Working With Teenagers In Therapy Group

Role-play

One of the most common techniques in therapy group is the role-playing game and it’s particularly effective with adolescents. Through dramatization, the teenagers are able to develop more insight about the critical situations arising in the group.

This kind of technique is also very useful when you have a situation in which verbal communication is difficult, it helps to get over the feelings of shame or the fear of shaming themselves in front of, or within a group, quite common among teenagers.

Group Function

In a non-therapeutic situation, an adolescent usually joins a group in order to experiment and unlink or unchain himself from his family (his original group), finding a new one which will act as his auxiliary ego. The same happens in the therapeutic group and the therapist should pay attention to all of these interactions and help the group along in forming a collective insight.

If you are a therapist you should pay special attention to the affective charge within a teenage group. This age group is specially overwhelmed by it, so it has a much greater impact than in an adult group.

Main Problems You May Find

As I said in a previous post, this kind of intervention is very efficient in adolescence, however, it also has some issues that you should be aware of:

– it can cause more anguish – communicating is not easy and, while doing it, you can often face some conflicts, which some of the group members may not react too well to

– maturity – even with the same age, the group members will have very different levels of maturity, which could cause quite a number of conflicts and make it hard for the members to identify with one another

– abstraction ability – this isn’t yet fully developed in most of the teenagers, which can potentially make it that much more difficult for them to accept our interpretative work

– body language – it’s quite common among teenagers, and the therapist need to learn to read it, be able to recognize it and even make use of it himself.

The truth is that the level of maturity is very important for group therapy to work, so the older or more mature teenagers show a better chance of evolving positively within a group, since they already show a more well-defined identity and a stronger ability to deal with conflicts inside the group.

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Group Therapy With Teenagers – Selection of Patients

When you are trying to create a therapy group with teenagers, the selection is made, actually, on a intuition basis. Usually you take into account the initial contact with the patient, his motive and why he would prefer a group therapy and the receptivity of the parents to this kind of treatment.

Despite that, you also need to separate them by ages or the group may not work. Usually, we provide this separation into three age groups: 13 to 15, 16 to 18 and within the last one we find the late teenagers, with 19 years old and more (you can form a group with early twenties here, the only concern is the maturity of all the members, so that the group can work).

The gender is also an important point and question. When you are talking about teenagers, the group should be, definitely, mixed. However, it’s hard to find the exact number of both sexes when creating a group. In fact, the distribution is:
– 13 to 15 years old: majority of patients are boys
– 16 to 18 years old: It’s in this age group that you find more balance, and both genres look for group therapy.
– 19 and above:there is a major difference with more women looking for that kind of therapy.

Finally, you should to be careful when trying to put together a group, it’s very counterproductive to reunite patients with the same defensive techniques. Intellectualization, for example, is quite common in adolescence and you should pay attention to it.

Group Therapy With Teenagers. Why?

This question is often posed when you try to get one of your teenager clients into a therapy group. Some parents seem not be sure of the advantages in doing so. But, in fact, this is the ideal method for teenagers, due to their natural tendency to look for support within a group, making it a place to voice their fears and anguishes.

For a teenager, the group has an important container function and for us, therapists, it makes it easy to get through to them, since as they are talking with each other, they feel supported and understood by the others and begin to feel as though they can speak more freely.

This is especially true with neurotic issues and when the normal teenage crisis evolves to pathologic levels.

However, as with any other kind of therapy, it has some delicate situations as well. First of all, you need to be very careful so the teenagers in question don’t “over-identify” with each other, or you will find trouble trying to evolve the group. It may also prove difficult to close or end the group itself as they may not react so well due to feeling some sort of dependency on it.

Patients with paranoid issues and psychotic features are not adequate for this kind of therapy and you may find some counter-productive results.

It’s also very important to note that sometimes it’s exceptionally hard to determine what is normal and what is pathological during adolescence, so, more than therapeutic, these groups also have an important diagnostic function.

Group Formation In Children Group Therapy

Putting together a therapy group is never easy, there are many concerns that need to be addressed and situations that need to be taken into account, and with children these are in even larger numbers.

This kind of group should never have more than 4 to 6 children and we must separate them by ages (usually, 6 to 9 and 9 to 12 years old, taking into account the maturity of some 9 year old children). Some authors recommend to separate the children by gender, due to the fact that some issues about sexuality may arise and they wouldn’t discuss it in front of one another.

The diagnosis is another important thing to keep in mind. It’s easier to deal with an homogeneous group, however, you should avoid a group of children who are excessively aggressive, who have some intellectual or social handicaps which wouldn’t allow them to interact with or follow along with their companions or those with hyperactivity caused by some organic issue and intense depressive symptoms. Group therapy just doesn’t really work on those children and they tend to bring down the rest of the group with them and harm or impede their development and progress.

For children younger than 6 years old, it’s recommendable, at least initially, to be inserted into family therapy instead, which also works as a source of information and understanding of many of the important dynamics in the child’s life.

Therapeutic Contract

This is a fundamental point when you’re working with children. There are two contracts that need to be done and neither of them can be forgotten or ignored.

The first one is the contract that you must do with the child’s parents. It’s important to give the parents some notions about therapeutic work, or they might boycott our action (some times, a couple’s therapy is very useful). And of course, all the practical matter, like honoraries, number of sessions, etc…

The next step is the contract with the children themselves. We should explain to them, the group dynamic, such as we do with an adult, but with appropriate language, according to their ages.

Working With Children In Group Therapy

Working with children, in general, isn’t easy, and in psychology this isn’t any different, due to the fact that they aren’t able to objectively communicate what they think or feel, so you need to be very patient and work at it every day, so you can reach through to them.

The first record of this kind of work goes back to the 19th century with a group of children with emotional problems, but it wasn’t until after World War II, and mostly due to the work of Anna Freud, that group therapy with children became more credible in the world of psychology.

As I said before, working with children is not easy, so if you want to do it, it’s important to keep in mind some specific characteristics that a children’s therapist should have. It’s important that you really enjoy working with and in a group. A group of children in a room can be very exhaustive and the presence of a second therapist is a very common step to address this. And, obviously, you really must like children, playing with them and always take an interest in their problems.

To become a children group therapist, is a long path to follow, since, the education is extensive, the work is physically demanding and exhausting and you must be really tolerant to frustration.

The environment is quite important to success. The space shouldn’t be too wide, so the children do not scatter too much, and it definitely needs to be easy to clean and have some furniture to allow you to keep any needed materials. These are also very important since each child must get some materials of his/her own (pencil, eraser, coloring material of many kinds and some dolls representative of family and animals) and some board games and molding material for the group.

The children should see the therapist as a container for their anguishes and the therapist must be mindful of own his analytic abilities, even when playing with the children, as to keep himself from forgetting that they are not small adults and can’t elaborate on their feelings in such a direct or objective manner as we, adults, are able to and often do.

HEALING CRITERIA IN PSYCHOANALYTIC GROUP THERAPY

Despite the title of this very post, in psychoanalysis you can’t exactly speak of healing, only of some changes to the psyche. These changes are the main goal of psychoanalytic group therapy.

First of all, group therapy intends to develop the patient’s communication and interaction skills, without losing all of the necessary boundaries. It will provide them with the possibility to develop a sense of belonging, a group sense if you will, which helps them improve by decreasing their paranoid and depressive anxieties.

It’s important that the patients develop a sense of individual identity, as well as a social or group identity, helping them find their own independence and develop a positive relationship with the identification models. This will give them the ability to deal with new situations, as with wins and losses.

The psychoanalytic group therapy also intends to lead a patient to a proper use of his projective identifications, which means, it tries to limit the amount in which a patient tends to distort the signals he receives from others, thus being much more likely to be able to create empathy and have the ability to put himself in other people’s shoes.

And of course, as we are speaking of psychoanalysis, at the end of therapy, the patient should reveal some insight ability and be able to make, in group, some interpretative activity.

COMMUNICATION AND INTERPRETATION IN PSYCHOANALYTIC GROUP THERAPY

Communication is the basis for any kind of psychotherapy, and in group therapy some communication problems tend to appear and present themselves in a more distinctive way, allowing the therapist to recognize the signs and provide treatment for the most frequent disorders.

There is a thin line separating the normal from the pathological, and in regards to communication, that line can be really hard to interpret or establish. Each person has their very own way of communicating and it reflects their personality. However, it’s important to keep in mind that talking is not the same as communicating, as, in truth, it can be used to block the communication and also remember that the non-verbal communication and its many ways and manifestations can tell us a lot about the individual in front of us.

Communication is also very important when it comes to providing data for therapists, that will allow them to develop the interpretative activity which is another major basis of psychoanalysis. In order for this to be the case, the therapist must carefully observe the way the messages from some patient resonate with the other members inside the group.

According to Zimmerman and Osorio (1997), the classic method of interpretation was clearly outdated, so these authors chose to reformulate it, through the following aspects.

1. Discriminating the individualities

2. Having a bigger appreciation of the countertransferential aspects

3. Posing questions, regarding to clarify what the patient means

4. Granting major relevance to the way patients use their ego functions

5. Giving special attention to communication problems

6. Stimulating the patients themselves in exercising an interpretative function

7. At the end of the session, suggesting a synthesis of the main affective experiences that occurred during it, looking for integration and group cohesion.

REFERENCES

ZIMERMAN, David E., OSORIO, Luiz Carlos & Col. (1997). Como Trabalhamos com Grupos. (How to work with groups) Porto Alegre: Artes Médicas.