
are expensive and people are very busy. In a recession and
post-recession economy, we have to provide services that are
efficient, cost effective and accessible. Fees for group therapy
are usually one-third to one-half the cost for individual and
family therapy. Six to 12 group members provide 1.5 to four
times the revenue of other modes of therapy in the same time
frame.
n
Group therapy requires extra work.
The group
therapist must schedule team development, recruiting and
screening clients, materials preparation and distribution,
record keeping, fee collection, out-of-group contact with
members, and follow-up treatment planning. This is not for
every counselor. Group therapists have to be more organized,
better marketers and enjoy highly stimulating therapy as
there is so much going on in a group. Good business acumen
is required to measure the economic impact of the group
program and it is always important that counselors manage
their personal stress.
Group therapists are able to: 1) train clients to be good
group participants, 2) observe, process, and respond rapidly
out of a rich reservoir of therapeutic tools, 3) enjoy higher
levels of stimulation given the number of people involved, 4)
respond quickly and think “on their feet,” 5) develop clients’
capacity to serve each other in therapeutic ways, 6) nurture
co-therapists where appropriate, and 7) create interventions
for extreme client behaviors, such as being overly talkative or
quiet and reclusive, displaying excessive emotional expression
or remaining stoic and withdrawn, or exploiting inappro-
priate social comments, dress or behavior.
Selecting the Type of Group Therapy
and Screening Clients
In outpatient process group therapy, people share informa-
tion about life experiences and receive feedback from group
members and the therapist. This can be very useful with high
functioning, verbal clients who have limited or dysfunctional
social networks. They need a safe place to share and learn
from others. Group selection for a process group is often
based on balance. If one has a large enough pool of subjects,
the counselor mixes gender, ethnicity, personality styles and
the needs and histories of clients to create a small community.
Problem focused groups employ research validated tech-
niques with a group of people who share similar concerns.
For example, in a social anxiety group, people share common
experiences. This counters the “I am the only one who suffers
like this” perception and provides the support and motivation
to make painful and challenging changes.
Technique or therapy modality groups focus on the
intervention. For example, Dialectical Behavior Therapy,
Mindful-Cognitive-Behavior Therapy, and Reminiscence
Group Therapy are defined by the techniques that are
prescribed for a population or set of problems. The counselor
trains clients in a set of skills and the group sessions become a
classroom where people learn, practice, and remain account-
able to each other. The more severe the pathology, the more
structure you need to have in your group. Manualized treat-
ments are highly structured with lots of rules and boundaries.
When the boundaries and expectations are clear, people are
less anxious.
I recommend that group leaders personally screen every
member prior to the start of a group, or before introducing
a new member to an existing group. This builds rapport and
reduces the anxieties of client and therapist alike. One-on-one
interaction helps the counselor assess the client’s capacity to be
a good group member.
Ethical Considerations
Ethical practices and procedures used in other modes of
psychotherapy and counseling also apply to group therapy.
Families, churches, schools, sports teams, choirs, clubs and most work environments
are groups that shape our identities, behavior patterns, expectations, and personal
preferences. Healthy groups develop positive, competent people; unhealthy
groups have serious negative impacts.
