Men's Group

Respond Group Work Seminar: 29th June 2000

I will be talking about a group that began in January 1996 and continued until this year. It is hoped that the group will begin again later this year. Like the group Liz has just described, this group worked to a slow open model, having as its core group six men who attended for an average of three years. For the purposes of this talk I will focus primarily on the first three years of the group.

The levels of learning disability varied from severe to mild and borderline, and I would raise this as a point of discussion. At times the gulf between those whose verbal and receptive skills were limited and those who were able to be more articulate felt like an immense one, a gulf that sometimes served to separate both sides of the group from each other. At other times, it seemed to serve more as a bridge. I can think of many examples where the more able members of the group acted as auxiliary ears and auxiliary voices for those who found it hard to speak and hear. And those with communication problems also learnt much about making themselves heard, and having to consider the other much more. There are, of course, different views about whether treatment groups should be homogenous or not, and compelling arguments either way. Having a group that is mixed in its levels of ability will always mean that the group therapist has to work much harder in the sessions to ensure that there is a spirit of equality in the room, that those with strong voices will not necessarily drown out those with softer voices.

This group also had a wide range of reasons for referral. It is thought that all group members were sexually abused. The perpetrators crossed the spectrum - fathers, mothers, uncles, siblings, paid carers, teachers and neighbours. All had significant early experiences of deprivation marked by chaotic attachment structures. All had acted out their experience of sexual trauma upon others. Some were paedophiles, while others had targeted adults, particularly other adults with learning disabilities. Some had been through the criminal justice system after having been charged with rape or indecent assault. Others, and these tended to be the less able group members, had committed acts of sexual abuse upon others but their crimes had not been recognised as such by the criminal justice system - often because of the combination of their learning disability and that of their victim. This undoubtedly had an effect upon the use they made of the group. An interesting later development was a hierarchy in the group where those charged of rape received all the hatred, vitriol and rage of the rest of the group, who argued that it is far better to be guilty of indecent assault. At times like this the group became a microcosm of wider society, with an investment in a ranking system that allowed the majority of the group to project their guilt into another who could conveniently carry it for them.

The assessment process for the group seeks to explore many of the areas that Liz has outlined. In addition we will explore levels of denial and responsibility. Some clients will have been through a three month risk assessment that will clarify this for us and them. Others come stating that they have not done what they are accused of doing, and even if they did it is all in the past and will never happen again. One client announced that he had been sent for assessment for the wrong group - he should be in a victim's group. He then walked out, but returned the following week to say that, even though it was still the wrong group, he would give it a try. He was an interesting example of someone whose level of denial of his sexual crimes seemed immovable. The experience, however, of being with other men with learning disabilities who were able to talk about their abuse of others did enable him to move on from the position in which he had been stuck since he offended. This is, I would suggest, one of the benefits of a group treatment that is not behavioural in orientation. He would not have benefited from an approach that focused solely on his behaviour, as he was coming from a position of denial his behaviour existed. The process for him had to be one of exploration of other parts of his self that he could bear to think about - if his case his own experiences of being the victim of abuse.

For other men in the group the oscillation between victim and perpetrator was a marked one. From the very first session there was a sense of some of the men being desperate to use the group as a mirror which would distort and reverse their experiences. Thus, the children they had abused had actually abused them, or the woman devastated by their assault had actually devastated them. This connects with the group's on going struggle with rules. At some point in the life of the group I would say that most of the ground rules we had formulated in the first session were bent or broken. Food was brought in, cans of coke were drunk, people were late, or acted out a constant toing and froing from the group home to the outside world, men tried to exchange telephone numbers, mobile phones were brought in and switched on. Already there was a group transference - the group itself representing a body whose skin could be easily broken, torn and penetrated, that could be vilified, turned into a bad object, something that was hard for the men to define as ever really mattering.

It was difficult in the first year to make the kind of group interpretations triggered by the subversion of the group rules. My sense was often that my interpretations were experienced as overly intrusive and attacking by the group, as if the group were in a very early stage of its development.

In these early stages I was aware of the lack of space in which interpretations could be made - vertical interpretations, at least. I am using the term vertical to describe the relationship between me and the group that often revolved around what I represented to them in terms of the parental/caregiving or care depriving transference. Perhaps one of the functions of group treatment as opposed to individual treatment is the added space for horizontal interpretations. By this, I mean interpretations focusing not just on the dynamic between therapist and client, but that between group members. For example, as the group progressed there emerged a high level of pairing and coupling within the group. These alliances seemed to form as a defence against the power and intensity of the mass of the group. There were couples that had a highly sexualised dynamic. For example, one man who had an intense preoccupation with a television programme. For the sake of convenience, I will say that the programme was Star Trek. Star Trek was used as a perverse accessory to his sexual acting out and had formed part of his targeting and grooming of children in local parks who would become fascinated by X's colourful Space Federation badges and stickers festooned over his bag and lapels.

Despite his low level of cognitive ability, X was skilled at picking out those children who were least likely to tell an adult about his interest in them, and deployed relatively sophisticated strategies for getting the children on their own under the guise of sharing Star Trek paraphernalia with them before sexually abusing them. He also deployed these tactics in his use of the group by bringing in photographs of cast members, asking to read out summaries of his favourite episodes, and christening other group members with the names of his most loved characters. This was all treated with a mixture of amusement, bafflement, acceptance and derision by the group. X then focused his attentions on one group member in particular, someone who had his own history of being abused by care givers skilled in grooming him through superficially attractive and compelling trappings. X made him a Star Trek id. card and a personalised badge - all of which was underscored by a very sexual dynamic.

It was, of course, terrible to observe this pairing occurring and it often did not feel enough to interpret and work with the meaning of what he was enacting - I had to struggle not to tell him off, to impose stricter boundaries on his use of the group. The interpretations had to be two fold: the view of his actions as a defence against the anxiety of just being himself - a human being with good parts and bad parts. And the enactment of a perversion in which he sought to exercise control over the group and then, when this did not work, a fragment of the group which became a helpless seven year old for him to seduce and abuse.

It was hard for the group to avoid a scapegoating process, which I will give some examples of. The first, which I've already touched on, the hierarchy of offences in the group by which the rapist becomes the recipient of all the other group members terrible feelings about themselves. A different version of this was the banning of the word "sex" by one group member who threatened to, and actually did, walk out in some sessions where sex was talked about. As well as attending to the personal slight he felt at his own harsh moral code being tested by the group, it was important to think about his actions as also being made on behalf of all of the group, who carried a high level of shame and secrecy about the role of sex in their view of themselves and the world. This man was scapegoated for his actions, as was, at an earlier stage of the group, another group member who used manic laughter to defend himself against any exploration of sexual trauma and acting out. Again, although the group said they hated him doing this, it was possible to also see how much of a relief it was for them, and that the more they could denigrate him the less they had to focus on their own anxieties.

Although I think it is rather too convenient to delineate the group into set stages, there were some broad phases they passed through over three years, The first was characterised by fear - a projection into me of the harsh superego - judge, policeman, abusing parent. There was a disdain for any connection I might try to make, an insistence that any breaks in the group did not matter, and interpretations are worthless and to be spoken over.

This evolved into an idealisation in which the therapist became the all protecting, idealised mother/father figure through whom all statements needed to be channelled, who protected the group form having to relate to each other.

Next came a period of denigration, coinciding with a testing out of all boundaries. A huge amount of secrets seemed to enter the group, accompanied by more talk of wanting to leave the group, and much more denigration of each other.

What we worked towards was more of a depressive view of the world in which good and bad could co-exist - the good and bad parts of them could be acknowledged instead of the view they had clung to of themselves being either all good or all bad. And, with this, a sense of the group as something that can tolerate hatred and love (need) - an object that can bear the thought of their terribleness.

Linked to this is an important function of group treatment with offenders - the ability to work with shame. This must be partly about the shame of the offence of the act of being abused, but can also be the shame attached to the learning disability itself - the original trauma. There was always a particular edge to these sessions in which group members would talk about things that had gone wrong with their birth, how they had not been wanted, how mothers and fathers could not cope with them (typified by their view of Diana after her death - initially venerated before being completely demonised). For many it was their first experience of putting into words their sense of being fundamentally different from the rest of the world.

It is on such issues as these that the role of clinical supervision becomes paramount. Working with offenders with learning disabilities cannot fail to arouse a wide range of emotions in us all, whether we are running a group or are charged with the responsibility of managing a care package. In addition to a space in which the practicalities can be attended to, it is vital to have a space in which to explore what gets put into us by working with dangerous clients.

This work could not and should not take place in a vacuum, and had to occupy a place in a system of care that was multi faceted. It was only really possible to work with issues such as the disability trauma or fantasies of acting out sexually by knowing that secure support structures were in place, and that other people were attending to the parts of the men that the group could not attend to. It was also important to be clear about our strategy for dealing with disclosures of abuse or abusing, or to know who to talk to if we were concerned that a vivid sexual fantasy was in danger of being enacted.

It was not an education group, and some offenders need properly thought out, sensitively handled sex education. The two can exist in a parallel and, as long as there is a sense of properly contained communication between different people providing different aspects of treatment, can productively co-exist.

Tamsin will say something about Respond's Professionals Forum, but I would like to briefly highly the importance of such spaces for the efficacy of treatment for offenders. The support group I facilitate for members of staff working with members of our Young People's Group works well as a source of support for members of staff, but also for the group itself. Fantasies about what the group may be doing with these dangerous and vulnerable young people may be talked about, alongside questions about the long term risk management of offenders for whom being a low risk may well be an unobtainable dream.

Copyright Alan Corbett 2000