Leaders and Difficult Members

I believe we all want to be leaders, especially if we have to lead a group. It can be overwhelming if it’s the first time but learning about group therapy is becoming more important in mental health and it gets easier with time, previous topics include:

• Group Introduction
• Group Stages and Yalom’s Therapeutic Forces 

To continue this quick review of group therapy, it is important to know good leadership skills, what to avoid, and conflicts.

Leadership Styles

• Autocratic Qualities: envision themselves as an expert, rigid, conventional, gives advice, directs the group, and demands obedience and conformity.
  Focus: the leader aka dictator
  Task Strategy: encouraged members to adopt the leader’s ideas. Members’ participation limited; individual creativity, group cohesiveness, productivity: LOW
• Democratic Qualities: more group-centered, serve more as facilitators, cooperate, and allows the group to develop their own potential
  Focus: members
  Task Strategy: group problem-solving. Members’ participation unlimited; individual creativity, group cohesiveness, productivity: HIGH
• Laissez-Faire Qualities: don’t provide structure or a direction for the group
  Focus, Task-Strategy, and member participation: undetermined, not defined, and inconsistent. Group cohesiveness and productivity: LOW

The best leader may have a mixture of different styles depending on the group, the content, and other factors. However, it’s best to stick in the middle (democratic), you don’t want to be too critical or the other extreme, a warm body collecting dust. Going back to Yalom’s factors, one of them was “imitative behaviors” and if your members are modeling extreme behaviors, it can make group therapy more difficult for everyone. This is from a study about great leadership characteristics:

Portrait of a Highly Effective Leader

• An ability to deeply enter the world of another without losing a sense of self
• A drive to master yet a sense of never arriving
• Be able to give of self to others while being able to nurture and take care of themselves
• Can draw on their therapeutic power to help others while maintaining a sense of humility
• Can provide an emotionally safe environment for clients while challenging them
• Have to ability to accept feedback about themselves without becoming desensitized by this feedback
• Integrate their personal and professional selves with clear boundaries between each dimension

-By Corey et. al 2014 pg 18

Different Traits in Group Members

• In successful groups, different members typically display different tasks and functions: initiator, information or opinion seeker, clarifying or elaborating, consensus-testing, devil’s advocate, and summarizer.
• Maintenance functions help keep the group members interested and connected to achieve the goal: encourager, expressing group feelings, compromising, gate-keeper, and standard-setting.
• Disruptive behaviors occur the group member(s) is more concerned about their own needs and agenda than contributing or learning from the therapy: blocking or diverting the discussion, power-seeking (over-bearing), recognition seeker, dominating, attention-seeking, constant clowning, or joking.

Why Individual Behaviors Occur

• Members have inadequate group skills
• Members don’t understand what to do
• The leader does not set therapeutic norms
• Group has a low level of maturity
• The group task is inappropriate or not reasonable
• Members have personality disorders

Dealing with Disruptive Behavior

Ways to manage disruptive behavior: depending on the level of harm the leader can ask the client to leave, reinforce the rules, and 5 other specific techniques for managing conflict in groups (Kormanski, 1982; Simpson, 1977):

1. Withdrawal from the conflict
2. Suppressing conflict
3. Integrating conflicting ideas to form new solutions
4. Working out a compromise
5. Using power to resolve the conflict

According to Yalom, conflict may continually recur in the group despite the successful resolution of past conflicts, however, unrestrained expression of rage is not the group goal either. He recommends the leader fine-tuning the conflict as a means for growth or to keep the conflict within constructive bounds by reestablishing goals and trust. He also discusses problematic group members:

The Monopolist: anxious with silence, responds to everyone’s comments, decreased ability to empathize with others, unaware of the impact on others, discusses issues in irrelevant endless details, may assume the role of an interrogator and start firing off questions, may tearfully describe his or her own crisis.
Intervention: Decrease the monopoly or control from the “aggressor”: Ask the group “Why are you allowing this person to take over your group?” Ask specific members, “Why are you silent? What are you thinking?”. Encourage members to give the person (Monopolist) feedback by completing the sentence, “When you speak like that it makes me feel ____________”. If the group can be helped to express its frustration, they might learn to control the behaviors that elicit negative feelings from others.

The Silent Member: dreads self-disclosure, perfectionistic, fear failure, dreads being center of attention, may feel conflicted, maintains control thru silence, maybe avoiding a display of feelings, may feel incapable of expressing self in ways other group members have done
Intervention: comment on non-verbal behaviors. Ask process questions like: “What is the ideal question that I could ask you today to get you involved in therapy?” Help members learn about self-thru his/her behaviors and get the member to explain why it is so hard for him/her to speak in a group.

The Boring Member: Yalom discusses how a person rarely seeks therapy for being boring yet this is a frequent complaint from people. They’re massively inhibited, lack spontaneity, don’t take risks, agree with the majority, could be dependent, silent (not aware of feelings), may have a core-dependent self, and dread rejection/abandonment.
Interventions: If you as a leader are bored by this person, so is the group. It’s tolerated behavior because it’s better than other problem behaviors since “boredom” rarely disrupts the group. Intervene by replacing boredom with curiosity, ask “How can I find the real, dynamic person behind this boring shell?” Inquire gradually over several sessions and encourage other members to do the same.

Help-Rejecting Complainer (HRC): A variant of the monopolist, 1^st described by J. Frank in 1952 and frequently appears in psychiatric literature. They also are associated with emotional distress with somatic complaints or clients with medically unexplainable symptoms and constitute a large primary care burden. HRC’s seek the therapist’s attention, implicitly or explicitly ask for help, then rejects any help offered, problems sound impossible to solve and take pride in this, may belittle problems of others, usually blames others for their own problems, highly conflicted about dependency
Interventions: Do not express your anger and frustration. Why? It will be considered a blunder for the therapist to express any resentment because it justifies and completes this cycle of their hostile mistrust and that no one can really understand them. Use empathy and self-disclosure about the hopelessness of the situation. Do not continue to offer help. Give support for the HRC to choose to accept or reject help. Use feedback only when trust is established. HRCs are generally not aware of their lack of empathy and helping them see their interpersonal impact on their member is key to changing the behavior. The HRC Cycle:

HRC Complains -> HRC requests help -> Member offers help -> Therapist/Group offers help -> HRC rejects help -> HRC complains again….

The Self Righteous Moralist (SRM): invokes guilt and blame, blames and judges other members, doesn’t care about being liked, usually appears self-assured and calm, will not admit to being wrong, feels shame on a deeper level, creates a maladaptive cycle, similar to HRC.
Interventions: Get a group to give SRM feedback on how the behavior makes them feel. Discuss the consequences of behavior on relationships with others. Use empathy to develop trust. Look at the pattern of behavior outside the group and the consequences for SRM.

Psychotic Member: Persons who are psychotic should not be included in a group. Irrational and illogical members take up vast amounts of group energy and may bring the group process to a stop Such members should be removed from the group until their psychosis comes under control. If a member becomes psychotic, he or she is unable to benefit from group treatment and needs hospitalization, according to Yalom.