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Peer groups: Cumbria spring group – cathartic work from the outside

So I wrote yesterday about the cathartic, emotion-focussed work that I went through.  In their classic 1973 book "Encounter groups: first facts"  the authors, Lieberman, Yalom and Miles, describe their major research on the potential benefits of these kinds of groups.  One of their findings was that people who benefited most seemed both to get strongly emotionally engaged with the group and also took time to reflect and make sense of what they had experienced.  In the weekly-format groups I run in Edinburgh, I try to encourage this reviewing process by explaining its value and then asking all the group participants (including myself) to fill in a reflection sheet at the end of each weekly meeting.  I then scan the reflection sheets and email them out to all group participants so that they can read them before the next session.  Everyone gets to see everyone else's reflection on the last meeting before the next meeting gets going.  In this way we're constantly feeding feelings, thoughts and reactions back into the group process.  In a similar way, especially if I'm working at a strong emotional level in one-to-one work with a client, I will tape record the session and hand the client the tape.  I'll ask them to both fill in a reflection sheet  ideally within a few hours of finishing the session, and then a further reflection sheet once they have listened to the tape (for more on this, see fuller comments on the "Introduction & monitoring" handouts page).  I emphasise that I'm suggesting all this because I think it's likely to help them get more benefit from the work we do together.  I say that if they have doubts about it, maybe they could try it out once or twice to see whether it's useful or not.

Part of the reason for tape recording one-to-one work, especially if it's pretty emotionally charged, is the often surprising difficulty the client may have in really remembering all they've experienced.  I'm pretty used to working with strong emotions and I know how confusing it can be to recall what one has been through.  So yesterday, working in the centre of the group, it felt a bit like tumbling, twisting and banging down river rapids.  I stayed with the flow of emotions, going into them, deliberately steering for where the feelings were strongest.  If I was guiding a client, I would be "on the bank of the emotional river" and would be able to help them navigate the whole process.  Going through something like this self-navigating isn't that hard if one has had enough experience.  I deliberately immerse into the feelings and every few moments it's as if my head breaks water and I get a flash, an intuition as to what might be helpful or scary or true to try next, to move to next.  It's very intuitive (although guided by overall maps of what I'm trying to achieve).  The process is two way.  "Theory maps" affect how I work with the emotions, and how the emotions emerge affects my understanding, the map I construct about what's going on. 

In my work in the group yesterday, I started with a "given" - the strong emotional experience in my chest.  Strong emotional reactions highlight territory that's very likely to be personally important.  I had various "stories" in my head about why I had the reaction, but once I started to work directly with the emotions, that moment-to-moment experience threw new light on which stories are currently of particular importance for me.  My understanding - the sense I make of what I experienced - is that I was out of balance in the group (and sometimes in my life as a whole).  That there wasn't enough space - I wasn't making enough space - for my own needs and our needs as a couple.  This seemed to relate both (no surprise that both) to the current situation (in some ways it suited both me and group for me to be the "experienced carer") and to my life history (an educational system that rewarded achievement in quite narrow ways).  What I feel I did in the group was quite a challenging "high dive" going in deep with quite a splash, but not in a way that antagonized or blamed others.  I think it affected the group's perception of me as nearly always being in experienced carer mode.  I think it allowed me to go beyond an only partly helpful achievement-reward-achievement-reward "treadmill".  I think it allowed me to affirm my love for Catero in a way that fed us deeply as a couple.  I know that there were other types of work that the dried out heart feeling could have led me to - for example into direct angry challenge to the group.  I do believe though that often working with hurt and vulnerability is more helpful than working with anger.  Certainly not always, but often - maybe especially for men. 

How I worked yesterday was an adaptation of "focusing- going into emotions via the body.  When I do emotional processing work with clients, I typically use a mix of focusing, forms of dialogue work (with other people in their life, or between different aspects of themselves), and working with trauma memories.  With many - probably most - clients I won't do any direct emotional processing work.   We look instead at what they're wanting to achieve, set goals, look at how to overcome obstacles, confront fears, problem solve, and so on.  Occasionally though the "ball and chain" of the past is getting in the way of their progress, and it becomes sensible to free up from being held back.  This often involves forms of emotional processing.  Our current understanding of parallel brain pathways - "rational" explicit and "emotional" implicit - involved in storing traumatic memories provides an underpinning to why working in this kind of way may sometimes be particularly helpful. It's no accident that the National Institute for Health and Clinical Excellence (NICE) guideline on posttraumatic stress disorder specifically recommends trauma-focussed (not standard) cognitive therapy for PTSD.

In the group too, only a smallish amount of time is spent with direct emotional processing.  When it is, it's often emotionally loud, direct, raw and, I usually find, hugely helpful.  I guess I can use this kind of approach because of 37 years experience of group work, because I've been here and explored and survived and found this way valuable so often for others in groups and for myself.  But I don't do deep intra-personal emotional work in the group that routinely for myself.  Maybe I did more many years ago.  I'm involved with a couple of four day residential peer groups per year.  It's maybe only once every three or four years that I'll do a bit of work like I did yesterday.  There are so many other rich ways participation in these groups provides benefits.  This kind of work is one high visibility example!  And this kind of experience informs my one-to-one work as a therapist (particularly when working with trauma), but it would be a very rare client who would work so "loudly" - partly because what comes pretty naturally three days or so into a deeply caring, experienced group is very different from what's typically possible in a one-to-one therapeutic hour or in a two hour weekly group session.

There's so much that I could write about forms of emotional processing work.  What I intend to do over the next couple of blog posts is to share models and maps that I use to make more sense of this kind of work with emotions.  If you're a health professional and you're interested in the similarities and differences between skills training groups and interpersonal process groups, you might be interested in a short five day course on "Groupwork - a professional training" that I've been asked to teach early next year for Glasgow Caledonian University and the University of Strathclyde.  See pages 12 & 13 of their downloadable brochure


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