Mutual Aid Based Group Work

Andrew Cicchetti (Member, AASWG, NYC Chapter) presents in this entry a discussion of mutual aid based group work. A point derived from this discussion is that the social worker-led group that seeks to cultivate mutual aid is better designated as 'mutual aid based group work', rather than 'mutual aid group' as is often the case in the social work literature. The term 'mutual aid group' should be reserved for the mutual aid/self-help group. Furthermore, the term 'mutual aid based group work' more accurately reflects the dynamic that emerges from the presence of a worker invested in maximizing the group's capacity for mutual aid.

Mutual Aid in the Social Work Group
Mutual aid as group work technology can be understood as an exchange of help wherein the group member is both the provider as well as the recipient of help in service of achieving common group and individual goals (Borkman, 1999; Gitterman, 2006; Lieberman, 1983; Northen & Kurland, 2001; Schwartz, 1961; Shulman, 2006, Steinberg, 2004; Toseland & Siporin, 1986). The rationale for cultivating mutual aid in the group encounter is premised on mutual aid's resonance with humanistic values (Glassman, 2002) and the following propositions: 1) members have strengths, opinions, perspectives, information, and experiences that can be drawn upon to help others in the group; 2) helping others helps the helper, a concept known as the helper-therapy principle (Reissman, 1965) which has been empirically validated (Roberts et al, 1999); and 3) some types of help, such as confrontation, are better received when emanating from a peer rather than the worker (Shulman, 2006). Mutual aid transactions that occur amongst and between members stimulate cognitive and behavioral processes and yield therapeutic, supportive and empowering benefits for the members (Breton, 1990;Northen & Kurland, 2001; Shulman, 1986, 2006).

The role of mutual aid processes in the social work group is illuminated by Gitterman (2006), a contemporary expert on mutual aid based group work from the field of social work. Gitterman (2006) contends that “mutual aid is the major rationale for the provision of group services” (p.93). Gitterman (2006) elaborates on mutual aid in the social work group noting that, “as members become involved with one another, they develop helping relationships and become invested in each other and in participating in the group” (p.93). The mutual aid processes that unfold help group members “to experience their concerns and life issues as universal”, “to reduce isolation and stigma”, “to offer and receive help from each other”, and “to learn from each other’s views, suggestions and challenges” (Gitterman, 2006, p.93).

The Concept of Mutual Aid
The concept of mutual aid was first elaborated by Kropotkin (1903), one of the most important evolutionary theorists and socio-biologists of his time, as an evolutionary theory to expand upon that proposed by Darwin which underscored the role of struggle and competition encapsulated in the notion of ‘natural selection’ amongst species, an idea often understood as ‘the survival of the fittest’. Kropotkin (1903) argued that mutual aid as exemplified in efforts at cooperation in the face of common environmental threats was a significant factor in the survival of species. Upon being influenced by a lecture entitled “On the Law of Mutual Aid” delivered at the Russian Congress of Naturalists in January, 1880, by noted zoologist, Professor Kessler, and through his own observations of a number of species that placed communal needs before individual needs rather than engaging in competition for survival, Kropotkin formulated the theory of mutual aid (Kropotkin, 1903). Kropotkin underscored the role of mutual aid with this observation:

“…wherever I saw animal life in abundance…on the lakes…in the colonies of rodents…in the migrations of birds…
in a migration of fallow dear…I saw Mutual Aid and Mutual Support carried on to an extent which passed before my eyes, I saw in it a feature of greatest importance for the maintenance of life, the preservation of each species, and its further evolution” (p.ii).

The role of mutual aid in human society was observed by Kropotkin (1903) as well. Kropotkin (1903) observed:

“the mutual aid tendency in man has so remote an origin, and is so deeply interwoven with all the past evolution of the human race, that it has been maintained by mankind up to the present time, notwithstanding all vicissitudes of history" (p.145).

He noted the role of mutual aid in primitive societies as well as his then contemporary society. He found himself “struck with the immense part which mutual aid and mutual support principles play even now-a-days in human life” (Kropotkin, 1903, p.148). Principles of mutual aid are operating in spontaneous neighborliness; utopian cooperatives; trade unions; labor unions; and the settlement house movement (Katz and Bender, 1976; Lee and Swenson, 2005).

The concept of mutual aid bears resemblance to that of social support (Lee and Swenson, 2005). Social support is thought to buffer or cushion the individual from potentially harmful or physiological conditions (Caplan, 1974). Social support can include professional helping offered by an individual worker; this however, represents a departure from the concept of mutual aid as treatment technology. The bi-directional nature of mutual aid is more clearly illuminated when the concept of social support from peers is paired with the helper-therapy principle (Lee & Swenson, 2005; Reissman, 1965). This principle hypothesizes that helping others helps the helper (Reissman, 1965), a hypothesis supported by empirical findings (Roberts et al, 1999). This concept is resonant with the concept of altruism, identified by Yalom (1995) as a therapeutic factor available through group therapy.
Furthermore, Reissman (1965) suggests that the principle impacts the group as a whole:

“not only are individual group members aided in the group, but the group as a whole may be greatly strengthened in manifold ways as it continually offers assistance to individual group members” (p.32).

The Group as Mutual Aid System
While mutual aid has been inarguably a feature of social group work since the earliest of incarnations, William Schwartz in introducing the phrase brought greater primacy to the concept and the view of the group as an enterprise in mutual aid. The model originally proposed by Schwartz in 1961 is often referred to as the Mutual Aid Model.

The Mutual Aid Model of group work practice (Gitterman, 2004) has its roots in the practice theory proposed by Schwartz (1961) which was introduced in the article, “The Social Worker in the Group”. Schwartz (1961) envisioned the group as an “enterprise in mutual aid, an alliance of individuals who need each other in varying degrees, to work on certain common problems” (p.266). Schwartz elaborated:

“the fact is that this is a helping system in which clients need each other as well as the worker. This need to use each other, to create not one but many helping relationships, is a vital ingredient of the group process and constitutes a need over and above the specific tasks for which the group was formed” (1961, p. 266).

Schwartz (1976) regarded this approach as resonant with the demands of a variety of group types including, natural and formed; therapeutic and task; open and closed; and voluntary and mandatory. Both the Mutual Aid Model and the concept of mutual aid have endured and continue to inform social work practice with groups (Gitterman, 2004). While sometimes referred to as social group work, Schwartz (1977) preferred the designation 'social work with groups'.

Schwartz (1961) premised his approach to practice on ideas expressed by Kropotkin (1903), Dewey (1910), Mead (1934) and Simmel (1955) that illuminated the nature of the relationship between the individual and society. The model was premised on the proposition that there exists a reciprocal, symbiotic relationship between the individual and society, a dynamic encapsulated in the small group (Schwartz, 1961). This type of mutualistic symbiosis was expressed by Schwartz (1971) as the “need to use each other” to work on resolving common problems (p.7).

Schwartz (1977) contrasted this model with approaches that failed to collaboratively work with groups. More importantly he rejected the medical model wherein the worker “decides what is wrong”, “labels it” and prescribes the treatment (Schwartz, 1977, p.1331). This was not to say that the worker avoids using prior professionally obtained knowledge but rather the worker uses this knowledge to deepen “preliminary empathy” (Schwartz, 1977, p.1334). A similar perspective was advanced by Tropp (1977b) who suggested that the worker should employ a phenomenological approach and attend to “current group and individual behavior rather than on prior personality diagnosis” (p.96).

A concept common amongst social group work approaches has been the ‘two-client’ perspective which views both the individual and the group as the two clients engaged with the worker (Trecker, 1948; Schwartz, 1977; Steinberg, 2004). For Schwartz (1977) this dualism was resolved by observing that they both are inextricably linked, engaged in reciprocal relationship. Both the individual and the group “needs the other for its own life and growth” argued Schwartz (1961, p. 153). From this stance flowed Schwartz’ beliefs about the mediating role of the worker, a role he argued belonged to the social work profession at large (Schwarz, 1961, 1971, 1977). Schwartz (1961) viewed the group as an organic whole and identified “the group organism as a complex of moving, interdependent human beings” (p.18). Expanding on this perspective he identified four main features of the group: the group is a

“collective, in which people face and interact with each other; people need each other; the purpose of the group is oriented by needing to work on common problems or tasks; and the work of the group is embedded in the function of the agency” (Schwartz, 1976, p. 185).

Schwartz (1971) proposed that the tasks of the worker and the members of the group are interdependent but different, an idea he expressed as “parallel process” (Schwartz, 1971, p.10). The members of the group are charged with both helping themselves and each other (Schwartz, 1971, 1976). The nature of the help could be understood as deriving from the exchange of members’ personal views and experience as well as the expression of feeling (Schwartz, 1977).

Drawing upon ideas about the use of time as expressed by Rank, Taft and Robinson Schwartz (1961) conceptualized a preferred sequence of worker activity expressed as 'the phases of helping'. These phases occur over the course of the group’s life cycle and include: preparation, beginning, work and ending phases (Schwartz, 1961; Gitterman, 2004). This framework has relevance for conceptualizing the sequencing of worker activity in each group session as well (Birnbaum and Cicchetti, 2000; Birnbaum, Mason & Cicchetti, 2002; Shalinsky, 1983; Shulman, 2006).

The model proposed by Schwartz followed a historical, theoretical path along the mainstream of social group work (Papell and Rothman, 1980; Tropp, 1977a). According to Tropp (1977a):

“the mainstream was more deeply explored by William Schwartz, who further elaborated the concepts of group function and worker involvement, while adding the dimensions of the mutual aid phenomenon and the contractual relation between worker and group” (p.1322).

Noting the importance of this model, Papell and Rothman (1966) had identified the model’s primary contribution to social group work practice theory: “its outstanding contribution” is as “the construct of a mutual aid system with professional interventions” (p. 130). For Papell and Rothman, the conceptual strength of the model lay in the observation that

“what had been vaguely referred to in the past as ‘helping members help themselves’ has acquired a higher level of theoretical statement. It is now possible to consider the attributes and culture of a specialized system and to transmit the skills necessary to support its realization. This is probably the single most important contribution that group work method can make to the social work profession at large (italics mine, 1966, p. 130).

Sharpening Papell and Rothman’s observation, Schwartz (1976) would note that the worker invested in cultivating mutual aid had “the additional task of not only helping people help themselves, but to help each other as well” (p. 194).


Mutual aid would come to be regarded as a hallowed concept in the practice of social group work (Tropp, 1977b). Hartford (1976) noted that the cultivation of mutual aid had become central to generic group work practice. Echoing this observation, Papell and Rothman (1980) noted that “the conception of the group as a mutual aid system had become a universal one in all of group work practice” and had become a feature of the ‘mainstream’ of practice (1980, p. 9).


Mutual Aid is Central to Social Work with Groups
Social workers have elaborated upon mutual aid in the social work group. Schwartz (1961, 1971, 1976, 1977) had proposed that the social work group engage in problem solving; employ authentic, affect-laden communication; accommodate expressions of difference and conflict; and discuss ‘taboo’ topics. Shulman (1979, 1986, 1992, 1999, 2006) advanced a conceptual framework of mutual aid processes comprised of the following 10 types of processes: sharing data; the dialectic process; entering taboo areas; the ‘all in the same boat’ phenomenon; developing a universal perspective; mutual support; mutual demand; individual problem solving; rehearsal; and the strength in numbers phenomenon.

Papell and Rothman (1980) indicated mutual aid was central to the mainstream of social work practice with groups. Middleman and Wood (1990) echoed the perspective advanced by Papell and Rothman (1980). Glassman and Kates (1990) tethered mutual aid processes to humanistic values and democratic principles. Kurland and Salmon (1992) promoted mutual aid based problem solving as an antidote to casework in a group. Breton (1990, 1994, 2004) encouraged group workers to view mutual aid as integral to empowerment oriented practice. Northen and Kurland (2001) presented “the dynamic forces of mutual aid” that builds upon the contributions from group psychotherapy research as well as the conceptualization articulated by Shulman (p.26). Their elaboration includes the following processes/dynamics: mutual support; cohesiveness; quality of relationships; universality; a sense of hope; altruism; acquisition of knowledge and skills; catharsis; reality testing; and group control (Northen and Kurland, 2001, p.25/26).


The Worker and other Members Collaborate
Mutual aid based group work draws upon the strengths possessed by the group's membership. A social worker invested in potentiating the group's capacity for mutual aid views the group as an enterprise in mutual aid; helps group members identify common ground; views her role as a mediator of the individual/group connection; helps the group understand the benefit of mutual aid; helps the group work through conflict rather than avoiding it; and supports the group in identifying and removing obstacles to mutual aid (Schwartz, 1961; Shulman, 2006). A social worker invested in being the expert, having control over the group process, and engaging in casework in the group setting is likely to truncate the emergence and power of mutual aid (Kurland & Salmon, 1992; Steinberg, 1992, 1993). In structured groups wherein the worker is called to share her expertise, in order to qualify as social work with groups the worker seeks to integrate opportunties for mutual aid (Middleman & Wood, 1990).

Special skills are required to cultivate mutual aid in the social work group. The social work literature is replete with discussions of these special skills (Gitterman & Shulman, 2005; Glassman & Kates, 1990; Kurland & Salmon, 1998; Middleman & Wood, 1990; Steinberg, 2004). Of note, for the purpose of this brief discussion, is an approach to mutual aid based problem solving that allows the worker to engage the group in the work of solving individual problems thereby avoiding the pitfall of practicing casework in the group. This approach to problem solving highlights the interaction between worker skill and group member expertise in helping each other and themselves simultaneously.

Kurland and Salmon (1992) have articulated an approach to problem solving in the small group that draws upon mutual aid. Mutual aid based problem solving has been posed as an approach that considers the needs of the individual and the group simultaneously (Kurland & Salmon, 1992). Drawing upon the problem solving process proposed by progressive educator John Dewey, Kurland and Salmon (1992) have presented an eight step model for mutual aid based problem solving: 1) an individual member raises a problem or issue of concern; 2) the problem is clearly identified by the individual and the group; 3) the problem is explored as the group elicits more information, listens attentively, responds empathically, and communicates understanding; 4) the worker asks group members to recount situations similar or relevant to the concern under current discussion; 5) the group generates possible solutions to the individual's problems upon consideration of the experiences shared by other group members; 6) the worker and the group members help the individual decide on a course of action and think through an implementation plan; 7) the worker asks all the group members what they have gained from the discussion; and 8) in a future session the worker or other group members follow up with the individual about their concern (p.9). The effectiveness of problem solving when the solution calls for individual behavior change is likely to be enhanced when the worker utilizes as part of her conceptual framework the Transtheoretical Stages of Change Model (Prochaska, DiClemente and Norcross, 1992) and Motivational Interviewing (Miller & Rollnick, 1991). Furthermore, Motivational Interviewing, an individual counseling technique can be applied to the group setting and is highly resonant with mutual aid processes, especially the dialectic process (Cicchetti, 2007).

Mutual Aid Group vs. Mutual Aid Based Group Work
Mutual aid is the fuel that drives both mutual aid groups, such as Alcoholics' Anonymous, as well as mutual aid based group work. While the term 'mutual aid group' has often been used to designate a social worker-led group (i.e. Gitterman & Shulman, 2005), this term is better used to denote the mutual aid/self-help group, such as 12 Step Fellowships, so as to avoid confusion amongst social workers and the general public as well as conflation of these two very different groups. While similar processes occur amongst and between members in mutual aid/self help groups as those found in social work groups, the manner in which these processes occur is different, often occurring in dyadic exchanges or through sharing without an exchange amongst members. Evidence indicates that worker-led groups potentially yield a wider range of mutual aid processes due to the special skills utilized by the worker (Lieberman, 1983). Flowing from this, the term 'mutual aid based group work' serves as a more accurate descriptor of this type of group, as it reflects the activity of the group worker and the group members who are engaged in the exchange of mutual aid. For this reason it can be said that through mutual aid based group work, the skilled worker can potentiate the presence of mutual aid, maximizing the potential for therapeutic, supportive, and empowering benefits.

Summary
In sum, this entry sought to demonstrate that in social work groups mutual aid has been a central, if not defining, element. At the same time, special knowledge needs to be skillfully utilized by a group worker who acts in such as way as to encourage the group members to act. Through the parallel process of worker activity and member activity the group is transformed into a system of mutual aid. The designation mutual aid based group work, it was argued, accurately describes this type of group as it reflects both worker and member activity. The term 'mutual aid group' is better reserved to designate groups, such as Alcoholics' Anonymous, that do not include professional leadership.



Selected References:
(All Available Upon Request)

Breton, M. (1990). Learning from social group work tradition. Social Work with Groups, 13(3), 21-34.

Gitterman, A. and Shulman, L. (Editors) (2005). Mutual aid groups, vulnerable & resilient populations, and the life cycle (3rd edition). New York: Columbia University Press.

Kropotkin, P. (1903). Mutual aid: A factor of evolution. McLean, Virginia: IndyPublish.com.

Riessman, F. (1965). The Helper Therapy Principle. Social Work, 10, April, 27-32.

Schwartz, W. (1959/1994). Group work and the social scene. In T. Berman-Rossi (ed.). Social Work: The collected writings of William Schwartz (pp.202-220). Itasca, Ill: Peacock Publishers.

Schwartz, W. (1961). The social worker in the group. In B. Saunders (Ed.), New perspectives on services to groups: Theory, organization, practice (pp. 7-29), New York: National Association of Social Workers.

Schwartz, W. (1964/1994). Analysis of papers presented on working definitions of group work practice. In T. Berman-Rossi (ed.). Social Work: The collected writings of William Schwartz (pp.310-308). Itasca, Ill: Peacock Publishers.

Schwartz, W. (1971). On the use of groups in social work practice. In Schwartz, W. and Zalba, S. (Eds.). (1971). The practice of group work (pp. 3-24). New York: Columbia University Press.

Schwartz, W. (1976). Between client and system: The mediating function. In R.W. Roberts and H. Northen (Eds.), Theories of social work with groups (pp.171-197). New York: Columbia University Press.

Schwartz, W. (1977). Social group work: The interactionist approach. In J.B. Turner (ed.) Encyclopedia of Social Work (17th Edition), 2:1328-1338. Washington, DC: National Association of Social Workers.

Schwartz, W. (1986). The group work tradition and social work practice. In A. Gitterman and L. Shulman (Eds.), The legacy of William Schwartz: Group practice as shared interaction (pp. 7-27). New York: Haworth Press.

Schwartz, W. (1994). Social work with groups: The search for a method (1968-1972). In T. Berman-Rossi (ed.). Social Work: The collected writings of William Schwartz (pp.1-194). Itasca, Ill: Peacock Publishers.

Schwartz, W. and Zalba, S. (Eds.). (1971). The practice of group work. New York: Columbia University Press.

Shulman, L. (2006). The skills of helping individuals, families, groups, and communities (Fifth edition). Belmont. CA: Thompson.

Steinberg, D.M. (2004). The mutual–aid approach to working with groups: Helping people to help each other (second edition). New York: The Haworth Press.

Tropp, E. (1977b). A humanistic foundation for group work practice (second edition). Richmond, VA: Virginia Commonwealth University.


~~~~Andrew Cicchetti

Mark Doel's Using Groupwork

We asked Mark Doel to discuss with us his reflections on his recently published book, Using Groupwork (Routledge). In his own words: As any-one who has written a book will tell you, it's not something to undertake lightly. I'm fortunate that I enjoy writing and the words come fairly readily, but the research behind a book is always a time-consuming and, at times, frustrating activity. One thing that keeps me going is passion. I haven't yet written a book that I have not felt passionate about - it's probably a disadvantage as well as an advantage! Using Groupwork was no exception.



What I think is radical about the book is the fact that it uses practitioners' accounts of their groupwork as its main reference point. This goes far beyond the use of 'vignettes', which we'd probably expect in any book written primarily for practitioners. I feel very strongly that we must find ways of gathering practitioners' experiences of groups and groupwork in a systematic way and broadcasting them to a wide audience. It's theory-building from the base. Of course, there must be proper permissions and privacies in place before we can go public with this knowledge. And the accounts need to move beyond the anecdotal; from description through analysis to reflection. They must be systematic.

A nine-year action research project with a state social work agency in England was the site for the development of groupwork 'portfolios' for continuing professional development. In these portfolios, practitioners used a common framework to collect their experiences of groupwork, to describe them in a systematic fashion, to relate them to their reading, to analyse them in relation to their understanding of theory, to evaluate using participative evaluative methods with group members, and, finally, to reflect on all of this process. I learned enormously from my part in this project, not just from the portfolios, but from the workshops and consultations which were part of the project. The Essential Groupworker which I wrote with my co-facilitator, Catherine Sawdon, was the first expression of this project.

In Using Groupwork I went on to choose nine groups from the project. These groups were chosen to include the widest range of groupwork approaches and group memberships. I used the groupworkers' portfolios of these nine groups as reference points for the content of the book, so most of the quotes are taken directly from the portfolios rather than quoting from academic sources. Of course, there are methodological limitations to this approach - mainly the reliability of self-report, especially when it is gathered for purposes of professional assessment (as these portfolios were). However, the knowledge I gained of the groups and groupworkers through the workshops and consultations went further than most researchers might expect to achieve, and I feel confident that the accounts of groupwork in these portfolios are accurate. They provide a vivid account of the group from the practitioners' perspective (and they included group members' perspectives, too). If anything, I think that the groupworkers were more inclined to underestimate than overestimate their part in the frequently dramatic changes experienced by group members.

I really hope that the systematic gathering of practitioners' work can become routine and that this book will encourage other similar attempts. Portfolios of practice, systematically written and incorporating descriptive, analytical and reflective elements, can provide a powerful archive for group experience and groupwork practice. From this we can develop theory on the back of practice. Also, it seems reasonable to suppose that practitioners relate more readily to the recorded experiences of other practitioners; certainly, and this has been confirmed by feedback I have received. Whilst this approach 'butters no parsnips' with the wider academic community, nor with those who determine how research funding is distributed (here in the UK, in any case), we groupworkers are no strangers to the left field, and building theory from the bottom up rather than top down, comes naturally to us.

~~~~Mark Doel

To purchase your copy of Using Groupwork in the United Kingdom, click here.
To purchase your copy of Using Groupwork in the United States, click here.
To purchase your copy of Using Groupwork in Canada, click here.

A Conversation with Katy Papell

Katy Papell (pictured center with Carol Cohen and Adelphi doctoral students) laughed when I suggested that she was a living legend for the group work community, but given all that she has contributed to our professional community it is difficult for me to think of a more suitable descriptor. After all, Katy, along with Beulah Rothman, was a founding editor of Social Work with Groups: A Journal of Community and Clinical Practice as well as a founding member of the Association for the Advancement of Social Work with Groups, along with others such as Beulah Rothman and Ruth Middleman. Together, Katy and Beulah published seminal papers about social work with groups, including Social group work models: possession and heritage in 1962 and Relating the mainstream model of social work with groups to group psychotherapy and the structured group approach in 1980. Dr. Papell also published and delivered presentations around the world on social work education, curriculum design, and student learning styles.



On the cusp of her 91st birthday which takes place on November 12, during this interview Katy was particularly mindful of her age and the experience of aging. As we spoke I sensed that she has been reflecting on her professional contributions as well as her personal experiences and the interaction between the two spheres of her life for awhile now. While some details and distant memories escaped her as we spoke, it was clear that she has been sitting with the important emotional themes in her life, her truths, if you will. Perhaps the most profound theme for Katy seemed to be her awareness of the healing power of “human togetherness”.

In our interview which took place on a chilly Autumn morning by phone we discussed many personal and group work related topics, including the journal, the inspiration for beginning the AASWG, Beulah Rothman, her academic career and theoretical contributions. I also heard from Katy a deep desire to know that she has made a contribution to the field and was impressed to discover that she wants to continue contributing. What stood out though was her deep appreciation for the healing power of ‘human togetherness’. Early in our conversation Katy read an excerpt from a paper she delivered at the Wurzweiler School of Social Work where Katy recieved her D.S.W. which underscored her feelings about togetherness.

A group represents human togetherness. It is not that the group creates the togetherness for the members. Rather it is the other way around-its members must create the group, and if they are unable to do this there is nothing but a collection of individuals striving helplessly for the unknown. Humane human relationship is group membership successfully created. When people-even just two-try to create a group and fail, the search for relationship-for togetherness-becomes tension, frustration, unfulfillment, anger, conflict, failure, and even violence.

Fulfillment in relationship does not come automatically to us humans. We each bring our very selves to the process, each of us with the complexity of our emerging needs. The human process of “grouping” constantly calls upon us to participate in meeting the needs of others in yearning for connectedness. Of course grouping is difficult, and always will be, as it will always be a fundamental human process that can be misused or fail.

….The skills of leadership of…humans in their groups is not technique alone; there is much knowledge but it is not technology. It requires our eternal efforts at togetherness…our own engagement with humanity.

For Katy this was how she has experienced and taught group work. As I sat back and listened to her ideas I couldn’t help but agree that as group workers we are called to fully engage with our own humanity and our own needs and tensions about togetherness; more than that though, as human beings we are called to connect, collaborate, and create community. Katy indicated this quite forcefully as we were discussing the application of attachment theory as a framework for understanding the healing power of group work, when she stated “aloness creates illness”. As we discussed other topics, Katy’s love for people, for groups, and the idea of ‘human togetherness’ always stood out.

On Beulah Rothman and Their Relationship

Beulah and I always laughed and said here we were, the Jewish girl from the Bronx and the WASP. As we worked together we each brought something to the other. Beulah was a talented teacher and wonderfully articulate and compelling. She eventually went to Barry (University) and graduated a lot of good group workers. I was much more reflective, philosophical…we wrote together but I had to prove myself and develop my own ideas and go further to write on my own. However, the work with Beulah was important to the profession.

On the Journal

In 1978 Bill Cohen of Haworth Press got in touch with Beulah and we agreed to do it (become Founding editors of the Journal). We were intentional about subtitling the journal A Journal of Clinical and Community Practice as we wanted to convey that group work was an effort to hold together the totality of the human experience as well as the totality of social work with groups. For us the primary philosophical and theoretical underpinning of social group work is that one could not grow alone…one can grow alone…but to try is illness.

Also, we called the journal social work with groups, an idea that is broader than social group work. Early on the idea of social work with groups was very important but for now I find it easier to identify with social group work, because the group work method has struggled (for survival in academic programs).

On the Association for the Advancement of Social Work with Groups

At Adelphi University we organized the curriculum starting with the idea of 'foundation' and developed one of the first course outlines designed to teach group work, case work and community organizing. We connected this idea to the belief that being a professional encompassed different aspects of humanity...the individual, community and group. An unintended impact of our efforts (as well as the Social Work profession at large was the erosion of group work in the acedemic setting). There was so much longing for opportunities to connect with other group workers.



It was at a CSWE conference in 1979 at a hotel in Boston that the the AASWG has its origins. Three group workers including myself, Beulah Rothman and Ruth Middleman put up a sign inviting all interested group workers to join us at a small meeting in a hotel room. So many people came that the hotel needed to open up another room for us. The enthusiasm was marvelous and we decided to have a symposium in October. The first Symposium was held in Cleveland, Ohio in honor of Grace Coyle (pictured) and held at Case Western Reserve University where Grace Coyle had taught group work as part of the MSW program . She kept the social action aspect of group work alive. We met in March and weren't sure we could prepare the conference for October, but it was Beulah's energy and positiveness that assured us we could do it. That first symposium was like a group work party.

Work with Involuntary Group Members

The dynamics of working with involuntary group members have been addressed in the social work with groups’ literature in general (Behroozi, 1992; Rooney and Chovanec, 2004) and most notably with regard to the group treatment of people with SUDs in particular (Milgram & Rubin, 1992). The concept of “treating” involuntary clients has raised concerns about professional ethics and values as well as treatment effectiveness (Behroozi, 1992; Breton, 1993; Milgram & Rubin, 1992; Rooney & Chovanec, 2004). The involuntary client can be understood as someone who is pressured by some external source to seek social services (Rooney & Chovanec, 2004). Mandated involuntary clients are pressured to seek services as a result of the legal system (Rooney & Chovanec, 2004).

Rooney and Chovanec (2004) identify reactance theory as an explanatory framework for the attitude and behaviors of the involuntary client and the mandated involuntary client. Reactance theory suggests that as a person is pressured to relinquish certain behaviors as a result of treatment efforts they experience reactance, “a motivational drive to restore those free behaviors” (Rooney & Chovanec, 2004, p.213). Rooney and Chovanec (2004) suggest an approach that draws upon the Transtheoretical Stages of Change Model and Motivational Interviewing in identifying strategies for engaging involuntary clients in the group process (both discussed below). Behroozi (1992) has noted tensions between the concept of working with mandated clients and professional ethics, such as the belief in fostering self determination. The chief concern is whether or not “involuntary applicants” are in fact “clients”, as to become a client of a professional social worker requires “mutual agreement” (Behroozi, 1992, p.224). In social work practice, the primary task given this issue is to help the applicant “transform to clienthood” (Behroozi, 1992, p.224). In the absence of this transformation, the mandated “client” is likely to be superficially compliant and deny they have any problems warranting social work attention (Behroozi, 1992; Breton, 1993; Milgram & Rubin, 1992).

Behroozi (1992) recommends that the primary strategy in transforming the applicant to clienthood is supporting them in owning the choice to be in treatment, as the best possible option given the range available to them. The worker should help the applicant identify and acknowledge feelings about being mandated to treatment, be given ample opportunity to exercise choice, and encouraged to identify their perception of their problems (Behroozi, 1992).

The process of transforming to clienthood has implications for group practice (Behroozi, 1992; Milgram & Rubin, 1992). Behroozi (1992) drawing upon the work of Lacoursiere’s developmental stage model identifies an additional pre-treatment stage identified as ‘negative orientation’ which is characterized by open hostility and suspicion. The work includes helping members identify and express their feelings; “examine the reasons for their reluctance”; “consider what would happen if they were not in the group”; and help participants “appreciate the usefulness of the group experience” (Behroozi, 1992, p.235).

The transtheoretical model of the stages of change and motivational interviewing should inform the worker's approach to working with groups comprised of mandated members. These two frameworks for promoting behavior change are not specific to mandated clients but have resonance with the challenges to be found in working with mandated group members.

Stages of Change
The transtheoretical model of behavior change posits that intentional behavior change can be best understood as a multistage process with specific challenges and tasks to be found in each stage (Prochaska, DiClemente and Norcross, 1992). This model illuminates the behavioral change process and has implications for treatment of people with SUDs and other addictive behaviors (Prochaska, DiClemente and Norcross, 1992).The five stages of the change process according to this model include: precontemplation, contemplation, preparation, action, and maintenance (DiClemente, 1993; Prochaska, DiClemente and Norcross, 1992). This model is best understood as a non-linear one with potential recycling through stages (Prochaska, DiClemente and Norcross, 1992).Precontemplation is “the stage where there is no intention to change behavior” (DiClemente, 1993; Prochaska, DiClemente and Norcross, 1992, p.1102). Contemplation is the stage where people are aware that a problem exists but are not yet ready to commit to change oriented action (DiClemente, 1993; Prochaska, DiClemente, Norcross, 1992). The preparation stage is characterized by deepened motivation to change and tentative efforts at change, such as reducing alcohol or substance use somewhat (DiClemente, 1993; Prochaska, DiClemente, Norcross, 1992). The action stage is characterized by nascent healthy behavior and environment modification so as to support change (DiClemente, 1993; Prochaska, DiClemente, Norcross, 1992). Prochaska, DiClemente, and Norcross (1992) suggest that people can be classified as being in the action stage if they have successfully changed their behavior for a period of “one day to six months” (p.1104). Maintenance occurs from six months up to an indeterminate length of time, even a lifetime (DiClemente, 1993; Prochaska, DiClemente, Norcross, 1992). People are likely to relapse and recycle back to a previous stage (DiClemente, 1993; Prochaska, DiClemente, Norcross, 1992).

Motivational Interviewing
Motivational Enhancement Therapy (MET) builds upon the stage of change perspective and motivational interviewing (Miller et al, 1995; Miller, 2002). The central idea of the MET approach is that the intervention should match the needs of the patient according to their placement within the stages of change framework (Miller et al, 1995; Miller, 2002).The intervention strategy draws upon counseling principles proposed by Miller and Rollnick (1991), referred to as motivational interviewing, to enhance motivation for change and movement from one stage to the next. The primary practice principles include: expressing empathy; developing discrepancy; avoiding argumentation; rolling with resistance; and supporting self-efficacy (Miller and Rollnick, 1991; Miller et al, 1995; Miller, 2002).

Kurt Sonnenfeld's Reflections on the AAGW

We asked Dr. Kurt Sonnenfeld (AASWG Member, NYC) to reflect on his membership in the American Association of Group Workers (AAGW), a group work association that preceded the Association for the Advancement of Social Work with Groups. The AAGW was formed in 1946 and disbanded in 1955 when that organization and six others merged to form the National Association of Social Workers. When we asked Kurt to write this entry he also told us that he is soon to be the recipient of the Lifetime Service Award from the Department of Youth and Community Development in collaboraton with the Association of New York State Youth Bureaus. We take this opportunity then to both thank and congratulate him for this well-deserved recognition.

The University of Pennsylvania website provides the following information about Kurt: "Dr. Sonnenfeld is a retired career employee of the New York City Department of Youth Services, one of the agencies merged to form the Department of Youth and Community Development in 1996. Dr. Sonnenfeld received his Doctorate of Education from Columbia University’s Teachers College, writing his dissertation on “Changing Perspectives on Youth Services as Seen Through the Historical Development of the New York City Youth Board.” Over the course of his 45-year career, Dr. Sonnenfeld held multiple positions at the Department of Youth Services, including Director of Training. He has also served on the Board of Directors of numerous community based organizations in NYC."

In his own words, here are Kurt's reflections on his membership in the AAGW: I joined the American Association of Group Workers (AAGW) toward the end of my first year of group work studies at Pennsylvania School of Social Work in 1948. At that time the school and the field work placement made me feel to be very much a part of the professional field, so that I aspired very much to join the American Association of Group Workers. AAGW was then two years old, the successor organization to the National Association for the Study of Group Work, founded in 1936 and changed to American Association for the Study of Group Work in 1938. A helpful factor in bringing students closer to the professional association was that both national conferences of social workers and Jewish Center workers took place most frequently in nearby Atlantic City (before casinos). Group workers were then imbued with group work as a method but also as a field, the group work field, where it was thought to be practiced in "group work agencies," i.e. community centers, settlement houses, Y's. after-school and recreational settings. Later the street was added as a setting in working with street gangs, but that was also in the hope of eventually moving the groups, after becoming more socialized, to the mainstream community centers.

In 1955 NASW was formed with a Group Work Section (of which I later became secretary) and sections for Psychiatric Social Work, Medical Social Work, and School Social Work, which were seen as casework settings. There came a time when in those settings groups were formed as helping milieus for individuals in need of such service and professional group workers, who had the understanding and skills for such groups were engaged and thus starting to be recognized as having a role in settings other than leisure time. However, the work of such group workers was dubbed as "group work in special settings."

I chaired a four-person panel of group workers in such settings and the conclusion was that group work can be performed in any setting and conversely, no setting should be the exclusive domain of casework. I then was invited to give a paper at the Psychiatric Social Work Section on the function and contribution of group work, where group work was still a guest so to speak to the host of casework and I remember I asked "What is so special about a special setting?" And why designate it for group work, which can be used universally. It produced some thoughts in the discussion period. Parenthetically, when I worked as group work consultant at the Warwick School for Boys (where under the juvenile delinquency act boys were remanded from court to the institution), we talked with the staff about working with groups in orientation sessions, in the classrooms, in the work fields, in the cottages and other venues. Gisela Konopka wrote very fittingly on this.

However, then came the great debacle whereby the NASW board (composed primarily of traditional casework members) decided to drop group work as a section. Several of us argued at a stormy meeting that NASW was a membership organization and in such an organization the membership has the right to make such a decision. But to no avail. And then some time later, after deep feelings by group workers that a forum for group work issues is very much necessary, leadership was taken by my friend Catherine Papell (AASWG Board, Founding Life Member) and Beulah Rothman and several others to establish the Association for the Advancement of Social Work with Groups. There is great need, as it says, to advance group work, for both practitioners and students. May it grow!

Challenging Homophobia in Social Work Education

A member of the group work community, Ady Ben-Israel, along with her colleague, Jill Kaufman, has created a DVD designed to challenge homophobia, transphobia and heterosexism in social work education. Ady joined the AASWG this past year and attended for the first time the annual AASWG Symposium held in New Jersey this past June. Ady is a graduate of the Hunter College School of Social Work where she studied group work. In addition to studying group work at Hunter, Ady has studied group therapy as developed by Louis Ormont at the Center for Group Studies. Ady currently works at the The Lesbian, Gay, Bisexual & Transgender Community Center in New York City.

Of Bad Fit: Challenging the prevalence of homophobia, transphobia, and heterosexism in social work education, Ady says, "we made Bad Fit in response to homophobic incidents taking place in social work settings, including NYC schools of social work". Ady and Jill decided to create a tool that could be used to help educators and field instructors spark conversation about these forms of oppression. Furthermore, Ady points out, "we also believe that through video we were able to bring the textured and lived experiences of our interviewees to our audience". Ady believes the DVD offers both agency workers and faculty "support in figuring out how to open up conversation about LGBTQ issues in social work". Finally, Ady tells us she "hopes it will be used to make all social work settings more accessible to the full range of clients who are already utilizing the services".

For more information, please go the BAD FIT Website. Below you will find the trailer for BAD FIT. Please note it will be hard to view on dial up.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Research Note from Mark Macgowan: Group Engagement Measure (GEM)

The Group Engagement Measure (GEM) was developed to assess engagement of individual group members in treatment groups. The original GEM consists of 37 items in seven dimensions: attendance, contributing, relating (to worker and with members), contracting, and working (on own problems, on others' problems). Several studies involving clinical and non-clinical samples have supported the measure’s reliability (internal consistency, test-retest, and interrater), validity (construct, concurrent, and predictive), and standard error of measurement, with favorable results (Macgowan, 1997, 2000; Macgowan & Levenson, 2003). To test the dimensionality of the measure, the factor structure was tested using confirmatory factor analysis involving clinical and non-clinical groups (Macgowan & Newman, 2005). The study confirmed the dimensionality of the original 7-factor, 37-item GEM for clinical groups. Two shorter versions were produced: A 7-factor, 27-item version for clinical groups, and a 5-factor, 21-item version suitable for clinical or non-clinical groups.

The GEM was conceived to be leader-scored. However, previous studies included validation measures completed by both members and leaders, suggesting minimal rating bias. In addition, member and leader ratings were correlated in previous research (Levenson & Macgowan, 2004; Macgowan, 1997).

Several publications offer ideas for using the measure in clinical practice. The first two were evidence-based approaches to increasing engagement in groups (Macgowan, 2003, 2006b). The second study was an application of the measure for women in a psychoeducational parenting skills group for substance abuse treatment (Plasse, 2000).

An unpublished pilot test of the GEM’s reliability was done by Macgowan involving a sample of adolescents (N = 71) from a larger study that compared Westchester Model Student Assistance Program group counseling (10 session, standardized format) with assessment/referral-only. An independent rater listened to audio tapes of sessions and completed the GEM on each adolescent at early (3rd or 4th session) and late (7th or 8th session) group stages. The coefficient alphas were .94 and .96 for the early and later group sessions, with Standard Error of Measurements of 5.22 and 5.06, respectively. Test-retest reliability was .68, p < .001. Thus, preliminary data suggest that the GEM has excellent internal consistency, a low SEM, and good stability with this sample of adolescents. The GEM has also been used in research on AOD use among Hispanics (Prado, Pantin, Schwartz, Lupei, & Szapocznik, 2005; Tapia, Schwartz, Prado, Lopez, & Pantin, 2006). A general overview of the GEM, with a focus on how it relates to AOD groups, has also been published (Macgowan, 2006a). For more information on the Group Engagement Measure, contact the author at Macgowan@fiu.edu.

Also, some readers may be interested in Mark Macgowans's new book, A Guide to Evidence Based Group Work published in January, 2008 by Oxford University Press. For easy on-line purchase, click this link!



References



Levenson, J. S., & Macgowan, M. J. (2004). Engagement, denial and treatment progress among sex offenders in group therapy. Sexual Abuse: A Journal of Research and Treatment, 16(1), 49-63.

Macgowan, M. J. (1997). A measure of engagement for social group work: The Groupwork Engagement Measure (GEM). Journal of Social Service Research, 23(2), 17-37.

Macgowan, M. J. (2000). Evaluation of a measure of engagement for group work. Research on Social Work Practice, 10(3), 348-361.

Macgowan, M. J. (2003). Increasing engagement in groups: A measurement based approach. Social Work with Groups, 26(1), 5-28.

Macgowan, M. J. (2006a). The Group Engagement Measure: A review of its conceptual and empirical properties. Journal of Groups in Addiction and Recovery, 1(2), 33-52.

Macgowan, M. J. (2006b). Measuring and increasing engagement in substance abuse treatment groups: Advancing evidence-based group work. Journal of Groups in Addiction and Recovery, 1(2), 53-67.

Macgowan, M. J., & Levenson, J. S. (2003). Psychometrics of the Group Engagement Measure with male sex offenders. Small Group Research, 34(2), 155-169.

Macgowan, M. J., & Newman, F. L. (2005). The factor structure of the Group Engagement Measure. Social Work Research, 29(2), 107-118.

Plasse, B. R. (2000). Components of engagement: Women in a psychoeducational parenting skills group in substance abuse treatment. Social Work with Groups, 22(4), 33-50.

Prado, G., Pantin, H., Schwartz, S. J., Lupei, N. S., & Szapocznik, J. (2005). Predictors of Engagement and Retention into a Parent-Centered, Ecodevelopmental HIV Preventive Intervention for Hispanic Adolescents and their Families. Journal of Pediatric Psychology.

Tapia, M. I., Schwartz, S. J., Prado, G., Lopez, B., & Pantin, H. (2006). Parent-Centered Intervention: A Practical Approach for Preventing Drug Abuse in Hispanic Adolescents. Research on Social Work Practice, 16(2), 146-165.

5 Questions for Larry Shulman

As many of you know, Larry Shulman has made numerous contributions to the field of Social Work for more than 40 years. He has made significant contributions through teaching, research, theory building, and the profession's literature. The author of the popular text, The Skills of Helping Individuals, Families, Groups and Communities is now in its fifth edition. Along with Alex Gitterman, Larry is also the co-editor of the popular book, Mutual Aid Groups, Vulnerable Populations and the Life Cycle. For those of us who employ a mutual aid based approach to group work we are likely to have encountered Larry Shulman's work. I am pleased that Larry agreed to this interview for Mutual Aid Based Group Work. com. I enjoyed the exchange and I hope you will too. For more about Larry Shulman's extensive and illustrious career please check the on-line final program for the 2007 AASWG Symposium which includes a discussion about Larry, who is a 2007 International Honoree, written by his long time colloborator and friend, Alex Gitterman.

Q. Larry, I imagine that William Schwartz, Bill, served as a significant influence on you professionally and personally. I see that you, along with Alex Gitterman, have furthered the conceptualization of the mutual aid model of group work and that you embrace the integrative approach to social work education, as exemplified in your popular text, The Skills of Helping, now in its 5th edition. Can you tell us a little bit about your relationship with Bill? How did you meet? What impact personally and professionally do you feel he has had on you?

A. I was a new field instructor for the Columbia University School of Social Work running a teen program at the Mt. Vernon YM&YWHA. We were required to take a six session workshop on field instruction and it was Bill's turn to provide one. At the first session I proudly volunteered to describe my student's assignment working with a group of white, Jewish teenagers on a project with an equivalent African-American group at a local church. The project was to provide a tutorial program for students at the church. I said: "Although that's the announced purpose of the program, our real goal is to enhance white and black relationships in the town". This was consistent with the"social goals" model of group work. Bill responded: "Do the members of the group know the real goal?" I was insulted as he pointed out, to my humiliation, that I had a "hidden agenda". I told my wife that night I would not return to the workshop but after some "healing" and reflection I realized he was right. I did have a hidden agenda. Bill had painfully and permanently "shifted my paradigm" of practice. I went back the next week and from that point on he became an important mentor as I had to re-learn much of my group work training and start to develop my elaboration of the mutual aid (or Interactional) model of practice.

Bill could be very tough and very demanding but also on a deeper level very caring. He was one of the most intelligent social work educators I ever met and was a scholar in the true sense of the word. Not only did Bill begin to describe a new paradigm of practice, rejecting the "medical model" study, diagnosis and treatment framework, he helped me and others to focus on method. What we knew about people (knowledge) was important but that had to be translated into specific interventions in order to qualify as a practice theory.

What was so striking about Bill's framework was that it was easily adapted to fit classroom teaching as well as supervision. The concept of the parallel process was another of his important contributions to our field. I only had a few opportunities to watch him present or teach however in each one I was struck by how he practiced what he was preaching. At times, I felt a bit more support and a bit less confrontation would be a better fit but for Bill, this was him. I would need to develop my own integration of support and demand. The really nice part of his framework was the fact that we could integrate our personal and our professional selves.



Q. When I read Schwartz’s work on what we call the Mutual Aid Model of Group Work, I see that he presented a fairly comprehensive and sophisticated model. I know that you expanded the elaboration of mutual aid processes and that you incorporate some of Bion’s thinking into the approach to practice. Can you talk about that and tell us how else you (with or without Alex) have expanded, added to or modified the model from it’s earlier incarnations.

A. Bill published many scholarly articles and had a number of unpublished works. For example, he tape recorded and then had transcribed the content of a series of continuing education classes he presented at Columbia which are a treasure trove of his original thinking about practice. (This interview is reminding me that I need to send copies of all of this original material and correspondence to the group work archives). Bill built on the work of pioneers such as Jessie Taft and Virginia Robinson who taught at the University at Pennsylvania School of Social Work. They were the founders of the "functional school" of social work. The debate between the functional school and the "diagnostic" school (the medical model consisting of three phases - study, diagnosis and treatment) has long been forgotten but it really was important. The functional school folks were isolated from the profession, turned inward and lost influence. Bill's work brought it back to life.

His original conceptualizations of the importance of mutual aid, the interactional nature of practice, the importance of contracting and the "two client" idea formed the foundation of my work and the work of others. I consider my contribution to be built on this foundation. I worked to translate his ideas into a practice text (The Skills of Helping Individuals, Families, Groups and Communities, 5th edition) that has been widely used since the first edition in the 1970s. Bill never completed his own text book (stopped after the first three chapters) however Alex Gitterman and I co-edited a volume consisting of these three chapters (updated by Toby Berman-Rossi) and all of his collected writing. It was published by Peacock Press but I don't think it is still in print.

In addition to making his work more widely available through publications and video tapes I elaborated on his model in a number of ways. I did the earliest research on the helping skills he described through a number of studies of child welfare individual and group practice, doctor-patient relationship and supervision. These studies began to provide evidence of the importance of process, the use of skills and the development and impact of the "working relationship". The research was focused on the interactional process rather than just on the outcomes. I am continuing this work in other areas of research such as school violence, substance abuse counselling and work with young people "aging out" of foster care.

On the model itself, I developed an early framework to operationalize a number of mutual aid processes such as the "all-in-the-same-boat" phenomenon. This framework has been used by others in research on the mutual aid process. I also wrote an early publication on the scapegoat phenomenon that illustrated the importance of the two client idea and the practice concept that required the group leader to be with both the individual and the group at the same time. While Bill used the functional model to discuss the four phases of work (preliminary, beginning - contracting, middle and ending/transitions) I extended that model to the description of an individual session (i.e., sessional tuning in, sessional contracting, elaborating skills).

My development of a category observation system for video taping sessions and then analyzing them using trained raters scoring the behaviors every three seconds allowed me to more closely understand how the dynamic interaction between client (individual or group) proceeded. For example, with over 100,000 entries analyzed through a "FORTRAN" program developed by a friend we were able to determine if sessional contracting had taken place (the worker and the client were on the same issues) or what worker behaviors followed three seconds of silence. To give some idea of how long ago this was we had to key punch cards with the data and then submit them to a main frame computer picking up our print outs a few hours later. If my current NIH application is funded I am returning to this research in the area of supervision and group work practice in the substance abuse field but with more sophisticated equipment and procedures.

I also tried to build on his work by using my own practice (I tried to lead at least one group a year) as illustrations of the power of mutual aid. For example, a short-term single parents group and a group for persons with AIDS in early substance abuse led to publications that included significant process recording excerpts demonstrating the incredible power of mutual aid as members helped each other and as I and my co-leaders encouraged this process. Perhaps the most widely used video tapes I made and distributed (Insight Media now carries them) were of the 1st and then the 19th session of a married couples group I led back in the late seventies. Whenever I use them in a class I have to pause after the first five minutes and tell the class "OK, get it out of your system" which leads to some loud laughter as they comment on how I have changed from that young guy in his 30s.

I also built on Bill's concept of supervision and elaborated it in my NASW published book "Interactional Supervision". With updated examples and chapters dealing with issues including supervision of staff in response to various traumas (i.e., the death of a child on a caseload or the physical attack on a worker) I feel I was able to communicate the core of his practice comments to a wider audience.



Q. From reading your text and chapters or articles I see that you share an interest of mine in working with groups of people who both have HIV/AIDS and a substance use disorder. How did you get involved with that? How were you received by the group? What stands out for you about that experience?

A. I was teaching at Boston University when we obtained a grant from an NIH agency designed to encourage social work faculty to find out more about substance abuse and to infuse this knowledge into their teaching and scholarship. I signed up with some other colleagues and for a year participated in a structured biweekly seminar. We were also required to do a project and I chose leading the group for persons with AIDS in early substance abuse recovery. This was, in effect, my field work assignment. I had been involved doing some volunteer training for the Boston AIDS Action Committee and decided to develop a group for clients living in a structured living environment (single room occupancy) with built-in support services. I partnered with a staff member who was an addictions counsellor and after doing our "system's work" we started a once a week group in the residence. I reported on this group in a key-note presentation at the AASWG conference in Quebec and later published it in the Haworth Press Social Work With Groups Journal. My reception by the group is detailed in the first session process recording in the article (and the detailed process in the Skills of Helping...) when at the end of the session I reached for the indirect cues from one member wondering about whether the co-leaders were in recovery. My co-leader was, but I was not. I reached for the underlying question and answered as honestly as I could about my teaching and my involvement in the NIH project. After which, my member who had raised the issue laughed and said: "Oh, I thought you were a narc!" We had begun to address the "authority theme". I learned a great deal during the year I co-led the group and not just about substance abuse, recovery and the impact of AIDS. This was early in the development of the triple drug therapies so some of the members were hoping for a cure, others hoping to be able to live with AIDS and my trans-gendered member whose use of hormone treatment had excluded her from the trials, saying she was just hoping to "Die with dignity instead of hustling old men on street corners for money to buy drugs". What I learned was the incredible strength these group members who had survived the most horrible of childhood experiences, including emotional, physical and sexual abuse, could bring to the task of tackling the dual issues of recovery and AIDS. I also saw first hand how powerful mutual aid could be for people who had been in the drug culture so long they had forgot how to care for others and be cared for by others. I also learned how strong our feelings can be for our clients, and how long the can persist, as even as I write this I still feel strong emotions associated with the death of my trans-gendered member soon after the group ended. I believe that the group did help her die with dignity.



Q. Ok. So you are Shulman! Tell us about group work mistakes you have made in your practice. What did you do with those ‘mistakes’?

A. As I tell my students, you take risks, make mistakes, learn from those mistakes and then make more sophisticated mistakes. I like to think that in my practice and teaching I am now making more sophisticated mistakes. Bill Schwartz had an expression: "You are only as good as your last session" by which he meant you have to keep working on your practice or you will find yourself making mistakes. I have found that to be true in that when my own life experiences or stresses have interfered I have had to look closely at how they were impacting my ability to hear and respond to what was going on in my class or my practice. An early mistake, from which I learned a lot, was when I began a group for widows with the canned line that said "The purpose of this group is for you to learn how to work through your grief." One member looked this thirty year-old group leader in the eye and said: "You don't learn to work through your grief, sonny, you learn to live with your grief". Never having lost someone close to me that was the start of my education about loss and grief. More recently, in an incident I documented in another article in the Journal of Social Work With Groups, I was leading a large (150 participant) two-day workshop on issues of diversity (inter-ethnic and intra-ethnic) in leading mutual aid support groups. After complaining about the lack of enough air conditioning the first day (it was a centrally controlled system) I started the second day (a Saturday) in the same room when 45 minutes after we began a young African-American man in jeans, a tee shirt and a baseball cap entered from the back of the room and was looking around the room. I said: "I'm glad you are here and the thermostat is over there". He replied: "I'm not the maintenance man, I'm a participant". Instantly feeling embarrassed by my mistake I quickly apologized and went right into my presentation. I was sweating profusely, and it wasn't from the heat, as I put my had down and tried to tough it out. After 15 minutes I stopped and went back to the incident and pointed out how I had felt about my response which reflected an internalized stereotype and how I tried to avoid dealing with it. Three African-American women in the first row laughed and one said: "We wondered if you were ever to get back to it." This started the best discussion of the workshop with both white participants and persons of color discussing how taboo the issue was and how hard it was to face it openly. For me, it was an important illustration, once again, of how one can go back and catch a mistake. As I have often reassured students, we all make mistakes the only question is if we have the skill and courage to go back to them and how quickly to we do so. I caught it in the same morning which I felt very good about.


Q. Finally, congratulations on your recent retirement from teaching and recognition by the Association for the Advancement of Social Work with Groups as an International Honoree. What is on the horizon for you now? What are you working on or are you simply spending more time with family and friends in New Hampshire.

A. I won't be formally teaching anymore, about which I have mixed feelings but mostly relief. I will be missing attending all of those wonderful faculty meetings and committee work (OK, maybe not so much). I will be moving over to the Research Foundation side of the University to do part-time research on my areas of interest - school violence, supervision and group work. I am now stationed in New Hampshire and commuting back to Buffalo as needed. As I write this our two grand children (11 and 5) are visiting with us for two weeks as their parents are off in Europe attending academic conferences, so yes, I will be spending more time with friends and family. I still travel and present workshops on practice, group work and supervision so that will keep my hands in the teaching process. I am also working on a 6th editon of Skills of Helping which should be available in 2008. I have a contract with the same publisher (Wadsworth) to do a group counselling book that will be aimed at all counselling professions -- not just social work. As I have worked with a great inter-disciplinary committee on a five-year NIH funded conference on clincial supervision (I co-chair the conference with Andy Safyer) I have realized that the concept of mutual aid has not really penetrated the literature of psychology, counselling psychology, nursing, school counselling, marriage and family therapy, etc. As I have been reviewing their central group work publications it becomes clear that this is fertile ground for continuing to dissmeninate the central ideas of the model. When my book proposal was circulated by the press for comments three of the six reviewers commented on what an interesting and novel idea this "mutual aid" was. Oh yes, I am playing tennis three times a week, year around, and enjoying more holidays. The full implications of no longer teaching hit when my wife Sheila decided to give me a present for my 70th birthday of a one-week trip to Paris and she scheduled it for the beginning of October. I guess that will go a long way to resolving my ambivalence about retiring.

Finally Larry warmly had this to say about the interview, "Thank you for this opportunity to respond to these questions. It brought back many nice memories. I hope this is what you are looking for.". Yes, that was exactly what I was looking for.

Group Work with People with Substance Use Disorders

In this entry, I present a discussion on group work with people with Substance Use Disorders. This entry has been selected for publication in The Encyclopedia of Social Work with Groups edited by Alex Gitterman and Robert Salmon published by the Haworth Press. The entry is presented here in accordance with the publication contract's section on preprint distribution rights. Stay tuned for more information about the Encyclopedia as it becomes available. Haworth Press can be reached at this link, Haworth Press Homepage.


Group treatment is the cornerstone of most abstinence based programs in the United States (Stinchfield et al, 1994). The popularity of group treatment for people with Substance Use Disorders (SUDs) can be best explained by the resonance of mutual aid with the demands of achieving and maintaining abstinence. The power of mutual aid processes, including the combined effect of mutual support and demand, in helping people get sober was phenomenologically discovered by the originators of Alcoholics Anonymous, whose success is likely to have lent credence to early efforts at providing group treatment with this population (Blume, 2002; Flores, 1997). Furthermore, collaborative, non-exploitive, mutual aid based relationships assuage the isolation, shame and stigma experienced by people with SUDs. Quite simply, mutual aid heals! At the same time, people with SUDs are likely to experience difficulty in trusting others and forming healthy attachments, a point which should inform the interventions of the worker. This entry will apply concepts and practice principles drawn from the Mutual Aid Model which can be integrated with a variety of group approaches with this population (Gitterman, 2004; Shulman, 2006).

Tasks of Early Recovery
Substance Use Disorders are best conceptualized as chronic, relapsing brain diseases with biopsychosocial antecedents and consequences (Leshner, 1999). Recovery from SUDs is an ongoing, perhaps life-long process with discrete developmental tasks and challenges to be found in early, middle, and ongoing stages. Typically clients in agency based substance abuse treatment are in the early or middle stage of recovery. The primary goals of the early and middle stages of recovery include achieving and maintaining abstinence. The nature of the work is primarily cognitive and behavioral, as opposed to being insight oriented (SAMHSA, 2005).

Common early recovery tasks include enhancing motivation for behavior change; learning about SUDs and recovery; identifying and verbalizing feelings; strengthening coping skills; cultivating self-esteem and self-care; and developing a sober support network (SAMHSA, 2005). Additional work exists for group members who have been mandated to treatment, which can be characterized as ‘transforming to clienthood’ (Rooney & Chovanec, 2004).

Orienting Knowledge
The effectiveness of group work is enhanced when the worker possesses knowledge both about group work as well as substance use disorders. Salient orienting knowledge includes an understanding of the biopsychosocial implications of SUDs; the concepts, principles and structure of 12 Step Fellowships; the Transtheoretical Model of the Stages of Change; and the principles and skills of motivational interviewing (Flores, 1997; Miller & Rollnick, 1991; Prochaska, DiClemente, & Norcross, 1992; SAMHSA, 2005).

Strengths and Resiliencies
Empowerment oriented practice necessitates that the worker view the group member from a strengths perspective. Furthermore, the mutual aid based group provides an opportunity for members to identify and experience their own and each others strengths. The opportunities that exist in group work to experience mutual aid both strengthen self-esteem and affirm the value of a sober network of peers. Members should be encouraged to view their capacity to share feelings, life experiences and taboo topics as individual and collective strengths. Furthermore, the quality of mutual aid becomes enriched as members move through the recovery process and draw upon their accumulated experience in navigating ‘life on life’s terms’ sober.

Recommendations for Helping
Preparation is enhanced when the worker tunes in to the members needs and feelings regarding both their being in treatment and in recovery. The stage of change model provides a useful framework for conceptualizing the needs of members as they engage with the change process. Accurately tuning in to these factors will help the worker identify topics that need to be addressed in early group sessions.

Workers should plan to respond to queries about their own recovery status. However, worker disclosure is secondary to the sub-text of such a query. Often members are really wondering if the worker will be helpful, trustworthy and non-judgmental. Additionally, such a request for self disclosure provides an opportunity for the worker to clarify worker role and member role. Of note, evidence indicates that worker recovery status has no impact on treatment outcome (Culbreth, 2000).

The worker in the beginning phase should actively attend to enhancing motivation for change and issues related to trust and safety. Members are likely to have ambivalent feelings about getting sober (Milgram & Rubin, 1992). The use of the mutual aid process, the dialectic process, is resonant with principles of motivational interviewing. Members can be encouraged to discuss the pros and cons of being in treatment and of getting sober. As the worker responds empathically and points out member commonalties organic opportunities arise to foster safety and trust as well as enhance motivation for change.

The work of the group is enhanced when member strengths and contributions are both encouraged and recognized. In an outpatient setting the worker stimulated the strengths in numbers phenomenon when the group agreed to accompany one member to his first A.A. meeting as he had been afraid to go on his own. In a residential setting, as members began looking for apartments in the community they often were shown dilapidated apartments in drug-infested neighborhoods. In one session, Francis shared her despair and stated, “I felt like getting high; I got sober to live in a crack-house!? But instead of getting high, I called my sponsor”. In the next session another member recounted the same experience but added, “I thought of you Francis. I thought to myself I couldn’t let you or the group down. So, I followed your lead and instead of getting high I called my sponsor.” The worker asked Francis what she felt in knowing that she had helped someone protect their sobriety. Her eyes welled up with tears as she said, “it feels good to help. All my life I had no help to offer anyone; if anything I was a taker”.

As most groups in substance abuse treatment settings are open-ended, typically members leave but the group continues. Variations on endings exist when members relapse and prematurely leave the program against medical advice. Ample time should be allotted for members to express their feelings and for the member who is leaving to consider their ongoing relapse prevention plan.

Finally sessional work is enhanced when the worker helps the group review the purpose and format of the group in each session, in part because of the short-term memory loss associated with early recovery and to help distinguish the work of one group from that of another. Sessional endings provide an opportunity for members to identify the salience of the group encounter with their own recovery process.

References
Blume, S. (2002). Group psychotherapy in the treatment of addictive disorders: Past, present and future. In Brook, D.W. and Spitz, H.I. (Eds.) (2002). The group therapy of substance abuse (pp. 411-428). Binghamton, NY: The Haworth Medical Press.

Culbreth, JR, (2000). Substance abuse counselors with and without a personal history of chemical dependency: A review of the literature. Alcoholism Treatment Quarterly, 18(2), 67-82.

Flores, P.J. (1997). Group psychotherapy with addicted populations: An integration of twelve-step and psychodynamic theory (2cnd edition). New York: The Haworth Press.

Gitterman, A. (2004). The mutual aid model. In C. Garvin, L. Gutierrez, and M. Galinsky (Eds.), Handbook of social work with groups (pp. 93-110). New York and London: The Guilford Press.

Leshner, A.I. (1999). Science-based views of drug addiction and its treatment. JAMA: The Journal of the American Medical Association, 282(14), 1314-1316.

Milgram, D. and Rubin, J. (1992). Resisting the resistance: Involuntary substance abuse group therapy. Social Work with Groups, 15(1), 95-110.

Miller, W.R. and Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviors. New York: The Guilford Press.

Prochaska, J.O., DiClemente, C.C., Norcross, J. (1992). In search of how people change: applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

Rooney, R. and Chovanec, M. (2004). Involuntary groups. In C. Garvin, L. Gutierrez, and M. Galinsky (Eds.), Handbook of social work with groups (pp. 212-226). New York and London: The Guilford Press.

Shulman, L. (2006). The skills of helping individuals, families, groups, and communities (Fifth edition). Belmont. CA: Thompson.

Stinchfield, R., Owen, P. and Winters, K.C. (1994). Group therapy for substance abuse: A review of the empirical research. In A. Fuhriman and G. Burlingame (Eds.) Handbook of group psychotherapy: An empirical and clinical synthesis (pp. 458-488). New York: John Wiley and Sons, Inc

Substance Abuse and Mental Health Services (2005). Substance abuse treatment: Group therapy. (Treatment Improvement Protocol No. 41). Department of Health and Human Services Publication No. (SMA) 05-3991. Rockville, MD: Department of Health and Human Services.