One mother’s use of a parents’ group
In this article, we describe an experience of running a parents’ group in an inner city Child and Adolescent Mental Health Service. We feel this might be of universal interest
to a variety of professionals working in different settings and with different parent populations. One model of parent group does not suit all and clearly the setting of the work, the aims of the intervention and the approach taken by group leaders with diverse theoretical trainings and experience are all factors influencing the way the groups are run. The description of our group is by no means intended as a template for running a group. Nonetheless, we imagine it may be helpful to think of the significant common processes and dynamics that occur in groups.
Why offer a group?
When children in CAMHS are offered ongoing therapy, either individually or in a group, their parents are usually offered sessions by a different clinician for the duration of the work. This is to help the family support and accommodate changes in their children resulting from the therapy and also to try to prevent troubled or deprived parents from unconsciously sabotaging the work. The parent work can comprise individual sessions but our experience is that some parents do particularly benefit from a group.
The aim of this kind of parents’ group is to encourage greater insight into the children’s difficulties and into how their own interaction with their children promotes or hinders the children’s development. In a group, a defended or fragile parent can be helped to recognise, in other parents, feelings or thoughts that they might not be ready to own in themselves. They can also often accept from another parent an observation or insight that would have taken years to accept from a clinician. Through group discussion, parents can recognise unacknowledged aspects of their own children’s personalities when they hear about them in the other children discussed.
Our material is drawn from a parents’ group we ran jointly for one academic year to support a children’s psychotherapy group run in parallel. The children had been selected with a variety of difficulties and had been carefully considered to form a working group. The parents, of course, were random so that neither we, nor they, knew beforehand quite what the dynamic would be. This unknown and changing dynamic forms part of the challenge of convening a parents’ group.
Part of the rationale for running a parents’ group in parallel to a children’s group is that when a children’s group stands alone whilst parents wait in the waiting room, a kind of ‘adolescent gang’ culture can develop (that is, something anti-adult and anti-parental). We had had previous experience of this happening in an educational psychotherapy group in our clinic. This ‘adolescent gang’ mentality can, of course, also happen within a parents’ group but here it can be worked with. If an assortment of parents is waiting in the waiting room whilst their children are in a therapy group, it cannot.
Two heads are better than one
We ran the group as a pair and built in time for our own regular supervision with a therapist experienced in such work. The benefit of co-working is to model a co-operative and thinking parental couple who are clearly working together, may also have different points of view that can be discussed in front of the group, but are never undermining each other. Leaders can arouse envy and provoke verbal attacks. These attacks, which are so powerful in a group, can be quite disabling for a single clinician. Although two leaders working together can be particularly envy provoking (and even more so for troubled parents), where there are two leaders, it is possible for one to continue thinking whilst the other takes the full force of the attack. Moreover, having two group leaders is reassuring to parents in this respect, as a couple feels stronger and more resilient than
a single person.
For our group, having a couple leading them carried particular meaning because not a single parent had experienced a well-functioning, containing parental couple in their own childhoods. Unsurprisingly for a CAMH service, we were to find that most of them had suffered high levels of neglect, abuse, trauma and violence
The setting and structure
Our group met in the same clinical room each week, during term time. This happened to be next door to the room in which the children’s group was held. We found it helpful to be seated in a circle. This facilitated discussion and gave a sense of everybody being equally included in the group thinking. It was also helpful for the group facilitators to sit separately, rather than next to each other, but still in sufficient physical relation to each other to be able to have easy eye contact.
The group had no overt ‘task’ or structure. It was a group for free discussion, framed only by the thinking from us about what was being said and by our growing awareness of themes emerging. It is important to say, perhaps, that whilst this was not a ‘therapy’ group for the parents, thinking about their children inevitably put the parents back in touch with their own experiences of being parented and mid-way through our group these childhood experiences were increasingly a feature of the discussions.
For those parents who disliked being in the spotlight, it was helpful that thinking about their own childhood experiences arose naturally, driven by the parents who implicitly encouraged each other to consider the past and to share it.
One mother’s experience in the group
Owing to restrictions of space in this article, and for the sake of clarity, we are going to illustrate the kind of change possible through working in a group by focusing on the experience of one mother. This particular parent was highly defended and found thinking difficult and we have chosen her because gradually, over time, she was able to use the group to facilitate significant change in herself and in her relationship with her son.
This mother, whom we will call Zelda, was an attractive, dark haired, plumpish woman in her early forties, who presented as carefully groomed and nicely turned out. She told us before the group started that she did not like groups and found it difficult to talk in them but that she was willing to give this one a try, for the sake of her son in the children’s group.
From nine-year old Michael’s previous assessment in our Neuro-Developmental Team, we knew that he had been diagnosed as being on the autistic spectrum. In addition, he had ADHD and was on medication for this. He suffered from intense separation anxiety and was preoccupied with death, both his own and his mother’s. His functioning was at a developmental level well below his years and he was quite unable to have ordinary friendships or to play co-operatively with other children.
Zelda, who came from an Egyptian family, was a single parent with three children: a daughter, by her first husband, who was in her early twenties with a baby of her own, and, at the start of the group, was living with her mother; a teenage son who, we were later to discover, had considerable difficulties of his own and nine-year old Michael. Zelda let us know that, despite their divorce, she had maintained a very friendly relationship with her ex-husband, who now resided in Alexandria. We were told that Zelda, her adolescent son and Michael, used to spend ‘lovely’ summers in Alexandria with Father.
The other members of the group
When Zelda arrived in the group she was faced for the first time with a heterogenous collection of people. Evelina was a very large woman - tattooed, with numerous body piercings and cropped hair that varied in colour from week to week. Her husband, Gary, was also a member of the group, and the only man. He was mild-mannered, similarly tattooed and also sported body piercings. The third member was Carol, who was young, slim, blonde and adolescent looking. Heidi, the fourth member, was from a more privileged background. She was clearly from a different country, as she had a foreign accent. She was slim, with a slightly ex-hippy-ish taste in clothes and was noticeably better educated than the rest of the group. Two sessions later, another couple arrived belatedly, lasted only a couple of sessions, and then dropped out.
Beginnings
At the start of the group, Zelda was content to let others fill the space, in particular the only couple in the group, Evelina and Gary, who each week regaled us with highly melodramatic and shocking stories of their son’s destructive activities. To all the parents, this boy was obviously out of control. Zelda - who always sat close to one of us- listened quietly, as if aligning herself with the leaders, and maintained a defensive superiority. She described to us all how her son ‘used to have difficulties.’ These were all in the past and she clearly felt he was now very much under her control. This control, we felt, was a factor contributing to Michael’s intense separation anxieties.
Zelda let us know about Michael’s early diagnosis of ADHD and how she had been given strategies and medication to cope with this. In this way, she immediately distanced herself from those whose children were currently more overtly disturbed. She also painted an envy-provoking picture of older, supportive children at home, and no need for a man. Denial of difficult feelings extended to her ‘not minding at all’ about the disappearance of the couple who dropped out after two sessions.
In these initial sessions, we noticed an attempt by the parents to find common ground. A diagnosis of ADHD seemed to be the one similarity between Michael and the other children acceptable to Zelda. At this time she also let us know that Michael could not tolerate anxiety and that she might need to rescue him if he were too unhappy in the children’s group next door. Our comment, that there were two adults to support him
in his group and that he may benefit from an experience of working through his anxiety, rather than being rescued by her, was met with some doubt.
Middle sessions
By the fifth session, Zelda was able to say that there was some similarity between Michael and Roger, who was the most floridly disturbed boy in the children’s group, in that Michael never left her side for a moment and ‘went on and on and on’. But she was pleased, of course, that Michael was not as violent as Roger.
The sixth session included a discussion about what the children made of coming to
their group and what their stories about it might be. This enabled us to see Michael’s incapacity for making links, conceptualising and thinking things through. Zelda let us know that when asked a question, Michael would simply answer, “Ask my mum.” This contrasted with the other children discussed and Zelda, for the first time, was confronted with a realistic view of Michael’s deficits in relation to other children of his age. It was important that this painful realisation took place within the context of a group that, by this time, Zelda had come to trust.
A theme arising at this point in the life of the group was loss and absence. This developed through discussion about the group members who had dropped out. We have said earlier that Zelda had denied any feelings about their loss. Most of the children had experienced the absence of a father and the parents discussed their children’s reactions to this. How did the children manage their painful feelings? Whilst two other mothers spoke movingly about their children’s upset feelings at their parent’s absence or unavailability, Zelda insisted that Michael never really thought about such things.
She then told us that he had, however, expressed disappointment about not going to Alexandria this year but that, if she provided outings and treats instead, he would forget all about it. Anyhow, she said, it was just his dad’s sweets and so on that he missed. We challenged this and suggested ‘sweets and so on’ came to stand, perhaps, for Dad. In exploring what Michael might make of Dad not living with them, Zelda said he just ‘forgets about it’ and gets on with things. When once he had said that he did wish they could all be together as a family, she had told him that Dad gets on her nerves. We helped her think about whether Michael may feel that boys who get on her nerves are jettisoned.
Secrets
The theme of being busy as a way of keeping painful thoughts at bay was all-pervasive
for Zelda and we returned to it frequently. ‘Out of sight out of mind’ had become a modus operandi for her. When discussions came up about holiday breaks and then the anticipated ending of the group, she stated that Thursdays (the day of the group) would soon get filled up with other things and one would quickly forget about the group. Later, we were to hear about the traumatic loss of her own father in her youth, where there had been no help and, ‘just forgetting and getting on with things’ had been for her the only way of managing.
We heard how Zelda kept secrets from her family who had no idea about the extent
of Michael’s difficulties. She told us how well her sister’s children had done, going to university, and how much she too wanted to succeed with her children. It seemed that she believed she would be criticised by her family, rather than supported, if she shared her difficulties. Zelda told us that when her mother used to visit, Michael would be playing on his computer, demonstrating none of the behavioural difficulties with which Zelda continually struggled. As a result, Nan would simply think he was ‘lovely.’ We felt this demonstrated Zelda’s attempts to keep secrets from herself – and that this was the way she protected herself and Michael from painful realities. The slow process of Zelda’s acknowledgement of reality became clearer in the group as time went on and we heard how this benefited Michael who came to have a growing expectation of support, rather than blame, from his mother.
Letting thoughts in
By group seven, Zelda was able to say that Michael did mind when children were absent from his group. She had heard him ask one of his children’s group facilitators where Roger was. From this time, Zelda showed a growing awareness that absence was important. The intrusive sounds from the children’s group next door and Michael’s occasional knocking on the door of the parents’ group room were useful as a concrete example of Michael’s behaviour and its effect on Zelda. We began to hear a bit more about her negative and angry feelings towards her son. Zelda said she ‘couldn’t concentrate’ and then let us know that Michael ‘never gave her any space’. He ‘suffocated her’ with his constant questions and demands.
Later still, Zelda was able to mention wistfully that she wished Michael could be more ‘extrovert’ like Roger and some of the others in his group. He was so very solitary. He wouldn’t join in with things or be spontaneous. It was sad for him, she said. That was why they were here. This statement represented quite a shift from her tendency to keep Michael as the good one in her mind and to allow the other children to carry the negative attributes. It was also helpful for the mothers of the children in question to hear a positive reframing of their children’s traits.
At about this time, when a parent described the effect of her husband’s death on their daughter and another parent described the impact on her of her father’s death, Zelda let us know that she too had suffered the traumatic loss of her father when she was twelve years old. We felt this was a highly significant acknowledgement of her original trauma. She told us about this at the very end of a session - and we could only say we had heard something very important from her and that we would make sure to revisit it in another session.
Lowering the drawbridge
In the eighth group, the discussion centred on adults feeling guilty about their children’s difficulties – and particularly about their children’s distress. Zelda said that Michael was always crying and worrying about death, both his and hers. She was fed up with having to deal with this all the time. He cried at school, she said, and the adults always expected her to sort it. It seemed that a flight into anger, rather than thinking, was Zelda’s response to distress in her children. Later, when other group members started discussing their children’s older siblings, we saw how Zelda found it unbearable to look beneath her older teenage son’s delinquent behaviour and to acknowledge how scared he actually was of being at risk of attack in the streets. She explained that she had had to ‘harden herself’ to ‘keep from going under.’
Once again, the fact that some group members persevered with exploring underlying feelings in their children allowed Zelda to let these thoughts in little by little as she felt
able. She could begin to see that letting herself be more vulnerable, although painful, could be helpful. Later in the life of the group, as her capacity to think developed, she mentioned how closed up her adolescent son was and how she wished she knew how to talk to him. This was a far cry from her earlier superior stance, when presenting her children in a positive light had been so important to her.
Reality seeps in
After one of the termly feedback sessions with the children’s group therapists, Zelda was clearly shocked at hearing how difficult Michael was in the children’s group. We had long known that, despite appearances and the way in which the parents represented their children in the group, Michael was much the most challenging and barely containable in his group because of his level of anxiety. Zelda was quite taken aback and repeated with some bewilderment that Michael really ‘enjoys’ the group. Later, it was Michael who became the only child to force a premature ending on the group session one week when he became completely unable to manage within it. When Zelda herself reflected back on this, we could see her growing awareness that Michael had significant difficulties, even compared to the more florid descriptions of Roger.
At about this time, Zelda let us know that, after Michael was born, she had not noticed anything untoward in his development until he had started at nursery. Then, a health visitor had thought something was not right. When her older children were young she had been able to observe difficulties, and we felt that Zelda’s lack of ability to notice how Michael was developing reflected, in part, her symbiotic relationship with him.
Sharing common ground
In the same session, attended only by Zelda and Gary (father of Roger), there was a mutual discovery that they had in common an experience of growing up with strict and abusive parents. Also, they were both now on anti-depressant medication. Zelda let us know that she had even become suicidal when she had tried to come off these pills – so now she took them only every other day. She told us the sad story of her life. It seemed to us that it was Gary’s openness and the similarities in their experience that enabled her to reveal her history. Much later, in response to hearing about past domestic violence sustained by another group member and, rather more dramatically, seeing it brought into a session when Gary arrived with a broken finger caused by his wife, she spoke of her own domestic violence at the hands of her first husband.
Thinking as a resource
By now, Zelda found it useful to hear from us that Michael seemed like a much younger child who plays alongside, rather than co-operatively with, other children. We also suggested that his difficulties in going to sleep at night might be connected to worries about separation. It seemed that Zelda could make use of very concrete clear explanations and links. She was helped to understand the gap between Michael’s developmental and chronological age by gaining a picture of the other children in the group.
In a later session when Zelda mentioned that Michael was managing better in school nowadays she was unsure how far this was attributable to the group. But she conceded that although Michael may have changed only a little, she now had another way of understanding his difficulties and this made a difference.
At one point, when a discussion was taking place about Roger not wanting to go to bed and leave his parents alone together, Zelda could suddenly see that saying, ‘Why won’t you leave us alone, son?’ was not the same as saying, ‘We know it is hard to leave us....’. She then exclaimed, ‘Oh, it’s not what you say but HOW you say it!’ As she became more conscious of the usefulness of thinking, she was able to see how helpful it could be that, although Michael found it hard to be separate from her, she could explain to him that when they were apart he could think about her and keep her in his head and that she too could hold him in her own mind. This was an example of several ‘strategies’ that she tried, based on better understanding of the difficulty - and the beginnings of using her own thinking as a resource.
Zelda showed a growing capacity too to think about others in the group and to anticipate their likely responses. At one point, when some of the mothers were describing life on their dangerous housing estates, she commented, ‘This maybe sounds like a film set to Heidi (our non-English mother) and maybe to you therapists too’. She also said, when people were trying to recall how it felt to be nine years old, ‘God. It’s so difficult. I can’t remember how it felt to be nine. It’s different for you professionals.’ It seemed that she was beginning to appreciate the differences in people’s thinking and experiences.
Painful endings
Our experience is that, in a group, members find the ending extremely difficult and often therefore avoid it by not turning up at all. Thereby, they give the therapists and other group members the experience of being left, rather than having to feel left themselves. Our final session demonstrated this. Sadly, only two of the parents – one of whom was Zelda – turned up. However, this session proved extremely meaningful for them and moving to us. Interestingly, it began with Zelda arriving in the room with Carol, saying that they were going to meet each other again, outside the group, and that they had discovered they had a lot in common. Zelda had previously let us know that she was generally quite solitary and had had painful disappointments, both in love and in friendships. Of course, her solitariness had impacted on Michael too.
In this session, Zelda and Carol revealed traumatic histories of loss. Zelda revisited the painful issue of her father’s premature death. When she was twelve years old, she had returned from school at lunchtime, to find that her father had had a heart attack in the street and had died that morning. She was told it was her fault. She had been particularly close to her father, despite his beltings. Zelda described movingly how it was after this that her life had gone downhill and had later involved desperate attempts to get other men to love her, although these men had subsequently been violently abusive towards her. That was when she had made attempts at suicide. As soon as she got close to men and showed her feelings, she said, they fled. She then felt she would be totally destroyed – ‘a wreck’ - and she could not bear the rejection.
She told us, in a moving soliloquy, that she did not want to play games with men – she wanted to be herself, be accepted and have them stay. She went on to say that now she was afraid to have relationships and be ‘dragged down’ and that it would not be fair on her children. We spoke about the impact of a tragic loss that could not be processed but that had nevertheless determined the course of Zelda’s life ever since.
Progress
We felt that, in the group, Zelda had a first experience of not needing to maintain a false self or ‘play games.’ She could aspire to ‘being herself.’ She found an acceptance and a sense that her pain could be borne.
Of all the parents, we felt that the group had assumed unequivocal importance for Zelda and that the ending for her was very significant. In contrast to her earlier presentation, when she had not minded the other couple’s fleeting attendance at the group, she was able to be deeply upset about the other parents’ absence at the last session. We also heard from her in the final sessions that Michael had changed considerably. Most unusually for him, he was facing the change to a new class with optimism and had begun to be able to play with other children.
Conclusion
It may seem, from reading this, that a group of parents chatting together for an hour a week can effect enormous change of itself. In fact, this is not so. We need to emphasise the crucial role of the facilitators in enabling this assorted collection of parents to become a working group. Our functions, of providing containment and making links, of drawing out themes and ensuring everybody had space to speak, of protecting parents from attacks by others and challenging unhelpful assumptions, were all essential in helping
this experience become an important piece of work for them all. Through talking together, at first about their children and then about their own lives, through discovering their similarities and differences, a collection of individuals became a group. They discovered that it helped to share difficulties, to feel they were not isolated in their individual struggles and that, by locating in others qualities each of them could not yet own in themselves, they could make the journey towards a recognition and assimilation of those qualities
that made their struggles bearable. Such is the power of the group.
In this article, we have been able to present only a limited aspect of the life of our group. However, we hope we have demonstrated the way in which one very vulnerable and highly defended parent was able to use the group’s safe thinking space and support to allow herself to begin to think about what had remained, until that point, ‘unthinkable.’