ACA Blog

Jaime Castillo
Jan 24, 2011

Learning Group Psychotherapy for Adults with Mental Retardation

In a previous entry “Indiana Jones and the Kingdom of the Crystal Client,” I discussed methods of providing individual psychotherapy with adults diagnosed with mental retardation. It’s not a surprise that we must also modify our traditional therapeutic techniques with this population when facilitating groups. Each week I run a group comprised of adults with mental retardation and co-morbid psychiatric diagnosis, and have been trained in the “Integrative-Behavioral Model” for group psychotherapy, as developed by Dr. Dan Tomasulo. Working with this population can be difficult. Not only are we faced with the MR and co-morbid psychiatric disorders, but also we are challenged by the numerous cognitive and social skill deficits these clients face.

Some of the most challenging barriers are the clients’ difficulty in forming social relationships, initiating conversations among each other, and listening. More often these individuals seek out staff from their group homes to talk to when facing issues, and ignore their peers. When their peers talk, they don’t listen or acknowledge their presence, which can make groups difficult. The purpose of our groups when working with this population is to facilitate peer-to-peer interactions.

Example of a group outside of this population:
Counselor: Would somebody like to share to the group an experience they had this week?
Dave: Sure. On Thursday evening my sister asked me to turn off the football game because I’d been hogging the TV all night. Instead of getting mad and screaming back at her, I asked for 5 more minutes to finish, then I’d turn it off.
Counselor: Sounds like you and your sister made a compromise.
Dave: Yea.
Counselor: What was it like for you reach that decision?
Dave: At first I wanted to get mad, but then thought it wasn’t worth it. She was right too, I’d been hogging the TV.
Counselor: Good job Dave, you showed patience. Who else would like to share?
In the above discussion, although there may be 5 others in this group, probably for anger management, the conversation is only happening between the counselor and the individual. When working with individuals with MR, we must facilitate interactions between the group members. This is done by the Counselor encouraging the individuals to look at each other, request for statements to be repeated, and talk to each other rather than to the Counselor.

Example of group specified population:
Counselor: Would somebody like to share to the group an experience they had this week?
Dave: Sure. On Thursday evening my sister asked me to turn off the football game because I’d been hogging the TV all night. Instead of getting mad and screaming back at her, I asked for 5 more minutes to finish, then I’d turn it off.
Counselor: Did anybody hear what David just shared? Karen…would you share with us what David said?
Karen: He said his sister…..
Counselor: Karen can you look at David as you share?
(Karen looks at David)
Karen: You said your sister wanted you to turn off the game.
David: Yea.
Counselor: Is that all he shared?
Karen: Um….I don’t remember.
Counselor: Karen maybe you can ask David to repeat what he shared.
Karen: (now looking at David) David can you repeat what you said?
David: Sure, I said because I’d been hogging the TV all night. Instead of getting mad and screaming back at her, I asked for 5 more minutes to finish, then I’d turn it off.
Karen: He said he’d been hogging the TV and didn’t get mad and said 5 more minutes.
Counselor: Is that right David?
David: Yes.
Counselor: David, can you say that to Karen?
(David looking at Karen)
David: Yes, that’s right.
Counselor: Great job guys. David would you like to pick someone who hasn’t shared yet?

As you read both can you feel the difference? If you have the opportunity to work with this population in a group setting, remember that it’s important to facilitate peer-to-peer interactions. Unlike traditional groups its important here to continuously encourage each member to be interacting through listening and repeating. Encourage the individuals to look at each other when speaking, and not to you. You want the individuals to learn to connect with each other. The content of the group is not as important as the interactions made.
This is only the tip of the iceberg when discussing the The Integrative –Behavioral Model for Group Psychotherapy, and by no means are you now an expert. If you’re interested in learning more, you can get started by reading the article in the link below.

http://web.mac.com/tomasulo1/The_Healing_Crowd/Welcome_files/group%20psychotherapy%20for%20ID.pdf



Jaime Castillo is a counselor who works for a non-profit agency in New York City.


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