Tuesday, November 29, 2011

Sometimes the Bear Gets You (and What to Do Next)

A thoughtful supervisor once sagely shared with me a piece of practice wisdom: "Sometimes you get the bear. Sometimes the bear gets you."

Now, I don't know the source for this quotation, or to what it originally referred. It was first told to me in the context of work with preschoolers. However, I have found it most relevant to the practice of group work - no matter the population.

If you've led groups, you've most likely had the experience of things...not going as planned. After all, there are many variables in group leadership that are out of the leader's control - for example, who attends on any given day, what mood they're in and what else is going on in their lives when they get to group, and how they will interact with each other. Because group composition and dynamics change over time, it's very likely that you will walk into a group that's changed in subtle ways since the last time it met - whether that's the next week, the next day, or the next hour!

I've spent a lot of time working in partial hospitalization programs - day programs that offer short-term treatment for acute psychiatric conditions, as a way to reduce or avoid hospitalization. Treatment happens primarily in groups, and the population changes on a daily basis as people are admitted and discharged. Combining acute psychiatric symptoms with constantly-changing group composition, and people at various stages of treatment, makes it hard to plan a group that's appropriate for everyone. It can feel risky to challenge the group too much, or to introduce a new intervention when you can never be sure how it will go over.

Sometime things go pretty much as expected - with various group members behaving predictably (in both helpful and unhelpful ways), and grasping the material to whatever extend their symptoms and abilities allow. These are the days  when no (metaphorical) bear puts in an appearance.

Occasionally, things go better than you could ever have anticipated. The group has a breakthrough, connecting to each other and/or the material in new, deeper, more authentic ways. Their passion, compassion, and creativity outstrip yours and take whatever you've planned to levels you couldn't have come up with (after all, we all know that a group is, in many ways, more creative than an individual). On these rare but precious occasions, you get the bear.

However, things don't always go as well as you hope, or expect (even when your expectations are low). Sometimes a group will go to pieces (metaphorically and literally). Members squabble, form cliques, and are unkind to each other. They become oppositional, clown around, make a scene, or otherwise interrupt the group process. Perhaps members who were previously divided suddenly find common ground, uniting against you (as happened to an unfortunate colleague today). At best, you spend the time putting out fires and responding to inappropriate behavior, and don't get to convey whatever material you had planned (in other words, the behavior is effective in its goal of disrupting/derailing the group for the day). At worst, you have to invite (*insist*) one or more members leave, or even just end the session. These (you guessed it!) are the occasions when the bear gets you.

It doesn't matter how brilliant you are as a therapist, or how motivated and cooperative your clients usually are - sooner or later this bearish group dynamic will take over, and get the best of you. It's normal, and sometimes a necessary stage in the group's development. The trick is to respond in a way that moves the group dynamic toward a more productive resting point. Perhaps, to continue with my metaphor, the way to prevent that bear from getting you again is to tame the bear as a circus performer instead of locking it up in a zoo. (Of course, remember that other bears will inevitably come along eventually!)

Easier said than done, but here are my suggestions:
1) Interrupt the disruptive behavior as soon as possible, to keep a counterproductive dynamic from becoming a new norm. Redirect, or when necessary remove instigators or stop the group.
2) If there are a small number of instigators, address their behavior 1:1 to figure out what happened to trigger it, and discuss how they can be more productive when the group resumes.
3) When the group resumes, reiterate the group guidelines, however they have previously been decided/conveyed. Invite the group to discuss the last meeting in the context of these guidelines. Hopefully, more positive group members will confront the disruptive behavior, thereby reestablishing pro-social and productive group norms. (It's more powerful when the message comes from peers rather than the facilitator).
4) When appropriate, invite further processing of the underlying issues that contributed to the group dynamics that occurred at the last meeting.
5) Move on to the real "work" the group has gathered to do, and whatever material you have prepared.
When the bear gets you, it's also incredibly helpful to process it with colleagues and/or in supervision. Process your own reactions and frustrations, try to figure out what (if anything!) you might have done differently, and discuss a plan for the group's next meeting. This step is absolutely crucial when the group is meeting as part of a milieu (e.g., the partial program), where other staff are running groups with the same participants, and working with various clients individually. Without good communication and mutual trust, negative group dynamics can infect the treatment team and become "staff splitting" - which has negative results for clients' treatment, and staff morale.

So, in summary: Bears will come and go. Sometimes you will get the bear, but other times the bear will get you. It's inevitable...but not always negative in the long run, because it offers an opportunity for groups to address specific issues that might not otherwise come to light, and it offers you an opportunity to hone your skill at leadership, and conflict resolution.

What suggestions do you have for when the bear gets you?

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