Medical knowledge is a social process: The conversations that occur around artifactual data are always more important than the data themselves. - John Lester
For many years I have run two kinds of "training group" for clients. One teaches what can loosely be thought of as "stress management skills". The latest version of this is the "Life skills for stress, health & wellbeing" course that I have been describing at some length in blog posts over the last three months. The other kind of group that I regularly facilitate focuses on relationships. As this group has evolved over the years it has been given various titles. For quite some time I called it the "Relationships & emotional intelligence" group. It was an accurate description of what we focused on, but it was kind of clunky as a label. I've now reverted to simply calling the course "Opening up". The publicity leaflet reads:
what is this course about? This course is about relationships and emotional intelligence. It involves working in a small group of 6 to 8 people (plus the facilitator Dr James Hawkins) over seven evenings and a full day session. We will be looking at relationships in three areas - in the group itself, in our lives generally, and in our pasts. The aim is to help us understand better and improve how we relate with others.
why take time to look at relationships? It's worth taking the time because relationships are such a huge part of our lives. Past relationships deeply affect how we feel about ourselves and how we interact with others. Current relationships can be a great source of joy, warmth and support, or of loneliness, frustration and unhappiness. Human beings are social animals. In many ways we are the sum of our relationships. As adults, we don't have to just accept how we learned to relate when we were younger. We can look at our interpersonal style and how we connect with our emotions. We can get feedback from others. We can decide what patterns we are happy with and what we'd like to improve on. The group gives us the opportunity to do this and a chance to practise new ways of being with others. We can change how we are in relationships. In doing so we change ourselves, our worlds, and the way we affect those around us.
how does working in the group help? There are specific personal characteristics that are crucially important in allowing us to develop really nourishing relationships. Our upbringing, education and society in general often actively inhibit this emotional intelligence. With care, hard work and the right situation, these qualities can be encouraged to develop. One of the mechanisms for this is by opening up. The diagram below illustrates how feedback and self-disclosure can allow us to share more deeply, opening the ‘window', and providing us with a chance to learn and change.
The so-called "Johari Window" illustrates the way that being more genuine allows others to get to know us better, while feedback helps us to learn how we actually affect those around us - in Burns' 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." The Johari diagram was developed by Jo Lufts and Harry Ingham many years ago and is a nice illustration of "opening up" (if you want a copy of the diagram, here are downloadable PDF and Powerpoint versions)
So yesterday was the first evening of the current "Opening up" course. I went to my first interpersonal group - a weekend "Encounter group" - back in 1972. It blew me away. I just hadn't realized people could be so open and honest with each other. I'd been brought up in a traditional, caring, good British family. I kind of felt the world would fall apart, and the walls smeared with blood, if one allowed such open expression of feeling. Not true! I dived into this group therapy world and have a pretty huge experience of many different types accumulated over nearly forty years. I can be a fairly questioning cerebral animal, and I've certainly done a good deal of reading and thinking about group processes. I've run many groups and I train other therapists in these approaches as well - see for example the five day course scheduled to run for the University of Strathclyde and Caledonian University next March (pages 15 & 16 of their "Psychological therapies knowledge exchange programme").
What I'd like to do over the eight sessions of this "Opening up" group is jot down some thoughts and reflections triggered by the different meetings. It's crucial that group participants feel as safe as possible in sharing personal material. I get everyone to sign a "Confidentiality agreement" on joining the course and I'm certainly not going to use this blog post to share anything about the work of individual participants. However reflection on the group is typically very useful, so I hope this series of general reflections will be helpful both for participants and would-be participants in "Opening up" groups - and for others who are interested in this format for therapy and personal growth.
The first session of a group can be quite challenging. Preparation of participants before they even walk through the door is important - why is coming to this group personally relevant for them, in what way might the group be helpful, what is the group interaction likely to involve? The American Group Psychotherapy Association website is a useful resource. It has a publicly orientated "About group psychotherapy" section, and a more therapist orientated set of "Practice guidelines for group psychotherapy" with pieces on a series of topics including "Creating successful therapy groups" and "Preparation and pre-group training". I wouldn't accept anybody onto an "Opening up" group if I hadn't already seen them one-to-one. I have also sent out a set of handouts which include a couple I've particulary asked them to read before the first meeting - "Group therapy, background information" and "What it's usually helpful to talk about in the group". Other handouts and pre-/post-assessment measures are listed in two previous blog posts - "Interpersonal groupwork 1" and "Interpersonal groupwork 2".
So we started with welcomes and gentle ice-breaking - an exercise in pairs "How did you feel coming to the group this evening?" with possible extensions into what this says about me more generally and the kinds of patterns I have relating with others. I've been in a lot of groups where we all sat around in more or less frozen silence for quite a while before anybody said anything. They have their value, but here in the "Opening up" group I'm strongly influenced by the early, and still relevant, findings on the kind of group facilitator style associated with better outcomes. Key facts are illustrated by this six-slides-to-a-page Powerpoint handout - also available as a PDF handout. These slides highlight particularly the importance of "caring" and of "meaning attribution" in how one facilitates groups.
A little later we moved on to a pair exercise exploring what each of us personally most want to achieve, or change, or learn more about in this group. This was then distilled down into one or two key sentences and I wrote each person's intentions up onto A1 flipcharts which will remain visible throughout all future sessions of the group. Participants may adapt or change their key intentions over the course of the group, but it can be very helpful continuing to relate what happens in the group to what each member particularly wants to be working on for themselves. Plenty of friendly, opening discussion. I sometimes see the early part of the group as constructing a safe enough, caring enough, strong enough "cooking pot" that will be able to contain the future group process as it heats up emotionally. And finally in the last ten or fifteen minutes I ask everyone - including myself - to fill in a "Reflection sheet" (see too the related "Background" description). This filling-in-of-reflection-sheets is scheduled at the end of every meeting. Later in the week I will copy or scan the reflection sheets, and all participants get copies of all sheets in time to look through before the next meeting. This can enrich the group and the learning process in all kinds of interesting ways. A good first session ... the boat is leaving harbour ...
See next week's post "Opening up group, second session" for more on how the group develops.