Using Group Therapy to Reduce Anger in Middle School BoysJosie Boehlert

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)

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)

Role of School Counselors

Support academic achievement

Support social development

Improve functioning of whole school

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

CBT Techniques

Modeling

Behavior rehearsal

Coaching

Homework

Feedback

Reinforcement

Cognitive restructuring

Pre-group Measures

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

Logistical Planning

Scheduling – 30 minutes

Location

Parental permission

Create plans

Obtain necessary materials

Group Process

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)

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

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

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

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

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

Presentation

Arrange with teacher

Introduce purpose to class

Introduce students

Observe while students teach classmates

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)

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)

Possible Issues

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

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

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

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

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.

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

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

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

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.