Medical knowledge is a social process: The conversations that occur around artifactual data are always more important than the data themselves. - John Lester
We had the final meeting of this eight session "Opening up" group last night. I wrote last week about the seventh session. This last meeting ran a day later than usual because of a clash with a family birthday.
Yesterday evening I wasn't feeling as buoyant as I usually do. Partly tiredness, partly physical aches & pains, maybe other reasons it's harder to put my finger on. Although - as usual - I meditated briefly before starting the group, I regretted not making a bit longer for this. I think it would have "cleared my palate" more. This is a rich issue - how important is my state of being as therapist/facilitator for doing good work? Pretty important! But not as straightforwardly as one might initially expect. I certainly do not experience that the happier and more "up" I am, the better the work I do. For me it's definitely not as simple as this. There have been times when I've been struggling with a difficult issue in my own life, when I think I've worked very well indeed as a therapist. It's been as if my own pain has helped me be more open, more sensitive, more caring for others. And I've had buoyant times when I've been insensitive and out of touch with others who were finding life much harder than I was. Overall though, being pretty buoyant as a therapist is probably a good thing. We do sit with a lot of suffering. We need to keep our heads above water. I'm lucky. I'm pretty naturally happy, and my life circumstances and how I look after myself nourishes a buoyant state too.
But this evening I was swimming a little lower in the water than usual. Facilitating a group seems to put me "more in the spotlight" than when I'm working one-to-one. It somewhat changes how I "swim" - the therapeutic choices I consider. So one way to go in this situation is for me to talk about my "out-of-sortness". I almost certainly wouldn't do this working one-to-one or teaching a stress management skills group, except possibly with a throwaway line like "Sorry, I've got a bit of a sniffle today". But I do consider this kind of self-disclosure much more in an "Opening up" style group. After all, modelling effective personal disclosure is one of the facilitator's challenges. Good to have choices though. This was the final evening of the group. Time was short as we were probably going to use much of the second half of the evening for a feedback exercise. And on the initial check-in, it was clear there were other more pressing issues. It felt better for me to keep swimming, to come out of myself more through opening my heart.
So how did it seem everyone had done in the group? Mixed, as one would expect. Some people clearly appear to have benefited a lot from the group experience, some a bit, and one or two were unclear how much or little they had learned. Inclusion is so important in group therapy, so too honouring people's experience and personal paths - see, for example, Sheldon & Bettencourt's paper "Psychological need-satisfaction and subjective well-being within social groups". Another issue we touched on again was the possiblity of contact with each other after the group had finished. I had blind-copied the weekly group reflection sheets to everyone when I'd emailed them out. Would some people, or maybe everyone, now like to share email addresses and/or phone numbers? In some types of group this would be a no-no, and in others an assumed part of the process. There's very little research evidence demonstrating that either contact or no-contact is therapeutically preferable. I asked participants to feel through what they personally would like and let me know after the group had finished. I could then post out contact details for those who wanted to be part of this process.
And then after a good deal of reviewing & discussing, we returned again to a process we've explored on a whole series of occasions in this group - getting feedback and Burns's words "O wad some power the giftie gie us to see oursels as ithers see us! It wad frae monie a blunder free us, an' foolish notion."
There was some discussion about how we might give & receive feedback more "formally" now on this last evening of the group. I lean a bit towards a spoken & tape-recorded version of this process, but it would be a rare group (of the current, eight weekly session format) where everyone felt OK about going with this rather "public" & challenging exercise. So, as is more usual, we used a written approach. Initially we spent time individually thinking about & jotting down some initial ideas about what we would like to say to each of the other people in the group. I suggested we split our feedback for each participant into two parts. One part is a celebration, an appreciation, a bouquet for something we've particularly enjoyed & valued about the way the other person has been in the group. And the second part, a request, a hope, a suggestion for something we'd like them to be aware of & to keep working on.
The group is kind. I upped the energy a bit, by pointing out that we might never see the person we're writing about again. What gift can we give them? What would we like them to know was particularly valued & appreciated about them if we were never going to have another chance to share this with them - and what would we especially want them to stay aware of & work on that we believe might help them to lead a happier, fuller life in the years to come? This is such a very rare opportunity. We've spent about 20 hours together over 8 weeks - 20 hours without distractions of other activities, 20 hours where the focus has been on our relationships with each other. Now here's a chance to get feedback from 6 other people (and from ourselves) about how we've been experienced. There may never be another opportunity like this in our lives.
We now each took a sheet of A4 paper and wrote our name at the bottom of it. At the top of the sheet we then gave ourselves feedback. What have we particulary appreciated, what do we especially celebrate about how we ourselves have been in the group over the last two months? We then switched to writing about what we had more difficulty with, what we would want to keep more aware of & try to work on over how we had related to others & ourselves in this group. Then after 3 or 4 minutes writing, I asked everyone to fold over the top of their sheet and pass it to the left. We each now had a feedback sheet for someone else - their name written at the bottom of the paper, but what had already been written hidden.
Now the same process again, but for the person whose feedback sheet we were now holding. Bouquets & brickbats. Celebrations & challenges. Again we took 3 or 4 minutes and passed once more to our left. So after 7 episodes of writing, we ended up with our own sheet back in our hands. Time to open them up and read what had been written about us by everyone in the group including ourselves. I too, of course, as another group member went through the same process also receiving & giving feedback.
Rich. Good to pay attention to. And some discussion. Clarification of people's handwriting! And then slowly the evening came to a close. I reiterated that for some people one 8 week "term" of this "Opening up" group was interesting and enough. I said however, that for those who had found it pretty useful, it was likely they would benefit more by returning for further "terms". How we relate with ourselves & others is so deeply part of who we are. To change, to evolve, takes time. Our experiences in the group spill out to & change "outside world" relationships, but this is a step by step process. I usually run a couple of these groups a year - one in the spring and one in the autumn. Some people will keep coming for several groups running over two or three years. This can be life-changing.
And partings, a group hug, good wishes. Heart-warming, very precious to have spent this time together.