How to start your first session

Objectives of Session 1

• 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.

Structure of Session 1

1	Welcome & housekeeping	15 min
2	Module content Program overview Participant introductions: Hopes and aspirations	45 min
3	Break	15 min
4	Module content Group guidelines	45 min
5	Closing session Wrap up and check out	15 min

 

Materials needed

• Name tags.
• Notepads & pens.
• Whiteboard and markers.
• Refreshments.
• Handouts:
  • Group Session Rating Scale.
  • Participant workbook.
  • Living Well: A Guide for Men.

Welcoming your participants

Prior to beginning the session, have the facilitators welcome clients individually. Assist in the creation of name tags for all participants. Offer refreshments, and answer any questions about the nature of the session. Pass out the 'Introductory package' of materials to each participant, including information on facilitator’s names and contact details.

Welcome

Introduce the course to the participants:

Foundations is an 8 week/session group program designed for men 18 years and over who have experienced childhood sexual abuse. Its purpose is to support men in addressing the impacts of sexual abuse on their lives, and enhancing their overall personal and relational well-being.

Research tells us that childhood sexual abuse can have a profound effect on boys and men’s lives, often leaving them feeling isolated and disconnected. This group is an opportunity for men to talk with other men who have had similar experiences in a professionally facilitated and supportive environment.

This week is about saying hello, introducing the content of the group program, hearing what some of your hopes and aspirations are for the group, and establishing a safe and supportive space.

We would like to acknowledge that coming to this group is a significant step that each of you has made. We know for some men attending a group is just not possible at present. You are here because you have found a way to overcome the many barriers and obstacles that can prevent men from getting support. We appreciate you making that effort.

Introduction of facilitators

Each facilitator is then to introduce themselves, their experience in this work, their hopes for the group, etc.

Explain the role of facilitators to the participants; that the job of the facilitators is to:

• Provide guidance and a framework for the group.
• Ensure that the group runs well and that safety is prioritised.
• Offer encouragement, support, and provide additional assistance where appropriate (e.g., comprehension, safety).
• Act as resource for the group, gathering information and additional information if requested. Remind the participants that everyone's input is equally important and that the group will be exploring ideas together.

Housekeeping

• Session length and emphasis on punctuality.
• Location of washrooms.
• Information on parking, smoking, refreshments.
• What to do in case of an absence (call in and leave a message).
• The schedule of breaks.
• The purpose of the handouts or participant manual.
• (Offer to the participants that they can take their material home with them or leave it with the program until the next session).
• Participants are encouraged to prioritise their self care whilst in the group (e.g. get up to stretch, drink water, etc).

Module content 1: Program overview

Briefly introduce the Foundations group program's purpose and content. Note that the Foundations group program operates within a trauma informed care framework, and draws on the research and practice knowledge in relation to what are key factors in enhancing the coping and well-being of men sexually abused in childhood. Focus on:

• Reducing the sense of isolation and addressing self-blame.
• Creating a safe, supportive space where men can access and offer support.
• Prioritising 'self care' in terms of introducing the basic building blocks that support physical and mental and well-being (sleep, exercise).
• Learning, in terms of what are common difficulties, what to expect and options for coping.
• Expectations of 'being a man' shapes men’s lives, and their understanding and response to trauma.
• Expanding the repertoire of tools and strategies for managing high levels of arousal, for dealing with overwhelming thoughts and emotions.
• Processing and meaning making for self in the present that develops self compassion and understanding, and addresses questions of responsibility, sense of guilt, and shame.
• Enhanced interpersonal and relationship skills.
• Enhancing sense of self mastery, personal integrity, and well-being.

In addition to utilising a trauma-informed approach, Foundations forefronts the gendered context of men's lives. Gender is a significant part of personal identity, and while every man is unique, men face some common social pressures about how they should behave, feel, and think. The Foundations model acknowledges that ideas about masculinity provide the context for men to make sense of their experiences of sexual abuse, and these ideas can sometimes be unhelpful for men’s well-being, while other aspects of men’s gender practices may be useful. Foundations is a group for men, and hence how 'being a man' shapes men’s experience and responses is more than a discrete topic or theme for a group session, but is an essential consideration for understanding men’s lives.

Conclude by noting that, although Foundations has an identified purpose and some established content, what is key is that participants find the group supportive and useful for them, and therefore is interested in hearing what are their hopes and aspirations for this group.

Module content 2: Hopes and aspirations

An activity for participant introductions.

Note: Although the Hopes and aspirations exercise is introduced here, in some groups facilitators prefer to establish and work through the group guidelines first.

The Hopes and aspirations exercise is an opportunity for the men to introduce themselves to each other, and identify topics that are a priority for them as individuals and as a group. It provides facilitators with information about which topics are considered a priority, where extra emphasis and time might be spent. Plus, it will help identify if there are any additional areas the men are interested in. It creates a road map of where we might be heading, and where the participants wish to stop and gain additional understanding and learning along the way.

Invite the participants to reflect for a moment and identify what are their hopes and aspirations in attending the group.

• What are your hopes and aspirations in attending the group?
• Are there any topics or questions you are particularly interested in?

It is the facilitators' role to support participants to introduce themselves (first name), and to identify, discuss, and share their individual hopes and aspirations. Typically, participants prefer warming up to the larger group discussion by starting with individual reflection, dyad or triad conversations. At an appropriate time, the facilitators invite participants to reconvene in the larger group, where it is the practitioner’s responsibility to support development of a collective document (flip chart or white board) that records the hopes and aspirations of this particular group.

Facilitators' active role

All participants have hopes and aspirations when commencing a group. This exercise aims to assist participants to articulate their individual hopes and aspirations, and to introduce them within the group context. The facilitators have a role in taking time to acknowledge each individual's hopes and aspirations, to note how these 'fit' with other men's experiences and hopes (past or present group), and, ideally, which sessions these hopes may be addressed within the group. The facilitators have a role in extending the discussion, focusing and clarifying participant's hopes and aspirations. Facilitator led discussion structured around 'less of' and 'more of' in specific domains of life can be useful.

• What shifts would you like to see?
• Are there particular aspects of your current life that you want to have less of, or more of, in the future?

The responses might address physical and mental health, relationships, or attitudes towards self, for example, 'I would like to be less overwhelmed by depression/anxiety'. When considering the things men would like 'less of' in their lives, facilitators can gently enquire with the man about what else this might enable him to do. For example- 'If depression or anxiety were to become less influential, what would this enable you to do?' The focus is not exclusively on symptom reduction (although of course this would be of great relief to most participants), but encourages men to envision themselves living their preferred lives.

Some groups appreciate the opportunity to use picture/photo/symbolic cards. Participants can be asked to reflect on what they hope might shift for them over the life of the group, and choose a symbol/card that represents this in some way. Participants can then be invited to speak about the symbol they have chosen if they wish. Some individuals like the structured approach of the SMART planning worksheet. This directs participants to consider specific domains of well-being (e.g. physical health, intimate and social relationships, community involvement), and set concrete activities for themselves. In some groups, participants will value the opportunity to record their individual hopes and aspiration on a piece of paper, and for them to be introduced into the group de-identified (this is not surprising given the sense of distrust and shame that sexual abuse can introduce into participants lives).

There may also be times where some gentle reality checking is required if it seems that someone is pinning their hopes on dramatic, unrealistic change over 8 sessions. It is important that these not be set up as potential failures- i.e. 'if x hasn’t changed after 8 weeks, I will give up'. Using the language of 'moving towards' and 'shifts', rather than achieving or not achieving, can be helpful. Some men in the group will already have had ample experience of believing they are failures, so it is important to be careful not to add to this.

Facilitators are to acknowledge and share with the men that it is natural to have some concerns when attending a group like this for the first time. It is understandable to experience a degree of concern/anxiety about how you will manage different emotions and situations. Some men may have concerns that expectations may be placed on them by facilitators or other group members. Sometimes it can be useful to name and address some of the fears and concerns that men bring to the group. Facilitators are to be aware that, for some men, naming fears and concerns too early may be difficult, resulting in them feeling 'vulnerable' or 'over exposed', either at the time or afterwards, leading to them exiting from the group. The group process for each man is an individual one, and each group is different. The facilitators convey that they are aware that there will be both similarities and differences with previous groups and within the group.

Example: Hopes and aspirations

• Feel ok to be around other people, around other men.
• Build self confidence and trust.
• Managing triggers better.
• To know I’m not the only one.
• To feel stronger – more of a man.
• To fit somewhere.
• Achieve more acceptance around issues and with myself.
• Move beyond abuse, so life can be something else.
• Talk with other men, hear from others.
• Learn how to do relationships.
• Feel more emotionally connected, how to do intimacy.
• Cope better with stress.
• Be a better partner and parent.
• Feel less isolated and more normal.
• Be less angry with others and myself.
• Hear how others deal with the effects of abuse.
• Get on with my life.

This is an opportunity to 'facilitate' discussion amongst the men, in order to develop a sense of group identity where there are 'similarities' and 'differences'. In documenting the group's hopes and aspirations, it is important to use the participants own words, and to make a copy available to them, as well as put the document on the wall whenever the group is operating.

A 15 minute break is held following this exercise.

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Module content 3: Developing group guidelines

In order for the group to operate as a safe, supportive, learning, and sharing environment, it is important participants agree upon a set of group guidelines or ground rules. The establishment of clear guidelines that detail expectations of how the group operates and how participants relate to each other will assist in early development of a functioning, safer, more supportive, and trusting group environment.

In establishing guidelines for a group for men who have been sexually abused, it is particularly important to clarify confidentiality, and to be sensitive to power dynamics and maintaining appropriate boundaries (recognising that sexual abuse is an act of boundary violation and abuse of power). There is no one ideal method of identifying and establishing group guidelines. The key is that the participants see the guidelines as meaningful and useful, and that they actively contribute to the group becoming a productive, supportive space.

One approach to establishing the group guidelines or agreement is to facilitate a collaborative discussion amongst group members. For example the Jacaranda group manual suggests starting with an open question like 'What do we need to agree on that will make this group a safe experience?'. The subsequent discussion and agreement could focus on issues such as taking turns, respect, sobriety, while forbidding topics like politics or religion. The strength of a collaborative approach creates a high degree of participant buy-in to the process, and the foregrounding of concerns that reflect their comfort and/or safety (this is helped by putting their actual words down on paper). Certain limitations that come with starting with a blank piece of paper can be: the time necessary for this discussion, the challenge of group consensus, the task of recreating the discussion in written format by the facilitators, and the exclusion of topics by participants that are seen as essential by the program staff.

An alternative technique is to introduce a pre-prepared 'set list' of guidelines that groups have found useful in the past: it acknowledges and builds connections with previous men's groups (we are not alone), it’s quicker; it covers the areas that the facilitators feel are essential; and it minimises ambiguity. Some people feel that most groups come up with more or less similar ideas, so the time taken to create these in the group can be better spent elsewhere. Where a pre-prepared set of guidelines is introduced, it is still important to check the group members understand them and have the opportunity to ask questions, to seek clafification, and to enquire about the rationale. For example, a group rule prohibiting communication between group members outside of the sessions may be confusing for people who feel extremely isolated.

At Foundations, we have found it is important to introduce and discuss the below suggested guidelines. Each statement or guideline is worked through, so that the intention and application is clear. In establishing the guidelines, it is helpful for facilitators to be up-front and transparent about any non-negotiable requirements from a professional or agency position. Group members generally understand that facilitators have some obligations (regarding duty of care, for example), and these should be made overt and discussed where necessary.

The below guidelines are not seen as an exhaustive list; it is important to invite the men to contribute to making the guidelines meaningful and useful for them, to add any extras they consider important, before asking the group to verbally sign off on them. The idea is that the guidelines are a working document that can be returned to or added to (some groups find it useful to put them up on the wall, and refer to during the life of the group).

Men’s culture and group agreements

It is useful to acknowledge that there are practices of 'men’s culture' that can be helpful and useful to draw upon like mateship, being there in time of need, and sharing a joke, while there are also practices that can be unhelpful and counter- productive like competitiveness, homophobic/sexist commentary, put downs, or sarcasm.

In some contexts, 'men’s culture' promotes ways of relating to one another that are antithetical to supportive and safe group dynamics. These ways of relating can feel comfortable for some men because they are familiar. Others will be acutely aware of feeling excluded, threatened, or marginalised by these ways of relating. For example, in some settings homophobic or sexist remarks may be tolerated or accepted, while obviously these would be highly problematic in the group setting.

This may need to be made overt and discussed with the group. It could be useful to explicitly name that the ways of relating in the group may be different to the norm of men in groups, and it may feel unfamiliar and take some practice to get used to. One suggestion arising from this is that group members can be generous with each other in their attempts to try out new ways of talking and relating with other men.

There are some aspects of men's culture that it is useful to foreground, encourage and embrace. Ideas of comradery, mateship, team loyalty, having a go, and risk-taking are all valuable resources.

Humour can be a valuable resource in a men's group, helping the men join together and lighten the load a little. Conversely, humour amongst men can sometimes take the form of put-downs or sarcasm. It is important not to discourage humour altogether- after all, a world without humour is quite a grim prospect. The idea of respectful humour, that avoids joking at someone else’s expense, is a good guide.

The issue of humour can be quite complex. In our experience, a number of men have told us that they 'use' humour as a defence, to avoid revealing painful or personal feelings. Paradoxically, this can lead some men to devalue their sense of humour in and of itself, so while other group members appreciate his sense of humour, he might view his use of humour as evidence of 'damage'. These can be tricky themes to negotiate over time. Ideally, in a safe supportive group, men can laugh and cry together.

Guidelines discussion

Key themes to be addressed usually include the following. We have provided examples of statements but you may wish to adapt or develop your own (see the participant handout and facilitator resources). For each point below we have added some questions and comments for facilitators to consider.

The group will start and finish on time. We make contact if we are running late or unable to attend.

Keeping time is an implicit boundary keeping practice. Being up front about this can assist when a group members is running late; it is not that the 'group started without him', but simply that it starts on time. Letting people know if you are going to be late or unable to attend is not only a matter of courtesy, but it can also reduce uncertainly and unhelpful speculation about what might be going on for that group member.

We will be sober and able to participate when we attend group sessions.

It is important to discuss the group's expectations for substance use. What should happen if someone attends and they are clearly intoxicated (i.e. it affects their ability to safely participate in the group)? What about medications that can affect mood? Some people may feel unable to attend at all (due to anxiety) without the use of substances or medication. It is important that the person is able to participate, to access what the group has to offer, and to make a positive contribution.

We will switch off our mobile phones. If it is necessary to leave a phone on, we will let group members know.

There are a range of reasons for this. For some people, constant engagement with mobile devices is the norm, so this 'rule' should be explicitly stated regardless of how obvious it may seem to you. Other group members are likely to find mobile phones distracting and will see it as a matter of common courtesy. For a few men, the matter may be more serious: for example they may become worried that a group member is texting information about the group. In cases where a group member must have access to their phone (for example they are expecting an urgent call or have a sick family member), this should be negotiated with the group.

We respect people’s privacy.

It is ok to talk with support people in your life about your own experience of the group. However, the names and identifying information about other group members need to be respected. If you happen to run into a group member in a social situation, understand that one or both of you may not want to acknowledge the other, and this should not be interpreted as a personal insult, but as a recognition of both people's right to privacy. If you both wish to acknowledge each other, do not reveal to any other people present the nature of your connection (again, this about respecting privacy and each person’s right to have control over who knows what about their life).

We recognise there are limits to confidentiality, and that facilitators have a responsibility to ensure children and adults are safe.

Facilitators should clarify limits to confidentiality and what steps they may need to take to ensure people are safe. This is mainly in relation to concerns around self-harm or intended harm to others, or where facilitators develop a concern for a child’s safety based on information shared in the group.

It's ok to disagree - We respect difference.

Conflict and disagreement are part of healthy communication. Sometimes it may be possible to discuss differences and come to a common agreement, while at other times consensus is neither possible nor desirable. Men's culture can encourage men to continue arguing until they are proven right (or have simply worn the other person down). How do we disagree in a respectful way? What language is ok and not ok to use? What is the difference between 'sharing ideas' and 'telling people what to do'? We can all benefit from the input of others, but it is important to remember to respect other people's opinions and decisions without imposing our own views too strongly. Conversely, each group member has a right to express an opinion, even if it differs from everyone else in the group. It might be useful to openly ask someone if they are open to advice or suggestions - they may or may not be at that moment.

We will not use personal insults, sarcasm, or put downs.

While this seems obvious, it is worth remembering that in many contexts, put downs between men is seen as banter or a form of humour. What one person may consider a gentle joke, another may perceive as a hostile attack. No group member needs to tolerate feeling insulted in the name of 'a joke'. Humour is perfectly ok and valuable, as long as it is not at someone's expense.

Language that is homophobic, racist, or sexist (which may be accepted in some facets of 'men's culture') is not conducive to safety, and can be challenged by other group members or facilitators. The group may agree that some expletives or swear words are ok in context (e.g. as an expression of anger or frustration) so long as they are not directed at other group members.

Facilitators should understand that some questioning of their authority may be a meaningful act of resistance or protest in relation to power.

There is no such thing as a silly question.

We want to encourage curiosity and clarification amongst the group. Acknowledge that differences in personal experience and cultural context will mean that what is obvious to one person may be unknown to another.

Everyone has the right to equal participation and the right to 'pass'.

Group members should be encouraged to contribute, while the choice not to speak is respected. It may be helpful to acknowledge the challenge of speaking up for many people; perhaps this has been discouraged or punished in their life experience; or someone may not believe their contribution is worthy. Facilitators can demonstrate and foster a spirit of enquiry and curiosity, where group members feel that others are interested in what they have to say, as well as being keen to hear the contributions of others.

Engaged listening is a valid contribution to the group; so is challenging yourself to say something that is difficult.

Listening is often an undervalued skill, and yet many people are profoundly moved by the experience of being genuinely listened to. It is often the case that apparently 'quieter' group members are deep listeners; lack of verbosity should be not be mistaken for disinterest. It can be useful for facilitators to gently enquire with these group members about what they have heard.

We will not physically touch other group members unless there is express permission (whether this is a handshake or a pat on the back).

This is about control over one's physical self, which was violated in the experience(s) of sexual abuse. Physical touch can be triggering, and may prompt flashbacks or protective trauma responses (fight, flight, freeze). Some groups prefer to have an absolute 'no-touch' rule; this should be stated clearly if this is the case. Touch between men can be further complicated by issues of homophobia and confusion around intimacy. Yet the group may, depending on the situation, provide a rare opportunity to experience appropriate, non-sexual, supportive, non-harming touch.

There is no expectation or pressure on group members to talk about abusive experiences. We will be sensitive to the impact on group members and avoid excessive detail.

It is important to let group members know that there is no expectation to disclose their abuse. However, for some this will be a meaningful act of breaking the silence and secrecy of abuse. It may also be an important counter-point to past experiences of 'telling' that have been dismissed or met with unhelpful responses. If someone wants to disclose, how should they go about it and what do they need to be mindful of to ensure that their retelling does not adversely affect other people in the group? What is the role of group facilitators in this, to support the 'teller', whilst considering the potential impacts on others?

It's ok to take a break.

Sometimes things can become overwhelming. For example, someone might feel triggered by a comment or detail in another person's story. We might need to consider the need to take a momentary break from the group sometimes. It can be useful to let people know what spaces are available in the building. It is also a good idea to have an agreement that a group facilitator will 'check in' with the person if they have not returned to group in 5 minutes or so.

We will limit communication with other group members outside of group during the life of this group.

Group members are adults and able to make independent choices about whom they spend time with. Some group members may openly state that isolation and loneliness are major problems in their life, and see the group as an opportunity to make connections and friendships with others who 'get' them. It is important to validate and acknowledge this human need. Also, there is a practical aspect, as some men might already know each other prior to the group, or their fellow participants attendance actively contributes to them being able to be there (e.g. they share the drive in).

At the same time, there are difficulties in this context. A group for men who have been sexually abused is a very specific context, different from almost any other situation in which men meet with other men. It is important to be clear about boundaries, and encourage group members to practice boundary keeping both for themselves and in their relationships to others. The forming of friendship pairs or social groups can both be welcome and make other group members feel excluded.

At the end of the group, there is no obligation to accept invitations for ongoing contact with other group members. This issue of post-group contact can be discussed towards the end of the group.

*Sexual and financial relationships between group members are prohibited.

We will discuss any concerns or difficulties adhering to the group guideline in the group.

When possible, group members should be encouraged to comment on actual or perceived breaches of the guidelines. This should ideally be done in a way that does not shame or blame, but draws attention to the guidelines and offers an invitation for the whole group to reflect. In rare cases, such as outright hostility or aggression, facilitators may need to ask a group member to leave the group for the benefit of the rest of the group. In these cases, the group member should be offered alternative means of support.

Once the guidelines are agreed upon

Thank the men for assisting in developing the group guidelines. Reiterate the focus in developing a safe, supportive environment where men feel comfortable to participate.

It is useful to pause and review the group agreement throughout the life of the group. A formal review in session/week 5 is recommended. In presenting and developing group guidelines, it is important that any non-negotiables are clearly stated.

A copy of the group guidelines are posted on the wall during subsequent sessions, in addition to be typed up and presented to participants.

Consider a continuum exercise

In this continuum exercise the men are invited to stand and place themselves on an imaginary line, running from one end of the room to the other, that signals their 'comfort level' in attending the group today. One end of the continuum is 'Feeling really uncomfortable, mind saying don’t want to be here, it's easier to exit', at the other end 'Feeling comfortable, this is feeling good, this is the right place for me to be.'

This exercise is not about 'comparing yourself to others', or where they may be standing on the continuum. It is about noticing where you are standing, and the thoughts and feelings you are experiencing. It is about noticing that, however much there might be questions and a level of discomfort in being here, you have chosen to stay. Notice and log what has kept you here, what has 'motivated' you to come to the group and to stand here today. You might also notice, how since coming through the door, whether your level of comfort and position on attending the group has changed.

Invite participants to share their thoughts, should they wish.

Note: The continuum exercise can be useful in bringing to a close session one, or as a starter for session two. Facilitators are to flag to participants that they plan to repeat this exercise in the final session.

Wrap Up: Check Out

Review: Processes/content covered/reflections

Mindfulness, relaxation, or grounding exercise

Facilitators are encouraged to introduce a grounding, mindfulness, or relaxation exercise prior to closing each week’s group session. This ensures that participants are grounded from any stress responses that may have arisen during the course of the group. Furthermore, it can act as a tool to ensure that participants are oriented to the here and now prior to leaving the group. Suggested exercises include:

• Abdominal breathing (from the Living Well app).
• Time2Breathe (from the Living Well app).
• Dyad grounding exercise – from the Facilitators Resources.

Provision of handout or resources

Provide copy of Living Well: A Guide for Men. Introduce Living Well app and information on how they may download.

Group feedback/evaluation

Invite participants complete the Group Session Rating Scale (GSRS) in relation to the week’s content.

Introduce upcoming session content

Emphasis is on continuing to develop safety and support so that men feel comfortable enough to participate. Part of this is building sense of competency, strategies for coping, and managing difficult thoughts and emotions in the present moment. It is not about not having any problems, but about having strategies for managing difficulties as they arise in a way that helps participants to get back on track ASAP.

Closing circle exercise: Comments/reflections/self care

 

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