Street Talk had the opportunity to set up a therapy group for women at one of the day centres. With the usual spirit of experimentation, an open group, with weekly sessions of one hour was offered to women. In parallel with the individual therapy, it took years for the women to start to use the group. We staggered on over the first two years, when there were weeks when no women came or one woman came, or two women which does not constitute a group. It took about two years for the women who used the day centre to get the hang of what a group had to offer, but once women began to use the group it became a surprisingly successful intervention. We are extremely grateful to the partner charity who allowed us to persevere, trying to get the group going, allowing us the time it needed. There was a cohort of about fifteen women who committed to regular participation in the group. An average of six women attended each week with a group therapist and an assistant present. The success lay in the way in which women seemed to find it easier to address difficult topics in the group than they did in individual therapy. It was interesting that some of the women who took part in the group were also in individual therapy with Street Talk but were able to speak about experiences in the group which they had not spoken about with their therapist. Women listened to one another attentively, respectfully without judgement. Over four years there was only one occasion when a woman spoke disrespectfully to another.
It was interesting and surprising that women were able to use the group to discuss subjects which usually remain taboo, not only in informal conversation but also within the context of individual therapy. Over the four years that the group ran with good attendance, clear themes emerged. Those themes were:
Removal of children
Women particularly wanted to talk about the details of the moment of the removal. They wanted to talk about how it happened, where it happened, who was there, how they said goodbye to their child, how it felt at that moment, how it felt afterwards, how it feels now.
Separation from children
Women spoke about the pain of separation from children who were removed who have been adopted, fostered or who are in a children’s unit. The discussions focussed on the common feeling women had of having failed or abandoned their children. Women also spoke of their grief, the constant heartache and longing for their children, as well as their constant fears for their well-being. A common theme was the fear that those caring for their children might abuse them, that the children might be suffering. Women collectively suffered from a sense of powerlessness to protect their children. Women spoke about birthdays the anniversary of when children were removed or when they saw them for the last time and the fact that the year is punctuated by painful anniversaries. There was discussion of their contact with children who had been removed. A common theme was guilt at not taking up contact visits to their children. Unanimously women described these visits as unbearably painful. Many shared that they did not attend contact because they were not sure they could survive the grief; this included the very last contact with a child who had been placed for adoption. Women spoke about how it was unbearable to go to a visit at a children’s centre to say goodbye to their child knowing that they would not see them again.
Some women use substances in groups and many have had the grim experience of witnessing accidental overdoses, sometimes leading to death. Women spoke about the events which led up to such incidents in some detail, with a focus on whether an ambulance was called or not, who tried to help, who did nothing. Women frequently expressed intense guilt when they had not called for help or not tried to resuscitate the person who died. They discussed their feelings towards the person who died, memories of that person and the confusing feelings of complicity and powerlessness. They discussed the consequences, whether anybody was arrested or charged. One woman spoke in the group about making a conscious choice not to try to resuscitate her partner when he accidentally overdosed, because in that moment she saw his death as her chance to free herself from his abuse and violence. Another told the group that she had allowed someone who had been present to be mistakenly arrested and charged for supplying, in the wake of an overdose when in fact her boyfreind had been the supplier.
Women reported the events surrounding their experiences of being arrested, being brutally treated, humiliated, beaten or verbally abused, their powerlessness and anger and their relationship with the authorities.
Street prostitution is characterised by violence. Punters are violent to the women, the drug dealers use violence to punish women and domestic violence and extreme bullying is common in their relationships. Women used the group to talk about their own violent behaviour to others, sometimes in self-defence, although not always, and explored their complex ambivalent feelings associated with that.
Women used the group to talk about their feelings about the deaths of family members, partners, children and other women. One third of the women had at least one child who had died whilst more than half had lost a partner. The women are always deeply disturbed by the death of one of their own community, which leaves them feeling acutely vulnerable. Most of the premature deaths of the women are from chronic ill health combined with poor care and neglect.
Women spoke about how it feels to have a psychosis or a mania about being put under section, the detailed events of exactly what happened and how that had felt. They discussed diagnoses and symptoms and there was a sense that women used the group to explore their own mental health history without stigma and without the difficulties encountered in a clinical context.
Clare and May
Clare had lived with bipolar disorder for twenty years. She had dual diagnosis and despite being under the care of a mental health team, she had been arrested by the police for actions she carried out when she was psychotic, behaviour which was involuntary. She served a year on remand, in solitary confinement for some of that time, without treatment for her illness. She described to the group the terror of living through a psychosis, alone in a prison cell with no human contact. She also talked about the beatings she had from other prisoners when she was out of her cell, provoked by her psychotic behaviour, explaining that her broken nose which had not set straight was the result of a beating in prison.
Clare’s generosity in sharing her experience of living with the illness and describing the symptoms, enabled four other members of the group to identify with her experiences and symptoms. They were motivated to seek help, culminating in a diagnosis and treatment for the disease. None of the women had been diagnosed or treated previously. One of the group, May, was a grandmother in her sixties whose son had been removed from her care over fifty years ago. Her son had made attempts to contact her, but her shame had prevented her from responding. After hearing Clare describe the symptoms of bipolar, May suspected that she had been living with undiagnosed and untreated bipolar for as long as she could remember. May requested a mental health assessment which resulted in a diagnosis of bipolar and treatment. She revisited the removal of her son, making sense of it in the context of her mental illness. She felt less shame and saw herself as someone who had been unable to cope with parenting because she had a chronic illness, rather than as someone who had abandoned her child. She made the decision to meet her son, as well as meeting her grandchildren for the first time, “I bloody found out I had been living with an illness all these years. Why did it take Clare to diagnose it? I have seen that many doctors all my life. She saw it straight away and she’s definitely not a doctor.”
The group became a safe place for women to talk about extremely difficult topics and to work through old grief, perhaps because the shared experience made it possible to take more risks. Women were unfailingly supportive of one another; there was never any judgement and there was always at least one other member of the group who had shared something of the experience discussed. The therapists and assistant intervened minimally, creating a safe place where women set their own agenda and where they responded to one another’s contributions. The therapists’ roles were to open and close the group with a summing up of the feelings and themes which had been expressed over the course of the session. Apart from individual outcomes for the group members, the overwhelming outcome was that this experiment demonstrated that women with complex needs can engage creatively in therapeutic group work.