A major ethical issue involved in group counseling is information security. The group leader has to ensure the confidentiality of the group members with regard to all that is discussed and revealed within the group. To have the confidential aspect strictly enforced, the leader should impress it upon the members from time to time; right from the screening interview to the final session. However there are possibilities for members to unintentionally breach the confidential aspect. Thus, if there are any such concerns, this should be taken for discussion in a group session.
The leader also has an additional responsibility of maintaining confidentiality of all group members’ discussed topics. Also, the limitations of the confidentiality aspect would be emphasized, thereby making it clear that when required to report by law, confidentiality cannot be held. Theoretical approach A therapist needs to finalize on the theoretical approach he or she intends to have for the group, at the early stages of group formation. This approach is selected based on the existing psychological problems, and helps the therapist to identify goals and work towards that.
The therapist interprets the observations in the group, based on the theory and also steers the group accordingly. Each theory has some advantages over others while also having some drawbacks and precautions. (Brabender, Fallon and Smolar). Sometimes an integrated approach is also adopted. Autism is associated with difficulties in social interaction, communication and interaction. Behavioral aspects associated with autism are typically repetitive behavior, reproduction of verbal utterances, lack of verbal communication interest etc.
The family and parental influence can have considerable bearing on these special need children. Effective therapy should include observation of the child, assess the child’s needs, plan activities and evaluate progress. Often the type of family like nuclear family, care home, single parent, same sex parents etc. can affect children. The family is comprised of the individual, parents, siblings and all who live in it.. Even for a normally developing child, its role and position in the family has considerable bearing in its later personality development (Powers & Griffith, 1987).
In the case of a special needs child these can either improve or worsen its condition. Children are also affected by family experiences like financial crises, poor housing, loss and grief. Although exercises are beneficial to all children, it is particularly beneficial to children with autism. However, the need for exercises is overlooked by parents either due to ignorance or lack of time (Morris, 2008) The Adlerian approach is more appropriate for group psychotherapy for parents with children with autism. Adlerians value family influence and believe it to have considerable influence on the individual.
To assess a child, the child needs to be looked from within and outside of the setting. Several concepts associated with Adler’s therapy are compatible with children too. The counseling of children is encouraged through several types of group activity. The Adler system is more directed towards the social aspects of the behavior than its biological aspects, working towards the realization of goals than with its origin. The main concept of Adler perception is its holistic approach in explaining one’s action from the point of the individual’s selected life style.
Adlerians are against the consideration of people as being psychologically sick and in need of a cure. Adlerian philosophy is that they only contribute to an educational process, helping people to learn to manage their tasks and meet challenges confronting them, by helping them to get away from compelling mistaken notions. Practitioners of Adlerian theory do not stick to any particular procedure or technique. They are required to be creative to develop techniques that suits the client and theory.
It should be noted here that no two children with autism would behave the same way; even if they are of they are of same age and come from a similar background. Adler’s theory focuses on the efforts of an individual to secure a place within the society or social arena. It sees group counseling as the perfect setting for reestablishing relationships. This is because members are able to experiment with their interactions, share them, which can lead to realization of mistaken goals and notions adopted till then. Social interests and community attachment are valued and fostered by Adler’s theory.
These are important aspects of group counseling, intending to progress from self-centric to social interest. Adler’s approach is more appropriate for group psychotherapy with parents of autistic children, because it places great emphasis on family participation and family role (Corey, 2004). Children adopt several aspects of their parent’s characteristics by observation and interaction. The child’s personality development is influenced by the family atmosphere. The positive and negative influences on the child are known by understanding the family structure and associated developments.
Most Adlerian concepts can be used in school settings and a significant aspect of the exercises in schools is directed towards generation of social interest. The sessions are planed to involve empathy, concern, cooperation and ability to listen to others. Adler’s theory is very appropriate when dealing with culturally diverse clients, helping them to benefit while being respectful of their cultural values. It should be emphasized here that many of Adlerian concepts have been found successful with people of diverse cultures. However, it should not be suppressed here that cultural differences can sometimes be a barrier in group counseling.
For instance Native Americans are very cautious when it comes to trust and would shy away from revealing personal information in a group discussion. Similarly the Adlerian view of cultural values, family and social linking goes hand in hand with the Latinos. However, the Adlerian concept of equality in a relationship is not accepted by the Latinos, particularly when it comes to parent-child relationship. The behavior of certain racial or ethnic majority members may be perceived by the group leaders as a resistance or non-cooperation. The Adlerian principles tries to counter culture based barriers by creating separate healing communities.
The healing communities are formed by moving away from a diverse multicultural setup. The Adlerian approach ensures that no member is grieved or upset due to infringement of their cultural attachments. No member is given an opportunity to be seen superior or more worthy at the cost of another person. Decisions are made with the participation of all particularly those who are affected (Kopp, 1997). A sense of mutual respect, increased tolerance to differences and a willingness to listen to others are promoted by identifying all members with a common purpose.
When Adlerian approach is practiced in the right and appropriate way, there should hardly be any limitations on its use from the cultural point of view. Adlerian psychology is perhaps the most comprehensive one among all traditional and modern studies. However many scholars in psychotherapy feel that Adler’s theory would soon be considered as being stagnated as there has been no notable development in he last two decades. Group activity The aim of group psychotherapy is not directed at attempting to help children to recover from autism, as there is no perfect cure for autism and continued therapy can only bring improvements.
Autism is a disorder affecting the normal growth and development of young children and is today increasing at an alarming rate (Lourdes, 2007). The group therapy involving parents is aimed at better integration of the autistic children with their family and the society. The exercises and activities are planned to improve the chemistry between children and the parents, and help parents to manage the needs of their children, better. Initial stage activity At the opening of a group session, members are asked to express themselves as to what their expectations are.
They are also encouraged to express their concerns or thoughts that might stem from any previous sessions meetings, but left unsolved. At the beginning, there is a general equal focus on all, and when many people come up with similar issues, a broad agenda is developed. As a way of continuity, the leader may want to make some relevance to the previous meeting. The initial stage is more directed at forging closer relationships among the members and help the leader get individual views and perception of the issues involving their autistic children.
The early stage exercises are designed to help members to reiterate their goals, build trust and to deal with fears and expectations. The initial stage activity is mainly associated with verbal techniques involving clarification and interpretation, and is more aimed at fostering relationships and understanding autism and related trends in treatment. Through clarification exercises by group leader, parents are taught to identify risks involved in helping their child develop newer skills. For instance, the child may even experience pain and confusion while being introduced to new developmental strategies.
Sudden flapping of hands, jumping are ways in which the child tries to cope up with the new situations, and when such symptoms go unnoticed; only worsens the situation. The effect of medications and dietary interventions are also discussed at the initial stages. Through active listening and facilitating, the leader encourages all the members to actively participate in the process. Even members who want to cooperate and see progress may not be willing to participate as a group (Dreikurs, 1969).
The leader must emphasize on the contributions of relationship to effective therapy and also ensure mutual respect and confidentiality within the group. Thus fostering better relationships within the group is a part of the initial activity, as this can have a direct bearing on the achievement of results. This can be achieved through discussions on the personal experiences, family compulsions, opinions etc. from the members, and coupled with leader’s recommendations. The purpose of the exercise is to make members feel confident in group working, rather than participate in group therapy, unconfident and uncomfortable.
Goal setting is also carried out in this initial stage. The primary goals of the session are to improve the sociability and communication abilities of the children. The group also intends to reduce their efforts and strain borne due to their autistic children, without compromising on the needs of their children. Mid-stage activity The mid-stage therapy includes more core work directed towards social development of the children. The exercises in the mid-stage therapy is aimed at improving speech, vision, imagination and sociability of the child.
The services of professionals for one to one therapy with children may also be necessary at this stage. Using the techniques of mirroring or reflection, parents are taught certain sign languages which they try to use with their children. Research confirms that the use of sign language increases the probability of children taking to spoken language. To incorporate vestibular stimulation effects, children should be asked to pronounce and speak while being engaged in jumping or swinging. Children should be encouraged to sing and dance to audio or video recordings.
The services of a Speech Language Pathologist (SLP) to improve voice tone, expressive forms or non-verbal communication is sought for a private individual session for each child (ARI). During the mid-stage, it is appropriate for the leader to check on the progress of the session. The leader can investigate by telling, “We are midway into the session, I just want to know how you feel the session is progressing? ”; “Is there anything you want to be taken up before the session ends? ”. Such evaluation would ensure that the participants are happy with the progress.
Through modeling or through video representation, parents are also taught to adopt use of written and pictorial instructions to help the child understand. For instance, pictures of plate, cup, glass, knife and fork etc. properly arranged together would help the child to seek them for arranging a dining table. When the pictures are arranged in a particular manner, then the child tries to get them in the same sequence. The Picture Exchange Communication System (PECS) is also very important for speech development like the sign language.
Parents would be asked to split a particular activity they want their child to do, into several pictorial representations. When these pictorial instructions are arranged sequentially, they would be meaningful to the children. For instance parents can, through pictures instruct their child to take a tooth brush and a toothpaste, apply the paste on the brush, close the paste and brush teeth. All sessions involving children should be capable of engrossing the interest and motivation of the children. Role playing activities are carried out that have relevance to autism.
Repetitive behavior is more pronounced with autistic children and activities aimed to break or change these are attempted with caution. Another exercise aimed at breaking monotony and repetitive actions of the child is the blocking technique by which an unwanted behavior pattern is blocked. For instance, if the child is used to lining up six toy cars, help the child to lineup five cars as usual and a bus or van. Next time use only three cars and three buses or vans. Through appropriate initiation, the child should be brought to associate with other children who are of the same developmental stage, irrespective of their ages.
The special needs child sees someone who has similar interests and is thus drawn towards it. Parents should facilitate and observe the child during the play. Parents should be warned against selecting a playmate of the same age but of different developmental stage. This is because there would not be much in common between them and the autistic child would not be interested in his or her playmate. (Siegel, 2003). Through role playing, parents are also introduced to exercises involving the use of prompts in getting their child initiated to speech or other activity.
At the initial stages, lot of prompting may be required to achieve success, but with time, prompting would be less required. End stage activity Towards the close of the session, the members summarize the experience they have just been through. Participants speak of what they would do between now and the next session. Members require to be guided on assessing whether their goals are met and they are satisfied with their progress. When such appraisals are done regularly, members can cause changes in the plan and progress of the sessions. These changes would ensure that the sessions are useful and directed towards their goals.
In the absence of regular appraisals and appropriate changes, participants would consider leaving the group. In the end-stage, parents are alerted on future care and symptom checks. Language simplification exercises are also carried out for the better understanding of the children. Some casual phrases or words are very likely to get deeply associated with an individual which might not be easily apprehensible for autistic children, even if they come across it several times. The use of such words are very likely to confuse them even while they make considerable effort to understand them.
Phrases like ‘pull up your socks’, ‘you’re an angel’, ‘jump in’ etc. needs to be put in the basic forms like ‘hurry up’, ‘you’re sweet’ and ‘get in’ respectively, for better understanding. The services of the Speech Language Pathologist (SLP) are again sought in a classroom setting. Parents are asked to develop a schedule for their child, either on a daily basis or on a week basis. Parents need to again observe their child when introducing them to newer activity and change the schedule according to their child’s interest and efforts. The schedule should be drawn keeping in mind their preferred activity.
As anything related or close to their preferred activity is sure to get their interest and involvement. The achievement of goals are evaluated at the end stage. The outcomes are again measured through questionnaires for parental evaluation of training and training effects, at the completion of the session. The questionnaire includes questions which reflect the developments and changes implemented as a result of the session. The questionnaire would reflect the opinion of the group members and state whether the desired outcomes were achieved or not.
Group Leader The success of a group counseling session is highly dependent on the qualities and characteristics of the group leader. I believe that the outcome of the group is not totally dependent on the techniques used or the characteristics of the participants alone. Effective group leaders have a good theoretical and practical knowledge of group behavior, apart from diagnostic and inferential qualities. Through their personal experience and vision they are capable of steering the session towards the intended goals of the members.
They must have the qualities which can drive and guide members to seek what they require. For instance when members want to promote growth in their lives, the leader must be a growth-oriented person. Personal strengths – Character The personality and character of the group leader are crucial for the outcomes and I feel that I have several of them. a) As a group leader I know that I should not be preoccupied when coming for a group session. I am very much alive to the happenings and reactions in the group. The ability of connecting emotionally with the members is very important for a group session.
Being moved by the feelings of others indicates genuine care and compassionate with the group members. b) Leaders need to exhibit their courage and tackle situations appropriately rather than just being a facilitator or avoiding confrontational issues. I take risks during the group sessions and don’t hesitate to confront others when situation demands. I act on my instincts and beliefs too and make sure that I am willing to admit mistakes. Despite being unclear, experiencing fear to some extent and not sure of my own behavior, I demonstrate a willingness to move forward.
Members need to experiment newer ways with a determined mind, if they want to get away from secure and familiar situations. c) As a leader setting out to make changes on others, I have a complete sense of control on myself. I am aware and confident of my personal ability to influence another person. The power in me would be used to invoke the unused power lying dominant on another person, which I would unleash and make the person more dependent on self, than others. d) I am very sensitive to the effect of my own culture and behavior in the group.
I analyze my own assumptions of culture, sex, race, gender and sexual orientation to ensure that my approach during the sessions is not biased by any such personal perceptions. Similarly, I also ensure that such assumptions by any member does not affect the achievement of desired outcomes for that individual. e) I put in considerable efforts to prepare the members suitably for a group session. When members come for their first session, I have no apprehensions of any unpredicted behavior from any of them, because their roles and requirements have been properly briefed.
I have specifically pointed out to each individual, the possible difficulties they are likely to face, based on each one’s personal life experience. I am confident that each one would take appropriate steps to ensure that they are not hindered by such factors, which benefits them individually and everyone as a group. f) I make it a point to make them understand how they can carry away the group experience with them to make their lives better. I understand the need to have a flexible approach rather than just sticking to a technique or method, heart and soul.
People and situations are different and no same technique can guarantee similar outcomes. Personal strengths – Skills It should be noted here that personal qualities and a passion to help; alone are not sufficient to be successful. Group leadership skills also play an important role in the making of a successful leader. Like any other skills, leadership skills can be learned and refined by practice. I personally feel that I have several skills characteristic of a good leader. a) A good leader has to have active listening skills is an important.
I am a good listener and not only concentrate on the content of what is being conveyed, either verbally or non-verbally, but also on the tone, body language, facial expressions with which these are conveyed. A lot can be conveyed from these apart from the content. b) Leaders need to help members in clarifying their thought and feelings. When members provide confusing or unclear information, it needs to be determined what the speaker really wants to convey. I help members in sorting out their compounding feelings and help them focus on the topic they experience or want to be dealt.
c) I am supportive and empathetic with the members. Members need encouragement and support when they deal with emotional or painful experience. I try to be psychologically in tune with the member, without losing my individuality. d) I understand the importance of giving feedbacks, whenever appropriate. It is an assessment of the member as perceived by another. I encourage members to provide feedback to others while being receptive too. e) One of the very important qualities I believe I have to a fairly good extent, and which I should keep updating is dealing with multicultural groups.
Working in multicultural groups involve understanding and respecting diversity in terms of sex, sexual attitudes, race, gender, religion and class. Theories and techniques need to be appropriately modified and applied, to be compatible with the beliefs and behaviors (DeLucia-Waack, 1996). Understanding multicultural implications are crucial to establishing problems associated with an individual, that are not internalized. The leader needs to demonstrate that he or she is culturally sensitive and respects the culture based perception of the members, to help members feel comfortable and open up for discussions on personal information.
My developmental needs as a leader Although, I have several qualities and skills relevant for a good leader, I understand that I need to develop a unique personality style that is identifiable only with me. Most aspects of my leadership styles have been incorporated by replication, imitation or by the influence of others. I understand the influence of others’ leadership qualities on me, like those of my supervisors and leaders whose workshops I’ve attended as a participant. I want to develop and function in an independent way, because only then will I be able to use my potentials to the fullest. Conclusion
Group therapy is being increasingly sought for various problems as it helps everyone to benefit from each others experience and understanding. It has several advantages and helps in affecting changes to an individual’s behavior, feelings, beliefs and assumptions. A group that has established a cohesion can definitely benefit from such groupings. For parents of autistic children, whose caring experience is limited to the development of their own child, can gain newer knowledge and understanding of autism. They can understand the rationale behind their frustration and helplessness, and find solutions for overcoming them.
A cooperative and goal oriented group, a capable leader and a strategic plan can together make a life difference not only for the parents of such children, but the children themselves too.
References
Rosenberg, S. , & Zimet, C. (1995). Brief group treatment and managed mental health care. International Journal of Group Psychotherapy DeLucia-Waack, J. L. , (1996) Multiculturalism is inherent in all work group. Journal for specialist in group work Brabender, V. A. , Fallon, A. E. , and Smolar, A. I. , (2004) Essentials of Group Therapy. John Willey and Sons Corey. G (2004). Theory & Practice of Group Counseling.
Thomson Books. CA Kopp, R. R (1997). Healing Community: An Adlerian approach. Individual Psychology: The Journal of Adlerian Theory, Research & Practice Siegel B. , (2003) Helping Children with Autism Learn. Oxford University Press Dreikurs, R.. , (1969) Group psychotherapy from the point of view of Adlerian Psychology. In H. M. Ruitenbeek (Ed. ), Group therapy today: Styles, Methods and Techniques. Atherton. Adams J. B. , et al. (2004) Advice for parents of young autistic children. Arizona State University. Arizona Autism Research Institute Be skeptical of any treatment that promises a “cure”.
[Electronic Version]. Downloaded on 12th June 2008 from http://www. pathfindersforautism. org/Therapies. aspx#ot Powers, R. L. , Griffith, J. , (1987) Understanding Life Style: The Psycho-clarity process. Americas Institute of Alderian Studies. Chicago Lourdes, M. , (2007) Autism: P. L. A. Y. Project. [Electronic Version]. Downloaded on 12th June 2008 from http://autismacitivties. blogspot. com/ Morris. B. K. , (2008) Physical Exercise and Autism . [Electronic Version]. Downloaded on 13th June 2008 from http://www. autism-help. org/family-physical-exercise-autism. htm