Groups in college counseling centers

College Counseling Centers are a fertile environment for group psychotherapy, and group trainings specific to this environment are helping to shape a specialization that has taken root more than 30 years ago. The Special Interest Group—College Counseling and Other Educational Settings offered through the American Group Psychotherapy Association, currently lists over 200 members interested in supporting the group work offered within this context and over 450 clinicians have subscribed to a special listserv that focuses on this unique setting. Further efforts include a special edition of the International Journal of Group Psychotherapy, which specifically focuses on group interventions in college counseling centers (McEneaney & Gross, 2009). In this same edition, Drum and Knott (2009) elucidate their research which covers thirty years of theme groups within the college counseling milieu. Further, they highlight the relevance of theme groups in serving the broader range of needs that college students present. Johnson (2009) highlights an interpersonal process group model which parallels the relational needs of college students. Process groups expand on the homogeneity that a theme group serves and rather seek to provide a vehicle for students to explore trust, boundaries, flexibility, and shared space within the context of self and others. In some sense, the theme in process groups is around understanding and exploring dynamics of relationships and the patterns external to group that may repeat themselves within the smaller system of the group. The interpersonal process group also sets the stage for exploring identity issues including race, ethnicity, nationality, class, gender, religion/spirituality, ability, and sexual orientation, to name a few. Though these identity markers can also be explored through theme-oriented groups, the general process group allows for a rich context to explore intersecting identities within the microcosm of our larger society. Finally, more outreach programs to the wider campus community are utilizing the group format in creating dialogues on diversity and the intersection of identities.

College counseling centers usually offer a mix between theme-oriented, process, and psycho-educational groups. Most senior staff clinicians have received training in either theme-oriented or psycho-educational groups and less training with facilitating interpersonal process groups. As a result, the college counseling center is often a training ground for senior staff clinicians, limited in process group experience, as well as pre-doctoral interns and practicum students, who tend to have less group experience overall. At times, senior staff clinicians may co-facilitate a group together for specialized training. In contrast, interns mostly co-facilitate with senior staff clinicians, at least during the beginning of their training. There are also opportunities for those new to group to be process observers. A process observer sits within the group but does not speak. Rather they observe themes, patterns, and dynamics in the group and provide a process note at the beginning of the next group which will be read by all members. Usually, the note elicits a reaction by members and sets the stage for working through unfinished business from the previous week.

Training/Professional Development

Groups offer an important holding environment where trust, vulnerability, and belonging can be explored. Once cohesion building occurs in the forming stages of group, members can begin to work through differences, and inevitable conflicts can then be managed and explored. However, without proper training of the staff and buy-in, a group program cannot expand and flourish. Thus having someone coordinate group efforts, provide a plan for group development, assess the pulse of competency of staff, create opportunities for group consultation, and plan ongoing trainings are important keys to success for any organization wanting to expand in group programs, particularly college counseling settings.

Oregon State University’s Counseling and Psychological Services has had a productive history in offering a variety of therapy and support groups. There were several group coordinators prior to my taking on the role, but there was little to no training in groups at the time I started at the agency in 2005. Groups were seen more as an add-on rather than a primary modality compared to individual therapy. In 2007, however, staff at CAPS started more intentional group efforts by first assessing the staff’s self-reported competence and confidence in facilitating psycho-educational, support, and process groups. Based on the outcomes, which specified a higher need for training in process groups, we began offering an in-service on stages of group psychotherapy, followed by an every other week consultation hour provided by an external consultant that specialized in group psychotherapy. At the same time, we began a pre-doctoral training program of group psychotherapy with two 2-hour seminars on group dynamics and process. As our internship program became APA accredited, our commitment to group training also became stronger. Currently, our group therapy seminar for interns runs for 20 weeks every other week for 1½ hours each session during fall and winter terms. Furthermore, CAPS group program went from offering approximately ten groups in 2007 to offering 26 groups in 2012. Out of a staff of 18 clinicians, 16 clinicians (including the three pre-doctoral interns) facilitate anywhere between one and three groups for any given term. Our groups cover a range of topics that include psycho-educational-support for women with bulimia; ADHD support; social skills; transgender support; single-parent support; sexual assault/abuse support, mindfulness, anxiety and depression management; DBT skills; grief and loss support; LGB support; family systems process; Native American student support; alcohol/drug recovery; bipolar support; and several process groups. All of our groups range from five to eleven members with the higher numbers populating our LBG support and alcohol/drug recovery.

Assessing Outcomes

Though there are many outcome measures that help screen clients prior to joining the group as well as assess process outcomes at various intervals of the group, OSU’s counseling center has utilized resources on the listserv and created outcome evaluations to assess learning outcomes as well as satisfaction. For spring term, there were 129 respondents to our group evaluation at the end of the term. Participants from the groups that completed the evaluation included Bipolar Support; Women, Food, and Self-Esteem; LGB support; Family Matters; Grief; Interpersonal Process; Social Skills; Women’s Empowerment; and Alcohol/Drug Recovery. On a scale of 1 (strongly disagree) to 5 (strongly agree), the mean score in terms of leader satisfaction and feeling understood and accepted by the leader was 4.54, and the mean score for leader satisfaction and feeling challenged in a way to help myself was 4.37. In terms of students’ overall satisfaction with the quality of their group counseling experience, the mean was 4.51. We also assessed learning outcomes as applied to three areas including relationships, academics, and mood/emotions. Scores for the learning outcomes included “I am able to apply what I learned in group to my everyday life in my”: relationships—4.38; academically—3.95; mood/ emotionally—4.37. There are also other areas that we were interested in assessing with our group program. Other areas we assessed included “I made progress toward my specific counseling goals”: Mean score was 4.20; “Group helped me improve my ability to communicate and interact with others”: Mean score was 4.45; “Because of group, my overall wellbeing has improved”: Mean score was 4.33. Overall, our group outcomes seem to have positive satisfaction ratings as well as learning equal to our individual therapy outcomes. There does seem to be uncertainty with learning outcomes in terms of academics and learning. One question that we have is whether students are not able to see the link between counseling and academics in our process groups, since academically oriented groups (ADHD) tend to be the only groups that score high on assisting students academically, with usually a mean of 5.0.

Although our objective measures are valuable, there are many times when clinicians also receive cards or emails regarding their experience and learning in group. One email that was received was from an international student two years after terminating from a 20-week interpersonal process group. His email shared some insight into the lasting impact group psychotherapy had on him:

I have been in the group counseling/therapy meetings guided by you in winter 2010 back in my freshman year. I am [X, the international] student in that group. I would just like to thank you very much for the awesome help the counseling meetings provided me. I [am] now in a very good academic standard with 3.8 GPA and in the honors college as well. I am having the best college life I dream of with wonderful social life. Thank you very much for the awesome services you provide for struggling freshmen students. The group counseling really helped me get back on my track and get better on both social and academic life. Now, as I made it to my junior year, I really appreciate the services OSU provides to students that are often times not taken advantage of. Even though it has been two (or three years I think) years, I still appreciate your efforts you put in helping me get back and find my way through college life.

This type of qualitative feedback (e.g., a client emailing a few years after a group experience) is invaluable in that our objective measures tend to only capture learning at the end of a brief group experience. Furthermore, receiving feedback as in the above example two years after the group experience or from clients who return to CAPS wanting group again over individual therapy really validates the importance of college counseling centers offering group experiences to the students we serve.

Non-Clinical Setting

Finally, I would be remiss if I didn’t mention how group psychotherapy skills in the college environment are transferrable to a variety of programming efforts including outreach on various topics such as diversity dialogues and transitions. The common therapeutic factors (Yalom, 2005), particularly cohesion and universality are key components that propel a community to share vulnerabilities with each other and potentially make positive change, even outside of the clinical domain. This year we offered a program to the larger campus community on understanding isms, specifically “shattering mental health-isms.” We had 16 faculty and staff attend our session which we facilitated in a group format. In terms of satisfaction on a scale from 1 (strongly disagree) to 5 (strongly agree), participants rated their satisfaction with the group process as a 4.6; satisfaction with the facilitators as a 4.5; the topic as being interesting and relevant to my life as a 4.8; and the presenter being sensitive to the needs of diverse groups as a 5.0. Learning that was reported by the program’s participants had similar themes to our psychotherapy groups in that attendees felt not alone in their experiences, a better sense of community. Additional comments were “Better insight into mental illness” and “Learned about resources on campus. Very positive and supportive safe space. People care!” This program and many other types of dialogue programs affirm how group enriches college counseling center work and campus communities.

In closing, college campuses are a rich venue for the specialty skills of group psychotherapists both in and out of the clinical group milieu. These factors are particularly curative within the clinical domain of support and therapy groups, but they are also having profound effects within the outreach domain where the need for understanding, cohesion, and eventually differentiation with difficult issues are needed to create a more inclusive and caring community.

References

Drum, D. J. , & Knott, E. (2009). Theme groups at thirty. International Journal of Group Psychotherapy, 59(4),491-510.

Johnson, C. V. (2009). A process-oriented group model for university students: A semi-structured approach. International Journal of Group Psychotherapy, 59(4), 511-528.

Slocum McEneaney, A. M, & Gross, J. (2009). Introduction to the special issue: Group interventions in college counseling centers. International Journal of Group Psychotherapy, 59(4), 455-460.

Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.