The College Counselor's Guide to Group Psychotherapy

Michele D. Ribeiro, Joshua M. Gross, Marcee M. Turner, Michele D. Ribeiro, Joshua M. Gross, Marcee M. Turner

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781134815104
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Group psychotherapy in college counseling centers continues to thrive as a popular approach to working with college students, and yet there continues to be a lack of up-to-date, comprehensive resources for group psychotherapists working with this unique population. The College Counselor's Guide to Group Psychotherapy highlights the role of the group therapist within college counseling centers; provides practical, step-by-step instructions for creating a thriving group program and culture; and unveils some of the opportunities to expand this under-recognized practice setting. This exciting new volume draws on the most current knowledge on group psychotherapy while paying particular attention to issues and ethical dilemmas that are unique to working with college students.

CHAPTER 1
The College Counseling Center as a Unique Practice Setting for Group Psychotherapy

Joshua M. Gross and Michele D. Ribeiro

Introductory Thoughts on the Practice and Its Setting

Every August when internships complete their annual cycle a few more experienced group therapists trickle out into their residency year. Many of them will take jobs or postdoctoral training contracts where their skills as group therapists have landed them a position with a center seeking to have a successful group therapy program. With their knowledge and experience that groups can be formed in various situations, they challenge the superstitions of those who suffered the dearth of education and training in basic group psychology and group psychotherapy.

The new interns may have come to the group training sites in search of group therapy skills or sometimes it is a more random affair. Nonetheless, it is commonly found that when thoughtfully exposed and adequately prepared, most individual counselors and therapists with solid interview, documentation, and crisis intervention skills can most often gain basic and essential skills in the group room. Much of this is dependent upon the level of preparation in the coursework that varies greatly across graduate education in all licensed mental health disciplines. Perhaps even more of an influence is the quality of the supervised clinical practice experience they receive in practicum, internship, and postdoctoral clinical training that is harder to find in group psychology and group psychotherapy than many other specialization areas of counseling center practice.

Group as a Specialty Practice

The American Board of Professional Psychology (ABPP) (2017) has been granting specialty diplomas for psychology since 1947 and now in 15 board certification areas of practice. Group psychology (American Academy of Group Psychology, 2017) is at present the only ABPP area of specialty, diploma psychology practice that is unacknowledged by the American Psychological Association Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP, 2017). CRSPPP sets specific criteria for proficiency and specialty level practice in professional psychology and when granted, sets expectations for how and who should practice and implies ways that may intersect with standards for practice and ethical issues.

Free from such boundaries, the practice of group psychology has been relegated to the edges of general clinical practice and at points subject to approaches that foster superstition about why group work may be scary or unreasonable. Group psychology and group therapy education and training in fact emphasize many of the skills and techniques that minimize bad outcomes and build upon more than 100 years of group therapy literature and science (DeLucia-Waack et al., 2004; MacKenzie, 1992). These traditions are commonly upheld in other related professional associations such as the National Association for Social Workers, Association for Specialists in Group Work, American Group Psychotherapy Association, and the Society for Group Psychology and Group Psychotherapy. The American Group Psychotherapy Association has developed the Certified Group Psychotherapist (CGP) credential (IBCGP, 2017) that is based upon a minimum 12-hour course entitled The Principles of Group Psychotherapy, 300 hours of group leadership experience, and 75 hours of consultation with a qualified group therapist. This credential was developed as a means for identifying individuals of all licensed mental health disciplines who meet a basic entry level of group therapy practice skills.

In recent years, there has been movement to define proficiency and specialty levels of practice in professional psychology. Acknowledgment of specialty and proficiency in group psychology has been nicely laid out by Barlow (2013), where it can be seen that training starts in the classroom within the academic program and moves out into the clinic in the process of practicum, internship, and residency leading to licensed practice. All mental health counselors, marriage and family counselors, social workers, and psychologists follow a similar path across all of these domains as well as psychiatry residents, and all are subject to the availability of trainers with group psychotherapy skills and experience. As a result, group therapy training depends heavily upon where one gains their internship and residency training and this is often both a matter of strategy and random luck.

For more than ten years, representatives from the leadership of the American Group Psychotherapy Association (AGPA), APA Division 49 (The Society for Group Psychology and Group Psychotherapy), The American Academy of Group Psychology (AAGP), and at times others have met with the goal of codifying and unifying ideas for certification and membership categories with regard to levels of group therapy training and experience. Each profession has its own approach to the work, and there are more similarities than differences. Group Council was formed as a professional body whose goal was to obtain APA CRSPPP certification for group psychology and group psychotherapy and now in collaboration with AGPA, Div. 49, and AAGP have submitted a new proposal in January of 2017. The Commission is requesting additional information for the proposal and has currently requested that a revised petition be submitted by January 2018 so that another review can be completed and a final determination provided regarding recognition of Group Psychology and Group Psychotherapy as a specialty (CRSPPP, 2017). Many of the training settings described in that proposal train group therapists, employ some of the authors of these chapters, and uphold our larger practice community standards.

Time and Cost Efficiencies With Group Therapy

Experienced group therapists can work a certain kind of economic magic that may be essential in the current situation of too many students and not enough clinicians. In two hours, a typical individual therapist can see two students. A generalist with group therapy proficiency or specialization may use these individual visits as initial steps of developing treatment plans working toward a well-timed and strategic referral to a therapy group. In this model over time those two hours can be a 90-minute group with time for notes that can alternately serve seven to nine students and may perhaps become a primary treatment medium. The economic savings in dollars, FTEs, or labor cost all demonstrate the same economy of scale. The trick is using group-based treatment plans, and the skill can be taught. Group therapy came of age in the time of war when there were too many patients and not enough doctors. The demand management characteristics offered by group-based treatment are readily available and can be made more common if we can do a better job of advocating for group therapy education and training in all of our practice professions.

Using a private practice economic model helps it become very clear. In a hypothetical four-week month, an individual will spend $400 for four $100 sessions at $100/hour. If we can work with that individual to move them into a weekly 90-minute therapy group that costs $50 a meeting, there is an opportunity to increase their therapy contact time and reduce their financial expenditure. If in the second month of treatment they can start group and meet individually every other week we have moved from four hours of contact at $400 in month one, to eight hours of contact (4 × 1.5 hour group = 6 hours of group therapy and two hours of individual therapy) for the same $400. If in month three they have four groups and one individual appointment, they have seven hours of contact for $300. If in month four they have only weekly group therapy, they have six hours of contact for $200. The incentive to the group therapist can also be seen because a group of eight at $50 is $400 for two hours and that is twice the $100 rate we are using. The applications of these economies of scale work just as well in staff model settings such as college counseling centers where everyone is on salary and the savings are better expressed in the ability to see more students with the same amount of staff. This certainly translates to other staff model clinics where professional services are provided by people paid on salary such as the military, public, HMO, and practice group clinical settings.

The opportunity for increased benefits, appreciated by administrators, clinicians, and the individuals in our care, are clearly demonstrated in these models. The issue is how to make these types of treatment plans more common, and much of this turns on the central themes of social justice and the need to serve a diverse community of individuals. There has been significant work over the past 20 years to promote this kind of access and our goal in this text is to codify and bring forward some of the better thinking about how to do this work in ways that better serve those who have not had the benefit of care, as well as providing solutions for providers and the institutions that are charged with health care service provision. One of the more significant milestones in this movement occurred in 2009 when a special edition of the International Journal of Group Psychotherapy was dedicated to the work of the college counseling center (McEneaney & Gross, 2009).

Building Upon a Special Issue

McEneaney and Gross (2009) were able to make a first advance in the movement toward understanding group work within college counseling center contexts through a special issue of the International Journal of Group Psychotherapy. The special issue focused on specific areas the authors, advisors, and editors thought to be relevant for that initial exploration. The first chapter examined the use of attachment theory in understanding college student development and its application in group therapy (Marmarosh, 2009). Drum and Knott’s work (2009) summarized the work to date on theme centered groups and the 30-year history of outcomes that have direct application to college student issues. Johnson (2009) provided what is now a classic article highlighting the interplay of interpersonal process groups, with structure from psychoeducational principles, to manage diverse students’ needs when entering a therapeutic group experience. What followed was outcome research that guides the practitioner into a science practitioner role that investigates beyond the intuitive level of the therapist to also include objective measures that directly access students lived experience in the group and with other members (Krogel, Beecher, Presnell, Burlingame, & Simonsen, 2009). Hahn’s (2009) commentary raised concern regarding the fluid language of the group leader that Johnson delineated could include “therapists, counselors, leaders, and facilitators.” This opened up the possibility for a constructivist role that sees fluidity of role and negotiation of power giving room to the concept of self-authorship, coined by Kegan (1982). This opportunity to define what kind of group leader a clinician takes on parallels the emerging needs of students from underrepresented and minoritized groups. Eason’s commentary (2009) followed, which criticized the emphasis of the group’s location situated within a Eurocentric context with theories accentuating White experiences. Eason further challenged researchers to be more inclusive with the experience of others that identify through non-dominant identities and how to understand the impact of groups when working with these populations. This call to action, where the special edition ended some years ago, is where our text begins.

Diversity Within Group Contexts

Much of group theory and therapy within its brief history has centered within a Eurocentric, heterocentric, and ablest framework. Although there have been more international perspectives including the previously mentioned special edition of the International Journal of Group Psychotherapy (Weber & Weinberg, 2015) and sporadic snapshots of domestic underrepresented population experiences in group (DeBord & Perez, 2000; Elligan & Utsey, 1999; Leong, Wagner, & Kim, 1995; White, 2000), much of the group therapy literature has insufficiently addressed these issues. Only recently have key theorists including DeLucia-Waack, Helms, D’Andrea, and Abernethy to name a few widened the conversation of diversity within the group context. This lack of salience of diversity has even led some colleges teaching group to omit theorists of color from bibliographies surrounding the discourse; one professor at a private elite college said there are not authors of color on the reference list due to no authors of color writing about group (Electronic Mailing List, M. Davis, 2016). This ignorance led to an investigation by a student of social work to create a secondary bibliography highlighting the plethora of authors of color writing about group, which was provided to this same professor a few weeks later (Electronic Mailing List, M. Davis, 2016). How can this happen? We took this question quite seriously not only because of the changing landscape of demographics happening in high schools and universities across the nation, but more so as an act of justice. The responsibility to respond to social justice advocacy beckons the group therapist into the role of advocate for the human rights of our marginalized clients, as well as our colleagues as they continue to struggle in pushing through the glass ceiling of the Ivory Tower/higher education. In many ways advocacy for group therapy training and education is a social justice issue with regard to the impact for access to cost-effective quality care for many individuals who have been denied access to mental health care due to dollars, insurance, and knowledge of these services. Our text seeks to raise our awareness and our intentions to recognize and respond to microaggressions, micro-insults, and micro-invalidations (Sue et al., 2007) and then to act. We need to be able to acknowledge and then repair ruptures in rapport between and within groups when they happen and to hold ourselves more accountable to emerging concerns regarding equity in access and provision of mental health services and basic humane treatment to marginalized populations (i.e. students of color, LGBTQ, differently abled, international, etc.).

Before we can understand larger systems of oppression, we have to understand ourselves. Our book intentionally opens with a chapter that invites group therapists to look at themselves. What this requires is an understanding of identities that provide us with privilege (related to race, nationality, language, gender, sexual orientation, socioeconomics, ability, religion) and identities that are treated with marginality in our society or perhaps certain regional areas of our society. Because identity is complex, we also invite further examination on the intersections across identities (e.g. race, gender, ability). Until we as group therapists begin to look at ourselves and understand power differentials that are constantly at play, we will not do our groups justice and will miss fundamentally vital aspects of our members we seek to serve.

Power Differential Within Group Contexts

Once group therapists begin to understand the cycle of how we are socialized to believe certain things operate in certain ways, our next task is to understand how systems are constructed to keep some in our society from consistently benefitting from and gaining access to services. Our book invites the reader to question what larger systems are constantly at play even if all we first notice are the immediacies of what occurs in our therapy groups. The intention is to raise the consciousness that system issues outside of and within the therapy group impact our members, leaders, and society at large. These levels include the college counseling center department, Student Affairs, which most if not all counseling centers lie within, the larger college or university structure, a state’s overt and covert historical underpinnings and current policies and practices, regional values and ways of living, national events and laws, and finally international practices and policies. Imagine that all these levels are influencing the group. Well, they are. An example of the international socio-political differential could be as simple as questioning whether a Japanese and a Chinese student can be in the same group without tensions around their country’s histories imposing on interpersonal group dynamics. Another example could be of a socio-cultural differential with having a Sunni Muslim and a Shia Muslim within the same group. These combinations are as complex as having a woman who recently but reluctantly had an abortion in the same group as a male student who recently encouraged his female partner to have an abortion along with a devout Catholic student all in the same group.

Our challenge as group therapists is to be emotionally attuned to who our members are and our capacity to manage what comes up within the group. Group ...