Group Therapy Interventions for Children and Adolescents

Managing Group Confrontations: The Case of Jody

The group leader has a responsibility to create and maintain a safe environment where members can interact positively and productively to maximize their health outcomes. Negative confrontations at any of the four stages of group development can undermine the calm environment that has already been established, creating room for defensiveness and scapegoating that could turn harmful if left unchecked (Corey, 2012). Based on this, the appropriate intervention is to discourage Jody from voicing her negative feelings. For instance, the leader could intercept the impending exchange through a remark such as: "Jody, I am wondering how useful it would be for you to continue with this discussion right now…" (Center for Substance Abuse Treatment, 2005). This would give the member time to regulate her emotions and consider the appropriateness of her impending statement at that particular moment.

There is a risk, however, that in doing so, the leader may lose Jody's trust, as she might think the leader is taking the other member's side and trying to prevent her from speaking up. To prevent this, the leader needs to make it clear that they are not intentionally refusing to listen to Jody's views; rather, they are trying to avoid a situation where members push other members away, and the group loses grip on its overall purpose (Center for Substance Abuse Treatment, 2005). The leader could convey this through a statement such as: "My asking you to stop, Jody, does not in any way mean that I am reluctant to hear you — it's not that at all. It's just that at this point, I am concerned that you might disclose or share more information than you may want to share." This would prevent Jody from feeling dismissed while also reassuring her that her perspective matters (Center for Substance Abuse Treatment, 2005).

There are several reasons why discouraging Jody from voicing her negative comments is the more advantageous course. First, if allowed, her comments could create room for scapegoating against the other member — particularly if other group members share similar grievances they have not yet felt confident enough to express. Moreover, since this is the final session and participants are expected to move on afterward, negative comments of this kind risk impairing the affected member's willingness or readiness to apply what has been learned in the group. This would render the entire process counterproductive for that individual. It would be safer for the leader to encourage Jody to meet the other member privately to discuss her concerns; in that setting, the feedback could be genuinely helpful without destabilizing the group's closing environment.

To lessen the danger of this type of confrontation occurring, the leader should establish norms in the very first session. As the leader lays out the rules that will govern the group throughout its term, he or she could encourage participants to always live by the principle of treating others as they themselves would wish to be treated. In Jody's case, the overriding principle would be: if you do not wish for your own negative qualities to be aired in public by another participant, do not do it to your colleague. This norm would help avert this, and similar situations, from disrupting the unity and cohesiveness of the group.

Preparing Members for Setbacks: The Case of Ned

Lapses can be expected for patients who have just completed psychological treatment. Patients are often exposed to pressures to return to their pre-treatment tendencies. In this case, Ned runs a substantially high risk of relapse — that is, returning to pre-treatment interpersonal communication patterns. He does not appear to see the value of the therapy he has just completed in the context of his daily life. He is frustrated, for instance, that despite attending the group sessions, he still cannot communicate effectively or build a closer relationship with his son. This frustration, if left unchecked, could become a trigger for returning to pre-treatment behavior.

Having identified this, the group leader needs to equip Ned with relevant strategies and coping mechanisms to prevent relapse. The foundation of these interventions is to help Ned understand that the risk of relapse is real — but so are the consequences (Center for Substance Abuse Treatment, 2006). The therapist needs to explain that the choice of whether or not to return to pre-treatment tendencies is ultimately Ned's own, but that the long-term rewards of maintaining the newly acquired skills far outweigh the immediate relief of abandoning them (Center for Substance Abuse Treatment, 2006). The therapist must be careful, however, not to assume too much control over the client's life at this stage, since the final stage of treatment is primarily the client's responsibility — to test how well they can apply the lessons and skills learned in the group within the context of their own lives.

The first possible intervention is to educate Ned about the cues to relapse, how relapse could damage relationships — including his relationship with his son even further — and the resources and support systems available to help him avert that risk (Center for Substance Abuse Treatment, 2006). Second, the leader could help Ned develop an effective relapse prevention plan outlining appropriate coping strategies, such as joining support group meetings, identifying positive aspects of post-treatment life, and committing to contact the group leader or other group members regularly if he feels he is on the verge of relapse (Center for Substance Abuse Treatment, 2006). Additionally, the group leader could have Ned sign a behavioral contract spelling out post-treatment expectations, rewards for meeting those expectations, and potential consequences for failing to do so (Center for Substance Abuse Treatment, 2006). This would make the possibility of relapse tangible while keeping the client prepared for its potential consequences.

As already noted, the risk of reverting to pre-treatment tendencies is partly dependent on how much the client values what they have learned in the therapeutic setting. Therapists can therefore reduce the risk of relapse by helping clients recognize the importance of the skills and lessons acquired. Therapeutic storytelling is one approach the therapist could use to help Ned appreciate the value of those lessons. For instance, the therapist could draw on specific examples of individuals — particularly Native Americans — who achieved personal and professional success as a direct result of strong communication skills. Such examples would give Ned a compelling reason to hold onto the skills he has learned when faced with potential triggers. They would also help him see that the world, which he currently perceives as indifferent to personal growth, does in fact reward people who can communicate effectively.

Group Therapy for Abused Children

Children and adolescents today constitute an at-risk population owing to lifestyle factors and changing family dynamics. Traditionally, women remained at home while men provided for the family financially. However, with more women now pursuing careers and higher education, this is no longer the norm in most families. Many children today are raised by working parents and are frequently separated from them by work-related commitments. As a result, parents play a less significant role in their children's daily lives, leaving children more vulnerable to peer influences and self-esteem challenges. Lifestyle conditions such as obesity are more prevalent than ever, and children affected by such conditions can become susceptible to mental health disorders like depression when they struggle to fit in socially and lack parental support. These dynamics collectively point to a growing need for counseling services for children and adolescents. The type of counseling offered will, however, depend on the age and specific treatment needs of individual patients. Research has shown group psychotherapy to be particularly appropriate for this population, as it helps children build self-esteem while connecting with and learning from peers.

Children who have been victims of abuse typically experience a range of thoughts and feelings related to anger, guilt, shame, loss, sadness, powerlessness, vulnerability, anxiety, fear, and hostility (Corey, Corey & Corey, 2008). They may consequently struggle with poor self-image, trust and self-esteem issues, and depression. Therapy sessions in such cases should therefore focus on rebuilding the child's trust and self-image and reestablishing their interpersonal relationship skills (Corey et al., 2008).

Corey and colleagues propose a number of best practices for structuring group therapy for abused children. First, the therapist should conduct a pre-group screening to assess each child's readiness for counseling (Corey et al., 2008). Readiness is influenced by, among other things, the time elapsed since the abuse, the severity of the trauma, and whether the child has already received individual or family counseling. If the latter is the case, the therapist should obtain clinical case notes from the family or individual therapist to inform the readiness assessment (Corey et al., 2008). It is essential that the therapist first obtain consent from the child's parents, guardians, and teachers to avoid any breach of privacy.

Another fundamental best practice concerns the composition of the group. It is important that group members be of similar age, gender, and physical size so that participants are not intimidated by one another and the environment remains safe for all (Corey et al., 2012). It is also recommended that group members have experienced the same type of abuse, so that children are not re-traumatized by hearing about others' different experiences.

The therapeutic setting is also crucial. For very young children, sessions work best when conducted in a playroom, where children can engage with games or relevant toys when feeling overwhelmed (Corey, Corey & Corey, 2008). For adolescents, a playroom may not be necessary; however, the setting should allow participants to release anger and frustration through physical expression — such as shouting or hitting designated objects.

Finally, it is recommended that group sessions be divided into three phases: a warm-up section (in which members check in with each other and reflect on their experiences since the last meeting); a work session (involving open discussions, role-playing, storytelling, and free play); and a wrap-up section (in which participants share their reactions to the session with each other) (Corey et al., 2008).

Conclusion: Designing Effective Group Therapy Programs

These cases demonstrate that the success of a group therapy program for children and adolescents is partly dependent on the quality of its design. The setting and the involvement of parents, teachers, and the local community are all crucial factors; however, the appropriate degree of each element's involvement depends on the age of the participants and the specific problem being addressed. In this regard, therapists must take care to understand the developmental stage and particular needs of the children they engage in group therapy — only then will they be able to design programs that are both effective and comprehensive. Informed, age-sensitive program design, grounded in established best practices such as those outlined by Corey and colleagues, remains the foundation of meaningful therapeutic outcomes for young people.

References

Center for Substance Abuse Treatment. (2005). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Center for Substance Abuse Treatment. (2006). Substance Abuse Treatment: Group Therapy. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Corey, G. (2012). Case Approach to Counseling and Psychotherapy (8th ed.). Belmont, CA: Cengage Learning.

Corey, M., Corey, G., & Corey, C. (2008). Groups: Process and Practice (8th ed.). Belmont, CA: Cengage Learning.