GROUP OBSERVATION ASSIGNMENT

Dr. Barsky’s “Clinical Social Work Practice with Groups” Course

*CONFIDENTIAL: This group observation assignment is confidential and is not to be

read by anyone other than Professor Allan Barsky. This assignment does not contain the
names or identifying information of any clients (if names are included in this assignment,
they are pseudonyms).

Student’s Name: Johana Velasco

Student’s Email Address: johanavelasc201@[Link]

Agency where group was observed: The CrossRoads Club

Date of session observed: March 18, 2024

1. Name and purpose of the group observed:

The group that I chose to observe was a twelve steps Narcotics Anonymous (NA) group
named “More Will Be Revealed.” This group meets on a weekly basis, on Monday
nights, and it is an open, mutual aid group. Its purpose is to provide a space for
individuals to help each other to abstain from all drugs and stay clean. In these meetings,
individuals are able to talk about their problems, share information, and provide support
to each other’s recovery.

2. Composition of the group:

The size of the group was around twenty-something people. It was composed of
individuals from various backgrounds and circumstances that brought them to the
meeting. There were people of different sexes, ages, and races. Even though the group
was heterogenous I noticed that there was a certain demographic that took majority. That
being individuals who were white, older males. I would estimate that a quarter of the
group was female, and even less than that were members that were non-white. Age was a
bit more evenly diverse, however everyone that attended was considered an adult thus
there were no children or adolescents. It seemed that almost all had problems with
substance addiction, and they varied on what drug they had a problem with.
As Toseland and Rivas (2021) stated, diversity will always be present in groups
and it is up the facilitator to guide the group to explore these differences. Being sensitive
to each person’s uniqueness helps avoid tendencies to stereotype and overgeneralize
which could lead to social oppression within the group (Popiel et al., 2021). Even though
diversity can be beneficial, some groups may face challenges with it. Diversity could lead
to member attrition as some may find difficulty with balancing a common group purpose
with the heterogeneity (Popiel et al., 2021). Another challenge could be that it varies the
group process with some members finding it hard to respond to conflicts that may arise,
and others seeing it as constructive and needed to build the cohesion (Popiel et al., 2021).
NA groups benefit various sub-groups, and seems to be one of the most culturally
diverse programs across the globe (Greene, 2021). During the start of the meeting, it was
stated that the group had no political or religious affiliation, and how anyone could join

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regardless of age, race, sexual identity, etc. Claiming neutrality and also being open for
anyone to attend when they feel comfortable created a sense of welcoming and inclusion.
The purpose of the group was read out load and it basically stated that they are all there
for their recovery journey. Stating the purpose at every meeting establishes commonality
amongst everyone and promotes empathy. Group expectations are also read at every
meeting, and this makes it clear what is expected in regards to respecting each other, and
avoiding conflicts. Also, having the facilitator be a member makes it easier for them to
relate and be culturally sensitive to the topic of addiction.

3. Group policies pertaining to confidentiality, informed consent, and expectations

for participation:
This group is not a professional treatment program, and is facilitated by a member
so there is not a formal discussion about informed consent. However, the group does have
principles that touch on confidentiality and expectations. Narcotics Anonymous follows
the twelve steps, which has twenty-four principles, that the members are encouraged to
follow in their daily lives. The purpose of the group and these principles are read out loud
during every meeting. This repetition allows for people to know what is going on and
what is expected from them (Toseland & Rivas, 2021). This is how individuals are
informed, and can make their own decision regarding their involvement in the program.
Anonymity is a big part of this program, and there are two principles, traditions
eleven and twelve, that even talk about it. A member is able to maintain whatever level of
anonymity they desire during the meeting, and is encouraged to maintain personal
anonymity with the general public about anything related to the group. When someone
shares, they only provide a first name and no further disclosing information. This group is
supposed to be a safe space for people to share openly, so it is expected that members
respect each other’s privacy and not share outside of the group. I think the anonymity
helps with making it comfortable to share because they are not sharing anything that
could identify themselves outside of the group.
Since this group is open, it allows for attendance to be voluntary. People are able
to attend and discontinue whenever they want. Due to it being a mutual aid group
participation is important because it is the sharing from members that facilitates help and
support (Toseland & Rivas, 2021). Even though participation is a cornerstone for the
meetings, it is entirely voluntary. There are opportunities to share, but if one only wants
to observe that is fine too. In the meeting I attended, only a handful of people shared with
some being newcomers and some being established members. Newcomers were not
forced to introduce themselves either. Participation was only encouraged and after any
sharing the rest of the group gave a supportive comment, which was a positive
reinforcement to continue that behavior.
One suggestion for improvement that could be implemented would be having a
slot in the meeting for members to be able to raise any concerns or provide input related
to confidentiality, informed consent, and participation. Once the rules and purpose were
read, the discussion went straight to sharing so this did not allow for group feedback.
Also, it is unknown if there are any exceptions to informed consent like risk of harm of
self or others, so making that clearer would be helpful.

4. Theories and research that inform the group process:

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 This group is guided by the twelve steps model. The model focuses on the
individual accepting their substance use as a disease, focuses on the value of strong bonds
and connection with other people recovering, emphasizes abstinence, and usage of the
twelve step tools. This is a popular intervention used for addiction, and it has been
researched on its efficacy. When evaluated in comparison with other interventions, like
motivational enhancement therapy or cognitive behavioral theory, the outcomes were
favorable regarding abstinence (McGovern & Carroll, 2003). A review was done with
twenty-seven studies, and the findings were that twelve steps had higher rates of
complete abstinence for longer periods, and reduced the severity of substance usage
(Greene, 2020).
Moos (2007) stated that twelve steps model is influenced by aspects of other
theories like social control theory, social learning, and stress and coping theory.
Regarding social control theory, twelve steps use support, structure, bonding, and goal
direction to have individuals accept their addiction, and emphasize the importance of
abstinence and adhering to the twelve steps principles. It also relies on social learning
theory because members identify with each other as they recover, and can learn from
abstinence-oriented role models. Sharing is thanked by the group which is a positive
reinforcement to encourage participation. Twelve steps emphasize self-efficacy and
members are asked to abstain thus providing an opportunity for them to develop coping
skills for stressful situations that can cause relapse.

5. Analysis of issues pertaining to diversity, human rights, and social and economic
justice that arose during the group process:
There were two members who briefly mentioned having experienced
homelessness in the past however there was no further discussion about that. It was just
mentioned as part of their journey in recovery. Homelessness would be an ideal topic that
could be addressed since some of the members have personal experience. Substance use
disorder is often associated with numerous issues like mental health, economic, legal, and
social problems. Any of these topics could be addressed in the group, and benefit the
members on how to deal with them or that they are not alone is facing it.
I think an important topic to discuss would be the stigma connected to substance
use disorder, and how it affects the individual. Unfornately, substance abuse is prevalent
in the U.S, and treatment has become a social justice issue. This negative stigma and
discrimination can reduce addressing substance abuse, lower resources, and limit
individuals to seek treatment (Yong et al., 2017). This public stigma can lead to
individuals feeling shame and self-stigmatization.

6. Stage of group process:

This is an open group so new members and established members were present,
thus the group would probably be at different stages of the group process depending on
the individual. Newcomers would be in a forming phase as they are getting to know the
new environment, learn what the norms are, and what their role is in the group (Toseland
& Rivas, 2021). There was no conflict that developed, and it seemed that they tried to
keep to the cohesiveness of the group. The facilitator had a set format of how the group is
run so that provided structure to make integration easy. He provided guidance by having
the rules and group purpose read out loud to the group. Also, to have the newcomers feel

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accepted and comfortable, the facilitator encouraged their participation but let them know
it is their choice whether they want to or not.
The rest of the group seemed to be going through the norming stage. These
members have already attended the group enough to create stronger interpersonal
relationships, and formed an understanding of the group’s common goal (Toseland &
Rivas, 2021). The members were supportive of each other, and welcomed the new
members. The facilitator assisted with the group cohesion by having the group purpose
read to remind why they are all there, and what they are working towards which is
recovery.

7. Critique of the facilitator’s use of clinical skills:

The facilitator of the session was not a professional, and was actually a member
of the group. It even says in one of the principles, tradition 8, that the group will always
be non-professional. He did not talk much and mostly made sure that the group was
following a set format in how it should be run. The group focuses a lot on sharing and
members making connections with each other. These two situations do limit the use of
clinical skills; however, he did demonstrate a minimal amount in his facilitation.
The majority of what he did was be supportive, and added direction the group flow
when needed. One skill he shows, was including members in participation by asking who
wanted to read the different documents about narcotics anonymous and the twelve steps.
When the group started, he provided self-disclosure by saying that he was an “addict” as
well. Disclosing models openness and shows that it is safe place to talk about these
difficult topics (Toseland & Rivas, 2021). Stating that he struggles like the rest of them
gives off the sense that there was no judgement, and that he is able to understand. He also
demonstrated the use of attending skills to convey empathy, genuineness, trust, and
respect through nonverbal communication (Toseland & Rivas, 2021).
Mutual aid groups require a collaborative effort to meet each other’s needs. I felt
that was lacking a bit in the meeting. When a person would finish sharing, attention was
put on the next person who wanted to share. There was no feedback from the facilitator
or the group, and that needs it be improved. The facilitator should be more engaged in the
discussion, and uses techniques for information gathering for a better understanding.
Doing so could lead for others to model this behavior and make the group more
collaborative by increasing engagement.

8. Critique of the methods of clinical intervention:

I do not think this group had any clinical intervention as it is a mutual aid group
so members are helping each other. There was no professional to be able to incorporate a
clinical intervention. One that could be used, would be cognitive-behavioral therapy
(CBT). CBT has some overlap with the twelve steps model in that they both have a
“common interest in identifying and changing maladaptive thoughts, feelings, and
behaviors” (Breuninger et al., 2020). Another commonality is that they both encourage
social engagement and prosocial behavior (Breuninger et al., 2020). Implementing CBT
practices can help reinforce the concepts of the twelve steps.
Applying mindfulness-based interventions would provide clients with coping
skills, reduce stress, and give them practice with acceptance (Breuninger et al., 2020).
Acceptance is a key component of the twelve steps. Meditation can help individuals

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develop more self-awareness. Another intervention that could be used is motivational
enhancement to increase motivation of living in abstinence. By sharing one’s story with
others in the group, it can motivate them to continue and have hope for recovery
(Breuninger et al., 2020)

9. Evaluation of the group session:

This meeting was not evaluated. The goal of the group is to recover from
addiction and abstain from all drugs. The opposite of abstinence is relapsing into using
again, so measuring the probability of relapsing could show if the program is effective in
helping individuals overcome addiction. There is a questionnaire that identifies warnings
signs of a relapse. This is the Advance Warning of Relapse scale. It is a 28 question self-
report questionnaire that have a 1-7 rating scale.

10. Reference List

Breuninger, M., Grosso, J., Hunter, W., & Dolan, S. (2020). Treatment of Alcohol Use
Disorder: Integration of Alcoholics Anonymous and Cognitive Behavioral
Therapy. Training and Education in Professional Psychology. 14(1), 19-26.
[Link]
Greene, D. S. (2021). Revisiting 12-Step Approaches: An Evidence-Based
Perspective. Addictions - Diagnosis and Treatment [Working Title].
McGovern, M. P., & Carroll, K. M. (2003). Evidence-based practices for substance use
disorders. The Psychiatric clinics of North America, 26(4), 991–1010.
[Link]
Moos R. H. (2007). Theory-based active ingredients of effective treatments for substance
use disorders. Drug and alcohol dependence, 88(2-3), 109–121.
[Link]
Popiel, M., LaRoque, S., Nicholas, D., Kilmer, C., Este, D., & Pelech, W. (2021).
Defining diversity in groupwork: A relational exploration. Groupwork. 30(1),
88-113.
Toseland, R. W., & Rivas, R. F. (2021). An introduction to group work practice (8th ed).
Pearson.
Yang, L. H., Wong, L. Y., Grivel, M. M., & Hasin, D. S. (2017). Stigma and substance
use disorders: an international phenomenon. Current opinion in psychiatry, 30(5),
378–388. [Link]

EVALUATION Dr. Barsky will evaluate your Process Recording based on the following
criteria:
1. Accurate coverage of the key components for this assignment:
2. Level of critical analysis:
3. Identification and integration of relevant theory and research:
4. Literary competence (grammar, spelling, structure, use of APA format for the
reference list):
Grade: % ( )

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