Selecting Members for Participating in Group Therapy

Facilitators and potential members of group therapy have a difficult task to understand what criteria are important to consider when selecting people to join and form a group. In this article, I'd like to share some of the tips I've learned about group therapy and counselling.

As a facilitator, it is important to be skillful in selecting members for a particular group who will contribute to developing a healthy environment that promotes growth. I think careful selection of group members is related to the group’s growth and it’s important to choose wisely who joins the group. For example, in some situations there may be financial motivations for selecting any client who is willing and interested in participating, especially within organizations who are funded by government programs. This can lead to problems with clients’ readiness to participate and commit; and with maintaining healthy boundaries for group counsellors and clients.

When a member is selected who might not be the right fit or match, it can result in unclear expectations around roles and responsibilities, as well as transference and countertransference that may be highly stressful to manage and potentially traumatizing for all parties. This seems to be a vulnerability within managed care and community-based service settings where fees for services are subsidized through federal or provincial governments. In these situations, a mismatch can be a disservice to both the clients and the counsellors or facilitators. The criteria to look for when interviewing or determining who to include in the group might include whether the referral was based on a non-legitimate (objective), illegitimate (subjective), or legitimate approach. Preferably, if it’s legitimate, the referrer believes that group therapy is the best treatment for this person because it offers the greatest therapeutic value. It’s also important to consider whether the person is joining a group based on a voluntary or involuntary choice. Some of the most suitable people for a group (or 1-on-1) are motivated by interpersonal problems that include existential, self-worth, loneliness, and intimacy issues.

I think it’s very fair and reasonable to ask whether there are factors that weigh heavily against considering a client for membership in a group. This might include factors that would negatively affect the group process. Hopefully, the individuals will benefit from and be compatible with the goals of the group. The initial interview should help determine how much energy and effort the person is willing to put into making changes. There is great variability in each person's level of motivation and readiness for change at any given moment. Finally, other issues that a potential group member might be experiencing which are worth considering as criteria for selection, include the following:

• Is the person experiencing a crisis, suicidal thinking, or escalating anxiety or panic?

• Is the person expressing behaviors that may be associated with a pathology (diagnosed as a medical illness or disease)?

• Is the person exhibiting poor impulse control?

• Are they recovering from a traumatic brain injury or any other neurological injury that affects their nervous system?

• Are they experiencing any form of acute paranoia (intense anxious or fearful feelings and thoughts often related to persecution, threats, or conspiracies)?

• Are they expressing any form of hypochondria (persistent fear that they have a serious or life-threatening illness despite few or no symptoms)?

• Are they actively involved in any form of addiction or impairment related to use of a psychoactive substance?

• Are they displaying any type of psychotic or sociopathic type traits (including lack of guilt, remorse or empathy; inability to form emotional attachments; dishonesty, deception, or manipulation; and aggressive or reckless behavior)?

  
  

The answers to these questions are factors which ought to give a facilitator and any potential group members pause for considering whether a person is a suitable candidate to select for participating in group therapy and counselling.

Sources

Fehr, S. S. (2018). Introduction to Group Therapy: A Practical Guide, Third Edition.

Routledge.

Yalom, I. D., & Leszcz, M. (2020). The Theory and Practice of Group Psychotherapy. Hachette

UK.