... 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)
So this was the seventh - and penultimate - meeting of this "Opening up" group. I wrote about the sixth session last week. Sadly, because of family crises, a couple of people hadn't been able to get to this evening's meeting. In fact, of the five of us at this session, one arrived late. Rather than simply get going and possibly want to update the late arrival once they were with us, or wait for them rather than getting started, I used a method that often seems helpful when somebody is a little late. So instead of starting with a verbal check-in, I suggested we all take ten minutes to write about how we were feeling now at the start of this evening, at the penultimate meeting of this group. As usual I explained that I wanted them to write very freely and deeply about their emotions and thoughts, but that they would then be totally free to share as much or as little of what they'd written as they wanted to.
Happily the latecomer arrived half way through this process and was able to do some writing before we moved onto the sharing phase. When we each took a bit of time to talk about what we'd written, various issues emerged. One of the issues was someone's doubts and unease about being in the group. One of my functions as group facilitator is to keep my eyes open for people becoming too isolated or sidelined. This can happen in a whole series of ways and it's a risk factor for someone being "damaged" by the group experience rather than gaining from it. I talked a bit about this in my post about the first session of this group when I explained what kind of facilitator style I would be using and why. I have been heavily influenced by the findings from Yalom et al's research. They commented, in a major trial monitoring the effects of 18 therapy groups, that "In some groups, almost every member underwent some positive change with no one suffering injury; in other groups, not a single member benefited, and one was fortunate to remain unchanged."
As the researchers reported "All meetings were observed (and tape recorded) - trained raters analyzed and coded all leader behaviours & statements; participants also completed questionnaires about the leaders. The therapeutic school that the leader represented (e.g. gestalt, psychodrama, transactional analysis, etc) had very little bearing on their behaviours/statements in the group. Factor analysis of what the leaders said and did highlighted four important leadership functions which had clear and striking relationships to outcome - these are emotional activation, caring, meaning attribution & executive function." Optimal outcomes were associated with leaders who were "middle of the road" for emotional activation and executive function, but very high on caring and meaning attribution. These research findings are described more fully in the following Powerpoint and PDF handouts.
I sometimes think of a good therapist as being like a good musician. You need to have put in hours of work practising, reviewing, digesting the knowledge and skills involved. This is a bit like the musician, the pianist, putting in thousands of hours of practice working on their fluidity and technique. Then in the concert hall - when actually playing with others - all these skills are at the service of something much more heartful, emotional, connected. It would be nice to think that sometimes I can work as a one-to-one or group therapist with a similar interconnection between head, heart & gut - and an underlying foundation of hours of background work, exploration & practice. And it isn't entirely different for anyone else hoping to be "skilled" or sensitive or deeply able to connect & navigate through a series of different interpersonal situations. It does take years to become an expert, but one needs caution. Better therapists - and people who are more facilitative & nourishing for others more generally - are not always the most experienced. If I interact badly, the fact I've done it this way many, many times may mean I've had a lot of experience - but the experience has been in becoming deeply entrenched in doing things the wrong way. This is one of the many reasons why feedback from others - as in this type of group - can be so important.
So we made space for the person who was having doubts about the group to share their thoughts and feelings. Important to hear and honour their position. Even though people's experience of the group may often mirror problems they struggle with and want to change in their everyday life, making this link isn't something to be done by a facilitator in a "one up" or defensive way. And the person involved and the group connected, softened, moved forward encouragingly. And a challenge for me - when group members are "swimming" in the group with quite varying degrees of ease & confidence - how to encourage everyone to "work" at a level that stretches them. And it's a subtle, at times controversial, issue how much it's my "job" to "activate" and how much it's my job to sit back and let people find their own way. My understanding is that my task is to steer a middle way here. Good as well for me to understand my own personal character style. I tend to push forwards, take risks in my own life. This can be fine, but as facilitator, it's the group's wellbeing that I need to focus on. Rich challenges.
So some people worked very authentically exploring their here-and-now relationship in the group, some talked about their cautious exploration into trusting the group & other people more and how they were succesfully experimenting with being more open in their outside relationships, and some linked their current group experience to difficulties & pain from early in childhood and looked at how that might change. Precious. So much, so many opportunities for helpful learning in the multiple interweaving interactions of groups. A little like playing chess, I think the good facilitator needs to have general guidelines in the back of their head for what directions it's likely to be productive to steer in, and what kinds of situations should be given priority - while at the same time being present and responding to the never-before-experienced newness of what's emerging in the here-and-now. It's not a surprise that recent work suggests that encouraging psychotherapists to practise forms of mindfulness meditation increases their helpfulness as therapists - see Grepmair et al's research "Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study" and other more recent qualitative and quantitative studies. It seems very probable that the same findings would apply more generally to non-therapists hoping that mindfulness practice would - amongst other benefits - help to nourish their interpersonal relationships.