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Working with Group Process in CPE: Advances in Theory and Practice. The Rev. A. Meigs Ross, ACPE, BCC, LMSW New York Presbyterian Hospital. Objectives:. To review recent advances in group theory and practice and how they are changing the way CPE groups function and students learn.

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Working with Group Process in CPE: Advances in Theory and Practice


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    1. Working with Group Process in CPE: Advances in Theory and Practice The Rev. A. Meigs Ross, ACPE, BCC, LMSW New York Presbyterian Hospital

    2. Objectives: • To review recent advances in group theory and practice and how they are changing the way CPE groups function and students learn. • To review membership and leadership roles in CPE groups and how role, goal and context impact learning outcomes. • To gain a greater understanding of the phases of group development. • To explore common restraining forces in group leadership and function and explore ways to undo these restraining forces and release energy for growth.

    3. Groups in CPE • Clinical Pastoral Education began as a small group educational endeavor • First Groups: • (1923) Dr. Wm Kellner - Cincinnati • (1925) Anton Boisen - Worcester St. MA • No notes on early “small process group”

    4. Groups in CPE • Three Distinct Types • Didactic - teaching groups • Verbatims - group supervision • Small Process Group

    5. Objective 1 - Theory and Learning • To review recent advances in group theory and practice and how they are changing the way CPE groups function and students learn.

    6. Group Theory & Certification ACPE • Joan Hemenway – comprehensive history of group work in CPE – history, development, theory and theology • Papers 20 years ago – only 60% included group theory. Three primary theories used: Yalom – interpersonal Bion (A.K. Rice) Group-as-Whole Bowen - Family System’s Theory Now - Group theory required in papers, committees

    7. Group Theories CPE – Traditional Interpersonal - Yalom, Corey & Corey, Modern Psychoanalytic - Ormont Group-as-a-Whole - Bion, Tavistock, Foulkes System/Subgroup - SCT- System Centered Theory, Agazarian and Family Systems Theory – Bowen

    8. Group Theory CPE - Today • Systems Theory* • Theory Driven • Integrative Approach** • Practice Driven *System Centered Theory - Agazarian, Family Systems -Bowen **Corey and Corey, Modern Psychoanalytic - Ormont

    9. Integrative Approach - Corey & Corey, Ormont – Practice Driven Approach • Thinking, Feeling, Behaving Model • Leaders self-developed theory - based on practice and study • Eclectic Methodology • Here and now, group as a whole, interpersonal • Affective, Cognitive, Behavioral

    10. Systems Theory • Theory Driven • Researched based • Focus on • Affective, Cognitive, Behavioral • Here and Now • GAW, Functional subgroups • Moving from explaining (known information) to exploring (new discoveries)

    11. System Centered Theory Developed by Yvonne Agazarian “SCT is a theory of living human systems that defines a hierarchy of isomorphic systems that are energy-organizing, self-correcting and goal directed.”

    12. Systems-Centered Theory:theory driven approach • Living human systems survive, develop, and transform from simple to complex through a developing ability to recognize differences and integrate them. • Systems-Centered theory explains how living human systems contain their energy within functional boundaries and direct it towards their goals: the primary goals of survival and development and the secondary goals of environment mastery. • Systems-Centered theory can be applied clinically… It can also be applied to all levels of the system in organizations.

    13. The Group • Groups Have: • Boundaries • Time, Space, Context, Reality • Leaders and Members • Different roles and tasks • Goals • Explicit • Implicit

    14. Boundaries Boundaries keep the energy focused • Space, Time, Here and Now • Psychological Boundaries • Reality - Irreality - exploring not explaining • Role

    15. All Groups Have: Three Systems • Member System (contains the individual) • Subgroup System • Group as a Whole

    16. Hierarchy

    17. Functional Subgrouping: work of the subsystem • This is the system in which the work of SCT is done • Prime arena for discriminating and integrating differences • Functional subgroups contain conflicts so that they can be explored rather than acted out

    18. Functional Subgrouping Tool for bringing in new information Means of working with conflict Acknowledging differences in the apparently similar and similarities in the apparently different

    19. Functional Subgrouping Tool for bringing in new information Means of working with conflict Acknowledging differences in the apparently similar and similarities in the apparently different

    20. Functional Subgrouping: How It Works • Member (student) brings experience into the group looks around and says “anyone else” • Another member joins and builds • Join on similarities and build with new information • Hold differences until the group is ready

    21. Functional Subgrouping In Small Process Group Ex. • I’m sad. I’ve been around death a lot today and I just feel sad. Anybody else? • Yes, me too. I feel sad and I feel like I’m carrying something heavy. My arms feel tired. AE? • Yeah. I feel the heaviness and I just want to run. I want some relief. AE? • I want some relief too. I want to run and just let all my burden go. My feet feel like they’re ready to move – right now. AE? A. Yeah – the heaviness is less and now I have more energy. In fact I feel some irritation. I have a lot of energy to run and drop the burden in my supervisor’s lap. Let her carry it for a while. AE?

    22. Learning Through Functional Subgrouping • Students don’t Learn alone • No scapegoating - to encapsulate difference and extrude it • No identified patients - to contain difference and expunge it • A way to develop from simple to more complex - by integrating differences • Means of bringing together information in the head and the heart - parallel to skills needed in pastoral care

    23. Objective 2 - Role Goal Context • To review membership and leadership roles in CPE groups and how role, goal and context impact learning outcomes.

    24. Foundation of Groups Role Goal Context

    25. When you think: Role, Goal, Context • Group Behavior is more influenced by the system than by the individual persons • Allows members to take up membership in a work team • Encourages members to take work less personally

    26. Role Requires • Authority • To implement the functions that come with the role • Responsibility • To perform effectively • Accountability • To the next higher level in the system

    27. Role of the Member: • FUNCTION: • To explore with others with attunement • To work toward the goals of the group Reduce restraining forces as they come up Put individual energy into member role - work on the goals of the context

    28. Role of the Leader: • Structure: • To take authority • Provide structure so the group can reach it’s goals • Assist in reducing restraining forces to goals • Attune to the group

    29. Functional Role • Collection of behaviors • Which serve the driving forces toward the goal • Appropriate to the context • Independent of the person who takes on the role

    30. Goal • Within the lines of accountability and responsibility of the role • Appropriate to the Context

    31. SCT Goal 1. ToSurvive, Develop, Transform “Living human systems survive, develop and transform from simple to complex through a developing ability to recognize differences and integrate them.” YA

    32. SCT Goal 2. To enable people to use their own common sense to manage their everyday lives • What is common sense? The product of a good relationship between two sub systems within the self – Comprehension & Apprehension. • How Do We Access Common Sense? Make the boundary permeable between apprehensive and comprehensive knowledge.

    33. SCT Goal 3. To allow a group to meet the explicit goals that they have identified for themselves.

    34. Small Process Group in CPE • Is the Goal in the Name? • IPR - interpersonal relations group • Covenant Group • Process Group • Open Agenda Group • EOE - Exploring Our Experience

    35. Goals of SPG • Making goals explicit: • Easier to meet goals when explicit • Easier to see when goals aren’t being met • Opens the door to theory and connection to pastoral care and pastoral development • Assists students in taking responsibility for meeting the goals

    36. Example: Process Group Goals Level II Residency 1. To build a learning system that will provide a supportive environment for emotional exploration and learning. 309.3 to develop students’ ability to engage and apply the support, confrontation and clarification of the peer group for the integration of personal attributes and pastoral functioning. 2. To increase the ability to emotionally attune to self and others in service of developing pastoral relationships and providing pastoral care. 309.5 to develop students’ skills in providing intensive and extensive pastoral care and counseling to persons.

    37. Example: Process Group Goals Level II Residency 3. To develop personally within one’s professional context with the goal of developing clergy identity and pastoral functioning 309.1 to develop students’ awareness of themselves as ministers and ofthe ways their ministry affects persons. 4. Differentiate functional roles from automatic/personalized roles. 309.2 to develop students’ awareness of how their attitudes, values, assumptions, strengths, and weaknesses affect their pastoral

    38. Example: Process Group GoalLevel I CPE Unit: 1. To explore your experiences with one another in order to better be able to assist patients in exploring their experiences 2. To open up the boundary between head and heart – thoughts and feelings 3. To develop a learning group that can provide support and challenge Pastoral Formation ACPE • 309.1 to develop students’ awareness of themselves as ministers and of the ways their ministry affects persons. • 309.2 to develop students’ awareness of how their attitudes, values, assumptions, strengths, and weaknesses affect their pastoral care. • 309.3 to develop students’ ability to engage and apply the support, confrontation and clarification of the peer group for the integration of personal attributes and pastoral functioning.

    39. Group Goal • The students write a goal as a group for their process group time • What they want to learn? • In line with the overall goals • Includes what resources they have and need • Includes the driving and restraining forces • What will help? What will get in the way?

    40. Example: Process Group Goals • Goals: Level II CPE Group • See attached text

    41. Driving andRestraining ForcesTo Reaching Goals: • Reduce Restraining Forces • Increase Driving Forces • Releasing Drive Toward Change • Movement Toward Goals

    42. Driving and Restraining Forces Driving forces move one toward a goal Every restraining force is a driving force for another goal

    43. Driving andRestraining Forces It’s More Effective to Reduce the Restraining Force than to Increase the Driving Force

    44. Reducing the Restraining Forces • Restraints and defenses are reduced • Energy is released • Energy is directed toward the goal

    45. Context • The environment • Includes the phase of the group • Goals of the system • Culture

    46. Context • Process Group • Verbatim Seminar • Didactic • Summer Unit • Residency • Supervisory Education

    47. Theory of Living Human Systems • Four Basic Constructs: Hierarchy Isomorphy Structure Function

    48. Hierarchy

    49. Isomorphy Systems are: • Similar in Structure and Function • Different in different contexts