The pre-group interview
When assessing potential group participants, and their suitability to fully participate in the Foundations group, it is important to consider the resources and needs of both the individuals and group. Facilitators have the responsibility of assisting the development of a cohesive, supportive group. For example, factors such as the men's ability to communicate in a group setting, the severity of their emotional distress or vulnerability, their motivations to participate in the group, their interpersonal ability to regulate their own emotions, and their social ability to connect, relate, and respect other participants all relate to the individual’s therapeutic needs, as well as key variables in group cohesion and functioning. Simply put, one need cannot outweigh the other.
Foundations serves men, 18 years or over, who have been sexually abused in childhood. Experience has shown that including men from a mix of diverse backgrounds and experiences can add value to the group.
Whilst Foundations is not designed specifically for men who have experienced adult sexual assault, these men typically have much in common with men who have experienced child sexual abuse. There are therefore occasions where facilitators may choose to support their participation in the Foundations group. An assessment process may also identify that these men may well have a background in prior sexual victimisation as children. In supporting their engagement and participation in the program, facilitators will be required to consider how particular themes and sessions will benefit from adaptation, to ensure a process that is inclusive and therapeutic for all. It is recommended that, in addition to participation to the group, facilitators ensure access to appropriate medical support and individual trauma therapy/counselling.
A more challenging area of assessment is in determining and supporting individuals who are unsuitable for the Foundations program at present. Here again, facilitators are required to both assess the individual's ability to benefit from the program, and ensure the focus and safety of the group as a whole. Exclusionary criteria may include:
- Active substance use, to the extent that they cannot attend the program without presenting as intoxicated or inhibited/disinhibited by drug misuse. While there is no requirement of Foundations that participants need to have sobriety to attend, they do need to be able to participate in a sober state.
- Severe and persistent mental health problems may also become a barrier for involvement in the program. For example, clients who experience psychoses, paranoia, or severe depression could all be exclusionary criteria, unless these issues are well monitored by their health care practitioner.
- Men with no memory of sexual abuse would not be suitable for the group. While the ability to recall the abuse may range from minimal memory to complete recall, some memory allows for a gel to form within the group membership. Some prospective clients may not have memory, yet possibly a 'hunch' or may be stirred by seeing depictions of abuse in the media. For these individuals, it is best to refer them to individual counselling first, with the understanding that they would be welcome to join the program if memories of sexual abuse are identified.
- Men who are unable to name their trauma experiences without becoming overwhelmed and 'flooded' with reactions beyond their capacity to manage, as well as men who exhibit chronic and profound dissociation, require individual 'pre-group' counselling prior to group commencement.
- Men who are actively self-harming or recently attempted suicide would also be best engaged through individual counselling before group admission.
- Men who are facing current and chronic life crises – e.g. homelessness, or are unable to meet their basic needs, is also contra-indicated for inclusion. A basic degree of safety and stabilisation in life is necessary for men to participate fully in the group.
- Adults who have perpetrated sexual abuse or sexual assault are to be excluded, regardless of their experiences of childhood sexual abuse. The involvement of these men, referred to as 'victim-perpetrators' in some criminology, would present serious safety concerns for group members. It is recommended that they be excluded. However, men who were sexually abused as children who subsequently engaged in sexualised behaviour as a child may be included. Though it is recommended that, prior to participation in a group, they have engaged in individual counselling specifically addressing their involvement in sexualised behaviour as a child. A dedicated program for these men would be the preferred alternative service to offer.
- Men who could not benefit from an insight-oriented group – e.g. men severe brain injury, or who are anti-social in nature.
There are other factors that could influence participation. For example, men who may be insufficiently motivated (e.g., 'mandated' by a third party to attend group, or engaging in group due to a lawyer's direction on issues concerning criminal or civil litigation). Men who exhibit threatening behaviour, or are engaging in intimate partner violence or generalised violence, will typically require additional professional assistance prior to acceptance into Foundations. In cases of men perpetrating domestic/family violence, a typical prerequisite would be participation in a men's behaviour change program and cessation of all controlling and aggressive behaviours. Finally, it is recommended that men who present as hostile, intolerant, unsupportive of diversity (e.g., unable to participate in culturally or sexually diverse groups), or someone who may inhibit safety and the building of trust, should be supported to attend individual counselling.
All of these factors suggest that the role of a comprehensive assessment process is critical to an effective group program. If concerns re: safety, and the ability of members to participate respectfully, are overlooked in the assessment process, they will quite often come back to haunt the facilitator and group as a whole. It is facilitators' responsibility to consider if those who are included and those are excluded will benefit from being referred to additional support services.
This section details the intake process for participants in Foundations.
Addressing inquiries from the community
Enquires may be received through established referral pathways, or as a result of media, advertising, or flyers distributed throughout the community. If a flyer is designed, it should clearly outline the purpose of the group, its intended goals, date, time, and locations, plus contact details.
As a men's group service becomes known in a community, phone and other enquiries may come in from a variety of sources. Enquiries may come from local service providers, concerned third parties, and prospective members themselves. It is not unusual to receive a significant number of enquiries from partners or family members. For these third party calls, it is useful to provide relevant information, and to ask them to encourage the man to contact the facilitators to have an introductory chat and possibly organise an intake interview.
In order to reach as many men as possible and to support diversity of participants, it is useful to promote the group as widely as possible. Typically, this will involve developing strong referral pathways amongst community and government agencies, neighbourhood centres, private practitioners, relationship counselling services, GPs, mental health and sexual health services, probation and parole, victim support services, and drug and alcohol services. It is also useful to advertise in local press and community centres. When organising and promoting a group program, there are occasions when planned groups will be delayed due to lack of initial responses, and times when facilitators will receive a flood of enquiries with little or no promotion. If a group program is delayed, it is important to check in with applicants who have expressed an interest, as a cancellation can be misread as a 'sign' that it is only them that has been abused or has problems, and lead to a sense of increased isolation and despair.
The intake process
While enquiries from prospective clients can come from a variety of sources, the most common method of first contact by men is by phone. The primary purpose of intake is to provide basic information about the program, to collect biographical information which will form the basis of a client file (assuming the man is not already being served within a broader scope of agency service), and to set a date for the assessment interview.
Providing reassurance to the caller, in terms of the nature of the service, is recommended. Ideally, even these initial enquiries will best be handled by the program facilitators. While gathering sensitive information from callers is not recommended (given safety and trust has yet to be established), some conversational starters include:
- How did you hear of the program?
- What do you hope to gain from participating in the group?
- What questions about the group program would you like to ask at this time?
Front line staff ideally give assurances to the caller, including the fact that coming in for an assessment interview does not commit them to being a client in the program. Some enquirers appreciate hearing that there will be no expectation or pressure to talk about anything they don’t want to talk about, or to disclose concerning their experience of abuse.
Given that often there is a small window of opportunity to engage and support men to access therapeutic support, it is optimum that the caller is provided with a time and date for a pre-group interview at first contact or call back. Further information to be provided includes length of the appointment, location, bus or parking options, cost, etc. Both for administrative and clinical reasons, a reminder call a day or two before the pre-group interview is highly recommended.
Given the focus on supporting therapeutic/psycho-educational engagement, safety and stabilisation the preferred group size for Foundations is 8-10 participants (suggested maximum of 12). Too large a number of participants will limit cohesion, be less personal, more challenging for facilitators to manage, and make it difficult for everyone to have their voices heard. Too few participants and it 'just isn’t a group', or the group itself may become too dependent on each individual member to contribute and maintain the energy of the group.
This section details the assessment process for prospective Foundations participants.
The pre-group assessment interview
An assessment interview is an essential aspect of group program service delivery. Its importance cannot be over-emphasied – a thorough process will ensure clinical fit, maximising success for the individual and the group, whilst an incomplete or perfunctory assessment may jeopardise both the individual's and the group's well-being.
Utilising the Foundations Assessment & review documents package, the initial assessment process can take up to 1.5 hours. For some clients who find the process highly stressful, the process may be best spread over two or three sessions. Whilst those conducting the assessment interview may utilise counselling skills to support the potential participant, this interview is not to be confused with a counselling assessment. The focus here is on engagement, and establishing a person’s interest and preparedness to participate in the group program. As part of this initial interview process, service providers are required to explain the standard limits of confidentiality, and to obtain client approval prior to collecting and recording any personal information.
The pre-group assessment interview is a mutual process, where the man is encouraged to ask questions and 'check out' the facilitator and service. It is an opportunity for the men to gather the information to make a informed decision about whether the group is right for them, to meet the facilitators, to ask any specific questions, and get a feel for the physical environment. Prior to the meeting, potential group participants are invited to think about what they want to know about the group, and what it can offer them, allowing time in advance to consider what they might ask (some may like to bring written questions).
For some men, the idea of a pre-group assessment is daunting. Some men prefer a more informal initial meeting to say hello, where they are invited to meet the service and facilitators.
For facilitators, meeting the men allows for a decision about their appropriateness for the group (based on the inclusion and exclusion criteria). However, it should also be seen as an opportunity to engage and consult with the men about important themes and questions they would like covered. Whilst it will not always be possible to meet 100% of every participants' expectations, it is an excellent opportunity for workers to engage and hear from the men what they are looking for. It is also an opportunity to warm the men to participating the larger group discussion, as the question 'What are your hopes and aspirations for the group?' is a central question asked at the first group meeting/session.
The initial interview is an opportunity to introduce assessment tools that will assist in identifying the impact of trauma on the participants' lives and current well-being. When introducing assessment tools, it is important to carefully explain the rationale for using them, and how they assist in supporting the individual and group. This should not be an onerous task, or distract from the process of client engagement and support. Two assessment tools that have been utilised in conjunction with the Foundations group program are the PCL-C (Trauma Checklist), and the DASS 21.
Acceptance of candidates
Only after the interview and assessment process has been completed can acceptance into the Foundations programs be formerly confirmed. The potential participant’s current mental health and well-being, access to professional support, accommodation and transportation, and group scheduling and composition may all play a role in the inclusion of an individual.
Essentially, there are four outcomes from the assessment interview:
- Acceptance into the group.
- Acceptance into the group along with a co-requisite (e.g maintaining individual counselling, maintenance of medication, continued participation in a substance misuse program).
- Acceptance into the group after completion of another commitment, engagement, or service (e.g., once the client moves to the area, completes anger management or intimate partner violence behavioural change program, is released from incarceration).
- Non-acceptance into the program.
It is perhaps this last category that poses the greatest challenge. It can be a difficult task for a counsellor/facilitator to inform a potential participant that they have not been accepted into the group, regardless of an expressed interest. This may involve naming health concerns or problematic behaviours that the client does not want to hear – for example being psychologically unwell, being in a chronic crisis state, or engaging in substance misuse that is not being managed. It is better to address concerns about group 'readiness' at the time of pre-group interview than to hope that difficulties will be managed and ‘worked out’ within the group.
It is recommended that facilitators consult with their clinical/operational manager prior to conveying any decision to not accept a person into the group. It is not surprising that some client’s experience this decision as re-victimising, as a judgement of them as individuals, or as confirmation they are 'too damaged'. A decision not to accept someone into an upcoming group needs to be accompanied with alternative care options, whether it is a supported referral to a counsellor, or to another relevant agency.
The role of individual counselling
Individual counselling can be an important and useful adjunct to a man’s involvement in group services. Some participants will value the opportunity to reflect upon and process the group experience, and their responses to it, with a counsellor. For some men, participation in the group would not be possible without the additional support of individual counselling.
Making individual counselling a prerequisite or co-requisite to group engagement can require some working through. Individuals may find accessing counselling in their area difficult or cost prohibitive, or they may have had unhelpful or even abusive counselling experiences in the past and be reluctant to engage in counselling. Facilitators, in conducting pre-group assessment, have a role to play in supporting participants who express an interest to access appropriate trauma informed counselling.
Typically, it is suggested that a group facilitator should not be a participant's individual counsellor. The basis for this principle is that, unless all the clients are seeing the counsellor, the neutrality of the counsellor can be considered in question, creating problems with perceived 'favoured' therapeutic alliances between the counsellor and select group members. However, it is also acknowledged that some participants will only commit to joining a group if 'their' counsellor is facilitating, and in some communities alternatives are limited. What is important is that the focus and limits of any individual counselling work are clearly identified, and are complimentary and supportive of engagement in the Foundations group program and its processes.
Meeting the facilitators
If the practitioner who conducted the assessment interview is not one of the facilitators conducting the Foundations program, it is advised that the potential participants be introduced to at least one facilitator prior to the formation of the group.
This introduction is a time to put the clinical matters to the side, and to have a more relaxed conversation. Participants may be seeking additional information, and have questions around group expectations, pre/post-group contact, and support. It is useful to show the participant the group room, location of the washrooms, etc. This is a valuable opportunity to engage with the man, to address any concerns/questions he may have, and to 'warm up' to working with him in the upcoming Foundations group.
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