Chapter 5: The Efficacy of Group Work

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Chapter 5 The Efficacy of Group Work

• Introduction to Group Work, 5th Edition
• Edited by David Capuzzi, Douglas R. Gross, and
  Mark D. Stauffer

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What Is Efficacy?

• Efficacy The degree to which desired goals or
  outcomes are achieved

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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.

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Quantitative Methods to Measure Efficacy

• Methods correlational, causalcomparative, 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

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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

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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?

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Effective Counselor Practices in Group Work

• Specific Factors and Outcomes
• Specific factors the counselors 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

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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 Yaloms 12 curative factors
  (e.g., universality, instillation of hope, etc.)

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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

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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

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Effective Interventions for Internalizing
Disorders

• Internalizing disorders When a clients
  aggression is turned inward
• Depression Most efficacious group counseling
  blends skill training, cognitive restructuring,
  and a supportive group process.
  Cognitivebehavioral group therapy is found to be
  the most efficacious.
• Eating disorders Cognitive, cognitivebehavioral,
  or interpersonal counseling prove most
  efficacious.

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Effective Interventions for Externalizing
Disorders

• Externalizing disorders When a clients
  aggression is turned outward toward others
• Spouse battering Cognitive approach is shown to
  have a 5385 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.

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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.

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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.

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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).

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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)

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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.