Sunday, September 3, 2017

Group Facilitation Made Easy

I have worked with small groups that have gathered to undertake work that would be impossible for one person to do alone. These groups have generally focused on four areas: professional training using a seminar format, group psychotherapy, consultation groups, batterer’s intervention and didactic anger management classes. In most of these situations, I have been asked to act as facilitator or trainer. In the seminar groups, I am clearly the trainer. In the other formats, I am the facilitator who assists the group in gaining from the unique experience of learning and sharing in a group. In French, the word facile means "easy." It is the aim of facilitators to make the work of a group easy.” This involves coming up with a plan and process that will help participants accomplish their goals. In all of the groups in which I have participated, I have found it useful to provide participant workbooks with an outline and, when possible, ancillary videos and other visual learning material. Facilitation involves helping people co-operate and act collectively. When a group works together in this way, they experience many benefits, including:
  • Synergy: The energy or motivation to work on the task is better or higher than working on the same task in isolation. 
  • Positive outcomes: By using the collected experiences of many individuals, the quality of what is produced is higher than if it had been attempted by one person. 
  • Broader impact: Each person in the group interacts with others outside the group, broadening the impact of the work. 
  • Greater resources: The individuals in a group can pool their knowledge, information, personal experiences, and other resources to help the collective do its work.
In this article, I will share some suggestions that may help you strengthen your group facilitation skills relative to anger management, stress management, communication and emotional intelligence.
Prior to the Meeting
Effective facilitation involves 80 percent preparation and 20 percent presentation. Facilitators should make themselves aware of any factors that may hinder or help the group's work. Make sure to review the material to be discussed and establish continuity between sessions. Be thorough, using what I call the "three p's for planning": participants, purpose, and process. Find out as much as possible about participants (those who will be attending) and the results of their assessments. Ask questions and learn as much as you can from the facilitator who conducted the assessment. Remind the participants at each session that the purpose of the program is to teach skills to enhance their skills in recognizing and managing anger, stress, communication, emotional intelligence.  As you develop this statement, keep in mind that groups often establish unrealistic goals for themselves, only to be mired in the reality of their circumstances. Realistic goals are those based on the nature of the task, the number of participants, and the time available. Achieving practical plans will enable groups to experience a sense of accomplishment and satisfaction that can give them the motivation they need to complete their task. (That is why it is important for facilitators to remember that the work is theirs, not ours.) They will be responsible for that work after they have completed the required number of sessions. As you prepare to work with your group, remember that every group deserves your unconditional respect and love. This is the spiritual side of all small group facilitation. Envision success for the group even before meeting them. If you do this, you are more likely to be effective in helping the group develop or enhance skills in managing anger, stress, assertive communication and increasing emotional intelligence.
At the Start of the Meeting
Plan to begin your meeting with a welcome, a goal statement, an explanation of the agenda, and group introductions. New members should be introduced last and asked to share their control log and assessment summary as well. Old members should be asked to summarize their experience in the group and further goals during their attendance. It is extremely useful to have each person say something within the first 10 percent of your time together. This helps each participant find her or his voice in the group. Short activities with this goal are known as climate setters, icebreakers, and warm-ups. A start-up activity can relate directly to the task or generate information about group members' lives outside the group. I often begin by referring to the goal and agenda of the group and then ask everyone to introduce themselves briefly with their name and one reason they are participating in the program. Be sure to clarify roles at the beginning of any meeting, including the expectations of the facilitator's role compared with that of participants.
Have participants answer these three questions:
  • What are your expectations of yourself? 
  • What are your expectations of other group members? 
  • What are your expectations of the group facilitator?
Discussing these questions will help surface realistic perceptions of your role as a facilitator and increase the likelihood of group ownership of the task. Ask members to share their thoughts in small groups of three or four and to prioritize two or three key expectations for the different roles. This activity will lead to a series of statements that can help the group to arrive at a mutual understanding of the facilitator as process guide and participants as owners and contributors to the task. Mutually agreed-upon statements of roles can be posted and used as a reference throughout the life of the group. Check in on group agreements regularly. This will ensure smooth functioning for the facilitator and the group.
Structuring the Meeting
After the group has completed its introductions, the facilitator presents a sequence of activities and discussions, which are contained in the client, work books. To the extent possible, material in the client workbook should be personalized to those in attendance.
The Importance of Ancillary Material for Visual Learners
It is essential to use the Contrasting Wheels of Behavior as well as the related DVDs and other visual material when conducting anger management groups.
Keeping the Group on Track
One of the major tasks of the facilitator is to keep the group focused on the task of the group and the material in the client workbooks. It is critical to deter the group from unrelated material. This is easy to day by simply stating, "Our discussion has to remain on the topics in the workbook.
Disruptive Participants
Often, people who want to improve their facilitation skills identify problem behaviors displayed by participants. They want to learn how to deal with the behaviors so those behaviors no longer hinder the group. I hesitate to spend time thinking about what to do when things go wrong in a group. I believe if we do a good job of staying with the topics in the workbooks, preparing and planning, we greatly increase the likelihood that people will stay on track. Your own enthusiasm for knowing the task and the process, and your confidence that the group will be effective in achieving this task, is highly infectious. Doubt about whether participants can do it or work together co-operatively can have self-fulfilling prophecy tendencies, and is highly contagious. Be enthusiastic about the task and the group's capacity to work well together.
Closing the Meeting
The closure of a meeting is a time to evaluate what has happened, share learning's, express appreciation, and announce the lesson for the next session. Allow 10 minutes of your time together for closure.
George Anderson, MSW, BCD, CAMF

Saturday, September 2, 2017

Emotional Intelligence, A Core Leadership Competency

A look back at George Anderson’s recent appearance at the The Association of Nigerian Physicians Of The America’s Annual Conference, held in Las Vegas. George gave a presentation titled “Emotional Intelligence, A Core Competency in Healthcare Leadership”. There were 500 physicians, nurses and pharmacists in attendance.

Anderson Newsletter

Current Trends In Coaching "Disruptive Physicians"

Effective January 1, 2009, The Joint Commission (JCAHO) issued new guidelines to respond to the negative behavior of physicians that often places patient care at risk while increasing medical errors. These new standards made it mandatory for Hospitals to establish written policies designed to address what is defined as "disruptive physician behavior." The following is one definition of what is considered "disruptive behavior":

Disruptive conduct can take many forms. Raised voice, profanity, name-calling, throwing things, abusive treatment of patients or employees, sexual harassment, disruption of meetings, repeated violations of policies or rules, or behavior that disparages or undermines confidence in the Hospital or its staff may be disruptive behavior, although this is not an exhaustive list. Unacceptable disruptive conduct can also include such behavior as:

I.    Attacks (verbal or physical) leveled at others that are personal, irrelevant, or go     beyond the bounds of fair professional comment.
2.     Impertinent and inappropriate comments written or illustrations drawn in patient medical records, or other official documents, impugning the quality of care in the Hospital, or attacking particular practitioners, employees, or Hospital policy.

3.     Non-constructive criticism, addressed to its recipient in such a way as to intimidate, undermine confidence, belittle, or to impute stupidity or incompetence.

4.     Refusal to accept medical staff assignments, or to participate in committee or departmental affairs on anything but his or her own terms or to do so in a disruptive manner.

5.     Imposing idiosyncratic requirements on the Hospital staff that have little impact on improved patient care but serve only to burden employees with "special" techniques and procedures.

When a practitioner's conduct disrupts the operation of the Hospital, it affects the ability of others to get their jobs done, creates a "hostile work environment" for Hospital employees or other practitioners, or begins to interfere with the practitioner's own ability to practice competently, action must be taken. Courts have consistently held that if a practitioner creates disharmony or disruption, the Hospital has a duty to intervene.

In addition to written policy and promotion of these new policy guidelines, physicians who are determined by the appropriate hospital committee or disciplinary unit to be "disruptive" must be mandated to participate in an appropriate intervention to address these issues and acquire appropriate interpersonal skills along with self-control, empathy, self-awareness and other key emotional intelligence skills.

Rarely are these physicians psychiatrically impaired, substance abusers or sexual abusers. Therefore, none of these options are available as resources without specific justification and documentation.
The typical physician referral is a highly skilled surgeon who is accused of throwing an instrument, cursing a staff member, yelling at co-workers or was impatient or discourteous to a patient. Stress is almost always a significant factor in the physicians' behavior.

Resources For "Disruptive Physicians"

Physicians and Healthcare Organizations nationwide are under pressure to find coaching resources for "disruptive physicians
." Mandating any physician to participate in an intervention for "disruptive behavior" is difficult for Physician Well-Being Committees, Medical Directors and Hospital Credential Committees as well as State Medical Licensing Boards.

Leaders responsible for managing physicians are willing to look the other way or do almost anything to avoid complying with this new Joint Commission requirement.
By delaying the decision to take action based on a distaste for adversarial tension, pressure begins to mount as the year comes to an end. Many organizations need to show evidence that they are following the Joint Commission Policy relative to mandating assistance for "disruptive physicians".

Two of the three major programs for "disruptive physician behavior" are already filled for 2017. These programs are the Distressed Physician Program at Vanderbilt University School of Medicine at Nashville and the PACE Program at the University of California School of Medicine at San Diego. Both the Vanderbilt Program and the PACE Program only accepts 8 physicians each quarter for its respective classes.

The largest provider of individual coaching for disruptive physicians is Los Angeles based Anderson & Anderson, APC. The uniqueness of the Anderson & Anderson curriculum is that it was specifically designed for "disruptive physicians." The Practice of Control, the client workbook and all of the DVDs, CDs and ancillary training material are carefully designed to improve assertive communication, increase self-awareness, self-perception, social awareness and relationship management and stress management.

Anderson & Anderson has a well trained Certified Coaching Faculty with the capacity to offer the internationally recognized EQ-i-2.0 Emotional Intelligence Assessment and intensive coaching On-site anywhere in the U.S. followed by six months of Aftercare and Post Tests. Emotional Intellige
nce Classes For The Prevention of "disruptive" Behavior at Work. In order to keep JCAHO accreditation, every hospital now must have a system in place for recognizing and effectively dealing with disruptive physicians — whether they’re on staff or simply have hospital admitting privileges.
In order to minimize the risk of adverse events and malpractice suits, medical groups must have the awareness and skill set to intervene effectively when a colleague or employee first begins behaving unprofessionally.

Organizations that identify and deal with disruptive behaviors and performance problems at the earliest stages can not only save a considerable amount of time and money — but also mitigate risk.

Since Emotional Intelligence is the core of most of the intervention programs for "disruptive behavior," it seems reasonable to offer general courses in emotional intelligence to physicians, nurses and other ancillary staff.

Such courses may focus on leadership, interpersonal relationships, self-control, social awareness, relationship management, stress management, decision -making or any of the many other emotional intelligence scales.

The American Medical Association as well as local medical associations are offering and/or promoting presentations on how to prevent or manage disruptive physician behavior. Kaiser
Permanente of Southern California has taking the lead in being proactive in preventing the consequences of "disruptive physician behavior" in hospitals and healthcare organizations.

 George Anderson, MSW, BCD, CAMF, CEAP

Monday, August 28, 2017

Is Anger Management A Viable Specialty Practice?

With the popularization of anger management in the media, many counselors, teachers and educators are flocking to Facilitator Certification Training in Anger Management. Many of these potential providers are attracted by the potential for providing anger management for profit.

As the major provider of anger management facilitator certification throughout the world, we are asked daily about the potential for establishing an anger management practice as a sole practice offering or as a separate area of specialization. Recently, we at Anderson & Anderson begin asking our active Certified Anger Management Facilitators (CAMF) for information regarding their current number of groups, executive coaching clients and related monthly income from private practice.

In January of 2017, a phone survey was made of the entire list of 45 Certified Anderson & Anderson Anger Management Facilitators in Los Angeles County. Of this group, 44 acknowledged earning what they considered to be an acceptable income from their anger management practice. Additional information was obtained from the one provider who was not profiting from his current practice. As it turned out, this provider offered only one group. This group was scheduled for Friday evenings from 7-9. The provider explained that this was the only time which he had available to schedule a class. 

Those providers who were successful offered classes days, evenings, Saturdays and Sundays. It is reasonable to conclude that the one provider who was not successful may have sealed his own fate by the lack of flexibility in his schedule. I personally interviewed this provider and asked if he would attend a class o Friday evenings if there were other options, his answer was no. I suggested that most potential clients would give the same answer.

During our survey, we learned that most Certified Anger Management Facilitators are Licensed Mental Health Clinicians or Substance Abuse Counselors who work full-time and have a small practice on a part-time basis. These Clinicians are not sophisticated in advertising, marketing, or the use of the Internet and most other small business practices.

Therefore, the question relative to the viability of anger management as a specialty practice is not much different than that of a psychotherapy practice. Essentially, it depends on the investment both financial and otherwise made by the provider. However, most anger management providers are able to do well at this time based on the inverse number of trained anger management providers in contrast to the need worldwide.

The average income from the part time practice of anger management ranges from a high of $12,000 per month for one provider with 5 locations to $2,000 per month for one provider who has two groups that meet once per week on Saturdays.

George Anderson, MSW, BCD, CAMF.

Friday, August 18, 2017

Aggressive Anger Is Becoming An Epidemic

2007 Presentation to Substance Abuse Conference at Jackson State University
Rather than speak for an hour as requested, I have opted to speak for 40 minutes and allow 20 minutes for questions and answers. Since anger management has been my area of specialization for the last 25 years, I am in daily contact with Certified Anger Management Providers from all over the world. These providers are the real experts on this topic.Therefore, in order to make this presentation more relevant to real world concerns, I decided to tap into my extensive network of anger management providers.
I sent emails to a select number of providers in Canada, Australia, England, Bermuda, Cayman Islands, the Philippines and the United States. In my email, I made a very simple request: Please send me ten reasons why anyone should consider completing an anger management course. I will share some of these responses with you, but, first, I would like to make certain that we define what anger management is and is not.
In passing, I would like to suggest that anger management became an international issue following the tragedy of 9/11. Prior to 9/11, anger management was becoming popular in the United States; however, it was almost unheard of in other non-English speaking nations.
According to the American Psychiatric Association, anger is a normal human emotion. It is not a pathological condition. Anger is not listed in the Diagnostic and Statistical Manual of Nervous and Mental Disorders.
Anger is considered by the American Psychiatric Association as a lifestyle issue which is a problem when it is too intense, occurs too frequently, lasts too long, impacts health, destroys interpersonal relationships or leads to person or property directed aggression.
Given this definition of unhealthy anger, it is immediately apparent that controlling anger is not the issue. Rather, it is unproductive anger that needs to be controlled. In Birmingham Alabama, a fragile quiet African American woman refused to give up her seat on a local bus to a white man (Rosa Parks). Her anger was the impetus to change the way the U.S. treated people of color. In this case, her anger was used in a positive way and did not need to be controlled. Controlling anger is important and necessary when the anger is a problem to the person experiencing it, or to others.
Mahatma Gandhi was angry over the domination of India by England. He used his anger in a non-aggressive manner to gain independence for India from England. Gandhi taught the world the importance of non-violent protest.
There is general agreement among most knowledgeable experts that the way one responds to anger is learned and, therefore, can be unlearned. Alternative approaches to dealing with anger can be taught like any other emotional intelligence skill.
Since anger is not a mental disorder, it is not responsive to counseling, psychotherapy or psychotropic medication.
Therefore, psychiatrists, psychologists, or clinical social workers are not necessarily trained to provide anger management classes unless they have completed specific Post Graduate training or Certification in Anger Management.(CAMF) If you take a survey of all the residency programs in psychiatry in the United States, you will find that none of these programs offer training in anger management. If you survey Ph.D. programs in psychology or MSW programs in Clinical Social Work, you will find that there is no training in anger management whatsoever.
Unfortunately, there is a natural societal tendency to assume that Doctors (MDs, PhDs) can provide the answer to any behavior that is considered unacceptable. In the case of anger management, this is simply not true. Anger management is a course or coaching that includes an Emotional Intelligence assessment, client workbook, videos, DVDs, posters and other ancillary training material. Specific material is critical in teaching enhancement skills in recognizing and managing stress, anger, improving assertive communication and enhancing emotional intelligence.
Anger is a normal, secondary human emotion that is always preceded by some other emotion such as stress, anxiety, depression, shame, disrespect or humiliation. Therefore, anger management classes must deal with the associated issues of stress, communication and emotional intelligence, that are keys to success in recognizing and managing anger and stress.
All participants in anger management classes should first complete an assessment, that is designed to determine the participant's level of functioning in recognizing and managing stress, anger, assertive communication and empathy or emotional intelligence.
A final category is, motivation to change, that is also important for success. Candidates who are not motivated to change are not likely to benefit much from participating in any type of anger management class.
Following the completion of an anger management class, each participant should complete a Post EI Assessment to determine the success or lack of success from participating in the course. Success is determined by the results on the Post Test and feedback from significant others.
Many, if not most of the news reports of persons attending anger management courses are inaccurate. Ron Attest is a major league basketball player currently with the Sacramento Kings. He was previously with the Indiana Pacers. Ron is reported to have completed an anger management class while with the Pacers.
This is incorrect. What really happened was quite different. Ron was ordered to see a Psychiatrist. The Psychiatrist informed him that he was suffering from depression and gave him a prescription for anti-depressant medication. Ron's response was, "bullshit, I ain't crazy and I ain't taking nothing". So, in this case, anger management was not a failure. Rather, it was never attempted nor completed.
Milton Bradley, who is now with the Oakland Athletics, was ordered by the Dodgers to attend an anger management class. He found a Christian Counselor from his mother's church who provided anger management counseling. Unfortunately, the counselor had no training or experience in anger management. This religious based counseling was not in anyway related to teaching skills to recognize and manage anger or stress.
Many celebrities, who are ordered to attend anger management classes through no fault of their own, receive either counseling for non-existing mental disorders or no help at all. But most of all, in nearly every county, there are classes for people ordered to attend anger management by the court – including such celebrities as Sean Combs, Courtney Love, Mike Tyson, Tommy Lee, Omar Sharif, Alec Baldwin, and Shannen Doherty. In spite of this, there is no state in the nation with standards that regulate the practice of anger management. Anyone can claim to provide anger management with or without training, experience or a specific curriculum.
Throughout the nation, such classes have become a fixture of modern life, run by thousands of criminal justice systems, private therapists and community mental health centers. The lack of a specific, tested curriculum is common nationwide.
The most credible research on the effectiveness of anger management comes from the Canadian Bureau of Prisons. The Canadian Bureau of Prisons has conducted a fifteen-year study that demonstrated that anger management classes are effective under the following conditions:
  • When there is a curriculum with client workbooks that include all of the material to be presented in the course.
  •  All providers are trained in the most effective techniques for teaching the course content.
  •   Pre and Post- tests are conducted on each participant.
  •  There must be integrity in the teaching of these courses which means that no ancillary handouts or shortcuts are taken.
I have many case examples of successes in anger management that I would like to share with you. In the interest of time I will now share with you, a summary of the responses that I received from this question: 
Why Control Anger? The most important reason to consider controlling unhealthy anger is the fact that legitimate anger management programs actually work. According to the Canadian study, 87 per cent of motivated participants who complete a structured anger management class teach the anger management skills offered in these classes.
Seven years ago, I conducted a pilot program for the U.S. Postal Service for 16,000 employees in one postal district in Los Angeles. In twelve months, the postal service experienced saving of 1.5 million dollars. There was a reduction of accidents, sick day usage, absenteeism and workplace violence. There was an increase in morale and productivity.
It has been a long time since you heard of anyone going postal. The Postal Service is proactive. Rather than waiting until a problem develops, the postal service has moved to prevent workplace aggression. Any Postal Employee can attend an anger management class on the clock for ten sessions without cost. A manager or supervisor can recommend anger management for an employee whose work performance indicates stress or anger. Any manager or supervisor can order anger management for an employee for behavior that suggests the need for help in managing anger as a condition of continued employment.
When Anger management is done properly, it can be a cost saving intervention. Anger management also reduces costly litigation. Currently, most referrals to anger management classes are from businesses including fortune 500 companies. When employees are the victim or perpetrator of verbal of physical threats or a hostile workplace environment, it poses a tremendous liability for the parent company. The average cost of an anger management liability lawsuit by employees is $700,000 per episode.
Therefore, it is in the best interest of the company to mandate anger management for employees who threaten or create a hostile work environment. My main office is located in Brentwood. Because of this, I receive a large number of referrals from the movie industry. Many of these referrals are from film production companies and Artist Agencies. Both film production and agencies representing artists are historically high - pressured places to work. 
I recently provided services for an agency executive who had lost an out of court settlement for creating an unsafe environment. He and his company had paid the settlement as well as the attorney fees and the court costs. To their surprise, three years later, they were forced by the litigants to follow through with anger management, which had been a part of the original settlement but was ignored.
Anger management improves the bottom line. The Malibu Realty Association contracted with me to provide emotional intelligence coaching for most of its members. While this is not anger management, it is one of the four topics that are the anchors of most anger management classes.
Anger management enhances communication skills. Assertive communication is one of the most powerful skills for anyone to acquire. I have many examples of this from clients who have taken the time to master assertive communication skills. For many anger management clients, anger management turns out to be a blessing in disguise.
  •   Anger management teaches stress management skills.
  •   Anger management leads to a reduction of sick day usage.
  •   Anger management reduces accidents and absenteeism.
  •    Anger management provides a framework to develop an early warning system to detect potently explosive employees.
  • Anger management Improves employee retention by improving the work environments using emotional intelligence and assertive communication.
  •   Anger management Reduces malingering.
Here are some of the benefits of controlling anger for individuals
  •  Anger management improves self-esteem.
  •    Anger management increases empathy.
  •  Anger management improves morale.
  •  Anger management improves leadership skills.
  •  Anger management improves interpersonal relationships.
Some benefits of controlling anger for physicians
As an indication of the importance of anger management, in the medical field, the Joint Commission on Hospital Accreditation has recently determined that all hospitals in the nation must have a written policy on "disruptive physicians". Disruptive physicians are defined as physicians whose aggressive behavior impacts patient care.
Anderson & Anderson has a contract to provide executive coaching for a hospital chain with 63 hospitals throughout the nation. In addition, we provide staff development in Emotional Intelligence. Below are some of the results that have been observed:
  • Anger management improves doctors' bedside manner.
  • Anger management improves patient care in medical settings.
  •   Anger management reduces staff burnout.
  • Anger management improves interdisciplinary communication.
  •  Reduces financial and/or legal problems.
  •  Anger management reduces staff turnover among nurses and ancillary staff in medical settings.
The advantages of introducing anger to substance abuse programs:
  • Anger management reduces relapse in substance abuse.
  •  Anger management can be apart of the program's Aftercare.
  •  Anger management can be used in Relapse Prevention.
  •   Anger management can be used in Activities of Daily Living groups.
  •    Anger management can be used in Family Groups.
  •   Anger management can be used for Staff Training, "Teamwork Building".
Anger Management can prevent a small relapse from turning into binging. Often, substance abusers themselves binge after a small relapse because the pain, shame and anger of relapse are uncomfortable in themselves. Anger Management is a deterrent to initial drug use as many drug users begin their drug career in an effort to escape pain and anger. Anger Management is essential in relapse prevention as drug users learn how to manage their emotions and reactions to daily life stressors. 
Some results of anger management in grade schools
A University of Florida study found that anger management lessons improved the behavior of all pupils, not just the troublemakers. Professor Stephen Smith and his team designed a 20-lesson anger management curriculum and tested it on 200 Florida pupils aged 10 and 11. They found that classroom 'harmony' improved when the children were taught how to control their temper and avoid trouble.
In summary, if anger management is defined as a class that is designed to teach skills in recognizing anger, stress, communication and enhancing emotional intelligence, anger management actually works. If anger management is defined as counseling or psychotherapy, it does not work. Regardless of the intervention offered, without motivation to change, nothing at all can be expected to work.
The most effective anger management intervention is provided by Certified Facilitators with a curriculum including an Emotional Intelligence assessment component as well as ancillary coaching/training material.
 George Anderson, BCD, MSW, CAMF