Topic outline

  • Foundations

    Foundations

    AUSTRALIAN EDITION MAY 2016
    AUTHORS: Gary Foster PhD & Rick Goodwin MSW RSW

    Foundations is a group program for working with men who have been sexually abused in childhood. The genesis of Foundations lies with a partnership and collaboration of combined efforts between Living Well in Australia and Men and Healing in Canada, working with and supporting men in their journey towards healing and well-being across two continents. The purpose of the program is simple - to support participants to address the experience and impacts of past sexual abuse, and to improve personal and relational well-being in the present.

    This Foundations module is designed to guide and support health care professionals in facilitating a therapeutic, psycho-educational group program for men who have been sexually abused in childhood. It provides the foundations for the development of a professionally facilitated support group. The module operates as a practical guide that will benefit from being adjusted and refined in response to the membership, dynamics, and service contexts of each particular group.

    In creating Foundations, we seek to avoid an overly-prescriptive approach to facilitating groups for men who have been sexually abused. At the same time, we believe it is important to ensure group program processes and facilitation are linked to, and informed by, current trauma informed care, research, and practice with men who have been sexually abused or sexually assaulted. We also believe that it is facilitators' responsibility to ensure they possess comprehensive knowledge and skill in working with men who have been sexually abused, as well as access to ongoing professional development and clinical supervision.

    • Introduction

      Trauma informed care framework

      Foundations is shaped by, and draws upon, the three stage trauma informed care framework, emphasising key principles of safety, trustworthiness, choice, collaboration, and empowerment. Whilst the theme of engagement, safety, and stabilisation is foregrounded and built upon throughout the group program, there is, at times, emphasis on reviewing and revising personal meaning making, and a commitment to the development of an increased sense of personal and relational integrity.

      It should be noted that Foundations does not operate with a prescriptive treatment focus, in the sense that it does not only aim to alleviate symptoms or ‘fix’ problems. Foundations content and processes are designed to support participants to individually and collectively address traumatic impacts, to increase knowledge and understanding, and to enhance personal and relational well-being and overall quality of life.

      Gender

      In addition to utilising a trauma informed care approach, Foundations acknowledges the gendered context of men’s lives. Gender is a significant aspect of personal identity, and while every man is unique, men face some common social pressures about how they are expected to behave, feel, and think. The Foundations model acknowledges that gender influences the context in which sexual abuse occurs, how men make sense of their experience, and how they respond. We suggest that the subject of gender is more than a discrete topic or theme for a group session, but an essential consideration for understanding men’s lives. These two lenses – trauma and gender – inform and infuse the Foundations model.

      Content

      In developing this Foundations group manual, we do not underestimate the importance of facilitators and organisations ensuring they have done the necessary preparation work to produce a safe, supportive, and productive group program that works for the men. Whilst we recognise a temptation to dive right in and engage with the ‘Session content and facilitation notes’, we encourage facilitators to take time to ensure they have adequately oriented themselves to group work with men who have been sexually abused, and have undertaken the essential planning and preparation with the necessary systems, policies, procedures, and practices in place. To support the development and delivery of a successful Foundations program, we have provided what we consider as introductory baseline information and resources.

      Contents of manual

      1. Base knowledge and introduction to trauma informed framework
      2. Group facilitation, knowledge, skills, preparation, tips, and challenges
      3. Pre-group interview, intake, and assessment
      4. Group structure & organisation
      5. Session content and facilitation notes
        • Session #1. Introduction to Foundations: Group guidelines – Hopes and aspirations.
        • Session #2. Self care: Common effects and strategies to enhance safety and stabilisation.
        • Session #3. Challenges men face: Barriers to disclosure
        • Session #4. Re-viewing the past: Silence and secrecy – Self blame, guilt, and shame
        • Session #5. Mid-group review: Emotionally-engaged living
        • Session #6. Developing healthy relationships: Trust, intimacy, sex
        • Session #7. Justice/injustice, revenge, telling, and getting on
        • Session #8. Consolidating learning & building a valued life

      Foundations: Appendices

      • Appendices 1: Assessment & review documents
      • Appendices 2: Participant resources & workbook
      • Appendices 3: Facilitator resources

      The partnerships informing Foundations

      Living Well is a service specifically designed to assist men who have been sexually abused or sexually assaulted, as well as partners, families, friends and service providers. It provides information, face to face counselling, and group support in Brisbane, Australia and surrounding areas, and telephone and online counselling support in Queensland state wide. The Living Well Group Program commenced in 2006, in response to a request from men who had been sexually abused to meet, engage, support, and learn in partnership with other men. The initial Living Well Group Program has evolved and transformed to become the Foundations Group for Men.

      Men & Healing LogoMen & Healing is a psychotherapy centre for men based in Ottawa, Canada. The centre is known for its innovative “Men & Healing” group program, for male survivors of sexual and physical abuse, that was developed within The Men’s Project (1997-2015). Foundational elements and strengths of the Men & Healing “Phase I” program form the basis of this manual. The “Men and Healing” program has won a number of awards, its effectiveness has been established through two evidence-based studies, and is now being replicated and drawn upon within Canada and internationally.

      1in6 Inc. USA forms the third service in this international partnership, and in a supportive role, has also played a part in the creation of Foundations. In essence, this is a collaboration of the learned experiences of men, spanning three countries, in their quest for healing and enhanced well-being.

      Acknowledgement

      ‘The Foundations group program manual for working with men sexually abused in childhood’ has been produced with a grant from the Commonwealth of Australia Department of Social Services, to support the delivery of Royal Commission Community Based Support Services.

      Fundamentals of Foundations

      Regardless of what continent men live, and such services operate on, the fundamentals of the work are clear. Men gather together in a supportive and professionally-facilitated environment in their quest for healing and well-being. Each week, the group centres on different themes and topics, and provides an opportunity to address concerns, enhance understanding, and develop skills and ways of managing, with a focus on getting on in life. There is a careful balance struck – while the variable impacts of past childhood sexual abuse on men’s lives are continually addressed, it is also a circle of men who are working together to enhance their personal and relational well-being in the present.

      Certainly, an eight session/week group program cannot be considered an end point in addressing childhood sexual abuse and recovering from complex trauma. In drawing on current research and practice knowledge in trauma informed care, and working with men sexually abused in childhood, we understand Foundations as simply that: a foundation for men’s continued journey toward personal, relational, and community well-being that is to be built upon into the future.

      • Base knowledge and information

        It is essential that practitioners facilitating Foundations have the necessary experience, knowledge, skills, training, and support to work safely and effectively with men who have been sexually abused in childhood. It is anticipated that facilitators will already have completed the accompanying online training modules and be accessing ongoing professional development and supervision specific to working with men sexually abused in childhood.

        Navigate through the manual content by visiting the links below.

      • Foundations: Session by session

        A detailed description of each session, week by week.
        • Session #1 Introduction to Foundations: Group guidelines - Hopes and aspirations Page

          Objectives

          • Introduction to Foundations.
          • Acknowledge participants’ commitment and concerns.
          • Introduce and establish group guidelines, structure and boundaries. Focus on providing a safe and supportive environment.
          • Discuss and establish expectations for the group. Identify and document group members' individual and collective hopes and aspirations
          • Invite, facilitate and encourage reflection.
          • Introduce to the topics contained in the Foundations program.
        • Session #2 Self care - Common effects and strategies to enhance safety and stabilisation Page

          Objectives

          • Review and introduce strategies that support safety and stabilisation.
          • Introduce and identify strategies to enhance coping, self care, and overall well-being
          • Develop understanding of ways child sexual abuse can impact on the lives of men, and useful strategies for dealing with them.
          • Develop sense of connection, where there are both similarities and differences amongst group members.
          • Introduce practice of self-care and reflection, mindfulness, breathing exercises, grounding tools.
        • Session #3 Challenges men face - Barriers to disclosure Page

          Objectives

          • Acknowledge present and past contexts of men's lives.
          • Critically unpack the gender expectations men grew up with and live with.
          • Review how masculinity shapes men’s day to day lives, and how they respond to childhood sexual abuse and its impacts.
          • Identify and discuss barriers to men's disclosure and speaking about child sexual abuse.
        • Session #4 Re-viewing the past: Silence and secrecy - Self blame, guilt, and shame Page

          Objectives

          • Orient to looking 'back' from the 'present' in a safe, supportive way that acknowledges different contexts.
          • Develop awareness of how silence and secrecy were introduced and have operated in men’s lives and ways of loosening the hold in the present
          • Develop awareness of how self blame, guilt, and shame were introduced and have operated in men's lives and ways of being.
        • Session #5 Mid-group review: Emotionally-engaged living Page

          Objectives

          • Mid-group review.
          • Developing emotional literacy and an emotionally-engaged life.
          • Introduce and consider 'Process model of expression' and 'Non expression of emotions'.
          • Expanding men’s emotional vocabulary and ways of dealing with strong emotions.
          • Introduce and enhance understanding of distress tolerance and emotional regulation.
        • Session #6 Developing healthy relationships: Trust, intimacy, sex Page

          Objectives

          • Identify and explore the components of healthy relationships, and the relationship challenges created by experiences of child sexual abuse.
          • Explore key aspects of relationship, trust, boundaries, communication skills, and how relationships dynamics can be impacted by childhood sexual abuse.
          • Explore the subject of developing intimacy in close relationships.
          • Explore particular challenges in developing and negotiating sexual intimacy, sexual difficulties, and sexual identity confusion.
        • Session #7 Justice/injustice, revenge, telling, and getting on Page

          Objectives

          • To consider the injustice of sexual abuse, and options for obtaining justice.
          • Confront thoughts of revenge that can weigh heavily on men.
          • Reflect upon ideas of forgiveness.
          • Identification of topics/difficulties to be resolved - considered important for 'getting on'.
          • Review options and productive ways of naming and 'telling'.
        • Session #8 Consolidating learning & building a valued life Page

          Objectives

          • To engage in reflection and acknowledgement of personal and group achievement.
          • To envision and articulate future change and preferences in a concrete, goal oriented approach to committed action.
          • To solidify next steps towards participants' future plan of well-being.
          • To provide feedback to the program as a whole as well as each other.

      • Acknowledgements

        The creation of Foundations has been a collaborative process. First, we would like to acknowledge and thank all the men who have shared their knowledge, understanding, learning, insights, difficulties, struggles, concerns, commitment, care and compassion. It is the participants of the group who have pushed and supported us to continue to refine and improve Foundations, and we hope will do so into the future.

        We would like to thank and acknowledge the contribution of the Living Well counsellors/facilitators, and our friends and supporters, who have sought to continually improve our services to men who have been sexually abused in childhood and sexually assaulted as adults, to partners, families and friends. In particular we acknowledge and thank: Cate Harvey, Heather Lord, Paul Montgomery, Hannah Lupo, Gillian Meteyard, Jessica Decker, Hugo Teixeira, Richard Nind, Cynthia Dunn, Sam Kilby, and Cameron Boyd.

        We would like to thank and acknowledge the contribution of the Men and Healing counsellors/facilitators, and our friends and supporters. In particular, we would like to credit Larry Gauthier, Roy Salole, Monica Forst, Mark Patton, Jennifer Hopton and Wes Moore for their contributions — knowing that every clinician who ran “Phase I” services further enhanced and strengthened the program.

        We would like to thank our colleagues and friends at 1in6.org, including Peter Pollard, Director of Communication for 1in6.

        • Foundations: Appendices

          • Appendices 1: Assessment & review documents

            Assessment and review documents:

            • Pre-group interview
            • Session plan overview
            • Group session rating scale
            • Post-session facilitator’s review
            • End of group feedback
            • Trauma checklist (PCL-C)
            • DASS 21 (Depression Anxiety Stress Scale)

          • Appendices 2: Participant workbook & resources

          • Appendices 3: Facilitator resources

            Appendices 3 contains the facilitator resources useful for running a Foundations group. These resources can be used in conjunction with the session outlines, as well as the resources from the Participant workbook.