Practicing Group Work Strategies

NEW! Tips for Group Work in Health Care Settings

​Brian L. Kelly, Loyola University Chicago, & Barbara Muskat, The Hospital for Sick Children​, Toronto

Why is this topic important in group work practice?

Since the early 20th century social workers have played an important role in the coordination and provision of services in various health care settings, including primary care facilities, hospitals, specialty clinics, schools, home health care settings, hospice care settings, continuing care settings, private physician groups, and research settings. While historically social casework and social diagnosis have been the predominant model of social work practice in health care coordination and provision, group work has played an important role in health promotion and the assessment and treatment of diseases and disorders within health care settings. Today, several types of groups are used in health care settings to address many different issues, including but not limited to treating cancer and its related effects for patients and their families, addressing chronic illnesses and their related effects, substance use treatment and recovery, and parenting. Group workers in health care settings incorporate a bio-psycho-social perspective in their practice, which seeks to recognize the whole person, as she or he exists within her or his environment.

What theory supports this topic in group work?

Mutual aid/empowerment

Mutual aid groups are described as “an alliance of individuals who need each other, in varying degrees, to work on certain common problems” (Schwartz, 1994, p.18). Mutual aid is also seen as a process whereby group members help themselves through helping one another and derive empowerment through the process (Gitterman & Shulman, 2005; Steinberg, 2014). The processes of mutual aid help group members experience the universal nature of their problems, reduce isolation and stigma associated with these struggles, and hear perspectives, challenges, and solutions from other members (Gitterman & Shulman, 2005).

Biopsychosocial

The biopsychosocial model of health recognizes that an individual’s health and well-being are impacted by the interaction among a number of factors. These include biological factors, psychological factors (i.e. emotions, mental health status), social factors (i.e. support from family/ friends) and environmental factors (i.e. the social determinants of health--i.e. finances/housing,). Group work hospital care settings is an ideal approach to incorporate these factors into a program of support.

What are a few essential reading on this topic?

- Drum, D., Swanbrow Becker, M., & Hess, E. (2011). Expanding the application of group interventions: Emergence of groups in health care settings. The Journal for Specialists in Group Work, 36(4), 247–263. doi: 10.1080/01933922.2011.613902
- Furr, S. (2008) .Structuring the group experience: A format for designing psychoeducational groups. Journal for Specialists in Group Work, 25(1), 29-49.
​- Kelly, B. L. (in press). Group work in health care settings. In C. D. Garvin, L. M. Gutierrez, & M. J. Galinsky (Eds.), Handbook of social work with groups (2nd edition), (pp. 203-219). New York, NY: Guilford Press.
- Kosoff, S.(2003). Single session groups: Applications and areas of expertise. Social Work with groups, 26(1), 29-45.
- Muskat, B., Salter, R., Shindler, S., Porter, M. & Bitnun, A. (published online, 24 Jun 2016). “Here you feel like it’s not taboo”: An evaluation of a pediatric hospital-based HIV support group. Journal of HIV/AIDS & Social Services, 353-370.

What are a few examples of how to implement this topic in group work practice?

Psychoeducational groups

In health-care settings, which operate under a medical model of care, patients may struggle with the sequelae of their medical conditions, such as anxiety, depression and difficulties adhering to treatment. As well, patients also may need support understanding their medical conditions and the lifestyle changes needed to manage them. Psychoeducational groups are often delivered to individuals with medical needs, to educate patients and/or their families about medical conditions and to teach skills required to help manage the conditions and the stress that often accompanies them. The psychoeducational offered in the groups may be informed by already developed treatment manuals or by materials developed by facilitators specifically for the group.

Groups are generally facilitated in a structured manner, such that material is presented by the leaders, skills are taught and practiced and members are encouraged to talk about what they have learned and how they will apply it outside the group. Leaders must be well-prepared ahead of time with content developed in advance, and also be skilled in facilitating group processes. Typically skill building groups have 10-12 sessions and educational groups tend to be shorter-from 3-5 sessions. Evaluation in these groups tends to examine acquisition of knowledge and/or skills.

Therapy and support groups

Therapy and support groups provide members with opportunities to address behavior change through cognitive behavioral techniques. For example, a facilitator might work with a group in early recovery from heroin on challenging negative and faulty thinking around methadone maintenance treatment. Therapy groups also provide members with opportunities to explore personal issues through process-oriented techniques, such as working with trans youth as they navigate negative family reactions to their decision to begin hormone treatment. Support groups help members identify coping strategies for dealing with stressful life events, often in a caring and empathetic environment, such as a support group for people living with a chronic illness.

Self-help groups offer a similarly supportive environment without formally trained facilitators. Examples of this include Alcoholics Anonymous, Narcotics Anonymous, and several other 12-step fellowships. These various types of treatment groups offer members important opportunities to experience all the benefits groups have to offer, including empathy, feedback, mutual aid, and support.

Single session groups

Single-session group practice has been seen as a source of significant benefits, both for participants and for the delivery of social work services (Ebenstein, 1999; Holmes-Garrett, 1990; Kosoff, 2003; Rotholz, 1985). These groups are a venue for the provision of information, connection, social support and the sharing of experience. They create a feeling of inclusion in a community of people who are “in the same boat” (Steinberg, 2004). Single-session groups can also be models of anti-oppressive practice based on social justice, social action, advocacy, community and diversity. As a strengths-based practice that utilizes purposeful activity and mutual aid, single-session groups are particularly useful in healthcare and can fulfill important needs for patients, families, staff and the organization. Single-session groups are suited to today’s fast-paced hospital environments and are commonly delivered in hospital settings. They include groups operated in clinics, in hospital units and in weekend family days. These groups are either newly formed each session or have an open format, with new members joining and/or attending each session. They tend to maintain an agenda and include all stages of groups within a single session, with the exception of the conflict stage. They are often used to impart information related to the health issue, or to bring people together who share a health issue to offer one another support, insights into coping strategies, and resources available outside the hospital. They require organized facilitators who must engage with members quickly, allow for maximal participation, keep the agenda moving, and terminate the group with the minimal unresolved matters. Evaluation of these groups is rare, but quick feedback surveys after each session are recommended.

 

General Strategies for Group Work


Process Recordings

  • Graybeal, C. T., & Ruff, E. (1995). Process recording: It's more than you think. Journal of Social Work Education, 31, 169-181.
  • Knauss, L. K. (2006). Ethical issues in recordkeeping in group psychotherapy. International Journal of Group Psychotherapy, 56, 415-430.
  • McGuire, J. M., Graves, S., & Blau, B. (1985). Depth of self-disclosure as a function of assured confidentiality and videotape recording. Journal of Counseling & Development, 64, 259-263.
  • Neuman, K. M., & Friedman, B. D. (1997). Process recordings: Fine-tuning an old instrument. Journal of Social Work Education, 33, 237-243.
  • Northen, H. (2004). Ethics and values in group work. In C. D. Garvin, M. J. Galinsky & P. M. Gutierrez (Eds.), Handbook of social work with groups (pp. 76-89). New York: Guilford.
  • Rapin, L. S. (2004). Guidelines for ethical and legal practice in counseling and psychotherapy groups. In J. DeLucia-Waack, D. Gerrity, C. Kalodner & M. Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 151-165). Thousand Oaks, CA: Sage.
  • Rapin, L. S. (2010). Ethics, best practices, and law in group counseling. In R. K. Conyne (Ed.), The Oxford handbook of group counseling (pp. 61-82). New York: Oxford University Press
  • Schwab, R., & Harris, T. L. (1984). Effects of audio and video recordings on evaluation of counseling interviews. Educational & Psychological Research, 4, p 57-65.
  • Vourlekis, B., Bembry, J., Hall, G., & Rosenblum, P. (1992). Evaluating the interrater reliability of process recordings. Research on Social Work Practice, 2, 198-206.
  • Wilson, S. J. (1980). Recording guidelines for social workers. New York: Free Press.

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