Dream Group

In this paper, I discussed a dream group proposal including working within rural communities specifically with the Amish and Mennonite population. The purpose of working with this community will be covered along with the goals, objectives, logistics, and description of group activities offered in the group.

Purpose and Rationale

Some populations are limited in mental health services they can acquire, and little research has been completed to understand this issue. Individuals living in rural America are those requiring more attention, specifically in the mental health field. Those living in rural communities have higher risks of chronic illness, overall poorer health, and difficulty accessing health care (Farrar, Kulig, & Sullivan-Wilson, 2018). The Rural Health Information Hub (RHIhub) has found three main barriers for this population including accessibility of mental health services, availability to providers, and acceptability of receiving mental healthcare (Rural Health Information Hub, 2018). Amish and Mennonite Americans require improved healthcare and mental health services. There are about 300,000 Amish Americans residing in rural communities in the United States and access to health care for this population are limited due to finding providers that are understanding of the cultural values of sequestration from modern society, avoidance of motorized transportation, and linguistic barriers (Farrar, Kulig, & Sullivan-Wilson, 2018). There are many different Amish communities in 31 states with most residing in rural states like Ohio, Pennsylvania, and Indiana (Miller-Fellows, Adams, Korbin, & Greksa, 2018). This means these states need more organizations and counselors who are culturally competent to serve this community. Cultural competence is significant in how sessions and counseling will be conducted. One example is the idea of self-discloser and how therapist typically avoid this within modern therapy. The Amish community is a close group who have high cohesion and intimacy, so therapist’s avoidance of self-discloser may be seen as withholding secrets and hurt rapport (Cates, 2005). Willingness for these populations to seek mental health services has increased in the last century and it is important to bridge the gap between Mennonites and Amish communities to competent mental health services (Nolt, 2011). My group will attempt to bridge the gap between art therapy groups and this population.

Specifically, the group I will be running will be held at a rural counseling agency a facility offering outpatient mental health services for Amish and Old Order Mennonite men, women, and children (SpringHaven, 2019). My group will be for adults both men and women who are struggling with anxiety and depressed symptoms. The art therapy group will focus on therapeutic art activities combined with cognitive-behavioral therapy. Counseling services for this community are important and implementing art activities offers a variety of options for the clients at this facility. By offering this art therapy group we can get a better understanding if these different therapeutic services are helpful and if more groups similar to this should be implemented in the future.

Goals and Objectives

Goal #1: Reduce anxiety, depression, and worry by learning and implementing coping skills.

Objective #1: Learn and implement 3 calming skills to reduce overall anxiety and help manage anxiety symptoms. Calming/relaxation skills including muscle relaxation, mindful breathing, and applied relaxation.

Objective #2: Realistically address worries by implementing 2 problem-solving strategies including generating options, creating optional actions, and using pros and cons.

Goal #2: Enhance ability to effectively cope with the full variety of life’s worries and anxieties.

Objective #1: Describe and create 2 situations, thoughts, feelings, and actions associated with anxieties and worries and attempt to resolve them.

Objective #2: Replace negative self-talk to positive, realistic, and empowering self-talk daily. Replace distorted messages with positive to increase self-confidence in coping.

Goal #3: Develop healthy thinking patterns and beliefs about self, others, and the world that lead to the alleviation and reduce symptoms of depression or anxiety.

Objective #1: Identify 4 important people in life, past or present, and describe quality of those relationships.

Objective #2: Create 2 artwork of healthy and unhealthy emotions and use the healthy emotions to guide actions.

Methods

The location of the group will take place at a rural therapy agency. I have a connection to one of the licensed professional counselors who has brought up the idea of providing an art therapy group at this facility. I will reach out to the clinical director and seek a licensed clinical counselor supervisor to supervise my work in this organization. I will follow through with whatever hiring/intern process is needed to be allowed to work in this facility. I would also propose the art therapy group idea to them to get approved. I would like to request a co-facilitator to help throughout the group sessions and to have someone who is more experienced with this population to help me become more competent. After the group is approved, I will encourage the therapists to recommend this group to client who will benefit from the sessions and also those who are interested in the art activities and interventions offered. I can send e-mails to the counselors asking for client referrals for this group along with information about times, dates, and how many members I will be accepting. I will also make flyers to be posted, so client can be made aware of this type of group being offered.

For this art therapy group, I will be looking to have around 8 to 13 members each session. The group will be open due to the nature of the facility and willingness to be flexible to who participates. The group will also take place each week for 12 weeks on Saturdays for an hour and a half session. Each week will have a theme and key activities will be offered correlating with the theme.

Selecting Group Members

The group will be open, but to make sure there are no more than 12 participants each session to decrease likelihood of overwhelming the therapists, I will screen group members by approving the referrals to the group. I will be an intern at this facility, so I will ask the counselors on staff to recommend clients who might benefit from this group. From there I would like to access the client’s records and looks over symptoms and progress throughout their treatment. I will specifically be looking for client who are open to new activities, have an artistic interest, and will request the primary counselors to ask these specific questions to clients. After looking over the referrals, consulting with the primary providers, and reviewing records I will ask 12 clients to joining the group. Referral are still recommended and depending on members staying or leaving others can be approved throughout the 8 weeks of the group. The last two weeks will be for final review and termination so new members will not join at this time.

Description of Group Activities

Week #1: Introduction- rules and art as therapy

The first session will be introductory for the co-facilitators as well as all the group members. The counselor will explain confidentiality and rules of group as well as education the role of art as therapy and expression throughout the art therapy group. The hope is to have members stay throughout sessions, but new members may join later, and others may leave early. It is important to cover this and explain confidentiality will be revisited weekly as well as the rules. This will be the forming stage of the group and members will be learning about the purpose, structure, culture, and leaders of the group. Counselors will need to start setting the example of starting on time, listening fully, and engaging in the here and now. Members will be establishing relationships and deciding if they belong. Members will also start low trust and hesitant to share so the first art task will allow them the chance to share as much as they want.

The first key activity will include an introduction to self. Clients will be asked to create a self-portrait. This directive will be coupled with a white sheet of paper and the option of pencils, color pencils, markers, or chalk pastels. Counselor will educate clients on how these medias can be used and offer help if clients are interested using something new. Counselors will educate clients about art as therapy and how process is more important than the product created. The introduction will take about 10 minutes, clients will have about 50 minutes to work on the activity before cleaning up.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. This will allow clients time to get comfortable with each other and share as much or little as they like in the first stages of the group. Some prompts for clients might include sharing interests, personality traits, favorites, and occupation. Clients will be encouraged to share something they learned from another member of the group to end the session.

Week #2: Introduction- rules and art as expression

The second session will be another introductory session since counselors and group members are still getting to know each other. If new members are present, have them introduce them self and revisit confidentiality and rules of the groups. This is a continuation of the forming stage, so it is important to model healthy norms, establish the therapeutic environment, and teach member to see the process of the group. Counselors will check in with each group member and summarize what happened in the first session and move onto the art activity set for session number two.

The second key activity is representing current state. For this art activity clients will use Crayola air-dry clay. This will be a new media and therapists will allow time for clients to work with the clay and get a feel for it before starting the directive. The counselors will prompt a discussion about current situation, feelings, or emotions and then ask clients to represent it into the clay. This directive will help counselors see individuals needs as well as the groups needs overall. Clients will work on the activity for 55 minutes with a 5-minute check-in.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. Clients will leave works at the facility and can later paint them in future session. To finish this session clients will discuss the process of the art they created and will name the artwork. Around this time the forming stage of the group is ending, and the group will be moving into the storming stages.

Week #3: Coping skills

The third session will focus on the first goal and objectives of learning coping skills. The activity will be to draw your breath. This mindful intervention will allow client to focus on here and now as well as bodily movement. A white piece of paper will be offered as well as an option of colored pencils, markers, chalk pastel, or acrylic paints. Paints will be a new medium in this group, therapist will take time to teach clients about paint and assist if needed. Before starting the directive, clients will practice deep breathing and focus on the rise and fall of their own body. Peaceful music will be offered, if all group members are interested, and will play throughout the session. Clients will then start creating after taking time to become more self-aware.

The storming phase will be starting around this time of the group. This time period may be a time of tension and disunity for members trying to find their place in the group. This is a time where fears come up of being too emotional or feeling judged. Counselors will need to help members deal with these conflicts, teach members to respect resistance, and to encourage members to express what they are experiencing. The deep breathing can be practiced for 10 minutes along with a 5-minute check-in at the beginning of session. The client can work on artwork for about 45 minutes.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. Counselors will encourage clients to discuss the reaction to the directive and ask if they learned anything that might help in future. This is one coping skills that will be encouraged to use outside of session to practice breathing and mindfulness.

Week #4: Coping skills

The fourth session will focus on coping skill goals and ask clients to create where they currently are and then where they desire to be. Clients will be offered white paper and paint, air dry clay, or chalk pastel. Hopefully this will get some clients to explore with new medias and therapist will be available to assist. Counselors will ask clients to create some sort of connection between the two spaces with a bridge or walkway. Counselors will prompt clients to think about where the group is currently and where they desire to be as a whole and personally. The storming phase will either be continued or ending, and it is important to explore group concerns and give support when needed. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. This intervention will help client share where they are and where they want to be. Counselors should ask client where they think they are in the artwork and how they might get to the desired. After clients have shared, it is important for counselors to prompt problem solving skill and coping skills discussion to help them reach the desired. At this point, other members should be more involved in discussion and relate to others artworks.

Week #5: Coping skills

The fifth session will focus on coping skills and start a discussion about coping skills learned from session and others that have been implemented and work for other members. The art directive will be creating coping cards with pre-cut cards and a mixture of paints, colored pencils, markers, pastels, or pre-cut magazine for collage. Collage will be a new technique used and clients can explore with this medium or combination of mediums. This session will flow with group cohesiveness and members will be working together to create coping cards. This is the beginning of the norming stage where all members play a role in the group and each member contributes. Creativity should be high, and members are more open and share on a personal and task level. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. This intervention specifically works on goal one and those objectives. The process through group phases also works with this directive in members brainstorming and working together while also sharing more. Client can keep their coping cards and will be asked to practice these skills out of session. Before ending session, client should share one skill they plan on using and a word to describe the art directive.

Week #6: Enhance ability

Session 6 will focus on goal two of enhancing ability to efficiently cope with life’s stressors. The art intervention will be a puzzle piece, each member will get a piece of the paper puzzle that can be put together at the end of session. Clients will have the option to use color pencils, markers, or pastels. The directive will have clients represent their symptoms of either depression or anxiety. The client can represent the symptoms, feeling, situations, thoughts, or actions associated with anxieties and worries. The goal is to identify and then attempt to resolve those representation. This will either be the end of norming phase or beginning of performing stage where the group members focus on ‘we-ness,’ cohesion, and more intimacy is starting. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. At this stage of the group, members will have more intimacy, and higher cohesion. Clients will each share their puzzle piece and members will attempt to help and resolve them together. Having members more willing to share and relate means sessions will become more productive and meaningful.

Week #7: Enhance ability

Group number 7 will focus on positive self-talk and challenging negative thinking. Counselor will educate members about negative thought process and challenge client to practice positive self-talk. The art activity for this session includes a white piece of paper and the words I am in the middle. The intervention implemented is called the ‘I AM’ and client will use college, chalk pastels, watercolor, or color pencils to create a positive representation. The second half of the activity will be to create a group project with ‘WE ARE’ in the middle to represent positives together. This will directly work toward replacing negative self-talk to positive, realistic, and empowering self-talk daily and replacing distorted messages with positive to increase self-confidence for group members. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. Clients will be prompted to share positives on a personal and group level which will allow growth for both. The preforming stage includes more self-disclosure meaning members will be giving and receiving feedback more throughout session. The preforming stage is the longest of the stages and will continue until adjourning in session 11. Counselors might start talking about the group ending in five more session and bring it up periodically to remind clients the group will be ending in the future.

Week #8: Healthy thinking

Session eight will focus on goal three of developing healthy thinking patterns and beliefs about self, others, and the world helping members to reduce symptoms of depression or anxiety. The art directive is weaving paper to create and encourage healthy emotions. For this project clients will start with two pieces of white paper or scrap paper. Clients will cut strips of paper and then write empowering quotes or lyrics with markers or color pencils on the strips of paper. Clients will weave the strips together and glue them together. Clients can also think of important people in their life and explain their importance on the strips of paper. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. This intervention can be personal to each member and members are encouraged to share what they created. This intervention will help clients focus on positive self-talk but also develop healthier thinking patterns about self and other. Before session ends clients will be asked to describe the directive with one word and to names the piece created.

Week #9: Healthy thinking

For session nine clients will start a 2-part process of mask making. The first session will focus on the inner mask. This will represent the unhealthy emotions that are within that lead to unhealthy action. Clients will be given a mask and may use paints, college, and found object the therapist will bring, to create a mix media project. The focus for this session is the unhealthy and to have members share experiences from the past or present they might regret or could have handled better. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. While the client will be sharing the unhealthy, sharing healthy ways is also encouraged to start thinking about the second part of outer mask. This will allow clients a clear way to view unhealthy behavior or feelings and start to think about healthier ways to interact in their environment.

Weeks #10: Healthy thinking

The 10th session will continue with the mask making and focus on the outer mask. The group will discuss last week and review the inner mask created that focuses on the unhealthy emotions and actions. After revisiting last week’s art directive, clients can move forward to focusing solely on healthy thinking and comparing healthy verse unhealthy emotions and expressing those emotions. The goal is to create a mask piece that can compare healthy and unhealthy emotions and use them to identify how these emotions can guide actions. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. Members will be able to identify unhealthy situations, feelings, and actions and work with one another to find healthy alternatives. This will be the end of the performing stage and move into the adjourning stage of group.

Week #11: Final review and termination

Session 11 will be the start of final review and termination of the group. This is the second to last session and it is important to prepare members to close the group. In this session the art directive will be a growth mandala. Clients will be given a white paper and able to use paints, markers, color pencils, watercolor, or pastels to create a mandala. The goal is to reflect on the group and review what they have learned. The growth mandala will represent the steps taken in the group and outside the group. In the adjourning phase, clients might struggle with denial, transference, and countertransference and counselors should be aware of problems that may arise. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. The focus is on growth and to reflect on the experiences from the group and to also recognizes feelings about the closing group. The clients will be given time to explore reservations of the group closing and work through any struggles the clients are facing as a group.

Week #12: Final review and termination

Session 12 is the final session and will complete the art therapy group. The last art directive is to create a self-portrait. Clients will get a piece of white paper and fold the paper in half. On one side clients will draw half of themselves they show to everyone and on the other is the side they show to no one or only a few. The first art directive was a self-portrait to allow space for every member to share. The dual self-portrait circles back and is a good directive to end the group. This intervention encourages clients to share more than they did at the very beginning and shows overall growth of trust and cohesion within the session. Goodbyes are hard and sad, but it is important to have time to process the change of no longer meeting for the group. The session will start with a 5-minute check-in and allow for 55 minutes on the art activity.

Clients will be instructed to start cleaning and putting things away 30 minutes before the session ends. In the last 20 minutes of session, clients will be asked to process the work they created and share with the group. This will be the final sharing and also be the goodbyes of each member. This directive can challenge clients to share inner self with more people as homework and can be used as a reflection of the experience from the group.

Evaluation of the Group

The art therapy group counselor will evaluate the effectiveness of the group by using a rating form for each member to complete at the end of the group session. Questions will include a 1 to 3 scale, 3 standing for satisfactory, 2 average, and 1 dissatisfied. Questions will include: what the overall experience of the counseling was, how satisfied were you with times allotted for the services, how satisfied were you with your counselors, how satisfied where you with the help acquired from counselors, do you think the art therapy group was suitable for this counseling agency, did the activities relate to overall goals, and how likely are you to participate in an art therapy group again? Comments sections will be given for each question for additional information.

Another form client will fill out will directly relate to the goals and objectives for the group. Clients will partake in a follow up interview with the counselor checking in with the client and filling out a final art therapy group questionnaire.

1. Did this group help reduce anxiety, depression, and worry by learning and implementing coping skills? YES NO UNSURE

a. Did you learn 3 calming skills including muscle relaxation, mindful breathing, and applied relaxation? YES NO UNSURE

b. Did you learn 2 problem-solving strategies including generating options, creating optional actions, and using pros and cons?

YES NO UNSURE

2. Did you enhance ability to effectively cope with life’s anxiety or worries?

YES NO UNSURE

a. Did you identify 2 situations, thoughts, feelings, and actions associated with anxieties and worries? YES NO UNSURE

b. Have you replaced negative self-talk with positive, realistic, and empowering self-talk daily? YES NO UNSURE

3. Have you developed healthy thinking patterns and beliefs about self, others, and the world? YES NO UNSURE

a. Did you identify 4 important people in your life?

YES NO UNSURE

b. Did you create 2 artworks identifying healthy and unhealthy emotions/actions? YES NO UNSURE

If you answered UNSURE please explain why and any additional comment below:

Conclusion

Within this paper, the author has identified a dream group where Amish and Mennonite Americans are the focal point. Understanding this population allows counselors to provide better mental health services presently and more in the future. Creating an art therapy group for the clients at this agency will allow clients to interact with others and express themselves with art interventions. The author created an outline for this dream group proposal and created goals and objectives that focus on those with anxious and depressed symptoms. More research should be done in understanding the specific cultural needs of this population and if art therapy can be an effective tool in treatment.

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References

Cates, J. A. (2005). Facing away: Mental health treatment with the old order Amish. American Journal of Psychotherapy, 59(4), 371–383. doi:10.11762005.59.4.371

Farrar, H. M., Kulig, J. C., & Sullivan-Wilson, J. (2018). Older adult caregiving in the Amish: An integrative review. Journal of Cultural Diversity, 25(2), 54–65. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=129643545&site=ehost-live

Miller-Fellows, S. C., Adams, J., Korbin, J. E., & Greksa, L. P. (2018). Creating culturally competent and responsive mental health services: A case study among the Amish population of Geauga County, Ohio. The Journal of Behavioral Health Services & Research, 45(4), 627–639. doi: 10.1007/s11414-018-9612-0

Nolt, S. M. (2011). Moving beyond stark options: Old Order Mennonite and Amish approaches to mental health. Journal of Mennonite Studies, 29, 133–151. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=63578432&site=ehost-live

Rural Health Information Hub. (2018). Retrieved from https://www.ruralhealthinfo.org/topics/mental-health.

Spring Haven Counseling Center. (2019). Retrieved from http://springhaven.us/.