Problem Gambling Forum: Presented by ABACUS Counselling Training & Supervision Ltd to the Problem Gambling National Provider Forum May 2012

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’