Group Work

Strategies for Strengthening Resiliency

Timothy Kelly B

• Publisher: Routledge
• Year: 2012
• Print ISBN: 9780789014733
• eBook ISBN: 9781136396991
• Topic: Medicine
• Subtopic: Health Care Delivery

Explore the latest research and practice information in group work!Group Work: Strategies for Strengthening Resiliency is a collection of research and information presented at the Twentieth Annual International Symposium on Social Work with Groups. Resiliency issues are explored in relation to children, couples, managers, survivors of torture, poor women, HIV/AIDS affected youth, and other population groups. The contributors were keynote speakers and paper presenters at the symposium. They represent a wide range of fields of practice and experience.For social workers, students, educators, and practitioners, this volume examines how group work can improve resiliency in your community. Here's a sample of what you'll find inside:

• Keynote Speaker Jeremy Woodcock's experiences in his groundbreaking resiliency work with victims of torture
• Alex Gitterman's brilliant exposition of the notions of resiliency and vulnerability--he outlines the current thinking and puts it into a group work context
• case examples that illustrate resiliency in children
• a discussion of how residential settings can function like a 24-hour group and how to use that group effectively to strengthen the resiliency of the residents
• a way to use groups to help develop social and economic capital for poor women through investment clubs
• group themes and practice strategies for group work with couples who have differing HIV statusGroup Work: Strategies for Strengthening Resiliency also contains chapters reflecting the personal experiences of the authors. One shares her transformation from a worker who did case work in a group into a social group worker. Another shares a reminiscence of a personal journey during her formative years as a budding group worker.

From its description of how the use of group work principles and skills can benefit managers and programs to its challenge to group workers to incorporate some community work skills into their repertoire, Group Work: Strategies for Strengthening Resiliency is more than a fascinating read--it is a tool to help you keep abreast of the latest theory and practice in this ever-changing field.

Chapter 1

Being, Noticing, Knowing: The Emergence of Resilience in Group Work

Jeremy Woodcock

Introduction

Group work, which takes up the challenge of working with people who have experienced extreme events, often must conduct a “dance” between acknowledging and working with the devastation that extreme experience can bring and promoting the resilience to endure. I have found three notions helpful when doing this work in groups. They are, first, the group’s capacity actually to be resilient, although it may not realize or accept that resilience; second, its capacity to notice resilience among group members; and, finally, its capacity to know with deep certainty that group members are resilient. This chapter explains how to make use of those ideas.

Political conflict, oppression, and war have always been with us. Yet in the twentieth century, wars have had increasingly detrimental effects on civilian populations. In the half century since the formation of the United Nations in 1945, over 170 wars have been fought in which 30 million people are estimated to have died, of which the greatest proportion have been civilian deaths (Zwi and Ugalde, 1989). As a result, societies and whole ways of life have been devastated. These facts form the backdrop of work with refugees. The proximity of individuals to war and oppression, both literally and in relation to the personal meaning of events, will shape their resilience or susceptibility to what they have suffered. Some may identify with resistance to oppression; others may feel like hapless victims.

Undoubtedly complex issues face refugees settling into a host country, and this demands a multidimensional approach from agencies that offer help. Our clinical experience at the Medical Foundation for the Care of Victims of Torture in London indicates that the vast majority of individuals do not require in-depth psychosocial help. In fact, most are helped by a period of supportive measures, advocacy, advice giving, and fairly directive counseling focused on the resolution of practical needs and adjustment to life in exile. Only a very small minority seeks special psychological interventions. Furthermore, despite the temptation to see refugees en masse through the lens of psychological theories, we cannot generalize from small clinic populations. It is from that clinic population that I write about group work, with understandable caution when moving to make remarks about a larger picture. It is the larger picture that contextualizes the clinical work, and these many dimensions need to be kept in mind when sitting in groups with refugee survivors.

Group Work at the Medical Foundation

At the Medical Foundation, all groups work on a slow open basis, which means they recruit about six members to start with and work to a capacity of about eight. As members leave, others are recruited; the group continues on that basis. Groups work very well when a large proportion are initially recruited from one’s own caseload or held in a process of assessment and individual work for a period while basic trust and attachment are developed between the facilitator and client. We run a great variety of groups, such as straightforward analytic groups, activity groups which offer such things as gardening or storytelling, and self-help groups which set out to encourage mutual problem-solving skills.

The “Dance” Between Knowing and Not Knowing and What to Offer

Various models of trauma are available; on the face of it, clinical descriptions of traumatic symptoms may seem to fit refugees very well. However, this writer prefers to eschew a singular reliance on the language of post-traumatic stress disorder for a more widely contextualized understanding of trauma as sets of extreme events in which the stresses are multiple and involve the interaction of personal, social, and political factors. Furthermore, stresses on refugees are not only related to singular extreme events but involve multiple losses, huge life changes, and ongoing stresses of adaptation. At best, this requires that practitioners adopt a holistic approach that is able to encompass these manifold experiences without being medically or psychologically reductionist.

In the clinical setting, the practitioner often experiences that survivors of extreme events seem poised between knowing and not knowing how the experience affects them. This quality taxes the practitioner. What if the clients’ cheery denial is a true representation of their inner world? What if their physically represented distress is the culturally sanctioned manner of signaling psychological disturbance? Usually the practitioner looks for evidence from other quarters. For instance, the client may report diminished interest in life, social withdrawal, and a sense of foreboding. However, these symptoms are in many ways unremarkable among refugees who have suffered loss and are coping with a new cultural milieu. They are, after all, the classic symptoms of individuals who are pining after loss. Furthermore, their physical presentation may be merely that of persons who are not “psychologically minded.” What if they are aware of distress but choose to seal it over rather than choose to face it?

In order to contend judiciously with these issues, we therefore begin with the notion of being resilient. To have endured so much means that one is a survivor. However, the survivor moves in a continuum between being a survivor and being a victim. But this is not a linear continuum. The survivor’s life constantly encompasses aspects of victimhood and survival. These states of being operate on different levels and may shadow, mirror, and conflict with each other.

Being Resilient: The Secure Base

Psychological thinking about the notion of the secure base can help us to understand resilience. Thus, one of the central tasks of the parent is to provide a secure base through which the developing child can experience a consistent attachment and in which their curiosity about the world can be met in good measure by protection, approval, understanding, and coherence from the parents. We understand from attachment theory that the parent internalizes the parenting he or she has received and “feeds” the child in a manner that is consistent with the attachment style received from his or her own parent (mediated, of course, through life experience, self-reflection, and the maturation process).

Thus we are learning from recent research that attachment styles are passed down through generations. One might say that in order to be a “good enough parent,” the parent needs to have his or her own internalized “good enough parent.” However, torture and atrocity attack that very nexus. The internalized parent can be weakened, compromised, conflicted—even destroyed. To put it another way, we could say that the facilitating environment that good parenting provides is damaged by extreme events. I shall refer to this facilitating environment again for it is precisely this that the group attempts to recreate.

However, to have survived extreme events means that one must have been resilient and must also continue to be resilient in some measure. Furthermore, even if the survivor does not feel very intact, some measure of strength and endurance will be available. Even so, survivors often find it difficult to really believe in their own resilience. But this notion of actually being resilient is an excellent starting point for therapy. It enables the practitioner to wonder with the client about survival skills, to chart out and positively connote strengths, and to acknowledge vulnerability. Furthermore, this sort of work is very effective when done in groups because of the different and often complementary strengths and vulnerabilities of group members which, when acknowledged, enable reciprocal acts of support to be offered.

Noticing

Noticing is the action by which the individual and the group, through conscious and unconscious processes, uncover the preconditions to a knowledge that each possesses qualities of resilience that can surmount the particular losses and atrocity that have been so personally devastating.

Noticing is also the action by which the group facilitator takes note of the resilience of the group as a whole and individual group members. The resilience of a group member may steal up on the practitioner almost unnoticed. For instance, one day it is seen that a group member is paying attention to the suffering of another member in the group, no longer intensely preoccupied with his or her own misery but engaging empathically with the reality of another’s situation. This may be a moment that the conductors had hoped for and worked toward, but why has it happened today? What internal shift has strengthened him or her and brought this about? How has the group dynamic contributed to the emergence of this altruistic identification with another in which there is a true engagement with both the rational and irrational aspects of each other? My belief is that this occurs through a number of interlinked processes that group and facilitator coconstruct together. They are:

1. Creating common narratives and pathways
2. Bringing forth identity based in ethnicity, religion, and spirituality
3. Tackling racism
4. Creating safety
5. Noticing and interpreting
6. Taking an active therapeutic stance

Creating Common Narratives and Pathways

The particular suffering which members of the group have endured provides a commonality that creates a narrative pathway through suffering to recovery; this commonality must be promoted by the facilitator and allowed to emerge through the aims, objectives, and setting of the group.

In one group of refugee survivors, the Hearth and Story Telling Group for African Women, the common pathway emerged thematically week after week with the guidance of the conductors. We began with their arrival in Great Britain; if we had started immediately with atrocity and loss, it may have caused the group to disband in its first session. One woman led with her recollections; each woman eventually contributed her own stories from the sad to the outrageous to the funny. As time passed and trust developed, experiences of loss, atrocity, and emotions such as despair and sadness emerged that touched a universal nerve. The fragmented life stories of these women emerged, forming a common story for the group as a whole around the theme of endurance and survival. Each recollection was like a shard from a shattered pot; the narrative that emerged reassembled the shards into a recognizable whole in which the group members were again able to identify themselves. This allowed many other more terrible experiences to emerge that had created complex psychological conflicts. Thus, out of the common pathway or narrative developed layers of conjecture, depth, and deep shadow aspects for exploration.

Bringing Forth Identity Based in Ethnicity, Religion, and Spirituality

The ties that bind people to the past are loosened dramatically by the refugee experience, and yet the longing for what once was and has now been lost often becomes acute. Sometimes a rigid version of ethnicity and spirituality may emerge because people are cut off from the living roots of their traditions and what they have can be preserved only in a limited or ossified way. Yet we know that ethnic, religious, and spiritual beliefs are central to identity. It is out of these traditions that personal identity is coconstructed. Furthermore, resilience emerges out of the manner with which ethnicity, religion, and spirituality negotiate realities. Indeed, the histories of peoples out of which ethnicity emerges and the religious traditions of people out of which spirituality emerges probably have more to say that is wise and preservative of resilience than many psychological texts. They speak of struggle, change, disaster, love, relationships, child rearing, travel, displacement, loss, mourning, hatred, and envy. The group is in an enormously advantageous position to make use of those traditions and to continue the challenge they represent. It is a means of having a holistic vision of the purpose of life in the midst of the fragmentation of the refugee experience.

Tackling Racism

Racism contains the threat that people will be categorized by certain hostile individuals and institutions they encounter by the spurious identification of skin color. My experience with black family members, colleagues, and clients is that black children growing up in Great Britain are taught by their parents how to tackle racism as an ever-present reality. Fortunately, white children are also now learning about how to tackle racism. However, refugees, despite persecution, are rarely prepared for racism. One colleague said to me, “Travel east and you will be treated like a king; travel west and you will be treated like a pauper, servant, or slave.” The denigration of racism undermines resiliene; it may resonate with the exclusion of exile and persecution, making people more or less aroused and able to deal with the consequences. Again the group is in a powerful position to tackle those issues and to think through how members can negotiate and challenge these new hazards. Any group working with refugees that takes resilience seriously must tackle the issue of racism.

Creating Safety

In most cases, it is the sociopolitical world that has inflicted the devastating human rights atrocities on these survivors. The group offers the participants a place where the social world that has caused them so much may be rendered safe. Although the group offers an opportunity for reparation, it may also confront them with the prospect of retraumatization; for instance, having experiences with others who have endured violence and atrocity in which there is intense identification and fellowship in equal measure with the wish to escape the horror. Furthermore, primitive feelings of abandonment and horror may resonate with the terrible experiences they have endured.

There is always much to celebrate in survivors groups but no enduring shift toward health will occur unless negative emotions are allowed to surface and be worked through. It is therefore paramount from the beginning that the facilitator represents and conducts the group as a place of safety. The group could be feared as a social space in which the survivor will be shamed because of the stigma of what they have endured, or survivors may fear that they may be seen as having survived because of selfishness. These fears need to be brought forth so that they can be worked through. It is therefore vitally important that new members are given an early and accurate experience during assessment and when the group is forming of having the intolerable aspects of their experience “held” by the conductor and by the group in a generous, health-giving, and integrative manner. The ideas about how mother and child form a basic attachment, described previously, is helpful. The group should therefore set out to provide a secure base in which intolerable experiences can be revealed and held, without group members reexperiencing the sort of abandonment feelings and loss of basic trust that are common during extreme events. As attachment and safety are established in the group, members will be able to explore issues that affect them with greater creativity.

This means that the group becomes a place where members notice themselves in others. They recognize that the group reflects aspects of themselves and their experience. They experience the group—making meaning, connecting feelings—and out of this emerges the knowledge that they can make relationships without their experience endangering or contaminating others. The group becomes a place to relate to oneself and others—damaged and healed—as a whole. For instance, a woman from Rwanda in a group felt her very being was contaminated, not only from the terrible things she had suffered but just simply in being Rwandan. She felt that people seemed to recoil from her in horror, and she herself was repelled by her nationality. Yet I thought her repulsion and the repulsion felt by others had less to do with the associations of nationality per se and much more to do with the unprocessed and undigested horror within her. The task for the group was to help let ordinary life reach her through the layers of terrible suffering that overshadowed her young life.

Noticing and Interpreting

In order for resilience to emerge, conditions in the group need to be optimized to enable not only repressed material to surface but, crucially, to enable hidden strengths to emerge and be noticed. This imposes a double task: we may be familiar with the notion that unconscious material surfaces only in time when the individual or group has sufficient ego strength to allow it to come forth (Bollas, 1987). I insist that the group facilitator must not automatically interpret flashes of resilience but allow them time to emerge through a process of noticing. What does this mean exactly? It means that the facilitator must understand that it is resilience that has the ability to hold the terrifying traumatic material that emerges. One could say that group resilience must be equal to the horror that can emerge and be successfully processed but (in loose terms) is likely to be in inverse proportion to the material that remains unprocessed. One has to make judgments about resilience very carefully; one should not be premature in believing that resilience is there with sufficient quality to bear the material in the group. One, therefore, must work with resilience and its shadow—and that shadow is actually the horror itself.

Survivors seem to sense the depth of horror that the group can bear. It is this notion of them sensing both horror and resilience that the facilitator must internalize as a skill of noticing, linking, and enabling. Equally important, the conductor must not be deterred from the actual work that needs to be done. He or she must facilitate the group’s work—while understanding that he or she, as the conductor, cannot do the work on behalf of the group. Thus the group facilitator has to focus his or her own mind by being constantly self-reflexive and considering ques...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• About the Editors
• Contributors
• Acknowledgments
• Introduction
• Chapter 1. Being, Noticing, Knowing: The Emergence of Resilience in Group Work
• Chapter 2. Vulnerability, Resilience, and Social Work with Groups
• Chapter 3. Building Resourceful Communities: A Group Worker’s Guide to Community Work
• Chapter 4. The Potential Impact of Small-Group Research on Social Group Work Practice
• Chapter 5. Fostering Resiliency in Children Through Group Work: Instilling Hope, Courage, and Life Skills
• Chapter 6. The Web of Life: A Reminiscence of a Group Experience with Incarcerated Adolescent Females
• Chapter 7. No Longer Invisible: Group Work with Children and Youth Affected by HIV and AIDS
• Chapter 8. Group Work in the Residential Setting: The Twenty-Four-Hour Group
• Chapter 9. Knowledge and Skills Needed by Managers and Supervisors of Social Group Work Practice in Agencies Serving Persons with Severe Mental Illnesses
• Chapter 10. The Assets Group Model: Empowerment Through Investment Clubs
• Chapter 11. Group Work for Heterosexual Couples of Mixed HIV Status
• Chapter 12. Social Group Work: A Journey of Discovery
• Index