FACILITATING GROUP THERAPY: Providing groups to various populations

1. FACILITATING GROUP THERAPY:Providing groups to various populations Rev. Lois C. Morrison, BCC, CACAC3

2. Goals of Session • Gain understanding of variety of groups • Understanding role of Chaplain in group facilitation • Benefits Groups can provide to patients

3. Rev. Lois C. Morrison, BCC, CACAC3 • Group facilitator since 1980 • Education and therapy groups for addicts and their families for 7 ½ years • Spirituality; Bereavement; Substance Abuse groups for dual diagnosed, the mentally ill; age specific groups for both inpatient and outpatient treatment centers for 22 years.

4. Groups in History • Oral tradition of the Bible • Native Americans around the campfire • Parker Palmers, “circles of healing” • Twelve Step groups • Therapy • Support

5. Groups are… • Individual and unique to time and place and persons • Fluid and ever changing

6. Positive Attributes of Groups • Participants can build sense of community • Participants begin to realize they are not alone • Safe place to share experiences • Can share individual perspectives and receive feedback • Invite participants to new understanding

7. Groups also can be destructive if: • Belittling occurs • Negativity takes over • Confidentiality is breached • Respect of individuals does not occur

8. Types of Groups • Educational: DUI groups mandated by court system. Very little interpersonal interaction. • Therapy: Specific Goals including patients identifying connections with behaviors and life satisfaction; self esteem issues; developing goals and empathy for others.

9. Breatheasy & Cardiac Rehab • Shared experiences • Safe place to share • Problem solve together • Share experience of chronic life limiting illness • Questions of faith / where God is in their journey

10. Spirituality Groups • Supportive, interactive • Reflective • Invitational, not confrontational • Environment of safety

11. Mental Health Inpatient • Adolescent Story Telling • Geriatric Story Telling • Axis II (Personality Disorder) focused groups • Axis I focused groups • Dual Diagnosis Groups • Bereavement Groups

12. Journey in Story: Adolescents • Iceberg Image • Relaxes teens… can help to drop defenses • Discovery… teens did not like to be read to • “Taking the ditch” story

13. Geriatrics Story Group • Integrating life experiences • Reminiscing • Discovery: Geriatrics like to be read to • Patients eager to share their stories

14. Dementia Groups • The moment is all you have • Don’t expect insight • Discovery… every moment is beautiful and meaningful… Embrace it.

15. Personality Disorders • Reality based groups • Focus on theme of group • Be wary of manipulation • Self esteem issues common • Be prepared for drama

16. Groups with Delusional Patients • Story telling kept to minimal to non existent • Groups focused, often times brief • Boundaries • Patients generally do not attend until medications begin taking effect

17. Notes about delusional patients • Fixed delusions are unchangeable – work within delusion. • Delusions have a grain of truth within them. It is helpful to discover it if possible. • Religiously preoccupied – discipline or preoccupation?

18. Bereavement Groups • Supportive – ongoing • Progressive – One groups builds on another. Participants commit to a 6-10 week program typically meeting once a week.

19. Supportive Bereavement Groups • People can come in at any point • Common experience of loss • People can experience hope • People at varying points of grief/loss • Ongoing

20. Supportive Bereavement Groups • Without agenda topic can be repetitive • Can turn into social clubs • Participants may have difficult time relating to one another

21. Progressive Grief Groups • Facilitator trained in Bereavement • Group members start out process together • Set agenda’s each week • Have a starting and ending point

22. Progressive Bereavement Groups • Difficulty in making commitments when grieving • Expectation of feeling better immediately • Participants entering too soon after loss • Another loss as group ends • Closed groups

23. Preparing for Group • Comprehension of mental illness diagnosis and/or addiction • Respect for another’s faith journey • Learning personal/professional flexibility • Setting clear boundaries • Openness • Skilled in re-direction • Determine group goals

24. Expectations • Willingness to respect one another • Guarantee your confidentiality • Set ground rules • Sharing encouraged

25. Facilitators Responsibilities • Maintain open, respectful presence • Redirection as necessary when off topic; patient monopolizing, evangelizing, agitation, disrespectful behavior • Open and close group on time • Set ground rules and boundaries

26. Group Example • In a six member group there is one conservative Christian, one Jewish, two agnostics and two who “Church hop”

27. Unanswerable Questions • “Why did God give me a mental illness?” • “Why do bad things happen to good people?” • “If God is good, why is there suffering?” • “Is there really a God?”

28. Spirituality or Religious • “Educated by my clients, I have expanded my notion of what it means to be religious, to be spiritual. The source of the word religion, the Latin religio, is “to bind back.” Religion is meant to bind us back to the Creator, not to bind us internally with knots of fear, anxiety, and prejudice. Spiritual, with its root in spirit or breath, refers to the source of life.” Wrestling with Our Inner Angels by Nancy Kehoe

29. DSM IV: V62.89 Religious or Spiritual Problem • “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized Church or religious institution.”

30. Religious Institutionsand the mentally ill • Can be destructive if message given is the mental illness is a judgment • Some religions do not support medications for the mentally ill • Lack of understanding of mental illness • People with mental illness are used to judgments… they will sense it if it is there

31. The mentally ill in Religious Settings • May speak out during worships services • Can monopolize, disrupting studies • Short attention spans

32. Questions • Thank you for attending this webinar. My prayer is you found something useful in this presentation. Blessings!

33. References • Kehoe, Nancy; Wrestling with our Inner Angels; Jossey-Bass, 2009 • American Psychiatric Association; Diagnostic and Statistical Manual of Mental Disorders; Fourth Edition, 1995 • Oates, Wayne; The Religious Care of the Psychiatric Patient; 1990 • Palmer, Parker; A Hidden Wholeness; Jossey-Bass; 2004

34. References • Benson, Robert; Between the Dreaming and the Coming True; Tarcher/Putman; 2001 • Devesone, Anne; Tell me I’m Here; Penguin Books; 1991 • Slater, Lauren; Welcome to My Country; Hamish Hamilton LTD; 1996