Orienting and Educating Clients*

Orienting and Educating Clients*

CHAPTER 5 Orienting and Educating Clients* JOHN R. PRICE AND DAVID R. HESCHELES This one comes under the heading "You Can Work with Anything that Ha...

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CHAPTER 5

Orienting and Educating Clients* JOHN R. PRICE AND DAVID R. HESCHELES

This one comes under the heading "You Can Work with Anything that Happens." I had a fairly new group. It was summertime, in the 1970s. A single, rather lonely guy in his 20s had just returned from a three-day weekend at Esalen. Monday night he came to group. Suddenly, in the midst of us, he began taking off his clothes. Soon, he was stark naked. At Esalen over the weekend, everybody had taken their clothes off. So he brought it back to group. Some group members were laughing, some were upset. One woman, who thought she was really sexually liberated, yelled "Put your clothes back on." We talked about the group members' reactions, and she, the "sexually liberated woman," began to talk about and work on her strict upbringing, realizing she was not as free as she thought she was. In group, you can work with anything that happens.

ORIENTING AND EDUCATING CLIENTS FOR COGNITIVE BEHAVIORAL FOCAL GROUPS Cognitive Behavioral Focal groups often start with only bare bones client orientation. These groups are directly goal-oriented; clients entering the group can acknowledge that goalmfor example, overcoming shyness or stopping the abuse of alcohol. Because these are homogeneous groups and because client selection is predetermined and focused, these groups generally cohere readily. They have a sense of purpose and a time frame in which to accomplish that purpose. Thus, the pregroup orientation and education factors diminish in importance. * A portion of this work reprinted with permission fromJohnson, C. & Riester, A. (1998). Group activities for children and adolescents: an activitygroup therapyapproach.Journal of Child and Adolescent Group Therapy, 2, 78-88. A Guide to Starting Psychotherapy Groups Copyright 9 by Academic Press. All rights of reproduction in any form reserved.

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A Guide to Starting Psychotherapy Groups

ORIENTING AND EDUCATING CLIENTS FOR PSYCHODYNAMIC AND ECLECTIC GROUPS Bearing in mind that the new referral may, at first, be unreceptive to the idea of group therapy, orientation towards acceptance must come slowly. The following steps can be among those to assist you in gaining the client's acceptance. 1. Introducing the idea of group therapy: The first step with a relatively new client is to casually mention that you do--or are thinking of doing---group therapy. For example, if you already have a therapy group, a casual remark when bringing a new client into the office can be "Have a seat anywhere you're comfortable. As you can see from the number of chairs available, I do group therapy." 2. Or, if you are just starting a group, you can introduce yourself to a new client by saying, "I am_____ ; I do individual and group therapy." These kinds of casual statements can constitute the first mention of group psychotherapy. They may scarcely be heard, but they can introduce the idea. Given the client's readiness, you can now decide when to mention group psychotherapy specifically for his or her treatment. The goal is both to establish rapport with the client and to reduce the client's anxiety about group therap)n For general referrals who have not been referred specifically for group psychotherapy, this process could take three to six sessions. For the client who has been specifically referred, an interview or two may be all that is needed. The specific mention of group therapy, then, as part of the treatment plan will not only vary in time but also in approach. For example, the client may speak of his or her poor interpersonal relationships: shyness or abrasive behavior in groups, difficulties in marriage, childrearing frustrations, or job dissatisfaction. As the client dwells on his or her poor interpersonal relationships, you can then mention, "We might want to think about the possibility of group psychotherapy to help with that." Or when the client talks about difficulties in expressing feelings in intimate relationships, you can say, "That is an area that can perhaps be successfully developed in a group setting." The specific mention, then, follows as a result of the therapist and the client's identifying a problem: poor interpersonal relations, difficulty in expressing feelings, or discomfort in other areas. The specific mention of group psychotherapy can, and perhaps should, occur at the very end of a session. When the client responds with a question "What is group psychotherapy?", you can then reply "We're out of time in this

Orienting and Educating Clients

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session. Let's talk more about this next time." Remember that clients often have a built-in apprehension about revealing themselves in front of others. Therefore, referring to the possibility of group therapy at the end of a session allows the client the opportunity to ponder the suggestion before your next session. You had previously mentioned to the client that you do group psychotherapy when the client noticed the number of chairs in the office or when you introduced yourself as a group as well as an individual psychotherapist. You had planted the idea with the client. The next step is to more formally discuss group psychotherapy with the client. Having set the stage by mentioning group psychotherapy both generally and specifically, you are prepared to go into more detail regarding what group psychotherapy is all about. In the interest of successfully marketing group psychotherapy to the client, keep in mind that the more information the client has about the process, the lower her or his anxiety will be. You might elect not to discuss group therapy with a client in the session immediately after your first suggesting it. However, you will want to go back and remind the client that you had mentioned group psychotherapy. In discussing the group psychotherapy process, tell the potential group member that you have three specific areas you want to address: 1. The contract with each client, made up of five ground rules by which clients are to abide. Tell them: "I will give you a copy of these ground rules before the session is over today." 2. Some administrative details about a therapy group 3. Your style as a group psychotherapist. Incidentally, this recitation usually takes only about 5 minutes. At the end of the enumeration of specifics, give the client the copy of what you've just described, "An Introduction to Group Psychotherapy." (See Appendix B.) Then ask the client if he or she has any questions; if so, discuss the these questions at this point. If there are no questions, you can say: "You might want to think about this, and we can discuss it further in a subsequent session." Some clients respond by saying immediately that they are ready to go into a group. Although this is not a rarity, more often clients need a period of time to think about the process of group therapy as another necessary step in their progress. Should a client respond after the discussion of group with "I'll try," you should tell her or him that she is not going to experience the full impact of group therapy in less than 4 to 6 months. Hence, you will ask for an oral contract to stay in group for at least 4 months. You may add that you have found this to be the minimum amount of time necessary for clients to begin to benefit from the group experience.

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A Guide to Starting Psychotherapy Groups

After the discussion of group therapy, should a client r e s p o n d with a refusal, bear in m i n d that the reasons for the refusal are almost invariably parallel to or a part of w h a t b r o u g h t the client to therapy in the first place. In the event of a refusal, explore this parallel with the client. Following are s o m e hypothetical examples:

Reasons for Refusal

Reasons for Group

"I am a private person."

Being an isolate, a private person, is what brought the client to the therapist. Group is the tool of choice to use in overcoming the problem. Group can be a safe place in which to learn intimacy and overcome jealousy.

"If the therapist has to have a 'no sex' rule, the people must be sexually dangerous." "Why the 'no physical violence'?"

Group can help the client be more accepting of his anger and learn how to deal with it more appropriately.

A n o t h e r a p p r o a c h to i n t r o d u c i n g the client to group therapy is contained in the following article by Leon Hoffman, "Preparing the Client for G r o u p Psychotherapy."