Knowledge, background, & training of facilitators
As a starting base, Foundations facilitators are expected to possess relevant professional knowledge and skills in working with men sexually abused in childhood (typically tertiary level qualifications in psychology, social work or counselling). The below guidelines and practice standards provide a useful introductory understanding and framework for services and practitioners working with victim/survivors of child sexual abuse:
- Australian Survivors of Child Abuse (ASCA) Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service (2012).
- National Association of Services Against Sexual Violence (NASASV) National Practice Standards 2nd Edition (2015).
- Victorian Centres Against Sexual Assault (CASA) Standards of Practice, 3rd Edition (2014).
In addition to the Trauma Informed Care Guidelines and National Practice Standards, it is suggested that those engaging and working 'therapeutically' with men subjected to childhood sexual abuse develop a working knowledge of the below texts, and have refined their practice and service responses accordingly:
- Briere, J. & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluations, and treatment. California: Sage Publications, Inc.
- Cloitre, M., Cohen, L.R. & Koenon, K. C. (2006). Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life, 1st Edition.
- Courtois, C. & Ford, J. (2013). Treatment of complex trauma: A sequenced, relationship based approach. New York: The Guildford Press.
- Courtois, C. & Ford, J.D. Eds (2009). Treating Complex Traumatic Stress Disorders.
- (Adults)Scientific Foundations and Therapeutic Models. New York: The Guilford Press.
- Duncan, Miller, Wampold & Hubble (2010). The heart & soul of change: Delivering what works in therapy.
- Follette, V. & Pistorello, J. (2007). Finding life beyond trauma: Using acceptance and commitment therapy to health for posttraumatic stress and trauma-related problems. California, USA: New Harbinger Publications, Inc.
- Herman, J. (2011). Trauma and recovery: From domestic abuse to political terror. London: Pandora.
- McMackin, R., Newman, E., Fogler, J. & Keane, T. (2012). Trauma therapy in context: The science and craft of evidence-based practice. Washington, DC: American Psychological Assocaiation.
- Ogden, P., Minton, K., Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W. W. Norton & Company.
- Sanderson, C. (2006). Counselling adult survivors of child sexual abuse. London, UK: Jessica Kingsley Publishers.
- Van der Kolk, B. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York, USA: The Penguin Group.
The challenges of effective group facilitation are not to be underestimated. Whilst counselling knowledge and skills provide a valuable starting place, understanding group processes, dynamics, and facilitation is an additional knowledge and skill set that benefits from specialised training. We recommend:
- Yalom, I.D. & Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy, 5th Edition. Basic Books: New York.
- Corey, M.S., Corey, G. & Corey, C. (2014) Groups Process and Practice, 9th Edition. Brooks/Cole: Belmont, California.
Watch video: Group work: Working with men who have experienced sexual abuse
As Yalom & Leszcz (2005:1) highlights, 'therapeutic change is an enormously complex process that occurs through an intricate interplay of human experiences.' Yalom & Leszcz (2005:1-76) goes on to identify eleven 'primary factors' that interact and support group effectiveness in producing therapeutic change:
- Instilling of hope.
- Imparting information.
- Re-enactment (corrective recapitulation of primary family group).
- Development of socialising techniques.
- Imitative behaviour.
- Interpersonal learning.
- Group cohesiveness.
- Emotional expression (catharsis).
- Existential factors.
Just as important as understanding what supports development of an effective group, is to possess knowledge and skill in the role of group facilitation (Yalom & Leszcz, 2005:117-200; Corey, Corey, & Corey 2014: 25-57). Corey et al provide a list of what they identify as key 'group leadership' skills:
- Active Listening.
The resources we have covered in this section outline of some of the complex factors, knowledge, and skills involved in facilitating a group program with men who have been sexually abused. It is for this reason that we emphasise the importance of carefully selecting/self selecting facilitators who have access to appropriate training, support, and supervision.
In addition to the above practitioner based literature and resources, there will be an expectation amongst many men who have been sexually abused that facilitators will have working knowledge of books and materials that specifically speak to and address the sexual abuse of males, including:
- Victims No Longer The Classic Guide for Men Recovering from Sexual Child Abuse - Mike Lew.
- Joining Forces: Empowering Male Survivors to Thrive - Howard Fradkin.
- Beyond Betrayal: Taking Charge of Your Life After Boyhood Sexual Abuse - Richard Gartner.
- Evicting the Perpetrator: A Male Survivor Guide to Recovery from Childhood Sexual Abuse - Ken Singer.
Ideally, a facilitator will possess experience working as a counsellor with men who have been sexually abused or assaulted. However, the reality is that services for men who have been sexually abused are limited in many locations, and hence practitioners motivated to facilitate groups will typically require additional training and support to develop the necessary skills. Knowledge and experience working in the areas of mental health, sexual health, men's health, and drug and alcohol misuse can provide relevant transferable skills. The accompanying online training modules created by Living Well, provides a starting knowledge base.
Irrespective of knowledge, skill, experience, and professional background, it is paramount that facilitators possess a genuine interest in working with this client group. While this could be said about any type of service delivery, working to address the impacts of sexual violence on people's lives and relationships can be personally confronting and challenging for practitioners, irrespective of previous training and experience. It is important that service managers sensitively consider facilitators' preparedness to engage in the work, recognising that 'preparedness' in this instant involves something more than access to training and clinical supervision.
Some factors to consider regarding facilitation of the group.
It is the premise of Foundations that all groups' programming should be facilitated by two counsellor/facilitators. We advise against sole facilitation of the Foundations group. Co-facilitation supports stronger clinical engagement, lessens the demands on the facilitator, minimised the disruption of staff absences, and increases the ability to effectively respond to individual difficulties and crises as they arise. A second facilitator offers timely assistance in checking in with and supporting group members who have stepped away from the group to re-join group. Co-facilitation also supports the modelling of interpersonal relationships, and help to moderate against burn out and vicarious trauma.
Co-facilitation allows for more dynamic engagement in the presentation and processing of critical information about trauma and recovery. While one practitioner is directly supporting discussion, processing content, and meaning making, the second practitioner can be more attentive to group dynamics, and individual responses and needs.
It is recognised that some agencies struggle to have either the financial or staffing resources to employ two professionally qualified facilitators for such a program. Possible solutions include bringing on interns as co-facilitators, or introducing and training up volunteers with requisite qualifications, skills, and knowledge. It is suggested that any new facilitator will be paired with an established, experienced lead practitioner.
Prior to commencement of the Foundations group, co-facilitators will want to set time aside to establish a working relationship that includes an understanding of each others' practice framework, knowledge, and skill in working with men sexually abused in childhood, as well as group work experience and learning, individual strengths and challenges, and preferred facilitation style.
Gender of facilitators
- Does it matter if the facilitators are male or female? Why?
Certainly, if we examined sexual assault service delivery for women survivors, we would find that there is an expectation that counsellors and group facilitators are women – women working with and supporting women. In relation to working with men - consider the following:
- Many men seeking first phase individual counselling for sexual abuse prefer a female counsellor.
- For most men, their primary experience of emotional care and nurturing will be from women.
- The majority of those who perpetrate sexual abuse on males are male.
For some participants, the question of the gender of the facilitators will be of utmost concern. For others, the facilitator's experience, knowledge and skills, rather than gender, will be of primary interest. In deciding on the facilitation team, practitioners and organisations will be aware that in many First Nations communities there is a delineation between 'men's business' and 'women's business', and hence in some instances, a male facilitator will be required in order for this group to be culturally appropriate. Rather than presume to know participants preferences, it is worth checking in to determine what their thoughts are, recognising that some men will not feel comfortable attending the group unless his expectations are addressed.
Having noted the above, Foundations preferred model of staffing is for both a male and a female facilitator. Such a facilitation team is able to model egalitarian power sharing between a man and woman, which addresses stereotypes, and supports a more nuanced and comprehensive discussion that acknowledges gender similarities and differences, and each person’s lived experience.
Regardless of the facilitator's gender, it is important that they are aware of and sensitive to the impact that their gender can potentially have on participants. It is also important that facilitators possess a comprehensive gender analysis (distinctly different from a men’s rights or women’s rights analysis). It is their responsibility to develop a working knowledge of how gender is formulated and operates, and to ensure they are aware of their own gendered practices and beliefs (typically, this will include an understanding of how genders and sexualities intersect).
Role of Foundations facilitators
There are a number of key responsibilities and roles to be fulfilled by the facilitators. These include, but are not restricted to:
- Making sure that the group runs well in general. The importance of a seemingly minor issue like starting and finishing on time should not be under-estimated.
- Providing a framework and structure for the group to discuss and address various topics.
- Ensuring the emotional safety of group members; that they feel as comfortable as possible, do not feel threatened, are not distressed and feel respected and free to contribute. Another essential task is to check in with participants if they seem 'out of sorts' or distressed at any time.
- To provide encouragement, and support participants to contribute and engage in discussions and activities. This is likely to be required more during the early sessions as participants are finding their feet and getting comfortable with the group. Facilitators are not the only source of support and encouragement, however, given that, as the group progresses, fellow participants will fill this role as well. Counsellors need to be mindful that everyone will go at their own pace, and some participants may take some time before they feel comfortable to contribute.
- Handling breakdowns, dysregulation, over-disclosure, and potential re-victimisation within the authority and scope of the role of counsellor/facilitator. This may require separating participants from the group to debrief and take steps to ensure the group can continue safely. Should there be group conflict, targeting or bullying, it is the facilitators' responsibility to address this in a non-confrontational and sensitive manner.
- Being 'resources' for group members. The ability to share knowledge without prescribing or giving advice is a fundamental characteristic of a good facilitator.
- Ensuring that while facilitators may have expertise to share, it is the participants' own knowledge and experiences that are just as (if not more) important and relevant to the group.
- Ensuring there are clear boundaries in place, and that facilitators demonstrate appropriate responsibility for the direction, flow, and decision-making in terms of the well-being of the group.
- Managing risk in a way that supports participants to challenge self and take considered risks. Noting that, if facilitation seeks to ameliorate against all risk and to cover every eventuality, it will involve a level of ‘control’ that would replicate unhelpful power dynamics.
- Interacting equally towards all participants. Taking care not to foreground 'special' or favoured relationships with particular participants whilst engaged in group facilitation (recognising the extra challenges for those facilitators who have been a participant’s counsellor).
- Maintaining appropriate boundaries before and after group sessions. Consider and discuss with your co-facilitator the issue of self-disclosure, agreed boundaries, and a shared understanding of appropriate responses to requests for personal information from men in the group.
- Keeping any conversations with participants pre and post sessions light and simple, and avoid engaging in sensitive or personal discussions during these times. If this occurs, the participant should be gently reminded to bring this new material to the next group session, or alternatively, to discuss it with their individual counsellor.
- Ensuring that the roles of victim, abuser, and/or rescuer are not replicated in the group – i.e., refraining from acting in a controlling or authoritative manner; avoiding the temptation to have to 'rescue' people in difficult times; not relegating power to controlling group members (maintain awareness of potential Trauma/Drama triangle dynamics being played out).
- Being influential and decentred. Being attentive that the role of facilitator will hold perceptions of authority – and thus being sensitive to taking on an authority or parental figure role towards the group members.
Preparation and planning
Pre-group preparation and planning
Once formal assessments have been completed, and the particular circumstances, preferences, and needs of potential group members identified, facilitators should meet for a comprehensive group program planning session prior to commencing any new group.
This will include a review of information obtained at the pre-group interview and via initial assessment tools.
- What are the group members' articulated hopes and aspirations, areas of interest/concern?
- What is the group's mix of ages, cultural backgrounds, sexual identities, literacy levels, disabilities, current well-being and levels of support, professional or otherwise?
- What are the similarities and differences in terms of current life circumstances, interests, experience and context of abuse?
- How might group members' previous experience of counselling/groups (12 Step/disclosure oriented group) shape their participation?
- What particular topics have been identified as important or challenging for this group of participants?
- Are there any additional factors that it is important to remain aware of (context of abuse, institutional setting, gender of offender, recent assault, religious belief etc.)?
Although it is only through participation and engagement in the group that the mix, interests, and concerns of this particular group will become apparent, it is useful for facilitators to have considered the above points, and how best to support and work with these men.
Pre-group check in and session planning
The facilitating team should meet prior to commencement of each group session (60 minutes), to clarify roles and responsibilities, and familiarise themselves with this session’s theme. It might be important to discuss things like: Respective energy levels, sharing of facilitation (including identifying who will take the lead in the presentation of any content, processing of group discussion, and at check in and check out). Plus, a review of the content and process notes from the previous session, identified learning, participants' involvement and support needs. The 'Session plan overview' document is designed to assist this process (see Appendix 1: Assessment review documents).
It is recommended that facilitators allow 30 to 45 minutes post-group to debrief, evaluate the session (see 'Post-session facilitator's review'), and process learning and any difficult or troubling moments. The debrief is an opportunity to properly document and review the session, noting any points for follow up or for taking to supervision, including next day check in with group members if required. It is important that facilitators check in re: their own well-being, and are supported to leave work at work.
It is also recommended that facilitators receive designated clinical supervision from an experienced practitioner who is familiar with current research and practice development in working with men sexually abused in childhood (and with Foundations). It is recommended that supervision for facilitators is booked in prior to commencement, at mid-group review, and on completion of the group program. Additional supervision may be needed if facilitators have not run a Foundations group before, or have limited experience. Clinical supervision involves client care case supervision (where the focus is on intervention or group/case issues concerning the individual client or clients), and process supervision (where the primary focus concerns facilitation processes and the intra-psychic experiences of the facilitator). Both forms of supervision are crucial to the well-being and clinical stamina of facilitators, particularly in relation to managing emotional exhaustion, stress or vicarious trauma.
Supervision also includes a focus on practitioner self care and well-being and that additional support, training, or alternate arrangements regarding work detail are all in place. It is anticipated that supporting agencies will recognise, understand, and value a clear delineation between clinical supervision and operational supervision provided by a line manager (See the 'Professional practice' module (coming soon)).
Additional considerations for facilitators
Personal disclosure and involvement in check in/out
Another issue that facilitator need to carefully consider is the question of personal disclosure of information to participants, whether individually or in group.
For disclosure to have therapeutic meaning, it needs to be purposeful – that in disclosing personal information, the facilitator is clear in his or her intention, and that the client/participants will benefit.
Participants may ask facilitators outright if they have had personal experience of sexual victimisation. Some participants who have had previous experience in self help groups or twelve step programs may believe personal experience is a prerequisite criteria for group facilitation. It is useful therefore for facilitators to have considered and discussed how they will respond to questions seeking personal information prior to commencing the group. However open and transparent facilitators may wish to be, some questions are likely to too personal or invasive, or to be asked with uncertain intention or unidentified therapeutic value. It can also create awkwardness if one facilitator practices self disclosure and one does not.
In group work, some facilitators choose to participate in the group 'check in' and 'check out' with the group participants. Often, it is stated by these facilitators that they want to show their personhood to the group and to ease the power imbalance between professional and client. Still, these check ins are rarely fully genuine or complete – which leaves the disclosure relatively shallow compared to the group participants. To avoid these dilemmas, it is suggested that facilitators foreground their choice not to participate in the check in or check out at all – indicating to all participants that this is not 'their' (the facilitators') group, the group is for the participants.
Survivor - Therapist - Facilitator
Practitioners who have had personal experience of childhood sexual abuse are often referred to as 'survivor-therapists'. Such practitioners are not rare – studies have indicated that trauma survivors are over-represented in the helping professions. A question is not whether survivor-therapists should act as facilitators, but that they are able to clearly differentiate between their personal experience and their professional role and responsibilities, and how these might intersect and influence group facilitation.
Survivor practitioners are neither privileged by nor compromised by their experiences. Like all practitioners, it is important that survivor-therapists develop a reflective, honest working relationship with their clinical supervisor that supports development of a resilient, effective practice (where topics of vicarious trauma, projection, and counter-transference can be openly explored). As previously mentioned, the impact identification as a 'survivor-therapist' may have on facilitation, and group members' experience, is something to be discussed with co-facilitators.
There is no hard and fast rule as to whether a facilitator should disclose or not a history of child sexual abuse. It is, however, a responsibility of a facilitator to have considered the therapeutic purpose of sharing of any personal information, and how this intervention will contribute to enhanced engagement, support, and well-being of participants.
It is considered best practice to avoid engaging in dual roles/relationships if facilitating a therapeutic group. It has been identified that dual roles can create boundary and relationship confusion, and complicate the therapeutic engagement and processes for all group members. Common dual roles include:
- Facilitator – Acquaintance/Friend (past or current association outside of the agency).
- Facilitator – Counsellor.
- Facilitator – Colleague (past or present).
- Facilitator – Volunteer (e.g., board member, intern).
Whilst dual roles are not ideal and can produce difficulties, it is not unusual for facilitators to have had previous contact with a client in a professional or personal capacity. This potential dynamic is more likely in smaller communities, or within certain minority populations or subcultures within a larger centre (e.g., the LGBTQI communities).
One dual role that regularly occurs and benefits from being addressed is that of Facilitator – Counsellor. This is not surprising given the limited availability of group programs, and counsellor requisite knowledge, skill, and interest in working with men have been sexually abused. In some instances, the fact that the facilitator is also their counsellor might be 'key' to the person attending the group. One man who only attended a Living Well group because his counsellor was a facilitator and encouraged him said:
“Attending a group for the first time is five times harder than individual counselling. But if you go, trust and stick at it, after three or four weeks it is five times the value.”
Practitioners have a responsibility to openly discuss any concerns or confusion about dual roles with potential participants, and to identify how these might be managed. It is the facilitator’s role to ensure that knowledge and understanding of any participant garnered through individual counselling or other contact is not introduced into the group by the facilitator.
Troubleshooting common difficulties
Whilst in no way complete, the following are common difficulties faced by practitioners when facilitating groups. It is not surprising, given that sexual abuse occurs in an interpersonal context and can significantly impact on interpersonal relationships, that negotiating relationships with group members and establishing appropriate boundaries can be challenging. The facilitation team should discuss the below potential dynamics, and identify how they can be responded to in a supportive manner. Participants may demonstrate behaviours such as:
- Becoming emotionally overwhelmed or numb.
- Monopolising discussion time. Seeking to take control of the group direction, acting as facilitator.
- Difficulties with punctuality and consistent attendance.
- Engaging in power struggles with group members or with facilitators.
- Interpersonal conflict, disrespect, aggression, passive aggression.
- Superficial or non-participation.
A comprehensive pre-group interview, and solid 'Group agreement' that is ratified in session one by all group members, is one way to minimise these common problems. However, not all behaviours and difficulties will be covered by the group agreement, and not all participants will successfully travel the forming, norming, storming, performing process.
While not providing a comprehensive list, the following scenarios and difficulties benefit from being discussed in preparation for the group. With any difficulty or challenge, facilitators will look to respond in a supportive way towards both individuals involved and the group, and group processes as a whole:
- If a client quickly leaves the room due to emotional distress, what will be the protocol?
- Similarly, if a client shows up to session in an inebriated state or under the influence of stimulants (legal/illegal), what will be the response?
- What do you understand as respectful language? How do you respond to sexist or racist language? Is swearing ok? Whose responsibility is it to intervene?
- Notwithstanding group agreements about safety, situations of distressing or aggressive behaviour may occur. What is the intervention required when threats or threatening gestures are made? Put-downs of other group members or facilitators? Telling stories with an emphasis on violent or explicit content? Sarcasm?
- What is the program response if a participant has been arrested or had a domestic/family violence protection order taken out against them while in the program?
- If during the program, a participant reveals he has committed sexual offences during his childhood/adulthood, what would be the response? (This can happen even after asking a screening question at initial assessment).
- Despite the assessment screening process, negative attitudes may exist towards gay men or men who have sex with men. What would be the response to homophobic or negative comments?
- How will you respond to non-adherence to the group agreement?
Whilst it is useful to talk through the above eventualities, and to have a shared understanding between facilitators about how you might respond, you cannot plan for every eventuality. A facilitator's flexibility, and ability to attend to, work with and process what is happening in the present are key skills: it is not their responsibility to have all the answers. What is important is that co-facilitators develop and demonstrate a productive working relationship, supported by a shared understanding of each others' strengths and preferred ways of working, as well as an awareness what patterns of behaviour or content areas each finds challenging or difficult to deal with.
Group cohesion, drop out, and follow up
An emphasis is placed on prioritising group engagement, safety, and stabilisation, supporting participants to develop a degree of comfort and cohesion amongst the group. With this in mind, it is recommended that newcomers are not introduced into the group past Week 2. Doing so will mean that they may have missed too much content and may disrupt the dynamics of the group (e.g. if an environment of comfort and cohesion has been built within the group, a new unfamiliar person may make people less comfortable to open up and share). Anyone wishing to join the group past Week 2 should be offered support and assisted to enrol in the next group. If members are absent from a group session without notice, it is recommended to give them a follow-up call to ensure they are ok, as well as to ascertain whether they wish to continue with the group. If they decide to drop out, respect their decision and check in with them as to whether they would like additional support, and how their decision to leave might best be conveyed to the group.
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