PRAC 6650 Psychotherapy With Groups and Families

Week 10: Group Therapy With Children and Adolescents

Context & Overview

Effective group treatment with children and adolescents rests upon three essential considerations: the clients that compose the group, the therapists responsible for conducting the group, and the setting in which the group occurs. Group therapy may be beneficial for children and adolescents because it often provides an environment that normalizes clients’ thoughts, feelings, and behaviors. However, as with any therapeutic approach, group therapy might not be appropriate for every client, every setting, or even every therapist. When selecting therapies, you must always consider the psychodynamics of the client and your own skill set.

This week, as you assess and develop diagnoses for clients presenting for child and adolescent group psychotherapy, you examine the effectiveness of this therapeutic approach. You also consider legal and ethical implications of counseling children and adolescent clients with psychiatric disorders.

Learning Objectives

Students will:

• Assess clients presenting for child and adolescent group psychotherapy
• Evaluate the effectiveness of therapeutic approaches for clients receiving child and adolescent group psychotherapy
• Develop client termination summaries
• Develop effective documentation skills to examine group therapy sessions with children and adolescents
• Develop diagnoses for child and adolescent clients receiving group psychotherapy
• Analyze legal and ethical implications of counseling child and adolescent clients with psychiatric disorders

Required Readings

• Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer. Chapter 17, “Psychotherapy with Children” (pp. 597–624); Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712).
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
• McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041–2051. doi:10.1007/s10803-014-2087-9
• Restek-Petrović, B., Bogović, A., Mihanović, M., Grah, M., Mayer, N., & Ivezić, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333–340. doi:10.3109/08039488.2013.839738
• Document: Group Therapy Progress Note

Required Media

• Microtraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria, VA: Author. (Approx. 140 minutes; accessed via Walden Library databases.)
• Psychotherapy.net (Producer). (2002). Adlerian parent consultation [Video file]. Mill Valley, CA: Author. (Approx. 117 minutes; accessed via Walden Library databases.)

Optional Resources

• Psychotherapy.net (Producer). (2012). Group counseling with adolescents: A multicultural approach [Video file]. Mill Valley, CA: Author.

Discussion: Clinical Supervision

In Week 3, you collaborated with colleagues as you participated in your first clinical supervision. This week, you have the opportunity to continue your collaboration as you reflect on and discuss your experiences with counseling children and adolescents in group settings. Psychotherapy with these clients is often more complex than psychotherapy with the general adult population. Personal reflection and discussion with colleagues are essential to your development and success as a psychiatric mental health nurse practitioner. For this clinical supervision, consider a child or adolescent client you are counseling who you do not think is adequately progressing according to expected clinical outcomes.

To prepare:

• Review this week’s media and consider the insights provided on group therapy with children and adolescents.
• Reflect on a child and adolescent group that you are currently counseling at your practicum site.

By Day 3: Post a 3- to 5-minute Kaltura video that addresses the following:

1. Describe a child and adolescent group you are counseling.
2. Describe a client from the group who you do not think is adequately progressing according to expected clinical outcomes. Note: Do not use the client’s actual name.
3. Explain your therapeutic approach with the group, including your perceived effectiveness of your approach with the client you identified.
4. Identify any additional information about this group and/or client that may potentially impact expected outcomes.

By Day 6: Respond to at least two of your colleagues by providing constructive feedback concerning their presentations of their client groups and by recommending alternative therapeutic approaches that may be used with the groups. Support your feedback with evidence-based literature and/or your own experiences with clients.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

Assignment 1: Practicum – Client Termination Summary

Although termination is an inevitable part of the therapeutic process, it is often difficult for clients. However, by discussing termination throughout therapy, you can better prepare your clients for life without you. Once a client has achieved his or her therapeutic goals, termination sessions should be held and documented in a client termination summary. For this Assignment, you have the opportunity to practice writing a termination summary for a client with whom you have worked during your practicum experience.

To prepare:

• For guidance on writing a client termination summary, review pages 693–712 of Wheeler (2014) in this week’s Learning Resources.
• Identify a client who may be ready to terminate therapy.

Instructions: With the client you selected in mind, address in a client termination summary (without violating HIPAA regulations) the following:

• Identifying information of client (e.g., hypothetical name and age)
• Date the client initially contacted therapist, date therapy began, duration of therapy, and date therapy will end
• Total number of sessions, including number of missed sessions
• Whether termination was planned or unplanned
• Presenting problem
• Major psychosocial issues
• Types of services rendered (e.g., individual, couple/family therapy, group therapy)
• Overview of treatment process
• Goal status (goals met, partially met, unmet)
• Treatment limitations (if any)
• Remaining difficulties and/or concerns
• Recommendations
• Follow-up plan (if indicated)
• Instructions for future contact
• Signatures

By Day 7: Submit your Assignment using the naming convention “WK10Assgn1+last name+first initial.(extension).”

Assignment 2: Practicum – Week 10 Journal Entry

Select two clients you observed or counseled this week during a group therapy session for children and adolescents. Note: The two clients you select must have attended the same group session. If you select the same group you selected for the Week 8 or Week 9 Journal Entries, you must select different clients.

Address in your Practicum Journal the following:

1. Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.
2. Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
3. Using the DSM-5, explain and justify your diagnosis for each client.
4. Explain any legal and/or ethical implications related to counseling each client.
5. Support your approach with evidence-based literature.

By Day 7: Submit your Assignment using the naming convention “WK10Assgn2+last name+first initial.(extension).”

Assignment 3: Practicum – Week 8 Journal Entry

Submit your Week 8 Journal Entry. Refer to Week 8 for additional guidance.

By Day 7: Submit your Assignment using the naming convention “WK10Assgn3+last name+first initial.(extension).”

Assignment 4: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point. These review questions provide practice that is critical in your preparation for the national certification exam required to certify you to practice as a nurse practitioner. Access Board Vitals through the link sent to you in email or via https://www.boardvitals.com/. Complete the questions by Day 7.

Grading Rubric — Assignment 1: Client Termination Summary

Client Termination Summary: Sample Answer Excerpt

A well-structured termination summary begins with accurate identifying information and a clear timeline. For a hypothetical client, “Maria,” a 14-year-old Latina female, the initial contact date was March 3, and therapy began on March 17 after a two-week assessment period. The planned termination date is November 14, yielding a total duration of approximately eight months. Over this period, Maria attended 22 of 24 scheduled group sessions; she missed two sessions due to family obligations. The presenting problem centered on social anxiety and peer relational difficulties that had contributed to school refusal behavior. Major psychosocial issues included parental separation, academic decline, and a history of being bullied in middle school. Services rendered consisted of weekly cognitive-behavioral group therapy augmented by two individual family sessions. The group protocol drew on evidence supporting CBT-based group interventions for adolescent internalizing difficulties; as McGillivray and Evert (2014) note, group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people. Maria’s treatment goals addressed increasing peer engagement, reducing avoidance behaviors, and developing adaptive coping self-statements. Goal status reflects that the first two goals were met, while the third goal was partially met; Maria occasionally reverts to negative self-talk under academic pressure. Treatment limitations included the group’s structured format, which sometimes limited individualized attention. Remaining concerns involve mild academic anxiety during examination periods. Recommendations include participation in a school-based social skills maintenance group and periodic booster sessions. A follow-up phone call is scheduled for December 12, with instructions for future contact provided to both Maria and her mother. All required signatures were obtained at the final session.

Evaluating Treatment Gains and Residual Vulnerability

When practitioners assess termination readiness, they must weigh observable behavioral change against the stability of those gains under everyday stressors. Maria’s case illustrates a common trajectory: social engagement and school attendance improved measurably, yet cognitive restructuring remained inconsistent. This pattern aligns with findings from a meta-analysis by Davis and colleagues, published in the Journal of the American Academy of Child & Adolescent Psychiatry, which demonstrated that group-based CBT interventions produce significant reductions in posttrauma and anxiety symptoms among children and adolescents, though effect sizes vary depending on symptom domain and follow-up duration (Davis, R. S., Meiser-Stedman, R., Afzal, N., Devaney, J., & Halligan, S. L., 2023, Systematic Review and Meta-analysis: Group-Based Interventions for Treating Posttraumatic Stress Symptoms in Children and Adolescents, Journal of the American Academy of Child & Adolescent Psychiatry, 62(11), 1217–1232). The review underscores that group modalities work partly through peer modeling and normalized disclosure, mechanisms that clearly benefited Maria. Her partial progress on cognitive self-talk suggests that termination summaries should flag residual cognitive vulnerabilities, not merely celebrate behavioral milestones. A termination summary that omits this nuance risks giving future providers an overly optimistic picture of the client’s functioning.

• Maria’s behavioral gains (school attendance, peer interaction) reflect group cohesion and in-session practice opportunities rather than fully internalized cognitive change.
• Clinicians can strengthen termination documentation by specifying the contexts in which a client remains vulnerable—academic examination periods, in Maria’s case—so that the follow-up plan targets those precise triggers.
• Research on group psychodynamic psychotherapy with young patients, such as the Restek-Petrović et al. (2014) study on cognitive functioning changes during long-term group treatment, reinforces the idea that cognitive shifts may lag behind behavioral improvements and require extended intervention.

Distinguishing Planned Termination From Premature Discontinuation

A frequent point of confusion for trainees is the distinction between a planned termination that leaves some goals partially unmet and a premature discontinuation that warrants clinical concern. Maria’s termination was planned; she and the therapist mutually agreed that the remaining cognitive work could transfer to a less intensive maintenance setting. This contrasts with a scenario in which a client stops attending sessions abruptly without processing the ending with the group. When writing a termination summary, the clinician should explicitly state the rationale for ending therapy at this juncture and document the client’s engagement in the termination process itself. This documentation serves both clinical continuity and risk-management functions. Legal and ethical considerations further shape the summary’s content. For adolescent clients, confidentiality boundaries intersect with parental rights in complex ways. A termination summary must record what information was shared with caregivers and under what conditions, particularly if the adolescent disclosed sensitive material during group sessions. Professional guidelines from the ASCA (2022) emphasize that group counselors must communicate confidentiality as a group norm while recognizing that absolute confidentiality cannot be guaranteed in a minor population. Maria’s summary therefore notes that her mother received a general overview of progress and the follow-up plan, while specific peer-conflict disclosures remained within the group.

1. Planned termination implies a deliberate, collaborative decision-making process between therapist and client; the summary should capture the content of the final session discussion.
2. Partial goal attainment does not signal treatment failure; it indicates that the client has derived sufficient benefit to continue growth in a lower-intensity context.
3. Confidentiality provisions for minors receiving group therapy require careful documentation of what information was disclosed to parents and what remained protected.
4. Legal obligations around mandatory reporting and duty-to-warn must be reviewed before finalizing the termination summary, ensuring no outstanding safety concerns remain unaddressed.

References / Learning Resources

1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author. https://doi.org/10.1176/appi.books.9780890425787
2. Davis, R. S., Meiser-Stedman, R., Afzal, N., Devaney, J., & Halligan, S. L. (2023). Systematic review and meta-analysis: Group-based interventions for treating posttraumatic stress symptoms in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 62(11), 1217–1232. https://doi.org/10.1016/j.jaac.2023.02.013
3. McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041–2051. https://doi.org/10.1007/s10803-014-2087-9
4. Restek-Petrović, B., Bogović, A., Mihanović, M., Grah, M., Mayer, N., & Ivezić, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333–340. https://doi.org/10.3109/08039488.2013.839738
5. Wheeler, K. (Ed.). (2022). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). New York, NY: Springer Publishing.

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1. Write a client termination summary for an adolescent group therapy client. Address identifying information, treatment overview, goal status, recommendations, and follow-up plan in 2–3 pages using APA format.
2. Submit a 2- to 3-page client termination summary documenting an adolescent group therapy case, including session history, psychosocial issues, treatment process, and goal evaluation.
3. Complete a HIPAA-compliant client termination summary for a child or adolescent from your practicum group, covering all required elements from Wheeler (2022) Chapter 20.

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Assignment: Week 11 — Group Therapy With Older Adults

Week 11 shifts focus to group therapy with older adult populations. Students will explore developmental considerations specific to later life, including grief, chronic illness, social isolation, and cognitive decline. The practicum journal entry requires documentation of two older adult clients observed during a group therapy session, along with DSM-5 diagnostic justification and analysis of legal and ethical implications unique to geriatric populations. The week also includes a reflective journal on practicum growth and a Board Vitals review module. Students will continue to apply the Group Therapy Progress Note template and evidence-based literature to support clinical decision-making.