The loss group is publicised via fliers within our student counselling centre, the university portal and is detailed on our website in the group work programme. The student medical practice also has details about the group. With the exception of one student, all the students have been referred as a result of one-to-one counselling.

Once the students register an interest, I arrange an initial appointment to establish whether or not the group is appropriate for them, to give them an idea of what to expect (and not to expect) with the intention of allaying their fears. I always explain the structure of the first session as this can be, in terms of getting over the threshold, the hardest session to attend.

The group is run in the spring term. This seems to be the best time of year - the autumn term is often taken up with ‘settling in’ and the summer term often appears short and fragmented. I also like the association of spring bringing forth renewed life and hopeful expectations. We have eight meetings on consecutive weeks - each meeting lasting for one and a half hours. At the end of the session an additional half hour is offered to the group without me being present. This is time without ‘mother’ and puts the students back into reality without ‘mother’. It is an opportunity to process the session, to network and bond.

This is as important to me as the content and process of each session; attention to detail and constancy matters. There are parallels between the empty group room and the empty space left after the death of the parent; the space is filled with the balance of my presence and giving enough space for the students’ presence – it is ‘filled enough’ with supportive nurturing. I have a ritual of setting up the room before the students arrive, holding in mind that, although they have elected to be in the group, the students are likely to feel churned up about attending.

I treat the preparation of the room as I would when expecting guests to my own house. Fresh flowers are placed in the room and biscuits, tea, coffee or water are provided. As the students arrive a drink is offered - it is usually me that makes the drink, although sometimes other group members will step in to help. I also have a scented burning candle in the room; again, symbolic of commemoration, warmth, light and hope. And of course there are boxes of tissues strategically placed not much further than arms length to avoid embarrassment of scrabbling around for one. Group members are often understandably cautious or nervous about taking food or drink in the first session especially until the first group member has accepted; but as the weeks go on they are often fighting over the last piece of flapjack or chocolate biscuit! There seems to be a parallel process of the students nourishing themselves, having been nourished by the group experience.

Some kind of activity is planned each week. This is by way of a starter to avoid fears of awkwardness or embarrassing silences. They have probably experienced quite enough of those since the deaths of their parent(s). Certainly, when I talk to the students individually before they join the group, the notion of planned activities, is usually met with relief:

‘I found that what worked best was the interaction between the group members – how they could make you realise a different, more positive point of view. Of course, this was achieved through, and thanks to, the different exercises we did. Even though these could be quite painful at times, they served their purpose very well, helping to confront and deal with issues.’

1) Introducing each other

In pairs: A and B. A tells B the story of their loss (usually for about ten minutes) then B tells their story to A for the same time allocation. Then the pairs return to the group and As and Bs are asked to introduce their partner to the group or example:

‘This is Alice. Her mum died from breast cancer when she was fifteen. One of the things Alice found most difficult was...’

Students often say they find it easier to talk about someone else’s experience rather than their own and that they immediately feel empathy for their partner.

It can be a powerful experience to hear their own story from someone else; sometimes students find this hard and begin to acknowledge that they have been through (and continue to go through) some hugely emotionally challenging times. It can also be difficult to report another’s sad, traumatic experiences.

2) Hopes and fears

Equipment: pencils, strips of two different colours of paper, a tin/box or hat. On a different coloured paper for hopes and for fears, group members are asked to write down any hopes and fears they have about being in the group. These are then folded and placed in the tin allowing for anonymity. When they have finished putting all their thoughts to paper, the tin is passed around the group in turn and the hopes and fears read out with comments invited. It is usual to find that many of the hopes and fears have similarities:

• ‘I fear that issues will arise and break down the huge wall I have built up to keep these issues out of mind’
• ‘I fear being lonely’
• ‘I fear losing other family members in the future’
• ‘I fear losing control’

• ‘I hope to be able to discuss the death of my father/mother more freely with my family'
• ‘I hope we make good friends and support one another'
• ‘I hope that all the support or comfort from the group will help deal with and confront the issues’
• ‘I hope to be able to stop hiding from... strong emotions, painful memories... reality'
• ‘Learn from others how they cope when they are upset’

Often, in the final group session we revisit the hopes and fears and consider how the expectations of being in the group were met.

3) Projective techniques/sculpting

Equipment: lots of buttons, pebbles and shells. I usually check to see if anybody has a phobia of buttons - this is usually met with a degree of mirth and I have heard comments like ‘God I thought I had problems!’

The students work in pairs and I suggest they sit on the floor. I always encourage group members to work with someone they have not already worked with. This side-by-side activity is immensely powerful and can quickly access emotions. It invites quite intimate disclosures in a seemingly relaxed mode (sitting casually on the floor) without the need for potentially embarrassing eye contact.

Students are invited to take turns, and using the buttons, pebbles and stones to represent significant people, activities or issues presently in their lives, I suggest they choose a button/shell/pebble to represent themselves, place it on the floor and then take time to select appropriate shells etc to represent other significant people/things in their current lives. As they make their personal map, they talk to their partner about why they have chosen this particular shell/button and why they have placed it where they have. So for instance, they may say something like:

‘I have chosen this glass button with multicolours to represent my best friend because she has a vibrant, sparkly personality. I have placed her near to me because she offers continued support to me. I have chosen this rough piece of coral for so and so because... This black button represents my uncle and I’m putting it (and him) as far away from me as possible because... This large stone close to me symbolizes the pressure of academic work which I am currently finding overbearing...’

After working in pairs the group come together and are invited to share their map. I usually ask them to consider if there is anything they would choose to change (someone nearer or more distant) or if they have omitted anyone, either deliberately or unknowingly.

My experience of using this activity early on is that it quickly accesses and helps to express feelings. It can give clarity about relationships and who is available (or unavailable) to offer love and support. It is acknowledged that there is always the possibility of fluidity, of the shape ever-changing – what is present in the map today may not be tomorrow; what appears close or distant today, may not be tomorrow.

These include invitations to the group to bring family photographs to the sessions. Again, the use of photographs can be immensely powerful - they may be photographs of the whole family on holiday, at Christmas or they may show the parent when their health was evidently in decline, bringing back painful memories. Photographs may include images of their parents before they were born, bringing about curiosity and sometimes speculation regarding the lives they led. It serves as a reminder that, just as our parents never knew everything about our lives, there is much that we will never know of theirs.

In other sessions members bring in memorabilia associated with the deceased parent(s). Contributions have included the order of service for the funeral, the last birthday card they ever received from the parent, letters, jewellery and items of clothing.

‘Just as emotionally we are only able to let those we love go from our life a little at a time, most of us allow the objects left behind by our loved ones to pass from us in stages’ (Wallbank S., Facing grief. Bereavement and the young adult. Lutterworth: The Lutterworth Press; 1991).

Another activity invites members to consider specific traits of the deceased parent. I begin by unzipping a pencil case and one by one I bring out various pencils and pens; these are labelled with a trait of my dad or mum e.g. generosity, nonjudgmental, gregariousness, flirtatious, manipulative, excess. It is important to include and acknowledge negative traits.

Sometimes there is relief that these are introduced - a reality check normalising the range of feelings, emotions and memories we all have with family members removed from expectations that we remember the deceased as being on a pedestal associated with the old adage, ‘never speak ill of the dead’.

One session (which often spills over into two) involves the students making collages from images and words cut from assorted magazines. This is usually a relaxed ‘side by side’ activity where the students flick through magazines, talk about the photos, adverts or articles and cut out anything that is relevant to them sticking these onto a large sheet of paper.

‘It was good to do the collage even though I was skeptical at first – it made me actually think about my mum’s character.’

It is often quite extraordinary just how much visual stimulus triggers memories and students are often surprised by the wealth of triggers.

Managing sensitivities

Despite common threads of experience, there are also vast differences: socioeconomic status, whether or not the relationship with the deceased parent was close, whether the student even knew the parent, whether the student was adopted, whether the death was sudden, whether there are siblings, the relationship the student has with the remaining parent, where the student was at the time of the death and how much time has elapsed since the death.

Where a student has been orphaned, it is tremendously hard for them to be in a group where others still have a parent. Understandably, envy is likely to be repressed. And the knowledge that ones’ worst fear (losing the other parent) actually can happen is a bitter reality to the other group members.

This creates an unspoken hierarchy of loss - ‘their loss is far greater than mine’. I believe the hierarchies are self constructed; I have known students who are ‘stuck’ in their grief, perhaps because they have never been allowed to express their feelings, and who say they feel fraudulent at being in the group seven years on from the death of their parent. These differences need careful attention and acknowledgement at appropriate times. Generally fellow group members are hugely empathic, sensitive and accepting of differences. These differences add to the richness of the group experience and students have commented that they would never have imagined (outside the group) mixing or getting on with particular individuals in the way that they do.

Inevitably, future losses are frequently raised; knowing that the dead parent will not be attending their graduation ceremony is particularly hard for final year students who often hit a period of ‘what’s the point of completing my degree?’ as they near the end of their university life. The fantasies of having two parents at their wedding or two grandparents for their children are often held in mind as broken dreams.<

It goes without saying that, as this is a group about loss, one has to be ever mindful of the ending of the group. At the initial interview I stress the importance of attending all the sessions and at the first group meeting this is reiterated. I begin the first session by saying ‘this is the first of our eight sessions’. And at the end of each session I remind the group ‘next week is the second of our eight sessions’.

Group members are actively encouraged to keep in touch with each other in between sessions - this they do readily via MSN, Facebook, MySpace or texting. Past group members have often gone for a drink after the sessions. They have talked of feeling empowered by the knowledge that they belong to a group having so often felt an outsider because of their experience.

‘The group has vastly improved my student experience as I now don’t feel so alone, as it has put me in contact with people in a similar situation to me and I’m extremely grateful.’

In considering comments on evaluation forms made this year and in other years, I am considering extending the length of the group, possibly to twelve weeks.

‘The one suggestion I do have is to make it a longer programme as I have only just properly settled in and now it’s finishing.’

‘The only way I would improve it is to make it last longer as it’s quite scary to think we won’t have this specific group time after Easter.’

I am aware that, however long the group is, it will never be enough. But I plan to trial a twelve-week programme where the students have eight weeks before the Easter break and a follow-up of four further weeks upon their return for the summer term. This would allow them to process issues raised (perhaps with their families) during the holidays and offer the opportunity to re-ignite friendships made from the group.