Rules and Contracting
Contracting is a tool that many groups use to help get
members to attend meetings and follow rules. Because it is very
important that all members agree to the requirements and rules
of the group, a document can be written up and copied for each
member and the group leader. Each member and the leader will sign
this contract. The contract sets forth the day or dates of meetings,
time, location and group rules.
Clearly stated and enforced rules are critical for a successful
group. They can free members to deal with recovery issues. For
example, when a rule of no violence is clearly stated and enforced,
it allows the patient to feel and express anger, knowing that
the group will not allow any one person to get out of control.
Rules also offer limits to patients who have very few internal
controls and who cannot set their own limits. Many substance abusers
grew up in situations that did not teach them controls and limits.
Establishing and enforcing group rules can help correct this.
Use the following guidelines in setting group rules.
- Do not make a rule that you or the agency cannot enforce.
- All rules must be enforced fairly and anytime they are violated.
- Rules should be clear and understood by all.
- Many substance abusers have memory problems; therefore, rules
should be restated periodically and whenever a new members joins
the group.
Group Rules
The following rules are designed to be used as part of the problem-solving
group process.
- You can say anything you want, any time you want to say it.
Silence is not a virtue in this group and can be harmful to your
recovery.
- You can refuse to answer any question or participate in any
activity except the basic group responsibilities. The group cannot
force you to participate, but group members do have the right
to express how they feel about your silence or your choice not
to get involved.
- What happens in the group stays among the members with one
exception: Counselors may consult with other counselors in order
to provide more effective treatment.
- No swearing, putting down, physical violence, or threat of
violence.
- No dating, romantic involvement, or sexual involvement among
the members of the group. Such activities can sabotage the treatment
of those involved and others. If such involvements develop, members
should bring it to the attention of the group or individual counselor
at once.
- Anyone who decides to leave group treatment must tell the
group in person prior to termination.
- Group sessions are 2 hours in duration. Patients should be
on time and plan on not leaving the session before it is over.
Smoking, eating, and drinking are not allowed in group sessions.
Responsibilities of patients in the group include the following:
- Listen to other group members' problems.
- Ask questions to help clarify problems or proposed solutions.
- Give feedback about what you think and feel about a problem
and the personal strengths you see in the person that will help
him or her solve the problem. Also give feedback about the weaknesses
you see that may set the person up to fail to solve the problem.
- Share personal experiences with similar problems when appropriate.
Self-disclosure must be carefully managed to keep the primary
focus on the patient who is working on the issue.
Problem-Solving Group Counseling Format
The Preparation Session
Before the group session begins, the counselors must prepare.
Counselors meet as a group. A brief written description of each
patient (a Athumbnail" sketch) is presented, and the patient's
progress is reviewed. An attempt is made to predict the assignments
and problems that patients will present.
The Opening Procedure (5 Minutes)
During the opening procedure, the counselor sets the climate for
the group, establishes leadership, and helps patients warm up
to the group process.
- The counselor enters the group room. He or she makes sure
that the room is set up with a circle of upright chairs arranged
close enough for the members to touch each other. The counselor
greets each member informally by talking to them before the group
starts.
- The counselor asks the members to touch the person on either
side and while doing this make eye contact with each person in
the group. He asks them to make sure the other person sees them
by nodding or giving another response.
- The counselor completes a centering technique (see Counseling
Techniques). This is designed to get the patient in touch with
himself or herself and leave nonrelated problems outside the group
room.
- The counselor then takes attendance. During the attendance
procedure, the counselor makes eye contact with each patient,
engages in a brief social greeting, and tries to get an idea of
each patient's attitude and mood before going on.
Reactions to Last Session (15 Minutes)
A reaction is a brief description of (1) what each group member
thought during the last group session, (2) how the group
member felt during the last group session, and (3) identification
of the three persons who stood out from the last session and why
they were remembered.
All group members are required to give a reaction to the last
session. This accomplishes a variety of goals:
- It forces each patient to talk in the first phase of the group
session.
- It breaks the tendency toward isolation and self-centeredness
by forcing the patient to notice and comment on at least three
other group members. This reaction forces group involvement.
- It provides training in basic communication and on how to
give feedback.
- It provides feedback to other group members about who stood
out from the last session and why.
- It puts pressure on group members to recall important events
from previous group sessions. As a result, it serves as a memory
training device.
- It tests a group member's motivation. Members who refuse to
give reactions or repeat what others say generally have problems
cooperating with other aspects of treatment.
- It provides an opportunity for the counselor to reflect on
the last group and compare his or her personal memory with the
group members' memories.
It is important to remember that a reaction is a one-way communication.
Other group members are not permitted to comment on the reactions.
If someone is upset by what another group member says, it is that
person's responsibility to volunteer to work on the issue when
the agenda is set.
A reaction is also a no-fault communication. There are no right
or wrong reactions. The only feedback the counselor and other
group members generally give is on the format and completeness
of the reaction. In other words, the group member is reporting
on his or her thoughts, feelings, and at least three persons who
stood out to them in the last session.
A typical reaction should have three parts:
- What I thought about during the last group session.
- How I felt during the last group session.
- Three people that stood out to me in the last group session.
A counselor must help patients by coaching their responses.
Typical problems that patients will have are
- They will say what they thought about or felt about the last
session, instead of what they thought or felt during the last
session.
- Example:
-
PatientI thought last week's session was good. (Incorrect)
CounselorYou misunderstand. What I would like you to do is tell
what conversations or pictures went on in your head.
PatientWhat I thought about during last week's session was how
my drinking and drug use has affected my life. (Correct)
- They will confuse thoughts and feelings.
- Example:
-
PatientI think I was angry. (Incorrect)
CounselorYou felt angry? (Explain the difference between a thought
and a feeling.)
PatientI felt angry. I was thinking about going to jail. (Correct)
- `They will talk about a group member instead of to them.
-
Example:
-
PatientJoe stood out because his life history was a lot like
mine. (Incorrect)
CounselorPlease say this again and this time speak directly
to Joe. Look at him and say, "Joe, you stood out because
. . ."
PatientJoe, you stood out because your life history was a lot
like mine. (Correct)
Examples of Good Responses. A typical reaction made by
a group member to the last group might be as follows:
- I thought a lot about how I deal with anger and frustration.
There was a lot of good feedback when I talked about my problem.
- I had a feeling of accomplishment as I worked on my problems.
I was surprised. I got excited instead of depressed for the first
time in a long time.
- Joe, you stood out to me because you understood what I was
talking about.
- Mary, you stood out to me because you told me you cared. I'm
not sure if I believe you. A part of me thought you were telling
the truth and I felt good. Another part of me said, "Why
should she careno one else does."
- Pete, you stood out because you did not seem to pay attention
to me when I was talking.
Learning To Give Good Reactions
It takes time for the average person to learn how to give good
reactions in group session. This learning takes place as a result
of instruction and imitation. The counselor and other group members
should explain the components of a good reaction to each new group
member. A written handout should be provided that describes the
components of a reaction and gives examples.
The group member will also learn by observing and imitating the
reactions of other group members. Counselors can speed up this
progress by acknowledging good reactions. This is done by saying,
"Good" or another positive response to encourage and
reward the person. The counselor gives positive feedback for doing
the reaction correctly, not based on agreement with the content
of what the person says.
Report on Assignments (10 minutes)
Assignments are exercises that patients are working on in their
workbook or in addition to their workbook. Additional assignments
are often given to help a group member solve a problem that is
being worked on in the group. Some of these assignments will be
completed in group, and others will need to be completed in between
group sessions. Immediately following reactions, the counselor
will ask all group members who have received assignments to briefly
answer six questions.
- What was the assignment and why was it assigned?
- Was the assignment completed? If not, what happened when you
tried to do it?
- What was learned from the completion of the assignment?
- What feelings and emotions did you experience while completing
the assignment?
- Did any issues surface that require additional work in group?
- Is there anything else that you want to work on in group today?
Patients should be asked to rate how important their assignment
or problems are in the group session by labeling them with a number
from 1 to 10, with 1 being not very important and 10 being extremely
important.
Setting the Agenda (3 Minutes)
After all assignments have been reported on, the group counselor
will identify all persons who want to work, and announce who will
work and in what order. Group members who do not have time to
present their work in this group session will be first on the
agenda in the following group session. It is best to not plan
on over three patients working in any group session.
The Problem-Solving Group Process (70 Minutes)
The problem solving group process is designed to allow patients
to present issues to the group, clarify these issues through group
questioning, receive feedback from the group, receive feedback
from the counselor (if appropriate), and develop assignments for
continued progress.
The problem solving process is guided in two ways. A series of
exercises are assigned and then processed in group. Special problems
that come up are discussed by the group. One goal of group counseling
is to teach problem solving skills that will enable the recovering
patient to handle difficult situations when they arise.
When dealing with problems that are not assignments, a standard
problem solving process is recommended. This process consists
of the following steps:
Step 1: Problem Identification.
First, have the members ask questions to identify what is causing
difficulty. What is the problem?
Step 2: Problem Clarification.
Encourage them to be specific and complete. Is this the real problem
or is there a more fundamental problem?
Step 3: Identification of Alternatives.
What are some options for dealing with the problem? Ask the patient
to list them on paper so they can readily see them. Try to have
the group come up with a list of at least five possible solutions.
This will give them more of a chance of choosing the best solution
and give them some alternatives if their first choice doesn't
work.
Step 4: Projected Consequences of Each Alternative.
What are the probable outcomes of each option? Have the group
ask the person the following questions:
- What is the best possible thing that could happen if you choose
this alternative?
- What is the worst possible thing that could happen?
- What is the most likely thing that will happen?
- What is your reaction (thoughts, feelings, memories, and future
projections) when you think about implementing that alternative?
Step 5: Decision.
Have the group ask the person which option offers the best outcomes
and seems to have the best chance for success. Ask them to make
a decision based upon the alternatives they have.
Step 6: Action.
Once they have decided on a solution to the problem, they need
to plan how they will carry it out. Making a plan answers the
question, "What are you going to do about it?" A plan
is a road map to achieve a goal. There are long range goals and
short range goals. Long range goals are achieved along with short
range goals. One step at a time.
Step 7: Followup.
Ask the person to carry out his or her plan and report on how
it is working.
Most problems will not be solved by presenting them one time in
group session. Personal problem solving is a process that requires
time. It may require three to six presentations of a problem,
accompanied by specific assignments completed between group sessions
to bring a problem to full resolution. Patients should be given
a limited time to present a problem or the summary of an assignment.
As a general rule, patients should not work in group for more
than 20 minutes.
Not every person will work on a problem during each session. There
is an 80/20 rule for group treatment. Eighty percent of the benefit
of group treatment occurs from learning how to become responsibly
involved in helping others to solve their problems. Only 20 percent
of the benefit is derived from working on personal problem issues.
Feedback
When you reach a point where part of the problem solving process
is completed or an assignment is presented, group members and
the counselor should give feedback. The counselor should go last.
Feedback should be given by having the members complete the following:
- My gut level reactions is . . . (A feeling, thought, or how
members can identify with the patient who presented)
- I think that how this affects your recovery is . . .
- What I think of you as a person is . . . .
The purpose of this feedback exercise is to practice communication
skills, learn to give and take feedback, and use the group for
problem solving. The counselor may give an assignment to the patient
if it would be helpful to continue to learn more about how to
solve this issue.
The Closure Exercise (15 minutes)
When there is approximately 15 minutes left in the group session,
the counselor will ask the members the following:
- What is the most important thing you learned in group this
evening? It is important to write this down in your notebook.
- What are you going to change about your behavior? Write this
down in your notebook.
- Share with the group what you learned and what changes you
are willing to make.
Each participant will then briefly review his or her answers to
those questions with the group. The counselor then adjourns the
group.
The Debriefing Session
The debriefing session is designed to review the patient's problems
and progress, prevent counselor burnout, and improve the group
skills of the counselor. If this can be done with other counselors
running similar groups, it is especially helpful. A brief review
of each patient is completed, outstanding group members and events
are identified, progress and problems are discussed, and the personal
feelings and reactions of the counselor are reviewed.
Outline for Group Counseling Sessions
Opening ProcedureFormat (5 minutes)
- Form a tight circle.
- Do physical and eye contact exercises.
- Do centering (breathing) exercise.
- Take attendance to identify moods.
Opening ProcedurePurpose
- Establish control.
- Get group members in contact with one another.
- Get group focused.
- Check members' attitude and mood.
Reactions to Last SessionsFormat (15 minutes)
- Ask what patients thought about during last session.
- Ask how they feel during last session.
- Ask which three people stood out from last session and why.
Reactions to Last SessionPurpose
- Communication training.
- Memory training.
- Tie together group experience.
- Force interest in other group members.
- Initiate high quality group interaction.
- Test motivation.
- Create opportunity for "no fault" communication.
Report on AssignmentsFormat (10 minutes)
- Find out who had an assignment.
- Ask whether they completed it.
- If yes, ask what they learned.
- If no, ask what happened when they tried to complete it.
- Ask how important is it for them to present this in group
tonight. (Rate 1-10.)
- Discuss any other problems that need to be worked on in group.
(Rate 1-10.)
Report on AssignmentsPurpose
- Accountability (getting only what you expect and inspect).
- Continuity (ensuring that all assignments are completed).
Setting the AgendaFormat (3 minutes)
- DECIDE and announce: The order of presentation by the group
members.
Setting the AgendaPurpose
- To identify the members who need to work in group.
- To review a brief description of the issue the member wants
to work on.
- To establish priorities based on:
- Problem severity
- History of participation
Problem Solving ProcessFormat (70 minutes)
- Problem presentation.
- Questioning by the group.
- Feedback from group members.
- Feedback from the group counselor, if appropriate.
- Closure by the therapist.
Problem Solving ProcessPurpose
- To present issues.
- To clarify the issue through questioning by the group.
- To receive feedback from group members.
- To develop assignments for continued progress.
Presenting a Problem in Group
- "The problem I want to work on is . . ."
- "This first became a problem when . . ."
- "The relationship of this problem to my addiction is
. . ."
- "I have tried to solve this problem in the past by .
. ."
Goals of Group Questioning
- To establish rapport by active listening.
- To encourage group members to know and understand the member
who is working on a problem.
- To convey the message, "You are listened to, understood,
taken seriously, and affirmed as a person."
Types of Questions
- OpenCannot be answered with a "yes" or "no."
- FocusForces a choice between limited options.
- ClosedForces a "yes" or" no" answer.
- LeadingForces consideration of a new point of view.
The "EIAG" Method.of Questioning
- EEXPERIENCE: "What exactly did you experience
and why is it a problem?"
- IIDENTIFICATION: "Can you identify what the
important parts, elements, or outcomes of the experience were
for you?"
- AANALYZE: "Why was this experience important?
What is its meaning or significance?
- GGENERALIZE: "What did you learn from this experience
and how will you apply what you learned to other experiences?"
Addiction-Focused Questions
- How did this problem or experience contribute to the development
of your addiction?
- How did this problem or experience affect your willingness
or ability to recognize or seek treatment for your addiction?
- How did this problem or experience affect your willingness
or ability to stay sober or maintain your recovery program?
- How did this problem or experience set you up to relapse in
the future?
Giving Feedback in Group
- "My gut level reaction to your problem or assignment
is . . ."
- "I believe your problem is . . ."
- "How I feel about you as a person is . . ."
The Timing of Change
- No problem is ever solved in one group presentation.
- To solve a single problem requires three to six group presentations.
- Each problem will need to be broken down into pieces that
can be worked on in 20- to 30-minute sessions.
- Limit each presentation to 2030 minutes.
- Allow time for two to four patients to work in each group.
The Problem Solving Process
- Problem identification
- Problem clarification
- Identification of alternatives
- Projecting the consequences of each alternative (best, worst,
most likely)
- Decision
- Action
- Followup
The Closure ExerciseFormat (15 minutes)
- Write down the most important thing you learned in group today.
- Write down what you will do differently as a result of what
you learned.
- Explain to the group the most important thing you learned
in group and what you will do differently as a result.
The Closure ExercisePurpose
- To ensure that each group member understands and integrates
the group experience.
- To assist in documenting the group process.
Adjournment
- Ask group members to report if they are not going to be in
the next group session.
- Confirm the day, date, and time of the next group.
- The group is officially ended.
The Debriefing SessionFormat
- Patient review: Review the progress and problems of each patient.
- Outstanding group members: Think about and record which group
members stood out the most in today's group and why.
- Outstanding events: Think about and record any outstanding
positive or negative events in the group.
- ProblemsProgress: Think about and record any problems or
progress observed in the overall management of the group.
- Personal feelings and reactions: Think about and record any
personal feelings and reactions about the group.
The Debriefing SessionPurpose
- To review patient progress and problems.
- To prevent counselor burnout.
- To train and develop the skills of the counselor team.
- Debriefing is critical to long-term group success.
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Last Updated 11-7-02