By: Renee R. Zandee-Adams, MSW, LCSW
I am not a “group” person. Don’t get me wrong. I understand the therapeutic value of the group, as well as the stages of group development for both the group and the leader. I have excelled in my academic study of group work and successfully participated in countless role plays in the presence of both peers and mentors throughout my entire academic career. However, I must confess, there are many, many things I wish I had known before beginning my first support group for caregivers of individuals residing in a skilled nursing facility.
In the same way that knowing how a car operates does not make one a good driver, earning a master’s degree in social work and studying the group process in depth does not necessarily make one a good facilitator. I believe that the skills needed to effectively facilitate a group are often highly underrated. I also believe that it is often assumed that if you are intelligent and have people skills, you can run a group. I have been present in groups as both observer and participant and generally have left with a less than satisfied feeling and secretly wondered if others felt the same way. This leads me to believe that I was not alone in my lack of preparedness and lack of respect for the true work and skill needed to be a good facilitator.
As professionals, we desire the best for our clients. We want to provide them with the tools to navigate their way through whatever situation they may be struggling with and achieve their “healthiest selves.” Because of this, I am going to share the pitfalls that I ran into as a new facilitator and hope to prevent you from experiencing the same.
I am going to share the biggest misconceptions that I held about the group dynamic and how these misconceptions affected my group, its development, and its therapeutic value. First and foremost was my belief that a “good” group essentially “runs itself” followed by the belief that my dual role as both Social Service Director and support group facilitator would somehow be beneficial to both the group and the facility for which I was employed and, lastly, my belief that all participants, at their core, have a similar goal of supporting and respecting one another.
I have heard, for years, from many respected individuals, that “the group essentially runs itself.” The problem with this belief is that, for many, it minimizes the true importance of preparation. I clung to this misconception as I decided to develop my first caregiver support group where I worked as a Social Service Director in a skilled nursing facility. Having worked as a Skilled Nursing Facility Director for four years, I identified a great need for in-house support for the family members of patients living there. Generally, this population of caregivers spent much of their day in the nursing home and either didn’t have the energy or the time to attend an off-site support group. My solution was to offer a group on Saturdays, on-site, in a safe, convenient, and familiar setting.
I followed the recipe for any successful group. I posted flyers, mailed out personal invitations, collected various resource materials and handouts, reserved a private area, and bought doughnuts. The RSVPs were rolling in, and I had a surprisingly hefty group of approximately 15 caregivers. As the attendees were seated and settled, I explained what I perceived to be the purpose of the group, reviewed some general guidelines and expectations, and asked that everyone introduce themselves. So far so good. I then opened the floor and asked if anyone had anything specific that he/she wanted to share. Silence—not the silence that gently pushes one to deeper insight, but the awkward silence when no one really knows what to say or how to begin or end.
Possibly, in an effort to end the awkward silence, or maybe because the attendees had an agenda quite different from my own, the support group transformed itself into a forum for voicing complaints. There were complaints about care, policies, administration, and departments. In my inexperience, I felt outnumbered, and my attempts at redirection—the ones that served me so well in my one-on-one practice—seemed to fail me in this setting.
Another misconception that I had about facilitating a group was that my being a Director at the same facility where I was facilitating the group was inherently positive. I had worked for four years as a Social Service Director in this facility. I served residents, their families, and the community while simultaneously representing the facility. Initially, I thought this would be a win-win situation. Even the facility administrator was hopeful that the group would be so successful that it might generate referrals from the community.
The problem was that the surroundings, and I, were too comfortable. It was just too easy to ask me a “quick” question. It seemed too difficult to expect the group members to view me as a facilitator when I may have just helped them apply for financial resources, select a mortuary, or locate lost dentures just a day before! Quite frankly, I, too, struggled with the required shifting of gears. I also felt somewhat guarded in what I said, or what I encouraged others to talk about. Some of their complaints/concerns were valid, but I believed that by somehow agreeing with them, I was indirectly turning my back on the facility where I worked.
The last misconception I held was that, at the core, each member shared the common goal of supporting one another. Perhaps a bit naïve, but I believed this. Because I am a fighter and refuse to give up easily, I continued to offer my weekly group. Over the weeks, I noticed that two or three members seemed to overpower the group with their thoughts/opinions and recommendations for facility change. I would see them linger after the group had ended—not in a supportive bonding way, but in a clandestine, underground way. I walked by once and heard the dreaded word “petition.”
The newly developed coalition recruited more members and showed up at the administrator’s door demanding change. Needless to say, the support group was dissolved with the full support of administration, and I went back to my primary function of providing one-on-one support to patients and families.
Looking back, it was almost humorous, but at the time, it felt devastating. I have since learned some very effective tools and ways to remedy situations like this, and as a result, I have since held some very successful groups.
One of the most helpful things is to always include a short, educational component with each group meeting. This seems to serve as a fool-proof way of initiating appropriate, topic-related conversation. It also helps keep the group on track and on task. If things get slow or flat, this gives me something to which I can refer. “So and so had a great point about XYZ. Has anyone else experienced something similar?” I prepare for each group as if I am preparing for a mini-lecture, complete with questions and resources, in case anyone chooses to research the topic further. This preparation has saved me numerous times and has prompted more compliments from attendees than any other single approach I have taken.
I have also started holding my groups in a neutral setting. Having my groups off-site allows for fewer distractions (for example, seeing their loved ones being cared for or escorted in wheelchairs to dinner). This lack of familiarity has become very conducive to staying focused and no one person feeling overly comfortable.
Some of the most valuable things I have learned have evolved out of experience, trial and error, and just plain instinct. I now understand that the group itself is as unique as its participants. I have learned that flexibility, on my part, is essential. I have learned that a successful group isn’t necessarily one in which my goals for it have been achieved. Success is more broadly defined by each individual in the group. Success may be one person befriending another as a result of the group. For someone else, it might be that he/she truly learned the importance of self care and signed up for a yoga class.
I now know that I cannot take credit for a successful group, nor should I assume full responsibility for a less than successful one. It is all part of the process of learning, together. We are learning about each other’s strengths, weaknesses, and shortcomings; in other words, our humanness. We are learning how to best support one another when there are no solutions or shortcuts to healing. We are learning that when someone cries, it’s okay if you don’t necessarily know what to say and choose to say nothing. The single most important thing that I can do and be as a facilitator is genuine. This overrides anything else and provides more long-lasting support than one can imagine.
I have learned that sometimes people demonstrate their pain in less than endearing ways. I have learned that sometimes the least loveable/likeable/approachable person needs support more than those who are easier to support. I have learned that everyone has a story, but not everyone wants to, or needs to, tell it in order to benefit. I have learned that some benefits are simply immeasurable and that a group of two or three can be as valuable and therapeutic as a larger group.
Most importantly, I have learned that my strength and preference for practice is still one-on-one work with clients, but that with preparation, compassion, structure, and flexibility, I can facilitate an excellent support group. So can you, with or without doughnuts!
Renee R. Zandee-Adams, MSW, LCSW, received her MSW from Arizona State University. She has worked as a hospice social worker for the past 12 years and previously was Social Service Director at a skilled nursing facility. She wrote a chapter in Days in the Lives of Gerontological Social Workers. She has also taught a graduate course in Social Work Practice with Elders at Arizona State University West.
This article appeared in the Winter 2013 issue of THE NEW SOCIAL WORKER. Copyright 2013. All rights reserved.