reflections on setting up a narrative therapy group in a london nhs practice: a conversation between nadia somers and fran lassman (clinical psychologists)

N- What kind of group was this?

F - It was a group for patients who were receiving care from a London hospital for a Congenital Heart Condition 

Fran

N- What led you to setting up the group?

F- I set this up with my colleague, Rachel. Since joining the service I noticed so many of the patients speaking about the isolation of having a congenital heart condition and asking about opportunities for meeting others. The cohort is different from most of the people that are in a hospital with an acquired heart condition, who are usually older or have lifestyle factors involved.  It got me thinking about creating opportunities for meeting other people. I also heard different things in this request- a desire to meet others to reduce the sense of isolation, and a desire to hear about how others were living life with this condition- a sense of being able to share knowledges, skills and expertise. 

N - Did you have any particular hopes or intentions for the group? 

F - We had a hope that people would find the value in their own experiences and knowledges. That in a way my role would be minimal, for there to just be a space of shared experience - to bring a sense of solidarity, less isolation, more connection.

Nadia

N - Why was that important? What led you to think shared experience/connection would be important to them? What does this say about how you practice?

F- honestly, it was a response to what people were asking for.

As much as I think one-to-one therapy can be beneficial, it does not allow for development of peoples own skills/knowledge/beliefs/practices within their own communities. I try to co-research these things with people in the therapy room, but I do not think these stories are robust enough if they are kept within the therapy room.  

This was a potential opportunity for people’s expertise, skills for navigating life with these complex conditions, to be made visible, to be witnessed by others. And those others being people with shared lived experience. 

N- Does anything stand out as having been particularly effective?

F- I think naming the collective stance they had taken to resisting societies’ pressures to “be normal”. They all shared different ways they had been trying to live up to normality in their lives, and then these exceptions, these “fuck it” moments. In sharing these, naming these, they became more visible, and not insignificant- but big collective steps in resisting the power of societal ideas of normality. This felt transformative. 

N - Did you have a team of support that you kept with you in this endeavour? 

F – A big team! Rachel who was by my side facilitating the group, always there to laugh with, share excitement; you two as my “confidence givers”- you bolster me as you notice me taking steps and this gives them greater meaning. And then Amanda Redstone, Poh Lin Lee, Sabine Vermiere, Vicky Kelly who is the most encouraging and positive person…and of course the patients I have met who I try and always stay accountable to.

N - Are there any ways you kept group participants at the centre - How did you make sure it was meaningful to them?

F -  Everything we shared was an invitation, offered in the context that some ideas may fit better than others. Their expertise was kept at the centre and we shared that we were nervous and did not know how things were going to land in the space. One person said you didn’t demand any information from us - you didn’t pry - we ended up wanting to tell you what was discussed. We never felt pushed or pulled in particular directions. 

N – That is quite different from ways we were trained about how professionals hold expertise - what were the effects of saying I’m nervous about the group but also we have ideas but are not holders of the expertise. 

F - it relaxed the atmosphere - everyone was feeling nervous so it became a shared experience. I think it stepped away from the idea that as the facilitators, the psychologists, we would know what we were doing and would know what was best for the group. It was a step in resisting power and centering the people we hoped to centre.

So much of the feedback was about a sense of confidence- both confidence in what they created in the group (which they named “their baby!”) and confidence in managing their lives with heart conditions. 

They also shared how different this was from other groups and therapy they had done before. They talked about previously being put into boxes or categories, therapists prying, making them talk about difficult things. This felt completely different- their experiences were held at the centre instead of our beliefs of what needed to be delved into/uncovered.

N - I’m wondering what you’re left with? 

F – A lot of energy to do this more, both inside and outside of the NHS. I feel this group really impacted peoples’ lives- confidence had stopped one person from working for 6 years and she went and and got a volunteering job after the group, another person loves photography but confidence stopped her from sharing pictures- her dad shared that she has now agreed for pictures to go up in the house. People seemed to be reunited with their abilities. I want to honour this and continue this practice elsewhere.