Creative Activities for

Group Therapy

The second edition of Creative Activities for Group Therapy focuses on evidence-based
alternatives for verbal expression in group therapy, which provide group
leaders with innovative inspirational tools, techniques, and intervention
strategies to address dilemmas and difficult situations, and help encourage
members’ self-exploration and self-disclosure.
Newly organized into three categories, the book covers group basics and
fundamentals, categories for activities, and a new section on diverse settings,
conditions, and applications. The first section outlines the use of activities,
benefits to groups, and tips for effective and safe use of creative activities.
Section two covers a range of creative activities for leaders to implement, such
as art therapies, movement therapies, and writing therapy, and includes new
activities for virtual sessions. The new section then addresses activities for
diverse settings such as groups in hospitals and prisons, various medical con-
ditions and psychological states, and inclusive applications that minimize
group conflict and promote emotional expression.
This new edition provides mental health professionals and students, includ-
ing therapists, counselors, and clinical social workers, with a wide array of
methods for enriching their therapy groups, and tools for implementing these
activities.

Nina W. Brown is a professor and eminent scholar at Old Dominion University

in Norfolk, VA. She received her doctorate from the College of William and
Mary and is the author of over 40 published books.
Creative Activities for
Group Therapy

Second edition

Nina W. Brown
© Getty Images
Second edition published 2023
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Nina W. Brown
The right of Nina W. Brown to be identified as author of this work has
been asserted in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks and are used only for identification and explanation
without intent to infringe.
First edition published by Routledge 2013
Library of Congress Cataloging-in-Publication Data
Names: Brown, Nina W., author.
Title: Creative activities for group therapy / by Nina W. Brown.
Description: Second edition. | New York, NY : Routledge, 2023. |
Includes bibliographical references and index. |
Identifiers: LCCN 2022041168 (print) | LCCN 2022041169 (ebook) |
ISBN 9781032171463 (hbk) | ISBN 9781032171470 (pbk) |
ISBN 9781003251989 (ebk)
Subjects: LCSH: Group psychotherapy. | Group counseling. |
Psychotherapist and patient.
Classification: LCC RC488 .B738 2023 (print) | LCC RC488 (ebook) |
DDC 616.89/152--dc23/eng/20220912
LC record available at https://lccn.loc.gov/2022041168
LC ebook record available at https://lccn.loc.gov/2022041169

ISBN: 978-1-032-17146-3 (hbk)

ISBN: 978-1-032-17147-0 (pbk)
ISBN: 978-1-003-25198-9 (ebk)
DOI: 10.4324/9781003251989

Typeset in Baskerville
by Taylor & Francis Books
This second edition is dedicated to Marsha Block who as the
former CEO of the American Group Psychotherapy Association
used her creative talents to sustain a viable and valuable organi-
zation. I want to especially thank her for her support and
encouragement during the successful preparation of the petition
to have group therapy recognized as a specialty by the American
Psychological Association.
Contents

Preface viii
Acknowledgments x

1 Introduction 1
2 Procedures and Process for Use of Creative Activities 22
3 Group Leader Facilitation Attributes and Skills 44
4 Art Activities: Drawing and Collage 67
5 Writing Activities: Essays, Lists, Journals, Poetry, and Cinquains 92
6 Physical Movement: Dance, Physical Exercise, Performance 119
7 Imagery, Mindfulness, and Music 138
8 Stories, Memories, Photos, Visual Journals, Flats, and Books 161
9 Creative Activities for Some Restrictive and Virtual Settings 177
10 Creative Activities for Diverse Conditions 200
11 Applications for Fostering Group Dynamics 225

Index 248
Preface

The second edition for creative activities presents evidence-based activities for
group therapy that include a variety of inspirational activities for use in a
variety of settings and conditions.
The activities and other book material are designed to do the following:

1 Present evidence-based categories of activities that are non-threatening,

easy to implement, and that can be helpful to promote group process.
2 Describe strategies that provide a means to uncover nonconscious and
unconscious material.
3 Clarify members’ associations and unfinished business that can lead to
understanding, growth, and healing.
4 Promote group members’ self-exploration, self-disclosure, and their
understanding of underlying issues and concerns.
5 Present activities to promote positive aspects of self, solve individual and
group problems and dilemmas, and illustrate how to build meaningful
and satisfying relationships among group members.

This edition presents a variety of activities that are suitable for the variety of
group members encountered in most group therapy. In addition, these can
be implemented by most group leaders as no specialized training is needed
by group leaders to adequately implement the activities. The activities pre-
sented intended that group members interpret their own products and not
the leader or other group members, which can deepen the group experience
and promote insight for the particular group member. Activities can be
immediately implemented, as extensive directions and guidelines are descri-
bed including suggestions for guiding the members to understand their own
unique personal products.
The book focuses on alternatives for verbal expression in group therapy,
encouraging members’ self-exploration and self-disclosure, strategies for
working around resistance, and defenses to access and express nonconscious
and unconscious material, and can facilitate members’ self-affirmations. The
creative activities can stimulate expressions of thoughts, ideas, feelings, and
 Preface ix

associations, and do so in a non-threatening way. Additional applications are

provided for group dilemmas, especially for those where the usual strategies
are not effective. An unusual feature is the variety of different activities that
group leaders can choose from to fit their talents as well as the group’s needs.
The creative and inspirational activities provide the following advantages:

! Simultaneous self-exploration by group members where each can partici-

pate at the same time.
! Prevent common difficult member behaviors, such as monopolizing,
story-telling, and prolonged silence by a member or members.
! Present a means whereby low verbal group members can express their
experiencing without having to grope for words.
! Allow for safer expression of difficult, and/or unacceptable feelings,
thoughts, associations, and the like.
! The presented activities and procedures are guides for explorations that
facilitate linking, associations with unfinished business and unresolved
issues, and insight.
! There are also activities that can assist group members to capitalize on
their strengths to make changes, grow, develop, and to heal.
! The group leader does not need specialized training to implement the
activities in the book.

Finally, the new edition presents additional new activities and new categories
of activities, a new section on strategies for creative activities for virtual ses-
sions, and activities helpful to the group leader to promote group therapeutic
factors such as cohesion, universality, and interpersonal learning; solve group
difficulties such as conflict, and to build self-adequacy.
Acknowledgments

This book could not have been written without the learning I accumulated
throughout the years about group therapy, leading groups, how group mem-
bers learn and heal, and other clinical aspects that guide group leaders.
Attending conferences such as the Mid-Atlantic Group Psychotherapy Society
and the American Group Psychotherapy Association allowed me to experi-
ence first-hand the myriad of creative activities that can contribute to group
therapy’s success. I was introduced to the wide variety of such activities,
experienced their benefits, and observed the impact of these on the other
participants. Learning by doing was extremely effective and that is what I
hope to accomplish for others with this book. Many thanks to the clinicians
whose presentations I attended over the years.
I wish to also acknowledge the contributions of the editors and editorial
staff at Routledge who guided me through the process for publishing. Sincere
appreciations are extended to all involved editors, staff, proofreaders, technicians,
and others involved in publishing. While I may not know you personally, your
contributions are appreciated.
Chapter 1

Introduction

Welcome to the second edition of Creative Activities in Group Therapy. This

edition extends the presentation of creative activities with additional
material for their effective use. It is important that activities are used in
ways that will benefit individual group members as well as the group as a
whole, as it is important for group leaders to facilitate the group’s devel-
opment as well as that for group members. It is also important and
essential that group leaders select and use creative activities with sensitivity
for members’ emotional states, their unique cultural and diversity factors,
and with a deep understanding of the group as a whole’s needs and desires
as these foster the group’s progress.
The activities contained in this book, while easy to implement, also have
other helpful aspects such as ease of implementation, guides to deepen and
expand the experiences, assistance to members for self-exploration, and are
helpful enhancements for some group processes. The activities can be more
safely used to benefit members and the group because all are presented as
requiring group members’ informed consent to their participation. Group
leaders are cautioned to let group members decide and agree to partici-
pate and are the deciders of the level and extent of their disclosures and
interpretations.
All activities list materials needed and the steps for implementation,
which helps the leader to better know if the activity is suitable for mem-
bers’ abilities and the group’s development. Guidelines present procedures
to introduce the activities, assist members with their productions, and to
lead the leader to expand and enhance members’ reporting of the out-
comes for the activity. Guidelines are also provided for group leaders to
help foster the emergence of helpful group therapeutic factors, manage
some member behaviors that are troubling or difficult in the group setting,
and address commonly appearing group dilemmas. The following is an
example for a creative activity, a cinquain that can promote deeper
understanding.

DOI: 10.4324/9781003251989-1
2 Introduction

Creative activities
Alternative paths to understanding
Inspiring, challenging, soothing, stimulating, exciting, expanding, enchanting, pleasurable
Communications from the internal self
New meanings

Presented is a cinquain used as a way to expand the image and under-

standing for creative activities. It begins with a title of two words, the
second line describes what it is with four words, the third line provides
eight adjectives about it, the fourth line provides the understanding of
what it does in four words, and the last line with two words renames it.
The structure of a cinquain starts with either one or two words, doubles
for the description, redoubles the number of words for the adjectives,
reduces back to the double, and then back to the beginning of one or two
words. This is an example of a creative activity.

Organization of the Book

The chapters are organized to first present the background that includes the
benefits and advantages for using creative activities, the principles for experi-
ential learning, some guiding theories, how these activities can assist the group
leader with difficulties that arise in the group, an overview of the categories
for the activities, the relevant ethics for using creative activities, and some
basic group leader preparation.
Central to the presentation and use of these activities is the focus that
these are alternatives for verbal expressions in group therapy, they encou-
rage members’ self-exploration and self-disclosure, they can assist to work
around resistance and defenses to help access and express nonconscious and
unconscious, and can provide members with some self-affirmations. These
activities can stimulate expressions of thoughts, ideas, feelings and associa-
tions in a non-threatening way. Also, additional applications are provided
for group dilemmas, especially for those where the usual strategies are not
effective.
A defining feature for the book is the variety of different activities where
group leaders can select those that best fit their group and do not require
additional training for the group leader although some specific training is
encouraged.

Benefits and Advantages for Group Members

Group leaders will find that using creative activities has many benefits and
advantages for the members and for the group. Among the major benefits and
advantages are the following:
 Introduction 3

! Provide simultaneous self-exploration for all group members at the same time.
! Can prevent common difficult member behaviors such as monopolizing,
story-telling and prolonged silence.
! Offer a means and the opportunity for low-verbal group members to
express their experiencing without having to grope for words.
! The expression of difficult and/or unacceptable feelings, thoughts, and
associations are more safely facilitated.
! The activities and facilitation procedures are guides for the kind of
explorations and assist group members to link and make associations with
unfinished business and unresolved issues, and can provide insight.
! The group leader does not need specialized training to implement the
activities presented although some training for leaders is encouraged.

Rationale
Definitions for the term creative use words and phrases such as, to bring into
being, original, new, and novel, and this forms the basis for the activities
described in this book. Creative activities are defined here as stimuli that can
have the following effects and outcomes for both individual group members
and for the group as a whole. These stimuli are taken from artistic, perform-
ing, and other such endeavors as well as the vast world of crafts. Effects and
outcomes include:

! Inspiring and challenging the creator

! Providing a focus for internal and external chaos, and screening out
distractions
! Distracting from unproductive worrying
! Expressing complicated thoughts, feelings, and ideas
! Clarifying perceptions of situations, people, and the like
! Helping to bring the obvious into focus, and highlighting important aspects
! A solace when confused, upset, or indecisive
! Helping sort through complex and conflicting values
! Can be centering and grounding
! New meanings can emerge
! Abstracting essentials from surrounding confusion, barrages, etc.
! Simplifying complexity
! Can address several levels and planes simultaneously
! Providing new ways to perceive and relate
! Reconnecting parts of the self to become balanced and rounded

Creative activities tap both the internal and external experiencing when used
in a group setting. The internal experiencing is made visible through the
product of the creative activity, and the external experiencing occurs with
the communication about the product and what occurred for the person in
4 Introduction

the production phase, and in the reactions and feedback from other group
members and the leader. This process can enhance growth and develop-
ment, stimulate self-exploration as new awareness emerges, can assist to
soothe and calm, and deepens and broadens thoughts and feelings. Both the
members and the group as a whole can benefit with use of creative activities.

Benefits for the Group

The benefits for use of creative activities can also enhance the functioning and
progress of the group and assist the group leader to capitalize on the resources
that the group can provide. Leading a group is a delicate balancing act of
tasks, dynamic group and individual factors, and the group leader’s expertise
and skill are fundamental to maintaining this balance. The group’s goal is
important as a guide, members’ needs must be identified, and attempts made
to meet some or all of them, the group as a whole attended to, and many
other factors and tasks needed for success also play roles. The central and
critical figure and component is the group leader, and their knowledge,
skills, and level of personal development are vital to the members’ growth,
development, and healing.
However, no matter how competent and well-prepared the group leader is,
there can be group situations that present challenges that are not easily
addressed, defy conventional interventions, and call for a different approach.
This book was developed to present one such different approach, the use of
creative activities applied to group dilemmas and personal situations. These
activities are conceptualized as being non-threatening means to access mate-
rial contributing to the dilemma or situation, expressing difficult feelings, and
allowing the individual members to better understand their personal responses
that are contributing to the dilemmas or situation. Some examples include the
following:

! Stuck or mired where the discussion becomes circular, no problem-solving

or insight occurs, members are exasperated but cannot seem to change the
pattern, and therapeutic work is not being accomplished.
! Conflict has emerged in the group and is being ignored, suppressed, or
denied. Or, the members fear conflict so much that they will go to
extraordinary means to keep it under wraps, and pretend that they are
harmonious.
! The group seems overly or under energized. When overly energized, they
skip from topic to topic, none of which are adding to the work of the
group, a lot of squirming and other nonverbal communication of dis-
comfort occurs, but interventions do not seem to help them concentrate
or focus. The under-energized group seems depressed or dead, but they
resist exploration of their feelings.
 Introduction 5

! Many or even most group members either cannot or do not express their
feelings, or express them in inappropriate ways. Feelings seem to be con-
sidered as dangerous and members avoid them.
! Members are exhibiting resistance and defensiveness well beyond what is
usually expected in the group. They are not making meaningful connec-
tions with each other, and are avoiding attempts to promote interactions
and involvement.
! Members are extremely tentative and cautious in revealing their selves to
the point where they do not disclose anything of importance. While safety
and trust need to be established before meaningful connections and dis-
closures can appear, this wariness has continued to the point where the
therapeutic work is thwarted.

Group leaders encountering these dilemmas and situations will intervene as

best they can, given their understanding of the group and its needs. However,
there are groups where the usual conventions do not work. The material
presented in this book is intended to give group leaders other tools, techni-
ques, intervention strategies, and the like to not only address dilemmas and
situations, but also to present them with alternatives designed to stimulate
exploration and expansion of members’ understanding of their personal issues.

A Rationale for Using Creative Activities for Group Dilemmas

It would be the rare group leader who has not encountered one or more
group dilemmas where the group became mired, tense, unproductive, little
therapeutic work was accomplished, and this lasted more than one session.
While frustrating for the group leader, these situations can be even more
frustrating for group members who probably lack the developed inner
resources for coping that the leader may have, leading to a very uncomfor-
table group situation for all. Adding to the frustration for the group leader is
when all interventions tried do not move the group from the uncomfortable
place. The leader’s analysis does not seem to be effective to produce under-
standing, or for suggested interventions, no matter how experienced or com-
petent the leader is. While these group situations are few and far between,
they can occur without warning.
These group dilemmas differ from those presented by a difficult group
member. Brown (2006) and Alonso and Rutan (1993, 1996) describe some
group dilemmas that can result from the presence of members with unidentified
problems and concerns such as, the member with a Narcissistic Personality
Disorder or with a Destructive Narcissistic Pattern, a member with a Borderline
condition, or a quiet explosive member. They propose that the difficulties and
dilemmas in these instances, result from the group’s effort to manage and con-
tain these members, the members’ unconscious sensing of danger and possible
destruction for their selves, and their attempts to control their intense emotions
6 Introduction

that were unconsciously aroused by these members. The leader and members
are working in the dark, but nothing constructive can happen until the difficult
member is identified and appropriate actions are taken. These difficult group
members present their own variations for group dilemmas, but this is not what
is meant for this book.
Suffice it to say that group leaders encountering these dilemmas look for
ways to understand the indirect communication so as to select appropriate
interventions. The group members do not have the ability to be clearer in
communication because they do not know what it is they want to commu-
nicate, can be fearful of consequences for what may emerge, are trying to
understand and communicate but are ineffective, and are frustrated at the
lack of clarity and understanding from self, other members, and the leader.
This book proposes that the described creative activities can assist the group
leader to address the group dilemmas, and provide relevant material for
group members’ self-exploration. These activities, although group-centered
and focused, can be personal for each member, bypass defenses, reveal
unconscious and hidden material in ways that can be perceived by them as
less threatening and dangerous, be encouraging for expression of difficult
and/or complex ideas, thoughts, and feelings, and even may provide guidance
to solutions for some members. At the very least, these creative activities can
provide a release of tension so that group members can think more clearly, be
more responsive, and be more willing to engage in self-exploration. Both the
group and members can benefit.

Principles of Experiential Learning

These principles are drawn from the concept of experiential learning pro-
posed by Kurt Lewin (1944) whereby learning is enhanced through group
participation. Three basic principles are used here: the contributions of the
group environment, active participation, and group membership.

! The social and supportive environment provided by the group promotes

intrapersonal and interpersonal learning. This environment encourages
experimentation with new ways of behaving and relating by providing
safety and trust; can open new pathways of understanding oneself and
others; constructive feedback can be given and received, and self-percep-
tions are more likely to be changed, or become more open to change.
! Learning is facilitated by active participation. When group members are
actively involved their different learning styles can be accommodated; the
learner can choose to focus on what they consider to be personally
important; more than one system can be tapped at one time – physical,
cognitive, emotional, creative, inspirational, and difficult material can be
more easily accepted when personally discovered thereby reducing resis-
tance and defensiveness.
 Introduction 7

! Accepting membership in the group encourages behavioral and attitu-

dinal change. Acceptance is facilitated by presenting oneself in a non-
threatening way and receiving positive responses and feedback from other
group members.

Additional fundamental assumptions are that the group activities foster the
emergence of many group-curative factors, promote self-disclosure and
member interactions, offer opportunities for members to discover unknown or
forgotten parts of self, and that these can highlight important material for
members’ exploration. In addition, the activities can strengthen connections
among group members, reduce resistance and defensiveness, and teach new
ways of understanding, behaving, and relating.

Theoretical Perspectives
The book does not follow a particular theoretical perspective, and the activ-
ities reflect the atheoretical approach. However, there are four main theories
that guided the development and selection of the activities: Behavioral, Cog-
nitive, Dialectical Behavioral Therapy, and Object-Relations/Self-Psychology.
Guidance from behavioral therapy includes the use of imagery (Lazarus,
1989), behavioral rehearsal, progressive relaxation, and self-modification
(Corey, 2009). The assumptions from Behavioral therapy are that clients are
expected to assume an active role, that insight is not necessary for behavioral
changes, and that interventions are best targeted to specific behaviors tailored
for the individual.
Cognitive theories of Beck (1995), Ellis (1997), and Meichenbaum (1977)
provide the perspective that many psychological difficulties stem from faulty
or irrational thinking, incorrect inferences or misinformation, and an inability
to distinguish between fantasy and reality. The activities in the book address
cognitive distortions such as, catastrophizing, inferring the whole from a
detail, overgeneralization, magnification and minimization, personalization,
labeling and mislabeling, and dichotomous thinking.
Dialectical Behavioral Therapy (DBT) (Linenhan, 1993) contributes the
integration of mindfulness into therapy, existential factors, and strategies for
emotional regulation and control. Although not used in a systematic way as in
DBT, the activities capitalize on these strategies and adapt them for use in the
group setting.
Object-relations and self-psychology theories contribute to the understanding
of what can emerge during the creative activity as well as for the outcomes. These
theories are more geared to the group leader’s understanding, and how to guide
members’ exploration and enhancement of their products.
Object-Relations theories (OR), such as those of Klein (1952), Mahler
(1975), Mahler, Pine and Bergman (1975), and Kernberg (1976), describe how
psychological growth and development occur, and emphasize the importance
8 Introduction

of early relationships, describing how these can continue to affect and impact
relationships throughout one’s life. No unified object-relations theory exists as
with many other theories.
Self-psychology incorporates many of the concepts of OR theories and
emphasizes the importance of the development of the “self”. Kohut (1977)
describes psychological development with a focus on narcissism, or self-focus.
He proposed that there was age-appropriate narcissism, which takes it away
from always being considered as pathological and proposes that infantile
narcissism, when developed along expected lines, can become transformed
into healthy adult narcissism characterized by wisdom, empathy, and an
appropriate sense of humor.

Creative Activities
What creative activities are described and presented? There are numerous
creative activities that could be helpful, but this presentation is limited to a
few. They were selected because the described uses do not require specialized
training, they are not an emphasis or focus for therapy, they are easy to
implement, these can be effective for the group as a whole as they involve the
entire group while at the same time they speak of the individual member’s per-
sonal situation or concern, and they can reveal nonconscious and unconscious
material. The major categories of expressive processes presented are art activities;
writing; imagery, mindfulness, and music; movement, exercise, dance, drama,
simulation, and role play; collage, flats, and scrapbooks. These categories are
briefly described with more extensive discussions and presentations provided in
their focus chapters.
Art activities include drawing and collage and are proposed as a means for
facilitating expression of difficult, complex, and ambiguous concepts and feelings
that could be helpful for members’ understanding. These can help moderate the
effects of defense mechanisms such as intellectualizing, can provide means for less
verbal members to contribute, and reveal nonconscious experiencing. These
exercises are not used or interpreted as they would be in art therapy, as that
requires specialized training. Drawing is used to focus and facilitate expression.
Writing is a form of expression that can be used in many ways. Presented
here are uses for journals, poems, and personal stories. Writing can aid in
recall, expansion of feelings and ideas, provide for the emergence of new
perspectives, and tap into the person’s creativity. It is a personal and private
way to recall, expand, and/or express, but can then contribute to personal
learning and understanding in the group.
The category for movement incorporates dance, drama, role play and
physical exercise. Movement will be presented as a means to energize, to con-
nect or reconnect to the body, and to become aware of the messages the body
may be sending. Simple movement activities are presented that can be per-
formed by people of all ages, and there will be very few who cannot do most
 Introduction 9

or all of the activities. Dance, like music and art can be the focus and emphasis
for therapy, but the activities here, again, only use this modality as a stimulus
to access important material and understanding for group members. The
leader does not have to be trained in dance therapy to use these activities.
Exercise is an activity that is also a means for focusing on one’s body. What is
presented is not intended to be a regime of exercising, but to use some exer-
cise moves as stimuli for expression and discussion. Simple stretching moves,
cardio-vascular activities, and the like are the focus for these exercises. Drama
and role play are categorized with movement as they call for group members to
move and interact, and to be aware of what they are experiencing in the
moment. Acting can promote empathy and understanding of oneself and of
others as other perspectives are assumed. Role play is a specific technique that
is similar to drama, but usually is built around real circumstances and per-
sonalities. Assuming the role of the other person can produce new learning
and a new perspective.
The next category includes imagery, mindfulness, and music. Imagery
activities provide a way to visualize concepts that are difficult to describe
with words but can be a technique to clarify worries and concerns, hopes
and aspirations for the future, current issues and concerns that are just below
the level of consciousness, and provide access to past experiences. Mindfulness
is a technique to teach concentration and focus for the present, to be aware
of oneself and all manner of the self-experiencing in the here and now, and
to become a self-soothing technique. While mindfulness has evidence of its
efficacy in alleviating physical and psychological stress and health conditions,
it is also valuable for teaching members how to manage and contain
uncomfortable feelings. Music is presented here to function just as drawing
does, as a stimulus but not as the major focus for therapy. Music has the
power to evoke emotions, and the use of music can facilitate members
accessing and expressing their feelings.
The final category has a collection of activities – stories, memories, photo-
graphy, visual journals and flats. Stories such as fairy tales can also help adults to
access some nonconscious and unconscious material. Bettleheim (1976), Diek-
mann (1997), and Holton (1995) describe these as having the potential for a rich
source of knowledge about developmental lacks and existential concerns. Fairy
tales describe parts of a successful individuation process and the need and
rewards for moral development. It is important to note that these tales tend to be
non-threatening and assist to help reframe existential issues, allow the personal
meaning of a story to emerge and associated with current experiencing, and sti-
mulates the search of the unconscious for greater personal understanding. Memory
activities revolve around the creative activity of scrapbooks. Scrapbooks are a
longer-term group project and are used here as a means to gather fragmented
pieces of self and memories, not as the usual scrapbooks, but are more a book
about oneself – or to be of assistance in the grieving process. Photography and visual
journals are activities that can guide self-expression for current experiencing. This
10 Introduction

can be especially helpful when group members’ current experiencing is difficult

for them to express fully in words. Flats are patterned after Flat Stanley and used
here as a way to communicate and build relations when people are socially iso-
lated, separated by geography or other means, as well as for group dilemmas.

Selecting an Activity
Most of the activities that are described in this book can be completed in
the group session, while others will need more time for completion of the
product and can be assigned as homework. Activities outside the group
would then be brought back to the group for the expansion and debriefing
phase. Group leaders will want to select the kind of activity to use based
on group members’ needs, characteristics, and abilities, and to choose
particular exercises to fit these and the time available in a session. It is
highly recommended that all exercises, other than the extensive ones
assigned as homework, be entirely completed in that session, including the
expansion phase, and be carried over to a subsequence session. Leaders
also need to be prepared that homework might not be completed by all
group members, as this will necessitate their having to deal with those who
did the work, and those who did not.

Ethical Considerations
Professionally competent group leaders follow the ethical codes of their pro-
fessional organizations or licensing boards. Central to the use of creative
activities are several ethical principles that are common to all mental health
professionals. These include to do no harm, the therapeutic relationship,
confidentiality and its limits, responsibilities and competence, professional
relationships, and a process for resolving ethical issues.

Do No Harm
The primary ethical concern when using creative activities is to do no harm.
Dimidjian and Hollon (2010) define treatment harm as being caused by the
treatment and harm that is or was not an inherent part of the problem. Using
this perspective, harm when using creative activities in a group setting would
be defined as being caused by the activity and harm that was not a part of the
presenting problem, member distress from interacting that is not attended to,
treatment that causes the member to experience problems in domains other
than the target problem, and the presenting problem or identified concern
becomes worse with treatment.
Prevention skills that can help reduce or eliminate the possibility of enga-
ging in potentially harmful treatment include the following with sample studies
cited to substantiate their efficacy.
 Introduction 11

! Enhance the therapeutic relationship (Horvath & Bedi, 2002; Martin et al.,
2000).
! Understanding how the therapist contributes to negative interactions,
ruptures in the therapeutic alliance and their influences, and impact
on improving therapeutic outcomes (Binder & Strupp, 1997; Castonguay
et al., 2004).
! Continually monitor and manage countertransference (Gelso et al., 2002).
! Identify transference without analyzing it (Crits-Christoph & Gibbons,
2002).
! Restrict interpretations, especially when treating personality disorders
(Schut et al., 2005).
! Recognize that the best predictor of outcomes is the level of the therapist’s
developed self (Wampold, 2006).

The therapeutic relationship is a special one that sets the frame for what can be
built between the group leader and members. This relationship encom-
passes more than the leader’s personal development, knowledge, and skills;
it also includes some professional responsibilities and tasks that are ethical
requirements. The group leader who attends to these is helping to promote
an atmosphere that can lead to feelings of trust and safety necessary for
reduction of ambiguity, mistrust, and resistance; and to promote cooperation,
self-disclosure, and reflection.
The tasks and responsibilities for ethically appropriate therapeutic
relationships are categorized as the group leaders’ personal development
and professional preparation, documentation, and client preparation. The
personal development and professional preparation of group leaders are
central to the therapeutic relationship and group development. Personal
development is central in the reduction of possible countertransference to
protect members, and in developing the inner states that are critical for
developing the therapeutic relationship. Group leaders must constantly stay
in touch with their personal needs and values so that these are not
imposed on group members.
Professional preparation includes the academic knowledge, skills training,
and appropriate supervised practice. Another major component in this pre-
paration is cultural sensitivity. Group leaders will most likely have a variety of
cultures in every group although, on the surface, members can appear to be
homogenous, and it is very necessary that leaders have cultural sensitivity and
competence. Further, cultural sensitivity can assist the leader in formulating
reasonable treatment plans and making appropriate interventions. While it
may not be possible to fully understand all the cultural differences you may
encounter, it is ethically responsible to ensure that you are culturally aware
and sensitive, to learn as much as possible about your members’ cultures, and
to consult about these when you do not have sufficient information about a
particular culture.
12 Introduction

Treatment plans are an ethical responsibility, and are generally required by

the treatment facility, and by insurers. Your treatment plans can be a guide
for working with individual members in the group, and you are encouraged to
develop these as a part of your planning for the group. Treatment plans
should reflect an integration of treatments; be realistic, objective and rational;
and should be consistent with clients’ abilities. It can be very helpful to
develop these in collaboration with other treatment professionals associated
with members, and with the individual member. The latter may not be pos-
sible with some members because of impairment, but even they should be
informed and encouraged to try to participate in their treatment planning.
Informed consent means that members understand what is proposed, are able
to evaluate the risks to them personally, and are not being forced or coerced
into participation without sufficient information. There is always the matter of
involuntary participation, such as court-ordered treatment; but even under
these circumstances members should be fully informed and provide signed
forms to document that you did provide the information.

Confidentiality and Its Limits

There are numerous reasons to specifically address confidentiality and group
leaders should make special efforts to openly discuss concerns members may
have about the leader’s responsibility, and the limitations on what can, or
cannot, be kept confidential. This includes the reporting of information with
other treatment professionals and concerned bodies such as insurance com-
panies. Group leaders should know and attend to the following ethical
responsibilities.

! Understand members’ cultural context for maintaining confidentiality.

Some conditions and illnesses are considered shameful in some cultures,
and there is a stigma attached to them. Do not assume that members
have the same cultural context as yours.
! Keep a respect for privacy. Just as there are cultural sensitivities, there
can be gender-related sensitivities and age-related ones. What may seem
unimportant to you may be very shame inducing for others.
! Proper and planned termination. It is not ethically responsible to aban-
don clients, and most codes of ethics strictly prohibits this action.
! If you find that you cannot assist the client for any reason such as lack of
proper training, significant countertransference issues, personal illnesses or
crises; it is your ethical responsibility to provide appropriate referral and/
or other transfer of services.
! Remember that clients must consent in order for you to share informa-
tion, even with other treatment professionals, and you need to obtain
their written consent before sharing any information.
 Introduction 13

! Clients should be fully informed about the need to share information

with other treatment professionals, the limits of your ability to maintain
confidentiality with them, and the purpose for sharing information.
! It is essential that security be maintained when sharing or transmitting
information about clients. This can mean that you do not share any
information in public places, such as hallways, and lunchrooms, and
that you are aware of the lack of security for phones, fax, email, voice
mail, answering machines and so on, and that you take proper
precautions.
! Court-ordered disclosures should be specified in advance, understood by
all parties concerned, prevented where possible, and narrowly defined. In
all cases, the amount of information should be limited and restricted to
essential information.
! The restrictions for court-ordered disclosures also apply to third-party
payers, and only when the client authorizes release of information.
! Group leaders have an ethical responsibility to report when a client exhibits
clear and eminent danger to self and/or others, and when there is a con-
tagious life-threatening disease. Group leaders are also advised to be aware
and follow state, federal, local, and institutional laws and policies for
reporting on these conditions.

Professional Responsibility
All codes of ethics for mental health professionals have standards for edu-
cation, training, and supervised experiences. It is your responsibility to
secure needed education and so on, and to only practice within the scope
of their training.

! Knowledge of standards of practice guidelines as specified by your licen-

sure and certification, and the ethics for your profession.
! Secure the needed training, education, and other experience specified as
basic for professional competence.
! Know, understand, and abide by the state and national professional
standards for credentialing.
! When practicing new specialties, techniques and the like, ensure that you
receive the proper professional experience.
! Consult when there are ethical issues, concerns, and dilemmas.
! Seek out and obtain appropriate continuing education opportunities.
! Take care to be clear and accurate in presenting your credentials.
! Take responsibility to report when you are impaired and to obtain
treatment.
! Take responsibility to ensure that your practice is nondiscriminatory.
! Seek appropriate consultation and collaboration to benefit clients.
14 Introduction

Process for Resolving Ethical Issues

Most processes for resolving ethical issues place considerable responsibility on the
group leader to recognize when ethics violations and conflicts exist, to understand
when and how to address these, and be willing to uphold professional standards.
A process for resolution includes all of the following.

! A complete knowledge of the ethics of the profession.

! Understanding of if and when the law conflicts with ethics, and the pos-
sible consequences.
! Understanding of when and how to report suspected violations, and the
need for consultation.

The Group Leader’s Preparation

A significant part of the leader’s preparation to establish a conducive group
climate for optimum use of creative activities, as well as establishing a ther-
apeutic relationship, includes the leader’s development of relating attributes,
communication skills, a developed self to provide emotional presence, knowl-
edge, and techniques for facilitating groups, empathic responding, and
empathic failure repair. These are basic and fundamental to group leadership
regardless of the type of group but may be even more important when incor-
porating creative activities into the group and are presented first.
Next presented are the basics of the group leader’s preparation for devel-
oping the therapeutic relationship, attention to process, awareness of the
potential for narcissistic injury, and the possible emotional states of group
members, all of which are critical to the group’s success and especially for
using creative activities (Yalom & Leszcz, 2005; Egan, 2006). Most of the
activities presented in this book can be best facilitated after safety and trust
has been established in the group, and the group leader’s ability to form a
therapeutic relationship is critical. This relationship allows group members to
believe that the group leader will take care of them, that relationships in the
group will be constructive, that the possibilities for growth, development, and
healing can be realized, and that confidential material will remain
confidential.

The Group Leader’s Development

Relating attributes include warmth, caring, concern, tolerance, acceptance,
genuineness, and respect. Rogers (1970) termed much of this as uncondi-
tional positive regard where the therapist perceives the client as capable,
worthwhile, and valued. These are more the outcomes for personal devel-
opment and cannot be taught and learned; the person has to have these as
a part of their self.
 Introduction 15

These characteristics can be extremely important when implementing

creative activities as members can be confronted with aspects of self that may
trigger guilt and shame. When this occurs, it is vital that the group leader is
able to communicate nonverbally and verbally their caring and concern,
acceptance of the person even with flaws, and to be encouraging and sup-
portive of their ability to tolerate and benefit from what emerged. The basic
relating attributes are central to conveying this and cannot be taught as they
have to be an integral part of the leader. Techniques and skills can be taught
and learned; attributes cannot.
Communication skills on the other hand, can be taught and learned. Listening
for feelings and content, an ability to express a wide variety of feelings, talking
in concrete and direct terms that are understood by the other person, under-
standing the role of questions, and giving verbal encouragement and support
are the most basic communication skills that have applications in all kinds of
interpersonal relationships, not just in therapy.
The group leader must understand and listen for the underlying feelings,
as the group member(s) may not be aware of these on a conscious level. This
is where the skill of the group leader can be helpful, to assist the members in
expressing those feelings, or expressing difficult feelings, or even just learning
how to express feelings. Activities can and do trigger feelings, others can
emerge as members hear about others’ reactions and experiences, and a vital
part of the group process is the focus on feelings and their expression.
Indeed, many of the creative activities have feelings as a central focus and
emphasis.
The importance of the group leader’s self-development has considerable
support in the literature on effective group leadership. Studies support the
proposal that the developed self of the group leader plays a significant role;
such as constructive use of countertransference to understand members’
experiencing, to manage and contain intense and difficult emotions, to pro-
vide an emotional presence where members are heard and understood, and to
be empathic. (Yalom & Leszcz, 2005; Alonso & Rutan, 1996; Gans & Alonso,
1998; Horwitz, 2000). Constructive use of countertransference refers to the
leader’s ability to know and understand what they are feeling, the roots or
antecedents of those feelings, and to be able to use these to better understand
the group member(s).
Managing and containing intense and difficult emotions will be a task for
the group leader to model these for group members. Some group members
may be fearful of their emotions, and the emotions of others, fearing that they
will become enmeshed or overwhelmed, that they will be taken over by others’
feelings to the point where they feel out of control. The group can be a good
place to learn that difficult and intense emotions can be experienced without
loss of control. Group leaders, of course, have to be proficient at expressing
their emotions, as well as being able to manage and control them, and this is a
part of their self-development.
16 Introduction

The self-development of the group leader calls for an understanding of their

unresolved family of origin issues and concerns, past experiences that carry unfin-
ished business, and personal undeveloped narcissism (Yalom & Lezcz, 2005; Brown,
2009). These must be examined and acknowledged as they can be the conscious,
nonconscious, and unconscious factors that impact the group and its members.

Some Basic Skills and Attributes

There are some basic group leadership skills and attributes. Critical skills
include a knowledge base, empathic responding, recognizing empathic failures
and facilitating their repair, attending to group process, preventing narcissistic
injury and an awareness of group members’ emotional states.
A knowledge base about groups and techniques is also basic, and these are
covered more fully in Chapter 4. Group leaders need a thorough grounding
in the fundamentals of group facilitation such as group stages of development,
therapeutic factors, and phases of group member development (Brown, 2009;
Trotzer, 2011). This is the information that leads to making informed choices
and decisions about when and how to use creative activities in a way that
promotes group member development.
Empathic responding is essential although it is recognized that the group leader
will find it impossible to be empathic with everyone all the time. However, the
group leader must have the capacity for empathic responding even if the
leader cannot be empathic at that time. Being empathic means entering the
world of the other person to feel what that person is feeling without losing the
sense of oneself as a separate and distinct individual. Empathic responding
means that the content and feelings of the other person are understood, but
this is on a more cognitive level. The leader is not feeling what the other
person feels, they are able to identify and communicate what that person is
feeling. Central to being empathic and responding empathically is that this is
conveyed to the other person in words. Nonverbal communication is not suf-
ficient, and can be misunderstood and misleading.
Empathic failure and repair are essential tasks for the group leader and can be
especially helpful when implementing creative activities. While other group
members can and do repair empathic failures, Kohut (1977) and Brown
(2021) propose that this is a primary task for the therapist. What are some
indicators that there has been an empathic failure that need attention?

! A group member self-discloses and no one makes a response.

! Someone expresses a feeling that is not acknowledged, and/or the discussion
changes topics.
! A group member is silently crying and no one says anything.
! Interactions among group members or with the leader become increasingly
tense, or circular, or seem stuck.
! A disclosure is minimized, ignored, or a trivial response is given.
 Introduction 17

These are a few examples, there are many more. What is important to know
is that neglecting to repair the empathic failure impacts that person and other
group members who may then fear that they too will not be understood or
receive an empathic response.
Attending to group process is an advanced group leadership skill, as is making
process commentary, but these are also facilitative to the group and its
members.

Process is the here and now experience in the group that describes how the
group is functioning, the quality of relationships between and among group
leaders and with the leader, the emotional experiences and reactions of the
group, and the group’s strongest desires and fears.
(Brown, 2003, p. 228).

Yalom (2005) proposes that process commentary illuminates what is taking

place in the group and may be impacting the group’s functioning without
members’ awareness of what is taking place.
Focusing on and intervening with individuals is productive, but until group
members learn how to coattail, that is, use what you are doing with one
individual to work on their personal issues, the leader is not doing group
therapy or group counseling but rather is doing individual therapy in a group
setting. Group therapy and group counseling that use the resources of the
group to help individuals is very effective and allows all members to work at
the same time.
Making group level process commentary allows the leader to work with all
group members.
Some specific indices that indicate the need for group process commentary are:

! Behaviors of the group, what the group is doing, or is not doing

! Feelings generated in the leader
! Feelings noted in members from their nonverbal behavior that seem
important but are not verbalized
! Impact of behaviors on members but they do not respond or acknowledge
the impact
! Links between issues, concerns, and feelings
! Themes that emerge in group.

When using group as a whole process commentary, a group leader will find it
helpful to be able to identify the session’s theme, the behaviors the group use
that reflects resistance, how the group manages conflict and difficult member
behaviors, feelings that are directly and openly expressed and those that are not,
empathic failures and repair, and how the group is using its energy, or not.
Preventing narcissistic injury or wounding starts with an awareness of what
it is and how it occurs. Reich (1972) conceptualized narcissistic injury as the
18 Introduction

hurt or wound that occurs to the developing self and is experienced by the
receiver with uncontrollable feelings of helplessness, anxiety, and rage. The
person’s self-esteem is negatively affected, and these injuries continue to exert
their negative influences and can be intensified when additional wounding
occurs. Reich (1972) is not clear if the additional wounding is a reinjury of the
initial wound or is a collection of different wounds. Kohut (1977) describes
narcissistic injuries as disturbances of narcissistic balance – usually easily
recognizable by the painful affect of embarrassment or shame that is experi-
enced, and characterizes the response as one of “shame and uncontrollable
rage”. Thus, a group leader has to maintain awareness that narcissistic injury
can and does occur in groups, that the individual is severely impacted by this
and their functioning in the group, and to work to reduce the incidents, and
repair the wounding.
Narcissistic wounding can occur when others, including the group leader,
make insensitive remarks that seem to insult or invalidate the receiver, when
microaggressions occur in the group, when the person feels that something
shameful has been revealed about them, when scapegoated or attacked, and
in other such circumstances. All of these cannot be prevented as the narcis-
sistic wounding is unique, personal and may differ for each group member,
but the group leader has to stay aware of the potential for such injuries and
intervene when noticed. Responses by group members can include with-
drawal, silence, becoming combative, premature termination, and other such
negative responses.
Repair of narcissistic wounding can be difficult as the receiver may not
acknowledge the wounding, discount the impact on them, and/or become
resistant to any attempt to repair it. Kohut (1977) proposes that the repair is
accomplished by mirroring and empathic responding by the leader.
A major consideration when using creative activities is the emotional state of
members. Tuning into states such as extent of emotional vulnerability, defen-
siveness and resistance and how these are manifested, the known and hidden
self, the potential for growth and development, and their self-perceptions
and self-esteem help leaders in the decision-making process to select and use
appropriate creative activities. Careful attending to the emotional vulner-
ability allows the group leader to select the activities that will be beneficial,
not harmful, by producing intense and sometimes overwhelming affect that
is difficulty to overcome or to control for that person or for several group
members. Safety is a prime concern, and not recognizing the emotional
vulnerability of one or more group members can make the group not feel
safe for many members.
All group members will have and exhibit some defensiveness and resistance,
and the group leader can address these with some creative activities that help
to bypass them, and allow the member to access important information about
self. It is not necessary or helpful to term members as defensive or resistance,
it is much more helpful to allow them to decide when or if to lower their
 Introduction 19

defenses, or reduce their resistance. Since it is likely, if there is group level

defensiveness and resistance, that each member is displaying these in a differ-
ent manner and form, the group leader can address all at the same time with
an appropriate well-chosen creative activity.

Judicious Use of Creative Activities

One of the benefits of participating in group therapy is becoming aware of
what is known and what is unknown about oneself. Discovering, and redis-
covering parts of self can be very rewarding, but is not easy to accomplish.
After all, there are many facets to oneself, and some are more visible to the
person than are others. Creative activities can point the way and guide the
group members to explore, discover, and enhance known and unknown parts
of self, to build and/or change parts of self, and to become a more fully aware
and authentic person.
Therapy is undertaken with the hope and possibility of growth and
development as well as providing avenues for problem-solving and deci-
sion-making. Growth and development of the self, of relationships, of knowing
and being are all possible, and are enhanced with the use of creative activities.
Considerable growth can and does occur during group sessions, participation in
creative activities, and as these promote the willingness for self-exploration and
self-enhancement, can be stimulating and inspiring.
Essential in choosing and using creative activities is the group leader’s
knowledge and understanding of group members’ self-perceptions and self-
esteem (Crits-Christoph et al., 2006). How members perceive and value
their selves provides clues as to which creative activities can be used to
increase their awareness, be affirming of the self, focus on strengths and
capitalize on these, and guide them to explore sensitive areas which are
part of the growth and change process. Since perceptions and esteem are
likely to vary among group members, creative activities allow the explora-
tion and expansion of these to occur for each member wherever they may
be on these dimensions.

Summary
This chapter covered a rationale for using creative activities, descriptions for
those presented in the book, the background evidence for the efficacy of
experiential learning, ethics related to using these activities, and some of the
basic leader attributes, skills, self-development, and basic knowledge. Chapters
2 and 3 discuss the procedures, processes and guidelines for how to implement
creative activities and how to guide members’ self-exploration. Chapters 4 to 8
describe the categories of activities with examples that can be used. Chapter 9
presents the background for using activities in diverse settings, restrictive and
virtual, and Chapter 10 presents the overview for the effectiveness of creative
20 Introduction

activities to address physical, emotional, and relational conditions. The final

chapter presents applications of creative activities for groups and some group
dilemmas, and for managing group processes.

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Chapter 2

Procedures and Process for Use

of Creative Activities

Introduction
This chapter presents the fundamental principles and assumptions about the
group and its members that guide the use of creative and expressive activities,
the general procedures for conducting the expressive activities, and a process
for guiding personal exploration and enhancement to facilitate an under-
standing of what emerges for group members during the experience. The
understanding and knowledge of the group leader is essential for helping
group members benefit from participating in the creative activities.

Fundamental Principles
There are ten principles to guide the use of creative activities: personal experien-
cing, meanings that emerge, how the inner world is reflected, current wishes and
the like, reduce defensiveness, acceptance, developmental and existential issues,
continued processing, evoking intense emotions, and basic ethical concerns.
Each member’s personal experiences are unique, and their responses are a
combination of many factors such as past experiences, family of origin factors,
personality, current physical and emotional states, and so on. Thus, each
group member’s experiencing will be unique and personally relevant for them.
The meanings for the product that emerge from the activity lie within that
person as they are currently, and even past experiences are perceived from a
current perspective. Elements of the product and/or outcome are reflective of the
inner world of the person at that time, including some of the possible influences
of their past cognitive and emotional states. What is helpful is when these can
be explored to understand their continuing impact on current experiencing,
such as the impact of past relationships on current ones.
The products or outcomes provide clues for the person’s current wishes, desires,
and needs. Cues carry personal implications; some are below conscious awareness,
and some may even be from the unconscious. Cues are best explored, and
meanings extracted by that person and not by others such as the leader, and this
is highly recommended in this book. Reducing defensiveness is best accomplished

DOI: 10.4324/9781003251989-2
 Procedures and Process for Use of Creative Activities 23

through allowing the group member to draw their own meanings, observations,
and conclusions, and by the group leader refraining from offering interpretations.
New pathways of understanding and insight can be opened for the group
member because their energy goes into understanding rather than to fending off
the perceived threatening material and/or the group leader’s interpretation.
Acceptance of what emerges during the activity is increased and tolerated when the
group member provides meaning for the products. The threat or danger to the
self from the material is managed better by being under the control of that group
member.
Developmental and existential issues can be tapped by some activities. These
are issues and concerns that reemerge throughout life, even when resolved
for the present. Many group members may be unaware that this reemer-
gence is expected, or may they not understand the impact these can and do
have on their current and future functioning. Expressive activities can acti-
vate them, bring them to consciousness, allow for their expression, and to
connect with other group members who are struggling with the same or
similar issues and concerns. These connections can be relieving, affirming,
and promote universality.
All of the possible learning, understanding, and insight may or may not
happen in the group setting and can continue after the activity is completed. The
expressive activities are stimuli material so group members can continue to
reflect on what they experienced, and additional learning, understanding, and
even repressed memories can emerge after the activity is completed, and
between group sessions. The continued processing of the experience can con-
tribute to their growth, development, and healing. In addition, intense and
unexpected emotions may arise during an activity, and these must be con-
tained and managed during the session. The group leader must be mentally
and emotionally prepared to cope with members’ intense emotions as these
can be an outcome for an activity. In this event, it is necessary to ensure that
the member(s) do not become mired or overwhelmed with the intensity, and
that they do not leave the session with considerable emotional intensity.
Ethical principles, as described in Chapter 1, guide the use of expressive
activities. A variety of expressive activities are presented in the book and these
were chosen as examples that do not require specialized training. However, it
is suggested that readers do get some training before implementing these in
the groups that they lead. It is not sufficient to have experienced these in their
training or therapy and think they are valuable – some more formal instruc-
tion is generally helpful. Workshops, conference institutes, and other means of
training could be used.

General Guiding Assumptions

Six major general assumptions guide this presentation: the focus is on the
group as a whole, clinical issues are the focus, the group has a dilemma and
24 Procedures and Process for Use of Creative Activities

the leader may have tried to intervene without success, the dilemma affects all
group members although members may vary in their personal reasons for the
dilemma, the group leader can also mirror and contain the dilemma, and the
group dilemma reflects resistance, confusion, fear, and/or uncertainty.

Group as a whole focus

One or more members may be reflecting the dilemma and there is a tendency
to focus on these members. Attending to the group as a whole allows the
leader to address each member’s concern, to be inclusive, lessens the potential
for scapegoating, and demonstrates understanding and empathy at a deep
level for all members.

Clinical issues
Clinical issues are the focus as dilemmas can be reflections of deep-seated
issues, concerns, and problems that are usually the focus for clinical groups.
Other types of groups that are more short term or that have a more cognitive
focus may not have sufficient numbers of sessions to adequately deal with the
sensitive material that can emerge from some creative activities. Expressive
processes could be used as a means to relieve tension for these shorter term or
more cognitive groups or help with encouraging expression of feelings, or as
aids to help members talk about difficult topics.

Tried interventions were ineffective

Group leaders are likely to have tried several interventions that were not
successful since the dilemmas continue to exist. Interventions may have
focused on individual members, exploration of feelings, group process com-
mentary, and other such usual interventions that worked for the leader in
the past. Individual interventions do not work because the dilemma is a
shared group member concern, although it is usually expressed differently
for each member. Exploration of feelings do not seem to be effective because
no understanding occurs and venting alone isn’t sufficient; or some members
may be suppressing, repressing, or denying feelings and these are not being
expressed; or members may be confused about their feelings and unable to
sort through them.

Reasons vary
Most often, members will have different reasons and sources for their reac-
tions. For example, some could be experiencing transference, some are pro-
jecting, some fear destruction of the self, and others could be so fearful of
what could emerge that they shut down. The group leader may not know or
 Procedures and Process for Use of Creative Activities 25

be aware of all of the individual reasons, and each may need a different
intervention, but the entire group is still impacted and reacting.

The leader mirrors and contains

The group leader’s inner experiencing can be a rich source of information
about what the group is experiencing. Leaders mirror and contain affect for
the group, and these are what the leader’s inner experiencing can be reflect-
ing. The leader’s level of personal development to reduce countertransference,
(Gelso & Hays, 2007) self-understanding to reduce projecting, and the ability
to be aware of here and now experiencing, and monitoring of their possible
countertransference and projecting, permits the leader to judge the validity of
their inner experiencing as mirroring and containing something for the group.

Reflects resistance, confusion, fear or uncertainty

The group members’ reactions will usually be resistance, confusion, fear and/or
uncertainty. Resistance to what can emerge about oneself, confusion about what
is being felt but not understanding one’s feelings, confusion about the dissonance
in the group and its source(s), fear of destruction or abandonment of the self,
and/or uncertainty with all its accompanying terror.

Guiding Assumptions About Group Members

Eight assumptions are made about the group members and about dilemmas
that can be addressed with creative activities.

Members’ unique contributions

All members contribute to the group’s dilemma, and each member makes
a unique contribution. Some members can opt for deflecting tactics, some
withdraw and are not emotionally present, some may become more active
but the activity lacks meaning or purpose, members may engage in conflict
that does not get resolved, there can be sniping and unflattering remarks
made to and about each other, refusal to explore feelings, and other
actions that bring the group to the dilemma. No one person institutes or
maintains the dilemma, and it is the group leader’s responsibility to
recognize each contribution.

Members’ histories and personalities differ

This may seem obvious, but it bears repeating. Each member brings a differ-
ent personality and history to the group, and these, too, contribute to the
dilemma and to their specific reactions. Selecting an intervention under these
26 Procedures and Process for Use of Creative Activities

circumstances can be a challenging endeavor as what might be useful for one

member could be so threatening for another member that they would retreat
even further, or worse. Further, there are family of origin and other past
experiences that are influential, but these may not have been revealed leaving
the group leader in ignorance, or the member could have repressed them, but
they still continue to exert influence.

Unaware
Members may be unaware of their fears and fantasies that are influencing
their reactions. Thus, when asked about their reactions, their responses are
not meaningful or helpful. They are unaware and cannot articulate their inner
experiencing in ways that others can understand. They resort to noncommittal
responses, to telling stories, or making no response, none of which provide the
leader with clues to their real concerns.

At a crossroads
It would not be unusual for some or all group members to be at a psy-
chological crossroads, threshold, or boundary that produces fear and
anxiety. These members can dimly sense impending changes, or even be
acutely aware that change is inevitable, but still be fearful and anxious
about the uncertainty and unknown personal future. Members will also
vary in how they accept and use their inner resources to cope, and will
display these in varying ways.

Incomplete development
Members can display indices of incomplete development, such as separation,
individuation and narcissistic development. Since each member is unique
and different, each will be at a different point for each of these lines of
development. The expressive processes take these incomplete development
statuses into account, and work with each member at their particular point
of development.

Existential concerns
Yalom and Leszcz (2005) propose that existential concerns are present in
every group regardless of the group’s focus, but that these concerns are not
always addressed, and some may never be mentioned in some groups.
However, there are also groups where some of these concerns, such as
death and existential despair, are acute and prominent in the group’s dis-
cussion. Even when existential concerns are not emphasized, they can still
be influential on group members.
 Procedures and Process for Use of Creative Activities 27

Varying means of making sense

Group members will use varying means to try and make sense of their worlds.
There are their internal forces that are not completely understood or fully
integrated. In addition, there are external forces that impact them over which
they have little or no control. For some members this seems chaotic and
directionless, and they have trouble sorting through and making sense of
them. Others can feel competent to handle one set of forces, but not both at
the same time. Others can feel overwhelmed and just shut down. Each
member responds in a unique way.

Dilemmas as defenses
Think of the group’s dilemma as a defense mechanism, but what it is
defending against is unknown, may be different for each group member, and
each uses a different defense mechanism although they collectively share in
producing the dilemma. These variations can make it difficult for a group
leader to zero in on the commonality because all they are presented with are
the differences.

Basic Group Conditions for Use of Creative Activities

There are several basic group conditions that guide the use of creative activities:
sufficient safety and trust has been developed; there are rules and guidelines for
participation, and for giving and receiving feedback; the group needs assistance
to further its functioning; and a problem-solving strategy is needed.
It is critical to develop sufficient safety and trust before conducting most of the
described activities. The only exceptions may be when an activity is used to
facilitate introduction of members where the activity is non-threatening and
does not call for disclosure of sensitive personal material; or using an activity
to just play and have fun. Safety and trust will facilitate self-disclosure by
members, and the level to which they are willing to reveal the real self.
Group leaders will usually have collaboratively established rules and guidelines
for participation, reviewed these with members to get their commitment,
and members will generally know what is expected for communication,
disclosure, and providing feedback to each other. It is recommended that
members be put in charge of their disclosure to decide when and how
much to disclose, and that neither the leader nor other members push for
a deeper level of disclosure. It is also helpful if members know that cour-
tesy and civility are expected in relating and communicating among each
other, but not to the extent where nothing significant is communicated.
Labeling, calling names, being disrespectful, and any activity that has the
potential for shaming, evoking defensiveness, or provoking aggressive
responses should be prohibited.
28 Procedures and Process for Use of Creative Activities

Relationships are enhanced when the members in the relationship(s) can be

open and direct with each other, but that also carries the responsibility of being
tolerant, respectful, and mindful when giving and receiving feedback. It is helpful for
the group leader to teach group members constructive ways to provide feed-
back, and to help members learn how to receive and accept feedback. These
competencies will facilitate personal learning from the creative activities.
There are times when the group needs assistance to express their thoughts,
ideas, and feelings in appropriate ways. One of the reasons that some difficult
situations or group dilemmas occur is that members are reluctant to express
negative feelings because they fear the fantasized outcomes to be destructive,
either to them, to the leader, or to the group. The leader’s expertise and use
of creative activities can facilitate expression and demonstrate how to do so
appropriately. Most of all, members can learn that feedback need not be
negative or destructive.
Group members can also learn problem-solving through participation in crea-
tive activities, especially when things are complex, ambiguous, and uncertain
as these occur in the group setting. Demonstrating that there are alternative
perspectives, different means to approach a problem or dilemma, and even
just the use of creativity can suggest to members that problems need not be
overwhelming and frustrating to the point where nothing constructive is
accomplished.
In addition to the basic six assumptions there are three other assumptions
that will be helpful: stage of group development; the group leader’s develop-
ment and expertise; and the therapeutic relationship. The stage of group is
influential when choosing an intervention as this can help decide if the group
will be able to manage the emotions or other material that can emerge from
the creative activity. For example, activities that can evoke irritation, aggres-
sion, or conflict would not be helpful if the group is in the second stage of
development (Conflict stage).
The group leader’s inner experiencing and clinical judgment are critical to
resolving difficult situations and dilemmas especially when the difficulties
arise in the here and now.
The therapeutic relationship is also a critical component; the extent of
development for the relationship, and the level of trust and safety established
in the group.

General Guidelines for Selecting Activities

Six guidelines are recommended for selecting activities: preventing potential
harm; members’ capabilities; materials; the members’ ages and stages of cog-
nitive and emotional development; space and environmental concerns; and
confidentiality and privacy concerns.
Prevent potential harm for members and consider their diagnosis and backgrounds
that could affect their participation. For example, reflecting on past events has
 Procedures and Process for Use of Creative Activities 29

the potential for triggering distressing feelings that may be difficult for the
member and/or the group to manage. Group leaders may want to reflect on
what might be evoked from the activity.
Members’ ableness to manipulate the materials has to be a major consideration.
Physical ability to use the needed materials for the activity can be a significant
barrier to their participation. The other possibility to consider in advance is the
setting for the activity that could be considered as ableness such as prisons and
other treatment facilities where materials could become destructive.
It is extremely important that group leaders ensure the availability of needed
materials in advance of implementing a creative activity. The materials should
be readily at hand and in sufficient number so that group members can be
assured of using the materials they want for their products. It is recommended
that group leaders secure the materials well in advance of the group session.
Members’ ages and stages of cognitive and emotional development are essential to con-
sider when selecting and implementing creative activities. While most of the
activities in this book are appropriate for a wide variety of group members, the
group leader will still need to determine what adjustments may be needed for
the particular group and their age and stage of development for an activity.
Space and environmental concerns are also important. There should be sufficient
space, appropriate surfaces and the like for group members to work on their
products. Adaptations may be necessary such as using large hardcover books
in lieu of tables for drawing and writing. Members should have sufficient
space to work so that they are not interrupting or being interrupted by others.
The final major concern for selecting activities is the group leader’s awareness
of the members’ needs for confidentiality and privacy especially outside of the group.
Some members may not have sufficient privacy to keep their products con-
fidential in the event that they are concerned about what others may learn or
understand about them. Group leaders may want to ask group members if they
have these concerns, or if they want the group leader to retain their products. A
major concern about confidentiality and privacy may be the need to restrict what
can be disclosed on social media and have a rule that members may not share
what other members did or said on their social media sites, including restrictions
on taking photographs of group members and their products.

General Guidelines for Use of Creative Activities

Each set or category of creative activity is unique, and specific instructions for
use of each are presented in the chapter that addresses that category. There
are also some general guidelines that apply to all categories of activities and
these are presented in this chapter. One of the major premises for this book is
that these activities should have purposeful intent. The group leader should
understand the group and its members’ needs before implementing creative
activities. This chapter presents the process for planning that also describes a
decision-making process for selecting a suitable activity and the four phases.
30 Procedures and Process for Use of Creative Activities

! The Implementation Phase presents the procedures and directions for when
and how to introduce the activity, and what to do while members are
creating projects.
! The Reporting Phase describes how to facilitate members sharing of products.
! The Expansion Phase has guidelines and procedures to use to guide group
members to understand their products, and the feelings they had while
constructing, and those during the reporting.
! The Enhancement Phase deepens the experience by guiding members to derive
and understand meanings and associations evoked by the creative activity.

The Implementation Phase

This phase includes planning, a decision-making procedure, and ethical
considerations.
Even experienced group leaders are encouraged to use the planning process
to gain optimum outcomes. Creative activities should be planned in advance,
and not impulsively used during the group session. Planning involves deter-
mining the purpose and goal(s) for the activity, selecting an activity, deter-
mining needed materials and supplies, and developing the questions that will
be used to guide exploration and enhancement.
When you first begin to use creative techniques, it will be helpful to write
the plan. That way you can ensure that you’ve covered all the major
requirements, and not have any lapses when using the activity in the group
session. As you become more familiar with these and develop your personal
favorites, you may not need the security of writing a plan.

1 The first step is to establish the purpose and goals for the activity. Have
you identified a group need? What are you intending to accomplish?
How would the activity meet the group’s need? There are numerous
purposes for activities. Following are some examples of group needs, some
identifiers of the need, and possible benefits from using a creative activity:
a Fear of conflict in the group. Group members seem skittish and
fearful of conflict emerging in the group, and an activity such as
those described in the application chapter could help reduce some of
their apprehension.
b Defensiveness. There is considerable intellectualizing and talking
about feelings rather than expressing feelings in several session. An
activity could provide a means for getting around these defenses to
allow members better access to their feelings, and/or facilitate
expression of feelings.
c Low verbal skills. Group members have low verbal skills, and have
difficulty expressing personal thoughts, feelings, and ideas because of
 Procedures and Process for Use of Creative Activities 31

vocabulary deficits. A creative activity could facilitate their expression

for these.
d Suppressed conflict. There is suppressed conflict in the group that is
causing considerable tension and discomfort. A creative activity could
relieve tension, provide a means for members to express their dis-
comfort and concern, and/or facilitate the expression of the suppressed
intense feelings.
e Lack of progress. The group seems stuck and discussions are circular,
no meaningful progress is being made and a creative activity could
assist them in expressing what is being suppressed, avoided or over-
looked in the group.
f Ineffective emotional venting. Several members engage in continual
emotional venting over several sessions about the same concern indi-
cating that little or no understanding or problem-solving is occurring.
An activity could help promote awareness and problem-solving.
g Group resistance. The group is avoiding or resisting a major concern,
such as developing intimacy, fear of not being safe in the group, and
other possible dangerous topics. An activity could help bring these
concerns to expression so as to be addressed in the group.

The initial purpose for using an activity is central during the decision-making
procedure (step 2 of the Implementation Phase) to select the activity that best
fits the purpose, group members, and the needs of both.

2 It is more helpful to work through the decision-making procedure, rather

than just using an activity, as this will allow the group leader to select an
activity that is best suited for the dilemma/concern, the group and the
benefit of group members. The described procedure has the following
steps:
a Identification of the concern, barrier, or dilemma. The decision-
making begins with specifying the concern, issue or dilemma where a
creative activity could be used as an intervention. These activities
should be used to tackle something that is affecting the group as a
whole, and not focused on one or two members’ individual concerns.
Try to be as specific as possible in this identification, and use both
observable behavior and your (the group leader’s) inner experiencing.
b Exploration of possible creative activities as intervention alternatives.
Review the kind of possible creative activity that could be used, such
as art, music, writing, imagery, and others that are presented in this
book. If you have used activities in groups before, you could look at
the list of these, and/or consult references for suggestions. Select a
creative activity that can be fully completed in the session.
32 Procedures and Process for Use of Creative Activities

c List the possible positive and negative outcomes for each creative
activity that is considered. Reflect on what is trying to be accom-
plished, group members’ vulnerabilities and emotional states, and the
purposes and goals for the various creative activities. Think of the
positive and negative aspects for each possible alternative, the known
characteristics of each group member, and if there could be a nega-
tive impact or not for any member, the possible benefit for the group
as a whole, and if any suggested activity could be eliminated because
of members’ capacities and ability to participate. Choices will be
narrowed using this process.
d Consider the possible impact on each individual group member.
Reflect on what is known about the group members from their
behaviors in group sessions, such as their defenses, arousal, and
handling of difficult feelings, uncomfortable memories that can be
triggered, and so on. Also consider the possible impact on each group
member, such as defenses, arousal, and handling of uncomfortable
memories and/or feelings.
e Describe the benefits on the group as a whole for using the activity.
How will the group’s functioning, progress, and process be facilitated
by using the creative activity? Possible benefits for the group can
include increased energy and interest, assist with expression of some
feelings, and reduce tension, which may help produce a group
atmosphere more conducive to growth and development. New
material can emerge that promotes therapeutic group factors such as
universality and interpersonal learning.
f Take into account members’ abilities to participate. When selecting
an activity, group leaders need to be concerned about group mem-
bers’ abilities and competencies to participate and gain from the
activity. There can be cognitive impairment, motor dexterity, and
other disabilities that would interfere with their being able to fully
participate. It is recommended that no activity be used where all
group members cannot participate.
g Consider group factors such as time needed for the activity and the
stage of group and ethical considerations. Estimate the time needed
to introduce the activity and distribute the materials, working time to
complete the product, the time needed for members to present their
products and share feelings in the group, and time needed to com-
plete the enhancing phase. Another important consideration is the
stage of the group’s development. For example, an activity that
focused on a deep level of self-disclosure used in the first stage of
group development, where trust and safety may not be firmly or
completely established, is not a good idea. Doing so could make
group members feel threatened and that makes trust and safety
harder to develop.
 Procedures and Process for Use of Creative Activities 33

Ethical considerations should also be reviewed as part of your planning.

Questions such as the following should be explored:

! Is there potential harm for any group member?

! Am I, the group leader, qualified to conduct this activity, and able to
handle intense emotions that may emerge?
! Is any part of the activity demanding forced self-disclosure for group
members?
! Have I provided for informed consent?
! Are members free to choose to not participate, and are there penalties for
not participating?

Tentative selection: by this time, you have narrowed your choices to very few,
or to one creative activity. If you still have more than one as a possibility,
review both and evaluate their suitability for the group. Each group has its
own unique set of characteristics, and you can now select the one that seems
to best fit the group and its need at this time.

Example Decision-Making Procedure

The following is an example of working through the decision-making proce-
dure for a group composed of adults who have no known disabilities, and
where the group has met for several sessions.

1 Identification of the dilemma. The group has no energy, members are

listless, feelings are not being expressed, and the atmosphere is heavy.
2 Possible alternatives for categories of activities.
3 Positive and negative aspects for each possible activity category:
a Fairy tale – positive aspect – relieve tension and focus thoughts.
Negative aspect – completion may take more time than is available in
a session.
b Drawing – positive aspect – provides a nonverbal way to express
feelings. Negative aspects – members may feel judged on artistic
ability, sufficient materials may not be available.
c Writing – positive aspects – can be private and provide an alternative
for expressing feelings. Negative aspects – lack of member-to-member
interaction, members could become more withdrawn, time constraints.
d Movement – positive aspect – tend to be energizing. Negative
aspect – can increase members’ self-consciousness.
4 Impact on individuals. From what is known about this group’s members,
there should not be any negative impacts and the positive outcomes for
individuals could promote their progress.
34 Procedures and Process for Use of Creative Activities

5 Benefits for the group: as a whole. Members can be taught how to express
feelings and encouraged to express these through use of a creative activ-
ity, members will become actively engaged in creating a product, energy
is introduced, and the group can move forward.
6 Members’ abilities: ability to participate. This was noted earlier in the
description of the group. All members have the capacity to participate.
7 Group factors: the group seems to have moved beyond the beginning
stage so that many creative activities could be less threatening. Thus,
it is likely that sufficient trust and safety have been established so that
members can trust the group leader to protect them, and this will
increase their willingness to participate. The group leader has to
describe the proposed activity, provide a rationale, solicit members’
cooperation, and be willing to not use the activity if members request
to not participate. All ethical considerations must be met.
8 Tentative selection: by this time, you have narrowed your choices to a
very few, or to one. If you still have more than one possible activity,
review both for suitability for your group. Each group has its own unique
set of characteristics, and you can now select one that seems to best fit the
group and its need at this time.

Questions for Exploring and Expansion

Develop a set of three to four questions you could pose that would keep
the activity focused on the goal and purpose, and that would guide mem-
bers’ personal exploration of their experiences and/or outcomes. General
questions that are almost always appropriate are as follows. These are in
addition to the focused ones.

! What feelings, thoughts or ideas emerged as you completed the activity?

! What feelings are you experiencing as you talk about the activity?
! What associations to your current or past life can you identify?
! Was any part of the activity a surprise or troubling for you?
! How would you summarize this experience for yourself?

The use of the described creative activities relies on the group member’s per-
sonal understanding and associations, and does not expect that the leader and
other group members have special knowledge that would provide an inter-
pretation that the member must accept. In other words, the leader does not
interpret the symbols for members, but rather allows the individual member to
suggest their own interpretations, associations, and meanings. The assumptions
that guide this perspective to allow members to make their own associations or
interpretations are as follows:
 Procedures and Process for Use of Creative Activities 35

! Symbols will have personal meanings and associations for members and it
is unlikely that others can know what these are.
! Group members will be more open and accepting and less defensive
when they can make their own interpretations.
! It is much less threatening to the person when personal associations are
accepted as valid.
! The understandings can emerge in a form that the person finds useful and
accurate.
! Members will feel more in charge of their own self-disclosure.
! Shame and guilt feelings can become more manageable for the group
and its members.

Materials and Supplies

If creative activities are used in a group, it is helpful to have appropriate and
sufficient materials readily available. Each activity in this book has a list of
needed materials and it may be helpful to have a “toolbox” of materials
always available. Suggested materials for a toolbox, or to always have avail-
able include the following:

1 A variety of paper in several sizes such as newsprint, copy paper, and

construction paper. The paper does not have to be expensive, but should
be available in sufficient amounts.
2 Glue sticks or paper glue.
3 A set of crayons, or colored pencils, or felt markers for each group
member. When you compile your toolbox you may not know how many
members are in the group, and it is suggested that you plan for at least
ten members.
4 Scissors for each member if group members are able to use these. Some
group members may have difficulty using scissors, or it may not be advi-
sable to let them have scissors, and in these cases, the group leader needs
to adjust the activity to eliminate their use. However, if it is appropriate
and the activity calls for their use, try to have at least one pair of scissors
for every two group members.
5 Unlined index cards in a variety of sizes. These can be used instead of
paper for some activities, and are sturdy for drawing and pasting.
6 Masking tape for posting directions and/or products.
7 Collect a variety of catalogues and magazines that can be used for images
and collage.

Once you have selected the kind of activity, or the specific activities you
intend to use, the next task is to gather needed materials, such as paper and
glue. Try to have sufficient materials so that each person has a separate set.
The activities presented in this book call for relatively inexpensive materials so
36 Procedures and Process for Use of Creative Activities

that having separate sets for group members should not be overly expensive.
The only kind of activity presented here that would be the exception to the
group leader’s supplying the materials is for scrapbooks. These are so personal
that it is probably best to have group members secure these for themselves. If
cost is a concern for group members, there are alternatives presented in the
discussion on using scrapbooks.

Generation of a Formal Plan for Implementation

A formal plan for implementation can begin now that you have an activity to
use. Up to now the planning has been primarily cognitive that is, thinking
about what to do. It could be helpful to write an outline for the information
such as the following.

Example Formal Plan

Activity: Emotions
Goal and objectives: To energize the group, and to provide a means for
expressing difficult feelings.
Materials: A set of crayons, or felt markers, or colored pencils for each
participant, and sheets of paper for drawing.
Procedure:
1. Introduction 3 minutes
(more time may be needed if there are numerous questions)
2. Distribution of materials 2 minutes
3. Instructions and production 10 minutes
(Read these one at a time allowing time to finish the symbol before moving to the next one)
a Select one color and draw a symbol for happy.
b Select one color and draw a symbol for sad.
c Select one color and draw a symbol for frustrated.
d Select one color and draw a symbol for contented
(peaceful).

4. Reporting and expansion – (sharing products) 10 minutes

5. Enhancement 15 minutes

Explore the following questions:

! What personal associations, thoughts, and feelings emerged as you completed the
activity?
! Which symbol was easiest to think of, and draw? Which was most difficult?
! What similarities do you see among group members? Differences?
! What is the most intense or focal feeling for you now?
 Procedures and Process for Use of Creative Activities 37

6. Review and evaluation

Take time to mentally review the session and reflect on what
went well, what did not go as planned or presented difficul-
ties, what needs to be changed, and if the goal and objectives
were accomplished. It can be helpful to reflect on what
emerged for the group and its members as material for fur-
ther consideration and exploration. Some activities can be
very meaningful for some group members, they will continue
to reflect and explore their personal material, and this can
reemerge in future sessions.

The Process for Implementation Phase

Now that the plan is complete, the process to introduce the activity is described,
including how and what to observe as members work, handling questions, and
providing encouragement.

Introduction of activity
It is very important to introduce the activity in a way that allows members to
assess their personal psychological risk(s) and make an informed choice about
participation. It is also ethically responsible to give members the option to not
participate and, if even one member objects, it is best to relinquish the plan
for the activity and to use that time to explore the resistance. The group does
not benefit when one or more members are openly resistant about completing
an activity. There is probably a shared reason for the resistance that could be
a reflection of unspoken resistance from other members. Do not force or push
an activity. Take that time to try to better understand what the resistance is
about, such as the following usual or common possibilities:

! Fear of unleashing uncontrollable conflict

! Fear of intimacy
! Fear of finding out something about oneself that could be upsetting
! A disguised way of challenging the leader
! Feelings of danger in the group such as an unidentified narcissist, bor-
derline, or quietly explosive member (Brown, 2007)
! An unrevealed urgent and important problem someone is experiencing

There are numerous valid reasons for the resistance, and these should be
respected.
Let’s assume that group members are cooperative and are willing to try the
activity. Don’t skimp on the information provided in the introduction, but
don’t overly explain either. Too much information could affect spontaneity
and creativity. Members may be inclined to want to give you what they think
38 Procedures and Process for Use of Creative Activities

you expect, instead of their personal experiencing, when you overexplain.

Introduce the activity with an explanation of the general purpose, what
members will be asked to do such as draw or write, and an overview of what
to expect will emerge for them such as feelings. Stay vague and general for the
last item as you don’t want to direct their personal experience. Give them
the option to stop participating at any time during the activity if they
should become upset, or feel overwhelmed. Note: if a member should stop
participating after beginning the activity, it would be helpful to guide their
understanding what was emerging, and what was producing the upset or
feelings of being overwhelmed.
A sample script for an introduction follows. The script is based on a perceived
group constraint around expressing feelings.

Sample Introduction of Activity Script

Some group members have identified one of their relationship difficulties as an
inability to express feelings, and all members seem to agree that it is difficult or
impossible for them to express negative thoughts and feelings (Problem identified). I
would like to try an activity that could begin to help make it easier to express all
types of feelings, and I need your permission to continue (Giving members control).
The activity consists of having you think of symbols for four emotions I’ll
name one at a time, then select a color that you related or associate with the
symbol, and draw the symbol on a card. We’ll then talk about the symbols
and their associations for you. (Description of the procedure) You can stop at any
point along the way if you choose. (Permission to opt out) Are there any ques-
tions? (Pause and answer questions) Does anyone object to doing this activity?
(This is where objections and resistance could be explored) Are we ready to
begin? (One last chance to opt out).

Observing Members As They Work

Important information can be gained through observing the individual group
members as the activity is introduced and as they work. Notice their facial
expressions, body postures, the pace at which they work to complete the
activity, pauses, and the need for clarification. Walk around while they are
working to get the best angles for observing each member, and at different
points during the activity.
Facial expressions can signal distress, confusion, impatience, delight, and
involvement, and other such feelings that can arise during an activity. Don’t
do anything unless it seems as if the member is becoming flooded and/or
overwhelmed with negative emotions. If this should occur, go to that member
and quietly ask if you can help as you noticed their distress. Give the member
permission to stop participating at this point, and ask if they will be willing to
talk about their experiencing during the reporting phase.
 Procedures and Process for Use of Creative Activities 39

Body postures, like facial expressions can also provide clues. Look for tense
body positions; if the member is protective or hiding their product, such as an
arm positioned as if they were shielding their product; legs moving restlessly or
entwined tightly; or other postures that signal excitement, pleasure, and so on.
Notice the pace used by each member when working. Do they work
effortlessly at a quick or measured pace, or are there starts and stops? Do they
seem decisive, at a loss, pensive, and so on? Interruptions of working could
signal thinking, unpleasant associations emerging, pleasant memories and
associations, and other such feelings.
Observing also extends to the other phases: reporting, and exploration, and
expansion. Observe members and the group as a whole as there is much
information that can be gathered other than the content that is verbally
expressed. Group leaders can find the following observations to be helpful:

! Similarities among members can be identified and remarked on even

when the similarities are not readily apparent to those members.
! Areas of sensitivity for members can be noted for exploration in subsequent
sessions but not commented on or explored in this session.
! Intense emotions can be observed and steps taken to reduce these before
the session comes to a close.
! Member-to-member empathic responses can be indicative of unrevealed or
unaware similarities that could be the basis for strengthening connections,
and for fruitful exploration.
! The strength of defenses mounted against knowing sensitive information
about oneself can help to understand what seems dangerous or threatening
to that member.
! Validation of hypothesized issues, concerns, and/or unfinished business
for various group members.
! The atmosphere and feeling tone during and about the activity.

Questions
When members raise numerous questions after the introduction, that can signal
resistance, a need for clarification, or uncertainty. Some members can be resis-
tant either consciously or unconsciously and this is expressed in questions about
the instructions, purpose, what the leader expects, and so on. Indeed, some may
not hear the instructions and ask that they be repeated. This is one reason why
it can be helpful to post the questions on a chalkboard or newsprint so that
members do not have to remember what to do. Others may express their
resistance by misunderstanding instructions, and later ask for clarification.
Another possible reason for requests for clarification is that the instructions were
not as clear as needed by the group. The group leader should note this need to
revise the instructions to be clearer. There is no need to address the resistance,
just note it and provide the needed answers to the questions.
40 Procedures and Process for Use of Creative Activities

Encouragement
Some members may need encouragement. They may want to be perfect in
what they do, e.g. write or draw, and past experiences have led them to be
very insecure about their ability. The group leader can provide the needed
encouragement and support by being very clear that talent and ability take a
back seat to expressions, and by being very accepting of whatever is produced.

The Reporting Phase

Each member should have an opportunity to present and share their experience
and product. The activity loses its power to promote understanding or insight
when carried over to another session and much valuable information for and
about the member can be lost as a result of the delay. The group leader must
manage this part of the activity experience to ensure that every member speaks
about their experience and product. This management of reporting can be a
challenge as some members will reveal material that could be very fruitful for
exploration, some members can be so excited about their experience and/or
product that they want to do more self-exploration immediately, and the group
leader can seize the opportunity to deepen the self-exploration and feeling
experience as members could benefit from this. All these reasons are valid and
enticing, but must be resisted for the moment as it is more important at this point
to have enough time for every member to report. Further exploration and dee-
pening can be accomplished during the expansion phase, which can be delayed to
another session when adequate time does not remain in this session. Group lea-
ders can note what could be returned to and explored further.
Why this insistence on having every member report? It is important because
of the following reasons:

! Speaking about the product helps each member feel validated and that
they are not being ignored, overlooked, or minimized.
! Old feelings around sibling rivalry are less likely to be triggered when each
member has an opportunity to speak rather than having some members
speak so long that there is not enough time for everyone to report.
! The group leader would not be perceived as playing favorites when all
members can report, not just some members.
! If only some members report then they may think that other group
members will perceive them as more worthy, or more needy.
! It will be more difficult for a member who had an intense feeling evoked
by the activity to conceal that and the group leader will then be able to
take care of that before the session ends so that the member does not
leave the group with an intense feeling.
! It becomes easier to identify important commonalities among group
members.
 Procedures and Process for Use of Creative Activities 41

The group leader gets a better understanding of what the experience was like
for the entire group when all members report, and this provides information
for the future of the group as a whole intervention.
Initiate the reporting phase with clear directions about what members are
supposed to do, such as the following: gather members back into the circle
and tell them that this phase involves having each member briefly present
their experiencing or product, and that there will be limited comments,
questions or explanations at this point as it is important that everyone has an
opportunity to present. Tell them that exploration such as questions will con-
tinue during the expansion phase after the reporting phase. Tell members that
they are being asked to give reflective or empathic responses to each other at
this time during the reporting, and to save other responses such as ques-
tions for later. The group leader should also follow these directions, but
can vary when it is therapeutically needed, such as when a member
becomes overwhelmed by intense emotions. That situation calls for
immediate intervention, but even then, the leader should resist deepening
the experience or going too far with exploration.
It is probably best that the leader does not give each member a time limit
for presentation, such as saying that each member has two minutes for pre-
senting. Giving a time limit could make some members rush, or feel rushed,
and they then can leave out what could be important information. What
could work better is to ask members to briefly present what seems important
for them to report at this time, and they can have more time later for
expansion and exploration either in this session or in later sessions, and to
mentally set a time limit for each presentation. This will enable the leader to
restrict their tendencies to deepen the experience at this point, and to move
on to the next member’s reporting.
If there seems to be something urgent and important for a member when
reporting, the group leader can respond empathically, and say that it will be
explored after all members have reported. The same script can be followed
when something is not urgent and important, but seems to be sensitive and/
or has the potential for fruitful exploration. Most activities, especially those
presented in this book, are unlikely to arouse deep-seated issues or
uncontrollable intense emotions, but the potential for these continue to exist,
and a leader must be prepared to manage these for the therapeutic benefit of
group members.

The Expansion and Enhancement Phases

After each member reports on personal experiencing and/or their products, the
group can move to the expansion and enhancement phase where the emerged
material can be explored for additional meaning and insight. This can be done
verbally, or through guided writing together with verbal reporting. The
previously developed list of questions can be used for both.
42 Procedures and Process for Use of Creative Activities

When verbal expansion is used, the leader and other members have an
opportunity to give empathic responses, and to ask for clarification. It is
recommended that the group leader sets the direction and tone for this phase
by telling the group that it will be helpful to the speaker for them to give
empathic responses, and to restrict questions for clarification only. This will
prevent any member from facing a barrage of questions that could be poten-
tially upsetting if they are in a sensitive state with memories, associations, and
the like, that were aroused by the activity. The leader should block digres-
sions, questions and other inappropriate comments so as to stay focused, and
to allow sufficient time for exploration by this and other members.
One disadvantage of verbal expansion is that members, other than the
speaker, can consciously or unconsciously incorporate other member’s
reactions and feelings into their responses, and thereby their responses
become contaminated and not entirely focused on their own personal
experiencing. Some members may be more open as a result of the activity, and this
openness facilitates catching others’ feelings. The similarities of experiencing can
also contribute to emotional susceptibility. Another disadvantage is that more time
may be taken per member to facilitate their personal exploration so that there is
not sufficient time remaining to take all group members through the process.
Guiding personal expansion and enhancement through writing prevents the
two disadvantages seen for verbal expansion and enhancement. Every
member facilitates their own exploration. The procedure would be as follows:

1 After the reporting phase is completed, distribute paper and writing

instruments.
2 Ask group members to reflect on their experience and products, and to
write responses to your questions.
3 Present the questions developed during the planning phase one at a time,
allowing sufficient time between questions for members to write their
responses. If someone does not seem finished, tell them that they can
return to the question later.
4 Have a mentally set time frame for writing, stay on task, and move it
along without wasting time.
5 Regroup and have members report as much or as little of what they
wrote as they choose.
6 Give empathic responses, restrict questioning, and ask group members to
do the same.

Additional expansion and enhancement can continue at a later time.

Group members can be less resistant and defensive when they are the ones
who decide what material to focus on, and this leads to more fruitful self-
exploration. Group leaders can note what emerged that can be returned to at
subsequent sessions, deeper and more meaningful similarities among mem-
bers, and possible areas of sensitivity.
 Procedures and Process for Use of Creative Activities 43

Summary
The ten principles for use of creative activities in group therapy, which form the
framework and basics for those activities that are presented in this book, were
described. Also presented were the general guiding assumptions for use of activ-
ities, a selection process, and the phases for constructive use of activities. Sample
activities were presented as illustrations for selection, initiating, reporting, and
expansion. The next chapter discusses the leader’s facilitative attributes and skills
that will aid members to derive the most from their group creative activities and
from the group experience.

References
Brown, N. (2007). Coping with infuriating, mean, critical people. Westport, CT: Praeger.
Gelso, C., & Hayes, J. (2007). Countertransference and the therapist’s inner experience: Perils and
possibilities. Mahwah, NJ: Erlbaum.
Yalom, I., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New
York: Basic Books.
Chapter 3

Group Leader Facilitation

Attributes and Skills

Introduction
This chapter presents material that addresses the most effective group leader
facilitation attributes and skills, the skills for working with individuals and at
the group level, and group process and process commentary that will be
especially helpful when using creative activities. These are the attributes and
skills that will help the group get the most out of participating in creative
activities. Presented are fundamental attributes, therapeutic skills, and the
development of the inner self. Attributes are the fundamental characteristics
that are embedded within the individual that contribute to the therapeutic
alliance. These fundamental attributes are conceptualized as empathy, the
attitudes toward group members that contribute to forming the therapeutic
relationship, the leader’s psychological boundary strength that will prevent
them from emotional contagion, help to provide increased emotional presence
in sessions, and the role of healthy adult narcissism.
Building on fundamental attributes are the therapeutic skills for individuals and
at the group level. They are skills that can be taught and learned. Examples of
helpful skills that are presented are empathic responding, identification of
empathic failures and how to repair these, process and process commentary,
and coping with resistance and transference.
The final major topic presented is developing an inner therapeutic self for the
group leader so as to facilitate the growth and development of group members
through the use of a self-reflective stance. This is how a group leader can
examine their thoughts about self and about others, monitor counter-
transference that had the potential for harm, understand the feelings that
emerge during group sessions, and make suggestions for differentiating
between self-reflection and self-absorption.

Fundamental Attributes
The basic relationship attributes that are critical for group leaders are empathy,
an emotional presence, genuineness, positive regard, tolerance, nonjudgmental,

DOI: 10.4324/9781003251989-3
 Group Leader Facilitation Attributes and Skills 45

psychological boundary strength, and development of healthy adult narcissism.

These are the inner attitudes and self-understanding that lead to behaviors that
will help build the therapeutic alliance, allow for effective interventions, and
reduce the likelihood of therapeutic ruptures.
Many people seem to consider empathy and sympathy as the same when they
describe the two, or when they describe their experiencing. Empathy is
defined as entering the world of the other person, sensing or feeling what they
are feeling without losing the sense of yourself as separate and distinct (Rogers,
1951). Being empathic does not mean that you lose your sense of yourself as
separate and distinct from the other person.
Central to the attributes for group leaders is the ability to have an emotional
presence in group sessions. This means that the leader is fully present in the here
and now and their focus is on the group and what the group members and the
group as a whole are experiencing. This emotional presence permits the group
leader to tune in to the group’s process, to have a better understanding of
what group members are feeling and experiencing, to observe group dynam-
ics, and to sense the cues for when interventions are needed.
Attitudes for developing the therapeutic relationship include authenticity,
caring, positive regard, and tolerance. Being real and authentic in your atti-
tudes and behaviors is important to build trust between the leader and mem-
bers and encourages their disclosures about very shameful and painful
personal information. The leader can also increase feelings of trust and safety
by making members feel cared for and that they are held in positive regard. Group
members must develop feelings of safety and trust in the leader and group
before they can conquer their fears enough to allow themselves to talk about
sensitive issues and concerns. What a leader does and says is critical to pro-
viding a group atmosphere to encourage self-disclosure and overcome fears.
Tolerance and being nonjudgmental as basic attributes mean that the group leader
is able to tolerate differing opinions, ideas, and even values. This can encou-
rage the expression of members’ thoughts, feelings, and ideas without fear of
being perceived as wrong, weird, or unacceptable. That does not mean that
the leader has to agree with members, just that they do not evaluate them.
Psychological boundary strength refers to the level and extent to which the
person has achieved separation and individuation so as to be in control of
what they let into themselves, and what they are able to screen out. This
understanding helps to prevent emotional contagion, incorporation of projec-
tive identification, and allows empathy consistent with the definition where the
inner world of the other is sensed without becoming overwhelmed or enme-
shed. Strong and resilient boundaries (Brown, 2018) allow the group leader to
feel what the member is feeling without incorporating that feeling into their
self and being unable to relinquish the feelings. This extent of psychological
boundary strength is particularly helpful when facilitating groups where
members can have intense negative feelings and, can also prevent the group
leader from becoming emotionally exhausted from group sessions.
 Group Leader Facilitation Attributes and Skills 47

where it occurred, it can also be helpful to repair it later. For example, when
reflecting on the session it becomes apparent that there was an empathic
failure. A repair begins with identifying what was considered to be an
empathic failure and in the next group session to complete the repair.
The results for trying to repair an empathic failure will vary. Some members
can deny that they felt empathically failed, some can respond that since they
were empathically failed, they assumed that what they were saying wasn’t
important, and some may not even remember what happened. Some members
may attempt to minimize their concerns by saying that what they were talking
about was trivial. However, there are group members for whom it will be a
huge relief to finally know they were heard, with the added outcome that other
group members will feel that they too will be heard in the future.
Group process refers to the relationships being expressed in the group in the
here and now (Brown, 2003). The relationship may be between individuals,
between subgroups, or between the group and the leader and the focus for
using process relies on here and now interactions. The focus and emphasis are
on what is taking place in the group at the present time, not why.
Highlighting process tends to promote understanding for both personal
individual issues, and for group issues. Yalom and Leszcz (2021) note that
behavior and relationships in the group mirror those that the members have
outside of the group, so observing how members interact and relate in the
group in the here and now provides important clues to those behaviors and
relationships outside of the group. Further, Chapman (1971) proposes that
“personality consists of the relatively long-term ways in which a person enga-
ges in interpersonal relationships” and, “can be studied, understood and
sometimes changed only in the context of interpersonal relationships”.
Process commentary focuses on what is happening between group members, or
what is being done by the group as a whole. Some unconscious, nonconscious,
and unspoken relationships between members that can form the basis for
process commentary are seeking connections, attempts to dominate or control,
soliciting support or approval, feeling or fearing rejection, demonstrating a
strong need to take care of others, and other such actions/inactions.
Group level process observes and identifies when the group as a whole seems to
be avoiding intimacy, or ignoring or suppressing conflict, yearning for safety
and trust, wanting the leader to take care of them, and the like. Some unspoken
needs or desires for the group as a whole are resistance, aggression, fear of
engulfment, fear of exclusion, depression, clarification of norms, feelings of
helplessness, or fear of destruction. Once the group’s needs are identified, this
forms the basis for process commentary.
Since the primary responsibility for process commentary lies with the
leader, there are certain tasks and skills that the leader must develop and use if
their commentary is to be helpful. These tasks and skills include assuming a
present-centered focus, having an ability to function as the container for the
group’s most uncomfortable feelings, such as fear or rage, understanding group
46 Group Leader Facilitation Attributes and Skills

Development of healthy adult narcissism (HAN) not only allows the group
leader to have the most positive and constructive therapeutic relating attri-
butes, in addition it can also prevent the leader from actions that can be
harmful to group members. HAN is defined by Kohut (1977), Stolorow
(1986), and Brown (1998, 2011, 2021) as having empathy, wisdom, creativity,
and an appropriate sense of humor. This perception of HAN conceives of
narcissism as self-esteem and as developing throughout life on a continuum.
An example of leader self-absorption is their thought and feelings similar to
the following: “Am I doing it right?” and “Do they (group members) like me?”

Therapeutic Skills
Therapeutic skills include both the individual and group levels. What is
presented here is not the entire list of therapeutic skills, but these are considered
to be fundamental and basic. Presented are empathic responding, empathic
failures and their repair, process commentary, coping with resistance, trans-
ference and countertransference, conflict resolution, blocking, linking, and
constructive use of questions.
It is helpful to respond empathically as much as possible especially when
using creative activities as these tend to evoke emotions. Group leaders will
find it helpful to increase their capacity to empathically respond as this
includes listening carefully for underlying meanings that group members may
be experiencing. Basic to therapeutic listening is to reserve judgment about
what the person is saying, to not become defensive or resistant and, at the
same time stay in touch with what feelings are internally emerging. It is also
important to not interrupt or finish thoughts for the speaker, and to not dis-
connect, minimize, or ignore the emotionally laden content as this carries the
most important part of the communication from the speaker.
There may be levels of empathic responding that could be used since it is not
realistic to expect group leaders to be fully empathic with everyone all of the
time. There are times when reflection of the feelings and content may be suffi-
cient or the use of moderate or connected empathic responding. Moderate
empathy is a short period of entering the other’s world that is just long enough so
that their feelings are sensed and somewhat felt while connected empathy occurs
when the duration of being connected to the other person’s feelings is longer than
it is with moderate empathy.
Empathic failures are common and are not always recognized as such (Brown,
2021; Kohut, 1977). Some indices of empathic failure include a member not
receiving a response to an emotionally laden disclosure, an abrupt change of
topic, content was the focus for responses with no attention or reflection pro-
vided for the emotional content, what a member said was treated as trivial or
unimportant, emotionally laden content was ignored in the response, or when
the speaker’s communication was used to tell another member’s story. While it
is best to be able to identify and repair an empathic failure in the session
48 Group Leader Facilitation Attributes and Skills

dynamics as they unfold and are exhibited in the session, and being judicious
about when and how to make group process commentary.
Tuning into process requires a present-centered focus for the group leader to
identify what the group is doing or not doing and how this is affecting the group.
This requires the emotional presence of the group leader and their understanding
of what the unspoken issues, needs, and concerns of the group may be at that
time. Part of this tuning in can be the group leader’s ability to function as a con-
tainer for the group members’ uncomfortable and sometimes intense feelings
which can allow the group leader to identify those unspoken feelings that are clues
to what is important for the group and its members. An understanding of the
group dynamics such as resistance and the session theme also provides information
for understanding the process and for making group process commentary.
It is important that the group leader remains aware that even when members
become accepting of process commentary, it should be provided judiciously and
in a way that the group can be accepting of it. Group level interventions process
comments can be very helpful and are able to address individual members’
concerns as well as the group-as-a-whole issues.

Transference and Countertransference

Like resistance, transference (members) and countertransference (leader) are
usually present in the group. Since these tend to be unconscious or non-
conscious, it is unlikely that members are aware of when this happens. Leaders
are advised to continually monitor the possibility of their subjective counter-
transference which can be harmful at times to and for others, but to also stay
aware of their objective countertransference as it can be reflective of what
group members are experiencing. Some indices of possible transference and
subjective countertransference are as follows:

! Liking or disliking a group member

! Have negative reactions to a member’s input
! Perceiving a member’s input as positive
! Agreement or disagreement with a group member
! Forging a strong emotional connection with one or more group members

It is not helpful for the group leader to label a member’s behavior or reaction as
transference as that is likely to evoke defensiveness. Group leaders can note it or
consider that it is a possibility, but it is best to wait for a more obvious opening
before pursuing the associations or connections to past or family relationships.

Therapeutic Responding or Communication Competencies

Therapeutic responding or communication competencies are divided into two
categories: basic and fundamental skills used in individual and group
 Group Leader Facilitation Attributes and Skills 49

counseling, and skills that have a particular application to group leader-

ship. Basic competencies include active listening and responding, a focus
on personal experiencing of members, encouraging direct responses among
members, redirecting, and reframing.

Basic Competencies
It is essential that group leaders hone their listening skills as the ability to hear
what is said, what is meant, and understand the underlying feelings is crucial
to helping group members. Listening in a group setting is considerably more
difficult than in an individual session as the interactions are faster and more
complex (Rutan, 1993). Responding includes reflection, paraphrasing, and
empathic responding. There are times when it is helpful to reflect or para-
phrase what the person said so as to clarify that what was heard was what the
speaker meant. Empathic responding includes verbalizing both the feelings
and the content.
A focus on the personal experiencing of group members especially in the here
and now is a skill that will pay dividends for the members and for developing
group cohesion. Although it is also appropriate to bring past and outside the
group concerns, problems, and issues to the session(s), these are more effec-
tively explored when they are brought into the present and the focus is on the
member’s present experiencing. Their feelings and thoughts in the present
allow them to better understand their issues, problems, and/or concerns.
Directness is a skill that the leader can model, and many members will likely
follow the leader’s example which is an asset to the group’s interactions as
well as for their communications outside of the group. It is helpful to
respond directly and specifically to what the speaker says and not to go off
on a tangent with the response. Helpful ways to respond directly include
paraphrasing, reflecting, verbalizing agreement or disagreement, or by
acknowledging the speaker’s perspective. Other means of being direct that
the group leader can model are for the leader to openly express their
important feelings as these are experienced during the interactions, and by
giving constructive feedback to speakers.
Reframing and redirecting are also termed relabeling by Weakland et al., 1974;
positive connotation by Selvini-Palazzoli et al. (1974) and noted as a positive
group leadership skill by Agazarian (1997). Reframing occurs by paraphrasing
what the group member said and giving it another perspective that does not
change what the person said. For example, if the member noted that conflict
was upsetting and that they could never be comfortable with it, a reframe
could be saying that they want their relationships to be harmonious.
Reframing is most useful when the speaker’s statements could use another
perspective. Examples include when the speaker is focused on their or other’s
deficiencies, weaknesses or mistakes; they do not seem to be aware of the
positive aspects of the situation or of their effectiveness, or personal strengths.
50 Group Leader Facilitation Attributes and Skills

In addition, reframing is helpful when the speaker has a negative perspective,

such as hopelessness, and reframing to provide another perspective could
show them how to become more hopeful.
Redirecting asks the speaker to look at other parts or aspects of the issue,
problem or concern that they may have overlooked, ignored or do not even
have an awareness that these exist or are possible. Redirecting is similar in
some ways to reframing except that the person is guided to consider the issue,
problem or concern from another direction. Reframing is particularly effective
when used at the group level to illustrate to the group that there are other
aspects and perceptions.

Advanced Group Level Skills

The next set of skills and interventions discussed are usually learned and can
be challenging to develop as some are not consistent with what was learned as
social convention behaviors. Social convention behaviors such as not inter-
rupting the speaker, that others should be soothed, and that others should
always be encouraged and supported. The skills discussed in this section are
encouraging and supporting, blocking, appropriate questioning, and use of
metaphors. An example of how metaphors could be used is also provided.
These are challenging because there are no hard and fast rules for when these
are needed or how to ensure that they are effective.
Group leaders can be very helpful when they provide encouragement and support
as many members are appreciative and may not have received this elsewhere in
their lives. The other side of this is that the encouragement and support may be
a hidden attempt to soothe the member(s) so that they do not experience
negative feelings that would be helpful for them to explore in the group or may
be given prior to understanding the situation in its entirety, or for other reasons
that do not help the members or the group. There is an art to knowing when
this would be helpful. For example, the leader’s encouragement and support
can be especially helpful during the beginning stages of group as group mem-
bers are anxious in the ambiguous and uncertain group environment but is less
helpful when the group is in the third or working group stage where members
work to explore difficult topics and feelings. The use of encouragement and
support is less helpful when they are used to soothe members or when it could
promote dependency that the group leader will rescue them from experiencing,
and other possible depression of personal exploration and learning.
Blocking is used when there is a need to protect group members such as
when a member is being attacked or the group is moving away from an
important topic, or when the emotional intensity is too high for the group to
constructively manage it. Blocking is especially useful when there is monopolizing
and story-telling in the group that is constant over several sessions.
An example of how blocking can be used that will take into account the
speaker and the group is when the leader interrupts the speaker to say that
 Group Leader Facilitation Attributes and Skills 51

they want to stop the speaker and then identifies the rationale for the inter-
ruption such as, saying that they noticed that one member seems in danger of
becoming scapegoated. The leader can then go on to say that it would be
more helpful if group members would report on their thoughts and feelings
about the impact of that member’s behavior on them rather than trying to tell
the member what they want changed.
Appropriate questioning is another term for probing, and knowing when and
how to use questions is a therapeutic skill. Questioning is considered appro-
priate when the group member does not feel attacked or become defensive,
there is a therapeutic rationale for the question such as clarification, and when
questions are not rhetorical. It can be important to learn when not to ask
questions and that it is more helpful to make statements. Brown (1998) lists
three basic uses for questioning: to obtain data and information; to clarify
misunderstandings; and to pinpoint something to take immediate action.
Using questions as a means of showing interest is not appropriate as this can
put others on the defensive. It is especially important that the group leader
should be careful not to ask numerous questions and, to refrain from focusing
on a member and pelting them with questions. Further, much information
sought by asking questions is not necessary or relevant to either accomplishing
the task or developing relationships in the group. Trotzer (1989) notes that
most questions are statements that signal what the speaker wants, especially
questions that are used as probes to guide the receiver to areas the speaker
feels are important.
Metaphors can be the abstract and ambiguous ways that the group is
expressing its issues, problems, and/or concerns and it is an advanced group
level skill to be able to use them to understand and make group process
commentary. The metaphors that emerge in the session are how the group is
talking about itself. Metaphors are things such as images, that are valid in and
of themselves, but that also stand for something else. Metaphors in group
sessions are being used as a nonconscious or unconscious way to express the
issues and relationships in the group. Members can find it easier to express
their thoughts and feelings about the group and its members by using meta-
phors because the real topic is too sensitive to talk about directly, or the topic
is both urgent and important. Whatever the group considers to be important
for the group is being expressed in metaphorical terms in the present. The
group leader uses the metaphor to better understand its relationship to the
group, and how the metaphor is being used by members. These metaphors
can be couched in terms that are realistic or, most often are expressed in
vague, abstract terms that tend to use or evoke vivid imagery or feeling. There
may be the presence or absence of significant affect when the metaphor
emerges and is being talked about, and although one member may express the
metaphor, its expression speaks both for the individual and for the group.
Metaphors tend to emerge when the group is struggling, or is at an impasse,
or when members are resisting awareness of significant material, or fearful of
52 Group Leader Facilitation Attributes and Skills

overwhelming affect, unaware of real issues, and the like, and the metaphor is
needed in order to express what is happening in and to the group.
The next section for the chapter presents the discussion on group dynamics,
group stages, and therapeutic factors.

Group Factors
There are certain group factors that are fundamental to understanding how
and when to intervene in group dilemmas, and are basic to the success of the
group. These factors include group dynamics, stages of group development,
therapeutic group factors, ethics, and cultural and diversity concerns. These
are the factors discussed in this chapter.

Group Dynamics
Group leaders can obtain many clues about the group and its members from
observing the dynamics of the group. These constantly changing factors are
signals about current experiencing for individual members, and for the group
as a whole. The observant group leader takes information, analyzes and syn-
thesizes it, ensures its validity from self-contamination of countertransference
and projection, and then uses this to decide on an appropriate intervention.
This is a process that can be used with individual group members, and with
the group as a whole. First, let’s define and describe the group dynamics that
are the sources of information.
Group dynamics is both a field of study and group processes according to
Forsyth (1999), but Lewin (1951) defined group dynamics as the powerful
processes that take place in the group. Johnson and Johnson (2006) note that
the field of group dynamics is a “twentieth-century, North American develop-
ment” (p. 35) that had its beginnings from many fields and has evolved into an
interdisciplinary field. Contemporary emphases for group dynamics focus on the
continuous movement and progression of the group, and on the interacting forces
that impact the group and its functioning (Brown, 2008).
As more became known about group dynamics and its complexities, more
studies were conducted that produced greater understanding of the helping
and restraining forces that comprise the dynamics. Studies included leadership
patterns (Lewin, Lippitt, & White, 1939) group decision-making processes
response patterns and roles (Bales 1950, 1953), sequential stage theory
(Moreland & Levine, 1988), basic themes (Bion, 1961), norms (Sherif, 1936),
interaction of personal and environmental factors (Lewin, 1951), communica-
tion and cohesion (Thibout & Kelley, 1959), motives and goals (Zander,
1971/1996), conflict (Deutch, 1949), interpersonal attraction (Newcomb,
1963), and communication networks (Shaw, 1964). Much of the early focus
was on the various components and aspects of the group, but as more of the
complexities emerged, more attention was given to the interactions of the
 Group Leader Facilitation Attributes and Skills 53

various dynamics, the importance of group process, and a focus on the group as a
whole. The idea of the group as a whole became more prominent through the
work of Bion (1961) who applied psychoanalytic theory to groups, and this work
added greatly to the understanding of how the whole group functioned. Bion
(1961) proposed three basic assumptions for groups; dependency where members
feel helpless and look to the leader for support, fight/flight where the group feels
in danger and uses one of these actions as a response, and pairing where mem-
bers have hopeful fantasies of being saved and of the group being constructive.
Observation and understanding of the group’s dynamics reveal the current
process for the group, and the identification and understanding of these
dynamics allow the group leader to better intervene, and to help the group
accomplish its task. The basic group dynamics to observe include: level of
participation, communication patterns, feelings expressed, resistance and
defenses, and how conflict is managed.

! Level of participation includes the characteristic interaction and changes

in interactions, input, and responses for individual members and for the
group as a whole.
! Communication patterns include both verbal and nonverbal commu-
nication. The verbal communication patterns can demonstrate inclusion
or exclusion, deference, where the perceived power and influence rests,
group norms, and current emotional state. Nonverbal behavior is the major
and most important part of communication, and is valuable information
about what the group and its members are experiencing at a deep level.
Behaviors such as, voice tone, body positioning, facial expression, body
movements or lack of movement, and clusters of gestures all convey deep
and important messages about current emotional states for both indivi-
dual members and for the group as a whole.
! Feelings expressed can be an important indicator of overt or hidden issues
in the group, as well as indicators for individual members’ emotional state,
sensitivities, and resistance. Hidden, disguised, and suppressed feelings are
important and significant for group members and for the group as a whole.
! Resistance is an indicator of sensitive material that is threatening and
thus, must be defended against, suppressed, or repressed. Acts mobilized
as defenses include denial, deflection, intellectualization, and displacement.
! Conflict can be revealing of the group’s fear, need or wishes, and the
most important signal is how the group manages conflict. Common group
conflict management strategies are denial, suppression, ignoring, and
working to resolve them.

Stages of Group Development

There are certain expected member behaviors that usually occur during the
group’s development, and these are associated with the stage or level of
54 Group Leader Facilitation Attributes and Skills

growth that has occurred for the group. Different theorists and authors may
use different terms for these stages, but the descriptions for members’ beha-
viors and needs have considerable similarities.
Tuckman (1965) was among the first to propose and document developmental
sequences for groups, and this later became known as group stages. These stages
are not separate, distinct or clear cut, but almost all types of groups seem to move
through some sequence of development. The literature shows several ways to
categorize these stages: Forming, Storming, Norming, and Performing
(Tuckman, 1965); Engagement, Differentiate, Individuation, Intimacy,
Mutuality, and Termination (MacKenzie, 1990); Orientation, Conflict,
Cohesion, Stability, and Termination (Yalom, 1995); Formation, Conflict,
Rebellion, and Termination (Weber, 2006), Formative, Reactive, Mature,
and Termination (Rutan & Stone, 2001).
All categorizations include the four stages that are used for this discussion:
Beginning, Conflict, Cohesion, and Termination. The group’s stage of develop-
ment can be a rich source of information about what members’ needs are at a
particular time, can suggest interventions, and can provide clues for difficulties,
challenges and dilemmas that may emerge. This information may be of parti-
cular importance for adult therapy groups who are likely to have sufficient time
available to experience all the group stages.

Stage 1 – Beginning
Stage 1 behaviors are reflective of the behaviors and internal states many group
members can experience in new situations where there is ambiguity and uncer-
tainty. Members are usually anxious about acceptance-rejection, the ability of the
group to meet their needs, the competence of the group leader to care for them
and to guide their changes, what is expected of them, and what will be their role
(s) in the group. Their past experiences with relationships and authority figures
also factor into their behavior, fears, and expectations. Group leaders must stay
aware of the anxiety that the first stage of the group engenders in the group
members, and focus on establishing trust and safety so that the group becomes a
safe place for members’ disclosure, self-exploration, and for contributing to each
other’s growth and development. Creative activities can be very helpful to
address all of these concerns.

! Openly address members’ fears and concerns which will mainly focus on
how they will be cared for in the group, whether they can be helped, and
symptom relief.
! Identify and highlight similarities among members. Groups become
cohesive around shared similarities and fail to become cohesive because
of perceived differences making it essential that the group leader focus on
similarities in the first stage of group development. Creative activities can
be used to identify major and covert similarities among group members.
 Group Leader Facilitation Attributes and Skills 55

! Collaboratively set goals with group members. While the organization of

the group may have a stated goal such as coping with substance abuse, it
is likely that each group member has a different definition of what this
will mean for them. Collaboratively setting goals allows members to
identify the common goals among them as well as their unique individual
goals. This allows the group leader to direct the group to accomplish the
agreed-on goal(s).
! Seek out members’ strengths to build on, as this is much more constructive
than trying to remediate deficiencies. In building on strengths, the chal-
lenges and/or weaknesses are also worked on but the encouragement to
continue to work comes from identifying and emphasizing their strengths.
! Provide symptom relief where possible. No general statement covers all of
the symptoms that members will bring to the group. But the group leader
should understand that symptom relief is most often sought so that
members can feel hopeful that they will be helped. Many members will be
seeking to feel better about themselves, that they can be adequate, and
that the group will be helpful.
! Foster an atmosphere of inclusion in order that group members feel the
group is safe, that they will not be rejected, and differences will be tolerated.
It doesn’t much matter what these differences are; the group’s climate should
be one of tolerating but not necessarily agreeing with differences of opinion,
values, and most of all, toleration of individual differences around religion,
race, ethnicity, identity, and so on.
! Instil realistic hope is a major group leader task. Members may be hope-
ful, but some do not have realistic hope for changes in that they want to
change another person, have someone else be different, ignore medical or
other scientific findings, and desire any number of outcomes from
attending the group that are not achievable, or unlikely to be achieved. It
is essential that the group leader does not foster unrealistic hope.
! Model empathic responding will be very helpful to group members to
help improve their interpersonal relationships both in the group and
outside the group in their other relationships.

Stage 2 – Conflict
Stage 2 is generally characterized by dissention, discord, and disagreements.
Group members are now starting to assert their independence and, just as
toddlers do, they want to both hold on for safety and to let go to explore, but
don’t quite know how to get both needs met at the same time. They lash out
in confusion and frustration, displacing their conflicting needs on others.
These are some of the reasons why this group stage is so uncomfortable and
can pose difficulties for members and the leader. Members challenge each
other and the leader to be both dependent and independent at the same time.
56 Group Leader Facilitation Attributes and Skills

Group leaders have to stay in touch with both sets of needs, to model how to
give and receive constructive feedback to eliminate or moderate negative
aspects of the behavior, teach positive confrontation or enlightenment skills, and
to monitor their old unresolved parental issues that could emerge as counter-
transference. The group leader’s self and skills are very important for the suc-
cessful transition of this stage as how the leader reacts to challenges from
members shows them how the leader perceives them and their roles. When the
leader is not defensive and responds in a positive way, members learn how to be
constructive when expressing disagreements, how to use the information from
the disagreement to strengthen relationships and not allow the disagreement to
be destructive, and guides members to learn new ways of understanding their
reactions and feelings, and new ways to relate and behave. This is a very busy
and potentially rich stage even with all of the discomfort.
Dilemmas and difficulties during stage 2 generally arise around conflict and
fears of being destroyed because of it. Some members fear conflict so much
because of their past experiences that they work hard to suppress any hint of
conflict. By far the most difficult situation that usually occurs in stage 2 is
when the leader is challenged or attacked. This challenge can come from one
or two members, but the challenge also expresses something about what other
members are thinking and feeling. How the group leader reacts during these
challenges plays the most important role in determining the success of the
journey through this stage.
The main group leader tasks during this stage include the following:

! Monitoring self-reactions and possible countertransference to prevent

defensiveness and/or reactive aggressiveness
! Model giving constructive feedback
! Intervene to prevent member to member attacks and other forms of
aggression
! Demonstrate and teach conflict resolution that can strengthen relation-
ships rather than destroying them
! Use opportunities to provide the corrective emotional experience
! Accept catharsis but provide guidance to foster intrapersonal and inter-
personal learning so that it does not remain as just emotional venting

Stage 3 – Cohesion
Often the cohesion stage, this level of group development, can be very productive
for group members. Sufficient trust and safety have been developed so many of
the fears around self-disclosure, acceptance, and positive regard are answered
and are of lesser concern. Time and experiences in the group have fostered
positive connections, the emergence of many group therapeutic factors, and it is
much less scary and threatening to engage in self-exploration of long-standing
issues and concerns. There is a spirit of cooperation, support, and hope in the
 Group Leader Facilitation Attributes and Skills 57

group. Members can be more confident in their self-efficacy, and more willing to
engage in personal risk-taking for disclosure and exploration of issues. There is a
deep intimacy for the group.
The group leader is less active during this stage, letting members be more
independent and interactive with each other. Members become willing to
explore sensitive issues, support and encourage each other, and considerable
therapeutic work is done. Sessions are harmonious; members derive enjoy-
ment and growth and are able to take charge of much of their development at
this point. There are two likely situations that need group leader interventions;
when the group starts to value harmony to the point where feelings are sup-
pressed and members are reluctant or avoid confronting each other, and when
the group engages in “group think” where no differences among members for
values, perspectives, opinions, and the like are tolerated. While the feelings
that harmony produces in the group are comforting and supportive, too much
harmony stifles expression and growth. Group leaders must stay aware of
these possibilities.

Stage 4 – Termination
Most groups have a beginning and ending stage, and the ending stage
should be a part of the planning done in advance of the group’s beginning
(Brown, 2007). The exception for this stage is continuing groups where
members may terminate, but the group itself does not end. In this case,
the planned closure should be for the terminating member, and for the
remaining members who will continue but in a different group because a
member has left the group.
Stage 4 member behaviors include some regression to behaviors from
earlier stages. The potential loss of the established security, connections, and
support can be frightening to some group members, and they can fear being
destroyed without the resources to lean on that the group and leader pro-
vide. Some groups may even produce dilemmas in the effort to prevent the
group from ending. Expected member behaviors can include panic, with-
drawal, sadness, and devaluing of the group experience as defenses against
feeling the loss of the group.
The major leader tasks are to prepare members for separation, and to
become independent and this process should begin about halfway through the
duration of the group. Preparation includes reminding members of the time
boundary, highlighting progress and growth, reviewing personal goals and
accomplishments, and affirming members’ strengths. It could be helpful for
some members to verbalize their fears so as to assess their realism and validity.
The group’s ending is a threshold or boundary, just as encountered in fairy
tales. There will be change, the future is uncertain, and there is concern about
one’s ability to cope.
58 Group Leader Facilitation Attributes and Skills

Cultural and Diversity Sensitivity

It can be extremely important for the group leader to have an understanding of
the need for cultural sensitivity. Culture is a significant influence on everyone’s
development, and many of its lessons are integrated into the person and acted on
unconsciously. In addition, there are different cultures, each with unique char-
acteristics and expectations that were internalized and are now an unconscious
component for the various group members. (Brinson & Fisher, 1999; Chen &
Han, 2001; Colmant & Merta, 1999; Haley-Banez & Walden, 1999; Kim,
Omizo, & D’andrea, 1998; Santiago-Rivera et al., 2002; Sue & Sue, 2003;
Torres-Rivera, Wilbur, Roberts-Wilbur, & Phan, 1999) Thus, group leaders
cannot know all of the cultural influences for every group member, but these
influences will have an impact on the interactions and functioning of the inter-
actions with group members. Group leaders need to have a high level of cultural
sensitivity and competence in order to develop the therapeutic relationship, help
group members set reasonable goals, understand how ethics will be oper-
ationalized, and to build safety and trust (Abernethy, 2002). This is a difficult job
even when group members are native USA citizens, and much more difficult
when group members are immigrants or citizens who continue to practice many
of the aspects of their culture of origin.
It is not possible to provide all the information needed for developing aware-
ness, sensitivity, and competence here as the subject is too broad for adequate
coverage. Readers are encouraged to consult the many books and articles on the
subject, to enroll in courses and workshops, and to consult with experts. The latter
will be especially important when there are group members from varying cultures.
This discussion is limited to presenting some cultural variables that can be
important for many group members. Variables that can be of importance include
the perceptions of authority figures, source of illnesses or other conditions, gender
and gender differences in expressing emotions, the role of family, meaning attri-
bution given to experiences, and language barriers, facility, and understanding.
Authority Figures – the group leader is generally perceived as an authority
figure by almost all group members. Group leaders are the holders of knowl-
edge, the guide for information and understanding, the teacher of skills and, if
a court ordered participation, the determiners or contributors to their fate.
However, there can be varying reactions to group leaders as authority figures
depending on group members’ reaction to authority, such as over compliance
or defiance; their perceptions of your authority as moderated by the leader’s
gender, age, race/ethnicity, and by their attitude toward differences.
Spierings (2004) provides three perceptions about the source for the illness or con-
dition; medical, magical, or religious. Medical refers to the western understanding
that many illnesses and conditions are caused by viruses, bacteria genetics,
environmental factors, and so on. They tend to look for an empirically derived
cause and effect that can be replicated and generalized. There is a considerable
emphasis on research and the scientific method.
 Group Leader Facilitation Attributes and Skills 59

Some cultures, even some in the USA, believe that illnesses and conditions
result from magical outside sources such as: the evil eye, an act of a wizard, or
a curse. They believe that they can only get better and be cured if the person
(usually) performing the magic can be overcome, or if they can find another
source that is more powerful with greater magic.
Religious sources for illnesses and conditions are seen by some as punish-
ment for sins, failing the higher power, or as karma or fate. People can believe
that they must pay the penalty for being who they are, or for what they did or
did not do through their pain and suffering. The source of the condition or
illness is the only one who can cure them or cause relief.
Faith is a huge factor in healing as has been documented in many studies
and can play a major role for many group members. The term, faith, is used
here because the perceptions of the source of the illness or condition relies
heavily on faith – whether that faith is in the medical and scientific profes-
sions, magic, or in religion. Group leaders with members from varying cul-
tures may want to explore what members believe to be the source for their
condition or disease.
Expressing Emotions – Group leaders are encouraged to learn the cultural
expectations for expression of feelings for major countries in the world as these
can be contributors to how or when group members will express their feelings. In
addition to cultural differences, there can be gender differences within countries/
cultures, and there can be unspoken norms about expressing certain emotions,
such as shame, guilt, anger, fear, and disgust. Group leaders cannot assume that
group members are resisting because of personal issues as the resistance to
expressing or exploring emotions could have its basis in the culture of origin.
Another part that merits attention is how feelings are or are not displayed.
In some cultures, even some within the United States, people are not expected
to display their feelings, and can go to great lengths to keep their nonverbal
behavior from reflecting their feelings. Generally, in the USA and some other
western countries, the facial expression is thought to be the prime conveyor of
feelings being experienced by the person. However, this is a fallacy as people
learn through their experiences that it is not always appropriate or safe to
show one’s true feelings on their face. There are other cultures where subtle
nonverbal behavior reveals the person’s feelings, and members of that culture
become expert at reading those signs. It can be helpful to research how emo-
tions are verbally and nonverbally expressed in the culture of origin for the
group members.
The Role of Family – Cultures that value collectivism (the group) over individu-
alism can also expect that the family and its members are intertwined and that
the family makes the decisions for the individual members. Thus, information is
freely shared among family members, and actions taken only after consultation
among them. Group members from these cultures may not consider sharing
information with family members as breaching confidentiality or be able to
implement an action plan prior to receiving family permission.
60 Group Leader Facilitation Attributes and Skills

Expect group members from collectivism cultures where the group leader is
educating all the family of those members. Be very specific in an effort to set
the limits for confidentiality for these members. For example, it can be per-
missible to discuss the factual material and the structure for the group sessions
or group, but not discuss what individual members say and do with people
outside the group, including with their family. Other things that can be shared
are the group members’ personal thoughts, ideas, and feelings about them-
selves and their conditions or illnesses, personal action plans, and sources of
information. If there are varying cultures represented in the groups, this
emphasis and specificity can be extremely important for establishing trust and
safety for other (all) group members.
Meaning Attribution – There are three major systems for attribution of meaning
for experiencing: personal responsibility, fate, and unseen forces. The USA
main culture places a lot of emphasis on personal responsibility and control of
what one experiences. Choices, decisions, and other personal interventions are
emphasized, and people are expected to actively participate in their healing and
recovery, to say nothing of active prevention actions. This expectation is at the
basis of the establishment and the wide use of support and therapy-related
psychoeducational groups where it is postulated and believed that these groups
can help facilitate coping, change, and recovery by providing information,
encouragement, and support, and by teaching specific skills.
There are some cultures where illnesses and other conditions are perceived
as fate or predestination. There was little or nothing the person could have
done to escape this experience. This perspective is closely tied to the spiritual/
religious bias of the culture and emphasizes illnesses and conditions as pun-
ishment for not being or living in accord with those principles, either in the
person’s current life, or in their former life. Group members from cultures
that have this perspective are not likely to take an active role in their recovery
or healing, as they can believe that they have no control or impact on what
happens to them.
The cultures that attribute meaning of experiences to unseen forces are
those that emphasize spirits in nature or from elsewhere, ancestors, and other
people who have magical powers. Group leaders cannot assume that members
from a particular country or culture will have the unseen forces perspective, as
beliefs vary in almost every culture.
There is also a certain amount of fatalism when people believe in the power
of unseen forces, and that the person caused the illness or condition by
themself or their actions. The primary way for getting well would be to
appease these forces, or to overcome them in some way. A group leader can
ask them to describe what they feel they must do, in addition to the medical
or other treatment they are receiving, to address these unseen forces. Do not
ignore or dismiss this perspective as being counter to the medical/scientific
one as it is important for improvement, healing, recovery, and for building
trust and safety in the group that members with these beliefs have some
 Group Leader Facilitation Attributes and Skills 61

acknowledgment of their perspective, and how it could be incorporated into the

more traditional western medical system, and other treatments and interventions.

Culturally Sensitive Group Leader Strategies

There are six basic strategies that can help guide group leaders to be, and to
be perceived as, more culturally sensitive and competent, become open to
learning about cultural differences, limit the amount of information given at
any one time, check to ensure clarity and understanding, use open questions,
use simple words and reduce or eliminate jargon, ask group members for
information about respectful interactions and cultural sensitivities and taboos.
The discussion to this point has emphasized the need to learn about other
cultures. It is helpful when the group leader demonstrates an openness to learning
more about members’ culturally determined expectations. Information from
consultants such as college professors from that culture or who have studied the
culture, books, the internet, and other reference materials, and the members
themselves can be rich resources for needed information and understanding.
Limit the amount of information given at any one time because the language and
concepts can be foreign and new, and because these group members may
need time to mentally translate the information into their native language and
then translate that understanding back to English in order to ask or answer
questions.
It is always helpful to have group members paraphrase or repeat instructions,
information, and so on, to ensure clarity and understanding and this can be
even more important when the group members are culturally different. There
can be times when group leaders think they are saying one thing, but say
something else, and there can be many occasions where members hear and
understand something different from what was actually said. Paraphrasing and
asking them to repeat what they heard, or what they thought was meant can
help prevent errors and misunderstandings.
Use open questions that will give group members an opportunity for
exploration and elaboration. This approach also prevents being pushed in a
particular direction, or to reach a predetermined conclusion or decision that
reflects the group leader’s perspective rather than members’ perspective,
values, and choices. Do not frame statements as questions as this can be
confusing to some people.
Language can be a barrier for culturally different group members, and group
leaders are encouraged to refrain from using professional jargon, and to use as
simple words as possible. It could be vitally important for group members’
understanding and compliance with treatment, learning coping skills, making
needed changes, and so on. Conveying the information so that it is understood
is of critical concern, and group leaders must pay attention to their choices for
words, even if they have to use several simple words instead of one word that
incorporates many complexities.
62 Group Leader Facilitation Attributes and Skills

Spierings (2004) recommends asking group members from a different cul-

ture about basic rituals that convey respect and regard. It could also be helpful to
ask about cultural sensitivities and taboos. It can be helpful to specifically
inquire about how to say hello and goodbye, greeting rituals and gesture,
correct titles for addressing them, such as Senor, Señora or Doctor, sequence
for names, as not all cultures put the family name last, the extent of eye con-
tact that is acceptable, unacceptable nonverbal postures, gestures, and body
positions, acceptable physical space or proximity, perceptions about authority
figures, sensitive topics, such as religion, history, relations with the US, and
politics, and how status or “face” is maintained. There are many culturally
determined ways to show respect and regard and conversely,
many ways to unintentionally insult or offend.

Therapeutic Factors
The importance of factors conducive to promoting therapeutic progress, healing
and change for group members has received attention in the literature (Corsini
& Rosenberg, 1955; Kivlighan & Mulligan, 1988; Colijn et al., 1991; Kivlighan
& Goldfine, 1991; Crouch et al., 1994; Fuhriman & Burlingame, 1994; Yalom,
1995; MacKenzie, 1990; Dies, 1997; Fuhriman, 1997; Kivlighan et al., 2000;
MacNair-Semands & Lese, 2000; Kivlighan & Holmes, 2004; Tschusckke &
Dies, 1994). What has emerged from these studies and reviews is confirmation
of the impact of behaviors and attitudes that are clustered as categories for
therapeutic, curative, and change; some are common and valued for all types of
groups, some differ in their importance and value depending on the type of
population; and that there are few guidelines for leaders on how to foster and
encourage the emergence of these factors.
These factors have been given various titles, but can be generally categorized
as Yalom (1995) presented them. These 11 factors are: universality, instillation
of hope, altruism, interpersonal learning, imparting information, catharsis, cor-
rective recapitulation of the primary family group, imitative behavior, existential
factors, socializing techniques, and cohesion. Universality contributes to therapy
by emphasizing commonalities among group members, reducing their feelings
of alienation, of being alone in their struggles or misery, and/or that they are
weird or significantly different from others in negative ways.
Hope is very valuable in providing motivation to continue the struggle and
provides a feeling that the struggle will pay off in meaningful ways. Hope can
increase members’ self-perceptions of worth and value to others and to the
universe and is inspiring.
Imparting information is not advice-giving. Rather, this therapeutic factor
decreases ignorance, empowers the receiver to act on their behalf, and
increases solution development for problems.
Interpersonal learning allows members to increase self-knowledge and self-under-
standing through feedback from others. This feedback provides the personal with
 Group Leader Facilitation Attributes and Skills 63

information that others can see, but is usually not seen by them but could be
important for relating and communicating with others as well as achieving a
greater understanding of their thoughts and feelings.
Existential factors are usually present in all groups although these may not be
visible or prominent. The therapeutic awareness and discussion for these factors
are encouraging to members as these discussions promote awareness that these
issues do not have solutions (e.g. the indifference and unfairness of the universe);
that all humans struggle with these issues throughout their lives; and that each
person has a unique approach and resolution for these factors.
Catharsis can bring relief when suppressed or repressed intense feelings are
expressed and seeing that this does not destroy oneself, others or relationships.
However, in order to be most effective the emotional venting must be
accompanied by a greater understanding of oneself through receiving
empathic responding, differing perceptions or other feedback that promotes
self-understanding.
Socializing techniques are very useful for almost all group members. Teaching
members these techniques demonstrates how they can initiate meaningful con-
nections to others, reduce behavior and attitudes that prevent connections, and
increases awareness of others-in-the-world as separate and distinct individuals.
Imitative behavior is demonstrated by both the leader and members. Members
can learn and practice new and more effective ways of behaving to get needs
met, develop more constructive attitudes through seeing the modeling behavior
of others that is more effective than their present behavior.
The corrective emotional recapitulation or reenactment of the family of origin makes
a valuable contribution to therapy by providing a new perspective for old hurts,
resentments, and relationships that can promote healing, forgiveness, and
changes.
Cohesion provides the necessary conditions for the productive or working stage
of the group. This is therapeutic because the group has reached a point where
members experience feelings of belonging, connectedness, and productivity;
they have learned the benefits of cooperation versus individual efforts, and there
are increased feelings of satisfaction with self and with others.

Summary
This chapter describes the basic group facilitation skills for all groups but may
be especially important for the leaders of groups who plan to use creative
activities. The brief overview of group leader attributes, communication skills,
process and process commentary, and developmental group stages are inten-
ded to assist group leaders in their selection of creative activities that will be
helpful for group members and for the group during the various stages of
group development. Also, this discussion may be helpful for group leaders in
facilitating the outcomes for these activities for further personal exploration by
group members.
64 Group Leader Facilitation Attributes and Skills

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Chapter 4

Art Activities
Drawing and Collage

Introduction: Drawing Activities

There are few studies on art activities in groups especially for drawing and
collage. Most studies are about the uses of art activities with individuals, or
with large numbers of subjects that are not in a group therapy setting, such as
the 133 subjects in a study on drawing and pain by Ohnmeiss, Vanharanta,
and Elkholm, 1999, where the subjects were not in therapy groups. Only one
study was found where group members participated in a drawing activity.
Nowicka-Sauer (2007) reported on the results for three of 38 women with
lupus (SLE) who participated in a group session. The analyses concluded that
the drawings were a rich source for understanding patients’ perceptions of
their condition, and the psychological dimensions for living with it.
Numerous studies point to the efficacy of drawing with individuals as a
means for expressing thoughts, feelings, and ideas about their issues, condi-
tions, or concerns (Gonzalez-Rivera & Bauermeister, 2007; Ohnmeiss et al.,
2000; Hopperstad, 2008; Lev-Wiesel & Liraz, 2007; Guillemin, 2004). These
studies were conducted in many countries – Puerto Rico, Sweden and Fin-
land, Norway, Israel, England, and the United States – and with all ages, and
variety of conditions, all of which emphasizes the multicultural applications for
drawing. What is missing and very much needed are studies on drawing as an
activity in group therapy where the focus is not on interpreting the drawing
product, but is used as a means to facilitate members’ expressions, present
them with new personal awareness and understanding, demonstrate and
highlight similarities among group members, and overcome resistance in a
non-threatening and supportive manner.
The use of drawing described here does not require specialized training,
such as with art therapists, nor are the products interpreted by the group
leader. Drawing is used as a means for individual expression for current
experiencing by group members, and if any deeper or past concerns or issues
are tapped, the individual themself identifies these. The group leader is the
facilitator only for this exploration and does not act as an interpreter for the
drawings.

DOI: 10.4324/9781003251989-4
68 Art Activities

Benefits and Advantages for Drawing Activities

What are some benefits and advantages for drawing in the group setting?
Discussed are uncontaminated expressions, focusing awareness, bypassing
defenses, identifying important components, relieving tension, and helping to
organize chaotic thoughts and feelings. Each benefit and advantage also has a
sample activity to illustrate the focus:

! Focuses awareness on important aspects of self that were nonconscious or

unconscious
! Bypasses some defenses, such as intellectualizing
! Assists members in identifying important components or aspects of self,
problems, situations, and so on
! Can relieve tension, and give an opportunity for play and creativity
! Helps to organize chaotic thoughts and feelings

Uncontaminated Expressions
Drawing can allow each member to express personal thoughts, feelings, ideas,
and awareness at the same time, and these will not be contaminated by hearing
what others have to say. Group members will have numerous and dynamic
unspoken and unexamined thoughts, feelings, and ideas during group sessions.
These are unspoken for a variety of reasons, but major reasons are the need to
have only one person speak at any given time, and the time available in a group
session. To these are added individual members’ tendencies to minimize their
experiencing, fear the potential for embarrassment for speaking about this
experiencing, fear of offending, suppression to avoid conflict or other disagree-
ments, a need to appear in control and competent, and many other such states.
All expressive processes could facilitate expression, and drawing is one activity
that group leaders will find useful.
In addition, some members may have limited vocabularies and do not have
sufficient words to verbally express their thoughts, feelings, and ideas. They
may try to express these, but can become frustrated and/or be shamed when
their words are inadequate expressions for what they are thinking and feeling.
Drawing can provide another means for expressing these; allow complex and
complicated thoughts, feelings, and ideas to be simplified and expressed; and
can be reassuring and encouraging for the person that they can be understood
in spite of the limited vocabulary.

Guidelines for Drawing Activities

The basic guidelines for activities are presented in Chapter 2. Presented here
are the preparation steps for drawing activities; gather materials and prepare
expansion and enhancement topics.
 Art Activities 69

Gather Materials
Drawing materials for these activities are very simple and modest. It is
recommended that the following materials be gathered in advance of group
sessions so as to have them readily available:

! Several sizes of drawing paper, 8½” " 11” and larger. Look for pads of
newsprint.
! Sets of crayons, felt markers, or colored pencils sufficient so that each member
can have a set, or so that no more than two members have to share these.
! Pencils and/or pens for drawing.
! Unlined index cards, 3” " 5” and 5” " 8”.
! Masking tape for mounting products on the wall or board.
! Other kinds of drawing paper if you desire.

Prepare Expansion and Enhancement Topics

When you have a lot of experience under your belt, you’ll already have your
topics ready to use in the group. But, until you do gain this experience, it will
be very helpful to develop your exploration and enhancement topics in
advance, and to write them on an index card. The topics should relate to the
purpose for the drawing activity, members’ triggered feelings, other associations
and awareness that may emerge, and similarities among group members. These
topics are usually presented in the form of open-ended questions for members
to respond to, such as the following:

! What feelings did you experience as you completed your drawing? As you
reported to the group?
! What are you aware of as you look at your drawing?
! Are there any associations with past events, people, or unfinished business
that emerged for you?
! What was easy or hard about the task?

Each of these can serve as a stimulus or guide without overly structuring the
responses, and can permit members to have their own unique personal experiences.
Following is a sample drawing activity that may help some members with
expressing their feelings.

Activity 4.1 Express Feelings

Materials
5” " 8” unlined index cards, a set of crayons, colored pencils, or felt markers
for each group member.
70 Art Activities

Procedure
1 Distribute materials.
2 Ask group members to draw symbols for three to five feelings they think
would be easy to express in the group.
3 Give time for members to share their symbols and feelings, but don’t
explore these unless the group member does so on their own. Give only
empathic responses.
4 Turn the cards over and have members draw symbols for three to five
feelings they think would be difficult to express in the group.
5 Repeat step three, only this time try to get members to assess if the difficulty
is of long-standing such as wanting to be liked, or if there is something about
the group, or if they are unaccustomed to expressing these feelings.

Focusing Awareness
Each expressive process has the potential for focusing members’ awareness,
and a carefully selected drawing activity can increase their awareness for
important aspects of their selves. The act of drawing can reveal current
experiencing which, in turn, provides associations in the present to past events,
issues and concerns that were not immediately apparent on the conscious
level. For example, completing the life satisfaction activity described later in
this chapter could enable members to identify current areas of concern that
had not yet risen to the level of awareness, to become more aware of positive
lifestyle behaviors and relationships, and to increase awareness of how their
past continues to influence them in unanticipated and unexpected ways. The
following drawing activity demonstrates how an activity can be used to help
group members to become more aware of their immediate reactions.

Activity 4.2 Immediate Awareness

Materials
Paper and crayons, colored pencils, or felt markers, and a suitable surface for
drawing.

Procedure
1 Distribute materials.
2 Ask group members to draw symbols or representations for all the awareness
they have at this moment for themselves, other group members, and for the
leader. The symbols are for their thoughts, feelings, sensations, and so on, at
this moment.
3 Allow five to ten minutes for the drawings.
 Art Activities 71

4 Reporting phase – ask members to first share their symbols.

5 When time permits, the expansion phase can give members an opportu-
nity to explain their meanings for their symbols, to note similarities and
differences among the members, and to express the feelings that emerged
as they drew and talked about their symbols.

Bypass Defenses
Drawing tends to bypass defenses that prevent material from emerging into
awareness. The act of concentration on what is needed to produce a product
puts the energy that was used to suppress or deny into creating. Some people
may be able to consciously lower their defenses, while most everyone can be
unaware when they are mounting their defenses, and neither can be aware of
what they are defending against. Becoming aware of how and when personal
defenses are used can lead to an understanding of the material being defended,
and these are major assets for constructive and productive therapy. Following is
an activity that can assist members in understanding their usual defenses.

Activity 4.3 My Defenses

Materials
Paper, at least two to three sheets per group member, and a set of crayons,
colored pencils, or felt markers.

Procedure
1 Find a suitable place for group members to draw and distribute the
materials.
2 Introduce the activity by telling group members the following:

Everyone uses defenses at times, and the defense is to prevent the person from becoming
hurt, either by others seeing something that they wish to keep hidden, or to keep yourself
from knowing something about you that you fear may be hurtful or dangerous. Defenses
are usually unconscious, that is the person is unaware that they are using a defense. The
activity is intended to increase your awareness of when a defense is being used by you or
by others. There will be two components: a drawing of what a defense looks like when
used by another person, and what a defense you use looks like. The drawing can be
representational, such as drawing a scene where you observed or used the defense,
abstract, or symbolic. Following are some common defenses, and you can select a defense
for your drawings, or two separate defenses one for each drawing. Here are some
examples of commonly used defenses, and there are others. (Note: the leader can either
give each member a list like the following or write them on a chalkboard or a piece of
large paper for posting. The leader can also add to this list.)
72 Art Activities

! Intellectualization – analyzing or interpreting something to make it a content or

factual discussion
! Deflection – such as changing the topic or focus
! Denial – refusal or inability to admit the existence of something that is painful or
anxiety provoking, either internal or external
! Displacement – feelings toward one person that are transferred or placed onto
another person
! Projection – putting onto another person something you don’t want to accept about
yourself, and then acting toward the person as if they had what was projected
3 Members are to prepare two drawings, one of an observed defense that
someone else used, and one for their own defense. Ask members to title
both drawings.
4 Give a time frame to complete the drawings and remind members when
close to the ending time so that they know that production time will be
expiring in five or so minutes.
5 Reconvene the group in a circle and have members describe their draw-
ings for the reporting phase.
6 The expansion phase is used for members to describe the experiences,
such as asking about their feelings that emerged while drawing, and when
they saw other members’ drawings, and when displaying their personal
drawings.
7 Summarize what emerged during the reporting and expansion, and if
time permits ask members to discuss what awareness emerged for them.

Identify Important Components

It seems to be usual and common for people to try and get away from dis-
comfort, especially mental discomfort that produces feelings of shame, guilt,
inadequacy, incompetence, and/or impotence. We worry and fret because
solutions are not apparent; we fear the possible or real negative consequences
for action or inaction, there can be confusion about personal needs and
wishes, and a whole host of other reasons that the important components and
aspects of self, situations, problems, and the like are not fully examined.
A drawing activity can help to focus on these important components.
Associations the member may produce can possibly help clarify the following:

! Central figures for the concern or problem

! Personal feelings about others that are involved
! Barriers and constraints that may interfere or prevent solution or
resolution
! Presence or absence of hope for the situation or relationship
! Possible decisions, alternatives, and/or solutions
 Art Activities 73

An example of an activity that could help clarify the most important components
follows.

Activity 4.4 My Concern(s)

Materials
Sheets of paper and a set of crayons, colored pencils, or felt markers, and a
suitable surface for drawing.

Procedure
1 Distribute materials and explain the objective of the activity which is to
clarify personal concerns.
2 Ask group members to draw a picture that captures the essence of their
most important problem, issue, or concern at this moment.
3 Drawings are shared and during this reporting phase the leader listens to
determine if the concern is clear, can be addressed in the group, or if
further clarification is needed.
4 The expansion phase could ask members to describe what would be a
satisfactory outcome for their concern, and if it can be accomplished in
the group.

Relieve Tension
Do not underestimate the positive aspects for relieving tension for individual
members and for the group as a whole. Some measure of tension and dis-
comfort can provide fertile ground for exploration of meaningful material.
However, when there is too much tension, and too much is ambiguous, then
members’ energies are used to defend and protect the self. They sense danger
all around and can shut down. No productive therapeutic work can be
accomplished under these conditions.
A drawing activity can be used just for play, or to focus on what in the
group seems dangerous and causing the tension, or to increase members’
awareness of the presence and effect on them for being tense. For example,
they could do an activity that asks them to draw what their thoughts, feelings,
and bodies experience when they are tense. Another example follows.

Activity 4.5 Tension

Materials
Sheets of paper and a set of crayons, colored pencils, or felt markers, and a
suitable surface for drawing.
74 Art Activities

Procedure
1 Introduce the activity by noting that body tension is often overlooked or
minimized, and that the activity is designed to bring awareness of tension
in the body.
2 Ask group members to draw a symbol, figure, shape, or the like for what
tension feels like in their bodies, noting where it is located by putting the
symbol on the following parts of the page.
a Tension in the head, face, neck at the top quarter of the page.
b Tension in the shoulders, chest, arms, or stomach (above the waist)
on the second quarter of the page.
c Tension in the abdomen, pelvis, lower back, etc., on the third quarter
of the page.
d Tension in the legs and feet on the bottom quarter of the page.
3 Ask members to share their drawings. The group leader can ask them to
rate (1–10) the extent or intensity of the felt tension.
4 The expansion phase could ask if the tension was more or less while they
were drawing, after drawing, and/or did it increase or decrease when
reporting.

Organize Chaotic Thoughts and Feelings

Organizing chaotic thoughts and feelings can be of immense help to group
members. Instead of staying mired in the chaos, shutting down, or avoiding
the chaos, members could learn to deal with this for now and for the future.
There is something important that can be learned about oneself through
working with the chaos rather than ignoring it, or denying that it exists.
For example, it is expected that members will experience some chaotic
thoughts and feelings at the beginning of the group. They are concerned
about their safety, inclusion, and other such matters as well as the problem or
concern that brings them to therapy. A simple drawing activity that focuses on
the major feelings, or concerns about the group can reduce the chaos and
focus members on the more important aspects of what they are thinking and
feeling at the time. Further, commonalities can be revealed fostering the
emergence of universality in the group. An example of an activity follows.

Activity 4.6 Organizing Internal Chaos

Materials
A list of possible feelings such as the one that follows or create a list that seems
to fit the group, sheets of paper, crayons, felt markers or colored pencils, and a
suitable surface for drawing.
 Art Activities 75

Procedure
1 Prepare a list of possible feelings members may be experiencing in
advance and make enough copies for each member.

Feelings

Dread Hopeless Fear Irritation

Anger Embarrassment Guilt Shame
Anticipation Excitement Relief Numb
Despair Lost Happy Sad
Hopeful Contentment Restless Inadequate

2 Distribute the lists and drawing materials.

3 Introduce the activity by telling members that they may be experiencing
multiple feelings, with some more important than others. Ask them to read
the list of feelings, add any that they are experiencing but are not on the
list, and then to select a different color for each important feeling and
draw a symbol for each of the feelings on the sheet of paper with the most
intense feeling symbols at the top, and the least intense at the bottom.
4 After the drawings are complete, members are asked to share their draw-
ings where they will describe the symbol, and the intensity.
5 Summarize the feelings drawn, and ask them to rate the intensity of those
feelings now as the activity is ending.

Many other expressive processes, such as fairy tales, can use drawing as a means
for personal expression. The drawing then becomes a focus on the essence of the
experience that can help identify the most important components and associations,
and will capture the essence of the personal experience for the individual group
member. Members can then report these experiences, associations, ideas, and so
on, without unconscious contamination from that of other group members, which
can happen when listening to them. This can be especially true for children. Fur-
ther, members who may think or fear that something they experience is trivial or
unimportant, especially when compared to what other members may report, can
concentrate on their personal experience without evaluating it as being of lesser or
no importance. It is important for that particular person where, what appears on
the surface to be minor conceals a deeper and more significant concern or issue.

Guidelines for Group as a Whole Drawing Activities

The primary guides for using a group-focused drawing activity are barriers
and constraints and selecting an activity. Although there are many good and
valid reasons to use a drawing activity, there may also be some barriers and
76 Art Activities

constraints. Do not fail to anticipate or recognize these as they can negatively

affect members’ feelings about the group, the amount and kind of learning
and insight that can occur, and may even be harmful in some instances. The
group leader is in the best position to identify these possible barriers and
constraints. Examples include the following:

! Physical conditions that would prevent one or more members from

drawing, such as a broken arm on the dominant side, or severe visual
problems.
! Cognitive deficits that would interfere with following directions and/or
gaining self-understanding.
! Insufficient time in the session to complete all portions of the activity.
! Inappropriate or insufficient working space. While some accommodation
can be made to provide a flat hard surface for drawing, having to make
do could be frustrating and thereby negatively affect outcomes.
! Using a drawing activity that is too complex and/or complicated for
group members.
! Emotional vulnerability of one or more members to the material so that
overly intense emotions will be generated by the activity.
! Group members fearing shame and embarrassment about their drawing
ability.

Some barriers and/or constraints can be worked around, but some signal that
a drawing activity is contraindicated, such as when one or more members
cannot physically draw, or follow directions, or there is insufficient time to
complete the activity. On the other hand, if all members can participate, an
activity to relieve tension doesn’t usually present barriers and constraints. The
guiding principle is that the group leader gives some attention to consideration
of potential barriers and constraints.
Selecting a drawing activity can be fairly easy as many are presented in this
book and are readily available from other sources. Almost all presented here
can be adapted or modified for the specific group’s purpose, and to meet the
abilities of group members. Other considerations for selection include the
following:

! The focus should be narrow and specific. Too much complexity can be
confusing and use the time and energy that should be on the purpose.
! The concepts illustrated should be easily understood by group members.
! Drawings need not be representative. Symbols, splashes of color, and
other abstract expressions can be helpful for some clients.
! Group members’ abilities should fit the drawing requirements.
! All materials should be readily available for every session.
! The drawing action should be relatively short as the most important tasks
are reporting, and the exploration and enhancement phases.
 Art Activities 77

Group leaders may want to collect some activities that they’ve experienced
and found useful. These then become activities that can be adapted for var-
ious purposes and audiences. It is helpful to remember that the drawing itself
is the stimulus for members’ personal material and associations, and that is its
main purpose and value. Almost any drawing can be the stimulus so you don’t
have to spend an inordinate amount of time searching for the activity that will
be perfect.

Examples for Group-Focused Activities

Presented are some examples for activities with a group focus. Other activities
may be found in the chapter on Applications.

! Assisting introductions in the first session

! Relieve tension
! Clarify members’ wants, needs, desires, and wishes
! Identify barriers and constraints for the group, such as resistance
! Teaching members how to give and receive constructive feedback
! Practice problem-solving and decision-making
! Provide a means for expressing difficult, unpleasant, and/or unacceptable
feelings
! Foster the emergence of therapeutic factors such as universality, encouraging
hope, catharsis, and identifying unresolved family of origin issues and other
unfinished business

Introductions can be facilitated with a short drawing activity where group

members are asked to present something non-threatening about themselves.
The anxiety and uncertainty that members can experience can make them
resistant to revealing anything they consider to be potentially embarrassing, or
that will lead to rejection and exclusion. There can be apprehension about
letting oneself be seen by others as these are strangers, or even when the other
group members are known to each other. Some group members will be
unsure about what personal information to disclose, some members may not
be articulate, some can be wary and cautious, and other such states where an
activity could be facilitative. Two examples for introductory drawing activities
are as follows.

Activity 4.7 Saying Hello

Materials
5” " 8” index cards, and a set of crayons, or colored pencils, or felt markers
for each person.
78 Art Activities

Procedure
Ask members to use the crayons and draw a symbol for each of the following:

! Favorite pastime
! Valued possession
! Favorite color
! Favorite season of the year

Activity 4.8 My Accomplishments

Materials
5” " 8” index cards, and a set of crayons, or colored pencils, or felt markers
for each person.

Procedure
1 Ask members to introduce themselves by drawing a symbol for each of
the following:
! Greatest achievement
! A talent and how it is used
! An aspiration, and how they are working on this

Relieving tension could be of value to the group, especially when that tension is
retarding group progress. Tension is a result of fear, and each member can fear
something different, but the outcomes are the same. For example, it doesn’t
matter if one member fears being shamed, another fears offending, another
fears being attacked, someone else fears being rejected, and another person
fears appearing stupid. They are all tense, fearing the worst. The group
leader may not know the individual fears, but is very aware of the tension.
A short drawing activity could help relieve some of the tension so that the
group could move forward. If the tension occurs during the beginning
stage of group development, the drawing activity should be something light
and non-threatening, such as the introductory activities presented previously.
Examples of activities for the second stage (conflict) are presented in
Chapter 11. Other tension-relieving activities are presented in the section
on mindfulness in Chapter 7.
Clarifying wants, needs, desires, and wishes can assist members in making realistic
choices and decisions, becoming aware of illogical and unrealistic thoughts
and expectations, obtaining a clearer focus and/or achievable goal, and in
identifying self-imposed and externally imposed barriers and constraints. Lack
of knowledge, chaotic circumstances, insufficient self-understanding, and other
such states can make it difficult for group members to have a clear sense of
 Art Activities 79

what they want, need, desire, and wish for, and the extent to which these are
reasonable, achievable, and will lead to the desired outcome(s).
When members have a clearer understanding of needs, wishes, desires, and
wants they can be more motivated to have a realistic action plan, to relinquish
unrealistic fantasies and expectations, to make needed changes, and to gain
self-confidence. They begin to explore avenues that serve as alternatives to
achieve the goals, to learn strategies to work around or overcome barriers and
constraints, and to understand how they are contributing to not getting what
they want, need, wish for, or desire, that is both realistic and achievable.
Giving up the fantasies will be the most difficult task, and this can take
considerable effort. Common fantasies include the following examples:

! The other person must or will change.

! Unlimited wealth, success, and the like.
! Attention and/or admiration will be theirs without effort.
! All others will perceive them as unique and special.
! Effortless winning of others’ approval and acceptance.
! Others will read their minds and give them what they want or need at all
times.
! They will be powerful enough to make others bow to their will, to change
others, to tell others what they need to do or be, and this will be carried
out without dissent.
! They will never have to suffer or worry, and will be happy all of the time.
! They can do what they want to without negative consequences.

Drawing activities can be a non-threatening way to make resistance visible, to

heighten awareness of its existence and possible reasons for this, and to suggest
ways to moderate or eliminate it. A further positive outcome could be an
understanding of personal resistance and its role and contributions to forming
and maintaining meaningful relationships.
It is generally not helpful to directly attack resistance as this can solidify
defenses, or leave the person unnecessarily vulnerable to overwhelming emo-
tions and/or memories. It is much more helpful when the person themself
chooses to explore the resistance and make a decision to let go of it. These are
some of the reasons why it is best to let resistance alone, and to use some non-
threatening means to highlight it. Word choice can make a difference also as
some members can perceive resistance as wrong, feel guilty or shamed, instead
of being open to exploring the personal function the resistance is serving.
When introducing an activity to highlight resistance, use phrases such as the
following (Activity 4.9 illustrates how an activity could be used to get around
barriers and constraints such as resistance):

! What in the group, or in yourself, feels like it’s getting in the way of your
participation, or disclosure, or feeling safe, or the like?
80 Art Activities

! What feedback do you want to give or receive that is absent?

! What does this group feel like to you?
! Describe, or use a symbol to depict the space between you and other
group members.

Activity 4.9 Wishes for the Group

Materials
Crayons or a set of colored pencils or felt markers, paper.

Procedure
1 Introduce the activity by telling group members that it could be helpful to
get each member’s perception of the group.
2 Ask members to select a different color for each and to draw symbols for
each of the following:
! The most important wish they have for the group
! What seems to be a constraint or barrier in the group
! What they want or need from other group members
! An overall feeling about the group
3 When members have finished their drawings ask them to present them to
the group.
4 After all sharing and responding is complete, ask members to title their
drawings and report these to the group.
5 Summarize the essence of the drawings for how members are feeling
about the group.

Constructive feedback is very helpful to group members and the group’s progress,
and members’ growth and development are facilitated by such feedback. It is
most likely that group members will have to overcome fears for both
receiving and giving feedback, and will need to be taught how to make their
feedback constructive. Drawing activities could be facilitative for focusing feed-
back, verbalizing fears about offending and rejection, show commonalities
among members, and as a means for giving constructive feedback that can be
accepted and used.
Drawing activities can facilitate the focus for feedback and, at the same
time, reduce the potentially threatening nature of the feedback since all group
members will be participating, no one member is singled out to receive feed-
back or is put on the hot seat, and the group leader structures and direct the
activity to focus on important aspects of the self. For example, group members
could be asked to draw a symbol for a characteristic they have observed about
every member. Another facilitative activity could be to have group members
 Art Activities 81

draw symbols, or select a color for the apprehensions and/or fears they have
about giving or receiving feedback.
Problem solving and decision-making can usually be accomplished by having
members set goals, determine steps to reach the goal, identify constraints, and
develop an action plan. However, there are times when members are so con-
fused and frustrated that they cannot see their way clearly to work through
these procedures. This is where drawing activities could be of assistance.
For example, a drawing activity could help members realize that their wishes
and fantasies are getting in the way of their problem-solving or interfering with
making decisions. They are not using their resources or competencies, they are
insisting that others change to suit them, or that magic will change circum-
stances so that they can prevail. The activity could clarify their unrealistic
expectations, thus clearing the way for them to work through a constructive and
productive procedure.
Drawing activities can also suggest alternatives to address problems or other
options for decisions. The resources of the group can be used in this way for
each group member to address their problem, or could be used for each
group member to propose alternatives for one member’s problem or decision.
Projecting outcomes and consequences can suggest new strategies, or even use
a combination of the proposed alternatives and options. This use of drawing is
another way of collaborative brainstorming that permits each member to
create ideas and to share them.

Activity 4.10 Desired Outcomes

Materials
Crayons, or colored pencils, or felt markers, paper for drawing.

Procedure
1 Ask members to close their eyes and go into the future and see the desired
outcome they want. Stay with the picture for a while, noticing as many
details as possible, and their feelings.
2 Give a few minutes for the pictures to emerge, and then tell members to
open their eyes and draw what they saw.
3 The group leader should respond empathically during the sharing period,
but don’t explore or point out the illogic or unreasonableness of the
desired outcome.
4 After sharing is completed, ask members to rate the possibility of the
desired outcome, and its reasonableness. This is shared among members.
5 The final step is to have members describe what steps they could take to
get the desired outcome, or to change their longing to a realistic outcome.
82 Art Activities

Expression of feelings can be expedited with drawing activities as these don’t

require words that members don’t have, or are unable to verbalize, seem
threatening or dangerous for various reasons, are unacceptable, appear to
be potentially shaming, and/or are abstract, complex, and difficult to
describe with words. There are numerous reasons why group members
could be assisted in expressing their feelings, and drawing could be one
way to facilitate this.
There are also some group situations where drawing could aid emotional
expression.

! Members who tend to intellectualize, story-tell, or monopolize would not

be able to hide behind words.
! Members who are avoiding expressing their feelings because these are
troubling or intense would have an opportunity to express these.

If there is conflict, or denial of conflict, a drawing activity could aid expressing

emotions that accompany the conflict without having to directly address the
threatening conflict. Examples of other creative activities for group focused
concerns are presented in other chapters and are a focus for Chapter 11.

Collage
This section describes how collage can be used in and with group therapy,
possible uses for flats (paper-doll representations of self or pets), and other
expressive activities that are difficult to categorize. Collage is just another
creative format for expression that can be more appealing for people who are
apprehensive about drawing. Being asked or expected to draw can raise many
fears about personal adequacy and rejection by others. Collage is much less
threatening and group leaders will face much less resistance.
Aimone (2000) defines collage as being any material that is attached to a
surface, simple or complex, and constructed without boundaries or rules.
Because collage is truly a combination of art and crafts, it is well suited for use
in therapy groups where expression is more important than artistic talent, and
where literally anything goes.
Effective use of collage begins with the group leader’s understanding and
practice in construction, especially if this is not something that is in the
leader’s repertoire. Although a workshop or class can facilitate the learn-
ing, these are necessary as there are many books and internet-accessible
resources to use as guides. This chapter will describe collage constructions
and uses for groups. The first part of the discussion focuses on the leader’s
development, and then presents possible uses.
The Group Leader’s Development for Using Collage – This will be described in
phases assuming that the leader has little or no experience with using collage.
 Art Activities 83

The first phase is an introduction, the second is practice, and the third is
forming activities for the group.
During the introductory phase, go to exhibitions or galleries and look at artistic
collage works to get some notions about how these are constructed, materials
used, and what is being depicted or expressed. You are most likely to find that
anything and everything can be used in construction, and that there are many
forms of expression. It can also be helpful to read some magazines as there are
numerous ones on the market that are intended for non-artists, particularly in the
craft and scrapbook sections. These usually have numerous examples illustrated,
and descriptions provided for many of the techniques used. In some ways you
don’t have to leave the introductory phase as you can continue to gather new
ideas and techniques for a very long time.
The next phase is the practicing phase, and this can be fun and enlightening. It
is essential for the group leader to become familiar with some of the techniques
used for constructing collages, as these will be needed for phase three, and may
be needed as illustrations for group members. All suggested procedures and
techniques are brief so as not to lose the focus and purpose for the group.
Following are three practice collage activities that can also be used later in
the group.

Activity 4.11 My Fave Five

Materials
A 5” " 8” index card, glue stick, scissors, and a favorite magazine or sales
catalogue.

Procedure
1 Search the magazine for pictures that represent some of your favorite
things, such as something you like to do, something that gives you plea-
sure, symbols for anything in your life that you favor. Cut out the pictures
and symbols.
2 Arrange these on the index card, trying different arrangements. These
don’t have to be symmetrical or straight.
3 After the arrangement suits you, carefully remove the elements, and use
the glue stick to replace them on the card.
4 Title your collage.

Variations
Use sheets of paper, or smaller index cards; have pre-cut images that group
members can select from; use torn paper to back the images and provide a
frame.
84 Art Activities

Activity 4.12 Just Play

Materials
A sheet of heavy, smooth, unlined paper; white glue or a glue stick; a collection
of paper and/or paint chips in one family of color, e.g. all purples; and scissors.
(Note: you need a variety of colors, but not much paper.)

Procedure
1 Cut or tear the paper and/or paint chips into various sized triangles and
mix them in a pile.
2 Select a handful of triangles and let them fall on the paper. Do this sev-
eral times.
3 Note the arrangements as they fall, and when you find one that is
appealing to you, note the placement of the triangles, and carefully
remove them. Replace them in the arrangement after putting glue on the
back of the triangles.
4 Title your collage.

Variation
Include triangles with words or images.

Activity 4.13 Collage with Shapes

Materials
Newspapers, magazines, and/or other print publications in black and white, e.g.
brochures and catalogues; a sheet of paper 8½” " 11” or larger; scissors; a glue
stick; a black sheet of paper and a white sheet of paper; and a variety of small
objects such as buttons, bottle caps, string, and the like.

Procedure
1 Decide first on what shapes you want to use, for example: hearts, flowers,
stars, or some other simple image. If you have something like a cookie
cutter that you can trace around, this could be your shape.
2 Trace the shape on the newspaper or print publication that you decide to
use, and either tear or cut out the shape. You will need three to four large
shapes, or six to eight smaller ones. If you need more shapes after you
start creating your collage, you can cut or tear more.
3 Carefully tear two 1½” " 11” strips each of the black and the white
paper.
 Art Activities 85

4 Glue the long strips to your paper, overlapping them slightly.

5 Arrange your shapes on the glued strips.
6 Distribute your objects on the shapes and/or strips, and glue down. If the
object is large or bulky, you may need to use a glue spot to attach them.
7 Title your collage.

Preparation For Use in Group

The first step when using collages in a group is to gather and prepare
materials in advance. Cut out images and shapes so that members then only
have to choose what they want to use. Having images cut out in advance can
facilitate the production, especially in those environments where scissors or
other cutting implements may not be feasible or allowed. Try to have a
variety of these in case more than one member wants the same shape or
image. The value of using images is that these can serve as symbols, and
many different images can symbolize the same thing. Following are some
topics that could be the basis for collages:

! Dreams and wishes for the future

! Greatest accomplishments
! Biggest disappointment
! Values and beliefs about oneself
! Positive personal attributes
! Any feeling word; happy, excitement, sadness
! Concepts such as conflict, intimacy, inadequacy

Depending on the complexity of the collages and the time available in group
sessions, some could be given as homework. Another alternative, if there is
space and it is appropriate for the group, is to let members come to a session
early to make their collages. Basic materials include the following:

! A variety of paper in different sizes and colors

! Several pairs of scissors
! Sets of colored pencils, crayons, and felt markers
! Old magazines and catalogues
! Pens, pencils. and permanent marker pens
! Twigs
! Paper clips in a variety of styles and colors
! Glue sticks, white glue, transparent tape, and double stick tape
! Cardstock or other heavy paper in a variety of colors, cardboard, canvas,
or other suitable backgrounds for collage
! A variety of objects such as string, yarn, button, safety pins, fabric scraps,
embroidery thread, sequins, and so on
! Index cards: 3” " 5” and 5” " 8”, unlined are best but not critical
86 Art Activities

It is also helpful to have printed sets of directions available, especially if the

collage is for a special project. Otherwise, just let members create on their own.

Focusing the Activity

As with all creative activities, collages should have a purpose and goals that
relates to the group and to members’ needs. While these can be created just to
relax and have fun, that too is a goal and purpose, to reduce stress and tension.
Possible goals and purposes include the following:

! Reveal an unidentified strength

! Increase awareness of accomplishments
! Assist in expressions for thoughts, feelings, and ideas
! Clarify goals, wishes, and fantasies
! Develop a creative part of self
! Give expression to abstract concepts, such as hope
! Make sense of chaos, overwhelming stimuli, and complexity
! Reduce intellectualizing, hiding behind words, masking feelings
! Highlight commonalities among members, and forge connections
! Increase feelings of being understood, competent, and of life’s successes
! Assist in making associations and linkages to important personal material

After determining the goal and purpose, it becomes easier to select the topic for
the collage activity. This, along with an introductory rationale, should be
written and read to the group when the activity is presented. It is easier to
write this in advance rather than trying to remember the important points, or
to create it as you stand or sit before the group. The introductory rationale
should include behavioral manifestations of a need, such as noticing that
members tend to minimize their strengths. Or, that members are avoiding
conflict, and that making a collage will enable each member to express their
fears or other feelings about conflict.
The group leader needs to plan and select the activity so that there is sufficient
time for construction and sharing. Exploration and expansion may be possi-
ble, but just creating and sharing can be sufficient at times. This is why it is
important to select an activity that doesn’t take the majority of session time to
construct. If it becomes important and/or meaningful to have group members
explore more complex issues through collage, this can be given as homework,
or to be completed in space outside the group. A guide for construction time
is that it consumes about 25% of session time at the most. For example, if the
session is 60 minutes, construction time would be no more than 15 minutes.
Using already cut out images, and the like can expedite construction. Practice
by constructing a collage on a 3” " 5” index card this way, and you’ll see that
you can do a lot in 15 minutes. Some members may feel rushed, but restrict-
ing the amount of time can sometimes reveal more meaningful material as
 Art Activities 87

restriction forces the use of free association and reduced defensiveness.

Their focus is more on production and less on resistance. Some relatively
quick-to-construct collage topics are the following, especially when materials
are prepared in advance of the session:

! Two to three closely held values

! A dream for the future
! My talents
! Enjoyment
! Hurt, sadness, grief
! Acceptance and positive regard
! Anger, conflict, disagreements

Activity 4.14 Who Am I – My Physical Self?

Materials
3” " 5” unlined index cards; cut out pictures of food, medicines, recreational
and exercise activities, sports, relaxation, pillows, mattresses, sleeping aides,
images reflecting doctor visits, toothbrushes, toothpaste, dental images, and
other physically relative images including some that are not ideal or healthy;
blank sheets of paper; glue sticks; scissors; and pens or pencils. Construct
samples of 3” " 5” collages to use as illustrations.

Procedure
1 Distribute index cards and arrange images on a table where members can
sort through them, and can construct their collages.
2 Introduce the activity by telling members to select images that depict their
physical selves at this time, and glue them on the card to construct a
collage. Images can be arranged in any formation on the card.
3 Give a time limit, such as 15 minutes.
4 Reform the group circle and have members display and explain their
cards.
5 Distribute the pens or pencils and sheets of paper and ask members to
write a brief paragraph about their “physical self at this time”; feelings
aroused as they constructed their collages, and areas of satisfaction and
dissatisfaction.
6 Reform the group and have members report any awareness that
emerged from either or both parts of the activity, and/or other thoughts
or feelings.

Following are the variations that can be used to depict other parts of members’
selves. Use the same procedures as described for physical self.
88 Art Activities

Activity 4.15 My Emotional Self

Materials
3” " 5” or 5” " 8” index cards, paint chips samples in a variety of colors; images
that could be symbols for feelings, such as tears or tombstones for sadness and
grief; glue sticks; scissors; crayons or colored pencils or felt markers.

Instructions to Group Members

Construct a collage that depicts your most easily expressed feelings, or those
that are most difficult for you to express openly and directly.

Activity 4.16 My Inspirational Self

Materials
3” " 5” or 5” " 8” index cards, crayons, or colored pencils, or felt markers;
images of beaches, mountains, and other scenic wonders; images that appeal
to you as inspirational and those that you think would appeal to others or get
them thinking about their inspirational self. (If a member or member wants to
equate inspirational with religion ask them to find or draw their own religious
symbols as these can be very personal and unique for them.) Plain sheets of
paper for drawing, scissors, and glue sticks.

Instructions
Reflect on your inspirational self and construct a collage that conveys your
sense of your inspirational self.

Activity 4.17 My Creative Self

Materials
8½” " 11” cardstock in white or a neutral color; newspapers, magazines,
and other print publications; scissors; glue sticks, white glue; crayons,
watercolors, and/or poster paints; two or more example collages prepared
in advance.

Instructions
Construct a collage that reflects your creative imaginative self. You may be
creative in ways other than art, and your collage can reflect this. Other avenues
for creativity include writing, cooking, gardening, sewing and other needlecrafts,
 Art Activities 89

dance, music, acting, fixing broken objects, and so on. Think of your creativity as
the part of you that produces new and novel products and/or processes.
It can be helpful for the group leader to provide samples for collage activities.
Two suggestions for example collages prepared in advance follow.

EXAMPLE 1

Tear long strips (12”) of newspaper and glue to white cardstock leaving spaces
between the strips. On another piece of newsprint, lightly draw a simple small
house outline, color it with the crayons, watercolor or poster paints, and let it
dry. When it is dry, cut it out leaving 1” or more all around, and glue to
another piece of cardstock and let dry. Now, cut the house out around the
lines, and glue to strips on the other piece of cardstock. Look in your drawers,
purse or pocket, and find things to put on the hours and/or strips. These are
the embellishments for your collage. Title your collage.

EXAMPLE 2

Draw or trace three large simple flower shapes on newspaper or other print
material, color in the flower shapes, cut out with a border, glue to cardstock and
let dry. When dry, cut out the flower shapes and glue to a large piece of cardstock.
Repeat the process for three medium, three small, and three very small flower
shapes. Stack three piles of flower shapes so that each stack has a medium, a small,
and a very small flower shape. Fold each flower shape in half, crease and put a
narrow strip of glue down the backside of the crease. Glue the stacked flowers and
let dry. After drying, put a narrow strip of glue down the back of each medium
flower and place these between the larger flower shapes on the cardstock. Use
buttons, coins, or other small round objects for the center of the flowers.

Additional Collage Activities

Activity 4.18 Inside/Outside

Materials
Large envelopes 5” " 9” or larger; images from magazines or catalogues (the
leader can have a collection of these cut in advance, or provide a variety of
magazines and catalogues where members can find images), glue or other
adhesive, pen or pencil; and a set of crayons, or colored pencils, or felt markers.

Procedure
1 Distribute the materials and ask members to construct a collage on the
outside of the envelope that illustrates what they find easy to disclose to
90 Art Activities

others, how they see themselves, and how they think others see them.
They are to find images that illustrate what they find difficult to disclose,
and their internal selves and put these inside the envelope. They will not
have to share what they put in the envelope.
2 Give a timeline for construction and notify members when about five
minutes are left.
3 Ask members to describe the outside of their envelopes, but do not do
exploration at this time.
4 After all members have shared, lead a discussion on what the experience
was like, e.g. feelings and thoughts, was it hard or easy to find
descriptive images, and what summary statement would they make
about the external collage.

Activity 4.19 Home

Materials
Cardstock, cut out images, paper scraps, glue, scissors, and a set of crayons,
colored pencils, or felt markers for each participant.

Procedure
1 Distribute the materials and ask participants to make a collage about the
place or building that gives them a feeling of home. The home can be
past, present, or a wish. The home can be representational, abstract, or
symbolic. It is whatever they choose to create.
2 Announce the timeframe for constructing the collages and remind them
of the remaining time available about five minutes before you call time.
3 Return to the group circle and ask participants to describe their collages.
Don’t explore at this time unless there are considerable emotions aroused
in the participant. All participants must have sufficient time to report on
their collages.
4 Next, ask them to describe their feelings as they thought about “home”,
as they constructed the collage, as they displayed their collage to the
group, and as they listened to others talk about their “home”.

References
Aimone, K. (2000). Creative collage for crafters. New York: Lark Books.
Gonzalez-Rivera, M., & Bauermeister, J. (2007). Children’s attitudes toward people
with AIDS in Puerto Rico: Exploring stigma through drawings and stories. Qualitative
Health Research, 17(2), 250–263.
Guillemin, M. (2004). Understanding illness: Using drawings as a research method.
Qualitative Health Research, 14(2), 272–289.
 Art Activities 91

Hopperstad, M. (2008). How children make meaning through drawing and play. Visual
Communication, 7, 77–96.
Lev-Wiesel, R., & Liraz, R. (2007). Drawings vs. narratives: Drawing as a tool to
encourage verbalization in children whose fathers are drug abusers. Clinical Child
Psychology and Psychiatry, 12, 65–75.
Nowicka-Sauer, K. (2007). Patients’ perspective: Lupus in patients’ drawings. Clinical
Rheumatology, 26, 523–1525.
Ohnmeiss, D., Vanharanta, H., & Elkholm, J. (1999). Relationship of pain drawings to
invasive tests assessing intervertebral disc pathology. European Spine Journal, 8, 126–131.
Ohnmeiss, D., Vanharanta, H., Estlander, A., & Jamsen, A. (2000). The relationship of
disability (OSWESTRY) and pain drawings to functional testing. European Spine
Journal, 9, 208–212.
Chapter 5

Writing Activities
Essays, Lists, Journals, Poetry, and
Cinquains

Introduction
Writing activities are a means for expressing and exploring thoughts, ideas, and
feelings to elaborate, clarify, and understand these. While generally used as
communication to others, writing activities are used in therapy primarily in
communication with oneself to better understand what you are thinking, feeling,
imagining, and associating. These activities can provide a thread that links the
present, the past, the nonconscious, and unconscious, and can provide access to
previously unexplored parts of self. Writing can differ from other expressive
activities in its ability to cover more material in less space and time, can be a
personal and private way to engage in self-exploration but also benefits from
being shared with others, and has various modes for implementation.
This chapter presents a variation for Expressive Writing (Pennebaker,
1997a) which is a copyrighted writing activity, an autobiographical activity,
expansion for life events, connecting the past to the future. Also presented are
14 different writing activities for general writing, poetry, writing for a single
session, and journaling.

Benefits From Writing Activities

Oatley and Djikic (2008) define writing as “thinking that uses paper and other
media to externalize and manipulate symbolic expressions” (p. 9). Getting
one’s thinking written down can accomplish several goals:

1 Communicate these thoughts to others

2 Organize and order the thoughts
3 Helps to make meaning, and to make that meaning clear
4 Express abstract and complex inner experiencing
5 Reveal hidden connections and associations
6 Allow the imagination to be expressed
7 Encourage and promote creativity
8 Provide inspiration and hope to self and to others

DOI: 10.4324/9781003251989-5
 Writing Activities 93

9 Clarify complex situations, relationships, and events

10 Provide a guide on how to do something, such as what this book does

Therapeutic benefits from writing can include some of the following:

! Expressing inner experiencing that is dangerous or shameful to verbally

express. Writing the words can seem less threatening.
! Clarifying confusing thoughts and feelings can be expedited through
writing. The act of trying to express the thoughts and feelings can
provide a means to help sort through them, prioritize their importance,
and reveal inconsistencies and irrationality.
! An opportunity to explore thoughts and feelings on one’s own to see
where these lead. The independence and privacy afforded by writing can
provide the space and time to engage in self-exploration uncontaminated
by others’ thoughts or presence.
! A visible realization of creative thoughts and ideas can emerge. The act
of putting these on paper or on the computer screen, the opportunity to
review them, and the possibility of seeing different associations and
alternatives can be realized through writing.
! Writing allows for associations to emerge, and these can provide
insight and understanding. Other associations such as precipitating
situations, events, and relationships can become clearer, and can
provide suggestions for alternative approaches and/or responses.
! Writing is a means to focus on the positives in one’s life and on personal
strengths. It is much easier for many people to emphasize the negatives
in their lives, and focusing the writing on the positive aspects of self, and
of one’s life can be affirming, encouraging, and inspiring.
! Defense mechanisms that may arise from verbal interactions can be
reduced or eliminated. Since writing can be much less threatening, it
is less necessary for the individual to be defensive about shaming
incidences, thoughts, and the like. The self can be more receptive
and open to considering flaws and inadequacies, thus providing
more opportunities to create better ways to behave and to relate.
! As a way to personalize treatment when in a group. There are times
when it is difficult to personalize group material because of the
complexity of the group, the dynamic movement, the confounding
that can occur from others’ stories and responses, and so on. Writing
about one’s personal experience is a way to sort through that per-
son’s thoughts, feelings, ideas, reactions, associations, and the like
without the confounding that can occur when interacting with other
members. While that constructive responding and feedback is valu-
able, it is sometimes more helpful for the individual members to
personalize their understanding and analyses prior to sharing these
with the group.
94 Writing Activities

! Center and ground oneself in the present. Writing can be a means to

bring the members into the here and now, and support their emo-
tional presence in the group. Outside concerns, past experiences, and
the unconscious continue to affect present experiencing, but becoming
centered and grounded in the present expedites the work of the group
and for the individual members.
! Assist with planning for the future, such as writing action plans and
anticipating barriers to these plans. When group members write these,
they increase their awareness of the possibilities, their potential, and
can even create possible alternatives and solutions.
! Conveying thoughts, ideas, and feelings to others. This can be espe-
cially helpful when what is being discussed carries intense emotional
content that can make it difficult to select the words to adequately
express what is intended. Writing these thoughts etc., provides
opportunities to sort through the myriad of feelings, to select words
and phrases that are accurate representatives of the feelings etc., and
to lessen intensity of feelings by becoming more cognitive.

How and Why Writing Can Help

Robinson (2000) proposed that “research shows that the majority of people
who write regularly feel that it helps them cope with and work on traumatic
experiences and is beneficial to their well-being” (p. 83). He discusses how the
process of writing relates to beneficial outcomes. It would appear that both
what is written, and the process of writing have benefits. Robinson uses Wilma
Bucci’s model (1995) as a basis for understanding the process. This model
assumes that experiences are stored in the mind in symbolic and non-symbolic
forms and that only symbolic forms are available for verbal communication and
thought, both written and oral. The non-symbolic forms appear in images,
emotions that seem to have no label, and other internal representations of
experiencing. Language is one way to try to connect to the nonsymbolic form
via referential activity by naming the experience and/or feeling, and to identify
this (Bucci, 1995). There are four stages for this process: Activation, Referential
1, Referential 2, and Reformulation.

1 Activation – Nonsymbolic images and/or feelings are activated.

2 Referential 1 – Internal images are formed that have referential meaning.
3 Referential 2 – These images are put into words.
4 Reformulation – The words assist in reformulation of the non-specific
images or feelings into known images or feelings.

This process illustrates the possible benefits for writing, and both the outcome
and the process contribute. Insight, understanding, and assimilation of
experiences can be facilitated for therapeutic benefit. Layers of ambiguity,
 Writing Activities 95

unawareness, and uncertainty can be stripped away so that meaning becomes

clearer, and a burden can be lifted.
Writing activities can be especially helpful in a group because they allow all
members to participate at the same time, and personalize the material. The
group leader does not have to be as concerned about what other members are
experiencing while working with one member. In addition, the use of journals
and other writing as homework can enrich and deepen the group experiences
for group members. The remainder of the chapter describes Pennebaker’s
Expressive Writing, poetry, journals, and selected activities.

Expressive Writing
Pennebaker (1997b) and Esterling et al. (1999) studied the effects of disclosure
writing, termed expressive writing, effects on health, and found that there were
many positive effects. The basic format for Expressive Writing asks participants
to write for 15 minutes each day on a topic for three days. The topics could be
the participant’s choice, or specific topics such as cherished values, life goals, or a
traumatic experience. Since Pennebaker began his studies others have
conducted studies, and he notes that the many studies on expressive writing
show the following effects on participants:

! Immediate and long-term cognitive changes

! Immediate and long-term emotional changes, such as reduction of negative
affect about a trauma (Park & Blumberg, 2002)
! Positive changes in participants’ social and relational lives
! Gradual and cumulative biological effects, such as better physical health

Hundreds of studies have been conducted using expressive writing for a variety
of conditions and subjects with mixed outcome results. The technique seems to
produce positive outcomes in most cases, but also tends to show positive out-
comes for narrowly focused and specific conditions. For example, in the study
by Koopman et al. (2005) using expressive writing effects changes in pain,
depression, and Post-Traumatic Stress Disorder (PTSD) symptoms for survivors
of intimate partner violence; they found that depressed women showed a sig-
nificant drop in depression, but the main effects were not significant for changes
in pain or PTSD. Sloan, Marx and Epstein (2005) found that expressive writing
with high-risk drug dependent patients at a primary care clinic who wrote about
the same traumatic event over three session had significant reductions in physi-
cal and psychological symptoms in comparison with a control group writing
about different or non-traumatic events over three sessions. Samples of other
studies on conditions and subjects include the following:

! Rape (Brown & Heimberg, 2001)

! Sexual abuse (Batten, Follette, & Palm, 2002)
96 Writing Activities

! Cancer (Sloan, et al., 2005)

! Rumination and depressive symptoms (Gortner, Rude, & Pennebaker, 2006)
! Prisoners and illness (Richards, et al., 2000)
! Coping with job loss by engineers (Spera, et al., 1994)
! Young adult smokers (Ames, et al., 2008)
! Maternal psychological distress (Barry & Singer, 2001)

Chan and Horneffer (2006) compared an expressive writing group, a drawing

group, and a control group on psychological symptoms before and after two
15-minute writing sessions. The expressive writing group had a significant
decrease in their symptoms compared to members of the other two groups.
The analysis did not identify specific symptoms that showed a decrease, just
that there was a general overall lessening of emotional distress.
Another approach to using expressive writing is described by Reisman et al.
(2006) where resident physicians were introduced to Abraham Verghese’s system
(2001) for writing that focuses on integrating creative writing with clinical
duties. This approach uses personal journals, parallel charts, and critical
incidents reports with an emphasis on describing the event and one’s per-
sonal reactions. The purposes are to encourage reflection and awareness,
increase emotional engagement and empathy, and to deepen interactions
with others. The process involved having participants write on a topic
relative to their experiences and feelings as residents, and a sample orally
presented and discussed by other residents. The discussion focuses on the
extent to which the writing aroused the reader’s/listener’s imagination.
The writer listens to the discussion, but can only comment at the end.
Reisman et al. (2006) reported than an unanticipated outcome was the
development of group cohesiveness. The other outcomes as reflected in a
qualitative analysis of themes in the writings, and a post-group focus eva-
luation, were increased awareness of self and others, an outlet for feelings
such as insecurity and impotence, and a deeper understanding of the
healing power of compassion.
The approach used by Reisman et al. (2006) used the group as part of the
process, which seems to have enriched the experience and even to have pro-
moted group factors, even though that was not a purpose for the group. What
may have happened that could be useful for other group leaders are the
following:

! Unacceptable and uncomfortable feelings expressed, were accepted and

not criticized by others.
! Commonalities for these feelings became visible, thus promoting connec-
tions and universality.
! Reading aloud was nonjudgmental and intended as expansion and
exploration.
 Writing Activities 97

! Real experiences were described and possible alternatives, options, and

changes explored which promoted feelings of self-efficacy.
! There was an increased awareness both for self and for others, especially
for those who were in a dependent state, e.g. patients.

There are many different approaches to use for expressive writing, but all
seem to produce positive benefits. The following set of activities uses
expressive writing, but group leaders must be aware that intense and
negative feelings can be aroused. Because of this, these activities must be
used with caution and the group leader must be prepared to deal with
what emerges, and to even be available between sessions if members are
having difficulty coping with the emerging feelings.

Activity 5.1 Group Expressive Writing

Materials
A suitable surface for writing, pen or pencil, paper, or a bound journal.

Procedure
Introduce the activity telling group members that the activity could help them
integrate and reduce the intensity of feelings about a distressful event from
their lives. Describe the activity as being three sessions of 15 minutes of writ-
ing each session. What they write will be personal and private for them, and
although you will collect the essays, you will not read them and will keep them
under lock and key. At the end of the three sessions, you will destroy the
essays or return them to the writer, their choice. Another option is to offer to
keep them until the last group session and make the decision then.
Tell members that they will write whatever they choose, without paying atten-
tion to grammar or other technical writing concerns. They can write sentence
fragments, or just words or phrases, they do not have to write complete sentences.

SESSION 1 – DISTRESSING EVENT DESCRIPTION

1 Ask members to think of a distressing event from their past that has a
distress rating of 5 or 6 on a 10-point scale, where 0 is no distress, and 10
is extreme distress. They are to then write about the event especially
noting feelings about it. Allow 15 minutes for writing.
2 Next, ask members to review what they wrote, and using another sheet
of paper make a list of the feelings that emerged as they wrote and as
they thought about the event. Rate each feeling on the 10-point scale
described in step 1.
3 Collect the essays and feelings, and keep these under lock and key.
98 Writing Activities

SESSION 2 – DISTRESSING EVENT PAST AND CURRENT FEELINGS

Use the same procedure as described for session 1, where they write about the
same event, list the current feelings, and give these a rating. Collect the essays
and feelings.

SESSION 3 – DISTRESSING EVENT REVISED

Use the same procedure described for session 1 and have them write about
the same event, make a list of the feelings experienced now. Collect the essays
and feelings.

a Ask members if they want to report on how or if their feelings changed

after three sessions of writing. Allow any member to opt out who wants to.
b Ask members how they want you to handle the essays and lists you collected;
keep, destroy, return.

The next activity is also presented to be completed in three sessions. Members

will write for 20–30 minutes about their lives beginning with the present.
Group leaders should state that members do not have to share what they
wrote but can choose to do so. The group reflection/reporting phase focuses
on the writing experience and the members’ feelings. Three sessions are pre-
sented here although more sessions could be used depending on group mem-
bers and the purpose for the group.

Activity 5.2 An Autobiographical Activity – Session 1

Materials
Sheets of paper or a journal, and writing instruments.

Procedure
1 Introduce the activity by telling group members that the next few sessions
will focus on writing an autobiography. They have lived their lives to this
point, and the purpose is to engage in self-examination by writing about
their life experiences.
2 Instruct members to take one sheet of paper and list all of the words and
phrases that apply to them to finish the lead, “Currently, I am”. You can
suggest that they look at their general feelings experienced, the relationships,
their work or other such activities, leisure pursuits, hobbies, interests, and so
on. Who are they at this moment in time?
3 Once that list is complete, ask them to take another sheet of paper and to
write an essay on their Current Self. Allow 20–30 minutes to complete
 Writing Activities 99

this portion. It may be that some will need to complete their essays out-
side the group session, and the leader can decide if this is appropriate for
this group.
4 After the writing period is over, ask members to reconvene in the group
circle and to share what the writing experience was like for them. Questions
that can guide the sharing include:
! What seems focal in your life today?
! What awareness emerged?
! What seems missing or incomplete?
! Were there any surprises?
! What feelings emerged as you thought and wrote about your current life?

Activity 5.3 An Autobiographical Activity – Session 2

Materials
Sheets of paper or a journal, and writing instruments.

Procedure
1 Introduce the activity by telling members that this session will focus on
their past life; its significant events, important people, meaningful and
important activities, and the like.
2 Instruct them to take three sheets of paper and to make a list of events,
people, activities, and so on for three life periods: one list for childhood, a
list for early adolescence 12–15, and a list for late adolescence/early adult
16–21.
3 The next step is to select one of the lists and to write an essay about that
life period. When time permits, they can write three essays, but if there is
not enough time for reporting, limit the writing to one list, and use the
other lists for discussion or reporting at another session.
4 Reconvene in the group and use the items in step four of the previous
activity to guide the exploration of the essays.

Activity 5.4 An Autobiographical Activity – Session 3

Materials
Sheets of paper or a journal, and writing instruments.

Procedure
1 Introduce the activity by telling members that this will be an exploration
of their desires and dreams for their future selves.
100 Writing Activities

2 Use the same categories listed in activity 5.3 and ask members to make a list
of their desires and dreams for each of these. These should be separate lists.
3 Instruct members to review these lists and select the one that seems most
important to them at this point, and to write an essay about their desires
and dreams in that category, for example what they envision and want
their relationships to be in the future. When the essay seems finished, ask
members to reflect on steps needed to realize the desire/dream, what they
are doing now that will help them realize this such as attending school to
get a degree in the desired profession, and how they are resisting moving
in that direction.
4 The other lists can be used for future group discussions.

This next activity can also be autobiographical but is presented here as a

single session activity.

Activity 5.5 Life Events

Materials
Sheets of paper and a pen or pencil for writing.

Procedure
1 Ask group members to make a list of significant events in their lives that
occurred during childhood, adolescence, or as adults. They should have
only one list for one period in their lives.
2 Have members review and reflect on their lists and select one event to
explore. Depending on the available time, more events can be explored
with the following process.
3 Write the event at the top of a clean sheet of paper, and then list all of
the people involved, the feelings experienced at that time, and the feelings
that are carried forward to the current time.
4 Next, write a paragraph, or more, that describes the event, the impact on
the person, and the lingering effects of the event on them today.
5 Ask members to share either the event, or the feelings aroused then and
now. They don’t have to share all of what they wrote as some may have
written a considerable amount.
6 Ask members to report on what the writing experience was like for them,
difficulties, new awareness, etc.

Single Session Writing Activities

Writing activities conducted during a group session provide an opportunity for
each member to work on his/her unique issue, reduce confounding or
 Writing Activities 101

emotional contagion by hearing what others have to say, can assist in organizing
members’ thoughts and ideas, provide an additional means for expressing feel-
ings, and can even tap material just below conscious awareness. Considerable
learning, understanding, and insight are possible in just one session.

Rationale
Session writing activities are conceptualized as stimuli to focus awareness on
an important topic or issue for group members, provide an opportunity for
individual input, and are completed within the time frame for the session.
Thus, the group leader has to select writing activities or activities that do not
take much time to complete, as most of the time has to be spent on members
reporting on their writing, and some exploration of what emerged. The
writing portion is the stimulus for accessing group members’ personal material
in the form of thoughts, feelings, and ideas.
Another benefit for group members is that their writing is not evaluation,
maybe for the first time ever. Misspelled words, verb-subject agreement,
punctuation, and other grammatical concerns are not important, and the
group leader has to make it clear that expression is the important concern
rather than technical writing matters.
Following are some examples for activities than can be accomplished in a single
session for groups that have ten or fewer members. If the group is larger than ten,
the reporting phase may be facilitated by breaking the large group into smaller
groups of five or less and asking them to share their products in the smaller group.
In this event, the group leader will also need to reconvene the large group and
have the small groups each report on what emerged for those group members.
They could be asked to report on the theme, commonalities, feelings, and the like.
Refer to the basic guidelines in Chapter 3 on managing a large group.

Session Writing – Past Reflections

The first set of four activities could form the focus for four sessions. These are
not all intended to be completed in one session, do one activity per session.

Activity 5.6 Childhood Event

Materials
A suitable surface for writing, a pen or pencil, and paper.

Procedure
Introduce the activity by telling members that the group is going to explore
childhood events.
102 Writing Activities

1 Ask them to think of a significant event or memory they have that

occurred when they were 12 or younger, and to write as full a description
as they can of the event or memory. If they can only remember a portion,
then just write what they can remember. Ask them to record all the feelings,
actions, people present, and other thoughts they remember at the time.
Allow about 15 minutes for this writing.
2 Approximately three minutes before the time is up, tell them that they
have three minutes to finish.
3 Have each member report on what they wrote. They can summarize or
give a brief description of what they wrote. The leader needs to allow
enough time for every member to report, so do not deepen the experi-
ence of a member, or explore what emerged at this time. If time permits,
you can return to do some exploration. In any event, if it is significant for
the member, he/she will bring it up again in another session.
4 Ask members what feelings emerged as they wrote about the event or
memory, and what feelings do they have now.

Activity 5.7 A Teen Event or Memory

Materials
Sheets of paper or a journal, and writing instruments.

Procedure
Introduce the activity as described in activity 5.6, substituting “teen event or
memory”. Follow steps 1–4.

Activity 5.8 An Adult Personal Event or Memory

Materials
Sheets of paper or a journal, and writing instruments.

Procedure
Introduce the activity as described in activity 5.6, substituting “an adult personal
event or memory”. Follow steps 1–4 in activity 5.6.

Activity 5.9 An Adult Work-Related Event or Memory

Materials
Sheets of paper or a journal, and writing instruments.
 Writing Activities 103

Procedure
Introduce the activity as described in activity 5.6 substituting “an adult
work-related event or memory”. Follow steps 1–4 in activity 5.6.

Session Writing – Free Associations

The next set of activities focuses on free associations. While five topics are
suggested, group leaders can use the procedures to focus the group on what
they are avoiding, resisting, or other important issues for the particular
group. The five topics are the group, life satisfactions, life dissatisfactions, a
wish, and my relationships. The materials and procedure will be the same as
described for “The Group”.

Activity 5.10 The Group

Materials
A suitable writing surface, pen or pencil, and paper.

Procedure
Introduce the activity by telling members that there are times when
thoughts and feelings seem difficult to express. At other times, there are
numerous thoughts and feelings being experienced so that it is difficult to
sort through them. This activity will demonstrate how to do free associa-
tion to make sense of difficult thoughts and feelings, or when they seem
too numerous.

1 Present the topic or issue that they are to write about, e.g. the group.
2 Ask members to list all of the thoughts, feelings and ideas that come to
mind when they think of the topic or issue, and to do so without stopping
to evaluate or judge what comes to mind. Write as many of these as they
can in the time given. Allow at least five minutes for writing, but some
groups may need a little longer.
3 The next step is to review their lists and place a check by all the thoughts,
ideas, and feelings that are negative.
4 Next, place a check by all that are positive.
5 Count the number of positives, and the number of negatives. Make a note
of the number of neutral thoughts, feelings, and ideas that remain.
6 Ask each member to report the number of positives, and the number of
negatives. The leader should pay attention to members who seem to have
the majority of positives, and those that have a majority of negatives. Do
not comment on these at the time. You are compiling the responses for
104 Writing Activities

the group as a whole response. When the compiling is complete, the

thoughts, feelings, and ideas members have about the topic or issue
should be either predominately positive, or negative, or neutral.
7 Lead a discussion about the outcomes, and solicit members’ input on
what is contributing to the perceptions and responses, and, if negative,
what can be done to make it more positive.

Activities 5. 11–5.14
Use the same materials and procedures in activity 5.10 to explore each of the
following.

Activity 5.11– Life satisfactions

Activity 5.12– Life dissatisfactions
Activity 5.13– A wish
Activity 5.14– My relationships

Session Writing – Letters

The next set consists of activities focused on the inner self of group members.
These can be done as a way of taking inventory of how each member feels
about him/herself, to increase awareness of self-satisfactions with oneself,
and to increase awareness of the need for self-care around a major part of
oneself. It is suggested that an activity focused on one aspect of self be
completed in a session. Thus, the six activities presented could be the focus
for six sessions.
The set of activities are letters to aspects of the inner self of the person. The
aspects are cognitive, interpersonal, emotional, creative, inspirational, and
physical. Each is presented separately as the focus for each aspect is different.

Activity 5.15 Letter to my Cognitive Self

Materials
A suitable surface for writing, a pen or pencil, and paper – several sheets for
each person. Post the following where members can see it:
The Cognitive Self
Thinking
Organizing
Clarity
Memory

If members and the leader agree, the writing can be done on the computer.
 Writing Activities 105

Procedure
Introduce the activity by telling group members that the focus will be on
writing a letter to their inner selves, and the first letter will be to their
cognitive self. The cognitive self is the mind, the mental life of the person.

1 Begin the letter with, “Dear Cognitive Self”, and write what you are
thinking, sensing, and feeling about each listed aspect of the cognitive self.
Write about what you appreciate, wish were different, any regrets, and
close with “thanks for being there”.
2 Allow 15–20 minutes for letters to be composed. If members need more
time, give one to two minutes and tell them they can finish after the group.
3 Ask members to read their letters if they wish, or any part. Notice similarities
among the letters, and link these for members.

Activity 5.16 The Interpersonal Self

Materials
Same as above, except post the following.
The Interpersonal Self
Relations with family
Intimate relationships
Work relationships
Other relationships

The Interpersonal Self is the ways in which you relate to others, and your
satisfaction with your relationships.

Procedure
Follow the same procedures for the Cognitive Self, substituting the Interpersonal
Self.

Activity 5.17 The Emotional Self

Materials
Same as above, except post the following.
The Emotional Self
Feelings experienced
Feelings easily expressed
106 Writing Activities

Feelings difficult to express

Feelings you are unable to access – never feel them

The Emotional Self focuses on the extent to which you can access and express
feelings, and if you are able to appropriately express your feelings.

Procedure
Follow the same procedures for the Cognitive Self, substituting the Emotional
Self.

Activity 5.18 The Creative Self

Materials
Same as above except, post the following.
The Creative Self
Imaginative
New and novel endeavors, processes, and the like
Unique ways of being and perceiving

The Creative Self emphasizes trying new and novel ways for different aspects
of your life. Examples are cooking, gardening, fixing things, artistic endeavors,
inventions, and the like.

Procedure
Follow the same procedures for the cognitive self, substituting the creative self.

Activity 5.19 The Inspirational Self

Materials
The same as above, except post the following.
The Inspirational Self
Altruistic acts
Hopes
Meditation, prayers, and the like
Transcendent

The Inspirational Self is the part of you that extends beyond the physical and
known. It connects you to the universe and to others.
 Writing Activities 107

Procedure
Follow the same procedures for the Cognitive Self, substituting the Inspirational
Self.

Activity 5.20 The Physical Self

Materials
The same as above, except post the following.
The Physical Self
Health habits
Health status
Medical conditions and concerns
Appearance

The Physical Self refers to the body, both inner and outer, its care or neglect,
and sensations. Other topics that may be addressed include medications, use
of other drugs and alcohol, eating habits, sleep, and physical exercise.

Procedure
Follow the same procedures for the Cognitive Self, substituting the Inspira-
tional Self.

Session Writing – Dreams

Dreams can be a rich source of information for group members as these can
tap into what is below awareness of the person’s current life, provide a focus
for what appear to be indefinite concerns, and bring feelings into awareness.
What follows is not dream analysis, as would be done in psychotherapy, but is
a short activity that can trigger insight and awareness for group members.

Activity 5.21 A Dream

Materials
A suitable surface for writing, pen or pencil, and two or more sheets of paper
for each member.

Procedure
Introduce the activity by telling group members that sometimes a dream has a
message for the dreamer, and that this activity could help reveal the message.
108 Writing Activities

1 Ask members to think of a dream or fragment of a dream, either recent

or in the past, and to write a summary of the dream. Allow time to
complete the summaries.
2 The next step is to have members read over the summaries, and list the
feelings associated with the dream, either then or in the present.
3 Ask group members to make a list of the major components in the
dream – people, actions, colors, whatever seems important to them.
4 The final step is to review the two lists and associate the items with their cur-
rent lives. It is helpful to have them write a statement about the associations.
5 Group members can share any part or all of what was written, but time
must be available for every member to share something. Group leaders
could just have members share the final statement about their associations.

Session Writing – Lists

Each of the following activities can be completed in a single session, but the effects
can be enduring and material that emerges during the activity can reemerge in
later sessions. It is recommended that only one of these be used in a session.

Activity 5.22 The Power of Lists

Materials
5” " 8” index cards, a pen or pencil, and a suitable writing surface.

Procedure
1 Distribute the materials and introduce the activity.

Oft times some people tend to focus more on their characteristics that they perceive as
inadequate, or negative. There are also times when others can say or do something that
triggers these undesirable thoughts about oneself, leading to experiencing uncomfortable
feelings like guilt and shame, or seeking to repress and deny the thoughts for fear of
triggering those feelings. This activity is designed to focus on your strengths, and to
provide you with a reminder of these.

2 Ask members to list ten strengths they have, such as being well-organized
and the like. Allow enough time for members to finish their lists.
3 Next, ask them to share their lists with the group, or to share as much or
as little as they desire.
4 After the sharing phase, explore the lists by asking the following:
! What feelings did you experience as you created your list?
! What feelings emerged as you presented these strengths to the group?
 Writing Activities 109

! Are there strength similarities among group members?

! Is there a strength you have that is underused? How could you
capitalize more on this strength?

5 Tell group members to keep their cards in a safe place, and to review
them periodically, such as weekly. Tell them that this strength list can be
used when they begin to have self-doubts, feel inadequate, or are chas-
tised for something. The list can help bring thoughts and feelings back to
their strengths.

Session Writing – Self-Affirmations

Activity 5.23 Life Enhancers

Materials
A sample list of life enhancers on newsprint, 5” " 8” index cards, and a pen
or pencil.

Procedure
1 Prepare the sample list of personal life enhancers. These are the things,
events, and the like that bring pleasure, make you smile, and can help you
savor your life. These are usually cost-free or inexpensive. Following are
examples.
Kittens playing
A child smiling at me
Snow gently falling
A snow-covered landscape
A fire in the fireplace
A drink of water on a hot day
Flying a kite
Reading an interesting book
2 Introduce the activity by presenting the prepared list and telling group
members the information in step 1.
3 Ask group members to make their personal lists of life enhancers.
4 When members finish their lists, ask them to share these in the group.
5 Explore the feelings aroused as they created their lists, as they shared
their list in the group, and as they listened to others’ lists.
6 Summarize what transpired and tell them that they have many life
enhancers, and that their pleasure and positive mood can be increased by
trying to ensure that they experience one or more of these every day.
110 Writing Activities

Activity 5.24 Self-boosters

Materials
A large sheet of newsprint, 5” " 8” index cards, a pen or pencil, and a pre-
pared sample.

Procedure
1 The group leader should prepare a sample in advance, either on the large
sheet of newsprint, or written on a whiteboard, or something similar.

SAMPLE

Finish the statement that begins with, I have …

Good work habits
An optimistic attitude
A sense of humor
A capacity to feel deeply
A thirst for knowledge and understanding

2 Introduce the activity to group members by telling them that it can be

helpful to remind themselves of some positive attributes they possess. Show
the sample and ask them to make their personal lists on the card.
3 Once members have completed their lists, have them read the list out loud
as if they are talking to someone in another room, that is read it loudly.
They can even shout if they like.
4 After all lists are read out loud, explore the feelings experienced as they
compiled their lists, and as they loudly read them. Be sure to ask if anyone
had difficulty in thinking of a self-booster.

Activity 5.25 A Letter

Materials
Two or more sheets of paper for each group member, and a pen or pencil

Procedure
1 Distribute the materials and introduce the activity.

This activity is focused on self-care and your satisfaction with what you do to take care
of yourself. This particular activity is focused on physical self-care, but you can use this
process to explore your self-care for other aspects of yourself. To begin, sit in silence and
 Writing Activities 111

concentrate on your breathing. Slowly, allow yourself to become aware of what bodily
sensations you have. Mentally scan your body from head to toe.

2 Tell members to begin their letters with “Dear (their name)”, and write
about their current body experiencing, and its reaction to their positive
and negative health habits, such as sleeping, eating, exercise, medication/
drug use, and so on. Write what your body wants to tell you about how
you care for it. If any part of your body is distressed, write what you think
it is saying to you. Tune in to all of your body and write about what its
message is.
3 When members seem to have completed their letters, ask them to review
the letters, and then write a summary statement about their body. For
example, what did they become aware of that is positive or negative?
What may they have ignored about their physical self that needs
attention?
4 Ask them to share their summaries or their letters. They can share as
much or as little as they are ready to disclose.
5 Explore the feelings about the activity.

Journaling
The final type of writing activity to be presented is journaling. Journal writing
is another form of expressive writing as it also uses this format for the
exploration of oneself for better understanding, healing, and fostering growth.
It has been shown to have both psychological and physical benefits (Lepole &
Smyth, 2002). One of the main benefits for journal writing is that it can be used
for expressing thoughts, feelings, and ideas, where doing so interpersonally is not
possible, or the circumstances are inappropriate to do so. Further, journaling
permits for expression free from the constraints of grammar, logic, sequencing,
and the like that are needed when trying to express these to another person.
Much has been written about the benefits of journaling in the past few
years, and with the research on expressive writing as a brief form of journal-
ing, there is considerable evidence for its efficacy. The benefits for journaling
seem to be considerable, for example as a stress reliever, clarifying thoughts
and ideas, expressing and sorting through feelings, identifying vague issues and
concerns, and so on. Other benefits include enhancing creativity and releasing
the flow of new ideas, an aid to coping with stressful events by using energy to
express reactions instead of having to suppress them, and as a record of life
events both positive and negative. People who use this modality report many
positive benefits.
There are numerous studies on the effects of written emotional expression on
physical and psychological health conditions – for example, Smyth, 1998;
Smyth et al., 1999; Spiegel, 1999; Walker et al., 1999). One study on emotional
writing and psychological symptoms that compared writing and drawing about
112 Writing Activities

a stressful event found that the psychological symptoms were significantly

decreased after two 15-minute sessions for the journaling group compared
to the drawing and control groups. This was especially significant for the
journal group participants who had measured higher psychological distress
on the pretest. A sample of other studies on the moderation of psycholo-
gical distress and/or traumatic events includes Lumley et al., (2002); Pen-
nebaker, (1999); Pizarro, (2004); Ullrich and Lutgendorf, (2002); and
Sweig, (2000).
Other uses for journal writing are in the medical training profession to
promote reflective thinking, and to explore and integrate experiences with
patients. Four examples of this use are: using reflective writing as a class blog,
(Chretien et al., 2008); reflective journals for learning for post-registration
nursing students (Chirema, 2006); medical students (Wald et al., 2010); and
for medical students experiencing the death of patients (Doll et al., 2008).
Other professional training programs also use journal writing such as the
following:

! Veterinary clinical pathology (Sharkey et al., 2007)

! Dental hygiene (Hanson & Alexandar, 2010)
! Emergency psychiatry (Bhuvaneswar, 2009)
! Physiotherapy (Donaghy & Morss, 2007)
! Athletic training education (Mensch & Ennis, 2002)
! Animal science and dairy science (Haug, 1996)

The group leader must be prepared for some resistance when asking members
to keep journals over a period of time. There are people for whom journaling
does not provide relief, but rather presents them with a burden and chore
which counter any possible positive benefits. Further, some group members
can resist journaling because of past experiences where their writing was cri-
ticized or evaluated as inadequate, or they think that their technical writing
skills such as spelling and punctuation are inferior, or they do not want others
in their world to see their writings and privacy is a real concern, or they just
don’t see any benefits for writing a journal. These are some reasons why
journaling may not be acceptable for some group members, and the group
leader needs to respect and accept these perceptions and to not insist that
members participate even when the leader feels that participating would be
beneficial. Before initiating this activity, it is helpful to judge the level of the
resistance because it is not beneficial for the group when some members are
participating, and some are not.
Let’s suppose that the group leader has some members who want to do
journaling, some who are skeptical, and some who are adamant about not
participating. Instead of forcing the activity as conceptualized, or dropping it
entirely, the leader could try one of the following activities as a way to ease
members into journaling.
 Writing Activities 113

Activity 5.26 Building Pleasure

Materials
A journal book or composition book. These are generally inexpensive and can
be found in many craft stores for a dollar. The leader can purchase these for
the group. Also needed is a pen or pencil for each member.

Procedure
1 Introduce the activity by telling members that it is helpful for their mood,
to be able to focus on pleasurable and personally rewarding things each
day. The journals are to record the following each day between sessions:
! A pleasant sight, such as flowers blooming, children playing, a smile
directed toward them, and the like
! A pleasant sound, such as music, car engine running smoothly, birds
singing, and so on
! A pleasant smell – food, perfume, fragrant flowers, lotion, soap, and
the like
! A pleasant taste – coffee, fruit, toothpaste, candy, and the like

2 They are also free to record anything else that was pleasant for them.
3 The first phase or week they would talk about their recorded items if they
choose to, or how it felt to remember and record these.
4 The leader can gradually ask for more associations, such as feelings
experienced for each recorded item, difficulties encountered, impact on
their mood and functioning. Members could also be encouraged to write
these in the journals as they record their experiences, but the leader
should present this as an option.

Activity 5.27 Home Contents

Materials
Same materials as in the previous activity.

Procedure
Introduce the activity as was done previously substituting writing about
something in their home. If there are homeless group members, substitute
writing about something that gives them a feeling of home. Items could be a
piece of furniture, an article of clothing, a book, magazine, food, or anything
they choose.
114 Writing Activities

1 Select one item each day and write about it addressing each of the following:
! Describe the item’s appearance, color, shape, etc.
! List the feelings triggered as they look and/or write about the item
! A short statement about what the item contributes to their life

Other Types of Journals

Journals are a record of thoughts, feelings, and ideas experienced daily,
weekly, or intermittently. There is no set pattern of what to write or when,
it’s up to the individual. Some people like to write daily, others want to
write when they have something to work out, convey, or to record. It’s
really up to the individual. Used this way in group settings, it becomes
homework where members are free to participate or not, to disclose what
they wrote or not, or to reveal to the group the insights and learning they
gleamed from journaling.
It can be very important that members have some place where they can
keep their journal private and free from intrusions. It can be very detri-
mental to a relationship to have one’s private thoughts read by someone
else without permission, and when you live with others, this is a real
possibility. Curiosity can overcome even the most well-meaning person
when they see the journal. If privacy and confidentiality of the journals
cannot be maintained by the members, it may be best not to use this
technique.
What can members write about and how should they express themselves?
There is no simple or easy answer to these questions. The group leader can
give a focus topic such as those listed as the end of this section, or allow
members to choose what to write about, or if there is a particular goal or
behavior change that is the focus for the group, to write about that. The
group leader can instruct members to write however they wish. They can
write poems, prose, a stream of consciousness, words, phrases, or what
occurs to them as they engage in the process of writing. No one is evaluating
what they write, grammar and punctuation are of no consequence except for
the writer, and the purpose is more to express something than how it is
expressed. Encourage members not to engage in self-evaluation or editing,
to just let the flow of thoughts, ideas and feelings continue without inter-
ruption of thinking about technical matters. Some possible topics or foci for
journals include the following:

! Daily thoughts and ideas

! Feelings experienced throughout the day, and their triggers
! What it’s like to practice mindfulness
! Current worries and concerns
! Hopes, dreams, wishes
 Writing Activities 115

Visual Journaling
A variation for journals is the visual journal where drawings, painting, collage,
etc. are added to the written words. There can be doodles, tracings, rubbings,
and other images that are added to the thoughts, feelings, and ideas that are
expressed in the journal. These enhancers also are expressions, and can be
clues to what is just below the level of consciousness at that particular time.
When reviewed later, these entries can help the person to better understand
past experiencing and its impact on him/her. Following is an activity for a
sample visual journaling page.

Activity 5.28 A Sample Visual Journal Page Demonstration

Preparation by the leader

Prepare a variety of pages (8½” " 11” or 9” " 10”) to be used as background
for the visual journal pages using heavyweight paper such as Bristol or
watercolor paper. These background pages can be painted or smudged with
ink pads. Use a variety of colors. These are prepared in advance to save time
in the group, as they need time to dry before adding writing or other
embellishments.

Materials
Scissors; magazines or catalogues for cutting out images; pen or pencils for
writing; glue sticks; sheets of paper; permanent black ink felt markers in fine,
medium, and broad points; and sets of crayons, or felt markers, or colored
pencils.

Procedure
1 It is best that the group work around a table so that materials can be
shared and easily accessed. Introduce the activity by telling members that
this is a demonstration for a visual journal entry about their day. Ask
them to reflect on their day from the time they woke up to the present.
2 Ask members to take a sheet of paper and a writing instrument, and jot
down five to seven items about their day such as the following:
! Moments of pleasure or beauty
! Thoughts they had throughout the day
! Sounds/tastes/sensations experienced
! Events
! People they encountered
! Feelings experienced
116 Writing Activities

They can list all items in one category or spread across categories. These lists
will be used to form the written entry for the page later.

1 Next, ask them to select a prepared journal page, and to cut out images
from the magazines or catalogues and paste on the page, and/or draw
images, doodle on the page, or use a combination of collage and drawing.
Remind members to leave room for their written entry.
2 The next step is to write about the items listed in step 2. Use the permanent
felt pen for writing as these will write over the paint or ink. Members
can write as much or as little as they wish, sentences do not have to
be complete, and there are no rules about punctuation. The task is to
write about their day.
3 Once pages are complete, reconvene the group and ask members to
share something about their pages and the feelings experienced as they
constructed the page.

References
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adjunct for young adult smokers. Nicotine & Tobacco Research, 9(2), 185–194.
Barry, L., & Singer, G. (2001). Reducing material psychological distress after the
NICU experience through journal writing. Journal of Early Intervention, 24, 287–297.
Batten, S., Follette, V., & Palm, K. (2002). Physical and psychological effects of written
disclosure among sexual abuse survivors. Behavior Therapy, 33, 107–122.
Bhuvaneswar, C., Stern, T., & Beresin, E. (2009). Using the technique of journal
writing to learn emergency psychiatry. Academic Psychiatry, 33(1), 43–46.
Brown, E., & Heimberg, R. (2001). Effects of writing about rape: Evaluating Pennebaker’s
paradigm with a severe trauma. Journal of Traumatic Stress, 14, 81–85.
Bucci, W. (1995). The power of the narrative: A multiple code account. In J. Pennebaker
(Ed.), Emotions, disclosure and health. (pp. 93–123). Washington, DC: American
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Chan, K., & Horneffer, K. (2006). Emotional expression and psychological symptoms:
A comparison of writing and drawing. The Arts in Psychotherapy, 33(1), 26–36.
Chirema, K. (2007). The use of reflective journal in the promotion of reflection
and learning in post-registration nursing students. Nurse Education Today, 27(3),
192–202.
Chretien, K., Goldman, E., & Faselis, C. (2008). The reflective writing class blog:
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General Internal Medicine, 23(12), 2066–2077.
Doll, K., Kereakoglow, S., Radhika, S., & Hare, J. (2008). Using students’ journals about
death experiences as a pedagogical tool. Gerontology Geriatric Education, 29(2), 124–138.
Donaghy, M., & Morss, K. (2007). An evaluation of a framework for facilitating and
assessing physiotherapy students’ reflection on practice. Physiotherapy Theory and Practice,
23(2), 83–94.
 Writing Activities 117

Esterling, B., L’Abate, L., Murray, E., & Pennebaker, J. (1999). Empirical foundations
for writing in prevention and psychotherapy: Mental and physical health outcomes.
Clinical Psychology Review, 19(1), 79–96.
Gortner, E., Rude, S., & Pennebaker, J. (2006). Benefits of expressive writing in lowering
rumination and depressive symptoms. Behavior Therapy, 37(3), 292–303.
Hanson, K., & Alexander, S. (2010). The influence of technology on reflective learning
in dental hygiene education. Journal of Dental Education, 74(6), 644–653.
Haugh, M. (1996). How to incorporate and evaluate writing skills in animal science
and dairy science courses. Journal of Animal Science, 74(11), 2835–2842.
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effects of expressive writing on pain, depression, and posttraumatic stress disorder
symptoms in survivors of intimate partner violence. Journal of Health Psychology, 10,
211–221.
Lepore, S., & Smyth, J. (Eds.). (2002). The writing cure. Washington, DC: American
Psychological Association.
Lumley, M., Tojek, T., & Macklem, D. (2002) The effects of written emotional disclosure
among repressive and alexithymic people. In S. J. Lepore, & J. Smyth (Eds.), The
writing cure: How expressive writing promotes health and emotional well-being. Washington,
DC: American Psychological Association.
Mensch, J., & Ennis, C. (2002). Pedagogic strategies perceived to enhance student
learning in athletic training education. Journal of Athletic Training, 37(4), S199–S207.
Oatley, K., & Djikuc, M. (2008). Writing as thinking. Review of General Psychology, 12(1),
9–27.
Park, C., & C. Blumberg (2002). Disclosing trauma through writing: Testing the
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Pennebaker, J. W. (1997a). Opening up: The healing power of expressing emotion. New York:
Guilford.
Pennebaker, J. W. (1997b). Writing about emotional experiences as a therapeutic process.
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Medical Ethics: Medical Humanities, 26, 79–84.
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118 Writing Activities

Sloan, D. M., Marx, B. P., & Epstein, E. M. (2005). Further examination of the
exposure model underlying the efficacy of written emotional disclosure. Journal of
Consulting and Clinical Psychology, 72, 165–175.
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moderating variables. Journal of Consulting and Clinical Psychology, 174–184.
Smyth, J., Stone, A., Hurewitz, A., & Kaeli, A. (1999). Effects of writing about stressful
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Chapter 6

Physical Movement
Dance, Physical Exercise, Performance

Introduction
This chapter focuses on releasing the wisdom, knowledge, creativity, and
emotional life of the body. Within the physical self are connections to the
other aspects of self that can be unavailable to the conscious. Some are
nonconscious material just below the level of consciousness, while others
are unconscious. Tuning into what one’s body knows and understands
brings meaning and relevance to much of what is experienced by other
parts of the self; or, this information can be used to reconnect to that part
of oneself which may have become repressed or split off from conscious
awareness. This can be very deep therapeutic work and is not the focus for
this chapter as that use calls for well-trained therapists in the particular
modality of body work as well as training in the therapeutic use of this
work in groups. What is presented here are physical movement activities
that group leaders can use that can enhance the therapeutic process with-
out necessarily triggering deeper nonconscious or unconscious material.
The activities presented here are primarily used for tension relief, to play
and have fun, to focus on one’s body and increase awareness of its present
functioning, and to demonstrate an access to one’s creativity. Presented
here are movement, dance, physical exercise, and drama/performance
activities, such as improvisation and role play.

A Rationale – the Mind-Body Connection

The work and research on the mind-body connections provide a rationale for
inclusion of physical activities in group therapy even when the primary focus
and emphases are on other issues and concerns. Although the group leader
may not be trained in a particular modality, such as dance therapy, there are
occasions where a simple movement activity could be of benefit to the group
and to members, and this is the intent of what is presented here.
Evidence for mind-body influences are derived from three sources (Goleman
& Gurin, 1993):

DOI: 10.4324/9781003251989-6
120 Physical Movement

! Physiological research on biological and biochemical connections between

the brain and body. Exciting new findings are emerging through studies
on neurobiology that is clarifying how and why these connections play an
important role.
! Epidemiological studies that focus on the associations and connections
between psychological factors and illnesses in the general population.
! Clinical studies to test the effectiveness of mind-body approaches to prevent,
alleviate, or treat diseases and conditions.

A short example activity may help clarify what is meant by the mind-body
connection.

Activity 6.1 Mind and Body

Materials
A sheet of paper and a pen or pencil

Procedure
1 Find a place to work where you will not be disturbed and that has an
appropriate writing surface available. Reflect or think about how you
physically and mentally feel at this time.
2 Write a short descriptive response to each of the following:
a Your current mood
b Your current mental/cognitive state
c Your current body status, e.g. aches, tensions, arousal, etc.
d Your feelings, e.g. sad, angry, pleased

3 Next, list a description or response for each of the following for the previous
12–18 hours in your life. Write in as much detail as possible.
a Food and drink consumed
b The quality of your sleep
c Recreation/leisure
d Physical exercise activities, e.g. walking, working out at the gym, etc.
e Medications taken, e.g. prescribed, over-the-counter medication, etc.
f Vitamins and minerals taken
g Physical and medical conditions, e.g. allergies, menopause, high or
low blood pressure
h Work and/or school-related activities and/or situations
 Physical Movement 121

4 Next, review your current status and your previous 12–18 hours’ activities.
Reflect on how your previous activities are impacting your current mood,
cognition, body, and feelings. The following questions can guide your
reflection:
a Were you able to eat healthy foods?
b Did you obtain sufficient and good quality sleep?
c Was there an opportunity to exercise or move your body?
d How many pleasurable activities did you experience?
e If you have a condition or symptoms that require medication, how
much did the medication control these?
f Did you feel stressed or overwhelmed, or were you relaxed and
comfortable?
5 Finally write a summary paragraph about the relationship of your body
care in the previous 12–18 hours to your current physical, cognitive
(mental), and emotional state or mood; and vice versa that is, how were
your previous mental and/or mood states influencing your mental state.

Taking time to reflect on your body and mind interrelationship, influences, and
other connections can demonstrate the viability and strength of the relationship,
and serve as a reminder of just how much can take place on the nonconscious
and unconscious levels.

General Guidelines
Any movement group activity has the potential to arouse intense feelings and the
group leader should stay aware of this potential when planning and conducting
such activities. Even ordinary physical activities such as walking across the room,
may trigger these feelings because of fears about being judged and evaluated, and
the group setting produces a venue for observation by others, which provides
opportunities for judgments and evaluation by others. Members can fear that
they will be found to be inadequate in some way and thus, shamed. Childhood
memories of being taunted and teased about athletic ability or its lack, how
one walks and/or their appearance when moving, looking funny or weird
when dancing, one’s agility, and the like can easily be triggered by thought of
a movement exercise in the group setting, and can be a source of resistance for
movement activities. Further, if there is a history of body-related trauma such
as rape, physical abuse, or multiple surgeries; fears and other emotions
around the event(s) may be aroused even when the person may have deeply
repressed such memories. The leader may not be aware of this history either
because the type of group may not require this kind of information as part of
screening or group assignment, or because the member does not remember it
or chooses to not reveal it, or other such reasons. However, these events do
continue to exert their influences. Ensuring the safety of group members when
122 Physical Movement

group leaders may lack information about their past experiences and/or
unresolved issues underlies the following guidelines.
Plan the activity based on group needs. It seems elementary to plan the
activity based on group needs, but there may be times when you as the leader
just want to do something spontaneously, or you think such an activity will be
“good for the group”. Those may be appropriate, but they are more likely to
be your needs, and not that of group members. There should be a specific
goal or purpose for the activity.

! Before using a movement activity, describe to members what they will be

asked to do and the goal and purpose for the proposed activity. Introduce
the activity in as much detail as possible so that members can give
informed consent for their participation. Doing so will help prevent
unanticipated distress, deep memories being accessed, intense feelings
aroused that may be uncontrollable for the person, and other such
negative outcomes.
! Use activities that are group focused and not just for a specific person or
subgroup. Movement activities, like other activities described in this book,
are intended for the entire group, and leaders should take care that the
chosen activity does not address what the leader feels a particular
member or subgroup needs. They may benefit, but the focus should be
on the entire group. This is also why I do not recommend that most
activities be performed in dyads and triads. Members may work inde-
pendently for some activities, but these are then shared and discussed in
the whole group.
! Restrict or avoid movement activities that involve touching as this can be
very scary and threatening for some group members even when they think
they can handle it. It is almost impossible for a group member to know if
touching others or being touched by others will trigger negative emotions
based on past experiences, but that remains a definite possibility. Using
activities that involve touch are risky and not recommended.
! Avoid activities that could trigger claustrophobic feelings, such as blind-
folds. There are several trust activities that call for one person in a dyad
to depend on another person and one such exercise involves blindfolding
a person and guiding him/her on a walk. In addition to such exercises
not being recommended because it breaks the group up into dyads, there
is the possibility that something like a blindfold could trigger claus-
trophobia, where the leader did know of that possibility, the member did
not know having never experienced being blindfolded before, or for a
whole host of other reasons. There are many other activities that could be
used to accomplish the same goals.
! Respect any and all resistance and reluctance to participate. Discussing
the feelings aroused by thoughts about the proposed activity may be more
productive. It is strongly recommended that group leaders respect any
 Physical Movement 123

and all resistance and reluctance to participate in a movement activity.

Holding a discussion about the feelings triggered by the thought of such
an activity could be much more fruitful than pressing ahead with it.
! Provide clear and specific directions and check to ensure members’
understanding. Most movement activities give all of the directions at the
front end, and group members can get confused about what they are
supposed to do. To cut down on this confusion, the group leader should
ensure that the directions are clear, and to answer any questions members
may have.
! Block comments by other group members about a member’s appearance,
agility, and the like. Keep the focus on the purpose for the activity. It is
essential that any comments be blocked that could be received as taunt-
ing, teasing, derogatory, or demeaning. The speaker may be trying to
joke, but these are the type of comments that can hurt and cause narcis-
sistic injury.

Movement
Movement can be energizing as well as providing a means to tune into the
body. Purposeful moving is described more fully in the sections on dance,
physical exercise, and role play. Movement here is simply to have group
members participate in a movement of some sort, and then reflect and
discuss what emerged for them as they moved. Topics that can be
explored include feelings experienced, thoughts that emerged, awareness of
bodily sensations especially pain and tension, and how they feel after the
movement. Following is a short list of some movements that can be easily
done in a session with reporting and exploration, that most if not all
members are capable of performing, that are relatively non-threatening,
and can be energizing. The group leader should, of course, ensure that all
group members can participate in the particular movement before intro-
ducing it as an activity.

! Move around the room without talking, and make eye contact with every
group member
! Skip, jump or hop around the room
! Line up according to birthday, from January 1
! Practicing sports signals: touchdown, safe and out in baseball, walking in
basketball, etc.

Activity 6.2 Speedy Introductions

Materials
None
124 Physical Movement

Procedure
1 Divide the group into dyads and label one dyad A, and the other dyad as
B. Have each dyad sit facing each other.
2 Instruct them to do the following:
! Each person in dyad A will talk to B for one minute, introducing him/
herself. At the end of the minute, the leader calls time, and each A person
will move one seat to the next B person and repeat the introductions.
! This continues until every A has had an opportunity to introduce
him/herself to every B.
! The procedure is repeated so that every B now has an opportunity to
introduce him/herself to every A.
! The next step is to divide the A’s into dyads, and do the same for the
B’s. They now speed introduce themselves to each other with all A’s
introducing themselves to other A’s, and B’s doing the same.
3 Reconvene the group and explore what feelings emerged as they did the
introductions, the listening, and the movement. What kind of information
was shared in the introductions?
4 Ask members to identify any similarities among other group members as
they were introduced.

Dance
Dance is defined here as a rhythmic movement usually accompanied by music.
Dancing can be solitary, with a dance partner, or as a group activity, such as line
dancing. Dance can tell a story, for example, ballet; convey nonverbal messages
such as in many South American dance forms; tune into spiritual matters such as
some Native American dances; and as a means of expressing emotions and other
abstractions such as with modern dance performances. When used in therapy,
dance can become an access to unknown and maybe unacceptable parts of one-
self, repressed and/or denied memories, a release of energy, and an expression of
creative and inspirational forces. When used for these reasons, dance activities
are the primary focus for the group, are used constantly in almost or in every
session and may have a sequential structure, and the group assumes less promi-
nence for therapy. As noted before, dance as therapy requires specialized training
and is not the focus in this presentation.
Recent literature on dance therapy addresses uses for diverse conditions
and issues:

! Body image (Langdon & Petracca, 2010; Swami et al., 2009)

! Medically unexplained symptoms (Payne, 2009)
! Parkinson’s disease (Hackney & Earhart, 2010)
! Emotionally focused couples therapy (Hazlett, 2010)
 Physical Movement 125

! Female perceptions of male strength (Hugill et al., 2009)

! Eating disorders (Alexandridis et al., 2007; Burn, 1987)
! Schizophrenia (Xia et al., 2009)
! The elderly (Alpert et al., 2009; Lima et al., 2007)

Dance is included in this chapter for information, and because it can be used in
a group for reasons other than those noted above. This presentation views
dance as an activity that can be used as a movement activity where appropriate
for the following purposes:

! To relieve tension and stress

! As a means to express current feelings
! To play and have fun
! Bring attention to the physical self and focus on its current state

Activity 6.3 Free-Form Dancing

Materials
Music and a music player.

Procedure
1 Start the music and tell members to move around the room any way they
want to. They can jump, skip, whirl around, do a dance step, and so on.
Let them dance for ten minutes.
2 Stop the music, ask members to return to the circle, and explore the
experience of moving without direction or purpose. Ask for feelings
experienced as they heard the directions, as they moved around the room,
and now as they talk about it.

Activity 6.4 In Sync

Materials
Music and a music player

Procedure
1 Pair off group members. While this is easier to do in pairs, triads can also
be used.
2 The pairs are to try to synchronize their movements (dance) without
talking. One will take the lead to begin the steps, and each should take a
turn in changing the movement, all without talking.
126 Physical Movement

3 Start the music and tell the pairs to begin moving. Allow 10–15 minutes
for the dance, and observe how the pair performs, how much or how
little in sync they are, and other body movements.
4 Stop the music and ask them to return to the circle. Explore the feelings
aroused by the experience, especially noting the feelings aroused by not
being able to talk. Ask them how they communicated without talking, if it
was difficult to become synchronized, and the extent of satisfaction with their
performance. The leader should note any observations as indicated in step 3.

Activity 6.5 Just Walking

Materials
Musical selection that has a variety of tempos from slow to fast, and a music
player.

Procedure
1 Tell members that you are going to give them directions as they walk
around the room, and ask that they become aware of the feelings aroused
as you change the directions. (The leader can provide a demonstration of
what will be the directions.)
2 Start the music and take them through the following sequence of walks.
Try to change the walk to fit the tempo of the music.
! Plod – walk as if the legs are carrying a heavy weight, and each step
seems to be an effort.
! Mosey – walk as if you don’t have a care in the world, have no time
pressures, and are enjoying yourself.
! Stride – walk fast and confidently.
3 Reconvene the group, and explore the walking experience, with parti-
cular attention to feelings experienced with each kind of walk.

Physical Exercise
The use of exercise (physical movements) in a group usually calls for the group
leader to have expertise and may even call for certification in the particular form
used such as yoga, in order to be most effective and to maintain appropriate
boundaries. There can be many applications for an activity using physical
exercise focused group such as the following.

! Cancer survivors (Sherman et al., 2010)

! Veterans with comorbid psychiatric and medical conditions (Periman,
2010)
 Physical Movement 127

! Weight loss (Byom, 2010)

! Post-stroke fatigue
! Chronic pain in elderly adults (Ersek et al., 2009)
! Depression (Kunic et al., 2008)
! Risk of coronary disease (Hardcastle et al., 2008)

A physical exercise focused group is defined as one where the majority of time in
a session is used for the exercise, and group discussion and interactions are less
emphasized although this too is considered a vital component. These physical
focused groups can generally have the following sequence: introductions/check-
in; warm-up; focused activity or physical exercise for the session; cool down; and
group discussion. This sequence requires that the leader is able to lead the phy-
sical exercise because having someone who is not a group member would be very
disruptive to the process and may cause resistance to disclosure.
Another way to use physical exercise as a focus would be to have members
perform the physical exercises outside the group session, and then the group
sessions would focus on members’ experiences as a stimulus for group discus-
sions about sensations and feelings aroused, memories triggered, and other
nonconscious and unconscious material. In some groups, the emphasis could
be on the performance as an aid to the condition, such as that described by
Kunik et al. (2008) for depression. Other groups may use members’ outside
exercise experiences to address other psychological concerns such as body
image (Byom, 2010). Both medical and psychiatric conditions may be
addressed with this use of physical exercise, and the leader need not be an
expert in the particular physical exercise.
A third way to use physical exercise in the group would not have the exercise as a
focus for the group session, call for members to perform these outside of the group,
or need the group leader be an expert in the particular group modality. This kind of
application simply uses an easily explained and implemented brief physical exercise
as a stimulus for group discussion where the majority of the time would be spent on
that. As with most all movement activities, members would be instructed to perform
the activity only to the point where they remain comfortable, and to not strain
themselves beyond this point. Possible reasons for use of brief physical exercises in
the group are to focus on the body, use sensations to access feelings, relieve tension
and stress, to energize, and to affirm health-enhancing behaviors.

Activity 6.6 Increase Energy

Note: be sure to consider the physical state of members before
initiating this activity.

Materials
None. If music is used, then a recording and a player is needed.
128 Physical Movement

Procedure
1 Ask group members to stand and position themselves about four feet apart.
2 Introduce the activity by telling members that you are going to lead them
through a short set of body movements are designed to increase energy.
The movements are easy, and tell them that they are to only do what is
comfortable for them.
3 Direct them through the following at a relaxed, easy pace:
! Head – Stand and spread feet apart about 12 inches, stand straight
with arms by their sides and knees slightly bent. Gently allow the
head to move toward the right shoulder, hold for 2–3 seconds, bring
the head back to center, and repeat for the left side. Do this slowly
4–5 times.
! Shoulders – Assume the same position as before. Raise both
shoulders up to the ears, hold for 2–3 seconds, and then relax. Do
this 4–5 times.
! Side stretches – Assume the same position as before. Slowly raise the
right arm overhead, and lean toward the left, thus stretching the right
side. Do the same for the left side. Repeat 4–5 times.
! Legs – Begin in the same position. If group members have difficulty
doing this move when standing, they can sit and do it. Instruct them
to raise their right knee up toward the chest, wrap their hands
around the knee, and pull it slightly toward the chest. Hold the
position for 5–10 seconds. Repeat the process for the left knee.
Repeat the entire process 4–5 times.
! Thighs – Begin in the same position, hold arms out to side at
shoulder height. Keeping the head up and eyes straight ahead,
slowly bend forward at the waist and hold for 5–10 seconds. Bring
body up to stand position and repeat the bend 4–5 times.
! Moving – Direct members to march around the room (music can be
used). Allow up to 5 minutes for marching.
! After the marching, repeat the stretching exercises with only 2–3
repetitions instead of 4–5.

4 Reconvene, sit in the circle, and explore the experience with a focus
on feelings before the routine, and feelings now as they sit in the
circle.

Activity 6.7 To Relax

Materials
None
 Physical Movement 129

Procedure
1 Ask members to rate their body tenseness at this time on a scale of 0 – not
tense to 10 – extremely tense.
2 This set of exercises can be completed standing or seated. Use the following
sequence of movements:
! Tell members to open their mouths as wide as they can, yawn, and
make a noise. Repeat for 30 seconds.
! Next, tell them to stand if possible, and arch their backs while stretching
their arms out to the side. Hold that position for 5–10 seconds, relax,
and remain standing or seated, and repeat the move 4–5 times.
! The next movement can be done seated or standing. Ask members to
sit or stand straight, bring their shoulders back as far as possible, hold
the position for 5–10 seconds, or as long as they can, and then relax.
Repeat 2–3 times.
! The final movement is in three parts:
! Allow the arms to hang loosely at the side, either standing or
sitting. Then, shake your fingers, hands, and arms for about 10
seconds.
! Repeat the same procedure for each leg separately.
! If seated, have members stand and shake their bodies for a few
seconds. (This move is difficult to perform in a seated position.)

3 Ask members to again rate their body tension (0 – no tension to 10 –

extremely tense). Explore the changes, if any, by asking where the tension
was at the beginning, and where is it now. Ask if the tenseness or lack of
tension make a difference in their mood, feelings, and the like.

Movement: Performance Activities

We now turn to a more controlled use of the body, which also brings thoughts
and feelings simultaneously into the experience, that of drama or performance
activities. Benefits of drama/performance activities include the following:

! Assists in breaking down social barriers between group members

! Promotes empathic understanding
! Reduces distancing and disassociation
! Increases emotional expressiveness
! Can be a means to demonstrate how to give and receive constructive
feedback
! Emphasizes the mind-body-emotional connections
! Can help reconnect to unknown, disowned and/or fragmented parts of self
! Increase clarity of thinking
130 Physical Movement

Perhaps the best-known form of drama in therapy is psychodrama created by

Moreno (1964), which is very action oriented to promote insight, creativity,
and explore personal problems. While there are some strategies used in psy-
chodrama that can be used without training, this technique requires con-
siderable and specialized training, and is presented here only as an example.
The main points for psychodrama are that spontaneity and creativity are
encouraged, the work is done in the present regardless of when the condition,
issue or problem occurred, exploring how connections are formed and main-
tained with others, what and how one is attracted or repelled by others, to
discover unrealized or unknown viewpoints, promote catharsis, and the group
provides reality testing. Psychodrama has three phases: warm-up, action, and
reporting and exploration. Procedures from Psychodrama that have been
translated to other theoretical approaches include role reversal, doubling
where the auxiliary plays the protagonist’s inner self, soliloquy, the empty
chair, and the mirror technique.
There are several forms for drama therapy such as the following:

! Interactive storytelling (Park, 2002) where the storyteller presents lines

from a well-known story or poem and group members respond with their
lines adding to the tale or poem.
! Dramatic play (Oon, 2010) that has three elements or phases: playspace,
role playing, and dramatic projection.
! Video interpretation (Horwitz et al., 2010) where group members were
trained in body and voice expression, then acted in a drama with profes-
sional actors that was taped, viewed the tape, and interpreted their own
emotional expression in the performance.
! Narradrama (Dunne, 2010) is a blend of narrative therapy with drama
therapy, and also uses other expressive arts such as music, poetry, and the
visual arts.
! Story-making drama and body mapping (Meyer, 2010).
! Improvisational theater (Veenstra, 2010).
! Cognitive behavior drama (Karnezi & Tierney, 2009), which integrates prin-
ciples and techniques from cognitive and behavioral therapies with drama.
! Psychodrama relapse prevention skills (Morris & Moore, 2009).

Drama therapy or dramatherapy encompasses numerous variations of

performance, but only three will be presented here; role play, improvisa-
tion, and simulation or games.

Role Play
Let’s define role play as assuming the role of another person as they are
described, and participating in a prescribed scene to perform a situation or
event. Benefits for this type of role play include the following:
 Physical Movement 131

! Insight can be enhanced

! Broader perspective gained
! Deeper and more empathic understanding of self and of others
! Ideas for alternatives and other possibilities generated
! Practice new behaviors
! Receive and give constructive feedback

Insight can be enhanced via role play because the participants have less
intense emotional involvement as playing a role involves cognitive processes
also. Further, when done in a group setting, there are also the variables and
influences of being observed, possibly being evaluated, and concern about
being found inadequate or becoming shamed that also combine to provide
some distance. Insight is more possible as the person is able to see him/herself
in a more objective way.
The broader perspective can be provided by the feedback from the observing
group members, leader, and other participants in the role play. Other’s percep-
tions have much less emotional involvement than would the generator of the role
play, and that might give them other perspectives, and hearing these allows for a
broader perspective to be adopted.
Playing another person’s role can produce deeper and more empathic
understanding of oneself and of others. Assuming a role requires that you
think, feel, and act as you think the other person would, and that allows you
to somewhat become as they are. Once you can get into the person, so to
speak, you can better understand what that person is experiencing, which
produces empathic understanding.
Stepping back and observing, hearing the feedback from others in the role
play, and from the observers will likely produce ideas for alternatives and
other possibilities. Some ideas and alternatives may come from others, but the
person generating the role play may now be able to see that there are other
ways to perceive, manage, and act that may produce more satisfying
outcomes.
Role play is a wonderful opportunity to practice new behaviors, and to
receive feedback on how these are perceived by others, as well as how it feels
and fits to assume new ways of behaving. Behavioral rehearsal is a valid
technique from Behavioral Therapy, and when there are others to participate,
that enriches the experience as well as being able to practice new behaviors in
a safe environment.
The group can provide opportunities to give and receive feedback, and
participating in a role play gives opportunities to practice how to make the
feedback constructive. Usually the role play has some sensitivity, especially
for the person generating the topic or scene for it, and group members are
aware of this sensitivity, and can seek to provide important feedback but to
also have it presented in such a way as to not hurt, insult, or offend.
132 Physical Movement

Guidelines for Role Play

The following guidelines are for role play in a group setting where three
or more members participate. Guidelines for dyads or triads are presented
later.

1 Relationships among members, and safety and trust must be built and
established prior to initiation of any role play activities in the group.
2 The leader should determine the focus, goal, or problem that the role
play is intended to address, and this should be at the group level so as to
be immediately relevant for all group members. Examples of group level
problems include shared difficulties in being appropriately assertive,
conflict behavior, and confrontation.
3 Introduce the activity and get members’ cooperation to participate. Have
them write about or draw a situation or event that captures the essence of
the focus for the role play, that is all members can have a personal
involvement in the subject for the role play.
4 After the writing or drawing, have members share their products, but do
not explore or elaborate on these at this time.
5 Ask one member to volunteer to have their scene as the role play. The
member who volunteers becomes the director for the role play.
6 The director selects the players, who do not have to play gender-specific
roles, and briefs them on the scene. The group leader is briefing observers
at the same time. Observers are expected to report on their feelings,
thoughts, and what verbal and nonverbal behaviors they saw during the
role play.
7 The action scene takes place.
8 The group leader then debriefs the director, the performers, and the
audience, usually in that order. Example debriefing questions are as
follows for each:
! The director: ask about the accuracy of the performance, i.e. did the
performers capture the essence of the director’s situation or event.
Explore the feelings aroused as the director watched the perfor-
mance. Finally, ask if the director has any new thoughts, ideas, or
insights.
! Performers: ask each performer to report on what it was like for
them to play the role? Was it difficult or easy? Did they find that
they shifted back into being their selves? What were the feelings
that emerged as they played the role? (Note: these can be reflec-
tive of the feelings of the other person(s) in the situation and may
be new information for the director.)
! Audience/observers: ask them to report on the feelings, thoughts,
and ideas that emerged as they observed.
 Physical Movement 133

Exercise 6.8 A Negative Confrontation

Materials
Drawing: paper and a set of crayons, or colored pencils, or felt markers for
each member.
Writing: paper and a pen or pencil.

Procedure
1 Distribute the materials and ask group members to think of a negative
confrontation they experienced, either as the giver or receiver of the
confrontation. They will be asked to draw or write about it first, and
then one or more will be invited to role play the situation. A negative
confrontation is defined as one where intense uncomfortable emotions were
aroused and/or displayed, where there was not a consensual resolution,
and/or where they left the interaction feeling dissatisfied or worse than
when they began.
2 Once they have thought of the experience, they are to either draw or
write a description.
3 When the writing or drawing is complete, reconvene the group and have
members share their experiences. Do not explore at this time.
4 Ask if a member wants to volunteer to have their situation role-played.
5 Follow the guidelines for role play for the action and exploration phases.
6 As a summary, ask the member whose situation was role played if they
gained any additional awareness or understanding of the situation, and if
there were additional steps that could have been taken to reduce the
negative effects on either or both participants.
7 If time permits, ask for another volunteer and repeat the procedure.

Simulations and Games

Other forms of role play can be called simulations and games, and the new
research that is emerging has revealed positive outcomes for neuroeconomic
games. For example, Singer et al. (2005) found the Trust game to produce a
greater understanding of the other’s perspective that was also observed for
changes in brain activity. There was increased activation in the parts of the
brain that have associations with reward, and these patterns of activation
were different when playing with a group than when playing on the com-
puter. Other new and exciting data are emerging to support the notion of
experiential learning in groups as a viable means for increasing skills and
awareness.
Following is a sample of a simulation/game activity for a large group, of
ten or more participants. The room should be large enough for small
134 Physical Movement

groups to work independently. The leader should select the topic for the
creed in advance. Examples of a topic or focus for the creed include the
following:

! Spiritual, spiritual practices, or a spiritual person

! A positive work environment
! Hope, positive attitude
! Caring and compassion
! Tolerance, respect

An Example Creed

AUTHENTICITY

I believe that authenticity is a valuable attribute that promotes deeper and more satisfying
relationships
Someone who is authentic can be trusted in what they say, and is congruent in their
actions.
You get and maintain authenticity when you have developed your self, have con-
fidence that you are adequate and capable, and have reduced self-absorption.
When you are not authentic, you can create ambiguity and uncertainty, promote
distrust, and are demonstrating a lack of respect for your self and for others.
Authenticity includes all aspects of life, valued relationships, and a commitment
to oneself.
We accept that becoming authentic is a process of developing oneself, is likely to be
misunderstood and unrecognized by others, but is an essential component for initiating and
maintaining enduring and satisfying relationships.

Exercise 6.9 Creation of a Creed

Goals or Purposes
To demonstrate consensus building, and clarify beliefs about the topic.

Materials
Paper and pencils for writing, large sheets of paper for each subgroup to
write their creed. Write a list of the tasks on a posted large sheet of
paper or a whiteboard (tasks: formulate a written creed arrived at by
consensus, draft a position statement about the creed, and select a
representative to deliver the statement and creed) and the following out-
line of statements that are included in a creed on another large sheet of
paper to be posted.
 Physical Movement 135

Creed Outline
I believe__________________ is
Someone who is____________
You get and maintain ________ when you abide by the principles
When you are not _____ you’re
________ includes these aspects of one’s life

Procedure
Explain that the task will be to develop a creed statement that presents their
beliefs that they hold in common about the topic, which is a public affirma-
tion of those beliefs, and which members can and do follow.

1 Divide the group into small groups of participants, and place the groups
in different places in the room. Groups do not have to be equal in size,
but that is the ideal.
2 Distribute the materials, and tell them the topic for which they will provide a
creed. All small groups should work on developing a creed for the same topic
or concept, and a position statement, such as why this is important. Tell
them the time frame for development, and that the representative will report
the creed to the large group. Another requirement is that the creed be a
consensus agreement, no voting is allowed.
3 Ask the groups to write their creed on the large paper, which will be
posted for all to see.
4 Allow sufficient time for the groups to work. Walk around and observe
the actions and the process. Tell groups when there are about five min-
utes remaining to complete the task.
5 Have each group representative report the creed and the position state-
ment to the large group. Allow questions to be asked about content, but
do not engage in exploration at this time.
6 After each group has reported, ask what it was like to participate in the
activity; what thoughts, ideas, and feelings emerged as they contemplated
their perspectives for the topic or concept; and thoughts and feelings
about the process used.
7 If time permits, lead a discussion about the impact of the creed(s), how they
are similar or how they are different; if it is possible to live by the creed; and if
group members have reservations or are they committed what was developed.

Summary
The nine activities presented are a variety of verbal and nonverbal ones
focused on movement, dance, physical exercise, drama, and role play. These
136 Physical Movement

activities can give group members opportunities to gain perspectives that may
have been hidden or overlooked. Body movements can be very revealing of
nonconscious and unconscious experiencing that is then brought to members’
awareness for better understanding and that can be further explored.

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Chapter 7

Imagery, Mindfulness, and Music

Introduction
Creative activities incorporating imagery, mindfulness, and music can tap
other dimensions of experiencing for group members. People learn in different
ways and these modalities can be used to enhance and expand learning and
understanding of oneself and of others. Although each of these, when used as
a focus and emphasis for therapy, call for specialized training, there are
activities that can be adapted for use by group leaders who do not have that
training. However, it is recommended that group leaders have some formal
training with the technique or modality, such as taking a workshop, prior to
using it with a group.
Imagery is a process for visualization of thoughts, feelings, ideas, wishes,
dreams, or fantasies that may be conscious or unconscious. These visualiza-
tions can increase awareness and understanding, suggest possibilities and
alternatives, make conscious the nonconscious and unconscious material,
and can provide comfort and solace. Mindfulness is a technique that has its
roots in meditation, but has been expanded to provide focus and con-
centration in all aspects of one’s life. Be here in the present is its mantra.
Further, mindfulness has considerable research as to its efficacy for stress
reduction, positive therapy outcomes, assistance with medical conditions,
and other uses. Music therapy has been used for some time, and there is
research to support its efficacy. Although what is presented in this chapter
does not focus on music therapy, it does provide some activities involving
music that can be used in groups.

Imagery
A search of databases for research on the use of imagery in therapy revealed
that the majority of studies were on medical conditions such as spasticity
(Bovend’Eerdt et al., 2009), spinal cord injury, breast cancer, (Cameron et al.,
2007), stroke and brain injury (Niemeier, 2001). These and other such studies
on medical conditions used prerecorded imagery activities, or a therapist

DOI: 10.4324/9781003251989-7
 Imagery, Mindfulness, and Music 139

trained in imagery techniques. Serious conditions like PTSD, medical

conditions, diagnosed anxiety disorders, and the like require specialized train-
ing in imagery for therapy, and this kind of training is beyond the scope of
this book. What is presented here are the short and simple imagery activities
that do not call for formal specialized training in the use of the technique
although readers are encouraged to participate in one or more workshops or
classes on the technique. Such preparation can facilitate the use of simple and
uncomplicated imagery techniques, and is useful in addition to the education
and training in group therapy previously accomplished.
This chapter focuses on using imagery for the following therapeutic reasons:

! Teaching relaxation – reduce stress and tension

! Coping with negative emotions
! Preparation for performances, such as tests
! Coping with difficult situations, distress, and the like
! Learning about one’s self-perception

Guidelines
Focus on a single purpose for using imagery in the group. Group members
may benefit in a variety of ways from the activity, but having more than
one therapeutic purpose and/or goal makes it too complicated and less
likely to accomplish any of the intended purposes. The purpose or goals
should be clear, specific, and focused on one of the reasons given in the
introduction.
Introduce the activity by describing what will be done and what members
are expected to do. Imagery activities can be described as a visualization
where the leader provides verbal cues for what to do, what to attend to, and
so on. Members supply their personal responses and associations, and are
encouraged to just let these emerge and to not try to alter these. Permission
is given to stop imaging at any time by opening their eyes, and/or to not
participate in the activity. There should be no penalty for declining to
participate.
Group leaders may want to secure recorded activities, such as for pro-
gressive relaxation. Scripts are also available if the leader feels it important
that group members hear them providing the instructions. Most of the
activities presented in this book and in this chapter have a script the group
leader can use. When reading or providing a script, be sure to do so with
suitable pauses of sufficient time to allow members’ images to emerge. What
can appear as a long time to the leader can be experienced as a very short
time to the group members.
Writing, drawing, or other expressive techniques are useful adjuncts for
imagery. Writing or drawing their images allows group members to capture
them before they become contaminated by thoughts, judgments or
140 Imagery, Mindfulness, and Music

evaluations, or by hearing what others experienced. Some group members

may not need to write or draw, but using these techniques with the imaging
can still be helpful. For example, I find that members’ images of a place of
peace seem to become more vivid and fixed when they draw after imaging.

Imagery
This chapter begins a little differently than other chapters by starting with an
activity to help set the frame for using imagery. The technique of imagery
comes from behavioral therapy, particularly that of the multimodal therapy by
Lazarus (1989), and has many applications. Many of these will be presented
and discussed later in the chapter. An activity is introduced now whose pur-
pose is to provide group members with a refuge to retreat to when encoun-
tering distress or intense negative feelings. Imagery activities can trigger these
for some people, and other theories and therapies, such as Dialectical Beha-
vioral Therapy, Cognitive Therapy, and Eye Movement Desensitization
Reprocessing (EMDR) present such a refuge prior to working with their ser-
ious issues and concerns. Although the activities in this chapter should not
produce distress, the possibility does exist that some group members may
experience this, and the following activity can be helpful. It is also a good way
to introduce group members to imagery.

Activity 7.1 A Haven

Materials
None if imagery alone is used, but if drawing the image is a part of the
activity, the following materials will be needed: paper, a set of crayons or
colored pencils or felt markers for each group member.

1 Introduce the activity by telling group members that they may want to
have a respite from distress or intense negative feelings at times, and the
image they produce from this activity will be there for them to visit at any
time. Tell them that the process will be as follows. You will ask them to
close their eyes, and let the designated image emerge without trying to
change or evaluate it as good or bad, right or wrong. If the image is dis-
turbing, opening their eyes brings them back to the room and stops the
imaging. Determine if anyone wants to opt out of doing the activity and
give them permission to do so.
2 Ask members to close their eyes and to become aware of their breathing.
Note if their breath is deep and even, short and jerky, or if they are
having difficulty breathing, e.g. a medical condition. Give 5–10 seconds
for this. Next, ask them to try and breathe deeply and evenly, and to
notice how this makes them feel. Give another 5–10 seconds for this part.
 Imagery, Mindfulness, and Music 141

3 Provide the following directions.

“As you sit in silence, and your breathing becomes deeper and more even, allow an
image to emerge of a place that gives you feelings of safety, peace, and serenity.
(Allow 5–10 seconds at least for an image to emerge).
Begin to notice details about your place of haven. It a place where you can go
at any time to be safe, peaceful, and serene. What do you see? What do you
hear? What other sensations do you have? (Allow 15–20 seconds or longer to
fix the image in their minds.) When you are ready, open your eyes and come
back to the room”.
4 Ask each member to describe their image. Note similarities among
members, but do not explore these or the images in detail. If you use
drawing, ask members to first draw their images, and then present these
to the group.
5 Have group members explore the following questions:
Was it easy or difficult to have an image emerge?
What feelings were triggered for you as you imaged? Talked about
your image?
Was it difficult to try and make your breathing deep and even? Did
this produce some calmness for you?
How do you feel now about your image?

This activity was presented first because imagery can be frightening and/or
distressful at times for some people, and having a safe haven image can be
reassuring. This image provides group members with a means of support
in the event of distress as they engage in other imagery activities, or in any
of the other expressive activities described in the book.

Reducing Tension and Anxiety

Marra (2005) describes anxiety as causing muscle tension and aches, reducing
the effectiveness of your ability to concentrate and pay attention, interfering
with decision-making, and lessening your capacity to experience joy, pleasure,
and the like. Physical symptoms can be restlessness, irritability, fatigue, heart
palpitations, breathing difficulties, and continual worry. Anxiety interferes
with almost every aspect of one’s life.
Teaching group members progressive relaxation could be helpful to
counter tension and anxiety. The script for relaxation is long, and readers
are encouraged to locate a professional tape to use. However, there are short
relaxation activities that can produce enough relaxation for members to feel
the difference, and that will help in producing images. One such activity
follows.
142 Imagery, Mindfulness, and Music

Activity 7.2 Body Tension

Materials
None

Procedure
1 Introduce the activity by describing some of the effects of tension on the body
and mind. Tell group members that you will guide them in a short activity
that could reduce some of the tension. They can participate with their eyes
closed or open. Closed eyes usually facilitate concentration on the body.
2 Survey group members as to the level of tension they currently feel rating
it 0 (no tension), to 10 (extremely tense). Also ask them where the major
tension is in their bodies.
3 Ask members to close their eyes and concentrate on their breathing, and
note if it is jerky, short, coming from their chest, or however it is at this
moment. Allow 15–20 seconds.
4 Next, ask them to consciously try to deepen their breath and to breathe
from their diaphragm (top of stomach). Tell them if they have difficulty to
just keep concentrating on their breathing.
5 Guide members through the following sequence.

“We’re going to journey through your body from the top of your head to your toes. Along
the way, become aware of any tension in that part of the body. You can consciously
relax the tension by contracting or tightening the muscles, holding the contraction, and
then release the contraction”.

1 We begin with the head. Notice if there is tension, tighten the muscles,
hold it, and let go. (Provide at least 10 seconds between instructions to
allow members to contract, hold, and let go.)
2 Next, we move to the neck. Notice if there is tension. If so, gently move
your head from one side to the other to tighten those muscles and let go.
3 Notice if there is tension in your shoulders. If so, hunch your shoulders up
toward your ears, hold it, and then let go. You can do this several times if
needed.
4 Move to your arms and hands. If there is tension, make a fist as tightly as you
can, hold and release. This should help release tension in the arms and hands.
5 Notice if there is tension in your chest. Breathe deeply and evenly to
release this tension.
6 Move to noticing if there is tension in your stomach. To contract these
muscles, pull your stomach in as far as you can, hold it, and then let go.
You can do this several times.
7 Notice if there is tension in your legs. Try to contract those muscles, hold
it, and then release.
 Imagery, Mindfulness, and Music 143

8 We’ve reached the feet and toes. If you are able, flex your feet by
stretching the leg horizontal, and flexing the toes to align with the heel.
Feel the stretch, hold it, and then release.
9 Perform a body scan by starting at the top of your head and progressing
through the body. Notice where you have tension, tighten those muscles,
hold it, and then release the contraction.

Coping With Negative Emotions

Negative emotions such as anger, fear, and the like, also have negative effects on
the body and mind. These can be triggered and become difficult to relinquish, or
are so intrusive that the person cannot effectively function, or can be expressed in
inappropriate ways so that relationships are impaired, and some group members
may not know how to manage and contain these emotions to reduce these negative
effects. While it can be best that members learn to work through these emotions, or
gain insight as to their causes, what can be helpful in the short term is to give them
a coping skill that can be used immediately when they experience these emotions.
The following set of activities can help members develop distracting strategies as a
coping skill that can be used when the negative emotions arise and linger.
It is recommended that group leaders use the entire set of imaging activities
since members will be responsive to differing distractions. Complete each
activity before moving to the next one.

Activity 7.3 Cope by Distracting Yourself

Materials
None

Procedure
Introduce the activity by telling group members that it can be difficult sometimes to
cope with negative emotions, and that they can become enmeshed or overwhelmed,
find it difficult to relinquish the particular emotion, and that becoming mired can
affect them and others who have to interact with them. What is presented is a set of
four imaging of distracting activities, and they will be taken through the entire set so
they can better select the distracting image that best fits them.

Activity 7.4 Visual Distraction

Procedure
1 Ask members to sit in silence and to concentrate on their breathing for a
few seconds. Then, ask them to allow a pleasant image to emerge, a visual
144 Imagery, Mindfulness, and Music

experience, e.g. kittens romping, children at play, the beach, or anything

that produces a feeling of pleasure. Tell them to note details of the image
and surroundings.
2 Tell members that when they are ready, to open their eyes and return to
the room.
3 Ask each member to share their image. After which, tell them that they
can return to this image when they are distressed, or feel an intense
negative emotion.

Activity 7.5 An Auditory Distraction

Procedure
1 Ask members to sit in silence and concentrate on their breathing for a few
seconds. Then, ask them to image a pleasant sound; a voice, music, birds
singing, or whatever sound pleases them when they hear it.
2 Tell members that when they are ready to open their eyes, and then to
share their images.
3 Tell them that the sound image can be used when distressed, or as a
distraction from a negative emotion.

Activity 7.6 A Taste Distraction

Procedure
1 Ask members to sit in silence and concentrate on their breathing for a few
seconds. Then, ask them to image a pleasant taste, to become mindful of
what it feels like on the tongue or in the mouth, the texture of the substance,
and the feeling that it produces.
2 Tell members that when they are ready, to open their eyes and then
share their images.
3 After step 2 is completed, tell them that they can return to this image as a
distraction whenever they are distressed, or use it as a distraction from
experiencing negative emotions.

Activity 7.7 Positive Touch Sensation

Procedure
1 Ask members to sit in silence and concentrate on their breathing for a few
seconds. Then, ask them to image a positive touch sensation where they feel
something on their skin. This could be something like a spray of refreshing
water, a silk garment, rubbing on lotion, and the like. (It’s probably best to
 Imagery, Mindfulness, and Music 145

not use an image or example of human touches since that can be upsetting to
some group members who may have had negative experiences.)
2 Tell members that when they are ready, to open their eyes and share
their images.
3 After step 2 is completed, tell them that they can return to this image to
use as a coping strategy.

Imagery for Performances

Performances such as taking a test, speaking in public, asking for a raise, and
other such situations can be very anxiety provoking, and even paralytic for
some people. The fear can be so pervasive that the person cannot access the
energy, information, or other resources needed to carry through with the task.
While one activity alone will not conquer this anxiety, an activity such as the
following can show them that it is possible to reduce the anxiety and/or fear
so that they can better perform whatever the task is.

Activity 7.8 A Future Situation

Materials
A suitable surface for writing, sheets of paper, a pen or pencil.

Procedure
1 Distribute materials and introduce the activity. Tell members that the
activity you will guide them through is a preparation for a future situa-
tion. They are free to choose the situation. Examples could be taking a
test, giving a talk in public, or any situation that produces considerable
anxiety for them.
2 Ask members to write a brief summary of the future situation. Give some
time for them to finish, and ask if anyone wants to share their future
situation.
3 Next, have them list the steps they will take to approach the situation
beginning with waking that morning, and to be as specific as possible
about what those steps are.
4 After the lists are complete, ask them to review their lists and to write
what feeling they think is associated with the step. For example, getting
out of bed may have dread associated with it because of anticipation of
the future event.
5 Next, ask them to write a statement or paragraph about what they could
change that would allow them to behave differently. The change should
be personal, not the situation or another person.
146 Imagery, Mindfulness, and Music

6 Have members put the writing instrument down, sit in silence, close their
eyes, and concentrate on their breathing. Use the following script to guide
the imaging.
“As you sit in silence, allow the future situation to emerge with the change in yourself that
will permit you to behave differently in the situation. As the situation emerges, become
aware of your feelings, your actions, and how you imagine the situation will unfold. Stay
with the action as long as you can, noting as many details as you can. When your
imaging has stopped, open your eyes and come back to the room”.
7 Allow enough time for the images to unfold. When all members have
opened their eyes, ask them to briefly write about the imaging.
8 Once that writing is complete, have members who wish to share the
experience do so. Members should be free to not share if they choose.

Coping With Difficult Situations or Distress

Some people find it difficult to cope with difficult situations or distress because
they tend to “catch” others’ feelings. Their psychological boundary strength is
insufficient to prevent others’ projections from being incorporated into their
selves, accepted, and acted on. This is why they end up overly disturbed with
intense emotions that do not disperse easily, they have their own feelings which
are generally negative, and have now incorporated others’ negative feelings on
top of what they were already feeling. These are also the people who generally
find it difficult to say no to others, or to not give in to others’ demands.
Psychological boundary strength refers to having a clear understanding of
where and how you are a separate individual person from others, that is where
you end and where others begin. The separation and individuation process
described by Mahler (1975) is incomplete and the boundary strength is insuffi-
cient to keep others from projecting their negative emotions onto you. Growing
in separation and individuation is a lifelong process, and when there are devel-
opmental delays, the person can have weak psychological boundaries. Growing
strong and resilient psychological boundary strength takes time and effort and is
beyond the scope of this book to explain and describe. What is presented here is
a short activity that group members could use while they are working on
developing and fortifying their psychological boundary strength. The imaging
activity gives them some emotional insulation that can be employed to prevent
taking in other’s negative feelings, criticisms or blame. (Brown, 2009)

Activity 7.9 Boundary Fortification

Materials
Paper or large index cards, a set of crayons or colored pencils or felt markers
for each group member.
 Imagery, Mindfulness, and Music 147

Procedure
1 Introduce the activity by telling members that there are times when
you feel disturbed or distressed in interactions with other people
because you cannot prevent their feelings from overwhelming you, or
you become enmeshed in their feelings. You “catch” their feelings.
You may even have termed this as being “too empathic”, but what
may be happening is that your psychological boundary strength is not
sufficient to prevent this from happening. (The leader should be pre-
pared to describe what catching means, and to give examples such as
what is presented in the introduction to this activity.) Explain that this
activity will give them a short-term strategy to help prevent “catching
others’ feelings”.
2 Ask members to sit in silence and concentrate on their breathing and to
try and make it deep and even.
3 As they sit in silence, use the following script.
“Image a barrier between you and another person that will allow you to hear
what they are saying, but will prevent you from catching their projected feelings.
This barrier can be something like a door you close, a shade you pull down, a
sliding steel wall that you close, a force field. It can be anything you choose, just
image what barrier you could use to prevent you from becoming distressed,
overwhelmed or enmeshed in their feelings. Stay with the image and notice all the
details you can. When you are ready, open your eyes, come back to the room,
and draw your barrier”.
4 After the drawing is complete, ask members to share their drawings and
note similarities between choices of barriers.
5 Tell members that they can image the barrier at any time, before they
interact with someone that seems to always leave them disturbed, and/or
when they are in an interaction and find that they are becoming dis-
tressed or disturbed.

Self-Perception
This section will present an activity to take inventory of members’ self-
perception in a way that can reveal their degree of satisfaction with dif-
ferent aspects of the self by comparing the current perception with the
ideal they hold for themselves. Because humans are multifaceted, it is not
unusual to find that some aspects of self are perceived positively, others
may be perceived negatively, but almost everyone has some part of their
self that they want to improve or change. The expansion and enhancement
phase of the activity can guide members in developing action plans for the
desired changes.
148 Imagery, Mindfulness, and Music

Activity 7.10 Self-Perceptions

Materials
Two sheets of paper with the columns labeled as designated below for each
member (the space for each column can be larger); a set of crayons, colored
pencils, or felt markers for each group member.

CURRENT

Physical Cognitive Emotional Creative Relational Spiritual

IDEAL

Physical Cognitive Emotional Creative Relational Spiritual

1 After distributing the materials, ask group members to sit back and
close their eyes. Tell them you will present each aspect separately
giving enough time for the image to emerge, and then ask them to
open their eyes and draw. You will ask them to image six times, and
to draw six times.
2 Present each aspect separately asking them to image that part of their
current selves. Allow 30–40 seconds for the image to emerge. After
each one, ask them to open their eyes and to draw the image that
emerged.
Physical
Cognitive
Emotional
Creative
Relational
Spiritual
3 After all six drawings are complete, ask group members to share their
drawings. You can approach this by doing all drawings for one aspect at
a time, or have members present all six aspects of their self at one time.
4 Repeat steps 1–3, substituting ideal self.
5 Questions to guide self-exploration follow.
 Imagery, Mindfulness, and Music 149

! How are the symbols for the different aspects of your current and
ideal self alike? Different?
! Which aspect(s) of your current self is (are) most pleasing to you?
! Are there any aspects that are displeasing to you?
! Are there any aspects of your ideal self that are unrealistic to obtain,
achieve, etc.?
! Which are achievable?
! Do you have an action plan to achieve the ideal aspect(s)?

Addressing Group Concerns

When the group encounters a dilemma, or when members are suppressing
feelings or conflict, it can be helpful to do an imagery activity that focuses on
the group as a whole. Such an activity can provide a way for group members
to express difficult thoughts and feelings, to clarify what they sense is hap-
pening in the group, can be a safe way to express what they fear to openly
say, and can allow the group leader to bring a difficult situation to the
attention of the group. The following activity could address unspoken group
concerns.

Activity 7.11 Image of the Group

Materials
None unless the leader wants to have the group write or draw the image.

Procedure
1 Ask members to sit in silence, concentrate on their breathing to try and
relax, and to close their eyes. Tell them you are going to ask them to
allow an image to emerge.
2 Begin by telling members how many sessions the group has met, and that
they have discussed many topics during that time. Ask them to reflect on
their experiences in the group, and to allow an image of the group to
emerge. The image can be symbolic, abstract, or whatever comes up for
them. Allow enough time for the imaging.
3 Tell them that when the imaging stops, to open their eyes and come back
to the room.
4 Have a go around to let members share their images. Or, if they draw or
write, provide enough time for this and then have them share their
images.
5 Observe similarities, differences, and ask members what their associations
are for the images, either their own, or that of others.
150 Imagery, Mindfulness, and Music

6 Try to summarize what the images are presenting about the group as a
whole in the present and invite members to provide their input about
your summary.

Mindfulness and Music: Mindfulness

Mindfulness occurs when you can stay focused on your thoughts, feelings,
physical sensations and actions in the present moment. In some ways, it is akin
to meditation, but is more extending than meditation as it seeks to expand
your awareness to both the inner and external experiencing. This section
presents an overview of some literature demonstrating the effectiveness of
mindfulness, the benefits for using it as a group activity, and some examples.
Kabat-Zinn is credited with conducting the research on use of mindfulness
with patients with chronic pain (Kabat-Zinn et al., 1985). This pioneering
research demonstrated a significant reduction (33%) in the pain rating index
after ten weeks of participation in mindfulness lessons, and also reductions in
mood disturbances and symptomatology. Subsequent studies by Goleman
(2003), Kabat-Zinn et al. (1992, 1998), Segal et al. (2002), Teasdale et al. (2000)
provided additional evidence of mindfulness’s efficacy for pain reduction.
Mindfulness has been shown to be effective in several studies about diverse
illnesses and conditions. Evans et al. (2007) used a mindfulness-based inter-
vention with patients with anxiety disorders and found that symptoms of
anxiety and depression were reduced. Kingston et al. (2007) used mindfulness
with patients experiencing continuing symptoms after a depressive episode.
They found that the depressive symptoms and rumination decreased, and this
continued when measured a month later. Barnes et al. (2007) studies on
mindfulness and relationships linked mindfulness with positive relationships.
Carlson and Garland (2005) studied the use of mindfulness with cancer
patients who had sleep disturbance. The results showed a decrease in sleep
disturbances and an increase in sleep quality. Prouix (2008) used mindfulness
in the treatment of bulimia and found that subjects showed improvement in
emotions, behavior, self-awareness, and acceptance.
Other research examples include the following.

! The elderly (Alexander et al., 1989)

! Gaining therapeutic insight (Kutz et al., 1985)
! Cancer (Carlson et al., 2003; Speca et al., 2000)
! Sleep disorders (Shapiro et al., 2003)
! Positive effects on quality of life (Reibel et al., 2001)
! Stress reduction (Davidson et al., 2003)

Mindfulness is also effective with children and adolescents. Saltzman (2008)

used mindfulness training for eight consecutive weeks with a sample of fourth
to seventh grade children and their parents. Outcomes included an increase in
 Imagery, Mindfulness, and Music 151

the ability to pay attention, and a decrease in anxiety. Biegel (2009) found that
adolescents who had been diagnosed as depressed and anxious were able to
experience reduced symptoms related to anxiety and depression, and
increased self-esteem and quality of sleep.
An important use for mindfulness is seen in the incorporation of it as an inte-
gral part of Dialectical Behavioral Treatment (DBT). It is used to increase self-
acceptance, becoming non-judgmental about self and others, learning emotional
regulation, and other therapeutic tasks in this system. Although the treatment
system was initially developed to treat parasuicidal patients, it has been expanded
as treatment for Borderline Personality Disorder, mood, anxiety, addictive,
eating, impulse-control, and other personality disorders (Marra, 2005).
The proposed uses in this book are for both the group leader and for group
members. The group leader can increase their emotional presence and
observational skills in the group. Members can benefit from learning how to
expand their internal and external experiencing; quiet, calm, and focus their
thoughts and feelings; and gain more self-acceptance.
Two principles from Tao that can be useful in mindfulness are the Principle of
P’u, and the Principle of Wu Wei. The Principle of P’u is described as the state of
the uncarved block which Hoff (1983) terms as the ability to attend to the simple
and the quiet, the natural and the plain. This state promotes experiencing things
and people without making judgments or evaluations. The Principle of Wu Wei
refers to do by not doing, allowing experiences to unfold and happen without
trying to influence or change them. When applied to mindfulness, the two prin-
ciples mean to attend to what is your internal and external experiencing without
making judgments or evaluations; and to be content to allow your experiencing
to unfold without trying to direct them in a particular pathway. These will be the
major directions for the mindfulness activities that are included.
It is recommended that the group leader practice mindfulness activities before
introducing them to the group. The first activity is also a script that can be used
when presenting mindfulness to group members. It is helpful for the group leader
to practice the activity for at least 15 minutes a day for 21 days so that it becomes
effortless, and the leader has a richness of experiences to guide them.

Activity 7.12 Mindfulness Activity

Materials
A notebook or paper and pen to record your experiences.

Procedure
1 Make a commitment to practice mindfulness a minimum of 15 minutes
every day for a specified period of time, for example 21 days.
2 Read the following script, and then follow it.
152 Imagery, Mindfulness, and Music

MINDFULNESS SCRIPT

Find a place to practice where you will not be disturbed. Begin by sitting in
a comfortable position. You can do the activity with your eyes open, or
closed whichever is most comfortable for you.

! Focus on your breathing, and try to make it even and deep.

! Become aware of your body and notice any physical sensations you are
experiencing. Scan your body from the top of your head to your feet and
note muscle tension, relaxed parts, tingles, etc.
! Notice any smells you experience; pleasant, unpleasant. If you don’t
notice any, concentrate on your breath and how the air feels as you take
it in, and let it out.
! Redirect your focus to your sense of hearing. Notice what sound you
hear; near, far, loud, and/or quiet. If your thoughts emerge, just redirect
these to the sounds.
! Attend once again to your breathing, and notice if there are any
changes.
! Let yourself become aware of what you are feeling at the moment, and
note if there are changes.
! Try to sit in silence for the entire 15 minutes and just allow your feelings,
thoughts, and ideas to emerge without following them, emphasizing them,
or evaluating them.
! It can be helpful to write a brief summary of your experience each day.

It is not unusual for people to find it difficult to keep their thoughts from
becoming central when they try to practice mindfulness. After all, there are
usually tasks that have to be accomplished, planning and organizing for
future tasks, concerns and worries, and so on that can be difficult to shut
down and enter a state of mindfulness. It is helpful to be able to empty the
mind, but that is difficult to do at times, especially when beginning the
practice. However, if you persist, you will find this useful in all kinds of
situations, such as trying to fall asleep at night. One way of keeping your
thoughts and feelings from intruding, or taking over is to use the thought
defusion strategy described by Hayes, Strosahl, and Wilson (1999). The
following activity demonstrates the strategy.

Activity 7.13 Passing Thoughts

Materials
None
 Imagery, Mindfulness, and Music 153

Procedure
Find a place to work that is free from distractions and where you will not be
disturbed.

1 Sit in silence with your eyes closed, and allow your breathing to become
deep and even.
2 As you sit in silence, thoughts and feelings may arise. Picture each
thought and/or feeling as one of the following:
a A bird flying by
b A billboard sign you see as you ride by on a bicycle
c On water swirling down a drain
d Pollen, blown by the wind out of sight
e Any image where the thought or feeling is noticed but then, disappears
3 If you find that you are staying with a thought or feeling, return to your
breathing, and try again to notice the thought or feeling as it is passing by
you, but not lingering.
4 The next activity is using mindfulness to cope with a distressing or nega-
tive feeling.

Activity 7.14 Managing Emotions

Materials
None

Procedure
1 Find a place to practice where you will not be disturbed, and that is free
from distractions. You can either close your eyes or let them stay open.
2 Identify your current dominant feeling, such as anger, sadness, and the like.
3 Refrain from making a judgment about the feeling, such as it being good
or bad, right or wrong. Perform a body scan and identify all sensations
you are experiencing for example: breathing hard, your heart racing,
muscle tenseness, and so on.
4 Next, concentrate on one sensation at a time, and try to control your
breathing. If muscles are tense, tighten these, hold and then let go.
5 Identify where the feeling is located in your body and focus on each of
the following characteristics.
! What shape does the feeling have?
! What is the weight? Heavy? Light? Moderate?
! What is its color?
154 Imagery, Mindfulness, and Music

! Is the feeling moving; such as pulsating, moving from place to place,

etc., or does it remain in one place?
6 Once you have completed the first set of questions in step 5, repeat it
three times, and then note if there are any changes in the location, shape,
weight, color, or movement. It may be that the feeling has been reduced,
subsided, or in some cases, it no longer exists.

Music
Music therapy requires the leader to have specialized training. What is pre-
sented here are a few simple activities that use music as a stimulus to energize,
calm, and/or to evoke emotions, but not as healing or for deep exploration of
personal issues.
Babani (2010) in a qualitative study on musical-triggered peak experiences notes
that “many individuals find that music activates insight, inspiration, emotional
catharsis, and enhanced self-awareness”. Hays (2005) in a study on older adults
found that meaning from the music experience was related to personal identity,
self-expression, and feelings of wellbeing. Thus, music can activate many aspects of
the self to promote understanding and increase awareness of experiencing.
Hodas (1994) proposes that music can influence the course of therapy by
increasing morale, providing validation and change for belief systems, and pro-
moting the therapeutic relationship. It is a way to tell a personal story, and
deepen connections. (Duffey et al., 2005; Hays & Minichiello, 2005). Silverman
(2010) obtained the perceptions about five different modalities for music therapy
from psychiatric inpatients who were severely and persistently mentally ill. Par-
ticipants reported the individual music game as the most helpful, and the group
musical game as the most enjoyable. The effects of music seem to be positive on
a range of physical, neurophysiological, and psychological conditions.
Trained clinicians use music therapy with a variety of medical illnesses and
conditions such as the following:

! Cancer (Boldt, 1996; Sabo & Michael, 1996; Williams et al., 2010)
! Organ transplant patients (Madson & Silverman, 2010)
! Premature infants’ treatment (Gooding, 2010)
! Parkinson disease (Batson, 2010)
! Cognitive rehabilitation (Thant, 2010)

Research on treatment of emotional disturbances with music therapy has also

shown to be effective. Examples of such studies include:

! Stress and anxiety (Hunter et al., 2010)

! Depression (Brandes et al., 2010; Castillo-Perez et al., 2010; Compass et al.,
1998)
 Imagery, Mindfulness, and Music 155

! Aggressive and oppositional children (Foulkrod & Davenport, 2010)

! Bereaved teenagers (McFerran et al., 2010)

Burns (2001) describes studies that integrate music and imagery with the out-
come of making the image “more vivid” (McKinney, 1990; McKinney &
Tims, 1995). A study by Band (1996) showed that the combination of music
and imagery led participants to become more immersed in the image, and
Quittner and Glueckauf (1983) proposed that music facilitated the emergence
of images. The review of literature also shows that music is combined with
movement (Luck et al., 2010); dramatherapy (Chipman, 2010); dance (Wen-
grower, 2010); art therapy (Crawford et al., 2010), and recreation therapy
(Bauer, 2010).
Since music can and does evoke emotions, images, memories, and the like,
the group leader should have an understanding of the importance of selection
of the pieces of music to be used in the group. In addition, it is also helpful to
have a pretty comprehensive knowledge of all types and kinds of music such as
classical, jazz, gospel, country, hip-hop, rap, rock, tech rock, pop, and rhythm
and blues to name a few. Trained music therapists will also know of specific
selections and performances within types and kinds of music and be able to
connect the renditions with the needs of the group members and the goal(s)
for using music in the group. It’s very complex to try and match music to the
group’s needs, and to decide what mode of presentation, such as listening or
singing, to be used. While art talent is not essential to the use of techniques
such as drawing or collage, it is difficult to see how music can be effectively
used without some musical talent, knowledge, and training.
The group leader may want to consult with a trained music therapist about
how best to incorporate music into the group session, and on the selection of
music. Following are some short musical activities that can be used by almost
any group leader.

Activity 7.15 Music and Feelings

Materials
A boom box or other device for playing prerecorded music; three musical
selections to evoke energy, reminiscence, and calmness.

Procedure
1 Introduce the activity by telling group members that you will play three
musical selections, and after each, they are invited to report on the feel-
ings evoked by the selection.
2 Play selection one for about five minutes, stop, and ask group members to
report on their feelings.
156 Imagery, Mindfulness, and Music

3 Play selection two for about five minutes and repeat the process described
in step 2.
4 Play selection three for about five minutes and repeat step 2.
5 Lead a discussion on the evoked feelings, and the feelings they are
experiencing now.

Activity 7.16 What Am I Thinking and Feeling?

Materials
A boom box or other device for playing prerecorded music; a musical selec-
tion that will be good as a background, paper and a set of crayons, colored
pencils, or felt markers for each group member.

Procedure
1 Introduce the activity by telling group members that you will play a musical
selection, and they are to draw whatever they want as they listen. Tell them
to try and just let the drawing emerge. They can begin drawing whenever
they like, but you will be playing the selection for about five minutes.
2 Start the music, and observe what group members do. Do some begin with
the music or shortly thereafter? Do some listen for a period of time and
then begin drawing? What do you observe about their nonverbal behavior?
3 Stop the music and reconvene the group in the circle.
4 Have members display their drawings, and describe their experience of
listening and drawing.
5 Ask them to explore how the music and drawing reflected their thoughts
and feelings in the moment, and if there are any surprises in their
products.

Summary
The chapter activities presented descriptions for sixteen activities that can be
helpful to group members to increase their awareness, focus their thoughts
and energy and to relieve tension and anxiety. These 16 nonverbal activities
using mindfulness, imagery, and music are particularly helpful to bypass
defenses so that some nonconscious personal material for group members can
be more readily accessed and explored.

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Chapter 8

Stories, Memories, Photos, Visual

Journals, Flats, and Books

Introduction
This chapter begins with a discussion and activities around stories that can be
characterized as folk tales, legends, fables, myths, and fairy tales. Although
these stories are usually thought of as ways to entertain and, in therapy, to
have therapeutic outcomes for children, this presentation emphasizes their
benefits for adults. Another presentation focuses on memories and how these
can be worked on if they are sad or expressed and intensified if they are happy
ones. Flats form the basis for another presentation.

Stories and the Unconscious

A primary benefit for using stories in therapy is that they can help make the
unconscious and nonconscious visible and conscious. Many people have little
awareness of the impact of these invisible forces on their conscious and func-
tioning and while stories are generally used with children, it can be very
helpful for the adult group members to assist them in better understanding
their selves. These can build greater awareness of the forces that influence
their actions, thoughts, and ideas.
Bettelheim (1976) writes, “In the child or adult, the unconscious is a
powerful determinant of behavior” (p. 7) and as such, is a rich source of
information about anxieties, fantasies, fears, hopes, and wishes as well as
material for creative and inspirational pursuits. It is through this material
that some of the psychological growth concerns are addressed: adjusting to
narcissistic disappointments, resolving sibling and/or parental rivalries,
becoming independent and separate, and developing healthy self-esteem.
But, when the unconscious material is either kept rigidly under control or
emerges in the conscious as overwhelming derivations of the constructs,
rather than being integrated, the person cannot make constructive use of the
material. When keeping threatening material suppressed or repressed as a
defense it can lead to the hampering of expected development and produce
impaired or ineffective functioning. This is the pattern from childhood on;

DOI: 10.4324/9781003251989-8
162 Stories, Memories, Photos, Visual Journals, Flats, and Books

the adult can become severely hampered in functioning by keeping the

feared material from the conscious.
The fearful, threatening, and potentially shameful nature of the unconscious
material in the unconscious can lead to the use of defenses; both to keep from
knowing and to prevent others from seeing. Adults in therapy have had
numerous years of employing their defenses, and are afraid to let go of these
as they fear the material that will be revealed to self, and/or to others will be
extremely shaming. This is only one reason why therapy is an uncovering
process that helps peel away layers to correct misperceptions, integrate pola-
rities, rediscover parts of self, reclaim disowned parts of self, and to develop a
more cohesive, grounded, and centered self. These defenses are generally
strong, of long standing, and effective so that it is difficult for the person to
relinquish them. This may be especially so in groups where there are strangers
who would see the shame. Group leaders must be understanding, tolerant,
and patient and not expect group members to lower their defenses any time
soon. However, through the use of stories they can be encouraged and
become hopeful that they too can work through their problems. They realize
that they are not alone in these struggles, and that their inner conflicts are not
unique to them, but are an expected part of growth and development, and
that moral development leads to greater belonging and connections. Feeling
encouraged and hopeful, they can be less discouraged when things don’t work
out as planned, or when their attempts at solving problems are not entirely
successful, or when other concerns emerge. They now have more confidence
in their ability to cope and manage their emotions, and to seek guidance from
within themselves. They can become more independent.

Forms for Stories

The forms for stories in this presentation are limited to folk tales, legends,
myths, fables, and fairy tales. Fairy tales are the stories used for the discussion
and focus for the creative activities. Folk tales tend to be universal because,
although the characters have different names, and some details vary, the
essential story remains the same in many countries. Many folk tales are stories
designed to teach a specific lesson valued by that culture, they suggest what
one should or ought to do, and there is punishment for failure to do what is
needed or expected.
Legends are stories about heroic and romanticized events that are handed
down from previous generations. These stories usually have a kernel of truth,
but the events, people, and actions have become magnified and exaggerated
to a great extent.
Myths deal with supernatural beings, ancestors, or heroes that embody a
culture’s ideals or deeply held emotions, and who serve as fundamental pri-
mordial types (Hohr, 2000). Bettelheim (1976) notes that “The myth presents
its theme in a majestic way; it carries spiritual force; and the divine is present
 Stories, Memories, Photos, Visual Journals, Flats, and Books 163

and is experienced in the form of superhuman heroes who make constant

demands on mere mortals”. The mortals cannot hope to emulate the superhu-
man heroes, and will always be inferior. Heroes, in myths, have names, do
extraordinary things, and are grander than humans can become.
Fables are designed to teach cultural values and morals. These stories have a
specific point to convey and the listener is supposed to learn that particular
lesson. While magic and improbable events are used in fables as they are in
fairy tales, these do not stand as metaphors or symbols for the listener’s inner
states, they are used as vehicles to get attention and transmit a particular
message.
Fairy tales are about ordinary people who meet the challenges that everyone
faces, and the listener can learn from this, and can aspire to achieve the same
tasks or goals. Fairy tales begin with an existential/developmental dilemma
that is briefly stated. The central figure(s) is (are) at a threshold where their
world is changing (usually their internal world), the future is uncertain, the self
is in danger or in a state of confusion, and old answers do not fit the new
situation. Sometimes there is a period of wandering where new events, chal-
lenges, and enchanted characters are encountered. The central premises in
fairy tales are that everyone has difficulties in life, these are unavoidable, and
they are a part of the human condition. The struggles, metaphors, and ulti-
mate triumph for the central characters show that it is possible to attain a
higher level of self and moral development when one’s inner resources are
used in a constructive way, and that problems can be solved if only for the
present. This description presents a rationale for why fairy tales can be useful
for adults in therapy.

Existential Issues in Fairy Tales

Among the many existential issues that are addressed in fairy tales are death,
freedom, will as the trigger of effort and seat of volition, the indifference of the
universe, struggle and suffering, existential isolation, and meaninglessness. The
current pandemic has raised all of these issues, and some have become more
visible. It can be very helpful to group members to realize that these issues can
only find solutions for the present, are universal, and that they can be expec-
ted to reoccur.

Developmental Issues in Fairy Tales

Although fairy tales are the focus for this section, many of the developmental
issues can also be found in other forms of stories and may be especially
relevant for some adults, especially those who are still in the process of
growing and developing. Group leaders may find some of these issues
applicable to their group members. Among the most prominent issues are
the following:
164 Stories, Memories, Photos, Visual Journals, Flats, and Books

Developing moral values that apply to the larger society

Achieving separation and individuation from parents and further developing
the self
Understanding how healthy adult narcissism development can be achieved
The importance of strong and resilient psychological boundary strength to
prevent emotional contagion, exploitation, and manipulation
Attaining emotional regulation and control
Becoming self-sufficient

It is not unusual for group members to have a hazy understanding of where they
are developmentally and where they can use more growth. The tales give voice to
these and assist members in better understanding of their developmental issues
and how these are affecting their current functioning and relationships.

General Fairy Tale Themes and Symbols

Following are some general themes found in fairy tales that may also be
applicable for other stories. Some general symbols and themes derived from
Bettelheim (1976, Brown (1992), and Brun et al. (1993) include the following:

Wandering – Latency, becoming ready for the next level of development

Forest – Search for meaning, purpose, or direction
Helpful animals, non-hostile dwarfs, and other people – Unrecognized
strengths and other inner resources
Wild animals, birds of prey, and destructive acts by others – Immature
parts of self
Leaving home – Becoming separated, achieving independence
Flowers – The idealized self
Water, ponds – Emotional life
Church – Sanctuary, safety
Keys – Untapped knowledge, resources
Turned to stone, stone animals or people – Lack of humanity and con-
nections to others
Food – Need for nurturance; overabundance or feasts – oral greediness
Simpleton, Witling, and so on – Simply childlike, the reality-based part of self
Hostile attacks and hostile people – Ineffective, aggressive, and destructive
parts of self that are not yet understood or controlled
Sleeping – Suspended animation, latency, waiting
Completing Tasks – Achieving self-actualization
Jewels – Rewards, success
Forester, Hunter – Protector

These are only suggestions, and it is highly recommended that group mem-
bers make their own personal associations for images and feelings that are
evoked by the fairy tale or other stories.
 Stories, Memories, Photos, Visual Journals, Flats, and Books 165

Creative Activities for Stories

Presented here are two activities that can be used for deriving the most out of
the story. These apply to all forms of stories. The activities all begin with the
group leader reading the story. It is strongly recommended that the story be
read by the leader and not be a prerecorded video or other transcription, and
that the story not be one that has appeared on television or film. It is also
recommended that the story or fairy tale selected be short and not take more
than ten minutes to read.

Read, Draw, and Write

The advantages of this approach are many as it provides opportunities for
personal exploration of connections to past unresolved issues and concerns,
unfinished business, and emotional content. The procedure(s) described will
take more time for individual work, but can produce more understanding
and insight. Considerable material for exploration in subsequent sessions can
be revealed. Two methods are described; one that focuses and guides the
writing.

Activity 8.1 Drawing and a Fairy Tale

(Any story form can use this process.)

Directions
Gather materials needed for drawing – paper, colored pen/pencils or crayons
or felt markers and ensure that members have a suitable surface for drawing.

Procedure
1 Read the story or fairy tale. When the tale is finished ask group members
to draw two scenes from the story or tale and to give each a title.
2 Regroup and ask each member to present their drawings.
3 Leaders can use the example existential and developmental items to help
members gain a deeper understanding of their drawings.
4 Ask members to write a summary statement or paragraph about the
experience and their drawings.

Activity 8.2 Writing and a Fairy Tale

Materials
Sheets of paper and writing instruments.
166 Stories, Memories, Photos, Visual Journals, Flats, and Books

Directions
Gather materials needed for writing – paper and writing instruments, a sui-
table surface.

Procedure
1 Read the story or fairy tale.
2 Distribute the paper and writing instruments and proceed through the
following sequence:
a Ask members to divide their paper into three columns and to list all
of the following that are in their drawings. Space should permit three
columns.
Material elements – For example, castles, trees, and the like
Actions or implied actions – For example, weeping, fighting
People – For example, kings, witches, sons, princesses
Animals and insects – For example, ants and birds
Immaterial beings – For example, fairies, trolls
Feeling tone – For example, danger, relief, happiness
b Beside each item on the list, write an association without thinking
carefully, editing or evaluating the association.
c Ask members to review the two lists and write a summary paragraph
about the list of elements and associations that reflects their current
life situation, concerns, struggles, celebrations, and so on.
3 Regroup and share at least one portion of what they wrote for a) to c), or
all of what was written.
4 Ask members to do one of the following:
a Write the feelings experienced during listening to the fairy tale, and
when they were writing and reporting; and relate these feelings to
their current life.
b Verbally report on the feelings and share awareness, surprises, and
feelings about the activity.

Scrapbooks
Scrapbooking has expanded and is no longer just gluing materials about an
event, such as a prom, in a photo book. Although they are also still used in
this way, there are numerous enhancements and extensions that provide a
creative venue for scrapbooks. Many materials and techniques are incorpo-
rated into the display including photos, objects, writings, drawings, poems,
and the like. Almost anything can be included in a scrapbook.
 Stories, Memories, Photos, Visual Journals, Flats, and Books 167

Using scrapbooking as a group activity usually means that members complete

their work outside of the group session, and periodically bring the completed
work to share with other group members. It is recommended that the group
leader schedule these sharing sessions in advance. Another variation is to have
an extended workshop session for members to work on their scrapbooks, and
this would also be an opportunity to share materials.
Advantages for using scrapbooks include the following:

! Members can get in touch with forgotten memories, people, events, and
so on.
! Feelings of creativity and inspiration can emerge and be encouraged and
supported.
! More self-disclosure about important parts of oneself can occur as mem-
bers display their work, and resistance and defensiveness can be reduced.
! Interactions and emergence of therapeutic factors, such as universality,
can be fostered.
! Exploration of important issues and concerns can be less threatening and
allowed to unfold.

Disadvantages are that:

! Scrapbooking is a longer-term activity that cannot be completed in a

session.
! Some members may not work well independently.
! Disquieting memories can be triggered.
! Some members may not have personal photos from their past.
! The cost of materials.

Following are some examples of topics for a scrapbook focus, and one example
of an activity.

! Use photos to tell a story, recall past events and people, highlight life
milestones and celebrations, show personal growth and development.

Activity 8.3 The “Now” of My Life

Materials
A scrapbook (4” " 4”, 6” " 6” or larger), camera for taking pictures, and
scrapbook materials for each member. Each member will need a collection of
photos that depict important people, activities, objects, and symbols of desires
and wishes at the present time. If photos are not available, or they don’t have
the ones they want, they should take pictures for inclusion in their scrapbook.
Members may be asked to supply their own materials.
168 Stories, Memories, Photos, Visual Journals, Flats, and Books

(Scrapbook materials include card stock, double-sided tape and/or glue,

pens for writing, and decorative paper or tape.)

Procedure
1 Introduce the activity by noting that sometimes we fail to take full notice
of our lives in the present and that the activity is designed to focus their
attention on the important things in their current lives without making
any judgment. There are no rights or wrongs, good or bad, just what
exists in the present. The task is to take photos of objects, scenes, persons,
and anything else that represents something about them and their current
lives and to mount the pictures in a scrapbook. They are also free to use
other objects, such as tickets, receipts, papers, and the like, that have
meaning for them at this time. It is helpful for the group leader to have a
sample scrapbook page to illustrate what is meant.
2 Distribute the list of materials and give members a timeline for comple-
tion, such as two weeks. Tell them to either use existing photos, or to take
photos if the desired or needed ones are not available, and to compile
them in a scrapbook. They are free to be creative as possible in making
the pages for the scrapbook.
3 When members return, have them share their scrapbooks in the group.
Focus the discussion on awareness that emerged as they thought about
what to put in the scrapbook that depicted parts of their current lives,
feelings experienced while creating and developing the scrapbook, and
feelings as they talked about the scrapbook in the group.
4 Have each member give a summary statement about their current lives.
! Use a collage to express thoughts, feelings, and ideas about a con-
cept, a concern, or to showcase skills or talent.

Activity 8.4 Inventory of My Relationship Attributes

Materials
Group members will need the following: a scrapbook (4” " 4” or 6” " 6”, or
8” " 8”); cardboard stock, double-sided tape, photos (if desired), images from
magazines or catalogues; paper for writing; and a group leader prepared list
and description for each attribute. The leader should prepare the list of
materials and the list and description of each attribute to distribute to each
group member.

RELATING ATTRIBUTES AND DESCRIPTIONS LIST

Caring – Conveys that the other person is valued and important.

Concern – The welfare of the other person is of importance.
 Stories, Memories, Photos, Visual Journals, Flats, and Books 169

Tolerance – The capacity to value differences of others from oneself,

accepting of diverse opinions, values and the like.
Respect – Regarding the other person as unique, separate, and
worthwhile.
Nonjudgmental attitude – An acceptance of differences (opinion, values,
worldview, physical, etc.) without putting a value judgment as to right or
wrong, or as being good or bad.
Openness – Being receptive to others as they are, and willing to consider
differing perspectives.
Genuineness – An ability to be real and authentic in interactions with others.

Procedure
1 Introduce the activity by providing descriptions and examples for each of
the relationship attributes. Show members a sample group leader con-
structed collage for one or more attributes.
2 2. Ask members to reflect on the relationship attribute as they apply to
them personally as they are asked to create a collage about each rela-
tionship attribute.
3 Distribute the materials and the timeline for completion, such as two
weeks to complete the collages and mount them in a scrapbook.
4 Direct members to create seven collages, one for each attribute, and put
them in the scrapbook. The collages should depict their personal attributes.
5 When members return with their scrapbooks, have them show them to
the group and talk about what the experience was like for them, such as
feelings that emerged. Lead a discussion about the importance of these
attributes in interpersonal relations, and where members see that growth
is needed or possible.
! Use found materials, objects, and recycled materials to be
imaginative and creative.

Activity 8.5 Old, New, Different

Materials
A scrapbook; adhesives; scissors; a set of crayons, colored pencils or felt mar-
kers; other embellishments; two or more example pages made by the leader
using found, recycled materials, and other objects.

Procedure
1 Ask each member to gather a collection of found materials, objects, and
recycled materials to use to create a scrapbook that illustrates something
170 Stories, Memories, Photos, Visual Journals, Flats, and Books

important for that member. The scrapbook should have six or more
pages and can be about anything that member chooses. Show the mem-
bers the example pages noting the materials used, how they formed new
things, and that recycled materials are being used in new ways.
2 Give the members a timeline for completion, such as two or three weeks.
3 When members return with the scrapbooks, have them share and explain
in the group just as was done in step 1 with the examples.
4 Explore the process of creating the scrapbooks; what was difficult, what
was easy, feelings that emerged, and any new insights or awareness that
occurred.
! Make a scrapbook to express thoughts and feelings to
others. For example, a short scrapbook could express sympathy,
thanks, congratulations, and/or when you want to say more and not
only use words.

Activity 8.6 A Card Book

Materials
Small scrapbooks, such as 4” " 4”, with about six to eight pages; materials
used for constructing collages – cardstock, photos, magazine images, stickers
and found objects, a pen for writing.

Procedure
1 Ask members to select a topic or celebration for the scrapbook, such as
happy birthday, condolences, or I’m thinking of you.
2 Tell them to construct the six to eight collages for the scrapbook that
illustrates the various thoughts, ideas, and emotions around the topic or
celebration. For example, a card about thanks could include collages that
illustrate caring, gratitude, appreciation, pleasure, thoughtfulness, and
giving. The facing page is where the member writes about the thoughts,
feelings, and ideas that accompany the expression of the collage. Give a
timeline for construction of the scrapbook.
3 When members return with their scrapbook, ask them to talk about their
card and the ease or difficulty of construction. Ask if they feel differently
about the topic or concept the card scrapbook expresses.

Visual Journaling
A variation for journals is the visual journal where drawings, painting, collage,
etc., are added to the written words. There can be doodles, tracings, rubbings,
and other images that are added to the thoughts, feelings, and ideas that are
 Stories, Memories, Photos, Visual Journals, Flats, and Books 171

expressed in the journal. These enhancers also are expressions and can be
clues to what is just below the level of consciousness at that particular time.
When reviewed at a later time, these entries can help the person to better
understand past experiencing and its impact on them.
Journals can be purchased or made. Books, magazines, sketchbooks, planners,
and other such premade items can be used for journals. When books or maga-
zines or other such items are used for the journals, these pages need to be glued
together to provide a suitable surface for painting, drawing, and the like.
It is important for group members to know that journals do not have to be
kept daily, or even sequentially. These are expressions for their experiences
and can take place over a period of time.
Group leaders should make sample visual journal pages in advance, and
also have a variety of possibilities for journals such as a purchased sketchbook.
This is a longer-term activity and members should be exposed to how they
can easily complete a visual journal that can be meaningful for them. Fol-
lowing are some example topics for visual journals:

! Challenging times
! Healing grief
! Non-death losses such as during the pandemic
! Illness and the journey
! Random and meaningful thoughts, ideas, and feelings
! Beauty and wonder in my life

You can see that there are many and diverse ways to construct a personally
meaningful journal. It can be helpful to consult art journal magazines, books,
or from the internet.

Journal Pages
There are no restrictions on what can be put on a journal page. A helpful
sequence for creating a journal page is to create the background for the page
for example, either painting, ink smudging, gluing paper(s), and the like. The
next layer can be doodles, torn or cut images or photos, stencils, or whatever
is available or that seems relevant. Over that layer is the writing for the
expression(s). These can be a quote, a thought, a word, or whatever expres-
sion seems relevant. Other possibilities include stamping, found objects,
ribbon, stickers, rub-ons, leaves, stamps, and just shapes.
Visual journaling can be focused on the past, or the present, or the future.
Members may want to journal about a memory that is meaningful, challenges
they are encountering, an illness or chronic condition, thoughts and feelings
about an important person in their lives, or even hopes and wishes for the future.
There are limitless possibilities for the subjects for visual journaling. Members get
the chance to explore and expand their thoughts in nonverbal ways that can raise
172 Stories, Memories, Photos, Visual Journals, Flats, and Books

awareness, sort through confusing feelings, help focus on essentials and important
things or people in their lives and expand ways for their expressions.
Following is a procedure that group leaders can find helpful when using
visual journals.

1 Calculate the time needed for members to complete a visual journal to

determine if there is sufficient time in the duration of the group for them
to complete (or almost complete) and to share their journals.
2 Decide on a topic for the journals. For example, a topic during the pan-
demic could be the impact of the pandemic changes on their lives. The
topic should be something relevant to all group members.
3 Gather materials to prepare a sample journal with several complete
pages. Doing so will give the group leader an understanding of what
materials are needed by group members as well as their availability.
While it is possible for the group leader to give members a variety of
materials or to have these available for their use, this may not be possible
for all groups such as virtual groups where the leader will have to rely on
group members to supply their materials.
4 Prepare a sample journal and present to the group. Notice their reactions
to the idea of creating a visual journal and be prepared for some resis-
tance as this is likely to be a new and novel activity for them. It will be
helpful to explore positive and negative reactions and responses in the
group before proceeding with the activity.

Activity 8.7 A Visual Journal Page – My Day

Preparation by the Leader

Prepare in advance a sample visual journal page around the chosen topic, and
a list of needed materials (see the list in Materials).

Materials
A purchased or made journal, scissors; cardstock, a variety of paper scraps, maga-
zines or catalogues for cutting out images; pen or pencils for writing; glue sticks
and/or double-faced tape; sheets of paper; permanent black ink felt markers in
fine, medium, and broad points for writing and/or drawing, and a set of crayons,
or felt markers, or colored pencils. Additional materials that can be used include
stamps and ink pads, stencils, stickers, found objects, ribbon, lace, and so on.

Procedure
1 The leader will introduce the activity, show the illustrated page(s), and ask
members to prepare a page. Members should have received a list of
 Stories, Memories, Photos, Visual Journals, Flats, and Books 173

possible materials including what could be used as a journal, in

advance so that they are prepared to create a page during the session.
It is also a possibility that the group leader will demonstrate the
activity during a session and ask members to create a page outside of
the session and bring it to the next session to share with the group.
2 Ask members to take a sheet of paper and a writing instrument, and jot
down five to seven items about their day such as the following:
! Moments of pleasure or beauty
! Thoughts they had throughout the day
! Sounds/tastes/sensations experienced
! Events
! People they encountered
! Feelings experienced

They can list all items in one category or spread across categories. These lists
will be used to form the written entry for the page later.

1 Next, ask them to select a journal page, and to cut out images from the
magazines or catalogues and paste on the page, and/or draw images,
doodle on the page, or use a combination of collage and drawing.
Remind them to leave room for their written entry.
2 The next step is to write about the items listed in step 2. Use the perma-
nent felt pen for writing as these will write over the paint or ink. Members
can write as much or as little as they wish, sentences do not have to be
complete, and there are no rules about punctuation. The task is to write
about their day.
3 The final step is to include the list on their page. They can paste the list
as is, tear around it and paste, or write the items on their journal page.
4 Once pages are complete, reconvene the group and ask members to share
something about their pages and the feelings experienced as they con-
structed the page.

Here are some other possibilities for topics for a visual journal:

Closely held values

Dreams
Meaningful words and phrases
Vacation
My professional life
My inspirational life
Gratitude and appreciation
174 Stories, Memories, Photos, Visual Journals, Flats, and Books

Flats
Flats originated from a book by Jeff Brown, illustrated by Tomi Ungerea (1964)
and has spawned a host of variations. Essentially, flats are paper dolls that are
drawn and decorated to usually resemble a person and are taken or mailed to
various sites where their pictures are taken. Stories can be created around their
travels, or a photo or scrapbook compiled, or a book written to illustrate their
adventures. Flats are appropriate for all age groups and can be used for a variety
of reasons that are explained later in this section. We begin our presentation with
a personal story about my experiences with a Flat – Flat Samantha.
The evening before I was to leave to attend a conference in Sarasota Fl., my youngest
daughter unexpectedly brought me Flat Samantha to take with me on the trip. It seems that it
was a class project for my granddaughter, Samantha, where the flat had to travel out of
town, and have photos to document her travels. To no avail, I pointed out that we lived at
most, ten minutes from three other cities. Flat Samantha was traveling with me to Fl.
Most flats have clothes drawn on them but, Flat Samantha wore jeans, a sweater, earr-
ings, and had a silver pipe cleaner belt. Somewhere there was a naked teddy bear. (The belt
is mentioned because someone we met said that they wanted a belt like that.)
I carefully packed Flat Samantha in a bag and put her with the materials I took on the
plane, taking no chances that she might not arrive with my checked luggage.
Flat Samantha’s first stop at the conference was the committee meeting where she was
introduced, made a member of the committee, photographed with the committee, and photo-
graphed with individual committee members. Later, the committee chair showed her pictures
to the organization’s board who included them with the conference pictures on the website.
Word got around the conference and many attendees asked to see her. We had a short
break one afternoon before the evening meeting, and another committee member and I went to
lunch and a stroll, taking Flat Samantha with us. We stopped to buy her a necklace at a
bead shop. Visualize four grown women carefully selecting four to five beads for flat’s neck-
lace. She was photographed with her new necklace, with a strolling model, and on a bench
outside of a shop with a new friend who was waiting for his wife. Flat Samantha also
visited the Barnum Museum and was photographed with docents, paintings by masters such
as Titian and Rembrandt, and with the rather extensive model of circus life. Everyone was
happy to take a picture with Flat Samantha.
You probably can tell from my tale that the Flat and I had a wonderful
experience. The responses, even from strangers, were very positive and this is
what I hear happened with others who participated in an activity with a Flat.
I still have the Flat and the pictures.
I mentioned before that Flats were usually of people, but I know of at least
one occasion when flats were of pet dogs. A colleague who heard my story
about Flat Samantha decided to make flats of her pet dogs to send to her step-
grandchildren who lived far away. The children took pictures with their flats
(there was a different dog flat for each child), took pictures of the flats in dif-
ferent places, and e-mailed her stories about the flats. Communications and
relationships were enhanced.
 Stories, Memories, Photos, Visual Journals, Flats, and Books 175

Constructing a Flat
Templates for Flats and other guidelines can be found at www.flatstanley.com.
Following are two activities using a Flat. The first could be used with group
members who are deficient in socializing skills, and the second with members
who have difficulty verbalizing their thoughts, feelings, and ideas.

Activity 8.8 Connecting

Materials
A template for Flats, heavy cardstock, scissors, and a set of crayons, or colored
pencils, or felt markers.

Procedure
1 Introduce the activity as an activity to foster creativity and imagination.
Tell group members what Flats are and provide them with an example of
a Flat that you prepared in advance.
2 Distribute the materials and have members cut the Flats out, and draw
facial features, and clothes.
3 Members then give their Flats a name. Names are usually the owner’s
name with Flat as the first name, such as Flat Samantha.
4 Next, members are to take the Flat three different outside places, such as
a mall, where there are people, and photograph the Flat at each site.
Other people can also be included.
5 At the next session, have members report on their experiences, and note
how the Flat facilitated initiating contact with other people, and how
communications were enhanced. Ask members about their thoughts and
feelings as they talked with strangers, took pictures, etc.

Activity 8.9 Adventures

Materials
Same as in the previous activity, with the addition of paper and pencil, or a
computer and printer if available to members.

1 Introduce the activity as an activity to foster creativity and imagination.

Tell group members what Flats are and provide them with an example of
a Flat that you prepared in advance.
2 Distribute the materials and have members cut the Flats out, and draw
facial features, and clothes.
176 Stories, Memories, Photos, Visual Journals, Flats, and Books

3 Members then give their Flats a name. Names are usually the owner’s
name with Flat as the first name, such as Flat Samantha.
4 The next step is to take their Flat to three places in their world, and write
a short story (even as short as a page) about each place they stop. For
example, if they take the Flat to work, that would be one story. Places
could be different rooms in their home, the car, the yard, wherever they
go. The stories would be about what the Flat experiences, such as what
does the Flat see; what thoughts, feelings, ideas, reactions, and the like
does the Flat have. Tell them to try and see the place from the Flat’s
perspective. They are free to be as fanciful as they want.
5 At the next session, ask members to share a story and then explore what
the experience was like to go to the various sites, and then to write a story.

Summary
A wide variety of creative activities was presented in this chapter, and there
are even more variations for these activities that could be used to aid group
members in their therapeutic journey. Some of the chapter activities may take
longer to implement than those presented in earlier chapters and the group
leader must be aware that it is still important to allow session time for every
member to report even if deeper exploration is implemented in later sessions.
The activities are also appropriate for a wide variety of audiences from chil-
dren to older adults.
The activities presented in this chapter can be the primary focus for a ses-
sion, for all of the group sessions, or as longer-term projects. The eight activ-
ities are multilayered, lend themselves to adaptation for particular problems,
issues or concerns, and will produce a wealth of information for group mem-
bers. Many more adaptations for each activity are possible and can be more
precisely tailored to the group and its members.

References
Bettelheim, B. (1976). The uses of enchantment: The meaning and importance of fairy tales. New
York: Knopf.
Brown, J. (1964). Flat Stanley. New York: Harper & Row.
Brown, N. (1992). Teaching group dynamics. Westport, CT: Praeger.
Brun, B., Pedersen, E., & Runberg, M. (1993). Symbols of the soul: Therapy and guidance
through fairy tales. London: Jessica Kingsley.
Hohr, H. (2000). Dynamic aspects of fairy tales: Social and emotional competence
through fairy tales. Scandinavia Psychoanalytic Review, 10(1), 51–77.
Chapter 9

Creative Activities for Some

Restrictive and Virtual Settings

Introduction
This chapter focuses on creative activities for single session, multiple sessions,
psychoeducational, restrictive settings, and virtual groups. These activities
can be enhancing for members’ learning, participation, and growth as they
can facilitate the lowering of resistance, as well as encouraging members’
interactions. There are some settings where more care must be taken when
planning and using creative activities for groups. Restrictive settings include
those where the setting puts limits on what members can do such as resi-
dential treatment facilities, prisons, and hospitals. Other restrictive settings
that also require careful planning because of the constraints are groups held
in a virtual setting.
Single session groups are those that are self-contained in a particular time
frame and where members will only be in group for that one session. Multiple
sessions discussed here are groups that may be open groups, where members
attend on an irregular basis and where the group may not have specific time
boundaries. Psychoeducational groups are usually closed groups with a specific
number of sessions, and which disseminate information about an issue, pro-
blem, or concern.

Single Session Groups

Planned single session groups will have only one session and that session can
have varying time frames such as one hour or one day. Planned single session
groups tend to be focused on education, skills training, work related topics,
and/or brief introductions to a therapeutic strategy. These groups have a
narrowly defined purpose and goal, are usually very structured, a significant
amount of time is devoted to teaching and dissemination of information, and
vary in the amount of time for that single session. Examples for planned single
session groups are workshops, training groups, presentations, and seminars for
small groups where there is expected member interaction and participation,
and demonstrations for a technique or skill.

DOI: 10.4324/9781003251989-9
178 Creative Activities for Some Restrictive and Virtual Settings

Benefits
There are at least six possible benefits for single session groups:

1 Receive information. Although it is a given that a single session is likely to be

insufficient for many concerns, issues, problems, or for learning a complex
skill, there are some positive outcomes for the member(s) who only attend(s)
one session. Receiving information is a benefit that should not be under-
estimated or discounted. Regardless of the issue, concern or need that is the
focus for the group, learning is an integral part of almost every group. The
information received does not have to be considerable or formally presented.
2 Provide an opportunity for expression of feelings. Group sessions can
provide an opportunity for members to more freely express their feelings,
especially their intense negative ones. It may also be that these members
have no other forum or safe place where these feelings can be openly
voiced without censure and the like. While simple venting does not pro-
duce insight or learning, it can provide some measure of relief. It can be
important for the group leader and members to be accepting of these
feelings and not to try to minimize them, ignore them, or in any way
suggest that the feelings are wrong. Leaders and members don’t have to
agree that the feelings are justified, but neither should they express dis-
approval. While it would be helpful if that member would return to the
group and work on the issue(s) and feelings, that does not always happen
so that the moment that the member does express some feelings should be
capitalized on by simply listening, reflecting the meaning(s), and/or be
provided with an empathic response.
3 Generate new ideas. Many members can be in turmoil when attending
the group, especially at the first session where they have the usual con-
cerns about being helped, included, understood, and can be apprehensive
about what is expected of them; is the group safe, can the leader and
other group members be trusted, and so on. There is so much swirling
around in their minds, and there could also be multiple and conflicting
feelings that prevent clear thinking. The members can be so mired in
their misery that they cannot envision how they can find the help they are
seeking. But, even in the first meeting, the group has the potential to help
members generate new ideas such as:
! Different ideas about the condition, issue or concern that brought
them to the group that could be helpful
! Other sources of help that could be tapped
! How to access their inner resources of resilience, hardiness, determi-
nation, and the like
! More effective ways to communicate and relate
! Increase the meaning and purpose for their lives
! Better coping strategies
 Creative Activities for Some Restrictive and Virtual Settings 179

Developing even one new idea can make that session worthwhile for that
group member.

1 Become inspired and more hopeful. Inspiration can happen at any time
and can come from many sources. While it is difficult to predict what is
inspiring for anyone, group leaders can plan for positive activities, inter-
ventions, and the like as an integral part of every session. Central to the
idea of providing inspiration for the group is the group leader’s ability to
model the following: faith in the group and in members that they have
the resources needed to grow, develop, and heal; an awareness of mem-
bers’ strengths that can be emphasized; an understanding of the impor-
tance of encouragement and support and the willingness to provide these;
and a realistic appraisal and acceptance of oneself as valued and worth-
while. Group members can also provide inspiration, but that cannot be
planned. However, the group leader can capitalize on these when they do
occur by highlighting them and their positive aspects. Inspiration can
provide a measure of realistic hope that can be very helpful.
2 Receive attention. The group is a place where members can receive
attention for their concerns and feelings. These can be expressed,
explored, and can receive empathic responses. The attentive and respon-
sive group leader does not discount, overlook, minimize, or try to get
away from these because of the intensity of the concerns and/or feelings.
Group members may not experience this level of attention and caring in
their everyday lives. Some may be alone without family or other social
support, some may not have family relationships that are constructive and
satisfying, and other such personal situations. This lack of acceptance,
caring, concern, and empathic responding in their everyday lives can be
especially acute if the member’s condition, concern, or issue is chronic
and complex. Others can feel helpless to fix it or make it better, and so
they withdraw, and the affected person does not get the attention and
responding that could be helpful.
3 The commonality that members have in the group around the issue, etc.,
can provide additional support and encouragement as well as attention
because of the shared situation or experiences. Other members can
understand at a deeper level some of the feelings and other experiences
each expresses and respond empathically. The group provides a climate
where attention to members is expected unlike many other places outside
of the group such as among family, colleagues, and friends where atten-
tion can be brief or even nonexistent. Some attention reassures that there
is value of the person.
4 Obtain consensual validation. Consensual validation refers to the agree-
ments among group members that feelings, experiences, reactions and so
on are real and are shared. This validation reduces isolation, feelings of
being different and/or alienated, and fears of having deep character flaws
180 Creative Activities for Some Restrictive and Virtual Settings

that cannot be “fixed” and are shaming. These states are difficult to
endure and are rarely spoken of openly but can have negative and lasting
effects on the individual’s self-esteem, relationships, and general func-
tioning. The realization that others share feelings and experiences can be
inspiring and comforting.

Constraints for Single Sessions

The constraints for single sessions are primarily related to the lack of sufficient
time for many group and therapeutic factors to appear or to unfold. Group
factors such as trust and safety, developing relationships among group mem-
bers and with the leader, learning to give and receive constructive feedback,
constructive management of conflict, and other such factors need time to
emerge, and a single session may not be or is not sufficient.
Yalom and Leczcz’s (2021) therapeutic group factors such as imitative beha-
vior, socializing techniques, and group cohesiveness are less likely to emerge and
be worked on in a single session. These are therapeutic group factors that need
time to emerge or be fostered, to be recognized and addressed, and for personal
associations or connections to be made by all or most group members.
The group leader can be keenly aware that a single session does not provide
enough time for group members to explore their reactions, personal associa-
tions, resistances, defenses, feelings that are triggered, or to generate complex
ideas or practice complex skills. The richness of experiencing that comes with
longer term groups is limited or nonexistent. These losses can produce con-
siderable leader frustration.
In some ways, the group leader’s frustration and feelings of futility are a
major constraint as these can prevent the leader from more fully capitalizing
on constructive use of the time that is available. Leaders who are more
attuned to what cannot be done, miss opportunities to make the single session
as productive as it could possibly be if the focus and attitude were on what can
be done, and have a sense of satisfaction and accomplishment for the limited
outcomes. It would be much more beneficial for the group and for the leader
to take pride and be joyful for the modest or minimal amount of work that is
done.

SAMPLE SINGLE SESSION PLAN

Manage Your Moods

PURPOSE: Learn strategies to help manage your moods.
OBJECTIVES: Identify sensory distractors, increase awareness of personal
strengths, identify two strategies to manage personal negative emotions.
TARGET AUDIENCE: Young adults ages 18–14, N=5–8
SESSION: One three-hour session
 Creative Activities for Some Restrictive and Virtual Settings 181

SCHEDULE

Event/Activity Time
Welcome, review of agenda and objectives, Q & A, introductions, 30 minutes
collaborative goal setting
Activity: My Moods – Triggers, Intensity 20 minutes
Mini-lecture: Sensory distractors and their value 10 minutes
Activity: Sensory distractors 30 minutes
Break 5 minutes
Mini-lecture: REBT – Perceptions of events 10 minutes
Activity: Strengths – Affirmations (Thoughts about self) 30 minutes
Summary and closure 20 minutes

Following is a sample mini-lecture for the sample single session group.

SENSORY DISTRACTORS

INTRODUCTION

Distractors can be a form of thoughts and feeling interruption that take you away from the down-
ward descent into a negative mood. Your attention is shifted from an internal focus to something
outside of you that evokes pleasurable unconscious or nonconscious associations and away from the
negative thoughts and feelings about yourself that are weighing you down. Those thoughts and
feelings become less burdensome as just being away from those negative thoughts and feelings, even
for a brief moment, can give you enough space and time for you to decide that you can control things
enough so that you do not have to return to your negative mood, nor do you have to immerse yourself
in that and be miserable, nor do you have to let the mood become worse and even more negative.

DEFINITIONS AND CATEGORIES FOR SENSORY DISTRACTORS

There are six categories for sensory distractors and any of these can have actions that are plea-
santly thought provoking or have pleasant associations or memories, and can invite you to linger
there for a while and enjoy yourself. There may also be some distractors that tap into more than
one category so that you access pleasure on more than one level, the combination intensifies your
pleasurable experiencing, and you can be drawn to allow yourself to have a more pleasant mood.

! Visual distractors for boosting a mood are sights that bring a smile and you are happy to see it.

When you really see something, your attention is focused on that, your brain is engaged in processing
it for identification, and your feelings can become engaged. All of these then lead you to a conclusion
that what is viewed is good or bad, pleasurable or distasteful, safe or dangerous, and so on.

! Auditory distractors are sounds that capture your attention and interest.
182 Creative Activities for Some Restrictive and Virtual Settings

Are there sounds that bring pleasure when you hear them? These can be used to distract from
a negative mood even when they are not spontaneous and you have to seek them out. Focused
on pleasurable sounds especially those in your immediate environment.

! Tactile or touch distractors are physical objects that are in contact with your skin and the
contact produces sensations that are soothing, comforting, refreshing, and evoke other
pleasant sensations.

Some tactile sensations are very soothing, or exciting, or provide pleasure in a variety of ways
as other sensory experiences can also be triggered. For example, the smooth sensation of cho-
colate melting on the tongue can also excite the taste sensation.

! Olfactory or smell distractors use odors that are in themselves pleasing, or that evoke
pleasant memories and sensations.

Scents, or olfactory distractors, are an important part of our lives and there are probably
numerous scents that can be pleasurable distractors when you are in a negative mood. Become
more aware of pleasant smells around you, and maybe on you such as lotions.

! Taste distractors capitalize on the sensations that emerge when something soothes, excites,
and is pleasing to your taste buds.

The flavors for these substances are sweet, sour, bitter, umami, or salty. Personal preferences
dictate what flavors you find pleasurable, although it seems that most people lean toward
favoring sweet-tasting substances.

! Kinesics distractors use body movement of some kind to move your attention to using the
body, or to become more aware of what your body is experiencing that is pleasurable, or
to put you in a place where other distractors can be used and/or experienced.

Movement of the body in a purposeful and mindful way can be a use distractor. The acts of
moving, paying attention to what you are doing, and staying aware of how your body feels
while in motion can be a powerful distractor. Focus on simple body movements that can
soothe, energize or otherwise be actions that serve as distractors.
Here is the other mini-lecture.

MINI-LECTURE – YOUR PERCEPTIONS

If you were to choose a word for your mood at this moment, what would that word be? If
your word describes a negative mood, how do you intend to make it better, or do you want to
make it better? Without going into too much detail at this point about why someone would
not want to make a negative mood become more positive, let’s just assume that the person has
reasons for staying with the negative mood. Some possible reasons for this can be that the
person feels unfairly treated, is deeply disappointed, perceives little or no personal control of
 Creative Activities for Some Restrictive and Virtual Settings 183

life events, and many more internal and external reasons. For the moment, however, we are
going on the premise that you do want to boost your mood to become a more positive one.
There are a few assumptions that guide this presentation.

! No one strategy will fit everyone or work every time.

What is helpful to you may not work for another person. Indeed, what worked for you
at one time may not work for you at this time. This is one reason why you need to have
a set of mood boosters, be open to adding new ones, and be flexible in choosing which to
use at any particular time. Place and time can also be factors for using effective mood
boosters.

! Each of you is unique and your mood boosters may or will not fit anyone else.

It can be tempting to try and be helpful when other people are having a negative mood,
but giving suggestions based on your personal experiences is not likely to be as effective as
those were for you. If you do have an urge to be helpful, try asking the person what
usually works for them, and gently suggest that whatever works be tried now, or if that
is not possible at this time, ask what other actions the person thinks might be helpful.

! You may not be aware of the resources you have or that are around you that will boost
your mood.

Many people may not realize or recognize resources they have available all around them and
so, fail to use these and remain mired in the negative mood. The sensory distractors are one
resource for helping to change a mood.

! Your mood boosters come from within you and are not entirely dependent on what
another person says or does.

Whatever your mood may be at any particular time, it is related to you and how you perceive
and feel about your self. Hence, what works to boost your mood lies within you.

! It is possible to catch others’ moods.

Emotional contagion has received a lot of attention and study by social psychology and has
documented that you can “catch” others’ feelings. To understand how this works just think about
how you feel at the times when you have to interact with someone who is sad, or is mad, or is
happy. You may find that you too become more in tune with that person’s feelings and start to
have some or all of that feeling too. That process is emotional contagion. This can also be what
happens to others when they interact with you when your mood is positive, or negative, or blah.

! How you perceive and react to life events has more impact on your mood than do the
events themselves.
184 Creative Activities for Some Restrictive and Virtual Settings

Albert Ellis, the originator of Rational Emotive Behavioral Therapy (REBT), has as one cor-
nerstone of his approach that it is not the life event itself that produces the feelings we experience, it
is how we perceive and react to these events that produces the feeling(s). This concept may have
some validity for understanding how ordinary life events affect our moods. Life events as used here
are not disasters, or crises, or traumatic events. While some life events may be unanticipated and/
or distressing, they are put in a category of ordinary life events that happen to almost everyone.
One means to addressing a negative mood is to recall positive things about yourself and
these are called affirmations. Affirmations are reminders of your positive points, strengths,
actions, and the like as a counterpoint for a negative mood.

Multiple Group Sessions

Planning for multiple group sessions is presented in Chapter 4. Basics are the
following:

1 Specify the goal and purpose for the group.

2 Plan objectives which are expressed as what participants will learn or do
in behavioral terms such as identify.
3 Review and plan structural components such as the target audience,
number of sessions, and the like.
4 Select strategies such as mini-lectures and activities to accomplish the
goals and objectives.

In addition, it is also helpful to plan the individual group sessions so that there
is a sequence to promote participants’ learning and growth. Review the sche-
dule for the single session group to see how a session can be planned to fit the
time available for it.
Group leaders should plan to have some information presented at every
session. It can be most helpful if the new information can stand alone by itself
and not be built on previous information, that is, the new information should
be capable of standing alone. If the group is planned to be only one session,
presenting information is a planned part of that group.
Psychoeducational groups can also provide opportunities to learn and practice
new skills, and group leaders could plan to introduce a different skill each session,
such as various communication and relating skills. The introduction of the skill
does not need to be formal or structured but can be an informal presentation and
an opportunity to practice a new skill. Examples for possible new skills that can
be the purpose for the group include the following:

! Practicing nonverbal attending skills, such as orienting the body toward

the speaker and/or maintaining eye contact
! Learning to accept compliments without disclaimers or self-disparagement
! Listening for feelings
! Naming or labeling one’s feelings instead of expecting others to intuit these
 Creative Activities for Some Restrictive and Virtual Settings 185

! Responding directly and concretely to others

! Respectful assertion
! Recognizing empathic failures

SAMPLE MULTIPLE SESSION GROUP PLAN

Following are the components for a sample psychoeducational group on
planning a psychoeducational group.

TARGET AUDIENCE: Experienced and entry level clinicians, adults,

earned degrees, licensure, group leadership experienced.
PURPOSE AND GOAL: Presented will be a planning model and process
for implementing a psychoeducational group.
TIME AND DURATION: Six, one-hour sessions once a week for six weeks
PRESENTATION: Remote, via zoom

SAMPLE MULTIPLE SESSIONS PLAN OVERVIEW

Session Event(s)
1. Introductions, overview of process and procedures, collaborative goal setting.
2. Planning the group – presentation of the planning model, discussion,
activity. Write a plan for a proposed psychoeducational group that includes
all of the components listed above.
3. Planning the group – purpose and goals, objectives.
4. Planning the group – information dissemination pros and cons; readings,
media, lecture, PowerPoints etc., most important information needed.
5. Planning the – group activities, cases, role play, etc.
6. Planning for Assessment and Closure: survey, semantic differential, open
ended items. Closure process.

Skills Building
The other examples focused on personal growth. Following are two examples
for skill building activities.

Making Connections

Materials
A preprinted sheet with the following items for each group member, and a pen or pencil for each.
“Find the group member who shares your interest in each of the following, write the spe-
cific interest in the designated space, such as football for sports, and the name of the person(s)
who shares your interest”.
186 Creative Activities for Some Restrictive and Virtual Settings

Specifics Person(s)
Sport ________________ __________________
TV show ________________ __________________
Kind of music ________________ __________________
Reading material, e.g. magazines, books ________________ __________________
Type of food, e.g. a dessert ________________ __________________

Procedure
Distribute the materials and explain the exercise. Ask members to talk to each member
separately and see if there is a commonality of interest. Allow about 10–15 minutes to
complete this portion. After members resume their seats in the group circle, ask them to share
their commonalities, and then ask what was it like to do the exercise, such as “What feelings
were aroused as you talked with other group members?”

Immediate Feelings

Materials
A sheet of paper and a set of crayons or felt markers for each group member, and a hard
surface suitable for drawing.

Procedure
Distribute the materials and explain the exercise as follows.
“Each of you brought some feelings to the session. Think of three feelings you have at this
moment or had as the group began. Select a different color for each feeling and draw a symbol
for each of the three feelings. The symbol can be realistic or abstract, whatever you choose”.
Allow 10–15 minutes for the drawing. Reconvene in the group circle, share the drawings with
as much explanation of the symbols as the member wishes to present. After each member has an
opportunity to share, ask them to report on the thoughts, feelings, and ideas they experienced as
they thought of the feelings they brought to the group, and as they shared in the group.
There are many such skills that could be mini-lessons with practice. This
way, even when someone attends one session, there is the possibility that they
gain something positive as a result of attending the session.

Groups In Restrictive Settings

Introduction
Examples of studies on the use of creative activities in a restrictive setting
include a systematic review of literature on the use of yoga, mindfulness, and
 Creative Activities for Some Restrictive and Virtual Settings 187

meditation in a prison, (Derlic, 2020); yoga (Bartels et al., 2019; Hauzinger,

2018; Norman, 2015); art (Erickson & Young, 2010; Hongo & Valenti, 2015;
Gussak, 2019a, Gussak, 2019b; Harun et al., 2018; Hauzinger, 2018; Home-
man-Wren, 2021; Kuria & Wainaina, 2019; Regev & Cohen-Yatziv, 2018;
Soape et al., 2021; Takkal et al., 2017); horticulture (Ascencio, 2018; Brown et
al., 2021; Daphne, 2020; Florence, 2019; Harris, 2022; Moran & Turner, 2019;
Toews et al., 2018); music (Chen & Hannibal, 2018; Gold et al., 2021; Hjørnevik
& Waage, 2019; Hjørnevik et al., 2022; Kokı,- - 2020; Odell-Miller et al., 2019);
animal therapy Collica-Cox & Day, 2021; Corleto, 2018; Dell et al., 2019;
Holman et al., 2020; Humby & Barclay, 2018; Rawleigh & Purc-Stephenson,
2021; Stetina et al., 2020; Villafaina-Dominguez et al., 2020). This chapter will
present the major concerns for use of activities in most of these diverse settings,
and a guide for selecting activities.

Major Concerns for Creative Activities in Restrictive Settings

Restrictive and virtual settings such as those listed have several concerns in
common that should be taken into consideration when planning to use
creative activities in those settings. While some of the concerns were pre-
sented in Chapter 2, they may be more essential for these settings. The
major concerns are privacy and confidentiality, need for documentation and
reporting, members’ fears about their personal information, constraints for
members’ emotional expression, media access, inconsistent member atten-
dance, freedom from disruptions, members’ emotional expressions, personal
boundary concerns, and fear of emotional contagion.
Privacy and confidentiality concerns can be of concern to participants as the
group leader will most likely be unable to guarantee either. Group mem-
bers can be rightfully concerned that what they say will be disclosed to
authorities and/or others in other settings, to other people, and that they
will be negatively affected by the disclosures. In addition, the products of
creative activities could be disseminated in some way, or group members
do not have anywhere the products can be kept without intrusions by
others. While this concern may be present for all groups, it can be much
more acute for members in these settings.
All needs for documentation and reporting by the group leader is also of concern
for some group members as they can fear that what they say and/or disclose
will be used in a negative way to impact their wellbeing. Group leaders must
be very careful and intentional in their disclosures of what they are required
or mandated to disclose and what they are able to keep confidential. It could
also be helpful in some settings to remind members that the group leader has
the responsibility and requirement to report and document some things.
Members’ can fear how the personal information and disclosures will be used
against them. It is not unusual for group members to have had experiences
where their personal information has been used in a way that is not in their
188 Creative Activities for Some Restrictive and Virtual Settings

best interests. Since this is a group setting where much personal information
may be disclosed and some may have to be reported or documented, this fear
is not irrational and must be taken into account when encouraging members
to talk about their creative products, which can be very revealing. Group
leaders are encouraged to emphasize confidentiality even though that may not
be maintained by some members, and to let the group members decide on
their personal disclosures. In other words, do not push for disclosure.
Restricted or inappropriate emotional expression by some members can be anticipated
in these settings as some are treatment facilities. Group members may not have
learned how or when to express their feelings, may have been criticized for even
expressing them, and/or may fear the consequences if they were to express their
feelings. Indeed, for some groups it may be best that the group leader minimize
asking for feelings, but not dismiss or ignore, feelings expression and keep the
focus on the cognitive content.
Peer and outside the group interactions cannot be prevented. Even if the group
rules ask that exchanges involving group matters be brought back to the
group, it will be difficult to enforce that rule. There are several difficulties with
these interactions that can affect the group and some members. One difficulty
is that the privacy and confidentiality for personal disclosures may be violated
without that person’s knowledge. Another difficulty is that the interactions can
lead to the development of cliques and these can negatively affect the group’s
cohesion. A primary difficulty is the erosion of any trust and safety that was
built in the group and members can easily feel that they too will be betrayed.
It is for these and other reasons that it is recommended that group leaders are
very careful in encouraging members to disclose personal information that
could be shameful or that could reflect negatively on them in some way.
Group leaders can ask and emphasize that members not talk about other
group members or any person disclosures in sessions, but in the particular
environment that request may not be respected.
Media access may be restricted, which means that some forms of information
dissemination may not be available. For example, such a restriction may mean
that the group leader could not show a YouTube presentation. Also, if the
group leader wanted to make some media-driven materials available for
members to view outside of the group session, the equipment and permission
may preclude this form of information dissemination.
The groups may have inconsistent member attendance for a number of reasons
some of which can be related to the type of restricted environment. This can
be troubling for the group leader for their planning, especially of sequenced
materials, for the development of trust and safety among group members and
can delay the development of any group cohesion. Further, the member(s)
who may miss sessions can feel that they are not a part of the group, which
presents difficulties for interactions and other group processes.
When the group leader cannot ensure freedom from disruptions during sessions,
this also leads to an erosion or lack of development for trust and safety. In
 Creative Activities for Some Restrictive and Virtual Settings 189

addition, these disruptions will negatively affect members’ beliefs about con-
fidentiality and privacy, which can, in turn, make them reluctant to express their
thoughts and feelings as well as their willingness to explore their issues, concerns
and problems. The group leader can try to lessen the impact of disruptions but
should be mentally and emotionally prepared to cope with their outcomes on the
group and on group members.
Some members may have extremely poor impulse control especially in some of
the more restrictive settings, and that indeed may be one of the major reasons
that they are in the particular restrictive setting. Group leaders will find it
helpful to be prepared to cope with the expressions from these group mem-
bers that can be inappropriate or hurtful for other group members. While
most expressions will likely be verbal, it is not unrealistic for the group leader
to be prepared for physical expressions and have a plan for how to manage
and handle these.
Members’ boundary concerns both physical and psychological, and their emo-
tional strengths and weaknesses will differ, but it can be important for the group
leader to be aware of these for each group member so as to help prevent viola-
tions or other concerns. Group treatment can build on strengths, allow members
to better understand their boundaries so as to prevent violations, and to show
them how to capitalize on their strengths. Many of the creative activities in this
book are designed to help with all of these.
Fear of emotional contagion is usually present in all kinds of groups. Members
can fear that they will “catch” other’s feelings and become enmeshed or
overwhelmed by these. Emotional contagion is possible especially when some
group members may be powerful senders, and others may be susceptible to
catching others’ feelings, start to feel these, and worse, be unable to relinquish
them. This is one of the reasons why it is important when using creative
activities that group leaders ensure that there is sufficient time for all group
members to report, and to focus on feelings that emerge for group members.

Use of Activities in Diverse Settings

There are three major considerations for using activities in all settings. First, is the
choice of type of activity, second is the availability of materials needed for the
activity, and the third is the possibility of evoked emotions and members’ capacity
to cope with or manage these. The latter is especially important in restrictive
settings where group members may be in treatment because they lack the capa-
city to successfully manage some emotions. It is recommended that group leaders
not only consider what emotions may be tapped, but also if members will be able
to manage these effectively especially since the group leader may not be able to
notice some indices of the intensity for some members.
Some activities will be easier to use in the particular restrictive or virtual
setting. For example, it can be relatively easy to use writing activities, music,
and movement activities in virtual group settings whereas it is much more
190 Creative Activities for Some Restrictive and Virtual Settings

difficult to use art-based ones, not impossible, just more difficult. Some of the
constraints about which activities include the rules and regulations in the
particular setting such as a treatment facility, the materials that are available,
members’ capacity for understanding the instructions for the activity, and the
time available for reporting. Let’s review some categories of activities for their
ease and difficulty in a virtual or other restrictive environment. Discussed are
writing, stories, music, art, and movement.

Choice of Activity
Writing activities such as Expressive Writing (Pennabaker,1997a,1997b,
1997c) lists, and brief essays can be easily used if group members are allowed
to have pencils or other writing instruments and if they have the cognitive
capacity to follow the directions. Advantages for using writing activities
include that this allows for all group members to participate at the same time
around the particular topic, members can be free to choose what they disclose
about what they wrote, and the act of writing can help focus their thoughts
and feelings. Disadvantages can include the absence of needed materials for a
member, their fears about not writing well although this does not matter for
these activities, and a reluctance to try and express their thoughts and feelings
in this way.
The category of stories also includes poems, and cinquains. Chapter 8
presents some ideas for how to use stories and the like and these can be
adapted for use in restrictive and virtual environments. The development of
the individual products will depend on the tools or implements that are
available. For example, if the environment does not permit scissors, then
collage may not be an option. Or, if pencils or other writing implements are
not available, then writing is not an option for a product.
Music activities (Brown, 2013) can be used to energize, calm or to evoke
emotions but not for deeper explorations such as those used by music thera-
pists. It is important that the group leader understand what feelings may be
evoked by their selection of particular pieces of music as well as knowing a
wide range of types of music that can be employed. It may be helpful to
consult a music therapist for suggestions of music that can be used by group
leaders who are not music therapists. Advantages of using music can be to
soothe, calm, relieve tension, promote feelings of wellbeing, energize, and the
like. Disadvantages are that the type of music selected may not be pleasing for
all group members and that some pieces may evoke unintended distressing
memories. In fact, there can be some types of music that are distasteful for
some people.
Art-based activities may be especially difficult to use in restricted settings as
these activities require the availability of art materials such as crayons, felt
markers, colored pencils, paint, pens or pencils for drawing activities and glue
sticks, scissors, colored paper, and other such materials for collages. It may be
 Creative Activities for Some Restrictive and Virtual Settings 191

difficulty for group members in virtual groups to obtain these materials.

Another constraint even with in-person groups can be members’ resistance to
anything art-based because of the erroneous idea that the activities require
artistic talent, and this can be more difficult to overcome in the virtual setting.
Some collage activities may be able to be implemented and some suggestions
for using these in restricted and virtual groups are presented.
Movement activities may be more difficult to implement due to space con-
cerns. Examples of movement activities are dance, yoga, stretching, or even
running in place. The intent of movement is to use the body as a means to
access feelings, experience different bodily sensations, relax, or energize.
However, space is needed for moving around and this may be limited for both
the leader and group members in restricted and/or virtual environments.
However, there are some that may be used, and ideas are presented later in
the chapter.

Evoked Emotions
There is always the possibility of evoking emotions for members when using
activities and that can be the purpose for some activities. There are times
when the evoked emotion can be distressful and/or intense and group leaders
must stay mindful and aware of this possibility, which is even more important
for virtual leadership. Members do not always speak of the distressful evoked
emotion and when the session is face to face, it can be easier for the group
leader to recognize when a member is distressed or has some other reactions
for an evoked emotion. Some visual cues are definitely missing or more easily
hidden with virtual sessions. Leaders can make it a part of the expansion
phase to ask members to verbalize evoked emotions.

Major Guidelines for Virtual Settings

There are numerous studies on the effectiveness of virtual groups for various
issues, conditions, and problems and more will be emerging rapidly because of
the need to go virtual for the pandemic. Researchers have found favorable
outcomes for virtual treatment for panic disorder (Lauckner & Whitten, 2016;
Lustgarten, 2017), anxiety, depression (Bischoff et al., 2017; Lauckner &
Whitten, 2016; Lustgarten, 2017), PTSD (Lauckner & Whitten, 2016; Lust-
garten, 2017), military-related combat PTSD (Acierno et al., 2016; Wierwille,
Pukay-Martin, Chard, & Klump, 2016; Yuen et al., 2015), substance abuse
(Lustgarten, 2017), chronic pain (Lustgarten, 2017), and obsessive-compulsive
disorder (Stubbings, Rees, & Roberts, 2015). Studies for different populations
have also found favorable results such as juvenile offenders (Batastini, 2016),
parent training (Comer et al., 2017), refugees with PTSD, at risk for suicide
(Gilmore & Ward-Ciesielski, 2017) adolescent depression (Kobak et al., 2015)
military with depression (Luxton et al., 2016).
192 Creative Activities for Some Restrictive and Virtual Settings

The guidelines for virtual groups begin with the group leader’s adjustment
or transition to understanding the benefits and challenges for virtually held
group that can be different from in-person groups, and the technology-related
planning and organizing tasks.

Benefits and Challenges

Benefits for members include increased access to services, the possibilities of
feeling less anxious or threatened, decreased emotional contagion, increased
ability to be emotionally present in session, fewer missed sessions and/or tardi-
ness, increased ability to attend sessions. Increased access to services includes
decreased costs to the member such as transportation and childcare, member
availability at designated times is easier, members in rural and other such areas
can receive treatment that might not be available in their communities, which
are definite benefits for the members. This access can also result in fewer missed
sessions or being tardy, a reduction in their isolation and alienation, and other
positive outcomes. The virtual sessions can also produce less anxiety about
being included in the group and how they will be perceived by group members.
There can also be a reduction in emotional contagion due to the distance and
separation of group members, which could improve their ability to be and stay
emotionally present in sessions.
There are also some disadvantages for virtual group sessions that include the
following: some or all members may lack the necessary reliable technology; their
space for attending the group may cause it to be harder for them to ensure lack
of disruptiveness and intrusions, which then reduces privacy and confidentiality
as well as what they are willing to disclose; technical difficulties that cause frus-
tration during sessions; and other such constraints. In addition, members may
experience a lessening of their verbal spontaneity for input and responses, have
uncertainty about when to speak, and may find it more difficult to develop a
therapeutic alliance.
Benefits for group leaders include more assurance of members’ attendance,
the ability to provide treatment and care for remote group members and thus
increase their access to care, and it may be easier to structure and direct
group sessions. (Lopez et al., 2020; Barak et al., 2008) In addition, virtual
groups can be beneficial for group leaders in that they can more easily provide
sessions in settings such as prisons, residential facilities, nursing homes, and
other venues where access to treatment may be more limited.
Adjusting to a virtual group environment presents many challenges for the
group and may be especially so for using creative activities. Some adjustments
include knowing and understanding the technology requirements, how to
establish a therapeutic relationship where group members will feel comfor-
table with disclosing personal material, and the inability to effectively use
some group facilitation strategies and techniques. Among the many difficulties
that holding virtual sessions present for group leaders include lost behavioral
 Creative Activities for Some Restrictive and Virtual Settings 193

cues; as members move and interact less and only their upper body is visible,
it is more difficult to scan the group and note members’ reactions. The leader
has to look at the camera as part of the better practices for leading virtual
groups and this makes it difficult to initiate and maintain eye contact, or to
evaluate members’ and the group’s emotional intensity, the reduction of some
therapeutic factors, harder to provide group process comments, establishing
the therapeutic alliance, fostering member to member interactions, and a
reduction of emotional presence.
Eysenbach et al. (2004) in their review of online groups found that the
online groups tended to develop in the same patterns as did in-person groups.
This pattern of development included the period of becoming acquainted,
interacting, and setting group norms, and encouraging and supporting group
members. They note that groups that had a structured psychoeducational
component were more effective than groups organized around a particular
condition or problem. Lopez (2020) states that people do find ways to connect
in remotely held group settings and are able to interact and connect despite
the limitations that these settings present.

Planning and Organizing Virtual Group Sessions

Crowe (2021) describes the technology requirements and security for virtual
sessions that are applicable for virtual group sessions. The technology require-
ments for both the group leader and members include a computer, camera,
microphone, internet connection, and appropriate videoconferencing software.
Lustgarten (2017), Luxton et al. (2016), and Swenson et al. (2016) explain that
the sessions must be in accord with Health Insurance Portability and Account-
ability Act (HIPAA) requirements and propose that there be an algorithmic
encryption of the video signal to ensure confidentiality. They also state that
there should be a backup plan for a technological failure, that the details of the
plan should be a part of the written consent, and that it is helpful to have
someone with technical expertise near to hand to help manage problems.
Much of the success of the virtual group session will rely on the quality of
the technology and services such as outdated computers, the reliability and
speed of the internet services, and the quality of the audio and video output.
When there are continual technical difficulties, computer problems, and/or
user inexperience, the leader and group members can become stressed and
frustrated. In addition, that means that the focus of the session becomes
something other than the designated topic and goal.
Another technology-related task is to decide how speaking will be organized
so that members can be guided to speak, decrease interruptions, and allow for
interactions and discussions. Group members can signal their desire to speak
by raising their hand either physically or electronically,
It is recommended that group leaders create their space that is seen on the
screen by group members to be free from distractions, disruptions, or
194 Creative Activities for Some Restrictive and Virtual Settings

interruptions, to include silencing phone and other devices, and to have this as
a requirement for group members. Pay attention to the background for the
leader and try to keep clutter, personal objects and the like either absent or
minimal, and a digital background is also a possibility. The attention should
be on the group leader, not their background.
Sessions will be less stressful if the leader and group members can reduce back-
ground noises and the easiest way to reduce the noises is to have members mute
their microphones. Depending on the level of maturity of the group members they
can be requested to mute their microphones until ready to speak, but this then
gives some members who already are resistant an excuse for not having input.
The group leader should ensure that group members have all needed
materials readily available before starting the session. It is very disruptive to
the process when materials and the like have to be secured from another
location even if that location is just next door.

How to Use Creative Activities in Diverse Settings

There are many challenges for using creative activities in diverse and virtual
settings and each of these has a unique set of challenges as described pre-
viously. In addition to these unique challenges, the group leader has to also
consider the target audience and the members’ characteristics, the group’s
needs, and the goals for the group so that the chosen activities meet the needs
for individual group members and for the group as a whole.
Given the constraints and the opportunities for the particular setting, group
leaders may want to choose activities from the categories of stress reduction
(Chapter 6), managing emotions (Chapter 8), and self-strengthening and personal
growth. Some activities from Chapters 4 and 5 may be useful depending on the
circumstance for the setting. Group leaders for restrictive and virtual settings may
want to be cautious in using imagery, journaling, and performance as they are at
a distance where the intensity level aroused may not be easily noticed.
Examples of activities for each category include the following:

Stress Reduction – Breathing, meditation, exercise, music, and body scans to

locate tension and try to reduce that.
Managing Emotions – Stories, fairy tales, poetry, music, breathing
Self-strengthening – Stories, developing self-affirmations, finding strengths
Directions for using activities from each category are included in this chapter
and some sample activities.

Directions for Using Stories, Fairy Tales, Poems, and

Cinquains
There are three methods for using stories – discussing, writing, and drawing.
Discussing is used when group members either are not permitted to have the
 Creative Activities for Some Restrictive and Virtual Settings 195

materials for drawing or writing, or these are not accessible for all group
members. If group members are permitted and have the needed materials for
drawing or writing, then either of these may be used. The advantages of using
stories, poems or cinquains are that this approach can provide opportunities
for group members to do personal exploration of connections to past unre-
solved issues and concerns, unfinished business, and emotional content at the
same time.

Directions for Discussion About Stories

1 The group leader informs the group that the leader will read a (story,
poem, fairy tale, or cinquain) and that group members are asked to listen
and report as directed.
2 The leader can ask what thoughts and feelings emerged when they heard
what was being proposed, and a rating for the intensity from 1 – little or
no intensity – to 10 – extreme intensity. (Note: If one or more members
have a negative thought or feeling with an intensity above 5, try to
explore what seems negative about what is being proposed that aroused
their feeling(s). This exploration is more important than proceeding with
the reading and discussion.)
3 The leader then reads the item.
4 Ask each group member to report on the thoughts and feelings evoked as
they listened.
5 Ask each group member to talk about any meanings, reflections, or
memories that emerged as they listened and as others reported.
6 The leader should note and emphasize commonalities among group
members.

Summary
There can be environments and audiences that are suitable for some activities
because of safety concerns for group members, or limitations for the materials
used. Some restrictive environments were described, a rationale for choosing
activities for the environment and for the limitations of the group members
were presented. Specific attention was given to the use of activities for groups
held virtually Ten activities were presented for groups held in these
environments.

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Chapter 10

Creative Activities for Diverse

Conditions

Introduction
Conditions where creative activities may be helpful include groups for particular
conditions such as medical illnesses, emotional disturbances, caretakers for people
with certain conditions, support groups, and transition groups, Examples for
studies on creative activities used in groups to treat various conditions include the
systematic review of group psychotherapy with fibromyalgia patients (Sen et al.,
2019), veterans group exercise (Goldstein et al., 2018), and adaptation of Multi-
Family Psychoeducational Psychotherapy (MF-PEP) for adolescents with mood
disorders (Fristad et al., 2018).
The first part of the chapter presents some commonalities among the target
audiences even though the conditions addressed may differ. All groups will
require basic planning although the strategies will vary because of the needs of
the target audience and their ableness to participate in activities. The second
part presents guides for activities such as symptom self-management, support
groups, and life transitions; sample activities; group factors and activities; and
managing difficult member behaviors and activities.

Guide for Selecting Activities

Group leaders should expect that members of these groups will likely be very
anxious, may be fearful, some will engage in self-blame or in blaming others,
may strongly need to be reassured that the outcome will be positive, and some
will be depressed. It is important that group leaders be accepting of members
as they are, demonstrate confidence that they can learn and change, encou-
rage and support even the smallest attempt and gain, and build a relationship
with group members that can be a motivating factor. This does not mean that
the group leader should over compliment or flatter members. Rather, the
leader needs to be genuine in encouragement and support, recognize efforts
expended by group members, point out progress that maybe they don’t see,
understand what difficulties or constraints they may encounter, and empathize
with them.

DOI: 10.4324/9781003251989-10
 Creative Activities for Diverse Conditions 201

! Activities should allow for expression of feelings.

! Use activities that emphasize universality for group members while, at the
same time, demonstrate individual personal connections to the material.
! Activities should be selected based on group members’ abilities – physical
and emotional.

Using creative activities that allow expression of feelings, activities that explore
current feelings, and the leader and group members acknowledging the validity
of expressed feelings can be very helpful as the group sessions may be the only
place that some members will feel that it is safe to express some of their feelings.
Usually, these groups are homogeneous around the condition. This can be
helpful in some ways such as providing some commonality among the mem-
bers, which can help reduce some of their anxiety; members may be able to
serve as models for how they manage parts of the condition, and the material
presented applies to all group members.
Group members will need to feel that they have a personal connection to
the material presented in the group. If they don’t have this personal connec-
tion, then they are apt to tune out and resist in other ways. Group leaders can
help members recognize their personal connections by linking current and
previous self-disclosures, pointing out universality, and by directly asking
members to explore what personal connections they may have.

Commonalities for Members of Diverse Conditions

Group leaders will most likely encounter groups where members are seeking
symptom relief as well as stress reduction, yearning for hope and inspiration,
and seeking ways to cope with changes, anxiety and depression, needing to
learn to manage their intense negative emotions, and experiencing existential
crises. Some members may be experiencing profound grief, loss, and other
changes for their lives either because of their condition or as a caretaker of
someone who has the condition and are looking for support and encourage-
ment as basic needs. While the conditions for the groups may differ and may
call for different strategies, these seem to be the basic concerns that will guide
group leaders in their treatment planning.

Basic Guidelines for Selection of Activities

The primary guiding principles for the selection of creative activities for
groups focusing on diverse medical or emotional conditions are that the per-
sonal understandings that can result can guide and direct decisions, choices,
attitudes, that in turn, affect behavior in a positive way. There are other out-
comes for these groups that are also positive, such as reducing alienation,
increasing a sense of universality or similarities with others, providing social
support, infusing hope, promoting interpersonal learning, and empowerment.
202 Creative Activities for Diverse Conditions

Basic planning includes the following:

! Consultation with the treatment personnel for the target medical or

emotional condition as well as reading the literature about the condition,
efficacy of group treatment, and other guiding materials.
! Establishment of goals and objectives. These should be narrowly defined
and presented in terms that are reasonable and achievable.
! The effect of the condition and/or medication on the ableness of the
group members.
! Outcomes should be capable of being assessed and relevant to the goals
and objectives for the group.

Consultation with treatment personnel and gathering information from published

studies on treatments and their efficacy is one of the first steps as this provides
the basic information to guide the development of group sessions. Many of
these groups will have a dissemination of information component and it is
essential that this information is accurate as well as informative. The treatment
personnel are more likely to have the relevant information such as the target
audience’s needs, progress of the condition, and expected outcomes. This step is
essential because it is difficult for an outsider, or even someone who is involved,
to have a thorough and comprehensive perspective of what the target audi-
ence’s needs may be. The professional literature has many studies on the effi-
cacy of teaching how to manage symptoms; prevent relapse or an escalation of
the disease, illness, or condition; and other such ways by which the person can
help themselves.
Some basic information could include the following:

! Problem identification – a description of the condition, disease, illness,

and so on
! Treatment options
! Expected outcomes
! Precipitating factors when these are important to know to prevent relapse,
or from becoming chronic
! Suggested helping strategies
! The impact on the quality of life
! Barriers and constraints
! Motivation and encouragement factors and strategies

It is very important to take into consideration the ableness of group members to

participate in the activity. Ableness would include physical ability such as
managing to cut out images or activities that call for physical movement;
cognitive ability in order to understand the instructions for completing the
activities, or lacking emotional regulation or impulse control; as well as other
abilities that may be affected by the condition or medication.
 Creative Activities for Diverse Conditions 203

Families and Caretakers

Planning can also include dissemination of information to others such as
families, caretakers, and others who interact with the affected client on a reg-
ular basis. When facilitating groups for diverse conditions it is important to
keep in mind the following:

1 The group member is not the only person who is affected by the condi-
tion, topic, disease, and so on. Parents, siblings, spouses, caretakers, and
the like also experience some impact.
2 Support and understanding from others in the environment is encoura-
ging and meaningful when they can show some knowledge of what the
person is experiencing.
3 Families and others can better cope when they have some knowledge of
what can be done, what is not helpful, and expected reactions and out-
comes. The families’ and others’ reactions are important components for
both the client and for them in reducing anxiety, increasing hope and
motivation, and can be empowering.
4 The condition, illness, disease, and the like can cause considerable anxiety
for both the person experiencing these, and for those who live with and/
or care for them. Further, when the condition, and so on are not under-
stood well, neither side can cope as well as possible. Relationships, quality
of life, self-esteem, and self-confidence, and even their social lives can be
negatively affected. So, not only is the affected person experiencing the
condition, other significant aspects of their lives can also be affected.

Some conditions, illnesses, diseases, and disturbances have shown improve-

ment for their possessors when psychoeducational groups are conducted for
their families and/or caretakers. The affected person does not attend these
groups, but seems to gain from others who do attend. Examples for these
groups include the following.

! Cancer (Bultz et al., 2000; Landry-Dattée et al., 2000)

! Alzheimer’s/Dementia (McFarlane & Sanders, 2000; Herbert et al., 2003)
! Eating disorders (Uehara et al., 2001)
! Schizophrenia (Dyck et al., 2002; Vallina-Fernandez et al., 2001)
! Psychiatric disorders (Cuijpers & Stam, 2000)

Families and caretakers reported less stress and burnout, and the patients had
better compliance with medication and following treatment plans, less relapse,
and for some, fewer and shorter hospitalizations.
McFarlane (2002) in the book, Multifamily Group Treatment in Schizophrenia,
describes the effective groups as “those that can make the transitions from
biological/pharmacological to psychological and social levels” (p. 117). Most
204 Creative Activities for Diverse Conditions

effective is when the group process can assist in changing attitudes, produce a
climate and social environment for recovery, instill motivation and hope, and
encourage the development of a social network. This can be applied for other
groups for families and caretakers.
The cognitive material focuses on helping families and caretakers understand
subtle and overt symptoms; the effects of medications; usual ways that families
and others are affected; how stress affects the patient and others in their world
and also impacts healing and/or recovery; coping and management strategies;
and the prognosis. This understanding is critical to gaining a sense of mastery
and empowerment, expectancy, and renewed commitment.

Guides for Activities: Symptoms and Self-Management

Self-managing or coping skills can be very affirming for group members of
these diverse groups around conditions. Activities can be used to teach group
members strategies that will assist them in adapting to a significant change in
their lives, such as an illness, condition or disease.
It will not be unusual for members of groups around conditions to be
depressed, despairing, in shock, angry, and/or experiencing other intense
negative emotions. Thus, group leaders need to be emotionally prepared to
encounter resistance, defiance, and displacement of anxiety and anger, which
is usually displaced on the leader. Whatever the group’s main purpose is, it
would not be unusual for group members to have some intense emotions that
they may find difficult to express, or to not have a venue for expression, or for
some to not admit their feelings.
Planning for these groups involves a lot of consultation and research because
many group leaders may not be familiar with the condition, illness or disease
that is the focus for the particular group. Further, cultural differences can also
play an important role in planning for what information to present, and also a
recognition that the western medical model is not the only model, and some
group members may have a different model or perspective. Accurate informa-
tion and an openness to understanding alternative perspectives are critical.
Group members can usually have the following symptoms:

! A common condition, illness, disturbance, or the like

! Intense and uncomfortable affect
! The strong desire to “fix it”, make it go away, and a denial of its severity
! Fears about the group, the condition, and the future
! Anger about the circumstances that brought them to the group whether
that is something they did to themselves, something others did, or just fate
! Shame at not being able to prevent or “fix it”, or not being good enough
! Resignation, depression, and/or despair

In addition to the above, some members will be in physical pain.

 Creative Activities for Diverse Conditions 205

They are seeking symptom relief and the group can help them learn self-
management of symptoms; adapting to changes in functioning, lifestyle, and
relationships; possible impairment of physical, psychological, and mental
wellbeing; forestalling the deterioration of the quality of life, acquiring ade-
quate insurance and personal funds; moderating the effects of medications;
and so on are some topics that can be expected and helpful for these groups.
Empowering and encouraging members to be as proactive as possible can
assist in adapting, recovery, and healing.
The group leader and members’ reactions to activities are an important
consideration especially during the reporting and exploration phases. Pro-
viding feedback about reactions is extremely important, and the group
leader has to manage this carefully so as to not appear as critical or
blaming. Some people tend to hear others’ reactions as being negative or
that they are wrong or that their performance is inadequate. These people
do not hear others’ reactions as that person’s observation, they hear it as
an attack on their self, can become hurt at the thought of being wrong or
inadequate, become defensive and/or defiant, and not participate as will-
ingly or fully. The leader can use the following steps for giving constructive
reactions and/or feedback that can be used and could be taught to group
members.

1 Begin with a positive comment about the member’s product or perfor-

mance. One positive outcome for doing so is that the comment can be an
observed strength that the member may be overlooking or minimizing.
2 Do not use language that says or suggests that the group member has a
fixed trait, which is something the person cannot change. Also refrain
from using words that suggest right, wrong, good or bad. Use words like
better, more effective, and so on.
3 Check to see if the reaction/feedback was understood as it was intended.
It can be easy for a receiver to misunderstand or distort a message,
especially if the receiver fears shame, blame, or guilt for not being “right”
or for making an error.
4 Stay in touch with the impact of the feedback on the receiver, and stop if
the group member seems to withdraw, their emotional intensity seems to
become more intense, and/or their reactions or answers are defensive.

It can also be helpful to have a process to implement when a group member

falters, goes in the wrong direction, seem to become paralyzed, withdraws,
or uses inappropriate disclosure or behavior. Begin by asking that group
member what they were experiencing at the point where they faltered or
withdrew. Try to get the person to express their thoughts, feelings, and ideas
at that particular time. The answers often provide clues to what triggered
their response. Examples of such triggers include the following:
206 Creative Activities for Diverse Conditions

! An inappropriate self-absorbed focus with too much concern about not

making a mistake
! Fear of offending or injuring another person, or of making a situation worse
! Lack of knowledge
! Anticipating the future instead of staying in the present
! Jumping to conclusions before having enough information
! Mind-wandering, zoning out, and other lack of attention behavior

Once the leader has some notion of what was taking place for the group
member at that time, it becomes easier for the leader to guide the member
through their reactions, such as withdrawing, future.

Support Groups
Brown (2005) presents an overview of the multiplicity of support and therapy
groups divided into three categories: medical illness; psychiatric, psychological,
and emotional disturbances; and recovery. These are termed support and
therapy related because they are defined as such in the literature. These
groups are usually defined as a major part of treatment for a condition, dis-
ease, illness, disturbance and so on, but there are other parts or phases in the
treatment plans.
Whatever the topic for the particular support or therapy group is, the
group leader can expect to encounter strong emotional reactions that can be
open, hidden or suppressed, and/or denied. The emotional component
becomes very prominent, and there is the possibility that the cognitive com-
ponent will become minimized, and that should be avoided because a major
goal is to educate group members about the condition, illness and so forth.
Leaders can expect existential factors to also be an important part of
support groups as well as the therapy groups around conditions. Leaders
should be prepared to lead discussions on topics such as death and the unfair-
ness and indifference of the universe to their pain and suffering, and/or to deal
with these as they emerge in the group. These factors are the “elephant under
the rug in the middle of the room”, especially if the members do not mention
them. There can be considerable unspoken fear shared in common by group
members around existential factors.

Life Transitions
The two categories for life transitions groups are general, where the topics refer
to expected life situations and events that can have a significant emotional
component associated with them, and specific, where the situations and/or
events are not universal but have become rather common in today’s society and
these can also have strong emotional content. These groups usually have the
following purposes and goals:
 Creative Activities for Diverse Conditions 207

! Reduce uncertainty and ambiguity about the transition

! Provide a venue for exploring experiences and expression of feelings
! Reduce feelings of alienation and isolation
! Introduce logical and rational thinking instead of concentrating mainly on
feelings
! Eliminate blame and criticism of self and of others
! Suggest and implement coping strategies
! Provide accurate and valid information

General life transition groups include groups formed around expected develop-
mental issues, such as forming intimate relationships, grief, and loss, dealing with
aging parents, employment and unemployment, retirement, adolescent physical
and emotional changes, and other such issues and concerns. The emotional
component can be very intense for some of these groups, such as what happens
with the topic of unemployment, but many of them will be more cognitively
focused than most other psychoeducational groups.
Specific life transitions groups are focused on a particular life transition that
is expected, but does not occur for everyone, or for most people. Topics
addressed for these groups include divorce and children of divorce, dealing
with an abusive partner, displaced homemakers, racial and cultural iden-
tity, independence for people with disabilities, and aging. The members in
these groups are usually experiencing the effects of the condition and so
on, and there can be considerable affect experienced and expressed in
these groups. The life transitions can bring back unresolved issues around
family of origin and other past experiences, unfinished business, and other
developmental issues. These groups may have considerable information to
be disseminated, but the affective part of the group experience should not
be neglected.

Sample Activity
Participants are presented with a list of change strategies to rate from 1 – not
at all doable, to 10 – very doable.

! The ratings discussed in the debriefing period.

! Group members report how they might or could change.
! Members are asked to commit to one to two changes that are of high
priority for them.
! Weekly reports to the group on progress, constraints, and so on.

Techniques that may be useful for this group include teaching relaxation
techniques, cognitive self-affirmations developed as encouragement and sup-
port, using members’ positive experiences with change as models, and role
play getting started on lifestyle changes. Developing specific and individual
208 Creative Activities for Diverse Conditions

action plans that prioritize actions, identify constraints and barriers, and with
behavioral indicators for progress would also be helpful.

Visualization – soothing oneself, Butterfly hug

Affirmations – personal qualities (bookmark?)
Collaborative – squiggle, descriptors, illustrate symbol for members
Six words – gratitude, regrets, and disappointments for oneself
A wish, a hope, a thought, and affirmation (one word for each – realistic,
projected outcome)
Daily appreciations – mediations – visualize, name, moos, garland
Envelope – inner and outer self; messages to different parts of self
Stories – hear and draw or write

Drawing Instructions
1 Gather and distribute materials needed for drawing. If this is virtual, ask
members to get the materials.
2 Read the story or poem or fairy tale and ask group members to draw two
scenes from it and to title each drawing.
3 Ask members to show their drawing. Do not explore at this time.
4 Next, ask members to make a personal association for each item in the
drawing – objects, buildings, people, animals etc. For example, an associa-
tion for a key could be education or learning, for a tree an association could
be stability and strength. The associations should be by that member only. If
they cannot think of an association, have them move on to the next item.

Writing Instructions
1 Gather and distribute materials needed for drawing. If this is virtual, ask
members to get the materials.
2 Read the story or poem or fairy tale.
3 Ask group members to visualize a scene from what was read and to make a list
of all of the elements in the scene: animals, plants, people, actions, and the like.
4 Next, have them write a word or phrase about themselves that comes to
mind as they think about the particular item on their list. For example, if
they had a flower on their list, their personal association might be
“growing and thriving”.
5 Ask members to read to the group their lists, associations, titles, and their
associations. Do not explore the meanings unless the member initiates the
exploration.
6 Finally, ask members to write a summary of the lists and its associations
with their current life.
7 Conclude by asking members to give a word or phrase that sums up the
experience for them.
 Creative Activities for Diverse Conditions 209

Activity 10.1 My Mood Trigger(s)

Materials
Sheets of paper and a pen or pencil or a suitable digital device.

Procedure
1 Gather materials and find a place to work with a suitable working surface
free from intrusions and disruptions or distractions.
2 Begin with an awareness of your present mood and record this with either
a word or phrase.
3 If your mood is positive, record your feelings at this time. Then recall your
most recent negative mood and the feelings that accompanied that mood.
4 If your mood is negative at this time, record the feelings you are
experiencing.
5 Use either the negative mood in step 4 or step 5, try to identify when the
negative mood began. Record your answers to as many of the following
as possible:
! What day of the week, or time of day, and/or time of year did you
become aware of the mood?
! What were you doing and what were you feeling about yourself?
! Who was present or were you alone?
! Identify three activities you did prior to the mood.
! How satisfied were you with your life overall at that time?
6 Review the answers you wrote for step 5 and determine if there was a
feeling, thought, action or person(s) that was the defining point for your
negative mood. For example, you may have received bad news, an
appliance may have needed repairs, you clashed with a peer or family
member, or the mood just seemed to appear out of nowhere.
7 If you did identify one or more triggers, now think back over a longer period
of time and recall if something similar triggered prior negative moods.
8 If you could not identify a specific trigger, continue to try to identify what
triggered your mood. For example, can you recall what events were
happening to and around you at that time? There could be a collection of
events that caused the triggered mood; or, were you ruminating about
your satisfaction with yourself, your achievements and the like? Or, were
you thinking about your failures, lost opportunities, lack of options or
alternatives, or fear of possible future events.
9 If you have some ideas about your trigger(s), record these.

Let’s begin this journey and exploration of your mood boosters with an exer-
cise about your current mood.
210 Creative Activities for Diverse Conditions

Activity 10.2 My Current Mood

Materials
A sheet of paper and a pen or pencil, or a suitable digital device.

Procedure
1 Find a place to work that is free from distractions and disruptions. Sit
in silence and gather your thoughts to focus on the exercise.
2 Let your thoughts focus on your current mood, and record all of the
thoughts, feelings, and ideas that emerge even if some are vague, or
just fragments. Do not edit or change what emerges as you think, and
do not try to rationalize or evaluate them, just let them emerge and
record them.
3 When you complete your list, review what you wrote and try to capture
the essence of what emerged in six words like the following:
Gloomy
sad, helpless
unable to help
Pleased
satisfied, powerful
Making a difference
Excited
Apprehensive, enthusiastic
a major event

Activity 10.3 Pleasant Sights

Materials
A sheet of paper and a pen or pencil, or a suitable electronic device for writing.

Procedure
1 Make a list of all of the sights that bring you some pleasure. Write your
list as quickly as you can without editing.
2 Once you find that you have slowed down thinking of these, sit back and
close your eyes so that you can reflect and maybe add more items to your list.
3 Next, return to your list and rate the level of pleasure the sight brings
using a scale of 1 (a little pleasure that is transitory) to 10 (a lot of plea-
sure that lingers).
 Creative Activities for Diverse Conditions 211

4 Next, rate the availability of each sight when you want or need a visual
distractor. For availability use the scale of 1 (somewhat unavailable) to 5
(almost always available).
5 Finally, write a summary statement or paragraph that describes your
feelings as you think about any or all of the items on your list.

Activity 10.4 Skin Distractors

Materials
One or more sheets of unlined paper, a pencil or a pen, and a set of colored
pencils or felt markers or crayons.

Procedure
1 Find a place to work that is free from distractions and interruptions, and
that has a suitable surface for writing and drawing.
2 Sit in silence and recall being aware of something pleasurable against
your skin. This could be a loving touch, a needed hug, becoming clean, a
soaking bath, or anything that comes to your mind.
3 Once you have the scene or an item emerge, use the colored implements
to draw the scene or item. When you finish the drawing, use the pen or
pencil to record your thoughts and feelings as you drew the scene or item,
and now, as you are reflecting. Work quickly, do not edit or evaluate, just
draw and write.
4 Steps 1–3 can jump-start your thinking about tactile sensations. Now,
select another sheet of paper and make a list of all pleasurable tactile
sensations you recall.
5 For each item on your list in step 4, write an association for it – for
example, how the silk scarf from your new outfit felt on your neck. Try to
have at least one association for each item on your list.
6 The final step is to place a check by each item that could be readily
available as a distractor. As noted before, some items may take effort on
your part to get them.

All of the usual senses have been described for distractors and you are
encouraged to explore the usefulness of each category for you, and to try some
activities for each category as well as creating some new activities.

Activity 10.5 Beginning to Be Mindful

Materials
No materials are needed.
212 Creative Activities for Diverse Conditions

Procedure
1 Find a place that has comfortable seating where you will not have intrusions
or interruptions.
2 Seat yourself and look around your space and find an object to focus on
and explore. If the object is small and movable, pick it up and look at it.
If the object is large and/or immovable, just examine it in detail. Either
way, do not make any value judgments about the object such as, good or
bad, right or wrong, or worthwhile or useless. Just observe it as it is.
3 Whichever object you choose, explore its characteristics as if you will
need to describe it to someone who is unfamiliar with it. Your exploration
questions can be its size, weight, its color(s), odors if any, transparency or
opaqueness, purpose, and other such characteristics. Notice as many
details about the object as possible.
4 When you are ready, come back to the present and notice the following:
! Approximately how much time passed
! How your body feels
! If your breathing is calmer than when you started the exercise
! How or if your feelings or thoughts changed
5 If you are keeping a journal as suggested in Chapter 1, you may wish to
write about this experience.

It may be difficult for you to focus and concentrate for any length of time at
first, and you may have intrusive thoughts. Be patient as you may have to
practice this several times before you can spend more than a couple of min-
utes being mindful. I recommend that you practice exploring an object every
day for a week and see if the time you remain involved with it becomes
greater. You can also practice the procedure without having an object. Just sit
in silence, don’t try to think about anything, empty your mind, and then see
how you feel afterward.

Activity 10.6 Handling Intrusive Thoughts

You have a lot on your mind and many tasks to accomplish. Part of your
negative mood may result from intrusive thoughts that you find difficult to
relinquish. What follows is a procedure that can help you manage intrusive
thoughts whether you are trying to be mindful, or at any other time.

Steps
1 An intrusive though emerges and you want to get rid of it.
2 Pause.
3 Do not try to block the thought, or to try to think of something else.
 Creative Activities for Diverse Conditions 213

4 Don’t examine the thought as that can lead to the depressive spiral.
5 Focus on the thought and visualize it as an image, e.g. a crumpled piece
of paper, a used tissue, a discarded grocery bag, any image you choose.
6 Once you have your image of the intrusive thought, then visualize it
moving away from you on its own for the present. You can use one of the
following as an image for its moving away:
! As a puff of smoke
! Riding off on a balloon across a field
! Drifting on a leaf in the wind
! Riding the waves toward the horizon
! On a twig drifting down a stream
! Being flushed down a drain

You are ridding yourself of the thought for the present time. If it is an
important thought, it will return on its own and you will be in a better place
to deal with it. A bonus is that your mood will be boosted because you did not
follow the intrusive thoughts.

Activity 10.7 My Special Place

Directions are provided for three different ways to complete the exercise and a
list of materials for each. Choose the method you feel best suits you.

Materials
Drawing – A sheet of paper and a set of colored pencils or felt markers, or
crayons and a pen or pencil for writing.
Writing – A sheet of paper and a pen or pencil or a suitable digital device.
Photo – A photo of a place that gives you the feeling of a retreat or happy
place or sanctuary, a sheet of paper, double-sided tape, and a pen or pencil.
Or, if the suitable computer and software devices are available, the photo and
exploration can be completed using these.

Procedure
1 Read the first two steps before beginning to work. Gather materials and
find a suitable place to complete the exercise that is free from distractions
and interruptions.
2 Close your eyes, sit in silence and try to clear your mind. Let an image of
a place or setting emerge that gives you a feeling of being safe, pleased,
and nurtured. Stay with that image as long as you like, noticing as many
details of the image as you can such as colors, sounds, shapes, actions,
objects, and the like.
214 Creative Activities for Diverse Conditions

3 When you are ready, open your eyes and do one of the following:
For drawing: Draw the place or setting.
For writing: Write a complete description of your image.
For the photo: Use the double-sided tape and tape the photo to the paper
and write the details you recall when you closed your eyes.
If you are working on the computer, use the software to paste the photo
on a page and follow the photo directions in step 3.
4 Next, make a list of the feelings evoked as you imaged your retreat, happy
place or sanctuary, as you wrote or drew or on the computer, and now as
you look at your product.
You now have an image that you can access whenever you feel a
negative mood emerging or when you realize that one is getting worse.
Just a brief respite can be enough to boost the mood.

Happy Moments
Few, if any, people can be happy all of the time, but all of us can experience
happy moments. What is proposed here is that you begin to collect some
happy moments to return to when you have the blues, blahs, or grumpies.
Happy moments lift spirits, provide hope, increase feelings of physical
wellbeing and has other such positive benefits. Like moods, these moments are
usually brief and transitory although we may wish them to be more lasting
and have sustainability. Prevention and intervention of your negative moods
can be enhanced when you have and revisit some happy moments.
What can constitute a happy moment for you?

! An unexpected recognition of an accomplishment

! Being present when a family member does something important or makes
him/her happy such as a birth, wedding, or receiving a sport or academic
award
! When your solution to a problem works or produces a positive result
! Hearing that you did get the job, raise or promotion
! Being recruited for membership in something you want or feel is important
! Seeing your creative product on display
! Finishing a complex, long involved project
! A gift from someone significant to you
! Playing
! The realization that you are getting better, recovering, or growing
! Feeling at peace with yourself

No one but you can define your happy moments and these are just suggestions
to get you started thinking about what gives you the feeling of happiness if
only for that moment or a short period of time.
 Creative Activities for Diverse Conditions 215

Reflection: What do you do when you are happy; smile, twirl, dance, sing, whistle, or the
like? When was the last time you did any of these or had a happy moment?
The next exercise can help get you started on your collection of happy
moments to have your collection of happy moments to revisit when you have
or start to have a negative mood.

Activity 10.8 My Happy Moments

Materials
Three 3” " 5” index cards and a pen or pencil.

Procedure
1 Find a place to work that is free from distractions or interruptions, and
that has a suitable writing surface. Sit in silence and reflect on the present
and your recent past.
2 As you focus on your present (however you choose to define it), recall
the moments when you felt happy. Do not try to focus on “being happy”
as that is more prolonged and has many complex variables. What is
called for here is a very brief period where you were genuinely pleased,
appreciative, happy, and the like.
3 Take one card and label it “Present”. Then list those happy moments you had
during this time period. Try to list eight to ten of these moments on your card.
4 Repeat step 2 for your recent past such as the previous one to two years.
5 Repeat step 3 and label another card “Recent Past” for your recent past
happy moments.
6 Put the two cards side by side and read what you wrote, noting any patterns
you see for these happy moments. Examples for patterns may be like the
following:
Your physical state
Time of day or week
Visual sights involving color
Your movements
Another person or a particular person
Finding something – lost, a solution, a new thing
Alone or with others
At home, or at work or somewhere else
7 Label your third card “My Patterns” and list all of the patterns you see
from the other two cards. Once you have your pattern(s), write a sentence
that describes how you can maximize the possibility of experiencing a
happy moment. For example, if part of a pattern was your physical state,
you can maximize that by noting that you could eat more regularly, or
216 Creative Activities for Diverse Conditions

get more sleep, and/or exercise more often to keep your physical state at
its optimum. Do this for each pattern you identified.
You now have a collection of happy moments, the pattern for these
that fit you, and may even have some thoughts for how to increase these.
Keep these cards where they are readily available,
First, we’ll focus on some common fantasies that may not be helpful
and that may contribute to a negative mood.

Activity 10.9 Fantasies

Materials
A sheet of paper and a pen or pencil for writing.

Procedure
1 Either reproduce the following scale or make a list of the number for each item.
2 Use the following scale to rate the extent to which you have the described
fantasy. You may need to be open to the possibility, even if you don’t like
to accept that you do have this wish or desire.
1 – A very strong wish or desire / I have this wish or desire very frequently.
2 – A strong wish or desire / I have this wish or desire frequently.
3 – A moderate wish or desire / I sometimes have this wish or desire.
4 – A mild wish or desire / I seldom have this wish or desire.
5 – Not like me at all / I never or almost never wish or desire this.

Common Fantasies Rating

1 Winning a large lottery.
2 Achieving fame and fortune.
3 Another person will change as I wish them to change.
4 I’ll never show signs of aging, become ill or the like.
5 I have a talent or ability such as being a top athlete, an artist, being
an inventor; but I just haven’t worked on it.
6 Everyone will admire and envy me, or they should do so.
7 I must never make a mistake.
8 Others, such as capable adults, need me to take care of them.
9 I must be perfect.
10 Others should do what I tell them to do.
11 I can do everything I want to do and do it well all of the time.
12 I am entitled to get and have what I want.
13 I must be powerful and win all of the time.
14 Others should have my needs and desires as their priorities, and
ensure that these are fulfilled.
 Creative Activities for Diverse Conditions 217

Activity 10.10 How Am I?

Materials
5” " 8” index cards, a set of crayons, or colored pencils, or felt markers for
each participant, and a pen or pencil. The group leader should prepare in
advance an example of possible feelings on a large sheet of newsprint to dis-
play. Possible feelings could include apprehension, dread, excitement, sadness,
hopeless, envy, anger, numbness, shame, incompetence, frustrated, resent-
ment, and so on. Also prepared in advance is an example 5” " 8” index card
with colors on it to fill up the card, such as triangles or squares of color, with
the name of the feeling depicted written in the color.

Procedure
1 This is an exercise to use after members have introduced themselves. Dis-
tribute the materials and ask members to use the colors to label their cur-
rent feelings as they begin the group experience. Note that many people
will have several feelings, but that each feeling may have differing intensity.
2 Instruct them to select the colors that best identify the feelings they have
at the current time, and to construct their card of feelings with the names
of the feelings in the color chosen. They can refer to the example card for
clarification.
3 After the cards are constructed, ask group members to give their cards a title.
4 Have each member display and describe their cards, noting similarities in
feelings identified, and color choices.
5 Explore the experience by asking them the following:
! Was it easy or hard to identify their current feelings?
! What was it like to sort through the different feelings, and select colors?
! What feelings emerged as they completed the exercise? When they
displayed their cards?
! What similarities have they identified among group members?

Group Factors: Inclusion

It can be easy for some people to feel excluded in a group, and it can be
easy for the group to exclude one or more members. Cliques and sub-
grouping are two examples of the group excluding members. However, the
group is unlikely to become cohesive unless all members feel included. The
group leader has to maintain an awareness of members feeling isolated,
alienated and/or excluded; and the group’s behavior that excludes one or
more members, such as what can happen with an identified patient, or the
member who is scapegoated.
218 Creative Activities for Diverse Conditions

Helping members to feel included involves giving them attention, soliciting

and valuing their input, listening and empathic responding, and respecting their
differences while emphasizing their similarities with other group members. The
last point is especially important as it can be easier for the group to highlight
and focus on differences than it is to recognize meaningful similarities. Visible
differences, such as age, or skin color, or accent, or disability, can produce
feelings of being different, or the member having the characteristic(s) can be
responded to in a different way than for other group members, or the member
can be put on the spot by having questions asked about race/ethnicity, heritage
or national origin, or other such questions that highlight their “difference”.
In addition, there can be hidden or masked characteristics that can cause
someone to feel different or excluded when the members or the leader makes
comments that touch that characteristic and, because the characteristic is not
obvious or visible, the affected group member can be put in a double bind
where they can be unsure whether to become visible or to stay hidden. An
example would be socioeconomic status that is not usually visible in the
United States from dress, language usage, accent, and the like. Having a
hidden characteristic that is discussed without knowing that a member has
that characteristic can produce feelings of being excluded for that person.
Use of a creative activity can assist with promoting inclusion when all members
report on their products, the responses and comments each member provides are
invited and directly responded to, and linking is used. This can be easier to
accomplish for all group members through reporting, exploration, and expansion
of their creative activity products. When the group expectation and climate are set
so that every group member has an opportunity to present their product; express
thoughts, ideas, and feelings; have comments and responses responded to directly
and with respect; be invited to have input; and other such actions, the outcome
can be feeling included. Promoting feelings and actions of inclusion is necessary so
that group members can feel the group to be welcoming and caring with oppor-
tunities for members to experience being a part of an experience that transcends
the individual. An introductory exercise that may facilitate inclusion follows.

Activity 10.11 Meet and Greet

Materials
None

Procedure
1 Divide members into dyads and have them move their chairs to face each
other.
2 Instruct the smaller groups to introduce themselves to each other by dis-
closing something important about themselves, and a goal they have for
 Creative Activities for Diverse Conditions 219

the group experience. They are given three minutes to complete this
phase, and then they move to face another person.
3 Repeat step 2 until all members have had an opportunity for
introductions.
4 Reconvene in the group circle and explore what the experience was like
with an emphasis on the feelings aroused, making sure that every member
has a chance to report.
5 Ask members to share with the group the goals they shared.

Encourage Emotional Expression

Creative activities can teach group members how to gain greater awareness of
their feelings, to understand their intense negative feelings so as to reduce the
fear that can surround these, learn more appropriate ways to express their
feelings and have this accepted by others, to identify gradations of feelings so
that subtle and lesser intense ones are consciously experienced, and to manage
and contain their feelings.
Awareness of what is felt can be taught and the group can be a safe place to
focus on and practice immediate feelings. Some people recognize what they
were feeling at a particular time only in retrospect. Others, because of family
of origin and other experiences, learned to repress or suppress their feelings
because of negative consequences, and now cannot access these. Even some
people who have some awareness of what they are feeling can grow in their
awareness. Creative activities can facilitate increased awareness with their sti-
mulus procedures.
Intense negative feelings such as anger, fear, and shame can be scary when
experienced and thus, can be denied, repressed, displaced or expressed in
inappropriate ways. These feelings are also detrimental to having and sus-
taining positive and satisfying relationships when they are not understood by
the person experiencing them, and/or expressed in ways that are destructive
to their relationships. Developing an understanding of why these feelings
emerge, their triggers, and what they are responding to, either from the
external event or from an internal state, can produce considerable self-under-
standing. The outcome can be a reduced need to have these feelings in
response to perceived threat whether an internal or external threat. Group
members can be taught about their feelings to help them better assess the
validity of the perceived threat that produces the feeling(s).
Learning more appropriate ways to express feelings can be taught and
learned in the group. Not just word choice, which can be important, but also
learning to consider the importance of staying in contact with the responses
and reactions of those who hear and receive the impact of the expressed feel-
ings. Appropriate expression of feelings incorporates the setting where speak-
ing of what is being felt takes place, the target receiver or audience, the
internal need or impetus to speak of the feelings(s), immediacy and control
220 Creative Activities for Diverse Conditions

where the intensity may suggest a loss of control, and the motive or intent.
The entire process of a creative activity promotes the learning needed for
appropriate emotional expression.
There may be group members who have never learned to identify graduations
of feelings, so they are only aware of when they experience the intense level. For
example, some people are not aware of the graduations for anger – disquiet,
irritation, annoyance, anger, rage – and in consequence, tend to only recognize
when they are angry or enraged. Learning to tune in to, accept, and express or
understand less intense feelings when they first occur can help prevent these from
escalating and becoming troublesome to the person and/or to their relationships.
Following is an exercise that focuses on feelings that may be difficult to express.

Activity 10.12 Difficult Feelings

Materials
Two sheets of paper, and a set of crayons, or colored pencils, or felt markers
for each group member.

Procedure
1 Distribute the materials, and introduce the exercise by telling group
members that there are some feelings that are easy for them to express,
and some that are difficult.
2 Instruct them to use the first sheet of paper and draw symbols for feelings
that they find easy to express. Ask them to use one color for each symbol
they draw. The symbols can be representative, abstractions, or just spla-
shes of color. Whatever they choose to do is acceptable.
3 Instruct them to take the other sheet of paper and repeat step 2 for feel-
ings they find difficult to express.
4 Have each group member show the drawings for feelings that are easy to
express. After which, each will show the symbols for feelings that are dif-
ficult to express. The group leader should note similarities among symbols
and colors chosen.
5 Lead a discussion on what members find difficult to express, and how
facilitation of these can be accomplished in the group.

Managing Difficult Member Behaviors

Difficult member behaviors include monopolizing, story-telling, prolonged
silence, the help rejecting complainer, and scapegoating. There are leader
strategies to address these behaviors, such as redirecting, linking, and the like;
but there can also be group activities that can be effective interventions.
Examples of creative activities for three of these behaviors are presented.
 Creative Activities for Diverse Conditions 221

Monopolizing
Attention can be the goal for the monopolizer. While group members can be
grateful in the beginning of the group to have a person who keeps the session
moving, it is not long before this behavior become tiresome and annoying.
Leaders can use strategies such as blocking and redirecting as interventions,
but there are times when these strategies may not fully address the behavior,
or do not work. A creative activity such as the following may be helpful.

Activity 10.13 Gifts

Materials
5” " 8” lined index cards, and a pen or pencil for writing. A suitable surface
for writing would be helpful.

Procedure
1 Distribute the materials and introduce the activity by telling members
that each brings unique gifts to the group.
2 Ask them to list each member by name, and to identify one or more gifts that
person brings to the group, such as willingness to share important feelings.
3 Allow sufficient time for writing, and then ask members to read the lists aloud.
4 Ask members to report on how they feel about the gifts that were identi-
fied about them.
5 Explore the feelings and reactions that members had while doing the
exercise, and while receiving the feedback.

Story-Telling
Many group members will engage in story-telling because they want others to fully
understand their situation. However, it is seldom necessary to have all of the details,
and although other group members will ask questions as a way of showing interest
or to keep that person talking so that they don’t have to talk, the group leader
should intervene as valuable group time is being consumed in providing details that
do not contribute to understanding or growth. An activity such as the following can
be an effective way to block the story-telling, and to engage all group members.

Activity 10.14 My Story

Materials
Sheets of paper for drawing, a set of crayons, colored pencils, or felt markers
for each person; and a suitable surface for drawing.
222 Creative Activities for Diverse Conditions

Procedure
1 Distribute the materials and ask members to close their eyes.
2 Next, ask members to think about a personal story they would like to tell
the group, or think it would be important to share, and to let the story
come to mind and unfold.
3 Tell them that when they are ready, to open their eyes and draw a picture
that captures the essence of their feelings about their story. Not the story
itself, the feelings about it. The picture may be realistic or abstract.
4 Allow sufficient time for drawing. When members seem finished, recon-
vene the circle and have them share their drawings.
5 Explore what was learned about each member’s story from the feelings
picture.

Scapegoating
Group leaders have to take immediate steps to intervene when a member is
becoming an identified patient, or is scapegoated. While the identified patient
is receiving attention and is being listened to, that member is also in the
position of being placed on the hot seat with too much attention that produces
discomfort. Further, by having an identified patient, other group members are
not working on their personal issues and concerns, but are putting their
energies toward fixing the identified patient.
The scapegoated member can easily feel excluded as they become the
repository for other group members’ negative feelings, and have to carry these
unless there is an intervention that helps group members acknowledge and
express their own negative uncomfortable feelings. Scapegoating can also be a
disguised and displaced attack such as what can happen when the group is
fearful of or reluctant to challenge the leader, and directs the challenge to a
group member. The leader has to intervene in a way that protects all group
members without placing any group member in a scapegoat position.

Activity 10.15 My Current Feelings

Materials
Sheet of paper, and a set of crayons, or colored pencils, or felt markers, and a
suitable surface for drawing.

Procedure
1 Distribute materials and ask members to select colors and draw shapes for
the feelings they are experiencing in the here and now. Tell them that
they may be experiencing several feelings, some are major and some are
 Creative Activities for Diverse Conditions 223

minor and to draw these in proportion – that is, the minor feelings would
be smaller than the major ones. Tell them to select the color that best
depicts the particular feeling.
2 Allow time for drawing, and reconvene the circle and have members
share their drawings with a focus on what the feelings are, not on why
they have the feeling that they do. Discourage exploration of why that
particular feeling.
3 Notice if the majority of the feelings depicted are positive or negative, and
how difficult or easy it is for them to express these feelings.

Summary
This chapter presented fifteen activities that can be adapted and used for
groups focusing on a particular condition held in common by all group
members. The activities provide a means for the group members to express
their thoughts, ideas, and feelings about their condition, to help them develop
reasonable goals and expectations for progress and/or recovery, and to enable
them to develop personal coping strategies.

References
Brown, N. (2005). Psychoeducational groups. In S.A. Wheelan (Ed.), The handbook of
group research and practice. (pp. 511–530). Thousand Oaks, CA: Sage.
Bultz, B., Speca, M., Brasker, P., Geggie, P., & Page, S. (2000). A randomized con-
trolled trial of a brief psychoeducational support group for partners of early stage
breast cancer patients. Psycho-Oncology, 9(4), 303–313.
Cuijpers, P. & Stam, H. (2000). Burnout among relatives of psychiatric patients
attending psychoeducational support groups. Psychiatric Services, 51(3), 375–379. http
s://doi.org/10.1176/appi.ps.51.3.375.
Dyck, E., M. Hendryx, R. Short, W. Voss, & W. McFarlane (2002). Service use among
patients with schizophrenia in psychoeducational multi-family group treatment.
Psychiatric Service, 53(6), 749–454.
Fristad, M., J. Ackerman, & E. Nick (2018) Adaptation of Multi-Family Psychoeduca-
tional Psychotherapy (MF-PEP) for Adolescents with Mood Disorders: Preliminary
Findings, Evidence-Based Practice in Child and Adolescent Mental Health, 3(4),
252–262, doi:10.1080/23794925.2018.1509031.
Goldstein, L., W. Mehling, T. Metzler (2018). Veterans group exercise: A randomized
pilot trial of an integrative exercise program for veterans with posttraumatic stress.
Journal of Affective Disorders, 235, 348–356.
Herbert, R., I. Levesque, J. Vezina, J. Lavoiek, F. Ducharme, C. Gendron, et al. (2003).
Efficacy of a psychoeducative group program for caregivers of demented persons
living at home: A randomized controlled trial. Journal of Gerontology, 58(1), S58–S67.
Landry-Dattée, N., A. Gauvain-Piquard, & M. Cosset-Delaigue (2000). A support
group for children with one parent with cancer: Report on 4-year experience of a
talking group. Bulletin of Cancer, 87(4), 355–362.
224 Creative Activities for Diverse Conditions

McFarlane, W. (2002). Multifamily groups in the treatment of severe psychiatric disorders. New
York: Guilford Press.
McFarlane, P., & S. Saunders (2000). Educational support groups for male caregivers
of individuals with Alzheimer’s disease. American Journal of Alzheimer’s Disease, 15(6),
367–373.
Sen, E., A. Hocaoglu, & O. Berk (2019). Group psychotherapy with fibromyalgia patients: A
systematic review. Archives of Rheumatology. ncbi.mlm.nih.gov.
Uehara, T. Y. Kawashima, M. Goto, S. Tasaki, & T. Someya (2001). Psychoeducation
for the families of patients with eating disorders and changes in expressed emotion:
A preliminary study. Comprehensive Psychiatry, 42(2), 132–138.
Vallina-Fernandez, O., S. Lemos-Giraldez, V. Roder, & A. Gutierrez-Perez (2001).
Controlled study of an integrated psychological intervention in schizophrenia. European
Journal of Psychiatry, 15(3), 167–179.
Chapter 11

Applications for Fostering Group

Dynamics

Introduction
This final chapter focuses on applications for using creative activities to
foster group dynamics, prevent some group level problems, and to manage
some group level difficulties. The major topics presented are considerations
for planning and using creative activities, the use of activities to promote
emergence of group therapeutic factors, to address some group difficulties,
how activities can enhance manualized group therapy, and considerations
for adapting creative activities for children, adolescents, adults, and older
adults.

Planning Creative Activities for Children’s Groups

Critical components when planning for children’s groups are their ages, educa-
tional level, and the purpose for the group. Group leaders should be prepared to
fully describe orally and in writing what is planned for the group, and to present
this to both the children and their parents. If this is taking place in a school set-
ting, the leader should also be prepared to describe this to the administration.
This is especially important for obtaining informed consent, which you must have
before the group begins.
The critical elements noted previously are the ones that play the major
roles for determining group membership. Try to limit the range of ages, and
educational level, and not to mix too many different ones. That will make it
easier to plan activities that maintain interest and attention. Other organiz-
ing elements include planning for briefer sessions, selecting instructional
strategies and activities that take into account members’ attention spans,
using more active experiences, building groups and/or sessions around
themes, and limiting information.
Plan briefer sessions for children up to ages 10 or 11, than you would for
older children. They work better with 20- to 30-minute sessions, although
some may be able to tolerate 50- to 60-minute sessions. Because sessions are
brief, this means that the leader must plan extensively, and has to be as

DOI: 10.4324/9781003251989-11
226 Applications for Fostering Group Dynamics

emotionally present as possible. This ensures that order is kept, behavior does
not get out of control, inappropriate comments and behaviors are blocked,
members retain their focus, and that emotional expression is fostered.
The attention span for all children is shorter than that of adults, and
you will need to make many accommodations for keeping their attention.
It is much better to plan for this than to have to adjust within a session, or
after the group begins. You may not be able to rely on verbal input or
interactions to keep their attention, or to help the session progress.
It can be helpful to use active group experiences that call for every member
to participate. It is also important not to have too many activities in order to give
members some time to integrate the learning and understanding that the
activity is intended to accomplish and to allow for self-reflection. It is a bal-
ancing act that is dependent on the leader’s expertise.
Theme-related groups and sessions can bring needed structure, focus, and
emphasis because activities, information, and even instructional strategies have
a cohesive direction and purpose. Themes such as emotional expression, grief
and loss, managing difficult emotions, self-perception, communication skills,
relational skills, and so on, are examples for an organizing theme-related
structure for a group.
Limiting information applies to groups of all ages, but it is essential for chil-
dren’s groups. Provide essential information and do so in several forms
because repetition can help with incorporation and use of the information.
For example, it may not be sufficient to just lecture or orally present infor-
mation. It could also be written in an outline with essential points, be the
focus for an activity, and presented more than once. Children will be able to
use information that is simple in its presentation, and when they are guided to
understand what personal application it has for them.
Other important considerations are the size of the group, parental or
other approval, and the environmental factors such as seating and surfaces
suitable for the activities. Most of the activities in this book can be adapted
for use with children by reducing the number of steps or what is asked for
in the activity to fit the time available for completing the activity and
allowing every child to report. Some activities may be too complex or the
group too large to adequately complete the activity. Before using an
activity with children in a setting such as a school or residential facility, it
may be necessary to get approvals. Be sure to check on the need for out-
side approval of an activity and be prepared to describe the activity and
what the goal is for using it. Following is an illustration of how to adapt
an activity for children. The activity illustrated is presented later in the
chapter for use with adolescents and adults. The activity illustrates uni-
versality and can be used as an introduction with children. First will be the
activity as it appears later, with highlighted parts used to illustrate the
adaptation.
 Applications for Fostering Group Dynamics 227

Activity 11.1 Similarities

Materials
Paper, and a set of crayons, or colored pencils, or felt markers, and a suitable
surface for drawing.

Procedure
1 Distribute the materials and ask members to draw a symbol or something
to depict each of the following: a value, a cherished material object, and a
favorite activity. The value, object and activity should be something that
they think would make them connect to another group member if it were
held in common. For example, if another member also read mysteries,
the person would feel connected to that member.
2 After drawing, reconvene in the group circle and report on the drawings.
The leader should point out similarities among the drawings.
3 Ask members if they identified any other similarities as they listened to
each present their drawing.

The adaptation for item 1 would be to have a different set of activities for
children such as a favorite game, television show, playtime activity, food, or
place. Instead of asking them to draw symbols, ask them to draw something to
represent their item such as something that represents their favorite game.
Item 2 would need to be handled carefully as it is possible that group mem-
bers will want to go into more detail or tell stories or talk more, which will
reduce the time needed for the other group members to report. It may be best
for the group leader to be ready to stop a group member in order to have
time for all to report. Asking members if they see other similarities among
them can help focus the children on similarities rather than differences.

Planning for Adolescent Groups

Leaders of adolescent groups should first know and understand general growth
and development issues for that age group. It is easier to understand adoles-
cents when you know what is usual and expected so that you can more easily
identify what is unusual and unexpected. Some basic considerations for lead-
ing adolescent groups include length of sessions, fostering therapeutic factors,
containing and managing intense emotions, the need for structuring and
directing, and encouraging them to seek other sources of information. Leaders
will also need to have and display patience and empathy as adolescents are
encountering the tumultuousness of growth and development present for all
adolescents with the addition of their condition or disease. Building creativity
and inspiration can also be of assistance.
228 Applications for Fostering Group Dynamics

Length of sessions can be longer for adolescents than for children although it
may still be wise to limit sessions to no more than one hour. Their attention
spans are longer, but you run the risk of further intensifying emotions that are
already intense, and/or leaving them with emotions they will be unable to
adequately control outside the sessions. As with children, you will also want to
limit the range of ages in a particular group. Girls will tend to be more
mature than boys of the same age, and this too may be a consideration when
forming a group. It may be helpful to have an age span of two to three years
only for a group. Any more than three years may lead to difficulty.
Fostering therapeutic factors, especially hope, altruism, universality, and exis-
tential issues can be very helpful. While these factors are helpful for everyone,
they may be especially helpful for adolescents who are searching for a self-
identity, trying to gain independence while still in a very dependent state, and
are trying to form meaningful connections. They need direct expressions and
examples of hope, opportunities to be altruistic, the connections that are
forged from commonalities, and opportunities to reduce loneliness, isolation,
and alienation. Leaders may need to introduce these topics and/or use exer-
cises that allow these factors to be explored.
Containing and managing intense emotions for almost all adolescents are leader
tasks that should be expected. Adolescence is a time of fluctuating moods and
emotions at the best of times. When a condition or illness is encountered in
addition, it’s no wonder that these adolescents can be constantly in the grip of
intense emotions. The leader’s skill at containing and managing these provides
relief for a short period so that they can explore issues and concerns in the
session, teaches them that emotions can be managed, and provides modeling
of how that is accomplished.
There is a considerable need for structure and direction to help adolescents
know what the limits are, to let them understand that safety is recognized as
important, to emphasize the group’s purpose and goals, and to give support
for helping to contain and manage anxiety. These psychoeducational groups
are brief, and much needs to be done in a relatively short time. Add to this
the intense anxiety of the age and condition of members, and it is easy to
understand that more will get done if there is sufficient structure and direc-
tion. It may even be advisable to have a set of procedures for each session,
and to stick to this as much as possible. For example, each session would have
information presenting, such as a lecture or video, discussion, an exercise, and
so on. The leader would be flexible enough to adapt to unexpected crises, and
other important needs, but there would be a set procedure for each session.
However you choose to have structure and direction is your decision.
Encourage members to seek other sources of information. Sources such as books,
self-help tapes and books, videos or DVD, the internet, and even others who
have experienced the same condition or illness can be of assistance. You
cannot provide all the available information, nor can you tailor for each
member as there is not enough time, nor can you know enough about each
 Applications for Fostering Group Dynamics 229

member prior to the group to meet their needs. When members seek other
sources of information, they are active participants in their own progress and
development, and this can be empowering.
Following is an activity for adolescents that can help focus on similarities.

Activity 11.2 My Favorite Things

Purpose
Self-identification.

Materials
A sheet of paper and a pen or pencil for writing, a suitable writing surface.
The group leader should prepare the list to post in advance of the group
session so that group members will know what they are asked to do. The
leader should also prepare another list to show with their answers to the items.

Procedure
1 Prepare a list with the following: list your favorite color, food, music, tel-
evision show, weather, book or reading material, music, sport or recrea-
tion activity, and vacation spot.
2 Introduce the activity by showing the leader’s items on the list. Then,
show the page with the list of items on it.
3 Tell the participants to make a list of their answers for the items on the
list such as their favorite sport.
4 Reconvene the group and ask members to read their lists while the leader
notes similarities.
5 Next, ask participants to talk about creating their lists and which items
could be easily named, those that took some thought, and if there were
any that they did not list.
6 Finally have group members write a summary statement about how they
feel about their “favorite things”.

Planning Groups for Adults and Older Adults

Planning groups for adults is much less complicated than planning groups for
children and adolescents in many ways. Their attention spans are usually
longer, they usually have the cognitive skills and techniques to absorb a larger
amount of information, there can be fewer behavior problems, they have
more experiences and resources to share with each other, and can be more
self-reflective. On the other hand, they can be more resistant to make needed
changes, exhibit more hopelessness and helplessness, and some members will
230 Applications for Fostering Group Dynamics

not like the idea of needing or accepting help for fear of appearing weak or
inadequate. In addition to the previous general guidelines, significant factors
for adult groups can be cognitive abilities and educational level, gender, past
traumas, and current support system.
Adults, like children and adolescents, will have differing cognitive abilities. It
can be helpful for leaders to know and stay aware of possible effects on
members’ participation as cognitive ability can significantly impact learning,
understanding, and interactions in the group. For example, the person who is
taking pain medication may be influenced by the sedating effects making it
difficult for them to focus, take in and process information, or to actively
participate. The group member may not even be aware of their impairment
as it can be subtle. Persons with very limited cognitive ability may not benefit
when placed in a group with higher functioning members, and vice versa.
Educational level is an important consideration for adult groups because it
plays a role in the leader’s decisions about what information to present,
instructional strategies, and the amount of information that can be absorbed
and learned. Then, too, there can be members’ apprehensions about being
included or excluded because of having little or by having considerable edu-
cation. Mixing a wide range of educational levels can sometimes produce a
rich experience, but sometimes it can make for a difficult and uncomfortable
group experience because of members’ fears, defensiveness, or arrogance.
Your planning can help mediate these effects.
Gender is a factor that can produce considerable projection, transference,
apprehension, and possible eroticism in groups. Members’ previous experi-
ences with members of the same or opposite sex, sexual orientation, impul-
sivity, expectations for behaviors and attitudes are some of the aspects related
to gender. You cannot prevent any of these effects, but you can anticipate
them, recognize them when they appear, and understand their influences.
Past traumas play a significant role for everyone in all types of groups. If
group leaders are able to screen members prior to group experience, they may
be able to recognize when members’ reactions, interactions, and/or responses
are more related to past trauma than they are to current experience and/or
their condition or illness.
Central to fostering hope and recovery is the extent of a member’s support
system. Although this factor is outside the group, it can be helpful for members
to become aware of the strengths and weaknesses of their support system, to
begin to develop and/or strengthen it, and to capitalize on this resource. Your
planning can include what you can do to highlight this factor; help members
learn and practice behaviors to strengthen, develop, and maintain meaningful
relationships both in and out of group; and how the group can be developed
to serve this function in the short term.
It is very important that group leaders pay attention to the physical and
mental capabilities of their adult group members and the need to adapt or
adjust their activities to meet the physical and mental needs of group members
 Applications for Fostering Group Dynamics 231

and this may be especially important when working with older adults as well
as with impaired adults. Suggestions for adaptations include reducing the task,
using suitable materials, and selecting activities to meet the members’ and the
group’s needs.

Creative Activities for Group Level Concerns

It would be the rare group leader who has not encountered one or more
group dilemmas where the group became mired, tense, unproductive, little
therapeutic work was accomplished, and this lasted more than one session.
While frustrating for the group leader, these situations can be even more
frustrating for group members who probably lack the developed inner
resources for coping that the leader may have leading to a very uncomfortable
group situation for all. Adding to the frustration for the group leader is when
all interventions tried do not move the group from the uncomfortable place.
The leader’s analysis does not seem to be effective to produce understanding,
or for suggested interventions, no matter how experienced or competent the
leader is. While these group situations are few and far between, they can
occur without warning.
These group dilemmas differ from those presented by a difficult group
member. Brown (2006) and Alonso and Rutan (1993, 1996) describe some
group dilemmas that can result from the presence of members with unidentified
problems and concerns such as, the member with a Narcissistic Personality
Disorder or with a Destructive Narcissistic Pattern, a member with a Borderline
condition, or a quiet explosive member. They propose that the difficulties and
dilemmas in these instances, result from the group’s effort to manage and con-
tain these members, the members’ unconscious sensing of danger and possible
destruction for their selves, and their attempts to control their intense emotions
that were unconsciously aroused by these members. The leader and members
are working in the dark, but nothing constructive can happen until the difficult
member is identified and appropriate actions are taken. These difficult group
members present their own variations for group dilemmas, but this is not what
is meant for this book.
Suffice it to say that group leaders encountering these dilemmas look for
ways to understand the indirect communication so as to select appropriate
interventions. The group members do not have the ability to be clearer in
communication because they don’t know what it is they want to communicate,
can be fearful of consequences for what may emerge, are trying to understand
and communicate but are ineffective, and are frustrated at the lack of clarity
and understanding from self, other members, and the leader.
Proposed is that the described creative activities can assist the group leader
to address some group dilemmas and provide relevant material for group
members’ self-exploration. These activities, although group centered and
focused, can be personal for each member, bypass defenses, reveal
232 Applications for Fostering Group Dynamics

unconscious and hidden material in ways that can be perceived by them as

less threatening and dangerous, encouraging for expression of difficult and/or
complex ideas, thoughts and feelings, and even may provide guidance to
solutions for some members. At the very least, these creative activities can
provide a release of tension so that group members can think clearer, be more
responsive, and be more willing to engage in self-exploration. Both the group
and members can benefit. Described are activities to promote the emergence
of group therapeutic factors, and to address resistance and conflict.

Activity 11.3 Resistance Artist Trading Card (ATC)

Materials
Refer to the materials lists under the section on guidelines (Chapter 2).

Procedure
Find a suitable place for the group to work where there are tables or the like
to display the materials, and create the collages.

1 Introduce the activity by explaining what ATCs are and showing some
examples of these.
2 Ask group members to reflect on resistance and what it feels like, especially
in group sessions. Tell them that the resistance could be their own personal
resistance, or when they feel others’ resistance.
3 Spread the materials out where they can be available to all group mem-
bers. Give a time frame for constructing the collage.
4 Allow members to work and observe if they talk among themselves, or
tend to be silent, and other such behaviors.
5 Follow the guidelines for calling time, reporting or sharing, and for
exploration and enhancement.

Therapeutic Factors
The importance of factors conducive to promoting therapeutic progress, healing
and change for group members has received attention in the literature. (Corsini
& Rosenberg, 1955; Kivlighan & Mulligan, 1988; Colijn et al., 1991; Kivlighan
& Goldfine, 1991; Crouch et al., 1994; Fuhriman & Burlingame, 1994; Yalom,
1995; MacKenzie, 1990; Dies, 1997; Fuhriman, 1997; Kivlighan et al., 2000;
MacNair-Semands & Lese, 2000; Kivlighan & Holmes, 2004; Tschusckke &
Dies, 1994). What has emerged from these studies and reviews are confirmation
of the impact of behaviors and attitudes that are clustered as categories for ther-
apeutic, curative, and change; some are common and valued for all types of
groups, some differ in their importance and value depending on the type of
 Applications for Fostering Group Dynamics 233

population; and that there are few guidelines for leaders on how to foster and
encourage the emergence of these factors.
These factors have been given various titles, but can be generally categor-
ized as Yalom (1995) presented them. These eleven factors are:
Universality – emphasizing commonalities among group members, reducing
their feelings of alienation, of being alone in their struggles or misery, and/or
that they are weird or significantly different from others in negative ways.
Instillation of hope – providing motivation to continue the struggle and pro-
vides a feeling that the struggle will pay off in meaningful ways. Hope can
increase members’ self-perceptions of worth and value to others and to the
universe and is inspiring.
Altruism has been shown to be beneficial for the giver and to the receiver.
Altruism is giving freely of oneself without expecting a return and group
members can realize that they do have something of value to give to others. It
is also rewarding to receive from others especially when there are no expec-
tations attached to the gift.
Interpersonal learning – allows members to increase self-knowledge and self-
understanding through feedback from others. This feedback provides the
personal with information that others can see, but that is usually not seen by
them, but could be important for relating and communicating with others as
well as achieving a greater understanding of their thoughts and feelings.
Guidance or imparting of information is not advice giving. Rather, this therapeutic
factor decreases ignorance, empowers the receiver to act on their behalf, and
increases the capacity to develop solutions for problems.
Catharsis – is generally thought of as emotional venting. The therapeutic use
of this in the group can bring relief for group members when suppressed or
when repressed intense feelings are expressed and receiving responses that do
not destroy oneself, others, or relationships. However, in order to be most
effective, the emotional venting must be accompanied by a greater under-
standing of oneself through receiving empathic responding, differing percep-
tions or other feedback that promotes self-understanding.
Corrective recapitulation of the primary family group – or reenactment of the family of
origin makes a valuable contribution to therapy by providing a new perspective
for old hurts, resentments, and relationships that can promote healing, forgive-
ness, and changes.
Imitative behavior – is demonstrated by both the leader and members. Members
can learn and practice new and more effective ways of behaving to get needs
met, develop more constructive attitudes through seeing the modeling behavior
of others that is more effective than their present behavior.

Corrective Emotional Experience

Existential factors – are usually present in all groups although these may not be
visible or prominent. The therapeutic awareness and discussion for these
234 Applications for Fostering Group Dynamics

factors are encouraging to members as these discussions promote awareness

that these issues do not have solutions (e.g. the indifference and unfairness of
the universe); that all human beings struggle with these issues throughout their
lives; and that each person has a unique approach and resolution for these
factors.
Socializing techniques – are very useful for almost all group members. Teach-
ing members these techniques demonstrates how they can initiate meaningful
connections to others, reduce behavior and attitudes that prevent connections,
and increases awareness of others-in-the-world as separate and distinct
individuals.
Cohesion – provides the necessary conditions for the productive or working
stage of the group. This is therapeutic because the group has reached a
point where members experience feelings of belonging, connectedness, and
productivity; they have learned the benefits of cooperation versus individual
efforts, and there are increased feelings of satisfaction with self and with
others.

Foster the Emergence of Some Therapeutic Factors

Presented next are three creative activities related to fostering the emergence
of three factors in the group; universality, hope, and catharsis. Each has a
short introduction to explain the importance of the particular factor that may
also be useful as an introduction to the activity.
Universality can be reassuring to members that they are not alone, isolated,
or weird. The commonalities among group members promote disclosure,
caring, and concern, and can lead to group cohesion. Thus, it is very impor-
tant for a group leader to give some attention to this therapeutic factor and
take every opportunity to highlight similarities among group members in atti-
tudes, experiences, feelings, and so on. Doing so could help this therapeutic
factor to emerge and be recognized.

Activity 11.4 Similarities

Materials
Paper, and a set of crayons, or colored pencils, or felt markers, and a suitable
surface for drawing.

Procedure
1 Distribute the materials and ask members to draw a symbol or something
to depict each of the following: a value, a cherished material object, and a
favorite activity. The value, object, and activity should be something that
they think would make them connect to another group member if it were
 Applications for Fostering Group Dynamics 235

held in common. For example, if another member also read mysteries,

the person would feel connected to that member.
2 After drawing, reconvene in the group circle and report on the drawings.
The leader should point out similarities among the drawings.
3 Ask members if they identified any other similarities as they listened to
each present their drawing.

Encouraging hope can also be facilitative, and the group leader can assist in its
emergence and being realistic. Unrealistic hope is a fantasy, and failure to
achieve what was hoped for can be depressing and lead to self-defeating
thoughts and feelings. However, it is hope that promotes persistence in the
face of adversity and motivates change.
Hope seems to be an individual perspective, and what is hopeful for one
person may not be so for another. Further, it could be that some members are
so focused on their misery, issues, problems, or concerns that they have not
been able to see hope in their lives, nor do they have a clear idea of their
personal signs of hope. A drawing activity that focuses on identifying signs in
indices of hope would be very helpful.
A further note, hope can grow among group members as they observe
hopefulness in other members. Seeing others get better, resolve problems,
make progress, and feel more secure and confident can serve as models for
group members that they too can experience these. This is an example of
hope that is realistic and reasonable.

Activity 11.5 Hopefulness

Materials
Paper and a set of crayons, colored pencils, or felt markers.

Procedure
1 Find a suitable surface for drawing and distribute the materials.
2 Introduce the activity by telling members something similar to what was
presented in the previous paragraphs and ask them to draw a symbol of
what hopefulness would feel or be like for them right now.
3 Reconvene in the group circle and share the drawings. Explore the
meanings of hopefulness for members and discuss how some or all of this
can be obtained in the group. The leader should be careful to note which
are realistic, and which may be fantasy. For example, having another
person change is fantasy. Learning to cope with what is, can be realistic.

Catharsis is another therapeutic factor, and the expression of feelings that were
suppressed, repressed, or denied; or becoming aware of having difficult or
236 Applications for Fostering Group Dynamics

unacceptable feelings can be of immense help to group members. This can

be especially true when the emotional venting is met with reactions of
understanding, care, and concern for the person instead of the feelings being
soothed, rationalized, minimized, or criticized as being irrational or wrong
by others in the group, such as what can happen in other settings like the
family.
However, catharsis is most helpful in the group when it is accompanied
with the interpersonal learning described by Yalom (2021). The catharsis
then is not just emotional venting, as the person can learn something
unknown, or of which they were unaware, that is valuable for self-under-
standing and growth. The group leader facilitates the catharsis and the
feedback that promotes the interpersonal learning. One way feedback can be
encouraged is by asking group members to tell the member experiencing
catharsis their personal feelings experienced while listening to them. A
drawing activity could be used for each, expressing strong intense feelings,
and reactions to the catharsis.

Activity 11.6 Catharsis

Materials
Paper, and a set of crayons, or colored pencils, or felt markers.

Procedure
1 Find a suitable drawing surface and distribute the materials.
2 2. Describe catharsis noting that it is more than just emotional venting.
Ask members to draw a picture from their experiences that depict cath-
arsis where they learned something about themselves in the feedback they
received in the interaction. For example, something upsetting happened
at work, the person brought it to the group, vented, and the feedback
they received increased the person’s awareness that they are in a toxic
situation where nothing they did or said would make a positive difference,
and that continuing to let it be upsetting was hurting them not the other
person, and nothing positive was being accomplished.

Existential Factors

Activity 11.7 Human Suffering – An Existential Factor

Materials
Collage – magazine images, paper, glue or double-faced tape, cardstock and
emphemera.
 Applications for Fostering Group Dynamics 237

Procedure
1 Introduce the activity by explaining what existential factors are as defined
earlier in the chapter, and that they are universal and can only have
current solutions and will emerge throughout their lives.
2 Ask group members to reflect on their personal perceptions of human
suffering and what it feels like or would feel like at the present time.
Another way to present the topic would be to ask them to think about
what would constitute or be illustrative of human suffering for them at the
present time and to use the materials to make a collage that illustrates
their thinking and feelings.
3 Give the signal to begin the constructions and note how much time is
allotted for the work.
4 Follow item 4 in the previous activity, and the guidelines for reporting,
and exploration.

Identifying unresolved family of origin issues and other unfinished business that
members have can be very helpful to their progress but can also be difficult to
accomplish. Drawing activities can contribute to the uncovering by each
member at the same time. When either of these is the purpose or goal for using
a drawing activity, the leader should be emotionally prepared for intense emo-
tions, and/or for unexpected material to be uncovered. Further, the group
should have sufficient safety and trust established so that members will be more
secure when disclosing painful material, and not have to be overly concerned
about the leader’s reactions to this material, feeling confidence that the leader’s
response will be understanding, show caring and concern, and that other group
members will not be rejecting. All of this suggests that the first stage of group,
and groups that are focused on other than counseling or psychotherapy may
not be appropriate for an activity that focuses on this factor.
When a drawing activity is used to accomplish the goal or purpose of
identifying family of origin factors or unfinished business, the group leader
should do the following.

! Ensure that all members have an opportunity to report their personal

experiences.
! Gauge the emotional intensity aroused for each member.
! Resist deeper exploration for a member at this time, but note a need to
return to it.
! Block critical and/or blaming comments by other group members.
! Give empathic responses to each member (this can be essential).
! Identify similarities in experiences and/or feelings among members.
! Reduce emotional intensity before the group ends so that group members do
not leave with feelings that are overwhelming or difficult for them to manage.
A check on emotional intensity, and a short relaxation activity can be helpful.
238 Applications for Fostering Group Dynamics

Address member difficulties, e.g. transference, resistance, problem behaviors.

Address group difficulties: conflict, resistance, defensiveness, tension.
There are numerous group level challenges that can arise, and drawing
can be a helpful strategy to bring these to the awareness of group members,
and to suggest solutions. Group level challenges are issues and concerns that
seem to be problematic for all group members even when they differ in
intensity and kind for separate group members. For example, resistance and
conflict are present in all groups, but in some groups these become barriers
and constraints because members repress, suppress, and/or deny they exist.
They tend to minimize or ignore them, fearing the loss of control, harmony,
or even of destruction. However, these challenges continue to affect the
effectiveness of the group. Use of a drawing activity can reduce some of the
perceived threat of even being aware of these challenges. Examples of group
level challenges include:

! Fear of intimacy
! Resistance
! Suppression of important feelings
! Conflict
! Fear of being seen by others, and thus being shamed
! Loss of control

Following are activities to address resistance and conflict. Using activities such
as these can make it easier for members to discuss these threatening concepts.

Activity 11.8 Resistance

Materials
Suitable surface for drawing, 5” " 8” index cards, a set of crayons, or colored
pencils, or felt markers for each group member.

Procedure
1 Distribute the materials and ask members to sit back, close their eyes, and
think of the concept, resistance. Think about what resistance feels like,
what it looks like, which can be symbolic or representational, and its other
characteristics.
2 Tell them to open their eyes and to draw what emerged as they thought
about resistance.
3 When the drawing is complete, ask members to share their drawings.
4 Explore the feelings that emerged as the directions were given to think
about resistance, when drawing the concept, and when sharing their
drawings in the group.
 Applications for Fostering Group Dynamics 239

5 If appropriate and the group has developed sufficient safety and trust, the
leader can have a discussion about members’ experience of resistance in
the group with a focus on their personal resistance.

Activity.11.9 Conflict

Materials
Paper, and a set of crayons, colored pencils, or felt markers for each group
member.

Procedure
1 Distribute materials and ask group members to draw a picture that cap-
tures the essence of a personal conflict with another person or persons,
either from the past or is current.
2 When drawing seems complete (the leader may have to set a specific time
frame for drawing), reconvene in the circle, and ask members to describe
their drawing.
3 As they describe their drawing ask them what feelings they are experien-
cing as they talk about their conflict.
4 Ask each how they handled, or are handling the conflict. Note if they
describe ignoring it, minimizing the impact on them or on others, sup-
pressing the conflict, or even denying that there is a conflict or the ser-
iousness of the conflict.
5 Bring the discussion to what is happening in the group, and explore if
members are handling conflicts in the group as they did with the one that
they drew.

Creative Activities for Manualized Groups

Manualized groups generally use a manual or curriculum designed and pub-
lished based on the result of research about interventions for a particular issue,
problem or concern. There are advantages and disadvantages for using these
manuals, which can present challenges for the use of creative activities. First
described are the advantages for using manuals for group therapy. Next is the
descriptions for the disadvantages and finally, are some suggestions for how
creative activities may be incorporated into the group therapy without com-
promising the treatment fidelity, which is based on following the manual.

Advantages for Manualized Groups

There are nine primary advantages for manualized groups: basis for the
manual; sequencing of learning; pre-prepared session plans; the availability of
240 Applications for Fostering Group Dynamics

preprepared presentations; evaluation and assessment forms and processes;

forms and activities such as homework are provided; narrow goals and objec-
tives; and planning time is reduced. Manualized group therapy can be
instrumental in reducing group leaders’ anxiety about what and how to
organize and direct the group sessions.
The strategies and techniques for most manuals were developed from
research findings for the particular issue, condition, or problem. This makes it
easier for the group leader to be able to support the group treatment strate-
gies and techniques as being evidence-based. The material that comprises the
manual has a sequence for presenting the cognitive material as well as guides for
effective ways to present the materials. Many manuals may have curriculum/
session plans that specify objectives with recommended strategies and the
sequence for presenting these. The group leader is expected to follow these
preprepared plans and is not left to develop these on their own. In addition,
the plans follow the goals and objectives that provide the framework for the
manualized treatment.
Some manuals and ancillary material contain preprepared presentations that
include media. This makes it easier for the group leader to prepare for the
group as the most essential information is provided as well as the presentation
method. It is also essential that the group leader be familiar with what is being
presented as they will have to answer questions and lead discussions.
Manualized therapy will many times also include evaluation forms as a part of
the manual either as print material or on a website. Using these forms assists
the group leader to assess members’ progression as well as assessing the effi-
cacy of the group treatment. Another advantage for these forms is that they
usually have evidence for validity and reliability.
Manualized treatment is usually focused on narrow and specific goals and objec-
tives. This narrow focus has goals that are usually behavioral in nature and are
capable of being observed and assessed such as reduction in the number of
days overeating. They are not vague such as “feeling better”, or subject to
personal interpretations where each person can have a different interpretation
or meaning. Some manuals will have activities and other forms, as well as
specific homework for group members. There are helpful because the group
leader will not have to find or create these and have the advantage that they
have been designed for the specific topic that defines the group. It is important
that the group leader use the forms, activities, and homework specified in the
manual as these will be a part of the therapeutic fidelity to ensure that the
evidence-based treatment will produce the desired results.
The knowledge to be disseminated is included in the manual. Having this infor-
mation already prepared can save the group leader considerable time and
effort to seek out and prepare the relevant information. On the other hand,
there can be new material that has emerged or created since the manual was
developed and will not be included. This is why it is still important for group
leaders of manualized groups to also do a literature search to determine
 Applications for Fostering Group Dynamics 241

whether there are updated findings that would be relevant prior to imple-
menting the group.
The use of manualized therapy not only reduces the time the leader needs
for planning; this can also help to reduce some leaders’ anxiety about the
ambiguity and uncertainty that can be present when planning, organizing,
directing, and presenting group sessions. It can be comforting to group lea-
ders, especially beginning group leaders and those who have not had enough
training, to have to facilitate a manualized group.

Disadvantages for Manualized Groups

However, there are some constraints to facilitation for manualized groups:
strict adherence to the manual, group leadership skills and processes to be
used, and the limited use for creative activities.
The studies on the use of manualized groups emphasize the need for strict
adherence to the manual in order for treatment to be most effective. While
minor modifications can be made, such as to accommodate members’ reading
abilities, major deviations can affect the outcomes and, in some instances, may
invalidate the results. Group leadership skills and processes may not be included
such as empathic failures and their repair so that, unless the group leader is
already educated about these, the group facilitation may be affected. Also, for
manualized groups, there is little attention given for the constructive use of group
dynamics, stages of group development, therapeutic group factors, and strate-
gies for managing difficult group member behaviors, nor do they provide for
an understanding of group process or use of group process commentary when
facilitating group therapy. The final disadvantage that is presented relates to
the absence of guides for the leader to manage group member factors such as
managing and containing intense emotions, and member to member interac-
tions. Some of the richness of group leadership is reduced or eliminated.

Enhancing Manualized Groups with Creative Activities

The success of manualized group sessions depends on the group leader’s
knowledge and group facilitation skills as well as adherence to the manual.
There may be some minor adjustments that need to be used but the manuals
provide the structure and frame for the sessions and the group leader must be
aware of what adjustments can be made within the framework of the manual.
Creative activities can be used in manualized groups and following are some
suggestions for how they may be incorporated in the very structured and
directed session: embedding, metaphors and symbols, reducing, and connecting.

! Embedding refers to incorporating a short activity as part of the pre-

sentation of didactic material. For example, group members can be asked
to list their thoughts and feelings about specific points that are being
242 Applications for Fostering Group Dynamics

presented and then allow time for them to read these at the end of the
presentation. The requests for lists can even be presented as part of a
PowerPoint presentation.
! Determine if there are metaphors in the materials and/or in members
disclosures and ask them to present these by drawing symbols for them.
! Distribute materials and ask members to draw or use colors for the feelings
and thoughts that are triggered by the group, or a presentation.
! Use short periods of mindfulness or meditation to reduce intensity of dis-
tressing feelings, everyday stress, triggers for the behaviors that are the
focus for the therapy, and to bring members into the here and now.
! Highlight members’ connections shown through their products and in
their reporting.
! Short drawing and writing creative activities can be used to expand and
reinforce the learning presented by the material.
! Use stress reduction techniques such as progressive relaxation, meditation
or breathing. This can help reduce members’ tensions thus promoting
more active involvement especially with personally sensitive material.

There are many opportunities for group leaders to include creative activities
in their manualized groups.

Group Dilemmas Cases and Creative Activities

Following are four vignettes that describe some possible group situations, all
with adult group members. Read each and imagine that you are the group
leader and are encountering the situation. Try to put yourself in the group,
accept that you tried interventions, but these were not successful, and that the
group continued this unproductive behavior. What would you do then? Some
suggested creative activities interventions follow each example.

Case Vignette I
A was the group leader of a group for young adults ages 29 to 36. This group had been
meeting once a week for the past three months and was becoming more cohesive where mem-
bers were beginning to engage in important self-disclosures. Sessions were interesting and
lively. A encouraged interactions among members, and they responded well. Everyone seemed
satisfied and willing to participate, attendance was regular, and members came to sessions
prepared to work.
During the twelfth session, about midway through the number of scheduled sessions, an
active group member announced that they needed to leave the group to care for a parent in
another city who was recovering from a stroke. A had met with the leaving group member in
advance of this session to plan the announcement and how to manage their feelings around
leaving the group.
 Applications for Fostering Group Dynamics 243

After the announcement, group members expressed their shock, dismay, and feelings of loss.
A had anticipated this reaction and guided the session so that the leaving group member and
other group members could express their feelings and take care of any unfinished business that
might be present.
The next session continued the goodbye and grieving process for the group members, and
several of them expressed regrets that A was no longer a part of the group. A had also
anticipated this possible reaction, and did not push the group to move on, feeling that they
would do so when they were ready. Some personal concerns surfaced, but members seemed
disinclined to deal with them, as these were quickly dropped when getting little response.
The group leader became concerned when the pattern of surfacing personal concerns and
then dropping them continued for the next two sessions. A tried to respond to the concerns, but
the members who spoke of their concerns would not or did not pursue the leads or guidance.
Members rarely spoke, and seldom was there any interaction among members, except at the
beginning of the sessions where they did talk about the weather, traffic, sports, and other such
topics. Sessions lacked energy, nothing A did encouraged participation, and little or no ther-
apeutic work was being done. A tried to analyze what was taking place in the group and
considered whether or not the group was continuing the grieving process, had fears of intense
uncontrollable emotions surfacing in the group, that members wanted to challenge the leader
but were fearful of doing so, and/or that something important that the group needed was
being overlooked. A tried introducing each of these, but the group remained unresponsive,
denying the possible fears, and stating that they felt safe enough to express their feelings, or to
challenge the leader.
Let’s assume that these are well-functioning adults without disabilities. The
leader may want to consider using a movement activity to energize the group;
or a drawing activity to label and express current feelings; or an imagery
activity where members image the group as a whole.

Case Vignette II
M was dreading the upcoming meeting for the group but was unable to pinpoint the source or
reason for the feeling. M had just finally admitted that the dread and reluctance had been
present for the last two sessions, and that there had been some disquieting thoughts and
feelings about the group prior to those sessions. M reviewed the session notes, and the infor-
mation about group members, but nothing jumped out as a possible reason for the dread. M
did not feel this way about their other groups, and usually looked forward to group sessions.
The dreaded session began for the group of eight young adults ages 25 to 35. They were
attending the 12-session group because of relationship problems that they wanted to resolve,
and this was the eighth session. The members were all working in productive jobs, reported
that they were in reasonably good physical health, did not have any major past traumas such
as abuse or rape, and seemed to be genuinely interested in what the group could offer them.
Two members were divorced, three were in the process of separation for divorce, and three had
never been married.
M started this eighth session in the usual way by asking if there was any unfinished
business from the previous session, there was none, and if anyone had something urgent and
244 Applications for Fostering Group Dynamics

important to bring to the group, again there was nothing. The group sat in silence for a few
minutes, which began to feel like an eternity to M. Just as M was going to intervene, a
member started talking about their marital problems, and did so for most of the session.
Whenever they sounded like they would stop, another member would ask a question, which
then led to an extended answer. Finally, the session ended. As M wrote the session notes, a
pattern had emerged over the last three sessions. It had gradually emerged, so that it would
have been hard to detect earlier, but this last session really highlighted the pattern. M
realized that the group allowed and encouraged story-telling by one or two people, and that
M’s efforts to stop it and get them more focused was ignored. The group seemed to agree
that they needed to focus, but would almost immediately return to telling the story. There
were also some long silences that members seemed content to endure, although someone
always broke the silence. The stories were always a rehash of what the member had told
before, there had been no movement that suggested progress or resolution, and other members
just listened and probed for more details when they spoke at all. M realized that what was
dreaded was more of the same, and at being unable or ineffective to stop this pattern of
behavior.
Creative activities could include using the next three sessions to have
members write for 10–15 minutes about their thoughts, feelings, and ideas
about the group, but not to read these or share in any way. Just to write.
Another creative activity could be to have members construct ATCs on the
topics of safety and trust in relationships, and to display and report on these in
the group. A third alternative could be to use a short mindfulness meditation
period, and afterward report on the perceptions and feelings experienced.

Case Vignette III

The group had started off with much promise and D, the group leader, was pleased with the
progress so far. D felt that members were gaining benefits from the group that would encou-
rage them to stick to their plans to combat their abuse of alcohol. D wasn’t naive with
unrealistic expectations, having worked with many clients having this condition over the years
and knew that their challenges would not be easily overcome, and that there was much hard
work for them to do. But, D was encouraged because of the behaviors in the group, and
members’ reported behaviors outside the group that seemed to be verified by family members.
During the sixth session, D noticed that several topics introduced by members did not seem
finished. As soon as one member finished talking, a perfunctory response was provided by
another member, but then that member or another one, went on to talk about something else.
D made a mental note to pay attention to this behavior and to bring it to the group’s attention
if it happened again. The next session was a repeat of the previous one, and D did intervene
with a group process comment. The members reflected on what they were doing, and possible
reasons, but it was not long before they were back into the skittering pattern. The same
happened the next session where D tried another group process comment. Members tried to be
reflective about what they were doing but continued the established pattern. There was no new
material in what the members were talking about, and they really seemed to try to cooperate
with D’s interventions.
 Applications for Fostering Group Dynamics 245

Suggested interventions using creative activities include using drawing and

collage with a focus on accessing and expressing feelings. The group leader may
want to reflect on identifying the feelings that the majority or all group members
find difficult to express, such as appreciation, happiness, anger, and fear.

Case Vignette IV
A conflict broke out between two group members when one accused the other of being bigoted,
and the accused member responded that their religion was not bigoted and that the accuser
was “just plain wrong”. The group leader, J, could tell that this topic was of immense
importance for these two members as their nonverbal language seemed to signal “fight”. J
tried to defuse the situation and lower the intensity by intervening and using some conflict
resolution skills that usually worked. However, while the conflicted group members partici-
pated in the resolution process, neither budged from their initial position, and the group
atmosphere remained very tense.
When J asked other group members how they were experiencing the conflict in the group,
the other group members reported that they had high levels of discomfort. A couple of members
just wanted to agree to disagree and move on to something else, and several members reported
that they wanted to leave and get away from the conflict. J felt that if the emotional intensity
was not reduced that there was a real possibility that one or more members might not return
to the next session.
J decided to explore members’ feelings and reactions around conflict in general, not just
the current one in the group, as an opportunity for both the members in the conflict and
other group members to gain insight, and to possibly reduce tension in the group. All group
members expressed many fears around conflict because they perceived it as destructive, that
any conflict triggered fears of danger related to their childhood experiences, and most group
members did not have expectations for positive outcomes from the conflict that was currently
in the group. There were even some comments made that suggested a lack of confidence in
J’s ability to moderate the conflict and fear that the group would be destroyed. The more
members talked, the more intense the atmosphere became on top of the already heightened
intensity.
The conflicting group members said that they wanted to group to remain intact, and would
just let the conflict go, and not try to resolve it. J knew that it was very unlikely that the
group would be helped if the conflict was suppressed, as then the conflict would become the
elephant in the room and would continue to negatively impact the group.
The group leader has to intervene quickly and take charge of the group.
Members are very fearful and some may even be panicking, and if not
addressed this could effectively destroy the group. The group leader has the
following tasks to perform, and these are in priority order:

! Reduce emotional intensity so that members can leave the session able to
handle their difficult feelings
! Reduce fears that the group and/or individual members are in danger of
being destroyed
246 Applications for Fostering Group Dynamics

! Increase feelings of trust and safety in the group, and in the competence of
the group leader to protect them from destruction or becoming abandoned
! Demonstrate that there can be a constructive resolution of conflict

Suggested interventions can begin with a breathing activity as described next.

Activity 11.10 Reduce Emotional Intensity

Materials
None

Procedure
1 The leader asks members to rate their emotional intensity at the present
time using a scale of 0 – little or no intensity, to 10 – considerable or
extreme intensity.
2 Introduce the exercise by telling members that one way to reduce emo-
tional intensity and to become calmer is to do a breathing exercise, and
that you will lead them through this.
3 Ask them to close their eyes, sit in silence for a moment, scan their body
and note the tense areas such as their shoulders, and to become aware of
their breathing pattern. Ask if they are breathing fast, slow, almost pant-
ing, or however their breath seems to them.
4 Tell them that once they are aware of their breathing pattern, to try and
consciously make it deep and even. They may not succeed at first, but to
keep trying to breathe deeply and evenly.

Allow at least five minutes for breathing.

5 At the end of the allotted period, ask members to open their eyes and once
more, to rate their emotional intensity. If the emotional intensity is five or
higher, continue the breathing exercise until all members have less than a
five rating.
Another activity that could be helpful is the relaxation in movement. An
imagery exercise where the members image taking a walk can also reduce
intensity. It is essential that the emotional intensity be reduced before
trying to address any of the other possible concerns.

Summary
The final chapter focused on using creative activities to foster the emergence
of group therapeutic factors, to address some group level problems and to
manage some group dynamics. Ten activities were described.
 Applications for Fostering Group Dynamics 247

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Index

acceptance 23 Bion, W. 53
active participation, in experiential blocking 50–51
learning 6 Bodin, A. M. 47
adolescent groups 227–229 Borderline Personality Disorder 151
adults groups 229–231 Brown, J. 174
Agazarian, Y. 47 Brown, K. 150
Aimone, K. 82 Brown, N. 5, 46, 51, 164, 206, 231
Alonso, A. 5, 231 Brown, N. W. 16
altruism 233 Brun, B. 164
anxiety, reducing 141 Bucci, W. 94
appropriate questioning 51 Bucci’s model 94
art-based activities 8; choice of 190–191; Burns, D. 155
see also collage activities; drawing
activities Campbell, W. 150
artist trading card (ATC) 232 card book 170
assumptions guide, creative activities caretakers, psychoeducational groups for
23–25 203–204
attention 59, 221; adolescent 228; Carlson, L. 150
adults/older adults 229; children 226; catharsis 63, 233, 235–236
receiving 179, 222 Chalmers, B. 193
attributes, group leaders 44–46 Chan, K. 95
auditory distraction 144, 181–182 chaotic thoughts and feelings, organizing
authority figures 58 74–75
autobiography 98–100 Chapman, T. J. 47
awareness: focusing by drawing activities children’s group 225–227
70–71; immediate 70–72 cinquains 194–195
Classen, C. 95
Babani, A. 154 clinical issues, as dilemmas 24
Band, J. 155 cognitive abilities, of adults/older
Barnes, S. 150 adults 230
Bates, A. 150 cognitive behavior drama 130
Beck, J. 7 cognitive theories 7, 140
beginning stage, of group development cohesion: stage of group development
54–55 56–57; as therapeutic factors 63, 234
behavioral therapy 7 collage activities: Creative Self 88–89;
Bergman, A. 7 defined 82; Emotional Self 88; favorite
Bettelheim, B. 9, 161, 162, 164 things, activity 83; in group 85–86;
Biegel, G. 151 group leader’s development for using
 Index 249

82–83; home 90; inside/outside 73; group-focused activities 75–82;

89–90; Inspirational Self 88; just play, organizing chaotic thoughts and feelings
activity 84; Physical Self 87; purpose 74–75; tension, relieving 73–74
and goals of 86–87; scrapbook and defensiveness, reducing 22–23, 30, 87
168; shapes 84–85 developmental issues 23, 163–164
commonality, for members of diverse dialectical behavioral therapy (DBT) 7,
conditions 201 140, 151
confidentiality and privacy 12–13; in Dieckmann, H. 9
restrictive settings 187; in selection of difficult member behaviors, managing
creative activities 29 220–223
conflict: activities to address 239; stage of Dimidjian, W. 10
group development 55–56 directness, of group leader 49
consensual validation 179–180 distress, coping with 146–147
constructive feedback 80–81 diverse conditions/settings: choice of
continued processing, of experience 23 activity 190–191; commonalities for
corrective emotional recapitulation members of 201; difficult member
63, 233 behaviors, managing 220–223; evoked
countertransference 48 emotions 191; guidelines for selection
creative activities 8–10; ableness, of activities 200–204; happy moments
consideration of 202; basic group lift spirits 214–217; inclusion 217–220;
conditions for use 27–28; basic life transitions 206–214; support groups
planning 202; benefits for use of 4; 206; symptoms and self-management
consultation 202; defined 3; ethical 204–206; ways to use creative activities
considerations for 10–14; Expansion in 194
and Enhancement Phases 41–43; for diversity sensitivity: authority figures 58;
families and caretakers 203–204; expressing emotions 59; family, role of
fundamental principles of 22–23; 59–60; meaning attribution 61; source
general guiding assumptions 23–29; for illness or condition 58–59
for group dilemmas 5–6; guidelines for Djikuc, M. 92
selecting activities 28–29, 200–204; Dooley, B. 150
Implementation Phase 30–40; judi- drama/performance activities 9, 129–130
cious use of 19; phases of constructive dramatic play 130
use of 29–43; Reporting Phase 40–41; drawing activities 67; benefits and
safety and trust 27; selection of 10, advantages for 68; bypass defenses
28–29; see also diverse conditions/ 71–82; express feelings by 69–70;
settings; specific activities focusing awareness 70–71; guidelines
creed, creation of 134–135 for 68–69; selection of 76;
Cropley, T. 150 uncontaminated expressions 68
Cully, J. 127 dreams 107–108
culturally sensitive group leader strategies
61, 62 effective groups, defined 203–204
cultural sensitivity 11; authority figures Elkholm, J. 67
58; expressing emotions 59; family, Ellis, A. 7
role of 59–60; meaning attribution 61; embedding 241–242
source for illness or condition 58–59 emotional contagion, fear of 189
current wishes, desires, and needs, clues emotional expression: difficult feelings
for 22 220; encouraging 219–220; restricted
or inappropriate 188
dance therapy 9, 124–126 emotional intensity, activity for
defenses, drawing activities 71–73; bar- reducing 246
riers and constraints 75–82; compo- emotional presence 45
nents, identifying 72–73; concern(s) emotional venting 31, 63, 233, 236
250 Index

emotional vulnerability 18 Garland, S. 150

emotions: evoked 191; expressing 59; gender, adults/older adults and 230
intense 23, 228; managing 153–154, general life transition 207
228; see also negative emotions gloomy mood 210
empathy 45, 46–47 Glueckauf, R. 155
encouragement and support, by group Goleman, D. 150
leader 50 Graham, D. 127
energy, increasing 127–128 Griffin, R. 193
Enhancement Phase 41–42 group: conditions, creative activities 27,
Epstein, E. M. 95 28; environment, contributions of 6;
Esterling, B. 95 level challenges/process 47, 238;
ethical considerations: confidentiality and stages 54; see also stages of group
limits 12–13; do no harm 10–12; development; specific entries
process for resolution 14; professional group, as a whole 3, 17, 52; benefits
responsibility in 13 on 32, 34; focus on 24, 53, 149;
ethical principles 23 guidelines for drawing activities 75–77;
Evans, S. 150 intervention 41; process commentary
evoked emotion 191 17, 47
excited mood 210 group dilemmas 5–6; activity, resistance
exercise 9; see also physical exercise artist trading card 232; cases and
existential factors 63, 233–234; conflict creative activities 242–246; clinical
239; fostering emergence of 236–239; issues as 24; creative activities for
human suffering 236–238; resistance 231–232; as defense mechanism 27;
238–239 difficult group member and 231;
Expansion Phase 41–42 emotional intensity, activity for
experiential learning 6–7 reducing 246
Expressive Writing 190; autobiographical group dynamics 47–48, 52–53; adoles-
98–100; group expressive 97–98; life cent 227–229; adults and older adults
events 100 229–231; children 225–227; con-
Eye Movement Desensitization structive use of 241; defined 52; group
Reprocessing (EMDR) 140 level concerns 231–232; manualized
groups 239–246; therapeutic factors
fables 163 232–239
fairy tales 162–166, 194–195 group-focused drawing activities: accom-
families: psychoeducational groups for plishments 78–80; clarifying wants,
203–204; role of 59–60 needs, desires, and wishes 78–79;
fear of conflict 30 constructive feedback 80–81; desired
feedback: constructive 80–81; giving and outcomes 81; examples for 77; goal
receiving 28 and purpose 86; guidelines for 75–77;
feelings: chaotic thoughts and 74–75; introductions 77; planning and
difficult 220; express 69–70; expression selecting 86–87; problem solving and
of 24, 82; identification of 217; immedi- decision-making 82; saying hello,
ate 186; music therapy and 155–156 activity 77–78; wishes for group 80–81
Fehr, E. 133 group leaders 4–5, 24–25; basic skills
Ferrando, S. 150 and attributes 16–19; communication
Findler, M. 150 skills 15; culturally sensitive strategies
Fisch, R. 47 61–62; development of 14–16, 28;
flats 174, 175–176 ethical considerations 10–14; expertise
Fletcher, K. 150 28; fundamental attributes for 44–46;
folk tales 162 inner experiencing and clinical
Forsyth, D. 52 judgment 28; inner therapeutic self,
free associations, writing 103–104 developing 52–63; preparation of 14;
 Index 251

self-development 15–16; skills and informed consent 12

processes 241; strategies 61–62; inspiration, new ideas and 179
therapeutic skills of 46–52; for using intense emotions 23, 228
collage 82–83 interactive storytelling 130
group members 25–27; advantages for interpersonal learning 62–63, 233
2–3; benefits for 2–5; creative activities intrusive thoughts, handling 212–213
for group dilemmas 5–6; membership, Ismailji, T. 95
in experiential learning 7; rationale 3–4
Johnson, D. 52
Haglin, D. 150 Johnson, F. 52
Hansen, H. 96 journaling: benefits for 111; building
happy moments 215–216; identification pleasure 113; home contents 113–114;
of feelings, activity for 217; things professional training programs using
constituting 214 112; types of 114; uses for 111–112;
Hayes, S. 152 visual 115–116
Hays, T. 154
Health Insurance Portability and Kabat-Zinn, J. 150
Accountability Act (HIPAA) 193 Kernberg, O. F. 7
healthy adult narcissism (HAN) 46 kinesics distractors 182
Hodas, G. 154 Kingston, T. 150
Hoff, B. 151 Klein, M. 7
Hollon, S. 10 Kohut, H. 8, 16, 18, 46
Holmes, D. 95 Koopman, C. 95
Holton, C. 9 Kristeller, J. 150
hope 62, 233, 235 Krusmark, E. 150
Hopko, D. 127 Kunik, M. 127
Horneffer, K. 96
human suffering, activities to addressing L’Abate, L. 95
236–238 Lau, M. 150
Lawlor, E. 150
imagery 9, 138–139; coping with difficult Lazarus, A. 140
situations or distress 146–147; coping leadership skills 15–17; see also group
with negative emotions 143–145; leaders
group concerns, addressing 149–150; legends 162
guidelines for 140; haven 140–141; for Lenderking, W. 150
performances 145–146; self-perception Leszcz, M. 17, 26, 47, 180
147–149; tension and anxiety, redu- letters, writing 104–107
cing 141–143 Lewin, K. 6, 52
imitative behavior 63, 233 life transition groups: being mindful
Implementation Phase 30–40; activity activity 211–212; categories for
introduction in 37–38; activity script 206–207; drawing instructions 208;
introduction in 38; decision-making focus on current mood, activity for
procedure 31–34; encouraging 210; general life 207; intrusive
members 40; formal plan for 36–37; thoughts, handling 212–213; mood
materials and supplies, availability trigger(s), activity for 209; pleasant
of 35–36; observation of members sights activity 210–211; purposes and
38–39; planning process 30–31; goals of 206–207; sample activity
process for 37–40; questions for 207–208; skin distractors activity 211;
exploring and expansion 34–35; special place activity 213–214; specific
raising questions 39 life 207; writing instructions 208–209
impulse control 151, 189, 202 Light, T. 150
inclusion 217, 218–219 listening skills, of group leader 49
252 Index

lists power of 108–109 Ohnmeiss, D. 67

Lopez, A. 193 older adults groups 229–231; see also
Lumley, M. 112 adults groups
Lustgarten, S. 193 olfactory/smell distractors 182
Lutgendorf, S. 112
Luxton, D. 193 Palesh, O. 95
past reflections, writing 101–103
Macklem, D. 112 Pedersen, E. 164
Mahler, M. 7, 146 Pennebaker, J. W. 95, 112
Malone, K. 150 performances 145–146
manualized groups: advantages for personal experiencing: of group leader
239–241; emotional intensity, redu- 49; member’s 22
cing 246; enhancing with creative Peterson, L. 150
activities 241–242; group dilemmas photography 9, 166–167; see also
cases and creative activities 242–246 scrapbooks
Marra, T. 141 physical exercise 126–129
Marx, B. P. 95 physical movement: dance 124–126;
Massion, A. 150 general guidelines 121–123; goal or
McFarlane, W. 203 purpose for 122; mind-body connection
meanings: attribution of 60; for the 119–121; movement 123–124; perfor-
product 22 mance activities 129–130; physical
media access 188 exercise 126–129; role play 130–135
Meichenbaum, D. 7 Pine, F. 7
memory activities 9; see also scrapbooks Pizarro, J. 112
metaphors 51–52 pleased mood 210
mind-body connection: activity for poems 194–195
120–121; rationale for 119–120 Principle of P’u 151
mindfulness 9, 150–151; activity 151–152, Principle of Wu Wei 151
211–212; managing emotions 153–154; privacy and confidentiality 12–13; in
passing thoughts 152–153 restrictive settings 187; in selection of
Minichiello, V. 154 creative activities 29
monopolizing 221 process: commentary 47–48; for
Moreno, J. L. 130 resolution 14
movement 8–9, 123–124, 191; see also professional preparation 11
physical movement professional responsibility 13
Multi-Family Psychoeducational Prouix, K. 150
Psychotherapy (MF-PEP) 200 Pruitt, L. 193
multimodal therapy 140 psychodrama 130
multiple group sessions 184–186 psychoeducational groups 184–186
Murray, E. 95 psychological boundary strength 45
music therapy 9, 154–156, 190
myths 162–163 questioning, appropriate 51
Quittner, A. 155
narcissistic wounding 8, 17–18
narradrama 130 Rastegas, A. 96
negative emotions 143–144 Rational Emotive Behavioral Therapy
new ideas, generating 178–180 (REBT) 184
nonverbal behavior 53 Reaser, E. 193
Nowicka-Sauer, K. 67 redirecting, group leader and 49–50
reflective of inner world of person 22
Oatley, K. 92 reframing, group leader and 49–50
object-relations theories (OR) 7–8 Reich, W. 17–18
 Index 253

Reisman, A. 96 Smart, C. 150

relating attributes 14 Smothermon, J. 193
Reporting Phase 40–41 socializing techniques 63, 234
resistance 53; artist trading card 232; Souchek, J. 127
drawing activities and 79; as existential Soulsby, J. 150
factor 238–239; group 31; group specific life transitions 207
members’ reactions 25; reason for Spierings, J. 58, 62
37, 39 stages of group development 28, 53–57
restrictive settings 186–189 Stanley, M. 127
Ridgeway, V. 150 Stolorow, R. 46
Robinson, M. 94 stories 9, 194–195; choice of 190; crea-
Rogers, C. 14 tive activities for 165–166; discussing,
Rogge, R. 150 writing, and drawing 165–166,
role play 9, 130–135 194–195; forms for 162–163; read,
Rosenblad, S. 193 draw, and write approach 165–166;
Rothberg, B. 193 and unconscious 161–162; see also
Runberg, M. 164 fables; fairy tales; folk tales; legends;
Rutan, J. S. 5, 231 myths
storytelling: difficult member behaviors
Saltzman, A. 150 221–222; interactive 130
scapegoating 222–223 Stowell, C. 150
Scharf, M. 150 Strosahl, K. 152
Schwenk, S. 193 support groups 206
scrapbooks 9, 166, 167–170 Sweig, T. 112
Segal, Z. 150 Swenson, J. 193
selection guidelines, of creative activities symptom relief 204–206
28–29
self-affirmations 109, 110–111 tactile/touch distractors 182
self-distraction 143 taste distraction 144, 182
self-exploration 231–232 Teasdale, J. 150
self-management of symptoms 204–206 tension: activity for 142–143; reducing
self-perception 147–149 141; relieving 73–74, 78
self-psychology 8 termination stage, of group development 57
Selvini-Palazzoli, A. 47 themes and symbols, of fairy tales 164
sensory distractors 181–182 therapeutic factors 62–63, 232–233, 234;
session writing: dreams 107–108; free cultural and diversity sensitivity 58–61;
associations 103–104; letters 104–107; existential factors 63, 233–234,
lists 108–109; past reflections 236–239; fostering 228, 234–236;
101–103; self-affirmations 109–111; group dynamics 52–53; stages of
single 100–101; see also writing group development 53–57
activities therapeutic relationship 11, 28
Silverman, M. 154 therapeutic skills, group leaders 44;
similarities, activity for focus on 227, empathic failures 46–47; empathic
234–235 responding 46; process commentary
simulations and games 133 47–48; therapeutic responding/
Singer, T. 133 communication competencies
single session groups 177; benefits for 48–52; transference and counter-
178–180; constraints for 180; sample transference 48
180–184 Tojek, T. 112
Skillings, A. 150 tolerance and being nonjudgmental 45
skin distractors, activity for 211 touch sensation, positive 144–145
Sloan, D. M. 95 transference, and countertransference 48
254 Index

traumas, past 230 Wagner, A. 193

Trotzer, J. 51 Wales, T. 95
Trust game 133 Watzlawick, P. 47
Tuckman, B. 54 Weakland, J. H. 47
Wheeler, E. 150
Ullrich, P. 112 Williams, J. 150
Ungerea, T. 174 Wilson, K. 152
universality: fostering emergence of 234; writing activities 8; benefits from 92–94;
as therapeutic factors 62, 233 choice of 190; defined 92; dreams
107–108; Expressive Writing 95–100;
Vanharanta, H. 67 free associations 103–104; journaling
Veazey, C. 127 111–116; letters 104–107; process and
Verghese, A. 96 reasons for 94–95; past reflections
video interpretation 130 101–103; single session 100–101
virtual settings 191–194
visual distraction 143–144, 181 Yalom, I. 17, 26, 47, 62, 180,
visual journaling 9, 115–116, 170–173 233, 236