by Bonnie Goldstein, Ph.D.
This article is a modified excerpt from the chapter, “Cultivating Curiosity, Confidence, and Self-Awareness through Mindful Group Therapy for Children and Adolescents,” in Play and Creativity in Psychotherapy edited by Marks-Tarlow, Solomon, and Siegel (2017).
Group therapy harnesses the desire to connect, belong, and feel part of a community, as members’ reflections about their interactions lead to insight and growth. This is especially true in young people who may not have had many opportunities to feel accepted and validated by others, which can reinforce mistaken beliefs about self and others. Young people who avoid others to avoid trauma, wind up isolating themselves from the even the relationships they need to heal and grow. Transformative moments begin with misreading another group member in the here and now, which may evoke feelings from past experiences and relationships. Capitalizing on such interchanges can lay the foundation for repair and resilience, social-emotional development and growth, and the cultivation of curiosity, creativity, and confidence.
Innovative and integrative group therapy comes about through co-creating a playful, safe, nurturing, growth-oriented therapeutic environment in which it becomes less shameful to show hidden parts of the self. Participants in group therapy can reassess their sense of self in relation to others, and gain reassurance as commonalities between members become evident, thus laying the foundation for shifts in experience. Observing changes in other group members can be helpful for those who cannot put into words their own thoughts, feelings and fears. Healing occurs as recognition, exploration, and resolution of trauma and developmental issues during the group experience are aided by an essential element of play, i.e., inviting curiosity. Mindfulness through playful queries such as “I’m curious” or “I wonder” offers a collaborative lens that welcomes wondrous and engaged curiosity, foundations in mindfulness practices, and fosters a deepening awareness of the present moment experience.
Creative and playful interventions to elicit mindfulness help to navigate complicated and contentious relationships, such as will be described in the case example of Danielle and Ian, two teen group members.
As a young child, Danielle emigrated from the Middle East with her mother after a change in government regime resulted in their lives being threatened. That was the last time she saw her father, who remained behind. Danielle experienced even greater trauma following September 11, 2001, when both her first and last names were changed. In the ensuing months, her family and others in their community experienced an upsurge of hostility, rage, and racial profiling. These experiences led Danielle to become fearful of others and hesitant to engage with her peers, resulting in her feeling marginalized and rejected.
Danielle was referred to me for her depression by her school counselor, and we began intensive one-on-one therapy as she was beginning 12th grade. I suggested that group therapy could help her combat her sense of isolation as well as aid in developing awareness of the overarching impact of her traumatic experiences. Danielle was wary, but she agreed to give it a try.
After initial resistance that required “curbside therapy,” i.e., meeting Danielle where she needed to be, we decided that she would enter the group with me, so she would not have to make conversation or face her peers alone. Danielle’s body stance implicitly let all members know of her hesitancy; she entered the room with her head down, arms crossed, appearing defiant or avoidant. Her initial responses to group members were curt, often one-word answers to their questions. There was no eye contact. At the time, Danielle seemed unaware of her self-protective stance, which she later recognized as “body armor.”
In a future meeting, group members were invited to share their experiences of one another. Addressing questions ranging from “What was your first impression of group?” to “What was your first impression of one another?” members developed insight and perspective, which led to more sensitivity toward each another. Danielle received feedback suggesting she shift her “body armor” so as to appear less alienating. A large, full-length mirror was brought out so Danielle could view herself in the stance we were discussing. Others also gazed in the mirror, supported by their peers, encouraged by the leaders, in what became a fun and interactive exercise providing much insight.
Danielle’s “body armor” had led to her isolation from her peers, which was exacerbated by her avoiding school clubs and teams, eating lunch alone in the library, and dodging opportunities to be with other students, lest they initiate conversation. In a social-feedback loop, her sense of isolation was maintained by her lack of insight into her avoidant behavior and the lack of tools to break out of this cycle.
As the group progressed, Danielle started to feel safer, both with people and with her own experiences, which slowly led to a sense of stability and confidence around others. She attained a better understanding of her body language and her own thoughts and feelings. This dyadic resonance went beyond simple mirroring to serve as the first step of a feedback loop that facilitated self-understanding. Danielle joined her peers in co-creating a safe environment by talking and listening, and supporting each other. Her intersubjective experience shifted, illustrating how the “group psychotherapy format offers an experiential immersion that fosters awareness and exploration of the ways we know and have a sense of the known within our subjective experience of being alive” (Goldstein & Siegel, in press, p. 260).
One group exercise focused on bringing members’ attention to their body-based experiences (e.g., noticing feelings of curiosity about a new member) or becoming aware of aches in their stomach, legs, and feet (perhaps an urge to mobilize or run). For Danielle, the impulse to bolt could be identified with a tingling in her feet. She noticed her limbs would begin to move and wiggle, which she connected to her instinct to flee the room.
As our group sessions progressed, the members became keener interpreters of their inner body and mind signals, for a large part due to the relational component of the collaborative work. Over time, Danielle was encouraged to lead other members in brief breath-work exercises. Taking a turn leading the group in breath-work further deepened her self-confidence and inspired a growing curiosity about other’s experiences.
Learning to be more centered and finding equanimity through these self-calming exercises, which were introduced in a playful manner, Danielle and her fellow group members developed tools to mitigate feelings of shame, anxiety, fear, etc. Leading these exercises helped Danielle deepen her subjective experience and enhance her own integrative capacity, which prepared her for her conflict-ridden interactions with Ian.
Ian’s ongoing interpersonal challenges and outbursts led his family to bring him to therapy so he could develop self-reflective skills and self-regulation strategies. In the months leading up to the 2016 presidential election, the issues of intolerance, separateness, inclusion, and belonging that were arising nationwide also arose within the therapeutic milieu. Ian, seemingly influenced by the political rhetoric, openly taunted his classmates, especially those whom he perceived as “different.” He proclaimed that he would help “build that wall,” arguing “some people don’t belong here.” Ian seemed to not understand the implications of his behavior, nor was he aware that it may have originated in his own experience of being a target of bullying. (It was later revealed that Ian had been teased and called a “mutt” by peers because of his olive skin and mixed ancestry.)
Ian’s attention-seeking behavior ranged from occasionally positive (bringing pumpkin cupcakes for his group mates) to frequently negative (using derogatory language, e.g., “dumb blonde” in reference to group members, or expressing oppositional or offensive opinions).
One of Ian’s targets of aggressive behavior (shoving, pushing) and verbal taunts was Danielle. After the 2016 election results, he championed the president-elect and called his co-members with opposing political views, “dumb” and “idiots.” He would yell “Make America Great Again” and “Build the Wall” in Danielle’s direction to purposefully trigger her insecurities about her otherness.
To address the escalation of conflict in the group, I directed their attention to explore the meaning Ian ascribed to his comments. I also aimed to illustrate to Ian that he was recreating the type of interpersonal conflict that occurred frequently at his school. This required looking at the moment-to-moment experience transpiring within the group milieu.
One strategy of de-escalating conflict is the “Power Pause.” The group knew that it was time to “down-regulate” when I stood up and indicated a stop sign with my hand, while whispering “Power Pause.” This encouraged group members to examine their own thoughts and feelings and how they were experienced in their bodies: were they feeling more nervous, anxious, more awakened, or numb as the conflict within group escalated? Some observed with wide-eyed panic (perhaps a flight or freeze response, perhaps reminiscent of other conflicts in interpersonal relationships), while others reacted by matching anger, in ever-escalating verbal assault (fight response). By regulating the pace and flow of the group dialogue, group members felt assured of being safely guided through these interactions with support and reinforcement.
Over time, Ian benefitted considerably from supportive positive feedback; his appearance shifted from the confident/cocky bully-rebel, off-putting teen to a more vulnerable, accessible person. This change manifested physically. For example, as he shrugged, Ian’s shoulders dropped forward, his eyes turned downcast. At these times he displayed a fleeting, palpable unease and sense of unworthiness. Often he found these feelings intolerable and would create a minor conflict or use his body provocatively, pushing boundaries or instigating interpersonal conflict to shift the moment or cause a distraction. Ian longed to be seen, recognized, honored, and respected, and these softer feelings were manifested over time in the group.
One way in which I led Danielle and Ian to address the conflict between them was through an interactive Sensorimotor Psychotherapy exercise that uses therapy balls. Danielle and Ian were asked to sit on two large therapy balls placed on opposite sides of the room. They could use gentle bouncing or soothing swaying movements, with feet pushing down on the ground. Gentle bouncing releases tension because it keeps one’s feet firmly gripping the floor in order to balance, and the gentle movement can be calming.
Danielle and Ian were asked to select locations where they could gaze at one another, but at a distance they co-created. Once they found their positions, their conversation continued as they sat on the ball. Another brief hostile interchange was interwoven with playful giggling as one fell slightly off the ball and had to reestablish balance. Some wobbliness ensued, as each was encouraged to find a distance between them that felt correct. Danielle moved back until she was outside the room, at which point Ian said, “that’s right…out…no more group for you”. Our office doors are glass sliders, so Danielle’s annoyance was visible as she sat on her ball without commenting on his incendiary words. Only after Danielle had moved far outside the group room did Ian indicate with his hands that she should stop (the glass “barrier” seemed to serve the function of offering safety).
At that juncture both Danielle and Ian were instructed to notice what they felt in their bodies. I asked body-oriented questions to encourage present moment awareness, including “What do you feel inside your body right now as you face one another?”, “What is happening in your stomach now?” or “Do you feel the anger now that you mentioned feeling earlier?” Although Ian started to recognize that perhaps he had sent Danielle too far away, he seemed to have difficulty suggesting she come forward. He was encouraged to notice what happened when he invited her back into the room with only his eyes and his hand gestures. Peering through the glass, his hesitancy was palpable. As they cautiously and slowly continued the exercise, this time coming closer, Ian acquiesced that he had feelings of anxiety when beckoning her near. Danielle, however, came to a different realization. She said that she had become accustomed to lots of personal space through years of aloneness, and she was not so quick to move back into the group room. She noted that she could breathe more easily when there was plenty of space between her and Ian. She expressed that Ian continued to intermittently remind her of others who had taunted her, and said that she preferred to observe group from outside the glass, looking in.
Little headway was made with respect to their interpersonal conflict until we were able to bring their implicit experience of one another into the room, by examining the underlying process and feelings underlying the conflict. The slower pace allowed for curiosity about what was happening in the present moment, and opened space for members to share their thoughts and feelings, emotions and cognitions amidst the contentious and argumentative banter. As the exercise continued, I instructed Ian to ask Danielle to slowly move towards him, while he remained seated on the ball, until he felt that she was just the right distance from him. In the spirit of curiosity, he was encouraged to use his hands as guides, which he did, albeit reluctantly. After a few moments, the exercise shifted their experience of one another, dispelling the tension over Ian’s comments. In time, Ian apologized for his abusive comments toward Danielle.
The support and respect Danielle garnered during her experiences in group therapy led to shifts in her sense of self in the world. This playful group experience encouraged Danielle to reach out to others at school. Her subsequent evident growth in confidence and willingness to risk being “seen” were clear manifestations of growth based on her group experience.
In this exercise, through the lens of curiosity and playfulness, the collaborative group experience offered connecting and redeeming opportunities that emerged as members shared with one another, as guided by the support of the group leaders. While the tension in the room continued, some members spoke out against Ian’s political beliefs; others offered words of support to Danielle (a unique and gratifying experience for her). In this safe atmosphere, both members could take personal risks, revisit their challenging beliefs, and have an authentic learning experience.
Similar playful exercises are often useful during high-conflict moments in group, allowing for mindful self-awareness to develop, in the present moment, with opportunities for practice, reinforcement, and new cognizance. Please refer to the book chapter for details.
Working with adolescents in the group milieu creates new possibilities for interactions, self-understanding, and confident engagement with others. This is especially important in an environment where politics and prejudice have found their way into the lives of young people. Cohesive therapy groups can thrive when members are kept emotionally safe within the group despite the inevitable interpersonal conflict. The group can model acceptance by not ostracizing anyone or by not allowing a member to be exiled or “killed off.” By prioritizing playful communication and movement exercises, group members can explore emerging internal conflicts, become more mindful of their moment-to-moment experience, and delve beneath the verbal content of presenting problems. All of this can lead to qualitative and quantitative healing and growth, as new neural pathways are created. Healing occurs when we understand how prejudices are mirrored in the body and how they prevent us from both feeling accepted and accepting others.
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Dr. Goldstein is a Child and Adolescent Consultant for the Lifespan Learning Institute and a faculty member of the Sensorimotor Psychotherapy Institute, both located in Los Angeles, CA. She is an expert on the Sensorimotor Psychotherapy approach of treating children, adolescents, and families. She is the author of several publications, including Understanding, Diagnosing, and Treating Attention Deficit Disorder/Hyperactivity Disorder in Children and Adolescents, The Handbook of Infant, Child, and Adolescent Psychotherapy: A Guide to Diagnosis and Treatment, Volumes I & II, A Text for Children and Their Families, I Will Know What to Do: A Guide to Dealing with Trauma, and so forth.