The first time I recall being part of听a group in a therapeutic setting听was the certificate year of my听counselling training. We met in听the evening, weekly over three听terms, with a timetable of learning to complete听and a common aim of finding out more about听counselling skills, practice and theory. But what听I remember most of that year was the skill of our听trainer in holding and containing us to feel safe听enough to explore difficult, uncomfortable听feelings. It was my first experience of truly听examining my own self in the company of others,听and, for me, a transformative experience. I think听I knew then that groupwork would appeal to me in听my future career.
Providing a container
Casement1 talks about a form of holding, such as a听mother gives to her distressed child. Psychoanalytic听theory names the parallel of how a mother allows听her child to express emotion while keeping them听safe, as concepts of holding and containing. It also听refers to the way the mother handles the infant鈥檚听projection of painful, angry, unbearable feelings,听returning them to the child in a modified, bearable听way. The therapist provides a similar function,听helping the client work through their emotions with听a reflective 鈥榓dult鈥� therapist. In this way, the client听learns to process and understand their emotional听experience and to contain their own feelings.
叠颈辞苍鈥檚2 theorising on containment also describes听social groups as a type of 鈥榤aternal container鈥�.听So the therapeutic group, led by a facilitator, can听become the container.
It鈥檚 important, therefore, that I set the scene for听this 鈥榗ontainer鈥� when making a contract with any听group I run. Rogers鈥� core conditions of empathy,听congruence and respect3 also provide solid听cornerstones of groupwork. So they are modelled听by me, and stated explicitly in language appropriate听to the group members (eg 鈥榃e listen to each other鈥檚听point of view鈥� or 鈥楨ach of us is allowed to have our听own opinion, and we don鈥檛 have to agree鈥�). We听discuss this way of being and hopefully include it in听the group contract. Depending on the age of the听group members, the setting, and the number of听sessions for which we will meet, we may spend more听or less time on agreeing the contract, but it should听always be made as a group, and I will also suggest听having some tangible representation of the听contract, written or otherwise. In one group of听younger children, at their suggestion, we used the听presence of a large teddy bear from the counselling听room to remind us to give each other space and听time to talk, and to take care of ourselves and each听other. That is, to be a container, without actually听mentioning the word.
Getting into groupwork听
I first met Nick Luxmoore when I attended a听workshop he held shortly after starting my previous听job, where I ran the counselling service in a听secondary school. On reading my first of his books听about young people,4 I found a case study about听therapeutic groupwork with young people. This听gave me the confidence I needed to start running听groups with students in school. I was nervous about听whether I could contain a group of students in my听new role, but keen to give it a go, so on Nick鈥檚 advice听I started with single-sex groups, focusing on听self-esteem. I felt safer staying on familiar ground.听For this reason 鈥� and drawing on my experience of听using play in the room from my volunteering with听Place2Be 鈥� we explored different ways for the听students to express their feelings through writing,听drawing, clay modelling and active games. Drawing听and modelling with clay in the early sessions not听only lessened our individual and collective anxiety,听but also allowed the students (aged 11 to 14) and me听to play on a level field 鈥� creating a space where the听students were free to talk or not, and to engage as听much or as little as they felt comfortable with as we听got to know each other within the group. As Julie听Kitchener explores,5 children (and adolescents)听may not want to talk or be talked to at all, and, for听them, their reluctant enlistment in this听communication may be what school and family life听largely consists of. To some extent, the use of听creative materials enables a space in which, while听participating, they can choose how and when to听communicate, and to exercise some of their own听autonomy, choosing when to come out of hiding.
Taking part, verbally or otherwise
An activity from Luxmoore鈥檚 book that I鈥檝e found听very helpful in this respect, and use in many of the听groups I run, involves preparing a number of cards,听each with a statement. For example, Fighting is听pathetic, Boys are only听 interested in one thing, or My听mum understands me. Each member of the group听writes their name on another card, and then takes听turns to choose a statement card, read it out, and听put it down in the centre of the group. They place听their name card close to it if they agree with the听statement, and further away the more they听disagree, and then each group member follows suit.听The person who places the card can explain their听opinion and name one other person to also explain听theirs (and they can choose not to explain). As听Luxmoore writes: 鈥極ne of the beauties of this听exercise is that everyone expresses an opinion听鈥� even if it is a non-verbal opinion 鈥� without being听shamed. The skill is to prepare a pack of statements听that will provoke a range of opinions. This statement听could just as easily have read, 鈥淢y mum doesn鈥檛听understand me鈥�, provided it provoked a spread of听name cards on the floor, because then a听conversation could begin.鈥�4
Luxmoore (who I quote again here with his听permission) adds a rationale for such an activity:听鈥楢nother aim is to allow the group to talk about its听underlying anxieties. In casual conversation, young听people habitually, incessantly, tell each other their听likes and dislikes, waiting for a response, waiting to听see if these parts of themselves are mirrored back听by friends. If a particular attitude is shared (or, at听least, not condemned), the anxiety lessens. If an听attitude is not shared but not condemned either,听the anxiety lessens nevertheless.鈥� As therapists,听we know that reducing anxiety in the group can听lead to further progress and better outcomes.
Choosing group members
This can present problems in some contexts.听Where I currently work, in a university setting,听therapeutic groupwork in our counselling service听with undergraduate and postgraduate students听does allow for the group therapist to meet once or听twice with each member individually to discuss their听needs, to think about previous family experiences听that could be (un)helpfully re-enacted, and听therefore to put together a functional group to听work together for eight months through the听academic year.
However, in schools, there is rarely this luxury.听As school counsellor in a secondary school, I ran听groups for five or six weekly sessions, and ideally I听had worked with (or at least assessed) each of the听students. But this was not always possible. Over听time (which fortunately coincided with an increase听in my experience and confidence in facilitating听groups), my groups had to be run in line with those听provided by other services 鈥� the main difference听being that students were referred by those teaching听or pastoral staff who felt that the child would听benefit from taking part. Many of these referrals听were insightful, and sometimes (not mutually听exclusively) they were a reflection of the referrer鈥檚听own anxiety and powerlessness to contain a听particular student in their own setting with them.听While such a student might well have benefitted听from being part of the group, their presence might听have been disruptive to other members of the听group, and indeed to my own hopes of what might听be achievable in the very short time we had听together. In 鈥榗hoosing鈥� students for my group, I听wanted potentially to avoid including students who听presented as particularly challenging (to my own听authority, and to my hopes for what we might cover听as a group). However, nurturing an emotionally听healthy child means having things not go to plan听and learning how to deal with that 鈥� what we call听鈥榬esilience鈥� 鈥� rather than trying to insure against听things ever going wrong. So I found that running a听group in a school is a really good place to model听and practise being resilient and able to adapt to听different situations.
Being realistic
I also found it very important to be realistic about听holding hard boundaries around attendance. It鈥檚听hard to make a contract stating that any student听who misses more than one session will not be able听to return to the group again, when you know their听lesson teacher may make them stay in class, despite听having agreed to allow them to attend the group.听The threat of Ofsted and associated targets can听sway the opinion of a teacher who fully appreciates听the value of therapeutic work for a student鈥檚听self-esteem, but also needs them in the lesson,听so they can do the work and pass their exam.
In a short-term group in school, where realistic听boundaries may feel less 鈥榟olding鈥� than is ideal, it is听important to remember, as Casement1 states, that听the therapeutic relationship is at least as important听a beneficial factor as any gain in cognitive insight or听psychoeducation. As Winnicott discusses,6 any听group can be a space for the original family听relationships of the child to be explored, and听relationships to be repeated and re-enacted听unconsciously. Of course, in a school, this is听happening in many other situations 鈥� the听registration tutor group, the debating club, the听photography class, the weekly staff briefing. But a听therapeutic group is where we have time and space听to consider and contain all that is going on for the听group members, without needing a separate motive听or goal. As with much short-term work with young听people, it may at times be difficult to believe that听much of use has been imparted, and this is when听our aim is to provide such a good-enough first听experience that they may return for therapeutic听help in the future, and that by experiencing being a听member of a group without judgment or ridicule,听they have internalised a part of themselves that听can be accepted as good enough by a group, and听allowed to belong.
Over the course of several years in school, I ran听different groups: girls鈥� and boys鈥� groups focusing on听self-esteem, a mixed group of deaf and hearing听students thinking about ways of communicating听and sharing experience, and, more recently, groups听of students who had been referred because of their听anxiety. These groups included some听psychoeducation around anxiety and its healthy听function as an ancient survival mechanism, a lot听of normalising, and plenty of games to enable the听students to talk about what things made them听anxious, and to explore how they might manage听this. Attending a workshop by Ben Weiner7 gave听me a lot of ideas to this end, particularly the use听of the , a CBT tool that听can be used to great effect in groups to explore听the relationships between thoughts, feelings,听bodily sensations and behaviours. He also gave a听book reference that has been invaluable in all my听subsequent work around anxiety,8 and which I听recommend to many clients, both adults and听young people.
My advice to anyone thinking about running听groups with young people would be to start with听what you know, be brave, and be prepared to learn听from your group at least as much as you will impart听to them.
Susie Ward is an integrative counsellor听and supervisor with a private practice in听North London. She ran a school听counselling service for five years, and is听now Peer Support Coordinator and a听student counsellor at the LSE. She is a听senior accredited member of 香港六合彩精准资料.听
References
1 Casement P. On learning from the听patient. London: Tavistock; 1985.
2 Bion WR. Experiences in groups and听other papers. London: Tavistock; 1961.
3 Rogers C. On becoming a person. New听York: Houghton Mifflin Harcourt; 1961.
4 Luxmoore N. Feeling like crap: young听people and the meaning of self-esteem.听London: Jessica Kingsley; 2008.
5 Kitchener J. A joy to be hidden, a听disaster not to be found. In: Horne A,听Lanyado M (eds). Winnicott鈥檚 children.听Hove: Routledge; 2012 (pp41鈥�59).
6 Winnicott DW. Home is where we start听from. London: Pelican Books; 1986.
7 Working with anxiety and adolescents: a听practical and critical guide to using CBT.听Workshop given by Ben Weiner on 18听March 2017 for Insight Therapeutic听Development. www.itdlondon.com
8 Shannon J. The anxiety survival guide for听teens. Oakland, CA: New Harbinger听Publications; 2015.