The science of learning is complex and multi-faceted, with most learning strategy researchers in agreement that cognitive, metacognitive, and social/affective processes directly contribute to learning and retention. We know from decades of educational research (Bransford et al., 2000; Astin, 1999; Hattie, 2009, 2012; Oxford, 1990) that there is a positive correlation between engagement, active listening, and knowledge/skills retention in the learner. But, what does any of that have to do with group therapy?
We propose that patients in a group therapy setting are, in fact, learners. In this model, the clinician facilitating the session assumes the role of the educator tasked with setting objectives for growth, creating a safe environment conducive to learning, shaping behavior, and providing formal skills training. By adjusting the lens through which we view roles in group therapy, a plethora of evidence-based best practices in education become available for practical application and the advancement of group therapy sessions. One such best practice is the focus task, a simple addition to any activity that promotes conscious attention when learners are most likely to zone out.
To put it in the most simplistic terms, engagement refers to the amount of physical and mental energy a learner devotes to a learning task. Learning tasks tend to fall within two categories, productive and receptive, with most zoning-out opportunities presenting themselves with the latter. Receptive skills involve listening, watching, reading, or any other instance where the learner is expected to absorb information passively.
Picture a group therapy session or recovery meeting with a clinician and twelve patients who are discussing how to communicate newly established boundaries with a less-than-receptive friend. Each patient is allotted five minutes of productive skill practice as they verbalize their communicative dialogue, strategize for possible contention from the receiving party, and reinforce why establishing the boundary is vital to their recovery. After the round-robin is complete, the hour is over, and each patient accumulated a lackluster five minutes of productive skills practice and a whopping 55 minutes of sitting and listening... maybe.
We say maybe listening because there is really no way to tell the thought processes of the eleven other group members as they waited for their five minutes to speak or for the session to end. As most therapists can attest when they scan the room, some people are daydreaming, some staring at their shoes, others whispering with the person next to them. Active listening is often a rarity in behavioral health groups.
This is where focus tasks come in. Focus tasks blend receptive and productive learning activities to ensure every participant is engaged and responsible for creation throughout the entire session. Simply put, "While they are doing that, you will be doing this."
Focus tasks are introduced at the beginning of a new activity, so everyone involved understands what they are expected to do; it gives purpose to patients who are not at the forefront of a particular practice or share. Going back to the example of communicating boundaries, while the patient is sharing their dialogue and troubleshooting potential resistance, the other group members are tasked with taking notes on aspects of the communication they felt went well and areas of opportunity where advice is warranted. By creating a purpose for observing group members, all members are now actively paying attention so they may achieve their individual objectives. Furthermore, by consciously thinking and problem-solving issues they observe, learners are synthesizing information and reinforcing neural links in their brain, increasing the likelihood the knowledge will transfer from the working to long-term, retrievable memory (Oakley et al., 2021).
Focus tasks also allow clinicians to formatively assess the progress patients make toward the desired outcome. Formative assessments are informal checks to monitor learning and provide feedback, furnishing the opportunity to address misconceptions in knowledge or skill (Wiliam, 2007). For example, if an observer's advice on another member's communication is counterintuitive to recovery, the clinician can redirect or challenge misguided advice to benefit the entire group. With no focus task in place, the clinician's window into the learning progress of the group is narrowly limited to the patient who is sharing at the moment. Focus tasks not only promote conscious engagement by all group members; they provide the clinician with insights into everyone's learning progress without the need for a formal test.
Reading literature on recovery (inspirational success stories, recovery capital skill building, etc.) allows patients to be informed as they comprehend and compare the text to their understanding of the world, personal insights, experiences, and opinions. Unfortunately, when the purpose of reading is for information rather than entertainment, the opportunity to drift off into daydreams is ever-present; that is unless there is a focus task involved. Video clips provide a little more support in terms of visualization, but the speed at which patients receive and process the information cannot be controlled, a similar challenge faced by auditory learning or didactic instruction. One drawback of video clips is that what people see isn’t necessarily what they learn; focus tasks draw attention to the session objective. Here are some sample focus tasks to improve engagement and accountability in group therapy:
- Make Questions- As patients read/watch/listen, have them write three questions they have about the content related to today’s session objective.
- Thinking Differently - As patients read/watch/listen, have them write down how they would handle something differently and explain how their approach might alter the outcome using their insights they’ve gained in the group so far.
- Stop and Jot - As therapists explain a concept, patients write down three new or meaningful ideas, including those that may conflict with their preconceived notions. Once they are done, have them summarize what they wrote down without using their notes. This activity can also be done for reading, where patients can summarize the necessary information from an article or after each page, depending on the length.
When integrating focus tasks into group sessions, the clinician should consider how it integrates with the desired learning outcomes and any formatively assessed information it may produce. The task's purpose and structure (what patients are expected to produce) should be communicated prior to the activity. These steps will help the group achieve the most significant benefits from the task's inclusion.
References:
Bransford, J., Brown, A. L., Cocking, R. R., National Research Council (U.S.). Committee on Developments in the Science of Learning., and National Research Council (U.S.). Committee on Learning Research and Educational Practice. (2000). How people learn: Brain, mind, experience, and school (Expanded ed.). Washington, DC: National Academy Press.
Astin, A., (1999). Student Involvement: A Developmental Theory for Higher Education. Journal of College Student Development. Vol 40. No 5.
Hattie, J. (2009). Visible Learning: A synthesis of over 800 meta-analyses relating to achievement. Milton Park, UK: Routledge.
Hattie, J. (2012). Visible Learning for Teachers: Maximising Impact on Learning. Milton Park, UK: Routledge.
Oakley, B., Rogowsky, B., Sejnowski T., (2021).Uncommon Sense Teaching: Practical Insights in Brain Science to Help Students Learn. Penguin Publishing. 0593329740, 9780593329740
Oxford, R. (1990). Language Learning Strategies: What Every Teacher Should Know. Boston: Heinle & Heinle Publishers.
Rabourn, K., BrackLorenz, A. & Shoup, R. (2018). Reimagining Student Engagement: How Nontraditional Adult Learners Engage in Traditional Postsecondary Environments. The Journal of Continuing Higher Education, 66(1_, 22-23. https:doi.org.10.1080/0737767.2018.1415635.
Wiliam, D. (2007). What Does Research Say the Benefits of Formative Assessment Are?. The National Council of Teachers of Mathematics.