367. Q&A: How to know if group therapy would be a good fit for my child?

Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello. Welcome back to Beyond the Session segment of the Securely Attached podcast where we answer listener questions. I have Dr. Emily Upshur here.

Dr. Emily (00:53):

Hi.

Dr. Sarah (00:55):

Good to see you.

Dr. Emily (00:56):

Always.

Dr. Sarah (00:58):

You ready for the question that this family wrote in?

Dr. Emily (01:01):

Yep.

Dr. Sarah (01:02):

Okay. So this parent writes, my 11-year-old has been struggling with anxiety and low self-esteem. We’ve tried one-on-one therapy, which has been somewhat helpful, but recently I heard the group therapy might be a good option for kids. Honestly, I can’t quite picture how it works. What do kids actually do in a group therapy session and how do you make sure it doesn’t just turn into kids sitting around feeling awkward or comparing themselves? I want to understand if this could really help my child feel less alone and build the confidence they need.

Dr. Emily (01:35):

I know. It’s good question.

Dr. Sarah (01:38):

I get this a lot. I don’t know if you get this a lot. I feel like I have a lot of families who are kind of like, what is that phrase? They’re like not sober, curious with a group, curious. They’re like, want to do it. But I think they have, I hear a lot of fears come up for parents. They’re like, is my kid just going to pick up a bunch of bad habits from kids who are having hard times and is it just going to make them worse?

Dr. Emily (02:05):

Great point.

Dr. Sarah (02:07):

I think that’s a legit fear. What other fears do you hear parents, I can hear this person kind of have that fear or maybe just being like, is my kid going to know what to do? Are they going to feel like pressure?

Dr. Emily (02:20):

Or is it going to have to be child led? I think they’re specifically asking what do we do as the treatment provider to make this feel a little less? And I guess I think you’re right. I think you have to have someone that’s working with you to help you choose the right group for your kids. So I think it’s a very good discerning question of this parent is to answer your first part, Sarah, about is every group good? I do think you have to be discerning about the group and your child and if it’s a good fit. But if you do find that this kid is in treatment already, I think it’s a great question to ask their provider. But I love a group depending on, I mean obviously pretending depending on the referral source, but the way I think of it is practice. So kids who have some of these difficulties have and are in individual therapy or have loving parents that are very involved, get a ton of practice with adults, but it’s really good to practice with peers with the support of a therapeutically minded adult. And I think that makes, again, just practice anything you practice and you practice in a way that feels held and supported you’re going to get better at. So that’s sort of my view on groups is if I want you to practice being maybe a little less timid, how are you going to practice that if you don’t do it with the peers that you’re going to be with? Right.

Dr. Sarah (03:52):

No, I think social skills groups and social anxiety groups, and even this child sounds like they have anxiety and low self-esteem. And so relationship stuff in general and confidence and a lot of that comes with taking up space and it’s really hard to practice that in one-on-one therapy with a grownup where you don’t have to practice taking up space. That’s not where it’s uncomfortable to take up space.

Dr. Emily (04:19):

Exactly.

Dr. Sarah (04:19):

To your point. I also think another thing that every time I have a family who has their kid do a group or for an adult who does a group one, never had anyone be like, well, I’m not glad I did that. Everyone’s always like, oh, that felt so much better than I thought it would. But I think one of the reasons why I specifically will recommend groups to certain clients that I’m working with or their kids would be when somebody feels very alone or isolated in their pain, whatever it is. I was working with a teen who had OCD and she would frequently talk about how I’m especially age appropriate, very interested in peers, very always kind of curious about the inner minds and worlds of peers, but they’re not sharing their struggles in homeroom, right? They’re not talking about kids tend to keep that a lot of their internal challenges to themselves.

(05:21):

And so each kid is kind holding it and thinking they’re the only one. So this girl was like, I don’t know. Nobody I know struggles with this. I’m the only one and it’s so hard and nobody’s going to get it if I talk to them about it. And I was like, well, one, it’s probably likely that a lot of your peers at school do have anxiety or worries or struggles that are not that dissimilar to yours. They’re not necessarily telling you about it. But two, there definitely are Elia right now. There are a lot of kids who have this struggle and being able to be in community with them and in a space where we all know this isn’t a secret, we all know we’re here because this is a challenge, and to just not feel alone is profoundly helpful for kids who are very motivated by peer just being included and belonging to a group of peers.

Dr. Emily (06:28):

And I also think to add to that, I think just with anything, there are positive things about a group mindset or collective think because it also helps with troubleshooting, giving coping strategies. And sometimes it’s better received from your peer than it is from a psychologist or your parent. So the same sandwich could taste very different. Depends on who makes it.

Dr. Sarah (06:54):

Exactly right. If you’re very resistant, if your kid is really resistant to taking your advice, your good advice, or maybe their therapist’s, good advice. I see this a lot with executive functioning. If you have an EF skills group and one of the kids is like, I’ve realized that using this planner helps so much, and then the kids are like, oh, okay, that’s a really good idea. Meanwhile, as the group facilitator, I’m like, I have been trying to get you to do this for so long. And it’s like totally, when a kid tells a kid that this thing works, it’s so much more accessible.

Dr. Emily (07:35):

No, I think that that’s another thing that’s a real joy to be a group leader is to see the sometimes really creative, great problem solving or coping skills or resources that kids come up with and being able to help them access those and be able to utilize them for, and maybe a group that might come up just to be really concrete with this parent. If an idea comes up from another child, the group facilitator can then really work on how that can be individualized to different people in the group. So it’s a really great way to have more impact. And just, I want to say one other thing is I love groups as standalone, but I also really like them as supplements to treatment when that is possible as well, because especially when there’s great communication between a group leader and an individual clinician, we can sort of push the envelope a little bit more about what we’re working on, what that individual child or even adult or young adult is working on in that group and working together in tandem with that individual therapist can really help bring out more for that child in the group or work on a specific skill that we know to be challenging from the individual work.

Dr. Sarah (08:53):

And the other pro that I can think of is to go back to the problem solving piece. If a kid in a group offers up a strategy that’s working for them that serves two important functions, one, the receiving kid is far more likely to take that suggestion in and be curious about how they could really use it for themselves. But two, the kid offering up the solution feels a sense of ownership and confidence and competence around that piece, which is great for building. So the fact that it is a format where kids can be both the receiver and the giver of something therapeutic is really, really helpful. And that doesn’t happen as much in individual therapy because usually they only really are going to be the receiver in one-on-one therapy.

(09:58):

So it just lacks that element of being able to help out somebody with something that you’ve been finding to be a strength or been finding to have success with. But I want to go back to this because this parent asks, I can’t picture how it works. What do kids actually do in a group therapy session? And I think it definitely depends on the group. I think we could talk a little bit about the different types of groups. I think I’m right about this. I would say there’s more or less, I think there’s three, I can think of three types, sort of basic ideas, types of groups. We have a skills-based group where you’re going to be learning a specific type of curriculum or skillset that’s sort of pre laid out. So that could be very, very specific. Like DBT skills group, like dialectical behavioral therapy skills group. That’s a very manualized treatment where you go through a set of, depends on if it’s a kid’s group or an adult group, but between four and five modules of skills.

(11:19):

And each group’s going to be different in how they engage the kids in thinking about these skills, practicing these skills. But really we’re just going to break it down. These are the skills and we’re going to practice them. And so it’s like a curriculum and skills groups could also be less formal than that. It could be more like we’re going to work on social skills and each group’s going to focus on a particular skill or number of skills and we’re going to practice them and talk about them. But it’s sort of didactic. It’s a little bit more structured. And then there are process groups. Emily, do you want to talk a little bit about a process group is and what that means if someone hears that term thrown about.

Dr. Emily (11:59):

A process group is, the way I think of it is a little bit more led by the group member. Not led in terms of a structured, but the content of the group could be based on what’s going on in the milieu between the kids or between the adults. Process groups are usually they jump around, but they tend to be very thematic based on what’s happening in. So I would want to the here, yeah, the here and now and troubleshooting what you’re going to do in the future, but it’s a little bit less of a curriculum, a little bit less structured. A good process group leader though might say, oh, these things keep coming up and let me sort of curate this a little bit and give you some tools or direct you or something. But it is a little bit more open-ended and continuous. And so it’s more about delving in understanding more depth and less, I would say still their skills. But I think it’s a little bit less manualized and structured in that way.

Dr. Sarah (13:01):

It’s less like a class or a, okay, today we’re going to be talking about this thing and ways to manage it. It’s more like, frankly, I think a lot more about interpersonal relationships. So if in a process group, usually people have some sort of unifying thing. It could be a process group for people who have an anxiety disorder or struggling with a symptoms of anxiety. It could be a process group for a type of population like postpartum moms or for kids, it might be a process group for kids who have neurodiverse diagnoses process group for kids who have recently moved or process group for kids who are dealing with divorce. So sometimes there’s a certain sort of connecting point that brings all these kids together, but the content of each particular group is not predetermined. So you’ll go around and sort of say, does someone have something they want to bring into the group today?

(14:01):

And someone, you might prompt them a little bit more specifically for kids today we’re going to talk about this thing, but the person kids will just share or they’ll do a shared activity for kids like a game, we’re going to play a game, we’re going to do this, we’re going to work on this art project, but we are going to be processing what’s happening in the here and now. So if someone is sharing and another person has a reaction to what they shared, we might say, looks like you have some thoughts about that. Can you share with them what that brought up for you as they were talking about this experience? And so a lot of it is about helping kids develop reflective capacity about their feelings, about their interpretations of what someone says or does, imagining how someone else might feel. It’s a lot of that insight building and reflective capacity that helps with relationships.

Dr. Emily (15:00):

And I think also to your point also providing support for other people, providing reflective capacity helps in a lot in process groups. It helps people feel less alone. I think rule of thumb, I think that we use in our practice though is we really do a lot of screening before groups, to your point, to have enough of something to hang on together thematically, whether that’s a divorce process group for children or adults or a postpartum. We really do try to make groups have a little bit of something to coalesce them, but then yes, we explore what’s happening for them right now and how we can help them with these interpersonal skills of feeling more connected.

Dr. Sarah (15:47):

And then there are other types of groups. I was saying there’s three. So there’s skills-based groups, there’s pure process groups, and then there’s some hybrids where it’s like a skills slash process hybrid, which is basically what we’ve been describing. Just a little bit more specific. And then I guess there are support groups, but that’s not as common with kids because it’s usually led by, it’s like a support group is typically not facilitated by a mental health elite group leader that’s like a licensed mental health provider. It’s usually a peer led support group or so, which again is less common with kids. It’s much more common with adults. Are there any other types of groups that I’m missing? Not skills groups can vary greatly in terms of, I will say, yeah, even skills groups can vary greatly in terms of how structured they are and what they’re targeting. We do a social skills group at our practice for five to seven year olds that looks so different than what a social skills group for an 11-year-old is going to look like. The younger the kids are, the more structured it usually is. There’s a lot of play incorporated as kids get older and they’re able to kind of tolerate and actually want to have a little bit more, it’s a little bit more talking, it’s a little bit more reflecting on the insight element is more central.

(17:24):

But it also depends on what we’re focusing on. There are anxiety skills like coping with anxiety groups. There’s also ERP groups where you actually do a treatment protocol within a group setting like exposure and response prevention for anxiety and OCD and phobias. So it runs the gamut. There’s all kinds of things. I think the best thing you can do if you’re trying to figure out if a group is good for your kid is to talk to the group leader running it. Usually people who run groups will have some sort of consultation to, because I know at our practice we do this, but most people who run groups want to make sure that even though the group is for, okay, anyone with anxiety could be a good fit. Once I start to fill the group, I have a better sense of you really want to think about the cohort that’s there.

(18:18):

And so most group leaders are going to be very open to sitting with you and kind of getting a sense of what’s going on with your kid, what’s their personality style? How comfortable are they? Are they in a group? Because a lot of times you can get kids that are super comfortable in a group and they do great. You can get kids who are really uncomfortable in a group setting. And when you put those kids together, they do great. There’s a little bit of crafting the group an intentionality about helping that group cohort really match each other well. So if you want your kid to do a group talk to the group leader, be very open and willing to give details about what your kid is like, what you’d hope to see them get out of that group and make sure that they feel like they’re going to thrive in that particular cohort. You can find the right type of group, but it’s still going to be cohort based in terms of is it the best match. So I definitely think that’s a starting point is just reach out to a group leader. Or if your kid is an individual therapy, a lot of individual therapists are in connection with other clinicians that run groups, and that is usually a great way to get started.

Dr. Emily (19:44):

I also say, I think if you run into, because I’m sure this, I know this is a broad audience all over the place, and I think child therapy can be really hard to get into. I think it’s also a great thing to do if you’re waiting for an individual therapist. So it’s a great bridge and a supplement. It can be both a supplement, but it can also be a bit great first step or a bridge into individual treatment if that’s needed. But you might find, oh, this worked out really well and we don’t need to pursue that.

Dr. Sarah (20:15):

Sometimes it’s just like it does what it needs to do and then you don’t need the individual therapy that you might be on a wait list for. Anyway. I hope that that helps. We love your questions. Thank you for sending them in, and we will see you guys next time with more questions.

Dr. Emily (20:33):

Sounds good.

Dr. Sarah (20:35):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.