Post University Boundaries and Rules Discussion Responses – Assignment Help

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DQ#1 Boundaries and Rules

Liz P

Groups with adolescents can be challenging because often times, they enter group because they are forced to. Clinicians need to feel comfortable with this population and set firm boundaries in place from the beginning.

One of the group rules – what happens in group, stays in group. Many adolescents struggle with their identity and self-esteem, therefore, they need to feel safe in an environment that they will be sharing feelings and thoughts, “Client engagement is an essential yet challenging ingredient in effective therapy” (Thompson, Bender, Lantry, & Flynn, 2007, p. 39). The clinician needs to facilitate an alliance with him/herself and the client, as well as with the other group members, because this will create “increased engagement” (Thompson, & et al., 2007, p. 39). This alliance will foster “achievement of goals, establishment of tasks, and building a bond” (Thompson, & et al., 2007, p. 39). Relationships are forged and help decrease anxiety and address underlying trust and attachment issues, thus teaching the client about self-empowerment and change, which ultimately result in positive treatment outcomes (Thompson, & et al., 2007).

The second most important group rule – show respect towards each other, this is a safe place. It is vital that the group members understand that safety is taken seriously and there are behavior expectations, both physical, verbal, and emotionally. Many of these clients have been hurt outside of the group and typically are not voluntarily there. Therefore, they are very resistant to group and are skeptical of the facilitator, the process, and of each other. The clinician needs to be responsible for creating a welcoming environment, allowing for “a feeling of intimacy and will differentiate the group from a class” (Berg, Landreth, & Fall, 2013, p. 171). Also, the facilitator needs to demonstrate straightforwardness, educating the group members about the purpose of the group and that “they are safe enough to risk sharing their concerns” (Berg, Landreth, & Fall, 2013, p. 172). This includes providing structure in order to help members feel security. When clients know the expectations and understand a routine, they will be more likely to risk sharing their feelings.

Developing “ethical parameters and boundaries around therapy is important in providing a safe treatment and environment” (Gola, Beidas, Antinoror-Burke, Kratz, & Fingerhut, 2016, p. 184). Adolescents live in a culture of social media, which is also a constant threat to their confidentiality. The facilitator must address this reality and the rules surrounding the use of social media as it pertains to the group members and the facilitator. Discussion about this allows for the group members to acknowledge that they understand, as it also reflects their vulnerabilities (Rideout, & Campbell, 2018).

The discussion of confidentiality as it relates to information shared in group – how much information is communicated to parents? The facilitator needs to explain his/her ethical responsibilities as a mandated reporter. And, he/she should discuss informed consent and treatment goals met. Therapists develop an alliance with their group members, and they must respect those boundaries, because if this is breached, it will destroy the individual therapeutic relationship, as it will also hurt the group (Rideout, & Campbell, 2018). Families can be “great supporters for their children and aid in their therapy; however, they also often unintentionally maintain their child’s anxiety (Rideout, & Campbell, 2018, p. 5).

Therapists also must present clear and direct information about the “rationale for treatment” (Rideout, & Campbell, 2018, p. 6). In order to establish boundaries, rules or a course of what clients can expect helps explain purpose and can “increase motivation in treatment” (Rideout, & Campbell, 2018, p.6). Clients need assurance that they will never be forced to do or say anything that they do not want to do. Ultimately, they are in control and they decide when they want to take risks.

References

Berg, R., Landreth, G. L., & Fall, K. A. (2013). Group counseling: Concepts and

procedures. New York: Routledge.

Gola, J. A., Beidas, R. S., Antinoro-Burke, D., Kratz, H. E., & Fingerhut, R. (2016). Ethical

considerations in exposure therapy with children. Cognitive and Behavioral Practice, 23(2), 184–193. https://doi.org/10.1016/j.cbpra.2015.04.003

Ridout, B., & Campbell, A. (2018). The use of social networking sites in mental health

interventions for young people: Systematic review. Journal of Medical Internet Research, 20(12), e12244. https://doi.org/10.2196/12244

Thompson, S. J., Bender, K., Lantry, J., & Flynn, P. M. (2007). Treatment engagement: Building

therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy, 29(1-2), 39–55. https://doi.org/10.1007/s10591-007-9030-6

Katherine J

A group leader should first prepare a “physical environment” when establishing a group therapy with adolescents (Berg,2013). The environment should be set up with precautionary surroundings that enable the adolescent to self reflect. Consistency of the surroundings is important as they establish safety in the mindset of the adolescent. As the therapist decides the best environment, they also must establish basic rules to ensure that everyone is on the same page.

The first rule that I think is relevant to today’s generation of adolescents would be to leave cell phones at the door in a basket. It can be picked up at the end of the session but if they can not adhere to this rule, ask that cell phones be turned off and put up as to not interfere with the group session. Adolescents are very much geared around the whole social media ideology and therefore not allowing phones in session would prevent a whole host of problems. The fear of adolescents secretly taping sessions, taking pictures of other group members without permission, and more importantly, can also be a distraction (Mulqueen,2019).

The second rule is the extreme concern for confidentiality is vital because it is a guideline that the American Counseling Association (ACA) implemented in its guideline of code of ethics (ACA,2014). Within the group there unknown issues of transference due to the many unknown variables that can present in the group. The illustration from the text of the “baby in the room” illustrates issues like this can occur and the therapist’s countertransference of the information given by the teenage girl was shocking (Gelner,2013). This is why the utmost urgency of confidentiality should be one of the rules in any given group therapy.

Group members need to understand the definition of what are boundaries and what do they represent. Boundaries represent our morals and beliefs that we often tend to be responsible for daily, but when individuals are forced to adhere to a boundary anger and hurt may occur. This may happen because the individual may not feel that they are being respected by boundaries being forced upon them (Gabriel, 2020). Boundaries within a group therapy with adolescents should be established as to what is required of each individual during group and what boundaries are expected while not in the group. It is vital to set boundaries before group sessions with adolescents because it sets limits that each will have to adhere to. If the boundaries have been not adhered to that describes the group members’ limits then utter “chaos” can arise within the group (Holmes, 2004). A boundary that needs to be addressed is the common practice of group members establishing an outside relationship that is not encouraged as it can establish a whole host of problems with the group therapy (O’Reilly,2019). The exchange of social media platforms and interchange between these platforms should not be encouraged. A challenge that can occur with boundaries is the inability of group members not respecting one another during group therapy sessions. This may be interrupting members as they are sharing, having personal conversations while group session is occuring and making negative nonverbal cues such as rolling of eyes, sighing or making inappropriate noises (O’Reilly, 2019). Another challenging boundary issue is consequences when boundaries are broken. These consequences should be implemented and agreed upon with the entire group what the consequences shall be.

References:

American Counseling Association. (2014). 2014 code of ethics – American counseling association. Retrieved February 15, 2021, from https://www.counseling.org/resources/aca-code-of-e…

Berg, R., Landreth, G. L., & Fall, K. A. (2013). Group counseling: Concepts and procedures. New York: Routledge.

Gabriel, A., Erickson, R., Diefendorff, J., & Krantz, D. (2020, March 25). When does feeling in control benefit well-being? The boundary conditions of identity commitment and self-esteem. Retrieved February 15, 2021, from https://www.sciencedirect.com/science/article/pii/…

Gelner, P. (2010). The baby in the room: group supervision on an adolescent girls therapy group. Modern Psychoanalysis, 35(2), 205–218.

Holmes, P. (2004, March 05). Boundaries or chaos: An outpatient psychodrama group for adolescents. Retrieved February 15, 2021, from https://www.sciencedirect.com/science/article/pii/…

Mulqueen, M. (2019). Who’s listening? Smartphones and psychotherapy. Retrieved February 15, 2021, from https://www.psychotherapy.net/article/smartphones-…

O’Reilly, M. (2019, June 7). Social media and adolescent mental health: the good, the bad and the ugly. Michelle O’Reilly https://www.tandfonline.com/doi/abs/10.1080/096382…

Robbins, E. S., & Haase, R. F. (1985). Power of nonverbal cues in counseling interactions: Availability, vividness, or salience? Journal of Counseling Psychology, 32(4), 502–513. https://doi.org/10.1037/0022-0167.32.4.502

DQ#2 Resistance

Liz P

Adolescents are typically involuntary clients, “at the behest of teachers, parents, or even the court system” (Berg, Landreth, & Fall, 2013, p. 173). It is vital that the therapist forge an individual alliance with each member of the group.

This can begin during the pre-screening interview. The clinician can begin to gauge why the client presented and their level of resistance. This is an opportunity for the therapist to begin answering questions and helping the client identify what they can take from the group (Berg, & et al., 2013). This helps give control to the client and allows them to examine how he/she can use the group to benefit themselves on their terms, versus on someone else’s terms.

Additionally, the therapist can also forge an alliance with each group member, and the group as a whole, when he/she implement activities that foster bonding. This allows the members of the group to see the clinician as someone who ‘gets it’ and as someone who can assist, without resembling the authoritative figure. These activities which have a psychoeducational component allow the individuals in the group to generate ideas and act as problem-solvers, which can “move the group toward accepting greater self-responsibility and in turn encourage other members to do the same” (Berg, & et al., 2013, p. 175). This allows for inclusion and acceptance, which in some cases, these adolescents have not experienced on the outside. The therapist strengthens the therapeutic alliance by valuing the needs and expectations of the client by listening and acknowledging concerns and fears (Koback, Zajac, Herres, & Krauthamer, & Ewing, 2015, p. 221).

The aim of group therapy is to “promote autonomy and maturity through interaction between peers and their therapist in a safe, containing environment” (Arias-Puiol, & Anguera, 2017, p. 1).

Despite these efforts, professionals need to be alert to the “high prevalence of low adherence to treatment during adolescence, which increases suicide and substance abuse risks and poorer quality of life” (Taddeo, Egedy, & Frappier, 2008, p. 19). Therapists strive to learn new techniques and approaches to help build and improve therapeutic alliances, individualize treatment, and help empower clients. Researching treatment adherence amongst this high risk population is an ongoing process. The repercussions of treatment failure can lead to hospitalizations, truancy, increased mental health symptoms leading to increased legal, academic, and familial problems (Taddeo, & et al., 2008).

Another concern therapists face when working with adolescents, is suicide risk, which is “a serious health problem as it is currently the third leading cause of death for teenagers between the ages of 15 and 24 years” (Gaaif, Sussman, Newcomb, & Locke, 2007, p. 27). Substance use is “widespread among today’s teenagers and is related to both suicidality and depression” (Gaaif, & et al., 2007, p. 27). Alcohol and drug use is a risk factor in attempted or completed suicide attempts. And, this could be coupled with depression, which increases the risk factor.

References

Arias-Pujol, E., & Anguera, M. T. (2017). Observation of interactions in adolescent group

therapy: A mixed methods study. Frontiers in Psychology, 8, 1188. https://doi.org/10.3389/fpsyg.2017.0118

Berg, R., Landreth, G. L., & Fall, K. A. (2013). Group counseling: Concepts and

procedures. New York: Routledge.

Galaif, E. R., Sussman, S., Newcomb, M. D., & Locke, T. F. (2007). Suicidality, depression, and

alcohol use among adolescents: a review of empirical findings. International Journal of Adolescent Medicine and Health, 19(1), 27–35. https://doi.org/10.1515/ijamh.2007.19.1.27

Kobak, R., Zajac, K., Herres, J., Krauthamer, & Ewing, E. S. (2015). Attachment based

treatments for adolescents: the secure cycle as a framework for assessment, treatment and evaluation. Attachment & Human Development, 17(2), 220–239. https://doi.org/10.1080/14616734.2015.1006388

Taddeo, D., Egedy, M., & Frappier, J. Y. (2008). Adherence to treatment in

adolescents. Paediatrics & Child Health, 13(1), 19–24. https://doi.org/10.1093/pch/13.1.19

Tiffany M

I feel as though gaining the trust of an adolescent client is harder than an ambivalent court ordered adult client. This is a delicate stage of development and emotions are felt so strongly at this age as their rational ability to compare emotional upsets to previous experiences is not existent yet; everything hurts hard and fast. One of the primary ways to build this rapport is to validate the client; validate their frustrations, validate any feelings they are having as they need to get comfortable with the idea of feeling. Moving forward explore what they want to gain out of treatment, not what their parent/caretaker wants but what do they want? Berg, Landreth, and Fall (2013) notes that creating an environment for adolescents includes limits, boundaries, and respect. While it may not be their choice to engage in therapy it can be viewed as lesson; to begin assessing their wants/needs and how do they get there? Jayarajan and Jacob (2018) notes that there is a certain level of mistrust from onset due to the lack of choice so by providing choices within the environment of therapy it begins to decrease the mistrust.

For some reason I keep thinking about cyberbullying when I contemplate concerns of group work with adolescents. Everything is so accessible due to the internet and social media, everything is on demand and can be posted, seen, and taken down in a matter of seconds. Those few seconds could create massive damage to a member(s) if the group content is shared. Emirtekin et al. (2020) highlights that cyberbullying leads to increased depression and inability to regulate impulse control. Awareness that confidentiality extends to social media is something that would need to be included in the confidentiality discussion.

Another issue that could be of concern when working with adolescents is that of status amongst the members; it is likely there will be members that belong to different social groups within the hierarchy of the school they attend. Pattiselanno (2015) explains that within a system there are varying social groups, when together they engage in similar interests/behaviors however when apart the balance of power is off, and this can create tension within an outside social system. Being aware of differing statuses within the group is helpful to neutralize any power struggles between members; acknowledging that everyone is sitting in the same room at the same moment maybe a great equalizer and promote inclusion.

With the exploration of self during this stage of development I would imagine there are numerous issues that can come up; personally, if I were to work with this population my self-care would have to be a priority as I could see burnout being high as dealing with resistance would be more of a daily occurrence.

Thank you,

Tiffany Morton

References

Berg, C., Fall, A., & Landreth, L. (2013). Group Counseling: Concepts and Procedures: Vol. 5th ed. Routledge.

Emirtekin, E., Balta, S., Kircaburun, K., & Griffiths, M. D. (2020). Childhood Emotional Abuse and Cyberbullying Perpetration Among Adolescents: The Mediating Role of Trait Mindfulness. International Journal of Mental Health & Addiction, 18(6), 1548–1559. https://doi.org/10.1007/s11469-019-0055-5

Jayarajan, D., & Jacob, P. (2018). Psychosocial interventions among children and adolescents. Indian Journal of Psychiatry, 60, S546–S552. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_22_18

Pattiselanno, K., Dijkstra, J. K., Steglich, C., Vollebergh, W., & Veenstra, R. (2015). Structure matters: The role of clique hierarchy in the relationship between adolescent social status and aggression and prosociality. Journal of Youth and Adolescence, 44(12), 2257–2274. https://doi.org/10.1007/s10964-015-0310-4

DQ#3 Groups with Adolescents

Liz P

The adolescent development span from ages 13 through 19 vary significantly; therefore, so do the therapeutic groups. There are some similarities in how groups are created, but they are different due to content and focus.

Most groups are small and intimate and allow for five to ten members. This allows for each member to check-in, engage in group processing work, and closure. Due to potential environment setting time constraints (i.e. school), the group member size will allow for each member to participate (Berg, Landreth, & Fall, 2013). And, groups need to have members that can relate to a topic – Why is the client in that particular group? Within that group, members need to have some commonality, this is attributed to experience, which allows members to share and provide feedback to one another during sessions.

Adolescence is a term that groups 13 year olds with 19 year olds. However, there is a huge difference between these groups and need to remain separated in group settings. They differ with their physical development, with the earlier group beginning puberty and experiencing hormonal shifts. This group is beginning to find themselves and shifting from family life to a social one. They are beginning to have romantic relationships and exploring how they fit into this new social world.

The older adolescent has almost completed puberty and preparing for independence through work and creating a life outside of school. They have more independence and developing his/her “unique personality and opinions” (Centers for Disease Control and Prevention, 2020). This group may have increased conflict with family and looking at life beyond high school.

This also translates into the nature of topics discussed in groups. The younger adolescents may focus more on character development topics like: cooperation, kindness, resilience, and honesty. This age group is beginning career awareness and academic independence. However, the older adolescents may be focused on: listening, interacting with others – including the professional world of work, fitting in, safe choices, and deeper self-assessment.

Despite even the best efforts, one challenge that can present itself when working with adolescents, are those that have parents that are not cooperative. The parent of an adolescent with psychiatric disorders and they do not follow through with recommendations or dismiss the therapist (Kreyenbuhl, Nossel, & Dixon, 2009). This can be frustrating for the clinician because the minor cannot access psychiatric care on their own – transportation, financial, and legal – while the parents ignore and/or negate the issues brought to their attention.

Another challenge therapists may face when working with this age group are disclosures that therapists may not feel comfortable with. Some clients may discuss parenting issues that are considered ‘normal’ in their culture, but clash with ‘Western’ ideas; “These situations [of what neglect may be] do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of information or assistance” (Determining Child Abuse & Neglect Across Cultures, 2018).

I think that it is critical for therapists to engage in continued learning and seek supervision to help process group sessions and feel comfortable asking questions. Clinicians need to seek assistance and educate themselves about their communities, which make up their clientele. As mandated reporters, some professionals feel pressure to react immeidately, however, there needs to be some discussion prior to making a report. Time is always a challenge when it comes to minors.

References

Berg, R., Landreth, G. L., & Fall, K. A. (2013). Group counseling: Concepts and

procedures. New York: Routledge.

Centers for Disease Control and Prevention. (2020, March 3). Child development: Teenagers

(15-17 years of age). U.S. Department of Health & Human Services. Retrieved from https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.html

Determining Child Abuse & Neglect Across Cultures. (2018). Bridging Refugee Youth &

Children’s Services. Washington, D.C. Retrieved from https://brycs.org/child-welfare/determining-child-abuse-neglect-across-cultures/

Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health

treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophrenia Bulletin, 35(4), 696–703. https://doi.org/10.1093/schbul/sbp046

Tiffany M

According to Berg, Fall, and Landreth (2013) groups with adolescents can be more diverse in a sense of content; while interactive activities are still of great use the motive behind using them changes slightly. In addition, this age group is diverse as it includes persons ranging in age from age 10- early 20’s. Curtis (2015) notes that there are three stages of adolescence: early, middle and late. Depending on the stage of development the activities could be modified to include more/less education, processing, or actual engagement in an activity to determine social skill level and interconnectedness (Berg et al, 2013). This leads into the group size as noted by Berg et al. (2013) group size is typically 5-10 and around the same age; a couple of years difference can be a major change in development with this population.

An appropriate group for adolescents depends on the stage of adolescence; for this assignment I was thinking about 13–15-year old’s as this is the end of early adolescents and the start of middle adolescence (Curtis,2015). A topic for discussion could be stress management as in this stage of development social needs become a priority as does pressure to make decisions about future goals. Jiménez-Iglesias et al. (2015) notes that depending on family construct the pressure to perform or the learned behavior of remaining passive may present as a coping method around this age to manage stress. This topic is also an area that can get people to talk as well as do so there would some education however if needed activities could be used. In addition, this is the start of examining interpersonal relationships and how they perceive expectations that are placed on them as well as self-imposed; how do these relate to stress and performance?

Berg et al. (2013) provides the example of a once per week group and holding in a free period or at lunch. I disagree with a group being held during a lunch break; it sends the message that taking a break is not important; I would prefer an after-school time or during study hall if it must be during school hours. I do agree with once per week and the time of 45minutes to an hour. Overall, no matter the age of the clients I have found that having the same space, set up the same way week after week provides comfort. Berg et al. (2013) notes that maintaining the same space is ideal as it limits the anxiety associated with adjusting to the environment.

As far as the age range goes, I feel as though this is something that must be adhered too as there are some major differences between a 13-year-old and a 17-year-old. A 13-year-old is either at the end of Junior High or just starting High School whereas a 17-year-old is finishing up High School and prepping for college/work. Life is different at each stage of adolescence. There are levels of social pressures, sexuality begins to be of interest, and people start developing personality characteristics based on internal/external influences (Curtis, 2015).

I think the biggest challenge in a group with this population is the resistance; resistance at on-set of engaging and then continued resistance as the group formulates and creates their own unique inner-workings. Being able to set the limits and boundaries while letting them explore their own personal limits within those parameters will set the expectations and allow the group to begin flowing (Berg et al.,2019).

Thank you,

Tiffany Morton

References

Berg, C., Fall, A., & Landreth, L. (2013). Group Counseling: Concepts and Procedures: Vol. 5th ed. Routledge.

Curtis, C. (2015). Defining adolescence. Journal of Adolescent and Family Health: Vol. 7 (2). Retrieved from https://scholar.utc.edu/jafh/vol7/iss2/2

Jiménez-Iglesias, A., Moreno, C., Ramos, P., & Rivera, F. (2015). What family dimensions are important for health-related quality of life in adolescence? Journal of Youth Studies, 18(1), 53–67. https://doi.org/10.1080/13676261.2014.933191

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