Working with Group Process in CPE:
Advances in Theory and Practice
The Rev. A. Meigs Ross, ACPE, BCC, LMSW
New York Presbyterian Hospital
1
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.
2
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”

3
Groups in CPE

Three Distinct Types

Didactic - teaching groups

Verbatims - group supervision

Small Process Group
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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.
5
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

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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
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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
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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
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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)
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System Centered Theory
Developed by Yvonne Agazarian
“SCT is a theory of living human
systems that defines a hierarchy of
isomorphic systems that are energyorganizing, self-correcting and goal
directed.”
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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.
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The Group

Groups Have:



Boundaries
 Time, Space, Context, Reality
Leaders and Members
 Different roles and tasks
Goals
 Explicit
 Implicit
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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
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Hierarchy
Member
Subgroup
Group as
a Whole
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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
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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
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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
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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?
B.
Yes, me too. I feel sad and I feel like I’m carrying something
heavy. My arms feel tired. AE?
C.
Yeah. I feel the heaviness and I just want to run. I want
some relief. AE?
D.
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?
A.
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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
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Objective 2 - Role Goal Context

To review membership and leadership
roles in CPE groups and how role, goal
and context impact learning outcomes.
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Foundation of Groups
Role
Goal
Context
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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
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Role Requires

Authority


Responsibility


To implement the functions that come with
the role
To perform effectively
Accountability

To the next higher level in the system
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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
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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
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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

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Goal


Within the lines of accountability and
responsibility of the role
Appropriate to the Context
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SCT Goal
1. To Survive, Develop, Transform
“Living human systems survive, develop and
transform from simple to complex through a
developing ability to recognize differences
and integrate them.” YA
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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.
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SCT Goal
3. To allow a group to meet the
explicit goals that they have
identified for themselves.
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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
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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
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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.
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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 of the 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
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Example: Process Group Goal
Level 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?
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Example: Process Group Goals

Goals: Level II CPE Group

See attached text
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Driving and
Restraining Forces
To Reaching Goals:

Reduce Restraining Forces

Increase Driving Forces

Releasing Drive Toward Change

Movement Toward Goals
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Driving and
Restraining Forces
Driving forces move one toward a
goal
Every restraining force is a
driving force for another goal
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Driving and
Restraining Forces
It’s More Effective to Reduce
the Restraining Force than to
Increase the Driving Force
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Reducing the Restraining
Forces

Restraints and defenses are reduced

Energy is released

Energy is directed toward the goal
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Context

The environment



Includes the phase of the group
Goals of the system
Culture
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Context



Process Group
Verbatim Seminar
Didactic



Summer Unit
Residency
Supervisory Education
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Theory of Living Human
Systems

Four Basic Constructs:
Hierarchy
Isomorphy
Structure
Function
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Hierarchy
Member
Subgroup
Group as
a Whole
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Isomorphy
Systems are:
 Similar in Structure and Function
 Different in different contexts
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Structure

Every System is defined by its
boundaries in
Space
 Time
 Reality
 Role

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Function

Systems
Survive
 Develop
 Transform from simple to more
complex by discriminating and
integrating differences

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Objective 3. Phase of Group
Development

To gain a greater understanding of the
phases of group development.
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Phases of Group
Development

Flight
Authority (Fight)

Intimacy

Work

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First Phase: Flight Phase
Social Behaviors: Primary Impulses to undo
Goals of Flight Phase:
1.
2.
3.
To move from personal role to member role
To move into reality - including goals
Undoing restraining forces to exploration
Parallels first steps in pastoral care
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Second Phase: Authority

Work is to explore:




•
Frustration, Irritation
Retaliatory Impulses - (not toward members, but
toward the leader)*
Explore competition in the group
Explore - disowning own authority &
externalizing all conflict onto authorities
Members aren’t yet ready to not take retaliation just personally – don’t yet
see the projections
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Third Phase: Intimacy 2 Parts:
Hope - all is good
Despair - there is no hope
Two side of same - opening up to reality
Parallels work with patients
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Fourth Phase: Work

Integration:



Access to fuller information in self and
group
Able to reality test, take things “less
personally”
Undo restraining forces to the goals in the
context
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Objective 4. Undoing Road
Blocks

To explore common restraining forces in
group leadership and function and
explore ways to undo these restraining
forces and release energy for growth.
59
Challenges
NEED
Patience
 Discipline - Containing frustration
 Team Players
 Long Range Thinking
 Interest in Discriminating and
Integrating Differences

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Leadership Challenges

(Restraining Forces to Undo)





One’s own stuff
Not taking up authority
Taking up authority in a way that shuts
down the group
Unclear about the goals of the group
Inconsistent leadership
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Directing Energy Toward the
Goal:

Reframe group or individual
experiences:
depathologizing
 legitimizing
 humanizing
 normalizing
 universalizing

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Taking Up Authority


Restraining Forces to Taking Up Authority
Appropriately for Group Leadership:
A Sample:





Taking things “just personally”
Haven’t done own group work
The “bad supervisor” role
Seeing the “bad group”
Wanting things to go faster, better, differently
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Theological Reflections

G-d’s Creation



Interconnected Systems
Developing - ongoing creation
New Creation and Community require the ability to
integrate differences
RESPONSBILITY
COMMUNITY
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Questions
?
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•Surprises
•Learnings
•Discoveries
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Bibliography
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References:
Agazarian, Yvonne, M. (1987) ReViewing Yalom: An interpersonal tale retold from the perspective of the
group-as-a-whole. Guest lecture, group psychotherapy, Harvard Medical School, Boston, MA, 3-5 April.
System centered practice, selected papers on group psychotherapy. (2006) NY: Karnac.
Agazarian, Yvonne, M. (1997) Systems-centered therapy for groups. NY: Guilford Press.
Agazarian, Y.M. & Gantt, S.P. (2000). Autobiography of a theory. London: Jessica Kingsley Publishers.
Agazarian, Y.M. (2001). A systems-centered approach to inpatient group psychotherapy. London: Jessica
Kingsley Publishers.
Agazarian, Y.M. & Gantt, S.P. (2005). The systems perspective. In S. Wheelan (Ed.), Handbook of group
research and practice. Thousand Oaks, CA: Sage Publications.
Corey, Marianne, Corey, Gerald, Corey, Cindy. (2010) Groups, Process and Practice. CA: Brooks/Cole
Bennis, W.G. and Shepard, H.A. (1957). “A theory of group development.” Human relations 9 (4), 415-437.
Bion, W. R. (1961) Experiences in groups and other papers. London: Tavistock.
Gantt, S.P. & Agazarian, Y.M. (2004). Systems-centered emotional intelligence: Organizational analysis, 12
(2), 147-169
Hemenway, Joan.(1996) Inside the Circle, a historical and practical inquiry concerning process groups in
clinical pastoral education. Atlanta, GA: Journal of Pastoral Care Publications
MacKenzie, K. Roy (1992) Classics in group psychotherapy. NY: Guilford Press.
Ormont, Louis R. (1992) The group therapy experience, from theory to practice. NY: St. Martin’s Press.
Overholser, James C. (2005) Group psychotherapy and existential concerns: an interview with Irvin Yalom.
Journal of contemporary psychotherapy, 35 (2), Summer.
Rioch Margaret J. (1991) The work of Wilfred Bion on groups. (summary of Bion: Experiences in groups and
other papers (1961). London: Routledge.
Yalom, I. (2005) The theory and practice of group psychotherapy. NY: Basic Books.
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Systems Oriented Groups