Social Work Group Leadership Style and Integrative Theoretical Perspective

© David©W. Butler 2009
David W. Butler 2009
David Butler

The following presentation is an extension of my personal
philosophy of practice to the practice of group
psychotherapy. This is, of course, a work in progress and
will be modified by my continued learning.
I will focus on two primary themes. The first, and possibly
most pragmatic, is a synthesis of some of the more
traditional approaches, with a particular emphasis on
humanistic theories. The second theme is more of an ideal
based on the relatively new, yet evidence-based practice of
mindfulness which provides the significant advantage of

© David W. Butler 2009
including compassion and acceptance as core components.

 People desire happiness  Therapy is most effective
 People have the potential when:
for  Experiential
 Self-awareness  Collaborative
 Self-determination  Phenomenological
 Self-actualization  Holistic
 Compassion for self and  Mind
others  Body
 Spirit
 Primacy of the therapeutic  Environment
relationship  Egalitarian
 People as human beings as  Shared journey

opposed to human doings
 Personal responsibility

“As human beings we all want to be happy and free from misery” His Holiness the Dalai Lama

Existential Person-centered
 Self-determination  Therapeutic relationship
 Personal  Necessary and (maybe)
responsibility sufficient
 Existential anxiety  Genuineness
 The “hole in the soul”  Unconditional positive
 Authenticity regard
 Acceptance

 Empathy

“man is, before all else, something which propels itself towards a future and is aware that it is doing so”. Sartre

Gestalt Transactional analysis
 Holism  Games
 Experiential  Life scripts
 Integrating polarities  Ego states
 Interpersonal conflict  Strokes
 Unfinished business  Injunctions

“Remember, be here now.” Ram Dass

Adlerian Other
 Holism  Psychoanalysis
 Self-determination  Transference
 Developmental stages
 Personal responsibility
 Collaborative  Solution-focused brief
partnership therapy
 client-centered
 counselor-as-consultant


Advantages Disadvantages
 Empirical data  Impersonal
 Designed to be  Emphasis on thoughts
scientifically evaluated and behaviors, not
 Funding feelings or experiences
 Supported by third
party payers and,
consequently, many

agencies
 Brief

Preferred Pragmatic
 Existential therapy  Cognitive behavioral
 Person-centered  CBT
 Cognitive restructuring
 Gestalt
 DBT
 Adlerian
 Transactional analysis

There appears to be a clear disconnect between my preferred orientation toward
the humanistic approaches and the current emphasis on cognitive behavioral
therapies. However, there is hope for reconciliation, thanks to…

While my heart is with the humanistic approaches,
especially person-centered and existential, the current
emphasis on CBT cannot be ignored.


 More person centered
 Acknowledges humanistic
concepts
 Less ‘clinical’
 Mindfulness-based Stress
Reduction (MBST)
 Mindfulness-based cognitive
therapy (MBCT; Segal,
Williams, & Teasdale, 2002)
 Acceptance and Commitment
Therapy (ACT; Hayes,
Strosahl, & Wilson, 1999)

 DBT

 Adds experiential  Mindfulness-based
component to CBT Stress Reduction (MBST)
 Also known as  Mindfulness-based
 Presence-centered cognitive therapy
psychotherapy (MBCT; Segal, Williams,
 Contemplative & Teasdale, 2002)
psychology  Acceptance and
 “technology of the mind” Commitment Therapy
(ACT; Hayes, Strosahl, &
Wilson, 1999)

 DBT

 Evidence of effectiveness in treating
 Stress disorders (Weinstein, et a., 2009)
 Depression
 Including reduction in relapse rates (
 Attentional problems
 Pain management
 Medical management (diabetes)
 Potential (tentative results)
 Substance abuse

 Generalized Anxiety Disorder

 Self-compassion
 Self-kindness versus self-judgment
 Common humanity versus isolation
 Mindfulness versus over-identification
 Deactivates threat system and activates self-soothing system
 Research indicates improvement in depression, anxiety,
rumination, thought suppression, social connectedness and
emotional intelligence (Neff, 2003)
 “Self-compassion involves having the right amount of
distance from one’s emotions so that they are fully
experienced while being approached with mindful

objectivity” (140)
(Neff et al., 2007)

 Advantages
 peer support and motivation
 Shared insight
 Reduced isolation

 Disadvantages
 Requires therapist training in both group work skills and
mindfulness therapy
 May require unlearning of incompatible skills

Melbourne Academic Mindfulness Group, 2006

 Limited long-term follow-up data
 (Mis)perception of mindfulness as a spiritual practice
 Substantial client commitment
 45 minutes of daily practice typically recommended
 Possibility of exacerbation of psychiatric symptoms,
especially with long-term (e.g. 10 day) retreats
(Melbourne Academic Mindfulness Group, 2006)
 Altered reality testing (with transcendental, as opposed

to mindfulness, meditation)
 May be contraindicated for current or past psychosis

 Leader as guide
 Shared journey of discovery
 Technical expert but not expert in the lives of the
members
 Least directive, least structured
 Assumes the development of a safe environment
 Whenever possible, the group should determine its own
direction and structure
 More structure often required in the early and late stages

of the group

 One size does not fit all
 Beginnings
 Structure and safety
 Optimism for change within group
 Teach essential concepts of cognitive therapy
 Automatic negative thoughts
 Relationship between cognition and emotion
 Basic mindfulness training
 Relaxation
 Mindful meditation
 Attachment/acceptance
 Working
 Egalitarian
 Equal partners

 Person-centered, Adlerian, Existential
 Endings
 Switch to more cognitive behavioral approach
 Skills training

Style Roles and functions
 Non-directive  Guide
 Egalitarian
 Teacher
 Equal partners on a journey
 Each with unique strengths  Mindfulness concepts
and contributions
 Genuine (Rogers)
 Least directive
 Actual amount of direction
dependent on needs and

abilities of members

Skills
Functions

Style Roles and functions
 Slightly more directive  Teacher


 Race
 Ethnicity
 Age
 Religion / spiritual tradition


General Mindfulness
 Evaluation of the empirical
evidence critiquing the
strengths and limitations of the
integrative approach
 Humanistic therapies
underrepresented in empirical
studies, especially as compared
with cognitive and/or behavioral
(Klein, 2008)
 Cohesiveness may not be as
predictive of positive outcomes

as previously believed (Hornsey,
et al., 2009)

 Plan for developing the necessary competence to lead
such a social work group using this integrative
theoretical approach
 Attend 5-day intensive training program through
UMASS Medical School, Oasis Professional Education
and Training program in January, if financially feasible
 Teacher certification in MBSR by 2012
 http://www.umassmed.edu/Content.aspx?id=44552


Melbourne…
Neff, K. D. (2003). The development and validation of a scale to
measure self-compassion. Self and Identity, 2, 223–250.
Neff, K. D., Kirkpatric, K. L., Rude, S. S. (2007). Self-compassion
and adaptive psychological functioning. Journal of Research in
Personality, 41, 139-154.
Klein, W.H. (2008). Toward the establishment of evidence–based
practices in group psychotherapy. International Journal of Group
Psychotherapy,58, 441-454.
Segal….
Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-
method examination of the effects of mindfulness on stress

attribution, coping, and emotional well-being. Journal of
Research in Personality, 43(3), 374-385.

Approach of Marina Claessens 
 adapting to the client and not the other  I will guide you towards clarifying what
way round. your aims and objectives are if you need
 most significant factor relating to to, and then towards achieving them.
successful outcome is not the therapist’s  This can be done not just by talking, but
preferred school of thought, but the also in many cases by a variety of
relationship between therapist and experiential exercises which can bring to
clients. awareness those aspects of oneself that
 establishing an empathic, safe and cannot be reached by words alone.
supportive therapeutic environment  Therapy remains at all times a
collaborative and creative process.
 Inot a question of me telling you what to
do but of us working together to explore
your current way of making sense of your
experience.
 This is done in order to identify how your

problems may have originated, how they
are maintained, the function they may
serve and the best way for you to
challenge them.

 Anxiety
 Being

“man is, before all else, something which
propels itself towards a future and is aware
that it is doing so”. Sartre

The PPT presentation will include:

(1) Key concepts of the approach;

(2) Role and function of the social work group leader at the various stages of
group development;

(3) Application of social work skills including the use of various therapeutic
techniques and procedures;

(4) Discussion of ethical/value issues and the application of the integrative
approach to multicultural populations;

(5) Evaluation of the empirical evidence critiquing the strengths and
limitations of the integrative approach, and a

(6) Plan for developing the necessary competence to lead such a social
work group using this integrative theoretical approach.

Social Work Group Leadership Style and Integrative Theoretical Perspective

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