guiding group process by facilitation elizabeth a. keene reder, ma, ct harriet lane compassionate...
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Guiding Group Process by Facilitation
Elizabeth A. Keene Reder, MA, CT
Harriet Lane Compassionate Care
Johns Hopkins Children’s CenterBaltimore, MD
September 11, 2008
Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008
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
Responding to Suffering
I wish I could show you,
when you are lonely or in darkness,
the astonishing light of your own being.
-Hafiz
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Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008
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
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
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
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
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
Essential Communication Skills
• Reflect content or feelings
• Paraphrase• Clarify• Open-ended
questions• Metacommunicatio
n
Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008
Stages of Group Development
.
• Forming
• Storming
• Norming
• Performing
• Adjourning
Tuckman, BW & Jensen, MA. (1977) Stages of small-group development revisited. Group and Organizational Studies.
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Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008
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
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
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
Implications from Bereavement Research
“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 styleDoka, 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
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
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
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
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
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
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Elizabeth A. Keene Reder, Harriet Lane Compassionate Care, Johns Hopkins Children's Center September 11, 2008
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