Handbook of Child and Adolescent Group Therapy

A Practitioner's Reference

Craig Haen, Seth Aronson

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317356387
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This handbook describes in detail different contemporary approaches to group work with children and adolescents. Further, this volume illustrates the application of these models to work with the youth of today, whether victims of trauma, adolescents struggling with LGBT issues, or youth with varying common diagnoses such as autism spectrum disorders, depression, and anxiety. It offers chapters presenting a variety of clinical approaches written by experts in these approaches, from classic (play therapy and dialectical behavior therapy) to cutting-edge (attachment-based intervention, mindfulness, and sensorimotor psychotherapy). Because of its broad scope, the book is suitable for a wide audience, from students to first-time group leaders to seasoned practitioners.

1
Origins of Group Therapy with Children and Adolescents

An Overview and Introduction

Seth Aronson

Introduction

As any observer of children will note, the world of childhood is composed of a network of groupings, ranging from informal play groups in the schoolyard during recess, to sports teams, religious youth organizations, after-school clubs, cliques, and of course, the classroom. Music (2014) described how attachment patterns in very young children can prime them for prosocial behavior and generally being more ‘other’ focused. Of the school-aged child, Erikson (1959) noted:

At no time is the individual more ready to learn quickly and avidly, to become big in the sense of sharing obligation, discipline and performance rather than power… and he is able and willing to profit fully by the association with teachers and ideal prototypes.

(p. 81)

In addition to the importance of groups in the lives of children, the propensity of adolescents for group life is well known (Aronson & Scheidlinger, 2002; Malekoff, 2014). Thus, the significance of group life for youth to develop the expression of emotions, learn to regulate affect, form more cohesive identities, and learn social skills is critical (as it is for adults; see Yalom & Leszcz, 2005).

Historical Background

This ready responsiveness of youth to group experiences was first used for therapeutic purposes in the early 1930s by Slavson (1943) and Redl (1944), with roots in the earlier work of Aichorn (1925). These new group therapy approaches were welcomed in child guidance clinics where clinicians were having difficulty trying to elicit verbal communications in a one-to-one treatment setting, while the number of youth in need of service was rising (Scheidlinger, 1982). S. R. Slavson (who, incidentally, founded one of the world’s largest group organizations, the American Group Psychotherapy Association) developed activity group therapy, which, as its name implies, stressed the expression of affect and fantasy through action in the form of activities and play. A permissive environment with an accepting adult in charge was used to promote a ‘benign regression’ that functioned as a corrective emotional experience to counter previous difficult encounters in groups. Interactions between members and with the therapist constituted the major therapeutic agents of change.

Fritz Redl (1944) first developed assessment groups, which were designed for detailed observation of children interacting in vivo. As Anthony (1957) wrote in his description of these groups, “By chance, place a child in a children’s group for a period long enough to let him warm up… [one] will observe him opening out like a Japanese flower in water, suddenly full of color and spontaneity” (p. 232). Redl (1966) extended his own original work with diagnostic groups to the creation of major models of group work with disturbed youth in outpatient and residential settings. His work was highly influential in the domain of residential and milieu treatment of children and adolescents (see Creeden & Haen, Chapter 21, this volume). Slavson’s more ‘classical’ method was extended by his students to include interpretive techniques with adolescents (Gabriel, 1939), as well as therapeutic play groups for preschoolers (Schiffer, 1969). Scheidlinger (1960) and Frank (1976) adapted the original model for work with inner-city youth as well as use in the public sector.

Virginia Axline’s work (1947), best known in the realm of play therapy, drew from the non-directive approach of Carl Rogers, as did Haim Ginott (1961). The work of the founder of psychodrama J. L. Moreno (1946) and those in the creative arts therapies movement (Kramer, 1958; Rosen, 1957; Slade, 1954) further contributed to the growth and expansion of the field of child and adolescent group therapy. Later advances in the behavioral group therapies, first advocated by Rose (1972) and Rose and Edelson (1987), led the way for some of the work described in this book (see, for example, Christner & Bernstein, Chapter 11, this volume).

What is significant to note is that many of the early pioneers in the field of group work with youth had backgrounds as educators. The classroom is, of course, a group, and those who first were interested in therapeutic group work with children and adolescents had learned how to manage a large group, impart information, and create cohesion among disparate individuals from different backgrounds.

Classifications of Groups With Children and Adolescents

Scheidlinger (1985) proposed classifications for adolescent groups, some of which can be applied to children as well. He distinguished between clinical psychotherapy groups, ‘therapeutic’ groups, and psycho-educational groups. (With adolescents he also noted the existence of self-help groups such as Alcoholics Anonymous and Marijuana Anonymous.) Clinical group psychotherapy entails a specially trained professional practitioner who works with a carefully balanced group, one in which each member has been screened and assessed diagnostically (see Grunblatt, Chapter 3, this volume). Therapeutic groups are aimed at preventive intervention, support, and remediation, but may not necessarily be conducted by trained professionals. These groups are also not balanced in composition; that is to say, group members are not selected for inclusion in group. Thus, a therapeutic group might be a daily community meeting in a residential facility for any youth in residence at that time. The aim of therapeutic groups is not direct amelioration of symptomatology (as might be described in the Diagnostic and Statistical Manual of Mental Disorders). Such groups may be held in schools, hospital units, or residential treatment facilities.

Psychoeducational groups are geared toward the prevention of mental health issues. They are used to provide information in the realm of affective or more direct education. These groups are often time limited and sponsored by schools, community agencies, or religious organizations. Recent examples include groups for eating disorders and healthy nutrition (Migliore & Ross, 1998), sexuality (Huegel, 2003; see Rofofsky, Kalyanam, Berwald, & Krishnakumar, Chapter 40, this volume), and chronic illness (Malberg, 2012).

In addition to the types of group described by Scheidlinger, support groups are designed to offer help to youth facing a common problem, such as coping with divorce, loss of a parent, or being diagnosed with a chronic medical illness. Their power comes from the universality of experience (Yalom & Leszcz, 2005). These groups are offered in both clinical and non-clinical settings.

Parent groups, first introduced by Slavson (1950), are a form of adjunct therapy, often connected to group work with children and adolescents (see for example Mitchell et al., Chapter 33, this volume; Bate et al., Chapter 10, this volume). The advantages of conjoint parent group work are in supporting the children’s gains, sharing information regarding developmental norms, teaching new parenting skills, and providing emotional support to parents who may be struggling with their own issues.

Other types of groups include diagnostic groups, an extension of the early work of Redl (1944). These groups may help evaluate children and adolescents for participation in more extended group work (Gupta, Hariton, & Kernberg, 1995; Liebowitz & Kernberg, 1986). Talking groups, especially for younger children, distinct from Slavson’s activity groups, were first described by Sugar (1974) and Charach (1983).

Therapeutic Factors

Yalom and Leszcz (2005) described a number of therapeutic factors in group therapy, of which many are applicable to group work with children and adolescents. Many young people enter group feeling themselves to be alone in their suffering. Universality is the sense that they are not alone and can be helped to appreciate their basic similarity to other members. As Harry Stack Sullivan (1953) famously wrote, “We are all more simply human than otherwise” (p. 7). Didactic instruction about topics such as common reactions to traumatic experiences, anger management, and mindfulness techniques falls under the therapeutic factor of imparting information. Given Phelan’s (1974) acknowledgement of the (adolescent) group leader simultaneously playing the roles of parent, therapist, and teacher, this factor can serve an important function in groups for youth.

Every young person comes to group with a history of having been in at least one previous group: their family of origin. This formative group experience is often unsatisfactory, if not in some instances harmful. Groups, then, offer an opportunity for a corrective recapitulation of the family experience. The presence of other members who play the transferential role of siblings further contributes to this fantasy and experience.

In therapy groups, children and adolescents can also benefit by giving to others. Youth treated in groups are often demoralized, with little self-worth, feeling that they have nothing of value to offer others. By learning to support, reassure, and advise other members, they can develop a sense of themselves as being able to offer something valuable, and in this way altruism can play a significant healing role. Social learning—the development of socializing techniques—is an important factor. Children and adolescents often come to groups in need of learning these tools. Many groups for youth address social learning directly as it is related, in some way, to the clinical presentation and need of members (see Hariton, Chapter 32, this volume).

Yalom and Leszcz (2005) emphasized the humanistic and existential benefits of group work. The leader’s role is critical in establishing cohesion, as well as instilling a sense of hope in all the members that they will benefit from the group experience. Finally, children and adolescents who participate in groups learn the importance of interpersonal relationships. Yalom and Lezcsz drew on the work of the American psychiatrist and psychoanalyst Harry Stack Sullivan, who was one of the first writers to emphasize the importance of social and interpersonal relationships for development. “Sullivan contends that the personality is almost entirely the product of interaction with other significant human beings… Sullivan’s formulations are exceedingly helpful for understanding the group therapeutic process” (Yalom & Leszcz, 2005, p. 20). Whether a group is aimed at learning anger management skills, receiving support for coming out to one’s family as transgender, or coping with the aftermath of domestic violence, the interaction between members and with the group leader, as Slavson first described 70 years ago, is critical to its success.

Conclusion

Since the pioneering work of Aichorn (1925), Slavson (1943), and Redl (1944), the field of child and adolescent group therapy has experienced tremendous growth. Groups are now offered in schools, hospitals, clinics, and residential treatment facilities in addition to varied settings all over the world. The proliferation of evidence-based treatments (see Sheppard, Chapter 5, this volume) has led child and adolescent group practitioners to closely examine their work, in addition to applying research findings to the clinical milieu (see Shechtman, Chapter 6, this volume). Groups are now rightly seen as a powerful format for providing help and support for youth facing a wide range of challenges so they can proceed with the developmental tasks ahead.

The Present Volume

The diversification and increasing sophistication within child and adolescent group therapy continue to the present day with the enhancement of foundational modalities and the development of novel approaches. Given its varied sources and influences, it is not surprising that the literature on child and adolescent group therapy and counseling has been diverse but scattered. The writing on child and adolescent group work has often existed in fragmented pockets, effecting a dialogue that often remains within one’s discipline of practice. This dynamic is per...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• CONTENTS
• Foreword
• About the Editors
• List of Contributors
• 1 Origins of Group Therapy with Children and Adolescents: An Overview and Introduction
• SECTION I Nuts and Bolts
• SECTION II Approaches
• SECTION III Settings
• SECTION IV Culture
• SECTION V Targeted Group Interventions
• Index