Counseling Children in Groups

Rosenthal (2005) contended that group interaction begins when a child is born into a family unit. Rosenthal explained that the knowledge of the child's first group, his family, is of substantial predictive value, as the role imposed upon the child in his family of origin will be reenacted by his group family. In effect, the patterns of social interaction and communication learned within the family unit are also applied as the child enters into larger peer groups.

Rosenthal (2005) argued the importance of peer groups, as they create the medium through which the child grows and explores and locates his overall place in society. Rosenthal contended that a child's perceived place in society is important, as it determines which opportunities a child takes advantage of while in pursuit of his life goals. Sonstegard and Bitter (1998) described the group as the reality in which children operate, stating that "those who serve children must become proficient in group process and group dynamics" (p. 251). Sonstegard and Bitter further explained that most of the positive and helpful influences adults could have on children is lost in the use of old-fashioned authoritarian procedures. In effect, parents, teachers, counselors, and anyone else who works closely with children could greatly increase the positive effects of their work through the use of some type of group communication. As Sonstegard and Bitter aptly phrased it, "group counseling offers adults their best opportunity for connecting with children as social equals" (p. 251).

Basic Components of Children's Therapy Groups

Guldner and O'Connor (1991) believed that group therapy with children serves as a corrective process that permits children to cope better with life by allowing them to embrace new coping strategies or to replace ineffective ones. This process is directed toward the alteration of behavior in the area of skill mastery. Guldner and O'Connor further explained that group therapy aids children in recognizing feelings and locating appropriate avenues for release of those feelings. In effect, child therapy is designed to promote the child's cognitive understanding at the developmental level of that specific child.

Group Structure

Sonstegard and Dreikurs (1973) believed that an atmosphere of equality must exist in the children's group. Equality is defined as "a mutual respect and dignity of others and respect for oneself ... through which the members learn that conflicts can be resolved without either fighting or yielding" (p. 71).

Guldner and O'Connor (1991) described children's therapy groups on a continuum, with preventative groups at one end and remedial groups at the other. From this continuum, Guldner and O'Connor identified four basic categories of groups into which children may be divided for counseling purposes. "Common Problems Group" is a group composed of children who are struggling with the same problem, such as loss, divorce, or school-related issues. In contrast, "Case-centered Group" refers to a group in which the individual child works on his own specific problems, which may vary greatly from one group member to the next. "Human Potential Group" describes a group in which children strive to develop the positive behaviors and strengths that lie dormant within them. Lastly, "Skill Development Group" is a group composed of children who are working to improve the various skills that enable them to cope more efficiently, such as communication skills and the ability to filter aggression.

Group Size

According to Schnitzer (1985), the two most important aspects in determining size of the children's therapy group are the developmental level at which the children are operating and the format of the expression of the children's disturbances. Schnitzer contended that in children's group therapy practice there is agreement regarding an optimal size of five to seven children. Schnitzer added that other factors influencing the size of the group include age, degree of acting out, manifestation of disturbance, and existence of co-therapists. In addition, Ginott (1961) cautioned that a larger group threatens to become too lively and makes it impossible for the therapist to observe the minute-to-minute activities of all the children and to react to each child in light of his own personal dynamics.

Group Composition

Siepker, Lewis, and Kandaras (1985) described children's therapy groups as differing from adult therapy groups in that children exhibit different therapeutic needs from those of adults. Van Velsor (2004) advised that prior to recruiting children for groups, the therapist should conduct a pregroup screening interview to check for appropriate fit. According to Schnitzer (1985), more exclusion criteria than inclusion criteria is presented in screening potential members. Exclusion criteria is defined as brain damage, paranoia, extreme narcissism, hypochondriasis, and acute psychosis. However, Schnitzer argued that the primary requirement for including a child in group therapy is the child's desire to be a part of the group and his ability to establish object relationships. In addition, Schnitzer posited that the child must also exhibit social hunger, which is defined as the child's potential capacity to "give up his undesirable behavior in return for the acceptance by the group" (p. 67).

Ginott (1961) believed that children must be grouped in such a way that they exert a corrective influence upon each other. In addition, Ginott contended that children with dissimilar syndromes should be placed together, so that each child may have the opportunity to associate with personalities different from and similar to his own. For example, withdrawn children require the opportunity to model their behaviors after outgoing group mates, just as fearful children should be in the company of more courageous children.

In addition, Ginott (1961) cautioned that the therapist should prevent children from experiencing in therapy the "devastating influences of their outside lives" (p. 31). In other words, children undergoing group therapy must experience relief from ridicule. In effect, Ginott contended that the therapy room must be a haven from persecution, and the intragroup relations must promote freedom from fear. Ginott also expressed the idea that it is undesirable to place in the same group children who have contact with each other outside of the therapy room. As one of the goals of therapy is to replace old attitudes with new ones, classmates, siblings, and other familiar faces should be placed in separate groups.

Ginott (1961) cautioned that special care must be taken to prevent antisocial and disruptive children from becoming dominant figures in the group. Ginott further explained that any delinquent who manages to attain hero status in the group will serve as an undesirable model of identification. In effect, Ginott advised the addition of one child who is not too disturbed and whose behavior can be controlled. This child is known as the neutralizer. Ginott explained that the neutralizer's insistence on socially acceptable behavior exerts a positive influence on overactive children.

Group Cohesion

Valore (2002) stressed the importance of group cohesion as a powerful force in small children's groups. Valore contended that in order to develop a positive cohesive group, the therapist must be strongly aware of group process and cultivate those processes throughout the day. This process is described as the place where the therapist becomes "part scientist, part technician, and part artist" (p. 91). According to Valore, the scientist is knowledgeable of the theory behind group work and plans the therapy session with that theory in mind. In effect, the technician implements the plans that focus on creating a positive cohesive unit, while the artist takes advantage of spontaneous opportunities that reinforce attitudes of positive cohesiveness. Valore posited that through the use of these roles, the therapist can establish a positive group culture with 10 to 12 different children who are from different geographical areas, who suffer from various problems, and who exhibit diverse cultural backgrounds.

Group Duration

Dinkmeyer and Muro (1979) reported that the ideal amount of time for any children's therapy group will vary with the type of group and the interest of the members. Schnitzer (1985) cautioned that as a rule, the more verbal, discussion-oriented the children's group, the less time it can tolerate. Schnitzer contended that while children's groups can generally handle 45 minutes, groups having both activity and discussion periods can be at least 60 minutes in length with two 30 minute periods.

Schnitzer (1985) reported that the overall duration of groups relates to setting, philosophy, and staffing needs. In effect, some settings parallel children's school schedules, which may last six to nine months, while other settings meet from three months to two years. Dinkmeyer and Muro (1979) suggested that developmental groups be informed that they will meet for eight to ten weeks, as the limited time stimulates some members to greater involvement.

Goal Setting

Schnitzer (1985) reported that in children's groups, individual goals are set by the child and the therapist together. Schnitzer explained that children's goals depend on individual motivation and should stem from diagnostic assessments, be stated in behavioral terms with a desired outcome, refer to improved functioning, be achievable, be ordered according to priorities, and be a shared process between members and workers. Schnitzer added that when group composition is known, the therapist may define a tentative set of group goals which are generally established from individual goals that may be common within the group. In effect, group goals must be realistic, not too difficult, and obtainable.

Variations of Children's Therapy Groups

Sonstegard and Bitter (1998) identified three variations of children's therapy groups. These variations include group guidance, group counseling, and group psychotherapy. Sonstegard and Bitter indicated that group guidance refers to any type of group teaching that occurs in the educational field. In addition, this process includes any type of guidance that centers on teaching children how to problem solve in reference to day-to-day activities. According to Sonstegard and Bitter, "adults working with children engage in group guidance when they stimulate children to learn what needs to be learned, rather than merely letting them learn what they want to learn" (p. 252).

Sonstegard and Bitter (1998) described group counseling as any therapeutic endeavor that is aimed at smaller groups of five to ten children. Sonstegard and Bitter distinguished group counseling from group guidance in that group counseling usually aims to reform mistaken goals, thus creating a motivational change in group members. Due to the fact that so much of early human life is spent in groups, Sonstegard and Bitter further identified group counseling as the preferred treatment for most children and adolescents.

In contrast with group guidance and group counseling, group psychotherapy is defined as a form of therapy applied in cases where children must be "called back from the darkness of some unfortunate, and often tragic, life circumstance" (Sonstegard and Bitter, 1998, p. 253). Sonstegard and Bitter distinguished the process of group psychotherapy from group counseling, not because of the skill or training of the leader, but because of the history, pain, and level of difficulties experienced by the child.

The Therapist in Group Therapy with Children

Rosenthal (2005) reported that the tasks of the therapist in group therapy with children are determined by the age level of the group members and the structure and setting of the group the therapist is conducting. Rosenthal further explained that the ways in which the therapist will carry out these tasks depends upon his background, his training, his theoretical preferences, and his life history.

Qualities of the Therapist

Van Velsor (2004) attributed the apparent shortage of children's groups to a paucity of adequately trained professionals. Ginott (1961) believed that the capacity to be empathic with children is the primary requirement for all therapists who work with children. In effect, Ginott stressed that the therapist must be young at heart and cannot be too serious. Guldner and O'Connor (1991) added that it is good therapy ethics that the therapist likes children and enjoys working with them. In working with children, Guldner and O'Connor reported that the therapist should strive to be extremely creative and spontaneous in order to meet the various contingencies that emerge while working with children in groups. Guldner and O'Connor recommended a co-therapy team of a male and a female, as this provides children with the best opportunity to work through issues with both parents, whether or not those parents are active in their lives.

Knowing the Child

Guldner and O'Connor (1991) stressed that the therapist must possess a working knowledge of children. Guldner and O'Connor further explained that the therapist must have a good understanding of child development as it relates to cognitive, affective, and behavioral levels of functioning. A system's background may be helpful in achieving this understanding, as Guldner and O'Connor reported that it enhances the therapist's knowledge of dynamics and increases his understanding of the child in the bigger picture of the child's life.

Rosenthal (2005) reported that the therapist's ability to know and to understand children is based upon the everyday experience of their physical and psychological incompleteness. Rosenthal defined this incompleteness as the limits of the child's ability to establish middle ground between his inner and outer worlds. In effect, Rosenthal stressed the importance of the therapist's ability to recognize and to attend to the child's primarily narcissistic functioning. In this way, the therapist is knowledgeable regarding the fragility of the child's emotional depth and of the exposed nature of his unconscious.

In reference to change, Rosenthal (1995) reported that the therapist who wishes to encourage growth must recognize that the child's capacity for change is considerably greater that that of an adult. Rosenthal further stressed that the therapist's understanding of the child's emotions includes the child's desire for motor activity that provides satisfaction of his needs to play and to release aggression. Rosenthal contended that most importantly, the therapist must be related to the child's vulnerability and his urgent need for support and growth, which encourages emotional contact with significant others.

Striking a Balance

Rosenthal (2005) stressed that the therapist must be capable of understanding the individual child while simultaneously understanding the forces and emotions that come to light when three or more children come together in the therapeutic group. In addition, Rosenthal discussed the importance of unique individual dynamics and explained that knowledge of the individual child prior to group entry is necessary for the development of a group treatment plan. Rosenthal aptly stated that an individual therapist will "grasp the full import of Freud's statement that in its essence resistance is nothing more than the character of the child" (p. 99). In effect, as a prelude to group therapy, Rosenthal contended that the successful group therapist will have had experience in treating individuals, thus encountering the complete spectrum of human emotion within the confines of the individual experience.

Proper Selection

Guldner and O'Connor (1991) reported that the therapist must be able to successfully select children for group placement. In effect, Guldner and O'Connor believed that the therapist should possess knowledge of the developmental tasks of children within every age group and design group process around these developmental tasks. In order to create functional group membership, Rosenthal (2005) explained that the therapist must be capable of assessing the child's level of ego strength. In other words, the therapist must successfully select children who are capable of handling the possibility of exposure to sibling hostility, the necessity of sharing the therapist, and the great degree of emotional stimulation. Rosenthal added that the therapist must be able to strike a therapeutic balance among the diverse personalities of the group members.

Therapeutic Potential

Rosenthal (2005) believed that in order to utilize the therapeutic potential, the therapist must be able to surrender the power of being the lone object of transference and identification. Rosenthal stated that being a group therapist requires a "readiness to yield some therapeutic omnipotence and an ability to accept that maximal therapeutic outcomes are attained from the children's contact with each other" (p. 99). Rosenthal insisted that being an effective group therapist requires the capacity to catch and correct subgroup and group resistances as they emerge. In effect, the group therapist faces the task of preserving the children's group as a therapeutic entity and protecting the treatment of its members.

The Child Within

Rosenthal (2005) contended that the final task of the therapist should be to know the child within himself and to recognize the ways in which this inner child interferes with his functioning in the group. Guldner and O'Connor (1991) reported that the therapist should find it easy to tap into his playful, childlike qualities when it is appropriate within the group. Rosenthal stressed that the creation of a happy and cohesive group family will require intervention in regard to arguments, conflicts, and disagreements. The ability to think like a child comes into play, as Rosenthal advised that overly swift interventions may only serve to deprive the child and the group of the opportunity to deal with the conflict at hand.

Various Concepts in Group Therapy with Children

Van Velsor (2004) reported that the therapist can effectively plan for groups through understanding the personalities and desires of preschool, latency-age, and adolescent children. Van Velsor further explained that groups for preschool children should center on play; groups for latency-age children should center on activities with some discussion; and groups for adolescents should center on discussion with some activities.

Developmental Areas

Van Velsor (2004) described preschool children as maintaining an egocentric worldview and limited verbal skills. Thus, as preschool-age children enter the group, Van Velsor explained that they fight over toys, territory, and adult attention. According to Van Velsor, the therapist's job is to "provide structure and consistency to help children cope with anxiety, to exercise patience with the chaos that often emerges in their egocentric play behaviors, and to offer enough freedom for children to resolve some of their own conflicts" (p. 139).

Van Velsor (2004) contended that latency-age children express themselves through nonverbal methods. According to Van Velsor, this suggests that the therapist should pay careful attention to children's nonverbal communications, implement age-appropriate activities, and encourage empathy. However, Van Velsor stressed that because latency-age children often benefit from some form of talk, the therapist should engage in spontaneous discussion which supersedes planned activities.

Van Velsor (2004) believed that adolescents seek peer acceptance and approval. In effect, it is critical that the therapist carefully choose group members who will create a supportive peer environment. Van Velsor posited that in light of adolescents' mood swings, extremes in self-disclosure, and questioning of authority, the therapist should offer sensitive and empathic responses and provide appropriate freedom in group sessions. Van Velsor noted that because adolescents engage in abstract thought, they primarily work through issues using verbal interactions. However, Van Velsor further explained that age appropriate activities can be used to stimulate insight and compensate for adolescents who are uncomfortable with talk.

Group Reflective Function

Barratt and Kerman (2001) contended that the development of the ability of children to become reflective regarding the minds of others, in addition to becoming self-reflective regarding their own minds, is a useful way of thinking about groups. Barratt and Kerman reported that children who have behavior problems act out in groups due to an under-developed self-reflective capacity. In effect, an increased capacity for self-reflectiveness will allow children to think about their feelings, behaviors, and actions, rather than just acting them out. Barratt and Kerman further explained that the therapist's tendency to reflect upon the children enables the children to think about their own feelings, in addition to the ways they respond to each other and affect each other. Barratt and Kerman posited that as the tendency to self-reflect is internalized, it can lead to alterations in the ways in which children behave with one another and relate to one another.

Barratt and Kerman (2001) advocated the use of children's drama groups to develop the child's reflective function, as drama groups offer the opportunity for self-expression through a technique which does not fully depend upon verbal interaction. In effect, children who are not articulate or who may not be comfortable with being heard benefit from experiencing freedom in the use of their bodies. Barratt and Kerman employed the use of interpretation and drama techniques in order to aid such children in communicating and relating to others.

According to Barratt and Kerman (2001) drama groups are composed of sessions in which various activities and discussions are encouraged. Barratt and Kerman stressed that during each session, the therapist should instruct the children to verbally communicate about things that have happened in the past week, placing special emphasis on the group understanding what each discussed experience means to each group member. In addition, the therapist should also encourage the children to think about each other's behaviors and feelings. Barratt and Kerman emphasized this point, as it is essential to the therapeutic work done in drama groups. As Barratt and Kerman aptly phrased it, "emphasis is placed on each child finding an image of himself in the mind of another" (p. 317).

Efficacy of Group Therapy with Children

Guldner and O'Connor (1991) reported that group therapy in dealing with children's issues is the therapy of choice. In addition, Hoag and Burlingame (1998) contended that a meta-analysis of 56 studies showed that group therapy is effective for children with psychiatric symptoms and various other problems. In the analysis, group treatment is defined as counseling, guidance, and training. Hoag and Burlingame explained that group therapy was equally effective for all types of problems, including learning disabilities, depression, social problems, behavior problems, effects of divorce, and various other categories of diagnoses. In effect, Guldner and O'Connor contended that group therapy with children is efficacious, because children learn to help each other and to become open and genuine regarding their inner and outer experiences.

Reference

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