Adult ADHD: A 6 Week Group Proposal

Running head: ADULT ADHD SUPPORT GROUP

Group Proposal: A Six Week Adult ADHD Therapeutic Support Group Myia Bennett Texas Woman’s University

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Running head: ADULT ADHD SUPPORT GROUP

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GROUP PROPOSAL: ADULT ADHD SUPPORT GROUP Table of Contents Section 1 ......................................................................................................................................... 4 Group Description ................................................................................................................... 4 Group Logistics ....................................................................................................................... 5 Group Goals............................................................................................................................. 7 Transference/Countertransference ........................................................................................... 7 Ethical Considerations ............................................................................................................. 8 Multicultural Considerations ................................................................................................... 8 Leadership Role ....................................................................................................................... 9 Section 2 ......................................................................................................................................... 9 Literature Review .................................................................................................................. 10 Section 3 ....................................................................................................................................... 12 Group Effectiveness .............................................................................................................. 12 References .................................................................................................................................... 15 Section 4: Appendix .................................................................................................................... 17 Figure 1: Professional Disclosure Statement & Therapeutic Relationship/Counseling Agreement ................................................................................................................................. 17 Figure 2: Client Agreement for Group Therapy .................................................................... 20 Figure 3: Measurements of Group Effectiveness .................................................................. 23 Figure 4: Group Flyer ............................................................................................................ 32 Figure 5: Session One Group Plan ........................................................................................ 33 Figure 6: Session Two Group Plan........................................................................................ 37 Figure 7: Session Three Group Plan...................................................................................... 39 Figure 8: Session Four Group Plan ....................................................................................... 42 Figure 9: Session Five Group Plan ........................................................................................ 43 Figure 10: Session Six Group Plan........................................................................................ 44

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Group Proposal: A Six Week Adult ADHD Therapeutic Support Group Section 1 Group Description Attention Deficit Hyperactivity Disorder (ADHD) is characterized by symptoms that include difficulty sustaining attention, difficulty with organization, is easily distracted, fidgeting, excessive talking, and avoiding activities that require sustained mental effort. Diagnosis is typically categorized into three types: predominantly inattentive, predominantly hyperactive, or a combination. ADHD is typically diagnosed in children, but adult diagnoses are rising as more information is provided to the public and symptoms surrounding the disorder are clarified. It was previously thought that ADHD diminished and most often disappeared as individuals developed into adults; this assumption has been proven inaccurate by research and is no longer widely held (Gentile, Atiq, & Gillig, 2006).

Challenges associated with ADHD include job loss, social awkwardness, lack of support systems, low self-esteem and perceived incompetence, anxiety, and depression (Gentile, Atiq, & Gillig, 2006). The proposed adult ADHD group will function as a therapeutic support group with psycho-educational components for both men and women. The supportive aspect will focus on encouraging increased supportive, social interaction. Therapeutic elements will work to guide participant self-exploration of thoughts, emotions, and behaviors. The psycho-educational layer will introduce increase the coping skills inventory for adults with ADHD. Efforts to solicit potential members will focus on three areas: partnering with local diagnosticians who specialize in ADHD testing, social media/web presence, and providing group information directly to human resource business partners responsible for implementing corporate wellness programs. Flyers will be posted in diagnosticians’ offices, a web page will be setup to

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provide details about the group and its orientation screening process and the group leader. A social media page will be created to mirror the web page and serve as a platform for interaction amongst interested viewers. A presentation will be given to human resource business partners who are often directly involved in the accommodations process should an employee notify them of a diagnosis. The diversity of these channels is hypothesized to solicit interest and potential members.

Group Logistics According to Jacobs, Masson, Harvill, and Schimmel (2012), the ideal group size for most groups range from 5-8 members; the ideal session duration for therapy and support groups ranges from 1 ½ to 3 hours. Sessions for this group will last for 1 ½ hour with a total of six sessions. The group will allow for a minimum of six members but target a total of eight. The 1 ½ hour format is brief and deliberately considers the nature of the disorder of ADHD. According to the American Psychiatric Association (2013), symptoms of ADHD include difficulty sustaining attention, remembering information, being easily distracted, fidgeting, and cognitive avoidance. The format allows for brevity; this is crucial in working with the symptom presentations of ADHD. The truncated six-session format is simplistic, content specific, and considers the cognitive avoidance and lack of follow through that is commonly seen in people with ADHD. Participation will be open to males and females over the age of 18; this broad range would allow for rich interjections and perspectives on coping with ADHD at different life stages and with different resource tool banks. The group’s supportive element will be most overt in its composition–requiring all members to have a diagnosis of ADHD. Support groups or those with principle supportive aspects typically consist of members who have something in common such

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as a life experience or disease. The therapeutic factor serves as a rationale for conducting this group as a closed that promotes trust and cohesiveness (Jacobs et al., 2012).

Pre-group interview screening increases the likelihood of an effective group by allowing the group leader to select potential members who would truly be good candidates for the group intervention process, and screen out those who might cause harm to others or restrain the progression of the group. The screening process would serve as a way to orient potential members to the group process, goals, ground rules and logistics like time and location. This initial interview would also create an opportunity for the group leader to go over paperwork, obtain authorization to, and conduct pre-group assessments, and answer questions (Jacobs et al., 2012).

The ground rules and paperwork for this ADHD group will be guided by the group purpose and the commitment to client safety and fostering a therapeutic environment.

Accommodations for the targeted ADHD population such as verbally reading over the paperwork with potential members in lieu of presenting multiple pages of documents for the participants to read will be made. They physical setting for group will also be conducive to soliciting optimal participation and focus from potential members by ensuring that there are minimal distractions in the group environment.

Group termination is planned for the sixth session. The closing stage and execution of group termination is greatly determined by the purpose and type of group, the number of sessions, and the evolution of the group over time (Jacobs et al., 2012). The duration of this ADHD group is brief; the rationale behind this examines the nature of the disorder itself and the likelihood that group participants might struggle to sustain focus on acquiring new coping skills if the group were to span over an extended period of time. A randomized controlled trial of

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DBT-based skills training with adults who have ADHD found that this format was effective.

Processing group termination occurred during the final session where members summarized their experience and made plans to continue working on their goals (Hirvikoski et al., 2011).

Group Goals The most important aspect of leading any group is having a clearly defined purpose with goals that reinforce the purpose of the group (Jacobs et al., 2012). The purpose of this group is to improve the overall functioning of ADHD group participants by increasing their coping skills inventory, providing support, and enhancing self-esteem. The desired outcomes of this group will be for individuals to develop new coping skills for dealing with the challenges of ADHD, and to feel more confident in personal and professional functioning ability despite their diagnosis.

Group effectiveness will be measured in four ways: the group evaluation form, use of the Ways of Coping Scale, use of the Janis and Field Feelings of Inadequacy Scale, and weekly observations. Pre-group and post-group administration of the scales will allow for comparison of scores to assess improvement in focal areas. The anonymous group evaluation form allows for self-reporting on the group efficacy from the participant perspective. Weekly observations will allow the group leader to assess effectiveness via behavior monitoring.

Transference/Countertransference Transference and countertransference happens even in a group setting; the group leader should be aware of this and monitor for evidence that it is occurring. Transference in a group setting can be observed through group process and dynamics. One research study proposed that observing participant attachment styles could be useful at identifying transference. Group process behaviors that might indicate transference include participant-to-participant dependency,

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participant-to-leader opposition, and an unbalanced perception of leader. An indication of countertransference includes the leader having a favorite group member. Potential approaches to resolving transference and countertransference includes addressing it in lieu of avoidance, encouraging and modeling transparency, and equal treatment of members (Markin & Marmarosh, 2010).

Ethical Considerations The group leader must ensure that they are knowledgeable and trained to lead groups.

Training includes being versed in the ethical codes that govern the profession. This group was designed to align with ethical guidelines while considering the demographic of the group. For example, the American Counseling Association (2014) (ACA Code, B.4.a) stresses that group counselors are to ensure that they plainly explain confidentiality requirements to all participants.

In addition, best practice is to ensure clients are aware of their rights and understand the counselor-client relationship. Conveying information to adults with ADHD might require forethought, but explanations of the therapeutic process will be offered in both verbal and written format for participants, with additional time allotted for questioning.

The Association for Specialists in Group Work (ASGW Code, C.3) requires that the group leader follow up with participants post-group as appropriate via C.3. This ethical practice will be used as part of the adult ADHD measurement of effectiveness; members will complete a follow up assessment post-group. In addition, (ASGW Code, B.7) points out how both formal and informal measurements should be used, not only at group conclusion, but also throughout the group duration (Thomas & Pender, 2008). Weekly observational assessments using tools like group rounds have been planned for this group and would align with these ethical requirements.

Multicultural Considerations

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Cultural background does affect diagnosis. Studies show significant differences around the world in the prevalence ADHD suggesting that there is a correlation between culture/location, and diagnosis. In addition, determining whether or not an individual meets the criteria for diagnosis often requires access to some form of mental healthcare. Historically, lower socio-economic populations and minorities have had disproportionally less access to healthcare; this would directly affect diagnosis and prevalence. Self-perception and change readiness is also a multicultural factor to consider (Asherson, et al., 2012).

Leadership Role The group leader is expected to be knowledgeable about group content, focus the group, set the session tones, enforces rules, ensure the group environment is safe, actively listen, is empathic, organized, and monitors group process. All group leaders working with various group types assume these responsibilities (Jacobs et al., 2012).

The types of group being led often shape leadership roles. Support group leaders tend to be more non-directive, allowing group participants to steer group with discussion and feedback.

Support group leaders primarily facilitate and encourage sharing. Therapeutic counseling group leaders’ leadership styles are typically influenced by their theoretical orientations; for example, cognitive behavioral therapist oriented leaders will be much more directive than person-centered aligned leaders (Jacobs et al., 2012). The leader of this group will shift roles – sometimes serving as an active and directional psycho-educational group educator, other times as a self-thoughts and self-feelings exploration guide, as well as a hands-off encourager of group sharing and support. Weekly structured group sessions that employ carefully selected exercises that promote group progress would work well with the challenges of ADHD group participants.

Section 2

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Literature Review ADHD symptom detection in adults can be more difficult to assess due to compensatory strategies that adults use to adjust to the limitations of their symptoms. These compensatory strategies can be positive or negative. For example, relying heavily on others as a way to sustain functioning could qualify as a maladaptive coping mechanism, while carefully selecting a career where strengths are capitalized and limitations are not important– these highlight mechanism polarity. Hines, King, and Curry (2012) conducted a study to assess the use of the Adult ADHD Self-Report Scale V1.1 (ARSR-V1.1) as a valid method of screening for ADHD in adults despite potential difficulty detecting symptoms. The study involved 217 participants averaging 40 years in age. Participants were administered the self-report scale and the study concluded that ASRSV1.1 is an effective screening tool for adults with ADHD. The compensatory strategies of adults with ADHD can have harmful effects if these strategies are maladaptive. The development of poor coping skills is associated with dysfunctional thinking and emotional disturbance. A study was conducted using 35 ADHD patients representing both inattentive and hyperactive presentations; both clinical and nonclinical groups were used in the study. The purpose of the study was to test the use of the CBT model with ADHD. The study would show/not show higher dysfunctional cognitions relative to control groups, a relationship between dysfunctional cognitions and the presence of depression and/or anxiety, more use of maladaptive coping mechanisms relative to the control group, a relationship between maladaptive coping skills, poor coping skills, emotional disturbance, and reduced quality of life. Several self-reporting questionnaires were used to measure ADHD symptoms, affect disturbances, and dysfunctional thinking; these questionnaires included the Automatic Thoughts Questionnaire-30, the DAS, WOCS, and the ADHD Rating Scale for Adults. The

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study results proved that ADHD patients’ scores higher than the non-ADHD control participants on the test for ADHD symptoms. Dysfunctional cognitions were higher in the ADHD patients, both the clinical groups experienced higher levels of depression than the non-ADHD control group. Coping skills were tested – specifically escape avoidance, and the results concluded that ADHD patients engaged in this maladaptive mechanism more than the non-ADHD control group (Torrente et al., 2014).

One serious maladaptive coping mechanism that compounds the difficulties experienced by adults with ADHD is cognitive avoidance via overly positive thinking. Individuals with ADHD avoid most activities that require sustained mental effort. In addition to this avoidance, individuals with ADHD typically attempt to circumvent awareness of their problems, low selfesteem, and negative self-perception by thinking overly positive automatic thoughts. Knouse and Mitchell (2014) conducted a functional analysis with the purpose of examining these overly positive thoughts. The study concluded that adults with ADHD frequently use positively valenced cognitive avoidance to evade emotional problems, negative self-perception, and life challenges.

Group training with specific skills training focuses/goals have been proven effective at reducing the symptoms of ADHD. A study was conducted using 51 adults with ADHD; they were randomly assigned to two different groups. One group was a Dialectical Behavior Therapy based skills training group, and the other was a fairly non-directive discussion group.

Participants of both groups attended 14 sessions consisting of 4-8 individuals per group. Weekly group session formats covered topics like stress management and emotional regulation in the psycho-educational skills training group. The study concluded that the DBT-based skills training group was more effective at reducing ADHD symptoms than the loose discussion group

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(Hirvikoski et al., 2011). Another study that examined the effectiveness of group therapy with an emphasis on skills training and psycho-education was conducted using 88 diagnosed ADHD participants. Participants were assigned to either a CBT based skills group or a support group.

The study reported that the CBT based skills group significantly improved symptoms of ADHD in functionally challenged capacities like time management and organization (Solanto et al., 2010).

Comorbid symptoms associated with ADHD include anxiety, depression, and low-self esteem. Group interventions work well to treat these presentations as well. A research study comprised of 61 Caucasian adults diagnosed with ADHD in adulthood examined a CBT-based group intervention and its effectiveness. The participants attended six ADHD psychoeducational workshops; each workshop lasted for one day and three workshops were held each month. The workshop focused on educational topics like time management, self-esteem, and relationship skills. Versions of the Evaluation Questionnaire were used to assess efficacy. The study concluded that psycho-educational groups are effective at treating maladaptive symptoms associated with ADHD (Bramham et al., 2009).

Section 3 Group Effectiveness Groups typically progress through stages. The title and what group interactions characterize these different stages, varies. It is widely accepted that group stages include a beginning, transition, middle, and end stage. During the beginning stage, group participants meet, and though trust is normally absent, rapport starts. The beginning stage moves into the transition stage when group members feel more comfortable with each other, but not quite comfortable enough to share on a deep, personal level. The most important stage is the middle

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stage, which is sometimes referred to as the working stage. It is during this stage that participants work the hardest to achieve personal growth, new perspective, learn new skills, and add value to the group collectively. The end or closing stage varies in length depending on the duration and type of group; during this stage, members reflect on what they’ve learned, gained, experienced and contributed to the group (Jacobs et al., 2012).

The format of this group aligns with these stages. It is expected that session one and part of session two will comprise the beginning stage. The remainder of session two and session three is expected to make up the transition stage. Session four and session five are expected to comprise the middle or working stage; a few minutes at the end of session five will begin the closing stage where members would be encouraged to share their feelings about the upcoming group termination. Session six will serve as the closing stage. These are general guidelines; adjustments would be made depending upon variables like group process, member engagement, and other aspects that affect the progression of the group.

Beginning stage activities will be formatted to consider the newness of the group and the absence of trust. Emphasis will be placed on encouraging rapport, and keeping members interested during the beginning stage. Rounds and processing questions will be used as tools to deepen the focus of the group during the middle stage. Activities will require more introspection and integration of skills through real life application. Varied group formatting and feedback solicitation will aid in maintaining group members’ attention. The ending or termination of group will be conducted via member processing and an activity that facilitates closure amongst participants. The topic of termination will be presented for discussion at the end of session five, and all of session six will be dedicated to closing the group. The final activity will allow for

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participant reflection, experience sharing, reiterating continued efforts be dedicated to optimal functioning, and feedback (Jacobs et al., 2012).

Adults with ADHD often develop maladaptive ways of coping with the symptoms and problems associated with their diagnosis. These dysfunctional coping mechanisms include being cronfrontative and practicing avoidance. Cognitive deficits factor into maladaptive behaviors; these deficits impede normal situational assessment, selection, and implementation of suitable problem solving and coping strategies. A study involving 44 adult ADHD participants and 34 healthy controls was conducted to assess coping mechanisms and identify a positive correlation between poor coping skills and adults with ADHD, as well as a negative correlation between ADHD and adaptive coping skills. It was predicted that the control group would be significantly less impaired than the ADHD group on flawed coping skills. The Ways of Coping Scale is the measurement tool that was used to assess for correlations in this study. The scale measures coping mechanisms like distancing, escape-avoidance, accepting responsibility, and planful problem solving. This tool was selected as the primary method to measure the effectiveness of this group, whose fundamental goal is to increase members’ coping skills inventory. The scale will be used pre-group and post-group; it is hypothesized that the group will facilitate an increase in measured use of adaptive coping skills (Young, 2005).

Use of the Janis and Field Feelings of Inadequacy scale will measure improvements in group participant self-esteem. This instrument will be administered pre-group and post-group.

Increased self-esteem is a desired outcome for group participants. Feelings of inadequacy and low levels of self-competence are associated with individuals diagnosed with ADHD. Group activities will target emotional impairment in this area; it is hypothesized that post-group scoring will reflect higher group participant scores (Torrente et al., 2014).

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References American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Asherson, P., Akerhurst, R., Kooij, S. J., Huss, M., Beusterien, K., Sasané, R., Gholizadeh, S., & Hodgkins, P. (2012). Under Diagnosis of Adult ADHD: Cultural Influences and Societal Burden. Journal of Attention Disorders 16(5), 20S-38S. DOI: 10.1177/1087054711435360 Bramham, J., Young, S., Bickerdike, A., Spain, D., McCartan, D., & Xenitidis, K. (2009).

Evaluation of Group Cognitive Behavioral Therapy for Adults with ADHD. Journal of Attention Disorders, 12(5), 434-441. DOI: 10.1177/1087054708314596 Gentile, J. P., Atiq, R., & Gillig, P. M. (2006). Psychotherapy for the patient with adult adhd.

Psychiatry, 3(8), 31-35.

Hines, J. L., King, T. S., & Curry, W. J. (2012). The Adult ADHD Self-Report Scale for Screening for Adult Attention Deficit-Hyperactivity Disorder (ADHD). Journal of the American Board of Family Medicine, 25(5), 857-853). DOI: 10.3122/jabfm.2012.06.120065 Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., Rück, J., Wiwe, C., Bothén, P., & Nordström, A. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial.

Behaviour Research and Therapy, 49, 175-185. DOI:10.1016/j.brat.2011.01.001 Jacobs, E. E., Masson, R. L., Harvill, R. L., & Schimmel, C. J. (2012). Group counseling strategies and skills (7th ed.). Belmont, CA: Brooks/Cole.

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Knouse, L.E. & Mitchell, J.T., Incautiously Optimistic: Positively Valenced Cognitive Avoidance in Adult ADHD, Cognitive and Behavioral Practice (2014), doi: 10.1016/j.cbpra.2014.06.003 Markin, R. D., & Marmarosh, C. (2010). Application of adult attachment theory to group member transference and the group therapy process. Psychotherapy: Theory, Research, Practice, Training, 47(1), 111-121. doi:10.1037/a0018840 Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. The American Journal of Psychiatry, 167(8), 958-68. Retrieved from http://ezproxy.twu.edu:2048/docview/734490217?accountid=7102 Thomas, V. R., & Pender, D. A. (2007). Association for specialists in group work: best practice guidelines 2007 revisions. Journal for Specialists in Group Work, 33(2), 111-117. doi:10.1080/01933920801971184 Torrente, F., Lopez, P., Prado, D. A., Kichic, R., Cetkovich-Bakmas, M., Lischinsky, A., & Manes, F. (2014). Dysfunctional Cognitions and their Emotional, Behavioral, and Functional Correlates in Adults with Attention Deficit Hyperactivity Disorder (ADHD): Is the Cognitive-Behavioral Model Valid? Journal of Attention Disorders, 18(5), 412-424.

Retrieved from www.jad.sagepub.com Young, S. (2005). Coping strategies used by adults with ADHD. Personality and Individual Differences, 38, 809-816. doi:10.1016/j.paid.2004.06.005

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Section 4: Appendix Figure 1: Professional Disclosure Statement & Therapeutic Relationship/Counseling Agreement Professional Disclosure Statement & Therapeutic Relationship/Counseling Agreement Myia Bennett, B.S., M.S. Student, TWU  Office: (972) 375-1351  E-mail: mbennett6@twu.edu I am pleased that you have selected me as your counselor. This document is designed to inform you about my background and to ensure that you understand our professional relationship.

Qualifications I earned a Bachelor of Science in Economics and Finance from Christian Brothers University in 2006 and a Master of Science in Clinical Mental Health Counseling at Texas Woman’s University in 2015. I hold certifications in/by the following: National Certified Counselor by the National Board of Counselors (National Certified Counselor #12345) and Certified Cognitive Therapist by the Academy of Cognitive Therapy (Certified Cognitive Therapist #12345). I am licensed by the Texas Board of Examiners of Professional Counselors as a Licensed Professional Counselor (License Professional Counselor #12345).

Counseling Background & Process Professional counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. As a professional counselor, I will work with you on strategies to overcome obstacles and personal challenges that you are facing – within a group format. My therapeutic approach is Cognitive Therapy; I endorse technical eclecticism – the use of techniques from different theories and approaches to achieve therapeutic goals. Cognitive Therapy theorizes that psychological distress is caused by a combination of biological, environmental and social factors. Emphasis is placed on the role of cognitions or thoughts as a source for subsequent behavior and feelings. Cognitions or thoughts, and individual core beliefs are believed to be the most effective point of intervention to foster change. In summary, if changes are made in thoughts, assumptions, beliefs and consequently perception, then changes in emotions and behaviors will follow. I utilize an Impact Therapy approach to group work within the context of cognitive therapy; this approach emphasizes engaging group members in a variety of ways using multi-sensory and varied techniques. My theoretical orientation and therapeutic approaches should be acceptable to you.

Your involvement in the therapeutic counseling process is crucial. You will have to work both in and out of the group counseling sessions. Change is not typically instantaneous, nor is the process typically onedimensional. Effort on your part could be multi-faceted and could also be long term. There are both benefits and risks associated with counseling. Risks might include experiencing uncomfortable levels of frustration, sadness, or anxiety. Change may not always lead to a seemingly positive conclusion (for example, group/individual counseling may not necessarily prevent the loss of a relationship). I have a special interest in your autonomy and well-being and will work alongside you within a group setting to promote your healthy functioning. I have five years of direct and group counseling experience working with adults. I do not take on clients whom, in my professional opinion, are beyond my professional scope of ability to help. I voluntarily participate in peer supervision to ensure best practice techniques and objectivity. Any cases reviewed during my supervision are kept confidential with all identifying information remaining withheld.

My office number is (972) 375-1351; please contact me with any questions or concerns, however if you are in crisis, experiencing an emergency and need immediate assistance, please go to the nearest Emergency Room.

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Our relationship will be solely professional. Contact will be limited to counseling sessions. You will be best served if, and by law I am required to ensure, our relationship remains strictly professional and that your counseling sessions focus exclusively on your concerns.

Session Fees and Length of Service In return for a fee of $40 per 1 ½ hour group counseling session, I agree to provide therapeutic support group counseling leadership/facilitator services to you as a group member/participant. Cash, credit card, or personal checks are acceptable for payment at the time services are rendered. Returned checks are subject to an additional $30 fee. If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, the group leader reserves the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. In most collection situations, the only information released regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due. If such legal action is necessary, its costs will be included in the claim. By signing this agreement, you authorize the group leader to employ the services of an outside collection agency or attorney to seek payment of all unpaid fees.

I am an in-network provider and can accept some insurance plans such as Blue Cross Blue Shield of Texas, Aetna, Tricare, United Healthcare, and Medicaid. You will be responsible for deductibles and copayments according to your insurance plan at the time services are rendered. My office will file claims to insurance providers for which I am listed as an in-network provider; please verify group counseling coverage in advance. It is important that you understand your managed healthcare company’s policies regarding the use of diagnoses and coverage terms; should a diagnosis be required for coverage, I will notify you in advance. You may also elect to pay for services yourself and request reimbursement from your insurance provider; my office will be happy to provide you with any required paperwork to facilitate reimbursement from your insurance company to you. I am also a provider for some Employee Assistance Programs. Please contact my office regarding any billing questions.

Group counseling sessions are 90 minutes in duration. The Adult ADHD Therapeutic Support Group will meet once weekly for six consecutive weeks. Group counseling sessions will occur weekly beginning Thursday July 24, 2014 and end August 28, 2014 (6 group counseling sessions). Counseling sessions will take place each week in the same location, which is: 1234 Dallas North Toll Suite 000 Dallas, TX 54321.

Sessions will be scheduled in advance at a mutually agreed upon time. If you are unable to keep an appointment/attend group, please contact my office to cancel or reschedule at least 24 hours in advance.

If no notice of cancellation or request to reschedule is received at least 24 hours in advance, you may be subject to a cancellation fee of $50. Please be aware that this fee cannot be billed to insurance providers; you will be responsible for this fee. If you are utilizing your Employee Assistance Program, late/missed/cancelled appointments can count as one of your sessions. Please contact my office with any questions regarding session length and scheduling.

Use of Diagnosis Some health insurance companies will reimburse clients for counseling services and some will not. In addition, most will require that a diagnosis of a mental-health condition and indicate that you must have an “illness” before they will agree to reimburse you. Some conditions for which people seek counseling do not qualify for reimbursement. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before submitting the diagnosis to a managed healthcare organization. Any diagnosis made will become part of your permanent insurance records.

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Confidentiality All of our communication becomes part of the clinical record, which is accessible to you upon request.

The clinical record includes, but is not limited to: client progress notes, relevant diagnoses, treatment plans, and previous medical records that I have received. The clinical record is maintained according to requirements as outlined by the Health Insurance Portability and Accountability Act (HIPAA). I will keep confidential anything you say as part of our therapeutic relationship, with the following exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to disclose information.

Complaints I encourage you to inform me if you are dissatisfied with any aspect of my work. If you think you have been treated unfairly or unethically and cannot resolve this problem with me, or if you feel I am in violation of ethical code, you may file a complaint against me with the Texas Board of Licensed Professional Counselors (http://www.dshs.state.tx.us/counselor/lpc_complaint.shtm).

Texas Board of Licensed Professional Counselors Complaints Management and Investigative Section P.O. Box 141369 Austin, Texas 78714-1369 E-mail: lpc@dshs.state.tx.us Telephone: (512) 834-6658 Fax: (512)834-6677 Acceptance of Terms & Consent for Treatment I voluntarily give my consent for evaluation and counseling services to be provided by Myia Bennett. I understand that I may withdraw myself at any tie from treatment and refuse any treatment offered.

Client: ___________________________________________________________________ Date: ___________ If under 18, Legal Guardian’s signature: _________________________________________ Date: ___________ Counselor: ________________________________________________________________ Date: ___________

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Figure 2: Client Agreement for Group Therapy Client Agreement for Group Therapy As a group member, I have rights and benefits as well as duties, and I understand that some of them are described in this agreement.

Group Logistics: This group will be called the Adult ADHD Therapeutic Support Group and will meet on Thursdays from 6:00 p.m. – 7:30 p.m. starting on July 24, 2014 and ending on August 28, 2014. The total cost of this group is $40 per session. I agree to pay the full fee if I do not show up for group or if I cancel without 24 hours’ notice, except in the case of emergency or illness. Payment is due in full at each group session. Group leaders accept either cash or check; a returned check is subject to an additional fee of $30.

Group Attendance: I will attend all meetings of this group from start to finish, even if I do not always feel like it. If I cannot attend, I will tell the group a week in advance (at the end of that meeting), or, if it is an emergency, call one of the leaders as soon as I know I cannot attend. If I decide not to go on or am unable to go on with the group, I will discuss my reasons with the group and its leaders, and I will give 2 weeks’ notice to the group.

Group Goals: I agree to work in this group. This means openly talking about my thoughts and feelings, honestly reporting my behaviors, completing homework, and exchanging helpful feedback with other members of the group. The purpose of this group is to provide me with the opportunity to achieve the following goals: Ø To learn new/more coping skills for dealing with symptoms of and challenges association with ADHD. Ø Stress Management Ø Functional Life Management Strategies: organization, and minimizing avoidant behaviors Ø Communication Strategies Ø To increase my self-confidence/self-esteem.

Group Confidentiality: Confidentiality within the group setting is a shared responsibility of all the members and leaders. Group leaders(s) are bound to keep confidentiality except provisions outlined by law. Though this is standard practice, group/client confidentiality cannot be guaranteed by the group leader(s).

I understand that the leaders are required by law to report any suspected child or elder abuse, or serious threats of harm to myself or another person, to the proper authorities.

I understand the need for confidentiality and agree to respect the privacy of all group members. I accept, but am not limited to, abiding by these rules regarding confidentiality: 1. Sharing/disclosing the names of the group members, or in any other way allowing someone not in the group to learn other group members’ names.

2. Permitting children, spouses, journalists, or any other visitors in the group counseling sessions.

3. Allowing, and/or participating in the recording of our sessions, even by our members or leaders.

4. Disclosing/sharing the content of any group counseling sessions – including, but not limited to: member problems, history, topics, or other facts presented by any group member, even if I conceal the name of the member.

5. I understand and agree that if I break rules 1–4 often without meaning to, or if I ever break one of these rules on purpose, I will be asked to leave the group. I will also face a possible lawsuit in

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which I may have to pay damages. If I reveal private information, I give the offended person or persons the right to recover for damages to his, her, or their reputation. Also, this person or persons may recover for any other damages that can be proven.

6. I understand and agree that the leaders will keep a clinical case record on each individual member, and that this record will not contain information by which any other members can be identified. This record, kept in each member’s name, can be shared with other professionals only with the member’s written consent or to meet legal requirements.

Legal Action: If legal actions occur in which the group leader(s) is (are) requested or subpoenaed to provide testimony (either by you or another party), you will be responsible to pay the group leader(s) directly for the following services: (a) the time spent preparing for court, (b) the time spent for transportation to/from court, and (c) the time spent in court. Because of the difficulty of legal involvement, group leaders charge $350.00 per hour for preparation and attendance at any legal proceedings. Payment for the estimated number of hours is due 10 days prior to the court date and must be paid in the form of a cashier’s check.

Other Agreements: Ø I understand and agree that unauthorized, unpermitted, and inappropriate physical contact is not permitted within the group setting. Ø I understand and agree that distractions that include but are not limited to, food, mobile phones (must be turned off during group), toys, music players, etc. are not permitted within the group setting. Ø I understand and agree that I will not engage in sub-group activity with any group members outside of group time for the duration of this group. Ø I understand and agree to participate in group without being under the influence of any controlled substance; I also understand that I will be asked to leave the group immediately if I attend group negatively impacted due to the consumption of controlled substance(s). Ø I understand and agree to be respectful of all group members and leader(s); I will not engage in in any activity that might be harmful to other group members – this includes but is not limited to, verbal attacks, verbal or non-verbal threats or bullying, etc. Ø I understand and agree that I have the right to ask questions about the counseling process inside and outside of the group setting. Ø I understand and agree that I have the right to expect that the group leaders will maintain professional and ethical boundaries by not entering into other personal, financial, or professional relationships with me or any other group member – all/any of which would greatly compromise the group’s work together. Ø I understand and agree that I have the right to voice concerns/file a complaint with the Texas Board of Counselors if I observe/experience the group leader/counselor engaging in unethical behaviors; board contact information is public and has been provided via the counseling agreement. Ø I understand and agree that the group leader may find it helpful to consult other professionals about a case/group work. During a consultation, the group leader makes every effort to avoid revealing your identity. The consultant is also legally bound to keep the information confidential.

If you don’t object, the group leader will not tell you about these consultations unless she feel it is important. Ø I understand and agree that a group evaluation form will be provided to me, and my feedback is welcome and can be given anonymously, without fear of repercussion. Ø I understand and agree that I have the right to discontinue receipt of therapeutic assistance from the group leader; referral resources would be provided should discontinuation occur.

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Ø I understand and agree that the group leader(s) reserve the right/authority to privately (1:1 participation with me) revisit my fit for the group and facilitate termination of my group participation agreement, at any time. Ø I understand that no one will force me to talk or reveal any information until I am ready to do so.

Consent to Group Counseling and Adherence of Group Requirements I have read and understand the contents of this Group Counseling Agreement. My questions about these policies have been answered. I agree to the professional and financial terms described above, as indicated by my signature below.

Member signature: ________________________________ Printed name: ____________________________________ Group Leader Signature: ___________________________ Printed name: ____________________________________ Group Leader Signature: ____________________________ Printed name: _____________________________________ Date: _________________

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Figure 3: Measurements of Group Effectiveness Measurements of Group Effectiveness Group effectiveness will be measured in 4 ways: Ø Group Evaluation Form: to be provided to group participants at the end of the last session. Ø Ways of Coping Scale: to be administered during the pre-screening interview and during the post-screening interview that will be conducted within 10 days post the last group counseling session. Ø Janis and Field Feelings of Inadequacy Scale: to be administered during the pre-screening interview and during the post screening interview that will be conducted within 10 days post the last group counseling session. Ø Weekly Session Goal Measurements: these will be qualitative observations, use of scaled rounds, homework completions, individual activity participation, etc. **Each of the overall group measurement tools are attached.

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ADHD Therapeutic Support Group Evaluation Form Group leader(s) are committed to providing positive, effective therapeutic group experiences for clients. Your feedback is welcomed, encouraged, and helps leader(s) improve future group interventions and approaches. It would be helpful if you would complete this anonymous questionnaire regarding your group experience.

Please complete: I am not continuing with counseling because (Check the appropriate item(s): __ I am dissatisfied with the services __ My group has successfully terminated __ Other __ I feel better/have met my goals Please feel free to explain in more detail: __________________________________________________________________________________________ __________________________________________________________________________________________ (Circle the appropriate response for the questions below):

Strongly Agree My counselor/group leader clearly communicated the group objectives & material.

I felt accepted and respected by my counselor/group leader.

My counselor was knowledgeable about ADHD & relevant group issues.

I felt safe in the group setting.

The group sessions were engaging & useful to me.

Group counseling has helped me better cope with ADHD. I feel more confident in my abilities to function well with ADHD. Overall, I am satisfied with my group counseling experience.

I would refer others for group counseling with this counselor/leader.

Agree Unsure Disagree

Strongly Agree

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How can the group leader(s) improve the group counseling experience? _____________________________________________________________________________________________ _____________________________________________________________________________________________ Additional Comments: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please return in the envelope provided.

Thank you!

Credit: Bennett, M. T., (2014). Self created.

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WAYS OF COPING SCALE Revised Please read each item below and think about how you generally have coped with stressful encounters that you have experienced. Using the following rating scale, to what extent did you generally use the strategies listed below.

Not Used 0

Used Somewhat 1

Used Quite A Bit 2

Used A great deal 3

_____ 1. Just concentrated on what I had to do next – the next step. _____ 2. I tried to analyze the problem in order to understand it better. _____ 3. Turned to work or substitute activity to take my mind off things. _____ 4. I felt that time would make a difference – the only thing to do was to wait. _____ 5. Bargained or compromised to get something positive from the situation. _____ 6. I did something which I didn’t think would work, but at least I was doing something. _____ 7. Tried to get the person responsible to change his or her mind. _____ 8. Talked to someone to find out more about the situation. _____ 9. Criticized or lectured myself. _____ 10. Tried not to burn my bridges, but leave things open somewhat. _____ 11. Hoped a miracle would happen. _____ 12. Went along with fate; sometimes I just have bad luck. _____ 13. Went on as if nothing had happened. _____ 14. I tried to keep my feelings to myself. _____ 15. Looked for the silver lining, so to speak; tried to look on the bright side of things _____ 16. Slept more than usual. _____ 17. I expressed anger to the person(s) who caused the problem. _____ 18. Accepted sympathy and understanding from someone. _____ 19. I told myself things that helped me to feel better. _____ 20. I was inspired to do something creative. _____ 21. Tried to forget the whole thing. _____ 22. I got professional help. _____ 23. Changed or grew as a person in a good way. _____ 24. I waited to see what would happen before doing anything. _____ 25. I apologized or did something to make up. _____ 26. I made a plan of action and followed it. _____ 27. I accepted the next best thing to what I wanted. _____ 28. I let my feelings out somehow. _____ 29. Realized I brought the problem on myself. _____ 30. I came out of the experience better than when I went in. _____ 31. Talked to someone who could do something concrete about the problem. _____ 32. Got away from it for a while; tried to rest or take a vacation. _____ 33. Tried to make myself feel better by eating, drinking, smoking, using drugs or meds. _____ 34. Took a big chance or did something very risky. _____ 35. I tried not to act too hastily or follow my first hunch. _____ 36. Found new faith. _____ 37. Maintained my pride and kept a stiff upper lip. _____ 38. Rediscovered what is important in life. _____ 39. Changed something so things would turn out all right. _____ 40. Avoided being with people in general. _____ 41. Didn’t let it get to me; refused to think too much about it. _____ 42. I asked a relative or friend I respected for advice.

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_____ 43. Kept others from knowing how bad things were. _____ 44. Made light of the situation; refused to get too serious about it. _____ 45. Talked to someone about how I was feeling. _____ 46. Stood my ground and fought for what I wanted. _____ 47. Took it out on other people. _____ 48. Drew on my past experiences; I was in a similar situation before. _____ 49. I knew what had to be done, so I doubled my efforts to make things work. _____ 50. Refused to believe that it had happened. _____ 51. I made a promise to myself that things would be different next time. _____ 52. Came up with a couple of different solutions to the problem. _____ 53. Accepted it, since nothing could be done. _____ 54. I tried to keep my feelings from interfering with other things too much. _____ 55. Wished that I could change what had happened or how I felt. _____ 56. I changed something about myself. _____ 57. I daydreamed or imagined a better time or place than the one I was in. _____ 58. Wished that the situation would go away or somehow be over with. _____ 59. Had fantasies or wishes about how things might turn out. _____ 60. I prayed. _____ 61. I prepared myself for the worst. _____ 62. I went over in my mind what I would say or do. _____ 63. I thought about how a person I admire would handle this situation and used that as a model. _____ 64. I tried to see things from the other person’s point of view. _____ 65. I reminded myself how much worse things could be. _____ 66. I jogged or exercised.

Credit: Adapted from Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. (1986). The dynamics of a stressful encounter: Cognitive appraisal, coping and encounter outcomes.

Journal of Personality and Social Psychology, 50, 992-1003.

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Ways of Coping Scales Score Sheet Sum your ratings for each of the items on the questionnaire CONFRONTIVE COPING _______46. Stood my ground and fought for what I wanted _______ 7. Tried to get the person responsible to change his or her mind. _______17. I expressed anger to the person(s) who caused the problem _______28. I let my feelings out somehow. _______34. Took a big chance or did something very risky. _______ 6. I did something which I didn’t think would work, but at least I was doing something. ________

Total Confrontive Coping

DISTANCING _______44. Made light of the situation; refused to get too serious about it _______13. Went on as if nothing had happened _______41. Didn’t let it get to me; refused to think too much about it _______21. Tried to forget the whole thing _______15. Looked for the silver lining, so to speak; tried to look on the bright side of things _______12. Went along with fate; sometimes I just have bad luck _______ Total Distancing SELF-CONTROLLING _______14. I tried to keep my feelings to myself _______43. Kept others from knowing how bad things were _______10. Tried not to burn my bridges, but leave things open somewhat _______35. I tried not to act too hastily or follow my first hunch _______54. I tried to keep my feelings from interfering with other things too much _______63. I thought about how a person I admire would handle this situation and used that as a model _______64. I tried to see things from the other person’s point of view _______ Total Self-Controlling SEEKING SOCIAL SUPPORT ________8. Talked to someone to find out more about the situation _______31. Talked to someone who could do something concrete about the problem _______42. I asked a relative or friend I respected for advice _______45. Talked to someone about how I was feeling _______18. Accepted sympathy and understanding from someone _______22. I got professional help _______ Total Seeking Social Support ACCEPTING RESPONSIBILITY ________9. Criticized or lectured myself _______29. Realized I brought the problem on myself _______51. I made a promise to myself that things would be different next time _______25. I apologized or did something to make up

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_______

Total Responsibility

ESCAPE-AVOIDANCE _______58. Wished that the situation would go away or somehow be over with _______11. Hoped a miracle would happen _______59. Had fantasies or wishes about how things might turn out _______33. Tried to make myself feel better by eating, drinking, smoking, using drugs or medication, etc _______40. Avoided being with people in general _______50. Refused to believe that it had happened _______47. Took it out on other people _______16. Slept more than usual. _______ Total Escape-Avoidance PLANFUL PROBLEM SOLVING _______49. I knew what had to be done, so I doubled my efforts to make things work _______26. I made a plan of action and followed it _______ 1. Just concentrated on what I had to do next – the next step _______39. Changed something so things would turn out all right. _______48. Drew on my past experiences; I was in a similar situation before _______52. Came up wit a couple of different solutions to the problem. _______Total Planful Problem Solving POSITIVE REAPPRAISAL _______23. Changed or grew as a person in a good way _______30. I came out of the experience better than when I went in _______36. Found new faith _______38. Rediscovered what is important in life _______60. I prayed _______56. I changed something about myself _______20. I was inspired to do something creative _______Total Positive Reappraisal

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Scoring the Ways of Coping Questionnaire Raw Scores To score the Ways of Coping Questionnaire, add the raw score for each item on the scale to get a total score. There are four possible responses, 0, 1, 2, and 3. These are also the weights that should be used to get the raw score. Note that not all 66 items are scaled. # of Items 6 6 7 6 4 8 6 7

Item in the Scale 6, 7, 17, 28, 34, 46 12, 13, 15, 21, 41, 44 10, 14, 35, 43, 54, 62, 63 8, 18, 22, 31, 42, 45 9, 25, 29, 51 11, 16, 33, 40, 47, 50, 58, 59 1, 26, 39, 48, 49, 52 20, 23, 30, 36, 38, 56, 60

Scale Confrontive Coping Distancing Self-Controlling Seeking Social Support Accepting Responsibility Escape-Avoidance Plan-ful Problem Solving Positive Reappraisal

Raw scores describe the coping effort for each of the eight types of coping. High raw scores indicate that the person often used the behaviors described by that scale in coping with the stressful event.

Relative Scores Relative scores describe the proportion of effort represented for each type of coping and are expressed as a percentage that ranges from 0 to 100. A high relative score on a scale means that the person used those coping behaviors more often than they used other behaviors.

To calculate the relative scores: 1. Calculate the average response per scale by dividing the total raw score by the number of items in the scale. For example, if the raw score for Confrontive Coping is 15 then the average response is 2.5 because there are 6 items on this scale.

2. Sum the average responses per scale across all the scales. For example, take the eight averages derived from 1 above and sum them.

3. Divide the average score for each scale (from 1) by the sum of the averages (from 2 above) for all 8 scales. This value is the relative score for the scale.

Credit: Adapted from www.mindgarden.com

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Revised Janis and Field Feelings of Inadequacy Scale Response Format 1= Very Often or Very Confident 2= Fairly Often or Fairly Confident 3=Sometimes or Slightly Confident 4=Once in a Great or While Not Very Confident 5= Practically Never or Not Confident At All 1.

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How often do you feel inferior to most of the people you know?

How often do you have the feeling that there is nothing you can do well?

When in a group of people, do you have trouble thinking of the right things to talk about?

How often do you feel worried or bothered about what other people think of you?

In turning in a major assignment such as term paper, how often do you feel you did an excellent job on it? (R) How confident are you that others see you as being physically appealing? (R) Do you ever think that you are a worthless individual?

How much do you worry about how well you get along with other people?

When you make an embarrassing mistake or have done something that makes you look foolish, how long does it take you to get over it?

When you have to read an essay and understand it for a class assignment, how worried or concerned do you feel about it?

Compared with classmates, how often do you feel you must study more than they do to get the same grades?

Have you ever thought of yourself as physically uncoordinated?

How confident do you feel that someday the people you know will look up to you and respect you? (R) How often do you worry about criticisms that might be made of your work by your teacher or employer?

Do you often feel uncomfortable meeting new people?

When you have to write an argument to convince your teacher, who may disagree with your ideas, how concerned or worried do you feel about it?

Have you ever felt ashamed of your physique or figure?

Have you ever felt inferior to most other people in athletic ability?

Do you ever feel so discouraged with yourself that you wonder whether you are a worthwhile person?

Do you ever feel afraid or anxious when you are going into a room by yourself where other people have already gathered and are talking?

How often do you worry whether other people like to be with you?

How often do you have trouble expressing your ideas when you have to put them in writing as an assignment?

Do you often feel that most of your friends or peers are more physically attractive than you?

When involved in sports requiring physical coordination, are you often concerned that you will not do well?

How often do you dislike yourself?

How often do you feel self-conscious?

How often are you troubled with shyness?

How often do you have trouble understanding things you read for class assignments?

Do you often wish or fantasize that you were better looking?

Have you ever thought that you lacked the ability to be a good dancer or do well at recreational activities involving coordination?

In general, how confident do you feel about your abilities? (R)

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32. How much do you worry about whether other people regard you as a success or failure in your job or at school?

33. When you think that some of the people you meet might have an unfavorable opinion of you, how concerned or worried do you feel about it?

34. How often do you imagine that you have less scholastic ability than your classmates?

35. Have you ever been concerned or worried about your ability to attract members of the opposite sex?

36. When trying to do well at a sport and you know other people are watching, how rattled or flustered do you get?

Note: Most items are reverse-scored so that a high self-esteem response leads to higher scores. Items with (R) are not reverse-scored. Some researchers use 7- point scales with different anchors, depending on the wording of the item.

Credit: Heatherton, T. F., & Wyland, C. L., Assessing Self-Esteem. Retrieved from http://www.dartmouth.edu/~thlab/pubs/03_Heatherton_Wyland_APP_ch.pdf

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Figure 4: Group Flyer

! Looking for more info/support of adults with ADHD?

Therapeutic, Supportive, Positive,

! Struggling with the functional challenges of ADHD?

Educational, Adult ADHD Group

! Seeking ways to better manage emotions associated with ADHD?

Counseling could be just what you need!

Call 972-375-1351 to schedule a free private screening or visit www.adhdcoping.com Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

Counselor: Myia Bennett

972-375-1351

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Figure 5: Session One Group Plan Group Counseling Session One Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Communicate group goals, rules, and expectations 2. Begin establishing cohesion 3. Reduce participant anxiety Session Objectives: 1. Begin group with a ground to assess anxiety level 2. Introduce acronym to reiterate group rules 3. Group members will complete human bingo activity 4. End group with round to reassess anxiety/stress level & introduce homework Description of Activities: Ø Intro round: Share name and anxiety level on a scale of 0-10. Ø Ground Rules: Remember the group ROPES!* Use the acronym R-O-P-E-S as a way to keep members engaged when covering ground rules. Write the acronym on the board and let group members know that you’ll rewrite it before each session starts as a friendly reminder. The purpose of this activity is to communicate group rules/boundaries & promote a safe group environment in an engaging way. o R= Respect/Risk § Treat each other with respect even if you disagree. No put downs. § Only one person speaks at a time – show respect by listening without interrupting while other members speak. o O = Openness/Ouch § Speak honestly – be real! Be willing to say what you think/feel & share.

We want to learn and hear from you! § If someone says something that offends you, it is your responsibility to say “Ouch!.” Let the speaker finish and then respectfully with the group how you feel and why. o P = Participation/Pass § Speak briefly so that everyone has a chance to participate. The group leader might interrupt you to ensure that all members are allowed the opportunity to share. § Stay on the topic at hand. The group leader may interject to keep you on task. o E = Education/Ears § Group leaders are not authoritative experts. Group member participation and sharing facilitates learning and growth. § Participation through listening encourages learning and growth! o S = Sensitivity/Safety

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§

Use “I” statements. Speak for yourself rather than as representative of the group. § Confidentiality is crucial. Confidentiality promotes group safety. Ø Complete Human Bingo Activity! Each group member will be given a bingo sheet and asked to find other group members who fit the description of each box. The purpose of this activity is to encourage relationship building, and to reduce stress by allowing members to meet one another and find out a little about each other. o Processing Questions: § What was it like having to approach other group members? § Did anyone find that they had something in common with other members? § What was it like to openly ask/answer questions about having ADHD? § Did anything about this activity stand out to someone? § What did you like most about this activity? Ø Word Round: Are anxiety levels “the same,” “improved,” or “worse” than they were at the start of group. Ask the entire group in a brief sentence or two – anyone can volunteer – what would lower anxiety levels, if someone answered “worse” in the round. This round serves as a way to measure whether or not the goal of reduced anxiety is being achieved. o Introduce homework, which is a handout on identifying stress. Ask participants to monitor their stress levels over the next week and try to document at least one experience/moment when they felt significant stress. *Adapted from www.diversity.uwgb.edu

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Session One: Human Bingo Group Activity Rules: The same person can only be used once in each row or column. Once you have identified a person who fits the description, write his/her name in the box. Try to list as many names as possible.

Speaks a foreign language

Has been diagnosed with ADHD for min 1 yr

Has met a celebrity

Can cook a gourmet meal

Has been married for at least five years

Is an only child

Is a visual learner

Currently has a cluttered work space

Has lived in another country

Is a vegetarian

Knows how to juggle

Has acted in a play

Loves karaoke

Has at least two children

Has taken a stimulant medication for ADHD

Can name the last two Dancing with the Stars winners

Struggled with ADHD as an adolescent

Exercises 4 times per week

Has driven across the country

Has received a speeding ticket in the last year

Has served in the military

Can wiggle his/her ears

Has at least two pets

Played a sport in high school

Has a black belt in a martial art

Likes spicy foods

Loves country music

*Adapted from: http://csmh.umaryland.edu/wellness/WellnessGroup

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Is addicted to reality TV

Has participated in a 5K or greater run

Is the oldest child in his/her family

Has been to Las Vegas

Played fantasy football or baseball this past year Watches TV to “zone out”

Has switched jobs Has gone camping in the last year in the last year

Session One: Symptoms of Stress Homework Handout

Physical • FaPgue • Sleep difficulPes • Headaches and/or migraines • Muscle pain/tension • IndigesPon • Stomachache • Chest pain • Neck and back pain • Nausea • Weakened immune system • Increased sweaPng *Adapted from www.therapistaid.com

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Emotional

Behavioral

• Loss of moPvaPon • Increased irritability and/or anger • Inability to focus • Anxiety • Restlessness • Depression or sadness • Decreased sex drive • Mood instability • Confusion • Insecurity

• Unhealthy eaPng (over and/or under eaPng) • Nail biPng • Drug or alcohol abuse • Social withdrawal

Figure 6: Session Two Group Plan Group Counseling Session Two Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Continue building group trust 2. Members will increase their stress awareness 3. Members will identify useful stress management techniques 4. Members will support one another through active discussion Session Objectives: 1. Begin group with a dyad; group members break up to discuss homework 2. Process homework experience 3. Group stress activity Description of Activities: Ø Intro dyad: Members will break into groups of 2-3 to discuss homework – what stressed them over the week, things they noticed that they didn’t before, how they handled their stress, etc. The purpose of this activity is to encourage relationship building/promote group interaction/foster trust, and to ease the anxiety of someone who might no have completed their homework – they can think back on the fly and come up with something in the dyad. Advances in group trust can be measured through monitoring group process and depth of content. Ø Process homework as a group; process questions: o What was it like to complete this homework assignment? o What were some of the challenges to this assignment? o What did you learn about yourself through this assignment? o Let’s share some of the stressors/triggers. o Did anyone find that they shared similar triggers/stressors with other members? Ø Group Stress Activity: Progressive Relaxation* – the group leader will play relaxation music and have all members close their eyes. The leader will start with the feet and have group participants tense up parts of their bodies, hold the tension, tense up even more, and then relax the body part while feeling the contrast between states. The leader will systematically go through various parts of the body, having members tense their legs, hands, face, and so on. o Processing would include having members express how they feel post exercise versus pre-exercise. o Members would be asked to brainstorm about other ways to “de-stress.” The group leader would write out member responses on the white board as they are given. (Interactive brainstorming facilitates member to member support). The group leader would add techniques that members might not think of such as Page 37 of 45

planning for the next day as opposed to engaging in cognitive avoidance – which causes stress, and also reminding members that they can say NO to overextension which also causes stress and isn’t uncommon for people who live with limiting challenges of ADHD. § Members would then be asked to pick out their favorite technique from the options on the white board and individually share a potential stressor/future experience when they could use their favorite technique (this exercise measures identification and usefulness of stress management techniques). Ø Close group by encouraging practice over the next week. * Belmont, J. A. (2006). The therapeutic toolbox: 103 group activities and tips, ideas, & practical strategies. Eau Claire, WI: PESI Publishing & Media.

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Figure 7: Session Three Group Plan Group Counseling Session Three Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Members will increase their awareness of some common ADHD symptoms (disorganization & cognitive avoidance) 2. Members will identify useful techniques to organize functional areas of their lives 3. Members will develop one plan to get organized Session Objectives: 1. Begin group with a round: review of week 2. Complete group activity 3. Introduce Plan Development worksheet 4. Process plans as a group Description of Activities: Ø Intro round: Members will be given a minute or two to think about it, then they will share in a few short sentences whether their chosen stress management strategy from the previous week was effective. o Members will be encouraged to give one another direct feedback, share directly with one another what might have worked better, or alternative strategies (another measurement to assess achievement of last session’s goals). Ø Group activity: Disorganized Chaos – members will form a circle and be asked to do multiple things at once, with random instructions added at any time. For example, members will be asked to “juggle” multiple stress balls without ever throwing to the same person consecutively. A random instruction added during the juggling would be to have everyone who has on a tee shirt to stand up – all while still juggling. The pace of all the instructions would increase as the game progressed, creating a sense of disorganized chaos, urgency, and evoking stress ( the exercise purpose is to simulate the ill effects of disorganization and absence of planning}. o How did that activity make you feel? o What were some thoughts going through your mind as random directions were rattled off? o How different would your experience have been had the instructions been organized, planned and given to you ahead of time? o How is this activity similar to disorganized, chaotic aspects of your life? Ø Introduce the Plan Development worksheet. Use whiteboard for visual aid. Write a sample plan on the whiteboard by asking quiet group members for input (draw them out).

If the group is comfortable enough, have members go up to the whiteboard themselves – taking turns working on different parts of the worksheet (the purpose of this exercise is to demonstrate how planning ahead can improve disorganization, reduce associated stress,

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and improve self perceived competence; it also shows how planning can be simplistic and does not have to be complex). o Give members a few minutes to think about a plan they want to try over the next week – then write it out on the worksheet (this activity achieves the goal of helping members get organized). Ø Process as a group: members will think through potential hurdles to the Plan (plan for not sticking to the plan!) as a group. Leader will write these hurdles out on the whiteboard for a visual. Members will identify and share ways to overcome these hurdles (also measures whether members are actually identifying new techniques). o Encourage members to think of and share previous successes – times when they were able to stick to a plan, and what helped in those instances.

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Session Three: Plan Development Worksheet

Goal Setting Worksheet (sample) Priority

Goals

Action Items

Get Organized

Organize Office

Empty Desk drawers Throw away old papers

Track work projects

Make list of all projects Create file folder for each project

Clean up emails

Delete all junk emails from inbox

Goal Setting Worksheet Priority

Goals

Action Items

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Figure 8: Session Four Group Plan Group Counseling Session Four Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Members will deepen their group work 2. Members will begin working on self-esteem improvement Session Objectives: 1. Begin group with a round: encourage members to share feelings/more deeply with deliberate questions.

2. Complete dyad activity 3. Complete group closing activity Description of Activities: Ø Intro round: On a scale of 0-10, how helpful do you think the homework assignments have been? o Process Questions to follow up after everyone’s round (questions go deeper than skills training – responses can serve as a way to gauge member readiness & achievement of session goal): § How do you all feel about having to do homework? § What if the homework doesn’t “make you better” or “change anything?” § Can anyone tell me about any pressure they might feel from themselves or others to “improve” or “fix the problem?” § How does all this affect you emotionally? § How does it affect your view of self? Your confidence? Ø Dyad Activity: Members break into groups of 2-3, grab index cards and are given a few minutes to think about, and then answer the following: o On a scale of 0-10, having ADHD affects my self-esteem __. o I don’t feel competent in my ability to/doing ________________. o Members are aware they will share their responses with their dyad. o Processing as a group would include questions about difficulties members might have had sharing, whether or not any member was surprised by his/her own response, etc. (activity purpose is to begin work on self esteem). Ø Group closing activity: Each group member is given a dollar bill and asked to try and destroy it without ripping it. Members are free to crumple it, throw it, etc. but not rip it.

After a minute or two, processing would cover the unharmed value of the dollar, how members’ self worth is much like the dollar’s worth – unchangeable, etc. Group closes with a round where each member is asked to name one personal strength; participants are encouraged to take the dollar home and place it in a visible location as a reminder over the next week that regardless of diagnoses and accompanying challenges, they are valuable and their worth remains unchanged (activity purpose is to build self-esteem).

Efficacy will be measured with the Janis and Field Feelings of Inadequacy Scale.

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Figure 9: Session Five Group Plan Group Counseling Session Five Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Members will be able to reframe the challenges of ADHD into a more positive perception.

Session Objectives: 1. Complete group introduction activity 2. Watch brief video clip 3. Communicate group termination schedule Description of Activities: Ø Intro activity: Members are asked to take a minute or two and think about completing the sentence, “ADHD is a strength/an asset to me because _______________.” o Processing questions will include: Tell me how easy or difficult was it to complete the sentence? What is it like thinking of ADHD as an asset? How has living with ADHD made you better/stronger/improved? Ø Watch brief video clip that highlights successful individuals that publicly credit ADHD for their success – i.e. Richard Branson, Walt Disney, Michael Phelps, David Neelman, Michael Jordan, Justin Timberlake, etc. o Processing questions include: What are your thoughts about that clip/information?

Tell me how the challenges of ADHD, if reframed, might be of use to you? Ø Close with a round: on a scale of 0-10, how are you feeling about termination next week? o Allow time for open discussion/processing.

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Figure 10: Session Six Group Plan Group Counseling Session Six Group Purpose: Improve overall functioning of ADHD group participants by increasing coping skills inventory, providing support, & enhancing self-esteem.

Session Goals: 1. Members will reflect on what they’ve learned in group.

2. Members will have an opportunity to experience “closure.”

Session Objectives: 1. Complete a word round 2. Complete group activity 3. Thank members for participation Description of Activities: Ø Intro activity: Members complete a round describing their week in one word. o Allow for processing should content require. Ø Complete Memos to Myself & Others* closing activity: members are give time to write a letter to themselves sharing what they have learned/gained from their group experience.

They will seal their letter in a provided envelope and address it to themselves. The group leader will inform the participants that this letter will be mailed to them in 3 months. o The second portion of this activity provides time for members to write, in a sentence or two, something that they learned from or liked about each of their group colleagues. Index cards with pre-label group member names will be provided for this activity. The group leader will collect and make a stack of index cards for each group member so that all group members will leave with memos from their group mates at the end of this session. Ø Close with a thank you to all group participants. *Belmont, J. A. (2006). The therapeutic toolbox: 103 group activities and tips, ideas, & practical strategies. Eau Claire, WI: PESI Publishing & Media.

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