This edition of our newsletter features an extended edition of our most popular column, Ask Violet.
This time Dr. Oaklander writes about working with children in groups.
DO YOU DO GROUP THERAPY WITH CHILDREN?
Yes, and I love this medium. I have worked with many groups with all kinds of configurations. I worked in camps starting at age 15. (At that time, some of my campers were only two years younger than me!) I did all kinds of group activities over the years: crafts, swimming, singing and much more. These were not therapy groups, but laid the foundation for me to feel comfortable and enjoy working with groups of children.
A therapy group has the advantage of being a small, insulated world in which
present behavior can be experienced and new behaviors tried out. The child’s
way of being in the group, and how the behavior affects others positively or
negatively, becomes clearly evident. The group becomes a safe laboratory for
experimenting with new behaviors through the support and guidance of the
Therapist. (Oaklander: Group Play Therapy from a Gestalt Therapy
Perspective: pages 162-175).
When I worked in the schools with emotionally disturbed children, serious therapy took place. The group consisted of twelve children each time. Many of the stories in my book, Windows to Our Children are about these groups.
My first “real” therapy group consisted of children whose fathers were in the U.S. Navy and part of an alcoholic treatment program. This group broke all the “rules” of groups. There were up to twelve children, ranging in age from eight years old to sixteen years old with a few siblings thrown in. There was always a core group, but a few children came and went, based on their Dad’s involvement in the treatment program. The group met weekly for two years in my own living room. We used all of the expressive techniques I wrote about (including clay) and most particularly with dreams. I still remember one fourteen-year-old boy’s dream: “I am in a car driven by my Dad. We are going down a steep hill and at the bottom is a lake. The brakes fail and we are going faster and faster and just before we fall into the lake, I wake up.” An eight-year-old boy in the group said, “I have a road just like that in my life.” If you walked into the room when this group was meeting, you would think you were seeing a very sophisticated Gestalt therapy group.
I have had many other kinds of groups as well and have experimented with a variety of group sizes. Generally six children who are over eight years old is a good size, and three to four children who are under eight. But any size is good since it can be an ideal setting for children who need connection with other children. It is helpful to have a co-therapist—occasionally a child does need some individual attention. We usually meet for one and half hours. Some groups can be time-limited though it’s important to know that it takes four to six weeks for a group to gel. I am not partial to groups of children who have had similar experiences, such as child abuse or divorce, since I feel such groups tend to label these children and isolate them from other children. I think children can understand and learn from varied experiences. Certainly the children of dads in the Navy was an exception to my belief!
One day I suddenly had the idea of forming pairs: two children of the same age meeting together. Many of the children I saw had social difficulties and I thought this would be a good way of making contact with one child, rather than a whole group. I started with two seven-year-old boys that I had seen individually. We played games, and they worked on sand tray scenes, drew pictures of anger. For the first three or four weeks, each boy was polite, interested and pleasant. They shared interests and complaints. After that, their problem behaviors shone through. They began fighting with each other, evidenced jealousy, and had difficulty staying present. So that’s when the work started! At each point, I would call a halt and discuss with the boys what was happening. Soon I noticed that they were beginning to catch themselves before bedlam happened. It was almost like watching the brain build new pathways. Their parents reported that there was carry-over at home and at school. I worked with several “pairs” after my first experiment, to similar success.
I think it’s important to have structure in a group. First of all it’s important to me to begin on time. As soon as the group members realize that we will start on time, magically each member appears on time. They don’t want to miss anything! They begin bugging their parents to be on time. We start the group with a check-in. Usually with children this is a time to say something that happened during the week, or even that day. The rule is that no one interrupts when someone is talking. We have used talking sticks or such which have been helpful. Of course they interrupt, but we ignore this and focus on the child who is talking. It has become clear to me that children tolerate much more disruption than I do.
We also end the group in a formal way. First the children help clean up and take their seats. This is a time for closure. Everyone is given the opportunity to say what they would like to say to the therapist or anyone else in the room, to critique the activity, to mention something they particularly liked during the time, or something that annoyed them. It is important for the therapist to pace this group session to allow time for cleanup and closure. I often use a kitchen timer to remind me and the children of time limits.
Example: At the closing time of a group of six children, ages 11 and 12, (four boys and two girls), Carrie, with much hesitation and caution, told Tommy, “I didn’t like it that you always tried to sit next to me today and when you did it was too close and I didn’t like it.” I said to Tommy, “Tommy, I’m glad you listened to Carrie; what she is saying is hard for her to say, and very important to her. Thank you.” At the next meeting’s closure Carrie said, “Tommy, I really appreciate that you didn’t try to sit next to me all the time, and when you did, you weren’t too close.” Tommy smiled as if he had received a great gift.
Unless my purpose is to observe free play, I will plan an activity. Sometimes something emerges from the check-in rounds that needs attention, or the children don’t like my agenda and my plan must be discarded. (This makes for good discussion and contact.) Usually the children respond very well and look forward to my plans. The activities are varied and generally enjoyable. Basically they facilitate expression of feelings, definition and strengthening of self, and experiences with healthier aspects of the self. Many projective techniques are used such as drawings, clay, collage, puppetry, music, body movement, creative dramatics, storytelling, fantasy and imagery. Sometimes we use themes that are relevant to the children, such as loneliness, teasing, rejection, embarrassment, loss, divorce, bullying, and others. I might ask the group to think about loneliness, for example, and draw something to represent that feeling. The children rarely make fun of anyone. I think my attitude of respect for each effort sets the tone.
An important theme for any group is anger; this lends itself to many activities: drawings, clay, music, discussion, and puppetry. For example, children may be asked to draw something that makes them angry, or to make a figure out of clay representing someone they are mad at, or to play a variety of percussion instruments expressing feelings, or to put on a puppet show about an angry scene. Gaining skills for expressing angry feelings safely and appropriately is an important aspect of these activities.
Discovering that other children have similar thoughts, concerns, worries and fears is a revelation to most children. The more they feel this commonality, the more support they appear to feel. This outside support strengthens their inner support and a stronger sense of self develops.
Example: Several your adolescent boys were given clay and asked to make something with their eyes closed. The group had been meeting weekly for about two months and Joe had not participated in any of the activities. He usually just sat quietly appearing to listen and watch.
Therapist: Joe, I see the clay on your board—could you describe what it is?
Joe: I didn’t make anything.
Therapist: Could you describe what’s there anyway?
Joe: (staring at the clay) It’s just a lump of nothing.
Joe then looks at the therapist.
Joe: And that’s what I am! A lump of nothing!
Therapist: How do you feel right now, Joe, in this group with all of us?
Joe: I feel like a lump of nothing.
Therapist: I guess what you are saying is that you feel like you’re not worth much.
Joe: That’s right, I’m not.
Therapist: Joe, I feel very appreciative of you for sharing how you feel with us. It shows that maybe you trust us
a little. Thank you.
Joe: (slight smile) That’s O.K.
Although I was tempted to tell Joe all about his good points and worthiness, that would have invalidated his feeling at the moment. I needed to respectfully accept Joe’s self-perception so that he could begin to accept himself. One of the other boys told Joe that he used to feel the same way a lot, and sometimes still does, though not so much anymore.
There was a huge difference in Joe’s participation in the group after this session.
A group, though made up of individual children, has a distinctive life of its own. Every group seems to follow more or less the same pattern. Most of the children in my groups have had some experience with me individually and a relationship has been established, but this has not always been possible. Usually the children do not know each other and come into the group feeling very much alone. Children are quite self-conscious in the beginning and some may tend to manifest a variety of negative behaviors to cover his or her anxiety. I would make use of this time to help the children feel safe and respected and to get to know each other through non-invasive, non-threatening activities. Limits and boundaries must be made clear as needed. After about four to six weeks, the children feel comfortable in the group setting, and anxieties about sharing themselves drop away. Roles often begin to emerge: one child becomes the leader, one becomes the clown, one is labeled the smart one, and so on. I can help the children become aware of these roles through various techniques.
A group of eight boys and girls, ages eleven and twelve, had been meeting together weekly for several months. They now knew each other quite well. Susan clearly emerged as the leader. I presented an exercise that I often use to promote communication, called, “I Like, I Don’t Like.” Each child has a turn making statements to everyone else (including me.) One child said to Susan, “I don’t like it that you always decide what we should do.” At the end of the exercise the game was open for reaction. Susan said, “I know what we should do. Let’s have each person be the therapist for one meeting and decide everything.” We did this for the next few weeks and it was an amazing experience for the children, and for me.
One day I brought in a variety of small games—jacks, pick-up sticks, dominoes, Blockhead, Connect 4—to a therapy group of eight children ages eleven and twelve. The children were paired off and each pair was instructed to choose a game. (This task in itself was interesting to observe.) A kitchen timer was set for ten minutes. When the timer went off, the group was asked to switch partners as well as games. At the end we talked about the experience.
This is the first time I ever played jacks with a boy. I had to teach him how to do it. It was great!
And I was the first boy who probably ever played jacks.
I lost and felt bad and was glad when the timer rang. I guess I just don’t like to lose.
Chris cheated, but stopped when I told him I didn’t like it.
He didn’t cheat at all with me. He was really cooperative.
The general tone of the children was gentle and tolerant and an air of contentment and calmness permeated the room after the game period. Of course there was a lot of noise, but it was the kind of noise one hears when people talk with each other.
Projections often interfere with the child’s ability to relate to other children.
Allen: I don’t like the way Phillip is looking at me!
Therapist: What do you think he is saying to you with that look?
Allen: He’s saying, “You’re stupid!”
Therapist: Pretend this monkey puppet is you and you are Phillip and say these words to yourself. (Therapist holds the puppet in her hand.)
Allen to puppet: You’re stupid!
Therapist: Allen, do you have a voice inside of you that says this to yourself sometimes?
Allen: Yeah! – And my brother says that to me sometimes.
Children need to learn that seeing a facial grimace is not the same as knowing the thoughts behind it. The other child might have a stomachache. Of course, projections are most active with children who have a low self-image and fuzzy boundaries. Group work lends itself to productive work regarding projections. Many games can be invented for illustration.
The video camera is a wonderful tool to use with groups. Sam, age fourteen had a friend his parents did not approve of. Recently Sam invited the boy into his house, ignoring his parent’s rule of not having this friend in the house when they weren’t home. As Sam stood by helplessly, the boy went into the parents’ bedroom and proceeded to examine everything. Sam had been working hard to feel a stronger sense of self and be able to stand up for himself; however, he totally capitulated with this boy. Since he was in great trouble with his parents over this incident, I made it a central theme of the group session. I suggested that the group act out the event in front of the video camera. Sam selected someone to play the part of the unruly boy, and with the camera rolling they proceeded to enact the event to the great enjoyment and suggestions of the other boys. (There were four boys in this group, ages 13 and 14.) I encouraged exaggeration to make the situation more obvious. With great energy, the “bad” boy knocked on the door, entered the house, and proceeded to trash the place, describing loudly what he was doing. Sam meekly stood by trying to protest. I then suggested that they try a different scene in which Sam would act the opposite way. In this scene Sam loudly admonished the other boy, forcing him to leave the house. At the suggestion of one of the group members, a third scene showed Sam’s father returning home (none of the boys wanted to play mother) and showing how proud and happy he was that Sam obeyed the rules. We then watched the enactment on the video monitor to much laughter, followed by a good discussion. Further enactments of other situations became a favorite activity of this group.
I highly recommend that you try some group work. It is an effective, gratifying way to work with children. Children learn social skills, a feeling of belonging and acceptance, a place to express previously unexpressed feelings, and a place to experiment with new behaviors. A successful group is one in which each child feels safe to be vulnerable. The sessions need to be enjoyable for the children, regardless of subject matter. In fact, the enjoyment and nurturing that children feel in a group actually encourages delving into painful places. As each child feels free to reveal his emotions, thoughts, opinions, and ideas, he or she knows that he and she will find support from and connection with the therapist and the other children. In this way, each child makes discoveries about the self that lead to increased self-support and healthy contact in and out of the group.
I am reminded of someone who said to me, “I didn’t know that you can work with children who have such terrible problems, and still have fun!”
Let me recommend a book called, “Group Play Therapy, edited by Daniel S. Sweeney and Linda E. Homeyer (San Francisco, Jossey Bass, 1999.) There are some wonderful chapters about groups.
I recommend, too, the section on Groups in WINDOWS TO OUR CHILDREN on page 285, as well as chapter 9 on groups in my book HIDDEN TREASURE.