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A Feeling of Belonging: Peer Success and Group Treatment By Lourdes Valdes, Ph.D.

Human beings are social animals, and as such, we spend most of our lives in connection with those around us. These social relationships facilitate the expression of emotion, the development of empathy, and the learning of specific social skills. Further, our relationships have far-reaching implications. Most psychologists believe that our perception of ourselves is highly influenced by how others respond to us. When we are very young, a healthy attachment to a sensitive caregiver helps us to feel safe and to perceive ourselves as separate from our parent. As we grow older, the peer group becomes more important and whether we are accepted and liked or excluded and disliked often contributes to our forming different opinions of ourselves. Our ability to function and self-manage in a group also has important implications for our physical health. Positive social affiliation has been shown to be the most important factor in health and disease since having a good social support network can actually protect us from disease.

"By the age of six, a child must know how to
be a good group member to be successful in school"

For children, the ability to function as part of a group is particularly important. The family (the group in which we learn most) is the first group in which a young child must learn to function. Fitting in to the family is essential for fitting in to all future groups. By the age of six, a child must know how to be a good group member to be successful in school. The lives of school age children are filled with groups including the family unit, the classroom, neighborhood playgroups, clubs, and athletic teams. One of the main social tasks in middle childhood is to learn to fit into a peer group. At this age, the peer group serves as a prime source of self-esteem. Success in these groups involves skills such as eye contact, reciprocity, perspective taking and most importantly, empathy.

For children with ADHD and other self-management difficulties, maintaining peer relationships is not always easy. These children are often impulsive, non-reflective, and have behaviors (such as being aggressive or disruptive) that may irritate others. As a result, children with self-management difficulties may experience social rejection, which in turn, can limit further opportunities to benefit from relationships.

Group treatment is considered one of the most effective ways to address deficits in self-management and social interaction during the school years. Middle childhood is a time when youngsters are readily responsive to group experiences. For them, the group is a natural setting for learning and group treatment simulates the world to which they are accustomed. Cognitive changes in the school age years also facilitate the use of group therapy. By the time children reach the school age years, they have more fully developed verbalization skills and a greater capacity for self-awareness. Peers at this age play an increasingly prominent role and peer reinforcement becomes very powerful.

"The characteristics of group treatment often
render it the most efficient way to address specific issues"

Like a family, the group provides reinforcement and support of appropriate social behaviors and provides limits for overly excited and aggressive behaviors. It provides a setting for members to practice and generalize skills and concepts learned in individual or family treatment.

Children with self-management disorders such as ADHD sometimes do not generalize well what they have learned in one setting to another. For these children, a group setting that recreates the world in which they will use the newly learned information may be more effective than individual psychotherapy. Group facilitators serve as models of sensitive and caring behavior. In a therapeutic peer group, children can obtain feedback from the peer group members, become more aware of behaviors that could be interfering with their interactions, and adopt more appropriate behaviors. Group treatment offers children with self-management difficulties the opportunity to see that they are not alone in their difficulty; it gives them a chance to help others as well as accept help from others.

A brief example of a typical session may help explain how school age children can work on recognizing feelings in themselves and others. The facilitator may discuss how feelings exist on the inside and the only way to determine how someone is feeling is by looking on the outside. Children can take turns making "feeling faces" and having the others in the group guess the emotion. The facilitator may also show pictures of real people cut out from magazines or newspapers and have the children give examples of what might be happening to make the people feel that way. They might play a game in which they take turns drawing cards that describe sticky social situations. Each child in the group might describe how they would feel about the situation and how they would cope with it. The facilitator may then encourage the children to share with the group a time when they felt a similar way. Activities such as these help the group members understand how other children may react differently from themselves in a similar situation. The children can learn the more subtle aspects of social relationships and share their experiences in a supportive environment.

The characteristics of group treatment often render it the most efficient way to address specific issues. For example, mental health professionals believe that empathy (the ability to react to another's feelings with an emotional response that is similar to the other's feelings) is necessary for the development of cooperating and helping behaviors. Also, research suggests that empathy develops most easily in an environment that:

• accepts and supports a child's feelings and emotional needs
• encourages a broad range of emotions
• provides numerous opportunities for a child to interact with others who are sensitive and responsive
• provides peers that the child may consider similar in some way to themselves
• focuses on the feelings of victims if they have been wronged

By providing an environment conductive to the development of empathy, group treatment can lay foundations that facilitate emotional connections and close friendships.

The effectiveness of group treatment for school age children is greatly enhanced by corresponding parent groups. In their own group, parents of children with self-management difficulties can learn about the happenings in their children's group, learn ways to support gains made by their children, and exchange feedback with group facilitators and other parents. Families of children with self-management difficulties are the primary source of support for their children; however, sometimes they feel isolated, alone, and unsure how to best manage the peer difficulties. A parent's group can provide families with ideas of how they can help their children generalize newly-acquired skills in real-life settings.

Research supports the use of group psychotherapy for peer and relationship difficulties. For example, a recent study (Sukhodolsky et al., 2000) compared the therapeutic effects of group therapy and of a structured play group for boys between 9 and 11. They found group therapy to be superior in reducing aggression toward others and classroom disruption (as reported by teachers). Further, these boys reported that they were more frequently attempting to use anger control strategies.

In summary, groups are where we all learn our most important lessons in connecting and sharing with others. For those with self-management difficulties, group treatments can offer abundant opportunities to learn to better manage our relationships and ourselves.