The Structure & Theory Behind Dana’s House Coping Skills Group
Group Plan
My Wednesday Coping Skills group at Dana’s House is for men recently released from prison who live at the house and have diagnosed or suspected mental health conditions. Most of the men living in the house are middle aged, Black or Latino and have lived together for about a year. Practically all of these men have been subject to community violence, family separation, discrimination, stigma, overpolicing, and structural barriers to housing and employment. Nearly all of these men have probation or parole constraints that limit their ability to engage fully with the larger community, as well as legal stressors and mistrust of institutions. Most of these men carry strong patriarchal values and exhibit hyper masculinity.
The primary goals of this group are to help my clients build practical coping skills to manage negative emotions, replace maladaptive coping skills, improve emotional regulation and distress tolerance to reduce impulsive or violent responses, foster healthy interpersonal connection, increase problem solving and adaptive thinking, reduce shame and increase client agency through culturally sensitive mutual aid. The group centers on core themes from Cognitive Behavioral Therapy and Dialectical Behavioral Therapy. On any given week we may touch on topics such as mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness, and other such topics.
I approach each group using a motivational interviewing tone, viewing each client through a strengths based and trauma informed perspective. The group follows an agenda to ensure a successful session. The first 10 minutes are spent allowing each group member to check in and share how they are doing in a sentence or two. The next 5 minutes are spent going over the agenda for that week's group as well as a brief review of last week’s topic. The next 20 minutes is spent teaching the CBT or DBT skill the group is focused on. Then the next 20 minutes of the group are spent doing a short activity to help clients learn to integrate the new skill into their daily life. The final 5 minutes are given for group members to ask clarifying questions.
Theoretical Foundations
A theory which supports the framework of this group is Relational Culture Theory. Relational Culture Theory suggests that human growth and resilience are rooted in connection and mutuality within interpersonal relationships (Wellesley Centers for Women, 2018). The theory suggests that healthy relationships are characterized by mutual empathy, empowerment, and honesty (Wellesley Centers for Women, 2018). Such relationships challenge more patriarchal models of relationship that emphasize individualism and separation. It could be argued that these traditional patriarchal models of relationship may be at the very root of what landed many of the members of the group into the legal system in the first place (Mereish, Poteat, 2015). The group exhibits Relational Culture Theory in that the group seeks to provide a community of mutual aid for the clients emphasizing RCT values empathy, empowerment, and honesty (Mereish, Poteat, 2015).
Intervention Models
Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are the main intervention models used in this group. CBT and DBT are both types of talk therapy that address negative thought patterns (Afshari et al. 2022). DBT is a more comprehensive and specialized form of CBT to treat acute behavioral and emotional issues (Afshari et al. 2022). CBT and DBT are ideal for these clients due to their emphasis on emotional regulation, distress tolerance, impulse control, and mindfulness which work to prevent high risk behaviors and support client reentry into the larger community (DBT vs CBT, n.d.).
Applications of Interventions
Using the “Group Handouts Appendix” section (found after the References page of this paper), in Handout 1: Mindfulness Group the intervention strategies include deep breathing as an anchor, mantra use for grounding, nonjudgmental observation of one’s internal state, and sensory grounding. In Handout 2: Self Validation Group the intervention strategies include teaching clients to acknowledge their emotions without judgment, allow their feelings to exist without suppression, and understand the context behind their emotions. In Handout 3: Relationship Management Group the intervention strategies include teaching clients how to have assertive, non defensive conversations, how to give and receive feedback in a healthy manner, manage conflict effectively, and how to express appreciation to loved ones in an appropriate manner.
These interventions are ideal for our group, consisting largely of Black and Latino men recently released from prison, many of whom experience chronic community trauma, mistrust of institutions, internalized patriarchal norms, emotional suppression and behavioral risks. These group interventions directly target these issues. Mindfulness offers grounding from emotional arousal and distress, self validation reduces shame surrounding criminal history and seeking help, relationship skills help reduce interpersonal conflict in communal living and decrease recidivism. Each intervention is trauma informed, culturally humble, and provides practical coping skills that each client can use in their daily life.
Managing Group Dynamics and Risk
Our group dynamics include a handful of dominant speakers, often the most hypermasculine members of the house who also function as house leaders, these men do most of the talking in the group. Most of the others function as silent members, taking their lead from the dominant speakers, speaking the way they do and according to the topics the dominant speakers are on when these silent members do speak. Occasionally we have resistant members, often those who distrust me due to institutional trauma. To address these dynamics, I try to support silent members using multimodal participation during the activity portion of the group such as writing, drawing and craft making. I also try to address the more dominant members of the group by gently redirecting them using motivational interviewing skills. Throughout the group I often try to highlight the group members' shared experiences and strengths, avoiding triggering content or language, and maintaining predictability and consistency each week.
Monitoring & Adjusting The Group
Group progress is monitored through a combination of client feedback, behavioral observation, and personal reflection. Feedback from my clients primarily comes from weekly check ins, where each member shares their current emotional state and how their day is in one to two sentences. Changes in how clients describe their emotional states serves as qualitative indicators of progress in my work with them. Behavioral changes are assessed by observing shifts in emotional regulation, interpersonal interactions, and impulse control within the group and within the Dana’s House community structure. Indicators of successful group sessions include increased willingness to participate, reduced conflict between house members, greater use of mindfulness and grounding strategies in moments of crisis, and more assertive rather than defensive communication in group.
This group is a constant in the life of the clients of Dana’s house for the year or more most of them spend here. I often reflect each week on what group topic the clients need that week. I have a wealth of group handouts and group facilitation plans at my disposal that I used during my time as an intern at Dana’s House. Now as an employee, I typically do not officially decide what group topic I will do that week till I have gone in and talked with the clinician and clinical director about where they feel the clients are at and how they are doing and compare it with my own contemplation on the state of our clients. I talk with the clients at their breakfast time and hear about their week. Finally, in light of those conversations I pick what topic we will have group on for that afternoon and print the relevant materials. In this way, the group is largely client led in the sense that each week I strive to tailor the group based on what they are actually experiencing and the challenges they are facing in that particular week.
Integration of Art Therapy For Client Self Expression
Art therapy is a powerful and culturally responsive group intervention that aligns well with CBT and DBT principles, especially for clients who struggle with emotional expression, shame, hypermasculinity, and mistrust of traditional therapy. Many formerly incarcerated men have learned to suppress emotions as a survival strategy, art and creativity offers a safer, nonverbal avenue to tap into their interior life. I have used art therapy throughout my time at Dana’s House and have found it to be one of the most powerful outlets of self expression and self reflection for my clients. Art therapy activities allow my clients to externalize and outwardly visualize their internal processes, making abstract concepts more concrete and less threatening for them. The physical art piece itself also gives them a thing they can hold up and share with the group in discussion which takes the direct focus of the discussion off of them and onto the art which enables more emotionally guarded clients to speak.
The power of art therapy is that it does not require artistic skill. The focus is on expression, not aesthetics. This makes participation accessible to all group members no matter their artistic background. Art therapy gives group members a shared, hands on task that lowers their emotional defenses. When clients sit together creating something, the environment becomes less hierarchical, less confrontational, and more communal. You will find group members often looking over at each other’s drawings with curiosity rather than with judgment, finding common ground in the shared experiences expressed in each other's art, participating without fear of appearing vulnerable. This fosters what Relational Cultural Theory calls mutual empathy and mutual empowerment, helping to rebuild relational trust that has often been damaged by incarceration and trauma (Davis et al. n.d.).
Reflection
CBT and DBT are deeply similar when used in either group or individual therapy. Both emphasize coping skill development, emotional regulation, and client empowerment. However, the way these topics emerge can differ based on the setting. In individual therapy, interventions are highly personalized. Clients explore thoughts, behaviors, and trauma histories at a depth that might not feel safe in a group setting. Safety planning and coping strategies are tailored directly to the client's unique triggers, symptoms, and personal goals. While in group therapy, shared experiences and mutual aid are emphasized. For clients coming from incarceration and traumatized communities, seeing peers struggle with similar emotional patterns reduces shame, increases connection, and strengthens their motivation. In a group setting, coping skills are taught in a more structured, educational format, with practice built into group interaction.
References
Afshari, B., Jafarian Dehkordi, F., Asgharnejad Farid, A. A., Aramfar, B., Balagabri, Z., Mohebi, M., Mardi, N., & Amiri, P. (2022). Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder. Trends in psychiatry and psychotherapy, 44, e20200156. https://doi.org/10.47626/2237-6089-2020-0156
Davis, J. M., Harris, C. E., & Edwards, J. B. (n.d.). Relational Cultural Theory: A Perspective for Adolescent Development. Georgia Southern Commons. https://digitalcommons.georgiasouthern.edu/nyar_savannah/2016/2016/88/
DBT vs CBT: DBT Outperforms CBT in Justice Settings with 40% Lower Reincarceration Rates. (n.d.). https://paloaltou.edu/resources/business-of-practice-blog/dbt-vs-cbt-dbt-outperforms-cbt-in-justice-settings-with-40-lower-reincarceration-rates
Mereish, E. H., & Poteat, V. P. (2015). The Conditions under which Growth-Fostering Relationships Promote Resilience and Alleviate Psychological Distress among Sexual Minorities: Applications of Relational Cultural Theory. Psychology of sexual orientation and gender diversity, 2(3), 339–344. https://doi.org/10.1037/sgd0000121
Wellesley Centers for Women. (2018, April 4). The development of Relational-Cultural Theory. Wcwonline. https://www.wcwonline.org/JBMTI-Site/the-development-of-relational-cultural-theory
Group Handouts Appendix
Handout 1: Mindfulness Group
Basics of Meditation ~ Staying in The Present
Breath deep. Use your breath as a focal point and/or anchor for your meditation. Breath deeply in through the nose, filling the belly, then out through the nose. Deep breathing helps to calm the body and relax our thoughts
Deep breathing can also be aided with the help of a religious or secular mantra such as (In Breath) Lord Jesus Christ (Out Breath) have mercy on me. Or something like (In Breath) be here (Out Breath) be now. Mantra helps to anchor our attention on the present moment while encouraging positive thoughts and eliminating negative thoughts.
Observation of one’s surroundings without judgment is also used to ground the mind in the present moment. This is best done in pleasant places like on a nature walk, but can always be done anywhere. Passively observe your surroundings with relaxed eyes. What do you feel? What do you see? What do you hear? Observe any negative or positive judgements your mind may try to place on the things in your surroundings “I see an ugly wall.” … “I hear a scary police siren” … try to eliminate those ideas of “ugly” or “scary” when they come up in your mind and allow the wall to simply be a wall, the siren to simply be a siren, without judgment. Instead try to take delight in the “isness” of your surroundings and most especially of your own self here in the present.
Mantras
Note: The “,” symbol is used to separate the part of the mantra at which you breathe in and the second part at which you breathe out.
Religious
Lord Jesus Christ, have mercy on me. (Christian)
Sweet Heart of Mary, be my salvation. (Christian)
La ilaha illallah, muhammadur rasulullah. (Muslim)
Elohai neshama, shenatata bi. (Jewish)
Om Gum, Ganapatayei Namaha (Hindu)
Sat, Nam (Sikh)
May the arms of the Great Mother, ever surround me. (Pagan/Wiccan)
Secular
Be here, be now.
I have everything I need, I am who I wanna be.
I am loved, I am worthy.
I breathe in trust, I exhale doubt.
I do all things in love, in love I do all things.
It's not a good feeling, it's not a bad feeling it just is.
All I need, I already have.
Handout 2: Self Validation Group
Self Validation
Self-validation is a distinctive DBT skill that focuses on accepting the emotions you are experiencing. If you have trouble regulating your emotions, then you probably have a hard time accepting them in the first place as well. You feel sad, or angry about something that happened around you, and you immediately tell yourself "I shouldn't feel like this, I should know better". So, on top of your primary emotions, you build other negative secondary emotions as a response. This can be a very exhausting and uncomfortable process. Learning to self-validate your emotions will help you cope with the overwhelming emotional process.
Step One: Acknowledging
The first step is to simply acknowledge the emotion that you are experiencing right now, without judging it. Just put a name on whatever you are feeling right now. If you feel sad, then just repeat that sentence to yourself without getting lost in the self-deprecating train of thought. Instead of saying to yourself "I am always feeling sad, I am so weak and unworthy of anything because I can never pick myself up", simply acknowledge the fact that the emotion is there: "I am feeling sad."
Step Two: Allowing
This step focuses on reminding yourself that it is okay to experience any emotion. You are allowed to feel whatever you feel right now or in an overwhelming situation that makes you feel intense emotions. Below are some statements that you can use to get in the headspace of allowing yourself to let the emotion be:
It is okay to feel the way I do right now.
I am allowed to experience this emotion.
Allowing myself to feel this way doesn't mean that I am behaving accordingly.
This will pass, but for now this emotion is here.
This emotion is uncomfortable, but it won't hurt me.
Step Three: Understanding
The last step is meant to help you create a context for the emotion you are feeling. Many of us don't always stop to try and understand why we feel the way we feel. In this step, take your time to think about the past events that have led you to experience this particular emotion. Don't judge yourself, just think about the objective facts that formed the context you are in right now. If you say to yourself that "I was being stupid, and that created my feeling of anger" -those are not the facts, but you judging yourself. Instead, you could say "It is no surprise that I felt so angry, since I always think that people will abandon me if they don't return my call".
Handout 3: Relationship Management Group
Video: The difference between healthy and unhealthy love | Katie Hood | TED
https://www.youtube.com/watch?v=ON4iy8hq2hM
Skills of Relationship Management
Communicating assertively. Use assertive, non-defensive communication that avoids aggressive, passive or passive-aggressive behaviours.
Giving and receiving negative feedback. Share negative feedback in a constructive and respectful way. This can help reduce your own and others’ negative reactions and responses.
Managing conflict. Approach, manage and resolve emotionally charged conflicts and disagreements effectively.
Influencing others positively. Understand how to effectively manage the emotions of a team or group.
Relationship Management Strategies
Improve listening and speaking skills
It can be challenging to communicate when emotions are involved. Communication can be more difficult and demanding than in calmer or more neutral situations. A few basic tips can improve your communication style when speaking and listening to someone with negative emotions.
Emotionally intelligent emailing
Many of us use email and social media to connect with the people in our lives. In many work spaces, this is a necessary part of the job. These can be an easy and quick ways to deliver information. There’s also a risk the message can be perceived in a different way than intended.
Express respect and appreciation
People feel good about themselves and proud of their contributions when they get positive feedback. It can help them feel capable, motivated and valued. It can also boost the person’s confidence and help them develop a meaningful bond with others. Expressing respect and appreciation is important to maintaining positive relationships.
