Group therapy plan

Group therapy plan (psychology experts only)
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Group therapy plan (psychology experts only)
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STRUCTURE FOR GROUP THERAPY TREATMENT PLAN/GROUP THERAPY PROPOSAL

DESCRIPTION OF GROUP

Aim i.e. treating anxiety disorder

BASIC ASSUMPTIONS

Why is group therapy the chosen treatment modality?

TARGET POPULATION

I.E. Adolescents

HOW WILL MEMBERS BE ADDED TO THE GROUP?

Screening

Advertising

GROUP FORMAT

Age

Size

Duration

Frequency

Leaders

GOALS AND OBJECTIVES

Remember, goals are WHAT we are going to do and objectives HOW we are going to do it.

CURRICULUM OVERVIEW (topics to be discussed)

WEEK 1

WEEK 2

Sample: (Sample is much longer than required)

Group Counseling Proposal

Existential Therapy for Burnout among counselors, psychologists, ministers, and bereavement support persons.

Group Counseling Proposal

Rationale

Description of the Group

The focus is to help human service workers deal with “a persistent, work-related state of mind that is characterized by distress, a sense of reduced effectiveness, decreased motivation, and the development of dysfunctional attitudes and behaviors at work” (van Dierendonck, Garssen, & Visser, 2005). The criterion for inclusion is that the member must be a human service worker who works as a counselor, psychologist, minister, or bereavement support person. Burnout, particularly compassion fatigue, often causes human service workers to question whether they are helping people and whether they can still be emotionally vested in their work. Anxiety and the questioning of purpose in life are two common themes. The methodology for working with burnout in this group will be a person-centered and existential therapeutic model that will incorporate themes from transpersonal psychology. This approach will help participants deal with the existential crisis caused by burnout by introducing the concept of self-realization and self-actualization. These concepts come from transpersonal psychology’s approach to helping people achieve the ability to look at their lives according to what brings meaning into their lives. The group will consist of ten group members ranging in ages of 30 – 55 years, of both men and women. The group will meet once a week for twelve weeks.

Basic Assumptions

Group therapy is the preferred method because one of the symptoms of burnout is loneliness or isolation and losing confidence in effectiveness with clients. Coming into group, people will experience having their issues normalized when colleagues express similar ideas, thoughts and experiences. In other words they will be validated in their experience which helps to normalize their reactions to situations. The long term benefits of group rather than individual therapy are better because group members will be reminded of what the necessary skills are to prevent burnout and the importance of taking time to re-establish and/or create new relationships with colleagues, friends, family, and community that will be supportive in the future. The social support provided by group counseling is one of the most important factors in preventing and treating burnout in human service workers (Kee, Johnson, & Hunt, 2002) Group therapy interactions increase the importance of mental and spiritual wellness while learning new ideas about how to handle situations that may cause burnout.

Why is this group needed?

According to Ofer Zur, Ph.D. (Zur, 2011), author of Taking of the Caretaker: How to Avoid Psychotherapists’ Burnout,“Psychotherapists focus on everyone else’s problems and consistently fail to attend to their own needs. This neglect has led to an extremely high rate of alcoholism, depression, and suicide among psychotherapists. Consequently, the burned-out or impaired therapist provides ineffective treatment, which may result in legal or ethical liabilities.”

Eve Ekman (Anwar, 2011), a doctoral student in social welfare at the University of California, Berkeley, researched ‘empathy fatigue’ in human service workers. Her research found that “Many professionals used to burn out and leave their jobs. Now they burn out and stay” most likely because of the national financial crisis. She continues, “Chronic stress can lead to a sense of helplessness that can cause people to withdraw emotionally from their work in order to protect themselves, but dehumanization leads to a lack of work fulfillment that can prevent people from doing their jobs well.”

Kee says, “A number of researchers have indicated that burnout is mentally and physically debilitating for workers, costly to institutions and agencies, and harmful to clients (Cherniss, 1980; Edelwich & Brodsky, 1980; Farber, 1983; Maslach, 1982; Maslach & Schaufeli, 1993; Pines, Aronson, & Kafry, 1981; Rogers, 1987)” (Kee, Johnson, & Hunt, 2002).

Theoretical Framework

Group Counseling Theory

Helping burned out therapists find new ways to give meaning to their work and their lives is the goal of this group. Existential and transpersonal therapy is considered a way of thinking rather than a particular style of practicing therapy. Universal human concerns and existential themes constitute the background of most groups. Rather than taking a deterministic, behavioral approach, existential therapy and transpersonal psychology provides the space for people to choose what to make of their circumstances. (Corey, 2008, 2012, pg 232) Also, existential and transpersonal therapy focuse on the nature of the relationships being created and this is the primary healing event identified as the most effective in dealing with burn out (Corey, 2008, 2012, pg. 250). Because members of the group are trained therapists themselves, this non-directive approach, coupled with a person-centered therapeutic model, will allow for flexibility in working with therapists that will be tempted to apply their own therapeutic models to the group dynamic.

Orientation of the Co-Leaders

Brittany Hardy’s orientation is based in humanistic psychology. She recognizes desires for personal and spiritual growth as a common experience among people, as well as acknowledges the human capacity for understanding and healing the self, with the therapist as a facilitator and watcher. She thinks this process best occurs in an environment where the person seeking therapy feels safe to engage in an empathic relationship with the therapist, who holds the person in unconditional positive regard.

Debra Redman’s orientation is toward a transpersonal psychological approach that facilitates a client’s ability to achieve milestones in self-realization and self-actualization that leads to an ability to use psychospiritual awareness as a means to deep healing.

Goal and Objectives

We are facilitating this group so that group members may attain the capacity to recognize signs of burnout and self-assess when needed. Group members will be able to explore and discuss possible causes and manifestations of burnout, and reflect on its numerous effects on them as individuals, as well as on other facets of their lives. Also, they will explore possible methods for relieving the symptoms of burnout and investigate ways to help prevent future occurrences. This exploration will aid in increasing satisfaction on a personal level, as well as provide aid on relational and organizational (i.e. workplace environment) levels. This group will provide a safe environment where members may choose to fully process their experiences leading up to and going through burnout, as well as create goals for moving past the experience and developing preventative measures that increase their resilience from further incidences (van Dierendonck, Garssen, & Visser, 2005).

Given the nature of existential and transpersonal exploration, establishing hard goals and objectives may not be effective. This is not a twelve-step program. The only measurable behavior that will occur is the voluntary actions of group members to re-establish, re-vitalize, or create relationships with coworkers, family, and friends. This behavior has been proven to be the most effective behavior for alleviating burnout in human service workers. Otherwise, observations of progress cannot be quantified outright, but will be observable through the members’ revelations of their personal processes as they progress through the therapy. This includes elements such as changes in outlook, any new experiences relevant to therapeutic work that the members wish to share, and new insights gained as part of the therapeutic process, among others (van Dierendonck, Garssen, & Visser, 2005).

Having said that, a change in a participant’s emotional state may be measured after the group experience by the use of the survey inventory Spirituality Assessment Survey (Baumhover, 2009, see appendix A). The Baumhover survey is shorter and less comprehensive than the Rojas Independent Spirituality Assessment Scalesurvey (Rojas, 2002), however, it addresses the primary areas of concern in measuring key areas of development that indicate that the client has moved out of a feeling of burnout and toward a feeling of rejuvenation in their work. Any differences in scoring related to assessment questions will reflect change of the client’s attitudes in regards to their experience during the group and any goals that they are working toward.

Procedures

When, Where, How

The group will consist of ten group members ranging in ages of 30 – 55 years, of both men and women. The group will meet once a week for twelve weeks. The group will meet in a rented office space that is currently being used as a group counseling office by a local licensed professional counselor on Tanner Street in Carrollton, GA.

Topics to Be Discussed

The following topics will be introduced over a series of eight sessions. Session nine through eleven are left open to allow space for closure for any open items in the group and to provide time for group members to process any new issues that are of interest to the group. The twelfth session is the termination session where the Baumhover survey tool would be administered. See Appendix D for detailed information about session topics and goals.

1. Setting group expectations of being a participant vs. a therapist

2. Can clients see the burnout?

3. Maintaining Social Connectedness

4. Violence, Vicarious Traumatization, PTSD

5. Family Interactions

6. Sustaining Faith in Your Ability to Help

7. Grieving, Depression, Emotional Depletion

8. Workplace Stress

9. Completion of Open Items and/or new topics

10. Completion of Open Items and/or new topics

11. Completion of Open Items and/or new topics

12. Wrap Up and Good-byes

Ethical Considerations

Informed Consent Form

An example of an Informed Consent Form is in Appendix C.

Confidentiality, Member Rights and Responsibilities

We would present an outline to the group detailing the following about their rights to confidentiality, giving a brief description of each point and addressing any questions a group member might have with each one.

● Group members agree to not discuss any portion of the contents of a meeting or identify in any way another group member outside of the group. Group members may work with similar or even the same clients and be known in the community. For this reason, it is suggested that the group unanimously agree to refrain from talking about the group to anyone not specifically affiliated with the group.

● Group members may determine that additional confidentiality or member rights be added to this list.

● A member of the group can ask for assistance from the group leaders in translating what they learn in the group into action in everyday life.

● A member will have opportunities to discuss what he/she has learned in the group and to bring closure to any issues in the group experience that may need to be resolved.

● Counselors are legally required to report members’ threats to harm themselves or others; abuse and/or neglect of an elderly person, dependent adult, or minor; physical or sexual abuse of a minor child and that child or other minor children are at risk of ongoing abuse. If a valid subpoena is issued for my records, or my records are otherwise subject to a court order or other legal process requiring disclosure.

● If a crisis arises as a result of participation in the group, the member is urged to consult with the group leaders for a referral to other resources if necessary.

● Members shall define among themselves how to create reasonable safeguards that determine how the group will set boundaries and rules of conduct during interactions.

● Members may expect group leaders to exercise reasonable safeguards to minimize any potential risks in the group and those leaders will maintain a strict policy of confidentiality themselves.

● Members may expect every other member to respect their journey and refrain from giving advice, trying to counsel, or in any other way, place their own value judgments on another member’s experience.

● Members may expect that each person will be treated with dignity, respect, and compassion by other group members and the leaders.

● Group members agree to follow the guidelines set by the handout describing the guidelines for contemplative discussions.

Psychological Risks of Group Members

Possible risks involved in participating in group counseling include:

1. The possibility for disruption in their daily lives. During the progression of the group, a member may decide to make changes that can create difficulty and strain on their relationships outside the group (Corey, 2012).

2. Unfortunately, a member may experience “scape-goating,” where s/he is singled out and blamed for different perceived problems within a group. However, this is an occurrence that should be dealt with by group leaders to prevent further harm to anyone who experiences this (Corey, 2012).

3. Confrontation is a normal and useful tool in therapy. However, it has the potential of being misused in a manner that can cause great harm to members. Preventative measures will be used as much as possible to minimize destructive confrontation that belittle, dominate, or cut-down any member (Corey, 2012).

Overall, the group leaders will seek to minimize the risk for psychological harm by clearly outlining their responsibilities toward group members, as well as ask members to express their commitment and willingness to participate in the group. This will encourage open dialogue between participants and leaders and make clear expectations concerning group participation and behavior. This can also help to instill in the members a sense of investment in completing the therapy group (Corey, 2012).

Group Leader Responsibilities

Assist clients in addressing their concerns, not just behaviorally and intellectually but experientially, by maximizing their capacity to transform themselves. As a partner to the group member, the group leaders will develop a collaborative therapeutic partnership with the participants. Group leaders must demonstrate presence and place emphasis on the I/Thou encounters. Group leaders will help members increase both the range and the depth of awareness of each member around the issues that have created the burn out. Group leaders will encourage group members to create relationships with other members since this is the ultimate goal of the group. Group leaders will focus on key existential concerns and provide a climate in which these concerns can be explored. Group leaders will engage in appropriate self-disclosure in order to foster a sense of communality of universal struggles (Corey, 2008, 2012 pgs. 248 – 249). Group leaders will make an effor to understand the subjective world of each participant.

Evaluation

Effectiveness Evaluation Methods

The use of the Maslach Burnout Inventory (Maslach, 2012) and the Independent Spiritual Assessment Inventory (Rojas, 2002) which were administered at the intake interview will be used again to evaluate the effectiveness of the group. In addition, a comment form will be distributed to allow for participants to write about their experience and provide feedback in narrative form to the group leaders. See Appendix A.

Screening Questions and Ground Rules

Considering the importance of profession and stage of life in the nature of therapy for this particular group, it is vital that the selection of group members is based partly on potential members being in particular fields of the human service industry (counseling, ministry, psychologist, or bereavement support in this case), as well as the proposed age range, which is ages 30-55. The use of the Maslach Burnout Survey and the Spiritual Inventory will screen for the levels of burnout and whether the person’s existential goals can be met using the existential-transpersonal modality. We are not a faith-based therapy group.

In order to ensure that the clients fall into these categories, measures would be put in the application process where the client would demonstrate proof of eligibility. For age, a current form of state issued identification would provide the necessary proof that the applicant falls into the age range for the group. To ensure participation in the human service field, proof of active participation, certification, or employment would be required, such as a contract of employment or certification/license to practice (*it is important to note that the applicant would be assured that any current or past employer would not be notified of his/her application or participation in therapy as part of confidentiality). Stage of life and level of burnout must be assessed through the use of two measurement tools, the Maslach Burnout Inventory (MBI) and the Independent Spirituality Assessment Scale, in order to structure a group that has a common ground of experience.

Screening Questions

There are really only a few basic questions that would help the counselor and the client determine whether an existential therapy group would be useful to the client:

1. Why are you or are you not interested in examining your basic assumptions explore the foundations of your human existence or are you more concerned with obtaining relief from specific symptoms?

2. Describe what you think burnout is and how it impacts you. Are you looking for someone to tell you what to do to fix your burnout or do you want someone who can consult with you and provide support as you become aware of the issues causing burn out?

3. What would you like to learn from a group that is exploring burnout?

These are open-ended questions that will encourage the potential group member explore their sense of burnout and will help the counselors assess to what degree the person may or may not be open to using an existential approach to working with burnout. These answers, coupled with the results of the survey instruments will be the determining factors in selecting group members.

Ground Rules

Contemplative Discussion Guidelines are outlined in Appendix B.

Appendices

Appendix A: Surveys

Maslach Burnout Survey

Independent Spirituality Assessment Survey (Rojas)

Spirituality Assessment Survey (Baumhover)

Appendix B: Contemplative Discussion Guidelines

Appendix C: Confidentiality Consent Form

Appendix D: Group Goals and Objectives

1) Setting group expectations of being a participant vs. a therapist

Selected participants will have already been introduced to the counselors, the counseling theories that will be employed, and a general idea of the topics for each session. This session will introduce the members to each other and establish the ground for a working group.

a) Members will be asked to state what their goals for the twelve week period will be and what they hope to get from the group.

b) Counselors will introduce the outline of the member rights and responsibilities, confidentiality rules and ground rule for compassionate listening. Members will be given an opportunity to determine whether there are any changes to be made to fit this group’s personality.

c) A discussion will be initiated around what it means to give up the mindset of being the expert and moving into the role of being a participant in a group setting. It is anticipated that additional ground rules that address any concerns that come up will be addressed.

d) Counselors will introduce the topics of conversation for the next eleven weeks and suggest that members begin to think about what these topics might mean to them. A discussion of the meaning of compassion fatigue and burnout will begin that process.

2) Can clients see the burnout?

a) A discussion of members’ experiences of how they perceive clients being impacted by burnout and the impact this has had on their ability to do their work.

b) To begin the conversation, the article Therapist Burnout: Can Clients See the Flames? (Renjilian, 2008) will be introduced.

c) The goal of this dicussion is to begin creating a conscious awareness around how compasion fatigue and severe stress by having members describe situations where they had an interaction with a client that indicated the client’s knowledge of their burnout. This will serve to bring validation to the members that they are not alone in this experience and develop comraderie among group members.

3) Maintaining Social Connectedness

a) A discussion of the state of members’ social connections professionally and personally.

b) Members will be encouraged to make a plan to connect with one new person, either personally or professionally, once a day for at least fifteen minutes. Whether they choose to keep a log or journal of this activity is voluntary and may be determined by the group. A verbal report of their progress will be suggested for the rest of the meetings.

c) To begin the conversation, the article Psychologists Maintaining Social Connectedness (Novotni, 2008) will be introduced to start the conversation. Additional ideas may be generated by the group

4) Violence, Vicarious Traumatization, PTSD

a) A discussion of the impact of physical and psychological trauma. Clients may discuss the impact of actual physical events or situations where the threat of harm was imminent or implied.

b) The article entitled Violence: incidence and frequency of physical and psychological assaults affecting mental health providers in Georgia (hippa-iq)will be introduced to initiate a discussion.

c) Members will be encouraged to help those have been impacted to develop coping mechanisms and find ways to restructure the resulting belief systems that may be contributing to burnout.

5) Family Interactions

6) Sustaining Faith in Your Ability to Help

7) Grieving, Depression, Emotional Depletion

8) Workplace Stress

9) Completion of Open Items and/or new topics

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