Chapter 13. Working with groups
Chapter Contents
Types of groups178
Potential benefits of group work178
When to use group work178
Group leadership180
Group behaviour182
Setting up a group183
Getting groups going185
Discussion skills186
Dealing with difficulties188
Summary
This chapter is about working with clients in groups and begins by discussing the range of groups in health promotion, potential benefits of group work and when it is appropriate to use it as an approach. Group leadership styles and responsibilities and individual group behaviour are considered. The last part of the chapter focuses on the competencies needed for working successfully with people in groups, including the practicalities and skills of setting up a group, getting groups established, discussion skills and dealing with difficulties. Exercises focus on identifying the benefits of joining a group, looking at your leadership style and planning a group meeting.
Health promoters work with many different kinds of groups in a variety of settings. Working with groups of colleagues is considered in Chapter 9; in this chapter, the focus is on the health promoter’s work with groups of clients, but many of the skills discussed in Chapter 9 (such as coordination, teamwork and working effectively in meetings and committees) may also apply when working with clients.
See Chapter 9.
Group work encourages clients to be active participants in their own health issues and with their communities. Many of the groups with which health promoters are involved will already exist, where members have come together for a common purpose and health issues form part, or the whole, of the agenda. The role of the health promoter may vary widely, from leading a one-off session to facilitating the development of a new group, or leading a group with a defined lifespan. Whatever the role, competencies in group work are needed. Leading therapeutic groups are excluded from the discussions in this chapter. Therapy requires in-depth professional training in a range of possible approaches, outside the scope of this book, but see Hogg & Scott Tindale (2002)Buckroyd & Rother (2007) and Bertram (2008) for discussion on therapeutic groups.
Types of Groups
Groups are formed for a variety of purposes and are not simply a random collection of individuals. Members generally have a sense of shared identity, common objectives, defined membership criteria and their own particular ways of working. The term group work can be applied to a range of activities such as group therapy, social action or self-help. Groups in the context of health promotion are usually formed for one or more of the following purposes.
For raising awareness
To increase members’ interest in, and awareness of, health issues through group discussion. This may be a group already in existence, such as a women’s group, which may agree to discuss a health issue.
For mutual support
To support members in difficult decision making, to help each other to cope with shared health problems/disabilities, or to change a health-damaging behaviour. Examples are self-help groups such as patients’ associations and Alcoholics Anonymous.
For social action
To use collective power to campaign for social change, for example tackling a local problem of drug misuse, housing standards or community facilities.
For education
To impart skills, offer information and sometimes to prepare members for specific life events, for example becoming a parent.
For group counselling
To help members to find solutions through exploring a shared problem with a counsellor, for example a group of menopausal women.
Being clear about the purpose of a group is important. Confusion can result if the tasks of a group are changed, especially if this means that individual members have to adopt different roles. For example, an individual will have difficulty if she attends a group to obtain support, and finds the task has changed to campaigning. A new group is required for the new task.
The type of task will determine the most effective size for the group; for example, educational groups may be larger than support groups.
Different kinds of groups may also require the health promoter to take on different roles, and use different skills. Leading or facilitating groups requires special skills and methods; later in this chapter group leadership and the skills you need to be effective as a group leader are discussed.
Potential Benefits of Group Work
It is important that a group leader or facilitator considers the benefits for the individual client of using a group as a medium for support (Stock Whitaker 2001). The process of being part of a group is often as important as the intended outcome of the group; for example, a young parent may gain friends and social skills by being part of a parenting group as well as learning parenting skills.
In addition to thinking of potential benefits for the group as a whole, the group facilitator needs to think about which benefits are relevant to individual group members. Different group members may benefit in different ways. Exercise 13.1 is designed to help you think about what joining a group could mean to a client.
EXERCISE 13.1
How can joining a group promote health?
Think of a group that you have:
▪ set up in the past, or
▪ intend to establish in the future, or
▪ belonged to yourself.
Consider the list of potential benefits below. Which ones could apply to members of your group?
| Trying out new behaviours that are better for the group members or other people they have contact with. | □ |
| Gaining new health knowledge, becoming better informed. | □ |
| Learning new ways of doing things and acquiring new skills for health. | □ |
| Finding better ways of coping with everyday life. | □ |
| Feeling less isolated, reducing the sense of being alone with an illness or problem or that nobody else understands. | □ |
| Developing more confidence, with group members having a more positive view of themselves. | □ |
| Group members recognising that they can make changes, they can see new possibilities. | □ |
| Revising previously held assumptions group members had about themselves and/or others; they think differently about themselves and others. | □ |
| Developing an understanding, or a fuller and more accurate understanding, of how past experiences have, until now, influenced group members. | □ |
| Feeling able to work with other people to take action about a health issue group members feel strongly about. | □ |
Can you think of any other benefits?
(This exercise is adjusted from Stock Whitaker 2001.)
When to Use Group Work
Health promoters may be unsure about when it is appropriate to use a group work approach to health promotion. Group work is appropriate when your plans fulfill the following criteria:
See also Chapter 5, section on deciding the best way of achieving your aims.
• You have looked critically at what other health promotion opportunities exist, and you have concluded that group work is needed to meet the particular needs of specific groups of people.
• You have evidence that group work is effective for this particular client group.
• You are going to be working with a defined group of people over a period of time, which will allow the group to build up trust and be able to help each other, for example a group of teenage mothers, a self-help group of patients who are recovering after heart attacks, or people who have been diagnosed as HIV positive.
• You have access to a comfortable, private and relaxed environment in which to run the group, for example a community centre.
• You have access to support and supervision in order to provide you with assistance when you need it and help you to develop your group work.
In some circumstances group work may be particularly helpful. Examples are:
• You are planning to work with people who are already in a close small group, and possibly already used to group work, for example a group of young people who are in a residential drug rehabilitation setting.
• You are establishing a connection with a number of people who have a common interest, and wish to develop an equal and respectful partnership with them, for example a group of people with mental health problems who have recently moved into a group home.
• You want to work with a particular ethnic minority community but you do not come from that group yourself and are faced with issues of differences in culture and language. In this case, it could be helpful to run a group to look at health issues in partnership with a link worker or health advocate who can offer culturally sensitive help and skills in translation and interpretation.
There are times when it may not be advisable to embark on group work, or to continue to run an existing group. These may include situations when:
• You have not consulted with prospective clients to establish their needs.
• Group members are from such a diverse range of backgrounds that they have little in common and feel uncomfortable with one another.
• The cultural or psychosocial background of the group will make it difficult for them to adapt to group work.
• The group will meet only once or twice, which means that people will not have long enough to get to know and trust one another.
• The membership of a group is not stable and people are constantly leaving or joining.
• Your aim is solely to transmit information, so that a talk with questions and answers would be better.
• The aim of the group is to encourage a change towards a healthier lifestyle but the people concerned do not have the opportunity to make changes because of lack of money, skills, support or facilities.
• You do not have suitable accommodation for meetings; for example, you only have available a large, tiered lecture theatre.
• You do not yet have the competencies to facilitate group work, or access to the necessary training and support.
Group Leadership
Two aspects of group leadership are useful to consider. One is your leadership style and the other is your responsibilities as a group leader.
Leadership Style
It is important that all the members of the group are agreed on who is the leader, and support the leader in this role. The leadership style needs to be compatible with the group members, especially if the group has to work together to complete complex tasks. For example, a group of highly motivated and trained professionals will work best with a leader who encourages participation and shared decision making. It is essential for leaders to be aware of which style members prefer, and to develop the ability to adjust their style if the situation demands it.
A key dimension of leadership style is where the leader stands on a continuum from authoritarian to participative.
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An authoritarian style is directive, with the group leader acting as a source of expertise. If you adopt this approach, you rely on your status, credibility and expertise to ensure acceptance of your views and leadership role.
The strength of this style is that children and vulnerable people (such as those who are sick or distressed) may feel secure, reassured and protected from harm.
The weaknesses of this style are that clients may become fearful, anxious and reluctant to take independent action; it does not develop their ability to take responsibility for their own decisions and actions. Furthermore, clients may respond by rebelling and rejecting your guidance.
A participative style involves shifting power from the group leader so that it is shared between the leader and the group members. This means using all the skills and knowledge of the group members as well as the leader, who is more likely to choose the title of facilitator. As a facilitator, you will need to show warmth and empathy, encourage group members to express their feelings and provide counsel and encouragement. You will need to be tolerant of different viewpoints, showing fairness and impartiality. You will need skills and ability to confront difficult issues and resolve conflict using a problem-solving approach.
See Chapter 9, section on understanding conflict and Exercise 9.3 on identifying your conflict resolution style.
The strength of this style is that clients learn to trust their own judgements and at the same time to appreciate other people’s rights and opinions.
The weaknesses of this style may be that strong feelings are uncovered and distress experienced by the client and yourself, which might be difficult to manage. Also, clients who are used to being told what to do may feel confused and dissatisfied because they are not receiving advice and direction. They will need to have the approach explained to them and be given suitable learning experiences to show them that it works.
Group leaders can operate somewhere between the two extremes, providing some authoritative leadership while also encouraging a degree of participation. Successful group leadership depends on a variety of factors such as:
• The leader’s preferred style of operating and personality. For example, if you have been used to being perceived as the expert, with the authority of professional knowledge that you want to pass on, you will probably feel (and look) uncomfortable if you try to switch to a facilitator style without sufficient training, and this may produce tension in the group.
• The group members’ preferred style of leadership in the specific circumstances of the group. For example, if group members are low in confidence, they may need you to be more authoritarian to start with, so that they feel secure. You can then gradually encourage participation and adopt a more facilitative style as members learn to trust you and each other, and feel confident enough to join in.
• The group’s objectives and tasks. For example, a group that has the objective of learning new skills (such as an exercise class) will need a more authoritarian leader who will tell them how to do the exercises properly, whereas a group of parents in a support group that aims to help them recover from the death of a child will need a facilitator to help members to express and work through their grief.
• The wider environment, such as the culture of the group members, and of the organisations they belong to. For example, the cultural norm of some ethnic minorities may be passive, and they may not only lack confidence about active participation in groups but may also perceive it as inappropriate.
You need to consider these factors and how they might be modified in order that the group achieves its purpose. The easiest thing to modify in the short term should be your own style, but in the long term it may also be possible to make other changes, for example to develop the group members’ confidence so that they are willing to take on more responsibility and participation.
See Chapter 3, section on analysing your aims and values: five approaches.
The participative style fits best with the self-empowering client-centred approach to health promotion. However, some health promoters will have been trained in an authoritarian style and will have modelled themselves on this experience. If this is true in your case, you will need to learn how to work in a participative style in order to become more effective in empowering your clients.
Finally, a participative style must be distinguished from a permissive style. A permissive style lets clients come to their own conclusions and aims to avoid conflict and keep everyone happy. Helping the clients to enjoy the experience is more important to the leader than achieving the goals of the group. Difficulties and conflict are not confronted and the clients may feel neither nurtured nor secure. Group leaders may need to build up their own assertiveness skills in order to avoid an overly permissive approach. Undertake Exercise 13.2 to determine your leadership style.
EXERCISE 13.2
Looking at your leadership style
The following questions aim to help you to examine your own leadership style. Put a tick in the appropriate box.
| Never | Sometimes | Usually | Always | |
|---|---|---|---|---|
| 1.Do your clients say what they feel? | □ | □ | □ | □ |
| 2.Do clients finish what they are saying before you respond? | □ | □ | □ | □ |
| 3.Do you think you are able to see things from your clients’ point of view? | □ | □ | □ | □ |
| 4.Do clients disagree with you? | □ | □ | □ | □ |
| 5.Do you explore with your clients the consequences of alternative actions? | □ | □ | □ | □ |
| 6.Do you help clients to discuss painful memories or sensitive issues? | □ | □ | □ | □ |
| 7.Do you share all the information at your disposal? | □ | □ | □ | □ |
| 8.Do you help clients to discover their own strengths? | □ | □ | □ | □ |
| 9.Do you respect your clients’ right to reject your advice? | □ | □ | □ | □ |
What leadership style – authoritarian, participative or permissive – do you think you usually use?
What influences led you to develop this style?
Can you identify any advantages in using alternative leadership styles in your work?
Can you identify any aspects of your leadership style that you would like to change?
Leadership Responsibilities
The responsibilities of group leaders will depend on the role they take; for example, whether they are responsible for the practical organisation such as booking a venue. But whatever the role, a leader’s responsibilities may include:
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