Group work as method: holding complexity in mental health research

Group work has long been part of mental health research. Focus groups, workshops, and reflective sessions offer ways to gather insight, test ideas, and hear from those with lived experience. But too often, these formats are treated as neutral tools. A facilitator arrives, a discussion unfolds, transcripts are typed up, themes are extracted. The group becomes a vessel for data, rather than a site where meaning can be made.

In my own practice, I’ve come to see group work not just as a research method, but as a layered, relational encounter. It’s a way of listening to people and systems, of holding contradiction, and noticing what sits beneath the surface. Whether I’m facilitating a survivor-led workshop, hosting an Open Space event, or sitting with frontline staff in a reflective session, I’m not just collecting data. I’m not just harvesting what they say. I’m reading the room. I’m watching how power moves, how silence speaks, how emotion circulates. I’m part of a field which yields multiple clues about what’s happening in that moment, what is being communicated, and what matters.

I’ve been at Centre for Mental Health now for just over four years and while I have been here, I have learnt a great deal. This blog brings together four strands of thinking about group work and how it can be used in mental health research. Each is shaped by theory, by knowledge of the systems in which we work and grounded in real-life practice, developed in collaboration with colleagues and ex-colleagues, including Nick Treloar and Anna Iskander-Reynolds, who have generously shared their expertise.

Focus groups as relational inquiry

The first strand is the most familiar: focus groups and workshops as a means of gathering qualitative data. Originating with Robert Merton and Patricia Kendall’s “focused interviews,” the format has become a staple of social research. But in mental health, especially when working with survivors, the stakes are higher. These are not neutral conversations. They are emotionally charged, ethically complex, and, for many of the people we work with, shaped by histories of exclusion.

I recall a workshop I facilitated with a group of lived experience researchers exploring crisis care. One participant remained silent for most of the session. In traditional analysis, that silence might be overlooked. But in the room, it was palpable. It spoke of resistance, discomfort, perhaps a refusal to be drawn into a narrative that didn’t feel safe. I couldn’t ascribe a meaning for sure, but I did see it and felt it to be significant. As facilitator, I held the silence without forcing speech. I noticed how others responded. I reflected on what it might mean for the group and wondered if it gave us any clues about the system we were trying to understand. During the coffee break I gently checked in with her, asked how she was doing. She said that she was feeling too upset to speak, that something another participant had said had reminded her how angry and confused she had felt when she was last in hospital. I listened carefully to what she had to say, arranged to speak one-to-one later that week, and asked her if I could add her observations, anonymously, to our data bank. I also reassured her that she could take time out or leave if she wanted. And I reminded her of the list of phone numbers we had provided if she needed support. She told me that she was fine, thanked me for my concern, and was able to say more in the following session.

Michael Agar’s work on ethnographic layering reminds us that focus groups are not just about what is said, but about how it is said, and who gets to speak. Sue Lloyd-Evans, writing on community engagement, emphasises the importance of relational ethics and participant voice. In my own work, I’ve come to see facilitation as a form of listening, not just to words, but to dynamics, tensions, and participants’ unspoken responses.

Participatory formats for system change

The second strand moves beyond data collection. Methods like World Café and Open Space Technology offer ways to change systems, not just study them. They encourage participants to set an agenda, interrogate issues important to them, share insights, and create actions. They are designed to flatten hierarchies, build inclusion, and support co-design.

I recently facilitated an Open Space event with my colleague Anna, aimed at redesigning a local mental health pathway. The room included professionals, service users, carers, and community organisers. There was no pre-set agenda. Participants named the issues they cared about – including access, equity, and cultural safety – and self-organised into discussion groups. What emerged was not just a set of themes, but a sense of shared ownership. People who had never met before found common ground. Power shifted, if only for a moment. As is common with Open Space, people looked a little confused at the beginning, but by the end commended us on engineering a satisfying and action-oriented experience.

Sherry Arnstein’s ladder of participation reminds us that not all engagement is equal. Too often, consultation is performative. These formats offer something more. Giorgio Tasca’s work on group cohesion shows how structure can support trust. But it’s not just about the format. It’s about how we hold the space. As a facilitator, I pay attention to who speaks first, who hesitates, who moves between groups. I watch for moments of connection, rupture, and repair.

Group work, when done well, is also cost-effective. It brings people together across roles and silos, enabling shared understanding and collective problem-solving. Several good minds will always come up with something better than one brilliant mind. And when systems are under pressure, it offers a way to do more with less, not by cutting corners, but by deepening connection.

Coming together is often the best way to address division, to identify eureka moments, to share half-baked ideas, and find the kernels of brilliance embedded in the systems in which we work. It allows people to hear each other, to find common ground, and to begin again with renewed purpose.

Psychodynamic insight and ethnographic practice

The third strand brings a deeper lens. Psychodynamic group work, rooted in the theories of Wilfred Bion and S. H. Foulkes, offers a way to understand unconscious processes in groups. Bion spoke of our “basic assumptions” – dependency, fight-flight, pairing – that shape group behaviour. Foulkes saw the group as a matrix of communication, where each member reflects and refracts the whole.

In a reflective session with frontline staff in a high-pressure service, I noticed these dynamics unfold. The conversation began with surface-level talk about “burnout” and “resilience.” But tension simmered. Some staff idealised their managers. Others scapegoated them. There was splitting, projection, role confusion. Rather than smoothing over conflict, I named it gently. I invited reflection. I held the discomfort.

The session became data. Not just the words spoken, but the dynamics revealed. The group offered a window into institutional anxiety, defence mechanisms, and systemic strain. Tuckman’s stages of group development – forming, storming, norming, performing – were visible, but so too were deeper currents. As a facilitator-researcher, I was part of the field. My own responses mattered. My presence shaped what emerged. I was not neutral, and my autocritique was important in understanding what was happening.

In moments of conflict or organisational strain, external facilitation can make a real difference. An independent presence can help a group name what’s difficult, find language for what’s been avoided, and begin to repair. It’s not about fixing people. It’s about creating the conditions for honesty, reflection, and forward movement. Such group work can help us build our ability to reflect together, to think systemically, and to move from shaming and blaming toward taking responsibility and ownership.

Holding difference without resolution

The fourth strand is a quieter critique. Group work often assumes cohesion, clarity, and consensus. But not all groups want to be unified. Not all participants want to be “representative.” Sometimes, the most honest thing a group can do is to sit with difference.

In a participatory workshop on LGBTQ+ mental health, these tensions surfaced. Some participants challenged the format itself. They didn’t want to speak on behalf of others. They questioned the assumptions behind the questions. They didn’t want the messiness of their lives to be turned into codified themes. They brought chaos, multiplicity, and critique. As facilitator, I held the space without forcing resolution. I let us sit in the discomfort. It wasn’t up to me to silence or corral, but to listen and amplify.

This kind of work draws on traditions of critical ethnography and participatory inquiry. It reminds us that not all knowledge is tidy, that refusal can be a form of insight, and that sometimes the most respectful thing we can do is hold space for what doesn’t fit.

Group work, in this sense, becomes a practice of humility. It asks us to notice our own assumptions, to stay curious, and to resist the urge to tidy up what is necessarily complex.

Systems already hold the knowledge they need. People within them know what the needs are and what must be done. The task of the experienced facilitator is to bring that knowledge to the surface, to piece it together, and to create the circumstances in which honest, constructive discussion can take place.

Group work helps us to listen carefully to what is said, what is unsaid, and what matters. It allows us to acknowledge different views and perspectives without forcing resolution, to notice power dynamics and emotions, and to work in ways that promote honest discussions. It gives us nuanced and useful insights as well as clear and high-impact actions. Get in touch with us to discuss how we can bring our passion and expertise to the benefit of your communities, services, organisations and systems.