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Grasses at North Uist

Group

a safer space

Andrew Perry

Participating in an online group can be therapeutic but it can also feel risky. A professionally facilitated group can help you take the first step to routinely accessing the help of others. 

Safer Space is one such group. It's a sixty minute, donation based, open, online group. It happens every Thursday at 6.30pm. It's for adults who choose to buy a ticket and take part.

I know thinking about joining a group can trigger different feelings. You may feel anxious at the prospect of sharing your experience and/or happiness at the prospect of feeling less alone. ​​ Participants have said they were helped by talking about the group before they came (you can contact me here.) This page can also help. When you feel ready, you can buy one of the eight tickets for each group. Just CLICK HERE 

Safer space

Safer space

What is Safer space?​


Safer Space is a place for conversation. It is like a group of people meeting for lunch. We are there to learn from each other, to digest and to take a break. We are curious and conversational rather than combative, recognising our shared interest. It is a practical solidarity which works for each of us. Akin to the the football game in no man's land on Christmas day in WW1. A cessation of hostilities that allows new helpful things to happen. A Safer Space.

 

The absence of a set agenda, and my low expectations, help us relax to discuss our lives more freely.  So we start each group by asking if we want anything specific today then begin. Closely adapting the focus of the group to the needs of the participants on that day. There is recourse through the facilitator, and elsewhere, but it is rarely used.

Safer space is based on my clinical experience of, and evidence for, effective therapeutic groups. This experience includes devising, facilitating, clinically governing and being a member of, therapeutic groups across my twenty five year career in mental health. These therapeutic groups have been in high secure settings, psychiatric wards, charitable organisations and the community. The focus of groups I have worked in include anger, anxiety management, self advocacy, intensive outpatient addiction rehabilitation, open addiction groups, ward talking groups, therapeutic music groups and community talking groups. I bring all this experience to Safer Space to create a therapeutic experience for you.

So I invite you to join our therapeutic group today, and discover a safer space to talk and be you. CLICK HERE.

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Wave

SAFER SPACE

THERAPEUTIC GROUP FOR UP TO 8 PEOPLE
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How does Safer space work?

Safer space works by practising a variety of good habits. These habits are the evidenced based, psychological, means to recover from a variety of mental health problems. They involve:

  • Increasing your self-awareness by communicating your experience, reflecting upon it, and being open to other people's experience.

  • Practising constructive emotional expression with others.

  • Identifying and evaluating the helpfulness of our thoughts, feelings and behaviours.

  • Evaluating and practising alternative ways of being.

  • Increasing our number responses to distressing experiences.

  • Rewarding yourself, and each other, for working on our problems.

  • Learning through observing other people.

  • Increasing your self-confidence through success in the group

  • Practising decision making about your participation in and the content of each group.

  • Increasing your sense of connection by asking for help, receiving help and helping other people in the group.​

These habits are the change mechanisms of motivational interviewing, cognitive, and behavioural psychotherapies.

What are the boundaries?

The group's boundaries are the structure within which we communicate. The group's structure is both minimal and vital.  in line with the ethical principles of least restrictive and patient centred care. Safer space has the following consistent boundaried structure.

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  • Entry criteria

  • Adults (16+) under Scottish law.

  • Adults who want to help themselves and other people in a group setting.

  • Participants will be assumed to have capacity to participate unless it is established that they lack capacity.

  • Confidentiality - what is said in the room stays in the room, unless people are put at significant risk of harm by this boundary e.g. when threats of violence and/or suicide are made. In this instance I will attempt to contact outside services to increase the  participants and other people's safety. I will also provide additional support to the participant(s), using the contact details provided through Eventbrite, outside the group. 

  • I receive clinical supervision where the group content may be discussed. I may also keep written notes of your participation.

  • Topics of conversation will be negotiated by the participants and facilitator.

  • People can come and go from the group during its operation.

  • People do not have to speak, or answer questions, if they do not want to, it is fine to just listen. 

  • Violence or intimidation toward other group members is not tolerated. Participants will be removed from the group if this happens.

  • The mute button will not be used to silence members.

  • If you need to use a phone please take the call outside the group.

  • Please do not record the group or take pictures of people in the group.

  • Dual relationships with the facilitator will be declared at the start of each group (except for 1:1 client work.)

  • Exclusion criteria

  • People for whom the intervention seems detrimental in terms of risk to self or others.

  • Repeated breaches of group boundaries. If this begins to happen I will talk with the person outside the group if the breaches are not disturbing the group members or in serous cases I would remove the person from that group before discussing their future involvement with them outside the group.

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Mingulay

SAFER SPACE

THERAPEUTIC GROUP UP TO 8 PEOPLE

Does group therapy work?

Group therapy has a long established scientific evidence base. Most recently : 'Research on group therapy over the past 30 years has been summarized in 11 meta-analyses, including 329 randomized controlled trials and 370 comparisons between group therapy and various control groups, together involving over 27,000 patients. Meta-analytic results demonstrate that group therapy is effective compared with nonactive treatment and is
equivalent to other active treatments for various mental disorders. Group therapy treatments have recently been applied to patients with a variety of medical conditions, such as neurological diseases, cancer, and chronic pain (Rosendahl, et al., 2021.)'

Can group therapy make you worse?

As with all interventions there is the possibility of negative effects in group therapy. Participants and facilitators are aware of this possibility, and the circumstance by which this may come about, helps reduce the likelihood of this happening. A summary of these possibilities can be found here : (Roback., 2000). 

What additional help is available?

In the event you feel adversely affected by a Safer space group you can contact me outside the group. I am usually available between 9am and 5pm Monday - Friday. I will not answer the phone when I am with a customer. When I am unavailable, please Text/Whatsapp message (07503 316840) or email me (contact@drandrewperry.org) I will make every effort to return your call, message, or e-mail on the same day you make it, apart from on weekends and holidays. I have also collated a list of helplines which may also be able to assist in this circumstance CLICK HERE

If you are unable to reach me and feel that you can’t wait for me to return your call, please contact your GP and ask for an emergency appointment. The NHS 24 (phone 111) service provides urgent health advice, when your GP practice is closed. Alternatively present at any Accident and & Emergency (A&E) department and ask for a mental health assessment. If you think that someone's life is at risk you should phone 999 immediately.

What are the limits of confidentiality in online therapeutic groups?

​I work within the codes of ethics of the Health and Care Professions Council (HCPC) and the British Psychological Society (BPS.) I am also compliant with the General Data Protection Regulation (GDPR.) As such I am a registered data controller with the Information Commissioner's Office (ICO.) There are additional potential breaches of confidentiality in an online therapy group. Participants need to be aware of and accept the risks involved. Groups will not be recorded. Potential breaches to confidentiality may include, but are not limited to: 

  • ​A group member attending group in a non-secure location where a nonmember (such as a family member or roommate) can see or hear the group.

  • A member recording or taking a screenshot of the group members.

  • A member using recorded material to share the identity of the group or a specific member.  ​

I also invite participants to read my frequently asked questions  page on this website. This page includes more information on the costs and benefits of clinical psychology, therapeutic groups and my business terms and conditions.

How might uncomfortable aspects of reality be avoided in groups?

In short through the fantasizing about ‘magical’ processes. Bion (1950) suggests four possibilities : over dependency on one person, fantasizing about a pairing or the group production of a saviour and/or the group remaining in a chronic flight/fight state. I will briefly outline them below:

 

Dependency : Members behave as though one member of the group is a 'godlike' figure who could give the rest of the group the change they need without any effort on their part. This can be seen as a regression to the total dependency of the infant on the parent. These godlike figures may also be external actors e.g. the aristocracy or other related institutions. In short, recuse by the 'highest' person.

 

Pairing : Quasi couples, sub groups or factions form. The fantasy is suggested to be sexual in nature and that our needs may be met in that way. Those excluded may feel envious, humiliated or excluded.

 

The group production of a saviour : an extension of the pairing fantasy is the possibility that the paring will produce a saviour to rescue the members of the group from their problems. 

Flight or fight group : A fantasy that all groups are threatening. Meaning an excess of aggressive or fearful relating. As if, safety, restraint and mutually helpful relationships were not possible. Separating ourselves from the task of relating, in these others ways, that may also be helpful 

What psychological theory & scientific evidence informs safer space?

Bailis, S. S., Lambert, A. S. R., & Bernstein, A. S. B. (2014). The Legacy of the Group: A Study of Group Therapy with a Transient Membership. Social Work in Health Care: A Handbook for Practice, 477.

Bauman, J. A., & James, G. L. (1990). A Support Group for Burn Victims and Their Families. Social Work With Groups, 12(4), 159–169. https://doi.org/10.1300/J009v12n04_10

Bion, W. R. (1950). Experiences in groups: VI. Human Relations, 3(4), 395-402.

Bradley, A. C., Baker, A., & Lewin, T. J. (2007). Group intervention for coexisting psychosis and substance use disorders in rural Australia: Outcomes over 3 years. Australian & New Zealand Journal of Psychiatry, 41(6), 501-508.

Catanzano M, Bennett SD, Kerry E, et al (2021). Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial. Evidence-Based Mental Health 2021;24:25-32.

Christensen, A., & Jacobson, N. S. (1994). Who (or what) can do psychotherapy: The status and challenge of nonprofessional therapies. Psychological science, 5(1), 8-14.

Clemans, S. E. (2005). Recognizing vicarious traumatization: A single session group model for trauma workers. Social Work with Groups, 27(2-3), 55-74.

Colon Y., Friedman B. (2003) Conducting group therapy online. In: Technology in Counselling and Psychotherapy. Palgrave, London

D. Darley, P. Blundell, L. Cherry, J.O. Wong, A.M. Wilson, S. Vaughan, K. Vandenberghe, B. Taylor, K. Scott, T. Ridgeway, S. Parker, S. Olson, L. Oakley, A. Newman, E. Murray, D.G. Hughes, N. Hasan, J. Harrison, M. Hall, L. GuidoBayliss, R. Edah, G. Eichsteller, L. Dougan, B. Burke, S. Boucher, A. Maestri-Banks & members of the Breaking the Boundaries Collective (2024) Breaking the Boundaries Collective – A Manifesto for Relationship-based Practice, Ethics and Social Welfare, DOI: 10.1080/17496535.2024.2317618

Davidson L, Hammond V, Maguire T. The implementation of a ‘Living with Voices’ group in a psychiatric intensive care unit: A pilot study. Journal of Psychiatric Intensive Care. 2009;5(2):89-94. doi:10.1017/S1742646408001362

Dibner, A. S., Palmer, R. D., Cohen, B., & Gofstein, A. G. (1963). The use of an open-ended group in the intake procedure of a mental hygiene unit. Journal of Consulting Psychology, 27(1), 83–88. https://doi.org/10.1037/h0041613

Elisheva van der Hal, Yvonne Tauber & Johanna Gottesfeld (1996) Open Groups For Children of Holocaust Survivors, International Journal of Group Psychotherapy, 46:2, 193-208, DOI: 10.1080/00207284.1996.11491494

Geddes, J. (2015). Therapeutic milieu approaches within a high security hospital: a qualitative analysis of patients' experiences of ward-talking-groups. https://era.ed.ac.uk/bitstream/handle/1842/11705/Geddes2015.pdf?sequence=3

Gentry, M. T., Lapid, M. I., Clark, M. M., & Rummans, T. A. (2019). Evidence for telehealth group-based treatment: A systematic review. Journal of telemedicine and telecare, 25(6), 327-342.

Gillard, S., White, R., Miller, S., & Turner, K. (2015). Open access support groups for people experiencing personality disorders: Do group members' experiences reflect the theoretical foundations of the SUN project?. Psychology and Psychotherapy: Theory, Research and Practice, 88(1), 87-104 https://bpspsychub.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/papt.12031?casa_token=KNak2_Yz0fMAAAAA:0gsT0XbIK7apJmq7Fl6sg4IUcTzfCYJEeLSfzVS4yvNnuwZ91ifktDh2mNmTxHTTPcSY8078Wev0tQ 

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Hayhoe Benedict, Verma Anju, Kumar Sonia. Shared medical appointments BMJ 2017; 358 :j4034​

Mark V.A. Howard & Zhigang Wei (2022) Effects of closed versus open groups on attrition and recidivism outcomes for sex offenders in custody-based treatment programmes, Journal of Sexual Aggression, 28:1, 76-90, DOI: 10.1080/13552600.2021.1905894

Mcleod, P. L., & Kettner-Polley, R. B. (2004). Contributions of psychodynamic theories to understanding small groups. Small group research, 35(3), 333-361.

Miller, S., & Crawford, M. J. (2010). Open access community support groups for people with personality disorder: attendance and impact on use of other services. The Psychiatrist, 34(5), 177-181. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/E30F298D2AF55EF3C1AEDB829403A5AC/S1758320900005072a.pdf/open-access-community-support-groups-for-people-with-personality-disorder-attendance-and-impact-on-use-of-other-services.pdf 

Miller, R., & Mason, S. E. (2012). Open-ended and Open-door Treatment Groups for Young People with Mental Illness. Social work with groups, 35(1), 50–67. https://doi.org/10.1080/01609513.2011.587099 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305594/ 

O'Leary, K., Schueller, S. M., Wobbrock, J. O., & Pratt, W. (2018, April). “Suddenly, we got to become therapists for each other” Designing Peer Support Chats for Mental Health. In Proceedings of the 2018 CHI conference on human factors in computing systems (pp. 1-14).

Perry, A., (December 20, 2023).  Milieu Outcome Focused Literature Review, Available at SSRN: https://ssrn.com/abstract=4670576

Perry, A., (2012) Swimming together : a positive therapeutic milieu at the State Hospital

Division of Clinical Psychology (DCP) Scotland Newsletter, 6, 11-14.

Phillips, A., & McCrum, A., (2023) Changing our approach to change. https://www.youtube.com/watch?v=7Mo4KJfXyO4

Radcliffe J, Bird L. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats. BJPsych Bulletin. 2016;40(4):187-191. doi:10.1192/pb.bp.114.047274  https://www.cambridge.org/core/journals/bjpsych-bulletin/article/talking-therapy-groups-on-acute-psychiatric-wards-patients-experience-of-two-structured-group-formats/30131690379319817E744E9EC1FDC0AC

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Riessman, F. (1990). Restructuring help: A human services paradigm for the 1990s. American Journal of Community Psychology, 18(2), 221-230.

Richards, D., & Viganó, N. (2013). Online counseling: A narrative and critical review of the literature. Journal of clinical psychology, 69(9), 994-1011.

Rosendahl, J., Alldredge, C. T., Burlingame, G. M., & Strauss, B. (2021). Recent developments in group psychotherapy research. American Journal of Psychotherapy, 74(2), 52-59.

Roback, H. B. (2000). Adverse outcomes in group psychotherapy: Risk factors, prevention, and research directions. The Journal of psychotherapy practice and research, 9(3), 113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330596/ 

Ron, Y. (2018). Psychodrama’s role in alleviating acute distress: A case study of an open therapy group in a psychiatric inpatient ward. Frontiers in Psychology, 9, 2075.

 

Stevenson, E. K., Thomas, S. D., & Daffern, M. (2023). Open versus closed group treatment of men with a history of sexual offenses. Sexual Abuse, 35(6), 667-686. No significant differences were observed between open and closed programs for sexual or for any recidivism.

Schopler, J. H., & Galinsky, M. J. (2005). Meeting practice needs: Conceptualizing the open-ended group. Social Work with Groups, 28(3-4), 49-68.

School of Life (2022) Therapeutic groups. 'No experience or preplanning is necessary; you can just book and join and instantly find yourself in an online room with people who are keen to share and to listen.'  https://www.eventbrite.co.uk/e/therapeutic-groups-tickets-450476305757?aff=ebdsoporgprofile

Thomas, McDonald, de Boer, Brand, Nedeljkovic & Seabrook (2021). Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/papt.12332

Tolland, H., & Laithwaite, H. (2018). Exploration of “Talking Groups” within a medium secure setting. Journal of Forensic Practice, 20(4), 239-248.

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White, R. G., McGeachan, C., Miller, G., & Xenophontos, S. (2020). “Other psychotherapies”: Healing interactions across time, geography, and culture.

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