Inpatient child and adolescent therapy groups: Boundary maintenance and group function

Inpatient therapy groups are described as subsystems of the social systems that comprise hospital units. System theory concepts are used to illustrate how clear group boundaries are essential for the effective functioning of inpatient therapy groups. Milieu dependency dynamics are viewed as a major source of resistance to group boundary formation in psychiatric institutions for children and adolescents.     

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.     

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.     

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.     

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.     

Using a self-evaluation system as a group contingency

The efficacy of a group-evaluation system was examined, with a reversal design, in two classes of students with disabilities. The results suggested that a group-evaluation system was effective in decreasing the inappropriate verbalizations of both groups. Student satisfaction data revealed that the students in both groups had positive reactions to the system. Factors contributing to the success of the intervention as well as suggestions for its implementation are discussed.     

Group cohesion in cognitive-behavioral group therapy for social phobia

Cognitive-behavior therapy (CBT) for Social Phobia is effective in both group and individual formats. However, the impact of group processes on treatment efficacy remains relatively unexplored. In this study we examined group cohesion ratings made by individuals at the midpoint and endpoint of CBT groups for social phobia. Symptom measures were also completed at the beginning and end of treatment. We found that cohesion ratings significantly increased over the course of the group and were associated with improvement over time in social anxiety symptoms, as well as improvement on measures of general anxiety, depression, and functional impairment. In conclusion, findings are consistent with the idea that changes in group cohesion are related to social anxiety symptom reduction and, therefore, speak to the importance of nonspecific therapeutic factors in treatment outcome.     

Hub Group: an innovative approach to group therapy in a short-term inpatient adolescent unit

Two and one-half years of Hub Group have shown that short-term, ward-based, heterogeneously mixed adolescent groups can work. Backed by a behaviorally based privilege system, Hub Group contracting methods facilitate rapid investment in group therapy, are flexible enough to accommodate change, and provide a meaningful ritual that involves all group members in promoting change for the individual. Hub Group's method of self-rating and rewards promotes objectivity in self-evaluation. The contracts' images are compact, but all encompassing, providing a continuum along which to move in developing greater responsibility and productive functioning for the adolescents. There are distinct advantages and disadvantages to mixed levels of functioning within the same group. The nurturance and tolerance for others fostered by Hub Group is a primary advantage. Despite the obvious disadvantages of rapid turnover, common issues such as acceptance, attachment, and separation are ever present to be addressed. Leadership must be either supportive or confrontive, but always active in these groups. Hub Groups have shown that with the support and supervision of IDTU's administrative staff, diversely trained staff can comfortably perform multiple roles within the unit and be effective as group leaders.     

The group as a self-active system: Outline of a theory of group action

Human social systems, and groups in partlcular, are conceived as units which, as a whole, actively strive towards the achievement of external and internal goals. This ‘group action’ consists of simultaneous integrated processes on various individual and social levels. Our theory comprises four groups of constructs, which refer to task structure, group structure, information processing and execution. In an ongoing group action, the task structure is projected on the group structure; according to the resulting pattern, the group processes its action related information and executes the act. The latter two processes proceed on two levels, on an individual and on a group level. There are cognition, emotion and volition on the individual, and communication on the group level of information processing; execution proceeds in individual action and in cooperation. A specific part of the theory concerns analogies between individual cognition and intragroup communication.     

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.     

Inpatient group processes parallel unit dynamics.

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.     

Bullying as a group process: Participant roles and their relations to social status within the group

Bullying was investigated as a group process, a social phenomenon taking place in a school setting among 573 Finnish sixth-grade children (286 girls, 287 boys) aged 12–13 years. Different Participant Roles taken by individual children in the bullying process were examined and related to a) self-estimated behavior in bullying situations, b) social acceptance and social rejection, and c) belongingness to one of the five sociometric status groups (popular, rejected, neglected, controversial, and average). The Participant Roles assigned to the subject were Victim, Bully, Reinforcer of the bully, Assistant of the bully, Defender of the victim, and Outsider. There were significant sex differences in the distribution of Participant Roles. Boys were more frequently in the roles of Bully, Reinforcer and Assistant, while the most frequent roles of the girls were those of Defender and Outsider. The subjects were moderately well aware of their Participant Roles, although they underestimated their participation in active bullying behavior and emphasized that they acted as Defenders and Outsiders. The sociometric status of the children was found to be connected to their Participant Roles. © 1996 Wiley-Liss, Inc.