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Group Psychotherapy Forchildren and Adolescents 244 Archives of Disease in Childhood 1993; 69: 244-250 TYPES OF PSYCHIATRIC TREATMENT Arch Dis Child: first published as 10.1136/adc.69.2.244 on 1 August 1993. Downloaded from Group psychotherapy for children and adolescents S Reid, I Kolvin This is the thirteenth ofa Definition reliable and which enables the exploration of series ofarticles on (A) treatment ofchild By definition, group psychotherapy involves combinations of relationships, dysfunctional psychiatric disorders the treatment of a number of children in communication, and unconscious processes. groups by a therapist or co-therapists. There Group psychotherapy recognises that all are two main theoretical orientations - psycho- children have a range of strengths as well as dynamic and behavioural/cognitive. The latter weaknesses, and an appreciation of these by distinction is not necessarily a clear cut one children has a potential for therapeutic impact and a rather simplistic view would be that on other group members. while behavioural psychotherapy in children The therapeutic aim is to enable four or five would seek directly to alter surface behaviour, younger children, or six to nine older psychodynamic psychotherapy is more geared children/adolescents, to become a group. With to helping children towards a deeper under- younger children the approach in essence may standing of their own behaviour. In this paper be that of psychodynamically orientated group we address ourselves to the psychodynamic therapy with a focus on following play approach. principles outlined by a number of group The original version of group psychotherapy therapists2 13-16 and with older children/ was 'activity' group therapy which, although adolescents with the focus on verbal inter- based on psychodynamic principles, tended actions.3 In becoming a group, the individuals not to use techniques of interpretation but need to recognise and value the uniqueness focused on activity, appreciating that some and sovereignty of each of the other members, young children could reveal themselves better and to come to understand those others as also in play and activity than in discussion. Group representing aspects of themselves.15 The play therapy developed by Axline2 utilising group provides an opportunity to explore and http://adc.bmj.com/ Rogers's non-directive principles3 has been capitalise on interactions between peers, the used widely in community settings.4 In this children and the therapist(s), as well as both version, expression of feelings are facilitated in present and past interpersonal experiences and the younger children; the therapist is reflective family relationships. In this model the therapist but not directive, and hence the play is not may set limits, may interpret interactions, and directed beyond the limits necessary to allow seeks to promote an understanding of social the therapy to continue within the clinic or skills and peer relationships. other setting. For example, the children must on September 26, 2021 by guest. Protected copyright. stay within the room and are expected not to destroy the fabric of the room or to hurt each (B) The nature ofthe group other physically. One of the main centres for It has often been asserted that a group is more the development of group therapy with child- than a mere collection of individuals but, ren in the UK is the Tavistock Clinic; their rather, that the members have a common task model emerged out of psychodynamic theory, and come to identifying with the group and its following the work of Klein5-8 and Bion9 10 and aims and are thus interdependent on each is described elsewhere.1' 12 other. In addition, Freud argued that the However, even within each orientation there fundamental component of the group was a may be variations and thus the approach leader.17 However, social psychologists offer employed is likely to be determined by the other definitions of groups, such as 'a social training of the therapist and the nature of the unit consisting of a number of individuals problems addressed. Therapy as described in who stand in role and status relationships to this paper is based on an understanding of one another, stabilised in some degree at the group dynamics, with the main impact being in time, and who possess a set ofvalues or norms Royal Free Hospital the context of the 'here and now' situation, of their own regulating their behaviour, at School ofMedicine, with a focus on the personality and behaviour least in matters of consequence to the The Tavistock Clinic, Child and Family of each child, the relationship between peers, group'.18 The latter definition implies that Department, Tavistock and the nature of each child's relationship with some individuals are inside, whereas others Centre, 120 Belsize the therapist, rather than an exploration of are outside the group; this gives rise to a sense Lane, London NW3 5BA early life events. The therapist seeks to create of group cohesiveness for those within the an atmosphere that allows each child to feel group. S Reid However, such cohesiveness may be in I Kolvin accepted and respected by the therapist for the danger of potential disruption by 'disturbing Correspondence to: person she/he is. A setting is provided that can motives' of individual members such as a wish Professor Kolvin. be experienced by the group as safe and to have the therapist for oneself or angry Group psychotherapy for chidren and adolescents 245 feelings about other group members. Such * Some parents are unable to tolerate disturbing motives need to be explored within the suggestion that their child needs thera- the group to enable members to find a con- peutic help because they perceive this as their Arch Dis Child: first published as 10.1136/adc.69.2.244 on 1 August 1993. Downloaded from structive or helpful solution. Other theorists child being singled out and for these an offer argue that the behaviour of clients in therapy of group psychotherapy is often less threaten- groups is governed by a balance of emotional ing. forces. 19 * Where assessment indicates that group psychotherapy is the treatment of choice, then it may be a more economic use of the (C) Some ways in which groups may be therapist's time. therapeutic * Many of the children, but particularly It is important to try to understand the ways in adolescents, referred for psychotherapeutic which groups may be therapeutic, especially in help suffer a sense of loneliness and isolation. relation to children, and Yalom makes a major For them a psychotherapy group offers a safe, contribution to this.20 He identifies a number supportive, empathic setting where boundaries of themes and we address those particularly and limits are determined by the therapist and relevant to children. First, the instillation of a where there is an opportunity for immediate sense of hope; second, children have a con- acceptance, first by the therapist(s) and then siderable need to 'belong' and within the group by the other group members. For many child- there is an opportunity to discover their peers ren it is their first experience of becoming an have problems that they thought were unique important part of the life of a peer group and to themselves; third, acquiring a deeper sense an opportunity, in a safe setting, of learning of altruism; fourth, correcting maladaptive how to make friends. patterns acquired in the primary family group; * Within the group the child is enabled to fifth, the acquisition of social skills; sixth, the see the consequences of his own behaviour imitation of prosocial behaviour; seventh, and to see the impact of the behaviour of interpersonal learning; eighth, group cohesive- others upon himself. This is because the ness; ninth, catharsis, which essentially con- group experience is shared, and children have sists of allowing children to discharge their an opportunity to see not only the con- emotions within overall limits; tenth, existen- sequence of their own projections, but also tial factors, which include the notion that life is how they may be vulnerable to the projections at times unfair and unjust, that perhaps there is of others. For example, the bullied child may ultimately no escape from some of the hurt of be helped to see why he is subtly provoking life experiences; and finally that group others to bully. members must ultimately come to take respon- * Being in the company of children with sibility for the way in which they live their own different personalities, and seeing their weak- lives. nesses and strengths, enables the child to http://adc.bmj.com/ Other writers identify those factors that are rediscover aspects of himself that have been of importance to the organisation and the suppressed, and to value the positive qualities functioning of groups. For instance, Bloch and she/he already has, thus enhancing a feeling of Crouch point out that the qualities of the self worth. group make a contribution, such as the group's * The group facilitates the exploration of a goals, size, composition, duration, context, number of relationships and offers different and stages of development (see section on models of behaviour and different perspectives composition of groups).21 on situations. This is particularly helpful for on September 26, 2021 by guest. Protected copyright. many deprived children, and for all children who have little capacity for reflection at the (D) Some advantages ofpsychotherapy time of referral. Similarly, with older children groups or even those who are relatively adolescent, * Unlike adults in therapy, children are group processes and the appreciation that per- dependent on others for attendance at therapy sonal problems are not unique may facilitate sessions. Hence, there are many children who self disclosure. would not attend as outpatients for regular * Each member of the group will acquire a psychotherapy sessions because their families memory of all those events that have a signifi- are unwilling or unable to provide the neces- cant impact on the life of the group.
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