The first time I recall being part of a group in a therapeutic setting was the certificate year of my counselling training. We met in the evening, weekly over three terms, with a timetable of learning to complete and a common aim of finding out more about counselling skills, practice and theory. But what I remember most of that year was the skill of our trainer in holding and containing us to feel safe enough to explore difficult, uncomfortable feelings. It was my first experience of truly examining my own self in the company of others, and, for me, a transformative experience. I think I knew then that groupwork would appeal to me in my future career.
Providing a container
Casement1 talks about a form of holding, such as a mother gives to her distressed child. Psychoanalytic theory names the parallel of how a mother allows her child to express emotion while keeping them safe, as concepts of holding and containing. It also refers to the way the mother handles the infant’s projection of painful, angry, unbearable feelings, returning them to the child in a modified, bearable way. The therapist provides a similar function, helping the client work through their emotions with a reflective ‘adult’ therapist. In this way, the client learns to process and understand their emotional experience and to contain their own feelings.
Bion’s2 theorising on containment also describes social groups as a type of ‘maternal container’. So the therapeutic group, led by a facilitator, can become the container.
It’s important, therefore, that I set the scene for this ‘container’ when making a contract with any group I run. Rogers’ core conditions of empathy, congruence and respect3 also provide solid cornerstones of groupwork. So they are modelled by me, and stated explicitly in language appropriate to the group members (eg ‘We listen to each other’s point of view’ or ‘Each of us is allowed to have our own opinion, and we don’t have to agree’). We discuss this way of being and hopefully include it in the group contract. Depending on the age of the group members, the setting, and the number of sessions for which we will meet, we may spend more or less time on agreeing the contract, but it should always be made as a group, and I will also suggest having some tangible representation of the contract, written or otherwise. In one group of younger children, at their suggestion, we used the presence of a large teddy bear from the counselling room to remind us to give each other space and time to talk, and to take care of ourselves and each other. That is, to be a container, without actually mentioning the word.
Getting into groupwork
I first met Nick Luxmoore when I attended a workshop he held shortly after starting my previous job, where I ran the counselling service in a secondary school. On reading my first of his books about young people,4 I found a case study about therapeutic groupwork with young people. This gave me the confidence I needed to start running groups with students in school. I was nervous about whether I could contain a group of students in my new role, but keen to give it a go, so on Nick’s advice I started with single-sex groups, focusing on self-esteem. I felt safer staying on familiar ground. For this reason – and drawing on my experience of using play in the room from my volunteering with Place2Be – we explored different ways for the students to express their feelings through writing, drawing, clay modelling and active games. Drawing and modelling with clay in the early sessions not only lessened our individual and collective anxiety, but also allowed the students (aged 11 to 14) and me to play on a level field – creating a space where the students were free to talk or not, and to engage as much or as little as they felt comfortable with as we got to know each other within the group. As Julie Kitchener explores,5 children (and adolescents) may not want to talk or be talked to at all, and, for them, their reluctant enlistment in this communication may be what school and family life largely consists of. To some extent, the use of creative materials enables a space in which, while participating, they can choose how and when to communicate, and to exercise some of their own autonomy, choosing when to come out of hiding.
Taking part, verbally or otherwise
An activity from Luxmoore’s book that I’ve found very helpful in this respect, and use in many of the groups I run, involves preparing a number of cards, each with a statement. For example, Fighting is pathetic, Boys are only interested in one thing, or My mum understands me. Each member of the group writes their name on another card, and then takes turns to choose a statement card, read it out, and put it down in the centre of the group. They place their name card close to it if they agree with the statement, and further away the more they disagree, and then each group member follows suit. The person who places the card can explain their opinion and name one other person to also explain theirs (and they can choose not to explain). As Luxmoore writes: ‘One of the beauties of this exercise is that everyone expresses an opinion – even if it is a non-verbal opinion – without being shamed. The skill is to prepare a pack of statements that will provoke a range of opinions. This statement could just as easily have read, “My mum doesn’t understand me”, provided it provoked a spread of name cards on the floor, because then a conversation could begin.’4
Luxmoore (who I quote again here with his permission) adds a rationale for such an activity: ‘Another aim is to allow the group to talk about its underlying anxieties. In casual conversation, young people habitually, incessantly, tell each other their likes and dislikes, waiting for a response, waiting to see if these parts of themselves are mirrored back by friends. If a particular attitude is shared (or, at least, not condemned), the anxiety lessens. If an attitude is not shared but not condemned either, the anxiety lessens nevertheless.’ As therapists, we know that reducing anxiety in the group can lead to further progress and better outcomes.
Choosing group members
This can present problems in some contexts. Where I currently work, in a university setting, therapeutic groupwork in our counselling service with undergraduate and postgraduate students does allow for the group therapist to meet once or twice with each member individually to discuss their needs, to think about previous family experiences that could be (un)helpfully re-enacted, and therefore to put together a functional group to work together for eight months through the academic year.
However, in schools, there is rarely this luxury. As school counsellor in a secondary school, I ran groups for five or six weekly sessions, and ideally I had worked with (or at least assessed) each of the students. But this was not always possible. Over time (which fortunately coincided with an increase in my experience and confidence in facilitating groups), my groups had to be run in line with those provided by other services – the main difference being that students were referred by those teaching or pastoral staff who felt that the child would benefit from taking part. Many of these referrals were insightful, and sometimes (not mutually exclusively) they were a reflection of the referrer’s own anxiety and powerlessness to contain a particular student in their own setting with them. While such a student might well have benefitted from being part of the group, their presence might have been disruptive to other members of the group, and indeed to my own hopes of what might be achievable in the very short time we had together. In ‘choosing’ students for my group, I wanted potentially to avoid including students who presented as particularly challenging (to my own authority, and to my hopes for what we might cover as a group). However, nurturing an emotionally healthy child means having things not go to plan and learning how to deal with that – what we call ‘resilience’ – rather than trying to insure against things ever going wrong. So I found that running a group in a school is a really good place to model and practise being resilient and able to adapt to different situations.
Being realistic
I also found it very important to be realistic about holding hard boundaries around attendance. It’s hard to make a contract stating that any student who misses more than one session will not be able to return to the group again, when you know their lesson teacher may make them stay in class, despite having agreed to allow them to attend the group. The threat of Ofsted and associated targets can sway the opinion of a teacher who fully appreciates the value of therapeutic work for a student’s self-esteem, but also needs them in the lesson, so they can do the work and pass their exam.
In a short-term group in school, where realistic boundaries may feel less ‘holding’ than is ideal, it is important to remember, as Casement1 states, that the therapeutic relationship is at least as important a beneficial factor as any gain in cognitive insight or psychoeducation. As Winnicott discusses,6 any group can be a space for the original family relationships of the child to be explored, and relationships to be repeated and re-enacted unconsciously. Of course, in a school, this is happening in many other situations – the registration tutor group, the debating club, the photography class, the weekly staff briefing. But a therapeutic group is where we have time and space to consider and contain all that is going on for the group members, without needing a separate motive or goal. As with much short-term work with young people, it may at times be difficult to believe that much of use has been imparted, and this is when our aim is to provide such a good-enough first experience that they may return for therapeutic help in the future, and that by experiencing being a member of a group without judgment or ridicule, they have internalised a part of themselves that can be accepted as good enough by a group, and allowed to belong.
Over the course of several years in school, I ran different groups: girls’ and boys’ groups focusing on self-esteem, a mixed group of deaf and hearing students thinking about ways of communicating and sharing experience, and, more recently, groups of students who had been referred because of their anxiety. These groups included some psychoeducation around anxiety and its healthy function as an ancient survival mechanism, a lot of normalising, and plenty of games to enable the students to talk about what things made them anxious, and to explore how they might manage this. Attending a workshop by Ben Weiner7 gave me a lot of ideas to this end, particularly the use of the ‘hot cross bun’ cross-sectional formulation, a CBT tool that can be used to great effect in groups to explore the relationships between thoughts, feelings, bodily sensations and behaviours. He also gave a book reference that has been invaluable in all my subsequent work around anxiety,8 and which I recommend to many clients, both adults and young people.
My advice to anyone thinking about running groups with young people would be to start with what you know, be brave, and be prepared to learn from your group at least as much as you will impart to them.
Susie Ward is an integrative counsellor and supervisor with a private practice in North London. She ran a school counselling service for five years, and is now Peer Support Coordinator and a student counsellor at the LSE. She is a senior accredited member of BACP.
References
1 Casement P. On learning from the patient. London: Tavistock; 1985.
2 Bion WR. Experiences in groups and other papers. London: Tavistock; 1961.
3 Rogers C. On becoming a person. New York: Houghton Mifflin Harcourt; 1961.
4 Luxmoore N. Feeling like crap: young people and the meaning of self-esteem. London: Jessica Kingsley; 2008.
5 Kitchener J. A joy to be hidden, a disaster not to be found. In: Horne A, Lanyado M (eds). Winnicott’s children. Hove: Routledge; 2012 (pp41–59).
6 Winnicott DW. Home is where we start from. London: Pelican Books; 1986.
7 Working with anxiety and adolescents: a practical and critical guide to using CBT. Workshop given by Ben Weiner on 18 March 2017 for Insight Therapeutic Development. www.itdlondon.com
8 Shannon J. The anxiety survival guide for teens. Oakland, CA: New Harbinger Publications; 2015.