Dealing with common difficulties in facilitating groups

From Implementing the program in Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

The therapists at CAMH’s Family Addiction Service have developed experience over many years in dealing with various group challenges. Below we discuss some of the common difficulties that you may face and how we recommend dealing with them. Our recommendations should inform, but not take the place of, your own clinical judgment, as well as professional ethics and agency procedures.

A group member arrives in crisis

If a person arrives early and in distress, we recommend that you ask to speak to him or her for a few minutes in private.

If a participant arrives in distress after the group has started, briefly assess whether the person wishes to discuss the crisis in the group, whether the crisis is relevant to the group and will not overwhelm the participants, and whether the issue can be dealt with easily. If so, set aside a brief period (e.g., five to 10 minutes) to discuss the crisis before moving into the regular group agenda. Since this is not a process group, the goal of the discussion should not be to process the crisis at length, but to validate and provide support to the person, and to help him or her become calm enough to focus on the group. You may offer to spend time with the person after the session to discuss the crisis in more detail and to help the person problem solve. During this discussion, you will need to assess the risk of harm to the participant or to others.

If the participant does not wish to discuss the crisis in the group, if the crisis is not relevant to the group or if it is too large to be dealt with in the group, you should suggest that the participant speak to you after the session. If, however, the person is too distressed and dysregulated to take part in the group, leave the group to further assess the situation. (If you are the only facilitator present, be brief and, if possible, call upon another therapist to help out so you can quickly return to the group.) The goal of this private meeting should be to help the person become calm enough to return to the group as soon as possible. You should also assess the risk of harm to the client or others. If anyone is at risk of harm, consult with other team members or with supervisors for guidance and support, following appropriate organizational and professional protocols. If the person is suicidal, if there is a risk of harm to others or if a child has been harmed, it may be necessary to breach confidentiality and contact the relevant authorities.

A group member becomes emotionally dysregulated

We recommend that facilitators try to keep group members’ emotions under reasonable control by providing adequate structure and containment, and at times limiting their emotional expression. Participants may nonetheless become dysregulated at times (e.g., crying inconsolably, shaking, yelling, swearing or even becoming violent). If this occurs, first ensure the safety of everyone involved, even if that means asking a person to leave the group. Once safety is ensured, validate the person’s emotions and ask what would be help him or her to become calmer. You may provide suggestions, such as focusing on breathing or counting, distracting himself or herself, or having something to drink or eat. Do not ask process or deepening questions, as they are likely to increase the person’s distress.

If the person is unable to control his or her emotions, you might suggest that he or she leave the group temporarily to calm down, for example by walking around, going to the bathroom, washing his or her face, or getting a drink. If you are concerned about the participant’s safety, one of the facilitators should accompany the person. If the participant leaves the group alone, a facilitator may follow up after a short time by checking how the person is doing and inviting him or her to return (people who become emotionally dysregulated in front of others often feel exposed, embarrassed or ashamed, and may find it difficult to return to the group).

A group member discloses information about ongoing abuse or imminent risk of harm

If a group member discloses his or her own current abuse or the risk of harm, we recommend that you do not process the person’s experience, but focus on developing a safety plan. Given how frequently abuse occurs in relationships affected by problematic substance use, this issue is important for everyone in your group to consider. Since other participants may have dealt with this issue themselves, they may be able to provide valuable support and feedback. In developing a safety plan, you should identify triggers and warning signs for violence, and help the person decide on possible plans of action should these warning signs occur. Emphasize to the participants that their safety is a priority and that should it be compromised, they should act immediately to protect themselves. If necessary, you may offer the family member an opportunity to discuss the situation in more detail after the session.

If a group member discloses the risk of harm to another adult, you will need to discuss how he or she can help this person become safe. You will need to assess whether confidentiality will need to be breached to ensure the person’s safety. Consult with other team members and supervisors in deciding how to proceed.

If a group member discloses harm or the risk of harm to a child, you will need to discuss the situation with the person privately and will need to determine whether child welfare authorities should be contacted. Again, you should consult with other team members and supervisors in deciding how to proceed. If you decide to contact child welfare authorities, we encourage you to try to involve the disclosing participant in making the call.

A group member makes an inappropriate comment

If a group member makes an inappropriate comment, we recommend that you intervene. Depending on the type of comment, you may state that not everyone might agree with or feel comfortable with the statement. You can allow other participants to respond, but we would caution against a long processing of the event. You may take the opportunity to revisit the group guidelines (see Module 1), and remind the participants of the need for these norms to ensure safety in the group. You may also choose to speak after the session with the person who made the inappropriate comment to determine whether any other issues need to be addressed.

If a participant tells you after a session that he or she was hurt or offended by something said in the group, you should take the opportunity at the next session to remind the group of the rules and norms and emphasize the importance of safety within the group, without referring to the specific incident.

Group members are in conflict

If a disagreement between two or more participants escalates to an inappropriate level, you should intervene to end the conflict. If a person is unable or unwilling to stop, you may ask the person to take a break from the group for a few minutes. Then, with all participants present, remind them of the group rules and norms, and discuss appropriate ways of managing differing viewpoints.

If the conflict continues, you might meet after the session with those involved to try to resolve the issue or obtain an agreement on how to manage the issue in future sessions. If the conflict cannot be resolved, you may have to offer those involved an alternative group or treatment.

Group members contribute unequally

In any group, some members will talk more and some less. However, if one or more participants talk excessively during the group, sidetrack the discussion, prevent others from contributing, dominate the discussion or reveal too much personal information, you will need to intervene to restore balance in the group. If a person is being wordy or tangential, you may need to interrupt and redirect him or her to the task at hand. Explain that everyone needs to have a turn speaking, and encourage others to contribute. If necessary, be more structured and task-focused in leading the group. For example, avoid open-ended or personal questions that could allow for lengthy sharing.

If one or more group members are frequently quiet, be sensitive to their need to listen, but also give them the time and space to contribute. You may need to pause for longer after asking questions to allow them the time to volunteer an answer. It may also be helpful to ask everyone to share by going around in a circle.

Families CARE: Helping Families Cope and Relate Effectively Facilitator’s Manual

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