Reflective Practice Group Functioning - Dimensional Grid

An open access tool for evaluation and research

Around seven years ago, with the help and encouragement of a small group of colleagues, I developed an evaluation and research tool for understanding and mapping experiences in groups of the membership, and in a different way of the facilitators, of Reflective Practice Groups (RPGs).

I have since then been using the tool to develop my own praxis and conceptualisations, and there are at least three networks of colleagues I am aware of, and one or two other lone practitioners besides, who have been using the Dimensional Grid to compare notes with each other as to different networks of RPGs.

The approach, in my mind, is phenomenological - rather than, for example, psychoanalytical, or group analytic, or hermeneutic. It brings these sorts of questions to bear upon the experience, and tries to find answers or pointers to answers, or to identify further questions that might be pertinent:

• What are the characteristic sorts of things that happen in such groups?

• What is the group up to and how is it functioning, especially in relation to ideas we might have about its given task?

• In what sort of state does the facilitator find the group?

• In what sort of state might the facilitator leave the group at the end of the session (not that the answer has to be different!)?

• How is the attention and emotional work of the group directed in different ways towards different objects?

• What is the feel of the particular session (taken all in all)?

• How is the group locating itself, and perhaps also holding its reality orientation, in relation to dimensions of time and place or space?

These groups are mostly convened with multi-disciplinary teams of practitioners delivering mental health and social care in complex systems (for example hospitals, prisons, clinics, schools, universities). They usually range in size (in terms of membership attending any one session) from a very small group of 3-5 members plus facilitator to a ‘median’ group of say 13-17 members. Typically they meet weekly or fortnightly in the same time and place, usually for one hour - there may be a range of departures from this norm, and the Dimensional Grid may be used to think about any similar group session.

The tool is ‘open access’ and anyone in the field is very welcome to pick it up and run with it. By the way, you can download the pdf version here. I have written this Substack piece in order to give a reference for the Dimensional Grid so that it can be more widely accessed, and then it is my intention later this year to try to write a more academically oriented psychosocial piece for possible journal publication.

Here then (below, Figure 1), without further preamble, is the Reflective Practice Group Functioning Dimensional Grid. Have a look at it to gather any first impressions, then read on…

Figure 1

This now needs a bit of explanation - although, if you have ever facilitated one of these groups, I hope you will readily grasp the gist, and if you have ever been a member of one of these groups, there might still be more than one readily available hook to hang this upon.

I am going to proceed here by assuming that I am not addressing an expert audience. I propose to strip down the Dimensional Grid before you, as though it were an engine, and then to build it back up again, component by component.

Figure 2

Here then is a simple crossed x-axis (horizontal) and y-axis (vertical). The fundamental idea was to take two aspects or dimensions of the particular phenomena manifesting in a given RPG session and to look at the interaction between the two dimensions thus foregrounded.

Figure 3

Now imagine (Figure 3) that at the phenomenological intersection of these two axes - these two continuums - is a territory, denoted with a circle, representing a state in which the emotional work of the group session is more or less evenly poised between the two sets of phenomena we have selected for investigation.

Figure 4

Figure 4 now shows the first two dimensions I selected. The x-axis represents the continuum in a given RPG session of the focus of thinking and discussion in the RPG being, at one extreme end of the continuum, on the presenting behaviour or (more subtly) the presenting state of mind of a particular individual client of the service - in something more of a ‘case discussion’ mode, as if the group were met for sole purposes of coming away with a better understanding of why the particular client is being the way they are being.

At the opposite extreme of the x-axis, the experience in the group of the behaviour or state of the wider system around it (the state of the world in which it finds itself, and, closer to home, the state of the system of care around it, or the particular subsystem (eg the area of the country, or the hospital campus) in which it is located. Team dynamics and inter-team dynamics are also part of this ‘half’ of the y-axis continuum.

Up and down the y-axis is a continuum of arousal linked to sense of threat, considering the state of the group as a whole, from high level of threat and arousal at the upper extreme of the y-axis down to low level of felt threat and arousal at the lower extreme.

We will come back later to more detailed discussion of the two dimensions - but in case the point is not self-evident, I should mention here that the y-axis is largely predicated upon theories of mentalisation - the ability to hold in mind one’s own mind, and the mind of another, and to make and sustain emotional connection accordingly - in the hopefully straightforward sense that groups and individuals alike are best able to sustain emotional thinking about their position or predicament or the object of their attention, when the emotional temperature is neither ‘too hot’ (too aroused or vigilant) nor ‘too cold’ (too flat and disinterested or dissociated).

At this stage, we are going to set aside the axes for a moment, and look at the emerging grid that they describe.

Figure 5

This image shows a simple version of a Johari window, in which an intersecting x-axis and y-axis generate and describe four quadrants - A and B above the line of the x-axis, C and D below the x-axis.

The discussion of Figure 4 above hopefully allows it to become clear that the A-window maps the territory in a given RPG in which arousal is relatively high and the focus is mostly on the individual client(s) - and that the territory of the C-window is characterised by relatively low arousal and client-focus. In turn, the B-window maps territory in which arousal is high and the focus is more on the wider system, and the D-window has a wider system focus, but finds the group in a state of lower arousal.

To give simple illustrations: an ‘A’ session might be one in which a ward team in a low secure unit are feeling very much under attack from a particular patient and their focus is on the patient’s behaviour. In a ‘C’ session, a hostel-based team reports that it’s ‘all quiet on the western front’, and chat in a more desultory way about a new resident who is keeping herself to herself.

In a ‘B’ session, a prison-based team are in a state of high threat/arousal because feeling very pushed around by the prison system in the area of staff redeployment. Lastly, in a ‘D’ session, a multi-disciplinary community mental health team are in a slightly self-conscious way ‘having a moan about management’ without their hearts being especially in it.

Figure 6

Returning again briefly to the intersecting axes, and to that territory which in figure 3 was denoted with a circle on and surrounding the point of intersection - how imagine that this territory is denoted by the letter ‘W’. This marks the zone of intersection between the four windows, A - B - C and D (see figure 7 below).

Figure 7

Think of the ‘W’ zone as a kind of ‘sweet spot’ on the grid - not exactly an ideal, because an ideal RPG would not be reflecting its complex and far from ideal realities, but the sort of experience in a group you’d be wanting to see, if you had to want to see a particular experience, as facilitator or member, and could choose.

In ‘W’, the level of arousal is neither too high nor too low - we’re in the temperate zones, emotionally speaking - and the focus switches between the clients and the wider system, in a way that at least from a systemic point of view, you’d want to see when a group is reflecting on its practice in a complex system.

Some readers will already have spotted a borrowing here from psychoanalytical theory here, specifically, WR Bion’s theory, set out in detail in his text Experiences in Groups (1961), of the ‘work group mentality’ of a group.

By this he meant, put very briefly and simply for now, that collective state (of mind) - of a group of people brought together to work on an appointed task - in which they clear about the nature of the task and are best able to focus upon that task and to collaborate in order to pursue it.

Bion denoted this group mentality by the symbol W and contrasted it with states of the group that tend to be dominated by different ideas of what the task should be and certain marked ways of defending against the challenges of learning from experience in the group’s work.

My own ‘W’ in the Dimensional Grid somewhat borrows the idea of ‘work group mentality’ - but with the reservation, which we might leave for further exploration, that there’s nothing in Bion’s text to say that W correlates to the temperate zones of emotional arousal, or to a gently oscillating focus on objects of enquiry or subjects of discussion.

You may with some justice feel that I am wishing to have my cake and eat it here - but I want to leave the reference or association of ideas open, without pinning my colours to Bion’s towering mast. So please allow for now that ‘W’ and W are related, but not coterminous!

Figure 8

Figure 8 drops the axes again for the moment and takes us back to the Jahari window in Figure 4, but with two changes, and suddenly you can see that the grid is now gaining and perhaps deepening in the complexity - and hopefully subtlety - of its way of describing the complex phenomena of an RPG session.

The first change is that each window of the original quad is now in turn divided into four. The second is that that mysterious ‘W’ zone is imprinted into the wider map, so that the four sub-windows around the (temporarily invisible!) ‘W’ zone are marked AW, BW, CW, DW.

A value of 'AC' for a given session would indicate patient focus but with threat level tending from higher towards lower; 'BA' would denote high threat but with systemic focus tending toward patient focus. 'A 'DW' session is predominantly concentrating on system issues with low arousal and some shift towards the free-floating centre - and so on. Also note:

• A 'CC' group concentrates on the disturbance of the clients but is not in touch with its anxiety about them; is largely unconscious of how wider system issues may be relevant and resistant to exploring them

• An 'AA' group is flooded with anxiety about the clients and can't see the (wider system) wood for the trees

• A 'BB' group is flooded with survival anxiety in relation to the wider system and can't see the (client) trees for the wood

• A 'DD' group concentrates on the disturbance in the wider system but is not in touch with its anxiety about it; is largely unconscious of how client issues may be relevant and resistant to exploring them

Now let’s reassemble the windows and axes.

Figure 9

There is no 'good' or 'bad' space in which a given RPG may find itself at any one point. However, to be stuck over time in AA or DD, or in the AA-BB or CC-DD rows of the grid, is to be stuck in places where creative thinking may be elusive and where fight-flight mentalities and states of incohesion may dominate.

Likewise, there is no 'good' or 'bad' focus for a given session, but to be stuck along the AA-CC column is to be stuck in a monocular view of the team's work that excludes the wider system perspective - along the BB-DD column, the system focus is perhaps problematically at the expense of concern for the clients.

One dimension is missing in Figure 9 from the image shown as Figure 1, and that is the dimension of time. Let’s quickly address that, and then close…

Figure 10

The temporal axis indicates whether the time frame of material being considered is predominantly in the past (t - 1), present (T), or future (t + 1).

As above, so too for the temporal dimension, it is not there is a ‘good’ place to be. The Dimensional Grid helps the facilitator to meet the group where she finds it, not to wish it were in some other state.

However, there might be a working hypothesis that a group that is either ruminating on a sort of mythical golden age of the organisation’s imagined history (t-1), or gazing with anticipation or dread into a feared or longed-for future (t+1) might be out of touch with the here-and-now realities that come more prosaically but perhaps more helpfully with a focus in 'T'.

Figure 11

This concludes my introduction to and description of the Reflective Practice Group Functioning Dimensional Grid. As mentioned above, I intend to write about the Dimensional Grid in a different way and from some different angles in a separate piece. In the meantime, while I haven’t said very much here about how I personally think about the place of RPGs in the system of care, I would refer the interested reader to my essay published in 2019 in the journal Organizational and Social Dynamics.