Group Work in Problem Gambling Settings


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Problem Gambling Forum:

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

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Group Work in Problem Gambling Settings

  1. 1. National Provider Forum 2012
 Group Work in Problem Gambling SettingsABACUS Counselling, Training and Supervision LtdSharlene Wong and Sean Sullivan
  2. 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. 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. 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. 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. 6. Tuckman’s Model of Group Development formingperforming storming norming
  7. 7. Developmental Group StagesForming – group is just coming togetherStorming – jockeying for positionNorming – form some idea of the group’s identityPerforming – group getting some work doneAdjourning – involves dissolution
  8. 8. Motivational InterviewingA person centred, goal oriented approach for facilitatingchange through exploring and resolving ambivalence (Miller 2006)
  9. 9. IntegratingMotivational Interviewing into Group Therapy
  10. 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. 11. Principles of MI (REDS) •  Roll With Resistance •  Express Empathy •  Develop Discrepancy •  Support Self efficacy
  12. 12. Micro Skills (OARS)•  Open Questions•  Affirmations•  Reflective Listening•  Summarising
  13. 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. 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. 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. 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. 17. Small group role play One or two counsellors Group membersChoices: •  Problem Gamblers Group •  Significant Others Group
  18. 18. MI Group - DebriefCounsellor/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. 19. Change Planning in GroupsChange 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. 20. •  The group has been discussing how may substitute gambling with other alcohol or drugs or unhealthy eating.•  Counsellor to lead some rounds
  21. 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. 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. 23. Group Exercise: Values CardsWhat’s Important in My Life Card Sorting Task for Individualswith Schizophrenia.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. 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’