Group work – love it or loathe it?

On Friday 27th June 2014, I did a presentation at the Hunter Networks of Practice, Triple P conference in Newcastle NSW.

I would like to thank Carolyn Ellis, Sara Evans, Hunter Networks of Practice, and Family Insight for their generosity, hospitality, and support.

I would also like to thank Dr Kate Sofronoff for her feedback and encouragement.

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Group Work – Love it or Loathe it ?

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cups

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I would like to acknowledge the traditional caretakers and custodians of the land on which we meet today, and pay my respects to Elders past and present.

I am of Cadigal and Kamillaroi descent, and I live and work on Dharug Country.

My name is Narelle Smith.

My qualifications are…

BA Education, Masters Child & Adolescent Mental Health, trained in Child-Centered Play Therapy, Art Therapy, Parent-Child Interaction Therapy

I only put these here to give you some idea of the lens from which I view my work. We all have a lens, and education, mental health, attachment, and working psychodynamically are my interests.

I am a Family Worker for four days per week, facilitating parenting programmes.

And one day per week, I am a Chaplain in a small public school, focusing on the social and emotional wellbeing of the students at the school.

I work for Nepean Community & Neighbourhood Services (NCNS). NCNS is a community development organisation. We are also a reconciliation organisation.

We have about 30 staff and approximately half of our staff are Aboriginal.

Our motto is…

RESPECT, RESILIENCE, RECONCILIATION

ncns staff

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THE BRIEF

I received an email from Sara Evans a few months ago. She said…

“Local practitioners are looking for practical support for their Triple P delivery on a higher level than what is currently offered”.

This is a common theme. I’ve heard this said in the area where I am working too.

Sara said…

 

macauleyyour name came up…

‘how’…

how does Narelle work with up to 20 people for Triple P group?

 

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Sara explained…

question

“We envision that practitioners would like to hear about how you run such large groups and cater to the needs in the intense groups, managing difficult dynamics, etc”

 

 

 

 

 

 

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STATE OF MIND

So, when Sara and Carolyn Ellis were talking to me about coming to talk to you, I got worried. I thought “I don’t really know what I do, I just do it. Group facilitation for me is a state of mind.

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impossible

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If you think it’s going to be hard, it will be!

It’s Triple P – the positive parenting programme. I go into each group with a positive mindset.

In this talk, I will be highlighting some of the ways that I approach the facilitation of group Triple P.

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‘MY’ TRIPLE P

My groups are really mixed.

I have had up to 24 people attend Group Triple P.

People from all walks of life come to the groups:

  • Aboriginal, non-Aboriginal, culturally and linguistically diverse,
  • Women
  • Men (20%)
  • Parents who are educated, from all socioeconomic areas, or from child protection
  • Parents who have a mental illness (depression, borderline personality disorder, bipolar disorder, anxiety, trauma). Frequently, trauma is related to domestic violence.

I haven’t had any people classified as refugees attend my groups, for example, from the African Nations.

About 20% of my groups are men. Many of them come to the group wearing their high visibility vests and work boots, and race off to work after the group. That is, they are taking time off work to attend the group.

One Dad who came to Triple P, was living in public housing with his young family. He said his partner would have liked to come to Triple P but she didn’t feel comfortable about travelling by bus with the baby. He got to the group by motorbike.

He was in casual employment on a construction site but had arranged an extended lunch break with the boss. He was a very shy man and lacking in self-confidence. He had his head down during all of the group sessions, and did not speak during any of the sessions. But he took a lot of notes. He missed one session, and was very grateful when I arranged a catch-up session with him.

At the catch-up session, he said that he couldn’t talk during the sessions but had been doing the homework activities and that he liked the course. At no stage can I recall him ever being able to look me in the eyes, they were always downcast.

Several months after the group ended I was visiting a local school at drop-off time. I heard a male voice shout out my name. Here was this Dad. We had a brief conversation during which he smiled the whole time, stood straight and proud, and was confident. He didn’t mention Triple P, and as we were in an area with parents coming and going neither did I. The changes in his bearing were significant and I was surprised at the difference in his level of engagement.

 

I run all of my groups in the daytime (10am to 12:30pm, or 12:15pm to 2:30pm). I don’t run any at night because I have my own children. What kind of Triple P facilitator would I be if I didn’t place my family’s needs as a priority?

We have trialled weekend and evening groups. We get a lot of registrations but people don’t follow through with attendance. I feel they are a waste of resources. I get high numbers for my daytime groups and the number of men attending indicates to me that they will make arrangements to attend if they see it as a priority. Community Health in our area runs evening groups but I don’t know what their numbers are like and who attends.

I don’t have a co-facilitator, either male or female, unless I am mentoring someone with their Triple P facilitation. I have never found that a male co-facilitator is necessary. I have found that men want high quality information and they like a competent facilitator who can answer their questions with confidence. Men like the practical and logical nature of Triple P. Triple P was written by a man.

Up to 20 per cent of participants in my groups are from the child protection system, in effect, they currently don’t have their children in their care. A lot of services exclude people in the child protection system, yet they are parents and community members. I work for a community development organisation, we don’t exclude community.

I recently had a group that had 22 participants. In that group, we had 5 infants in the room, 5 participants were men, 5 families had children with ADHD, 6 people were from the child protection system, and 2 participants were Aboriginal. Quite a number of people in that group had blended families. That was such a dynamic group, and I will always remember that group with great fondness. It was so positive and supportive. The families with a child with ADHD would chat for up to an hour after the group supporting each other and swapping strategies.

I facilitate 1 to 3 Triple P groups per school term depending on the need and circumstances. I have facilitated Triple P groups for parents with specific interests (for example, multiple births).

I facilitate Indigenous Triple P about once per year, when one of my Indigenous co-workers has got an interested group of parents together. In the Indigenous groups we have found that using the ‘whitefella’ DVD and workbook is more acceptable to the participants and more effective. They like seeing the ‘whitefellas stuff up’. We run Triple P the way it is supposed to be run when working with Indigenous people, there are no diversions such as art, craft or ‘yarn time’. And we certainly don’t run it under the shade of a tree. I remember once when someone asked if we should run Triple P outside, one of the Aboriginal workers piped up and asked “aren’t we good enough to sit inside?” Enough said.

I facilitate Triple P seminars and Level 5 Triple P (Pathways & Enhanced). I have a blog, write articles for a local monthly gazette (readership of 48,000+), and have a FaceBook page, and these all focus on positive parenting. There are many layers in which I engage with the community.

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PROGRAMME FIDELITY

Research informs my practice, and keeps it fresh and relevant. I like my parenting programmes evidence-based!

One of the reasons I have had such high numbers in my groups is that in Western Sydney, practitioners and organisations appear to have abandoned Triple P. There has been a strong anti-Triple P sentiment.

And there are those who don’t run it the way it is supposed to be done. I’ve heard that some run it like an informal chat group. They play the DVD and let the participants chat about their kids, not in relation to the strategies but like it is a coffee club. There is no discussion of the strategies and how parents can apply them.

The problem with this is that I get the rebounders. They do Triple P elsewhere and then sign-up for “Narelle’s Triple P”. But it’s not my Triple P, it is Triple P. This is a waste of resources and a waste of people’s lives.

Why?

A young mother with 2 young children came to my group. She was very anxious from Session 1, “are you going to talk about the Triple P strategies?” she asked many times. I thought it was an odd question. I explained that in Session 1 we talk about the theory and get on to strategies from Session 2. She later told me that she had been to Triple P twelve months ago, and got no strategies from it. Now, this mother had depression, and was struggling with domestic violence, and had a child who from her description could have been affected by ADHD, anxiety, and/or trauma. That should have been picked up 12 months ago when she did her first Triple P! She had to struggle for another 12 months, and her son was now 4 – too sad. I gave her a referral to a clinical psychologist who would be able to assist her to sort out all of her struggles. I have to admit that I was extremely angry. Whoever had run that dastardly Triple P not only put Triple P into disrepute but also the parenting education field.

 

I get quite cranky about this. I ask the anti-Triple P brigade if they have a PhD, or have done 30+ years of research. If not, then I suggest that they do not know better than Triple P. They are running hippy-la-la programmes which have a nil to poor evidence base. Who is missing out? Parents, children, and our community.

These practitioners object to Triple P containing the “time-out” strategy. I say that I tell my parents that time-out is a last resort. With Triple P you get a great big toolbag of parenting strategies. Parents can choose whichever tools they like. If you use the relationship building tools you become so attuned to your child that you don’t need to use time-out. I recommend time-out for what I call “crimes against humanity” – hitting or malicious/vicious behaviour. Time-out is used to communicate to the child “here’s the line and you just crossed it”.

So many parents these days have trouble taking charge and setting reasonable limits and boundaries. By not setting and following through on limits and boundaries they create more problems for themselves It  leads them to be harsh and punitive when they have totally lost their patience and the result is more extreme behaviour from their children. Emotion coaching is frequently used incorrectly by parents. They emotion coach when they should be setting limits and taking charge.

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SMALL CHANGES

I have made small changes to the way I present information in Triple P to cater to the idiosyncrasies of the community I work in.

In this community, the words “discipline” and “punishment” have the connotation that you have to have payback on your child for their behaviour, and you have to be mean and harsh. So I avoid the use of those words, and I explain to the parents why I do this. I use the words “guidance” and “education” instead.

I replace “misbehaviour” with “mistaken behaviour” which is a term I borrowed from Dan Gartrell in the USA. In some pockets of the community, it is almost a status symbol to have ‘naughty’ kids or ‘little buggers’.

There is a high level of dismissive parenting. So, if a little fella falls over and hurts himself, a typical response from a parent might be “get up, you’re not hurt, don’t be a girl”.

I place a strong emphasis on the parent-child relationship with every strategy and communicate empathy for the child. I encourage parents to see how things are from their child’s perspective.

I add the video of Thomas from Driving Mum and Dad Mad, because I think parents like to see that the programme actually does work.

I talk about the difference between shame and guilt, because of the long-term effects of shaming on mental health. Young Angus on the Triple P DVD is being shamed.

I provide handouts on:

  • how to run a family meeting (mentioned in the Triple P workbook but not discussed)
  • variations of descriptive praise because parents have said that they get tired of hearing themselves say the same thing over and over.
  • parenting as a team. The biggest problem that I see in Triple P is parents taking Triple P home and not discussing it with their partners.

I also give an example of what ’reflective listening’ is. It’s mentioned in the workbook but not discussed and parents have no idea what it is.

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I AM A TRIPLE P TRUE BELIEVER

true believer

 

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Maya Angelou

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“Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.”

Howard Thurman

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I love Triple P…

because it works.

I value process over product. I believe that my job is done if I have assisted parents to become more reflective about what they are saying to their children and how they are saying it, and what they are doing to and with their children. Everything else is a bonus!

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HAVE A GREAT SET OF GROUP RULES!

Actually, I call them ‘group guidelines’.

I believe that most of the group work wrinkles are ironed out with a great set of group guidelines. I reckon that half the difficulties are sorted out from the start. And if you think about it, it’s just like the ‘Planning Ahead’ activity in Triple P.

I go through the group guidelines before I give the participants the opportunity to introduce themselves.

My group guidelines are stated in the positive. Why? Because Triple P reminds parents to tell kids ‘what to do’ rather than ‘what not to do’, and in Triple P we state our goals in positive terms.

I acknowledge all of the ‘elephants’ in the room.

Who are the elephants?

  •  Parents in the child protection system
  •  Men
  •  Aboriginal people

I always say an Acknowledgement to Country whether there are Aboriginal  people in the room or not, because it is respectful and because it exposes non-Aboriginal people to NCNS’ principles of reconciliation.

I acknowledge the men in the room. I say that it’s great to see Dads coming to parenting groups because their role in parenting children is very important. I remind the women in the group that their issues with their partners are exactly that, and we are to respect these men coming to this group.

I acknowledge the parents in the group who are not currently caring for their children. I tell the participants that all of the people in the group are parents in some form or other and we need to respect each other as parents for all of the difficulties and complexities that the role brings. Too often in our community, parents feel isolated and judged and that’s not helpful to being the best parent you can be.

I say…

“Be kinder than necessary as everyone you meet is struggling with something.”

I ask parents to please ask questions as we go along. If I think we are going to answer the question down the track I’ll let them know when and where. But I do remind parents that we are here to discuss Triple P and I can’t go into the finer details of the difficulties with their kids within the group. This reduces the number and length of personal stories and keeps the discussion focused on the Triple P strategies.

As I work in the community I am able to see people individually, and I make lots of time for people either after the group or by appointment.

I remind people that Triple P is not a therapy group and they should only disclose information they feel comfortable disclosing. They absolutely must keep themselves safe, especially as I am usually running Triple P on my own. This gives the parents in the child protection system the permission to keep their stuff personal if they wish to.

I state that I am a mandatory notifier and I explain what this entails.

I remind parents that this is a positive parenting programme. I tell them that all the way through I am going to prompt them with the following guiding principle (which I wrote)…

right now

 

I place so much importance on the group guidelines that if people miss the first session, they can’t come to the other sessions. I’ve learnt from experience that if people miss this part of the group experience, a shared understanding of what is acceptable behaviour within the group, and I subsequently let them into the group then the whole group experience is off-kilter and I find it difficult to recover balance. The need to come to the first session is communicated in all of the advertising and personally when they register. If people miss subsequent sessions I do catch up sessions with them, but they must have come to the first session.

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CONSIDER A PARENT CO-FACILITATOR

Someone who can “talk up” the strategies. Someone who has done the work, and has made significant change within the family.

I have had parent co-facilitators in my groups and they add credibility. I even had a single Dad as a parent co-facilitator.

I can say that a strategy works, that I use it with my own children, but parents believe the parent co-facilitator more.

For this reason it has to be the ‘right’ person. You have to choose wisely. I don’t have a parent co-facilitator at the moment because I’m waiting for the right person to come along.

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BE A GREAT ROLE MODEL

Be a role model for the skills you want your participants to learn.

What kind of skills do you hope your parents will learn?

qualities

As a group facilitator you have to be all of that because you want your parents to show these qualities to their children.

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DR DONALD WINNICOTT”S ‘HOLDING ENVIRONMENT’

Dr Winnicott coined the phrase “the good enough mother”.

From Wikipedia…

 “Winnicott (1965) suggested, the therapist recreates a ‘holding environment’ that resembles that of the mother and infant”

 “A symbolic parallel.”

 “Understanding goes deeper.”

I see the group as a holding environment, and in this environment I create emotional safety and trust. If I’m talking about providing emotional safety for our children then the parents should experience what that feels like.

What kind of a world would it be if every child experienced emotional safety within their family? And if every parent experienced emotional safety within their network of family, friends, and community?

From goodtherapy.org…

“Winnicott and his wife [Clare Britton] used the term ‘holding’ to refer to the supportive environment that a therapist creates for a client. The concept can be likened to the nurturing and caring behaviour a mother engages in with her child that results in a sense of trust and safety.”

 

I visualise the holding environment as gently holding a baby bird in the cup of your hands. You don’t drop the baby bird, you don’t flick it off or give it a shove. You kindly and gently wait until the bird grows strong enough to exercise its wings and you wait for it to take flight.

Dr Garry Landreth advises that we can only support people in their growth, and uses the analogy of a bean plant. When the bean starts to break the surface of the soil, we can only provide the right conditions for its growth. If we try to straighten the crook of the bean before it is ready, it will snap.

But wait a minute! I’m talking about psychotherapeutic techniques for psychoeducational groups –  Triple P is not a therapy group.

Yeah, but you’re working with people, and people have “stuff”.

And where does their “stuff” come from?

Their experience of being parented.

And we are talking about parenting in Triple P.

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THE DEFENCES

In the process of delivering Triple P, you are going to press on sore points – pain, grief, loss, trauma, hurt, guilt, shame.

And then what happens?

The defences go up (Sigmund Freud).

defences

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A participant will start to argue, and get defensive and ‘difficult’.

What do you do then?

Be the “good enough” parent. Acknowledge the feelings. Be reflective. Offer time at the end of the group to listen and provide more ‘holding’.

There was an Aboriginal grandfather in one of my groups who wanted to argue every point with me. I said to myself “there’s pain there, his defences are up” and why wouldn’t he have pain? Aboriginal people have a lot of pain.

It doesn’t matter which of the defences it is. It just is.

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DELINQUENCY = HOPE

I view disagreement as healthy.

Why?

Delinquency = Hope (Winnicott)

Have you worked with anyone in the depths of depression, where everything is completely and utterly hopeless and helpless? There’s no fight left in them.

It’s really hard to work with people who have no fight in them.

If they’re fighting, squiggling, squirming, arguing, defending – they are thinking, reflecting, comparing, analysing.

It’s healthy! It’s hopeful!

This is the reason that I encourage parents to ask questions as we go along – I want to know what they are thinking and what they are wrestling with!

I once had a Dad in a group who declared up front that everything I was going to say was rubbish. He didn’t believe in any of it. That he was smacked and treated rough, and he was ok. In fact, he said, children are so hopeless these days because they haven’t been treated harshly enough by their parents. I thanked him for his honesty, and politely offered that I would be really interested in what he had to say at the end of the group programme.

What I knew, was that this man had spent time in gaol for domestic violence, and had all sorts of angst about one of his children being in foster care – he was not ok. I did some individual work with the man and his partner upon their request, in addition to the group work. At the end of the programme he said to me in private “you’ve convinced me with this different way of parenting of yours” and he asked for a referral for his domestic violence, and he followed up on the referral.

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UNCONDITIONAL POSITIVE REGARD

I cringe when I hear practitioners mocking their communities and clients, criticising them. I was once at a conference and one of the speakers was mocking the participants in her research study. I couldn’t believe it.

Freud moral estimates

As Freud said, it’s not about moral estimates. Parents are very good at criticising other parents, but when practitioners do it that’s another level of contempt and it’s not helpful.

When parents know better they do better. Triple P is more knowledge!

I never mock the parents or community I work with. Carl Rogers talked about having unconditional positive regard. I have the utmost respect for the parents who have come to the group because they are there. They have arrived! And that’s a very good start.

Knowledge can be at a head level or a heart level. Some parents can talk about the strategies in far more fluent ways than I can (head level) but they have trouble putting them into practice (heart level). That’s ok, it takes a lot of talking and practice and reflection for knowledge to become operational.

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SAFE HANDS

circle of security

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I was exposed to the Circle of Security model twelve years ago whilst studying my masters degree. At the time I thought that it made so much sense for parents, but I also thought it applied to practitioners working with parents.

We are the safe hands.

Where are our clients on the Circle?

Professor Matt Sanders talks about the need for parents to develop self-efficacy with their Triple P. I do not encourage dependency, however I have found that there is a small percentage of parents who require additional support. These are the parents who are on the bottom half of the Circle. Far too many parents in our community dismiss their children’s needs and they dismiss their own needs, so I am not going to dismiss any request for help.

I find that some parents come back to me 6 to 12 months after completing Triple P. They contact me because they say that Triple P is no longer working for them, and they need the newest and best parenting programme. Parents sometimes forget that they need to do Triple P consistently every day. I comfort them and organise their feelings around their struggles and delight in the gains they have made with their positive parenting. Then together we go back to the parenting goals they wrote down in Session 1.

I then go through the Triple P strategies with the parent again so she can identify what she needs to focus on with her children given their stage of their development and the family’s circumstances. I give the parents ‘just enough help’ to revise their goals and get them back onto the top half of the Circle.

We need to be bigger, stronger, wiser, and kind.

SUMMED UP

  • Group facilitation is a state of mind!
  • All people are complex and have ‘stuff’.
  •  Run Triple P the way it is supposed to be run.
  •  The group guidelines set the tone – the job is half done.
  •  Parent co-facilitator?
  •  Role model the skills that you hope the participants will learn so they can become more responsive parents.
  •  A ‘holding environment’ creates emotional safety.
  •  People are only ‘difficult’ because they are in pain.
  •  Delinquency = Hope
  •  When people know better they do better.
  •  Respect them and their process.
  •  Reflect on where people are on the “Circle”.

It doesn’t matter how your group is made up. It has people in it. Your group will be a sample of your community and that’s a good thing because we can all learn from each other. The only way I can continue to offer Triple P at the level that I do is through diversity. Every group is different and that makes it so interesting, dynamic, and enjoyable. I delight in seeing parents effect the changes they do to make their parenting more positive and joyful. If you think it’s meant to be enriching and empowering, it will be.

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Narelle Smith

 

 

 

 

 

 

 

 

 

 

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About Narelle Smith

Child & Family Worker

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