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PART I
BASICS AND BACKGROUND
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1
Groupwork and Solution-Focused Brief Therapy
āI will show you Hellā, the Lord said to the rabbi, whom he took to a large room full of miserable looking people. They all sat around an appetising cauldron of food, but none could eat. The only spoons in the room had long handles, which were long enough to reach the cauldron and scoop up some food, but too long to get the food into oneās mouth. As a result, all were frustrated and starving.
āI will now show you Heavenā, the Lord said and took the rabbi to another room. This room was identical, with a large group of people sitting around the same cauldron with the same long spoons. But they looked content, satisfied and definitely well-fed.
āWhatās the difference?ā asked the puzzled rabbi.
āAhhā, replied the Lord, āThe group in the second room have mastered an important skill. They have learnt how to feed one another.ā
The above Hasidic story was used by Irvin Yalom and Katy Weers to open their first group for cancer patients in 1973 (Yalom, 1995). It illustrates how group cultures can differ and the powerful influence of others in peopleās lives for good and sometimes for bad. The therapeutic group aims to create a group culture that is positively influential, so that members can literally learn āhow to feedā one another. In particular, solution-focused groupwork aims to establish collective and mutually beneficial goals and to harness the groupās resources and strengths towards empowering members to make realistic steps towards these goals in the short term. Before describing the principles of the approach in Chapter 2, this chapter outlines the development of solution-focused groupwork, in particular:
- Tracing the emergence of solution-focused groupwork from traditional longer-term forms of groupwork, in particular looking at the influence of the self-help movement and a growing cultural preference for strengths-based, shorter forms of treatment.
- Describing the therapeutic factors which give groupwork its unique power for change, and how these are activated in a solution-focused approach.
- Evaluating the research evidence for the effectiveness of groupwork in general and of solution-focused groupwork in particular.
The development of solution-focused groupwork
People have always come together in groups to create and achieve things that they could not possibly have done alone, whether this has been to plan or carry out tasks, to teach or learn, or to dialogue about and resolve disagreements. In ancient Irish history there is reference to the mythological āfifth provinceā where the kings of all the other provinces would meet to receive counsel and resolve disputes (Colgan McCarthy and OāReilly Byrne, 1995). This could be conceived as one of the first mediation groups!
It is not surprising, therefore, that psychotherapists, though initially only working with individuals, began to see the need to work with people in groups in order to harness the power of group dynamics. Joseph Hersey Pratt is attributed with organising the first therapeutic groups in 1905 when he brought together groups of tuberculosis patients to monitor their progress and to educate them about the disease and its management (Gladding, 1991; Tudor, 1999). Initially, Pratt conceived of the group as a cost-effective endeavour, as it saved time to educate patients in groups, but he quickly witnessed how much support and encouragement the patients provided to one another. To Prattās credit he recognised and promoted this positive group influence and thus was one of the first theorists to utilise the therapeutic power of groupwork (Gladding, 1991).
Though psychoanalysis in the 1920s and 1930s primarily concerned itself with intrapsychic conflict and thus individual work with patients, there were some exceptions, notably Adler who used group counselling in prison and child guidance settings (Gazda, 1989). During this time, a major contribution to the development of groupwork was to come from Moreno, who used psychodrama with adults and children and who first coined the terms group psychotherapy and group therapy (Gladding, 1991). The 1940s and 1950s are often seen as the beginning of the modern groupwork period. Bion (1961), working at the Tavistock in London, developed a psychodynamic understanding of group process and Kurt Lewin (1951) developed āfield theoryā, giving insight into group dynamics and how people relate to one another in a group context. Lewinās work was influential in the development of training or T-Groups and the subsequent encounter group movement.
The 1960s were the heyday of group therapy and groupwork and led the New York Times to declare that 1968 was the āyear of the groupā (Gladding, 1991). There was a rapid growth in the participation in groupwork both by traditional clients and by the general public who attended personal growth groups and encounter groups. The variety and types of groups available also expanded and it was a period of great theoretical diversity. Many of the major humanistic practitioners applied and developed their ideas to group settings. Perls (1967) and Berne (1966) applied gestalt theory and transactional analysis, respectively, to group therapy. Carl Rogers applied his person-centred approach to groupwork and he was instrumental in the development of the encounter group movement, which became a major social phenomenon in America and the rest of the world (Rogers, 1970). Ordinary people, driven by a desire for personal growth and connection with other people, attended encounter groups in large numbers. The 1970s represented a period of consolidation in the development of groupwork. Though participation continued to grow, there was also widespread criticism and an awareness of the potentially damaging effect of groups (Gladding, 1991). Yalom made a major contribution in 1970 with the publication of The Theory and Practice of Group Psychotherapy, which provided a research-based and pan-theoretical account of the therapeutic factors inherent in all forms of groupwork (Yalom, 1970).
Influence of brief therapy
Up until the 1980s therapeutic groupwork was generally characterised by a long-term, open-content, open-ended format. Like its parallel, individual psychotherapy, courses of treatment were thought to take several months or even years to complete. However, many research studies during this period found that, even in planned long-term treatments, therapy does not last for an extended time period. In a study of patients referred to open-ended, long-term groups, Stone and Rutan (1983) found that only 8 per cent attended a group for as long as one year. These findings are paralleled in individual therapy where the majority of studies over recent decades have indicated that on average treatments last between four and eight sessions (Garfield and Bergin, 1994). This can lead us to the tentative conclusion that in everyday practice most psychotherapy and counselling, whatever the orientation, is brief.
While traditional groupwork might have been āinadvertentlyā brief in many instances, there has been a growing interest in planned brief therapy since the 1980s (Hoyt, 1995; Yalom, 1995). As OāConnell (1998: 6) put it: āBrief therapy does not mean āless of the sameā but therapy with its own structure and process that differs from long term.ā Many writers have attempted to characterise the features of these new brief group interventions (Budman and Gurman, 1988; Klein, 1993; MacKenzie, 1994), which are summarised in Box 1.1.
Box 1.1 Characteristics of brief groupwork
- Clear, specific goals, which can be achieved in the time available.
- The establishing of good group cohesion as soon as possible.
- A focus on present issues and recent problems.
- Client homogeneity: they have similar problems, goals or life experiences.
- Focus on interpersonal rather than intrapersonal concerns.
- The therapist is active, positive and openly influential.
The increasing popularity of brief groupwork represents a number of paradigm shifts that have taken place in society. There is increasingly a call for therapy to be cost-effective and accountable and for agencies to address the needs of a population of potential service users rather than a small number of clients who avail themselves of long-term therapy. In addition there is a growing customer preference for shorter forms of intervention (OāConnell, 1998). It is now generally recognised that most clients come to therapy believing that their problems will take only a few sessions to resolve (Koss and Shiang, 1994) and there is some evidence that clients will opt for shorter treatment even when they could pursue extra sessions at no cost to themselves (Hoyt, 1995). The emergence of brief groupwork represents a response to the new context in which therapists and clients find themselves. Currently, within mental health services in the UK and the USA the majority of groups offered to clients are short-term, issue-focused groups such as 10- to 12-week CBT groups on anger management, social skills or managing anxiety or depression (Lambert, 2004).
Influence of self-help groups
Although the first self-help group, Alcoholics Anonymous (AA), was established in the 1930s, it is in the last 20 years that the self-help group movement has really taken off to become a major contributor to positive mental health. Yalom (1995) suggests that the thriving self-help group movement has replaced the encounter movement as the choice for the average person who is looking for the support and encouragement of peers that is to be found in the interpersonal interaction of groups. It is now possible to attend a self-help group for just about every problem or specific issue facing people, whether it is an alcohol or drug problem, being bereaved or affected by suicide, wishing to overcome shyness or recovering from major mental illness. For nearly every medical condition there is now an associated self-help group from which sufferers or their families can seek support. Self-help groups also bring together people who are stigmatised or alienated in society whether it is on account of being obese, black, gay, a single parent, or from any other minority. They are also a major source of support to people going through common life transitions such as being a new parent, being recently divorced or undergoing retirement. In recent years huge numbers of people in North America have attended a self-help group. A recent study of graduate students in social work and clinical psychology found that nearly 40 per cent of them had personal experience with a self-help group (Meissen, et al. 1991). A comprehensive survey of the general population in North America in 1991 revealed that approximately 7 per cent of the adult population had attended a self-help group (Wuthnow, 1994). Given that this figure is equivalent to or greater than the take-up of professional therapeutic services it is arguable that self-help groups are as important as professional mental health services in providing support to the general public (Corey, 2000; Yalom, 1995).
There are many parallels and overlaps between the development of brief models of groupwork and the development of self-help groups. Both demonstrate the increasing value placed on clients solving problems from their own strengths as opposed to being dependent on a professional facilitator. Indeed, all therapeutic interpersonal groupwork could be conceived as having a āself-helpā component to it. The primary power of a mature or advanced therapy group is the influence of the members on each other. What counts is how members help one another. As we shall see in later chapters, the aim of the facilitator is to establish the conditions and trust in the group whereby clients can help one another and then to get out of the way to allow them to do it. There are also overlaps between brief groupwork and self-help groups and the distinction is often blurred. In a survey of self-help groups in North America it was found that between 70 and 80 per cent have some form of professional involvement, whether this is when they were being established or...
