Chapter Seven
The final stage of group life

In the second year of the courses at both institutions, there has always been a tension between the allocation of time to the PPD module meetings and attending to other demands on the trainees' time. Despite a general commitment to the module, other aspects of the course tend to be prioritized. Trainees and group leaders continue to find this frustrating, emphasizing that it is at these very times—when the trainees are under the greatest pressure—that the PPD module, with its capacity to provide containment, is most needed. Nonetheless, because of the exigencies of time, regular group meetings may be forfeited.

On one occasion, a group was so preoccupied with pre-exam concerns that the leader encouraged a discussion and then created an exercise about the different ways in which people express anxiety and the possible effects of their behaviour both personally and professionally, at these times (see Exercise 20).

Another example of competing pressures is when dissertations are in preparation; it can then be difficult to divert the trainees' attention elsewhere. Quite consistently, the module meeting just before the handing in of draft dissertations has proved very uncomfortable: the group leader becomes the main repository of the group's frustration, anxiety, and any disappointments about their experiences on the course. At these points, I tend to place more emphasis on relaxing the group pace and acknowledging that the trainees themselves can act as a resource and provide support for each other. This also provides a training link with parallels in family therapy when families may be particularly distressed and lose sight of their strengths,

Exercise 20
"Coping with Group Anxiety"

1. Each person in the group is asked to think of an occasion when he or she was very young and very anxious.
2. They are asked to think about how they had felt and how they had responded to the situation.
3. They are asked to recall whether anyone else was involved; if so, to consider how the other person or people had responded and whether this had helped or hindered them in coping with the situation.
4. They are then asked to recall a recent worrying event and how they had coped with it. Was it a similar or dissimilar process to the earlier one above?
5. Finally, they are asked to talk in pairs about how their own experiences and responses could affect their clinical practice, when either they or their clients are especially anxious or preoccupied.

Timing 30 minutes.

Comment On some occasions this might be followed by role-plays of anxiety-provoking scenarios that the trainees had been discussing. The aim would be to look for alternative approaches the group could suggest to deal with these issues in clinical practice. Trainees are encouraged to learn that there is no one response to a clinical situation; rather, there is a range, depending on which model they favour and what seems to be an appropriate "fit" for that particular family.

Caveat The early part of this exercise can tap into intense feelings, so the leader should be prepared to take longer over it if necessary.

Professional pointer This exercise may go on to provide a good opportunity for trainees to practice intervening using a range of alternative approaches based on different systemic models. An hour of extra time should be allowed for this.

Exercise 21
"Family Patterns"

The approach of the Christmas break is a useful trigger-event for looking at different cultural, religious, and family patterns and how they have evolved.

This exercise starts with personal perspectives, then moves to a consideration of social pressures in the wider community and of how clinicians might address these issues in therapy.

1. In pairs, discuss the significance of Christmas in your family—regardless of your culture.
2. Explain the usual way this period was/is dealt with
   1. in your family of origin
   2. currently
3. Have any changes been made, and if so what triggered them?
4. Consider any underlying issues—e.g. the different ways in which family members may wish to deal with the event, or a recognition that children may be confused by celebrations at school at Christmas time, given their different religious beliefs.
5. General group discussion.
6. Role-play to experiment with different ways of addressing these issues with families from different cultures and at different lifecycle stages.

Timing 45-50 minutes.

Comment This exercise usually evokes a lot of interest and feeling, often tapping into dilemmas about following traditional family practices or creating one's own. This exercise is equally effective in small or large groups.

Professional pointer Given that family therapists are currently working with ever more diverse populations, it is essential to help trainees recognize the significance and differing experience of being in a minority or in a majority. Asking for information about other cultures in this context provides opportunities for therapists to demonstrate their interest and a genuine wish to learn from and about their clients' experience.

Exercise 22
"All Change"

When there are major changes on the MSc course—for example, someone withdrawing from a course, or two supervision groups being merged, or if trainees change to new supervision groups in the second year—trainees often use the PPD group as a forum for exploring such issues. On one occasion following a general discussion, I introduced an adaptation of an exercise I had first seen in a workshop on stepfamilies given by M. Robinson and D. Smith at an Association of Family Therapy conference in 1992. It was used to demonstrate common ambivalent feelings about moving from one context to another.

1. In pairs, the trainees are asked to talk about a process of change that they have experienced.
2. After 5-10 minutes, usually in the middle of intense conversation, the leader interrupts and each pair is asked to combine with another and continue talking.
3. Ten minutes later, one person from each group is asked to move on to another group (in this way, each group loses one member and gains another).
4. The newly formed groups talk for 10 minutes.
5. General group discussion.

Timing 50 minutes.

Comment The leader encourages a focus on the process of the experience and the effect on everyone of changing the membership of the groups. Trainees may raise issues of loyalty to past and present groups, their anxiety about having to start all over again, and fears about how long it will be before the next demand for change is made. Trainees often demonstrate a high level of irritation, as well as a degree of excitement at the apparently arbitrary nature of the changes. They generally report a concomitant lack of control about the whole experience.

Professional pointer This leads into skills training in relation to working with separating and divorced families, and step-parenting issues. Role-plays are used in which the above issues are addressed, with a trainee as observer monitoring the directness of information given and age-appropriate language used so that all family members understand what is happening. This discussion often leads to an exploration of the differences—real and imagined—between mediation and therapy.

Exercise 23
"This House Proposes"

One of the precipitating factors that led us to establish the original PPD module was a recognition of the increasing gap between the life-cycle stage of "book-learned" trainee therapists and their older, "life-learned" clients. This could cause some trainees to feel overwhelmed and anxious, resulting in an unintended lack of respect, defensiveness, or symmetricality. The following exercise has been helpful in recognizing and learning to accept that, all too often, we do not know what we do not know. In many cases, the experiences of an older generation and the premises on which it bases its beliefs become outmoded; more than ever, therapists need to take courage and ask the clients for help in order to be sympathetic and to understand their attitudes.

1. A formal debate is arranged: "This House proposes that..."
2. The subject of the debate is a firmly held view about a major social change within the last few decades—e.g. culturally and generationally challenging issues such as "divorce is the only solution to an unhappy marriage"; "living with someone if you are not married is immoral"; "adolescents should always do as their parents tell them".
3. Four trainees (a proposer and seconder for each side) are encouraged to volunteer and to declare which side of the argument they support.
4. They are then asked to argue in support of the opposite view.
5. General group discussion.

Timing 35 minutes: approximately 5 minutes per speaker and 15 minutes for discussion.

Comment and caveat This is a lively exercise which people enjoy, but there needs to be adequate discussion afterwards to consider what was learnt—both from the process of the debate as well as from the content—that helped or hindered them in expanding their perspectives.

Professional pointer The aim here is to help trainees listen constructively to a view to which they may be initially unsympathetic and which, as a result, could lead them to become symmetrical and disrespectful. Arguing from the opposite perspective tends to make it harder to retain a rigid position. Therapists profit from questioning themselves and their assumptions in the same way as they question their clients and their preconceived views.

Exercise 24
"Now and Then"

This exercise is useful towards the end of the course, to monitor personal change.

1. Think about the following, individually:
   1. If you have a partner, what comments do you think he or she would make about any changes in you over the past two years, since you have been on the course? If you don't have a partner, imagine what might be said by someone close to you.
   2. Repeat this process, thinking of another friend or colleague.
   3. Would either mention any losses or gains for you, and for themselves?
   4. How do you think you may have changed, and is this congruent with the views expressed above?
   5. What changes would you like to suggest to the course organizers?
2. Now divide into pairs to discuss your thoughts so far.
3. General group discussion about the advantages and disadvantages of change.
4. Consider a specific family you have seen, and in pairs discuss what the family may have gained and lost through changes as a result of their therapy with you.

Timing 45 minutes.

Professional pointer Encourage the trainees to think about specific details of the changes that they mention, thereby stimulating them to be more curious about detail in their clinical practice.

Exercise 25
"Take Your Time"

There was a period when two or three particular trainees tended to wander in late for module meetings, and this was clearly noticed by other participants. On the first two occasions, I briefly recapped the meeting so far, but on the third occasion I deliberately continued with the discussion without further explanation to the latecomers. They appeared a bit surprised but then began to concentrate in order to catch up.

The issue was later tackled as follows, without making overt links to the trainees' poor time-keeping:

1. The group was asked to think about
   1. what being late signified to them
   2. how they dealt with their own and other people's lateness.
2. They were then asked to link this with their own upbringing and their family's attitude to lateness.
3. Finally, they were asked to consider how they perceived and dealt with their clients' lateness in clinical practice.
4. General group discussion.

Timing 25 minutes.

Comment The ensuing discussion may reveal negative comments about clients' "resistance" when late for therapy sessions, in contrast to therapists' rationalizations in relation to their own tardiness.

Exercise 26
"Putting it on Paper"

As Bacigalupe (1996) comments,

Writing can play an important role in aiding clients and therapists to include multiple voices and diverse positions in their communications. . . .

There is the potential for therapists as well as clients to see themselves as storied individuals, their lives as an evolving text. [pp. 371-372]

1. The group had been talking about working systemically with an individual, and the mood had become quite introspective. Tapping into this, I suggested that each person made a list of chapter headings for their autobiography, which would highlight salient internal and external events, important influences, special people, life-cycle stages, etc. This activity evoked a great deal of interest and quiet contemplation; it seemed to be a rapid method of bringing the past into the present, observing patterns over time and ideas of continuity.
2. During the general group discussion that followed, the trainees were asked to consider whether they might use this in their clinical practice either during a therapy session or as a set task. The method could be applied to an individual, the story of a couple, or a family's narrative.

Timing 30 minutes.

Exercise 27
"The Snake Exercise"

This is a popular exercise used to emphasize possible connections between an individual's behaviour in a group situation and in his or her family of origin.

1. The group (the larger the better) is asked to form a ring, holding hands.
2. They are told that they are free to move and do whatever they like, with the one proviso that they must not let go of each other's hands (this symbolizes their connection with their family of origin, regardless of whether it is positive, negative, or exists only in phantasy).
3. They are then encouraged to run, jump, get apparently inextricably intertwined, wrapped round each other, etc. Don't be surprised at how little encouragement is needed to create mayhem! When they look impossibly enmeshed, they are exhorted to try even harder.
4. They are then asked to freeze in their position, however uncomfortable it is, and then to shout out in one or two words how they feel, and to note their position in the group. They are then asked to unravel themselves and return to their original circle—but, of course, without letting go of each other's hands.
5. When they finally manage this, amidst much laughter and acrobatic contortions, they are asked to think about the process that made it possible for them to return to their original circle.
6. Then they are asked to think of one or two words to describe their position in their family of origin.
7. Finally, they are asked to consider if there was any similarity between their position in the group and in their family of origin, and between the words they chose to describe both. For many people, this proves a fruitful exercise, in which they can make unexpected powerful connections—for others, it may just be fun, but as the exercise tends to stay in the mind hopefully the message about the links between the past and the present may too.

Timing 20 minutes.

Comment This can serve as a useful ending ritual, in which everyone is actively involved, connected to each other, required to collaborate to reach a solution, and enjoying themselves.

Caveat This exercise requires lots of space and is very energetic!

"The snake exercise"

General Considerations

1. The pace of groupwork must take into account and respond to the preoccupations and energy levels of the trainees.
2. It is important to allow enough time at each stage of an exercise for emotions to surface and, at the end, in order to process them.
3. Clear connections between the personal experience and the professional application of the concepts should be made.
4. It is essential to allow time for discussion rather than relying on too many different exercises.
5. The larger the group, the longer the time required for feedback.
6. In the large group context, it can be helpful to subdivide the group into smaller working units for some of the time, in order to give more participants an opportunity for active involvement.
7. If gaps in training are spotted (e.g. as in the case of the "homework" task to observe children, in Chapter 4), it is important to weigh up the advantages of tackling these in the group setting as opposed to suggesting that supervisors might deal with specific issues in supervision groups, or informing the course convenors about the omission.
8. There are many important topics that could usefully be included in future modules but for which no exercises have been given here—for example, the impact of illness, disability, ageing, class, and spirituality. The exercises described in these chapters reflect the issues raised by trainess in the cohorts between 1993 and 1995.