THE HEALING CROWD: PROCESS, CONTENT AND TECHNIQUE ISSUES IN GROUP COUNSELING FOR PEOPLE WITH MENTAL RETARDATION

DANIEL J. TOMASULO, PH.D., T.E.P., ELLEN KELLER, M.A., M.S., and AL PFADT, PH.D.

Within the field of human services, the use of group therapy for people with mental retardation and people with psychiatric and developmental disabilities has been extremely limited (reference 18). However, over the past twenty years or so there have been a number of noteworthy exceptions (references 5, 6, 7, 8, 19, 20, 24). While varied in their approach and focus it is important to note that many of these formats have included role playing as the method of choice.   ...More

Group Therapy for People with Mental Retardation: The Interactive-Behavioral Therapy Model

Adapted from, Weiner D (Ed.) (1999) Beyond Talk Therapy: Using Movement and Expressive Techniques in Clinical Practice. Washington, DC: American Psychological Association. Copyright, 1999 by American Psychological Association. Reproduced with permission. No further reproduction or distribution is permitted without the written permission of the American Psychological Association

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GROUP THERAPY FOR PEOPLE WITH MENTAL RETARDATION: THE INTERACTIVE-BEHAVIORAL THERAPY MODEL

Traditional psychodrama group action methods generally consist of three components: (a) a warm-up, (b) an enactment, and (c) a sharing. The warm-up allows participants to prepare for the enactment stage by having them identify what they want to work on. The enactment phase allows action methods to be used to explore the problem, and the sharing phase allows each member to reflect on his or her experiences within the group. In pilot studies, this traditional process was only marginally effective with people with mental retardation. As a result, the interactive-behavioral therapy (IBT) model was constructed (Tomasulo, 1998). It was designed specifically to assist people whose cognitive skills are diminished in some way to benefit from interaction with their peers in a therapeutic setting. The IBT model of group therapy offers a format for using action methods from the field of psychodrama with people who have a primary diagnosis of mild or moderate mental retardation (IQ scores between 40 and 69) and who often have a secondary psychiatric diagnosis. Specific modifications made to accommodate people with mental retardation include the following:

-shortening the session time to between 45 and 60 minutes (the more typical timetable is 90 - 120 minutes);

-describing the process and mechanics of the action to the members during the enactment stage;

-dividing the process into four distinct stages (i.e., orientation, warm-up and sharing, enactment, and affirmation; see Figure 7-1) as a way of readying members for using action methods and ending their group experience in a positive fashion; and

-identifying therapeutic factors displayed by members during the process and reinforcing them when they occur as well as in the affirmation stage.

These modifications have been adopted for the following reasons:

-The condensed time increases the possibility that members will remain physically and emotionally present.

-The time frame and four-stage model keeps the facilitator or facilitators more focused on the necessary tasks to be accomplished in each stage. In addition, facilitators are better able to attend to the process of the group rather than the content.

-The shorter time frame more readily fits into the schedules of most hospitals, agencies, residences, vocational settings, and schools; that is, IBT groups can easily replace social-skills training groups.

Psychodrama and sociodramatic theory (Blatner & Blatner, 1988; Steinberg & Garcia, 1989) offer the most widely accepted format for facilitating role-playing techniques within a group setting.

During the enactment stage, participants are provided with a greater awareness of the mechanics of the action than are nondisabled members of traditional psychodrama groups. This awareness requires that the facilitator or facilitators ensure that participants can follow the action, identify the roles played by the auxiliaries, know who is supposed to be occupying the empty chair, and recognize what role is being played during role reversals. Additionally, the use of active and interactive techniques often is preferred because they stimulate more sensory and affective modes of learning than verbal therapy alone. (Hurley, Pfadt, Tomasulo & Gardner, 1996; Tomasulo, 1994).

A Pilot Program in Character Education in the Jersey City Public Schools:

Developmental Disabilities/Mental Health Treatment

-Referred by others
-Unmotivated for treatment
-Unaware of the consequenses of non-participation
-Detoxification may not be possible prior to treatment due to lack of adequet staff and staff training
-DD and MH programs are generally supportive. Intense confrontation is counter-productive and anti-therapeutic
-Avoid hitting bottom. Treatment follows stabilization
-Must help to maintain fragile defense structure

Interactive_Behavioral Therapy - Overview

(IBT) Interactive-Behavioral Therapy- Research

The following excerpt from Dr. Tomasulo's book Action Methods in Group Psychotherapy: Practical Aspects (Accelerated Development, Philadelphia PA., 1998) is reprinted with permission from the publisher.

The Interactive-Behavioral Model of Group Counseling For People with Mental Retardation and Chronic Psychiatric Illness.
Daniel J. Tomasulo, Ph.D.

In recent years The Interactive-Behavioral model of Group Psychotherapy (IBT) has gained wide acceptance for use with people suffering from mental retardation, chronic psychiatric disabilities, and those with a dual (MR/MH) diagnosis. The IBT model uses an abbreviated four-stage format to activate therapeutic factors through the use of action techniques. The remainder of this section will be devoted to the understanding of this model and its implications for use. ...More