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As a therapist in private practice, one of my favorite aspects of my job is running groups. I learned the skill while working in a psychiatric hospital and became very practiced, as the day program I worked in was group-based.

Running groups is definitely an art form.

There are several aspects to master: making sure you have relevant content, making sure the content is covered, making sure there is adequate discussion, making sure everyone feels heard, and making sure one person does not dominate the discussion.

No matter how small the group is, there is always ONE person who dominates the group. One trick I use with redirecting is to wait for a natural pause, then redirect back to the topic at hand. Another trick is to find something in their comments that relates to the topic and state that they have provided a good example of what you are trying to demonstrate, then redirect back to the topic.

As far as finding relevant content, you do not need to buy a lot of workbooks to find great worksheets to use in group.

My favorite method for creating great content is to find a good article that has a relevant and specific topic, then create my own worksheet to assist group members with exploring and further incorporating the concept.

I find great articles at the Psychology Today website and at GoodTherapy.org. On the Good Therapy site, click on “Learn”, then click on Good Therapy Blog for lots of great articles.

good therapy website arrow to Learn link

good therapy website arrow to blog

An article that would be appropriate for group should be based on several factors.

  1. The length of the group. My depression and anxiety group is 90 minutes long. I find articles that are between 3 and 5 pages long. A one page article would be too short to fill a 90 minute group. If your group is shorter, such as 30 minutes, you will need to choose a shorter article. I have group members take turns reading, then we work on the worksheet and have a discussion.
  1. An appropriate topic. A depression and anxiety group is fairly broad, so many articles are appropriate. Many of my group members are older, so I avoid articles about the anxiety of getting started in a new career, or anxiety and finances, as they are not appropriate for the group members. If your group is substance abuse oriented, articles about substance use will be appropriate. A domestic violence survivors group will need articles specific to their issues (boundaries, self-esteem, safety, etc.).
  1. An appropriate level. Groups in an inpatient setting will need help with more basic skills (generally), compared to an outpatient setting. Also, some groups may be more high functioning, such as a group for gifted students, which would require higher level material. I conducted a homeless parenting group series where we covered basic parenting skills, budgeting skills, communication skills, and emotional regulation skills.

colorful group therapy image

Next, I read the article. I identify ways in which the concepts can be reinforced and use examples to practice the concepts.

Here is an example: I found information about 13 patterns of automatic thought distortions. Each pattern had a brief explanation and an example. I created a simple worksheet of 3 columns. The first column listed each thought pattern.

The second column was titled “Example.” In this column, the group member identified an personal example of the thought pattern (if it applied).

The third column was titled “Replacement.” In this column, the group member identified a way to replace the unhealthy example they identified with a healthier thought pattern.

Here is an example of what a member would create:

 

Pattern Example Replacement
Assuming My friend is mad at me. My friend is at work and can’t text back quickly.

 

This article and exercise is an excellent group topic because each member most likely has several thought distortion patterns and it makes for extensive discussion.

Group therapy word cloud concept

Here is another example about an article about the power of not taking things personally. With this worksheet, I thought about a process to incorporate the concept by using some cognitive behavioral therapy techniques of assisting the client with identifying unhealthy thoughts and emotions and replacing them with healthier ones.

 

SITUATION HOW I FELT MY INTERPRETATION/ HOW I TOOK IT PERSONALLY NEW INTERPRETATION/ HOW IT WAS NOT PERSONAL NEW FEELING
Example: My sister got a new car when she graduated from college and I got a card. Humiliated

Rejected

Unloved

Worthless

They love her more than they love me. I’m not worth the financial sacrifice of a new car. I’m not worthy of love. My sister is spoiled and I am better off as an adult because I was not spoiled. My worthiness and lovability does not depend on how my parents treated me. Worthy

Empowered

Still a little sad about my rough childhood.

Once you practice this method of creating mental health group materials, it gets easier after a few times. With this method, there is an endless supply of group topics and you will always be able to whip something together quickly that is sure to be helpful.

Day-Treatment-Group-meeting

Good luck!

Kristin Stonesifer, LCSW

 

 

 

 

 

 

 

The subject of boundaries is an incredibly important topic when it comes to mental health. Unhealthy boundaries are often a big part of the source of depression and anxiety symptoms.

For those with unhealthy boundaries in their lives, establishing healthy boundaries will be a more difficult task than one might think. Establishing healthy boundaries involves multiple steps: learning what boundaries are, identifying where unhealthy boundaries exist, improving self-esteem and identifying the right within yourself to create and maintain healthy boundaries, practicing new and healthy boundaries in small ways, practicing new and healthy boundaries in more important areas and relationships, dealing with push back (people who are used to violating your boundaries don’t like change), and continually practicing new boundaries and recovering from relapses.

Let’s begin by defining boundaries. Consider boundaries as an invisible line in human interactions, whether physical or psychological, that define acceptable parameters. When crossed, the boundary violation generates an emotional response and damages the person, persons, and/or the relationship.

The easiest, more classic example of a boundary is a property line. Property lines define what is my property and what is not my property. If someone decides to bring their belongings and set up a yard sale on my property, I have the right to tell them to leave my property. Psychological boundaries are no different. Psychological boundaries include mental, emotional, and spiritual boundaries. Physical boundaries include material and bodily boundaries.

Before we further define psychological and physical boundaries, let’s discuss some basic concepts.

Boundaries are not ultimatums. Ultimatums are threats, coercions, or manipulations. When beginning to implement new boundaries, many people often mistakenly resort to issuing ultimatums. If you look at boundaries as more of an exchange or offering of information in order to create understanding and to assist with defining personal boundaries, you are more likely to be successful with boundary implementation.

For example, rather than saying “Don’t talk to me that way,” which connotes an underlying threat, a healthier way of establishing a healthy verbal, emotional boundary would be “When you tell me that my idea to write a book is stupid, it hurts my feelings. I would prefer words of encouragement instead.”

Another falsehood about boundaries is that “No” is a complete sentence. If you remember that establishing healthy boundaries involves creating understanding, then using just a “No” may not accomplish that goal and may come across as hostile. That being said, there may be circumstances when “No” is appropriate. However, a goal of creating understanding is also not constantly explaining yourself. Here are examples when using “No” only may come across with an unintended hostile undertone.

Do you want to discuss our disagreement? No.

A better response that conveys a different, more understanding attitude would be:

Do you want to discuss our disagreement? No, I’m not ready yet. But I will come to you soon when I am ready to talk.

Just a little bit of explanation eliminates a possible misinterpretation of hostility and creates understanding.

Here is another example:

Would you be available to help me on Saturday? No.

Again, simply saying “No” may leave room for misinterpretation. A better alternative might be:

Would you be available to help me on Saturday? No, I have to work. Is there another day I could help for a couple hours?

The response with an explanation establishes a healthier boundary because it establishes what I am willing to offer, when, and for how long. It also is not unintentionally hostile, which would be a violation of someone else’s boundary.

On another note, this concept is especially important when it comes to electronic communication, such as text and email. Tone of voice is not conveyed, which increases the chance for misinterpretation.

Defining Physical Boundaries

Physical boundaries include material and bodily boundaries, which includes my physical body and the space immediately surrounding it.

Material boundaries include property such as your home, personal belongings such as your vehicle, personal items such as clothes and home furnishings, and your services and/or labor such as helping with tasks. An example might include friends asking to borrow your pick-up truck and returning it dirty, damaged, or out of gas. Another example may include friends or family asking or expecting your tax accounting services for free.

Bodily boundaries relate to your physical body and your personal space. Notice how uncomfortable you feel when you encounter a “close talker.” Bodily boundaries include who can touch you, how they can touch you, where they can touch you, and when they can touch you. Bodily boundaries also include sexual boundaries. An example of bodily boundaries would be a boss who routinely touches or hugs a subordinate without permission.

Psychological Boundaries

Psychological boundaries include mental, emotional, and spiritual boundaries.

Mental boundaries include thoughts, values, opinions, and beliefs. An example would include imposing your own values or beliefs on another person, such as “You should teach your kids about the importance of volunteering in the community.” Volunteering may be an important value in my family, but it may not be in someone else’s family.

Emotional boundaries are about separating your feelings from someone else’s in a healthy way. While the basis of human connection is emotional bonding and empathy is an important skill, you are entitled to your own feelings and do not have to take on the burden of other people’s feelings. Healthy emotional boundaries include knowing where you end and I begin, being your own person, being aware of your own feelings, being aware of the impact of your behavior on the feelings of others. There is a difference between feeling responsible for the emotional well-being of others and owning the emotional impact of your behaviors on others.

An example would include giving feedback to someone about an idea that they presented. If the other person’s feelings were hurt by your comments, they have a responsibility to let you know and you have a responsibility to apologize and make amends. If the person comes to you and tells you that it is your fault that they lost the confidence to pursue their idea, that is not your responsibility. They are responsible for managing their own emotions and behaviors. Sometimes “I’m sorry” isn’t enough!

Spiritual boundaries relate to the spiritual aspect of our beliefs. For some people, spiritual boundaries include organized religion. For others, spirituality may involve less formal forms of beliefs, such as attunement with nature or the universe. Discussing spirituality is not necessarily a boundary violation but disparaging or discounting another person’s religion is a violation.

Identifying Boundaries

Some questions to consider when beginning the process of identifying boundaries:

Am I having an emotional response in this situation?

If so, what am I feeling?

What type of boundary was violated?

What type of boundary did I violate in someone else?

What do I find offensive?

Who seems to be a source of unhealthy boundaries in my life?

To further identify your personal boundaries, complete the following assessment:

 

PERSONAL BOUNDARY ASSESSMENT  
  Not at all

1

Not often

2

Sometimes

3

All the time

4

I have a difficult time saying no to people        
If I say no to someone in my personal life, I feel guilty        
If I say no to someone at work, I feel guilty        
If I say no to someone in my family, I feel guilty        
I easily have my feelings hurt        
I am afraid of falling apart        
If someone hurts my feelings, I have difficulty telling them.        
I would describe myself as a doormat        
Others describe me as a doormat        
I would describe myself as aggressive towards others        
Others would describe me as aggressive towards others        
I care what other people think        
I try not to have opinions about things        
I am not tolerant of other points of view        
I am not tolerant of other religions        
I need to know what is going on in other people’s lives        
I need to ‘be in the know’ at work        
I don’t trust people easily or at all        
I put the needs and wants of others before my own        
I try to fix the problems of others        
I need to control other people        
Other people would describe me as controlling        
I need to control situations        
I allow others to determine how I spend my time        
I avoid conflict then feel resentful        
I expect reciprocal treatment for my time or generosity        
I expect loyalty for giving my own loyalty        
I often use anger or intimidation to get my way        
I often allow others to violate my personal space against my wishes        
I have a difficult time expressing my emotions        
I find myself stressed and overwhelmed frequently        
I feel like other people run my life (kids, spouse, parents, friends, boss)        
I allow others to take advantage of me        
I hate disappointing people and avoid it        
I get upset if someone doesn’t like me        
If someone criticizes me, I believe it and fall apart        
I let others define me        
I am afraid to question or challenge professionals even when I am paying for their service (doctors, lawyers, accountants, auto repair)        

 

If your scores are mostly 3s and 4s, there are some unhealthy boundaries at play in your life.

Now that we have identified what boundaries are and conducted a preliminary assessment of personal boundaries, let’s further identify the functioning of boundaries in various areas of your life with the following worksheet:

 

BOUNDARY INVENTORY
For each area, assess the overall functioning in the relationship. Consider whether you see areas that need improvement, if there are times when you feel uncomfortable, do you feel people pulling away, do you find people avoiding you, how far off are these relationships from where you want them to be, what does an ideal relationship in this area look like, what prevents an ideal relationship from existing? You may need an additional piece of paper to address all aspects of the boundaries within each category.
MARRIAGE/INTIMATE RELATIONSHIP:
PARENTS:
CHILDREN:
SIBLINGS:
OTHER FAMILY MEMBERS:
FRIENDS:
WORK/COWORKERS/SCHOOL:
THE GENERAL PUBLIC/OTHERS:

 

Establishing Boundaries

Using the information you identified on the previous worksheet, identify who violates your boundaries and why?

Begin having your boundaries heard and understood with those who violate your boundaries. Often, the same person exhibits the same pattern in the same categories and may exhibit the pattern with others, as well. Ask yourself why this person finds their behavior acceptable, think about whether or not they are aware of their boundary crossing, and if it is malicious. If your boundaries are violated by multiple people in the same category, you will need to begin to address the issue first within yourself then with others.

Watch what happens in your life when you begin to establish healthy boundaries with others. Often, those closest to you will not like the new you, but they will eventually come to accept it.

When setting boundaries, consider:

Am I easily offended? Am I being sensible and rational?

Remember, boundaries are not about issuing ultimatums or shutting people out. They are intended to improve relationships and interactions.

Not everyone is familiar with the concept of boundaries but by establishing your own, you can control you own emotional well-being and have a positive effect on your relationships with others without waiting for others to change.

Boundaries are assertive, not aggressive. Often people don’t realize their communication is aggressive. It’s not what you say, it’s how you say it. Being assertive is about standing up FOR yourself. Being aggressive is standing AGAINST someone else.  Being aggressive cuts you off from others, as they will distance themselves in order to avoid having their boundaries violated.

Setting healthy boundaries does not include making up excuses or white lies.

Be calm, matter-of-fact, polite, and confident. Stick to the point. Do not allow others to use distraction or minimization techniques.

Keys To Setting Boundaries

Remember, the main idea with setting boundaries is to convey information and create understanding.

In the previous example of a physically touchy boss, establishing a healthy boundary would look like this:

“I know you are a hugger but I’m more comfortable with a handshake than a hug.”

Other examples of healthy boundary language includes:

You can ask someone, “Is there anything I can do for you? I am available to listen. Do you want my help? Do you want any suggestions? What is it that you need?”

You can state, “I have a concern. May I share it with you?”

If someone asks you, “What should I do, or what would you do?” your reply might be: “I can share with you what I might do in that situation” or “What do you think are your options?”

You can tell someone, “I cannot participate in this conversation. This interaction is not healthy for you or me. This interaction is pushing me away from you.” You always have the option of leaving, especially if there is an escalation in the conversation.

You can keep someone on topic by stating, “We can talk about your concern/issue but first I would like to finish addressing the issue I brought up.”

Boundary Practice

As you begin to incorporate new boundaries, recognize that, just like any other skill, you will need to practice, you will make mistakes, you will have a learning curve, and it will become easier and more natural with continued practice.

Expect challenges to your newly established boundaries. You may not be taken seriously at first, so others may continue existing behaviors, and new boundaries may need to be reiterated. Make sure you are consistent with new boundaries in order to establish change. Change doesn’t happen overnight but consistency will speed up the process.

Use the following My Boundaries with Others worksheet as a guide for identifying unhealthy boundaries and establishing new boundaries.

MY BOUNDARIES WITH OTHERS (EXAMPLES)

 

SITUATION/ WHAT I SAID OR DID MY INTERPRETATION OF SITUATION HOW I FELT UNHEALTHY BOUNDARY NEW BOUNDARY

(try using “I know you’re accustomed to…but I would prefer…)

EXAMPLE: My child did not do her chores, went to basketball game with her friends after being told no. I am a horrible parent and cannot even control my own child. She does not respect me. Disrespected

Powerless

Unloved

Inadequate

 

Yelled at her, punished her, took her car away. Have a talk with her calmly. Discuss consequences of her choices and set up a parenting consequence chart to teach her rather than punish her. “I know you are accustomed to disobeying me instead of following instructions but I would prefer that you listen when I tell you no.”
EXAMPLE: My husband tells our friends what a terrible cook I am. I am a bad wife. I am incompetent. Disrespected

Unloved

Incompetent

Embarrassed

I ignore it and try to laugh it off. I don’t address his hurtful statements with him. Talk to him. “I know you are accustomed to teasing me in front of others about my cooking but I would prefer less teasing and more positive comments about me to others.”
EXAMPLE: My coworker does not do his fair share of work and often stands around while others pick up the slack. I have to get the work done and don’t have the right to speak up. Speaking up will just cause problems. Burdened

Obligated

Used

Disrespected

Ignore the situation and do the extra work. Address the issue. “I know you are used to the rest of us making sure all of the work gets done but I would prefer if you would pitch in more and help us make sure all of the clients are contacted.”
EXAMPLE: My friend constantly runs late when we meet for lunch. She doesn’t respect me. I am not worthy of respect. She doesn’t care about my time or our friendship. Offended

Frustrated

Unworthy

Show up late for lunch.

Stop meeting her for lunch. Back away from the friendship.

Address the issue with her. “I know you are accustomed to running late when we meet for lunch but I would prefer if you could meet on time instead of having me wait 15 minutes for you.”

 

MY BOUNDARIES WITH OTHERS

 

SITUATION/ WHAT I SAID OR DID MY INTERPRETATION OF SITUATION HOW I FELT UNHEALTHY BOUNDARY NEW BOUNDARY

(try using “I know you’re accustomed to…but I would prefer…)

         
         
         
         

 

As you begin the journey of creating boundaries, expect that it will be a long process that will be full of challenges and relapses.

For more information on other mental health topics, check out my new book, 30 Day Mental Health Boot Camp. 30 days, 30 topics, practical, easy to follow help.

Good luck with your boundaries journey!

Kristin Stonesifer, LCSW

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