GC SOC 386 Week 5 Discussion Latest

GC SOC 386 Week 5 Discussion Latest

Please answer each DQ.

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

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

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

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

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

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

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

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

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