... the current system for bringing promising biomedical research to the bedside is operating at an obsolete level of efficiency, causing great delay, and consequently resulting in the loss of many lives. - Roger Rosenberg (JAMA 2003;289:1305-6)
Here are a set of handouts and questionnaires that I often use when I'm running interpersonal process groups. Also on the left of this page you'll find links to a session-by-session description of one such group. As the "Group therapy, background information" leaflet (see below) comments: "Group therapy simply means that therapeutic work is done in groups rather than one-to-one. Many different types of therapy have been tried in group format. Rather than construct a long list of such therapies, it may be more helpful to divide the many types of therapy group into two general categories - structured groups and process groups. Structured group therapy often involves the transfer of skills and knowledge. It may feel a bit like a classroom situation. Frequently, structured groups are used as a cost-effective way of delivering similar forms of therapy to individual one-to-one work. Process groups, however, use groups not just for cost effectiveness but also to focus on forms of learning that are specific to the group format itself. Process groups acknowledge that the developing relationships between group members are also a major therapeutic resource." In actual practice this structured-group/process-group distinction isn't so cut and dried. See the post on "Training in group facilitation" for more on this. Many participants in, for example, structured stress management groups will comment how they have benefited from listening to the experiences and comments of other group members. Similarly, facilitators of structured groups will knowingly or unknowingly have interpersonal group processes contributing to the effectiveness or ineffectiveness of the groups they run. However the handouts listed below are those I am more likely to use in groups that acknowledge interpersonal process as a major learning resource. It's likely that most people would benefit from participation in groups of one type or another e.g. group education, group activities, group support, group therapy, and so on. This variety is illustrated by the blog post "Different kinds of group, different kinds of friendship". These interpersonal groups however, that focus on how we relate with others, are primarily for those who are robust enough and psychologically minded enough to engage with this fascinating and rich opportunity to share, learn, and develop deeper, more open, more compassionate ways of being with other people.
Group therapy, background information - this brief overview of group therapy aims to provide some initial orientation for would-be participants.
Course publicity leaflet - the kinds of interpersonal process groups I run have evolved over the years. This publicity leaflet illustrates the current "Opening Up" (relationships & emotional intelligence) format that I'm working with. Everyone who joins these groups will have also had some individual one-to-one sessions with me. Facilitators no doubt vary a lot in how they use the mix of group and one-to-one therapy. There are advantages and disadvantages to running them side by side. I personally find it very useful to at least see group participants for one-to-one orientating and reviewing sessions.
Confidentiality agreement - people coming to these interpersonal groups are likely to be challenged by the degree of honesty and self-disclosure involved. It's important to minimise reasons why participants might feel inhibited about opening up. I make it explicit verbally in initial one-to-one orientation, at the first session of the group, and via this "Confidentiality agreement" that any personal information shared by members of the group is to be treated as confidential and is not to be discussed with non-group members.
Inventory of interpersonal problems (IIP-48) - there are many before-and-after assessment measures that are potentially relevant to the kind of work focused on in these interpersonal process groups. I routinely ask participants to fill in this 48 item version of the "Inventory of Interpersonal Problems". Scores on the six subscales can be added up and noted on the "IIP-48 Scoring Chart". I then typically join these six subscale points to make what is likely to be an irregular star shape. The more the spikes of the star are distant from the "no-problem" centre, the more difficulty the person is likely to be experiencing in interpersonal relationships. I both pay particular attention to any large spikes on the scoring chart and also any "3" or "4" answers on the IIP questionnaire itself. I chart change both by adding further - hopefully reduced in size - stars to the person's diagram as they later retake the IIP-48, and also by simply monitoring reduction in the IIP-48 total score which is simply the sum of the six subscale scores.
Personal community map - this is another assessment exercise that I ask would-be course participants to complete when considering whether to come to the group. It is a helpful way of encouraging people to begin describing their relationships. It may take an hour or so to fill in properly, but it can then provide a major focus for subsequent therapy. When handing out this chart, I also give the instructions and questions sheets (see below)
Personal community map instructions - these instructions go with the "Personal community map" (above), explaining how to fill the chart in, and giving background information.
Personal community map questions - I ask people to answer these questions as they fill in, and after they've filled in, their personal community map (see above). Their answers help to clarify what they probably need to do to continue building personal relationships that promote health, stress resilience, and wellbeing. Sheldon Cohen's work, for example, highlights the value of building high scores on intimacy (question 2) and integration (question 4), while maintaining low scores on - at least chronic - conflict (question 5). There will almost certainly be times in our lives when scores on these questions won't be good, but an awareness of this gives us challenges to work on - for example, deepening our relationships with some people on the map so they come in closer to the centre, developing a cluster of close relationships so we don't have "too many eggs in one basket", having a wide variety of acquaintances/less close friends so our personal community map is more "mountain shaped" (cluster of close relationships at the top/in the centre, broad range of acquaintances/less-close friends further down the mountain/further away from the centre) rather than "pole shaped" (some close relationships at the top/centre but only a smallish number of acquaintances/less-close friends further down/further out). "Pole shaped" personal communities seem too vulnerable to illnesses, friends/family moving away, changes in job, and so on. It seems important too, to maintain the ability to make new friends over our lives, so as we age we don't simply see a progressive attrition and shrinkage of our early life personal community. Healthy gardens have a mix of plants in them!
Maladaptive schema assessment - this is a fairly quick/straightforward way, from Young's work, of getting a sense of internal beliefs/feeling structures that may sabotage making good, close relationships. These "schema" are likely themselves to be largely caused by experiences in relationships earlier in our lives.
I tend to pretty routinely use these three questionnaires - the "IIP-48", the "Personal Community Map" and the "Maladaptive Schema Assessment" - for all group participants. I ask them to answer the questionnaires for the last month or some other time period that represents how they usually function. We may well use a model like the one described in the blog post "Our life stories: needs, beliefs & behaviours" to help organise emerging patterns. Depending on what is most important for each individual, we may also use other questionnaires from those listed on the "Relationships in general", "Relationships, families, couples & psychosexual", "Wellbeing, time management & self-determination" and other pages.
Initial difficulties severity scale - this scale attempts to distil the picture that has emerged from the other assessment questionnaires and from one-to-one discussion to give a key area(s) that each participant currently wants to work on in the interpersonal group.
It's usually time very well spent, orientating would-be participants to what the group is likely to involve. This both speeds up the time it takes new group members to start engaging helpfully in group interactions, and reduces drop-out rates. Participants who know roughly what the group is going to be like, why the experience is relevant to what they want to change in their lives, and how they can best engage with the group to gain most benefit, are likely to be participants who get most from the group experience. I've listed various handouts that can be relevant in this orientation process.
Our life stories: needs, beliefs & behaviours, page 1 & page 2 - here is a two page handout (printed out at 2 Powerpoint slides to a page) that I use a lot, especially when working with long term personality patterns. The blog post "Our life stories: needs, beliefs & behaviours" gives a fuller explanation. Although a bit "complicated", this "map" can be helpful in clarifying, for would-be group participants, where it might be most helpful for them to focus when working in the group. The ideas aren't at all original, although this particular way of presenting them is my own. I point out that a triangle of frustrated needs, dysfunctional beliefs, and outdated unhelpful behaviours probably made sense and may even have served them well, when the pattern developed in childhood/adolescence (e.g. in relation to "past people", slide 4), but that the triangle may well not be serving them well now (in relation to "current people" in their lives, and possibly with "therapist or group" too). I tend to encourage work at all corners of the triangle - clarifying healthy needs, challenging dysfunctional beliefs, and exploring more functional behaviours.
What it's usually helpful to talk about in the group - research shows that explaining to would-be group participants what the group focuses on, how it works, and why it's relevant for them, reduces subsequent drop-out rates and helps participants engage in the group more quickly and more productively. The already described assessment questionnaires are useful here. This "What it's usually helpful to talk about in the group" leaflet is a further step in this orientation process.
Therapeutic factors - here are the 12 therapeutic factor categories that Irvin Yalom describes in his seminal book "The theory and practice of group psychotherapy". Typically interpersonal factors, catharsis and group cohesiveness are rated very highly. There is considerable variation though - with the type of group studied, with how long the group has been meeting for, and with the participant's level of functioning and personality style.
Group facilitator style & outcome - Lieberman, Yalom & Miles's major early group research profoundly affects the way I facilitate groups and the way I teach group facilitation. 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. The slides also remind us that group therapy is not "neutral" - some facilitators were found to run groups where almost all participants benefited and none seemed to experience a negative outcome. With other facilitators, participants were lucky if they managed to leave the group unscathed psychologically.
Self-acceptance & other comments on the value of group work - here is a 25 slide Powerpoint presentation that I gave at a big cognitive therapy conference in Edinburgh in 2008. The talk makes a number of points about the importance of the therapeutic alliance including the potential value of experiential group work for health professionals themselves.
Communication scales - a handout from Carkhuff & Berenson's adaption of the classic Rogerian person-centred triad highlighting key interpersonal qualities in close relationships.
Honesty, transparency & confrontation - this interesting 3 page handout describes the emotion-focused therapist Les Greenberg's comments on honesty/authenticity in therapeutic relationships. His remarks however are also very relevant to other close relationships that are basically supportive but sometimes run into difficulties e.g. couples, families, and friendships.
Self-concealment scale & related references - this is an interesting questionnaire I use occasionally to highlight the health risks of being to "self-concealing" and "private". It links in with the overall benefits of intimacy and interpersonal trust. It links too with the importance of clients feeling they can be really open in the therapeutic relationship.
Experiencing scale - this scale assesses seven levels of emotional and cognitive involvement with one's ongoing (internal) experience. Primarily tested in person-centered therapy - but also for other therapies such as group therapy and CBT - it has been found that being more emotionally engaged with therapy tends to be associated with better subsequent outcomes.
Although I currently call the interpersonal process groups I run here in Edinburgh "Opening Up", they used to have the rather clunky title "Relationships & emotional intelligence". This is still a pretty good description of what the groups focus on, and below are half a dozen handouts more specifically on emotions and emotional intelligence.
Emotions & feelings - this six Powerpoint slides to a page handout discusses definitions, components, types and functions of emotions.
Emotions are like a ‘radar system' - this pair of Powerpoint slides, that I print out as a two-slides-to-a-page handout, introduces the idea of emotions as an evolutionarily adaptive system. I use the metaphor of emotions as a 'radar & rapid response system' - normalising emotions and conceptualising emotional problems as inappropriate levels of activation in a basically adaptive system.
Emotions, ‘arriving' & ‘leaving' - this pair of Powerpoint slides handout introduces a simple model of 'arriving' (understanding what one is feeling) and 'leaving' (acting from or processing the feelings). The ideas are based on the work of Les Greenberg, Robert Elliott and others.
Emotions, awareness & regulation - again a pair of Powerpoint slides based largely on the work of Greenberg and colleagues. The handout both looks at aspects of emotions and introduces a metaphor of wading into a river as a way of considering over- and under-regulated emotions.
Emotions as different rooms in a house, page 1 & page 2 - here are four Powerpoint slides that I usually print out as a handout with two slides per page. Page 1, with ideas from Antonio Damasio, looks at the changes emotions produce in body and brain. Page 2, partly inspired by John Teasdale, suggests that different emotions produce such different mind-body states that it may sometimes be helpful to view humans as possessing a series of different "minds" rather than just one. I then introduce the metaphor of humans as "houses" with a collection of different mind-body "rooms" that we move between.
Understanding our reactions: self monitoring - this is an assessment form that can be used to self-monitor or to complete within a therapeutic session. It looks at experiences of strong emotional reactions and asks a series of questions that can clarify the source of the emotion (leading to ideas about appropriate responses).
And finally here are a couple of handouts, below, used to encourage group participants to reflect on what they're experiencing. "Meaning attribution" has been highlighted as a key process that group facilitators should focus on by the Lieberman, Yalom & Miles research mentioned earlier.
Reflection sheet & Session rating scale and background - I ask all group participants - including myself as facilitator - to fill in a reflection sheet & session rating scale in the last 10 minutes or so of each session. I then copy or scan the reflection sheets (and chart the session ratings), 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.
The eight session "Opening up group" course outline that follows is intended for various different audiences. Other current and would-be process group facilitators may find aspects of this material useful for their work. Clients who are wondering whether to take part in this kind of group process may like to read through some or all of this description before deciding whether or not to enrol on a course. Other readers may like to dip into these postings for their relevance to relationships more generally. Whatever your particular focus, I hope you find something of interest here.