Clinical Consultation Paper

Simmons School of Social Work

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinical Consultation Paper

Following is a view on the facilitators Ilana and Meredith that are co-facilitating a group that has been running for several weeks. The two co-facilitators worked together to meet the needs of the clients while offering each other with their struggles. The two facilitators work together to help the clients and to work through their ambivalence with ending the group. The facilitator focuses on strengthening their skills in group facilitation. The following are the things we can learn from this experience.

Facilitators Strength

The facilitators worked well together as a team as they complimented and supporting what each other said. The two worked collaboratively to achieve the expected outcome, an indicator that they had prepared together as they were on the same page on what they offered to the clients. They both offered to give the clients time to help them after the group. Ilana and Meredith were not talking over each other. The two took time to scan the room throughout and read the latent content in the room. Having understood the content in-depth, Ilana and Meredith could effectively work with the clients by allowing them to express themselves and their feelings. They both did a great job, validating the hardships with leaving the group. The two understood the importance of a client-centered context in achieving positive results. Therefore, they both respected the clients and built on what they said. They both recognized the underlying tension and confusion of some clients and tried making sense of it, tried to put the feelings into words for them. They allowed the clients to speak up at the end when there was silence, and they seemed okay with the silence that made some share more.

While offering service to the clients, Ilana did some reflective listening and showed compassion. She expressed what she thought they were trying to say and expressed her understanding of loss and beginnings. Ilana gave the clients essential ideas of what they can do, like finding outside support.

Meredith did a great job acknowledging the client’s feelings. She was able to pinpoint quite precisely what they were trying to say, and that seemed to make the clients feel understood. Meredith did not speak a lot, which in itself spoke volumes. Also, Meredith did not talk over Ilana even though she might have thought about things differently.

The combination of the two skills benefited the group as they might have felt more understood when two facilitators are listening fully, reflect with respect and understanding.

Facilitators Growth Opportunities

Perhaps Ilana could have given the clients a chance to respond, agree or disagree with some reflections she made, such as how some clients leaving the group can be a loss, or this can be a chance for a new beginning as well as jumping to tell them about outside support. Maybe the clients would have come to this conclusion when the questions would be asked to the group members as to what they are thinking can be helpful. Incorporating the client’s view would be essential in finding a solution to the problems. Clients are experts in their lives; hence, they can offer the most appropriate recommendation when given a chance. The role of the facilitator is to help the client access and trust themselves to bring out the ideas they have for change (Miller & Rollnick, 2013).

Perhaps Meredith could have asked more of an open-ended question at the end, like what they think she and the co-facilitator can do to help them instead of just offering to help them find a place where to start. Open-ended questions help clients think and talk more, be engaged, and explore options, and they do not just give yes or no answers (Miller & Rollnick, 2013). The answers and opinions offered by the clients would act as a starting point for Meredith to choose the most effective help.

Mutual Aid

The clients were helping each other by validating, giving ideas of what they can do, ask, and as well as explain what one member was trying to say. When the facilitators asked clients to respond to other ideas and thoughts, they did so happily and gave a genuine response. Through responding to the ideas and thought of the colleagues, the clients got an opportunity to think for themselves. During the facilitation process, mutual aid is powerful since the clients take advice from others that are in the same situation more than anyone else, giving the offer, advice, or suggestion (Shulman, 1986).

Ilana and Meredith applied solution-focused therapy by following the steps of outlining the problem, clarifying, and making sure that the client and the therapist are on the same page. During the therapy, the two facilitators focused on acknowledging the problem, miracle question, building on the progress, and provide closure (Banks, 2005).

Ilana applied the Solution-focused brief therapy when she recognized the client looked tensed. Ilana used the therapy to clarified with clients that it is normal to feel nervous about ending and not being sure about the future. Ilana realized that it was not the right time to introduce the miracle question hence skipped it. The miracle question might do more harm than good when used in inappropriate settings, such as asking the question to someone who is grieving for a loved one. Asking the miracle question might cause pain and anguish as the only response would be that the deceased was still alive, and there is not too much that can be built on that (Tyrrrell, 2014).

Meredith used the solution-focused when she acknowledges what the members said that this might be just a beginning by starting to recognize our future needs. She also wrapped up the session by asking the clients if they will utilize the opportunity to talk about resources after the group.

The skills of motivational interviewing are essential to help clients move forward, especially when making changes. The clients are exiting the group and have to decide on how they will deal with the group ending and what they will do about it. When using motivational interviewing, we need to recognize the current client’s stage of change. We need to help the client look at the pros and cons of changing and talk themselves into change. We do that by using open-ended questions, giving affirmations, reflective listening, and summarizing what the client is saying (Miller & Rollnick, 2013).

Ilana did not ask open-ended questions but; rather reflected what the clients were saying to elicit more responses. She sometimes used clarifying questions such as what the client meant when he said not having anyone outside of the group.

Meredith summed up and reflected on what the clients were saying. Whenever the client said how the situation was hard and exhausting, Meredith summed the situation up. This helped the client to feel understood and relieved almost.

Interventions

There were some missed opportunities to deepen the discussion, such as when clients mentioned feeling uncomfortable about ending and start to dive into what is making him feel that way. For instance, focusing on what is endings or beginnings remind them of their situations. There was a time during the consultation that one client degraded herself about talking too much. In such a scenario, a different way would be to dive into that and maybe question if this might be a cognitive distortion. The facilitators need to take control of the situation and help the client despite annoying others. Moving to another client without solving the situation at hand or thanking her for sharing will not solve the issue.

When facilitating a team, the tension is high throughout the group. The facilitators need to address the issue directly and explore the cause and solution of pressure with the group.  It would also be nice to have the clients dig deeper and share more about why it is so hard. Then the clients can explore what they can do about not having the support. The client will then explore how they can support in situations when there is no one available for them. Ideas can include self-soothing activities, exercise, taking a walk, writing, and many others.

Another thing that might be important is to recognize that the group members shared heavy stuff. The abrupt exit of the room does not seem to be very therapeutic. Ending off in a calm relaxed way with a reminder that time will be up soon and by having some planned activity to end the group on a lighter note. Here, the facilitators can ease the tension by ending off with something light or even silly.

Differences/Social Locations

During the facilitation process, social location and differences affect the success of the facilitation, especially where the facilitator and client are from different cultures. The issue of Class, race, ethnic, gender has been in existence for several years. The educated white females’ client might feel misunderstood by the facilitators who have a differing social location. When it comes to people working together with so many differences, it might cause feelings of mistrust, misunderstanding. People might feel less than those who are marginalized, such as people with disabilities, people of color, immigrants, low income, prisoners, and those with a history of substance abuse. The room had a diverse population, perhaps that made a difference in the discussion as well. The clients might have been thinking that it is easy for them to talk about finding other support as they have no idea what it means to be out in the world with no income and or no support. The facilitators might have felt that the clients are looking at them as superiors but did not seem to have the time to address it as it might have been exciting as to how such a discussion would unfold.

Best practices for addressing differences in groups might be to be open and talk about it. The facilitators should initially inform the team that talking about social differences might feel awkward at first. By talking about the differences, the group might become more open and understanding with each other (Shechtman, 2007). There will always be people who have more power and privilege, raising the question of how we can help out those who have no power and privileges. Awareness is vital as to how people of different races/ethnicity view differences, especially when it comes to physical and mental health (Schub & Smith, 2018). The training should be culturally sensitive and humble to ask about their understanding and believes in providing culturally competent care.

As a white, educated woman, the clients might feel that they can never understand how hard it is to find a place of comfort. The client becomes vulnerable and trusting, and then have to say goodbye, knowing that they will not easily find another place.

Ethical Concerns

During the facilitation, Ilana and Meredith faced several ethical issues, which affected the smooth facilitation process. One of the moral concerns arose when one client told the two other clients that they could get together outside of the group. It was not so clear to me if that would be ethical as the others might feel uncomfortable being left out and might be afraid of being talked about. The issue is always a problem with group settings that confidentiality cannot be guaranteed. In case the clients decided between themselves not to speak outside of the group, then this relationship might be problematic. The situation might have changed as the group come to an end. Some group members might have decided not to talk to each other outside of the group. The facilitators might also have to let the clients know that people might not follow through and discuss the client’s information outside of the group. The ethical concerns were solved per NASW and IASWG codes of ethics.

The NASW for social workers state 1.07 privacy and confidentiality F- (f)

“When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements” (NASW, 2017).

The IASWG standards state in section three A-tasks and skills c. “Confidentiality and limits thereof are identified.” As well as section five A elements of ethical practice in social work group work 4. “Discussion of the importance, limits, and implications of privacy and confidentiality with the members” (Abels & Garvin, 2015).

Addressing ethical concerns as a worker can be a challenge, especially when reminding the clients about the contract, addressing the issues as it comes up. It would be challenging to ask how the client would feel if two members get together when the group is over to continue the relationship when the situation arises.

New Understanding

During the entire facilitating, I have learned a lot from my facilitators and the clients. The group has taught me the importance of listening to clients and understanding the hidden meaning of what they are saying, what are they trying to say but are not saying. It was especially apparent the need for check-in and check-out, as was mentioned before. Also, I learned better ways of incorporating the group facilitators’ expertise in reflection, summarizing, and open-ended questions. I learned the importance of giving the clients a chance to talk to facilitators after group for support or specific resources.

Group work is an essential process for clients. Remembering that clients might go out of their way to attend group sessions and making the most out of the time spent in group sessions is vital. Clients can benefit from the support more than individual therapy as they feel understood by their peers.

References

Abels, P. A., & Garvin, C. D. (2015). STANDARDS FOR SOCIAL WORK PRACTICE WITH GROUPS. Retrieved from INTERNATIONAL ASSOCIATION FOR SOCIAL WORK WITH GROUPS: https://www.iaswg.org/assets/2015_IASWG_STANDARDS_FOR_SOCIAL_WORK_PRACTICE_WITH_GROUPS.pdf

Banks, R. (2005). Solution-Focused Group Therapy. Retrieved from Journal of Family Psychotherapy, 16(1/2), 17–21.: https://doi-org.ezproxy.simmons.edu/10.1300/J085v16n01_05

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing : helping people change. Retrieved from Guilford Press.: https://search.ebscohost.com/login.aspx?direct=true&db=cat01806a&AN=sim.b1886247&site=eds-live&scope=site

NASW. (2017). National Association of Social Workers. Retrieved from Code of Ethics: https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English.aspx

Schub, T. B., & Smith, N. R. (2018). Obesity in a Culturally Diverse Population: an Overview — Providing Culturally Competent Care. Retrieved from CINAHL Nursing Guide. : https://search-ebscohost-com.ezproxy.simmons.edu/login.aspx?direct=true&db=nup&AN=T704490&site=eds-live&scope=site

Shechtman, Z. (2007). Group counseling and psychotherapy with children and adolescents : theory, research, and practice. Retrieved from L. Erlbaum Associates.: https://search.ebscohost.com/login.aspx?direct=true&db=cat01806a&AN=sim.b1622178&site=eds-live&scope=site

Shulman, L. (1986). The Dynamics of Mutual Aid, Social Work with Groups. Retrieved from 8:4, 51-60, DOI: 10.1300/J009v08n04_06

Tyrrrell, M. (2014). 3 Miracle Question Examples to Use With Your Therapy Clients. Retrieved from Mark Tyrrell’s Therapy Skills: https://www.unk.com/blog/miracle-question-examples/