Social Work Group Leadership Style and Integrative Theoretical Perspective

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David Butler

Social Work Group Leadership Style and Integrative

Theoretical Perspective

© D

avid W. B

utler 2009

The following presentation is an extension of my personal philosophy of practice to the practice of group psychotherapy. This is, of course, a work in progress and will be modified by my continued learning.

I will focus on two primary themes. The first, and possibly most pragmatic, is a synthesis of some of the more traditional approaches, with a particular emphasis on humanistic theories. The second theme is more of an ideal based on the relatively new, yet evidence-based practice of mindfulness which provides the significant advantage of including compassion and acceptance as core components.

Introduction

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Core beliefsPeople desire happinessPeople have the potential

forSelf-awarenessSelf-determinationSelf-actualizationCompassion for self and

othersPrimacy of the therapeutic

relationshipPeople as human beings as

opposed to human doingsPersonal responsibility

Therapy is most effective when:ExperientialCollaborativePhenomenologicalHolistic

MindBodySpiritEnvironment

EgalitarianShared journey

“As human beings we all want to be happy and free from misery” His Holiness the Dalai Lama

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ExistentialSelf-determinationPersonal

responsibilityExistential anxiety

The “hole in the soul”

Authenticity

Therapeutic relationshipNecessary and

(maybe) sufficientGenuinenessUnconditional

positive regardAcceptanceEmpathy

Traditional theoretical foundations

Person-centered

“man is, before all else, something which propels itself towards a future and is aware that it is doing so”. Sartre

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GestaltHolismExperientialIntegrating

polaritiesInterpersonal

conflictUnfinished business

GamesLife scriptsEgo statesStrokesInjunctions

Traditional theoretical foundationsTransactional analysis

“Remember, be here now.” Ram Dass

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AdlerianHolismSelf-determinationPersonal

responsibilityCollaborative

partnership

PsychoanalysisTransferenceDevelopmental

stagesSolution-focused

brief therapyclient-centeredcounselor-as-

consultant

Traditional theoretical foundations

Other

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AdvantagesEmpirical data

Designed to be scientifically evaluated

FundingSupported by third

party payers and, consequently, many agencies

Brief

ImpersonalEmphasis on

thoughts and behaviors, not feelings or experiences

Cognitive Behavioral Therapy

Disadvantages

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Preferred

Existential therapyPerson-centeredGestaltAdlerianTransactional

analysis

Cognitive behavioralCBTCognitive

restructuringDBT

Theoretical foundations

Pragmatic

There appears to be a clear disconnect between my preferred orientation toward the humanistic approaches and the current emphasis on cognitive behavioral therapies. However, there is hope for reconciliation, thanks to…

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While my heart is with the humanistic approaches, especially person-centered and existential, the current emphasis on CBT cannot be ignored.

Synthesis

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The Third WaveMore person centeredAcknowledges humanistic

conceptsLess ‘clinical’Mindfulness-based Stress

Reduction (MBST)Mindfulness-based cognitive

therapy (MBCT; Segal, Williams, & Teasdale, 2002)

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)

DBT

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MindfulnessAdds experiential

component to CBTAlso known as

Presence-centered psychotherapy

Contemplative psychology

“technology of the mind”

Mindfulness-based Stress Reduction (MBST)

Mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002)

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999)

DBT

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Evidence of effectiveness in treatingStress disorders (Weinstein, et a., 2009)Depression

Including reduction in relapse rates (Attentional problemsPain managementMedical management (diabetes)Potential (tentative results)

Substance abuseGeneralized Anxiety Disorder

Mindfulness

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Self-compassionSelf-kindness versus self-judgmentCommon humanity versus isolationMindfulness versus over-identificationDeactivates threat system and activates self-soothing

systemResearch indicates improvement in depression, anxiety,

rumination, thought suppression, social connectedness and emotional intelligence (Neff, 2003)

“Self-compassion involves having the right amount of distance from one’s emotions so that they are fully experienced while being approached with mindful objectivity” (140)(Neff et al., 2007)

Mindfulness concepts

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Advantagespeer support and motivationShared insightReduced isolation

DisadvantagesRequires therapist training in both group work

skills and mindfulness therapyMay require unlearning of incompatible skills

Mindfulness in group setting

Melbourne Academic Mindfulness Group, 2006

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Limited long-term follow-up data(Mis)perception of mindfulness as a spiritual

practiceSubstantial client commitment

45 minutes of daily practice typically recommendedPossibility of exacerbation of psychiatric symptoms,

especially with long-term (e.g. 10 day) retreats (Melbourne Academic Mindfulness Group, 2006) Altered reality testing (with transcendental, as

opposed to mindfulness, meditation)May be contraindicated for current or past psychosis

Mindfulness limitations

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Leader as guideShared journey of discoveryTechnical expert but not expert in the lives of

the membersLeast directive, least structured

Assumes the development of a safe environment

Whenever possible, the group should determine its own direction and structure

More structure often required in the early and late stages of the group

Leadership Style

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One size does not fit all Beginnings

Structure and safety Optimism for change within group Teach essential concepts of cognitive therapy

Automatic negative thoughts Relationship between cognition and emotion

Basic mindfulness training Relaxation Mindful meditation Attachment/acceptance

Working Egalitarian Equal partners Person-centered, Adlerian, Existential

Endings Switch to more cognitive behavioral approach Skills training

Ideal model

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StyleNon-directiveEgalitarian

Equal partners on a journey

Each with unique strengths and contributions

Genuine (Rogers)Least directive

Actual amount of direction dependent on needs and abilities of members

GuideTeacher

Mindfulness concepts

Leadership Style – Working Stages

Roles and functions

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Functions

Leadership Style – Working Stages

Skills

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StyleSlightly more

directiveTeacher

Leadership Style – Later Stages

Roles and functions

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Techniques and procedures

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RaceEthnicityAgeReligion / spiritual tradition

ethical/value issues

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General Evaluation of the empirical

evidence critiquing the strengths and limitations of the integrative approach

Humanistic therapies underrepresented in empirical studies, especially as compared with cognitive and/or behavioral (Klein, 2008)

Cohesiveness may not be as predictive of positive outcomes as previously believed (Hornsey, et al., 2009)

Empirical Evidence

Mindfulness

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Plan for developing the necessary competence to lead such a social work group using this integrative theoretical approach

Attend 5-day intensive training program through UMASS Medical School, Oasis Professional Education and Training program in January, if financially feasible

Teacher certification in MBSR by 2012http://www.umassmed.edu/Content.aspx?id=4

4552

Development Plan

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Melbourne…Neff, K. D. (2003). The development and validation of a scale

to measure self-compassion. Self and Identity, 2, 223–250.Neff, K. D., Kirkpatric, K. L., Rude, S. S. (2007). Self-

compassion and adaptive psychological functioning. Journal of Research in Personality, 41, 139-154.

Klein, W.H. (2008). Toward the establishment of evidence–based practices in group psychotherapy. International Journal of Group Psychotherapy,58, 441-454.

Segal….Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-

method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374-385.

References

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Approach of Marina Claessens

adapting to the client and not the other way round.  

most significant factor relating to successful outcome is not the therapist’s preferred school of thought, but the relationship between therapist and clients.  

establishing an empathic, safe and supportive therapeutic environment

  I will guide you towards clarifying what

your aims and objectives are if you need to, and then towards achieving them.  

This can be done not just by talking, but also in many cases by a variety of experiential exercises which can bring to awareness those aspects of oneself that cannot be reached by words alone.  

Therapy remains at all times a collaborative and creative process.

Inot a question of me telling you what to do but of us working together to explore your current way of making sense of your experience.  

This is done in order to identify how your problems may have originated, how they are maintained, the function they may serve and the best way for you to challenge them.

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AnxietyBeing

Existential

“man is, before all else, something which propels itself towards a future and is aware that it is doing so”. Sartre

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The PPT presentation will include:

(1) Key concepts of the approach;

(2) Role and function of the social work group leader at the various stages of group development;

(3) Application of social work skills including the use of various therapeutic techniques and procedures;

(4) Discussion of ethical/value issues and the application of the integrative approach to multicultural populations;

(5) Evaluation of the empirical evidence critiquing the strengths and limitations of the integrative approach, and a

(6) Plan for developing the necessary competence to lead such a social work group using this integrative theoretical approach.