**The primary task of the facilitator during the middle stage is to help members accomplish the goals they have contracted to achieve.

After an initial period of testing, conflict, and adjustment by members, the main focus of the middle stage turns to goal achievement.

During the middle stage groups are focused on accomplishing goals, objectives and tasks developed earlier in the group.

During this stage, the facilitator regularly assesses goal attainment work and helps members make changes based on assessment of:

› The group’s development (DYNAMICS)› The changing needs of members (INTRA,

INTER, ENVIRONMENT)› The changing demands of the SOCIAL

ENVIRONMENT in which the group functions

The Middle Stage is a continual cycle of:

ASSESSMENT MODIFICATION REASSESSMENT

Preparing for group meetings Structuring the group’s work Involving and empowering members Helping members to achieve goals Working with reluctant and resistant

members Monitoring and evaluating the group’s

progress

Prepare an agenda Program materials – activities, games,

and exercises designed for fun/interest and goal attainment (also provides medium for assessment) see fig. 9.1

Review recordings of previous meetings and data from other sources

Visualizing how meeting should be conducted

Structure is the use of planned, systemic, time-limited interventions and program activities.

The degree of structure in a group can be variable.› Pro: Structure is an efficient means to learn new

skills and helps provide consistency, safety, etc.

› Con: Less structure allows more group interaction and ownership

During the middle stage, a facilitator can perform a variety of activities to structure a group’s work:

Inform members about beginning and ending group on time (manage “doorknob” communications)

Give attention apportioning time for ending meetings and providing summary of session

Set verbal or written agendas – allow member input when preparing and presenting

Establish and maintain orderly communication and interaction patterns

Help members progress towards their goal – determine how much time should be spent on each member’s goal

Attend to smooth transitions between group activities

Focus on multi-level interventions: Individual (INTER, INTRA,

ENVIRONMENT) Group-as-a-whole (GROUP DYNAMICS) External environment

**The ultimate goal of system interventions is to empower members so that they can take charge of their own lives both within the intervention process (in this case, the group) and outside of it.

Show belief in members’ strengths Acknowledge difficulties and obstacles Let members know they have a stake in

the content and direction of the group Praise members for reaching out to one

another Encourage members to try out new

behaviors and actions within and outside of the group

Program activities

A portion of a treatment group’s work should always be devoted to maintaining a group’s optimal functioning – attending to the group’s DYNAMICS (Cohesion, Culture, Social Control Mechanisms, & Communication and Interaction Patterns) – but MOST of an effective group’s time during the middle stage should be focused on HELPING MEMBERS ACHIEVE THEIR GOALS.

Contracting for treatment goals is an evolving process:› Tentative agreement/contract during

planning stage› Contract reaffirmed and made more

concrete during the beginning stage› Focus of middle stage is on carrying out

developed goals and contracts – secondary contracts may be developed

HELP MEMBERS MAINTAIN THEIR AWARENESS OF THE GOALS THEY IDENTIFIED AND AGREED TO WORK ON IN THE BEGINNING STAGE› Facilitators should never assume that

members remain aware of their goals as the group progresses

› Develop a process for reviewing treatment goals and contracts: It is a good practice to go round the group at the

beginning of each session to review these and identify accomplishments and/or obstacles

DEVELOPING TREATMENT PLANS (a continuation of goal-setting)› For the group-as-a-whole› For the individual

Enlist support of all group members - “helper-therapy” principle

Guided group discussion on specifics Exploration of alternatives Assess for additional information Creation of tasks to accomplish goals – between

and in meetings

OVERCOMING OBSTACLES TO MEMBERS’ WORK› “Demand for work”› Careful analysis of goal/contract› Increasing member motivation› Use of “how” or “what” questions (avoid

“why”)› Help members decide which action to take

Use of five intervention roles” (pg. 272)› Enabler› Broker› Mediator› Advocate› Educator

Point out consequences of refusal Clarify non-negotiable aspects of

participation Develop non-judgmental, accepting,

and safe group environment Assess members’ motivation for being

there

Adopt a position that maximizes members’ sense of control and expertise

Acknowledge members’ feelings and reactions to being in the group

Reframe resistance- acknowledge anger Assess source of resistance (Worker,

Client, Environment) Avoid moralizing or blaming

Use “I” statements Use constructive confrontations Allow member to member

confrontation (but don’t expect too early in the group and be prepared to intervene if it is not done constructively)

Monitoring and evaluating progress provides feed-back for workers and members, which is useful in developing, modifying, and changing treatment plans.

It is also helpful for maintaining the functioning of the group-as-a-whole.

Information should be systematically solicited, collected, and acted on.

Evaluation forms are one of the most commonly used methods of obtaining feedback and can be used to assess:› Facilitator› Individual› Group-as-a-whole