Group therapeutic change

The key to this intervention Therapeutic and skills-based group interventions facilitate development through reflection, openness and exploration in a trusting environment. Participants are dynamic resources in the process of change, they are not simply intervened upon.

What is the activity?

There are two basic models for the provision of therapeutic change and skills-building with groups, known as group-work interventions and as support groups. We describe them each separately here.

Group-work interventions target and recruit members of sub-groups within a population that are likely to share specific sets of HIV prevention need (such as those with multiple concurrent sexual partners, or people in sero-discordant relationships for example). Meeting over a pre-determined course of time (for example, one weekend plus four week nights spanning a six week period). The group is facilitated by qualified counsellors and / or trainers. The aims of group-work interventions should be clearly articulated at recruitment stage, and will involve some mixture of all of the following elements: information-giving, skills development, resolution of psycho-social conflict, and an increase in social capacity. Such activities may be regarded as short intensive courses that help people to kick-start broader reflective processes regarding specific behaviours that relate to their sexual health.

Support-group interventions offer diverse groups of service-users safe space to exchange experiences and ideas with peers. Sharing concerns and challenges can help people to begin processes of problem-solving in their own lives. Although the ethos of self-help and empowerment pervades such interventions, often professional facilitators some training in counseling skills are present. Support-groups can provide a vital life-line for those who feel socially and emotionally isolated.

Although support-groups may operate weekly or monthly over very extended periods of time, those attending will vary, so the aims are likely to be much less defined than they would be for group-work, for example. However, they will also include some elements of: information-giving, skills development, resolution of psycho-social conflict, and an increase in social capacity – but these will be delivered using relatively informal methods. Facilitators may help to stimulate discussion and personal development by hosting a variety of speakers on topics that will be of interest to attendees.

Groups that provide social or community infrastructure (such as more general youth, social or interest groups) and therefore contribute to the aims of community development are discussed elsewhere.

Strengths and limitations

Due to the high cost of delivery, short-course therapeutic interventions are unlikely to be feasible for more than a very small proportion of African people. This means that careful consideration should be given to recruiting only those whose unmet need has the greatest impact on the epidemic.

Attending groups requires that participants self-refer, meaning that they have to identify and prioritise their HIV prevention needs. It is possible that those in greatest need of group interventions may be least able to access them because they may feel alienated from them, are unsure of their outcomes, or have other obligations or resource limitations that make engagement unlikely.

Evaluation has demonstrated that these interventions are likely to have a significant advantage over other less intensive interventions because their duration encourages identification of detailed personally-relevant issues, reflection on these factors, and support in finding acceptable solutions. This means that the potential for behaviour change resulting from skills-based and therapeutic interventions for groups far exceeds what can be expected from some other forms of prevention activity (see the Planning section).

Where does it happen?

Group-work and support-groups are usually centre-based activities. Where agencies lack the necessary facilities, accessible locations (such as church halls, or community centres) can be hired. Selection will need to prioritise users’ needs to feel welcomed and safe, as well as attending to privacy and confidentiality. To this end, user consultation prior to naming and siting of groups will help to determine their acceptability. Reception staff should be briefed on the discreet handling of attendees, and a private area off the main room might be useful for those who require one-to-one support or space to themselves after an emotive or provocative session.

Frequently delivered alongside ...

Issues to consider

Whereas support groups are traditionally regarded as being the model of service provision for people with diagnosed HIV, many of groups of people likely to be involved in HIV transmission can benefit from their provision. Consideration should be given to broadening out support groups for others such as behaviourally bisexual African men or partners of people with diagnosed HIV.

Groups of all kinds are most effective when their identity and role are clear. As such, members should be aware of a group’s function, and can be asked to contribute to the development of its identity. Where interventions have an extensive therapeutic element, it is ideal that they are convened by those with professional training, accreditation and supervision.

Outcomes

The outcomes of this intervention tend to focus on participants’ motivation and skills to avoid participating in HIV transmission. The list below offers some examples of outcomes (dependant on the content of the therapeutic group intervention), but is not exhaustive. Outcomes among people participating in therapeutic and skills building group interventions can include:

  • Increased confidence and motivation to openly discuss sex, sexuality, and sexual health with partners and in social networks, as modelled and rehearsed in the intervention (see associated needs).
  • Increased likelihood of establishing and maintaining sero-concordancy with sexual partners (see associated needs).
  • Increased control over involvement in HIV exposure and transmission in their lives (see associated needs and here).
  • Increased confidence to decline any unwanted sexual activity (see associated needs here and the KWP approach section).
  • Better management of anxiety and depression due to less social isolation (see associated needs).
  • Increased desire to contribute to the health and well-being of their community (see associated needs).
  • Feeling that their cultural, religious, tribal and ethnic attributes and values are recognised as being part of the rich mosaic of pan-Africanism in the UK (see detail).

Monitoring and evaluation

Access evaluation can be undertaken alongside monitoring activities, to determine the profile of people attending. While this does not address effectiveness, it can be compared with needs data from research samples in order to establish whether those sub-groups most in need are accessing the intervention.

Evaluating the effectiveness of support group attendance could be undertaken through face-to-face interviewing or focus groups with current, past and non-attendees in order to determine reasons for attendance and attrition, and to gain input into future planning. In the case of group-work, questionnaires distributed at the outset of the intervention should clearly articulate the outcomes. Attendees can add information about how they came to hear about the group, and what motivated them to attend. As soon as the intervention is complete, they can also be asked to complete a satisfaction questionnaire.

A more costly, but more useful means of evaluating group-work would be to follow-up attendees through face-to-face or telephone interviews (after say, three or six months) to determine what they found to be of use to them from the intervention, and what further needs they have identified as a result.

Page last updated: 17 July 2013