Originally published 12/29/21 on Recovery View.
While group counseling continues to be the most common and cost-effective way of treating addictive disorders, the propensity toward conducting group evaluations by programs is surprisingly low. In fact, I’ve conducted numerous group evaluations where counselors have told me they’d been conducting groups for decades, and never had a formal group eval. While I suspect there are several reasons for this, I would like to see our profession prioritize this practice. My hope here is to spark an interest toward what is happening in our groups and toward intentionally improving this service. To begin shedding a light on this subject, presented here are a just couple of observations from group evals I’ve conducted over the past three decades: Facilitator Over-Involvement and Group Distractions.
One of the most common counselor errors observed is the over-involvement of counselors. This manifests in various ways and is often the result of overlooking the fact that the counselor is facilitating what should be considered the patients’ group, rather than the patients participating in the counselor’s group. Counselors can seriously hamper the growth and maturity of the group and its individual members by “taking over” the group. They can also inadvertently sabotage learning of much-needed problem-solving skills and the practicing of some of the most basic recovery tools and strategies.
The first thing to acknowledge is that most people who do this work have a wealth of recovery knowledge to pass on to patients and are more than eager to do so. This can be especially true for newer counselors. After all the required education received in school, and (hopefully) practicing group facilitation under direct supervision, they are finally doing their own groups and can’t wait to show themselves and their patients that they know what they’re doing. So, when the opportunity arises to provide their expertise in the form of feedback, they often can’t wait to do so. However, and here’s is the rub: one of our jobs as counselors is to work ourselves out of a job with our patients so they don’t need us anymore. To accomplish this, they need to learn problem-solving skills. If the counselor provides all the answers, patients are prevented from thinking for themselves and, therefore, are not developing such needed skills. In fact, they end up relying on the counselor to provide the problem-solving feedback and become dependent on the counselor for such. In this way, we are fostering dependence rather than working ourselves out of a job with our patients. If we are providing feedback that the clients might otherwise be able to give, their growth is stunted.
Therefore, counselors should resist providing feedback themselves and always give patients the first shot at feedback (unless of course the person’s trauma has been activated or other intense feelings are being processed, then the counselor should be the first one in to empathize and set the tone for group feedback.) It may be that in groups with newer patients, some counselor modeling of appropriate feedback is necessary in the beginning. As counselors gradually reduce their involvement in feedback, patients could be prompted with questions like:
- What recovery tools might Suzie use when…?
- Have any other members of the group ever felt that way?
- What relapse prevention techniques could Jose use here?
- Is anyone curious about whether or not Diane has a sober support system?
- Who can tell us what we mean by utilizing sober support?
- Has anyone noticed progress in Deion since they got here?
Another important point here is assessing the skill of utilizing peer support to stay sober post-rehab. Some of our clients lack the skills required to both seek and receive feedback and support from others – not to mention developing the ability to provide such. By withholding counselor feedback and observing patients’ strengths and weaknesses in this area, difficulties can be identified, skills taught, and further opportunities for practicing their new skills are facilitated.
My general guideline is that, in process groups, counselors should only speak about 10% of the time. I find this is best facilitated by using the following formula once the group guidelines have been reviewed and a brief check-in (preferably a “feeling round”) is conducted:
Patient shares -> Group asks any clarifying questions à Group provides feedback.
The counselor’s role then is to determine when it is time for the group to move on the next patient share. Moving the group along may include: the counselor providing some sort of summary statement regarding the work and feedback provided, any brief feedback the counselor wants to add (although I prefer the counselor hinting group members towards any missing feedback) and providing positive feedback and/or acknowledging progress of the group member. The latter is another big deficit of group counselors I have observed. Many of our patients have come from backgrounds where positive strokes were rare or absent. Others have been running amuck in their addiction so it may have been some time since anyone had anything positive to say to them. Positive feedback could feel so good and be so encouraging that it may be the one thing that keeps them coming back. It also naturally encourages further improvement due to positive reinforcement.
Another very common deficit of counselors is lack of protecting the group from distractions. Such distraction comes in many forms as seen below. In our post-group debriefings with counselors, I often encourage treating the group as sacred – nothing should be allowed to interrupt it. Following are some of the most common distractions identified and addressed:
Tardiness: One of the ways the sacred nature of the group is violated is by people walking in late. In fact, some counselors inadvertently encourage it by starting groups 5 or 10 minutes after the scheduled start time. Consequently, people show up late as they know the group never starts on time. Even then, people will still come late and, in the process, interrupt what is happening in the group. Very often, such tardiness is never even confronted by the counselor – further reinforcing the behavior.
Walking out: People walk out of group for various reasons: going to the restroom, to go smoke, boredom, issues discussed are a little too “close to home”, answering phone or making calls, hungry or thirsty, etc. This should just not happen. Such behavior disrupts and changes the dynamic of the group. Without trying to, when the person gets up and leaves, they are drawing attention of every person in the group – and possibly hurting the feelings of someone who may be sharing vulnerably and getting their feelings hurt in the process.
I’ve also seen therapists interrupt groups by pulling clients out for their individual sessions. This should also never happen. If they have a therapy session during that hour, they should not be in group to begin with and so the group does not get interrupted.
Food and drinks: I once did a group eval when one of the patients got up from the group, placed a Cup-o-noodles in the microwave (both of which were in the group room), went to their backpack to fetch a bag of hot Cheetos and proceeded to, very noisily, crunch up the Cheetos into little pieces so he could top off this creative snack. Once it was ready to eat, he prepared a big bite of this delicacy onto his fork and lifted it to his mouth with most of the group watching. Just as he was about to take that first bite, he stopped with the fork about 6 inches from his mouth and started sharing (he never lowered the fork – incredible!) In my group counseling career, I did not allow the distraction of any food or drinks in group, but eventually loosened up to allow water (although not noisy plastic water bottles).
Cell phones: If a cell phone is brought into group and even if it is placed on silent, patients just can’t resist checking to see who has called or texted them. Therefore, unless there is a good and specific reason not to, (i.e., some sort of safety issue) all cell phones should be shut off prior to group.
The best defense against group interruptions is addressing them in the group rules. Such rules should be reviewed prior to every group. I like having a group member read them or, if the group has been together awhile, having them take turns naming a group rule. Reviewing the rules not only reminds participants of them but reinforces the safety of the group. I encourage facilitators to include the “no walking out” rule which could sound something like this: “We ask that you to take care of business prior to the group so you don’t interrupt it by leaving to go to the restroom. If you get so uncomfortable that you just can’t handle sitting in the group any longer, please let the counselor know that prior to leaving.”
Enforcing the group rules is equally important. You might be amazed at how often the group rules are read and subsequently broken during group without confrontation by the counselor. Not enforcing the rules undermines the integrity of the group, sabotages our attempts to model structure (something our clients need from us) and reinforces rule violations. For example, if a participant knows they can leave the group without being confronted about it, they can just leave without experiencing the tension created by calling them on it. The same holds true for tardiness; if they know they can show up late without being called on it, many will not see a problem with it. Conversely, if the facilitator asks the person why they were late and reminds them that the rule and expectation is to be on time, the chances of being late again are significantly decreased. Reviewing the rules prior to each group also supports the counselor in enforcing them and makes breaking them less likely.
I will tell you that it is clear very early on in group which counselors enforced the rules and which don’t. Simply put, those who do not enforce the rules have groups that are chaotic and often unproductive, and those who enforce them lay a foundation for smooth, safe, and productive group work.
In summary, facilitator over-involvement and group distractions are some of the biggest deficits I have observed while conducting group evaluations. I hope that sharing some of this experience and information sparks your interest in receiving or, if you are a supervisor, providing group evaluations. I also hope that illuminating these common group facilitating deficits sparks your interest in addressing such areas as a counselor or supervisor and that improving group skills in general can be an agenda item for your 2022! Happy Holidays!