Skip to content Skip to navigation

Group treatment agreements: amplifying the therapeutic

April 22, 2014
by Izaak L. Williams, CSAC, and Lorrain Burgess, CSAC
| Reprints

As much as anything characterizing group treatment, the constant rehearsal of group agreements before each session can powerfully influence group members. Installing value and purpose into the agreements becomes essential. Yet this emphasis generally means centering the agreements on fortifying structure, creating a sense of safety, setting a particular tone, and articulating expectations that shape social norms as a means to “keep the peace.” To that end, the agreements may fulfill one goal but simultaneously lose their therapeutic luster and durability.

In this case, several things might happen: 1) the group agreements fail to engage members therapeutically as they hear instruction on what is not allowed; 2) mere lip service is given to the group agreements in a round-robin reading exercise before the start of each session; 3) the agreements fail to incorporate lessons on delayed gratification and other features that group members can apply outside of the session. In essence, the group agreements may not offer significant explanation of the value in practicing certain behaviors.

This article aims to enhance the therapeutic value of group agreements by proposing elements that can be added to an existing foundation. We present a set of group agreements and rationales, albeit without a “crowning touch” as the agreements continue to be a work in progress. These agreements apply specifically to a court-mandated subpopulation in an outpatient setting with revolving-door membership.

Before introducing the group agreements, we intend to engage discussion on the question of why these are called “agreements” and not rules, responsibilities, or guidelines. Arguably, what the group agreements are called matters.

Rules

Beneath the surface, for a broad subset of court-mandated individuals the conceptual window is restricted as to what rules mean. Because rules intone punishment or consequence for rule breaking, the word would seem to conjure images of authority, probation officers, authoritarian parents, etc. This generates a set of corresponding thoughts, not the least of which is, “Oh, here we go with the rules…power-trippin’ time!”

For the court-mandated, regardless of how the rules are phrased, the word is fused with such negative connotations that it might as well sit as an ingredient in a powder keg. Rules yield a perception that smacks of authority, control and order, which is further reinforced by the way in which the rules might come across in circular reasoning (e.g., “There is no eating in the group room.“ Why? “Because, well, it’s the rule”). Depending on the group member’s personal history with rules, this can also implicitly induce counter-transference. Once that happens, it can trigger the tendency to incite the very “discord” and “sustain talk” (“resistant” behaviors)1 it tries to avert.

Responsibilities

Simply resorting to calling every item on a laundry list “your responsibility” also can be counterproductive. Christening each item as a responsibility offers a weak explanation for why some items should be honored. Hearing this relied on over and over again might become too overwhelming and personally deflating, if every time a group agreement is not followed the person is overtly or covertly called out as irresponsible.

Guidelines

The word “guideline” may invoke the image of a guidepost that a hiker on a trail might commonly see that assists him in staying on the well-trodden path. A more exaggerated image is that of a lifeguard who throws a drowning swimmer a guideline to buoy and reel him/her to safety. Applying that image to group work makes it difficult to see the therapeutic value inherent in guidelines. Guidelines can more loosely come across as “negotiable rules” that apply to any situation, leaving the door wide open to bargaining. Therein lies the problem with guidelines: The term (along with substitute terms such as “expectations”) seems a bit too ambiguous for the group treatment setting.

Group agreements

Although the term “agreement” presupposes that members already have given consent, the group facilitator inevitably cannot go too long before hearing, “I didn’t agree to that group agreement.” When a member objects to honoring any one of the group agreements, the member in effect has cast his/her vote not to participate in the group session as part of the social contract (the group’s agreed-upon structure or protocol) among members.

Here is our set of group agreements and rationales:

1. To practice our “kuleana” (responsibility) to each other, we agree to be on time for all our sessions. We also agree to communicate, by phone, any unexpected delays that might prevent us from being on time. We understand and agree that if the group has started and the group room door is closed, we sit in the waiting area to complete our self-assessment sheets until the door opens at the break.

Rationale: In the real world, timeliness and tardiness each garner different outcomes. This comes to life in group agreement number 1.

2. To practice preparedness, we agree to come to class well-rested, well-nourished with an empty bladder, free from drugs and alcohol, well-supplied with completed assignments, notes from previous sessions, a pen, and ready to share and learn with each other.

Rationale: As in life, preparedness usually improves the experience. Coming to sessions prepared increases the likelihood of an enhanced session experience.

Pages

Topics