Group dynamics and the role of the facilitator Part 2

14th October, 2006

Summary

In the first article the topic of group psychotherapy was discussed with a particular emphasis on the therapeutic factors that can influence group psychotherapy. The following article sets out to take this a step further by exploring the nature and complexities of the role of the facilitator in such interactions with clients.

Part 2. Facilitator competencies in group psychotherapy

Although there may be a common misconception that some clinicians will simply ‘get by’ because groups can take care of themselves (Stokes & Tait, 1980), it would seem that this kind of thinking is somewhat foolhardy as the facilitator can clearly have a significant impact on the group, it’s objectives and, ultimately it’s outcomes (Wong 2005).

In order to understand the role of the facilitator and what skills he/she may need to help overcome the problems that may arise during group psychotherapy, we must first of all have an understanding of what the term ‘facilitate’ means. Collins dictionary (2001) suggests the term ‘facilitate’ is to “make easy” whilst Gerard (1996) suggests that to facilitate is “To carry out a set of functions or activities before, during and after a meeting to help the group achieve its own objectives”

The first of these definitions is somewhat simplistic but, nevertheless, accurate. The second being much more descriptive and specifically related to group-work. So, if we look at the role of the facilitator based upon the above definitions we can perhaps be more definitive when exploring the skills/characteristics that are required of a competent facilitator.

Role of the Facilitator

There are many definitions relating to the role of the facilitator (www.Albany.net/~sschuman/Definitions.htm) however one that seems to encapsulate this multi-faceted role is described by Moore & Feldt (1993) as being “A person who serves as the director and tracker of group discussions, deliberations and process. This person does his/her best to remain neutral. He or she is not involved in the content discussion of the group. This person is, however, a deliberate manipulator* of the process and flow of the groups work. He or she manipulates what the group does so as to maximise full participation, to minimise individuals dominating and interrupting the group, and to optimise the groups performance and satisfaction”(* Manipulate – “Handle skilfully, manage”. Collins dictionary)

Being unaware of the qualities/skills a facilitator should possess could probably (if not likely) result in the group failing to reach their goals and, in turn, perhaps escalating or reinforcing each individual’s psychological difficulties (Wong, 2005).

It would therefore seem useful to breakdown this definition of the role of the facilitator and explore each element of this in more depth in order to obtain a clearer understanding of this role

The Role of Facilitator

  1. Director and tracker of the groups’ discussions, deliberations and process.
  2. Remain as neutral as possible.
  3. Not involved in the content discussion of the group.
  4. Deliberate manipulator of the process and flow of the group’s work.
  5. Maximise full participation.
  6. Minimise individuals dominating or interrupting.
  7. Optimise the group’s performance and satisfaction.

Moore & Feldt (1993)

Director and tracker of the group’s discussions, deliberations and process

The facilitators task is to decide what the goals and purposes of the group therapy will be and to ensure that each member of the group is selected appropriately e.g. through a screening interview where each potential group member will be seen individually, given an outline of the nature and the purpose of the group work and to be given the opportunity to ask questions or /voice any concerns or reservations they may have. Along with this they would be given the opportunity to accept or refuse ‘membership’ of the group.

Planning is also a crucial element, which, if carried out effectively, can increase the chances of the group starting off ‘on the right foot’ (Wong, 2005). Considerations need to be given to venue, timing and generally the removal of any barriers (both physical and psychological) between the facilitator and the group. This has been highlighted by (Douglas, 1995) who suggests that “necessary thinking, discussion, preparation and exploration must take place”. The fundamental skill here is the ability to watch/observe each individual in the group and note what is going on, that is, “to be able to see where the current behaviour in the group is heading and whether it is actually where the group needs or wants to go”.

In a one-to-one interview situation, the ability to watch/observe, track and direct therapy, in comparison to group therapy, is relatively straightforward. Attention is directed at only one person and distractions are therefore minimal. In a group situation however, this task is much more complicated. The facilitator not only has to concentrate on what one group member may be saying but also on the effect(s) this is having on the other group members. It is therefore worth bearing in mind that it is no exaggeration to say that effective observation is the basis of all effective work with groups (Douglas, 2000).

Remain as neutral as possible

We all have our own ideas, views and opinions about most subjects, which many of us quite happily voice. It would seem a very natural thing to do and, in many ways, group therapy encourages each individual to express these views. The facilitator however must be vigilant with regards to neutrality. Remaining neutral requires the facilitator to be pragmatic and to take an objective viewpoint at any group discussion and to view each point on its own merit. Being neutral to the discussion will enable the facilitator to concentrate on the group process and dynamics, as opposed to being opinionated and subsequently ‘missing’ what is going on within the group. Working in a group setting as opposed to working on a one-to-one basis can however be much more taxing for the therapist due to the possibility of unconscious processes between the therapist and group occurring. It would therefore seem crucial that supervision is accessed from an experienced group facilitator or a co-facilitator takes part in the group sessions (or indeed both). This would more than likely help alleviate some of the anxieties the facilitator may experience and, ultimately improve the chances of effective group-work being carried out (Aiken, 2000).

Not involved in the content discussion of the group.

The group facilitator may have a vast academic knowledge of the emotional and psychological problems and issues being discussed/addressed in group psychotherapy, however, group members (which the facilitator is not one of) have experienced the psychological aspects of this. While it may be appropriate to display empathy, genuineness and positive regard (Rogers, 1992), actually becoming involved in the content discussion would be unwise. The reasons for this being that it may convey a lack of understanding or disregard of each member’s emotional difficulties. This in turn may lead to obstruction or revolt from some members and effectively destroy the whole group therapy process. Subsequently, the group facilitator must be acutely aware of the possible effect any intrusion, on their part, may have on the group (Wilson, 2005).

Deliberate manipulator of the process and flow of the group’s work

Managing the group skilfully is clearly an important role and is multidimensional i.e. the facilitator may have to act as referee from time to time whereby they will have to maintain order of the group discussion and limit digression. This is particularly so when he/she has identified that there is no real purpose to be served by continuing with any given topic. This of course would have to be handled quite deftly in order to reduce the risk of offending or alienating any of the group members.

When the group interaction is poor (which, in my own experience, tends to happen in the first few sessions i.e. ‘forming’ and ‘storming’) or going in the wrong direction e.g. digression, then the facilitator may have to promote or instigate new discussion. He or she may also be called upon to fill various roles such as leader, supporter and inquisitor to ensure that the group process flows as smoothly as possible (Tunley Crenshaw, 2003).

The ability to acknowledge and positively reinforce contributions made by all members (and to be able to identify relevant poiints when taking discussions forward) without showing favour for one persons contribution compared to another’s is also an important aspect of the facilitators interaction with the group. He or she must be very perceptive and possess the skills, gained through experience and learning, to recognise undertones within the group; using the
positive ones to the group’s advantage and countering negative ones to eradicate them.

Maximise full participation /Minimise domination

There are many issues that can effect the maximisation of full participation. Some of these will come from the group members with others coming directly from the facilitator. Having a basic understanding of psychopathology and group dynamics will most likely help the therapist identify this (Pines & Schlapobersky, 2000).
Whilst most groups will have one or two more loquacious members it is important that they be given the opportunity to voice their views and opinions, just as the quieter ones should. There is of course the temptation on the facilitator’s part to either thwart the more vociferous members or, alternatively, let them ‘ramble on’ for fear of alienating them. Clearly a balance needs to be reached whereby everyone has the opportunity to put across their views, with some members requiring more encouragement than others (Blumberg et al, 1986).

Optimise the group’s performance and satisfaction.

In order to optimise the group’s performance and satisfaction, both the facilitator and the group must have a very clear understanding of the objectives and goals of therapy and, in turn, ensure the focus of the group does not stray too much (Wong, 2005). This can be further enhanced by ensuring that there is the opportunity and time at the end of each session for summarising and concluding, positively reinforcing all contributions and providing the time for any questions.

Discussion

It would seem that the role of the facilitator is, by no means, an easy straightforward task. However, having a sound knowledge of both group dynamics and facilitator competencies would appear to go some way towards increasing the likelihood of a positive outcome when conducting this type of intervention. Whilst the role of facilitator is clearly demanding, the pressure of this can be eased if he or she ensures that clinical supervision is accessed and/or they conduct the group sessions with a co-facilitator.

Group work is considered a valuable adjunct to individual therapy as well as a powerful treatment modality in its own right (Jones, 1995) however; there are potential pitfalls that need to be taken into consideration. For example, confidentiality may be broken if a group member repeats a conversation shared during the group session, out-with. Some individuals may be resistive to change or simply fear being emotionally exposed to others.

Ultimately, the effective group facilitator will be skilled in a variety of techniques and interventions that will promote and enhance group interaction and shape group behaviour and growth (Tunley Crenshaw, 2003). If people learn in groups they take more control of their lives and they are more optimistic about being able to change things in their lives (Collier et al, 2006).

Finally, it would appear that one of the most accurate descriptions of what a decent group facilitator/leader should be like was highlighted by Foulkes (1964) who suggested that he/she:

“.....treats the group as adults on an equal level to his own and exerts an important influence by his own example ... representing and promoting reality, reason, tolerance, understanding, insight, catharsis, independence, frankness, and an open mind for new experiences”.

References

Aiken, F. (2000). Leader of the pack. Nursing Standard Volume 14(32), 26 April 2000, p 61 Nursing Standard Publishing Company Ltd. (www.Albany.net/~sschuman/Definitions.htm)

Blumberg, H, H., Davis, M, F. & Kent, V. (1986). Interacting in Groups. In A Handbook of Communication Skills. Edited by Hargie, G. Croom Helm Ltd, 1986.

Collier, J., Longmore, M. & Brinsden, M. (2006). Oxford Handbook of Clinical Specialties Oxford University Press, 2006

Collins (2001) Collins Dictionary & Thesaurus. HarperCollins publications.

Douglas, T. (1995) Survival in Groups – The basics of group membership. Open University Press. Douglas, T. (2000) Basic Groupwork (2nd edition). London: Routledge.

Foulkes, S.H. (1964). Therapeutic group analysis. George Allen & Unwin, London. Gerard (1996) Group Facilitation. www.ee.ed.ac.uk/~gerard/MENG/MECD/topics.htlm

Jones, J. (1995) Helping adults cope with abuse as children. Nursing Standard Volume 9(51), 13-19 September 1995, pp 30-33

Moore, A & Feldt, J. (1993). Facilitating Community and Decision Making Groups. Krieger Publishing, 1993.

Pines, M. & Schlapobersky, J. (2000) Group methods in adult psychiatry. In New Oxford Textbook of Psychiatry. (1st Edition) Edited by Gelder, M, G., Lopez-Ibor, J, J., & Andreasen, N. Oxford University Press (2000)

Rogers, C, R. (1992) The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting and Clinical Psychology. Volume 60(6), 827-832.

Stokes, J, P. & Tait , R, C. (1980). Design of a Short-Term Training Program in Group Facilitation Skils. Profes- sional Psychology. American Psychological Association, Inc. 1980.

Tunley Crenshaw, B, G. (2003). Working with groups In Psychiatric Mental Health Nursing (fifth edition). Edited by Mohr, W, K.. Lippincott Williams & WiIliams. (2003)

Wilson, J. (1995). How to work with self help groups: Guidelines for professionals. Ashgate Publishing Company, 1995.

Wong, N. (2005). Group Psychotherapy and Combined Individual and Group Psychotherapy. In Comprehensive Textbook of Psychiatry. Edited by Sadock, B, J. & Sadock,V,A.  Lippincott Williams & Wilkins, 2005.


Scott Kane (RMN, CBT, MSc). Clinical Nurse Specialist in Liaison Psychiatry.

Address for correspondence:
Department of Liaison Psychiatry,
The Carseview Centre,
4 Tom McDonald Avenue,
Dundee DD2 1NH.
E-mail: scottkane@nhs.net