I am a clinical social worker with over 25 years of experience in a variety of fields. My clinical focus in recent years has been on geriatric social work. In my opinion, geriatric social work is the most rewarding kind of clinical work, and the challenges it presents are ever changing. This being said, evidence-based social work clinical interventions are also dynamic. Recently I began a group, at times partnering with a facility social workers and co-facilitating. The group has been rewarding for both the clients, per their report, and for me and my esteemed co-facilitator.
Why A Group?
NEG does a great deal of individual, family, and staff intervention for their elderly clients in nursing homes. Group is an effective approach that allows the delivery of multiple therapeutic aims. In addition, group allows me to keep up with more clients!
Therapeutic Aspects of Groups
There are many kinds of group therapy, psychoeducational, support, task, and other types of groups. The group we started is a combination of psychoeducation and support. According to Cohen & Graybeal (2007) groups are effective mutual aid vehicles. Mutual aid is defined by these authors as providing group members with opportunities to find their “common struggles” and the realization that each person is not alone in facing common challenges (p42). As a group this realization can lead to empowerment, in my experience. Facilitating an emotionally safe and confidential environment leads to mutual aid among group members (Tuckman, 1965), which includes social support.
Our group has responded well, and numbers are increasing. Necessity dictates that this be an open group. The age spectrum is wide, including a centenarian and a disabled adult in his thirties. In spite of this, clients have much in common. The group members frequently mention this during group. The adjustment to nursing home life is a major theme. The group gives its members an opportunity to verbalize their experiences and reactions and also to do some problem solving with each other.
In the group, we model, teach and encourage basic relaxation and affect management skills. For example, we start each group with three-part breathing and end with PMR (Progressive Muscle Relaxation). We have used mantra meditation and visualization. Each week we review these tools and check when group members use or practice these. Attending every week, the group members know they will be asked if they have practiced. Feedback is encouraged, as some of these techniques need to be modified for certain group members, depending on their disability or other limitations.
In my work I have referred to the phenomenon of “internal locus of control” (Neeman, 1995) in individual clients. This can be an outgrowth of the therapeutic relationship. As we know, our relationships with our clients are in fact the major therapeutic mechanism, as research has shown (see for example Martin, Garske & Davis, 2000).
The term ‘internal locus of control’ means a person’s ability to attribute life events to the self, (‘internal’) vs the control coming from external sources. This concept is key in a supervised setting such as a nursing home. In our group, we emphasize the experience of the internal locus of control, starting with the group members learning relaxation skills for themselves and practicing when not in group. Supportive interaction with peers comes with an emphasis on responsibility for the self, and what improvements can be made if one cannot change the behavior of others (such as a staff person or a roommate). In addition, the facilitator of the group must maintain a positive attitude toward the client, demonstrating confidence in that person’s ability to have his or her own locus of control, along with solution focused techniques such as praise, reinforcement, and building on a client’s strengths.
In conclusion, as in individual therapy many forces are at play in group therapy. There are many advantages to employing group work in a nursing home setting, one of which is the sense of satisfaction this work can give the facilitators!
Graybeal, Clay; Cohen, Marcia. Using Solution-Oriented Techniques in Mutual Aid Groups. Social Work With Groups, 08/2007, Volume 30, Issue 4
Neeman, Lisa (01/01/1995). Using the therapeutic relationship to promote an internal locus of control in elderly mental health clients. Journal of Gerontological Social Work (0163-4372), 23 (3-4), p. 161.
Tuckman, Bruce W; Jensen, Mary Ann C. Stages of Small-Group Development Revisited. Group Facilitation 10 (2010): 43-48.