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Section 6
Treating Self-Imposed Social Isolation through Group Therapy

Question 6 | Answer Booklet | Table of Contents

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In the last section, we discussed a three-step model for telephone crisis counseling based on the three-step crisis interview model examined in sections 2, 3, and 4.  These three steps are the beginning, middle and ending phases.

In this section, we will discuss three phases of a crisis group therapy technique.  These three phases are the formulation of a crisis situation, intervention, and termination.

Linda, 43, came to the crisis center for her pregroup interview with her daughter, Alice, 15.  Alice had recently ran away from home and had been picked up by the police while trying to hitchhike to a well-known commune.  When the police had called Linda to notify her that Alice had been found, Linda refused to come pick up her daughter, stating, "You had better keep her, I can’t do anything with her!" 

Alice spent a terrifying night in juvenile lockup.  Alice stated that she had ran away because her mother refused to let her have any friends.  Linda stated that because her divorce had left her with little money to support her daughter, she had been forced to move to their present, low socioeconomic area.  Linda stated, "I’m just trying to protect Alice from the undesirable elements and people in the area, but apparently I just can’t handle her any more!"

Crisis Group Therapy Technique - 3 Phases

♦ Phase #1: Formulation of the Crisis Situation
A first stage in the crisis group therapy technique is the formulation of the crisis situation.  At Linda’s first session, I introduced her to the other members of the group.  All of the members in Linda’s group were mothers dealing with family related crises.  I then asked Linda to state what problems she was having with Alice.  Linda stated that she had forbidden Alice to go to a dance held by the local teen social center because if the event was poorly chaperoned, Alice would meet the "wrong people." 

The next day while Alice was at school, a neighbor had informed Linda that she had seen Alice at the dance.  Linda drove to the school, and pulled Alice out of class.  When confronted, Alice admitted she had been to the dance, and that she would sneak out again given the chance.  Linda then slapped Alice.  This resulted in the incident in which Alice ran away.

Some members of the family crisis group responded to Linda’s comments with superficial supportive statements, such as "It sure is difficult to raise kids these days!"  Others suggested that Linda was being too rigid, and that she needed to give Alice more freedom.  One stated that Linda’s behavior had caused Alice to run away. 

As is understandable, one of the mothers who had lived in the neighborhood her whole life was challenging to Linda, stating, "If you don’t have the money to move out of here, why don’t you find a damn job instead of staying home and trying to play perfect mother!"  However, other members of the group offered alternate ways of coping for Linda based on their own experiences. Teresa, who had been to four prior group meetings, stated, "You don’t have to give in to Alice all the way, but give her a chance; if it doesn’t work, then try something else."  

Clearly, group members like Teresa allow me as the therapist to continue in a much more observatory role.  Linda’s initial response to the group’s suggestions and confrontations was very hostile.  She maintained that her behavior was justified, and rationalized by stating firmly that she "couldn’t care less what other people think!" 

Later, however, the group began making specific suggestions for different ways of maintaining discipline and still allowing Alice some freedom, Linda responded with, "I’ll consider it."  By the end of the first session, she began reacting more warmly toward group members who made supportive statements or suggestions.  However, to members who made negative statements, Linda responded in a superior and cold manner.

♦ Phase #2: Intervention
A second stage in the crisis group therapy technique is the intervention stage.  Since our group had a six-session limit for members, the intervention stage covered sessions two through five.  I maintained a directive role, ensuring that each member had equal time to speak.  Most of the suggestions for specific action were exchanged and evaluated by the group members as a unit. 

By the third session, Linda was much less threatened, and was able to both thank group members who made suggestions, and express her feelings of guilt for slapping Alice.  Additionally, she began displaying an ability to adapt the group’s suggestions to better fit her situation. 

By the fourth session, Linda reported that she was needing to punish Alice less since she was able to reason with her more effectively.  The other group members still challenged her rigidity and inconsistency about not wanting to work while Alice was in school, but Linda was less hostile when challenged.  She confided in me after one session that she felt she and Alice were understanding each other better.

I found that the three most positive aspects of group crisis counseling for Linda were that the group was able to, with some direction, focus on specific problem areas.  Secondly, the group tested coping strategies in role play and thirdly engaged in reality testing.

♦ Phase #3: Termination
In addition formulation and intervention, the third phase of group crisis counseling is of course termination, which in Linda’s case occurred at the sixth session as set in the mandates of the group.  By this sixth session Linda had effectively resolved her crisis with the help of the group, and was implementing effective coping strategies with Alice. 

Additionally, the group had provided Linda with a chance to overcome her illogical isolation of herself and her daughter from the community.  Linda became friendly with several of the group members, and they began visiting each other’s homes.  Through their encouragement, Linda took a part-time job as a secretary at a junior college, and announced in the sixth session that she was very pleased with the position.

In the sixth session, I assisted the group in directing attention to reviewing the work Linda had done through previous sessions.  Linda expressed some reluctance about termination, but was reassured by all group members that they would keep in touch.  In an attempt to overcome her feelings, Linda invited the entire group to her house for cake and coffee after the session, which everyone accepted.

I felt that since many of Linda’s challenges in coping with her crisis were connected to her self-imposed social isolation, the choice to resolve her crisis through a crisis group offered Linda a better opportunity for a satisfactory resolution that would have been offered through individual sessions alone.  Would you agree? 

Would a crisis group be suitable for a client in crisis who you are currently treating?

In this section, we have discussed three phases of a crisis group therapy technique.  These three phases are the formulation of a crisis situation, intervention, and termination.

In the next section, we will discuss three factors influencing client equilibrium during crisis resolution.  These three factors are perception of the event, situational supports, and coping mechanisms.

QUESTION 6
What can be three positive aspects of group crisis counseling? To select and enter your answer go to Answer Booklet.


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