Cohesion in therapy groups is the most widely researched therapeutic factor and is consistently correlated with positive patient change in the general group therapy literature, (Burlingame et al., 2018) and in research specific to the treatment of adults who sexually offend (Beech & Hamilton-Giachritsis, 2005).  Cohesion has been defined in a variety of ways and generally refers to the connection group members feel to each other and to the group.

Our role as group facilitators is to first create, and then maintain, a safe and predictable structure (time, personal boundaries, attendance, financial expectations, etc). Within that safe structure the group members can freely interact with each other, present their own therapy work and experience positive and constructive feedback.

How we facilitate the group may be the most important interpersonal and interactive dynamic factor in an ongoing group process. This means that our role, and how we verbally, nonverbally, and interpersonally work with the group has a significant influence on the evolution of the group relationships and ultimately, the occurrence of cohesion between members.

We can visualize sitting in the room with a group in a variety of ways. We can be at the center with the group around us as though we are the hub of the wheel with all interactions cycling between group members and us as the facilitator in the center of the room (think spokes of a wheel). Clearly most groups do not operate this way and are not set up this way. Ideally, a group is in a room sitting in a circle so that all members can see each other and the facilitator is part of this circle. Even in this scenario it is common that we as facilitators are still the focal point. In other words, interactions that occur are between individual members and the facilitator. A visual of this is that if we draw a line between all the group members and the facilitator instead of each member focused on the facilitator our role is to help each group member talk to each other so that we become less of a center and the primary focal point. This role of facilitating the members talking to each other is critical to how we can facilitate the evolution of the experience of cohesion.

Eye contact is an important non-verbal facilitation technique where we visually encourage group members, even during a brief check-in, to talk to the group instead of focusing on us as facilitator and note taker.  We do this by looking at the whole group and scanning the whole group when assignments are presented, or a particular issue is discussed by a member such that we that we are nonverbally demonstrating looking at all group members and not focusing on one person.

For example, John has an assignment and asked for time. He presents the assignment, and he looks at the facilitator because the facilitator is taking notes. The facilitator, being a good interpersonal communicator and wanting to be attentive, makes eye contact with John as he presents the assignment and waits for feedback. This becomes an interaction between John and the facilitator. The longer this goes on the longer the facilitator is not seeing the whole group and the more John is focused on presenting his assignment to the facilitator. Over time this becomes the experience of individual therapy in the group.

John presents the assignment and,
The facilitator keeps eye contact with John, and
John has a question or finishes and looks at the facilitator for feedback, then
The facilitator gives feedback to John while the group listens and observes.

When John is finished the facilitator naturally wants to give feedback and John wants feedback from the facilitator. All of that nonverbal interaction reinforces that this is a conversation between John and the facilitator. This occurs so naturally that it's often hard to even see the pattern and therefore hard to interrupt the pattern.

An alternative when John is finished is to say,

“What does the group want to say to John about his assignment?”  Making that statement and looking at the whole group and then being silent encourages the whole group to engage and to give feedback. This method takes repetition.

Again, ask the whole group, “What feedback do you all have for John?” That is called a whole group intervention. “What feedback do you all have for John?” And then silence. One group member gives feedback. Silence.

Again, we say, “What do the rest of you think about the work John just did?”  Silence. Repetition.

“What did the rest of you think? Any other feedback for John?” And again, looking at the whole group. And silence.

The silence allows for more hesitant members to speak up, and it also reinforces that the expectation is that the whole group contributes. What often happens is one group member will give feedback and then that's the end of the feedback, even though only one member out of seven or eight or nine members gave feedback.

So, the repetition, “What other feedback does the group have? And then silence. “What other group members have feedback?” What are the rest of you think? Silence. This is repetition of whole group questions not directed to John. And then silence by the facilitator.

So as a facilitator, it is essential to be looking at the whole group. We can call that roving eye contact. So that we're not simply looking at John, but we're looking at the whole group. And by virtue of that, we are encouraging John to be seeing and looking and talking to the whole group. Even though it's thought of as really good role modeling and social skills to make eye contact, we don't have to be looking at John the whole time that he is presenting his assignment. We can be looking at the whole group while we're still paying careful attention to what John is saying.  

Facilitating member to member engagement and interaction is an important group therapy skill that can lead to the experience of connection which is the foundation of a cohesive group experience for all members.

References

Beech, A. & Hamilton-Giachritsis, C. (2005). Relationship between therapeutic climate & treatment outcome in group-based sexual offender treatment programs. Sexual Abuse: A Journal of Research & Treatment, 17, 127-140.

Burlingame, G.M., McClendon, D., & Yang, C. (2018). Cohesion in Group Therapy: A Meta-Analysis.  Psychotherapy, 55(4), 384–398.