Time-limited group treatment of children.

SALVATORE LOMONACO, M.D.,* SAUL SCHEIDLINGER, Ph.D.** SETH ARONSON, Psy.*** While the mushrooming recent use of short-term treatment modalities for adults, related, in part at least, to the cost-cutting efforts of the country's managed health care system, is relatively well-known,l the parallel growing practice of time-limited groups for children, has so far not been appropriately covered in child psychotherapy's textbooks. This is especially regrettable since the journal literature suggests a current predominance of these abbreviated child-group approaches in clinical work. Time-limited group treatment will be viewed in this paper as encompassing 8 to 25 sessions over the course of six months. Fewer are crisis intervention, while more are long-term psychotherapy. Historical Precedents The beginnings of clinical psychotherapy groups for children were understandably anchored in the then prevailing broader psychodynamic model of open-ended, and long-term "reconstructive" interventions.23 These approaches were preceded and accompanied, however, by less intensive psychoeducational kinds of shorter-term group modalities, especially diagnostic groups,4 as well as groups associated with therapeutic camping.5 In the 1950s and 1960s, in tandem with these developments, pediatric hospital wards had employed short-term groups for their child patients.6 Characteristically, ever changing in line with the flux of medical admissions, these groups emphasized cathartic expressions of fears, corrections of anxieties and of distortions, provision of factual information, and, above all, companionship and mutual support.7,8 At about the same time, psychoeducational groups for so-called "children-at-risk," made their appearance. Conceptualized within the context of primary prevention, Churchill9 used discussion groups for siblings of hospitalized psychiatric patients aimed at modifying the strains and stresses inherent in such situations. Anthony10 similarly relied on the abbreviated group medium to help children of psychotic parents. Besides offering factual information about the illness, the group sessions were designed to help these children cope with the irrational conduct of their elders, as well as to achieve a degree of distance and of objectivity from the psychotic elements in their lives. In the field of community mental health, time-limited children's groups also emerged during the 1960s as part of the War on Poverty, within the context of "crisis intervention." Located in clinics, in schools, and in youth-serving organizations, children-of-divorce groups addressed themselves to offer the millions of affected youths ongoing support through shared information and emotional expression. The sense of a peer communality, coupled with the disavowal of blame for the parental discord, were expected to prevent the emergence of personality pathology.11,12 Through the impetus from related community mental health programs, inner-city schools also developed special groupings for children with learning disabilities and behavioral problems. Self-esteem-enhancing activities, together with the release of feelings, were expected to lead to improvements in children's attitudes and behavior.13 While all of the time-limited group-intervention modalities discussed so far fall into the general category of psychoeducation, the following sparser approaches were more strictly clinical in character. They, thus, entailed specially trained group therapists who worked in clinical settings, with child-patients in small, carefully planned groups to effect "repair" of diagnosed dysfunctions.14 In the inpatient context, the literature of the 1970s carried only three references that pertained to short-term groups. The first, by Abramson, Hoffman and Johns,lf dealt with an open-ended play group for severely impulsive, hospitalized, elementary school-aged children. The twiceweekly sessions emphasized verbal interventions in response to the content of the play, to group interactions, and to emotional ideations. …