Group Counseling: 50 Basic Premises and the Need for Mainstreaming
Abstract and Keywords
This final chapter of the Handbook is intended both to summarize the major content contained in the previous 30 chapters about group counseling and to identify an important direction for action. The first goal is met by drawing from the material 50 basic premises pertaining to group counseling. All chapters are represented in these premises, and they range across the Handbook’s major sections of Context, Key Change Processes, Research, Leadership, and Applications. The second goal of identifying an important future direction is addressed by observing that group counseling, although now characterized by a substantial literature base documenting effective practices and procedures and now awaiting clearer actionable strategies for practitioners, continues to sit largely outside of mainstream practice and awareness. It is little known or appreciated among academics, researchers, and practitioners operating outside the group-counseling specialty, and to members of the public it seems largely to be a mystery. Group counseling must be mainstreamed by proactive promulgation of its knowledge base related to education and training, practice, and research.
In pondering the voluminous content of the previous chapters, I am reminded of a wonderful movie title from (far too many) decades ago, What’s It All About, Alfie? While not so concerned in this final chapter with coming to grips with what one person’s life is all about, as in that movie, I am seeking to identify the essential meaning running through this volume’s chapters. To rephrase the movie’s refrain, in a sense I am asking, “What’s group counseling all about, Alfie?” That is, what are some of the basic premises that serve to guide its practice?
The content of this book will provide the basic raw material for my examination. I have scoured it, and here I report on it (note: refer to the chapters directly for citations and references). Obviously, the resulting 50 premises reflect my perspective alone, and I encourage you to compare it with your own. Putting the two together no doubt will produce a fuller and perhaps more valid depiction of what group counseling is all about.
In addition, it is apparent to me that the value of group counseling is a kind of “best-kept secret.” That is, it is metaphorically locked away in a safe box to which only those of us in the group-counseling inner circle hold a key. We have been focused, I suggest, on talking among ourselves (such as through the pages of this volume), sharing our practice and evidence. Of course, this level of discourse is absolutely fundamental to any scientific and educational endeavor. However, generally, we have failed to communicate the value of group counseling to those outside our small arena: to academics in areas and specialties outside our own; to stakeholders and thought leaders in education, health, and government; and to the public at large. We might ask, therefore, If group counseling is so valuable, why is its application so limited? The last (p. 554) section of this final chapter, therefore, will address the need for group counseling to become a more obvious part of the mainstream.
My exploration of this volume’s content will proceed in parallel with the sequence of the chapters themselves, beginning with the discussion of the definition of group counseling and ending with that of trauma and disaster groups. However, the presentation will be organized by the major sections of the volume, which operate as lenses through which we can identify the basic premises of group counseling. These lenses are as follows:
50 Basic Premises of Group Counseling
Premise 1: To Understand Group Counseling, One Must First Understand “Groups”
Forsyth indicates that the essential elements of a group are found in the relationships connecting members, boundaries, interdependence, structure, cohesion, and entitativity (perceived “groupness”). He points out that as human beings are social animals who spend much of their lives in groups rather than alone, a group-level analysis is needed to supplement the more typical individual-level analysis of adjustment, well-being, and treatment. Group counseling provides a medium through which these (and other, see Chapter 7) approaches can be integrated.
Premise 2: Group Approaches Have Proven Themselves to Be Effective, But They Are Not the Preferred Mode of Treatment For Most Therapists and Clients
Forsyth suggests that as theorists, researchers, and practitioners confirm the central importance of groups in people’s lives, people will in time begin to think of themselves as group members first and individuals second and that group counseling will benefit as a helping modality.
Premise 3: Group Work is A Useful Umbrella Term For the Broad Array of Group Modalities, Including Group Counseling
A discussion of any phenomenon needs first to proceed with defining key terms. So it is with group counseling. Ward pushed and prodded for some common ground, pointing out, as have others, that group counseling is a complex activity that is understood in a variety of ways. He concludes that the term group work is the “logical” one to use when referring to the broad field of helping people in groups.
Premise 4: Group Counseling is Interpersonal, Process-Oriented, and Strengths-Based
As for group counseling, which is part of the group-work manifold, Ward indicates it is characterized by an interpersonal, process orientation that focuses on increasing the strengths and wellness of members. He suggests that these emphases guide the necessary work to produce empirical evidence, combined with clinical wisdom, of the effectiveness of group counseling with specific populations in particular settings. As well, these elements supply the foundation for professional counselor training, which, in turn, needs to be centered on the dynamic properties of group interaction rather than serving as an extension of individual counseling.
Premise 5: History Points to New Generational Thinking
Leddick points out that successful originators of therapeutic models (e.g., Perls, Rogers) typically develop avid followers during their lifetimes. These supporters grow less fervid after the founder’s death. Once the cult of personality subsides, what remains in our collective imaginations are effective strategies, helpful conceptual frameworks, and useful techniques. He wonders how the next generation of scholars and researchers will make history by synthesizing, originating, and configuring innovative combinations of group-counseling practice that will galvanize and inspire further evolution and improvement.
Premise 6: The Professions of Counseling, Psychology, and Social Work Enjoy Unique Identities But They Share Ethical Foundations With Each Other And With Older Professions Such As Law And Medicine
Rapin observes that all of these professions follow the fundamental ethical principle of the Hippocratic oath of first do no harm. Their ethical documents that guide appropriate behavior reflect shared values. As well, counseling, psychology, and social work are professions governed by licensure and specific state or provincial regulation.
(p. 555) Premise 7: Ethical Decision Making in Group Counseling is Unalterably Connected to Development of an Ethical Frame of Reference That is Relevant to Both the Individual and the Profession
Drawing from a thorough review of existing publications and approaches across several group-oriented mental health professional associations, Rapin fashions a generic equation to assist in understanding how this connection operates, stipulating that ethical behavior in group counseling is a function of moral and ethical development, professional ethics, core knowledge and skills, specialty best practices, and legal parameters. She emphasizes that these major elements of ethical behavior are applied in interaction with a decision-making model. Without consideration of ethical development and the context in which a dilemma occurs, decision making in group counseling is both incomplete and flawed.
Premise 8: Group Counseling Practice Must Include Cultural Competence Built on Empirical Findings Associated With A Range of Ethnic and Racial Groups, Adapted to the Unique Demands Of Cultural Sensitivity
DeLucia-Waack observes that six domains of cultural adaptation seem to apply to group counseling, including dynamic issues and cultural complexities; orienting clients to psychotherapy and increasing mental health awareness; understanding cultural beliefs about mental illness, its causes, and its appropriate treatment; improving the client–therapist relationship; understanding cultural differences in the expression and communication of distress; and addressing cultural issues specific to the population. In addition, social class needs considerably more attention, as does the cultural background of the group leader.
Premise 9: It is No Longer Possible to Treat Mental Health Problems (And Prevention of Problems) in Isolation From Social Problems
Hage et al. suggest that group leaders need to take a proactive approach to assure that social justice be included within training curricula, research agenda, and practice orientations. Strategies should include multilevel interventions, of which group is a part, and a focus on social transformation. Thus, individual change and influence become parts of the equation, not the whole formula. Indeed, group-work practice and training need to be infused with socioeconomic, political, and demographic trends occurring in modern society, pursuing social justice so that wellness may blossom at all levels.
Key Change Processes
Premise 10: Therapeutic Factors in Group Counseling Are Core Concepts That Have Generated A Significant Amount of Empirical and Clinical Interest: Research Needs to Identify Which Therapeutic Factors Are Fundamental And What Interrelationships Exist Among Them
Kivlighan et al. maintain that some therapeutic factors are more influential than others or that this may vary depending on who is asked and in what kind of group. It is likely that key factors interact rather than stand independently. All of these matters need to be researched.
Premise 11: Further Research is Needed to Specify What Group Leader Behaviors Connect With Which Therapeutic Factors
Kivlighan et al. suggest that therapeutic factors become especially important when they are considered as being actionable by group leaders. But what behaviors may be tied to which factors to yield the most positive outcomes? (Note: Redundancy surrounds this research direction, with similar needs existing to identify linkages between group leader behaviors and group cohesion, group climate, and group development).
Premise 12: Research on Therapeutic Factors Occurring in Groups Needs to Be Conducted Using A Group Perspective
Kivlighan et al. lament that research on therapeutic factors operating in group has lacked a focus on the group itself and, even more important, largely has failed to account for essential group interactional constructs, such as mutual influence. They believe that research on therapeutic factors in groups will not advance until theorists and researchers start formulating and testing theories and models that have a group perspective.
Premise 13: in Group Counseling, the Sense of Cohesion, Alliance, and Group Climate Are The Relationship Factors That Provide The Foundation For Successful Treatment
Despite the contradictory reports and often because of the myriad of influencing factors that can lead to ambiguity and inconsistency in research findings, Marmarosh and Van Horn conclude from prevailing group research (p. 556) that cohesion is among the three vital processes accounting for successful group-counseling efforts.
Premise 14: Future Research in Group Cohesion Needs to Be Particularized
Marmarosh and Van Horn make the following recommendations: (1) explore the direct and indirect ways cohesion relates to process and outcome, (2) consistently define cohesion and use validated measures of cohesion from different perspectives in the same studies, (3) consider group development and measure cohesion at different points in time over the course of counseling, (4) replicate studies using similar group populations in order to understand inconsistent findings, (5) study cohesion in diverse groups that utilize different interventions, (6) explore the impact that leader and group member individual differences bring to the development and usefulness of cohesion, and (7) explore the overlapping relationships between cohesion and other therapeutic factors.
Premise 15: Research is Urgently Needed to Explore the Impact That Member and Leader Qualities Exert on The Development of Cohesion in Groups
Marmarosh and Van Horn point to the understudied importance of how attachment style (e.g., a dismissive group leader or an avoidant group member) affects group cohesion and how race, ethnicity, and sexual orientation of group members and leaders are likely to influence it.
Premise 16: There is Sufficient Depth and Breadth of Knowledge to Indicate That Group Climate Can Be Viewed As An Empirically Supported Process To Be Considered By Evidence-Based Group Counselors
One recent indicator pointed to by McClendon and Burlingame are the group psychotherapy practice guidelines ratified by the American Group Psychotherapy Association (AGPA), supporting group climate as an evidence-based process.
Premise 17: The Ultimate Value of Group Climate is That It Provides Actionable Information For Group Leaders
MacKenzie and the AGPA/Transcoop cooperation both endorse the importance of actionable information to empirically guide group leaders. Both have made recommendations regarding their respective measures (Group Climate Questionnaire [GCQ] and Group Questionnaire). McClendon and Burlingame encourage authors of existing and future group-climate measures to adopt the same perspective so that research results have a direct impact on the clinical practice of group treatments.
Premise 18: The Gcq is A Tested Measure For Predicting Group Outcome and Other Salient Group Processes And It Fits Well Within Evidence-Based Projects
Two of the three scales of the GCQ have proven to be moderately to highly predictive of group outcome and other important processes, resulting in it being the premier group-climate instrument available.
Premise 19: A Three-Factor Model of Group Climate, Resulting From A Series Of Large International Studies, Shows Promise For Providing An Alternative Understanding Of Group Climate As Including But Exceeding A Member-To-Group Phenomenon
McClendon and Burlingame summarize these factors as follows: (1) positive bonding relationship among members, (2) positive working relationship and group climate, and (3) negative relationship and affect connected to tension, withdrawal, avoidance, and conflict. Additional research is being conducted and demands to be followed by others.
Premise 20: Group Development in Counseling Groups Evolves In Ways That Are Orderly, Systematic, and Potentially Progressive
Indeed, as Brabender suggests, groups can not only change but grow. While change might be naturally expected, growth is not guaranteed. Whether or not the group grows is a matter of importance to the members: Their ability to accomplish their purposes for being in the group is affected by whether the group progresses, languishes, or retreats. Therefore, group development is of importance to the group counselor as well.
Premise 21: Group Leaders Need to Time Their Interventions To Mirror Developmental Stages
But research is lacking on what leader behaviors might be best suited by group developmental stage. Brabender explores if there is a general time in a group for leaders to be more or less active. Does structure or open process moderate what might be done when? Does the unique population of a group affect the timing of leader interventions? These kinds of issues await further needed research.
(p. 557) Premise 22: Although Group Development has Been Investigated for Years, Research on the Topic of How Systematic Progressive Change is Facilitated by its Leader has Just Begun
Brabender encourages the launching of research into the relationship between group development and leader interventions (and other areas). This situation is similar to those existing in the areas of therapeutic factors, group climate, and group cohesion, all discussed earlier: Research is needed to link desired group leader actionable behaviors with important group processes.
Premise 23: Mounting Evidence Clearly Shows That Group Counseling Generally is Effective, Yet It Also Is Becoming More Apparent That Certain Treatment Models For Particular Patient Populations Work Best; This Continuing Search For More Precise Key Mechanisms Will Lead to Even More Important Connections
Drawing from her own work and that of others, Barlow lays out a number of steps that will promote research of key change mechanisms. Three of these are to include in write-ups relevant information about studies, to select state-of-the-art research methods and designs, and to focus on process–outcome linkages.
Premise 24: Evidence-Based Professional Practice and Evidence-Supported Treatments Need to Yield A Kind of Middle Ground To Benefit Group Members, Professions, And Research And Practice
As Barlow observes, an essential requirement for all practitioners is to avidly pursue knowledge while allowing for human contextuality. Over time and with enough intention, group counselors can master an appropriate blend that effectively integrates evidence with clinical judgment.
Premise 25: Group Phenomena Are Complex, Involving Processes That Connect and Are Interactive; Future Researchers Need to Discover Linkages Among These Processes And How They Affect Group Outcomes Across A Range of Group-Work Types
Drawing from other research as well as their own, Stockton and Morran emphasize two important directions for future research: (1) to better understand the complexities of which group therapeutic factors are most important at various group stages for which types of groups and (2) to investigate the connection between leader interventions and group therapeutic factors to guide how leaders concretely can promote the emergence of important therapeutic forces within groups.
Premise 26: Given the Need For More Long-Term and Complex Inquiry Efforts in Group Counseling, It Would Seem Important to Emphasize The Value of Teamwork
As Stockton and Morran point out, the formation of ongoing research teams provides researchers the collaborative opportunity to combine their knowledge, experience, and resources productively. This need is increasing because group approaches are multidisciplinary in origin and application. Additionally, a research team model yields a fertile training environment for graduate students and novice researchers while also providing a natural format for practitioner–researcher collaboration, interdisciplinary cooperation, and the creation of programmatic lines of inquiry.
Premise 27: Group Leader Training Continues to Need Elaboration
Although research, best practices, and training models have emerged over the last several years to advance the knowledge base surrounding group leader training, Stockton and Morran identify continuing needs in this area. They focus their attention on novice group leaders and suggest that progress needs to be made in helping them to acquire knowledge competencies, basic and advanced skill competencies, clinical experience competencies, coleader competencies, and multicultural competencies (see also Chapter 19).
Premise 28: Overall, Group Research Suggests That Assessment of the Group Format As A Whole Demonstrates That It is Efficacious, on Par With Individual Approaches; However, There Is Limited Empirical Evidence Validating This Concept As The Complex Interactions Of Whole-Group Dynamics With Individual Participant Dynamics Are Not Well Understood
Group dynamics and leadership may be thought of as a young science. The importance and abundance of group work lead Schwartz, Waldo, and Moravec (as well as other authors in this handbook) to (p. 558) emphasize the critical need for empirically supported group practice. In turn, this need for empirical research mandates pursuit of effective and accurate measurement.
Premise 29: Qualitative Research Approaches May Have Unique Applicability to Group Counseling–Related Research
Indeed, certain qualitative approaches may be uniquely suited to exploring specific group-counseling issues and research needs. However, Rubel and Okech also caution that qualitative approaches are not a panacea for the challenges facing group-counseling researchers. Without careful planning and implementation, qualitative group-counseling studies will not meet these challenges and fail to provide the credibility to impact practice.
Premise 30: The “Personhood” of The Group Leader is A Concept That Integrates Personal Development and Professional Development; Connects Person, Process, And Product; Melds Character And Competence; And Unites Training/Teaching, Practice, And Research
Group leadership is more than the use of skills and techniques, of course. Trotzer maintains that group leader skills and competence evolving from training and practice yield attitudes, values, and beliefs that serve to drive group leadership. The personhood of the leader is a summative quality that turns on a coherent combination of character and competence. Trotzer sees it as impelling who the leader is and inspiring what the leader does.
Premise 31: The Training of Group Leaders Needs to Be Examined Empirically To Determine Efficacy in Training and Practice And The Comprehensiveness, Utility, And Adaptability Of Training Approaches
While a number of group-counseling training approaches are used, Newmeyer (and Brown in Chapter 19) find scant evidence of supportive research. This important area demands further study because the preparation of group leaders must be based on approaches suffused with known effectiveness. The purposeful group technique model highlighted by Newmeyer represents an approach that would seem to satisfy in terms of comprehensiveness, utility, and adaptability, yet evidence of its efficacy is needed.
Premise 32: Group Leadership Styles and Functions Are Comprised of A Set Of Tasks That Need to Be Defined Clearly, Followed By Helping Trainees Learn How Strategies And Techniques Can Be Employed To Discharge Those Tasks
Bauman suggests that training begin with identifying what group leaders need to do, not with how they should be or even how they should accomplish necessary tasks. She encourages group-work researchers and practitioners to explore a number of questions: (1) What do they need to know about leader functions and styles that would improve training and practice? (2) Is client outcome the best measure of the utility of various functions and styles? (3) How can situational variables, which vary across groups and within a group, be accounted for when considering leader function or style?
Premise 33: How to Prepare Future Group Leaders is Marked By Valuable Expert Opinion But By Relatively Few Empirical Studies on Teaching Group Leadership, Components, Models For Group Leadership and its Training, Or Training Outcomes
Therefore, Brown notes, a unified research-based vision for group leader training that is endorsed by multiple professional associations is lacking and is needed. Such an interassociational perspec-tive might define desired outcomes for training, including what knowledge, leader personal qualities, and techniques would characterize a competent group leader. Evidence-based teaching strategies that support these desired outcomes also are needed.
Premise 34: Professional Input and Agreement is Needed to Establish the Criteria Necessary For Adequacy of Entry Level Preparation
Brown observes that the typical situation of requiring one course to teach all of the dimensions of groups and group leadership does not meet the entry-level needs for knowledge and skill as group leaders. She suggests that trainees should have opportunities to practice leading different types of groups, but the reality is that they may lead just one group during the supervised practicum.
(p. 559) Premise 35: Training Guidelines of Professional Associations Should be Clearly Supported by Evidence-Based Research Whenever Possible and Aimed at Promoting Competencies Capable of Being Objectively Assessed
In Brown’s review of training standards of five professional associations (also see Chapter 5), no clear connections were found to indicate that any standard was developed from research evidence. The complexity of many group leadership skills, various theoretical perspectives and applications, and the role of intangible factors such as the level of the group leader’s personal development combine to make this a challenging goal to achieve—yet one that is necessary to attempt.
Premise 36: Research Examining Group Supervision and Skill Development of Supervisees Needs to Define What Supervisory Methods Work, How Supervision Methods Are Related To Client Outcomes, And How Supervision Can Increase Cognitive Complexity And Other Valued Characteristics Typically Found in Expert Group Leaders
Riva suggests that it is important to investigate and then to identify effective methods for developing supervisee skills. Moreover, studies of the ability of supervisees to translate those skills subsequently to group-counseling practice are needed.
Premise 37: Research is in its Infancy In Terms of Determining If the Supervision Of Group Leaders Improves Outcomes For Group Members
As Riva implies, it is an expectation in the field that supervision of group leaders positively influences group leadership, which then can yield improved group member outcomes. Some limited research suggests this may be the case, but Riva’s suggestion for training programs to track client outcomes as a consequence of group leader supervision and of group leader practice under supervision needs some takers.
Premise 38: Ethical Considerations Involved in the Group Supervisory Relationship Need to Be Researched
Riva identifies several issues that are worth exploring (again, also see Chapter 5) about the ethics of group supervision. These include (1) how supervisors provide supervision with group leaders, (2) what methods they use to teach ethical decision making, (3) how aware supervisors are with the ethical and legal guidelines for their state, (4) what effective methods are used to respond to a supervisee possessing inadequate skill development, (5) what personality difficulties interfere with client care, and (6) which supervisor characteristics are most related to supervisee’s positive skill development.
Premise 39: Creativity and Spontaneity, Always A Part of Group Counseling And Other Forms Of Group Work, Add to the Vitality Of Groups And Make Them Richer As Well As More Interesting And Productive
Gladding observes that creativity and spontaneity in a group take time to develop. Barriers include personal fear and insecurity, environmental restraints, being too cognitive, lack of a challenge, and lack of reinforcement. Yet, when it occurs, creativity in a group can be purposeful and playful, promote collegiality, facilitate communication, enable group members to see multiple aspects of themselves and the world, and encourage nonverbal and emotional participation. It promotes interactions that might not occur otherwise. How to appropriately include creativity and spontaneity into group teaching, training, supervision, and practice is an issue to be addressed and researched.
Premise 40: Groups Are Ubiquitous Today, With Many Types of Groups Addressing An Ever-Increasing Number Of Topics and Issues
This omnipresence and broad diversity lead to a kind of fragmentation in the research on groups; that is, we know some things about some kinds of groups in some settings, but vast gaps in our knowledge remain. Group practitioners and researchers need to focus on studying the efficacy and the mechanisms behind the efficacy for groups occurring in these vastly different settings. The tools used to assess the effects of group interventions should include some measure of group cohesion or a way to assess the power of the group in explaining the changes that occur. Overall, conclude Kalodner and Hanus, there is much we know but much more that we still do not know about how groups work in these different settings.
(p. 560) Premise 41: It is Helpful When Creating And Leading Groups From A Life-Span Perspective For Group Leaders to Conceptualize Members From A Developmental Context, Including Assessment of Which Psychosocial Tasks They are Facing
Keim and Olguin suggest that group leaders attend to the pattern existing between group counseling and group member psychosocial stages. It appears that, regardless of group work type (i.e., task, psychoe-ducation, counseling, or psychotherapy), groups developmentally evolve similarly to the psychosocial stages of development (note Chapter 11). This parallel developmental evolution can assist group leaders in assessing which social tasks members may have previously attained and which tasks are yet to be resolved. Focusing groups based on psychosocial developmental stage permits group counselors to help members address the unique needs of each stage of life.
Premise 42: When Group Counselors Comprehend the Unique Dynamics That Sexual Minority Clients Bring to The Group Encounter and Possess The Skills To Lead The Group Through its Many Transitions, Growth Can Occur For Every Individual Involved
Ritter maintains that all group members, including sexual minority clients, can heal and grow through group counseling when leaders understand the unique experiences of members, mirror positive qualities, and are able to effectively implement the guidelines, best practices, competencies, standards, and codes and principles that characterize group counseling and group work.
Premise 43: The Resilience of Lesbian, Gay, Bisexual, and Transgendered Individuals Should Not Be Underestimated As A Primary Source Of Strength For Group Counseling
Group-counselor skills and understanding of oppression, minority stress, and cohort and developmental differences are very important but only a part of the helping equation. Ritter emphasizes that the inherent resilience of members of this population also needs to be honored and harnessed as a force for growth.
Premise 44: Prevention Groups Possess Unique Qualities That Can Forestall Problem Development and Build Strengths
Waldo, Schwartz, Horne, and Côté suggest that future directions for prevention groups are many, including the extraordinary potential for expansion of prevention impact by encouraging prevention group members to recruit new members, become prevention group leaders, and serve as change agents and resources within their social networks.
Premise 45: Group Counselors Can Learn Much From the Rich Array of Global Group Work
McWhirter et al. observe that group-counseling interventions are evolving to address medical, health, exercise, spirituality, and religious issues. Increased communication regarding the effectiveness of group studies and practices internationally is increasing. This building awareness of what works in other cultures across the globe may provide practitioners with new learning and help promote investigations leading to group programs that are more broadly comprehensive.
Premise 46: A Global Perspective May Provide the Best Foundation to Generate Solutions, Develop Recommendations, and Propose Standards For Evaluating Group Efficacy And Implementation
A global perspective, the product of practices, research, and wisdom accumulated from cultures around the world, may provide a comprehensive and useful foundation for addressing challenging group issues, according to McWhirter et al. As an example, they suggest that widely held assumptions regarding the presence and nature of therapeutic factors among group members might be analyzed in new ways, informed by knowledge and practice gained through a broader international and multicultural context.
Premise 47: The Adequacy of Training Programs For Future Group Leaders Largely Will Determine The Future Of Brief Group Treatment
Particularly at the doctoral level, Shapiro believes, training programs have failed to provide mandatory or even elective training in the modalities, such as brief group approaches, that many experts believe rest at the forefront of the future of counseling and psychotherapy, including group counseling. (Note: In fact, at the doctoral level in psychology, group training largely has disappeared.) Group training in clinical and counseling programs needs to be expanded and strengthened to include more adequate supervision in brief groups and trainee participation in groups.
(p. 561) Premise 48: For Mutual Help Groups to Function Well, Group Counselors Need to Collaborate With Group Members and Participating Organizations, Rather Than to Independently Direct the Action
Silverman describes mutual help groups as caring communities. Through interaction with other group members and in conjunction with professional helpers who partner with them, members discover they are not alone and often are able to adopt effective coping strategies, leading to more satisfying lives. A key is for professional group leaders to collaborate with them and not to dominate.
Premise 49: Online Groups Can Be Expected to Increase Rapidly in Numbers and In the Complexity of Technology Used: Will Group Counselors Engage In Online Group Work With Sufficient Frequency And Numbers To Become A Force Promoting Ethical Practice And Effective Care?
Or, Page wonders, will they perceive online groups as being either second class or a little out of the reach of professional ethics and regulations—an “emerging field” for exploration and perhaps personal participation but not for professional care in groups? To assist with strengthening the professional basis for involvement with online groups, a number of best-practice approaches are available for consideration, including helping to clarify the somewhat fuzzy line between counseling groups and support groups. Here, the suggestion is that professional mental health providers take the initiative in clarifying the confusion by assuming that all groups they lead are professional counseling/therapy groups and subject to appropriate ethical codes and laws governing professional practice. In other words, as Page suggests, professional practice is the default relationship.
Premise 50: Developers of Trauma and Disaster (Td) Groups Have Recently Begun to Focus on Improving Early Intervention Efforts (E.G., Psychological First Aid) Or On Key Comorbid Issues (E.G., Spirituality And Trauma), Which Have Not Yet Been Subjected To Preliminary Field Studies That Would Lead To Rigorous Randomized Control Trials; However, They Do Illustrate the Increasing Range Of Clinical Issues in Td For Which Group Interventions Are Useful
While rationally derived “best practices” for dealing with practical issues, such as TD group organization, member selection, and leadership, are available, Foy et al. conclude that it is probably premature to claim that most TD group interventions are “evidence-based.” However, it does seem appropriate to label those backed by positive results from several studies as being “evidence-informed.” Increasing levels of empirical support for TD groups will lend additional support to their already wide application.
The Need for Mainstreaming Group Counseling
The contents of this handbook demonstrate that group counseling is a viable, valid, flexible, and effective way to help people repair and restore positive mental health. Despite a substantial research and practice base, however, group counseling is used at relatively low rates and its presence within training programs is diminishing rather than growing. It flows through what might be considered to be a fairly minor tributary of the mental health and education river. Available evidence attesting to its effectiveness, as well as understandings of how broadly group procedures can be used, suggest that it somehow be rerouted from a minor position to a major one in the mental health and education delivery system.
In short, group counseling needs to be mainstreamed. To discuss this need, I will describe one current initiative and let its discussion stand as a representative example of several of the salient issues in mainstreaming group counseling.
Leaders of several group-oriented professional associations have formed an alliance with the aim of mainstreaming group work within mental health. Core member associations include the Society of Group Psychology and Group Psychotherapy (Division 49 of the American Psychological Association), the Association for Specialists in Group Work (a division of the American Counseling Association), and two freestanding associations, the American Group Psychotherapy Association and the Association for the Advancement of Social Work with Groups. Other affiliates include the Group Section of the Division of Psychoanalysis of the American Psychological Association and the Society of Consulting Psychology (Division 13 of the American Psychological Association). The collaborative affiliation of these member associations is known as the Group Practice and Research Network (GPRN), whose purpose is to advance the cause of group counseling and other forms of group work.
(p. 562) I will resist describing the dynamics characterizing the formation, operation, and maintenance of the GPRN, an interesting story in itself, in favor of indicating some of the matters the network members are considering. These issues serve to illustrate blockages that need to be removed in order for group counseling—and all forms of group work—to enter the mainstream.
Some Issues Blockading Mainstreaming
As GPRN members struggled with defining the key issues in promoting group work more widely, they decided to gather information by surveying association leaders using a common instrument. Results will be used by the GPRN to guide subsequent actions, including the possibility of offering a national planning conference. The following brief discussion represents my summary of information stimulated by the survey. It is arranged into categories of education and training as well as practice. Many of the issues also are reflected throughout the chapters of this handbook.
Education and Training
Significant problems appear to reside in the low profile given by academic programs to training group leaders. Establishing competency in group leadership does not seem to be viewed by many training programs as being important or essential. Two markers of this low status are that training standards for group leadership, if present, generally are viewed as being inconsequential and group courses in curricula are either totally absent or few in number or, if they do exist, they emphasize didactic information at the expense of interactive experience and practice. Either because of these drawbacks or as a reflection of them, the public tends to be unaware of how group counseling and other forms of group work may be of benefit.
The provision of group counseling presents challenges. Graduates of training programs typically find it laborious, and too often discouraging, to discover how to effectively and efficiently apply group work in their practice settings. One explanation for this problem is that reimbursement procedures of group counseling remain largely inconsistent, often not respecting group leader training and competence while also being tied to systems that reimburse individual counseling or group counseling but not both. Another barrier for more broadly introducing group counseling into practice settings is the reluctance often encountered among many fellow practitioners and the public who hold the belief that group counseling is inferior to individual counseling as a mode of help giving.
As a consequence of these training and delivery challenges, group counseling remains a minor modality, its promise largely unrealized. Therefore, to mainstream group counseling, concrete gains need to be made both within training programs and in delivery systems. Training programs need to value group and to find ways to systematically incorporate it within courses, practica, and internships. Where training standards exist, they need to be accorded importance; and where they do not, they need to be developed and followed. Consistent and fair reimbursement procedures for group counseling need to be put into place by insurance companies. Advocacy programs need to be developed to educate various elements of the public—legislators, insurance providers, the mental health establishment, accrediting bodies, the lay public, and even fellow practitioners—that group counseling is an essential vehicle for promoting and sustaining positive functioning.
Research has accumulated to attest that group counseling works. Many of the mechanisms for why this is so also have been identified, such as the importance of group cohesion and therapeutic factors and recent examinations of the role of attachments in both member and leader behavior.
Awaiting discovery, among other points, is specifying the linkage between these and other processes and specific group leader behaviors, skills, interventions, and functions. Just as important, if not more so, is publishing research results in atypical sources, as well as in more obvious and traditional ones. That is, publication in scholarly journals needs to be supplemented by transmitting group-counseling research in other vehicles and in unique ways. Researchers need to communicate their findings to a wider array of publics so that group counseling’s utility and value become known to others beyond the more limited scholarly community that is presently aware. Collaborating with professionals skilled in public health information dissemination might provide a route toward communicating the positive message of group counseling to this broader constituency.
As this handbook illustrates, group counseling is robust and effective, sitting on the verge of becoming a breakout approach. The sorts of measures I have outlined in the areas of education and training, practice, and research would help to move group counseling from its minor role to one that is in the mainstream of help giving.