Using Groups to Help People

Dorothy Stock Whitaker

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134645503
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

This new edition of Using Groups to Help People has been written with the interests, needs, and concerns of group therapists and group workers in mind. It is designed to help practitioners to plan and conduct therapeutic groups of diverse kinds, and it presents frameworks to assist practitioners to understand and judge how to respond to the unique situations which arise during group sessions. It deals with such issues as:

• choosing groups formats and structures to match the needs and capabilities if different populations of people
• observing and listening to groups, and making sense of what one sees and hears.
• problem situations, and how they can be turned into opportunities why, how and when to intervene in a group
• events which can occur in therapeutic groups which cannot occur in individual psychotherapy, and implications for the therapist uses and misuses of theory when planning and conducting groups
• planning and conducting research on one's own groups and those of colleagues.

This practical and readable book will prove valuable to all those involved in making use of small face-to-face groups to benefit their members. It takes into account new developments in the field during the past fifteen years, including new writing and the author's further experiences and thinking during this time.

Part I

Thinking about groups before any plans made or actions taken

Chapter 1
A therapist’s purposes in conducting a group

WHY BEGIN WITH PURPOSES?

This is a book for practitioners, and practitioners are constantly engaged in making decisions. Amongst the decisions which face a group therapist are: Should this group proceed by open discussion, or by topics, or by activities, or by some combination? If topics are to be used, should I introduce them or should I encourage the group members to identify topics they wish to discuss? If activities are to be used, how should they be chosen? Should the group be time-limited or open-ended? How long should each session be, and how frequently should the group meet? What preparatory work do I need to undertake, if any? What shall I say and do when a group first meets? What should I be paying attention to while a group is in session? How and when should I intervene, and when is it best to say nothing? What should I say and do if the whole group turns on me? if one person gets extremely distressed? if two members attack one another?

Decisions and actions are guided by purposes. It is therefore reasonable to begin by thinking about the purposes which a therapist holds when planning and conducting a therapeutic group.

This chapter is organised as follows:

• A therapist’s overall purpose.
• Instrumental or sub-purposes.
• Interconnections between instrumental purposes.
• A rationale for this way of formulating a therapist’s purposes.
• Additional purposes likely to be held by a therapist.
• Distinguishing between purposes, goals, aims and tasks.
• Further questions arising from the statement of overall purpose.

A THERAPIST’S OVERALL PURPOSE

Anyone who conducts a therapeutic group, whatever its form, intends to make use of the group situation to benefit each person in it. This is an overall purpose. It can be stated more formally as:

A group therapist’s overall purpose is to enable and assist each individual in a group to achieve personal benefit through making as full use as possible of the potentials of the group as a medium for help.

This overall statement of purpose needs to be spelled out, or ‘unpacked’. A set of sub- or instrumental purposes is needed to help therapists to see what to work towards if the overall purpose is to be achieved. Such a set of instrumental purposes should suggest foci of attention and directions for a therapist’s efforts. Instrumental purposes need to be more specific than the overall purpose but not so situation-specific that a vast number of them need to be stated, each applying only to a narrow range of tasks or situations.

The six sub- or instrumental purposes which follow are one way of factoring out the overall purpose.

INSTRUMENTAL OR SUB-PURPOSES

1. To plan and conduct the group so as to maintain a general sense of safety at a level at which members feel safe enough to stay in the group and to take personal risks.
2. To avoid the irredeemable collapse of structure.
3. To work towards the establishment and maintenance of norms, and shared beliefs and assumptions, which support the group as a positive medium for help.
4. To utilise events occurring in the group for the benefit of individual members.
5. To avoid harmful consequences for the members of the group, for oneself as therapist, and for the group’s wider environment.
6. To avoid making errors as much as possible, and to discern such errors as occur and think out how to retrieve their consequences.

Each of these needs elaboration.

1
Planning and conducting the group so as to maintain a general sense of safety at a level at which members feel safe enough to stay in the group and to take personal risks

If group members do not feel safe they will not involve themselves in the group. They will either flee, literally, or stay in the group but find ways to insulate themselves from the experience. Personal gains will not occur or will be limited.

Hardly anyone feels safe enough to take risks when first entering a therapeutic group. Most people who join a therapeutic group want to make positive use of the group experience but are also aware of, or sense, that there are hazards in participating. More often than not, becoming a member of a therapeutic group is a frightening prospect. Group members often anticipate that revealing themselves to others and exploring their own feelings and experiences carries risks of being ridiculed or criticised or shamed by other members, or of being overwhelmed by their own feelings or of being rejected by the therapist.

It is possible for members of a group to achieve a sense of safety by not taking any personal risks at all. In order to avoid pain or threat they may, individually or collectively, establish ways of participating which threaten no one but also reduce the likelihood that gains will occur. Individuals may sink comfortably into some familiar and customary way of behaving. Nothing new is experienced or tried. Collectively, members may establish collusive defences which render the group innocuous.

Feeling ‘safe enough to take personal risks’ falls somewhere between the two extremes of feeling so safe that personal gain does not occur, and feeling unbearably at risk. Feeling ‘safe enough’ does not mean the absence of all threat and challenge. On the contrary, it means feeling confident that threat and challenge can be borne and will be worthwhile.

A therapist, mindful of members’ likely initial anxieties, will seek to avoid the group becoming either dysfunctionally threatening or so safe an environment that nothing of real importance is likely to occur. The middle ground—a group in which members feel ‘safe enough to take risks’—is what is wanted.

2
Avoiding the irredeemable collapse of structure

By ‘structure’, I mean whether the group is to proceed by open discussion, topic-based discussion, activities or exercises, or some variation or combination of these; whether it is to be time-limited or open-ended, shorter- or longer-term, and meet at frequent or infrequent intervals.

Before a group begins, a therapist plans a structure which he or she predicts will fit the needs and capabilities of members. However, it is only when the group starts to meet that the suitability of the structure is put to the test. The structure introduced by the therapist may turn out to be manageable by the members. They ‘take to it’ and all is well. However, it is also possible that the structure does not mesh well with the members’ needs and capacities. They are unable to use it or they resist using it, and the group is off to a difficult start.

Any structure needs to be given a fair chance to work as intended, with the therapist intervening in ways to help the members to work within it. Members often respond to such efforts, but sometimes they do not and cannot. A group whose members persistently fail to operate within the structure which the therapist has introduced may be experiencing intolerable distress brought about simply by being in the group situation. Or group members may lack skills in listening and communicating and, in consequence, cannot participate as the therapist hopes. If experience shows that members cannot work within the structure, the therapist will need to change or adapt it. The members cannot change, so the therapist must. The therapist’s purpose is not to insist on maintaining the structure which he or she has planned, but to arrive at a structure which is manageable by the members of the group.

3
Working towards the establishment and maintenance of norms, and shared beliefs and assumptions, which support the group as a positive medium for help

All groups establish norms (or standards) which define acceptable and unacceptable ways of behaving in the group. Members also develop shared beliefs about themselves and the world around them. A group will be a more effective medium for help if its norms and shared beliefs support members in expressing feelings freely and frankly, sharing experiences, responding to one another’s contributions and trying out new behaviours.

Norms which support the therapeutic process include, for instance, a mutual understanding that diverse opinions will be listened to and respected, that what members say about themselves inside the group will not be gossiped about outside, that individual differences will be accepted. Shared beliefs and assumptions which support the therapeutic process include, for instance, seeing each person as valuable and worthwhile, accepting as ‘only human’ feelings to which guilt or shame are often attached, accepting that it is a mark of personal courage to admit that one has personal problems and is prepared to discuss them.

Some norms and shared beliefs work against the effectiveness of a group, and some can do harm to individuals. Disadvantageous norms include, for instance, expressing hostile criticism in a sugary way, disguised as ‘helping’; or regarding such feelings as anger or envy as unacceptable; or consistently behaving dismissively towards one person in the group. Shared beliefs which undermine the value of the group include assuming that all the members of the group are inferior beings because they cannot manage themselves without help; that all problems are due to outside agents or ‘society’; that the therapist is likely to disapprove of members and use his or her power against them. Such norms and such beliefs and assumptions constrict what can be explored in the group and hence also constrict the gains which members can achieve.

A therapist can and should monitor the norms and beliefs which evolve through the members’ interactions. If the therapist has introduced a norm in the form of a rule or a guideline, monitoring members’ responses to it will show whether or not a guideline has been accepted as a norm. A therapist cannot, in fact, impose a norm on a group and be sure that it will stick. Whether or not a norm or a belief becomes an established feature of the group depends on the interactions of the members. A therapist who observes and listens with care may develop hypotheses about the nature of the norms, beliefs and assumptions which are in fact in operation, the function they are serving for the members and the forces which are holding them in place. On the basis of such provisional understandings, a therapist may intervene to encourage facilitative norms/beliefs to become established and discourage non-facilitative or destructive ones.

4
Utilising events occurring in the group for the specific benefit of individual members

To achieve this purpose, therapists need to understand each person well enough to form hypotheses about what, for each, would constitute benefit. They need to understand what it is about a group which can contribute to personal gain. In particular they need to appreciate that, in a group, benefit does not derive only and directly from the therapist, but from how members interact with one another. Under facilitative group conditions, members can share and compare feelings and assumptions and experiences; support one another in acknowledging feelings previously regarded as unacceptable by self or others; give and receive constructive feedback; try out new behaviours within the group; and, in general, feel supported in exploring dangerous territory.

In a group, themes emerge through the interactions of members, or else are given to the members by the therapist in the form of a topic and then accepted or transformed by the members. Individuals gain through exploring within a shared theme which means something to everyone, though the meaning will be unique for each person. As examples, themes which touch on anger and resentment, or envy, or feelings of deprivation or abandonment, or lack of self-worth, are likely to touch everyone in one way or another. It is to be expected that members relate to a theme in individual ways, seeing particular connections with current experiences outside the group and/or past experiences within the family or with significant other people, for instance in school, the neighbourhood, the armed forces, and so on. Exploring within themes provides therapeutic opportunities for more than one person at the same time. Sometimes there are special resonances between group and individual dynamics, or two or more persons become especially important to one another. These, too, offer opportunities for profitable exploration.

Many benefit-producing situations are generated by interactions amongst members. The therapist does not need to intervene, apart from offering general support and encouragement. At other times therapist interventions are crucial and can make the difference between exploiting a situation for the benefit or one or more members or letting it slide by without it having much impact. At times, it is useful or necessary to intervene in order to support therapeutic work, or forestall harm, or turn difficult situations into opportunities for gain. For this, a therapist needs a repertoire of interventions to select from when faced with particular circumstances. A therapist also needs a sense of when not to intervene. It is often appropriate to allow the therapeutic potentials of interactions amongst members to occur without interfering too much or at the wrong times. When a therapist chooses to intervene, he or she may direct an intervention to one person, or to two people in interaction with one another, or to several people in order to emphasise their different reactions to a theme. Sometimes the therapist will address the members in general, encouraging mutual exploration, or trying to ensure that members have noticed and registered significant events.

Adopting a monitoring stance towards events arising in the group is essential for intervening in order to benefit individuals. The therapist needs to note the themes which emerge and how members contribute to and respond to them. He or she needs to listen with care to what members reveal about themselves, how they interact with one another, how they feel about and respond to the therapist, and who comes to have a special meaning for whom.

Seeing how to make use of a group for the benefit of individual members includes being sensitive to its destructive as well as its constructive potentials. On the positive side, group members can be effective helpers to one another; the group itself can be a benign and supportive environment; and individuals may create opportunities to explore issues important to themselves. On the other hand, members sometimes behave in ways which damage or threaten others or prevent the group from becoming a gain-promoting environment. Some group processes can do harm. It follows that a therapist needs to monitor a group with its potentials for helping and harming in mind, intervening in order to support the former and to interrupt and reverse the consequences of the latter. This brings us to the next instrumental purpose:

5
Avoiding harmful consequences for the members of the group, for oneself as therapist, and for the wider environment in which the group is operating

Everyone knows that harm can come to people through their being in a group. Anyone who has been bullied at school, or seen it happen, knows this. So does anyone who (as leader or as member) has been excluded from a group, or become the target of direct or subtle ridicule or criticism, or been made uneasy by being drawn by others into behaviours usually avoided or kept under control, or been told by others some ‘truths’ about themselves which are hard to bear.

All of these potentially harm-generating events can occur in therapeutic groups. Members may be pressed into participating in ways which generate excessive threat. They may be unable to stop themselves from revealing personal matters which stir up unmanageable anxiety. They may find some long-held view of themselves abruptly jarred. Personal defences could be rendered inoperable at a time when they are still needed. An individual’s model of self and surroundings could be challenged or overturned, with consequent upsurges of hard-to-manage anxiety.

Sometimes harm-inducing events, and the feelings of distress and hurt which follow, are temporary. If well explored and utilised they can eventuate in personal gain. A person may experience distress and pain, but pain is not necessarily harm.

Of course, it is too simple to say that participating in groups leads to harm or can ‘cause’ harm. Potentially harmful events do occur in groups, but what is critical is how these interact with the fears and vulnerabilities and defensive strategies which each person brings to a group, and how the therapist and others respond to the potentially harm-generating event. What is overwhelmingly threatening to one person is bearable and manageable by another. Abiding harm follows when some threat occurs and an individual has no defence against it and nothing happens to assist the person to recover from the impact of the event and make good use of it.

A therapist, too, can experience harm through participating in a group. It is to be expected that, in therapeutic groups, there will be times when events occurring in the group touch the therapist personally, stirring up feelings which are painful and hard to manage. A therapist can experience severe threat if he or she comes under persistent attack, or feels out of control or helpless in the face of some group event, or if some aspect of the therapist’s model of self and surroundings is challenged or undermined. Especially if there is no one to turn to for consultation, a therapist may be left with a sense of confusion and helplessness, and may make matters worse by his/her responses to group events. If co-therapists have incompatible ideas about how to proceed, and if they persistently behave in ways which undo one another’s efforts, then harm or at least substantial discomfort may ensue.

Harm can also come to the wider organisation. Many therapists work in settings in which a group is only one of a number of therapeutic activities which take place, alongside individual psychotherapy, task or planning groups, or a programme of activities. This is the case, for instance, in day centres, psychiatric hospital war...