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Introduction
The present manual offers key information about the formation of a psychotherapeutic group that is focused on addressing the problem of alcohol addiction. The manual features the type, topic, and target population of the group and justifies them as relevant and appropriate. Furthermore, a description of the groups advertising, setting, dates, structure, and phases of formation is provided with related explanations. An example advertisement, informed consent document, selection criteria sheet, ground rules list, and pre- and post-intervention instruments are offered as ready-to-use tools. The manual is based on the research evidence presented in the current literature on the related topics, including articles and books.
Type of Group
The project is going to involve a psychoeducational group; it is planned to support it with the help of pharmacological treatment. The latter is not used very commonly for alcohol addiction, but it is a promising possibility (Thompson, Ashcroft, Owens, Staa, & Pirmohamed, 2017). As well as with other substance use disorders, a combined approach that incorporates both medication and psychotherapy is usually shown to be more effective and, therefore, preferable (Sessa, Higbed, & Nutt, 2019; Subodh, Sharma, & Shah, 2018; Thompson et al., 2017). Furthermore, psychoeducational group interventions are shown to be effective in helping patients to achieve addiction-related goals, including those of people with alcohol addiction (Yeh, Tung, Horng, & Sung, 2017). Therefore, the chosen solution is reasonable and can be recommended.
The following features of a psychoeducation group are noteworthy. Psychoeducation is generally focused on informing participants (Palli, 2017; Pessagno, 2014). It is an approach to interventions, including group interventions, that transfers relevant knowledge to patients while addressing motivational and behavioral aspects to ensure the development of skills that would enable a person to effectively adhere to the studied treatment (Ekhtiari, Rezapour, Aupperle, & Paulus, 2017; Pessagno, 2014). Psychoeducational groups offer both support and relevant information to the individuals who share the need to resolve a particular problem (Santos, & Cutcliffe, 2018; Washington Coalition of Sexual Assault Programs, 2014). This approach to addressing the problem of alcohol addiction is justified since people with this issue need both the knowledge and motivation to resolve it.
Furthermore, it should be noted that the group will be homogenous and use the closed group formation approach. The former feature refers to the group consisting of the people who appear to share important characteristics, including gender and age. This method of group formation is used to help participants to interact with the people who are likely to have similar experiences (Koukourikos & Pasmatzi, 2014). Closed groups do not change members for the entirety of their duration, and this method is helpful in facilitating cohesion (American Psychological Association, 2019; Ezhumalai, Muralidhar, Dhanasekarapandian, & Nikketha, 2018). Also, closed groups are easier to assess for effectiveness. Thus, the group type was chosen to reflect the needs of the target population and facilitate its formation.
Topic/Theme of the Group
The theme of the group is alcohol addiction, which is a major issue in many countries, including the US (Grant et al., 2017; Rehm et al., 2014). Alcohol abuse is dangerous for human health and can result in social issues for the afflicted individuals (for example, the deterioration of personal or work-related relationships) (Rehm et al., 2014; Sessa et al., 2019; Thompson et al., 2017). In addition, alcohol abuse has been linked to certain antisocial behaviors, and the treatment of alcohol abuse, as well as its health-related consequences, is an economic burden for the country (Rehm et al., 2014; Sessa et al., 2019). Finally, addiction is difficult to treat; often, even the interventions that result in abstinence fail to ensure its maintenance (Khan et al., 2016). In summary, alcohol addiction is an issue that is difficult to resolve but that can be addressed through psychotherapy and psychoeducation (Gür et al., 2017; Khan et al., 2016; Yeh et al., 2017). Therefore, the choice of the theme for the group is justified.
Target Population and Age of Participants
The target population consists of men aged 21-35 who are struggling with alcohol addiction. The focus on the men is explained by the prevalence of alcohol addiction among men, which is persistent and can be observed in many countries (Grant et al., 2017; Rehm et al., 2014). For example, in the US, the prevalence of alcohol use disorder was 12.4% in 2001, and it grew to 16.7 percent by 2012; for women, the numbers were 4.5% and 9% respectively (Grant et al., 2017). These figures do demonstrate that women are becoming increasingly affected by the issue, but men are still more likely to develop alcohol addiction, which is why the group will be aimed at helping them.
The focus on young adults is concerned with the prevalence of alcohol addiction in young men, as well as group organization concerns. In particular, the group uses the homogenous approach to ensure that the people involved in it are more likely to have shared experiences (Koukourikos & Pasmatzi, 2014). As a result, a more specific group out of the general target population of people with addiction was chosen. Furthermore, younger people are generally more likely to develop an addiction (Grant et al., 2017). Therefore, it is logical to recruit young adult men for the described group.
Population and the Group Relevance
The group is relevant for the target population because evidence indicates that psychotherapy is important for positive outcomes when substance use disorders and addictions are considered. In particular, due to the focus on alcohol addiction, it is important that research consistently suggests that combined treatments can be more effective in reducing addiction than individual approaches (Gür, Can Gür, & Okanl1, 2017; Khan et al., 2016; Subodh et al., 2018; Thompson et al., 2017). Therefore, psychotherapy is a significant tool in addressing addiction. Furthermore, it can also be noted that psychoeducation is among the methods that can be helpful in working with people with alcohol addiction (Gür et al., 2017; Khan et al., 2016; Yeh et al., 2017). Particularly, they can help participants to develop abstinence, although they do not always ensure its maintenance (Khan et al., 2016). Therefore, the proposed group will offer an effective, evidence-based service to the population that needs it.
Setting
This manual is developed for a group that will negotiate the settings in which the meetings are going to occur. This approach to determining appropriate settings is aimed at making the participants as comfortable as possible and allowing them to make choices about the group. Still, several options have been considered, including public and private spaces. One of the first solutions is using a public space, specifically the Miami-Dade Community Services clinic. It is preferable for multiple reasons; first of all, the developer of the manual has access to the clinic, which is why some space for a six-member psychotherapy group can be arranged. Secondly, this setting will allow for reasonable privacy. Thirdly, it is preferable because it is a neutral ground; nobodys personal space is being invaded. Overall, it is the most reasonable and feasible choice. However, in case the participants object to the proposal, private spaces can be used, particularly that of the group leader.
Dates and Times
The dates are not currently set; rather, the participants and the group leader will negotiate to ensure that the most convenient solution is found. However, the duration and frequency of meetings for the group have been determined. It is planned that the group will proceed to meet for nine weeks; weekly sessions are going to take two and a half hours during one day of each week. Thus, there will be nine sessions that will take place once a week when it is most convenient for everybody involved. The participants will engage in counseling (one and a half hours) and psychoeducation or psychotherapy (one hour). This approach is evidence-based; research indicates that interventions which combine psychoeducation with other methods, including counseling, are effective in encouraging abstinence (Khan et al., 2016). At the end of the ninth week, the participants will be offered another period of group activity if they find it interesting.
Qualifications for the Group Leader
The role of the leader is central to a psychoeducational group (Ezhumalai et al., 2018). While it is technically possible for a person without relevant education to lead one, in this manual, it is suggested to employ a professional (Pessagno, 2014). It should be noted that different kinds of professionals can perform the role; licensed professional counselors and registered nurses are common candidates. As a psychiatric nurse practitioner, the developer of this manual is qualified for the task.
Advertising
Advertising is significant for a group since it will determine the members who are going to participate (Corey, 2015). Given the projects targeted population, it requires reaching out for young male adults who have been diagnosed with alcohol addiction. To do that, the Miami-Dade Community Services clinic will be supplied with advertisement flyers. The reasons for choosing Miami-Dade Community Services are predominantly concerned with convenience. On the one hand, the developer of this manual has access to the clinic; on the other hand, the clinic offers services to many populations, and people with addiction are among them. Therefore, some of the patients of Miami-Dade Community Services may be interested in the described group, and the developer of the manual can deliver the flyers with the advertisement to this location.
The flyers will be placed in practitioners offices, as well as the receptionist area. This way, the participants who might need the service will be informed about it and will be able to make a decision about whether or not they want to contact the group leader. The practitioners will be informed that endorsing the group and especially coercing patients into participating is not ethical. Rather, the flyers may be offered in case a patient can benefit from considering the sort of intervention that the group provides, but he or she should be allowed make the decision based on the information provided in the flyer. An example flyer is provided below; it will be used to simultaneously identify and attract eligible people while providing them with the contact information that will help them to find their way into the group.
Advertisement Example
A psychotherapy group for people with alcohol addiction starts recruiting. Men between the ages of 21 and 35 who have been diagnosed with alcohol addiction can join.
In a group of six people, we will work to reduce addiction by meeting every week for two and a half hours for the duration of nine weeks. A psychiatric nurse practitioner will facilitate the meetings.
The group will use psychoeducation to provide important information about addressing addiction and help its participants to develop thinking and behavioral skills that can assist in achieving this goal.
If you are interested in learning the details about the group, use the contact information below.
Commentary on the Advertisement
As can be seen from the example, the advertisement will avoid coercive language and calls for action; it will simply present the information about the service for consideration to avoid misleading people. The content of the advertisement will include the key information about the group (in particular, its type and the planned duration of meetings). Furthermore, it will specify who is being recruited by mentioning the participant selection criteria. Finally, it will offer contact information (email), which will be used by potential participants to contact the group leader. Upon contact, the participants will be screened and selected using the criteria below.
Participant Selection and Interviewing
Given that the number of participants is not very large, the screening will not take much time. The maximum number of group members is going to result in quotas for participants; basically, the first six eligible men are going to be recruited. Potential participants will be interviewed individually using several steps of selection. First, a participants general eligibility will be considered: it will be established that he is a man of appropriate age who is diagnosed with alcohol addiction. Second, it will be necessary to ensure that the participant is ready and willing to participate in a group.
In order to perform the selection, a personal meeting (an interview) with the potential participant will be carried out, in which he will be provided with the informed consent document. A discussion of the informed consent, which will contain all the key information about the group, will help to answer all the questions the potential participant has while determining if the group would be the best solution for him. In addition, the interviewer will use the Simple Screening Instrument for Substance Abuse to determine if alcohol abuse is exhibited by the participant. The tool can be found in the materials published by the Center for Substance Abuse Treatment (2005); it is free for use, valid, and reliable (Boothroyd, Peters, Armstrong, Rynearson-Moody, & Caudy, 2013). In summary, the selection process is determined by the needs of both the group and participants. On the one hand, it is geared towards ensuring that the members of the group correspond to its selection criteria; on the other hand, it takes into account the different needs of the potential participants.
Screening Sheet
Below is an example screening sheet which will be used by the group leader during the initial interview in addition to the Simple Screening Instrument for Substance Abuse.
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The participant is eligible (male, 21-35, addiction diagnosis).
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The participant understands the specifics of the group and finds this approach suitable for himself.
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The participant understands what psychoeducation is and finds it suitable for himself.
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The participant understands the ground rules and confidentiality concerns and agrees with them.
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The participant can benefit from participation.
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The participant is interested in the group and wants to participate.
An Informed Consent Document
The informed consent document is required to ensure that the participation is informed and voluntary; since the group does not involve children, only the consent forms for adult participants are required. The creation of the example below was guided by the general premise of what an informed consent is: it is a document that contains all the information that is required to make an informed decision and offers a mechanism of obtaining consent (in this case, signature). In addition, the informed consent documents of other manuals were reviewed to check for general structures, appropriate language, and topics to be considered (Washington Coalition of Sexual Assault Programs, 2014). Below is the proposed text that provides details about the group, participants rights, and invites potential participants to ask questions if required. The contact information at the end of the document is not added since this is an example of an informed consent.
Informed Consent
Please read this document to the end. If you have any questions, make sure to ask them. You can ask the group leader directly or use the contact information at the end of the document. Sign this document only if you understand and agree with everything presented below.
Group description
This is a psychoeducational group for people struggling with alcohol addiction. Psychoeducation is an approach in psychology that exists to help people learn more about their health conditions and the ways of dealing with them. The main feature of psychoeducation is that it uses psychotherapy to motivate people to solve their problems. Basically, you will be provided with the information about alcohol addiction and solutions to it, taught the skills that will help you deal with the problem, and instructed on how to motivate yourself to stick to your chosen solution. Resolving the problem of addiction is not easy, but it is possible, and we will do our best to improve the situation.
Note that this is a psychotherapy group. You will be meeting with six other people (one of them the psychiatric nurse who will oversee the process), discussing your experiences, and practicing your skills with them. Psychotherapy groups are an effective solution for alcohol addiction, but they might not be for everyone. If you are not comfortable with working in a group, another approach may be better for you.
Eligibility
If you are reading this document, you have already been interviewed, which means that you can participate in the group. This group focuses on men aged 21-35 who struggle with alcohol addiction. The other members of the group will be able to share experiences that are similar to yours, which is the point of this approach to psychotherapy.
Process
If you sign this document, you will become a part of a six-member group (it will also include the nurse). You will be meeting with them once a week for nine weeks; each weekly session will take up two and a half hours. The first hour and a half will be dedicated to counseling; then, psychoeducation and psychotherapy will take place. Participation requires some time commitment; please keep that in mind. The settings and time will be chosen by all the members during the first meeting, which will take place at the Miami-Dade Community Services clinic. The group leader will contact you once the group is formed to negotiate the time for the first meeting.
In order to see the results, you will need to participate in more or less every session. The following list contains the rules that are established for the members of the group; please make sure that you understand and agree with them.
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The meetings must be confidential; you cannot disclose any information about the participants anywhere.
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The meetings must be safe. They cannot involve alcohol or drugs, and there can be no violence or threats of violence.
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The meetings will be civil, respectful, and supportive. You should respect other participants, which, among other things, means that you need to be punctual and attend each session in time.
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There will be boundaries. You do not have to share anything you do not want to share, and you can keep any information to yourself. Whenever you feel unsafe, pressured, or just uncomfortable, make sure to comment on it. Respect others boundaries as well.
Failure to follow the rules can end your participation in the group.
Confidentiality
You have the right to confidentiality, and we will respect it. No confidential information about you will be disclosed at any time outside of the group. However, during psychotherapy, certain information may come up which a health professional has to disclose. That includes the instances of abuse and neglect directed at vulnerable groups (especially children, the elderly, and people with disabilities) and the cases of self-harm or harm to others. If this sort of information is brought up during sessions, your group leader might have to disclose it. However, in every other instance, your personal, confidential information will not be provided to anyone outside of the group. You will not be required to use your real name during sessions, and you will be expected to also support the confidentiality of other participants.
Fees and canceling participation
It is best to avoid canceling participation since you will need all the nine sessions for the best effect. However, if you want to cancel, please make sure to do so beforehand (at least 24 hours before the session). The costs of sessions are covered by insurance.
Consent
Re-read this document and check if this group fits your needs and if you agree with the described processes and confidentiality requirements. Do not be afraid to ask questions; perhaps, you want to learn more about psychoeducation or counseling or their proven impact on alcohol addiction. If you understand everything in this document, agree with it, and want to participate, please sign the form below to indicate your consent.
Ground Rules
The ground rules that are proposed for the group are common ones; their primary goal is to ensure that the group functions effectively without too many conflicts and that there are the means of resolving conflicts. The sources that were consulted to develop the rules include the manuals by DeMarce, Gnys, Raffa, and Karlin (2014) and the Washington Coalition of Sexual Assault Programs (2014), which were used as examples. Also, some academic sources were consulted, including those by Alle-Corliss and Alle-Corliss (2009), Corey (2015), Ezhumalai et al. (2018), and Koukourikos and Pasmatzi (2014).
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Confidentiality. The participants will be instructed to preserve the confidentiality of each other. Given that it is a common concern for group therapy (Ezhumalai et al., 2018), this rule is very important.
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Safety. No drugs or alcohol will be present during the meetings. Any violence or threats of violence will be strictly prohibited.
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Civility, inclusivity, and support. Participants will be encouraged to behave in a civil, supportive, and respectful manner. This rule includes punctuality; not being punctual is disrespectful toward other members.
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Respect for boundaries. Participants will be invited to set boundaries and respect them with oneself and others.
Structure for Eight Sessions
The group will consist of nine sessions; the first one will function as a pre-group session, and it will be used for organizational purposes. The rest of them will be aimed at achieving positive outcomes for the participants. While psychoeducation groups are structured and have a schedule and a curriculum, it is typical for them to adjust to the needs of the participants, allowing the latter to make choices about the discussion topics that they are interested in (Pessagno, 2014). This approach is intended to maximize the usefulness of psychoeducation, which aims to inform participants about the things that they do not know and teach them the skills they do not have. Other than that, the structure was informed by existing manuals, for example, that by DeMarce et al. (2014), as well as information on group interventions from academic sources like that by Corey (2015).
The initial, pre-group session is going to be different from the rest of the meetings since it will focus on organizing the processes of the group. Its structure is presented below; it is informed by the need to establish ground rules, goals, and explain it to the participants what they can expect from the intervention.
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The participants and the leader welcome each other and introduce themselves.
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The leader provides an explanation of the goals of this session (organizing the group activities).
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The leader provides an explanation of the goals of the group (assisting the participants in dealing with alcohol addiction).
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The leader provides an explanation of the methods of the group (psychoeducation, counseling, as well as their effectiveness in dealing with alcohol addiction).
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Questions about the group and its methods are invited by the leader.
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Ground rules are established and explained by the leader.
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Confidentiality concerns are introduced by the leader.
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Questions about rules and confidentiality are invited. The participants agree to follow the rules and maintain confidentiality.
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Organizational questions (settings, dates) are addressed.
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Pre-intervention assessment is carried out.
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Any remaining questions are invited. The leader ends the session with a recap of the session.
The following sessions are going to have a different structure that is based on the general goals of the group, as well as the phases of group formation and development. Furthermore, the second session will be used to provide participants with the information that is required for them to choose the content of the remaining sessions. This approach will be in line with ensuring that the psychoeducational intervention offers new and useful information and skills (Pessagno, 2014). As a result, it makes sense to consider the structure of the second session separately.
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Welcoming and greetings.
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Recapping the rules.
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Recapping the goals of the group.
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Explaining the goals of the session (providing some information for future choices).
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The content of the session: providing information about alcohol use and abuse, alcohol addiction, and solutions to it.
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Questions.
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Explaining how psychoeducation can help with the issue. Proposing content for the future activities.
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Making joint decisions about the topics that are most important or interesting for the group.
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Questions.
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Finishing the session with a recap.
For sessions 3-7, the following structure will be used. It will be aimed at ensuring the continuity of the sessions while also covering all the topics that the participants are interested in (DeMarce et al., 2014; Pessagno, 2014). These sessions constitute the core of the groups activities.
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Welcoming and greetings.
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Recapping the rules if needed.
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Recapping the previous session and connecting it to the current one.
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Laying out the goals of this session.
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Questions if needed.
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The counseling element of this session.
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The psychoeducational element of this session.
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Planning home assignment if applicable.
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Questions and planning the next session.
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Closing the session with a recap.
The two final sessions will follow the same basic structure, but they will also include activities aimed at successfully overcoming the termination stage of the group, which can be especially difficult (Maples & Walker, 2014). As a result, the content of these two sessions will include the reminders of the upcoming end of the group and activities aimed at assessing the outcomes of participation. In summary, the nine sessions are going to be structured in a way that would ensure the achievement of the groups goals while taking into account the group development stages.
Stages/Phases in the Sessions
There are several stages that are relevant to group therapy. While different theorists propose various approaches to the topic, the present manual considers the five-stage one and uses it to structure the sessions (Ezhumalai et al., 2018; Kumar, Deshmukh, & Adhish, 2014; Pessagno, 2014). Logically, the stages follow one after the other; the first one is characterized by uncertainty (forming); the next one is associated with conflicts (storming). The norming and performing stages enable the group to become cohesive and work toward the set goals. Finally, the termination stage results in disbanding the group.
For the described group, the deadline is set at nine weeks. As a result of the short period that is available, as well as the limited time the participants will spend together, the norming and performing stages need to be achieved very quickly. The first session includes the determination of goals and establishment of ground rules; with their help, the group will be able to determine the direction for their performance while receiving the discipline and structure required for the reduction of uncertainty and conflicts. The same session, as well as the one after it, will also be used to build trust and rapport between the participants and the group leader. Specifically, the ground rules of respect and the leaders demonstration of the appreciation of each participant will be used to this end (Lacerenza, Marlow, Tannenbaum, & Salas, 2018). The rules of this group aim to ensure positive, healthy interactions within it, which makes them appropriate for the task.
In addition, the leaders behavior will be a crucial factor in advancing the group formation. Indeed, the leader should remain objective and neutral, as well as just: nobody should be treated preferentially, and all participants need to feel that they, their contribution, and their progress are recognized and appreciated. Mistakes and inappropriate behaviors or ideas do require correction, but they should not be the focus to ensure that the leader remains supportive. Cultural competence can help to improve a leaders ability to understand the personalities of members, which is necessary for effective group management (Palli, 2017). The leader also needs to lead by example; the leader is the one who ensures the communication of group values to the members (Ezhumalai et al., 2018). Finally, the leader cannot be defensive and has to make sure to recognize his or her mistakes. It should also be noted that the leader will be the one to ensure effective resolution of conflicts (Kumar et al., 2014; Lacerenza et al., 2018). This type of leader behavior will be used to inspire trust and promote mutual respect between the participants; by following the rules, the leader will promote rule adherence in the rest of the group.
It should be noted that each session will contribute to the cohesion and commitment of the group. Research suggests that group activities can have an impact on trust (Lacerenza et al., 2018), and every session will incorporate them. In summary, the rules, leaders actions, and multiple elements of different sessions will be aimed at achieving the performing and norming stages of the groups development as quickly as possible. In the best case, the first and second sessions will mostly resolve uncertainty and conflicts, and the third one will already belong to the norming or working phase.
During the norming and working (or performing) stage, the group makes progress. The members benefit from the process (Corey, 2015). Throughout this stage, it is important to continually evaluate and promote member participation, as well as their work on planning future sessions. This approach will help participants to feel appreciated,
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