Group Work in Problem Gambling Settings
- 1. National Provider Forum 2012 Group Work in Problem Gambling Settings ABACUS Counselling, Training and Supervision Ltd Sharlene Wong and Sean Sullivan
- 2. Programme • Experience in room, types of groups • Starting Up Groups • Yalom’s Primary Stages of Change • Stages in Group Development • Integrating Motivational Interviewing into Group Therapy
- 3. Discussion – Counsellor experience in the room • Support groups vs Therapy groups • Education groups, Life Skills groups • Gamblers groups, Significant Others groups • Couples groups • Maori, Pacific Island, Asian etc groups • Abstinence vs Controlled Gambling groups • Female vs Male groups • Aftercare groups, Maintenance groups etc
- 4. Starting Up Groups • Type of group – support, problem focussed, process- orientated, abstinence vs controlled, etc • Degree of structure • Gender and culture issues (facilitators and participant) • Group goals – systemic and personal • Open vs closed group – new members, participant numbers • Group dynamics, including power issues of facilitator/s • Rules (confidentiality, meeting outside of group, etc) • Time keeping, recording, statistics • Duration of group • Facilitator as “expert” • Debriefing/support for facilitator, back up for absence
- 5. Yalom’s “Primary Agents of Change” in group therapy • Instillation of hope • Universality • Information giving • Altruism • Corrective recapitulation of the primary family • Improved social skills • Imitative behaviour • Interpersonal learning • Group cohesiveness • Catharsis • Existential factors
- 6. Tuckman’s Model of Group Development forming performing storming norming
- 7. Developmental Group Stages Forming – group is just coming together Storming – jockeying for position Norming – form some idea of the group’s identity Performing – group getting some work done Adjourning – involves dissolution
- 8. Motivational Interviewing A person centred, goal oriented approach for facilitating change through exploring and resolving ambivalence (Miller 2006)
- 9. Integrating Motivational Interviewing into Group Therapy
- 10. Advantages of Using MI in Groups • Increases people’s self esteem • Develops their own motivation • Developing skills in MI improves outcomes • Takes into account that people’s reasons for changing may be their own or may be a demand or ultimatum from another • Acknowledges indecisiveness is normal: There are often as many good reasons to stay the same as to change = ambivalence
- 11. Principles of MI (REDS) • Roll With Resistance • Express Empathy • Develop Discrepancy • Support Self efficacy
- 12. Micro Skills (OARS) • Open Questions • Affirmations • Reflective Listening • Summarising
- 13. “Motivational Interviewing in Groups” M. Valesquez, N Stephens & K. Ingersoll Journal of Groups in Addiction in Recovery, vol 1 (1) 2006) • Can be advantageous to have two counsellors - one focuses on reflecting while the other focuses on process (taxing to sustain both) • Sit in circle. Counsellors avoid sitting together, as creates an expert corner • Present style and spirit of MI when opening (group rules, collaborative approach) – while you have some skills and experience, change is up to them • OPEN
- 14. OPEN • Open with group purpose, learn more about group thoughts, concerns and choices • Personal choice is emphasised • Environment is one of respect and encouragement for all members • Non-confrontational nature of the group
- 15. OPEN: Group purpose, thoughts, concerns and choices • Ever run a group where some of the group members are reporting abstinence yet other sources suggest otherwise? • How do you manage a situation where a group member tells you, outside of group, that another group member is not being truthful about their gambling (or alcohol/drug use) ? • How/when would you set guidelines in the group around this possible scenario?
- 16. Sharing/Reflection/Linking • Theme Counsellor offers group invitation eg “What’s something we could focus on for the next … minutes/hours?” or “Today we are going to look at alcohol (brochure handout). Tell me what stands out for you as you look at it.” • 1 on 1, member shares (counsellor offers reflective listening, emphasis on change talk, counsellor checks that other group members are engaged and listening through eye contact, body language, modelling) • Theme Reflect, summarise, add “we-ness” eg “It’s common for people to replace gambling with another way of escaping…” • 1 on 1, 2nd member shares (reflective listening, encourages others’ feedback/reflection • Theme (summary, possible links with past sharing, links to big picture) “It seems like we all recognise that a gap is created when we reduce or stop gambling…it’s a trap to fill that space with unhealthy behaviour…”… “What supports are useful at these times?”
- 17. Small group role play One or two counsellors Group members Choices: • Problem Gamblers Group • Significant Others Group
- 18. MI Group - Debrief Counsellor/s’ round - 1 thing I did well… 1 thing I did less well… 1 thing I want feedback from you on is… Group members’ round - 1 thing you found helpful… 1 thing you did well… 1 thing to explore…
- 19. Change Planning in Groups Change planning in group exercise Round one: “After you leave today what is one change that you can make to ….” “Why is it important for you to take this step?” (On scale 1-10 “how important to take step?”) Eg Round two: How will you do it? Round three: How will you know if it’s working? Round four: What will you do if it’s not working? Round five: How can the group (and others) help? Use summaries to make links/emphasise commonalities between group members.
- 20. • The group has been discussing how may substitute gambling with other alcohol or drugs or unhealthy eating. • Counsellor to lead some rounds
- 21. Counsellor/s’ round - 1 thing I did well… 1 thing I did less well… 1 thing I want feedback from you on is… Group members’ round - 1 thing you found helpful… 1 thing you did well… 1 thing to explore…
- 22. Values Exploration in Groups • Invitation or open ended question to elicit what values they have related to an issue the group is focussing on. e.g. health, work/ home balance, financial wealth • Check out how these values play out in other situations: “How do these values relate to...” • “How may these values guide you in future situations?” • Use OARS. Link together by reflecting on content, specific values and/or how values interact with an issue. Same for summaries. e.g. “Although your values say spending time with your children is important, you find yourself working overtime to pay for gambling.” • •
- 23. Group Exercise: Values Cards What’s Important in My Life http://casaa.unm.edu/inst/Values Card Sorting Task for Individuals with Schizophrenia.pdf http://www.motivationalinterview.net/library/valuescardsort.pdf • Each group member has a set of cards. • Step One – Three pile sort: Not Important, Important, Very Important • Step Two: Sort of pile of your top five “Very important” • Step Three: Do a round, sharing what you wish to share
- 24. Group MI Summary • Working in MI style in a group uses the same skills – the key is to elicit from the group and its members some shared recovery themes • Work collaboratively with the group as a whole by linking common themes and relating to the ‘big picture’ using OARS • Preparing for change as a group while acknowledging different stages of change; enhance links and mutual affirmation/support • Support positive shared group values to highlight discrepancies to elicit ‘change talk’