GC SOC 386 Human Behavior and the Social Environment Full Course

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SOC 386 Human Behavior and the Social Environment Full Course Grand Canyon

GC SOC 386 Week 1 Discussion Latest

  1. Human Behavior and the Social Environment: Social Systems Theory National Association of Social Workers
  2. Use the NASW Code of Ethics as a resource for the Topic 1 assignments.

http://socialworkers.org/pubs/code/default.asp

Social Systems Theory Foundations

List of System :

  1. General system(Dale & Smith, 2013)
  2. Ecological theory(Dale & Smith, 2013)
  3. Functional theory(Dale & Smith, 2013)
  4. Symbolic  Interaction theory(Dale & Smith, 2013)
  5. Role theory(Dale & Smith, 2013)

Answer each question

Make sure that each answer is at least a paragraph long and has to be citied in apa

Discussions Questions

  1. “The Role of Theories in Social Work Practice” in Applying Theory to Generalist Social Work Practice. Why is it important for the generalist practitioner to understand theories? Identify which CSWE core competencies and behaviors address the need for understanding theory?
  2. “The Strengths Perspective” in Applying Theory to Generalist Social Work Practice. Identify and give examples of each of the key concepts of the Strengths Perspective as it applies to you.

 

 

GC SOC 386 GC Week 2 Discussion Latest

  1. Examine your role in a job that you had or that you are currently doing. Discuss your role from the perspective of social structure. Include social norms such as conceptions and expectations in your analysis. How can you apply this to your role as a generalist practitioner? Explain.
  2. What type of social work do you want to do? (Family and children) Discuss four behaviors that you will need to incorporate into the development of your professional identity as a generalist practitioner. What do you anticipate might be barriers to the development of your professional identity? How does a Christian worldview influence your professional identity?

 

 

GC SOC 386 GC Week 3 Discussion Latest

Week3 Psychological Theories

Answer each question

For question 1 The Eight Stages of the Life Cycle

Watch the video “The Eight Stages of the Life Cycle” from Films on Demand.

https://lopes.idm.oclc.org/login?url=http://fod.infobase.com/PortalPlaylists.aspx?wID=96349&xtid=44915&loid=121201

Bio psychosocial Model

Watch the video “Bio psychosocial Model” from Films on Demand.

https://lopes.idm.oclc.org/login?url=http://fod.infobase.com/PortalPlaylists.aspx?wID=96349&xtid=44901&loid=114708

  1. Review the last three stages of Erickson’s psychosocial stages. Watch the videos “Bio psychosocial Model,” and “The Eight Stages of the Life Cycle.” What do you think are the critical social systems during the last three adult stages and why?

 

For question 2 Psychodynamic Theory: The Essential Elements

Read 6.2.16 “Psychodynamic Theory: The Essential Elements” in The Blackwell Companion to Social Work by David Martin (2013).

6.2.16 Psychodynamic Theory: The Essential Elements Jack Nathan

Whilst differences exist between different psychoanalytic schools, clinicians working within the ‘psychodynamic frame’ share certain key elements. The first key element is that the mind operates on a conscious and an unconscious level, and that there is a dynamic relationship between these two levels of consciousness that result in powerful internal psychic conflicts. For example: Tom repeatedly misses key meetings with his worker regarding having his child back home. His conscious explanations include: he ‘forgot’, ‘the traffic was bad’, etc. These accounts mask unconscious dynamics which may include being fearful of the worker’s persecuting authority (‘I’m going to be attacked for being a bad father’), Tom’s tendency to sabotage progress in their work together (‘I destroy all my relationships, even with my child’), even that he does not want his child back (‘I’m too much of a child myself to be a responsible parent’) and so on. Implicit in this form of practice is hermeneutics: ‘the making of meaning’ where the practitioner’s task is to explore the client’s behavior. This is particularly the case when confronted by what appears, at a ‘common sense’ level, contradictory: viz. Tom consciously asserts that he wants his child home. The need to understand psychic conflict and how we ‘make meaning’ of highly destructive forms of behavior is especially crystallized in clients who self-harm. For example, Sarah tells her social worker that as well as regularly burning herself, when cutting her legs with a razor blade, she pours acid on the wounds. The client is both a ‘victim’ of the cutting, burning, etc., and also the ‘perpetrator’ of these self-damaging acts. Such behaviors, however destructive, do having meaning: as a way of managing overwhelming anxiety, and/or as an expression of rage against her hated ‘weakness’ and/or a protective act ensuring that she doesn’t violently attack someone else.

Such complexities are further compounded by the hugely powerful emotions aroused in us as practitioners. We can feel particularly perplexed, when confronted by the sheer violence of the self-harmer. This touches on another key feature, namely that ‘meaning making’ fundamentally arises out of the relationship with the worker. This places the client– practitioner interaction at the heart of the work. This does not mean the outside world is ignored, as engaging and negotiating with external reality is essential to therapeutic progress. The relationship is a ‘working laboratory’ exploring how the client functions ‘out there’, by paying careful attention to what is happening in treatment. For example, in a supervision group, Femi, a mental health social worker, presents a first meeting with Barbara, who accuses him of wanting to section her. A picture emerges of a woman who was abused by her father over many years. It then becomes clearer that Barbara comes to the meeting with a predetermined sense of an abusing male authority figure, mirroring her experience of her father. Freud referred to this phenomenon as the transference, by which he meant that experiences ‘belonging’ to the past are inevitably experienced in the present. Barbara carries an historical burden that corrupts her relationships in her current life. It is through the seminal work by Bowlby (1971) on attachment that we have come to understand these processes in greater detail. What we now understand is that Barbara views the new worker through the prism of a pre-existing ‘internal working model’.

To make sense of these dynamics requires an emotional strength and self-knowledge as powerful emotions are inevitably aroused in the practitioner. Freud called this the counter-transference, by which is meant the totality of the practitioner’s emotional responses to their client. He suggested that our own personal issues can limit the work with our clients, hence the importance of personal therapy for therapists. However, the counter-transference can also tell the practitioner something that the client is not conscious of. For example, when a client spoke in a flat, detached manner about not having seen his 3-year-old daughter for two years, I felt a tearful sadness and suggested that he was not letting me know just how upset he was feeling. He began to cry describing with a forlorn intensity the longing for his beloved daughter: an experience he had so penetratingly communicated non-verbally to me. Such experiences reflect a further key feature, namely the use of defenses – in this case, projection , a mechanism whereby the client ‘pushes’ feelings he does not want to experience onto me; I then have his sense of unacknowledged anguish about his daughter. From today’s vantage point it is difficult to appreciate just how revolutionary Freud’s work really was. Unlike conventional practice at the time that was geared to making symptoms disappear through hypnosis, Freud encouraged his mostly female patients to ‘free associate’ i.e. to talk about whatever came to mind. Personal experiences, however strange or bizarre, were now being taken seriously as ‘signals from the unconscious’ with profound idiosyncratic meaning and not simply the hysterical ranting’s of the ‘mad’.

Psychodynamic work is designed for use with any service user wishing to think about their part in what ‘happens to them’. One client put it succinctly: ‘After 10 years of failed relationships, I concluded that there was only one common denominator: it was me.’ She needed to find out what ‘goes wrong’ through engaging in a relationship with a therapist. Because of the emphasis on making the unconscious conscious, the client has to have some capacity to take responsibility for these insights and therefore subsequent behaviors. In modified forms of psychodynamic work, the practitioner can support such change through the use of more cognitive and behavioral techniques. Thus, other than the limitations imposed by clients who are actively abusing drugs or alcohol, there are no constraints on undertaking psychodynamic treatment. Psychodynamic work has 120 years of scholarship behind it. There is a growing body of evidence in both short and long-term work with depression and the range of personality disorders based on metallization-based therapy and transference- focused psychotherapy.

  1. Write a reflection on “Psychodynamic Theory: The Essential Elements” by Jack Nathan. Discuss the concepts of transference and countertransference. Review the CSWE core competencies and behaviors. Which competencies and practice behaviors address the issues presented in transference and countertransference situation? Explain your rationale. Post your reflection to the Discussion Forum.

For assignment Application of Psychosocial Theory to Gerontology Systems

Electronic Resource1. National Association of Social Workers

Use the NASW Code of Ethics as a resource for the Topic 3 assignments.

http://socialworkers.org/pubs/code/default.asp

  1. Erik Erikson’s Identity Crisis: Who am I?

Watch the YouTube video: Erik Erikson’s Identity Crisis: Who am I?

  1. Person-Centered and Participant-Directed Social Work Competencies

Read “Person-Centered and Participant-Directed Social Work Competencies” (2016) from the Council on Social Work Education website.

http://www.cswe.org/File.aspx?id=70727

  1. Geriatric Social Work Competency Scale II with Life-long Leadership Skills

Read and review “Geriatric Social Work Competency Scale II with Life-long Leadership Skills: Social Work Practice Behaviors in the Field of Aging” from the Council on Social Work Education website.

http://www.cswe.org/File.aspx?id=25445

  1. Alzheimer’s Patient Case Study

Watch the video “Alzheimer’s Patient Case Study” from Films on Demand in the GCU library.

https://lopes.idm.oclc.org/login?url=http://fod.infobase.com/PortalPlaylists.aspx?wID=96349&xtid=32231&loid=4002

 

GC SOC 386 Week 4 Discussion Latest

Human Behavior and the social environment

DQ 1

Read the Case Example of Hamad Sarraf in Chapter 7 of “Applying Theory to Generalist Social Work Practice.” Discuss two cognitive behavioral theraphy (CBT) strategies and two CSWE competencies/behaviors that are critical for Sarraf as he leads the parenting group.

Case Example:  Hamad Sarraf is a parent educator who was hired by a Head Start program after completing his Bachelor of Social Work (BSW) degree. Head Start is a prevention program that supports at-risk youth by providing preschool education, parent training, and case management to help meet the basic needs of the children and families. One of the primary purposes of the program is to prepare a child for kindergarten. Many preschoolers who attend this program demonstrate behavioral problems, including low attention span, conflict with peers, and difficulty following the program rules. These challenges could hinder a child’s success when entering elementary school. Hamad’s job is to meet with parents both individually and in a group setting to respond to these behavioral challenges by providing support and education for the parents.

There are many ways in which Hamad applies the principles of cognitive and behavioral theories in this work as a parent educator. As one example, he provides psychoeducation when he meets one on one with parents and when he facilitates the parenting group on Thursday evenings. Psychoeducation for parents involves teaching families about how to create an environment that supports healthy functioning of a child (Corcoran, 2003). Parent skill training according to cognitivebehavioral theories involves (a) helping parents shape positive behavior in their children by setting up reinforcement schedules and (b) replacing unhelpful thinking patterns with parenting schemas that support effective parenting.

On Thursday, Hamad started his first parenting group. Six single parents and three partnered couples attended the group to learn about how this Head Start program can support their parenting. Hamad chose to start the group by using Socratic questioning, asking the parents to discuss what they see as their primary purpose as a parent. This question offered an exploration of automatic thoughts and core beliefs that inform parenting strategy. The parents discussed a series of thoughts ranging from a primary focus of safety to one of responsibility to teach their children how to develop into productive citizens within their communities.

Although most of this conversation was quite positive, one mother appeared frustrated by the group experience. Brenda Davis, an African American grandmother, was raising her three grandchildren, and the youngest was enrolled in the Head Start program. When Hamad asked Brenda for her thoughts about parenting, she asked in return, “Can I ask you something? How old are you, and do you even have any kids of your own?” Hamad, a 23-year-old recent BSW graduate of Iranian descent did not have children and was raised in a small rural town, quite different from the large metropolitan area in which this Head Start program resided.

Hidden in Brenda’s comments was a fear that this young man, whose experiences in terms of his race, culture, and lack of parenting history were so different from Brenda’s own, may make him unhelpful as a leader of a parent education group. This fear may be warranted based on Brenda’s previous experiences. Hamad responded to Brenda’s question openly and respectfully, stating, “I am happy to answer your questions. But first, can you tell me a little bit about what about this information is important for you?” This question is a way of understanding Brenda’s position. It also offers an exploration about her thinking patterns, her past experiences, and how these inform this current interaction.

Brenda explained to the group that she had been in previous groups with young, inexperienced social workers who she felt did not understand the challenges of being a grandmother raising three African American young men in a community that was primarily Latino and white. She stated that she has felt judged and unsupported by previous service providers and therefore did not trust that this group experience would be helpful for her. Hamad first modeled open communication listening closely to Brenda’s concern. Rather than trying to defend his ability to lead the group, he validated Brenda’s concern through minimal encouragers and nonverbal responses that demonstrated he was interested in hearing her concerns.

As he encouraged Brenda to speak further, it became clear that Brenda’s thinking about this group was based on previous negative or ineffective experiences. It is not unusual for clients to enter a new helping relationship with concerns grounded in previous negative experiences, leading to automatic thoughts about a current helping relationship. Hamad took this opportunity to understand the thinking processes on which Brenda’s initial question was grounded. He used the microskill of summarization to reflect Brenda’s concern and acknowledged how frustrating it must be to have such extensive yet unvalued parenting experience as a mother and grandmother. As a way of restructuring her thoughts, Hamad behaved in a way that was different from Brenda’s past experience. He acknowledged Brenda’s expertise and then responded to her initial question, stating that he was young, did not have children, and would not pretend to have more to say about parenting than someone with her history. He then explained that he was a facilitator of the group, that he was there to provide support to parents and facilitate dialogue with the group about parenting, and that he would personally commit to her that her experience was an essential part of this group discussion and that her expertise would be valued. After this exchange, Brenda appeared more comfortable. She stated that she appreciated his honesty and pointed out that his approach was different from previous experiences.

In this exchange, there are several examples of cognitive and behavioral theories. First, Hamad was modeling the type of interaction he was hoping to achieve in the group. Second, this modeling and his direct statement that he would honor Brenda’s experience was a way of restructuring her thought processes about what it means to be in this helping relationship. Hamad was not claiming that all helping relationships moving forward would be positive or would look like the one being established in this group, but he was causing Brenda to view this helping relationship in a different way, thereby increasing her willingness to participate. Finally, shaping was present. When Hamad reinforced Brenda through supportive interviewing skills, he encouraged the behavior of open dialogue. When Brenda then responded positively to Hamad and thanked him for answering her questions honestly, she in turn was reinforcing his approach. As the group continued, interventions including modeling, shaping, and cognitive restructuring were a part of the content of parent training and were implemented throughout ongoing interactions within the group.

Student Application of Skills As described in Chapter 1, social workers use microskills to facilitate social work interviews. Several basic and advanced interviewing skills have been discussed in this chapter. For example, we discussed the use of Socratic questioning and open-ended questions to uncover unhelpful automatic thoughts and schemas. In contrast, active listening techniques such as reflecting feelings and content may be helpful when seeking to understand the links among cognition, emotions, and behavior. Consider the following questions to increase your understanding of how social work skills are used to implement cognitive and behavioral theories. 1. 2. When social workers use cognitive and behavioral theories, assessment involves collecting information about the duration, severity, and intensity of the problem. What questions might you ask when conducting an assessment with a young mother whose 5-year-old is refusing to attend kindergarten because of anxiety? Information sharing is an advanced interviewing skill that fosters growth by offering new understanding about a particular topic. Psychoeducation, as discussed earlier in this chapter, is an example from cognitive theory of information sharing. What information might you share with this mother regarding how positive and negative reinforcers may be encouraging her child’s problem behavior? Part of intervention according to cognitive theory involves identifying and restructuring illogical beliefs. You may help the child to imagine what it feels like to walk into kindergarten. The microskill of asking questions might be used to help the child talk about what he is thinking as he imagines entering school. This process is done to uncover automatic negative thoughts. Describe how you would structure this imagery activity to fit the developmental stage of a 5-year-old. Behaviorism suggests behaviors that are reinforced will be increased. You may intervene in this situation by meeting with the mother to create a reinforcement schedule to encourage her son when he makes the choice to attend school. How would you and the mother work to create this schedule? How would you determine which reinforcements should be included? Compare and contrast what a social worker using cognitive and behavioral theories might be thinking about this case compared with a social worker who is using a strengths perspective. What might be similar and different according to these varied theoretical approaches? How are microskills implemented differently when contrasting cognitive and behavioral theories with a strengths perspective?

Strengths and Limitations of Cognitive and Behavioral Theories As mentioned in Chapter 1, social work has become increasingly interested in identifying and choosing interventions that are identified as effective through research evidence. One of the strongest benefits of choosing CBT is that it has been established through extensive research evidence as effective for anger management (Beck & Fernandez, 1998), depression (Beck & Dozois, 2011), and other psychiatric disorders (Butler, Chapman, Forman, & Beck, 2006). CBT has demonstrated positive effects for children and adolescents (James, James, Cowdrey, Soler, & Choke, 2013), young and middle-age adults (Stewart & Chambless, 2009), and older adults (Shah, Scogin, Presnell, Morthland, & Kaufman, 2013). Therefore, CBT is one of the most widely used interventions across social work settings. Cognitive and behavioral theories also offer both an explanation and a corresponding intervention for application with various client groups and social problems. Some people might suggest that cognitive and behavioral theories are well developed. The concepts and underlying principles are relatively clear, increasing the ease of application for many social workers, particularly when training has been provided regarding specific cognitive and behavioral interventions (Shah et al., 2013). However, cognitive and behavioral theories have some important limitations that should be understood. One concern is that they tend to focus on individual functioning and pay little attention to macrosystem influences (Walsh, 2010). As described in Chapter 2, social work values a person-in-environment perspective that considers how the interaction with environment and society provides an important explanation of behavior. Cognitive and behavior theories remain focused on the individual and the closest systems. For practitioners working on a mezzo practice or macro practice level, cognitive and behavioral theories may be less helpful. Another limitation of cognitive and behavioral theories stems from a concern that by seeking to change thoughts and behavior, these methods can give social workers too much authority. Social work as a profession values self-determination and advocates a client’s right to autonomy. Some people are concerned that an irresponsible use of cognitive and behavioral theories can replicate the experience of colonization through which marginalized groups are required to adapt to the social norms and values of the dominant society. Although some of the theoretical perspectives discussed earlier in this book, such as the strengths perspective, seek to build egalitarian relationships with clients, early implementation of cognitive and behavioral theories was founded in the idea that the expertise for how best to make changes lies within the professional. This is not to say that all social workers engaging in cognitive and behavioral theories practice according to this assumption. As mentioned in Chapter 1, many workers integrate a set of theories to overcome the limitations of one theory. Integration is one way to address this problem. It is essential that practitioners implement any theory according to social work’s mission and values. To employ the theoretical assumptions of cognitive and behavioral theories, particularly when working with underprivileged groups such as children and people of color, it is essential that social work practitioners understand the potential risk of using cognitive-behavioral interventions in a way that imposes values inconsistent with the worldview of a child, adult, family, or community.

DQ 2

Principles of Cognitive and Behavioral Theory (CBT) are discussed with several examples of how CBT is applied. You are a case manager for a homeless veteran named Sam. What three strategies from CBT would you use and what specifically would you do? What questions would you ask? What would you attempt to implement that helps Sam based on the CBT model.

 

 

GC SOC 386 Week 5 Discussion Latest

Please answer each DQ.

Read “Case Study 7-1: A Mutual-Aid Support Group for Persons With AIDS in Early Substance Abuse Recovery” in Case Studies in Social Work Practice.  Case study listed below. Answer question #1 and #2 that are posed at the beginning of the chapter.

  1. What skills are evident in the group leader’s approach to working with the group and the individuals in the group? 2. What types of follow-up and supplementary services would be appropriate for clients during the life of the group and after completing the group?

Read “Case Study 7-1: A Mutual-Aid Support Group for Persons With AIDS in Early Substance Abuse Recovery” in Case Studies in Social Work Practice. Case study listed below. Answer question #3 that is posed at the beginning of the chapter.

  1. How did the group leader address the issue of the group member– group leader dynamics referred to as the authority theme early in the first sessions?

Case Study 7-1 A Mutual-Aid Support Group for Persons with AIDS in Early Substance Abuse Recovery 

Persons with AIDS who are in substance abuse recovery struggling with similar concerns can gain support and resources through mutual-aid groups. This case study illustrates the social worker’s methods in enhancing mutual aid among participants in an intensive, 8-month, weekly group held in a residence sponsored by an AIDS Action Committee. Questions 1. What skills are evident in the group leader’s approach to working with the group and the individuals in the group? 2. What types of follow-up and supplementary services would be appropriate for clients during the life of the group and after completing the group? 3. How did the group leader address the issue of the group member– group leader dynamics referred to as the authority theme early in the first sessions? 4. What did the group leader do to create a “demand for work” in the group during the fourth session when he recognized the illusion of work?

Case Studies 5. in Group Work In what ways did the group leader help move the group from the beginning through ending and transition phases of group work? This is a case illustration of social work practice with a small group of five clients, all facing the dual struggle of coping with AIDS and early substance abuse recovery. 1 This group was held in the early days of the AIDS epidemic, with the triple drug therapy just undergoing testing. Three members were using the therapy and showing progress in lowering their viral counts and raising their white blood cell counts. They were hopeful for a cure. One member, Theresa, was waiting for her blood work levels to make her eligible for the treatment. The fifth member, Tina, was transgendered and, because of the use of hormone drugs for her transition from being a man to a woman, she would not be eligible for treatment. As she pointed out: “I know I’m going to die from the virus, but at least I would like to die with dignity and not be standing on street corners sucking old men’s dicks for drug money.” For each client, an additional and related issue was dealing with the impact of serious early physical, emotional, and sexual abuse in their childhood and adolescence. Maladaptive efforts to cope during their teenage and early adult years, including serious substance abuse, also had a devastating impact on group members. For each client, there were added layers of complexity caused by poly substance abuse, criminal behavior, prostitution, homelessness, prison time, and destructive interpersonal relationships. The group members’ ability to trust and to develop true intimacy after so many years of being exploited, as well as having exploited others to meet their emotional and drug needs, was severely diminished. Despite these obstacles, this is also a story of magnificent courage in the face of adversity and the wonderful ability of mutual aid to uncover and nurture the essential impetus toward social connection and caring. The approach used in this case example focused on the development of a mutualaid process in the group (Schwartz, 1961; Shulman, 2011, 2012). The underlying assumption was that these clients, who were struggling with similar concerns, could be helpful to each other. The task of the social worker was seen as helping the group members to help each other. In addition, as an example of longer term group work (8 months), the impact of time on the process is evident. The clients, my coleader, and I were conscious of the need to work directly and quickly in order to make the best use of the time available. As will be seen repeatedly in the case example, the clients are simply waiting for the signal from the group leaders that they are ready and willing to work on tough issues. The First Session: The Beginning Phase Our goals in the first session were to establish a clear sense of group purpose reflecting the common ground between the needs of the members and the service offered by the agency. We wanted the group members to get a sense of our roles not as experts on life but rather as group leaders (one social worker and one substance abuse counselor), who were there to help them to be sources of support for each other. In addition, we hoped to set out the ground rules and to develop a beginning sense of trust in us as the leaders (leader– member alliance), as well as in other group members (member– member alliance). Also important was the need to convey what I call “the demand for work.” We wanted the clients to get a sense that we meant business and that, in this group, we were prepared to deal with tough and painful issues and emotions just as soon as they felt ready. Our signal to them came in my direct opening statement as well as my effort to reach for painful feelings. To fashion an appropriate opening statement, I had consulted with staff and other clients in similar situations and then decided on the following: Everyone in this group is struggling with AIDS and early recovery from some form of substance abuse. Most of you currently are or may have in the past attended 12-step groups such as AA or NA, at which you are able to share your experiences coping with addiction and recovery. In addition, you are currently or may have in the past attended groups at AIDS Action that address the particular struggles you face dealing with whatever phase of the disease you are experiencing. You can talk about recovery at your AA and NA groups, but most likely you don’t feel comfortable discussing your AIDS. In turn, AIDS is on the agenda for your AIDS groups, but it may be more difficult to discuss addiction and recovery. This group is a place where you can discuss both— AIDS and substance abuse recovery— as well as how the two interact and affect each other. Heads were shaking affirmatively as I spoke, so I continued to describe our roles and clarify the issue of confidentiality as follows: John and I will be the co-leaders of this group. We don’t see ourselves as experts, here to give you advice. Our job is essentially to help each of you help each other. We think you are the experts on your own lives and that you have a lot you can give to each other, having experienced similar problems and challenges, so we will try to help you do that. I pointed out that the discussion in the group would be kept confidential and that we would only be required to share information if they disclosed there was a danger to themselves, a danger to others, or criminal activity taking place in the residence. John and I could assure them of confidentiality as the coleaders, and I hoped they would agree to respect confidentiality as well. Heads were once again shaking affirmatively. My next effort was to encourage more specifics in this problem-swapping process. I wanted to help them develop an agenda, one with which they could all connect. Also, it is only in the specifics that real help can be given. I asked them if they could take some time to share some of the specific issues they faced and that we could talk about in the group. I pointed out we did not need to solve all of these problems in one night, but it might help to identify issues for group discussion. The issues they shared were mainly related to the problems they faced in early substance abuse recovery. Since the group started just before Thanksgiving, many members, including Tina, described the temptations they experienced going to parties where drugs were plentiful or attending family events (Jake) with significant consumption of liquor or drugs. One member, John, described the problem of wanting to see his friends at the local pool hall, but that was the place where drugs were sold. In an example of the members drawing on their AA and NA experiences, one member said to John: “If you hang around a barbershop long enough,” and as he hesitated, the other group members said in chorus: “You are going to get a haircut.” We all laughed at this AA saying. Another member, Theresa, told group members that she was living in a nearby singleoccupancy building and was hoping to be accepted into this residence. She said: “There is drug dealing in that building, and I know I have to get out or I’m going to relapse.” The barbershop analogy was one example of their drawing on their 12-step group experiences. One member, Jake, had a problem understanding that this mutual-aid group was different from the 12-step groups since we actually encouraged them to respond to each other, which was not encouraged as participants told their “drug stories” or “drugalogues” at meetings. I noticed at the next few meetings that he brought handouts for me from the other programs. When I asked why he was doing this, he replied: “Well, it’s obvious you need help in running a recovery group.” I laughed and said I could use all the help I could get. I used this as an opportunity to address with the group members what they all perceived as a different kind of group. Even with a clear statement of purpose and our roles in the first meeting, it is wrong to think they all heard, understood, and even remembered what we said. As the meetings proceed, re-contracting is needed to help them really understand. At the end of the first session, we asked them to comment on the group— both what they liked and also what they didn’t like about this session. One member, Tania, commented on the tough time they faced dealing with early recovery and then pointed to me and my co-leader and said: “Well, you both understand.” I took that as an indirect cue that she was raising the authority theme. I responded directly to what I perceived as an indirect cue and said: Tania, I think what you really are asking is have we been in recovery and would we understand what you are going through. I can speak for myself, and the answer is that I have not. I teach at the School of Social Work, and each year I lead a group to help me to stay close to the realities of practice, and this group is the one I decided to work with this year. If I’m to be helpful, I’m going to have to understand, and you are going to have to help me. She smiled and said: “So, you’re not a narc” (narcotics cop). I laughed and said I wasn’t and pulled up my sweater and said, “See, no wire.” A noticeable relaxing of the group members followed my response. I said, “Trust does not come easily, so you have to give us a chance, and I hope we can earn your trust over time.” My co-leader, who was in recovery, responded by saying: “I am in recovery; however, recovery is different for each of us, so we will need to understand what it is like for you.” Who you are and what kind of group leaders you will be are the primary questions in a first meeting (the authority theme). These questions are often raised indirectly, as in this example, so the group leader has to be ready to hear them and to respond. In their theory of group development, Bennis and Shepard (1956) suggested that the group has to first deal with the leader and then members can turn to dealing with each other. It really didn’t matter, in the long run, whether my co-leader and I had been in recovery. As in this example, both I and my co-leader had to make clear we were there to learn from them as the experts in their own lives. The meeting was ending at this point, and I noted that one member, Kerry, who had told us at the start that he could only stay for the first of the 2 hours, had stayed for the full session. I pointed this out and asked him his views on the session. He said he had been reluctant to come, but it looked okay as long as we meant what we said about keeping the discussion confidential. It’s interesting to note that each member directly or indirectly raised an important issue for their work in the first session. The member, John, who was concerned about the pool hall, did relapse but then returned to the group after a week at a detox center. Both members who raised the authority theme, Tina and Kerry, were mandated to attend this group or some other form of service by the residence staff because they had broken the rules and used drugs in the residence. Kerry left the residence and moved to New York City and was the only dropout in the group. Tina stayed and participated fully in the remaining group sessions. The Fourth Session: The Transition to the Middle (Work) Phase In a group such as this one, meeting 2 hours per week over 8 months, at some point the group must make the transition to the middle or work phase. If the contracting work has been clear and the group leaders have defined their roles and addressed the authority theme, then the group is now poised to move to the next phase. Note that I said addressed the authority theme, not resolved it. The authority theme will reemerge during the life of the group and return with some force as the group prepares to end. The signal to the group leader that the group is prepared to shift to deepen the work often emerges as what I call “the illusion of work.” That is, conversation is taking place and it looks like real work, sounds like real work, but somehow it’s missing the emotions or content that may be experienced by group members as taboo. In other words, the group members have to address the culture of the group— the norms, taboos, stated and unstated rules, roles, and so forth— that make up what I call “the-group-as-a-whole.” This organism is more than the sum of its parts. It is the culture that is created beginning with the first session— usually reflecting the general culture in our society— or in this case, the culture of addiction. It is not possible to physically see this group and its culture; however, the leader will see the group acting as if it is there. For example, a shared but unstated taboo subject may be AIDS. Their past experience in 12-step groups encourages a norm to maintain the AIDS discussion-free zone in this group. The signal to me that this norm was blocking the group from moving into the work phase was the concentration in the first three sessions on substance abuse recovery, with almost no discussion of their struggle with AIDS. I decided to challenge this illusion of work, to make what I call the “demand for work,” and to explore the possible reasons for the evasion of work in the following way: When we started the group, we said this was a place to discuss both your struggle with recovery and dealing with AIDS and how they impact each other. For the first three meetings, all you have discussed is recovery, and you have avoided talking about AIDS. How come? Is it too hard, too painful, too scary, or maybe too embarrassing to talk about? In most cases, this would result in a group discussion of what made it hard and what, if anything, would make it easier. As the members talk about what made it hard or easier, they were also talking about AIDS. For example, if they mentioned the issue of stigma as a barrier, they would actually be talking about what it was like to have AIDS, how others saw them and they saw themselves. There are many false dichotomies in our practice, where we think two ideas are diametrically opposed and we fail to see the connection. Talking about process in the group is often posed as a choice the leader makes instead of dealing with content . I argue that this is a false dichotomy, and as the members talk about what makes it hard to discuss AIDS (the process), they are really well into deepening the discussion of the content. In this case, in response to my gentle confrontation, Theresa, who emerged as an internal leader in the group (the group leaders are the external leaders), began to talk with great emotion. Theresa started to talk about her concerns. She said she was 18 months clean and sober, and so she was in the middle of the second year, which was a “feelings year.” She went on to describe that this was the period when she and, she thought, everyone in recovery, started to face all those feelings they had been running from. She said it was a complex and difficult time, and that it was hard to sort things out. She went on to say that her boyfriend had trouble sharing his feelings with her. When she wanted to talk to her boyfriend about issues, such as her AIDS, he pulled back and told her it was too painful. As a result, she backed off. She knows he’s experienced a lot of losses, including the death of his wife from illness fairly recently, and she realizes he is still early in recovery, but she has things she wants to talk to him about. She has a closeness she wanted to achieve. She has some commitments she wants from him, and she is afraid that he can’t make commitments at this point. He’s holding back. I asked the others in the group if they had any advice for Theresa on this issue. Theresa had spoken with great emotion, and I was determined not to do casework in the group, and instead, to wait for members to respond. Kerry, who usually sits quietly at the meetings, and who had indicated that he was going to have to leave early that night, jumped right in. Kerry said he thought that her boyfriend was having trouble dealing with his losses, and it wasn’t easy. He described a very close relationship with his partner, Billy, that ended 2 years ago, when his partner died of AIDS on Christmas Day. He said he still didn’t think he’d come to grips with all of the feelings that he had and the loss that he’d experienced. I said that must make each Christmas even more difficult for him, and he agreed. He went on to talk about how he had been raised by an extremely physically abusive mother and that his grandmother was the only person who provided him with any support and love. He said he didn’t think he had gotten over her dying either. He told Theresa that she had to realize that the process takes a long time and that it might not be easy for her boyfriend to discuss it with her, because he knew it wasn’t easy for him to discuss his loss with other people.

As Kerry talked, I saw a sensitive and caring side of him that he keeps covered up with his abrasive, grandiose, angry front, with his consistently telling us he doesn’t need anybody and, if they don’t care about him, “the hell with them.” Theresa acknowledged his comments and thanked Kerry for sharing that with her, as did the other group members. Tania came in at that point and reinforced what Kerry had been saying. Jake was shaking his head as if he understood that difficulty as well. In this next excerpt, we see the group members accepting our invitation to help Theresa and, by doing so, really also helping themselves. This is an example of another false dichotomy: “Do we deal with the individual problem or do we deal with the group?” By helping the group address each individual’s specific concern, they are also addressing their own versions of the same issues. You do not have to choose between the individual and the group, just as you don’t have to choose between content and process. You do have to recognize the connections between these supposedly alternative choices. Whenever a group member raises a general problem, there is usually a specific, recent example that is creating a sense of urgency. I attempted to help Theresa elaborate on her “first offering” by using a skill I call “reaching from the general to the specific” (Shulman, 2011, 2012). I asked Theresa if anything had happened recently to make her feel so strongly about this issue. Theresa described an incident that led to a major fight with her boyfriend. They were in a car together, and she was in the back

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