Group therapy with brain-damaged children.

Abstract

tions, giving me valuable information about how they saw themselves in their family constellations. They also were able to talk about their parents' attitudes toward them when the parents visited the hospital and when the boys were home on visits. It is especially significant that the boys could point out one another's inappropriate behavior. In the fifth session, they told Jimmy, who was angry because he couldn't do what he wanted to, that he couldn't always have his own way, that he probably acted like that at home, and that his behavior was pretty foolish. Another time Frank said that he was wetting the bed, which immediately brought teasing from Harry. The other two boys came to Frank's defense, saying that he couldn't help wetting the bed, because of the medicine he was taking. The teasing ended, with agreement that teasing was not the proper thing to do. A third example of insight occurred when Harry began to pester me; Bill, the 10-year-old, told Harry he was just trying to get attention, and Harry stopped. Of equal importance was the boys' ability, through verbal interaction in the group, to develop an awareness of the behavior that led to their admission. For instance, Harry said that when he first came to the hospital he “? howled and made more noise than a dog.―He said he thought his stepmoth er didn't like him, but he guessed he was the one who was “? goofed up.― He ran away because he thought his stepmother didn't want him, but he guessed she did, as she sent him packages. Jimmy said he beat up his sisters and brothers, wouldn't mind his mom and dad, and wrecked his dad's car. He said he came to the hospital because of his temper. All four boys recognized that when they left the hospital, they couldn't continue such behavior. We made additional observations that might be helpful. The group should be composed of an uneven number of youngsters; otherwise the members tend to break up into pairs. The group should meet at the same time and same place for each session, with as few cancellations and interruptions as pos. sible, because continuity is extremely important. The chairs should always be set up before the members arrive, to prevent the horseplay that often occurs when boys of this age begin arranging furni 4 HEPROGRAM foremotionally ill childrenatNew berry State Hospital at one time included four boys aged 10 through 13 who were brain-damaged, retarded, or both, and who had behavior problems. We decided to use group psychotherapy to see if it would benefit such patients. The meetings would also be used as a teaching device, with each one re corded and then discussed with the treatment team. The boys' IQs ranged from 61 to 75. Two of the four had diagnoses of chronic brain syndrome with behavioral reaction, the third a diagnosis of chronic brain syndrome with psychotic reaction, and the fourth a diagnosis of psychotic reaction without chronic brain syndrome. All had shown some of the secondary symptoms of inability to get along with their peers, physical abusiveness to them, poor self control and judgment, thievery, fire-setting, other destructiveness, pathological lying, disobedience, hy peractivity, impulsivity, and a prolonged history of running away. Fifteen weekly hour-long sessions were sched uled, with myself as therapist. I had some previous experience in group psychotherapy with teen-agers, and an experienced group therapist observed each session. While the boys were attending the sessions, they were also receiving chemotherapy and taking part in recreation therapy and the school program. * Duringthe sessions the boyssaton straight backed chairs in a circle. They were not allowed to bring anything to hold, play with, or eat. The group was the catalytic agent, and I took a passive role except to use gestures and facial expressions to stimulate or control the group when necessary. It was clear that the boys wanted the sessions. On two or three occasions when I was late, they came looking for me. When it was necessary to cancel a session, they greeted me the following week with “? Why didn't we have group therapy @ast week?― or “? Where were you last week?― Seldom was it necessary for me to directly control their physical activity. It was usually controlled by the group itself, more often than not by one of its members who had emerged as a leader. The boys became aware that it was their group, and that they were there to talk. They were able to discuss and express feelings about their home situa