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INTRODUCTION
tl7
LITERATURE REVIEW
Psychosocial
Development
and LearningDisabilities
AdolescentGroup Therapy
1968;Raubolt,1983;Sheidlinger& Aronson,L99L).Theseauthorsagree
that group therapyaidspeersin assistingand confrontingone another;pro-
vides a mirror to stimulatenew conceptsof self; enablesthe adolescent
membersto feel less isolated;and facilitatesincreasedself-esteemboth
through being acceptedby the group and by helping others.A group ex-
perienceallowsthe adolescents to expressrebellionand conflict,to become
more independentand to identifywith the leaders(Azima & Dies, 1989;
Azima & Richmond,1.989;Berkovitz& Sugar,1986;Maclennan & Fel-
senfeld,1968;Scheidlinger& Aronson, 1991).Peer support in therapy
groupsfacilitatesa working alliancedespitethe adolescent'sfrequent op-
positionto attendingthe group (Raubolt,1983).
These authors emphasizethat the developmentalstageadolescents
are irr-ryhich includesseparationfrom parents"-makesgroup particularly
effectivefor adolescents. The peergroup is central,importantand powerful
for adolescents; it facilitatesidentification,directionand aids in the task
of differentiation/separation.
A studyof curativefactorsin adolescentgrouppsychotherapy (Corder
et al., 1981)cited the mosthelpfulfactorsto be cohesion,universaliW, ca-
tharsisand interpersonallearning,with insightand direct interpretation
perceivedas the leasthelpful.Thesefindingswere similar to a previous
studywith adults(Yalom, 1975).
who haveLearningDisabilities
Group Therapywith Adolescents
PROGRAM DESCRIPTION
and change. The goals and objectives for all the members include: (i)
greater ability to expressthemselvesand to verbalize theh feelings; (ii) in-
creased self-esteemand ability to take risks; (iii) increased social compe-
tence, which includes the ability to understand and relate to others, to
perceiveverbal and nonverbal cues and to be lesssocially isolated; and (iv)
greater ability to initiate social interaction,assumeresponsibility,and, in a
beginningway, deal with issuesof independence.
The group-as-a-wholetasks include finding commonalities and devel-
oping a sense of trust. In light of the absenceof appropriate social skills
among this population, the groups must deal with silly or inappropriate
behaviourswhich are exacerbatedby the learning disabilities.The leaders
help the adolescentsdeal with problematic interactions by encouraging
them to support and challengeone another. A key objective is to enable
the members to assumegreater responsibilityfor the group's functioning
over time, and thereby reduce their dependencyupon the leaders.
We make adjustmentsto accommodateparticular learning disabilities
and levels of social functioning. Iraders assessand respond to the needs
of individual group members. In doing so, a leader might clarify verbal
statements and nonverbal cues; monitor group discussionsto ensure that
members follow the conversationsand recall what others have said; offer
connectionsbetweeninappropriatebehavioursand underlyingfeelings;and
provide active direction and assistanceto enable membersto acknowledge
and talk to each other. Further adjustmentsdue to the adolescents'learning
disabilitiesand social isolation include having contact with parents while
the adolescentsare involved in groups, and encouraging members to so-
cialize with one another outside the group.
The groups can be understoodalong a continuum of social function-
ing. At one end are adolescentswho need help to make basic social con-
tacts;at the other end are adolescentswho displaysome socialcompetence
but need help to develop self-awareness and internalizedcoping strategies.
The extent to which leadersintervenein each group varies along this con-
tinuum. With memberswho need help in making basic social contacts,the
leaders actively direct, guide and provide structure for the group members.
With those who need help in developing self-awareness,the leaders offer
non-directive facilitation and interpretation. Parental involvement also var-
ies accordingto where the groups fall along the continuum of social com-
petence,decreasingas the adolescents'competenceincreases.For example,
in groups where socializationis just beginningand the adolescentsare less
able to speak for themselves,contact with parents can enhance the ado-
lescents' participation. Parents can suggestrelevant issuesfor the adoles-
cents to deal with in group, can encourage reluctant adolescentsto attend
group and can assistadolescentsto socialize outside the group.
t24 Mishrru,Kainran, Little, and Tarshls
Group Examllle #1
This example reflects a group that falls towards the end of the con-
tinuum where socializationis at an early stage.This was an 8-weekgroup,
which met weekly for | 1,12hour sessions.It was composedof seven ado-
lescentboys rangingin age from 13 to 16, all of whom had severelearning
disabilities.Their languageand conrmunicationdisabilitiescontributedto
their social isolation and dependenceupon their parents.The boys had
long historiesof being teasedand victimizedby peersdue to unusualman-
nerismsand behaviours.Most were withdrawnand afraid to initiate inter-
actionswith peers.Two femalesco-led the group.
In the sixth session,the leadersgavethe boystwo soft spongeplaying
balls during the group break. One boy, Martin, sat apart from the group
and tosseda ball into the air. The rest of the boys excitedlythrew the
secondball to one another,while Martirr watched.One boy, Alan, playfully
tried to grab Martin's ball, but Martin preventedhim. After severalat-
tempts,Alan walked away.At the end of group, Alan told the boys that
he had wanted to play with Martin. Another boy added that he too felt
disappointedthat Martin had not played with them. In response,Martin
declaredthat he did not want to play with the others.As it was time to
end, the leaderssuggestedthat they could continue this discussionin the
next group.
At the beginningof the following nreeting,Martin brought up the
previousweek's issueand told the group that he preferred to play by him-
self.Alan respondedby telling Martin that he thought that was a problem
and added that he wanted to play with Martin. A third boy, Charlie,sug-
gestedthat Alan wantedto be Martin's friend. He said he understoodMar-
tin becausein the past he too wanted to play alone,but that he now liked
playing with others and having friends.Alan agreed that he did want to
be Martin's friend to which Martin reiteratedthat he wanted to play alone.
During the break, Martin again tossedone ball up in the air and
Alan once more tried to engagehim by grabbingthe ball. Martin held the
ball tightly againsthis body. Alan playfully hit Martin with a cushion,to
which Martin respondedby laughingand dodging Alan. After the break,
Group Therapy wlth AdolescentsWho Have Learnlng Disabllitles 125
Discussion
what aware of his impact on others and of their feelings.His desire not
to hurt them and to not be misunderstoodby them suggestedthe increasing
importance of group to Martin.
It was essentialthat the group members accept Martin for his pref-
erence to play alone. Once the others acceptedhim but still sought him
out, he showed a more active interest in their play. Thus, the group's ac-
ceptanceof his difference allowed Martin to risk joining in their play.
This group dealt with issuesof inclusionand trust. The exampleshows
the importanceof group membersfeeling acceptedbefore taking risks.This
was a group of boys who initially were not able to engagein spontaneous
social encounters.The boys needed the leadersto facilitate their interac-
tions to enhancetheir ability to relate to another.
Martin provideda significantchallengeto the other group members.
In response,they made dramaticshifts in their interactions.One boy took
a risk by initiating social contact and one boy displayedempathy for an-
other by recallingthat he too had similar feelings.The boys in the group
enactedtheir desiresto connect,play and have fun. They also expressed
their feelingsand needs.They understoodMartin's desire to play on his
own and could recall when they were like that. They identifiednew needs
and the changesthey had nrade in their desireto socializewith others.
By the end of the group, the boysestablished enoughcomfort to talk,
joke, roughhouse,plan a party and see each other outsidegroup. Several
monthsafter the group ended,most of the boyswere talking on the phone
and making plans to see one another.
Group Exanrple#2
and expressedthe pain they felt. Lana, who has a nonverbal learning dis-
"only friend in the world" would
ability, told the group her problem: her
phone her and after five minutes ask to speak to her younger sister.Typical
of these adolescents'situations,her sister was socially and academicallysuc-
cessful.Lana asked for advice to get her sister to stop talking to her friend.
Although the girls offered her advice,she was not comforted and continued
asking them what to do. Finally, the girls questioned whether the girl was
"friend", but the girls
indeed a good friend. lana initially defended her
pursued in their challenge. The leaders suggestedthat perhaps Lana ex-
cused the friend and blamed her sister out of fear of being alone. Lana
agreed and said that she was afraid shd would be lonely and friendless. In
responseto Lana expressingvulnerability, the other girls reached out and
told her that she could turn to them. Although it was difficult, Lana even-
tually was able to hear and think about the girls' feedback.
A significant issue in this group was the manner in which Lana ex-
pressedher issue by sitting forward in her chair and focused exclusivelyon
the leaders.She did not make eye contact with the group members.Not
long after she began talking, the girls stopped paying attention, became
restless,whisperedto one another and looked to the leadersfor direction.
Lana did not notice what was taking place, despite the obvious distracti-
bility of the group members.Eventually,one of the leadersstopped Lana
and askedthe group how they could help her talk to them rather than just
to the leaders.The girls immediatelytold Lana to try to look at them when
she spoke. She did so, but needed several reminders to continue talking
to the group. The leadersgave the first two remindersafter which the girls
spontaneouslyprompted her.
Discussion
In this group, Lana shared one problem and enacted another with
the group and received feedback about her relationshipsand behaviour.
The other group members challengedher to look at the problem differ-
ently, helping her to evaluate her friend's behaviour more objectively.In
the discussionthat followed, it emerged that Lana was afraid of being
alone. lraders linked this fear to her tendency to protect the friend and
blame her sister. As a result of the girls' feedback,Lana began to view her
situation differently. After Lana expressedloneliness,the girls felt empathy
and reached out to her, whereas previously they were frustrated with her
apparent obliviousnessto them.
Lana's behaviour in this group was due to severalfactors such as her
anxiety and lack of ability to socializeas a result of her learning disability.
128 Nlishnn, Kainran, Littlc, and Tnrshis
SIJi\{Mr\IlY
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