Group Leadership Skills: Interpersonal Process in Group Counseling and Therapy


Mei-whei Chen & Christopher Rybak

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    The power of a group in action fascinates and humbles those who behold. No matter how many times you sit in a group, you cannot help but be captivated by the surprising richness and complexity of the forces at work within it. As members’ interpersonal and intrapersonal processes wed, you are privileged to catch sight of an explosion of dynamics—each with a personality and a life of its own, commanding your unfaltering respect and appreciation.

    Many therapists and counselors, however, shy away from leading groups because of this uncontainable richness and complexity, which, as we have seen, can dazzle even the most seasoned of therapists. Feeling ill-equipped to handle group dynamics, new group facilitators feel nauseous, and even break out in a cold sweat, at the mere thought of leading groups.

    This sense of anxiety and inadequacy completely makes sense as many budding therapists feel like they lack the necessary skills and competencies to run a group—even with training. The fact is that with the one or two group training courses that they may have taken, their preparation has often been too general to provide an in-depth understanding of how to tackle the intricacies inherent in each group session, much less how to help group members transform. As such, numerous beginning group leaders thirst for practical and tangible instructions that provide not only conceptual discussion but also specific guidelines and illustrations to help them brave the many challenges of group counseling.

    We believe that the first edition of this text met such needs through converting abstract concepts into concrete actions, by way of skill and technique illustration. From the feedback that we received from its active users, it was made clear to us that the practical, as well as tangible, skills and techniques within the text have made a significant contribution to the beginning group leader’s foray into the unendingly fertile and intricate world of group work.

    We have been told that they begin to triumph over their fear and anxiety of taking on this most complex modality of counseling and therapy by the help of this book’s skills and techniques—much like a ship at sea, in dark and stormy waters, being shown safely to the shore by a lighthouse.

    We hope to extend this vital impact with this second edition.

    In this new edition, we continue to hone in on the power of the group. We continue to offer a wealth of case histories, creative ways of conducting groups, and examples for skills and techniques—all in an effort to get right to the heart and the action of the group practice, without lingering overly long in the realm of abstraction.

    What, then, is new here? We add leadership skills from several theoretical foundations: solution-focused therapy, strength-based therapy, cognitive behavior therapy, and interpersonal neurobiology. We also add three new chapters to join the lineup:

    Taking the suggestions of our reviewers, we spread the here-and-now leadership skills over four different locations to suit varying stages of member readiness:

    • Chapter 8 introduces the first baby steps, suitable for the early stages of a group.
    • Chapter 10 ushers in the intermediate steps, fitting for the norming stage.
    • Chapters 11 and 12 expound upon the most advanced steps, apt for the working stage.

    Even at the advanced level featured in Chapters 11 and 12, the here-and-now techniques are further partitioned into several levels of intensity. The hope is that success with the less intense techniques will embolden new group leaders to apply those of higher intensity if it so suits the needs of their groups.

    In addition, the entire manuscript went through a major makeover—a welcomed revision of the previous contents and a proud enhancement via the new research, new concepts, new cases, and new delivery style—giving the entire text a different feel.

    Due to limited space, we let go of two old chapters (professional standards/best practices and further development of the group leader) so as to leave room for the added chapters.

    The power of a group in action fascinates and humbles those who behold. No matter how many times you sit in a group, you cannot help but be captivated by the surprising richness and complexity of the forces at work within it. To work with this power, one must enter its sphere with utter openness, curiosity, willingness, humility, and a sense of awe—an attitude that can be best described as a Zen mind, or a beginner’s mind. It is with this same attitude that we fashion this second edition.


    We feel privileged to be given the honor to create this book. The precise honor, however, must go to the numerous trainees and group participants who have given us insights into group dynamics and interpersonal processes that no amount of study in literature and theories can achieve. It is through seeing groups at work that the ideas and concepts in this text began to germinate.

    It is with the deepest gratefulness that we thank our trainees and group participants, especially those who have given us permission to use their personal cases and journals, though anonymously, to demonstrate points in the text. We thank them for their generosity and the trust they have placed in us.

    We want to thank Annie Huston and Wendy Haas. You hunt down and expunge flabby expressions, correct grammatical errors, tighten sentences, place words here and exchange words there—until the writing reveals its message in the clearest way possible. Your contributions quicken the pace of the book, making it easier and lighter to read.

    Special thanks are to Ed Porter. This text has more to offer because of your linguistic acumen, scrupulous attention to detail, and insight into elusive group processes—a rare find of amalgamation of talents.

    Thank you, Ana Ferraz-Castilho, for your assistance in updating the bibliography. What a patient researcher you are! Without your help, we would have been bogged down by the mammoth task of researching.

    Thank you, Sarah Cozzi and Thomas Nedderman, for contributing your thoughtful ideas to several exercises in this text. And thank you, Kimberly Buikema, for so generously sharing with the readers the group proposal in Appendix A.

    It is with utter gratitude that we thank the following reviewers—as “iron sharpens iron,” the astute comments from you have sharpened our minds and visions as we go about completing this new edition:

    • Professor Jack Flight, Dominican University;
    • Professor Karin Lindstrom Bremer, Minnesota State University, Mankato;
    • Professor Kevin A. Curtin, Alfred University;
    • Professor Susan Claxton, Georgia Highlands College;
    • Professor Susan Glassburn Larimer, Indiana University;
    • Professor Tracey M. Duncan, New Jersey City University;
    • Professor Tracy A. Marschall, University of Indianapolis;
    • and Professor Charles Timothy Dickel, Creighton University.

    Finally, thanks be given to Abbie Rickard, Kimaya Khashnobish, Nathan Davidson, Lara Parra, Kassie Graves, Alissa Nance, Jenna Retana, and our copyeditor, Michelle Ponce, at Sage. Your professionalism and your passionate enthusiasm for this book make the undertaking of this project clear and focused; your supportive approach adds an extra measure of positive energy to the entire authoring process.

    For our parents, family, partners, and friends, words are inadequate to express our gratitude for your unyielding support, understanding, and love.

    The authors’ ultimate gratitude must go to the larger community of group counseling and therapy through which the heritage of group work is maintained and through which precious knowledge is handed on to the generations of therapists to come.

    About the Authors

    Mei-whei Chen, PhD, Licensed Clinical Psychologist Dr. Chen is a professor at Northeastern Illinois University. She teaches group counseling, individual counseling, theories in counseling and psychotherapy, mental health counseling, grief counseling, and stress management. In addition, she maintains her own private practice, on the side, in Illinois. She has received three Faculty Excellence Awards from Northeastern Illinois University. As well, she received the Beverly Brown Award for Outstanding Contributions to the Field of Group Counseling from the Illinois Association for Specialists in Group Work (IASGW). Besides the text of Group Leadership Skills, Dr. Chen also publishes Individual Counseling and Therapy: Skills and Techniques (3rd edition coming out in 2018) and has published many journal articles in related areas.

    Christopher J. Rybak, PhD, Licensed Clinical Professional Counselor Dr. Rybak was a professor and chair of the Department of Educational Leadership & Human Development at Bradley University and a specialist in group work. He taught group counseling, counseling diverse populations, practicum and internship in counseling, theories and techniques of counseling, and pre-practicum in counseling. Dr. Rybak served as the director of the ELH Counseling Clinic and several times as president of the Illinois Association for Specialists in Group Work. He received awards for innovative teaching and integrated learning, a research award, two Fulbright scholarship awards, and the Beverly Brown Award for Outstanding Contributions to the Field of Group Counseling from the Illinois Association for Specialists in Group Work (IASGW).

  • Appendices

    Appendix A A Sample of the Group Proposal
    Group Proposal for Working With Trans* Individuals

    Gender dysphoria refers to the distress that accompanies “the incongruence between one’s experienced/expressed gender and one’s assigned gender” (DSM-5, 2013, p. 451). The incongruence itself is not a dysfunction; the distress surrounding the incongruence, however, is worthy of attention and care. Despite a growing trans* population in Chicago, no experiential groups exist in the city to support such a vulnerable population. As I take interest in working with this population and feel a great deal of compassion and empathy for trans* individuals, I would like to propose a hybrid of support and experiential group at our center for trans*.

    The proposed group will provide understanding to trans* individuals who deserve to live within society whilst having their true, authentic selves honored. The hybrid group can provide a mechanism of support, psychoeducation, and growth while lessening the distress that trans* members may feel. The group can also serve as a place of empowerment and advocacy.


    It is essential for all counselors working with trans* individuals to understand and stay up to date with relevant transgender terminology and policy. The following terminology is current and relevant in regard to the trans* population, which I will continue to use throughout this proposal and in future work with trans* clients (Killermann, 2013).

    • Transgender—an umbrella term for those who do not follow the gender norms that have been assigned by society.
    • Trans*—a broader (than transgender) umbrella term for those who do not identify themselves within the binary gender spectrum. This includes those who identify as transgender, transsexual, genderqueer, genderfluid, transvestite, genderless, and so on. Our group will welcome all trans* individuals, not just those who identify as transgender. Therefore, trans* will be used throughout the remainder of my proposal.
    • Transition—the process a trans* individual goes through when changing gender expression.
    • Transman, Female to Male, FTM, F2M—An individual who was assigned as a female at birth but identifies herself as male.
    • Transwoman, Male to Female, MTF, M2F—An individual who was assigned as a male at birth but identifies himself as female.

    Permission for use by Kimberly Buikema

    Type and Purpose of Group

    Group counseling can especially help trans* individuals by providing a supportive network of acceptance and a kind of understanding from those who share similar experiences and by allowing individuals to work through and process their distress to their fellow members who not only support them but also understand and have lived through and learned from similar experiences.

    Group also provides a great opportunity for members to discuss barriers and practical issues. Members can receive both emotional support and practical feedback. Aware of the power of the group, I am confident that the hybrid of a support and experiential group can be especially beneficial for trans* individuals.

    While many types of the group can be helpful for trans* individuals, pscyhoeducational, mindfulness, topic-based, or process to name a few, the proposed group will be a hybrid support and experiential group.

    The support aspect will be naturally built into the group since members will be able to bring in their own topics or issues to work through in a supportive and understanding environment.

    The experiential aspect of the group, however, will make the best use of the power and growth inherent in the group process that focuses on examining the “here-and-now” materials that organically occur within the group.

    I was able to consult with a trans* therapist who works at an LGBTQ specific practice in Andersonville. She has found this type of hybrid group to be incredibly successful. In fact, the group was so successful that her practice started a second group of the same nature, and she encouraged me to run this type of group here in our center, given how powerful and effective the group can be. She said that many group members have claimed that “it feels like home” (R. McDaniel, personal communication, March 28, 2016). Given the large trans* population that frequents our center, I am confident this type of group will be of great need for them.


    Group members will commit to the group on a voluntary basis. In regard to emotional safety and comfort level, all members will be trans*. That means they could be all over the stages of questioning, working through finding identity, transitioning, or living and expressing as trans*.

    Closed or Open Group

    The group will be a closed, longer-term, ongoing group. However, if a spot opens up within the group, a new member may join. Admission is pending on both permission by the group and an individual screening procedure with my co-leader or myself.

    Group Size

    As it is a hybrid support/experiential group, the group size will be kept slightly smaller. Eight members would be an ideal number (Chen & Ryback, 2004), but the group could be run with members numbering between six and 10. A group with fewer than four members will not be conducive, and if more than 10 members are willing and eligible, creating two groups will be the proposed choice.

    Session Length and Frequency

    Sessions will run 90 minutes, once a week, from 7 p.m. to 8:30 p.m. on a weeknight. This would allow group members to arrive after work but still have time to get home safely via walking, cycling, or public transport.


    The group’s meeting place needs to be accessible, private, and sensitive, whilst creating a feeling of safety. It may be upsetting, offensive, or triggering for group members to attend a meeting in a religious institution or place of worship, considering the discrimination or rejection some members have faced from such places (Dickey & Loewy, 2010). Fortunately, in the center, we have space in our facility to hold group sessions every week; neither privacy nor security is an issue.

    Leaders’ Qualifications

    According to WPATH’s (World Professional Association for Transgender Health) Standards of Care, group leaders must have, at a minimum, an MA in mental health counseling, counseling psychology, or social work. They must also be licensed as an LPC, LCPC, or LCSW (World Professional Association for Transgender Health, 2012, p. 22).

    However, as I only just completed my MA, I am still waiting for my LPC credentials to come through. I also don’t have a lot of experience working with trans* individuals. Therefore, I will seek out consultation and supervision from a therapist experienced in working with trans* individuals, as outlined in ACA’s (American Counseling Association) Competencies for Counseling With Transgender Clients (American Counseling Association, 2010).

    Fortunately, Joe, the LCPC in our center, has agreed to act as my supervisor and consultant in this instance, as he has received specific trans* counseling training and has the required experience. He has also agreed to co-lead the group with me, as he also realizes that this type of group could be very beneficial for our trans* population. In this case, he could fill the roles of mentor/consultant, co-leader, and supervisor. This could benefit both myself (getting the supervision and mentoring I would need) and the group, as they would have two therapists facilitating the group.

    Once I have received my LPC licensure, attended a trans* specific training at Live Oak or Center on Halsted, and received substantial supervision from Joe, I will be able to run a trans* hybrid group independently, as I’ll have the necessary degree, credentials, training, and experience.

    Joe and I will ensure that we are compliant with both ACA’s Competencies for Counseling With Transgender Clients (ACA, 2010) and WPATH’s Standards of Care (2012). This includes having a strong understanding of the transition process, state and federal policy in regard to discrimination, documentation and medical intervention, and appropriate knowledge of terminology, including correct pronouns.

    Screening Procedure

    Group members will go through a screening intake interview with both Joe and myself. From there, we will make a decision in regard to whether members are appropriate for the group setting. Individuals with more serious diagnoses such as bipolar disorder, borderline personality disorder, schizophrenia, or other psychoses will not be appropriate in this group setting, as they could affect the safety of other group members (Chen & Rybak, 2004, p. 63).

    Since many trans* individuals are susceptible to distress, depression, anxiety, and PTSD due to discrimination, lack of acceptance, and microaggressions (Riley, Wong, & Sitharthan, 2011), those who may have these separate diagnoses will be appropriate candidates for admission.

    However, if individuals are suicidal or suffering from extreme depression, anxiety, or PTSD, they may not be suitable for the group setting at this time. In this case, we may refer them to individual counseling or a diagnosis-based trans* group, of which there is a limited number in Chicago. This is for the safety of the individual wanting to attend and the safety of group members.

    Joe and I will also carefully consider other factors such as identifying or expressing gender of group members. Transmen (female to male) may feel less supported in a group setting, as transwomen (male to female) are more predominant (Dickey & Loewy, 2010). This is a worthy consideration in regard to group make-up. We will also take into consideration those who identify as genderqueer, gender fluid, or gender expansive and how that may impact the group.

    Ground Rules

    As with all other groups, confidentiality and safety are of the highest priority, as is maintaining a respectful and nonjudgmental atmosphere. Hateful language will not be allowed or tolerated. In order to feel safe, all members of the group must identify as trans*. Members have the power to choose which pronouns they would like to be referred to and have permission to change that pronoun at any time.

    Joe and I will also be very cognizant of the unspoken pressure that group members may feel within the group setting. We will regularly remind members that it is very important to remember that each trans* individual’s journey is different. In no way should a group member feel pressured by other members to identify or express gender in a way that they are not ready for or that does not feel authentic to them, including medical interventions. According to Bockting, Knudson, and Goldberg (2006), this kind of pressure can be a very real issue.

    Judgment about others’ gender identity and expression will not be tolerated. This rule will be clearly laid out and repeated if and when it is necessary.

    We will also keep an atmosphere of respect throughout and remind group members to do so. This extends to the topics that are brought in by group members. We will ask all members to maintain a willingness to discuss the topics others bring in. We will also establish a rule to encourage members to work in the “here and now” processing moments. With the use of both methods (process and topic-based support), the group can work within both spheres simultaneously.


    We will run the group structured for the first three to four sessions, then move into an unstructured format. However, a regular check-in every week will be maintained. This will allow members to share topics they’d like to discuss in the bulk of the session. If processing needs to continue from the previous session, that will also be encouraged. If we run out of time before presenting issues can get discussed, we will put something on hold until the following week. We will also manage crises as and when they arise.

    Special Needs and Characteristics of the Trans* Population

    Many trans* individuals are at a greater risk of depression, anxiety, suicide, and PTSD due to both gender identity incongruency and regular discrimination and microaggressions. Discrimination also places trans* individuals at a greater risk of unemployment and homelessness (ACA, 2010; Bockting et al., 2006).

    Many trans* individuals also suffer from lack of self and lack of self-acceptance, again making them more susceptible to mental health issues and distress. This lack of self, identity, and distress whilst navigating regular discrimination can make trans* individuals particularly vulnerable.

    Minority trans* and trans* individuals who live in poverty are in a double bind in regard to discrimination and oppression, which also merits particular attention and care (ACA, 2010).

    Understanding, honoring, and acknowledging these vulnerabilities will inform our approach and work within the group, alongside the theories and techniques outlined in the section below.

    Concepts and Techniques

    Aaron Devor created a 14-step model of transgender identity formation (Devor, 2004), which we plan to use as a tool to help gain a general idea of where group members may be in regard to their identity.

    Queer theory also provides a helpful perspective from which to draw understanding about gender identity and expression. The following quote by Dilley (1999) helps clarify:

    Queer theory is not easily understood partly because it challenges basic tropes used to organize our society and our language: even words are gendered, and through that gendering, an elliptical view of the hierarchy of society, and presumption of what is male and what is female, shines through. Queer theory rejects such binary distinctions as arbitrarily determined and defined by those with social power. (p. 460)

    This tenet of queer theory provides a lens through which to examine, understand, and deconstruct the binary, gender-normative, and heteronormative bias of most Western cultures.

    Gaining this perspective can help the group leader cultivate compassion and empathy in regard to the bias in which trans* individuals live. This perspective and theory will also inform our group work with trans* individuals.

    Dickey and Loewy (2010) have pointed out that multicultural, feminist, and social justice frameworks can prove helpful to both empower and advocate for trans* individuals. I’ve also been advised that relational, trauma-informed, systemic, strength-based, and internal family systems could prove helpful (R. McDaniel, personal communication, March 25, 2016).

    Joe and I have decided that a holistic, collaborative, respectful, trauma-informed approach that encourages empowerment could be very powerful in the group setting. We may draw on the aforementioned frameworks as and when the need arises.

    We will also draw guidance from Jack Annon’s PLISSIT model of intervention as outlined by Riley et al. (2011) and Henkin (2007).

    The following are ways we plan to incorporate the PLISSIT model of intervention into the group setting:

    • Permission—Give permission for members to define their own gender identity and expression, both of which can be fluid and exist on a spectrum.
    • Limited Information—Members share how much they are comfortable sharing in the moment.
    • Specific Suggestions—Help members brainstorm ways of expression that are safe.
    • Intensive Therapy—Members can choose how intensely they want to participate in the group each week.

    Using this model and application reflects the emphasis on mutual respect toward each member’s pace of identity and acceptance whilst encouraging discussion, which could be particularly empowering for trans* individuals.

    Possible Issues or Topics

    In 2004 or 2005, a cognitive behavior therapy (CBT) research group was run in a VA Hospital in Boston. Six transgender women (MtF) participated. The group met for 60 minutes for 12 weeks. Topics in the study included identity, development, personal safety, family issues, parenting, medical issues, body issues, and intimate relationships (Maguen, Shipherd, & Harris, 2005). Joe and I found that these topics could be useful in our group, too. These topics may arise naturally, or we may bring them up if it seems appropriate and relevant.

    Other topics could include self-acceptance, transition, authenticity, friendships, disclosure, discrimination and microaggressions, housing, employment, gender expression, legal issues, dating, sexuality, and any other topics that members choose to discuss.

    We may repeat topics as necessary, as there are many layers involved in a lot of these topics. Of course, members’ topics and processing will get priority.


    Trans* individuals constantly search for identity, authenticity, self-acceptance, and self-validation. This does not differ greatly from many other individuals seeking out group or individual counseling. What is unique when working with the trans* population is helping them figure out how to identify, navigate, and operate within society, families, and workplaces that insist upon the either/or, gender binary identification and expectation. Joe and I look forward to exploring all of this within our group.


    American Counseling Association. (2010). Competencies for counseling with transgender clients. Journal of LGBT Issues in Counseling, 4(3–4), 135–159. doi:10.1080/15538605.2010.524839

    American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Bockting, W. O., Knudson, G., & Goldberg, J. M. (2006). Counseling and mental health care for transgender adults and loved ones. International Journal of Transgenderism, 9(3–4), 35–82. doi:10.1300/J485v09n03_03

    Chen, M., & Rybak, C. J. (2004). Group leadership skills: Interpersonal process in group counseling and therapy. Belmont, CA: Brooks/Cole.

    Devor, A. H. (2004). Witnessing and mirroring: A fourteen stage model of transsexual identity formation. Journal of Gay & Lesbian Psychotherapy, 8(1–2), 41–67. doi:10.1300/J236v08n01_05

    Dickey, L. M., & Loewy, M. I. (2010). Group work with transgender clients. The Journal for Specialists in Group Work, 35(3), 236–245. doi:10.1080/01933922.2010.492904

    Dilley, P. (1999). Queer theory: Under construction. International Journal of Qualitative Studies in Education, 12(5), 457–472. doi:10.1080/095183999235890

    Henkin, W. A. (2007). Coming out trans: Questions of identity for therapists working with transgendered individuals. Electronic Journal of Human Sexuality, 11. Retrieved from

    Killermann, S. (2013). The social advocate’s handbook: A guide to gender. Austin, TX: Impetus Books.

    Maguen, S., Shipherd, J. C., & Harris, H. N. (2005). Providing culturally sensitive care for transgender patients. Cognitive and Behavioral Practice, 12(4), 479–490. doi:10.1016/S1077-7229(05)80075-6

    Riley, E. A., Wong, W. T., & Sitharthan, G. (2011). Counseling support for the forgotten transgender community. Journal of Gay & Lesbian Social Services, 23(3), 395–410. doi:10.1080/10538720.2011.590779

    World Professional Association for Transgender Health. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232. doi:10.1080/15532739.2011.700873

    Appendix B Pregroup Orientation Handouts
    Orientation to Being in a Therapy Group

    Student Counseling Services, Iowa State University. Reprinted with Permission

    If this is your first experience in a therapy group, along with some excitement and anticipation, you probably have some apprehensions as most people do. People have common concerns such as, “What will the other members be like?” and “Will the experience be helpful and meaningful to me?” In this orientation, we will outline some of the benefits of being in a group as well as guidelines to assist you in taking advantage of the experience.

    What Can You Expect from Being in Group Therapy

    Group therapy affords opportunities to address the issues that concern you, identify with others, and examine life patterns that are interfering with your personal growth. In a group, you have the opportunity to gain immediate feedback from other group members and the leaders. By receiving feedback from others (that is, how they perceive you), you increase your awareness of yourself and aspects of your life you wish to change.

    Group therapy also gives you an opportunity to try out new behaviors, to express feelings you have been hesitant to express, to assert yourself in new ways, or to experiment with new ideas. You will also be able to learn from other members as you identify and connect with their struggles and successes.

    With the assistance of the group leaders and your fellow group members, you will have the task of determining how you take advantage of these opportunities. You determine the amount of energy—mental and emotional—you wish to invest in the group process. Needless to say, the more you invest, the more you benefit.

    What To Do to Get the Most Out of a Therapy Group
    • Be yourself. Start from where you are, not how you think others want you to be. This might mean asking questions, expressing anger, or communicating confusion and hopelessness. Growth begins by taking the first step of sharing in the group.
    • Define goals. Take time before each session to define your goals for that session. Nevertheless, being flexible about your goals is also important. You may be surprised to find that your goals continue to change throughout the group process.
    • Recognize and respect your pace for getting involved in the group. Some group members will easily be ready to disclose their thoughts and feelings; others need more time to gain feelings of trust and security. By respecting your needs you are learning self-acceptance. If you are having a difficult time with how to discuss your problems with the group, then ask the group to help you.
    • Take time for yourself. You have the right to take group time to talk about yourself. Many people may feel that other’s issues are more important than their own, may have a difficult time facing feelings, or may have fears of appearing “weak.” By recognizing what the reluctance means, you begin the growth process.
    • Recognize and express thoughts and feelings. The use of either thoughts or feelings alone is insufficient in working through problems. If you are having difficulties recognizing and expressing your thoughts or feelings, ask the group to help. Learning to express yourself fully, without censorship, enables exploration and resolution of interpersonal conflicts and self-affirmation.
    • Take risks. Experiment with different ways of behaving and expressing yourself. By taking risks, you can discover what works for you and what doesn’t. This may mean expressing difficult feelings, sharing information you usually keep secret, or confronting someone about something upsetting to you.
    • Give and receive feedback. Giving and receiving feedback is a major aspect of group therapy. The best way to get feedback is to request it from specific individuals, those whose impression means the most to you. You have the right to ask for either negative or positive comment (or both), depending on what you are ready to hear.

      Feedback should be concrete and specific, brief but to the point, and representative of both your feelings and thoughts. It is provided in the spirit of helpfulness and respect. The purpose is to help others identify patterns, personal presentations, unrecognized attitudes, and inconsistencies.

      Most group members learn that giving advice, suggestions, and solutions is seldom helpful. For advice-givers, it takes time to learn how to express personal reactions, communicate understanding, give support, and listen attentively.

    • Become aware of distancing behaviors. All of us have ways of behaving that prevent others from getting close to us such as remaining silent and uninvolved, telling long involved stories, responding to others with intellectual statements, and talking only about external events. As you become involved in the group, you will have the opportunity to identify what you do to distance yourself from others. Keep in mind that distancing behaviors have had a purpose in the past. The question you will face is whether the behavior is preventing you from getting what you want such as close relationships with people.
    • Be patient with yourself. Growth takes time, effort, and patience. Changing what has become such an integral part of ourselves is very difficult and slow. By having patience with ourselves and accepting and understanding these blocks to growth, we set the foundation for growth and change.
    • Work outside the group. In order to get the most from the group experience, you will need to spend time between sessions thinking about yourself, trying out new behaviors, reflecting on what you are learning, reassessing your goals, and paying attention to your feelings and reactions.
    The Group Leaders

    Usually, groups have two leaders whose function is to use their knowledge and experience to facilitate individual and group growth. Leaders will promote an atmosphere of safety and encourage open communication between members. Group leaders will also help to identify group patterns, feelings, and underlying meanings.

    The activity level of the group leaders will vary, depending on what is happening in the group. When the members are relating freely with each other and the energy level and involvement is high, the leaders tend to be less active. You are also encouraged to communicate your reactions and thoughts to them concerning their role and activities.

    Additional Questions?

    We hope this orientation guide will help you to prepare for the group experience. If you have questions about being in a group that are not addressed in this orientation, ask your group leader.

    Group Therapy Agreement

    Student Counseling Services, Iowa State University. Reprinted with Permission

    Group therapy is often the treatment of choice for people who experience troubled relationships, loneliness, depression, anxiety, grief/loss, and low self-esteem. People who participate in groups have the opportunity to benefit from sharing personal experiences, giving and receiving support/constructive feedback, and experimenting with new interpersonal behaviors. In order for the group to work, a safe environment must be created and expectations for members and co-leaders must be understood by the participants. The best way to create a safe environment for personal growth is for you to understand and to agree to these guidelines.

    • Confidentiality—Feeling safe in the group is very important to a successful group experience. Confidentiality is the shared responsibility of all group members and leaders. Please keep discussions that occur in group confidential and keep names and identities of other group members confidential. You are free to disclose to people that you are a member of a group and that you attend group, but to protect confidentiality, please do not discuss person-specific details of other group members to persons outside the group.
    • Attendance—Group members are expected to make a commitment to attend group the entire term. Members also agree to come on time every week. If you are running late or have an emergency/illness that prohibits you from coming to the group, we ask that you call or email one of the co-leaders or let the front desk staff know. If you know ahead of time that you will miss a later group session, we ask that you share the date of your absence with the group beforehand. Individual and group sessions are provided at no charge but failure to attend group without canceling will result in a $25 charge. If you are unable to attend group consistently, you may be asked to discontinue group.

    Members often feel anxious about participating in groups and seeing the results can take time. If you do decide to discontinue attending the group and have explored your concerns with the leaders and other members, we ask that you come back to the group to say good-bye. Members will begin to care about one another and though this may feel hard to imagine now, members may experience unresolved feelings if you leave without any explanation.

    • Relationships With Other Members—Outside relationships between members can disrupt group cohesion and the therapeutic process. As long as group members are in a group, relationships outside of group should be avoided. This includes texting and social media. If you do have contact with someone outside of group (e.g. see someone on campus), we ask that you share that contact with the group at the next meeting.
    • Safety—If you experience thoughts of self-harm, suicide, or harm to others, it is expected that you will bring this up in the group and/or make separate contact with an SCS counselor to discuss your thoughts. If you are in crisis, you are expected to seek out the help that is required to keep you and others safe. Possible actions include coming to SCS for a walk-in crisis appointment (M–F 8:00–5:00), calling the National Crisis Line at 800-273-8255, contacting the Crisis Text Line by texting “ISU” to 741741, calling 911, or going to the hospital emergency room.
    • Questions—If you have questions or concerns, please discuss these with the group leaders. In addition, you may contact the group coordinator (name, phone, email) or the associate director (name, phone, email).

    Your signature below indicates that you have read and understood this Group Therapy Agreement and you agree to adhere to the boundaries specified for group therapy.



    Name:(Please Print)   Signature   Date


    Therapy Goals for the Semester:





    Appendix C Examples of Interpersonal Skills for Member to Practice in the Session
    • Maintaining one’s center and identity in interpersonal relationships

      In this session, I want to try to articulate my feelings, whether they are positive or negative, to the person I am interacting with.

      In today’s session, I want to try to take good care of myself and be truthful about my feelings, even if that requires me to bring up difficult subjects.

      I want to resist my tendency toward withdrawal and try to stay engaged with people, even if I feel nervous or rejected.

      I want to lower the wall I build in my relationships with people. I want to be able to show others who I really am, without being controlled by fear of rejection.

      I want to respond nondefensively when I face criticism.

      I want to be my true self without always wearing a smiling persona or constantly trying to change my behaviors to please or control others.

      I want to stand comfortably for myself, without second-guessing or worrying about what others think of me.

      I want to say no to what I don’t want, without feeling guilty.

      I want to express my feelings, positive or negative, diplomatically without worrying about others’ approval and without making others feel defensive.

    • Comforting and soothing oneself when faced with stress or difficulties

      In today’s session, I want to try to use my inner resources to calm myself and step back from interactions when others are in the midst of anger and hostility, or step back from situations that can cause trauma.

      I want to slow down, instead of leaping into an argument or losing my temper.

      I want to stay present with my own feelings when under stressful interactions, instead of engaging in compulsive or addictive behaviors.

    • Having one’s self-esteem and mood remain constant in the presence of others’ anxieties and worries

      In this session, I want to try to remain empathic and supportive without feeling compelled to rescue others or worry about them when they are anxious, depressed, or going through a hard time.

      I want to remain a loving witness to others’ struggle and growth, without absorbing their painful feelings or feeling responsible for fixing problems for them.

    • Knowing that one’s values are constant

      In today’s session, I want to try to let my sense of self-worth remain stable whether I am praised, criticized, making progress, failing, in pain, or in a cheerful mood.

      I want to hold the ground that my value is inherent in being who I am and being alive, without needing to please others.

      I want to foster my self-worth through internal validation. I won’t let my self-worth rely on what kind of praise, grades, status, looks, or weight I get.

    • Being able to self-assert and self-confront

      In this session, I want to try to routinely reflect on my behaviors and confront myself. I want to be able to stop and ask myself, “How did I contribute to the problem in this interaction?” I want to keep the focus inward, own up to my own mistakes, apologize when appropriate, and stop other people when they are hurtful to me.

      I want to set boundaries for myself. When an interaction is intruding into one of my boundaries, I want to be able to say no and leave that interaction without fear of feeling alone.

    • Asking for and receiving support without feeling weak or compromised

      Today I want to learn to accept help from others without feeling indebted.

      I want to reach out for help when I am in need.

      I want to connect with others through receiving. I want to experience that my ability to receive allows someone else to experience the gift of giving.

      I want to ask for what I desire, without feeling embarrassed.

    • Developing a set of values through reflection, awareness, learning, and experimentation

      Here in this session, I want to practice trusting my own inner wisdom that comes through my experiences and my own personal reflections, instead of relying on my family, school, or religious institutions to determine what is important for me.

    • Feeling comfortable with different belief systems and perspectives

      Today I want to try to feel comfortable, whether or not anyone agrees with me. I want to learn to appreciate differences as unthreatening, enriching, and interesting.

      I want to allow myself to be curious, rather than jumping into self-defensiveness immediately when differences surface in my interactions with people.

    • Seeing others clearly

      In this session, I want to practice dropping my preconceived beliefs and expectations about people. I want to get to know the persons in front of me as who they truly are, allowing myself to feel close to their unique idiosyncrasies.

    Appendix D Examples of Brief Relaxation Exercises for Opening the Group

    The key to guiding a relaxation exercise is personalized pacing, as explained below:

    • First, do what you instruct others to do.

    If you say, “Breathe in for four counts,” you yourself need to also breathe in for four counts. If you say, “Breathe out for six counts,” you must do the same. This way, you won’t hasten in your instructions that are out of pace with the actual actions.

    • Second, use a slow, soothing, and calm voice to guide this exercise.
    Example 1:

    Before we dive into the session, let’s spend 3 to 4 minutes on a relaxation exercise. Please find a comfortable sitting position. [pause] Take a quiet and slow breath. Notice how your stomach rises when you inhale. Notice your stomach slowly descend as you exhale.

    Continue to take quiet and slow breaths. [pause] When you feel comfortable, slowly close your eyes.

    Concentrate on your body sensations as you breathe. If your mind begins to wander, just allow the competing thoughts to dissipate and bring your focus back to your breathing sensations. [pause]

    Allow yourself to remain in this total state of relaxation for 2 minutes. [pause]

    As your eyes remain closed, allow yourself to gather thoughts about whatever you would like to share or to accomplish today in the group meeting. [pause]

    When you are ready, you may open your eyes.

    Example 2:

    This example involves reprogramming the mind in order to override the stress caused by daily life:

    Before we start today’s session, let’s do a simple relaxation exercise. Please sit comfortably on your chair. Close your eyes, and breathe slowly. Let your arms and legs go limp. [pause]

    As you continue to breathe in and out slowly, notice your arms and hands begin to feel heavier and heavier. [pause]

    Next, notice your legs and feet begin to feel heavier and heavier. [pause] At the same time, notice your arms and legs begin to feel warmer and warmer. [pause]

    Your heart is calm and relaxed. Your heartbeat is slow and relaxed. [pause] Your breathing is slow and comfortable. Your stomach is calm and relaxed. Your forehead is cool and calm. Your entire body is calm and relaxed. [pause]

    Allow yourself to be in this total relaxation for awhile. [pause] While you are relaxed, let your attention go to the thoughts, feelings, or issues that you want to share with the group today. [pause]

    When you are ready, please open your eyes.

    Example 3:

    The most relaxing exercise is one that uses less wording so as to allow members to completely tune in and connect with their inner self. It goes like this:

    Before we start today’s session, let’s do a simple relaxation exercise. Sit comfortably on your chair. Close your eyes and breathe slowly. Take a deep breath in (four silent counts) and out (six silent counts).

    Continue this slow and deep breathing for the next 2 minutes. We will sit in silence while we do this.

    [3 minutes later] Now we are all rested, let’s open our eyes.


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