The RPG model (Dawber 2006-2009)

A message from Chris

This webpage provides an overview of my Reflective Practice Group (RPG) model and offers some guidelines for those thinking of implementing RPGs in their workplace or wanting to know more about RPG facilitation.

The evolution of RPGs in Queensland has really been the story of a grass roots movement. Originally formulated for nurses by nurses, I believe that part of the model’s success has been the sense of ownership and empowerment that group members have felt around their own groups, and a corresponding sense of involvement and investment in the evolution of the movement. For well over a decade, RPGs did not receive much in the way of formal support or acknowledgement from organisations/management. In fact, in the early stages there was considerable resistance from certain elements within the health service. Thankfully, this has now changed as evidence supporting the model grows.

At this point, I would like to acknowledge the Kabi Kabi, Jagera and Turrbul people, who are the indigenous custodians of the land where I live and work. It was only after I came to know about the tradition of aboriginal ‘yarning circles’ in 2019 that I was able to reconceptualise and appreciate the significance of the RPG model through an anthropological lens.

Yarning circles are a ritual where participants sit in a circle. Each participant is provided with the opportunity to speak in a safe non-judgmental space; sharing perspectives in an inclusive and collaborative learning environment. Yarning circles focus on strengths not problem solving or criticism, allowing open and honest communication, and fostering connection and empathy.

Such traditions of coming together to tell stories are a key element of many indigenous cultures. Communal storytelling is a way of connecting communities; creating a sense of shared identity, promoting cohesion and social support, encouraging understanding & empathy, preserving culture, sharing wisdom and inspiring collective action. Sitting in a circle emphasizes a sense of equality (or as I prefer to say, equivalence). In RPG, whoever is speaking becomes the leader of the circle for that period of time.

There have been other RPG models described over the past 10 years. In 2017, I became aware of the work of Chris Scanlon (2017) and his colleague, John Adlam, through whom I became involved in the UK-based Reflective Practice Research Network. In 2021, I connected with Arabella Kurtz who was developing her own Heads and Hearts RPG model (Kurtz 2020). I acknowledge these people for the work that they have done with RPGs, just as I acknowledge my collaborators from within the Qld RPG community, the research community, and related areas of staff support and supervision.

In more recent years, RPGs have come to be accepted as an evidence-based form of clinical supervision (ACMHN, ACM, ACN 2024), and this has shifted my relationship with my RPG model. I now find myself taking on somewhat of a cautionary, governance role – a role that seems necessary but is uncomfortable for me.

Working with groups can be extremely rewarding but also very challenging. Those considering RPGs for their workplace should take time to consider and plan the process of implementation, provide adequate training and support for facilitators, and adhere to key principles of a clearly articulated RPG model. Significant issues can arise if facilitators are not appropriately trained and supported, groups are not adequately prepared, and key principles of a model are not considered and/or correctly applied.

Background

I first learnt of RPGs during a conference presentation by Julie Sharrock, mental health nurse consultant and key figure in Australian nursing supervision and began developing my RPG model during psychotherapy studies at the University of Queensland. This was later consolidated as a masters dissertation at the University of the Sunshine Coast. The model was informed by theoretical frameworks from psychotherapy, reflective practice and supervision and was initially a set of principles to guide my foray into group supervision. The model has evolved over time, with more structure and clarity emerging from lessons learnt and evidence gained from practice.

The RPG model now used by a number of Queensland health services and non-government organisations was developed between 2006 and 2009 and first published in 2013 (Dawber 2013a & b). Initially implemented as a consultation liaison psychiatric nursing initiative to provide support and supervision to nurses and midwives, the model has subsequently been adopted by doctors, allied health clinicians and a range of associated health workers, including multi-disciplinary teams.

RPGs aim to help health workers reflect on practice and practice reflection, with a particular focus on the emotional and interpersonal aspects of their work. RPGs are particularly suited to acute medical workplaces where staff face emotionally charged, ethically complex, and relationally intense situations, and where it can be difficult to find the opportunity or capacity for other forms of supervision.

The Dawber RPG model takes a process-focused, intersubjective approach to reflection; integrating psychotherapeutic and educational theories to provide a framework for regular small group sessions where staff can reflect in a supportive space. RPGs promote psychological safety, with facilitators focussing strongly on building a working alliance with, and within, each group. Facilitation techniques promote non-judgemental awareness, reflective inquiry, and a holistic approach to shared exploration of the clinical narrative (stories) brought to sessions. Typical RPG topics include workplace relationships (clients and colleagues), critical incidents, professional and ethical dilemmas, workplace context issues.

Key Aims of RPGs

1. Provide emotional/psychosocial support
2. Encourage and develop intra- and inter-subjective reflection
3. Develop insight, self-awareness and critical thinking
4. Facilitate processing of clinical, professional, ethical issues/dilemmas
5. Improve communication skills
6. Increase personal and job resources
7. Foster team cohesion
8. Contribute to a compassionate, humanistic, holistic workplace culture

RPG Structure and Process

Logistical considerations and arrangements for each RPG should be explored and negotiated with each group prior to commencement. The success of this RPG Model has been influenced by a culture of consultation and collaboration which begins prior to commencement of the groups. The setting up of an RPG should involve and engage its membership from an early stage, creating a sense of ownership and empowerment.

Group Composition

• • 6–12 participants from same or similar clinical work areas and/or professional roles

• • Power differentials, hierarchies and inter-disciplinary differences should be carefully considered in deciding the composition of an RPG. Whilst not always contra-indicated, such factors can complicate dynamics within the group, and may require increased vigilance and intervention by the facilitator.

• • The membership of RPGs is often defined by work unit rather than a group of individuals. Many nursing groups, in particular, are considered ‘semi-closed’ for staff from a particular work unit and may have different membership from session to session due to shift work, rosters, etc

Frequency and Duration

• Sessions are held every 2–4 weeks
• Recommended duration is 60–120 minutes per session
• After an initial 3-6 month trial, RPGs are renewed in 12-month cycles in response to positive evaluation and vote to continue by group members.

Session Format

Each session typically includes:

1. Grounding and decompression – Facilitator coregulation, moving to slow thinking
2. Containment – Group reaffirms task and goals, ritualistic reiteration of group rules
3. Check-in – brief update from individuals or the group – emotional temperature
4. Story telling – participant(s) relates a recent work-related experience
5. Facilitated reflection – exploration of thoughts, feelings, actions, and meanings
6. Thematic analysis – Facilitator/group identifies patterns, dilemmas, and insights
7. Closing reflections – individual takeaways and group summary. Closing ritual.

Ground Rules

Establishing clear ground rules is essential:

• Confidentiality: What is shared in the group stays in the group
• Voluntary participation: Participants choose to attend and how deeply to disclose
• Respect, supportiveness and equivalency: All voices are valued and given airtime
• Non-judgment: No blaming or shaming. Speaking your own truth. Listening to others
• Appreciation of Diversity: Different perspectives are invited and encouraged
• Reflective stance: Focus on critical thinking, learning and growing rather than fixing.

Core Features of the Model

1. Voluntary Participation and ownership of the group by its members

• • Establishment of an RPG is approved by managers but negotiated with workgroups

• • Time is taken to ensure that staff are given relevant information, opportunity to ask questions, and consideration required to make informed decision about starting RPG

• • A charter with clear guidelines is collaboratively developed by/with each group

• • Attendance is voluntary but strongly encouraged, with practical support provided by the organisation; including the provision of backfill and/or time in lieu arrangements

• • Sessions are scheduled monthly or fortnightly for a 3–6-month trial period and then continue with the approval and support of the group.

• • Group members evaluate their RPG through an anonymous survey, and vote on whether they want their group to continue or not

• • As long as the group votes to continue, RPGs are contracted for a year at a time

2. Balancing psychological safety and critical reflection

• • Group guidelines prioritize confidentiality, respect, non-judgment and diversity

• • Grounding, stabilisation, and mindfulness practices are incorporated to the group to decompress and reduce heightened arousal from busy clinical environments

• • When functioning cohesively and supportively, the group setting provides a “containing environment” for emotions to be acknowledged and explored.

• • Facilitators attend to group dynamics and psychological safety; helping to acknowledge, validate, and contain distress when intense emotions arise

• Participants are encouraged to present the group-as-a-whole* with alternative experiences and perspectives whilst supporting each other on a personal level

* “Group-as-a-whole” is a systems theory perspective that views the group as a distinct entity rather than merely a collection of individuals (Altfield 1999, Karterud & Stone 2003).

3. Facilitation

• • The Dawber model recommends a co-facilitation approach, with accredited external lead facilitator and co-facilitator (often, but not always, a trainee or ‘apprentice’).

• • RPG facilitators should be experienced clinicians with previous training in clinical supervision, group facilitation and/or reflective practice group involvement.

• • Prospective facilitators undertake an apprenticeship that involves a foundational workshop, mentoring, monthly supervision and support from a ‘council of elders’*.

*The concept of a council of elders draws on a tradition found in many Indigenous cultures. A council of elders provides support and guidance, has a role in governance, and helps make decisions. It serves as a ‘cultural heart’ for the RPG community of practice, holding wisdom gained through experience, mentoring apprentice facilitators and advocating for ideals and principles of the model.

• • Facilitators initially focus on the working alliance with, and within, each group

• • Facilitation encourages/enables the sharing of clinical, or workplace related ‘stories’, promote interactions and provide interventions that create a safe space for open, respectful dialogue whilst prompting critical reflection by the group

• • Facilitators support groups to consider, process, address, accept or sit with the associated tension that such intersecting norms can create. Participants can then self-evaluate against the ideal professional prototype constructed during/by each RPG within context of the intersecting norms and clinical milieu

• • Facilitators need to be skilled in managing group dynamics, maintaining boundaries and promoting psychological safety

• • Accredited RPG facilitators are those who have completed an apprenticeship, preferably within an established RPG community of practice

• • Achieving accreditation is competency-based and can take months or even years.

• • Accreditation is awarded through observation and evaluation of their facilitation, in real group settings.

4. Focus on Process

• • Facilitators promote a style of communication that involves meaningful speaking, mindful listening and slow thinking (Kahneman 2011) to encourage critical reflection.

• • Facilitators are trained to attend to group dynamics, noticing non-verbal communication, defensiveness, or group tensions that may indicate deeper issues.

• • Facilitators often interact with or address the group-as-a-whole, but they also look for verbal and non-verbal cues to provide space for individuals to contribute.

• • All participants are given space to contribute if they wish.

• • Themes are identified and explicated for the group to consider and explore.

• • The primary focus is not on ‘fixing’ or problem solving, but exploring.
  • RPGs are sometimes described as solution-focused (process) whilst acknowledging that there may not always be a solution (in terms of a goal or destination).

5. Collaborative, whole person learning through storytelling and reflection

• • The model acknowledges the emotional impact of clinical work, particularly in high-stress or relationally intense fields like healthcare or education.

• • Group members are encouraged to bring real-life professional experiences to sessions in the form of narratives (or stories) from the clinical field.

• • The rest of the group is encouraged to listen deeply, ask questions, and offer reflections on these stories rather than give advice of default to problem solving.

• • Insights evolve from thoughtful deconstruction and reconstruction of stories (D’Arcy & Holmes 2020).

• • Learning is enhanced through the shared experience of collective sense-making.

• • Facilitators encourage group members to be aware of their bodily/somatic sensations and reactions to provide further insight into the effects of workplace stress and trauma, and to explore the subjective experience of working in the dilemmatic space (Honig 1996, as quoted in Scanlon 2017).

• • The group explores underlying themes, values and assumptions (Kolb 1984), identifying themes, perspectives, actions that might be implemented in practice.

• • In these ways, facilitators help the group acknowledge, process and explore thoughts, sensations and feelings.

• RPGs are not just about solving problems. They are about becoming healthier, more integrated, ethical, and emotionally intelligent practitioners.

Theoretical Underpinnings

The model is integrative, drawing on a number of psychological and educational frameworks.

Together, these frameworks inform the structure, facilitation style, and goals of RPGs:

• Nursing Supervision (Proctor 1986) outlines restorative, formative and normative functions of effective supervision

• Group Therapy Principles (Karterud & Stone 2003, Yalom, 1985 Bion 1961) emphasize group cohesion, universality, shared vulnerability, peer learning, and the processing of interpersonal dynamics and emotional experiences within the group.
  • The group-as-a-whole is viewed as an entity that can enhance or inhibit emotional processing and meaningful reflection.
  • When constructively engaged by/with the facilitator, the group acts as a “container” to help staff process and make meaning of distress without feeling too overwhelmed.

• Reflective Practice Theory (Boud, Keogh & Walker, 1985, Kolb, 1984, Schön 1983) proposes that reflection-on-action promotes reflection-in-action; helping practitioners make sense of and evolve through the exploration of their clinical experiences.

• Psychodynamic theory (Altfield 1999, Winnicott 1971) and Humanistic Psychology (Rogers 1959) provides frameworks for understanding the unconscious processes and emotional defences that can arise in professional roles. The unconscious mind influences behaviour outside awareness. Professional roles can trigger transference or projection. Empathic, non-judgmental exploration of such issues can help clinicians become more self-aware, and ultimately more effective.

• Narrative Therapy (White 2007) guides how clinical narrative is explored in a supportive group environment, encouraging participants to share professional, clinical, ethical, and personal insights. A story can evolve in the telling, the hearing, and the responses pf the listeners, creating a collaborative learning loop of exploration and consideration of alternative narratives.

RPG Implementation and Evaluation

Implementing an RPG program

• Engagement, collaboration with, and empowerment of prospective group members is considered an important part of setting up RPGs
• Leadership support is critical to ensure cultural embedding and sustainability. Leaders should also have their own RPG/supervision.
• This support needs to be both in-principle and practical, with provision of tangible support for attendance.
• Preparation, training and supervision of facilitators is essential.
• Preparation and training of prospective group members and their leadership team should always occur prior to the commencement of an RPG.
• All involved need to understand enough about the RPGs to provide informed consent and support the process of their implementation.
• Time and space allocation must be protected within the work place.

Evaluation Methods

• Informal participant feedback is invited regularly during and after RPG sessions
• Facilitator observations on process and content are shared in post-session debriefs
• Specific facilitation issues and concerns are brought to monthly supervision
• Formal evaluation should occur at least annually.
• Anonymous surveys incorporate a version of the Clinical Supervision Evaluation Questionnaire (CSEQ) designed by Horton et al (2008) plus de-identified demographics and qualitative feedback.

Anticipated Outcomes

• Increased self-awareness and reflective capacity
• Enhanced personal and job resources
• Improved emotional well-being and job satisfaction
• Enhanced clinical/personal insights
• Enhanced professional identity and confidence
• Improved team cohesion and workplace culture

RPG Facilitator Training

Overview

Training as a facilitator in this model for RPGs involves an ‘apprenticeship’ or traineeship.

A foundational workshop outlines the theories and frameworks underpinning the model and provides participants with the experience of facilitating RPG.

This is followed by a program of mentored facilitator development and supervision.

The length of time taken to complete the apprenticeship can vary from 6 months to several years; taking into account factors such as previous training in clinical supervision, prior experience with group work, other transposable skills and professional/personal attributes.

The ‘conversion rate’ of those who go on from the foundational workshop to complete the apprenticeship and become accredited is around 15%.

Another 30% remain co-facilitators, who support the running of groups but do not take a lead role.

2-day foundational workshop

Prospective RPG facilitators can apply to participate in a 2-day highly experiential workshop, including both small and large group work. Experiential sessions are designed to promote awareness of group process and allow participants to practice facilitation skills. There are also a number of didactic sessions, including:

• Models of supervision
• Models of reflection
• Models of group development
• Frameworks for understanding group dynamics
• Exploring narrative in RPGs

Supported practice

Following the initial workshop, interested participants undertake a co-facilitator ‘apprenticeship’ with an accredited/experienced facilitator. This can last anywhere from 6 months to 3 or more years, depending on competency and confidence, but generally involves a minimum requirement:

• Participate in 3 RPGs as a group member
• Observe the facilitation of 3 RPGs – as a group member or external observer
• Co-facilitate at least 3 RPGs with an experienced facilitator
• Be the lead facilitator in at least 3 RPGs with support of an accredited facilitator. Apprentices are supported in their development through the modelling and mentoring of the experienced facilitator.

Each RPG session is followed by a post-group debrief where group dynamics, facilitator interventions and personal reflections are explored. Opportunities for the trainee co-facilitator to take a more active in-group facilitation role increase over time.

Monthly facilitator supervision

All facilitators are encouraged to attend monthly supervision sessions, where logistical, ethical, and group process issues are explored in a supervision group that follows a similar format to the RPGs themselves. There is a minimum attendance expectation of 6 supervision groups per year.

• Cross-group observation and collaboration — All RPG facilitators, whether novice or experienced, are encouraged to sit in on each other’s group periodically (with the consent of the groups’ members). The aim is to observe different group dynamics and processes, learn from different facilitation styles and techniques, share reflections on the groups’ process, and provide feedback and support to other facilitators.

Council of Elders

As each program evolves, there is the formation of what we call a “council of elders.”

This collective consists of a group of more experienced facilitators who work collaboratively to assist program coordinators, provide support to apprentice facilitators, identify/advise/address emergent issues with the RPG program and specific groups.

Community of Practice (CoP)

The concept of a CoP is very important to the RPG model; embodying principles of collaboration, support and compassion

RPG facilitators are encouraged to access support and ad hoc ‘debriefing’ from each other, and/or accredited facilitators, for emergent group related issues.

Facilitators have access to a CoP online platform providing links to a range of resources, such as tip sheets, journal articles and evaluation tools.

We celebrate each other’s achievements and look for opportunities to collaborate; whether this be interdepartmental, interdisciplinary, inter-service or international.

In essence , it is important to practice what we preach in RPGs.

Accreditation

Accreditation occurs when the mentoring facilitator and ‘apprentice’ co-facilitator agree that they have sufficiently developed their skills and confidence. Accreditation involves longitudinal evaluation by the mentoring facilitator as well as an in-group assessment of the apprentice facilitating a group by a delegated senior facilitator – either in-person or by video link.

Up until recently, accreditation has only been undertaken by the author of the model, however an evaluation tool has been developed to allow nominated senior facilitators &/or RPG program coordinators to perform this role at each site.

Master classes

Master classes provide the opportunity for further skills development, simulation of difficult facilitation situations, collaboration, sharing of experiences and techniques between experienced/accredited facilitators, and demonstrations by guest presenters from our RPG community of practice and associated RPG-oriented supervision models.

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