3 ), 182 – 196 shamika e H u m a n i t i e s

3 ), 182 – 196 shamika e H u m a n i t i e s

DQ#1 Groups with Children

Liz P

Group therapy for children focuses on the “exploration of combinations of relationships, dysfunctional communication, and unconscious processes” (Reid, & Kolvin, 1993, p. 244). It is best when there are “four or five younger children [for 6-11 year olds], or six to nine older children/adolescents [for 11-15 year olds], to become a group” (Reid, & Kolvin, 1993, p. 244). The focus of each of these groups will differ because of the respective developmental stages. The younger children will primarily focus on play principles and the older children/adolescents will focus on healthy communication and verbal interactions (Reid, & Kolvin, 1993).

Groups for young children offer a sense of belonging, a safe place to learn about others their age that experience and feel a similar way, and a place to learn new behaviors. Stability and routine is very important for this age group, therefore regular attendance for these small groups is essential. Children are dependent upon their parents for transportation, and often times this can be challenging. These groups can take place in schools, hospital units, and clinic settings which can provide more autonomy for these group members, as well as consistent attendance. Adolescents benefit from these groups because the group can provide “a safe supportive empathic setting where boundaries and limits are determined, and there is an opportunity for immediate acceptance” (Reid, & Kolvin, 1993, p. 245).

Children and adolescents can practice skills in these groups and observe behaviors and the consequences amongst their peers, offering insight and ways to change. These groups can be mixed or same-sex, depending on the nature of the group. Same sex groups are better when there is trauma or abuse related theme and mixed groups are better when behavioral issues are the focus (Reid, & Kolvin, 1993). Groups can be facilitated by a single therapist or by co-leaders. Co-leaders should ideally be male and female, in order to help teach and model dynamics, communication, and behavior. These groups will last for different periods of time, depending on the setting. For example, groups on inpatient hospital units may last the period of the hospitalization, which can range dramatically. Groups that take place in school settings may last the school year or a semester. And, groups that take place in clinic settings can take place for 24 treatment sessions over a span of 8 months (Arias-Puiol, & Anguera, 2017).

Facilitators want to create a safe environment which allows the children/adolescents to grow and some techniques used may be: “encouraging turn-taking by the more inhibited members of the group, stimulating conversation from the early stages of therapy, and promoting metallization toward the end of therapy” (Arias-Puiol, & Anguera, 2017, p. 8).

There are always challenges when working with any population. However, there are some specific issues around children and adolescents. There can be limitations regarding confidentiality. Yet, this is paramount when working with a population that is distrustful and afraid. Confidentiality between “provider and patient is a foundational principle” (Wadman, Thul, Elliot, Kennedy, Mitchell, & Pinzon, 2014, p. 13).There are a number of ethical standards within the 2014 ACA Code of Ethics, “A.2.a. (Primary Responsibility), A.2.d (Inability to Give Consent), B.1.b (Respect for Privacy), B.1.c. (Respect for Confidentiality), B.2.d, (Court-Ordered Disclosure, when dealing with legal concerns such as custody agreements), B.2.e. (Minimal Disclosure), B.5. (Clients Lacking Capacity to Give Informed Consent), and B.6.e. (Client Access) (Wade, 2015, p.1).


Arias-Pujol, E., & Anguera, M. T. (2017). Observation of interactions in adolescent group

therapy: A mixed methods study. Frontiers in Psychology, 8, 1188. https://doi.org/10.3389/fpsyg.2017.01188

Reid, S., & Kolvin, I. (1993). Group psychotherapy for children and adolescents. Archives of

Disease in Childhood; 69: 244-250.

Wade, M. E. (2015, September). Confidentiality concerns with minors. Ethics Inquiries:

Counseling Today. Retrieved https://doi.org/10.1093/pch/19.2.e011

Shamika E

For as long as she can remember the writer has wanted to work with children. It wasn’t until a few years ago that she understood how she could do so. She was squeamish in regards to bodily fluid and she didn’t feel a connection to teaching. But when she thought about being a listening ear and resource she knew that was what would be best for her. She has always felt that a child’s feelings are often and easily overlooked. They are most likely the least understood out of all age groups (Berg, 2013).Group therapy can be very beneficial. “A meta- analysis of 56 studies over a 20 year period reported that group therapy is more effective than any other form of therapy for children(Grover, 2017).But its important to overstand and follow guidelines to get the best results.

No matter what age group you are working with you need to be ethical, and practice all the guidelines in the aca ethical guidelines. Specifics to remember when working with children is that they have shorter attention spans(Berg, 2013). Being aware of this will also help your remember not to overload the number of participants in the group. It also gives you a guideline for how long sessions should be. For example therapy groups for children from preschool to the age of 9 years old should have no more than 6 children in the group and the sessions should be no longer than 45 minutes (Berg, 2013).Having too many children in the group or running the session too long with cause the group to lose focus. What would be a circumstance where session time or group number could exceed the recommended amount if any?For example what if you have already accepted your group but a parent pleads to have her child in the group because they are severely concerned. How would you handle it?



Grover, S.(2017).5 Reasons group therapy is the best choice struggling teens.Psychologytoday. Liz P

I think working with children is very difficult. Children communicate differently than do adults and it is harder for them to understand and follow group rules. Depending on the type of group, children can be “blatantly disruptive and may even ignore the best facilitation moves the counselor has to offer” (Berg, Landreth, & Fall, 2013, p. 152). A trained facilitator is required to maintain control in a professional manner, otherwise “it may be difficult for many group facilitators to refrain from reacting as a typical parent to disruptive behavior in a children’s group” (Berg, Landreth, & Fall, 2013, p. 152). Additionally, another challenge when working with children/adolescents, has to do with confidentiality. Facilitators need to familiarize themselves with state, professional organization(s), and employer laws as it relates to parents or legal guardians. Thirdly, commissioning parents or legal guardians to engage in their child’s mental health treatment “despite continuing advances in evidence-based treatment approaches and efforts” remains a challenge (Gopalan, Goldstein, Klingenstein, Sicher, Blake, & McKay, 2010, p. 183). Families of minority children “are less likely to be engaged in mental health services” (Gopalan, & et al., 2010, p. 184).

Therapists should engage in trainings and supervised clinical hours to become more comfortable with this population. Learning and understanding legal and ethical confidentiality responsibilities would also be important prior to working with this population. One should have a knowledgeable supervisor to process the liability and potential behavior issues that could unfold in group. Continued trainings should be offered to anyone working with children to ensure professionalism, boundaries, and skills-training. Therapists working with children, must also work with adults, the parents or the legal guardians. And, this dual relationship can become difficult, but important. Clinicians need to understand legal issues regarding mandated reporting and documentation. Trainings by both clinical and legal professionals during supervision would help ensure current responsibilities and mandates. And, educational trainings involving evidenced-based practice and multicultural aspects of family therapy need to be reviewed periodically in an effort to increase therapeutic alliance, which could potentially retain family members in treatment for longer periods of time and decrease treatment drop out (Gopalan, & et al., 2010).

One of the “most highly-ranked challenges revolved around providing therapy to a population without appropriate training and supervision” and in turn this affects the therapeutic alliance causing the group to be “more guarded and less trusting and open” (Glebova, Foster, Cunningham, Brennan, & Whitmore, 2012, p. 54). I am not comfortable with working with children. I do not have the training and I am not interested in working with this population. I do not mind working with families of the patient that I am treating. However, I am not comfortable with young children.


Berg, R., Landreth, G. L., & Fall, K. A. (2013). Group counseling: Concepts and procedures.New York:


Glebova, T., Foster, S. L., Cunningham, P. B., Brennan, P. A., & Whitmore, E. (2012).

Examining therapist comfort in delivering family therapy in home and community settings: development and evaluation of the Therapist Comfort Scale. Psychotherapy (Chicago, Ill.), 49(1), 52–61. https://doi.org/10.1037/a0025910

Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. M. (2010).

Engaging families into child mental health treatment: updates and special considerations. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 19(3), 182–196

Shamika E

As the writer has previously stated she has always wanted to work with children. She has had the opportunity to work with them in one on one settings as well as groups but felt she wanted to do more. She is currently in a position where she is a apart of a heath care team called the family engagement center. In this department I work with problems regarding children with special needs and their families. So she is familiar with working with complex issues with children and their families. But she also knows it will be different in a counseling setting. One reason in particular is because she will be interacting face to face and for the last few years all of her work has been over the phone.

There are two challenges that the writer feels can be challenging. The challenges would be confidentiality and resistance. Depending on the age of the child the counselor must notify the parent or guardian on the nature of the group and progress of the sessions(Berg, 2013).The problem with this is that even as a minor the child has rights to confidentiality and the counselor must follow those guidelines as well. For example in health care at age 13 we must ask parents if they have permission to speak on behalf of there child. More times than not parents response is “they’re a minor” “I pay for the insurance”. So the writer knows there could be bigger problems with more complex subjects and situations such as sex and drugs. The second problem would be resistance. Most children are not willing participants of counseling and because of this they view counseling as a punishment (Berg, 2013). Trying to build that relationship with a person who doesn’t feel they belong may be tough. Berg discusses in his text that building rapport should start during the pre group interviews. Another great tip is not to try and be “cool”. As the counselor you should not be trying to relate to the adolescents as you are not their age. You can show you support without using their verbiage or behavior. This can cause a big problem because an adolescent will see through that and then feel like they’re being tricked (Berg, 2013). If the client doesn’t trust the counselor the treatment will beu unsuccessful.


Berg, R.,Landreth, G.L.,& Fall, K.A.(2013).Group counseling:concepts and procedures. New York: Routledge

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