CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
FACILITATING MUTUAL SUPPORT GROUPS
FOR PATIENTS WITH CHRONIC ILLNESS:
A TRAINING CURRICULUM
A graduate project submitted in partial satisfaction
of the requirements for the degree of
Master of Public Health
by
Diane R. Tamburello
January 1987
The Graduate Project of Diane R. Tamburello is approved:
Goteti B. Krishnamurty, Dr. P • •
Susan C. Giarratano, Ed.D.
Committee Chair
California State University, Northridge
ii
To Chris, who loved and supported
me and shared in my growth,
And whose contributions were
invaluable,
I
dedicate this Project.
iii
ACKNOWLEDGMENT
I wish to express my appreciation and gratitude to
those individuals whose contributions have made this
project a reality.
First,
I wish to thank the members of my committee for
their support,
guidance, and suggestions.
My appreciation
is extended to Dr. Goteti B. Krishnamurty for his suggestions regarding the project's manuscript.
My sincere
gratitude is offered to Dr. Susan C. Giarratano, committee
chair, for her guidance and suggestions throughout the
project and for her commitment to excellence which significantly influenced the final product.
you goes to my mentor and friend,
A very special thank
Mei-Ling Schwartz,
M.P.H., Member Health Education Administrator at Kaiser
Permanente Medical Center in Panorama City.
For her
guidance and support from the project's inception through
its completion,
I extend my heartfelt gratitude.
Next, I wish to thank Phyllis Spear, M.P.H., Health
Education Specialist at Kaiser Permanente, for her ongoing
support and encouragement throughout this entire project
and for her invaluable contributions in the planning and
implementation of the training workshop.
Finally,
I wish to acknowledge the Kaiser Permanente
members who participated in the pilot test of the Mutual
Support Group Facilitator Training Curriculum.
iv
TABLE OF CONTENTS
Page
iii
DEDICATION
iv
ACKNOWLEDGMENT
vii
ABSTRACT
Chapter
1.
1
INTRODUCTION
Statement of the Problem
2
Purpose of the Project
3
Justification •
4
Target Group
8
Assumptions •
2.
3.
.
• .
• • .
10
Project Limitations . . • .
10
Definition of Terms
11
13
REVIEW OF THE LITERATURE
Historical Background of Self-Help Groups .
13
Self-Help Groups in Health Care . • . • . •
17
The Professional Role in Self-Help Groups .
22
Training Support Group Facilitators
26
METHODOLOGY . • • • .
31
Needs Assessment
31
Curriculum Development
33
Implementation
39
Administrative Support and Clearance
39
Staff Involvement • • • • • • . • • .
40
Teacher Qualifications
41
Recruiting Workshop Participants
42
"
In-Service Education
••.••••
43
Teaching Facilities .
44
Teaching Materials
45
The Workshop
45
• • •
45
Evaluation Scheme •
v
0 '
Page
Chapter
RESULTS AND DISCUSSION
Results .
Discussion
49
s.
SUMMARY AND RECOMMENDATIONS .
Summary .
Recommendations .
68
68
71
6.
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING CURRICULUM . . . . . . .
74
4.
49
59
REFERENCES
141
BIBLIOGRAPHY
144
APPENDICES
. . . .
. . .
A. Mutual Support Group Facilitator
Training Workshop Agenda . . . .
B. Mutual Support Group Facilitator
Training Workshop Evaluation Questionnaire
148
vi
148
151
ABSTRACT
FACILITATING MUTUAL SUPPORT GROUPS
FOR PATIENTS WITH CHRONIC ILLNESS:
A TRAINING CURRICULUM
by
Diane R. Tamburello
Master of Public Health
The purpose of this project was to develop a curriculum designed to train individuals as facilitators of mutual
support groups for patients with chronic illness.
The
curriculum targets individuals who are either members of
existing support groups or are intending to become members
of existing or planned groups.
Those individuals would be
trained in group facilitation theory and techniques in an
effort to increase the effectiveness and enhance the
quality and success of the groups.
The training curriculum was developed in response to
an expressed and assessed need for such a program at Kaiser
Permanente Medical Center in Panorama City.
Following the
development of the curriculum, a two-day workshop was
planned by the staff of the Kaiser Permanente Member Health
vii
Education Department as a means of implementing and pilottesting the curriculum.
The staff of three health
education specialists conducted the workshop for a group
of 16 participants,
representing chronic conditions such
as arthritis, diabetes, cancer, and overeating.
The final phase of this project involved a subjective
evaluation of the entire program based on observations made
by the trainers throughout the workshop and an evaluation
questionnaire completed by workshop participants at the end
of the program.
It was determined,
based on the results of
the evaluation, that the curriculum goal, which was to
provide information about group theory and the opportunity
to practice skills in facilitating group process and communication, was clearly met.
It was also determined that
the workshop was an effective means of implementing the
training curriculum,
although specific revisions in the
design of the workshop were suggested for future
implementation.
viii
Chapter 1
INTRODUCTION
The ever-increasing demand for health care is requiring
health educators to examine carefully the role of their
profession and how it relates to the needs of individuals
who are seeking health care services.
The major goals of
health education are 1) to plan educationally sound methods
of behavior change that will directly or indirectly affect
people's health, and 2) to integrate information and attitudes individuals have acquired regarding health so they
will be able not only to make informed choices, but also
to assume responsibility for their own health.
The concept of individual responsibility relates to the
idea of developing self-empowerment, as in self-care, selfmanagement, or self-help.
This means that the individual
has the power to play a major role in maintaining wellness,
as well as managing illness, as an adjunct to traditional
medical care.
The role of the health educator, therefore,
becomes one of not only assisting in the learning process,
but also one of providing motivation for individuals to
seize their power to make positive changes in health.
This role of the health educator becomes a greater
challenge as it relates to servicing the needs of chronically ill patients.
One approach is to involve the patients
themselves in the care and management of their illness by
1
2
providing educational programs,
recognizing the potential
for improving people's health by promoting changes in what
they do and do not do for themselves.
This approach on the
part of the health educator can be taken one step further by
promoting and forming self-help mutual support groups for
chronically ill patients.
tions,
Various health service organiza-
including Kaiser Permanente Medical Center in
Panorama City, have begun to develop such support groups
which provide education, skills, encouragement, and other
'
forms of support for people united by the common bond of a
chronic health situation.
The current growth in mutual support group activities
has stimulated interest among health service providers,
including health educators, about the structure and dynamics
of these groups.
These individuals interested in forming
mutual support groups have been confronted with an apparent
lack of training materials and programs.
This project
represents an effort to provide health professionals,
involved with mutual support groups for patients with
chronic illness, with a program designed to train selected
individuals in group facilitation theory and techniques as a
means of enhancing the quality and success of such groups.
Statement of the Problem
An examination of existing mutual support groups for
patients with chronic illness,
initiated by the Member
Health Education Department at Kaiser Permanente Medical
3
Center in Panorama City, has revealed a variety of problems
related to group process and the interaction between group
members which are affecting the groups' ability to function
effectively.
Discussions with group leaders, input from
other group members, and observations by Health Education
personnel have all pointed to the need to establish some
type of educational program aimed at training current and
future group members interested in group facilitation theory
and techniques.
In addition, an investigation of available
resources in this area has revealed limited training programs and materials developed specifically for use with lay
persons interested in becoming facilitators of these mutual
support groups organized for patients with chronic illness.
Purpose of the Project
The purpose of this project is:
1. To develop a curriculum,
in the area of group
facilitation theory and techniques, designed to train
selected individuals as facilitators of mutual support
groups for patients with chronic illness.
2. To train these individuals, who are either members
of existing mutual support groups or are intending to become
members of existing or planned groups, in group facilitation
theory and techniques in an attempt to increase the effectiveness and enhance the quality and success of these
groups.
3. To pilot test the curriculum by implementing it in
4
a training workshop with selected individuals who have
expressed a willingness to be trained as facilitators of
mutual support groups at Kaiser Permanente Medical Center
in Panorama City.
Justification
The growth and proliferation of the current self-help
movement in health care appear to coincide with the shift in
major health problems which has been evident during the last
50 years.
During that time,
there has been a decrease in
the incidence of acute infectious type illnesses and an
ever-increasing incidence of a broad range of chronic illnesses,
including such disorders as diabetes, arthritis,
cancer, heart disease, hypertension, and emphysema.
About
50 percent of the population now suffers from chronic illnesses and these disorders account for at least 70 percent
of all physician visits (1:783).
Despite this shift toward
increased chronic illness. the nation's health care delivery
system has retained its traditional doctor-patient relationship model designed for the pre-chronic disease era.
doing,
it has failed to develop a continuous form of care to
replace that based on treatment of acute illness.
words,
In so
In other
there has been a failure to shift from the concept of
"sick" care to that of "well" care (2:412).
There is a significant disparity between the needs of
the chronically ill and the structure of the health care
system.
Patients newly diagnosed with a chronic illness
5
usually experience a variety of feelings,
including shock,
disbelief, denial, anger, self-pity, grief, and resentment,
upon realizing that there is no cure at the present time for
their illness (3:40).
These responses can lead to feelings
of helplessness and aloneness.
Often demoralized, chroni-
cally ill patients become less able to cope with life's
problems, and may isolate themselves from sources of social
support.
This behavior pattern can lead to a failure to
comply with prescribed regimens of diet, exercise, and
medication, thereby resulting in more severe symptomatology
(4:326).
The current health care system does little to encourage
patient activity and responsibility.
Patients commonly com-
plain that the physician does not spend enough time talking
with them and explaining matters, or that the explanations
are too technical.
In addition, many patients feel that
physicians simply do not understand the frustrations
involved in the disruption of routine living that patients
and families must undergo in the course of adapting to
chronic illness (2:412).
Noncompliance on the part of the
patient, therefore, may be a visible manifestation of a
dysfunctional relationship between patients and health care
professionals, a relationship in which many patients receive
little individual attention, and in return assume little
responsibility for the management of their illness (4:326).
When there is a disparity between felt need and the
existence of available services and programs adequate to
6
meet such needs,
the ground is prepared for the development
of a social movement to fill that vacuum, a movement such as
the emergence of self-help groups and organizations (2:413).
Self-help groups (also called mutual aid or mutual support
groups) have been defined as
voluntary, small group structures for mutual aid and
the accomplishment of a special purpose.
They are
usually formed by peers who have come together for
mutual assistance in satisfying a common need,
overcoming a common handicap or life-disrupting
problem, and bringing about desired social and/or
personal change.
The initiators and members of such
groups perceive that their needs are not, or cannot
be, met by or through existing social institutions.
Self-help groups emphasize face-to-face social
interactions and the assumption of personal
responsibility by members.
They often provide
material assistance, as well as emotional support;
they are frequently "cause''-oriented, and
promulgate an ideology or values through which
members may attain an enhanced sense of personal
identity. (5:9)
The emergence of self-help mutual support groups for
patients with chronic illness has provided the opportunity
for many patients to seek support and assistance in dealing
'
with the problems associated with long-term illness and
disability, as well as to play a more active role in the
treatment and management of their illness.
Participation
in mutual support groups can be a valuable experience for
patients trying to cope with similar health problems.
Adap-
tation and adjustment to the demands of altered life styles
and increased responsibility are encouraged by the support
of others who have had similar experiences.
Support groups
also allow for open discussions about feelings in a nonjudgmental atmosphere providing empathy,
encouragement, and
7
acceptance.
In addition,
these groups represent a valuable
adjunct to continuing medical care by providing information
and resources which can promote better understanding and
compliance with medical regimens.
A primary goal of mutual
support groups is to provide a vehicle that reduces feelings
of helplessness and loss, and in so doing, enables chronically ill patients and their family members to develop an
improved capacity for taking control of their lives and
enhancing mastery of their health care (6:75).
An antici-
pated outcome of membership in a mutual support group would
involve the resumption of role responsibilities appropriate
to the patient's illness-determined optimal level of
physical,
social, and psychological functioning (4:327).
At present,
the self-help movement is not large enough
to reach more than a fraction of the population in need.
There is a need for more health care providers to recognize
the importance of the role that self-help mutual support
groups can play in dealing with problems related to chronic
illness.
Currently, major recognition of the work of
support groups is coming from established voluntary health
organizations which are sponsoring such groups.
However, a
variety of community and health service organizations,
including health maintenance organizations such as Kaiser
Permanente, have shown an interest in forming support groups
for their patients with chronic illness.
Of particular significance in this current trend of
starting support groups is the role of health education.
8
The self-help movement offers a tremendous opportunity for
health educators to further their professional and ethical
goals of enhancing the quality of life, by becoming involved
in the promotion and formation of mutual support groups for
patients with chronic illness.
A major consideration for health educators, or any
health service provider, thinking about starting support
groups is the need to train individuals interested in taking
on the role of group facilitator.
figure in the group.
The facilitator is a key
The goal of the facilitator is to
foster the emergence of a process whereby group members
can more effectively seek help from and give help to one
another,
thereby enabling the group to become a viable
alternate care-providing system which encourages each member
to take responsibility for the care and management of their
illness (4:334).
The performance of this role requires
skills in facilitating group communication and processes,
problem-solving skills within the framework of a helping
relationship, and the modeling of these skills for the
benefit of other group members.
Many support groups falter
and possibly even fail because of the lack of skills among
their members.
The need for skill acquisition is the basic
premise upon which this curriculum is based.
Target Group
This curriculum is designed as a training program for
lay persons interested in becoming facilitators of mutual
> .
9
support groups organized for patients with chronic illness
who are members of Kaiser Permanente in Panorama City,
California.
These potential group facilitators might
already be members of an existing support group or they
might be individuals who are interested in joining a newly
formed group.
Whichever the case, the individuals must have
the chronic illness around which the group is formed.
They
also must be planning to continue as, or to become active
members of the group.
It is anticipated that the program participants will be
adults of varying ages (mostly middle-aged and older), backgrounds, and educational levels.
however,
It will be a condition,
that all individuals suffer from a chronic illness
such as diabetes, arthritis, cancer, or chronic obstructive
pulmonary disease, and that they will have all attended an
educational program dealing with their specific illness.
Some of the participants will still be active members of the
work force,
while others will be retired or unemployed,
either by choice or because of their illness.
While it is
assumed that at least some of the participants will have had
some type of group experience, it is unlikely that any of
them will have ever had any type of formal training in
facilitating group processes and communication, even though
some participants may possess group process or communication
skills acquired through work experience.
assumed that,
the knowledge,
Therefore, it is
regardless of the participants' background,
skills, behaviors,
and attitudes necessary
10
for facilitating mutual support groups could be fostered or
further refined with the training provided by this curriculum.
Assumptions
1. The knowledge,
skills, behaviors, and attitudes
necessary for facilitating mutual support groups can be
fostered or refined by means of a formal training program,
regardless of the participants' age, background, or
educational level.
2. Training selected individuals in group facilitation
theory and techniques can increase the effectiveness and
enhance the quality and success of mutual support groups.
Project Limitations
1. This project is designed and targeted for patients
with a chronic illness who are members of Kaiser Permanente
in Panorama City and who are willing to be trained as mutual
support group facilitators.
Implementation of the project
in other locales or health care settings may not have the
same outcomes.
2. The generalizability of the outcomes of this project
will be limited due to testing on only one group of individuals and due to the size of that group.
11
Definition of Terms
Mutual support groups (or self-help groups):
"voluntary,
small group structures for mutual aid and the accomplishment
of a special purpose.
They are usually formed by peers who
have come together for mutual assistance in satisfying a
common need,
overcoming a common handicap or life-disrupting
problem, and bringing about desired social and/or personal
change" (5:9).
Throughout this paper,
support group, mutual aid group,
the terms mutual
and mutual help group will
be used interchangeably or in conjunction with self-help
group.
In all instances,
the above definition is appli-
cable.
Mutual support group facilitator:
an individual within a
support group who is capable of assisting or making easier
the process of mutual and self-help by
*
directing group members to become actively involved
with one another;
*
encouraging members to support one another through
reporting similar experiences;
*
directing members to seek help from and give help to
one another;
*
promoting shared responsibility among members for
group functions;
*
creating an atmosphere conducive to coping with
problems;
*
not serving as a primary information source; and
12
*
not dominating the group process or assuming the role
of being the central channel through which all information flows.
Leadership in mutual support groups:
a functional approach
to helping the group achieve its desired goals and purposes.
This approach is based on a set of functions through which
the group coordinates the efforts of individuals and
suggests that group members have a shared responsibility to
carry out the various leadership functions.
The facilitator
assists the group in carrying out these functions.
Formative evaluation:
evaluation which occurs during the
instructional period of an educational program and which
assesses instructional techniques and learning opportunities, as well as the progress that is being made toward
stated objectives.
Continuous evaluation provides feedback
which enables the instructor to make revisions or minor
adjustments in the instructional program so that the needs
of the learner can better be met.
Summative evaluation:
evaluation which occurs following the
completion of the instructional program and which assesses
the program's outcomes, as well as the extent to which the
stated objectives have been met.
T~e results of this evalu-
ation serve as a basis for revising and improving the
overall instructional program.
v '
~}
Chapter 2
REVIEW OF THE LITERATURE
There is a grnwing body of professional literature on
self-help mutual support groups.
The vast majority of this
literature is of a descriptive nature, dealing with the
large variety of self-help approaches and many different
aspects of self-help groups.
Despite varying interpreta-
tions of the role of self-help groups, rarely is the
literature critical of the overall value of these groups
as a viable adjunct to traditional human service delivery
systems.
This chapter reviews four specific areas of the literature.
First, a brief historical background of self-help
groups is presented.
Second, the role of self-help in
health care, the major focus of this project, is examined.
Third,
the role of the professional in self-help health
groups is reviewed.
Finally, this chapter examines current
programs and literature related to the training of self-help
support group members in the areas of group facilitation and
communication skills.
Historical Background of Self-Help Groups
Self-help is not a new idea,
but rather, has been a
part of society since the beginning of social organization.
In his original and influential piece of work, Mutual Aid,
13
'
14
Petr Kropotkin (7) outlined the history of mutual aid and
self-help in Europe from primitive times to the beginning
of the twentieth century.
There have been few attempts by
contemporary writers to follow Kropotkin's comprehensive
analysis of this social phenomenon.
In primitive societies, tribes or clan members grouped
together in mutual aid.
Their survival depended on the
development of habits of social cooperation--food-gathering
and sharing, land use, and the maintenance of group safety
and defense.
Although these primitive forms of mutual aid
became threatened, according to Kropotkin, with the creation
of families,
the stronger clans formed a new type of social
organization,
the village community, where membership bonds
were based on mutual protection of the village territory.
During the Middle Ages, classical forms of mutual aid
began to appear.
This was especially evident in the various
community groups--trade guilds, culture groups,
orders--whose members shared a common problem,
or custom.
social
occupation,
However, membership in such groups was largely
exclusive and aid would be extended only to bona fide
members of the in-group (5:16).
In the centuries to follow,
the public poor relief laws
ultimately extended various forms of welfare and health
benefits to all citizens,
the same time,
however,
including the working class.
At
the effects of the Industrial
Revolution were beginning to produce an expanding chaos of
social,
economic, and health problems for the ever-growing
15
population (8:268).
This led the way to the development of
mutual aid groups of industrial workers.
The Friendly Societies of nineteenth century England
represented a return to mutual aid principles of attempting
to cope with adverse living conditions.
They were groups
of workers who sought collective support from one another
in times of crisis such as illness, death, or financial
need.
That this movement toward mutual aid was meeting a
popular need was evidenced by the fact that over 27,000
Friendly Societies existed in England by the turn of the
twentieth century (5:17).
In the United States, mutual aid principles originated
with the early colonists, as they banded together in small
communities for protection against nature and to produce
necessities.
However, these early communal efforts in
agriculture and crafts were short-lived as they were gradually replaced by the "marked individualism in production,
ownership, and consumership that has characterized American
society ever since" (8:273).
With the coming of the Industrial Revolution in the
nineteenth century, many of the problems which existed in
England began to appear in the United States also.
Workers
began to band together in new forms of mutual aid organizations such as craft and trade unions.
The emergence of
these groups, as with the Friendly Societies in England,
"reflected constant efforts by workers to help each other
and help themselves to cope with the health and social
16
problems associated with capitalist development" (9:21).
The clearest example of people turning to one another
for help was with the massive waves of immigrants to America
in the late nineteenth and early twentieth century.
With
few formal services to aid in their survival, immigrant
groups organized large networks for self-help and mutual
aid.
However, by the 1930s, as immigration to North America
had decreased significantly, many of the previously important self-help and mutual aid fraternal organizations formed
to serve the needs of immigrants and their children declined
or disappeared altogether (8:277).
According to Katz and Bender (5:26), self-help groups
in their contemporary forms were virtually unknown prior to
the 1940s, with the exception of Alcoholics Anonymous (AA),
which has been cited as having served as a model for selfhelp service activities since its inception in 1935 (9:22).
The "unprecedented flowering in North America of the greatest number and variety of self-help groups ever known in
human history" (5:23) did not begin until after the end of
World War II.
According to Zola (10:453), one explanation
for this was that the war "forced a confrontation with the
most massive job of rehabilitation we have ever faced and
this made certain kinds of physical handicaps no longer a
personal but a national responsibility."
This growth in the more contemporary type of self-help
groups continued during the decades following the war, and
was especially evident during the social movements of the
17
1960s.
Gartner and Riessman (11:3-4) look at the self-help
movement as having been "powerfully affected by the values
of the 1960s--by the concern for personal autonomy, participation, quality of life, human potential, consumer rights,
deprofessionalization, and decentralization."
During the
1970s, self-help groups continued to emerge all around the
country and by the early 1980s, totaled about 500,000 and
involved some 15 million people (12:631).
Self-help groups
play an important role in helping many people cope with
various life crises.
The growing number of groups organized
to help individuals deal with a wide range of health-related
problems points to this social phenomenon as one potential
means of meeting the increasing demands placed on health
service delivery systems.
Self-Help Groups in Health Care
The overall demand for health care today is due largely
to the ever-increasing incidence of a broad range of chronic
illnesses such as diabetes, arthritis, cancer, hypertension,
heart disease, and emphysema.
These are disorders for which
there is no known cure, and which usually require medical
management for extended periods of time, sometimes for life.
According to Gartner and Riessman (1:783), one approach to
solving our modern health problems is to "involve the
patients themselves, both individually and in self-help
groups, recognizing that a most significant potential for
improving people's health is through changes in what they do
18
and do not do for themselves."
Encouraging patients to play a more active role in
their health care, in essence, is promoting an increase in
self-care activities.
Levin (13:206) defines self-care as
"a process whereby a layperson functions on his/her own
behalf in health promotion and prevention and in disease
detection and treatment at the level of the primary health
resource in the health care system."
In reference to
patients with a chronic illness, this self-care process
involves three steps, as outlined by Strauss (14:36), which
can enable these patients to cope with their illness.
steps include:
These
1) the ability to read signs that portend
crisis (a form of self-diagnosis); 2) the ability to respond
to the crisis of the moment (a form of self-treatment); and
3) the ability to establish and maintain a regimen.
All
three of these abilities are central characteristics of a
consumer-centered model of health care.
Gartner and Riessman (11:13-18) have written at great
length on this subject.
They call for a fundamental
restructuring of the basic nature of the human services so
that the consumer, not the professional,
center.
tries,
stands at the
In health care, as in many other service industhe consumer frequently plays an important part in
effecting productivity.
In other words, "an individual's
health depends mainly on what he or she does about maintaining it, preventing illness, and building positive
health."
Gartner and Riessman refer to this concept as
19
"consumer intensivity," which means "the more the productivity of the provider depends on consumer behavior, the
more consumer intensive is the activity."
They feel that
consumer intensivity increases significantly when the
consumer, or patient, functions as both a deliverer and a
receiver of a service, as is usually the case in self-help
mutual aid groups.
Health is a particularly significant area with regard
to self-help group activity.
In the United States, there
are over 32 million people with arthritis, 20 million with
high blood pressure,
five million with diabetes, and many
more millions suffering from other physical ailments
(12:635).
It is impossible for the current professional
health care system to provide all the services needed by
these people.
Thus the self-help approach is one means of
filling the gap between what clinical medicine can offer and
what chronically ill patients need to achieve optimal functioning (15:388).
It is important to note here that,
in most of the
literature, the quality of technical medical care for
patients with chronic illness is not the issue.
Based on an
extensive survey of self-help health group members, Tracy
and Gussow (15:389) found that patients themselves feel that
"while the physician provides more than adequate medical
care for the clinical condition,
physician assistance in
adaptive problems is less than adequate."
Therefore, a
major concern of chronically ill patients is finding a means
20
of adapting to their illness.
In this regard, Gartner, A.
and Riessman (12:635) see the self-help mutual support group
as playing a "powerful role in helping individuals cope with
their illness and with life problems related to family,
job,
and life style."
The most fundamental characteristic of mutual support
groups is the experiential input in dealing with problems or
needs.
Since these groups are made up of people experi-
encing similar problems, they can "provide an opportunity
for members to express feelings openly, discuss problems,
and receive support from others who are dealing or have
successfully dealt with similar problems.
Because the group
is founded on the mutuality of the helping relationship,
reciprocity is emphasized" (16:239).
Within this mutually
supportive environment, education, coping skills, peer
encouragement, and other supporting activities are provided
in helping chronically ill patients deal with their medical
problems.
According to Robinson (17:416), self-help groups,
in addition to providing mutual support, also "find practical solutions to specific difficulties and provide an
opportunity for members to build, on the basis of mutual
trust and understanding, a new set of relationships and
even, for some, a new way of life."
It has been said that the social support inherent in
self-help groups might even act to encourage chronically ill
patients to take the first steps toward self-care (4:327);
in other words, to play a more active role in their own
,,
'
21
health care.
Gartner and Riessman (11:91) have said that
"both self-care and mutual aid activities are movements
away from 'medicocentrism'
(health care that is medically
centered) and emphasize the power (and responsibility)
individuals have for their own well-being.
As such, they
represent an expression of self-empowerment.''
This
empowering dimension of self-help groups is particularly
important in the area of health care since it enables group
members "to feel and use their own strengths and their own
power and to have contrnl over their own lives'' (11:99).
The self-help approach within the health care delivery
system, according to Gartner and Riessman (11:107), "represents the essence of consumer involvement in that the role
of the professinnal service provider is, at most, minimal.''
This approach stresses, as Gartner and Riessman (11:13-14)
have coined it, an "aprofessional" dimension--the concrete,
the subjective,
the experiential, and the intuitive--in
contrast to the professional emphasis on distance, perspective,
systematic knowledge, and understanding.
This
professional orientation is very different from the already
described self-help orientation which is much more activistic,
consumer centered,
informal, open, and inexpensive.
Gartner and Riessman explain further that both the professional and the aprofessional have valuable attributes in an
integrated practice and that each is needed.
In addition,
the two orientations together could provide far better human
service practice, and that "a balance between the two could
22
result in the professional input being used much more
efficiently than is the current practice" (11:15).
The Professional Role in Self-Help Groups
Of particular significance in a review of the selfhelp movement is the ongoing controversy over professional
involvement with self-help support groups.
Professionals
have been involved with these groups for a number of years,
with their participation ranging from following a hands-off
policy to maintaining the role of group leader.
then,
At issue,
is the nature and extent of professional involvement
in the functioning and everyday activities of self-help
groups.
The role of the professional in self-help groups is a
subject which has been addressed by a number of authors
(11,12,15,17-24).
In a review of the traditional self-help
group model, Jaques and Patterson (18:56) explain that a
professional cannot be a member or leader of a self-help
group unless specific conditions exist,
such as sharing a
common problem, peer relationship or mutual aid; otherwise,
it would be a violation of the self-help model.
On a
similar note, according to Gartner, A. and Riessman
(12:634), "independence from professional intervention has
been part of the self-help rhetoric from the beginning of
the movement, and concern has often been expressed about the
potential hazards of involving professionals, such as their
usurping control of the group."
In citing an example of a
23
self-help group which experienced being taken over by a
professional organization, Tyler (20:447) reports that such
groups "lose their unique identity and much of the spontaneous enthusiasm that is such an important factor in their
effectiveness.''
He adds that a policy designed to have
professionals take over self-help groups would most likely
be self-defeating.
In his research on self-help groups, Levy (19:312)
included only those groups which met certain conditions
pertaining to purpose, origin and sanction, source of help,
composition, and control.
groups,
With his definition of self-help
he ruled out agency-sponsored and professionally-led
therapy groups, and included only those groups in which the
members themselves, not professionals, had primary control
over the functioning of the group.
Agreeing with this view
of self-help groups, Bumbalo and Young (22:1591),
examination of the self-help phenomenon,
in their
state that the
leadership of these groups should always remain with the
membership and that professional intervention should be
avoided.
However, most authors, including those just cited,
agree that professionals may play a peripheral role in
relation to self-help groups.
For example, professionals
may initiate or facilitate the development of a group,
persons to a group,
or function as a consultant,
resource person, or trainer.
refer
sponsor,
These roles are appropriate as
long as the professional in no way leads the group or makes
any decisions for the giotlp.
24
Some of the authors (12,15,17,21,24) who have written
about this subject examine the role of the professional in
relation to self-help support groups specifically in the
areas of health and disease.
In the health-related support
groups, professionals often play a role that differs from
their roles in other support groups.
Lurie and Shulman
(21:72-76) examine variations and examples of professional
(usually social work) involvement with self-help groups.
This involvement ranges from the already described peripheral role of the professional to an active involvement in
which the professional actually leads the group, such as
with the hospital-based treatment groups identified by Lurie
and Shulman.
Tracy and Gussow (15:395-396),
in their review of
self-help health groups, describe physician attitudes about
such groups.
They explain that, although many physicians
recognize their limits in dealing with the problems of the
chronically ill and recognize the role of self-help groups,
general acceptance of such groups on the part of the medical
profession is still spotty and hesitant.
However, accep-
tance appears to be more readily granted when these groups
meet at hospitals with active professional participation.
Tracy and Gussow, while questioning such an active role on
the part of the professional, as opposed to the advisorytype role, state that "the chief difference between the two
approaches lies in the balance of control over the activities and services provided to patient-members--whether the
25
groups will remain patient-run and grass-roots or become
physician-hospital oriented and professionalized."
Gartner and Riessman's (12:634-635) explanation of the
role of the professional in health-related self-help support
groups appears to be a combination of the two approaches.
Although they agree that the professional role in other
support groups should be peripheral, they feel that the
professional may become more involved in health-related
groups because the members themselves recognize that relevant medical information and feedback are essential.
For
example, in arthritis support groups, members typically want
professional information regarding the most recent developments in treatment of the disease, new research findings,
and new approaches to alleviating the day-to-day effects of
the illness.
The professional can also play an important
role in correcting misinformation often gathered from
sources such as friends and the media.
Although the profes-
sional may play a more active role than is generally the
case in other support groups, he/she in no way leads the
group or makes decisions for the group.
The basic autonomy
of the group remains intact, even though "there is a special
role for the professional that the group recognizes and
typically requests."
In essence,
this "mixed" type of self-
help group in the area of health, as Gartner, A. and
Riessman refer to it, incorporates the two basic
characteristics of all self-help mutual support groups-the group's autonomy and decision-making power, and its
26
experiential input for dealing with problems--while adding
a third component, professional expertise.
Training Support Group Facilitators
One of the most significant factors related to the
effectiveness of self-help mutual support groups is the
group process itself.
support,
reinforcement,
The group 1) provides peer help,
sanctions, and norms;
2) extends the
power of the individual; and 3) enables its members to share
with one another (11:113).
process is the facilitator.
The key figure in this group
The facilitator's role is to
foster the emergence of a process whereby group members can
more effectively seek help from and give help to one
another,
thereby enabling the group to become a viable
alternate care-providing system which encourages each member
to take responsibility for the care and management of their
illness (4:334).
Since health-related support groups, especially those
based in a hospital or clinic setting, are often initiated
by professionals,
first,
the facilitators of such groups may, at
be those professionals.
Eventually, however,
facilitation of the group process must come from the group
members themselves if the group hopes to achieve autonomy
and decision-making power, a fundamental characteristic of
all self-help mutual support groups.
The performance of this facilitator role requires
skills in facilitating group communication and processes,
@
'
27
problem-solving skills within the framework of a helping
relationship, and the modeling of these skills for the
benefit of other group members.
Few support group members,
especially among the population of patients suffering from
chronic illness, have had any type of training in this area.
Even many traditionally trained professionals, as well as
paraprofessionals, find that their training has not prepared
them with the knowledge, skills, or attitudes necessary to
work with mutual support groups (25:9).
This apparent lack
of skills among both professionals and lay persons interested in working with support groups has resulted in the
recent development of programs and guides designed to train
individuals in facilitating group process and communication.
One such training guide is Leading Self-Help Groups: A
Guide for Training Facilitators by Lucretia Mallory (26).
This guide was developed to help persons who want training
in facilitator skills and those who are doing training of
facilitators.
It has been used successfully in training
individuals whose levels of education range from a high
school diploma to a graduate degree.
The training is
designed to provide a basis of knowledge on which potential
facilitators can build.
Specifically, it provides 1) a
language and structure for thinking and talking about selfhelp groups;
2) communication skills; 3) practice and feed-
back as a facilitator in a practice group; 4) affirmation of
existing skills; and 5) understanding of basic human needs.
According to Mallory (26:14), group facilitators will
28
perform the role best if they are positively focused people
with "a belief and a trust in the capacity of others to make
healthy decisions and act in their own best interests.
The
facilitator needs skills to communicate these beliefs, and
to help create a group atmosphere of trust and acceptance."
With this in mind, the guide focuses on behaviors and skills
that are useful in creating a positive group culture.
Another training guide is Elinor Bowles' Self-Help
Groups: Perspectives and Directions -
An Instructional Guide
For Developing Self-Help Mutual Aid Groups (25).
This
training guide is in the form of a curriculum, and is
designed for use by both professionals and lay persons who
are interested in forming,
help groups.
organizing and maintaining self-
One of the goals of the curriculum is to
demonstrate that paraprofessionals as well as nonprofessionals and volunteers can be trained to work effectively
with self-help groups.
However, the audiences for whom the
curriculum is intended are primarily individuals who either
already work with or are in training to work with various
self-help groups, but who do not share the problem around
which the group was formed.
One premise upon which this
curriculum is based is that many self-help groups have
relied on, and their success has depended on, the use of
such "outsiders" (25:5).
The curriculum, however, does
incorporate group facilitator and problem-solving skills,
and can be adapted for use with lay persons who are actual
members of self-help groups.
29
A final program worth noting is the Common Concern
Program developed by the California Self-Help Center at the
University of California, Los Angeles (UCLA),
in conjunction
with the California Department of Mental Health (27).
The
program consists of a combination of audiotapes and printed
guides specially developed for groups of people with a wide
range of life-disrupting problems.
These groups are formed
around a particular problem, and are referred to as Common
Concern groups.
The program is designed to be used by
anyone interested in starting a Common Concern group or
improving an on-going mutual support group.
The
train~ng
program consists of instructions received
from a series of audiotapes,
containing brief lectures and
exercises that teach communication and group management
skills, along with a printed Leader's Guide designed to be
easily followed,
even by totally inexperienced leaders.
This current program is based on several years of research
by the UCLA Interpersonal Process Research Group.
This
research group developed an audiotape program which has
trained small groups in helping skills for many years.
That program was adapted,
tested, and aimed specifically at
teaching communication skills to members of Common Concern,
or self-help mutual support groups.
Support group members
who finish the program say the skills they learned make a
world of difference in their support groups and their lives.
In summary, all the training programs just described
include components pertaining to group process and
30
communication skills, areas which are essential in the
training of individuals as group facilitators.
However,
none of these programs were designed to deal specifically
with the needs and concerns of individuals suffering from
a chronic illness.
In fact,
no programs specifically
designed as such could be found amid the available literature pertaining to the training of mutual support group
facilitators.
Chapter 3
METHODOLOGY
The development of this mutual support group facilitator training program involved several steps.
Initially,
the need for such a program at Kaiser Permanente Medical
Center in Panorama City was established following an examination of the current status of mutual support groups
formed at that facility to service the needs of patients
with chronic illness.
The next phase of the project
involved the planning of the program, focusing on the
development of the actual training curriculum.
its development,
of a workshop.
Following
the curriculum was implemented in the form
Finally, the entire program was evaluated
to determine its effectiveness and potential for future
use.
This chapter reviews each of these steps in depth.
Needs Assessment
The establishment of mutual support groups for
patients with chronic illness was initiated at Kaiser
Permanente Medical Center in Panorama City by the Member
Health Education (MHE) Department approximately two years
prior to the development of this curriculum project.
With-
in that time, while planning the development of support
groups for diabetes patients, the MHE staff decided to
conducF a one-day workshop to train leaders of those
31
0
32
diabetes groups.
The workshop included lecture and dis-
cussion on the topics of group process, organization and
planning,
communication techniques, and control and
management of diabetes.
workshop,
During the year following the
the MHE staff received solicited and unsolicited
feedback from support group leaders and members, while
concurrently making periodic observations of the groups
during their meetings.
feedback received,
Based on those observations and the
it was determined that skills necessary
for facilitating support groups were, to varying degrees,
still lacking among the current group leaders and would
most likely be lacking among the population of patients
from which future group leaders/facilitators would come.
With the intent to continue promoting and establishing
mutual support groups for patients, the MHE staff decided
that a new training program was needed in order to better
prepare individuals as facilitators of these groups.
It
was further decided that the new program should be designed
for a workshop format and that it should emphasize both
knowledge and process skills, a lack of which was a major
shortcoming of the original workshop.
In addition,
there
were some actively involved support group members who had
expressed both the need for and a willingness to attend
such a training program.
This established need and the
expressed desire for a support group facilitator training
program at Kaiser Permanente Medical Center in Panorama
City prompted the development of this curriculum.
'
,,
33
Curriculum Development
As previously mentioned,
the performance of the role
of mutual support group facilitator requires group process
and communication skills, problem-solving skills within the
framework of a helping relationship, and the modeling of
these skills for the benefit of other group members.
The
need for acquiring and practicing these skills is the basic
premise upon which this curriculum is based.
A second premise upon which the curriculum is based
is the importance of the attitudes and values of mutual
support group members.
These attitudes and values relate
to the strengths that people possess and their capacity to
overcome, with their own resources, many of the problems
they face.
It is an attitude that rejects "doing for" and
focuses instead on "enabling" persons to overcome obstacles
and t o g r ow s·t ron g e r
in t he p r o c e s s
( 25 : 4 ) .
As a conse-
quence of this premise, the curriculum devotes considerable
attention to the attitudes and values of the trainees.
The importance of group facilitation skills and attitude/values awareness can be better understood by examining
the basic operational assumptions of the self-help mutual
support group approach.
These assumptions are as follows:
1. Groups are organized with reference to a specific
problem or condition (such as a chronic illness).
These
groups are not organized for social purposes, although they
may fulfill such functions.
2. Members of groups are peers, sharing the same
'
34
problem or condition, who join with the expectation of
helping themselves and each other; that is, both the selfhelp and mutual support aspects are central to the group
process (18:53).
3. The group identifies with specific purposes and
goals, related to the shared condition, which emerge from
the group itself and are actively supported by group
members.
4. Groups are action oriented.
consists of actively relating,
The group process
"owning," and revealing
problems, giving and receiving feedback to each other, and
sharing experiences, criticism, hope, and encouragement in
relation to the day-to-day goals of individual behavior
change (18:53).
5. Group members are considered and are held responsible for themselves and their own actions and behavior.
6. Helping others,
or playing the helper role, is an
expressed norm of these groups.
Since all members of the
group play this role at one time or another,
benefit from the helping process.
they all can
In addition to the value
of receiving help and support from other group members,
there are special benefits to be achieved by playing the
helper role, a concept enunciated by Riessman in his
helper-therapy principle (28:27-32).
deal with a similar problem,
In helping another
the helper 1) acquires an
increased sense of power over his/her own life as a result
of exercising skills and knowledge to help another;
35
2) begins to assess and attempt to resolve his/her own
problems in a more objective and skillful manner; and
3) obtains a feeling of social usefulness and worth by
fulfilling this role.
7. Group leadership is on a peer basis and involves
skills in facilitating group development and processes, as
well as skills in communication as a means of enhancing the
helping process.
8. The role of the professional is not that of group
member/participant, but rather one of providing assistance,
recognition,
resources, sponsorship, consultation, or
training.
In an attempt to address these various aspects of
mutual support groups as a means of facilitating more
effective involvement in such groups,
this curriculum
focuses on the following topics:
characteristics and needs
of patients with chronic illness,
establishment of group
purposes and goals,
ship,
communication,
stages of group development,
leader-
the helping process, problem solving,
intervention strategies, and planning for meetings.
The
content presented within the curriculum was selected to
provide a common language and a structure of thinking and
talking about the facilitator's role within mutual support
groups.
It was presumed that,
regardless of a partici-
pant's background or educational level, knowledge,
skills,
behaviors, and attitudes necessary for facilitating mutual
support groups could be fostered or further refined with
36
the training provided by this curriculum.
The design of this curriculum was based on certain
principles of adult learning.
Adult learning theory, as
developed by Knowles (29:43-44),
is based on four crucial
assumptions:
1. An adult's self-concept moves from one of a dependent personality toward one of being a self-directed human
being.
2. An adult's growing reservoir of experience becomes
an increasing resource for learning.
3. An adult's readiness to learn becomes oriented
increasingly to the developmental tasks of his/her social
roles.
4. An adult's time perspective changes from one of
postponed application of knowledge to immediacy of application.
Based on these assumptions, certain conditions of
learning, which are associated with specific principles of
teaching, are more conducive than others to growth and
development and are thought to enhance the opportunity for
learning (30:83-85).
The following conditions and related
principles of teaching served as guidelines for the design
of the selected learning opportunities in this curriculum:
1. The participant feels a need to learn.
- The trainer allows and encourages input from
participants regarding their perceived needs and
desires as they relate to the training program.
37
- The trainer creates a non-threatening situation
in which participants can discover for themselves
what they need most to learn.
- The trainer seeks suggestions from participants
regarding specific problem areas to be addressed
during group activities.
The trainer exposes participants to new possibilities for refining their communication and
group process skills.
2. The learning environment is characterized by mutual
trust and respect, mutual helpfulness, freedom of expression, and acceptance of differences.
- The trainer accepts each participant as a person
of worth and respects his/her feelings and ideas.
- The trainer seeks to build relationships of
mutual trust and helpfulness among participants
by encouraging cooperative activities and
refraining from inducing competition or making
value judgments.
3. The participants actively participate in the
learning process.
The trainer helps participants to organize themselves to share responsibility in the process
of mutual inquiry.
- The trainer selects learning activities which
require participants to be actively involved
rather than passive receivers of information.
38
4. The learning process is related to and makes use of
the experience of the participants.
- The trainer helps participants exploit their own
experiences as resources for learning through the
use of discussion,
role playing, and small group
interactions.
The trainer gears the presentation of his/her
resources to the levels of experience of the
particular participants.
-
The trainer helps participants make application
of new learning within the group setting and thus
make the learning more meaningful and integrated.
The experiences of the participants are considered
invaluable; therefore, most of the learning opportunities
rely heavily on an exploration of these experiences.
Each
topic area within the curriculum is examined within the
framework of the participants' experiences with chronic
illness and how those experiences can positively influence
their role as a group facilitator.
In light of the type of group at which this curriculum
is targeted,
behaviors,
tive
the objectives are stated in terms of group
instead of individual behaviors, and the evalua-
cr~teria,
for the most part, are based on observations
of these group behaviors.
In addition,
the objectives
include behaviors within the taxonomy of both the cognitive
and affective domains, as the curriculum emphasizes both
knowledge of group theory and techniques, as well as
39
attitude/values awareness.
For ease of understanding and implementation, the
curriculum was formatted so that the objectives and evaluative criteria for each topic area follow the corresponding
topic generalization and precede the content,
learning
opportunities, and resources related to each topic.
The
content, learning opportunities, and resources were matched
across the pages for ease of viewing.
The curriculum in
its entirety can be found in Chapter 6.
Implementation
Implementation refers to the steps taken to pilot test
the curriculum in the form of a two-day training workshop.
Those steps included obtaining administrative support and
clearance, determining staff involvement and teacher qualifications,
recruiting workshop participants, providing
in-service education for the staff,
teaching facilities,
generating and assembling needed
teaching materials, and finally,
This
se~tion
locating appropriate
conducting the workshop.
expands upon each of these implementation
steps.
Administrative Support and Clearance
The educational programs developed and coordinated by
the Member Health Education (MHE) Department require formal
approval at the Medical Center Clinic administrative level.
This approval is received following the submission of
11
•
40
formal program proposals from the MHE Department.
Mutual
support groups established for patients evolve from
existing patient education programs.
Therefore, the
formation of these support groups does not require formal
approval; however, administrative support is sought as it
is with all other department activities.
The initial development of the support group facilitator training curriculum required the support of the MHE
Department Administrator who not only enthusiastically
supported the endeavor, but also expressed an interest and
a willingness to participate in the implementation of the
curriculum.
Prior to the actual training workshop, a copy
of the curriculum and the plans for implementation were
sent to the Medical Center Clinic Administrator, from whom
equally enthusiastic support was received.
Staff Involvement
The curriculum developer, a health education specialist, was joined by the MHE Department Administrator and
another health education specialist in the implementation
of the training curriculum.
The involvement of these indi-
viduals included collaboration in the 1) planning of the
presentation format;
2) determination of when and where
the workshop would take place; 3) recruitment of workshop
participants;
4) selection of those learning opportunities
deemed appropriate for the chosen format;
and collection of needed materials;
5) preparation
6) actual teaching of
41
the training workshop; 7) evaluation of the workshop; and
8) generating of suggestions for revisions in the curriculum and recommendations for its future implementation, at
Kaiser Permanente as well as at other institutions or
health care facilities.
Teacher Qualifications
The teachers for the training workshop were the two
health education specialists and the MHE Department
Administrator previously identified as the staff involved
in the implementation of the curriculum.
These individuals
were considered qualified as the teachers for this workshop
based on the following criteria:
1. They had been trained in educational theory and
practice by nature of their academic background and had
applied these principles in their professional work experience.
2. They had some experience in the areas of leadership,
group process, and group dynamics.
3. They had observed mutual support groups and had
demonstrated an understanding of the interactive process
unique to these groups.
4. They were familiar with the characteristics and
needs of patients with chronic illness, the population from
which existing or planned mutual support group membership
is formed and from which the training workshop participants
were recruited.
42
5. They were aware of how experiences with chronic
illness could relate to meaningful assimilation of the
program content by the participants, and therefore, were
better able to develop teaching strategies which would
facilitate that outcome.
Recruiting Workshop Participants
The search for individuals interested in participating
in the training workshop took several directions.
First,
members of the training staff contacted those individuals
who were currently playing or who had previously played an
active role in a mutual support group, and who had provided
valuable input into the determination of the need for a
facilitator training program.
These individuals had also
previously expressed both an interest and a willingness to
participate in such a training program.
Second, the above individuals were asked to recommend
others who they felt would be appropriate participants in
the training workshop based on their interactions with
these people in the support group setting.
Those indi-
viduals were then contacted by members of the training
workshop staff.
Third, a member of the workshop staff met with some of
the existing support groups to discuss the upcoming facilitator training workshop.
Any interested individuals were
encouraged to attend.
Firi~lly,
staff members within and outside of the MHE
43
Department were asked to assess those individuals, who were
in either a support group or an educational program with
which the staff member had been involved, who they felt
might make a good facilitator for an existing or planned
support group and who they would recommend attend the
training workshop.
These staff members were asked to speak
with those selected individuals regarding their interest in
attending the workshop and then to refer those who were
interested to a member of the workshop staff for further
details.
In-Service Education
The exchange of information and ideas among workshop
staff members was necessary to ensure the success of implementing the curriculum.
Due to the fact that the staff
members involved in teaching the training workshop were
also responsible for developing the plans for implementation,
in-service education among the staff occurred
informally throughout the entire implementation process.
The initial in-service involved the curriculum developer familiarizing the other staff members with the various
components of the curriculum.
Additional in-servicing
occurred periodically during scheduled planning meetings at
which time decisions were made regarding the use of a workshop format,
dates and times for the workshop,
the agenda,
areas of responsibility for each person, and needed teaching and handout materials.
Ongoing discussion regarding
44
the curriculum content and learning opportunities occurred
throughout these planning meetings as well as during casual
conversation.
Implementation of this curriculum by other individuals
would require the establishment of a means of in-service
education tailored to meet the needs of the instructors.
Consideration should be given to the instructors' qualifications, the target group, and the means of implementation.
Teaching Facilities
The facilitator training workshop was held in a Member
Health Education Department conference room which was set
up to comfortably seat 20-25 individuals around several
large tables.
The movable chairs were easily rearranged
throughout the workshop to accommodate the various smallgroup activities.
The conference room also met the
following criteria which helped create a desirable environment for the training workshop:
-
adequate lighting and ability to darken the room
-
available electrical outlets
-
built-in chalkboard and film screen
wheelchair accessibility
-
reasonably located near restrooms,
fountain,
telephone, water
and vending machines (although morning
snacks and lunch were provided)
availability of adequate and convenient parking
45
Teaching Materials
The following materials were utilized throughout the
workshop either by the participants or by the teaching
staff as part of the various selected activities:
-
name tags and marking pens
- workshop packets which included a welcome, the
agenda,
blank paper, a pencil, and other materials
referred to during the workshop
-
flip charts with stands, marking pens, and masking
tape
The Workshop
The support group facilitator training curriculum was
implemented at Kaiser Permanente Medical Center in Panorama
City during a two-day workshop which took place on March 4
and 5, 1986.
Each day's activities were scheduled over a
six-hour period, beginning at 9:30 a.m. and ending at 3:30
p.m.
(see Appendix A for workshop agenda).
A total of 16
participants were present on each day of the workshop,
representing chronic conditions such as arthritis, diabetes, cancer, and overeating.
The workshop staff
(trainers) completed the entire agenda during the two-day
period, meaning that all major topic areas were covered.
Evaluation Scheme
Evaluation of the training curriculum and its implementation focused on determining 1) whether the goal of the
46
curriculum,
to provide information about group theory and
the opportunity to practice skills in facilitating group
process and communication, was met based on the criteria
established for measuring the objectives; and 2) whether
the design of the two-day training workshop was an effective means of implementing the curriculum.
Formative and summative evaluation were utilized
during the evaluative process.
Formative evaluation
occurred throughout the instructional period with the
intent of making revisions in the design of the workshop
as deemed necessary by the workshop trainers to increase
the likelihood of the participants achieving the stated
objectives.
Summative evaluation occurred following the
completion of the two-day workshop to determine the success
of the workshop in implementing the curriculum and any
needed changes in the curriculum or the design of the
workshop prior to future implementation.
The evaluation was primarily subjective in nature,
based on observations made by the trainers throughout the
workshop and an evaluation questionnaire completed by
workshop participants at the end of the program.
Formative Evaluation
This aspect of the workshop evaluation focused on
1) the participants' response to the selected learning
opportunities,
act~vity
including their apparent understanding of
directions,
their interest level, and their degree
il
47
of motivation;
2) verbal feedback solicited from the par-
ticipants at the end of the first day of the workshop; and
3) the performance of the trainers with respect to the
effectiveness of teaching strategies, their ability to
communicate clearly, their rapport with the participants
as well as each other, and their sensitivity to the needs
of the participants.
Summative Evaluation
The post-workshop evaluation focused on 1) whether or
not the curriculum objectives were met;
2) the partici-
pants' responses on a workshop evaluation questionnaire;
3) the final verbal feedback provided by the participants
at the end of the workshop; and 4) an overall assessment of
the effectiveness of the trainers.
The curriculum objectives were evaluated based on
observations made by the trainers throughout the two-day
workshop.
tion,
Utilizing the criteria established for evalua-
the subjective determination of whether or not the
objectives were met was made based on the degree to which
the group as a whole demonstrated the various behaviors
sought by the objectives.
At the end of the two-day workshop,
the participants
were asked to complete an evaluation questionnaire (see
Appendix B) which focused on their assessment of and satisfaction with the training workshop.
Specifically, the
participants were asked to evaluate 1) the usefulness of
'
48
the content in meeting their needs as facilitators of
mutual support groups;
2) the helpfulness of the group
activities in practicing group facilitation skills;
3) their perceived skill in group facilitation before and
after the workshop;
of the workshop;
4) the appropriateness of the length
5) their confidence in their ability to
facilitate a support group; 6) their degree of satisfaction
with the presentation by the workshop trainers; and 7) the
degree to which the workshop met their expectations.
addition,
In
participants were asked to identify those work-
shop activities which were most and least beneficial to
them, and those topics about which they would like further
instruction.
Also at the end of the workshop, verbal feedback was
once again solicited from the participants to provide them
with a final opportunity to share their comments and
feelings regarding their workshop experience.
Finally, following the completion of the workshop,
the
trainers assessed their overall performance throughout the
entire two-day workshop based on their own observations and
opinions, as well as those of the workshop participants.
Chapter 4
RESULTS AND DISCUSSION
As noted in the previous chapter, the evaluation of
the training curriculum and its implementation focused on
determining whether the goal of the curriculum was met and
whether the design of the two-day training workshop was an
effective means of implementing the curriculum.
effort to make that determination,
this chapter reports and
examines the results of that evaluation.
in making that determination,
In an
To further assist
this chapter also focuses on
a discussion of the strengths and weaknesses of both the
training workshop and the curriculum, a discussion based on
adult learning theory.
Results
As previously described,
both formative and summative
evaluation were utilized during the evaluative process.
The results reported here are presented within each of
those two categories of evaluation.
Formative Evaluation
In evaluating the participants' response to the
learning opportunities throughout the first day of the
workshop,
the trainers agreed that all the participants
had demonstrated a high degree of interest and motivation
49
50
regarding the subject matter and selected activities.
This
conclusion was based on the fact that nearly all the participants were very vocal and played an active role in the
early brainstorming activities.
In addition, nearly every-
one actively participated in the small group activities
dealing with the subject of communication skills, often
demonstrating a willingness to share their feelings,
even
with total strangers.
There did not appear to be any difficulty among the
participants in the understanding of activity directions
on day one of the workshop,
leadership.
except during the section on
It was decided that the difficulty in that
area was probably more a result of a poorly chosen activity, in terms of practicing the desired behavior, rather
than a complete lack of understanding on the part of the
participants.
The problems observed during that section
affected the participants' ability to meet the stated
objectives for that topic.
Therefore, an effort was
made during the remainder of the workshop to continually
reinforce the subject matter as well as provide appropriate
opportunities to practice the behaviors with the hope that
the objectives would be met prior to the end of the workshop.
Observations of the participants on day two of the
workshop resulted in similar conclusions with respect to
the degree of interest and motivation demonstrated.
However, there did appear to be a significant degree of
51
difficulty among the participants with the morning
activities (see workshop agenda in Appendix A).
A discus-
sion among the trainers during the lunch break regarding
these apparent difficulties with the subject matter and/or
the
activit~es
resulted in a decision to change the planned
afternoon activities in the hope of clearing up some of the
confusion and
misun~erstanding
exhibited by the partici-
The trainers agreed that most of the participants
pants.
demonstrated a far greater understanding of the activities
as well as the subject matter following the last minute
changes.
The verbal feedback solicited from the participants
at the end of the first day of the workshop validated the
trainers' evaluation of what had occurred to that point.
Inquiries regarding whether or not the workshop was meeting
their expectations and meeting their needs in terms of the
pacing of instruction and activities,
resulted in very
positive responses on both accounts.
Overall,
the partic-
ipants expressed excitement and pleasure regarding the
subject matter, the activities, and the performance of the
trainers.
Especially noteworthy was the fact that many
participants commented on how quickly the day went by, thus
reassuring the trainers that the six-hour workshop session
was not more than this group could handle.
Also at the end of the first day of the workshop,
trainers evaluated their own performance throughout the
day.
They agreed that the teaching strategies used
the
52
appeared to have been effective in terms of generating
interest and motivation on the part of the participants as
evidenced by their active participation in all the selected
activities.
In those areas, as previously mentioned,
in
which the participants appeared to be having some difficulty,
teaching strategies were slightly modified to better
accommodate the needs of the participants.
Additionally,
the trainers agreed that they all commu-
nicated clearly, with respect to both instructional content
and activity directions,
an assessment validated by the
participants themselves with the feedback they provided at
the end of the day.
Finally, it was agreed that all the trainers successfully established a good rapport with the participants on
the opening day,
needs,
including showing sensitivity to their
as evidenced by an almost immediate willingness on
the part of the participants to speak openly and honestly
and to share their ideas, feelings,
and concerns.
It was
also agreed that the trainers worked very well together
as they complemented each other throughout the day's
activities.
Summative Evaluation
In evaluating whether or not the curriculum objectives
were met,
the trainers agreed that the group had no diffi-
culty meeting the objectives for the first two topic areas
of the curriculum (see Chapter 6,
pages 79-83).
Throughout
,,
53
the morning of day one of the workshop,
the group continu-
ally demonstrated its understanding of the characteristics
and needs of patients with chronic illness and the role of
a support group in meeting those needs, by generating and
expanding upon lists of ideas which went far beyond the
minimum expected based on the objectives.
Similarly, the
group clearly understood the concept of stages of group
development as evidenced by the many references made to
those group stages, during small and large group discussion,
throughout the remainder of the day.
The topic on leadership in mutual support groups (see
pages 84-86) posed a significant degree of difficulty for
the group as a whole.
Neither objective was met following
the session regarding this topic,
probably a result of
an inappropriate learning opportunity for the desired
behavior.
However,
subsequent activities during the
remainder of the workshop integrated this topic into the
new subject matter being discussed,
thus providing addi-
tional practice opportunities for the participants.
The
trainers agreed that by the end of the second day of the
workshop,
the majority of the participants finally showed
signs of understanding the topic as evidenced by their
comments in both small and large group discussions.
The section of the curriculum on communication (see
pages 87-90) was very successful, with all objectives
having been met.
From that point on during the workshop,
the group continually demonstrated the application of
'
54
communication skills during any type of small group
interaction.
The objective dealing with the relationship
between communication skills and interpersonal behaviors in
groups was more difficult to meet.
shop,
By the end of the work-
however, most of the participants were demonstrating
a level of understanding which would allow them to analyze
such a relationship.
The next section of the curriculum (see pages 91-95),
concerning the topic of the helping process, posed many
difficulties for the group as a whole.
With only one
exception, none of the objectives were met to the satisfaction of the trainers.
It was clear that the participants
were given a great deal of information in a relatively
short period of time, and were not provided with ample
opportunity for practicing the desired behaviors.
The topic of problem solving (see pages 96-97) was
much more straightforward than the previous one and
presented far fewer difficulties for the group.
The
participants clearly understood the steps involved in the
problem-solving process as evidenced by their actions while
practicing these techniques in small group interactions.
The trainers did feel,
however,
that a slightly different
group activity may have provided an even better opportunity
for the participants to practice the application of group
problem-solving techniques.
The section on intervention strategies (see pages 98101) saw a last minute revision in the planned learning
55
opportunities.
Rather than have all the participants
practice these strategies in small group interactions, one
group was formed to role play a situation in which some
members created a problem to be dealt with by the rest of
It turned out to be a very valuable activity
the group.
for all the participants as it provided an opportunity for
them to observe a group in the process of attempting to
deal with problems which may interfere with group process.
Although all the participants did not take part in small
group interactions during this section, most of them did
demonstrate, during a large group follow-up discussion, an
understanding of the application of group intervention
strategies.
The final section of the curriculum (see pages 102103) was presented in a hurried fashion due to time limitations.
Nevertheless, the group had little difficulty
understanding the basic steps involved in selecting agenda
items when planning for a group meeting.
the lack of time,
However, due to
the group did not have the opportunity to
practice agenda planning and therefore was unable to meet
the second objective for this topic.
The next component of the summative evaluation was an
assessment of the workshop evaluation questionnaire (see
Appendix B) responses.
The questionnaire was completed
by 15 of the 16 workshop participants.
The responses
indicated that the participants felt the topics selected
for the training workshop were helpful and met their needs
56
as mutual support group facilitators.
When asked to
evaluate the degree to which the various topics were
helpful, at least 11 or more of the participants rated
every topic area as very helpful, with one exception.
The
topic on characteristics and needs of patients with chronic
illness was considered very helpful to only half of the
group and somewhat helpful to the other half.
Two topic
areas, purposes and goals of support groups and the
facilitator's role in support groups, were rated as very
helpful by all 15 participants.
Some of the participants also indicated those topic
areas in which they would be interested in receiving additional information and/or skill training.
included communication,
Those areas
the facilitator's role, agenda
planning, problem solving, and intervention strategies (an
area listed by several of the participants).
When asked whether or not the various activities were
helpful in practicing group facilitation skills, all 15
participants responded positively.
Those activities listed
as most helpful included brainstorming,
and interaction with others.
problem solving,
In addition,
several partic-
ipants listed small group discussions, while over half of
the group listed role playing as a helpful activity.
When
asked to list those activities which were least helpful,
one participant responded with problem solving.
In response to the question which asked them to rate,
using a 10-point scale, what they perceived to be their
57
overall skill in group facilitation at both the beginning
and at the end of the two-day workshop, all but one of the
participants rated themselves at a higher skill level at
the end of the workshop.
The participants' perceived
increase in skill level averaged 2.9 on the 10-point scale.
In the final section of the questionnaire,
the partic-
ipants indicated the degree to which they either agreed or
disagreed with various statements regarding the workshop.
With respect to the appropriateness of the length of the
workshop for the amount of information presented, the
responses were almost evenly divided three ways with five
participants strongly agreeing that the length was appropriate, six agreeing, and four disagreeing.
In response
to the statement regarding their feeling of confidence in
facilitating a support group,
six participants strongly
agreed and eight agreed that they felt more confident in
their ability to facilitate a group, while only one disagreed.
Twelve of the 15 participants strongly agreed,
while three agreed,
with the statement indicating satis-
faction with the presentation of the workshop trainers.
Finally,
13 strongly agreed and two agreed that they
got what they expected out of the workshop.
participants who strongly agreed,
Of the 13
two indicated that they
actually got more than they expected out of the workshop.
At the end of the questionnaire,
the participants took
the opportunity to make additional comments and share any
feelings they had regarding the workshop.
There were a few
58
comments dealing with the need for a longer workshop to
more adequately cover the material, and for additional
workshops to update the participants and reinforce previously covered material.
The majority of the comments,
however, were very complimentary in nature.
Some of the
participants indicated that the workshop was excellent as
well as professionally executed; more specifically, that it
I
was well-planned, well-organized, well-conducted, and very
enjoyable.
Others indicated that the trainers were very
qualified and presented the material in a most interesting
manner for lay people,
wonderful people.
in addition to being real, human and
Still others commented on how they felt
the workshop would help them in day-to-day living,
in
handling people on an individual basis, and in feeling
freer to express their opinions more openly.
The verbal feedback provided by the participants
at the end of the workshop was similar in nature to the
comments made on the written evaluations.
The participants
were very complimentary about every aspect of the workshop,
especially about the performance of the trainers.
They
were glad they chose to attend the workshop and some were
sorry it ended so soon.
Overall,
the workshop appeared to
have been a positive experience for all the participants
based on both their verbal as well as their written
comments.
Finally, the workshop trainers,
in assessing their
overall performance during the entire workshop, agreed with
59
the comments made by the participants.
They also agreed
that if they had been even more prepared, they may have
been better able to anticipate some of the problems which
did occur during the workshop.
However, the trainers felt
that they were flexible and were able to adapt when a
problem or unanticipated situation did occur.
Overall,
they agreed that their performance was truly a team effort,
and one that was appreciated by the workshop participants.
Discussion
An examination of the results of the workshop evaluation points to several strengths and weaknesses in the
design of the workshop.
learning theory,
The design was based on adult
specifically that which was developed by
Knowles (30:83-85) and which was discussed previously in
Chapter 3 in reference to the curriculum design.
Knowles' adult learning theory is based on certain
conditions of learning associated with specific principles
of teaching, which are thought to enhance the opportunity
for adult learning.
The following discussion of the
strengths and weaknesses of the workshop, as they relate
to the opportunities for learning which were provided, is
presented within the framework of four of Knowles' conditions of learning.
Additionally,
suggestions are made
regarding the future implementation of the curriculum.
60
Condition One
The first condition of learning is that the participant feels a need to learn.
One teaching strategy related
to creating this condition is to allow and encourage input
from participants regarding their perceived needs and
desires regarding the training program.
This strategy was
used throughout the entire workshop, especially when
discussing the topics of characteristics and needs of
patients with chronic illness and intervention strategies
for facilitators.
The participants shared their needs and
desires during large group discussions as well as during
small group interactions, when many participants were even
more willing to share their feelings with the trainers.
A second teaching strategy is one in which suggestions
are sought from participants regarding specific problem
areas to be addressed during group activities.
This
strategy was used most often when discussing communication
in groups and intervention strategies.
Various techniques
were discussed and practiced in small groups based on
identified areas of concern among the participants.
This
turned out to be one of the strong points about the workshop based on feedback received from the participants and
observations by the trainers during the group activities.
A final teaching strategy related to creating a
feeling of a need to learn is to expose participants to new
~ossibilities
for refining their communication and group
process skills.
As the key elements in a facilitator
,,
'
61
training program, considerable attention was given to these
areas.
Many techniques were discussed and practiced during
several small group interactions.
It was clear, based on
trainer observations and participant feedback,
that these
activities were the most valuable and produced the most
significant change in behavior over the two-day period of
the workshop.
Condition Two
The second condition of learning is that the environment be characterized by mutual trust and respect, mutual
helpfulness,
differences.
freedom of expression, and acceptance of
One essential teaching principle necessary to
create this condition is that the trainer accept each participant as a person of worth and respects his/her feelings
and ideas.
Throughout the entire workshop,
each trainer
made the effort to encourage the participants to share
their feelings and ideas, even when they were in direct
conflict with the opinions of the other participants.
addition,
In
all the participants demonstrated an acceptance
of others' opinions as well as a willingness to listen to
whatever anyone had to say.
This was especially noticeable
during the topics dealing with communication and the
helping process.
Along similar lines is the result of efforts made by
the trainers to build relationships of mutual trust
and helpfulness among the participants by encouraging
62
cooperative activities and refraining from inducing
competition or making value judgments.
This concept was
introduced early in the workshop when discussing purposes
and goals of mutual support groups.
The trainers then
attempted to create such a trusting environment for the
remainder of the workshop.
The learning opportunities utilized during the topics
on communication and the helping process involved several
small group activities during which the participants
practiced various types of communication skills.
It was
during these activities that the trainers first began to
notice the trust that was building among the participants.
There was a significant degree of openness observed during
these interactions as the participants shared many feelings
regarding issues related to their illnesses or conditions.
The communication which occurred not only was trusting and
open, but also demonstrated the increased use of the skills
being practiced.
The increased use of communication skills continued
during the topic on the helping process.
section, however,
It was in this
that some major weaknesses in the work-
shop design were evident.
The evaluation of this topic
area by the trainers clearly indicated that the participants had some difficulty as evidenced by their lack of
success in meeting most of the related objectives.
It was
determined that the content of this topic area was far more
difficult for the participants to grasp than was the case
63
in other topic areas.
The trainers further determined that
considering the amount of content covered and its degree of
difficulty,
the opportunities for practice were far too few
and inadequate to reasonably expect the participants to
meet the stated objectives.
It was suggested that addi-
tional learning opportunities, involving participation in
and/or observation of role-playing activities, would be an
appropriate and effective means of practicing helping
behaviors.
Both the verbal and written feedback received
from the participants at the end of the workshop regarding
the use of such activities further validated the trainers'
observations.
Condition Three
A third condition of learning is that the participants
actively participate in the learning process.
The primary
responsibility of the trainer here is to select activities
which require the participants to be actively involved
rather than passive receivers of information.
This
occurred at the very beginning of the workshop as the
trainers chose a brainstorming activity as a means of
generating a discussion about both characteristics and
needs of patients with chronic illness and purposes and
goals of mutual support groups.
The participants not only
generated an extensive list of ideas,
but included ideas
not even considered by the trainers.
Every participant
contributed to the discussion,
some more than others,
64
making it clear from the outset that it was a very vocal
group of individuals.
The trainers agreed that this activ-
ity most likely set the tone for the rest of the workshop
in terms of the degree of active participation.
They also
agreed that the many small group activities used throughout
the workshop further encouraged and resulted in a high
level of active participation.
Condition Four
The final condition of adult learning is that the
process be related to and makes use of the experience of
the participants.
One essential teaching strategy to
create this condition is for the trainer to help the participants exploit their own experiences as resources for
learning through the use of discussion,
small group interactions.
role playing, and
The entire curriculum was
designed with these types of activities in mind, and the
workshop incorporated a variety of all these activities as
the means by which the participants practiced all the
desired behaviors.
Another teaching strategy related to this condition
of learning is to gear the presentation to the levels of
experience of the participants.
knowledge of the participants'
limited,
Although the trainers'
background experience was
the trainers did have some idea as a result of the
method by which the participants were recruited.
some knowledge of the participants'
Even with
prior experience in
65
groups, especially support groups,
the trainers still had
some difficulty with the topic area on leadership.
Based
on their type of experience with groups and their level of
involvement with such groups, each participant had their
own perception of what group leadership meant.
Therefore,
the trainers had a difficult time trying to convey the
concept of facilitating a group interaction versus leading
a group in the more traditional,
authoritative manner.
It
was suggested that a different type of learning opportunity, one that more clearly differentiates between a
support group facilitator and a traditional group leader,
would be a more appropriate and probably more effective way
of teaching this concept.
The trainers believed that if
the participants had understood this concept earlier in the
workshop,
rather than at the end of the second day,
the
rest of the topic areas covered might have been even more
meaningful than was the case.
The final teaching strategy related to this condition
of learning is to help participants make application of
new learning within the group setting and thus make the
learning more meaningful and integrated.
entire workshop,
Throughout the
the trainers provided many opportunities
for the participants to practice making
appli~ation
of new
learning, especially during small group interactions.
The
lists of ideas generated by the participants during the
discussion of the first topic area and then
the room for future reference,
provided an
po~ted
around
ad~itional
66
opportunity for the participants to integrate various
components of the workshop together in a more meaningful
fashion.
Summary
An examination of those curriculum topic areas with
which the participants had some difficulty meeting the
objectives, points to activities which appear to have
provided an inadequate opportunity for the participants to
integrate their new learning in a meaningful way based on
their own personal experiences with both chronic illness
and group interactions.
Therefore, future implementation
of this curriculum would require a longer instructional
period in order tn adequately cover all topic areas,
especially those which proved to be the most difficult for
the participants to understand.
Additionally, there is a
need to incorporate more transitional activities into the
curriculum as a means of more effectively integrating the
various topics in a way which would be meaningful to
members of the curriculum's target group.
This discussion has focused on various strengths and
weaknesses of the curriculum and the workshop design to
determine if the curriculum goal was met and if the design
of the workshop was an effective means of implementing the
curriculum.
Based on the results of the evaluation and
the subsequent discussion,
there is no question that the
curriculum goal, which was to provide information about
0
67
group theory and the opportunity to practice skills in
facilitating group process and communication, was clearly
met as a result of the two-day workshop.
It was also
determined that the design of the workshop was an effective
means of implementing the curriculum, although additional
time would most likely have increased the workshop's
effectiveness even more.
'
Chapter 5
SUMMARY AND RECOMMENDATIONS
This chapter focuses on a summary of the mutual
support group facilitator training curriculum project, from
its inception to the evaluation of the workshop,
by which the curriculum was implemented.
the method
In addition,
recommendations are made regarding the potential future use
of the training curriculum.
Also, recommendations are made
regarding the future direction of mutual support groups for
patients with chronic illness, beyond Kaiser Permanente in
Panorama City.
Summary
The purpose of this project was to develop a curriculum designed to train individuals as facilitators of mutual
support groups for patients with chronic illness.
The
curriculum targets individuals who are either members of
existing support groups or are intending to become members
of existing or planned groups.
Those individuals would be
trained in group facilitation theory and techniques in an
effort to increase the effectiveness and enhance the
quality and success of the groups.
A review of the literature on the self-help movement
and the establishment of mutual support groups revealed an
extensive history of the existence of such groups for
68
69
purposes of coping with various life-disrupting problems.
The most recent trend in this self-help movement has seen
the proliferation of support groups in the area of health
care, especially to service the needs of patients with
chronic illness.
The literature also substantiates the theory that,
to be the most effective, mutual support groups should
function with minimal or no involvement on the part of
professionals.
Therefore, the question arises as to the
need for providing lay members of support groups with some
degree of skill in facilitating the group process.
The
often presumed, and in part substantiated, lack of skills
among lay persons and professionals alike, who are
interested in working with support groups, has resulted in
the recent development of programs to train individuals in
group facilitation.
The development of such a training program at Kaiser
Permanente Medical Center in Panorama City was based not
only on the need as expressed in the literature, but also
on the need which was determined as a result of an assessment of existing mutual support groups established at that
facility to service the needs of patients with chronic
illness.
That assessment revealed a variety of problems
related to group process and the interaction between group
members which were affecting the groups' ability to function effectively.
In addition to that assessment, an
examination of existing training programs revealed an
70
apparent lack of any such program designed specifically to
deal with the needs and concerns of individuals who have a
chronic illness.
Therefore, this mutual support group
facilitator training curriculum was created to satisfy the
apparent need for such a program.
Following the development of the training curriculum,
a two-day workshop was planned by the staff of the Kaiser
Permanente Member Health Education Department as a means
of implementing the curriculum.
The staff of three health
education specialists conducted the workshop for a group of
16 participants, representing chronic conditions such as
arthritis, diabetes,
cancer, and overeating.
The final phase of this project involved a subjective
evaluation of the entire program based on observations made
by the trainers throughout the workshop and an evaluation
questionnaire completed by workshop participants at the end
of the program.
It was determined,
based on the results of
the evaluation, that the curriculum goal, which was to
provide information about group theory and the opportunity
to practice skills in facilitating group process and communication, was clearly met.
It was also determined that
the workshop was an effective means of implementing the
training curriculum,
_
~d_e-.S
although specific revisions in the
i g n o f_t he \Y_ or k s h o p we r e s u g g e s t e d f o r f u t u r e imp 1 e-
mentation.
71
Recommendations
The research, development,
implementation, and eval-
uation of this mutual support group facilitator training
curriculum lead to a number of recommendations regarding
the future use of the curriculum, as well as the future
direction of mutual support groups for patients with
chronic illness, at Kaiser Permanente in Panorama City
and at other health care facilities.
The first recommendation specifically regarding the
training curriculum is to conduct a follow-up evaluation of
the support group facilitators who attended the workshop as
well as an evaluation of the groups with which they are
involved.
The purpose of such an evaluation would be to
determine if the training program has in any way affected
the performance of the individual facilitators or the
quality and success of the support groups.
A second recommendation regarding the curriculum is to
conduct a review session for the benefit of those individuals who attended the workshop and have remained active in
their support groups.
A review session would provide an
opportunity for the support group facilitators to share
their experiences with other facilitators as well as with
the workshop trainers.
This type of feedback can be a very
valuable learning opportunity for the facilitators them··-· seTve--s-rn-Eerms<:>f-nreir growEh and deve_l_o_p_m_e-n·t-1n-eh-at----·-·----·-·-·---role,
and for the workshop trainers as well,
updating and revising the curriculum.
in terms of
72
A third recommendation is to update and revise the
curriculum based on the feedback received from the followup evaluation and review session,
and then implement it
again when there are new potential facilitators to be
trained.
A fourth recommendation for consideration is to
develop an abbreviated version of the workshop based on
the revised curriculum,
and take the program directly to
existing support groups or newly formed groups.
way,
In this
the entire membership of a group would be exposed to
the various skills involved in group facilitation,
with the
hope that a greater number of group members would play a
more active role in the group process and do it in a more
skillful manner.
The expectation of there being a need to implement a
facilitator training program in the future,
at Kaiser
Permanente in Panorama City as well as at other health care
facilities,
implies the on-going establishment of mutual
support groups for patients with chronic illness.
The
commitment to further expand the scope of such groups
already exists at Kaiser Permanente in Panorama City as
demonstrated by the on-going efforts of the health education personnel at that health care facility.
A fifth
recommendation is that health educators, involved with
__p_a_ti_e_n_ts who have a chronic illness, expand their role to
include the promotion and formation of self-help mutual
support groups for those patients as a means of furthering
their professional and ethical goals of enhancing the
73
'
'
quality of life.
The challenge facing those health educators who are
supportive of the self-help approach to health care is to
engage the support of other health care professionals,
particularly physicians, in the promotion and formation
of mutual support groups for their patients.
A final
recommendation is that health educators become more
involved in research studies which attempt to demonstrate
the effectiveness of self-help approaches in health care in
an effort to substantiate, among professionals, the worth
of mutual support groups.
For example, a long-term study
might be conducted to determine the effectiveness of a
support group facilitator training program in relation to
the quality and success of the groups.
However the challenge can be met, members of the medical community who are in a position to play a significant
role in the on-going efforts of self-help support groups,
must recognize that the majority of these groups do not
deny in any way the importance of the functions of the
medical community.
The self-help approach merely attempts
to supplement these functions of the more traditional
system of health care delivery.
therefore,
The real challenge,
is for health care professionals to not only
recognize the self-help approach,
but to "use it wisely,
aware of both limitations and potential, and to be unafraid
-------1:-o
s-h-a-r-e-t-n.e posn:Ion--01- helper with those who are helped"
(31:117).
(1
Chapter 6
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING CURRICULUM
This chapter contains the actual Mutual Support Group
Facilitator Training Curriculum.
The curriculum is divided
into three parts including the scope and sequence, the body
of the curriculum, and the appendices.
The scope and sequence of the curriculum refers to how
the various components of the curriculum are organized.
This part consists of a listing of each of the curriculum's
major topic areas,
objectives,
along with related generalizations and
in order to provide an overview of the scope of
the curriculum's content.
Generalizations are considered
the primary themes of the various topic areas and serve as
organizers of the curriculum content.
They provide a focus
for the selection of the content and are emphasized continuously throughout the instructional period.
The objectives
are the identified behaviors expected of the curriculum's
target group,
tions.
and are based on the selected generaliza-
The sequence of topic areas is organized so that
each new topic builds upon the previous one in such a way
as to provide the learner an opportunity to integrate the
content in a meaningful way.
The main body of the curriculum is divided into eight
sections, each covering a major topic area.
74
Each section
•
75
consists of a topic generalization, objectives, evaluative
criteria, content,
suggested learning opportunities, and
resources for both content material and suggested activities.
The evaluative criteria are the established guidelines
for determining whether or not the curriculum objectives
have been met.
The curriculum content provides an outline
of information to be presented in each topic area.
The
learning opportunities include several suggested activities
designed to provide the learner an opportunity to practice
the various identified behaviors sought in the objectives.
Resources are listed throughout the body of the curriculum
should potential implementors wish to refer to original
sources used in the selection of the content and suggested
learning opportunities.
Complete references for all
resources can be found in the project's Bibliography.
The final part of the curriculum consists of the
appendices.
This section immediately follows the body
of the curriculum and includes several of the suggested
activities referred to throughout the curriculum's learning
opportunities.
It should be noted that these curriculum
appendices are included in this chapter and are not to be
confused with the project's appendices located at the end
of this project.
76
CURRICULUM SCOPE AND SEQUENCE
Primary Generalization
Training selected individuals as faciiitators of mntual support
groups for patients with chronic illness may enhance the quality
and success of those groups.
Topic I:
Mutual Support Groups for Patients with Chronic Illness
Generalization: Purposes and goals which accurately
reflect the collective needs of group members, and are
clearly determined in the early stages of group
formation, may guide group activities toward desired
outcomes.
Objectives:
able to
Following instruction, the group will be
I. Determine common characteristics and the resultant
needs of patients with chronic illness, which can be
met through membership in mutual support groups.
(Comprehension)
2. Determine various purposes and goals of a mutual
support group.
(Comprehension)
Topic II:
Stages of Group Development
Generalization: Knowledge and understanding of the
stages of group development may promote more effective
leader interventions in group process.
Objective:
able to
Following instruction, the group will be
1. Describe the various stages of group development in
their sequential order.
(Comprehension)
Topic III:
Leadership in Mutual Support Groups
Generalization: Achievement of a mutual support
group's desired goals may be facilitated by a
functional leadership approach.
Objectives:
able to
Following instruction, the group will be
1. Explain leadership in mutual support groups.
(Comprehension)
2. Distinguish between task and maintenance leadership
functions.
(Comprehension)
77
Topic IV:
Communication In Groups
Generalization:
Communication utilizing effective
interpersonal behaviors may promote the development of
helping relationships among mutual support group
members.
Objectives:
able to
Following instruction, the group will be
1. Practice the application of interpersonal communication skills including active listening, questioning,
use of "I" statements, and non-verbal communication.
(Application)
2. Identify the use of various communication skills
and the resulting effects on interpersonal behaviors
in a group setting.
(Analysis)
3. Demonstrate a commitment to utilize effective
communication skills as a means of enhancing
interpersonal relationships.
(Affective-valuing)
Topic V:
The Helping Process
Generalization:
The collective goals of a group may be
accomplished in an atmosphere of mutual help and
support.
Objectives:
able to
Following instruction, the group will be
1. Explain the nature of the helping relationship,
including the role of and benefits to the helper.
(Comprehension)
2. Identify the three primary helper characteristics.
(Knowledge)
3. Demonstrate an awareness of personal needs,
attitudes, values, and feelings which may affect the
helpe! role.
(Affective-receiving)
4. Demonstrate a commitment to give and to receive
strokes as units of recognition in the helping
process.
(Affective-valuing)
5. Analyze the relationship between the helping process
and leadership in a mutual support group. (Analysis)
Topic VI:
Problem Solving
Generalization:
Problem solving is a process utilized
by mutual support groups in their attempts to satisfy
the needs of group members.
78
Objectives:
able to
Following instruction, the group will be
1. Identify the steps involved in the group problemsolving process.
(Knowledge)
2. Practice the application of group problem-solving
techniques.
(Application)
Topic VII:
Intervention Strategies for Group Facilitators
Generalization:
Knowledge and use of intervention
strategies may enhance the effectiveness of group
process.
Objective:
able to
Following instruction, the group will be
1. Practice making application of group intervention
strategies.
(Application)
Topic VIII: Planning for Meetings
Generalization:
Planning gives direction to the
accomplishment of a group's designated tasks.
Objectives:
able to
Following instruction, the group will be
1. Identify the steps involved in selecting agenda
items when planning for a meeting.
(Knowledge)
2. Practice the application of format criteria in the
composition of a meeting agenda.
(Application)
TOPIC I:
MUTUAL SUPPORT GROUPS FOR PATIENTS WITH CHRONIC ILLNESS
Generalization:
Purposes and goals which accurately reflect the collective needs of
group members, and are clearly determined in the early stages of group formation, may
guide group activities toward desired outcomes.
Objectives:
Following instruction, the group will be able to
1. Determine common characteristics and the resultant needs of patients with chronic
illness, which can be met through membership in mutual support groups.
(Comprehension)
Evaluative criteria:
During follow-up discussion, the group will list at least four
characteristics and four resultant needs of patients with chronic illness, which can
be met through membership in mutual support groups.
2. Determine various purposes and goals of a mutual support group.
{Comprehension)
Evaluative criteria:
During follow-up discussion, the group will list at least four
purposes and four goals of a mutual support group.
CONTENT
SUGGESTED LEARNING OPPORTUNITIES
A. Characteristics of the Patient
with Chronic Illness
1. Experience unpredictable events
in the disease process
2. View themselves as helpless
victims of a disease process
out of their control
3. Less able to cope with life's
problems
4. Isolate themselves from sources
of social support
5. May fail to comply with
prescribed regimens of diet,
exercise, and medications
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
RESOURCES
C =Content resources
C: Cole, et al.
"Self-Help Groups
In addition, any combination of the
for Clinic Patients
following activities may be used in
with Chronic Illconjunction with the lecture.
ness"
1. Trainer will initiate a large
group discussion about characteristics of patients with chronic
.......
\0
TOPIC I:
MUTUAL SUPPORT GROUPS FOR PATIENTS WITH CHRONIC ILLNESS
(Continued)
CONTENT
SUGGESTED LEARNING OPPORTUNITIES
6. Exhibit behaviors related to
illness by posing questions such
as the following, which explore
participants' beliefs about
potential members in the groups
with which they expect to work:
"What kinds of problems might
potential support group members
be experiencing as a result of
their illness?"
"What kinds of attitudes might
potential support group members
have regarding their illness when
they first come to the group?"
the five stages of grief
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance
B. Needs of Patients with Chronic
Illness
1. To feel they are valued and
respected by others
2. Knowledge of disease management
3. Skills for coping with stresses
imposed by their illness
4. Emotional and social support
C. Purposes of Mutual Support Groups
1. Enable participants to seek help
from and give help to other
people with the same medical
condition
2. Provide a program of activities
encouraging members to assume
greater responsibility for their
health
3. Provide information and educational materials related to
management of medical condition
4. Provide social and emotional
support
RESOURCES
C:
Kubler-Ross. On
Death and Dying,
2. In small groups of three or four,
participants will share and discuss
personal experiences with chronic
illness as they relate to the five
stages of grief. Then, each group
will identify behaviors exhibited by
patients with chronic illness as they
relate to the five stages of grief.
In addition, each group will formulate
comments which might be expressed by
a patient with chronic illness at each
of the five stages of grief.
Finally,
each group will share its formulated
comments with the rest of the class,
while the class tries to match the
correct stage of grief with each
comment.
00
0
TOPIC I:
MUTUAL SUPPORT GROUPS FOR PATIENTS WITH CHRONIC ILLNESS
CONTENT
D. Goals of Mutual Support Groups
1. Improved self-care
2. Appropriate use of health
services
3. Better understanding of and
better compliance with medical
regimens
4. Improved coping and adaptation
5. Reduced morbidity and need for
hospitalization
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
3. Trainer will initiate a large
group discussion about the needs of
patients with chronic illness by
referring to previously identified
characteristics of these individuals.
Participants will be encouraged to
identify potential needs based on
their experiences with chronic illness or their familiarity with others
with similar needs. Trainer will
list participant responses on a flip
chart.
4. Trainer will initiate a large
group discussion about purposes and
goals of mutual support groups for
patients with chronic illness by
posing que~tions such as the following:
"Based on the previously identified
needs of patients with chronic illness, how might a mutual support
group meet .those needs?"
"What might be some long-term goals
of mutual support groups for patients
with chronic illness?"
00
1-'
TOPIC II:
STAGES OF GROUP DEVELOPMENT
Generalization:
Knowledge and understanding of the stages of group development may
promote more effective leader interventions in group process.
Objective:
Following instruction, the group will be able to
1. Describe the various stages of group development in their sequential order.
(Comprehension)
Evaluative criteria:
During follow-up discussion, the group will describe the four
stages of group development in their sequential order, explaining what typically
occurs in a group during each stage.
CONTENT
A. Key Points About Group Development
1. Groups grow and change naturally
as time passes.
2. They change in terms of individual's sense of identification
with group.
3. Identification with group relates
to cohesiveness.
4. Cohesiveness relates to feelings
of trust and comfort among group
members.
B. Four Stages of Group Development
1. Forming
a. Members get acquainted
b. Establish individual
expectations
c. Explore possible group
purposes and goals
d. Begin to develop trust among
members
SUGGESTED LEARNING OPPORTUNITIES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as,
auditory input.
RESOURCES
C = Content resources
C: Mallory. Leading
Self-Help Groups.
In addition, any combination of the
following activities may be used in
conjunction with the lecture.
1. Trainer will initiate a large
group discussion by posing questio~s
such as the following:
C:
"How would you describe characteristics of groups in each of the
various stages, using examples of
groups with which you are familiar?"
"If you are already involved in a
mutual support group, what events
C:
or situations occurred in the
forming stage? the other stages?"
Sampson and
Marthas. Group
Process for the
Health Professions
Hill. Helping You
Helps Me.
00
N
TOPIC II:
STAGES OF GROUP DEVELOPMENT
CONTENT
2. Storming
a. Conflict may arise and disagreements may begin to
surface regarding purposes,
goals, and activities.
b. Leader and/or members may be
challenged.
c. Conflict can be an opportunity
for group to gain greater
trust if dealt with openly
and positively.
3. Norming
a. Discussion becomes more open.
b. Purposes, goals, and
activities are determined.
c. Friendships develop
d. Group norms, or shared expectations regarding appropriate
behaviors, are established.
e. Trust and cohesiveness grow
among members.
4. Performing
a. All ground rules and expectations are established.
b. Group begins to work on the
task at hand.
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
Participants will engage in the
large group discussion to differentiate between the four stages
of group development.
RESOURCES
C: Corey, et al.
Group Techniques.
2. In groups of three or four,
the participants will discuss
characteristics of groups at
different developmental stages
using examples of groups with
which they are familiar.
Then,
each small group will develop
potential strategies to be used
during the initial stage of
their mutual support group's
development, including activities
to help members get acquainted and
to help the group begin to develop
trust among its members.
Finally,
each group will report to the class
the strategies they have developed.
00
w
TOPIC III:
LEADERSHIP IN MUTUAL SUPPORT GROUPS
Generalization: Achievement of a mutual support group's desired goals may be
facilitated by a functional leadership approach.
Objectives:
Following instruction, the group will be able to
1. Explain leadership in mutual support groups.
(Comprehension)
Evaluative criteria: During follow-up discussion, the group will explain leadership
in mutual support groups as a functional approach to helping the group achieve its
desired goals through shared efforts among group members.
2. Distinguish between task and maintenance leadership functions.
(Comprehension)
Evaluative criteria: During follow-up discussion, the group will distinguish
between task and maintenance leadership functions by ascribing the appropriate
categorical label to selected function descriptors.
CONTENT
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
A. Definitions
1. Set of functions through
which the group coordinates
efforts of individuals (the
functional leadership approach)
2. Performance of those acts which
help the group achieve its
desired goals
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
C =Content resources
A= Activity resources
B. Characteristics
1. A process of facilitation
2. A responsibility shared among
group members
In addition, any combination of the
following activities may be used in
conjunction with the lecture.
1. Participants will complete the
"Group Climate Self-Assessment"
(see Appendix A). Scores will be
tallied and results will be used
C: Bowles. Self-Help
Groups: Perspectives & Directions
A: Beebe & Masterson.
Communicating in
Small Groups,
pp. 96-97.
00
-1>
TOPIC III:
LEADERSHIP IN MUTUAL SUPPORT GROUPS
CONTENT
C. Functions
1. Task functions
a. Initiating discussion and
stimulating member participation
b. Making suggestions and
offering new ideas
c. Giving information and/or
opinions
d. Asking for more information
e. Clarifying ideas
f. Summarizing group progress
g. Making procedural observations or recommendations
h. Assisting in decision-making
i. Keeping discussion directed
toward the subject
2. Maintenance functions
a. Offering encouragement
b. Showing approval or acceptance
c. Mediating conflict
d. Seeking compromise
e. Helping keep communication
channels open
f. Sensing and expressing group
feelings
g. Sharing and soliciting
personal feelings
h. Assessing member satisfaction
i. Providing needed tension
release
j. Setting standards
k. Minimizing blocks to good
discussion
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
by each individual to assess
personal leadership strengths
and weaknesses,
RESOURCES
C: Hill. Helping You
Helps Me.
2. In small groups of five or six,
C: Beebe & Masterson.
participants will undertake the
Communicating in
task of completing the "Winter
Small Groups.
Survival Exercise" (see Appendix B).
An observer will be selected in
each group to record the number of
times various task and maintenance
leadership functions occur and
which individuals perform those
functions.
Following completion of
the exercise, a member of each group
will be asked to summarize the
decisions reached by the group.
Then, the observers will be asked to
report on their observations of the
performance of task and maintenance
leadership functions.
A large group
discussion of those observations will
follow.
3. In groups of three or four, parA: Mallory. Leading
ticipants will identify and list
Self-Help Groups
behaviors of people they know to be
pp. 27-28.
good group facilitators or people who
have been helpful in some way, After
each group has made an individual
list, each group's list will be shared
with the whole class.
As a large
group, participants will be asked to
think of the mutual support group with
which they expect to work and the
00
lJ1
TOPIC III:
LEADERSHIP IN MUTUAL SUPPORT GROUPS
CONTENT
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
group's focus and purpose, then
respond to the following questions:
"Which of these behaviors you have
identified are essential to your group?"
"Which of these behaviors can members
be expected to perform?"
"How can you communicate these expectations to members?"
c:x>
0"1
TOPIC IV:
COMMUNICATION IN GROUPS
Generalization:
Communication utilizing effective interpersonal behaviors may promote
the development of helping relationships among mutual support group members.
Objectives:
Following instruction, the group will be able to
1. Practice the application of interpersonal communication skills including active
listening, questioning, use of "I'' statements, and non-verbal communication.
(Application)
Evaluative criteria:
During small group interactions, the group will be observed to
be practicing the responding and attending behaviors associated with active
listening, questioning techniques, the use of "I" statements, and forms of non-verbal
communication.
2. Identify the use of various communication skills and the resulting effects on
interpersonal behaviors in a group setting.
(Analysis)
Evaluative criteria:
During follow-up discussion, group members will analyze
observations of. small group interactions in terms of the use of communication skills
and the resulting effects on the interpersonal behaviors of group members.
3. Demonstrate a commitment to utilize effective communication skills as a means of
enhancing interpersonal relationships.
(Affective-valuing)
Evaluative criteria: Throughout the course of program instruction, the group will be
observed to demonstrate increased use of "effective'' communication skills during
interactions with other group members.
CONTENT
A. Active Listening
1. Prerequisites
a. Intense concentration
b. Desire to understand
c. Emotional and intellectual
in put
d. Energy and commitment
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
C""Content resources
A= Activity resources
C: Munn and Metzger.
Effective Communication in Health
Care.
co
"-.!
TOPIC IV:
COMMUNICATION IN GROUPS
CONTENT
e. Listening for all possible
meanings
f. Suspension of judgments
throughout interaction
g. Awareness of personal
feelings
2. Skills
a. Responding behaviors (verbal)
1) Paraphrasing
2) Summarizing
3) Reflecting feelings
4) Accepting
5) Clarifying
b. Attending behaviors (nonverbal)
1) Facing the other person
2) Maintaining good eye contact
3) Being relatively relaxed
4) Reflecting attention
through facial expressions
S) Attending with vocal cues
B. Questioning
1. Open-response questions
a. Begin with the words "how"
or "what"
b. Promote exploratory thinking
c. Promote complete rather than
quick route to problem-solving
2. Closed-response questions
a. Elicit yes/no responses
b. Limit exploratory thinking
c. May cause defensiveness
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
In addition, any combination of the
following activities may be used in
conjunction with the lecture.
RESOURCES
C: Glaser. Toward
Communication
Competency.
1. Trainer will initiate a large
group discussion about participants'
experiences with communication
behaviors by posing questions such
as the following:
"What ineffective communication
behaviors or circumstances have
you experienced?"
"What effective communication
behaviors or circumstances have
you experienced?"
"What made those behaviors effective or ineffective?"
2. Participants will complete
A: Pfeiffer, et al.
the "Interpersonal Communication
Instrumentation in
Inventory" (see Appendix C).
Human Relations
Scores will be calculated and used
Training, pp. 167to indicate personal tendencies in
168.
interpersonal communication.
3. Two trainers will demonstrate
proper and improper listening
techniques. Following the demonstration, observations of the
various listening techniques will
be discussed by the group as a
whole.
00
00
"'
TOPIC IV:
COMMUNICATION IN GROUPS
CONTENT
C. "I" Statements
1. More easily received than
"You" statements
2. Reflect assumed responsibility
on the part of the sender
3. Effective technique to use
in conflict resolution
D. Non-Verbal Communication
1. Must be congruent with verbal
messages for clear communication
2. Forms of non-verbal communication
a. Facial expressions
b. Eye contact
c. Paralanguage
d. Body actions
e. Touching
f. Use of space
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
4. In small groups of three or four,
participants will engage in a communication exercise designed to
focus practice on application of
active listening principles in a
small group interaction (see
Appendix D, exercise A). One
member of each group will be designated as observer who will record
non-verbal attending behaviors
using an observation form (see
Appendix E).
Large group will
reassemble to discuss small group
experiences, including observer
reports.
A: Bertcher. Group
Participation,
5. In small groups of five or six,
A: Bertcher. Group
Participation,
participants will engage in a communication exercise designed to
practice use of paraphrasing in a
small group interaction (see
Appendix D, exercise B). Large
group will reassemble to discuss
small group experiences.
6. In small groups of three or four,
participants will engage in a communication exercise designed to
practice identifying and responding
to feelings in a small group interaction (see Appendix F). Large
group will reassemble to discuss
small group experiences, including
observer reports.
p. 37.
A: Glaser. Toward
Communication
Competency,
p. 187.
p. 38.
A: Bertcher. Group
Participation,
pp. 92-93.
00
\.0
TOPIC IV:
COMMUNICATION IN GROUPS
CONTENT
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
7. Each participant will work with
A: Glaser. Toward
a partner to complete a "Perception
Communication
Checking" worksheet (see Appendix G).
Competency,
Large group will reassemble to hear
pp. 169-170.
partner reports and to discuss activity experiences.
8. Two trainers will demonstrate use
of open and closed questioning.
Following the demonstration, observations of the two questioning techniques
will be discussed by the group.
9. Working in pairs, participants will
use open-ended questioning techniques
to discover something unique about
their partner. Large group will
reassemble to hear partner reports and
to discuss activity experiences.
10. Each participant will work with a
partner to complete an "I Statement"
worksheet (see Appendix H). Large
group will reassemble to compare worksheet responses.
11. Working in pairs, participants
will engage in a communication exercise designed to experience the
importance of non-verbal communication (see Appendix I).
Large group
will reassemble to discuss activity
experiences.
A: Glaser. Toward
Communication
Competency,
p. 181.
\0
0
TOPIC V:
THE HELPING PROCESS
Generalization: The collective goals of a group may be accomplished in an atmosphere of
mutual help and support.
Objectives:
Following
instruction, the group will be able to
1. Explain the nature of the helping relationship, including the role of and benefits to
the helper.
(Comprehension)
Evaluative criteria: During follow-up discussion, the group will explain aspects of
the helping relationship to include definition, goal, and role of and benefits to the
helper.
2. Identify the three primary helper characteristics.
(Knowledge)
Evaluative criteria: When questioned, the group will identify the three primary
helper characteristics as empathy, respect, and genuineness.
3. Demonstrate an awareness of personal needs, attitudes, values, and feelings which may
affect the helper role.
(Affective-receiving)
Evaluative criteria: The group will demonstrate an awareness of personal needs,
attitudes, values, and feelings by completing a self-assessment survey,
4. Demonstrate a commitment to give and to receive strokes as units of recognition in
the helping process.
(Affective-valuing)
Evaluative criteria: Throughout the course of program instruction, the group will be
observed to demonstrate increased use of strokes during interactions with other group
members.
5. Analyze the relationship between the helping process and leadership in a mutual
support group.
(Analysis)
Evaluative criteria: During a summative discussion, the group will cite leadership
functions which promote the helping process within a mutual support group.
\0
1--l
TOPIC V:
THE HELPING PROCESS
(Continued)
CONTENT
A. A Helping Relationship
1. Definition - one in which at
least one of the individuals
intends to help promote the
growth, development, improved
functioning, and improved
coping with life of the other
2. Goal - increased self-sufficiency
and self-actualization for the
helpee
3. Role of the helper
a. To serve as guide, enabler,
and model
b. Should not take over functions
that could be assumed by the
helpee
4. Benefits to the helper
a. Increased sense of power over
own life
b. Begins to assess and attempt
to resolve own problems in a
more objective and skillful
manner
c. Obtains a feeling of social
usefulness and worth by fulfilling the helper role
S. Helper characteristics
a. Three most essential
1) Demonstrates empathy
2) Respects others
3) Projects genuineness
b. Additional characteristics
1) Believes people can help
themselves
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
C = Content resources
A= Activity resources
In addition, any combination of the
following activities may be used in
conjunction with the lecture.
C: Bowles. Self-Help
Groups: Perspectives & Directions
1. Trainer will initiate a large
group discussion about the helping
process as it relates to participants' experiences with chronic
illness by posing questions such
as the following:
"What do you see as the role of
the helper in a helping relationship?"
"What benefits can the helper
derive from a helping relationship?"
2. Trainer will initiate a large
group brainstorming session about
helper characteristics by posing the
question: "What helper characteristics
have you found to be important in
your experience with the helping
relationship?" Trainer will list
responses on a flip chart.
A discussion of those characteristics will
follow, with special emphasis placed
on the characteristics of empathy,
respect and genuineness.
\0
N
TOPIC V:
THE HELPING PROCESS
(Continued)
CONTENT
2) Good coping and problemsolving skills
3) Inspires confidence and
trust
4) Aware of own feelings,
values, attitudes, needs
5) Sincere interest in people
6) Capacity to care and
display warmth
7) Is nonjudgmental
6. Requires a climate of mutual
trust
7. Group leaders as helpers
a. Knowledgeable about helping
and problem-solving skills
b. Able to use them in a way
that provides a model and
serves to train members
of the group in the use
of these skills
B. Trust Building
1. Basic component of all helping
relationships
2. Takes time to develop
3. Result of basic characteristics
of the helper and helpee
C. Awareness of Needs, Attitudes,
Values, and Feelings
1. Self-awareness
a. Required in order to be an
effective helper
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
3. Each participant will complete an
"Interpersonal Needs/Satisfactions
Grid" at the conclusion of one or
more portions of the "Interpersonal
Needs/Satisfactions" exercise (see
Appendix J).
Results of the exercise may assist the participants
in gaining an awareness of their
interpersonal needs.
Large group
discussion of issues and insights
raised by the worksheet will follow.
A: Tubesing.
Structured
Exercises in
Well ness
Promotion,
pp. 81-89.
4. Each participant will complete
A: Tubesing.
Structured
Exercises in
Well ness
Promotion,
pp. 100-103.
the "What Do You Need?" worksheet
(see Appendix K).
Results of the
worksheet assessment may assist
the participants in gaining an
awareness of their personal needs,
Large group discussion of issues
and insights raised by the worksheet
will follow,
5. Each participant will complete a
"Survey of Interpersonal Values"
(see Appendix L). The results of
the survey may assist the participants in gaining an awareness of
their personal values which may
affect their role as helper.
Large group discussion of issues
and insights raised by the survey
will follow.
A: Pfeiffer, et al.
Instrumentation
in Human Relation
Training,
pp. 173-175.
\.0
w
TOPIC V:
THE HELPING PROCESS
(Continued)
CONTENT
b. Can be achieved by focusing
on how they facilitate or
interfere with communication
and positive helping
relationships
2. Awareness of others
a. Requires effective use
of communication skills
b. Necessary in development of
positive helping relationships
D. Strokes (units of recognition)
1. Important part of the process
of mutual support
2. Examples include a compliment,
a smile, acknowledgement of
another's accomplishments
3. Involves both giving and
receiving strokes
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
6. Each participant will engage in
the "Values Focus Game" which is
designed to assist participants in
understanding and accepting different points of view (see Appendix M).
Large group discussion of issues and
insights raised by the game will
follow.
A: Simon, et al.
Values
Clarification,
pp. 171-173.
7. Each participant will engage in
one or more portions of the
''Discriminating Feeler" exercise
(see Appendix N).
Large group
brainstorming of emotions that
may be aroused in specific situations, and small group exploration
of personal feeling preferences
and patterns are utilized in this
activity.
Large group discussion
of issues and insights raised by
this exercise will follow.
A: Tubesing.
Structured
Exercises in
Wellness
Promotion,
pp. 74-79.
8. Each participant will write three
C & A: Mallory.
Leading SelfHelp Groups,
pp. 41-42.
positive traits about him/herself
which will help that person be a
good group facilitator.
Working
with a partner, each participant
will read his/her list to the other.
The partner will hear and repeat
each positive trait as a stroke.
The person reading his/her list
must acknowledge the receipt of the
stroke with a "Thank you."
When
the list is completed, the partner
will add two additional positive
\.0
+:-
TOPIC V:
THE HELPING PROCESS
CONTENT
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
traits that s/he has observed in
the other, providing additional
practice in giving and receiving
strokes.
Partners will then switch
roles. Large group discussion of
issues and insights raised by the
activity will follow.
9. In small groups of three or four,
participants will cite task and
maintenance leadership functions
which serve the helping process.
A list of leader functions will be
provided for this activity.
Each
group will be expected to describe
to the large group in a follow-up
discussion, how various leadership
functions relate to the helping
process.
\D
V1
TOPIC VI:
PROBLEM SOLVING
Generalization: Problem solving is a process utilized by mutual support groups in their
attempts to satisfy the needs of group members.
Objectives:
Following instruction, the group will be able to
l, Identify the steps involved in the group problem-solving process.
(Knowledge)
Evaluative criteria: When questioned, the group will identify the six steps involved
in the group problem-solving process.
2. Practice the application of group problem-solving techniques.
(Application)
Evaluative criteria: During small group interactions, the group will be observed to
be practicing group problem-solving techniques.
CONTENT
A. Key Points About Problem Solving
I. Skills essential for members
of mutual support groups
2. Is a learning process
3. Should focus on goals rather
than problems, on strengths
rather than weaknesses
B. Process of Problem Solving
1. Identify the problem as it
relates to the goal
2. Determine whether group or
individual problem
a. Group problem
1) Clarify the problem
2) Brainstorm solutions
3) List pros and cons
of solutions
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
C = Content resources
In addition, the following activity
will be used in conjunction with
the lecture,
In groups of five or six, participants will engage in the group
problem-solving process by first
deciding upon the selection of a
chronic-illness specific problem
to explore, Then, each group will
practice application of group
problem-solving techniques in
C: Bowles, Self-Help
Groups: Perspectives & Directions
C: Hill. Helping You
Helps Me.
C: Mallory. Leading
Self-Help Groups.
\.0
(j'\
TOPIC VI:
PROBLEM SOLVING
(Continued)
CONTENT
4) Choose appropriate solution
a) Majority rule
b) Consensus decision-making
5) Act on group's decision
6) Review the results
b. Individual problem
1) Determine if person with
problem wants ideas
from the group
2) When group help is desired
a) Clarify the problem
b) Identify solutions tried
c) Determine desired outcome
d) Brainstorm solutions
3) Individual determines
personal course of action
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
exploration of possible solutions.
A large group discussion will
follow, during which each group
will report on 1) the selection of
the problem, 2) the steps used
in the problem-solving process,
and 3) the recommended solutions
to the identified problem.
C: Beebe & Masterson.
Communicating in
Small Groups.
\0
"'
TOPIC VII:
INTERVENTION STRATEGIES FOR GROUP FACILITATORS
Generalization:
Knowledge and use of intervention strategies may enhance the
effectiveness of group process,
Objective:
Following instruction, the group will be able to
l, Practice making application of group intervention strategies.
(Application)
Evaluative criteria:
During small group interactions, the group will be observed to
be practicing application of intervention strategies by planning strategies to deal
with problems which interfere with group processes.
CONTENT
A. Dealing With Difficult Members
1. Assessments of these individuals
reflect on leader's own dynamics
2. Leaders responsible for facilitating insight and growth, for
themselves and other group members
3. Should ascertain what members
might be trying to communicate
through their behavior
4, Should seek to communicate own
responses to them (using "I" statements), thus modeling this kind of
feedback for other group members
5. Should try to communicate caring
and respect and an openness to
them as they now are; encourage
them to consider experimenting
with different behaviors
6. Examples include: the silent
member, the monopolizer, the
theorist, the arguer, the rambler,
the conversationalist, the negativist, the aggravator, the critic
SUGGESTED LEARNING OPPORTUNITIES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input,
In addition, any combination of the
following activities may be used in
conjunction with the lecture,
1. Trainer will initiate a large
group brainstorming session about
intervention strategies for dealing
with difficult members by posing
the question: "Thinking back on
group experiences you have had in
the past, what kind of member
difficulty are you most concerned
about dealing with or facing as a
leader of a mutual support group?"
Trainer will list responses on a
flip chart, This activity should
RESOURCES
C =Content resources
C: Sampson & Marthas.
Group Process for
the Health
Professions,
C: Corey, et al.
Group Techniques.
\0
00
TOPIC VII:
INTERVENTION STRATEGIES FOR GROUP FACILITATORS
CONTENT
B. Dealing With Group Conflict
1. Typical in the development
of a group
2. Indicates liveliness and
innovation in problem solving
3. Used constructively can help
a group to grow
4. Destructive conflict must be
recognized and dealt with openly
a. Leaders must be sensitive
to participants involved and
the basis of their conflict
b. Early intervention helps
prevent escalation of unproductive conflict; helps build a
firm foundation for using
constructive conflicts as a
group resource
c. Interventions must occur within
a climate of cohesion and trust
d. Intervention strategy
1) Point out conflict is present
a) Interpretation
b) Reflect behavior
c) Reflect feeling
d) Confrontation
2) Facilitate negotiation
of a compromise
a) Support and legitimate
conflict
b) Help clarify basis
of conflict
c) Help negotiate compromise
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
be repeated to brainstorm for
intervention strategies dealing with
group conflict and emotional outbursts, as well.
The expressed
concerns listed on the flip chart
can be used to supply specific
problems to be addressed in small
group interactions.
2. In groups of four or five,
participants will be assigned two
identified group problems related to
difficult members, group conflict or
emotional outbursts.
The group task
will be to devise at least two alternative ways of dealing with each
problem.
As time allows, the group
will structure its interventions and
role play one of the problems with
one member acting as facilitator,
while the others in the group role
play group members reacting to the
problem intervention.
In a large
group follow-up discussion, each
group will report on 1) the problems
assigned and the intervention
strategies developed, and 2) issues
and insights raised by the role play
experience.
It may be desirable to repeat this
activity in its entirety, rotating
problem areas and group members, to
give further practice in the development of intervention strategies for
\0
1..0
TOPIC VII:
INTERVENTION STRATEGIES FOR GROUP FACILITATORS
CONTENT
C. Dealing With Emotional Outbursts
1. Typical reaction is silence, withdrawal, and avoidance
2. Interventions involve helping
individual deal with expressed
feelings; helping group develop
more responsible and less avoiding
attitude toward such occurences
a. Diagnostic interventions clarify the meaning of outburst
b. Supportive interventions - help
member deal with feelings
resulting from the behavior
c. Group-centered interventions help group members explore
feelings about what has occurred
and degree to which they share
those feelings and experiences
3. Successful interventions result in:
a. Increased group cohesion
b. Greater openness and willingness
to share and talk about feelings
c. Integration of affected member
into the group
d. Ability of group to face up to
difficult matters as they occur
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
dealing with problems which interfere
with group processes.
3. Trainer will initiate a large group
discussion about the issue of group
member termination by posing questions
such as the following:
"Reflecting back on when you were a
member of a group, what kinds of
feelings or behaviors were experienced
within the group when you or another
member were anticipating leaving the
group?"
"How did those feelings or behaviors
interfere with normal group processes?"
Then, in groups of four or five,
participants will devise two intervention strategies to deal with member
termination.
Finally, in a large group
follow-up discussion, each group will
report on its planned intervention
strategies.
(One or more of these
strategies may be used to conclude the
actual training program.)
D. Dealing With Member Termination
1. Assisting the group
a. Encourage members to face
resulting changes in group
composition and dynamics
b. Encourage members to discuss
feelings of separation
I-'
0
0
TOPIC VII:
INTERVENTION STRATEGIES FOR GROUP FACILITATORS
CONTENT
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
c. Encourage members to complete
any unfinished business they
have with the leaving member(s)
2. Assisting the leaving member(s)
a. Charge leaving member(s) to
carry forth what's been learned
b. Help individuals make specific
plans for change
c. Help individuals discover ways
of creating personal support
systems after leaving the group
.......
.......
0
TOPIC VIII: PLANNING FOR MEETINGS
Generalization:
tasks.
Objectives:
Planning gives direction to the accomplishment of a group's designated
Following instruction, the group will be able to
1. Identify the steps involved in selecting agenda items when planning for a meeting.
(Knowledge)
Evaluative criteria: When questioned, the group will identify the six steps involved
in selecting agenda items when planning for a meeting.
2. Practice the application of format criteria in the composition of a meeting agenda.
(Application)
Evaluative criteria: During small group interactions, the group will be observed to
be practicing the application of format criteria when asked to compose a meeting
agenda.
CONTENT
A. Determination of Agenda
1. Responsibility of group
participants
2. Plans for next meeting addressed
at end of current session
3. Process of selecting agenda items
a. Identify subjects of concern
b. Assess knowledge of subjects
c. Prioritize identified subjects
d. Determine possible strategies
for addressing subjects
e. Assess time needed vs. time
available
f. Select agenda items
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
Trainer will lecture on topic
content, using overhead transparencies, flip chart, or chalkboard,
to supply visual, as well as
auditory input.
In addition, any combination of the
following activities may be used in
conjunction with the lecture.
1. Trainer will initiate a large
group brainstorming session about
locating and accessing resources
1--'
0
N
TOPIC VIII: PLANNING FOR MEETINGS
CONTENT
4. Agenda setting
a. Indicate time, date, place,
and issues to be addressed
b. Indicate order of topics
c. Indicate amount of time to
be spent per topic
d. Indicate person or persons
responsible for topic presentations
e. Indicate process to be used
to cover topics
B. Resources
1. Locating available information/
materials
2. Accessing guest speakers
(Continued)
SUGGESTED LEARNING OPPORTUNITIES
RESOURCES
for planned meetings, by posing
the following question: "Where
might you look, or who might you
contact, for possible resources
to be used when planning future
meetings of your mutual support
group?" Trainer will list
responses on a flip chart.
2. In groups of three or four,
participants will plan and write
a mock agenda for an initial
meeting of a mutual support group
for patients with chronic illness.
In a large group follow-up discussion, each group will report
on 1) the steps used in selecting
agenda items, and 2) the actual
agenda planned.
1-'
0
w
104
APPENDIX A
Group Climate Self-Assessment18
How does your behavior affect group climate? The following questions may
provide some insight
Circle the number of the response which describes most accurately your
behavior in groups.
1
I try to clarify the ideas of others.
2
I plan what I am going to say while others are speaking.
1
I
Always!
3
4
3
4
5
6
u
F
50150
0
s
I tend to tell
o~hers
I
7
N
when their ideas are irrelevant or inappropriate.
1
2
3
4
5
6
A
u
F
50; 50
0
s
I
7
N
Iris ex:rer::e!y important to me for the group to adopt my point of view.
1
A
5
2
2
lu
3
4
5
6
7
F
50150
0
s
N
My responses :o others' comments are direct and supportive.
7
6
5
4
3
2
1
A
u
F
50/50
0
s
N
105
6
I express my ideas without concern for others' previous comments and
personal feelings.
1
A
7
A
A
10
4
5
6
F
50150
0
s
I
7
N
I
6
5
4
3
2
u
F
50150
0
s
I
1
N
In a group I feel free to share my feelings about the group's task and
other group members.
7
9
Iu
3
I make frequent contributions to a group discussion;
7
8
2
I
I
6
5
4
3
2
u
F
50/50
0
s
I
1
N
I encot:.rage my group to confront problems as they arise.
7
6
5
4
3
2
1
A
u
F
50150
0
s
N
1 pra:se others for their good ideas.
7
6
5
4
3
2
1
A
u
F
50/50
0
s
N
P..C.d up ::.e circ!zd numbers to determine your score. Compare your score
whh other grcup members. Discuss the results.
Beebe, Stephen A. and Masterson, John T. Communic~tina in
Small GrJ~Ds: Principles and Practices. Glenv1ew,
lll:nois: Scott, Foresman and Company, 1982.
106
APPENDIX B
l'i'Im-ER SUF.VIV•.\1 E'XE.!.>.CISE
Tne Situation
You have jt:..st crash-lanced in the ••oods of Ko-r-Jlem Minnesota and Southern
1-!a."'litcba. It is 11:32 a.m. :in lnid-Ja.J.uazy. The small pla."le :in which you
were traveling 1-..as been cc:r;>letely destroyed except for the frame. The
pilot and co-pilot have been killed, but no one else is seriously :injured.
The crash ~~ su.d.::e:nly be::ore t."J.e pilot had tin:e to radio for help or
i..J.:fonn <myone of yo:= positic:t. Si.:u:e yoUT pilot was tying to avoid a
storm you bow the plan 'h-as considerably of:: course. Tne pilot a.-mounced
shortly before t.."le crash 6at you l'Fere eigh~ miles north;.;est of a Sll'.all
town that is t.'le nearest k:lc•.n habitation.
You are in a w"ilee:r::ess area made t.'P of thic.~ \o.'Oods broken by many lakes a.'"ld
'!"ive-:-s. Tnere are pat:±es a.J.d d...-i:::ts of snc·,.; frc:n a previous sno;.;stor.a.
Th.e last:.;..·ea:-!.:er rep~rt ~-::..:.ca=:d that tl_le te:r;>eratu;-e ':''O~d reach tU..'"lus
t•enty-=:.';e ce,;:-ees J.."""l t.":e eaytJ.r.e ar.d Ill:U"""lUS forty at ru.gnt. You are dressed
i.""l lo.'ir:.te::- clo:::.i.:."""lg a:?;rrcp:=-:.ate for cit'/ wear suits, pa.."ltsui't.S, street shoes,
a."'1.d ove::-=oa:s.
Wnile es::a::L.-:g r:-:::n t.""le J:l::..::e your grct.7 salvaged the fi£teen ite::-.s listed
belc,.;. Yc·~ ta.s:.- is to ::-z:-~ these ite~ acco:-dbg to tne~r i••;Jo:::-...a..'"l.ce to
your s1.::-.'"ivz::...
~..c-!.l =:;;.y' ~~:.=_; ~~~ "t::e r:=.:e::- is t...~e sar.e as t.:~ n~:r
·:..::~~ t...":.e grc~? 1-'...z..s ag:-eeC :o stid: toget..1.er.
"1"
=ollc~:L~g i~e;.s a=::r~~g to ~~eir i-~o=-~~ce
::c~ t.;,e ~s't ~::-t~-::~ a.!d. p::cceed.i...T'lg to ''lSn
-----
Cq::-ess kit
c-..-::~.'1 28-£-:., 2-:in. ga::.:::e)
:L'1. your
grc~7
....._
to yot.rr" suni.'\"'2..1., sta~:.::g
for the least. i::por:a..-:.t:
Secticna.!. air I:a? o::.e
- - - - - - of plastic
----- Ball of steel wool
----- 30 feet of ~e
----- Loaded .45 ca:iber pistol
----- Flasb.li;ht "'~-:.:~ 1:s:~:e:'ies
---------- C~ass
----- '!';.;;:, ski
----- Knife
~:;les
- - - - - - - E.--::::ra shirt :!!":.::! 'Ca::.-:5
each siZ'Vi.vo::- -
- - - - - - - C2:1. of s1-.ort~:-.::.ng
,::,.._
107
APPENDIX C
INTERPERSONAL COMMUNICATION
INVENTORY (ICI)
Millard J. Bienvenu, Sr.
DESCRIPTION
Length:
forty items
Time: Administering
Scoring
fifteen minutes
ten minutes
Scale:
Interpersonal Communication
This inventory offers one an opportunity to make an objective study of the degree and
patterns of communication in one's interpersonal relationships. It is intended to identify
pattcms, characteristics, and styles of communication based on fh~e interpersonal components: (I) an adequate self-concept, (2) the ability to he a good listener, (3) the skill of
CAllrcssin~ one's thoughts and iciC'as clearly, (4) being ahle to cope with one's emotions,
particularly atq,.,rry fcclin~s. am! expressiu~ them in a constmctive way, and (5) the willingness to disclose oneself to others tmthfuily and freely.
Sc::f-C:oiiCCpf.
Sample question:
Do you find it difficult to express your ideas tchcn they differ from those around you?
..()
l'es
No
-3
Sometimes-]
L:stclling.
Sample question:
In conn·rsati.m, do
!f"U
hat'e a tcntll'ncy to clo more talking than the other prrso1t?
Yes
..()
No
..J
Svrnetimes-1
I:rprcssing.
S;mt rlc question:
.1rt• you au.:are of how your tune of L"Oice may affect others?
l't'.f
-3
No
-0
Sometimcs-2
108
168
Instrumentation in Human Relations Training
Angry Feelings.
Sample question:
Do you fiud it dif!ir.u/1 to think clearly IL'hen you ora angry wit/a someone?
Yes
-0
No
-3
Sometimes- I
Sdf-DL~closure.
Sample question:
Is it dijfiru/1 far yo11 to confide in paoplc?
Yes
-0
No
-3
Sonl<:liuws-1
After the respondent has completed the questionnaire and scored each of the forty
items: he then adds up his total score. The total may be compared with the norms included with the scoring key.
V.•cs: The ICI is a?plicable ~enerally to social interaction in a wide variety of situations. It
is an attempt to measure £Cncral tcndeucics in interpersonal communicatiou, antl·it may
he used as a counseling tool, as a teaching device, as a supplement to an interview, by
managcmcut, ur for research.
Positive Features: The ICI measures many of the aspects of communication that facilitators attempt to influcncc in human relations training. It is simple and easy to use. It can
lx• used in a wide ;:rray of training tlesigns with various types of partil'ipants. Tho.: items
arc t:;aod disc~ssion startc~s in personal growtl1 laboratories as well as in commur-:ic<1!ion
;uJclleadcrship courses.
Concerns: :\lthot:;il the ICI contains items on five different aspects of social discourse, it
;.iclds only <Hac ~'"ore. Tht• instrument is too brief to generate reliable subscorcs. The facilitator may. huwt,Vl'r. wi~iJ to categorize the items for discussion purposes.
ORDERING
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enivcrsity Assoc:i:ttl'S
'75\iG E:Hls 1\ venue
La Jolb, California 92037
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J.
\V. Pfciifer :wJ
E. J<>ncs (Ed,.). The 1974 .-\nnrwl IlcmdiJonk far Croup Fud!ilatc•rs. La Jolla. Calif.: t:niwr~it.v :\ss<Jciaks, 197-1, pp. 97-101. Loosclcafnotcbook (8 1.~" X
Also in
ll"), S 15.50:
har~hounJ
:.6"
.~
.W!'),
.sl.1.;)();
paperbouud (6'' x 8 1/:"), S 10.00.
109
APPENDIX D
* The Attending behavior practiced in Exercise A below
is referred to as Active Listening behavior in the
curriculum content.
EXERCISE A
This exercise may seem so obvious, so simplistic, that you are
tempted to skip it. Don't. It makes a basic point that you can not
afford to ignore.
1. Goals
To give you practice in Attending in a one-to-two-or-more situation.
2. Time Required
About twenty minutes.
3. Process
a. The ccmvenor will divide the learning group into subgroups of three
or four. E:.11.:h subgroup should be far enough apart so as not to
interfere with the other subgroups (e.g., each subgroup could work
in a corner of the room).
b. Desigl1:lte one member of each subgroup to be an active attender in
the first part of this exercise.
c. Have a five-minute conversation in the subgroup during which the
attender actively uses Attending behavior for the first three minutes.
TI1e discussion could be about why the members are in this learning
group, how each sees it fitting into his c::Heer pl:lns, how learning to
work in or with groups is important to their jobs, or some other
topic suggested by the convenor. After three minutes, the convenor
will signal the attender in each group to stop Attending while the
convers:~tion continues for another two minutes.
d. Change roles so tlut all th.: other members arc designated :lS attenders and repeat the pro-:ess (i.e., three minutes of Attending, followed by two minutes of non:1ttending) in which all of the attenders
stop Attending at th~ thr:!e-minute point.
e. Reassemble the total learning group and discuss your experiences.
\'.'lnt significance uoes this experience have for your work as a
learning uoup? As a member of any group? When you are in the
position of Group Lead~r? :\nd so forth.
Q
•
110
EXERCISE B
The convenor should select a controversial topic in which the group is
likely to be interested. Ask two members to be forceful spokespersons for
opposing points of view, whether or not they personally agree with the
position they will propound. Each spokesperson (A then B) is to be given a
minute or two to make an introductory statement supporting his or her
viewpoint. From that point, let the group members join in, addressing their
questions or comments to any member not just the spokesperson. But here is
the catch: before anyone can· speak, he or she has to briefly restate the gist of
what the person who spoke just before has saill, to that persons satisfaction.
Remember: the previous speaker has to be satisfied that his or her position,
comment, or question has been restated correctly before the new speaker c:~n
mak~· his or her own statement. If the new speaker has missed, she/he must
work to find a restatement that satisfies the previous speaker. And after the
new speak:!r has s:~tisfied the previous spe:~ker and then made his or her 0\~
statement, th;: next speaker must restate the just-previous-speaker's position,
and so on. (Tlte only ones who are excused from this obligation of restatem:nt are tll<' two spokesp~rsons--A and B--when they m:!ke their first
pusi tion st:~t.::ncn ts. There:~ftcr, spokespersons must restate what has gone
b::fore, as everyone clse.must.) See how far th.:: group g<!ts in discussing the
topic: t!lt!n dis.:uss the cxperiwce. WhJt kinds oi statements were easier to
re:-.t:.tc? H:trd~r? Wh:1l are the implic::~tions of your observations for particip:tti0~l in group discussions either as kader or member? And so forth. Cornp!,:'~ t!~e excr..:is.: anJ discussion bdore re:Jding further.
Bertcher, Harvey J. Grouo Particioation: Techniques
for Leaders and Members. Beverly Hills: Sage
Publications, Inc., 1979.
111
APPENDIX E
Group Member Observation Form
Instructions: During each person's behavior rehearsal, record your observations of his or her nonverbal
behavior in each of the categories described below.
Group Member Observed: - - - - - - - - - - - - - - - - - - - - - - - - - - - Situation:
Nonverbal Behaviors:
1. Vocal Characteristics:
2.
Gestures: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3.
Body P o s i t i o n : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4.
Facial Expressions: - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5. Movement:
112
APPENDIX F
RESPONDING TO FEEUNGS
A. Coais: To practice identifying and responding to feelings in a small
group.
B. Time
R~quir;:d:
45-60 minutes
C. M:!teria!s: None
D. Sp!!cializcd Ro!.::s: One memb.:r at a time plays the role of pre:;enter,
the others pi:Jy the role of responder or observer.
E.
Pro~ess:
I. Divide the group into subgroups of four or five.
2. In each subgroup, ont! metr.ber (the presenter) should tell the respor.ccrs (for five minut.:s) how she/he feels about one position in
life (e.g., stud~nt, spous~. worker, parent, etc.) that is important to
him or her. The persons sh~/he tells these things to (i.e., the
resjJOllJcrs are to try wrn:1lly :md nonverbally-through f:J~ial ex•
pression, bodily posture, and so on-to respond to the feelings being
expressed as they are expressed (i.e., they do not w:~it until the rnd
of the five minutes), in a way that captures them most completely,
with all the subtle sh:~des of me:~ning involved. The responders m:~y
be tempted to move to problem-solving responses or Inform:.~tion
Sreki:-~g, but should resist the temptation in f:tvor of Responding to
Feelings that are expressed, implied, or sensed throughout the fivemi;1:.:te period because this is an exercise in Responding to Fedings,
not a realistic attempt to solve a problem. One person in the
subgroup should act as observer, to both observe :mel watch the
time. At the end of the five minutes, the subgroup should review the
interaction. In the discussion, the presenter should describe his or her
re:Jctions when one or more of the responders hits the nail on the
head or \vhen the responders were ofi the mark. The observer m::y
point out behaviors that the presenter and responders m:~y not have
been aware of, the accuracy with which the observer thinks the
responders identified the presenter's feelings; the imp:~ct of th:!
responders' statements on the presenter and vice vers:t, and so on.
After five to ten minutes of discussion select a new presenter :tnd
a new observer and repeat the above process, with a five-minute
present:ition and a five- to ten-minute discussion of th:tt exchange.
Repeat the process, as time allows, unril everyone has h:1d a chance
to perform in all three of the speci:llized roles.
113
3. Next, the learning group should reconvene and discuss the insights
and observations made during the exercise. The following questions
could be discussed:
(a) Were feelings correctly identified? If not, why not?
(b) What were the reactions of the presenters to the responses made
to them?
(c) Were the responders aware of their own emotional responses?
Did the observers think the presenters were always right in
judging whether the responders were on or off target in identify.
ing the presenter's feelings?
(d) Wnat kinds of positions did presenters ch0ose t0 discuss and
why? \\'hat feelings about sdf, family, and soci;!ty were involved
in people's feelings about the positions they chose? Did feelings
about the positions they chose have some effect on the way
they felt about themselves, others, and so.:iety or was it that
feelings about these things (self, others, society) dl·termine how
people felt about their positions?
Bertcher, Harvey J. Grouo Participation: Techniques
for Leaders and Members. Beverly Hills: Sage
Publications, Inc., 1979.
114
APPENDIX G
Perception Checking: Written Practice
Following i!> a list of inference!> thJt one partner in a rclation!>hip might make about the other. For cJch
inference, write a perception check that would help to clarify the validity of the conclusion.
1. "You don't seem interested in what I have to say anymore."
2.
"You really seem tense and uptight tonight."
3.
"You are afraid :hat your parents will disapprove of the way we're living.''
4.
"You dnn't
5.
"Why have you been so depressed lately?"
se~!':l
::.l
=
i~el
ilS
clv,~'
to me as you u.;ed to."
7owa~j ~-~municat~cr Ccmoetencv: Develooinc
~.
Interce:s~rs: Sk~l:s. ~~gene, 0:~;:,: Holt, R1~erar: ana
Gl -sor
c: ._,..._ ' Suc=r
.........
I
lrhns:cn,
'
l:?~:.
J..
-
._.
•
•
115
APPENDIX H
"I" Statement Worksheet
Directions:
Rewrite each of the following statements to reflect
personal ownership of feelings using an "I" statement format.
Examples:
a) "You make me feel guilty that I don't call you mnre
often."
changed to
"I feel guilty that I don't call you more often."
b) "You are wasting my precious time!"
changed to •••
"I feel my precious time is being wasted when
1. "You ought to do it this way."
2.
"~obody
wants to do that."
3. "Doctors never tell you anything."
4.
"You embarrass :ne when you say those things."
5.
"7~ere's
6.
"You're crazy to believe that!"
7.
"You frighten me when you do that."
8.
""Iou're just being silly."
9.
"You never :;.isten to me."
no::jing anyone can do."
10. "You have to try this."
"
116
APPENDIX I
An Exercise in Nonverbal Attention
This activity is to be done in dyads. After your class has paired off and each person has a partner, decide
who will speak first and who will listen. As the speaker, your task is to relate an especially significant or
exciting idea, feeling, or experience. Try as hard as you can to get your listener involved in what you are
saying. As the listener, your task is to give no signs of nonverbal attention: no "umhums," no smiles,
nods, facial expressions-nothing. After the speaker has talked for three minutes, switch poles.
When you have completed both rounds oi this assignment, discuss what it felt like to: (a) receive no
nonverbJI attention; and (b) give no nonverbal attention. Which was more difficult to do? \Vhy?
Now replay this activity sending the same messages, but this time attending nonverbally. Still, as the
listener. you should not make any yerbal input. but your nonverbal input should be significant. When
you have completed this assignment consider the following questions: As the speaker, what was the most
signifil<Jnt difference you found in relating your message to a nonverbally <:Jttentive listener? How did you
feel! Did it eiiect your message in any way? As a listener, how were you efiec:ed by .lttending
nonverb.::!ly? Did it h.1ve uny impact on your covert listening? Did you feel any differently? What do you
think :; :~e eifect of nonverbal attention on interpersonal episodes?
Glaser, Susan R. Toward Communication Competency: Develooing
Inter~ersona! Skills. E~gene, Oregon: Holt, Rinehart and
'tJinston, l9EC.
@
•
117
APPENDIX J
Structured Exercises in Wellness Promotion Volume I
81
19 INTERPERSONAL NEEDS/SATISFACTIONS
In this exercise participants generate an overall list of
people with whom they relate. They then examine their
social connections in light of the demands and rewards
inherent in various levels of relationships. Utilizing
the "Interpersonal Needs/Satisfactions Grid" participants
examine the quality of their current relationship in
light of how satisfactorily each relationship meets their
need for support and nurture. Following small group discussion of issues and insights raised by the worksheet,
each participant identifies two or three persons they
wish to recruit into their support network.
GOALS
ll
To highlight the variety of intensity and purpose that
exists within relationships.
2)
To assist individuals in recognizing their interpersonal needs, and to identify the various sources of
their support.
3)
To motivate par~icipants to be intentional in building
a support network that nurtures them at many levels of
need.
GROUP SIZE
Unlimited; this exercise is appropriate for both small
group settings and large gatherings of 200 or more, as
long as the space and timing permit the formation of four
person sharing groups.
TIME FRAME
60-90 minutes
MATERIALS NEEDED
.:0.. cop:? of the "Interpersonal Needs/Satisfactions Grid" for
each ~articipant.
PROCESS
1)
The trainer may wish to open the exercise by discussing the importance of supportive interpersonal relationships and their health enhancing potential.
Concepts may include:
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1983
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118
Structured Exercises in Wellness Promotion Volume I
82
• Everyone needs to be appreciated, known fully, loved
and valued. Everyone needs to belong.
• Nest people are not very intentional in seeking and
forming fulfilling relationships and in building
their support network. They relate by chance, more
often than by choice.
• To be supported, people must be willing to risk
opening themselves and stating clearly what they
need and want. Guessing games never work out very
well for either the giver or the receiver.
A.
':'HE
~VIDE
OF RELrlT!Cl\SEIPS (15-20 minutes)
NET.~ORK
Tte trainer asks participants to ma~e a list of people
::!":ey relate to -- as mar.y as possible in 3-5 minutes.
The trair.er
enc~uraqes
~~e~
to think
~f
many groups --
close family, distant relatives, old school friends,
·.~ork associates, cl'.ili or :::!lurch memeers, service perso~~el, et=. -- and ~o !~st t~e names of specific
?es.:;;.le as quickly as ?OSsible.
2)
?ollcwing
~)
T~e
::~e
exer:::ise
t~e
trainer asks participants
trainer may announce ~at this is a contest -tl-:e winner being the one \,•ho listed t.'1e most names.
Take a vote --·
o :lew ::1any listed :nore '.:.'Jan 20? 50? 100? etc.
o
~Iotice who listed more names on '.:..'1e average. Men?
or \vo:nen? ivnat's the significance?
o
Dete~.ine
a male winner and a female winner.
o Ask them to come forward and each to describe the
types of groups they noted.
D
out a certificate for the winners or read a
commendation similar to these examples:
~rite
"We hereby honor (wor.:an) as honorary state senator.
Rumor has it she has .:.::issed more babies, shaken
more hands, held more ~eads, had more tears shed on
her. shoulders, knows ~ore people, has given more
favors than anyone else here."
©
1983
\\'hole Person Press
PO Box 3151
Ouiulh. MN 55803
119
Structured Exercises in Wellness Promotion Volume I
83
"We hereby honor (man) honorary father figure
(or chairman of the board). He has mentored more
people, remembered more names, changed more
diapers, scheduled more meetings, returned more
phone calls, volunteered more time, coached more
little league baseball than anyone here."
c Present a clever award to each winner, utilizing
materials on hand in the room such as:
* an ash tray -- "To hold your ashes after you
burn out"
* a pitcher of water -- 1/2 full, 1/2 empty
* a candle, burning on both ends
* a pack of sugar
"Because you're so sweet"
* a cup of coffee -- "Because we know you gave
yours away"
B.
THE REWARDS AND
5)
DE~ANDS
IN RELATIONSHIPS (15-20 minutes)
Utilizing the top portion of the "Interpersonal Needs/
Satisfactions Grid" worksheet, the trainer asks participants to list the names of three or four people with
whom they have significant connections (upper lefthand column labeled "l1y major social connections").
Note:
Suggest that participants do not select the
most primary relationship in their iife, but
that they also do not select insignificant
relationships -- ones of moderate importance
should be the focus here.
Vary the length and intensity of this segment
by the number of people listed. If time is
short -- ask participants to complete the exercise with only one person as a focus. They
will still get the point.
6)
The trainer asks participants to focus on the demands
in each relationship.
Ask the following questions one at a time, giving ample
time for participants to reflect and write their
answers in the column labeled "the demands."
o
demands (requirements) are placed on you in
this relationship? List all you can think of.
\~at
©
1983
Whole Peroon Press
PO Box 3151
Dululh. MN 55803
120
Structured Exercises in Wellness Promotion Volume I
84
o l'iho sets this demand as a requi:!:"ement in the relationship? Answer this question separately for each
demand you identified! Use an ":·1" for "my requirement," an 11 0" for the ,.other's demand" or a uB" for
"both require it."
o If this requirement were not fulfilled by you what
difference would it make? Would the relationship
still exist? In what form?
o What observations and insights occur to you in
light of your answers?
7)
The trainer asks participants to foc~s on the rewards
in each relationshi?. Ask the follc~ing questions,
one at a time, gi •:ing ample time for pan:icipants to
reflect and write their answers in ::::e column labeled
"the
~ewards.
11
speci fie rev;ards =.o you ex;:ec-: in each relatio:-Iship? List: as many as you ..:.;.n th:..nk of.
:J \·iha~
a Nhat.
c
of the time does ~he relations!-1:..!;
(100%? 73~? 10~?}
percenta~e
you this
gi~·e
~e~ard?
~c..; :-~!:':~·le::e:·;· does the reward ::-.a:.c!l. up to your
ex;.ec'!:a tions?
{100~~
total:~· !"e·.-:a::-di~g
50% -I
not us:.:a.:.. .:..r very rewarC.i!'":.g.'
Ea~e
~·ou
e~·ey
expe=t
yc~
\·.;}:r?
the other ~e~so~ di~ectly ~ha~
rewards? Answe~ ~or each re~ard!
~old
t~:2se
Why net?
0 ;•;"r.at obser·:a-::.:c:-.s and ~:;.sights
liqht of you~ answers?
THE SOCIAL XEEDS n:_;7 :;L'RTCRE
S)
to you in
(15-20 ::-:.:.:::.;tes)
The trai~er ~ci~~~ out that relatic~s~i~s =ill a
variety of separ.:..~e _!?erso:Ial needs. One at a ti::te
the 'trai:1er des:::.!-.lbes each need lis~ed on the bot:.c~
le:t siC:e o£ the "::-.ter_;:,er.sonal Neeis/Satisfactior-.s
Grid" ·..;crksheet -- t~en a.s~s, "Rig~:: now in ycur li=e
~vh0 de ~·ou look t~ primarily ~o :.:.:.: ":his need for
\Participa~ts list one pers~~ ;:,nly.)
you?"
0
© '983
~-==ur
Lis~e:1i!1C:
al:!.. ~eed somec::e to hea~ u.s, and
where we're at -- ~o pay atte~tion
H'no in ·~·our 2..: :::e riq!-:'": :1c·.v do you look to
--
to
~ndersta~d
to
~s.
Whole Person Press
~·:e
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Duluth. MN 55803
121
Structured Exercises in Wellness Promotion Volume I
85
primarily to listen to you?
O Emotional Suoport -- We all not only need someone
to listen to us, we also need someone to accept us,
and tell us we are loved, and that no matter what
happens, we're OK. Who in your life right now do
you primarily look to for emotional support?
o Emotional Challenge -- At times, we all need someone to give us feedback, to tell us whether we're
crazy, whether we're misinterpreting-- someone
to hold a mirror up to us and help us see ourselves from the outside. Usually we will allow
people to challenge us and offer us a reality test,
only after they have first listened to us and
accepted us. Who in your life right now do you
primarily look to for this emotional challenge?
o
0
Suooort -- We also need someone to tell
us that we're good at what we do. l-lhether our pro:ession is home work or office work, whether we're
paid for our work or not -- we all want someone to
praise us for our skills and for a job well done.
t·ihc in youY life right new do you pril:larily look
to for this technical support?
Tec~nical
Te~~~ical
~~:~ulation
-- In our
relat~cnshi~s
we
not 2!n2.::·· ;:eeC: ;;ra.1se, we al£0 ::eed tc be challenqed
to ~:-c·..;, .::.r.C stir.;u.iated wi":h new ideas.
t\:ho in
0
:.i:e
thi.o
:ec~ni2al
"nl - · ·
-- Final!y, we all need people to play with.
~
r-:::::!~
ncv.: Co :.·c:.l E?rimaril::· :.ook to :or
yo'..:~
This is not
ath:e~ic
;:.:.~·
sti~ulation?
t~e
com;;etiti,;e play seen in many
contests.
The technical word for the
·Ne ha\·e ::..n :nind is "to dink around \•:it.h. 11
\vhc :.n your life Yight now do you look to prinarily
to ~col arc~nd with -- to play with?
9)
The t:::-a:_:-.er asks ~artici;:an~s to ccrnplet.e the uhow
successf:.;.l" col;.:::-..n on the worksheet -- by considering
the ::ues~ion, "~ow suc-=essfully does the person yc'..l
identi~~:~
tages
~ =)
~~!~~l:
~~ esti~a~e
t~is
~he
need
a~swer
~or
\•ou?''
(lO%,
28~,
Use Fercen98%, etc).
7!-:e ::.!:""a..:.:·.er ask3 72.r":.:..: ~;ants to mark any need that
i.s :-:c:~ :·_2..:il2.e:! ::t least. 75% o: the tir:1e.
Fe:- ~'"lose
~~eCs ;3~~~2~~~~ts
ot::er ;:;:"'sc:-.s
:-:eeC.
·.-:-:o
are asked to list two or three
cculd ::c~enc:iall~· help fill this
::=e s:.:re :::.J.rtic::~:an~s identi!:y specific people
:;o--..:. !:Y-':)ad cateqori..es.)
t=-:.e~: \:-.::·..:,
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Structured Exercises in Wellness Promotion Volume I
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D.
SMALL GROUP SHARING
11)
(20-30 minutes)
The trainer divides participants into groups of four
persons each (or utilizes previously established discussion groups). Participants are instructed to spend
4-5 minutes each, sharing as much as they like about
their social needs, and the manner in which these are
currently being filled. The trainer may encourage participants to look for the following factors:
c Do you rely on one person primarily for all needs?
or many different people?
c Do you ever look for a need to be fulfilled by a
person unlikely to ever offer you that? Is your
hope inappropriate? Necessary?
c What are the similarities and differences among
members of your group?
c Who would you like to recruit for your support network? (two or three people), and how will you plan
to begin developing this relationship to a greater
depth after this workshop is over?
?LENARY :nsc::ss:;:oN
.::..
1:)
(10 minutes)
Followina the sharing in small groups, the trainer
reconvenes the entire group and asks for observations
and insights. The following issues may be highlighted
by the trainer if not expressed by the group. Personal
examples of each may be elicited as well.
In re-vie•,;ing your support network, keep these
principles in mind:
• It is extremely unlikely that one person can meet
all of our interpersonal needs. Don't depend on a
single soul to function as your entire support
net'.·:ork. If they have a bad day, you get nothing!
Also, it's a heavy burden to place on someone else.
•
'£:'-
~963
Fr~stration results when we expect an inappropriate
person to meet a particular need. Don't bother
lcokir.g for "listening" from someone you know can't
or won't come thro~gh. Don't wait forever for your
boss to say, "I love you." Just accept her praise
of your work and appreciate that!
:Jho1e Po:>r~on Prt:-ss
PO Box 3151
Dututn MN 55603
~1
•
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Structured Exercises in Wellness Promotion Volume I
87
o If there's a vacant position (e.g. spouse, best
friend, father confessor) in your life for a time
that may be disappointing, but you can still find
people to meet each of the interpersonal needs.
o Intentionality is essential in human relationships.
Know what you need and then search out someone to
help you satisfy that need. You have to reveal
yourself to get your needs met. Ask for what you
want. It's foolish to say to yourself, "If they
really loved me they would know what I want without my asking." It's foolish to make other people
guess what you need. When you do, you're less
likely to receive what would fill you.
o It's risky to ask for what you want. Others might
not gi •;e it to you. Or if they do, you may discover that it's net as satisfying as you had imagined. The risk of rejection and dissatisfaction,
however, seem small in comparison to the risk of
isolation and frustration.
o When you find yourself feeling isolated and
lonely, it's likely that you're not getting all
of what you need from others. It might be necessary for you to acknowledge the support you're
missing and to ~arefully analyze your support network ar.d to recru:~ people who will fill the gaps
~r.
;o~r
relaticr.s~i~s.
VARIATIONS
•
•
is short, this exercise could be cut to as little
minutes by focusing ~ri:narily on Section C "The
Soc~al Needs That Nurture."
:f
~ine
as
:o
~he
exercise could be su==lemented by a session which helps
i=entify ar.d ?lan steps for the development
of 3 personal support gro~r-·
~ar~ici~ar.ts
• '!'he trainer :nay very well substitute a different list of
interperso~al ~eeds, whi:e still utilizing and benefiting
:rom the process as out~ined in this exercise.
The "Interpersc:1al :leeds/Satis:actions Grid" is baseci on
resear::;h repor>::ed i::y A Pines cr.d E Aronson in Bur:1cut: From
Tedi..:.-:: >::c Fers-:-:-.:;2. c;rowt::-. (::e~-.· '!ork: The Free Press, 1983).
©
,953
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Structured Exercises in Wellness Promotion Volume I
88
INTERPERSONAL NEEDS/SATISFACTIONS GRID
MY MAJOR SOCIAL CONNECTIONS
1)
2)
3)
4)
:1Y
to whom do you look?
SOCIAL :lEEDS
listening
eMot~cnal
support
emotional challenge
technical support
technical stimulation
© 1983 WM1e Person Press
PO Box 3151
Duluth, MN 55803
125
Structured Exercises in Wellness Promotion Volume I
89
THE DEMANDS
THE REWARDS
how successful?
who else could potentially
fill this need?
©
1983
Whole Person Press
PO Box 3151
Oululh. t.IN 55803
126
APPENDIX K
Structured Exercises in Wellness Promotion Volume I
100
23 WHAT DO YOU NEED?
This checklist helps participants identify qualities which
may need personal attention/development. This revealing
exercise may be used as an independent icebreaker or
assessment tool, but is especially effective near the end
of a session.
GOALS
1)
To identify personal needs/values.
2)
To determine ways to meet those needs.
3)
To see trends and categories of needs.
GROUP SIZE
Unlimited; also applicable for work with individuals.
TIME FRAME
10-15 minutes
MATERIALS NEEDED
A copy of the ">-lhat I Really Need" worksheet for each
participant.
PROCESS
© 1983
ll
The trainer distributes the "What I Really Need" worksheet and invites participants to complete Section A
checking all words that would finish the sentence,
"What I really need in my life right now is more •
2)
After everyone has finished the checklist the trainer
may ask participants if they see any similarities in
the items of each column (#1 physical, #2 mental/
career, #3 emotional/relationships, #4 spiritual/self).
The trainer may also ask people to notice any particular
patterns in their present needs assessment.
3)
The trainer then introduces Part B of the worksheet
noting that participants will be able to develop many
of their chosen qualities on their own, but for some
they may need outside help. Participants are asked
to underline the "do-it-yourself" needs and {§irc0
those that will require outside assistance.
Whole Person Press. PO Box 3151
Dululh. MN 55803
127
Structured Exercises in Wellness Promotion Volume I
101
As part of Step "B," participants should also identify
people/institutions that might potentially help them
meet the checked needs.
4)
The trainer may ask participants to reflect on the
balance between needs which the individual can develop
alone and those qualities which the individual will
want to seek help in developing. The trainer may
challenge participants to reflect on which needs are
most important -- and which ones they can start working on immediately.
5)
The exercise concludes with a recommendation that
participants save their worksheets and re-evaluate
themselves in a few weeks, a few months or next year
in order to check their progress and discover how their
needs have changed.
VARIATIONS
•
Participants may ask a spouse or close friend to fill
out a duplicate questionnaire for them and then compare
the two. "Do others see you as you see yourself?"
•
Participants may share their discoveries with a partner
or small group.
TRAINER'S
NOTES
Submitted by Martha Belknap
.©
198~
·,·,oc•e Peoson Press
PO Bo• 3151
Duluth. MN 55803
......
@
0
1'.)
<D
WHAT
"'w
I REALLY NEED
IN MY LIFE RIGHT NOW
IS MORE
,
::;:
..",
..u;
0
A.
Check the words below which fit into this sentence for you.
<ne also importilnt in your life .
0
,"
vi t.:.~li ty
Add any other words which
self-esteem
tenderness
composure
centering
"'"''"
,
security
recognition
generosity
0
activity
confidence
caring
awareness
"'
~
health
motivation
sharing
solitude
~
~
strength
know lcdge/sk i 11
music
devotion
energy
opportunities
laughter
contemplation
fitness
challenges
support
serenity
relaxation
variety
self-expression
trust
0
c
c
7
;::
z
"'
~w
comfort
structure
companionship
insight
nutrition
accomplishments
harmony
joy
touchinq
control
romance
commitment
~
2
0
c:
ib
m
X
a.
(I)
0
iii'
(I)
Ill
:;:E
!!!.
5"
(I)
Ill
Ill
sex
imagination
intimacy
communion
sleep
money
patience
integration
,...
2.
coordination
res pons ibi l i ty
beauty
forgiveness
flexibility
education/training
sensitivity
surrender
exercise
experience
receptivity
faith
self-control
freedom
self-awareness
purpose
0
3
s·
::1
<
0
c
3
(I)
1-'
N
00
!!.?
...
B.
Study the qualities which you have checked. Underline the ones which you can develop
by yourself. ~the ones with which vou will need some outside help. v Check where
yc.>u can receive the help you need.
c:
0
c
iil
a.
m
X
0
friends
111
partner/mate
@
111
family
u;·
(/)
::;,
::E
teacher/counselor
~
doctor/nurse
111
employer/employee/co-workers
::;,
(/)
(/)
"tJ
w
i1
community center/church
0
:E
:::r
health facility/mental health center
o·5!.::;,
...,
support group/club
0
organization/institution
0
~
,
~
~
school/university
3
<
0
c:
3
111
~
"'~
~
'::
0
c
1:
?
;t
z
"'"'
"'
'"'
0
.....
0
w
1--'
N
\0
130
APPENDIX L
SURVEY OF INTERPERSONAL VALUES
Leonard V. Gordon
DESCRIPTION
Length: thirty sets of three statements
Time: Administering fifteen minutes
Scoring
five to ten minutes
Scales:
Support
Conformity
Recognition
1ndependence
Benevolence
Leadership
The SIV is designed to measure certain critical values involving the individual's
relationships to other people or their relationships to him, which are important
in the indh.;dual's personal, social, marital, and occupational adjustment. Thescales are defined by what high-scoring indi'"iduals value. There arc no separate
descriptions for low-scoring individuals; they simply do not value what is defined
by the particular scale.
For each set of three statements the individual is to choose the one statt>mPnt he
considers the most important to him and the one statement he considers the least
important to him.
Support. Being treated with understanding, receiving encouragement from othe-r
people, being treated with kindness and consideration.
Sample statement:
To have people u:illing to of fer r~e a helping hancl.
Confomlity. Doing what is socially correct, following regulations closely, doing
what is accf'pted and proper, being a conformist.
Recognition. Being looked up to and admired. bf'ing considered important, attracting favorabl"" notice, achieving recognition.
Sample statement:
To associate u..-ith peoplP who are u..·cll knou..·n.
li3
131
174
lrastrumentalion in Human Relations Training
Independence. Having the right to do whatever one wants to do, being free to
make one's own decisions, being able to do things in one's own way.
Sample statemt>nl:
To lu allowed to do u.-hatcver I uonlto do.
Benevolenc-e. Doing things for other pt>ople, sharing with others, helping the unfortunate, bt>ing gl'nerous.
Leadership. Being in charge of other people, having authority over others, being in a position of leadership or power.
Uses: Scores on various scales of the SI\' c:~n be used to point out the possibility
tlaat the disagreements among group members might derive from the differences
in the int.:-rpersonal values ther hold.
Positive Features: One of the positive fcatur('S of the SIV is that it measures
six values. chosen br factor anal)·sis, critic:~! to the individual's relationships
to other people or their rel:ttionships to him in the individual's personal, social,
marital. and occupational adjustment.
The SIV is brief, self-administering (all directions required are given on the
title page of the booklet), easy to score, and fairly simple to interpret using the
information provided in the test m:mual.
Concerns: Because the SI\' is a self-description instrument, there is concern
with Iring and self-deception, but the forct>d-choice form:~t :~nd equating of triads
in social d('Sirability discourages these somewhat.
ORDERING
\\'here To Order: Science Rcscarch Associates, Inc.
259 East Eric Street
Chicago, Illinois 60611
Phone: (312) 266-5000
Cost:
Spccim.:m St"t
Hurul-Scoring StC11cil
Manual
2.'5 Tests
S-UO
1.23
2.20
6.60
ADMINISTERING, SCORING, AND INTERPRETING
Scoring: Scorin~ is done through the use of a hand o,·erlay stencil: count the number of rt"sponses showin~ through for e:~ch scale separatelr and record that num·
ber at the hottom of the page in thl' appropriate box. After each of the scales are
scort"d in this way, the scores are totall'd, and. if the SJV has been corrt"ctly
nurkcd. the number attained will ht> 90. If the scores fall between 85 and 95 and
no more than two sets of statemt"nts ha,·e been mism:~rked or omitted, the obtained scores may bt> used.
Sc.:.ring could be done- by ont> or more- persons dl'pending upon the number of
hand overlay stencils a\"aibhle.
Interpreting: Interpretations of the score on the SIV is made by reference to norms
prepared for each of the scales. The norms for males and females for the \'arious
groups were selected to represent regions of the country and are included in the
test manual.
All norms arc presented in pt>rccnlilcs, ancl the fir.~t step in the in!elJlretation
of score.~ is to convert the raw scores to percentiles by using the appropriate tablt"
~h·en in the manual. The individual's percentile score provides an indication of his
rebti\"e standing on a gi,·cn value in c:omparison with other members of tl•t· samt'
normative group.
132
APPENDIX M
VALUES CLARIFICATION
171
STRATEGY NUMBER 18
Values Focus Game10
PURPOSE
The search for values is facilitated when there is a supportive and accepting environment. To encourage this kind of
climate in the classroom, both the teacher and the students must learn to respect each other's right to hold different views and to act in accordance with their different
convictions. The Values-Focus Came is designed to help
students be open to, accept and understand even if they
do not agree with, different points of view. The objective
of this activity is to help students understand more effectively another person's point of view, rather than to attempt to change the person's mind through attack or debate.
PROCEDURE
To introduce the game, the teacher has the students complete in \vriting several stem sentences. Two that work
very well in this context are:
10An adaptation of the Positive-Focus Came developed by Sa\;lle Sax,
NEXTEP Program, Southern Illinois University, Edwardsville, Illinois.
133
172
VALUES CLARIFICATION
"I feel best when I am in a group of people that
...
"I feel worst when I am in a group of people that
After each student ha.~ completed his unfinished sentences,
the teacher asks the class to arrange themselves into
groups of three. Each student in the group is to have the
focus-the full attention of the other two group members-for a period of five min.utes. During this period the
focus person is to talk about his responses. The group's interaction is to be governed by the following rules:
1.
Tlle Rule of Focusing. Each group member is to be
the focus person for a period of five minutes. Do not let
the attention of the group shift from the focus person
until his time is up or until he asks to stop. ~-taintain
eye contact with the focus person at a comfortable level. Qut:stiuns may be asked of the focus person if they
clu not shift the focus to another group member.
2.
1'hc Rule of Acceptance. De warm, supportive and
accepting of the focus person. Nods, smiles and expressions of understanding when sincerely given help communicate acceptance. If you do not agree with the
focus. person, do not express disagreement or negative
feelings during the discussion part of the game. There
will be time for this later on.
3.
1'hc Rule of Drau:ing Out. Attempt to understand the
focus person's position, feelings and beliefs. Ask questions \\'hich will help to clarify the reasons for the focus
134
VALUES CLARIFICATION
173
person's feelings. Make sure that your questions do not
shift the focus to yourself, or reveal negative fc..>elings
which you may have about the focus person or about
what he is saying.
Each student is provided with a copy of the rules and
the teacher explains them fully.
TO THE TEACHER
The Values-Focus Game can be used with almost any values activity that requires small group discussion. It really
teaches listening. The rule of focusing can be dropped, if
need be, to facilitate a more free-floating discussion.
Upon completion of the game, especially the first few
times, the teacher may suggest that students rate themselves and each other, on a five-point scale, to assess how
,..,·ell they were able to follow the three rules. These rates
should then be shared and discussed in the small group
with the intent of helping students become more proficient at really listening to others and understanding their
feelings and ideas.
After the students have rated themselves and each other
on how well they listened, time can be taken for students
to react to each other's positions. They voice their agreement or disagreement, and discuss their various points of
view.
135
APPENDIX N
Structured Exercises in Wellness Promotion Volume I
74
18 THE DISCRIMINATING FEELER
This three part exercise includes an introductory chalk
talk on the importance of feelings in mental health, a
large group brainstorming of emotions that migh" be aroused
in specific situations and small group exploration of personal feeling preferences and patterns.
GOALS
1)
To help participants expand their vocabulary of feeling
words.
2)
To explore emotional responses to a variety of situations.
3)
To identify personal response styles and consider
other options.
GROUP SIZE
Unlimited
TIME
FRAME
30-45 minutes
MATERIALS NEEDED
.
Blackboard or =-~t~. ·s~.ri~t easel
"Fee ling Vigne~t-2s .. anci "Fee.:ins h"'ords" list
PROCESS
1)
~ 1983
The trainer ir.trcduces mental health as an essential
area =or ex~loration in wel~ness prcmotic~ ar.C ex~~~i~s
the importance of feelings as a component 0: ~er.ta~
health. The trainer may want to incorporate the :c:lowing points in this introduction:
a)
Mentally healthy people are characterized by
* capacity to feel deeply
* sensitivity to feelings in themselves and :::::hers
* willingness to experience feelings
* appr0priate expression of a wide range 0:
feelings
b)
As human beings we are ;;reated with a capacit'! ::o
feel a wide spectrum of emo"ions from irri::aticr. to
'v\'r.coie Person Press
PO Bt)x 3151
Duluth. MN 55803
136
Structured Exercises in Wellness Promotion Volume I
75
rage, delight to exhiliration. Yet most people
limit themselves to a narrow range because • • •
* we want to limit "bad" feelings and only
experience "good" emotions (or vice versa) and
consequently spend a good deal of energy "keeping the lid on" feelings rather than exploring
the limits of our emotional capacity;
* we confuse experiencing an emotion with expressing it or acting on it and thus we shut off
our anger (or sexual attraction) before we
feel it fully because we fear the implications
of expressing those feelings;
* most of us lack the vocabulary to distinguish
and describe the subtle shades of our emotional
experience.
2)
The t!:"ainer reads one of the "Feelings Vignettes"
(p 77) asking particiFants to tune into themselves
and i~agine how they might feel in that situation.
3}
The t!:"ainer solicits from the group eight to ten
exaEples of different (or similar) feeling responses
to the situation and writes these feeling words on the
blackt:oard conunentir.g on the variety of reactions and
diffe!:"ences between people's experiences .
.~·ot.e:
..J}
The trainer ,,...ay want to group the responses
in categories that illustrate shades of meaning in a ger.eral feeling tone .
The t!:=.iner reads se·.·e!:al more vigne::::es, following
the fr=cess outlined in Steps #2 and =3, again highligh~.:..:-.g the diversit1-" of response •
.':ote:
5}
:·2-.e~
Some groups may need help zeroing in on nuances
of feeling.
If t~xee people in a row respond
wit.'J "upset," (or a similar vague feeling), the
::rainer cJtn :wciqe participants by asking for
clarification -- "Do you mean anxious? or
worried? or irritated?" etc). If a group
really gets sti.lck, the trainer can ask them to
imagine all the different emotions people miaht
have ir. respo:-:se to the situa::.ion.
(Ho~>• would
your ~other react.? A favorite teacher? A
child? etc.}
=. :="J.bsta:<t~.:;l
:::c::e:::l:ion of feeling words has
==llected o~ ~he board, the trair.er can ask the
c::rct:;: ::c add e':er: :..eYe :'"eeling words to fill in the
bee~
:Joles,
brair.stcY::.i~.g
SC ·.·;c::-:7-s cr r.Ic!"e.
-:ccether until the list includes
137
Structured Exercises in Wellness Promotion Volume 1
76
Note:
See the "Feeling Words" list {pp 78-79) for
ideas if the group gets stuck.
6)
Participants are asked to jot down their own five
favorite and five least favorite feelings.
7)
Participants divide into groups of four {or reJ01n
previous groups). The trainer asks each group to come
to a consensus on their top five favorite emotions and
their five least favorite feelings.
{10 minutes)
Note:
The trainer may want to remind group members
of the good listening rules and encourage
groups to make sure that all op~n~ons receive
serious consideration in the consensus process.
VARIATIONS
At the end of this exercise the trainer may wish to challenge ~artici~ants to undertake a three-step feelings
awareness experiment:
• choose one or two feelings you would like to be more
open to;
•
:::o~nit yourself to search out at least two opportunit:.es to experience that emotion;
e ,-,ot:i:::e the outcome when you allow yourself to experience
the
~eeli~~
fully.
r: t:'lis is a:1 :J!"lgoing '..Jellr1ess course participants could
report 0:1 the experiment at the next group meeting.
TRAINER'S NOTES
:©
'982
·;..Jt"lc~~e Pe•s.on Pre5S
PO Box 3151
Oulutn. MN 55003
138
Structured Exercises in Wellness Promotion Volume I
77
FEELING VIGNETTES
You wake up in the night and hear a strange noise
You are rocking gently with a young child on your lap
You are watching the state basketball championship. The game
is tied wiL~ three seconds to go and your team has the
ball . • •
You discover your child has just shoplifted something •
You are talking with an employee about her performance, knowing that you have to fire her ••
You get a letter from your father .
The car in front of you is going 50 mph in a 55 mile zone.
There's no place to pass .
You overhear a friend gossiping with a third person about
you
You step on the scale . . .
Someone you love touches you
You are sitting in the lounge waiting for word from surgery . • •
You watch your child perform in a talent show .
T~e
Sears
~ee;.;.
~
~~partnent calls for the third
asking :or payment on your bill
Credi~
?erson you
fi~d
ti~e
this
attractive sits down next to you at a
;:arty . . . .
You walk througr. :he door on the first day of your new job .
You walk through :he door on the last day of your job • •
A frier.C. tei.ls
~·c".J
what a wonderful
;.e~son
you are • • •
Your spouse is ar.(Jr"J wi t!l you and so upset and fn:strated
when you a:-:s·h·er back that he strides out, slanung the
door so har~ ~he house shakes .
Your teenacer co:::es home from school and says "hello" with
warmth and e:-:thusiasrn
You have just
s~illed
your drink on the carpet
©
1983
1\/hole Per>on Press
PO Bo
3151
Dululh. MN 55803
139
Structured Exercises in Wellness Promotion Volume I
78
FEELING WORDS LIST
acceptance
admiring
adored
affectionate
aggravated
alarmed
alert
alienated
amazed
ambivalent
amused
<:1ngry
annoyed
antagonistic
anticipating
anxious
apathetic
<:1ppalled
atopealing
appreciated
apprehensive
ashamed
assured
a.st::;nis!;ed
auCaclous
awe:i
comfortable
confusion
consoled
contemptuous
cornered
courageous
coveting
crushed
curious
cynical
daring
defeated
degraded
dejected
delighted
dependent
depressed
despair
desperate
despised
devastated
disappointed
disar:proval
disconcerted
disconsol.-:1te
discot:r.3ged
glac
gleeful
gloomy
good
grateful
great
grieved
gro~chy
gr:.:.7.py
gui:ty
dislike
disr.1al
dismayed
hap_,:y
hate
helpless
bold
dissatisfied
hc~e~ul
bored
bothered
distrustful
disturbed
bouyant
doubtful
brave
bright
burned up
dour
down
dread
hq;eless
horrified
hostile
hur..bled
calm
cared-for
eager
ca".Jticus
cocky
co::r:etent
ela:.ed
er.lbarrZtsseC
edgy
enrac;ed
envious
esteemed
concer:--t abcut
concern =or
estr.J.nc;ed
1983
faith in
fearful
fed up
fond
forlorn
frantic
friendly
frightened
frustration
ful:'illed
furious
futility
disgruntlec
disc;usted
tel:!.igerer.t
bene'-'Olen t
bewildered
bitter
©
exasperated
excited
exhausted
expectant
VJhole Person Press
PO Box 3151
Duluth. MN.55803
h~.:.::tiliated
hurt.
140
Structured Exercises in Wellness Promotion Volume I
patient
peaceful
perplexed
pessimistic
pitiful
pleased
pressured
proud
provoked
put down
puzzled
impatient
important
idolized
inadequate
independent
indifferent
indignant
ineffectual
infatuated
inferior
inhibited
inquisitive
irritated
insecure
insulted
refreshed
regretful
reje:::ted
relaxed
jealous
jittery
jolly
jumpy
rel:eved
rel·~:::tant
re?·~lsed
rese:::. tful
res:.gned
res:::ess
lethargic
listless
loathed
lonely
longing
ris!:ing
sad
sa.o:.:..3faction
79
tough
tranquil
trapped
trepidation
troubled
trusting
turned off
turned on
uncomfortable
uneasy
unfulfilled
unhappy
unsure
untroubled
unwanted
upset
uptight
used
useless
valiant
valued
vibrant
vital
vulnerable
lest
sc~:::ed
love
loved
loyal
se::=--co!1scious
war:::th
se:·:·:
weak
s!J-::~~ed
weary
wonder
worn out
worried
worthless
worthy
wounded
wrung out
lust
s:.<:.e;.<:ical
:nad
so2.e:-:1n
mear.ingless
sc::::::y
melancholy
:::iserable
mistrustf:..1::.
st~~~led
st:~born
mixed up
s-...:...:...:..en
:::lCOCy
s:..:.~;orted
yearning
s~:-~rised
nervous
nosey
sy:::;::athetic
optimistic
out of place
teec-off
te:-:der
outraged
te:-:se
o':erwhel:::ec
te:::pted
threatened
th::::lled
s'..ls;.icious
;:ained
;:::anic~~:!
t.:..:::-.ld
passicnJte
t:C!"::
©
19!i3
zealous
Uf
•lnu•e Pe•son Pre"
PO Box 3151
Du1u1n. Mt-. 55803
REFERENCES
1. Gartner, Alan and Riessman, Frank.
Self-Help Models and
Consumer Intensive Health Practice.
American
Journal of Public Health, 1976, 66(8), 783-786.
2. Gussow, Zachary and Tracy, George S.
The Role of SelfHelp Clubs in Adaptation to Chronic Illness and
Disability.
Social Science and Medicine, 1976, 10,
407-414.
3. Papatheodorou, Noreen Hall.
in Diabetes Education.
1981, 7(3), 40-49.
The Use of Support Groups
The Diabetes Educator,
4. Cole, Stephen A., O'Connor, Sally and Bennett, Lillian.
Self-Help Groups for Clinic Patients with Chronic
Illness.
Primary Care, 1979, 6(2), 325-340.
5. Katz, Alfred H. and Bender, Eugene I.
The Strength In
Us: Self-Help Groups in the Modern World.
New
York: New Viewpoints-A Division of Franklin Watts,
1976.
6. Papatheodorou, Noreen Hall.
Self-Help Groups as an
Adjunct to Diabetes Education.
The Diabetes
Educator, Special 1984, 75-77.
7. Kropotkin, Petr.
Mutual Aid: A Factor of Evolution.
New York: New York University Press, 1972.
8. Katz, Alfred H. and Bender, Eugene I.
Self-Help
Groups in Western Society: History and Prospects.
Journal of Applied Behavioral Science, 1976, 12(3),
265-282.
9. Withorn, Ann.
Helping Ourselves: The Limits and
Potential of Self-Help.
Social Policy, 1980, 11,
20-27.
10. Zola, Irving Kenneth.
Helping One Another: A
Speculative History of the Self-Help Movement.
Archives of Physical Medicine and Rehabilitation,
1979, 60, 452-456.
11. Gartner, Alan and Riessman, Frank.
Self-Help in the
Human Services.
San Francisco: Jossey-Bass
Publishers, 1977.
141
142
12. Gartner, Audrey J. and Riessman, Frank.
Self-Help and
Mental Health.
Hospital and Community Psychiatry,
1982, 33, 631-635.
13. Levin, Lowell S.
The Layperson as the Primary Care
Practitioner.
Public Health Reports, 1976, 91,
206-210.
14. Strauss, A.
Chronic Illness.
Society, 1973, 10, 26-36.
15. Tracy, George S. and Gussow, Zachary.
Self-Help Health
Groups: A Grass-Roots Response to a Need for
Services.
Journal of Applied Behavioral Science,
1976, 12(3), 381-396.
16. Rounds, Kathleen A. and Israel, Barbara A.
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The Self-Help Component of Primary
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Self-Help and Mutual-Support Groups:
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APPENDIX A
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING WORKSHOP
AGENDA
148
149
KAISER PERMANENTE MEDICAL CENTER
MEMBER HEALTH EDUCATION
PANORAMA CITY
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING WORKSHOP
MARCH 4, 1986
9:15 -
9:30 a.m.
Social Gathering
9:30 -
9:45 a.m.
Introduction
9:45 - 10:00 a.m.
Characteristics/Needs of
Patients with Chronic Illness
10:00 - 10:30 a.m.
Purposes/Goals of Mutual
Support Groups
10:30- 11:00 a.m.
Stages of Group Development
11:00 - 11:15 a.m.
Break
11:15 - 12:30 p.m.
Leadership/Facilitator's Role
in Mutual Support Groups
12:30 -
1:30 p.m.
Lunch
1:30 -
3:20 p.m.
Communication in Groups
3:20 -
3:30 p.m.
Wrap-Up of Day's Activities
150
KAISER PERMANENTE MEDICAL CENTER
MEMBER HEALTH EDUCATION
PANORAMA CITY
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING WORKSHOP
MARCH 5, 1986
9:15 -
9:30 a.m.
9:30- 11:00 a.m.
11:00- 11:10 a.m.
Social Gathering
The Helping Process
Break
-
12:00 p.m.
12:00 -
1:00 p.m.
Lunch
1:00 -
2:40 p.m.
Intervention Strategies for
Group Facilitators
2:40 -
3:15 p.m.
Planning for Group Meetings
3: 15 -
3:30 p.m.
Wrap-Up/Evaluation
11:10
Problem Solving
APPENDIX B
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING WORKSHOP
EVALUATION QUESTIONNAIRE
151
152
MUTUAL SUPPORT GROUP FACILITATOR
TRAINING WORKSHOP
EVALUATION QUESTIONNAIRE
1.
Did the topics selected for presentation meet your needs as
a mutual support group facilitator?
_ _ _YES
_ _ _.NO
If NO, please suggest some areas you would have liked
included in the workshop.
2.
Based on the information you received in the following topic
areas, rate each area according to how helpful you feel they
will be for you in facilitating mutual support groups.
(Circle one number based on the following scale.)
1
2
3
very helpful
somewhat helpful
not helpful at all
Characteristics/needs of
patients with chronic illness ......••.••••••.•• 1
2
3
Purposes/goals of mutual support groups .•••.••. 1
2
3
Stages of group development ..•...•...•....•..•. 1
3.
3
Facilitator's role in mutual support groups •••• 1
2
3
Communication in groups ....•...••....•.••.•.••• 1
2
3
The helping process •.••••........•.•.•••••••••. 1
2
3
Problem-solving .••••.••••••.•....•.••.•••••••.• 1
2
3
Intervention strategies for group facilitators . 1
2
3
Planning for group meetings ....•..•...•••...... 1
2
3
In what topic areas would you be interested in receiving
additional information and/or skill training?
(over)
153
4.
Did you find the various activities helpful in practicing
group facilitation skills?
_ _ _ YES
_ _ _ NO
If YES, which activities were the most helpful to you?
Which were the least helpful to you?
5.
On the following scale of 1-10 (1=poor, 10=excellent), how
would you rate your overall skill in group facilitation at:
(circle one number in each line)
The beginning of the workshop
1
2
3
4
5
6
7
8
9
10
The end of the workshop
1
2
3
4
5
6
7
8
9
10
Using the scale below, answer questions #6-9 by circling
the number which best describes how you feel.
1
2
3
4
6.
7.
8.
9.
10.
Strongly agree
Agree
Disagree
Strongly disagree
The length of the workshop was appropriate
for the amount of information presented .•..•.•. 1
2
3
4
After this workshop, I feel more confident
in my ability to facilitate a support group .••. 1
2
3
4
Overall, I was satisfied with the
presentation by the workshop trainers .••••••••• 1
2
3
4
got what I expected out of this workshop .•.•• 1
2
3
4
I
Additional comments: (Please feel free to express any feelings
you have about this training workshop, including feelings
regarding the pacing of instruction or activities.)