A Mandate for Groups
In The Power to Care, a study on clinical effectiveness, we described empirically based findings that demonstrate success in helping clients who are overwhelmed by personal, socioeconomic, and environmental problems to move to higher levels of functioning. Our findings highlighted promising interventions and underscored the significance for clinicians of helping skills that are anchored in flexible functioning, in respect for and understanding of their clients' culture, and in the capacity to hold them to high expectations.
Interventions that hold promise include effective assessment, advocacy, empowerment, individual treatment, and group treatment. Group treatment was actually highly effective, with particularly dramatic outcomes in work with youthful populations, but surprisingly it was not the intervention of choice. Why was this so? Pursuing answers to this seemingly simple question has challenged us to further thought and investigation, with the goal of identifying the philosophical, institutional/operational, professional, and/or practitioner barriers that block or retard the use of groups as an interventive modality. Paradoxically, while groups were not widely used in clinical work with clients, they were used for training, and for sustaining and supporting staff in their work with clients. Despite the fact that groups were used to empower staff, there was little evidence that this resource and knowledge was applied to clients and their communities as a means of empowerment. We question whether or not a conceptual connection has been overlooked between the needs for staff development and growth and community needs for growth and development.
In seeking to understand the connection, between the use of groups and the successful outcomes achieved in work with overwhelmed clients we noted several factors: the impact of group participation on the functioning of these clients, the bonding between members, the validation and support derived from members, as well as the role model of the professional group facilitator. To explore these aspects of group process and success in work with this population we pondered the following: What roles do group leaders play, both professionally and nonprofessionally? What do they bring to the various stages of group formation, development, and termination? Given the importance and need for models in the lives of clients, what, if any, attributes, skills, and/or values do clients learn from leaders or facilitators? Some of the group experiences brought support to members as they were struggling with pressing problems that earlier generations had never faced. These included groups for children whose parents were infected with HIV/AIDS, support groups for college women and new immigrant women, therapeutic groups, mixed gender groups, groups for troubled gang youths, for parents who were drug addicts in recovery, and for women dealing with sexual and domestic abuse often precipitated by drug or alcohol addiction. In observing the way drugs have taken over far too many lives, wrecking marriages or relationships, destroying families and communities, we pondered the response of agencies to this phenomenon and the role of groups in helping people manage the consequences of addiction and learn to manage their lives free from drugs. Some examples are presented in the several chapters that follow.
We became deeply concerned about the vulnerability of children under these conditions, and in particular their vulnerability to relational starvation. What about the child whose parents are addicts and whose grandparent, unable to cope, is forced to give up that grandchild to a flawed foster care system? Can there be a promising future for that child? Multiply this scenario-block by block, neighborhood by neighborhood. What you have are a number of fragmented and disconnected families and neighborhoods that create individuals who have not learned to care for or about one another. Sucked as they are into the commodity identity so idealized today, they become obsessed with acquiring the material goods which they believe can add meaning to their empty lives. For example, even while she was in a recovery group, one addicted mother was preoccupied with how she could obtain the expensive clothing, toys, jewelry, and electronic equipment for her children that her drug pushing and using boyfriend had been providing. She worried:
What will my kids think when they can't get new clothes every week? What will my kids say when their friends talk about them and how they took in old stuff?
From our research it has seemed logical to conclude that unless new national policy initiatives provide opportunities for work at decent wages and pro-family services such as basic health care, and unless these are complemented by nurturing and supportive neighborhood-level family services, effective educational programs, day care, and child development activities, there will be an escalation in the circular reinforcing problems that are symptomatic of client entrapment and powerlessness: poverty, drug and alcohol addiction, gangs and undisciplined children, domestic violence, sexual abuse, mental disorders, and community-wide destructiveness.
Our findings suggest that there may be emerging a stronger role and place for professionally led groups in contemporary society as a moderating and hopeful force for addressing both personal and societal problems. Such groups can provide a much-needed sense of connection to others for those suffering from abandonment and a sense of alienation due to societal conditions.
We think groups represent a powerful and underutilized resource for the helping professions to assist clients in repairing the disconnection and relationship starvation from which many suffer, providing the supports necessary for survival, empowerment, personal growth, and change. Groups can also address the need for neighborhood empowerment and growth, thereby effecting change on both individual and societal levels.
Another finding from The Power to Care -- that effective outcome is associated with practitioners who have high expectations for their clients -- may have far-reaching heuristic value. This finding concerning practitioners' tendencies to hold clients to a high standard of functioning, to believe in their capacity to cope successfully, may be inconsistent with the traditional helping approach that focuses on "the problem," dysfunction, and pathology. Holding high expectations means focusing on strengths and requires practitioners to be very comfortable with the goal of client empowerment. A clinician who focuses on strength and is able to use her own power to empower her client must be flexible, able to identify, support, and enhance strengths, and must eschew a focus on pathology and on the use of labels in ways that reinforce pathology. Practitioners who have a personal need to be the expert and the powerful one may not be able to focus on strengths and may be unable to push the client to action that will lead to greater competence or equal power in the relationship. As the reader will see in a case described later on, one practitioner who worked with a mothers' group demonstrated this capacity in her expectations of one of the group's members.
EMPOWERMENT AND POWERLESS SOCIETAL ROLES
In the course of our research for the book we noted how difficult it is for practitioners to sustain a diverse group when certain constellations related to powerless societal roles exist. Staff who recruited white and Latino women for one mothers' group were not successful in sustaining the interest of many. Why? We proffer ideas about the role of the practitioner and the dynamics of power and powerlessness related to race, gender, and social class, and then develop a conceptual framework that we believe will guide work in this area. We acknowledge that all of these variables are significant in clients' problems, clinical process, and outcomes in this work. Each of these dimensions of social status represents a significant influence in the relationship of practitioner and group and of group member to group member. Although all members of a given group may be people of color and poor, their experience of poverty and oppression stemming from ethnic identity and national origin and their perception of obstacles to be overcome will be different. Thus while the group's members will exhibit some similarities, there are also differences which must be appreciated, respected, and ultimately negotiated. These dynamics compound the complexities embodied in work with this population.
WHY GROUPS CAN BE DIFFICULT TO START
Group activities are often hard to deliver in the face of certain day-to-day logistical realities. First, there are the dynamics of getting started; often people must languish on a waiting list until enough persons with the appropriate characteristics are available to start a group. Second, group attendance can be compromised by participants' anxieties related to threatening outside activities. For example, a parent may be anxious about what day and at what time a particular drug activity is to take place and what will happen if law enforcement tries to pull a bust. Third, and especially during evenings, there may be no safe space to meet in a community setting that is not affiliated with an agency or church -- institutions that are often unacceptable to adolescents and young adults, who don't find them "cool."
In addition to logistical concerns there are other, more substantive reasons why many social agencies do not consider groups a preferable treatment mode. There is the question of the availability of practitioners who are proficient in group skills, since many practitioners have worked mostly with individual client systems.
GROUPS AS INTERVENTION OF CHOICE WITH OVERWHELMED POPULATIONS
In the following chapters we intend to show that groups constitute an intervention of choice for work with oppressed populations. We arguethat preparing practitioners to be skillful in group intervention with this population should become a priority for the helping professions. The sense of empowerment that clients derive from group experiences should be more highly respected and valued. Groups should not be seen, as so often is the case, as detracting from the highly valued one-on-one clinical modality, but as a compelling addition to the total helping repertoire.Copyright © 1999 by June Gary Hopps and Elaine Pinderhughes