Problem
Case Study
The sexuality and gender group at the women's residential substance abuse treatment facility meets twice a month. This is a support group for lesbian, bisexual, and transgender women, as well as women who are questioning their sexuality and/or gender identity. Women in the treatment facility are informed about the group by their counselors, and participation in the group is strictly voluntary. The facilitator is a licensed clinical social worker who is also a social work professor and a lesbian. The composition of the group can change with each session because women are entering and exiting the facility regularly. Typically, 8 to 15 women attend the group. The duration of the treatment program is 90 days; however, some of the women choose to leave the program before treatment has been done. Many of the women in the group are parents; some of them have brought their children into treatment with them because one of the treatment programs at this facility allows women and their children to come into residence. Most of the women in this group identify as African American or Latinx and range in age from 19 to 50. The facilitator is Jewish and in her early 40s. The following is an account of one of the group sessions. Pseudonyms for all the group members and the facilitator are used in this case.
Deb has been facilitating the sexuality and gender group at the substance abuse treatment facility, the first of its kind at this facility, for about a year. It has been a good learning experience for her, and she has grown quite attached to the group. She particularly is impressed with the candidness of the group members and often refers to this population of women as superb "BS detectors" because they are not afraid to call each other out when denial or deceitfulness surfaces.
The group members are already in the lounge where group meets when Deb arrives. She smiles and acknowledges each of the group members through eye contact. She notices that out of the dozen women in the room, about eight of them were there for the last group session. Deb introduces herself and makes a point to say that she is a lesbian but not in recovery, although she has worked with many women who are in recovery. She mentions where she works and how long she has been facilitating this group. She then asks the women to introduce themselves using first names. In their introductions, some of the women mention why they have come to group or how long they've attended group. Two of the women share that they were curious about the group but don't identify as lesbian or bisexual; however, they have considered same-sex relationships and have had feelings of same-sex attraction. One of the group members notes that she has recently exited the prison system and had relationships with other women while she was incarcerated but never while "on the streets."
Deb describes the purpose of the group as a place for members to talk about sexual orientation, whether they are lesbian, bisexual, or questioning. Deb stresses that what is said in the room stays in the room and that members should refrain from sharing someone's story with others outside of the group. Confidentiality is especially important to emphasize in residential programs. Deb also mentions that the group is open and that members can freely discuss what they want to.
Deb usually has a loosely planned agenda for each group session but also waits to see what issues may get raised in the introductions and check-in at the beginning of the group. Today, she brought the documentary film All God's Children to show the group (Mosbacher et al., 1996). The film highlights the experiences of African American lesbians, gay men, and bisexual individuals, particularly related to family, church, and community. It's a powerful film and reminds the group members that their sexual orientations are not experienced in a bubble; rather, the intersections of faith, neighborhood, geography, and other identities and characteristics influence how they experience their sexual orientations.
One part of the film seems to arouse much energy and discussion: whether a person is born gay or makes a decision or choice to be gay. Tamika, one of the younger women in group, strongly asserts that a person chooses to be gay. She shuns the labels of lesbian and bisexual; instead, she prefers to allow herself to date or fall in love with whoever is attractive to her, regardless of their gender. Monica, a woman in her early 50s, disagrees that sexual orientation is a choice. She shares a story of how she "knew" she was a lesbian when she was 12 and she fell head over heels for a girl in her neighborhood. She tried to suppress those feelings and pretended she was into boys all through middle school and the beginning of high school. By her junior year, she just couldn't pretend anymore. She secretly would date girls, but no one in her family or her church knew. To this day, many years later, she has never openly said to any of her family members that she is a lesbian. They all seem to know that she is, but it isn't discussed. She experienced a deep hurt at her church when her pastor delivered a sermon that Monica thought was very antigay. Her parents insisted that she attend church. She really didn't want to go to church after that sermon, but she also didn't want to tell her parents the reason why. That wasn't the first or last time that antigay remarks were made in her church. Gail, usually quiet in group, shares that her experience at church has been the opposite of Monica's. Her family attended a progressive church and persons of all sexual orientations were welcomed. She still hesitated to come out to her family members when she first began dating women but then eventually began to disclose to the family members to whom she felt closest. Their positive responses encouraged her to continue to disclose to other family members and close friends.
The discussion of the film moves the group into deeper core themes related to their sexual orientation and their addiction. As the facilitator, Deb looks for opportunities to work the parallel process in group-to note the similarities between the negative consequences of an addiction and the experience of being a sexual minority who is often discriminated against and ostracized. A few of these common issues include shame, fear, emotional dependence, and despair and loneliness. Shame is a particularly powerful emotion; the women in the group connect shame to experiences they've had as sexual minorities and the guilt and embarrassment about behaviors in which they've engaged while they were using drugs. Negative judgments from others about their sexual orientations and/or their addictions exacerbated the shame. One of the group members shares with the group about how she would get high in order to allow herself to be intimate with women. She thought it was the only way she could mask her fear and shame about her attraction to other women. Many of the group members struggle with feelings of internalized homophobia. In the group, Deb emphasizes how acceptance of oneself is important to group members' emotional health.
The group comes to a close. Most of the women have spoken in group today. The film seemed to strike a chord with many of them. On the way back to her workplace, Deb thinks about all the group members and what they shared that day. She feels fortunate to be let into the inner lives of the women during a time when they are working hard to heal.
Task
A. Which group process theories seem most relevant?
B. Discuss how each theory could be applied to analyzing the group process in the group session that is described.
C. Could this group be offered as a virtual (online) group?