Behavioral Group Therapy with Children and Youth

Description of the Strategy

Be havioral group therapy (BGT) is a major vehicle for the delivery of cognitive-behavioral treatment to children and adolescents. There are a number of advantages of working with children in groups. The peer group is a natural part of child and adolescent development, and as such, the treatment more nearly simulates their real world than the client-adult dyad. Groups also represent a more efficient way of delivering interventions than in dyads. Group membership commonly ends the sense of isolation and lack of understanding many clients experience, since they are surrounded by other children who are dealing with similar issues and problems. Groups may be divided into subgroups for certain exercises and as a way of increasing the amount and breadth of interaction in the group. Certain interventions are more accessible or more effective in the small group, for example, the use of brainstorming in teaching problem-solving skills. Feedback from other members following role playing and designing extra-group tasks and goals is another. Groups are an effective way of delivering information. Games and other recreational activities in groups are more challenging and cohesion building and can be adapted to encourage trying out new behaviors. Finally, groups enhance generalization of change, since each member observes and helps solve a diversity of problems manifested by the other clients as well as his or her own.

Most therapy groups range in size from 5 to 15 members, although the norm is about 6 to 9. They range in duration from 6 to 20 sessions, depending on the complexity of the presenting problems. Most sessions last from 45 minutes to one and one half hours. There are either one or two therapists. One experienced therapist is more efficient, but two provide an opportunity for therapist training and provide the members with multiple adult roles. Most groups are closed and time limited with a fixed beginning and ending time ranging from 4 to 16 sessions. Open groups in which members are added and dropped periodically are more common in institutions. Most of these decisions regarding the above issues are made for practical reasons. However, there is some data to support smaller groups versus larger groups as well as for providing group structure that permits intense interaction by everyone in the group. The more complex the problems, the longer the length of time in each session and the larger the number of sessions required.

BGT is guided by several principles unique to group context. The first is that there is broad and active participation if the above advantages are to be realized. The interaction should be characterized by its provision of support and reinforcement or mutual aid for each other. The second principle is gradual progress toward independence and autonomy. The therapist initially provides structure and gradually delegates or encourages responsibility for that structure to the members. The third principle is that the goals of treatment ultimately are formulated in terms of generalization of the behaviors and attitudes learned in the group. The fourth principle is that of gradually increased demand for self-disclosure. We begin with introductory interviews in pairs and then describe one's interviewee to the group, the analysis of a case in terms of how each is similar and different from that case, and ultimately in formulating problems with [Page 724]which each client is confronted. It is the behavior and cognitions in these problem situations that become the target of the interventions. Interrelated to the above principles is building the cohesion of the group. With children and youth, the therapy group should be both a work and a fun experience.

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