dealing with difficult group members in therapy

Importantly, most clinicians expressed positive attitudes towards EBTs or manualized therapies (especially to guide new clinicians) but only if sufficient flexibility is permitted. This leads to a discussion about their anger and the consequences of spewing it everywhere. No, with right training it is not. Read our. Characteristics of participants are summarized in Table 1. To avoid conflict and avoid potentially losing a relationship, I try to understand their emotions and perspectives, which is, again, demonstrating empathy. So we are basically telling them in those education pieces how to not use, what to do instead. The https:// ensures that you are connecting to the Theory and practice of group psychotherapy. According to Clifton Mitchell, a professor at East Tennessee State University, Resistance goes two ways. According to the behavioral model, the failure of the patient to comply with therapy may be the result of inappropriate reinforcers or reinforcement contingencies (Leahy, 2003). In some cases this process involved co-facilitation or being observed by a supervisor, particularly for clinicians who initially were student trainees at the clinics. If someone is yelling at you, being rude, or even threatening, its hard to remain calm. How to elicit and implement group feedback, Online role-playing games as group therapy during the COVID-19 pandemic, The power of virtual group therapy during a time of quarantine, Advocacy Update: Tips for effective advocacy, Conceptualizing and assessing race-based traumatic stress, From the President: Creating change within the profession, 5 takeaways from the 2023 Virtual Hill Day, The thing I fear most about being in this group is ________ (for any group), If I give up drugs, it would mean _____________ (for mandated drug offenders), I tend to hit those I love when _______________ (for mandated batterers), The hardest thing about being on probation is ___________ (for those mandated due to probation), Leader: Im going to ask each of you to answer either yes or no regarding whether alcohol was involved in your arrest. (The leader can ask follow-up questions to those who answer yes. And so again, it's meeting the clients where they are at. Interview questions addressed organizational characteristics, services provided, group therapy curricula, and use of EBTs or other structured treatments. The Unfocused One. Flexible, individualized treatment also was discussed through various, albeit limited, ways in which one-on-one encounters with clients intersected with group therapy. According to the American Counseling Association, there are several exercises and approaches counselors can use to manage and reduce the negative impact of resistance (Shallcross, 2010): Ask the client how others in their environment treat them. The .gov means its official. International Journal for Quality in Health Care. Particularly within the model of MIGP, the facilitator pays great attention to altruistic moves on the part of members. Second, some clinicians reported having limited or inadequate experience with or training in group therapy facilitation. In addition to cost considerations, a meta-analysis of 24 studies suggested that group therapy is generally equally effective as individual therapy for SUD treatment (Weiss et al., 2004; see also Sobell & Sobell, 2011). He then tells the client what he needs from him or her. AA says not to do it. And so, if they are able to even mimic that stuff, even if they don't think it applies, then at least I know they are hearing it. We look at common reasons for difficult behavior, how you can remain calm and composed in the midst of a challenging situation, and how you can deal with conflicts in the workplace and with family. WebAbstract. I think [clients] would enjoy it more, instead of necessarily just sitting there and just talking again and again about the negative consequences of their substance use. This study consists of interviews with 13 clinicians from three SUD specialty outpatient clinics located in the same metropolitan area in the Midwestern U.S. An assumption that seemed to be commonly reflected by clinicians in this study is that group therapy experience comes by observing other clinicians' groups and then facilitating one's own groups, perhaps with co-facilitation and/or supervisory observation in between. By encouraging controlled talking through the use of a round, a leader can hear from everyone and also better manage any negativity by having the round be in the form of a word or phrase. Perhaps you simply retreated into your mind and started thinking about where to go on vacation, what to make for dinner or other things you could be accomplishing with your time. A round is an activity in which all group members are asked to participate by sharing a word, number, comment or phrase. National Library of Medicine Third, clinicians relied heavily on didactic educational groups, perhaps reflective of a narrow range of therapy options. Use open-ended questions to help the client explore their personal experience without influence. All mental health professionals have challenging clients. I would say groups are my weakest point. This has been nearly twenty years ago and I still tote with me a box of props along with a well worn copy of your, Creative Counseling Techniques. Brodsky, S.L., &, Titcomb, C.R. Discuss the discrepancies between what they are saying and the tone they are using in the group. A final implication for group facilitation pertains to clinicians' reliance on didactic education within groups. The title of this article caught my attention because I am currently leading groups in an inpatient setting. Reach mutually agreed-upon goals for the therapy. How has your week gone? To be sure, making clinical decisions on the status of an entire group (e.g., group cohesion) would be consistent with a systems approach to treatment that typically underlies group therapy theory (American Group Psychotherapy Association, 2007); however, in the case of short-term open-enrolling groups (where membership is constantly in flux), clinicians may have difficulty knowing how much to emphasize group-level appraisals versus the individual needs of group members who are most at risk. These and other related questions relative to group therapy facilitation are the focus of this exploratory qualitative study. One represents no desire to change, and 10 represents a strong desire to change., Leader: Rate your week on a 1-10 scale, with 10 representing a very good week and 1 representing a very bad week.. When I was in school, I was interested in going into counseling. Group size ranged from 5 to over 20 clients, with most groups having between 12-18 clients. Dealing with resistance in group therapy This digest examines two representative problems in groups and Connecting with the client and understanding their perception as a victim with little control is vital. Clinicians consistently emphasized the need for flexibly implemented therapy. Express empathy. In the book: Clinician's Guide to Self-renewal: Essential Advice from the Field, 2014, Strategies for Working with Difficult Clients We interviewed clinicians concerning complexities of group therapy facilitation. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. In order to provide individualized and engaging care, clinicians universally expressed the necessity of being flexible in their group therapy facilitation. dealing with difficult group Web . I started to sweat. Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. We have plenty of tools, techniques, and worksheets to encourage cooperation within the therapeutic process and improve clients self-image and hope for the future. The Dominator. One clinician was especially blunt about the lack of quality control efforts in the clinic: What do I think that this place does to ensure that group sessions are high in quality? Blaming others comes handy sometimes Plus, be the first to receive exclusive content & discounts. That may be coping with a specific medical condition, In addition, limited attention was given to group therapy quality control efforts. When leading groups with involuntary members, doing the unexpected eliminates some of the anticipated negativity that often occurs in these groups. The Challenger. Rather, the assumption seems to have been that existing EBTsdesigned for and tested on individual therapysimply need to be adapted into group format. In addition to challenges with having clients with varying levels of engagement, eight clinicians discussed challenges with working with clients having differing levels of severity or readiness to change. 204 CONDUCTING AND MANAGING GROUPS - Nova The offers that appear in this table are from partnerships from which Verywell Mind receives compensation. Knudsen HK, Ducharme LJ, Roman PM. In spite of the high prevalence of group therapy for SUDs in real world settings, research efforts have focused primarily on individual therapy. Challenging clients aren't just a problem for clinical and counseling psychologists, either. And both of those methods can This flexibility was evident in clinicians' commonly reported group therapy processes and activities. Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence. Deal With Difficult (Lane, Recovery Services), As reflected in the above vignettes, clinicians and their clinics balanced group therapy with individualized attention by attempting to provide multiple approaches, allowing individual clients to glean from the various approaches and find what works for them.. Still, it should be noted that open groups have clinical (not just economic) advantages, in terms of new clients with urgent needs being able to initiate treatment more rapidly. Although New Day routinely had clients complete feedback forms at the end of each group session, formalized or systematic quality control efforts were absent for each clinic, based on participants' reports. This article explores, both theoretically and clinically, the behavior of the habitual group monopolist, an individual who dominates a group in a nontherapeutic manner. However, even in the absence of innovative group therapy protocols, clinicians and administrators could make efforts for incorporating more skills practice and interaction within group sessions (see Wenzel et al., 2012). Watkins KE, Hunter SB, Hepner KA, Paddock SM, de la Cruz E, Zhou AJ, Gilmore J. Discuss why the client could not attend one or multiple group sessions, and ask if there are any other underlying reasons. A person can become irritable, aggressive, intolerant, and noncommunicative for a number of both internal and external reasons, including: Author Natasha Bowman, JD, SPHR, noticed that her behavior changed as she dealt with the responses of family members and friends to her bipolar diagnosis. Connors GJ, DiClemente CC, Velasquez MM, Donovan DM. You can also take steps to regulate your own behavior by taking deep, calming breaths, practicing focused mindfulness, or even taking a break from the situation by removing yourself and coming back to the conversation later. So I scrolled up and thats exactly what I saw. Ask them to sit up, remain focused, and talk openly in this safe space. Miller, W. R. (1999). Clinicians also discussed problems with the inflexibility of some manualized/structured therapies in the context of group therapy. This next activity may serve as an excellent movement exercise to focus on the idea of setting goals. Perhaps Im misreading, but it sounds like. In addition, clinicians may need greater guidance for making decisions about balancing content and process, including knowing when and how to deviate from a treatment manual or agenda. He was working with two parents and their daughter, when the father started attacking Honda, making hostile comments about his abilities as a therapist. - Its 3 p.m. and you are anxious about going to the group you are leading because its members are being forced to attend by the court, the principal or some other authority figure. During the warm-up phase of the first session, a round that often works is: Given that you have to be here, in a phrase or a sentence, what can I or we do to make this a somewhat worthwhile experience for you?. They allow both client and therapist to practice interpersonal conflict resolution skills and promote growth that may not occur in their absence. Your email address will not be published. Through daily practice of mindfulness, clinicians can learn to notice sensations arising in the body and thoughts arising in the mind without judgment. A final complexity is the predominant role of clinicians' providing didactic education in group settings. In contrast, active skills practice was reported to be infrequent, primarily limited to mindfulness exercises in some group sessions at New Day and SUD Intensive Clinic, and minimal role playing at SUD Intensive Clinic; these skills were especially utilized in groups based on CBT and third-wave behavioral principles. Those who subscribe to more of a facilitator model of group leading, where much of the responsibility for the flow of the session is given to the members, will likely find leading mandated groups to be frustrating, to say the least. They told me all kinds of good things that I should do, so thats what I have planned for this group. "I say, 'If you worked as hard to make your life better as you do to make sure nothing changes, you could be extraordinarily successful,'" he says. Morgan-Lopez AA, Fals-Stewart W. Analyzing data from open enrollment groups: Current considerations and future directions. As a service to our customers we are providing this early version of the manuscript. They can also keep in mind the core values that undergird therapy. Let's get somebody else's input. Not that it's not important, but I can kind of see people zoning out. 2023 Dotdash Media, Inc. All rights reserved. Accessibility Let your manager know that you are constantly being challenged by your co-workers difficult behaviors and ask them to intervene.. This page Empirically supported treatments or Type I errors? , . Instead, encourage the client to explore and explain their feelings and show that you recognize and understand them. The sample was diverse in gender (67% women), age (range from 25-65 years; mean of 39 years), years providing SUD services (range from 1-45 years; mean of 10 years), and personal recovery status (31% endorsed). This requires poise and Instead, suggests Hanna, praise the client's resistance. Volume 19, Issue 1 Working with difficult group members The Journal for Specialists in Group Work Volume 19, 1994 - Issue 1 224 Views 7 CrossRef citations to I might stand up and do an interactive lecture. 4. 8600 Rockville Pike The importance of flexibility for group therapy in SUD settings has complex implications relative to the use of EBTs. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Although SUD clinicians report a high use of MI components in group settings (Author, 2017), several clinicians in this study reported having difficulty with implementing MI processes in groups, or even wondering if such was possible. To compensate, for this study care was taken to elicit detailed accounts of group therapy facilitation, including in-depth discussion of a recent session the clinician facilitated. Dealing With Difficult People in Specific Situations . The three participating clinics (identified here by pseudonyms) were diverse in their operational structures, treatment philosophies, interventions, and types of clientele. Your email address will not be published. Recidivism rate is the worst It feels like we r helping client bcm a better functioning crimminals Psychopaths/antisocial r not criminally insane?!. I almost ran out of the office.". In a group conflict sometime arises between two or more members. Visual props help to engage group members because props are novel and engage both sides of the brain. These situations can be most helpful. This may be concerning, given that SUD treatment limited to didactic education is generally ineffective (see Gifford et al., 2012; Power, Nishimi, & Kizer, 2005). A first step, then, would be to explore clinicians' perspectives on complexities with group therapy facilitation in SUD specialty treatment settings. This article explores, both theoretically and clinically, the behavior of the habitual group monopolist, an individual who dominates a group in a nontherapeutic manner. These are people who are often with you day in and day out. Some might propose that the burden is on clinicians to adapt existing EBTs into group formats. Bethesda, MD 20894, Web Policies Terrified of Group Therapy: Investigating Obstacles to Entering or The first author contacted the clinical directors of the three clinics, and each director agreed for clinicians to be recruited. With workplace challenges, understanding why a person is being difficult can help with the approach to handling them. Dont forget to download our three Positive Psychology Exercises for free. sharing sensitive information, make sure youre on a federal Make your limits clear and communicate what behavior you will and will not tolerate. How can I say, Well, you have to do it this particular way? Here are 5 main reasons people resist change. In particular, clinicians expounded on the difficulties of facilitating groups with clients who vary in their level of engagement and readiness to change. 204 CONDUCTING AND MANAGING GROUPS This article explores, both theoretically and clinically, the behavior of the habitual group monopolist, an individual who dominates a group in a nontherapeutic manner. Carroll KM, Rounsaville BJ. Ungreatful bricks! These results are not surprising, given that MI training efforts have focused primarily on individual therapy. Dealing With Difficult People in Specific Situations, How to Navigate Difficult Relationships With Your Family. In other cases, clinicians from all three clinics discussed decisions to depart from what was planned at the outset, in light of last-minute appraisals of group needs. Leader: Everyone stand and line up side by side. (Leader moves about 8 feet in front of the members and draws an imaginary line.) Be clear about your boundaries and communicate them assertively. WebDifficult patients: their construction in group therapy. I asked a guy and he let me sit in on one of his group therapy sessions with troubled teens. Evidence base on outpatient behavioral treatments for adolescent substance use: Updates and recommendations 20072013. Think of them as being in the center of our circle. (Leader puts a large piece of paper with the word GOALS in the center and allows members some time to stare at the sign and think about their goals.) Sentence completion, in which all members complete two to five sentences about something, works well for almost any population if the sentence stems are relevant and interesting. Positive Psychology 19 Apr 2023 Client Resistance in Therapy: How to Help Difficult Clients 21 Apr 2021 by Jeremy Sutton, Ph.D. Scientifically reviewed by Maike Neuhaus Ph.D. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. WebAbstract. Clinical versus actuarial judgment. Some of these challenges pertain to the burden of facilitating dynamics in groups with highly diverse clients, especially in terms of clients with differing motivation to change. This page examines some of the most common: Conflict, Non-Participation or Considerable research has shown limitations of clinical wisdom used to depart from established protocols (gisdttir et al., 2006; Bamatter et al., 2010; Dawes, Faust, & Meehl, 1989; Martino, Ball, Nich, Frankforter, & Carroll, 2009). The members spent a few minutes naming their group. Working with difficult group members Group size generally ranged from 6-12 clients, with intensive groups being on the higher end. Don't engage. This creative technique has a much greater chance of engaging the members regarding the consequences of their drinking in comparison with simply asking them about the consequences. WebDifficult Group Behaviours. Deal with Difficult Finally, an educational approach may be assumed to be the natural adaptation of existing EBTs for SUDs. In cognitive models such as Albert Elliss, resistance is often the result of unrealistic expectations and other irrational beliefs. The person that wrote [a treatment manual] doesn't know the people in front of me. It was very interesting, and not what I expected. Participants were reimbursed $30 per hour for the interview, and $15 for completing a survey that included demographic information. (Maddy, New Day), I may have a plan in my mind, and then I gauge it on the group and their level of how alert they are and awake. in Therapy And one of the common things that they identify is having the ability to take it in a direction or subject where they need to address something at that time. Volume 19, Issue 1 Working with difficult group members The Journal for Specialists in Group Work Volume 19, 1994 - Issue 1 224 Views 7 CrossRef citations to date 0 Altmetric Original Articles Working with difficult group members Jeffrey A. Kottler Pages 3-10 | Published online: 31 Jan 2008 Download citation Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. Written exercises are extremely valuable for the leader because they make it easier to draw out members. Such is an especially difficult task in terms of appraising the status of entire groups, as some individuals may not fit the group appraisal. And will this engage them or will this put them asleep today? One, two, three.. (Kris, New Day). Instead, encourage the client to say more about why you're so unattractive. If it is a rainy, gloomy day like this, I would not show a video. For those of you willing or wanting to participate fully and actively, pull your chairs to the center. Facing a client who is resistant or possibly hostile to the therapeutic process or therapist can be unsettling and challenge the treatments success (Clay, 2017). Web . A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. These check in periods, reported by all 10 clinicians for New Day and Recovery Services, would last from a few to 15-20 minutes of a 90-minute group. The second clinic, Recovery Services, was operated by a state medical school, and included an intensive outpatient track and a standard outpatient track; its treatment approach was eclectic, with therapeutic orientations varying per clinician. Clinicians reported challenges and complexities with group facilitation. WebSuggestions for Responding to Difcult Clients in Groups Silent Sam With such clients the goal is to nd a way to get all members, especially those who are less verbal, to D'Amico EJ, Hunter SB, Miles JNV, Ewing BA, Osilla KC. So I'm going to try to use whatever I think might work. Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. Webactions they employ increase group fluidity and focus while dealing with difficult situations and behaviors. WebSo people may have only three reactions in the face of anger and conflict: withdraw, attack, or avoid. WebResponding the wrong way whether by pushing back at the client or withdrawing can derail the client's progress, say Honda and others. The interview protocol was piloted with a volunteer student clinician. Dealing with difficult group members - Spokane Community Miller WR, Wilbourne PL. Common Stress Reactions - A Self-Assessment. Ask them what techniques they have used in the past to cope and manage the situation and whether they were successful. Motivational interviewing groups for dually diagnosed patients. How can psychologists respond effectively to challenging clients? But don't resist resistance, says Hanna. (Alex, New Day) Other clinicians described the importance of this flexibility, using phrases such as doing my little twists and turns (Brett, Recovery Services) or putting my own spin on the material (Karlie, SUD Intensive Clinic). The process of resolution can overturn the clients long-term, maladaptive interpersonal schemata. We also want to provide an array of ideas to help make a mandatory group a positive experience for most, if not all, of its members, as well as for you, the group leader. "A big reason for that is because people don't talk enough about their difficulties," he says. (Karlie, SUD Intensive Clinic), A lot of what happens in the group is really based upon where the [clients] are at. There are several distinct types of 'difficult behaviour' which can occur in group situations. Clients who think a psychologist is terrible at his or her job have every right to question credentials, challenge therapeutic decisions or even decide to end the relationship, says Honda. Do you want to call it the drug group, or do you want to give it some new name that sounds better than the drug group?. Support groups developed to join people together who are dealing with similar difficult circumstances. Support Groups: Types, Benefits, and What to Expect Invite the client to envision and describe how the future could be different once the problem has been resolved. Was the discussion we just had helpful? (The leader can ask follow-up questions regarding why the members said yes or no. Osilla KC, Alexis J, V N, Pedersen ER, Houck JM, D'Amico EJ. The key is to develop thought-provoking sentences, but not too many of them. Take care drawing attention to the behavior in a group setting, as it may be upsetting to hear and cause further resistance. These group dynamics were sometimes complicated by frequent changes in enrollment, beyond the clinician's control, that influenced or impaired group cohesion. So, therapists dont have right training. Managing the group monopolist - PubMed (Alex, New Day), I do believe that [clients] are the world's best expert on themselves. WebFirst, make sure your own house is in order. Here are some examples. Save my name, email, and website in this browser for the next time I comment. Responding the wrong way whether by pushing back at the client or withdrawing can derail the client's progress, say Honda and others. Schnitker, S.A., Blews, A.E., & Foss, J.A. Finally, we suggest that training efforts focused on group MI may be especially promising. Because these EBTs are designed and evaluated for use with individual clientsand thus lack explicit consideration of group processclinicians may be prone to simply port content into group format. We discuss specific strategies for improved innovation and implementation of EBTs for SUD group therapy. Calm yourself. During this and previous times that I had conflicted with my close family and friends, I noticed a pattern and was also triggered by them, she explains. I want you to assume that this line is you reaching the goals we talked about in the first and second sessions. As a therapist, it can help to remember that you are there to bear the burden of your clients pain.
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