Group Treatment of Adolescents in Context: Outpatient, Inpatient, And School (Book Review)

Author:  Aronson, Seth and Scheidlinger, Saul
Publisher: Madison, CT: International Universities Press, 2003
Reviewed By: Andrea Corn, Winter 2005, pp.61-62

It is indeed a pleasure to be asked to review this book, as I have listened to many of Seth Aronson’s engaging presentations at Division 39 conferences. This book is down to earth and user friendly for both the analyst and non-analyst. The editors have filled an important void, as cost effective treatment approaches today are a necessity. They acknowledge the sad reality that most outpatient treatment centers have undergone significant internal changes as financial reimbursements have superceded patient needs. Many facilities have acquiesced to time-limited, psychoeducational approaches, thereby diminishing opportunities to obtain in depth self-reflective and structural change. Consequently, this has even prompted adolescent inpatient care to be transformed into short-term venues that revolve around “diagnosis, crisis intervention,” and psychopharmacological treatment. Despite this unpleasant reality, adolescent group treatment within a hospital milieu is given considerable attention.

One of the underlying tenets of this book has been to point out how adolescent treatment groups are inherently related to their environment. Broadly speaking, this text systematically deconstructs the various elements that comprise an adolescent group. It begins with the physical setting, which includes the creation of a therapeutic space of safety and trust; the social setting, (e.g., outpatient, inpatient, or school) plus the corresponding administrative structure; and the temporal factors, which comprise the group’s established meeting time, rules, and goals.

This book is practically constructed and neatly divided into three parts. Part I examines outpatient groups, Part II, inpatient treatment, and Part III, group therapy in schools. In the first chapter, Scheidlinger discusses the rationale for adolescent group treatment. He notes that, “ample empirical and research evidence indicates the adolescent peer group serves a crucial role in the promotion of self-esteem, a sense of identity, social and moral maturation, and above all, emancipation from the parents” (p. 2). Common sense, helpful tips are offered such as how to minimize fears and facilitate group cohesion and heterogeneity with prospective teens, plus how to create that positive connection with parents. Developmental tasks are different for younger and older teens, so in Chapter 2, Aronson weights the pros and cons for separating early adolescents (12-14 years old) from older (16-18 years old) teens. The next topic Aronson addresses covers many of the tangible aspects. Examples are: the importance of location, the arrangement of the furniture, pros and cons of using one or two co-therapists, gender factors, and whether or not to serve food. The chapter concludes with an overview of the initial meeting, and the importance of establishing rules, educating teens about confidentiality matters, and demonstrating responsible conduct. A number of these troubleshooting tips would be most instructive for a beginning therapist.

In Chapter 3, Aronson continues discussing outpatient group treatment, highlighting the role of the therapist to outlining the phases in group development, to a discussion on differing theoretical orientations. Thumbnail sketches of a number of theorists and their contributions to adolescence development are offered. Issues pertaining to transference, countertransference, defenses, resistances, negotiations and working through are discussed in relation to the group, its members, and their goals. In Chapter 4, Aronson describes working with the most commonly referred adolescent groups, notably, Conduct Disorders, Attention Deficit, Substance Abuse, Mood Disorders, Sexual Abuse, and Gay, Lesbian, and Bisexual Youth groups. Brief vignettes accompanied each segment to highlight individual strengths and deficits of selected group members. In Chapter 5, Scheidlinger presents several in-depth series containing dialogue of group sessions from different ages and genders in outpatient and inpatient programs. Notwithstanding the different ages and presenting problems, this chapter demonstrates the importance of the therapist’s authenticity and ingenuity, and how problems are handled when the defenses of denial, projective identifications, seductiveness, resistances against painful affect, and regressions surround the termination phase of treatment.

Part II examines the Inpatient Group population. In Chapters 6 and 7, Fady Hajal describes her experiences utilizing group psychotherapy with psychiatrically hospitalized adolescents. Chapter 6 starts by outlining the myriad of changes that have taken place during the 1990’s and how managed care has irrevocably changed the nature of treatment interventions. “Faster, Shorter, and Single-Focused” is the motto that captures adolescent inpatient units operating in brief, time-limited experiences, and where symptom relief becomes the primary treatment goal. Additionally, inpatient psychotherapeutic groups strive to improve problem solving and conflict resolution skills so that teens can acquire enough emotional and behavioral control to be reunified with their family and peers. Hajal touches on some of the difficulties teens have once they are admitted into an inpatient unit, and how group leaders can ease some of their initial distress. Hajal goes into detail outlining the different social roles various inpatient members can assume as well as listing multiple group treatment modalities. Practitioners who work in inpatient settings will find these two chapters instructive and quite meaningful.

Chapter 8 examines Group Therapy with Adolescents on Dual Diagnosis Inpatient Units. The authors, Emile Pincus, Fady Hajal, and Juanita James, examine the role alcohol and marijuana play and the deleterious effects that can result for teens diagnosed with substance abuse. These authors describe an integrated inpatient program that is strictly behavioral in its interventions within a multifaceted group therapy program. According to the authors, this process works best when integrated with a host of other treatment modalities, including individual and family therapy, as well as milieu treatment, and psychopharmacology. Last, other therapeutic services including open–ended traditional therapy groups, with recovery oriented groups, and educational and ancillary groups, were explored .

The last portion of the book, Part III, explores group therapy within the School setting, and how high schools have become important outpatient treatment settings. Undoubtedly, the biggest factor occurred following the horrific tragedy at Columbine High School in Littleton, Colorado, and from there the groundswell grew as parents across the county demanded early intervention programs to assist teens at risk besides combating such daily issues as bullying, school violence, substance abuse, teen suicide, etc. In Chapter 9, Albert Riester, discusses the organizational planning and details involved in conducting therapy within a high school setting. Riester clearly reminds us how important it is to coordinate the planning of services with administrators and school counselors. Riester discusses many of the same considerations Aronson did in preselecting patients. He incorporates the necessity of being sensitive to the high school culture and how to work within this administrative structure. Riester details the stages of adolescent group work: establishing the group formation (3 sessions), the storming or conflict stage (2 sessions), the working through phase, or stage of cohesion (2 stages) and the termination and transition stage (3 sessions). Primarily, these groups are designed to respond to social issues as well as particular emotional and behavioral problems, in order to help students reach their full potential. Since relationships are critically important in the lives of teenagers, ways to enhance communication skills and peer friendships are also presented. As long as the group counseling experience is able to enhance a student’s well-being, foster improvement in his or her academic functioning, and teach prosocial coping skills, schools can and should advocate for such services.

In Chapter 10, Riester, continues his discussion of group counseling in the American high school, and notes the value counseling groups provide in helping teens resolve their everyday problems in an environment of interpersonal support. Today the high school setting holds a very influential place in shaping the adolescent’s identity, academic achievements, and interpersonal interactions. Therefore, Riester notes, “it is imperative for therapists and counselors to understand the school culture where adolescents experience mastery, rejection, frustration, recognition, failure, and a variety of peer and adult relationships” (p.194). For some teenagers, high school may be the only place where they can find support and feel understood. In 1983, Boyer stated, “for many, the school (it) becomes a crisis center to help youths cope with their dysfunctional families and to deal with a variety of problems such as substance abuse, health problems, teen pregnancy, violence, and abandonment.”

The book concludes here. For me, this chapter left an impression about how essential it is for educators and school counselors to work collaboratively within the school’s culture, and establish preventive and intervention programs to ensure the well being of adolescents today and tomorrow. Despite the departure from Aronson’s highly creative and imaginative musings heard in his analytic presentations, this book provides wonderfully practical and constructive information, and is likely to become a classic primer for the practitioner new to group therapy as well as the seasoned clinician.

References

Boyer, E.L. (1983). High School: A Report on Secondary Education in America. New York: Harper & Row.

Reviewer Note

Andrea Corn is a psychologist in private practice in Ft. Lauderdale FL. She is very active in Section IV (Local Chapters), and currently is the Section IV representative to the division board.

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