Facilitating group process: an exploratory study of adolescent psychotherapy groups in residential treatment centers

Residential treatment centers are restrictive and intensive care environments intended to address the needs of adolescents with high-risk emotional and behavioral dysfunction and issues of complex trauma. Individual, milieu, and group therapies are key treatment modalities for adolescents in these settings. While collective treatment outcomes are commonly discussed in previous research, there is a limited body of literature detailing the provision of the specialized services offered—especially group psychotherapy, which targets the critical task of interpersonal development for adolescents through group process. Many features of residential treatment settings differentiate them from settings for which standard models of treatment were originated. Thus there are some significant disparities between theory and practice. A comprehensive understanding of group therapy services for adolescents in residential treatment centers, particularly those with process components, requires a phenomenological examination of the treatment process, as implemented by clinicians with interdisciplinary mental health backgrounds in these settings. This exploratory study investigated the experiences of clinicians facilitating groups with process components for adolescents in residential treatment centers. Ten clinicians who have facilitated such groups within the last five years participated in the study, which used a qualitative research design. Participants were interviewed using a semi-structured questionnaire. Themes emerging from their responses were analyzed using grounded theory techniques. Identified themes included (a) preparation for clinical work in residential treatment centers; (b) impact of variety of contextual factors; (c) clinician influence on facilitation of group process; (d) the need to move to system-level trauma-informed care; (e) impact of direct care staff on group process; (f) attention to and focus on individual needs; (g) balancing structure and flexibility in group facilitation; (h) variety in group types as treatment component; and (i) the benefit of group process for adolescents in residential treatment centers. Implications for future research direction, training needs, group clinicians facilitating these groups, and residential treatment centers were discussed.Psy.D.Includes bibliographical referencesby Shemika M. Brook