using group therapy to reduce anger in middle school boys josie boehlert
TRANSCRIPT
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Using Group Therapy to Reduce Anger in Middle School BoysJosie Boehlert
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Problems Associated with Anger Issues
Academic failure
Truancy
Dropout
Peer rejection
Tobacco, alcohol and drug use
Suicidal behavior
Often becomes worse over time
(Sutcu, Aydin, & Sorias, 2010)
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Reasons Group Therapy Should be Used
Access to multiple students (Burt, Patel, & Lewis, 2012)
Students’ behaviors are shaped by peer perception – presence of others might affect behavior
Support inside and outside of group
“Naturally occurring community of reinforcers”
Minimize stress of unfamiliar
Members might feel more open to share with people that they can relate to(Dwivedi & Gupta, 2000)
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Role of School Counselors
Support academic achievement
Support social development
Improve functioning of whole school
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Application of CBT
Behavior is learned and can be changed
Allows member to try out new behaviors
Promote understanding of anger as a process
Identifies clear goals
Helps students identify triggers
Provides coping strategies
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CBT Techniques
Modeling
Behavior rehearsal
Coaching
Homework
Feedback
Reinforcement
Cognitive restructuring
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Pre-group Measures
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Screening
Initial pool from teacher referral
Research conduct reports (Burt, Patel, & Lewis, 2012)
Observation
Brief interview (Dwivedi & Gupta, 2000)
Assess potential for change
Consider group dynamics
Ability to gain parental consent
Choose 5-7 students in same grade
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Logistical Planning
Scheduling – 30 minutes
Location
Parental permission
Create plans
Obtain necessary materials
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Group Process
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Initial Session
Explain purpose
Positive framing (Burt, Patel, & Lewis, 2012)
Informed consent/confidentiality
Identify goals
Create rules & consequences
Pre-intervention questionnaire (Burt, Patel, & Lewis, 2012)
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Session 2Summarize previous session/review goals
Introduce topic
Psychoeducation:Talk about situations that cause anger
Discuss how anger feels for students
Activity: Create an “anger-log.” Students may decorate. On first page, include goals and note signs of anger to watch for
Assign Homework:Instruct students to pay attention to triggers, physiological reactions, and behaviors and log
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Session 3
Review previous session/ review goals
Share notes in anger log homework and discuss
Psychoeducation:Talk about acceptable reactions to anger
Activity:Play the “Anger Solution Game”
Assign homework:Students should record their acceptable and unacceptable reactions to anger
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Session 4Review previous session/ review goals
Share notes in anger log homework and discuss
Focus on strengths
Psychoeducation:Coping skills: Thought stopping, breathing exercises, Progressive Muscle Relaxation (PMR)
Activity:Engage in PMT and breathing exercise. Discuss.
Inform students that they will be responsible for teaching classmates PMR and/or breathing exercise as a final project
Homework:Instruct students to use coping strategies in anger situations and log
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Session 5
Review previous session/ review goals
Share notes in anger log homework and discuss
Psychoeducation:Talk about problem solving skills and communication
Activity:Role play anger situations
Practice breathing and PMR
Homework:Log anger reactions and successful use of problem solving skills, communication skills, breathing exercises and PMR
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Session 6Review previous session/ review goals
Share notes in anger log homework and discuss
Address termination
Activity: Remind students that they will be instructing their classmates in PMR or breathing in the coming week
Work together to create a script and assign roles
Practice presentation
Discuss feelings about presentation
Homework:Practice presentation
Log anger and coping strategies
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Presentation
Arrange with teacher
Introduce purpose to class
Introduce students
Observe while students teach classmates
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Session 7: TerminationReview previous session/ review goals
Discuss presentation and associated feelings
Share notes in anger log homework and discuss
Activity:Review goals. Discuss how they have been achieved.
Ask students to write the “autobiography” of their futures
Address strengths
Address feelings associated with termination
Give certificate of achievement (Dwivedi & Gupta, 2000)
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Post-group Measures/EvaluationPost-intervention questionnaire
Compare results to original
Record increase in positive responses to anger as reported in students’ logs
6 month follow up (Sutcu, Aydin, & Sorias, 2010)
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Possible Issues
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Forming: Issues that may arise
May be difficult to establish trust if members see counselor as disciplinarian
All members have issues with social skills = may be difficult to form bonds
Involuntary members may be unwilling to follow rules or engage
Make goals of the group clear
Set ground rules
Deal openly with issues
Encourage members to express themselves in constructive ways
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Storming: Issues that may arise
Members may feel defensive
Conflict may arise
Members may have conflict with leader
Members may become annoyed with a difficult member
Counselor should openly address conflict
Counselor should teach members constructive ways of expressing feelings
Counselor should have another adult that she can call on in the case of physical aggression
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Norming/Performing: Issues that may arise
Members may show improvement inside of group but not outside
Make sure to revisit goals
Give practical homework and activities
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Issues that may arise in termination
Strong feelings
Members may not apply new skills outside of group
Address termination early
Encourage members to express feelings
Discuss ways members will apply new skills
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Skills that will be needed
Group management
Assertiveness
Crisis management
Knowledge of anger and coping strategies
Knowledge of CBT
Ability to confront
Basic skills: listening, summarizing, reflecting, supporting, empathizing, goal setting, linking, blocking, etc.
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Therapeutic Factors
Trust – Members must build trust or be able to express lack of trust
Empathy – members will benefit from empathy received from leader and other members. Members will work on the cultivation of empathy
Intimacy – members will benefit from learning that they are like others
Hope – CBT provides hope that change is possible
Freedom to Experiment – Role play, relaxation
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Therapeutic Factors Cont.
Cognitive Restructuring –CBT helps spark change. Adopt more constructive beliefs
Commitment to Change – Leader should attempt to elicit by stressing goals
Self-Disclosure – Members with share with group
Confrontation – Members will be encouraged to take responsibility for actions
Feedback – Members and leaders will comment on strengths
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Ethical/Multicultural Considerations
Confidentiality (giving parents info)
Attempt to ensure that no students feel isolated
Incorporate diversity
Protect members from harm
Involuntary members - help them understand
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ReferencesBurt, I., Patel, S. H., & Lewis, S. V. (2012). Anger management leadership groups: A creative intervention for increasing relational and social competencies aith aggressive youth. Journal Of Creativity In Mental Health, 7(3), 249-261. doi:10.1080/15401383.2012.710168
Dwivedi, K., & Gupta, A. (2000). 'Keeping cool': Anger management through group work. Support For Learning, 15(2), 76.
Gaines, T., & Barry, L. M. (2008). The effect of a self-monitored relaxation breathing exercise on male adolescent aggressive behavior. Adolescence, 43(170), 291-302.
Sportsman, E. L., Carlson, J. S., & Guthrie, K. M. (2010). Lesson learned from leading an anger management group using the 'Seeing Red’ curriculum within an elementary school. Journal Of Applied School Psychology, 26(4), 339-350. doi:10.1080/15377903.2010.518823
Sütcü, S., Aydın, A., & Sorias, O. (2010). Effectiveness of a cognitive behavioral group therapy program for reducing anger and aggression in adolescents. Turk Psikoloji Dergisi, 25(66), 68-72.