4.1. Therapeutic groups

Purpose: This session aims to support parents from culturally and linguistically diverse backgrounds who have requested help with parenting their young people. Its purpose is to improve family functioning and reduce the risk of youth homelessness.

Resources required: Nil.

Beginning phase: Contracting is conducted; the social work facilitator states what is about to happen and explains the group values, such as respecting what others say.

Middle phase: The facilitator explains what PACE stands for; it is an acronym for Playfulness, Acceptance, Curiosity, and Empathy (DDP Network, 2024). They share how parents can use these techniques to create a sense of safety for their children and young people (DDP Network, 2024). The people in the group are invited to give examples of what they do that match each letter of the PACE acronym.

Ending phase: The social work facilitator checks if participants have any questions/feedback and then ends the group with the following questions:

• How are you feeling?
• What are your highlights?
• What will you do after the group for self-care?

This therapeutic activity is inspired by the EveryMan Australia Program (2024) Working With The Man.

Purpose: To increase the group members’ understanding of anger and for them to start to recognise and reflect on the difference between anger and behaviours. The goal is to evoke reflection from the group on the links between their own anger and behaviours in order to improve their relationships and parenting ability.

Resources required: A whiteboard and markers.

Beginning phase: Welcome the group members and introduce the session focus, by writing ‘understanding anger’ on the board.

Group agreement: The social work facilitator reaffirms and clarifies the group confidentiality agreement and reporting requirements. Then, they ask the group to contribute to the group agreement by suggesting important values and ‘ground rules’ for the group. They seek input from each of the group members for this component and, expand on the points, and validate their suggestions.

Ensure that the rules of respect, no swearing, non-judgement, and input from everyone are mentioned early. Highlight that the group is a space to be free from blame and criticism of partners or others and that the facilitator will call out any instances of blame if they occur.

Middle phase: Write ‘ANGER’ on the board with a large circle around it. Ask the group to provide words that they associate with anger as if they were describing anger and explaining what it may look like to someone who does not know. List these words on the board.

Prompt the group by asking what their own anger looks like. Ensure the circle is filled with a number of ‘behaviours’ including violence, hitting, yelling, swearing, name-calling, etc. Explain that, as men, we have been hard done by when it comes to our relationships with anger. Highlight that anger is the emotion society has accepted for boys and men to express when describing or showing any other emotion. The facilitator explains that anger doesn’t need to be visible to others; it is the emotion many men are generally most comfortable expressing outwardly.

Specify that when our anger is expressed outwardly, these behaviours can have a harmful impact on others and lead to fear, intimidation, and feeling hurt and controlled. In these instances, this behaviour is abusive. Discuss the differences between behaviours and emotions and that we have control over our behaviours.

Highlight that in the group, identifying and acknowledging our behaviours is the first step in changing them. Often, behaviours are packaged under ‘anger’, ‘short fuse’, or ‘bad temper’, but if we are honest in disclosing behaviours— “I shoved my partner, swore at my kids, etc.”— the excuses become harder to accept.

Ending phase: Ask the group to reflect on the activity and their own anger and behaviours. Also, ask what each group member is taking away from the group.

The social work facilitator closes the group by thanking the people for their input. They acknowledge that taking accountability and discussing things we are not proud of is difficult, but it is a necessary step towards change. Ask the group to commit to coming back next week, indicating that we will check in about their experiences with anger and behaviour throughout the week.

This activity is inspired by The Oxford Muse Foundation Feast of Strangers, established by Theodore Zeldin (Riga International Biennial of Contemporary Art, 2022).

Purpose: To enhance social connectedness for people who are experiencing suicidality and loneliness. This group is not for people in acute suicidal distress at the time of the meeting.

Resources required: Copies of the Feast of Strangers handout – one for each group member. See Table 1 below for an example of a handout.

Beginning phase: The facilitator welcomes members to the group, introduces themselves, outlines the purpose of the group, and acknowledges that suicidality can be an isolating experience. Group safety and confidentiality, except for notifiable concerns, are continually mentioned. The facilitator encourages members to share their experiences safely, highlighting that everyone needs to be mindful of the impact their words may have on other group members, such as not including distressing details when sharing a narrative.

Middle phase: Group members split into pairs and spend ten minutes asking each other questions from the menu handout, see Table 1. Members work through as many questions as they can within the ten minutes, being sure to answer at least one question from each course of the question menu.

Table 1:

The Menu. Designed by Tyne Smedley.

End phase: Group members are invited by the social work facilitator to reflect on the activity through the following questions:

• What was that activity like for each of us?
• Did you find it easy or difficult to answer the questions?
• Did anyone find they had something in common with their partner?
• How are you going?
• How did you find the group this week?

This therapeutic activity is inspired by the Mindfulness Script (Canberra Health Service, 2022). 

Purpose: First, to reduce the stress levels of people living with mental health challenges such as anxiety, depression, suicidal ideation, and Post Traumatic Stress Disorder. Second, for people to experience the potential benefits of deep breathing and progressive muscle relaxation therapies.

These potential benefits are:

• Helping to manage anxiety,
• Promoting better sleep,
• Relieving stress and tension headaches,
• Lowering blood pressure and heart rate,
• Reducing stress hormone levels in the blood,
• Enhancing immune system function,
• Boosting physical energy,
• Increasing feelings of calm and well-being.

Resources required: A handout with information about the service and other similar activities within the service.

Beginning phase: The social work facilitator explains the group activity and that many have found this activity helpful in reducing tension, for example:

Today, we will be doing some progressive muscle relaxation, which involves tensing your muscles on the in-breath and then letting that tension go on the out-breath. You can choose to either sit or lie down, whatever is more comfortable for you. Just before we start, it’s important to know that you might not be able to reach zero levels of tension, and that’s ok. The aim is to let go of the tension the best you can. It is also important to know that this activity shouldn’t hurt, and if you are becoming more tense or experiencing pain at any point, you should stop.

The following statement is also shared, indicating the group is an optional activity:

If that activity does not work for you, that is okay; please feel free not to participate.

The facilitator will remind the group participants that trying different mindfulness activities is about finding out what works for them.

The facilitator will need to explain early on how to do progressive relaxation. For example, stating that for this activity, we will:

Start at the feet and squeeze various muscle groups, hold the squeeze for a little while, then relax. Next, move to the thighs and do something similar.  Slowly move up the body to the head, allowing every muscle group to be squeezed and then relaxed.

The social work facilitator will also need to introduce deep breathing:

Take a deep breath, hold it and take a deep breath out.

Middle phase: In this phase, people reflect on their tension and release it. The facilitator states:

Take a moment to notice how your body feels right now. Identify any areas of tension. We’ll begin by focusing on our breathing. If comfortable, close your eyes. Let’s start deep breathing: In… hold… Out… In… hold… Out…

Now, concentrate on your right leg. Squeeze your foot, calf, and thigh as tightly as possible. Feel the tension. Inhale deeply and tighten further. Exhale and release the squeeze and tension, noticing the difference.

Next, focus on your left leg. Squeeze your foot muscles, calf, and thigh tightly. Feel the tension. Inhale deeply, tighten more, then exhale and release. Notice the sensation. Move your attention to your abdomen and chest. Squeeze them tightly, feel it, inhale deeply and tighten further. Exhale and release, noticing the relaxation.

Now, focus on your right arm and hand. squeeze them tightly, feel the tension, inhale deeply, tighten more, then exhale and release. Notice the change. Do the same with your left arm and hand. Squeeze them tightly, feel it, inhale deeply, tighten more, then exhale and release. Observe the change. Shift attention to your neck and shoulders. Squeeze tightly, feel it, inhale deeply, tighten more, exhale, and release. Notice the difference.

Finally, focus on your head and face. Squeeze by scrunching your face, and tightening your lips and jaw. Feel the tension, inhale deeply, tighten more, then exhale and release. Observe the relaxation. After working through the whole body, do a body scan for any remaining tension. If you find any, squeeze and gently release it with your breath. Don’t worry if you can’t reach zero tension. Focus on feeling relaxed.

Now, gently wiggle your fingers and toes, and move your arms and legs a bit. When you’re ready, open your eyes.

Ending phase: The social work facilitator will ask for feedback and check if participants found the session helpful. They will ask participants for suggestions or ideas on how to improve the session. Also, they will distribute extra information detailing the mindfulness steps so people can practice independently and provide information about the service.

Purpose: To conduct a support and therapeutic group using a strengths and empowerment framework for people living with anxiety (Duncombe, 2014).

Background information: The group work presented here is a six-week series of two-hour sessions that support people’s knowledge of, and active role in, managing the anxiety that affects them. This group has an empowerment element by increasing people’s own control and management of the anxiety. The group setting reduces the isolation that may be experienced as a result of the anxiety and helps normalise people’s experience by being in a group of 12 people with similar concerns. The series introduces and practises a range of evidence-based strategies for anxiety management, as well as discussing anxiety medications.

Each participant develops the series goals regarding:

• Their understanding of the anxiety that affects them and their own self-management program.
• Their confidence to manage the anxiety and decrease the impact of the anxiety on their lives.

Resources used: A folder with a statement of the series goal, a notebook, information on the basic neurobiology of anxiety, a pen, a name tag for each participant, a whiteboard and markers, tables, chairs, and refreshments. Additionally, an anxiety assessment scale is needed; this could be the generalised anxiety scale (GAD), the depression and anxiety scale (DASS) or the Kessler psychological distress scale (K10) (Kessler et al. 2002; Lovibond & Lovibond, 1995; Spitzer et al. 2006).

Resource materials are distributed each week and are added to the folder. The folder becomes a portfolio of anxiety management strategies explored over the series.

Beginning phase: The group series begins with a welcome, pre-testing using the chosen anxiety assessment scale, introductions, and information-sharing time.

In this activity, anxiety is located within the wider social and environmental structures that increase its incidence rather than inherently in the person. People then identify the symptoms that affect them. The narrative therapy strategy of externalising the anxiety and separating the person from the anxiety is introduced (White & Morgan, 2006). Consequently, the facilitator and group members always refer to the anxiety and the symptoms and what the anxiety and symptoms do, rather than referring to my anxiety or my symptoms. That is, the anxiety is not ‘me’ – rather, it affects me.

Each session begins with an activity where everyone, including facilitators, identifies something that has been good or better over the intervening week. Each group member adds a reflective paragraph to their notebook, and the content of the previous session is reviewed.

The second group activity is a relaxation, breathing, mindfulness or guided imagery exercise. A different one of these activities is introduced in each session. This is followed by exploring an anxiety management strategy.

Middle Phase: In the middle phase of each session, the content is introduced, including the philosophy, theory and practice of the strategy. The approaches introduced include cognitive restructuring, the therapeutic tool – a pleasure diary, acceptance and commitment therapy (ACT), graded exposure to anxiety, problem-solving skills and approaches, breathing strategies, and self-soothing activities. Each strategy is practised in the group as it is introduced, and participants are encouraged to experiment with the strategies during the week. It is suggested that two anxiety management strategies are practised in each session, with a morning tea break in the middle.

Table 2

An example of a beginners guide session format.

Ending phase: Each session finishes with another relaxation, breathing, guided imagery or meditative technique.

Evaluation: At the end of the series, the group completes the chosen anxiety assessment scale again to see if there has been any change. The series ending exercise includes all participants, with people letting other group members know what they appreciate about them. An additional morning tea is held at the end of the final session, providing extra socialising time.