Staff Support Groups in the Helping Professions

Principles, Practice and Pitfalls

Phil Hartley, David Kennard, Phil Hartley, David Kennard

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9780415447737
• eBook ISBN: 9781134061778
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Staff burnout and work-related stress in mental health professionals cost the National Health Service not only millions of pounds each year, but also impact upon the welfare of those being cared for. Staff Support Groups in the Helping Professions takes the lead from recent Department of Health initiatives, promoting the use of staff support groups to foster emotional resilience, deal with potential conflict and support reflective practice.

In this book Hartley, Kennard and their contributors explore the influences that help and hinder the setting up and running of staff support groups, and attempt to counter the often negative reactions that the term 'staff support' can evoke. They demonstrate that such support groups can be a sophisticated and valuable intervention that needs careful preparation and skilful management to succeed, and will in turn not only benefit the individual, but also the department as a whole and those that they care for.

Contributors share their experiences of facilitating support groups in a number of settings including:

• psychiatric wards
• therapeutic communities
• social services
• schools
• children's homes.

Containing a wealth of case material, Staff Support Groups in the Helping Professions will provide much-needed guidance for those professionals attending, managing, or in the process of setting up a staff support group.

PART I

Chapter 1
What staff support groups are for

David Kennard and Phil Hartley

Staff support groups are for staff who work closely together under conditions of some stress—e.g. on a hospital ward, in a children’s unit, a secure unit or a hospice. They may be set up in response to a perceived problem in the staff team, or as part of a general policy for staff support and development. They are generally created with the twin aims of helping team members as individuals to cope with the stresses of the job, and helping the team as a whole to work better together.

In attempting to define the aims of staff support groups we meet the mix of straightforwardness and fuzziness that the reader will come to recognize as a feature. The following statements (some taken from other writers, some our own) address different aspects of what staff support groups are for.

1 To promote the value and the practice of open communication. Although we can all agree in principle with the importance of good communication between team members, there are often obstacles to translating this into practice. Some obstacles are practical (not enough time, too much information), others can arise between individuals—e.g. disagreements, feeling slighted—or in the team as a whole—e.g. low morale, feeing undervalued. Clearing away these obstacles to open communication takes time, commitment and practice.

2 To provide a protected time and space in which staff can get support from colleagues and learn from each other. In a busy, pressured environment, the commitment to spend one hour a week (or some comparable time) away from the coal face in a quiet, preferably undisturbed room, without a clinical or business agenda to get through, provides the opportunity to ‘touch base’—with colleagues and with oneself—and to develop the skills of open communication. Arguably it is the fact of the existence of this fixed, protected time ‘for the staff’ that is as important as what goes on within it.

3 ‘To improve staff well-being in ways that are associated with better patient care and smoother unit functioning’ (Lederberg 1998:276). Lederberg cautions that the demands of high-stress medical units require some suppression of feelings by the staff, and that it is the job of the support group in such settings to help maintain the viability of the work setting, and not to probe feelings except where these are harming the individual or the task.

To enable staff to express, discuss and manage difficult or painful emotional responses—such as guilt or anxiety—to people and situations in their work. ‘Difficult interactions with patients leave us with subjective experiences that are often unpleasant. We feel things, for example, frustrated, inadequate or angry. If we act on these feelings directly we run the risk of acting unprofessionally’ (Haigh 2000:312). Haigh is explaining the need for staff sensitivity groups. Although staff support groups are different in some ways (see below) the point is equally relevant. We owe it to ourselves, our colleagues and our patients/clients to be aware of our personal reactions to our experiences at work, and to cope with them in ways that don’t end up compromising the help we offer, our working relationships, or our own health and well-being.

‘To enable staff to use the full range of their emotional responses in the service of the task—not to have to protect themselves by shutting down emotionally’ (Farquharson 2003). This expands the above aim. One way of coping is to switch off all our feelings, just to get through the day. The problem with this is that it means we also switch off our sensitivity to others’ feelings and emotional states. We can miss cues, and be experienced as brusque or giving inappropriate responses. In providing the opportunity to become aware of their emotional responses, staff support groups can help staff to cope with their own reactions in more constructive ways.

‘To create an environment where the vulnerable parts of ourselves, which have been shielded by our defences, can be responded to and understood’ (Rifkind 1995:211). Rifkind points out that we may be afraid of revealing our feelings because it would leave us vulnerable to criticism, or give the impression of not coping. She notes that in a staff group ‘we feel the pressure to claim that we are coping with change and doing a good job’. Enabling staff to acknowledge their vulnerable sides without this being seen as a sign of weakness or needing special help—normalising vulnerability—is a core aim of a staff support group.

To enable the team to discuss obstacles to team working that may arise from issues between individuals, within the team as a whole, or between the team and the wider organisation. This last aim is a catch-all that may more properly belong with a group set up specifically to explore staff team relations, group dynamics or organisational issues. However, where these are clearly impinging on a team’s functioning or on staff well-being, the staff support group can address the problem.

The reader will see that the above aims range from ones that would be widely accepted as a ‘good thing’ through to those that deal with more deep seated, harder to reach aspects of a team’s experience. Bolton and Roberts (1994:157) have found it useful to distinguish between three levels in the aims of staff support groups. There are the overt, publicly stated aims (e.g. to improve staff communication), there may be covert aims which are known to some participants but are not openly acknowledged (e.g. to cope with a difficult team member, to push through unpopular changes), and there may also be unconscious aims which ‘remain to be discovered’. We will return to these levels in looking at different agendas in responding to requests for a staff support group in Chapter 4.

HOW STAFF SUPPORT GROUPS DIFFER FROM OTHER KINDS OF STAFF GROUPS

Another element of fuzziness we have to negotiate is the lack of clear distinctions between different kinds of staff groups. Many labels are used for groups that are created to help staff in care-giving settings with their work. You may have come across the following:

• case discussion group;

• continuing professional development group;

• consultation group;

• experiential group;

• personal development group;

• process group;

• reflective practice group;

• seminar group;

• sensitivity group;

• staff support group;

• supervision group;

• training group.

It doesn’t help that these terms are only a loose guide to what actually happens in a group. It is likely that some groups that are similar in practice will have different names, while groups with the same name may operate differently from each other.

A name may be chosen for a variety of reasons. One of the authors was invited to run a ‘supervision group’ on a hospital ward but soon realised that what was wanted was more like a staff support group, exploring communication issues within the team. It seemed that calling it supervision may have helped the group feel more ‘contained’ and task-focused. (Avoiding the term ‘support’ is taken up in Chapter 2.)

In what follows we give what we see as the main attributes of the more commonly used terms, and in doing so try to highlight what is distinctive about staff support groups.

Reflective practice groups

The concept of the reflective practitioner was introduced in the 1980s by Donald Schon (Schon 1984). Reflective practice has become widely used in higher education and in the training of health professionals including nurses, midwives, physiotherapists and clinical psychologists. Reflective practice has been described as a process by which the practitioner should stop and think about their practice, consciously analyse their decisionmaking processes, and relate theory to what they do in practice. This can take place in different ways, e.g. keeping a diary, peer review, in clinical supervision and through significant incident analysis. It can also take place in groups, either in the context of a training course, or in the everyday practice of a team or a hospital ward.

Our impression is that in some settings the term ‘reflective practice group’ nowadays refers to what would have been called a ‘staff support group’ 10 or 20 years ago. The change in name in this case may reflect more a change in fashion than in actual practice. Both staff support and reflective practice groups provide an agreed time and place to step outside the work with clients to reflect on what was done and the feelings aroused. Both encourage sharing of experiences, drawing on and learning from colleagues’ experience. Where differences occur, they are most likely to be in the degree of structure and the role of the facilitator. The reflective practice group may be more structured, with a timed format ending with an action plan. The structure will also encourage members to maintain a degree of emotional detachment. The facilitator may take a tutorial role, bringing in relevant policies, theories and evidence. By contrast a staff support group is relatively unstructured, encouraging the expression of emotional responses, and the facilitator is likely to focus on members learning from their own and each other’s experience.

Sensitivity groups

As with reflective practice, the term ‘sensitivity group’ is sometimes used interchangeably with staff support group. Again the aims are similar—to help staff be aware of and cope with their personal responses to challenging people and situations. However, a sensitivity group explicitly focuses on the personal relationships and dynamics within the team, and requires a commitment by the group members to exploring these despite the discomfort this may cause. To the extent that it pursues this exploration a sensitivity group may not be experienced as supportive. However, it has been observed that, ‘The measure of efficiency of a staff sensitivity group is not necessarily the amount of support that happens inside the group but the amount of support that happens elsewhere outside of the group’ (Winship and Hardy 1999:309).

Bramley (1990:302) has offered the following comprehensive definition of the task of a sensitivity group: ‘to come to a better understanding of the manifest and latent relationships between, and reciprocal influence of, self, colleagues, clients, the job itself, and any relevant wider context, so as to improve job performance.’ Sensitivity groups may be particularly valuable for staff teams that use a psychodynamic approach in their work and who value the exploration of hidden or unconscious elements in personal relationships as a relevant and necessary part of their job.

An important difference between sensitivity and support groups is that in sensitivity groups exploration of staff relationships is a required task, whereas in staff support groups relationships may be explored in the context of a particular issue—e.g. coping with organisational change—or if they are having an effect on team working or well-being, but this is not the primary aim of the group.

Supervision groups

The main aim of supervision is to help practitioners monitor and improve the quality of their work with patients. However, it does also have an important supportive function. In Supervision in the Helping Professions Hawkins and Shohet (2000:22) describe supervision as, ‘a central form of support, where we can focus on our own difficulties …’. In writing about supervision in groups, Hawkins and Shohet identify three types of supervision group: those that only meet for supervision, those that work as a team but with different clients, and those that work as a team with the same clients. Staff support groups are for the second and third of these and mostly the third—teams who work with the same client group.

Supervision groups are also likely to function differently from staff support groups. Groups may be quite small (typically 3–5 supervisees) with the focus clearly on individual learning. There may be explicit agreements on the supervisees’ and supervisor’s roles and responsibilities in the group, and different formats according to the members’ level of development (Proctor 2000). Members usually take it in turns to present a case, which is then discussed by the group with the supervisor facilitating the discussion and helping the group to make theory-practice links according to the therapeutic model being practised. Case discussion groups are similar to supervision groups but may focus more on the particular issues raised by the case present...

Table of contents

• Contents
• Editors
• Contributors
• Foreword
• Preface
• Acknowledgements
• Introduction
• PART I
• PART II
• Editors’ conclusion
• References
• Author index
• Subject index