Chapter 5: The Efficacy of Group Work

1. Chapter 5: The Efficacy of Group Work Introduction to Group Work, 5th Edition Edited by David Capuzzi, Douglas R. Gross, and Mark D. Stauffer

2. What Is Efficacy? • Efficacy = The degree to which desired goals or outcomes are achieved

3. Why are efficacy questions important? • Ethics: Nonmaleficence — Do not impose interventions that risk harm. • Ethics: Beneficence — Apply interventions that research proves efficacious. • Professionalism: Base actions upon scientific knowledge and not on personal preference. • Economics: Managed care makes counselors responsible for demonstrating the cost effectiveness of their methods.

4. Quantitative Methods to Measure Efficacy • Methods = correlational, causal–comparative, true experimental, quasi-experimental, action research • Statistical analysis of numerical data for targeted behaviors • Includes behavioral, role, or process phenomenon that can be defined and counted • Focus on client and group characteristics that can vary (independent and dependent variables) • Controls for the influence of factors other than the independent variable on the dependent variable

5. Qualitative Methods to Measure Efficacy • Based on interpretable data generated through “thick” description of client phenomena • Thick description is built through narratives, surveys, interviews, and observations • Outcome data can include assessments of change in such things as worldview or personal idiosyncrasy

6. Outcome Measurement • Outcome Measurement: Will the tools used to study the behaviors of interest obtain a measurement that is complete and accurate? • Reliability • Qualitative: Is there a match between what is observed as happening and the data that is recorded? • Quantitative: Is consistency found across the different observations? • Validity • Qualitative: Does the assessment process have credibility? Do the constructed realities of the participants match the constructed reality of the researcher? • Quantitative: Does a particular assessment tool measure what it claims to measure?

7. Effective Counselor Practices in Group Work • Specific Factors and Outcomes • Specific factors = the counselor’s acts that are unique to a particular theory of counseling • Lack of structure = can create cognitive distortion, interpersonal fear, subjective distress, and premature termination • Providing alternatives and instruction = will prevent client reactance and produces more client involvement

8. Effective Counselor Practices in Group Work • Nonspecific Factors and Outcomes • Nonspecific factors = change-producing elements present in counseling regardless of the theoretical orientation • Working alliance = the best predictor of outcomes and has three components: goal, task, and bond • Curative factors = Yalom’s 12 curative factors (e.g., universality, instillation of hope, etc.)

9. Effective Counselor Practices in Group Work • Nonspecific Factors and Outcomes • Group development = knowledge of the group stages (e.g., forming, storming, norming, performing, adjourning, etc.) • Leadership = providing a sense of hope, matching leadership style with client personality, and having personal characteristics which include being positive and emotionally supportive

10. Group Counseling Modes and Outcomes • Task/work mode (TASK): Focus on identification and completion of specific goals • Psychoeducational mode (EDUC): Purpose is to prevent psychological maladjustment • Counseling mode (COUN): Focus is on interpersonal growth and problem solving • Psychotherapy mode (THRP): For clients who may be experiencing severe and/or chronic maladjustment

11. Effective Interventions for Internalizing Disorders • Internalizing disorders: When a client’s aggression is turned inward • Depression: Most efficacious group counseling blends skill training, cognitive restructuring, and a supportive group process. Cognitive–behavioral group therapy is found to be the most efficacious. • Eating disorders: Cognitive, cognitive–behavioral, or interpersonal counseling prove most efficacious.

12. Effective Interventions for Externalizing Disorders • Externalizing disorders: When a client’s aggression is turned outward toward others • Spouse battering: Cognitive approach is shown to have a 53%–85% success rate. Most successful therapies include cognitive techniques, profeminist components, and highly structured group process. • Disruptive behavior disorders and delinquency: Therapies found effective are cognitive, nondirective group therapy interventions, and eclectic behavioral interventions.

13. Effective Interventions for Physical Health Problems • Geriatric cognitive dysfunction: Resocialization groups have been found effective. • Insomnia: Cognitive and behavioral approaches have been successful. • Other psychical health problems: Group counseling has been found efficacious for clients with cancer, respiratory diseases, and chronic headaches, among other ailments.

14. Crossing Boundaries • Group counseling is also efficacious for the following: • Personal growth • Career development and work performance • Interpersonal relations • Multicultural understanding • Diversity is a critical factor affecting outcomes. Methods addressing culture, identity, and socialization positively influence efficacy.

15. Ineffective Interventions • Large group guidance (LG-EDUC) in the schools has not been shown to be efficacious with the exception of career development and Second Step (groups designed to lessen school violence).

16. Harmful Interventions • Poor pre-group screening (counselors must have knowledge of contraindication issues) • Contraindication types • Barriers (e.g., lack of clients with similar issues, scheduling problems, lack of qualified counselors) • Client treatment needs (e.g., clients in crisis or suicidal, clients who need more attention than the group can provide) • Client personality factors (e.g., paranoid or psychotic, extreme interpersonal sensitivity) • Counselor actions • Training/skills issues (e.g., knowledge or skills deficits, employing techniques with little training) • Counselor personality issues (e.g., traits such as coldness, obsessiveness, seductiveness, pessimism, unconscious hostility)

17. Unanswered Issues Regarding Group Counseling Effectiveness • The research on group counseling causalities has focused exclusively on counseling and psychotherapy groups. Researchers have not addressed psychoeducational groups. • There are still questions regarding the best way to compose a group — homogeneously or heterogeneously — with respect to diagnosis. • There is not sufficient research on group counseling interventions with children and adolescents.