Hector L. Figueroa Dr.

Shantih Clemens Swk 6023, Social Work Group Work I October 26, 2009 Pre-Group Planning part 1 Briefly (1-2 paragraphs) describe your filed work agency. Whats is Agency’s mission? What are the needs of the client’s? How do you imagine the clients will benefit from group experience? Who needs to give you the green light to proceed with your group? [pull from your readings and class discussions on agency context, needs, and group planning.] The agency that I will perform my field placement is called Promesa, which means ‘promise’ in Spanish. It is also an acronym, which stands for Puerto Rican Organization to Motivate, Enlighten and Serve Addicts. They are located at 1776 Clay Avenue in the Bronx. It is a multi-service agency that operates many different modalities of drug treatment. It has a 23 bed, Inpatient Rehabilitation center, which offers comprehensive drug treatment services. It is this agencies philosophy that substance abuse is a disease, and as such, can be arrested at some point by effective treatment and supportive services. The treatment goal would be to focus on the physical, social, emotional and spiritual aspects of recovery for the individual and all other systems that directly impact them; and to integrate the self help theory, relapse prevention education and supportive therapy groups into treatment. Once admitted into the Rehab the patient’s are required to attend all therapy groups. Which makes it somewhat easy for me to plan a group. I happen to work in this same agency, only in another treatment modality. I started to become familiar with the staff that works in this facility a couple of months before I started my internship. It is my natural tendency to get familiar with other staff, at all levels of the agencies structure. The staff enjoys meals together in the cafeteria during lunchtime. In my experience, I see that not all staff is as extroverted as I am. I want to get to know people, because it makes access to resources so much easier. I want to also get to know who is group friendly and who is not. It’s important to get outside of your comfort zone, and meet and explore other modalities of treatment. A colleague of mine introduced me to my field instructor, Ms. Beth Lazarus. I explained that I was looking for a placement and would consider working in the Rehab if she would have me. The meeting was pleasant and inviting, and she accepted me as a student intern. When I began my internship in September 2009, I explained to my field instructor that my concentration in school was going to focus on group dynamics. Ms. Lazarus explained that I would be assigned 3-4 cases and would have an opportunity to facilitate groups. She introduced me to Dr. Lee (PhD in Philosophy), who is the Supervisor of the Detox and Rehab unit. Dr. Lee “loves” to facilitate groups, and is a group specialist. My field instructor had me sit in on a few groups with Dr Lee. The first time I experienced groups in the Rehab was with Dr. Lee. Dr. Lee met with myself and two other student interns in a post

2|Page group meeting. Dr. Lee handed out a 4-page essay summarizing Dr. Irvin D. Yalom’s group dynamic methods. We all went into the group and Dr. Lee introduced us to the patients in the rehab as student interns. Dr. Lee facilitated the group, and we were all part of the membership of the group that evening. There were 18 patients, and 3 student interns in the group. I was eager and excited to see what he had planned. The membership consisted of 2 women, and 16 men. There were members that did not speak English and so Dr. Lee asked if someone could translate. I am not as fluent in Spanish so another intern translated. I was uncomfortable with this, because I thought this was going to affect the group dynamics and the flow of emotions that would be invoked. The group members took turns introducing themselves. The group participants reported the group’s rules. Then Dr. Lee created an activity where he asked members to face one another in dyads. We shared “a little about ourselves” for 5 minutes, then the group members expressed there feelings about what transpired to the rest of the group. I enjoyed the exercise, because it became intimate with the one on one dyad, which was the purpose of the exercise. Dr. Lee met with the students afterward and asked us what we thought of the exercise. In preparing for my group, I shared a few ideas with Ms. Lazarus. I reported to her that I did not think that the bilingual groups were a good idea. I thought that it was unfair to the members of the group that we had to pause for translation. I thought there would be missed opportunities to engage a group member when issues were presented. Ms Lazarus agreed with me, she said that she would prefer to have two separate but there were not enough staff to facilitate. Ms. Lazarus did not immediately allow the students the opportunity to facilitate groups alone. She wanted the students to co-facilitate the groups for a couple of weeks. Then after a few weeks had gone by, she would allow for the students to run individual groups. Prepare a specific plan for the creation of a new client group in your agency. What is the purpose of this group? How will you articulate the purpose to the new members? Include a one to two paragraph statement of purpose in your paper. [literature on purpose] After several weeks have gone by, I am feeling prepared to begin facilitating groups alone. I begin by creating a purpose for the groups I want to facilitate. As Wright (2005) reports, “purpose remains nebulous far too frequently in practice” (p. 209), with that in mind I will try to be as concise as possible. With this population, I believe activities and educational based groups would be most effective. This group will be a psychosocial cognitive educational group that uses DiClemente & Prochaska's (1993) "Stages of Change" model. This group as Northen and Kurland (2001) would say, uses the group process to help members better understand and cope with the emotional reactions to the information imparted and taught; members can apply the learning to their life situations, including taking action to change environmental conditions that hinder their growth (p. 126). This purpose was designed with the needs of this particular population in mind. This groups membership consist of ninety-five percent homeless Alcoholics and Drug addicts whose maladaptive behaviors have led them to recklessness lifestyle that effects their lack of self-awareness, self-esteem and sense of loss of identity. I am being careful as Wright (2005) states, not to be “consistent with the ‘culture of

3|Page poverty’ theory, a victim blaming philosophy; and that in ideology and function…treating them as deviants” (p. 81). Working with addicts and alcoholics can be quite challenging, because some of them are sincere about their efforts to stay clean and some of them have not totally surrendered to their addictions just yet. So I am careful not to judge them, and meet them where they are. Goldberg and Simpson (1995) reports that “practitioners view these patients in a globally negative way…many treaters tend to lump all alcoholics into one grand group of untreatable patients” (p. 83). The dynamics that are applied in groupwork I believe are essential to the basics of human beings to heal one another through interactions and identification of their related problems. When people are interacting and relating to one another no matter what the situation there is a sense of support, knowing that you are not alone. There is also the element that I believe is deep down inside them that want to help others and reach out. There is a saying in the 12-step program “the therapeutic value of one addict helping another is without parallel”. To me this means there is no unbalance in the natural aspect of reaching out. The members can meet each other on common ground. Flores and Georgi (2005) state that this value is effective when “people who abuse substances often are more likely to remain abstinent and committed to recovery when treatment is provided in groups, apparently because of rewarding and therapeutic forces such as affiliation, confrontation, support, gratification, and identification.” (p. 2). I wanted to have a separate intervention strategy for DiClemente’s Stages of Change (1993), but I will include it in Motivational Interviewing because you will see that there are some similarities in this MI approach. Abadinsky (2008) describes Motivational Interviewing in simple terms as “a client-centered counseling approach for initiating behavior change by helping clients to resolve ambivalence about engaging in treatment and stopping drug use….[MI] principles are used to strengthen motivation and build a plan for change’. (p. 244). In addition to drug abuse intervention Motivational Interviewing can be applied to the assistance and motivation for individuals to modify and hopefully decrease HIV risk behaviors and medication adherence, and improving medical and psychiatric treatment preservation and compliance, and improving diet and exercise (Cloud et al., 2006). This is helpful in addressing this population because in most case there are going to be dealing with co-occurring disorders. This makes the case for using the Stages of Change as tool for motivation. In the consumers process of recovery they will under go stages in which they will be guided and educated through these stages. How will you recruit group members? What mechanisms will you use to advertise for this group? What difficulties do you anticipate in this area? [literature on recruitment strategies] Who will be members of this group? How will you make this decision? What pregroup contacts will you have? [Literature on pre-planning and composition] Talk in detail about the structure and composition of this group. Will it be an open or closed group? Where will the groups be held and for how long? What are the factors that went into this decision? [pull from literature on structure, composition, and leadership] The men and women who attend this group will have extensive backgrounds in drug addiction and alcoholism. They claim to report multiple drug treatment episodes

4|Page and some have had experience with 12 step programs. They are predominantly Spanish speaking. The membership of the group will have commonalities that will help to elicit from each other the support and mutual aid necessary to recover from their addictions. The agency is regulated by the New York State Office of Alcohol and Substance Abuse Services located in Albany, New York. OASAS mandates to the program that it’s groups should no bigger then 15 members. However, according to Northen and Kurland (2001), the group size can be left to the judgment of the facilitators (p. 136). Northen and Kurland also cite Irvin D. Yalom concluding that the groups should be no smaller then “seven to eight members”. The reason being that the smaller the groups the more likely the member will open up and become more intimate with each other (p. 136). It is my desire to run a small group of about six to eight members. Because there are other students available to run other groups, I believe I will have this opportunity. Furthermore, Goldberg and Simpson (1995) confirm “relatively small group size has been long desirable in the treatment of alcoholics and addicts because of its recognized ability to build cohesion among disaffiliated individuals and to address “core” issues of denial and rationalization that often lead to relapse (p. 85). Provide a detailed description of what you will include in your first session, including an introductory statement, session goals, and specific illustrations of mutual aid. I’d like you to write this section as a process recording where you provide a narrative account of what you will say in a first session. The first session, will be held in a small group room. I have been going around and reminding the members of the group and time it will be held. I am going to start with meeting members that have arrived to Rehab this week. So they are fairly new to each other and the program. Worker: Good evening everyone, I am a [state my name] and am a student intern at Promesa’s Rehab. I would like to start off this evening’s group by going around the room and introducing ourselves to each other. Can you say your name, what is your drug of choice and how much clean time you have. If you don’t feel like sharing that’s ok too. Paul: I am Paul, and I am addicted to crack and alcohol. I just came from detox so I have 8 days clean. Worker: Great, thank you for sharing. (I clap, and everyone else joins me). Jane: My name is Jane. I have 5 days clean and I was using Heroin. Worker: Excellent, thank you for sharing. (I clap, and everyone else joins me). Joe: I don’t feel like sharing. Worker: that’s ok, but can you say your name? Joe: My name is Joe. Lisa: I am Lisa, I am an alcoholic. I have 7 days clean. Worker: Thank you for sharing. (worker claps, and invites everyone else join). John: (came in 10 minutes late), my name is John. Sorry I was late. What are we doing? Worker: We are just going around and introducing ourselves. Welcome to the group. Jason: I am Jason, I just came out of detox for alcohol and crack, I am here for the 3rd time, and I am little embarrassed about the whole thing. I am so sick of this crap…

5|Page Worker: Jason, it sounds like you have some things on your mind you want to share, but is it ok, if we finish going around the room with the introductions and then we can come back to you? Jason: oh sure man. Ok. Worker: (gestures to Robert to go ahead and introduce himself). Robert: I am Robert, I am a Heroin user, and I am detoxing 8 days clean now. Worker: awesome, thank you for coming tonight (everyone claps). Thank you all for coming out tonight. All of you are fairly new to the program and in the induction phase of the program. The purpose of this group is to hopefully develop a cohesive bond of support, learn coping skills to avoid relapse and encourage one another during the tough times ahead for next couple of weeks. So Jason, you were saying this is your 3rd time here and it sounds like your frustrated, is that what you were saying? (reflecting, clarification). Jason: Man listen, this addiction got me licked, I am so beat down and tired of this crap. I just don’t have it in me to keep fighting. It was actually worse this last time. I started looking for ways to ties my furniture to a rope and toss it out the window to sell it on the corner, just so I can’t keep getting high. I sat in my living room and just kept thinking of ways of getting more money to use drugs. Worker: (scanning the room) So Paul, I saw your reaction to Jason’s story, would you share your thoughts with us? Paul: It just reminds me of my last run, I felt the same way, I was desperate, I couldn’t think of anything but wanting to use more drugs. (gestures toward Jason) I know how you feel man. Worker: (scanning, Joe leans forward and appears involved) So you both felt desperate and hopeless? With a show of hands can anyone else identify with these feelings? (everyone, except Joe raised their hands). It seems to me that many of you are having an opportunity to see that you are not alone. Lisa: (begins tearing) I feel so ashamed, my drinking led me to doing many things, that I thought I would never do. I neglected my daughter, by leaving her with strangers, I feel so sad that I am not with her now. Jason: don’t worry Lisa, we got your back. We can do this together, isn’t that right? Jane: that’s right Lisa, we got your back, and you are not alone, I have done many things, I wouldn’t dare to mention in this group that I am ashamed of, but in time we will get to know each other. Worker: You all are doing so well connecting with each other, thank you for sharing and become so personal with each other. This is exactly what I had in mind when I thought of the purpose of this group. I would encourage you all to continue this action even while we have completed this evening’s first session. Do you think you can do that? Jason: absolutely. Worker: Well we have accomplished so much in this first session. Is there anyone else that would like to add something before we close? Joe: Yeah. I don’t want you all to think I am a hard-ass or something like that, by not wanting to speak, but I just want to say that I got a lot out of this group

6|Page tonight, and thank you for sharing your business with me. In time I will probably open up, just be patient with me, ok? Jason: Man, listen, it’s ok man. You take your time, after all we have 2 to 3 more weeks to go, right? Joe: Yeah, that’s true. Worker: thank you, Joe. That was brave of you. You all have been brave tonight. We will meet again next week, ok, thank you. (group closes). Identify and define at least 6 social groups work skills that you use in your facilitation of this group. Include examples from your process recordings to illustrate these specific skills. During the process recording I highlighted some skills that were discussed in class. Also according to Northen and Kurland (2001) skills such a reflecting, clarification, paraphrasing (p. 100). In the last part of the process recording I was using skills that Northen and Kurland (2001) refer to as “illumination of group process”. This skill is “used to clarify the process that is going on in the group” and the “worker ask the members to reflect on what has happened in their relationships with each other” (p. 101). I know that I may have probed much deeper, but just for the sake of it being the first session, I wanted them get more comfortable with each other first, which I believe was happening. This is the case as Shulman (2005) reports, “mutual support occurs when group members provide emotional support to one another. When the group culture support the open expression of feelings, members can empathize with one another” (274). Thus giving way to the “all-in-the-same-boat” phenomenon in which “group members gain support from discovering that other groups members have similar problems, concerns, feelings, and experiences” (Shulman, p. 272). As time permits, I can use skills such as Rehearsal or Modeling. Cohen and Graybeal (2007) report that the worker encourages group members “in rehearsal by helping the group develop an atmosphere conducive to risk taking” (p. 43). Talk about how you feel about this group. What are your fears and concerns? How will you manage these feelings? What has been the role of supervision in your planning of this group? What skills will you bring to this group? Where do you feel you are lacking? What are your hopes for the group? What are your next steps? I am certain about the direction that I want to take with this group. I am confident in my skills as a counselor and the objections that will come up from the members of the group. What makes me feel uncomfortable is that I would have to work in a modality of drug treatment that I am unfamiliar with, mostly with the fact that it is an inpatient population and the faces change rapidly. The membership will dynamic rather than static. I would prefer working with a membership that is consistent. I have no way of measuring the success of the group and the effects of the members that dropped out or left against medical advice. I will report my concerns to my field instructor and resort to supervision to gain insight and knowledge in working with this population and the problems that the group dynamics will express. My hope for the group is that an effective and cohesive mutual aid dynamic will occur among the members. They will learn from one another and engage each other for support. I am hoping that at the very least members will know that they are not alone in their desperate search for sanity, and make sense of the madness of drug addiction.


References Abadinsky, H. (2008). Drug Use and Abuse: A Comprehensive Introduction, 6th ed. Belmont, CA: Wadworth. Cloud, R. N., Besel, K., Bledsoe, L., Golder, S., McKiernan, P., Patterson, D., et al. (2006). Adapting Motivational Interviewing Strategies to Increase Posttreatment 12 Step Meeting Attendance. Alcoholism Treatment Quarterly, 24 (3) 31-53. Cohen M. B. & Graybeal C. T. (2007). Using Solution-Oriented Techniques in Mutual Aid Groups. Social Work With Groups, 30 (4) 41-58. DiClemente, Carlo C. (1993). Changing Addictive Behaviors: A Process Perspective. Current Directions in Psychological Science, 2 (4) 101-106. Flores, P., & Georgi J. M. (2005). Substance Abuse Treatment: Group Therapy. Rockville, MD: Substance Abuse and Mental Health Services Administration. Goldberg, E. V. & Simpson T. (1995). Challenging Stereotypes in Treatment of the Homeless Alcoholic and Addict: Creating Freedom Through Structure in Large Groups. Social Work with Groups, 18 (2/3) 79-93. Northen, H., & Kurland, R. (2001). Social Work with Groups (3rd ed.). New York: Columbia U University Press. Shulman, L. (2005). The Skills of Helping Individuals, families, Groups and Communities (5th ed.). Belmont, CA: Wadworth Publishing Co. Wright W. (2005). The Use of Purpose in On-Going Activity Groups: A Framework for Maximizing the Therapeutic Impact. Social Work With Groups, 28 (3/4) 205 – 227.