Guiding Group Process by Facilitation

1. Guiding Group Process by Facilitation Elizabeth A. Keene Reder, MA, CT Harriet Lane Compassionate Care Johns Hopkins Children’s Center Baltimore, MD September 11, 2008

2. Examples of groups • Bereavement support • Disease-directed (cancer, HIV) • Caregiver support (Alzheimer’s, cancer) • Substance abuse support • Domestic violence • Offenders • Scripture study • Support for health care professionals • Chaplain peer support • Departmental work group Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

3. Responding to Suffering I wish I could show you, when you are lonely or in darkness, the astonishing light of your own being. -Hafiz Everystockphoto.com Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

4. Group Process • Therapeutic factors • Instillation of hope • Altruism • Cohesiveness • Guidance • Identification • Inter-personal learning (input and output) • Self-understanding • Universality • Catharsis Yalom, The Theory and Practice of Group Psychotherapy, 2005 (5th edition). Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

5. Group Process • Support vs. psycho educational vs. self-help groups • Support groups focus more on “mutual aid”; psycho educational groups strive for behavioral or social change • Support groups have a professional leader; self-help groups do not Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

6. Role of Facilitator • Establish a “Gracious Space” • Set an accepting; nonjudgmental tone • Manage time • Establish group rules • Encourage sharing • Challenge when appropriate • Be aware of your own vulnerabilities Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

7. Group Facilitation Skills • Skill of Silence • Skill of Connecting Group Members • Skill of Differentiation • Skill of Identifying Common Themes • Skill of Developing Group Rituals • Skill of Developing Group Cohesion Adapted from The Dougy Center Facilitator Skills Manual, The Dougy Center, The National Center for Grieving Children and Their Families Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

8. Group Format • Target audience-institution or community? • Screening or “just show up”? • Voluntary or mandatory? • Open ended or time limited? • Structured content or free-flow sharing? • Fee or free? Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

9. Essential Communication Skills • Reflect content or feelings • Paraphrase • Clarify • Open-ended questions • Metacommunication Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

10. . Forming Storming Norming Performing Adjourning Tuckman, BW & Jensen, MA. (1977) Stages of small-group development revisited. Group and Organizational Studies. Stages of Group Development Freedigitalphotos.net Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

11. Roadblocks • Attendance • Resistance • Non participants • Murphy’s law for communities (Palmer) • “The conversation hog” • “The advice giver” • “The comparer” • ??? Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

12. Resources • National Catholic Ministry to the Bereaved: Ministry of Consolation Training Manual www.griefwork.org • Wolfelt, Alan. How to Start and Lead a Bereavement Support Group, Companion Press. • The Dougy Center, The National Center for Grieving Children www.dougy.org • Hughes, Patricia. Gracious Space, Center for Ethical Leadership Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

13. Resources • The Journal for Specialists in Group Work, Routledge Press • Association for Specialists in Group Work: Best Practice Guidelines 2007 Revisions published in The Journal for Specialists in Group Work, June 2008. • Trainings through national associations: • Suicide prevention, cancer, HIV • Trainings through local organizations: • Hospice programs, community outreach programs Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

14. Implications from BereavementResearch “All he ever does is work.” “I can’t stand to see her cry.” • Grief Coping Styles • Intuitive: Process-oriented, focus on feelings, cope by expressive approaches • Instrumental: Task-oriented, focus on thoughts, cope by behavioral approaches • Dissonant: Unable to respond within particular style Doka, K. ( 2000) Men Don’t Cry…Women Do. Bruner/Mazel. Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

15. Implications from Bereavement Research “Everyone tells me I should join a support group to talk about my feelings.” • Effects of disclosure of emotions • No evidence that disclosure facilitates adjustment (spousal loss) • Some evidence that teaching instrumental grievers emotion-focused techniques/intuitive grievers problem-focused techniques is helpful Parkes, CM. (2002) “Grief: lessons from the past, visions for the future.” Death Studies. Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

16. Implications from Bereavement Research “I don’t know why you say good-bye, I say hello…*” • Continuing bonds • Shift in grief model from severing the attachment to the deceased to constructing healthy continuing bonds • Continuing bonds support behaviors and attitudes of cooperation and help overcome depression, anger and resentment *Browning, D. Innovations in End-of-Life Care, 2001. Klass, D. Continuing Bonds: New Understandings of Grief, 1996. Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

17. Grief and the Health Care Professional • Model for health care professionals • Grief can be related to: • Loss of relationship with child • Identification with parents’ pain • Loss of assumptions about worldview • Previous, unresolved losses (or future anticipated) • Personal mortality • Loss of sense of integrity, professional expectations Papadatou, D. (2000) “A proposed model of health professionals’ grieving process.” Omega. 41(5), 59-77. Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

18. Grief and the Health Care Professional • Interventions • Clinical support • Information • Emotional support • Meaning-making Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

19. Outcomes Do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? -Robert Greenleaf, Servant Leadership freedigitalphotos.net Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008

20. Guiding Group Process • Part of a comprehensive, multifaceted plan for support • Take advantage of existing resources • Partner with community organizations • Be aware of your own vulnerabilities Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008