Child Group Psychotherapy in the School at the Threshold of a New Millennium

More and more children and adolescents today are exhibiting adjustment problems in the school. Some of these problems are part of their normal developmental tasks, whereas others are a result of stressful events in their lives. For instance, the transition from one neighborhood to another, or from one school to another, may be a normal transition for some yet might present a great emotional and social challenge to others. Moreover, many children experience test anxiety, school failure, social isolation or rejection, or are involved in bullying. Unfortunately, a growing number of children and adolescents also experience unusual stressful life events that have a detrimental impact on their emotional well-being, social life, and school performance. Family break-up, parental neglect and abuse, death, war, and world disasters are all stressors that affect how children function (American Psychiatric Association, 2000). Such events are reflected in deviant behavior of an internalized or externalized nature: withdrawal, depression, suicidal behavior, eating disorders, aggression, violence, and delinquency. Whether such problems are merely developmental or anchored in mildly or severely stressful life events, child group psychotherapy may be the treatment of choice. Of all psychotherapy modalities, therapy in a group effectively and efficiently furthers children's capacities for social interaction and intimacy through interaction that is familiar and nonthreatening to them (Kymissis, 1996; Rose, 1998; Schaefer, 1999). Such intervention, which has proven to be as effective as individual therapy (Hoag & Burlingame, 1997; Shechtman & Ben-David, 1999), is cost-effective. With a ratio of 1 counselor to 400 students (DeLucia-Waack, 2000), economic considerations clearly call for greater prominence of child group psychotherapy. Indeed, the high level of need has contributed to an increase of group work in the schools, and over 80% of children's psychotherapy groups are performed in that setting (Hoag & Burlingame, 1997; Kulic, Horne, & Dagley, 2000). Rapid development of children's groups in the school does not always produce the best results. Treatments should be tested to establish their accountability, and existing group processes should be explored to inform practitioners about the best practices. In this respect, research on child group psychotherapy has fallen short. In a recent journal reviewing 100 years of group research, the editor (i.e., Forsyth, 2000) concluded that "the scientific study of groups is only reaching its adolescence" (p. 4). In the case of child group psychotherapy, it would probably be correct to suggest that research is still in its infancy, based mostly on the least rigorous methodologies, such as case studies (Barlow, Burlingame, & Fuhriman, 2000). Too much of what is known about group work with children is based on adult groups; however, it is clear that the dynamics in children's groups--as well as children's needs--are very different from those of adults (DeLucia-Waack, 2000). In light of this lacuna, this article presents and discusses the types of groups practiced in schools and their outcomes, highlights the very few process studies available, and draws some practical implications that might eventually improve our clinical work. TYPES OF GROUPS PRACTICED WITH CHILDREN The typology of group intervention with children includes three types of groups: Guidance/Educational, Counseling/ Interpersonal Problem-Solving, and Psychotherapy/Personality Reconstruction (Gazda, 1989; Gladding, 1995). Of the groups practiced with children in the school, 37% entail guidance groups, 55% are counseling groups, and most of the rest are a combination of the two (Kulic et al., 2000). Most educational and counseling groups are time-limited (about 3 months) and take a cognitive-behavioral approach (Barlow et al., 2000; Hoag & Burlingame, 1997; Kulic et al. …