Running Effective Groups With Children & Adolescents

A Primer on Group Therapy: Yalom’s Therapeutic Factors Installation of Hope – Patients’ belief in the efficacy of the group mode – Things will improve during course of therapy Universality – Disconfirm patient’s feelings of uniqueness – See commonalities in each other, relief

Yalom’s Therapeutic Factors Imparting Information – Didactic instruction – Direct advice – Examine misconceptions Altruism – Learning to give of one’s self – Seeing the benefit in doing so

Yalom’s Therapeutic Factors Imparting Information – Didactic instruction – Direct advice – Examine misconceptions Altruism – Learning to give of one’s self – Seeing the benefit in doing so

Yalom’s Therapeutic Factors Corrective recapitulation of primary family group – Correctly resolve early family conflicts – Group symbolically resembles original family Development of socializing techniques – Basic social skills – Both direct (role play) and indirect (feedback)

Yalom’s Therapeutic Factors Imitative behavior – Group members imitate behavior of other members and therapist (vicarious-spectator) – Helps patients try new behaviors Interpersonal learning – Diminish parataxic distortions – Form rewarding relationships

Yalom’s Therapeutic Factors Group cohesiveness – Increases tolerance of disagreement – Facilitates feedback and disclosure Catharsis – Strong emotional component – Cognitive component promotes change ( necessary ) Existential factors – Face ultimate concerns of existence: death, isolation, freedom, and meaninglessness

Co-Therapist Model Advantages – Reduce chance of burnout – Shared attention, greater observational range – Infrequent cancellation due to illness – Explore reactions together – Sensitivity to countertransference – Split roles – provocative v. nurturing – Help maintain objectivity

Co-Leadership Model (cont) Disadvantages – Lack of synchronization – Competition and rivalry – Lack of trust in other’s competence – Different theoretical orientation – Openly siding with members against leader

Working with Children and Adolescents Legal considerations – Clarify what you can and cannot keep confidential – Be aware of your legal responsibility to report abuse or suspected abuse of minors – Secure written consent of parents or guardians

Practical Considerations Frequency and Duration – With children and adolescents it may be better to meet more frequently and for a shorter period of time to suit their attention span. – If meeting in a school setting, meeting times should correspond to regularly scheduled class periods (if possible) Group Size – elementary school children: 3-4 people – adolescents: 6-8 people Setting – Will the site provide privacy? – Will there be enough room for all students?

Practical Considerations (cont) Communicate expectations – Set rules and follow through with firmness Preparation – Avoid insisting on “covering your agenda” Parental involvement – Meet with or write to parents about the group, if appropriate

Screening Process Define the following areas: – Population (age, gender, etc.) – Frequency and Duration – Length – Size – Open v. Closed Who will be present? What information do you want to collect? What information do you want to impart?

Working with Children and Adolescents Strategies in the Group – Self-Disclosure Direct child to express how affected by incident rather than allow them to reveal everything about it – Emphasize confidentiality Use language that is developmentally tailored to convey importance of privacy Encourage parents to avoid asking questions that could lead to breach

Working with Children and Adolescents Strategies in the Group (cont) – Maintain neutrality Avoid siding with children or adolescents against their parents or a particular institution – Use appropriate exercises and techniques Even though their unwillingness to participate may stem from a lack of understanding, children and adolescents have the same rights to not participate in exercises they see as inappropriate

Working with Children and Adolescents Strategies in the Group (cont) – Listen and remain open Encourage young people to express themselves in their own words Be aware of preconceived labels and diagnoses that subtly influence your interactions – Prepare for termination Let children know that the termination point is not far off well before your group ends This enables children to express their sadness (or other feelings related to termination)

Working with Reluctant Adolescents Explain the rationale of the group in jargon-free language Allow members to express reactions to being sent to a group Go with resistance – Don’t go against resistance Avoid getting defensive Be clear and firm with your boundaries

Key Points – Child Groups Get the support of administrators Communicate the importance of confidentiality in their language Not all children are ready for group therapy Some structure is important Think about methods for evaluating outcomes

Key Points – Adolescent Groups Understand and respect resistance Role-playing techniques can often be creatively used in adolescent groups Find ways to involve parents Co-leadership models are especially useful in facilitating an adolescent group