Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.     

Training in child and adolescent group therapy: Two surveys and a model

Although group therapy is widely used in the treatment of children and adolescents, there has been little attention paid to establishing training standards and developing comprehensive programs for training psychiatry fellows in child and adolescent group psychotherapy. The authors conducted two surveys of child and adolescent training programs. After reviewing the literature, they present the data from their surveys, compare similarities and differences, and discuss trends. Finally, they propose a model for training in child and adolescent group therapy.     

Inpatient adolescent and latency-age children's perspectives on the curative factors in group psychotherapy

Thirty-three adolescent and 11 child psychiatric inpatients were administered a downward revision of Yalom's (1970) 60-item Q-sort, which sets forth 12 putative curative factors of group, to assess patient perceptions of which factors in group therapy are most curative. The impact that age, patient level of functioning, and time in treatment had on which factors were most valued was assessed. Patient perceptions of the value of group compared to other treatment modalities were also assessed. Both child and adolescent subjects highly valued the factors of Hope, Cohesiveness, and Universality. Patients' level of functioning had limited effects on adolescents' perceptions, but did effect children's perceptions of what was most valued in group. The modest effect of time in treatment was attributed to the short duration of inpatient treatment. Implications for inpatient adolescent and child group therapy and future research are explored.Appreciation is extended to Mary Kelly, Elly Cobb, and Anna Csaky-Chase for their conceptual and editorial assistance.     

Listening to the adolescent therapy group

This article reviews traditional psychodynamic views of listening to the manifest and latent content of the patient's communication. It then reviews the literature on the application of such listening in group treatment. The particular application of such listening and intervention in groups for adolescents with significant ego deficits is explored.     

Esteem maintenance among groups: Laboratory and field studies of group performance cognitions

Across 48 experimental groups, those that scored higher on group self-esteem attributed perceived positive outcomes to internal factors and negative outcomes to external factors. Groups provided more elaborate rationalizations about perceived negative outcomes and less elaborate rationalizations about perceived positive outcomes. They also espoused greater confidence in improved performance after negative outcomes and less confidence following positive outcomes. Similar findings were observed among 252 intact work groups in an employment setting. We discuss the implications of these findings for understanding how group self-esteem influences how groups evaluate and respond to performance feedback.     

Outcome studies of family therapy in child and adolescent depression

There is surprisingly little good-quality evidence for the effectiveness of family systemic interventions with child and adolescent depression given the prevalence of depression and the demonstrated association with a range of family factors. What studies there are suggest the possibility of family therapy being an effective intervention but more research is needed before firm conclusions may be drawn. Family interventions may be more effective in children than in adolescents and where other family members are depressed. It is possible that family interventions continue to bring about improvement in symptoms after cessation of treatment. What research there is evaluates older structural models of therapy: there is a real need for more evaluation of newer models of practice.     

Inpatient group psychotherapy: Cohesion facilitates separation

Inpatient group psychotherapy is affected by the time-limited nature of hospitalization. Although the brevity of treatment has been viewed by some as detrimental to patient improvement, other aspects of the treatment setting promote cohesion and allow group members to confront the threatening fears of separation and loss which likely prompted hospitalization. Separation issues are accentuated by the time parameters and the continual terminations of patients and staff. Unplanned terminations are seen as disruptive to the group process.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

Doing anger differently: a group percussion therapy for angry adolescent boys

This paper describes Doing Anger Differently (DAD), a group treatment for young adolescent boys with high levels of anger. The approach is school-based, 10 weeks long, and utilizes music in the form of percussion to engage this difficult to treat population into treatment and to represent the experience of anger. A tri-level intervention is described: the experience of anger and its influence on action; the formation of meaning and identity resulting from anger and aggression; and the emphasis on group work and the interpersonal basis of anger. Techniques used throughout the group are discussed and illustrative case vignettes are provided.     

Surf therapy for improving child and adolescent mental health: A pilot randomised control trial

The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8–18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children’s Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.     

The function of the new member in an adolescent group

SUMMARY

In this paper we examine, through clinical examples, the impact a new member makes in an adolescent group. We were prepared for the disadvantages we felt would be experienced by the introduction of new members. However, we were clinically and theoretically interested in the way that new members brought extra space to the group, rather than diminishing it.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

On the Boundary: Family Therapy in a Long-Term Inpatient Setting

This paper presents a paradigm of family therapy in a long-term inpatient setting. After reviewing literature commenting on the necessity of attending to the needs of families of inpatients, the essential functions of inpatient treatment are discussed and an approach to family therapy, related to and reflecting those functions, is developed. Four functions of inpatient family therapy are delineated: joining, support, intervention, and validation. What distinguishes these from similar functions in outpatient treatment is the family therapist's position on the hospital-family boundary.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.