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Using Group Therapy to Reduce Anger in Middle School Boys

Using Group Therapy to Reduce Anger in Middle School Boys. Josie 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).

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Using Group Therapy to Reduce Anger in Middle School Boys

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  1. Using Group Therapy to Reduce Anger in Middle School Boys Josie Boehlert

  2. 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)

  3. 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)

  4. Role of School Counselors • Support academic achievement • Support social development • Improve functioning of whole school

  5. 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

  6. CBT Techniques • Modeling • Behavior rehearsal • Coaching • Homework • Feedback • Reinforcement • Cognitive restructuring

  7. Pre-group Measures

  8. 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

  9. Logistical Planning • Scheduling – 30 minutes • Location • Parental permission • Create plans • Obtain necessary materials

  10. Group Process

  11. 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)

  12. Session 2 • Summarize 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

  13. 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

  14. Session 4 • Review 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

  15. 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

  16. Session 6 • Review 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

  17. Presentation • Arrange with teacher • Introduce purpose to class • Introduce students • Observe while students teach classmates

  18. Session 7: Termination • Review 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)

  19. Post-group Measures/Evaluation • Post-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)

  20. Possible Issues

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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.

  26. 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

  27. 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

  28. 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

  29. References • Burt, 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 PsikolojiDergisi, 25(66), 68-72.

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