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CHAPTER 3

Pregroup Interviews and Group Sessions

nce procedural decisions have been made about the type, goals, length, and time frame of a psychoeducational group, it is time to begin the selection process for potential group members. Two key aspects are important to group member selection: (a) providing information to potential group members (and their parents when necessary) about details of the group (goals, topics, typical interventions) so that they are truly giving informed consent when they agree to participate; and (b) gathering information to decide whether potential group members would benefit from participation in this particular group based on their goals, willingness to participate, and interpersonal skills. In this chapter, the focus will be on using pregroup screening interviews and preparation sessions to select potential group members who are most likely to benefit from participation in a psychoeducational group.

Informed Consent for Group Members (and Parents)

To make an informed decision about participation in a group, children and adolescents (and parents) must be given information about the type of group; its goals, format, structure, and typical interventions; and the leadership style and credentials of the group leader(s). It is helpful to provide parents with both verbal information and written materials. A one-page handout that summarizes goals, topics, and interventions; discusses confidentiality; and provides contact information is helpful. The American Counseling Associations (1997) Ethical Standards are very specific about information to be disclosed in order to obtain informed consent: purposes, goals, techniques, procedures, limitations, potential risks, limits of confidentiality, and benefits of services. The ASGWs (1998) Best Practice Standards also suggests discussion of group leader credentials and the roles and responsibilities of
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group members and leaders. Appendix I contains an example of an informational form for parents about psychoeducational groups. An issue that is often raised when leading groups has to do with information and consent needed for a child to participate. It is important to establish with an administrator(s) whose consent is necessary. Is the consent of the custodial parent alone valid and/or even acceptable when parents have joint custody? Should the noncustodial parent be informed of the group as it may affect his or her relationship with the child (hopefully positively)? How is consent handled when the child or adolescent lives with another family member but one or both parents have legal custody? What about high school students who are almost but not quite of legal age? Some schools take the stance that if a student wants to participate in a group, his or her consent is enough. Other schools assume consent unless a parent indicates otherwise. Typically, the student handbook provides information about the types of group and individual counseling services available through the school, and that parents should contact the school if they do not want their son or daughter to participate in any of these activities. Ritchie and Huss (2000) provide a valuable reference with regard to how to make decisions related to selection, screening, and recruiting of minors in a way that protects confidentiality and addresses issues of informed consent. They make several valuable suggestions about how to secure parental consent without violating confidentiality. Wilcoxon and Magnuson (1999) also provide specific suggestions about how to balance the needs and demands of custodial and noncustodial parents, and most importantly, the student, while taking into consideration each individual situation and ethical and legal issues. For children and adolescents as potential group members, make sure that they are informed about the group at a level they can understand. Leaders should choose words that are appropriate to the grade level, and use examples whenever possible. It is helpful to explain goals, typical activities, and ground rules before the students enter the group to ensure that they understand and are ready to participate. Such information must be included at several points: verbally explained during a pregroup screen interview, in writing to either or both the student and the parents, and during the first group session. Before beginning the process of recruiting and informing potential group members, group leaders must clarify with their administration the order of how information will be presented. For example, some schools first send a letter to the parents informing them about a particular type of group and asking parents to consent, which is then followed by pregroup screening interviews conducted with potential group members. Other schools may interview students first to assess whether they would benefit from this particular group, and then if they are interested in participating, notes are sent home to parents for further consent.

Selection Criteria
Regardless of the order in which potential group member and parental consents are obtained, it is important to develop clear selection criteria. When Yalom

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(1995) writes about the selection of members for psychotherapy groups, he actually emphasizes deselection criteria more than selection criteria. This holds true for psychoeducational groups as well, to some extent. The goal is to create a group where children and adolescents feel accepted and cared about so that they are willing to try out new behaviors and ways of thinking. If students do not feel a part of the group or feel judged, they will not participate fully or sometimes at all. Selection criteria will be discussed on three levels: (a) general rules and guidelines that apply to most psychoeducational groups, (b) specific criteria developed around the goals for the psychoeducational group, and (c) potential group members willingness to participate in a psychoeducational group.

General Selection Criteria

The following general selection criteria are suggested for psychoeducational groups for children and adolescents: All group members must be within 2 years of each other so that they are similar in emotional development (Smead, 1995). This is crucial for younger children but is still important even for teenagers. Group members must be close to each other in maturity level in order to work together and learn from each other. Siblings should not be in the same group due to conflict of loyalty and the difficulty of the group in acknowledging two perspectives in the same family. Ideally, there should be a mixture of family situations or problems among the children with variation in living situation, communication skills, level of distress, and strengths and weaknesses. These differences will serve to promote peer role models, generate alternative solutions to problems, and instill hope. Any one group member should not be so different that he or she feels isolated or scapegoated by the group. Although it is impossible to prevent scapegoating, a conscious effort to select and link members based on their similarities (e.g., feelings, experiences) may help group members to make connections and increase cohesiveness among members. It is important that group members connect with each other around the topic of the group. Gender, race, socioeconomic status, and ethnicity of group members should be taken into consideration when trying to prevent scapegoating (Hines & Fields, 2002). In schools, it is particularly important that no two group members have a history of significant conflict with each other. Because these groups are so short, there is no time to repair damaged relationships. Trust must be established, and it is easier to do so when there is no history of past conflict. Riva, Lippert, and Tackett (2000) described this as compatibility, suggesting that if two students have a relationship that might negatively affect the group process or put confidentiality at risk, then these students are not compatible. Each group member must have at least one person in the group with whom he or she can initially connect and one person who will be able to serve as a role model for him or her.

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Deselection criteria include the following: Students whose goals do not match group goals Students who are overly hostile, angry, or aggressive Students who are extremely hyperactive and who cannot focus on a group activity for even a short length of time Students who cannot empathize with others Students who are extremely sensitive to criticism Students who are in crisis or suicidal There are some exceptions to these criteria based on the group. In an anger management group, some members, by definition, would be angry or aggressive. The key is not to create a group of all angry or aggressive members, but to try to also include group members who hold in their anger so that members can learn from each other and serve as potential role models for each other. The best suggestion regarding including group members who are angry or hyperactive, or who cannot empathize with others, would be to include one or two members with these characteristics, but do not have it be a common characteristic of all group members. Remember that group members must be able to serve as role models for each other as well as present different strengths and approaches to increase the range of problem-solving options.

Specific Criteria to Assess Fit With Group Goals

The range of behavior that will be addressed within a specific psychoeducational group needs to be identified clearly. From there, goals (behavioral, cognitive, and affective) will be determined. Based on these goals, specific criteria can be generated to decide which group members will benefit most from participation in this group. For example, students exhibiting restricting or binge-eating behavior may not be good candidates for a positive body image group. However, those students may be a good fit for bulimia prevention that focuses on the identification and modification of feelings to prevent disordered eating behaviors (Weiss, Katzman, & Wolchick, 1985). Homogeneity with regard to problem type and severity in psychoeducational groups for children and adolescents is essential. Group members must be able to initially connect with each other around the group goal (e.g., improving self-esteem or learning ways to make friends) to promote universality, hope, and cohesion. Although there can be some range in terms of the severity of concern, group members need to be on the same general level of needing help. For example, it would not be wise to put a student who is potentially suicidal in an improving self-esteem group. This person would end up either feeling isolated and scapegoated or taking up much of the groups time and attention because he or she is perceived as needing the most help. However, heterogeneity is also needed with regard to group members. One might ask, how can you achieve heterogeneity when you have already selected a

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homogeneous group? Smead (2000b) sums it up by saying a coping model is what we are looking for in a groupyouths who have the same [homogeneous] major issue but who are different in terms of experience and personality (p. 7). Key differences related to this coping skills model are as follows: Different coping skills to deal with different situations (e.g., internalizing vs. externalizing anger) Different stages of dealing with the problem (e.g., students whose parents have been divorced for several years and students whose parents are newly separated) Different attitudes about the problem situation Different values regarding the situation Different disclosure levels Different emotional response levels Different emotional responses to the situation Different cultural heritage Different socioeconomic levels Different levels of resiliency Mixed gender Different family situations Different birth order The criteria must be somewhat wide ranging in order to get a good number of students and a good mix. Smead (1995) calls this concept role balance. She emphasizes that excluding all members who have hit someone or thrown something from an anger management group might make it very difficult to find any members at all. The ultimate goal in the selection of members for an anger management group would be to have members who display the wide range of ways to express anger, balancing those members who hold their anger in with those members who act it out physically. (p. 5)

Potential Group Members Willingness to Participate in a Psychoeducational Group

There are some clear indicators of who is most likely to benefit from groups. Riva et al. (2004), based on a review of the literature, suggested two areas of attention in selecting group members for counseling groups: interpersonal and intrapersonal characteristics. Piper and McCallum (1994) emphasized, as inclusion criteria, a moderate amount of social ability and frustration tolerance, and a commitment to changing interpersonal behaviors. For psychoeducational groups, this means choosing potential group members who can interact somewhat cooperatively within a group (e g., can disagree without hitting someone) and who express some willingness to learn and try out new behaviors.

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Selection/Inclusion Grid
To ensure that all the information necessary to make a decision about the appropriateness of a potential group member for a group is included, I suggest creating a grid with four columns. Once the grid is created, questions to assess each area can be inserted into the screening interview so that all important areas are covered. Each goal, selection, and deselection criterion should have at least one question that assesses its content as well as some general questions about how the potential group member participates in groups. Table 3.1 in this chapter includes the grid. The first column in the grid is Group Goals. They should be specific, including behavior, cognition, and affect. For an 8- to 10-session psychoeducational group, a total of three to five goals is realistic. For example, in an anger management group in the schools, typical goals might be (a) identify situations that make group members angry, (b) teach new ways of thinking in situations that make group members angry, and (c) practice new behaviors in situations that make group members angry. The second column in the grid is Selection and Deselection Criteria Based on Group Goals. This column should include both criteria that you want group members to possess, and criteria that would indicate exclusion from the group. The American Counseling Association Code of Ethics and Standards of Practice (1997) states that group leaders select group members whose needs and goals are compatible with the goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience (p. 2). Thus, it is important to select members who fit well within a group as well as deselect members who do not fit with the group, may be harmed by the group, or may harm others. It is important to think about the range of group members that can be accommodated in the group based on the goals, focus, interventions, and length. If the group is psychoeducational in nature, then those with more severe problems may not benefit or may interfere with other group members learning. Consequently, first, how well the group members goals fit with the group goals must be assessed. Second, other criteria related to the specific group topic must be assessed. For example, in an anger management group, a selection criterion might be the ability to identify situations that make group members angry, and a deselection criterion might be using violence on a regular basis to express anger. To assess, you might ask in the interview, How often do you get angry, and what do you typically do to express your anger? In an effort to assess how likely the group member will be to experiment with new behaviors, it is important to assess willingness to reflect on his or her interpersonal style and to make changes. Useful questions are as follows: What have you tried to do that has worked? What hasnt worked? How have your family and relationships influenced your goal(s) and problem(s)? To assess intrapersonal and interpersonal variables, group leaders may ask about potential members relationships with others (e.g., Describe how you typically act in a group of people), their expectations that the group will help them (e.g., How much do you expect this group to help you?), and the ability to be self-reflective or psychologically minded (e.g., Describe some things you would like to change about yourself but find it hard to).

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Pregroup Interviews and Group Sessions55 Table 3.1 Outline for Screening Criteria Grid Selection and Deselection Criteria Based on Group Goals

Group Goals

Questions to Ask During Screening Interview That Assess Specific Screening Criteria (1a) What would you like to get out of this group? (1b) What would you like to learn from this group? (1c) How would you like to be different at the end of this group? (1d) Related to the theme of our group, ___, what do you need to learn? (1e) What have you tried to do that has worked? What hasn't worked? (1f) How has your family and relationship history influenced your goal(s) and problem(s)? (2a) How do you see yourself working on this goal in group? (2b) How would the group help you with this goal? (2c) What things could you do in this group to help you with this goal? (2d) What activities and interventions that we just discussed do you think might be helpful? (3) These questions relate to the severity of the problem and help define whether this group member's goal(s) can be met during this group.

How Well Does This Member Fit in This Group (1a) Is goal(s) realistic? (1b) Does goal(s) fit with group goal?

(1a) Behavioral (1) How well do their goals fit (1b) Cognitive with group (1c) Affective goals?

(2) Can this goal be worked on in this group?

(2a) Do they have insight into the development of the problem and what the issues are?

(3) Specific selection and deselection criteria related to the topic and theme of the group (4) General selection criteria for groups

(3a) Do they perceive the problem as something they can change, or over which they can have control? (4a) Are they willing to participate? (4b) Do they typically participate in groups? (4c) Are they willing to try and help others and also to be helped by others? (Continued)

(4a) How do you typically participate in groups? (4b) Have you ever been in a psychoeducational or counseling group before? Was it helpful? Why or why not? (4c) How comfortable are you talking about your feelings? (4d) How comfortable are you talking about this problem or issue?

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56LEADING PSYCHOEDUCATIONAL GROUPS FOR CHILDREN Table 3.1 (Continued) (4e) What strengths would you bring to this group? (4f) What unique contribution would you make to this group? (4g) How could you help others with similar concerns? (4h) Where do you see yourself having the most trouble as we begin to talk about some of these issues? (4d) Do their concerns seem like typical ones expressed by most group members? (4e) With whom could they connect? (4f) For whom could they serve as a role model?

(5) Willingness to agree to the ground rules and procedures of this group

(5a) Are you willing to attend all group sessions on time? (5b) Are you willing to keep things confidential? (5c) Are you willing to selfdisclose? (5d) Are you willing to try new behaviors?

The third column in the grid is Questions to Ask During the Screening Interview That Assess Specific Selection Criteria. For each selection criterion, there should be least one question that assesses fit of group goals, selection or deselection criteria, commitment to ground rules, and general group participation criteria. For example, the group leader should describe the group goals and then ask members what their specific goal would be. How would they like to be different at the end of the group? What changes would they like to make? The fourth column in the grid is called How Well Does the Member Fit in This Group? Group leaders must now take the information that they have learned and assess how well the group member might function in group. Questions in this column related to goals might include the following: Does the group member have a goal for the group? Is the goal realistic based on the goals of the group and the length of the group? Does the goal fit with group goals? Does the group member have insight into the development of the problem and what the issues are? Does he or she perceive the problem as something that can be changedsomething over which he or she can have control? Has the group member been in counseling before, or is he or she currently? Is he or she willing to sign a consent form for you to speak with his or her current counselor? In addition, other questions about potential group member fit include the following: Is he or she willing to participate? How willing is the group member to disclose information related to the topics to be discussed in this group? How does

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Conduct your lit review to identify specific goals, themes and topics, interventions, and selection and deselection criteria. Identify the needs of the population. Select goals based on the needs of the population and the type of group (psychoeducational or counseling). Decide on selection criteria related to the activities, focus, and structure of your group. Include inclusion and exclusion criteria. Outline your screening session in terms of what information you will provide, what questions you will ask to assess for appropriateness for group based on questions 4 and 5 (Table 3.1). Include questions that relate to the problem/issue focus of the group and behaviors that are needed to participate in the group. Figure 3.1 Directions for Identifying Screening Interview Questions

he or she typically participate in groups? Is he or she willing to try and help others and also to be helped by others? Do his or her concerns seem like typical ones expressed by most group members? It is also helpful at this time to think about how well each group member would fit with other group members. Smead (1995) suggested that group members should not be so different in terms of their situation or problem that they feel isolated or scapegoated by the group. Although it is impossible to prevent scapegoating, a conscious effort to select and link members based on their similarities (e.g., feelings, experiences) may help group members to make connections and increase cohesiveness among members. Each group member should have at least one other person in the group with whom he or she can initially connect on some similarity of experience, situation, or problem. In addition, it is helpful to consciously plan for each group member to be able to serve as a role model for someone else in the group to facilitation altruism and hope. Consequently, two questions should be included related to fit: (a) To which other group member(s) would this person be able to relate? and (b) For whom could this person serve as a role model in the group? Figure 3.1 in this chapter suggests an outline for organizing questions to be used in the screening interview.

Screening Interviews
As I conduct workshops about how to lead effective groups in schools, one of the comments I hear most often from practicing school counselors is, So you really use a screening interview to select who will be in the group; I always thought it was just a formality. And then they go on to describe how hard it is to get students to participate in a group, so they accept everyone into the group who shows interest.

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When I ask about the success rate of their groups, I often hear that their groups fall apart before the last session. In addition, my own experiences with leading groups suggest that although it may take a little longer to get groups started, effective screening is much more likely to ensure a successful and productive group. I have led many eating disorders counseling groups, and screening was essential to choosing group members who would benefit from group. Often, when potential group members heard the list of topics, issues, and interventions that typically occurred in an eating disorders group, they decided that individual counseling would be a better option for them at this point in time. It was certainly better for them (and other group members) not to begin this group at all than to drop out and feel badly for themselves while also possibly creating feelings of guilt for the members who stayed in the group (who then wondered if they did something to make the person leave the group). Screening interviews also often helped decide whether a psychoeducational group or counseling group was most appropriate for a potential group member. It became apparent that if potential group members goals were related to losing weight (when they were not overweight) rather than understanding the connection between their disordered eating behavior, their feelings, and their relationships, a psychoeducational group was more appropriate. Psychoeducational groups are focused on identifying potentially problematic thoughts and behaviors and replacing them with more appropriate thoughts and behaviors. Group members in psychoeducational groups for eating disorders (e.g., Weiss et al., 1985) begin to learn new ways of thinking and behaving but often struggle to implement these new strategies consistently. Counseling groups help group members to examine what gets in the way of implementing these strategies and improving self-esteem, depression, and relationships. For eating disorders groups with a counseling focus that I led, one clear criterion was that the group members needed to understand that what they were thinking and feeling and how they related to people influenced their eating-disordered behavior; thus, in order to change their eating-disordered behavior, they needed to examine and possibly adapt how they thought about, felt about, and related to people. What follows is a list of suggestions on how to create an effective screening interview for psychoeducational groups and a tentative outline for screening interviews.

Goals of the Screening Interview

All students should be interviewed by the leader(s) of the group to assess their ability to participate in and benefit from group. An interview lasting 30 to 45 minutes should be sufficient. There are several goals for an effective screening interview. The first is to provide information to the potential group member. It is essential to give information about the goals of the group; general guidelines and ground rules (e.g., attendance, respect for others, confidentiality); and procedural information, such as length and time of sessions, group topics, activities, and typical interventions. The second goal is to assess how well a potential group members needs, issues, and goals match group goals. The third goal is to assess a potential group members interpersonal style and potential to succeed in this group. The interview allows the group leader(s) the chance to observe the potential group members

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behavior to see if he or she can talk about the presenting problem and, to some extent, to see if he or she can follow directions and stay on task. The screening interview also gives the leader an opportunity to observe the potential group members verbal and nonverbal behaviors, specifically level of comfort, eye contact, willingness to self-disclose, posture, tone of voice, and ease of communicating. The fourth goal is to address any questions or concerns that the potential group member might have about participation in this group. In addition, it is important to begin to establish a relationship with the potential group member to develop trust and the willingness to reflect on current behaviors and try out new behaviors. Meeting with potential group members individually also helps group leaders to begin to think about which members will be able to serve as role models for each other. Appendix J includes a sample screening interview that can be adapted for most psychoeducational groups.

Sequence and Format of the Screening Interview

The screening interview should be an interactive process where both parties have a chance to ask questions, gain information, and decide whether this particular group is a good fit for the potential group member. If the sequencing of topics is not attended to, a potential group member may be first bombarded with a great deal of information and then asked an overwhelming series of questions all in a row. It is also important to think about putting the potential group member at ease by beginning with the information that is the least anxiety provoking and gradually increasing the depth of the topics and questions as the interview progresses. To avoid a stilted interaction and encourage a collaborative discussion, the following sequence for the screening interview is suggested: 1. Introduction of Group Leaders, Purpose of the Screening Interview, Procedural Details of the Group, and the Goals of the Group. It is important to discuss briefly who the leaders are, their credentials, and the purpose of the screening interview. Procedural details such as when the group meets, where, and for how long are important to disclose at the beginning. There is no sense conducting a whole interview only to find out the person has a commitment at the time the group meets. Related to goals, it is useful to discuss what the group can and cannot do, what are appropriate individual goals, and when a potential member needs to decide on a goal. 2. Potential Group Members Goals for the Group. Following from a general overview of group goals and typical individual goals, it is useful to discuss with potential group members what their goal(s) would be for this group. Background information should also be gathered in terms of how they perceive their problem, issue, or concern; what they think has influenced the development of the problem (e.g., family, work, situational factors); and what has worked and what has not worked related to the problem area or the theme of the group. 3. Information About Procedures and Ground Rules for This Group. Ground rules specific to the group should be discussed at this time, such as commitment to the group for a period of time, how and when new members join the group,

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confidentiality, fees, no socializing outside of group, attendance, punctuality, respect for others, and willingness to self-disclose and take risks. It is important to frame group norms as necessary to keep group members safe and to learn from group, rather than merely as rules to be followed. If group members, particularly adolescents, hear rules, it sometimes encourages rebellion. 4. Commitment to Ground Rules. It is important to ask if the potential group member can commit to these ground rules, particularly attendance, confidentiality, and willingness to participate. Depending on the group, leaders may ask group members to sign an informed consent as well. 5. Information About How Groups Work and Specific Interventions and Activities to Be Used in This Group. At this time, group leaders should provide information in terms of how groups work, roles of leaders and members, and specific interventions and activities that typically occur in this kind of group. Some discussion of group process is helpful, such as problem-solving, role-playing, and giving feedback. 6. How Will This Potential Group Member Be Able to Work on His or Her Goals in This Group? Based on the earlier discussion of typical themes, topics, activities, and interventions to be used in the group, potential group members should be asked how they will work on their goal. What activities and topics seem relevant? The emphasis during this discussion is on helping the group member connect to the group and develop an investment in participating in the sessions and trying out new behaviors. 7. Questions Related to Specific Selection and Deselection Criteria for This Group. At this time, it is important to ask for specific information that will help decide whether the potential group member is a good fit for this type of group. For example, in a grief group, it is important to not include people with a very recent death, so one criterion might be at least 3 months from the significant persons death. In a psychoeducational anger management group, one deselection criterion might be use of violence on a regular basis. 8. Questions Related to How This Potential Group Member Would Act/Contribute as a Group Member. This category of questions relates to potential group members interpersonal style. It is important to assess how comfortable they feel discussing the topic of the group, how they deal with disagreements or feedback that is difficult to hear, and how they typically act in groups. Asking questions about what potential group members are thinking and feeling as they go through the interview also gives information about how they might act in group. Such questions include, How was this interview for them? How did they feel about disclosing to strangers? How did they feel about talking about their problems? Verbal responses to interview questions as well as nonverbal reactions will be important sources of information throughout the interview. 9. Any Questions or Concerns the Potential Group Member Has About Being in This Group. Potential group members often have misperceptions about how groups operate or what happens in group. It is helpful to ask if they have any questions or concerns and to address them directly, because misperceptions may negatively influence their participation in group.

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10. Closing of Screening Interview. As the screening interview ends, it is helpful to clearly describe to the potential group member the process of what will happen. If he or she is a good candidate for this group, the group leader might inform the member of this now. If other things need to happen first (further assessment, another interview, co-leaders must meet, parental consent), the potential group member should be informed of what needs to happen and the time line of when this will occur. Referrals should be made for other counseling interventions if the group is not a viable option.

Measures to Assess Group Member Fit

Several measures have been developed that may be useful in selecting group members who will be successful in psychoeducational groups. They fall into two categories: attitudes toward group and group leadership, and group member fit for group. A brief description of relevant measures follow. Group Therapy Survey (GTS) (Slocum, 1987). The GTS is the only measure that assesses misperceptions about group therapy with some empirical support. The GTS has 25 items rated on a 4-point scale from strongly agree to strongly disagree. Slocum (1987) suggested that the items were based on three categories of unfavorable expectations: It Is Unpredictable, It Is Not as Effective as Individual Therapy, and It Can Be Detrimental. Internal consistency of the GTS was reported as .59 using a sample of 96 students with a mean age of 20.2 years (range 16 to 50 years). Later, Broday, Gieda, Mullison, and Sedlacek (1989) conducted a factor analysis using a sample of 147 students with an mean age of 18 and suggested three slightly different factors. They used only 15 items that together predicted 41% of the variance with a Cronbachs alpha of .59 (individual variances predicted are indicated in the parentheses): Positive Attitudes (7 items, 20%); Self-Disclosure Fears (4 items, 13%); and Misconceptions (4 items, 8%). Recently, Carter et al. (2001) revised the GTS by replacing the words group therapy with group counseling, modifying the wording of a few items, and using a 5-point scale from strongly agree to strongly disagree, with high scores indicating more positive attitudes toward counseling. A factor analysis of the Group Therapy Survey-Revised (GTS-R) with a sample of 212 students with a mean age of 20 years (range from 17 to 50 years) indicated three subscales using 20 of the 25 items that together predicted 41% of the total variance (individual variance predicted in parentheses): Efficacy (27%), Myths (8%), and Vulnerability (6%). The internal consistency of the overall GTS-R as measured by Cronbachs alpha was .88, and for the individual subscales, .78 for Efficacy, .77 for Myths, and .75 for Vulnerability. The 2-week test-retest reliability coefficient for the overall GTS-R was .79 for a different sample of 93 college students with a mean age of 23 years. Reported means were 3.66 for Efficacy, 3.69 for Myths, and 3.43 for Vulnerability, suggesting neutral or positive attitudes toward group counseling from college students who presented for counseling.

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The GTS is one of the few group measures that has been examined with regard to cultural influences. Leong, Wagner, and Kim (1995) found that attitudes toward group counseling were predicted by level of acculturation for Asian American students. Using a sample of 134 Asian American college students (95% between 21 and 24 years old), a hierarchial multiple regression analysis indicated that the integration subscale of the Acculturation Attitudes Scale (Kim, 1988) positively and significantly correlated with Positive Attitudes subscale (r = .35, p < .01). The revised version of the GTS may be useful with adolescents, particularly those who might have a negative perception of groups and/or counseling. Information from this measure may help identify areas of misperception that need to be clarified with potential group members. Expectations About Counseling (EAC) (Tinsley, Workman, & Kass, 1980). The Expectations About Counseling measure was developed for use in assessments of expectancies for specific, theoretically relevant dimensions of counseling behavior (Subich, 1983, p. 422). The short form consists of 60 items rated on a 7-point scale from definitely do not expect this to be true to definitely expect this to be true. The scale measures five categories: client attitudes and behavior (responsibility, openness, motivation); counselor attitudes and behavior (acceptance, confrontation, genuineness, directiveness, empathy, self-disclosure, nurturance); counselor characteristics (attractiveness, expertise, trustworthiness, tolerance); characteristics of process (immediacy, concreteness); and quality of outcome (outcome). The EAC may also be useful in identifying negative attitudes toward counseling and/or groups in adolescents. The Group Assessment Form (GAF) (Lynn, 1994). The GAF was designed specifically for children and adolescents to measure social competence based on information collected from the adolescent and parent. It assesses motivation for group, appropriateness for group, and an outline of recommended treatment goals and techniques for group. Readiness for Group (RFG) (DeLucia-Waack, 2006). Based on current literature that suggests that several factors predict which group members are most likely to benefit from group, a short measure designed to be completed after a screening interview was developed to assess whether potential group members have the motivation and skills to participate in a counseling or psychoeducational group. The model for this measure is the Group Psychotherapy Evaluation Scale (Kew, 1975), which used cut-offs to predict which group members were better suited for group therapy. The RFG is completed by the group leader(s) after a screening interview and assesses the following categories: amount and quality of communication; capacity for change; willingness to discuss problem; commitment to change; identification, fit, and specificity of goals; ability to serve as a role model for others; potential for connection with others; level of anxiety; amount of interviewer activity; and interviewer connection with potential group member. After an initial interview, potential group members are rated on a 5-point scale ranging from 0 = low emphasis to 4 = high emphasis. These items are based on the literature that predicts dropouts from group in adult groups.

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Preparation Sessions
Goals of the Preparation Session
Pregroup preparation sets treatment expectations, defines group rules, and instructs members in appropriate roles and skills needed for effective group participation and group cohesion (Burlingame, Fuhriman, & Johnson, 2001, p. 375). Pregroup preparation has been shown to be related to the development of group cohesion and group member satisfaction, decreased risk of dropping out, and positive group member behaviors (Bednar & Kaul, 1994). Group members often begin uncertain about what other members will be like, how groups work, what is expected of them, and how they will benefit from group, and also with heightened anxiety and unrealistic expectations of the groups (Jones & Crandall, 1985; Yalom, 1995). Research has suggested that preparing potential group members, using a preparation session, helps acclimate members to how groups work and allows both group leaders and members an opportunity to assess members fit for a particular group. Preparation sessions typically include information about how groups work, roles of group leaders and members, topics and typical activities, and a chance to practice typical behaviors. Group members have a chance to experience what it is like to interact with other group members around the themes and topics of the group. Group leaders also are able to assess the following for each group member: willingness to participate, willingness and ability to disclose thoughts and feelings, willingness and ability to follow directions and answer questions, potential conflicts between group members, and who can serve as role models and connections for each group member. During a preparation session, the potential group members ability to fit in with others can be assessed. Members may sometimes act very differently with one or both group leaders than they do with several potential group members. It is important that group members be selected so that the group is diverse, yet members should be connected with one another. Group members should also be selected based upon their willingness to work with others and what they can bring to group. In addition to specific procedural information about the group, it is important to provide potential group members with information about how groups work in terms of the process. From a practical standpoint, leaders can use preparation techniques to convey procedural information and help group members gain some understanding about how groups function. There is no standard method of preparation, yet Couch (1995) suggested a four-step model: identify the clients needs, expectations, and commitment; challenge any myths and misconceptions; convey information; and screen the person for group fit. The importance of using preparation sessions as an instrument for both the group leaders and the potential group member to decide whether the group member is ready to be in group became clear to me when supervising a college eating disorders group. The leaders of the group came to me saying they were having trouble keeping members in the group, and the dropout rate was affecting the morale of those members who chose to stay. A student of mine was conducting a dissertation on the effectiveness of different types of preparation sessions for training

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groups, and so we decided to use a variation of it with potential members of the eating disorders group in an effort to orient them to the themes, topics, and typical interventions used in this type of group. The anecdotal results were pretty impressive. Based on the preparation sessions, the group leaders did not deselect any members. However, about half of the potential group members that participated in a preparation session then decided that they were not ready to join the group; most elected to begin or continue in individual counseling. Even more astounding was the fact that none of the group members who chose to participate in the eating disorders group after completing a preparation session then dropped out of the group. The preparation session seems to have had the effect of helping group members decide whether they were ready to be in a group or not before they began the group, thus greatly eliminating the number of dropouts.

Sequence and Format of the Preparation Session

The preparation session occurs after potential group members have had a pregroup screening interview and have met the initial criteria to participate in the group, but prior to the first session. It allows them to gain a better understanding of how the group will work, as well as gives them an opportunity to practice some of the typical group behaviors. In addition, the preparation session allows group leaders to see how group members interact with each other. It also serves the serendipitous purpose of allowing leaders to maintain contact with group members but not actually begin group. This is especially important when selection of members is taking awhile and group leaders want to continue interaction with group members in order to maintain their interest without starting the group with a small number of members. There is general consensus about the format and content of the preparation session. A format that includes cognitive, vicarious, and experiential methods in an effort to address the different learning styles of group members is recommended. The content should include group member and group leader roles, how groups typically function, and skill training. Bowman (Bowman & DeLucia, 1993; Bowman & DeLucia-Waack, 1996) developed a preparation session for groups that has been modified for use with specific psychoeducational groups. An example of the outline for the session, handouts, and experiential activities can be found in Appendix K. Cummins (1996) provides an example of how to adapt Bowmans preparation session for a specific type of group, an eating disorders group. The format is flexible and can be used with a small group of potential group members, two potential group members, or one potential group member. Ideally, before a group begins and when a substantial number of potential group members have been identified, group leaders can conduct a preparation session that allows them to observe individual group member behavior and interactions between potential group members. If the group has already begun or a group preparation session has already taken place, two potential group members could participate in the preparation session together. Preparing two members at the same time would allow them to interact with the group leaders and also with each other, hopefully promoting connections and cohesiveness. One potential group member could also be prepared by one group leader. This would allow the potential group member to meet and interact with both group leaders if only one of the group leaders had conducted the screening interview.

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The preparation session is designed to take approximately an hour and consists of cognitive, vicarious, and experiential components. The cognitive component is a written handout that describes what a psychoeducational group is, the roles of group leaders and members, goals for psychoeducational groups, specific skills to be used in psychoeducational groups, and typical topics and interventions for this type of psychoeducational group. The vicarious component consists of viewing 10 to 15 minutes of a videotape of a typical psychoeducational group. Potential group members are then asked to identify instances of the specific skills that they had read about earlier in the handout, and how other group members responded to the use of these skills. The Smead (1996) videotape is a good example of an anger management group for elementary school students. Bowman and DeLucia-Waack (1996) suggested using a segment from popular films such as The Breakfast Club, Twelve Angry Men, or Lord of the Flies. Finally, in the experiential component, potential group members are asked to participate in a series of short role-plays to practice skills identified in the handout and viewed on the videotape. In the handout, videotape, and experiential activities, behaviors that are typically focused on for psychoeducational groups for children and adolescents are self-disclosure, feedback, challenging, and role-plays. If conducting the preparation session with multiple potential group members, they should pair up with each other to practice the skills. This allows them to practice new behaviors and also to begin to make connections with other group members, and it allows group leaders a chance to observe between-member interactions. If two potential group members are participating in the preparation session together, they would also pair up to role-play the skills. If the preparation session is being conducted with one group leader and one potential group member, then they would role-play the skills together.

Summary
Once decisions have been made about the goals and activities in a psychoeducational group, the process of selecting and preparing potential group members can begin. Goals and focus of the group determine selection (and deselection) criteria. This chapter suggested outlines for pregroup screening interviews and preparation sessions in an effort to choose group members who will be successful in psychoeducational groups.

Suggested Training Activities

1. Devise Selection Criteria and a Screening Interview
Create a grid that includes Goals for your group Selection criteria related to who would benefit and not benefit from the group