Analysis of Wellbeing and Group Process Measures
In this section, CYP’s mapping of their experience of the group and its impact are represented through their scores over time on CORS and CGRS. In the CORS measures, CYP were asked: “Looking back over the last week, including today, help us understand how you have been feeling by rating how well you have been doing in the following areas of your life”. In Figs. 2 and 3, two individual UK participants’ data is presented, showing how wellbeing scores changed across the duration of the 10-week UK intervention programme. This is a typical pattern, generally observed across the intervention in all 4 countries. Subjective wellbeing is rated in roughly the middle of the scale at the beginning of the intervention, and generally improves across all domains, but there is variability in this pattern, particularly in the middle of the intervention.
For many CYP, the ‘dip’ in scores in the middle of the intervention tended to be related to their perception of wellbeing in the family and in other relationships. Figure 4 shows 64% of the English participants reported fluctuations in subjective ‘family’ wellbeing scores, with sharp troughs and peaks – also typical of the Italian and Spanish cohort data. During the programme in England, carers at times contacted facilitators, to express concerns about changes in their child’s behaviour, specifically, their child’s desire to talk parent who used violence. The dip in family wellbeing scores may therefore represent the difficulties CYP experienced in raising emotionally challenging material within the family, potentially unsettling the family system. This pattern varied in Greece, the intervention was conducted in a residential setting, where most participants had been removed from family of origin, or were receiving specialist day centre support from a statutory service for vulnerable families. Here participants consistently rated wellbeing highly across all domains (see Fig. 5). This may reflect the high level of additional support that CYP received in this context.
In the Child Group Session Rating Scale questionnaires (CGRS), CYP rated how they felt the group ‘Listened’, the ‘Importance’ of discussions, how they felt about ‘Activities’ and about each session ‘Overall’. CYP in Spain and Italy (see Figs. 6 and 7) evaluated the group process positively, and the Italian data suggests a steady increase in positive appraisal over time. The sudden dip in scores for 1 individual noted in Fig. 6, and the general decrease in scores for participants in sessions 4 and 5 visible in Fig. 7 illustrate one of the advantages of session by session tracking of the group process. Although facilitators only saw anonymised data from the measures, they still could identify patterns that enabled them to monitor how the group was going, and respond. At each session, CYP were offered an opportunity to discuss their responses if they wished, opening space for reflection and feedback. By offering a relatively ‘safe’ way for CYP to offer regular feedback, the measures offered space for reflection, better tailoring of the intervention, and improved group cohesion. This may have contributed to the relatively low dropout rate observed for the intervention.
Tables 3 and 4 show the European quantitative pre- and post-intervention evaluation data, based on the CORS and CGRS data. The output from the Wilcoxon test shows participants’ positive ratings in each item outweigh negative ranks, suggesting an improvement in subjective wellbeing and perception of the group process, and these differences are statistically significant. The consistency of the difference between pre and post intervention scores is perhaps more remarkable than the significance of the difference, as it suggests that almost all CYP experienced the group and its impact as positive over time. Because there was no control group, it is impossible to comment on whether this improvement was directly related to the intervention, but it does suggest an overall positive trend, that tallies with the qualitative interviews completed with children. The routine outcomes data suggests that overall, participants found the group process to be a positive experience, the intervention content of value and importance, activities enjoyable and felt as though they were listened to by the facilitators and their peers.
Analysis of Semi-Structured Interviews
Three themes emerged from the thematic analysis of CYP’s accounts of their experiences and perceptions of the intervention. These were “Working Together: Building Trust and Sharing Common Experiences” in which CYP reflected on the value of working in groups with other CYP who had also experienced domestic violence and abuse; “Disclosures, creativity and working with emotions”, in which we explore CYP’s accounts of the elements of the group that enabled them to work through complex emotions and difficult experiences; and “Roots and Branches: Working with relationships”, which considers CYP’s accounts of working with and transforming relational experiences.
Working Together: Building Trust and Sharing Common Experiences
One of the things CYP seemed to value most about their experiences in the group was that they shared a common history with other group participants that helped them to share more freely and enabled them to feel less isolated and ‘different’ from other CYP. The groups were contexts of solidarity, in which CYP felt they were able to express themselves and be understood. The children reported that they felt the group was a positive context, a space that they valued and looked forward to:
Rosa (16, Spain): I truly liked it, I felt heard, because you talk about things you've lived and that others have experienced the same thing and that ... and I've never met anyone before who’d had the same family problems as me, um ... abuse... thus ... then ... is a (softly) dunno how to... like ...it has been very positive.
Most children commented that they had not previously understood that other children had had similar experiences, and that being in the group with other survivors of domestic violence enabled them to feel a commonality with the other children. This helped them to feel less different from other children, because of a sense of shared history. Understanding that there were others with similar experiences also enabled the children to build a stronger sense of community, which allowed for a deeper level of connection and self-expression. Shared experiences enabled children to feel less isolated and different from others, recognising that other children had experienced the same kinds of difficulties they had. Shared histories were seen as particularly powerful in one of the group activities, where participants explored some photos and stories children had shared with researchers during interviews in the first phase of the project. When asked what she had learned from the intervention, Delia (17, England) said: “That I’m not the only one who has witnessed domestic violence.” Talking with CYP who shared common experiences enabled them to talk openly about their experiences, without feeling embarrassed or ashamed of what might be seen as a stigmatised experience. This community context also enabled CYP to feel more positively about themselves. They experienced not just what they could take from the group, but also what they could give to others, allowing them to have positive relational experiences.
Giorge (15, Greece): I gave good friendship, contact, good behaviour, I could be a role model to many kids. I saw many kids do this. What I gave, in general, when we talked - someone was giving advice to the other. So I am not bigging myself up. I liked that. I helped, and they helped me at that time.
The groups provided a context in which mutual support, respect and kindness was a group norm. This enabled all participants to experience the benefits of these qualities, both in themselves and others. The shared experience is seen as enabling mutual support. The CYP reported that the mutuality of experience was key to the benefits they derived from the group – that shared experience both enabled others to listen to them when they spoke, and also enabled them to support others:
Children described the group as a positive, trusting environment in which they could express themselves, build self-confidence, and test out and strengthen their capacity to trust others. Trust was foundational to the work that children were able to do together, and was built organically. Antonia (18, Italy) notes:
I learnt to respect my self and to open up with others. I learnt to trust in myself…. The intervention made us stronger, and improved our self-confidence.
From the shared activities, and particularly shared creative activities, children built a sense of trust in each other and in the group. For instance, commenting on doing the Tree of Life activity in the group, Hannah (11, England) noted: “I learnt who I can trust”. Trusting relationships were established in the group, not just through explicit trust building activities but also through shared experience and communal activity. Participants suggested that trust was a key facilitator and outcome of the group process. They felt that their experiences in the group enabled them to live more trustingly outside the group.
Giorge (15, Greece): The most important thing I learnt? To trust people, as I didn’t before. I was cautious. But when you get to know someone and they trust you, you can test that out. And this is the most important thing for me, trust.
Through trusting others within the group, Giorge learned important skills that he can apply beyond the group. This included an ability to trust consciously, but not unthinkingly, as he recognised that trust emerges in relationships as you get to know someone; people should be allowed to demonstrate their trustworthiness in relationships.
In some groups, there was a strongly expressed wish for this sense of community to extend beyond the therapeutic context, for example Rosaria (18, Italy): I would have loved to go out with the others… For instance, to go to the sea. This suggests that the intervention provided CYP with a supportive context, and a sense of community, that they wished could be extended beyond the intervention context. Many participants reported that they wanted more time in the group. Giorge made a particularly poignant point that the number of sessions was enough to produce a sense of bonding in the group, but not enough for them to sustain the relationships formed there.
We are emotionally tied together, psychologists, children. Most of us, all of us were moved at the last session… hugs, kisses, saying goodbye… I would say that if it could last longer, then we could manage on our own. Now we know the way.
The sense of not having enough time did seem to be a reflection of both how positively the group was regarded, the value CYP felt in the relationships they built in the group, and a sense of needing more space and time to process issues that emerged there.
Disclosures, Creativity and Working with Emotions
Being in a trusting environment enabled participants to express themselves, and to disclose things that they had not previously felt able to discuss. For example, Ruby (11, England) said: “The first time I was a bit scared and talking about the bullying … So Penny (facilitator) helped me say what happened.” The group and the facilitator were able to provide a safe space to talk about current experiences of violence and coercion (bullying) that were troubling her. Sharing in the group was also experienced as liberating:
Ruby (11, England): It feels like how I feel and that I don’t have to be afraid any more. (Int: Afraid of what?) Ruby: Talking. I can speak more about what I want to do, and so I don’t feel trapped inside anymore … I think that I’m more confident around people now. Before I wouldn't talk, nobody really knew anything about me. But now I actually like talk to people and show them how much I talk and the stuff I like and stuff
She suggests here that speaking out built her confidence, and had a significant knock on effect for the way that she saw herself generally, undermining her negative self-image, and enabling her to question her acceptance of other people’s negative comments about her.
Although CYP felt it was important to be able to disclose, it was also important that they did not feel pressured to talk in the group:
Eugenia (14, Greece): Most times we didn’t talk about the things we didn’t want, and we didn’t feel the pressure to do so.
The non-directive, facilitative approach of the group, and the lack of a strict, overly manualised format provided space for them to discuss issues that mattered to them. This is a marked difference between the MPOWER programme and many manualised programmes for CYP working with the experience of domestic violence and abuse. The programme suggests themes and activities for sessions, but these are used flexibly, and the session focus is agreed with CYP at each session. CYP described this as central to the group’s success, enabling them to see the group as a safe space. The ability to decide when and how to speak about experiences is also an important element of personal boundary maintenance, and a key component of effective self-expression.
This trusting space does not need to always be serious – rather the children often used the term ‘fun’ to describe their experiences of the group.
Hannah (11, England): Sometimes during the sessions they will say something and then one of the staff or one of the children would start making a couple of jokes so it doesn’t get too uncomfortable, and we’ll have a laugh and then we’ll go back to it.
Hannah suggested here that interspersing of difficult, more serious subjects with humour, was used intuitively in the group as a way of managing difficult emotion. This helped to diffuse tension and discomfort, enabling an interlude before more serious discussion is restored.
Of course, humour can also be used defensively, as a means of deflecting focus away from painful and difficult issues.
Kevin (13.England) Things like when things are awkward I used to sometimes try and mess about and make it a bit funny to help me cope. Personal things that I don’t really want to talk about and so I try and avoid answering the questions.
Through his participation in the group, Kevin has become aware of his use of humour as a defence, and has understood that he uses this as a strategy to avoid talking about difficult experiences. He later notes that this is also part of the way he tries to support other people, by lightening the mood and trying to cheer them up when he feels down: “I’ve learned more about how I make people feel and what reaction I have on people.” This is a very positive reframing of what is a very common form of coping for boys who experience violence – the tendency to be the ‘class clown’, something that is often problematically labelled as disruptive or negative behaviour in schools for instance. Through the group, Kevin has identified his use of this strategy as a defence against difficult his and others’ feelings, and has been able to re-work it (also) as a positive aspect of his self.
In our first phase interviews with CYP, creative methods were seen as very powerful in exploring challenging issues around domestic abuse (See Callaghan and Alexander 2015, 2017a; Fellin et al. 2018b). Children also told us in phase one that they used embodied strategies to maintain a sense of agency and coping (Alexander et al. 2016, Callaghan et al. 2017a; Fellin et al. 2018b). For these reasons creative methods (drawing, music, and drama therapy techniques) were used in the intervention. These were highly valued by participants in all four countries:
Antonia (18, Italy): I loved when at the beginning of each session we listened to and danced with the music we could choose
Ruby (11, England): Drawing and talking about our feelings and things, that made me a bit happier.
The physical and expressive aspects of the group were also valued by CYP who were restless and physically agitated (a common response to experiences of domestic abuse) (Graham-Bermann and Seng 2005; Szymanski et al. 2011). As Kevin (13, England) said: “Because I don’t like sitting still.”
These methods were also valued as a means of expressing experiences that were difficult to articulate, and as a vehicle for emotional catharsis and working with feelings, and for understanding the spatial and embodied aspects of their experiences of violence and recovery from violence. Talking about an activity in which participants were encouraged to explore their use of space, and their sense of personal space, Giorge (Greece) notes:
It had some meaning because I could see what my limits were and probably how they will be forever, because I don’t think they will change.
The activity helped Giorge understand his experience of interpersonal space and how that might shape future social interactions.
Creative techniques in the group enabled CYP to safely explore their experiences of embodied emotion, enabling a space for them to express and begin to name difficult emotional experience:
Hannah (11, England): There was a sheet and it had a man drawn on it and we had to write good and bad feelings we’ve had… Sometimes when I get really upset it feels like my belly is going to burst open - I drew that. That’s what we do, it’s quite fun.
One of the things that is perhaps remarkable about Hannah’s statement here is that, while she was describing a very challenging, difficult emotional experience that clearly is painful for her, the safe space of the group and the creative experience enabled this to be a non-threatening experience for her – one she is in retrospect able to label as ‘fun’. She later comments on this activity again:
My most favourite was the person, because when we did the feelings we understood how they felt and if they were ever feeling like that again, we know how to comfort them and stuff. If I’ve got that pain again, they know how to comfort me.
In the shared creative experience she has acquired a profound understanding of the feelings she has, which had previously been unnamed and unarticulated. Now she is able to both recognise the feeling, and soothe herself. She returns to this concern when discussing her experience of anger, as something uncontrollable, explosive, that made her feel pulled apart (“it feels like my mind’s blowing up and let’s just say it feels like I’ve been chopped into cubes, glued back together and been blown up”). Being able to put this into such evocative words was something she found helpful:
Yeah it’s actually helped me be calmer. I’ve still got the strength on me, but it’s sort of weakened it just a tiny bit, so I can hold it in more and not have to let it all out.
Creative activities have enabled her to express her anger in a more contained and safe way, enabling her to gain insight and perspective, seeing her ‘strength’ as something she has more control over – she is ‘calmer’, less violent. Being ‘calmer’ does not undermine her sense of personal strength, but she feels less compelled to express it explosively.
Rosa (16, Spain): We brought pictures, and each one expressed what happened to you in your past. You remember and you realize, for example, what you should have done to get out of this, how you might have fixed it but were blocked. I didn’t know how to react, and now from coming here, now I know not to shut things up.
Rosa found that talking through the photos she brought to group enabled her to work out that she could have ‘fixed’ things if she had been enabled, but that the family circumstances prevented this. She recognises that she now has a different set of strategies, ones that enable her to express her feelings and not be silenced.
Roots and Branches: Working with Relationships
Some activities were designed to enable CYP to visualise and work through their family experiences – for example, the ‘tree of life’ (Ncube 2006), family sculpture (Duhl et al. 1973) and ecomaps (Hartman 1979) or family drawings. These were particularly highly valued by participants. For example, Martina (14, Spain) said “the tree seemed…like you came out from a past ... Dunno, I liked it... because you can tell a story in a picture …” These visual and spatial representations of family helped CYP connect their past to their present and future, and to express experiences of complex and conflicted family relationships they might otherwise have found hard to put into words.
Relationships were described as both a source of considerable strength for CYP, and a source of conflict, complexity and challenge. For example, being positioned as a ‘carer’ enabled CYP to feel powerful, capable, kind – all contributing to a positive sense of self. Children suggested the groups helped them to develop a better understanding of domestic violence itself, and its impact on family relationships.
Hannah (11, England): Because now I know how mum was feeling and now I can support her more… Yeah because now I know what she’s been doing, how she feels and how to solve fights and arguments, to keep her calm.
Hannah saw her group-learning as having a positive impact on her relationship with her mother, who she feels she now understands better. By gaining better insight into her own feelings of anger, and the way that these are in turn shaped by her experiences of violence, she is able to extend those insights to her relationship with her mother. Hannah describes herself engaged in what other authors have described as problematic parentified behaviour (Katz 2015) – caregiving for her mother, looking after her feelings. But Hannah clearly derives a sense of competence from her ability to understand her mother’s responses, and it may be that supporting CYP to think flexibly about their often positive, empowered experience of self-as carer might be more useful in intervention than dismissing it as premature or pathological. Here, Hannah presents herself as a partner with her mother, managing difficult feelings together, in alliance, suggesting this might be a potential route for building a sense of emotional competence.
Positions in the family could also unsettle CYP. The paradoxes of role inversions, being ‘friends’ or carers to siblings and to the non-violent adult, as well as familial alliances, conflicted loyalties, and familial fractures and feuds, also required attention and consideration in the groups. The group based activities and discussions helped CYP have a better understanding of the broader relational impact of domestic abuse. This included an understanding of the limits of their own responsibilities and what they should do in relation to preventing violence.
One source of considerable challenge for CYP was their often ambivalent relationship with the perpetrator, who was often their father. In many families, and in the services that CYP had used, the perpetrator was often represented in very absolute and polarised ways, as entirely bad. In some families the perpetrator had become an unspeakable entity, making it difficult for CYP to talk through their relationships with them:
Ruby (11, England): It (the group) makes me more confident. Like I aim and talk to my mum more, but we don’t really talk about him in the house because my brothers don’t like him.
This can produce challenges for CYP in establishing realistic images of their perpetrator fathers (or stepfathers), or of integrating more positive relational experiences of their fathers with a recognition of their negative behaviour. For instance, Ruby had started to idealise her father, craving contact. The group provided a space in which Ruby could start to speak about her ambivalent feelings about her father. Ruby used resources she learned in the group – particularly the drawings and other creative activities produced in the group – to ‘take home’ these messages to her family. This was not an easy process, and it is important to recognise that the desire to see the father is rooted in idealisation and may not be a realistic or safe desire to indulge. But by retaining silence around him, the family dynamic was encouraging rather than dealing with her perception of his place in her life, and of his absence.
CYP also described their anxiety about becoming the perpetrator, taking on the violent (step)parent’s aggression, relational challenges and irrationality. Given the popularity of the discourse of intergenerational transmission in professional work with families affected by domestic violence, this anxiety about learning the perpetrator’s behaviours is often entrenched by well-meaning professionals. This is further underscored by a service model that, when it does concern itself with children, tends to emphasise managing their problem behaviours, a model that is dependent on a view of children as passive recipients of environmental learning. For many CYP, the complexity of family life hinged around (perpetrator) fathers. For instance Leo (17, England UK) said:
I did because I used to have anger issues, and my dad did to an extent, and I was worried that maybe in an argument I would just snap and I would just start shouting or maybe start hurting maybe my own kid or someone else.
Leo found space within the group to express his anxieties about ‘intergenerational transmission’, about growing up to be like his father, and also to work through those anxieties. For many of the boys, this was expressed as a worry about being a bad parent:
I think we were discussing about how maybe I don't want kids or maybe how I don't want this, because I don't want to turn out like my mum or my dad. And they kind of say to you, "Look, you can grow strong enough to grow away from that. You're a good person and you're a better person than that." … The other day they said, "Look, you'd be a brilliant dad," or this and that, "because of your personality." And maybe if you do feel like you've got some of your dad in you or some of your mum in you, then you can break away from that because, by doing that and knowing what's wrong, you know what's right.
By recognising positive qualities that were different from the perpetrator, the group reassured Leo, and helped him to begin to envision an alternative positive future for himself.
This sense of the father as an unspeakable within the family was particularly problematic for some children, for whom the violent parent became larger than life, or for whom the positive elements of their relationship with the violent parents became inexpressible. The need to recognise both the positive and negative aspects of historical relationships with perpetrator parents was discussed at length, particularly in the English groups. This was not always straightforward – for instance, Leo says:
So in a way, my dad's wrongdoing has done a lot of right, but at a sacrifice. So as much as I want to drink and explore as a teenager and a young adult, when you grow up you kind of realise what damage it does, not only to your personal health but your actual mental health and what you can do to other people.
By talking through the problematic aspects of his relationships with his father, and working through is experiences with him, Leo is able to find ways of incorporating these positively into his sense of who he is – and who he is not. This enabled the emergence of a more realistic and optimistic future orientation for himself. Many of the CYP we spoke to shared Leo’s anxieties about being doomed to repeat the cycles of violence and abuse to which they had been exposed. This is a significant discourse in circulation in professional, academic and popular representations of children who experience domestic violence, and it is particularly important that many CYP felt that they had shifted their perspective on this, and had, through the intervention, been able to forge a more positive vision of their future selves.
The creative and systemic methods used in the group both explicitly and implicitly supported CYP to reframe and retell their stories, to change the endings, to play with different plots and different outcomes. This structure enables children to challenge a sense of themselves often articulated in domestic violence services and literature, that they are doomed to follow one plot line – the repetition of violence and conflict.
Rosaria (18, Italy): I learned that anything that happens in our lives, even bad things, can be transformed.
Here, Rosaria articulates the possibility of transformation, which she is not doomed to repeat. Giorge (15, Greece) also highlighted this sense of new possibilities:
The facilitator asked us to imagine our life in 10 years. And we closed our eyes and thought about how we would be. I thought of a profession and finding my wife. My children, my home. I had an imaginary world in my mind and it was very nice, I was relaxed. How nice if the future was like that. Now it’s still early, I can make my future, I have enough time. I have more optimism for the future than I did before.
He envisions himself not just successful in the world of work, but also as relationally competent, happy and settled. He ascribes this to a sense of fresh hope that he had built in the group intervention context – a new optimism that a better future was possible for himself. In addition to this focus on the distant future, children also reflected on the changes that they have been able to make in the present and near future, and how this will help them build towards a positive adulthood:
Rosa (Spain): Cos you express yourself, and you think about your future, your past and your present ... and that normally you do not stop to think about all that, your dreams, your skills ... how you are too, it helps to know yourself inside.
Arturo (13, Italy): Because it helps to cope with these moments and to move forward.
For many people’s experiences of trauma produce a sense of a foreshortened future – of living only for today (American Psychiatric Association 2013). Ratcliffe et al. (2014, p. 2) suggest this sense of foreshortened future involves “a sense that the future is bereft of positive, meaningful life events is equally a sense that one’s meaningful life is in the past, finished.” Adding to this the anxiety children felt about being doomed to repeat cycles of violence, and it is clear that this shift in their feelings about ‘tomorrow’ is an important one. Leo very eloquently articulates how the integration of familial experiences into his sense of self enables the development of this more positive sense of his future:
Leo : we did do a bit of activity where we did the tree of life… where you discuss your roots and then what your main things are, your trunks, and then your branches off and your fruits, your dreams and that. So that helps you think ahead and think about what you really want to be. It made you really realise what you've got and what you want … So when you talk about the tree of life, you're trying not to forget where you come from. So when you talk about your roots and talk about your family and who's helped you and who's been there in your dark times and your good times, by doing that you can also talk about who you've got right now and where you want to go after, just in case, because the branches identify different paths if you don't make it. So if I don't make it as a footballer, I've always wanted to be into sports science at university. And if I don't do that, I want to be maybe an artist or an architect. So you can just aspire and you can also discover your other interests and see if they'll ever take you somewhere.
Like almost any bright, capable teenager, Leo describes a sense of his future where his world is his oyster. This is rooted in a sense of his family where he is no longer doomed to repeat familial patterns, but is able to take strength from and learn from his history, and use it – even the broken and painful bits – to build a sense of his future.