Managing the Child with Behavioral Disorders in Group Therapy

As a leader of a support group for children, one can contest that may children with emotional trauma, can be described as disruptive, or with having a behavioral disorder. This child’s bad behavior is not unique, in fact, for those children who have a multitude of external stressors; he or she is the norm. Authors, Kann and Hanna (2000) reviewed current studies related to the prevalence of two behavioral disorders, Conduct Disorder and Oppositional Defiant Disorder, in children. Kann and Hanna (2000) found that risk factors play a significant role in the development of behavioral disorder, these “risk factors can be societal, familial, or individual in nature,” (p. 270). Researchers Moss et. al. (1995) found that most often, low economic status seems to be the most reliable correlate associated with behavioral disorders, while Kann and Hanna (2000) find that parental behavior and disorder seem to be a strong predictor of behavioral disorder in children.

Given the known impact that external stressors can have on a child’s likelihood to manifest behavioral disorders, it would be in both the client and the therapist’s best interest to meet privately in order to discuss the possibility that these issues exist. It is quite probable that the child’s behavior is rooted in the their experience of external stressors. Therefore, to ignore this possibility, and attempt merely to correct the behavior disorder, will surely result in failure to effectively treat the child. Meeting individually will also allow the therapist to discuss the impact and consequence of the child’s behavior onto the other group members without public embarrassment. Yalom and Leszcz (2006) suggest that in order for treatment to be effective “the individual’s behavior and the impact of that behavior on others need to be revealed and processed if the members are to arrive at an empathetic understanding of one another,” (p. 43). Additionally, during this individual meeting, the therapist should reiterate the group rules and behavior expectations that were explained to him or her at the initial meeting; be respectful others; keep hands, feet and other objects to yourself; wait to be called on before talking. It is possible that he or she has forgotten these rules and a simple reminder may prove effective for the next session or two.

While the therapist may be inclined to remove the child from group, it is not necessarily appropriate to exclude the child solely based on their display of behavioral issues. If these behaviors are a result of a trauma they have experienced, it is likely that these will improve as their treatment progresses and their issues are resolved (Kaduson, 2006). Furthermore, clients who present with interpersonal or impulsivity issues typically work better in groups, than they do in individual therapies (Yalom & Leszcz, 2005; Jacobs, Masson & Harvill, 2009). Group therapy, by its nature, is a social setting, which facilitates the development interpersonal skills and learning through modeling. Children, therefore, tend to behave favorably in group settings because of their desire to maintain social cohesion, (Gerrity & Delucia-Waack, 2007).

For the child who unable to verbalize their feelings or the source of their anger, treatment that utilizes play therapy may be effective in a group setting. Through play, children learn to communicate their feelings instead of acting them out, as is the case of with the disruptive child, (Pearce, 2006). Jacobs, Masson and Harvill (2009) also suggest that structured group activities be intermingled with lecture, a method that has shown to be tremendously effective at keeping the child client focused on the topic, thus reducing disruptive behaviors. Consistency is also key, as the child then knows what behaviors and consequences are expected and therefore will be better able to maintain status quo.

In general, child clients, more so than their adult counterparts, have a tendency to evoke feelings within their therapists of irritation, disgust, anger, resentment, sympathy, anguish, and defeat (Church, 1994). Therapists also report that clients with behavioral disorders are often the most challenging and difficult to manage (Kann & Hanna, 2000; Church, 1994). Kann and Hanna (2000) suggest, “the consequences of these behaviors affect not only the children and adolescents who suffer from them, but their families, their peers, and society as a whole,” (p. 267) and left untreated, this disorder can further manifest itself in adulthood. Therefore, while the child may prove difficult to control, it is imperative that they receive treatment.

When working with children with behavior disorders, it is important that the therapist remain empathetic, understanding, and consistent. As previously noted, a strong correlation exists between the presence of external stressors and the child’s likilhood to present with behavioral disorders. Kann and Hanna (2000) report that in most adolscents report that they only feel comfortable with disclosing personal information when they believe that their therapist is genuinely concerned with their thoughts, experiences and feelings. It has been shown that children flourish when in a predictable environment, as these rituals tend to serve as the foundation for structure and stability, thereby setting the tone for healthy interactions (Dickstein, 2002). If provisions are made to incorporate these aspects, group therapy can prove to be incredibly therapeutic and effective in correcting behavioral disorders in children.

Stephanie Lowrance-Henckel

References

Church, E. (1994). The role of autonomy in adolescent psychotherapy. Psychotherapy, 31, 101-108.

Dickstein, S. (2002). Family routines and rituals-The importance of family functioning: Comment on a special section. Journal of Family Psychology, 16, 441-444.

Gerrity, D. & DeLucia-Waack, J. (2007). Effectiveness of groups in schools. Journal for Specialists in Group Work, 32(1), 97.

Jacobs, E., Masson, R. & Harvill, R. (2009). Group counseling; Strategies and skills (6th ed.). ThomsonBrooks/Cole. Belmont, CA.

Kann, T. R. & Hanna, F.J. (2000). Disruptive behavior disorders in children and adolescents: How do girls differ from boys? Journal of Counseling and Development, 78(3), 267-274.

Kaduson, H.G. (Editor). (2006). Short-term play therapy for children (2nd ed.). New York, NY. Guilford Publications, Inc.

Moss, H.B., Mezzich, A., Yao, J.K., Gavaler, J. & Martin, C.s. (1995). Aggressivity among sons of substance-abusing fathers: Association with psychiatric disorder in the father and son, paternal personality, pubertal development, and socioeconomic status. American Journal of Drug and Alcohol Abuse, 21, 195-208.

Pearce, J.W. (2006). Psychotherapy of abused and neglected children (2nd ed.) New York, NY. Guilford Publications, Inc.

Yalom, I. & Leszcz, M. (1995). The theory and practice of group psychotherapy (4th ed.). BasicBooks. New York, NY.