Using Group Therapy to Reduce Anger in Middle School BoysJosie Boehlert

Problems Associated with Anger Issues

Academic failureTruancyDropoutPeer rejectionTobacco, alcohol and drug useSuicidal behaviorOften becomes worse over time(Sutcu, Aydin, & Sorias, 2010)

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 behaviorSupport inside and outside of group“Naturally occurring community of reinforcers”Minimize stress of unfamiliarMembers might feel more open to share with people that they can relate to(Dwivedi & Gupta, 2000)

Role of School Counselors

Support academic achievementSupport social developmentImprove functioning of whole school

Application of CBTBehavior is learned and can be changedAllows member to try out new behaviorsPromote understanding of anger as a processIdentifies clear goalsHelps students identify triggersProvides coping strategies

CBT TechniquesModelingBehavior rehearsalCoachingHomeworkFeedbackReinforcementCognitive restructuring

Pre-group Measures

ScreeningInitial pool from teacher referralResearch conduct reports (Burt, Patel, & Lewis, 2012)ObservationBrief interview (Dwivedi & Gupta, 2000)

Assess potential for changeConsider group dynamicsAbility to gain parental consentChoose 5-7 students in same grade

Logistical PlanningScheduling – 30 minutesLocationParental permissionCreate plansObtain necessary materials

Group Process

Initial SessionExplain purpose Positive framing (Burt, Patel, & Lewis, 2012)Informed consent/confidentialityIdentify goalsCreate rules & consequencesPre-intervention questionnaire (Burt, Patel, & Lewis, 2012)

Session 2Summarize previous session/review goalsIntroduce topic Psychoeducation:

Talk about situations that cause angerDiscuss 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

Session 3Review previous session/ review goalsShare notes in anger log homework and discussPsychoeducation:

Talk about acceptable reactions to anger

Activity:Play the “Anger Solution Game”

Assign homework:Students should record their acceptable and unacceptable reactions to anger

Session 4Review previous session/ review goalsShare notes in anger log homework and discussFocus on strengthsPsychoeducation:

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

Session 5Review previous session/ review goalsShare notes in anger log homework and discussPsychoeducation:

Talk about problem solving skills and communication

Activity:Role play anger situationsPractice breathing and PMR

Homework:Log anger reactions and successful use of problem solving skills, communication skills, breathing exercises and PMR

Session 6Review previous session/ review goalsShare notes in anger log homework and discussAddress terminationActivity:

Remind students that they will be instructing their classmates in PMR or breathing in the coming weekWork together to create a script and assign rolesPractice presentationDiscuss feelings about presentation

Homework:Practice presentationLog anger and coping strategies

PresentationArrange with teacherIntroduce purpose to classIntroduce studentsObserve while students teach classmates

Session 7: TerminationReview previous session/ review goalsDiscuss presentation and associated feelingsShare notes in anger log homework and discussActivity:

Review goals. Discuss how they have been achieved.Ask students to write the “autobiography” of their futures

Address strengthsAddress feelings associated with terminationGive certificate of achievement (Dwivedi & Gupta, 2000)

Post-group Measures/EvaluationPost-intervention questionnaireCompare results to originalRecord increase in positive responses to anger as reported in students’ logs6 month follow up (Sutcu, Aydin, & Sorias, 2010)

Possible Issues

Forming: Issues that may ariseMay be difficult to establish trust if members see counselor as disciplinarianAll members have issues with social skills = may be difficult to form bondsInvoluntary members may be unwilling to follow rules or engage

Make goals of the group clearSet ground rulesDeal openly with issuesEncourage members to express themselves in constructive ways

Storming: Issues that may arise

Members may feel defensiveConflict may ariseMembers may have conflict with leaderMembers may become annoyed with a difficult member

Counselor should openly address conflictCounselor should teach members constructive ways of expressing feelingsCounselor should have another adult that she can call on in the case of physical aggression

Norming/Performing: Issues that may arise

Members may show improvement inside of group but not outside

Make sure to revisit goalsGive practical homework and activities

Issues that may arise in termination

Strong feelingsMembers may not apply new skills outside of group

Address termination earlyEncourage members to express feelingsDiscuss ways members will apply new skills

Skills that will be needed

Group managementAssertivenessCrisis managementKnowledge of anger and coping strategiesKnowledge of CBTAbility to confrontBasic skills: listening, summarizing, reflecting, supporting, empathizing, goal setting, linking, blocking, etc.

Therapeutic FactorsTrust – Members must build trust or be able to express lack of trustEmpathy – 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 othersHope – CBT provides hope that change is possibleFreedom to Experiment – Role play, relaxation

Therapeutic Factors Cont.

Cognitive Restructuring –CBT helps spark change. Adopt more constructive beliefs Commitment to Change – Leader should attempt to elicit by stressing goalsSelf-Disclosure – Members with share with group

Confrontation – Members will be encouraged to take responsibility for actionsFeedback – Members and leaders will comment on strengths

Ethical/Multicultural Considerations

Confidentiality (giving parents info)Attempt to ensure that no students feel isolatedIncorporate diversityProtect members from harmInvoluntary members - help them understand

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:10.1080/15401383.2012.710168Dwivedi, 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:10.1080/15377903.2010.518823Sütcü, 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.