Running Effective Groups
With Children &
Adolescents
A Primer on Group Therapy:
Yalom’s Therapeutic Factors
• Installation of Hope
– Patients’ belief in the efficacy of the group mode
– Things will improve during course of therapy
• Universality
– Disconfirm patient’s feelings of uniqueness
– See commonalities in each other, relief
Yalom’s Therapeutic Factors
• Imparting Information
– Didactic instruction
– Direct advice
– Examine misconceptions
• Altruism
– Learning to give of one’s self
– Seeing the benefit in doing so
Yalom’s Therapeutic Factors
• Imparting Information
– Didactic instruction
– Direct advice
– Examine misconceptions
• Altruism
– Learning to give of one’s self
– Seeing the benefit in doing so
Yalom’s Therapeutic Factors
• Corrective recapitulation of primary family group
– Correctly resolve early family conflicts
– Group symbolically resembles original family
• Development of socializing techniques
– Basic social skills
– Both direct (role play) and indirect (feedback)
Yalom’s Therapeutic Factors
• Imitative behavior
– Group members imitate behavior of other
members and therapist (vicarious-spectator)
– Helps patients try new behaviors
• Interpersonal learning
– Diminish parataxic distortions
– Form rewarding relationships
Yalom’s Therapeutic Factors
• Group cohesiveness
– Increases tolerance of disagreement
– Facilitates feedback and disclosure
• Catharsis
– Strong emotional component
– Cognitive component promotes change (necessary)
• Existential factors
– Face ultimate concerns of existence: death, isolation, freedom,
and meaninglessness
Co-Therapist Model
• Advantages
– Reduce chance of burnout
– Shared attention, greater observational range
– Infrequent cancellation due to illness
– Explore reactions together
– Sensitivity to countertransference
– Split roles – provocative v. nurturing
– Help maintain objectivity
Co-Leadership Model (cont)
• Disadvantages
– Lack of synchronization
– Competition and rivalry
– Lack of trust in other’s competence
– Different theoretical orientation
– Openly siding with members against leader
Working with Children and
Adolescents
• Legal considerations
– Clarify what you can and cannot keep confidential
– Be aware of your legal responsibility to report abuse or
suspected abuse of minors
– Secure written consent of parents or guardians
Practical Considerations
• Frequency and Duration
– With children and adolescents it may be better to meet more
frequently and for a shorter period of time to suit their attention
span.
– If meeting in a school setting, meeting times should correspond to
regularly scheduled class periods (if possible)
• Group Size
– elementary school children: 3-4 people
– adolescents: 6-8 people
• Setting
– Will the site provide privacy?
– Will there be enough room for all students?
Practical Considerations (cont)
• Communicate expectations
– Set rules and follow through with firmness
• Preparation
– Avoid insisting on “covering your agenda”
• Parental involvement
– Meet with or write to parents about the group, if
appropriate
Screening Process
• Define the following areas:
– Population (age, gender, etc.)
– Frequency and Duration
– Length
– Size
– Open v. Closed
• Who will be present?
• What information do you want to collect?
• What information do you want to impart?
Working with Children and
Adolescents
• Strategies in the Group
– Self-Disclosure
• Direct child to express how affected by incident
rather than allow them to reveal everything about it
– Emphasize confidentiality
• Use language that is developmentally tailored to
convey importance of privacy
• Encourage parents to avoid asking questions that
could lead to breach
Working with Children and
Adolescents
• Strategies in the Group (cont)
– Maintain neutrality
• Avoid siding with children or adolescents against
their parents or a particular institution
– Use appropriate exercises and techniques
• Even though their unwillingness to participate may
stem from a lack of understanding, children and
adolescents have the same rights to not participate in
exercises they see as inappropriate
Working with Children and
Adolescents
• Strategies in the Group (cont)
– Listen and remain open
• Encourage young people to express themselves in their own words
• Be aware of preconceived labels and diagnoses that subtly
influence your interactions
– Prepare for termination
• Let children know that the termination point is not far off well before
your group ends
• This enables children to express their sadness (or other feelings
related to termination)
Working with Reluctant
Adolescents
• Explain the rationale of the group in jargon-free
language
• Allow members to express reactions to being sent
to a group
• Go with resistance – Don’t go against resistance
• Avoid getting defensive
• Be clear and firm with your boundaries
Key Points – Child Groups
• Get the support of administrators
• Communicate the importance of confidentiality in
their language
• Not all children are ready for group therapy
• Some structure is important
• Think about methods for evaluating outcomes
Key Points –
Adolescent Groups
• Understand and respect resistance
• Role-playing techniques can often be creatively
used in adolescent groups
• Find ways to involve parents
• Co-leadership models are especially useful in
facilitating an adolescent group