Case Studies of Prevention, Reparation, & Protection through
Sharon R. Kahn, Ph.D
This paper was originally published as "Play therapy groups: Case
studies of prevention, reparation, and protection through children’s play," in Journal of Child and adolescent Group Therapy, 3, 48-53. The original year of publication was 1994. SK
This paper presents a literature review of therapeutic indications for placing children in group therapy and case examples of two latency age females in a children's group therapy. The case material indicates that peer and therapist interactions help identify children's strengths and deficits. Childrens group therapy may have an impact on the larger interpersonal world of the child, as therapists interact with and influence parents and teachers. Modulations in children's behavior suggest that therapeutic intervention yields modest benefits on the child's social world.
Children's behavior occurs in a context, although the background may not be obvious to the outsider. Their abilities to engage in and to sustain relationships usually reflect their earlier socialization struggles within their family. Few families are so pathological that they resemble the beastliest ogres from the grimmest fairytales. If they were, how much easier it would be to reject them as negative role models for relationships. Instead, periods of adequacy and of nurturance are randomly interspersed with periods of harshness. (See, for example, articles by LePantois, 1986 or Naiditch, 1988 detailing their work with children of substance abusers). The inconsistency and unpredictability of treatment creates ambivalent feelings in the child toward their family. These people who hurt them are the same people who fed them, clothed them, and showed them the world.
There are ramifications that extend beyond the family for such children. As children develop, they naturally spend less time with their families and more time engaged with peers. Sullivan (1972) and Erikson (1963) suggested that peer relationships can serve either to limit the ill-effects of an unhealthy family life or, conversely, to facilitate the development of an anti-social identity, depending on what traits the peer group reinforces. Unfortunately, socialization in the ill-related family can hinder the later formation of pro-social peer relationships. For example, Hargrave & Hargrave (1983) listed dysfunctional family relationships as one of the handicapping conditions that prevented the creation of effective interpersonal relationships (the other two conditions were emotional problems and developmental difficulties).
The focus of this paper is to describe a female latency age after-school group. During the treatment period, therapists attempted to enhance the parents' ability to nurture, act, and influence their child. Case material will be presented which demonstrates how peer and therapist interactions identified and engaged each child's intrapsychic strengths in the service of social and academic adjustment. Before presenting the case material, I offer a few rationales (and caveats) regarding group treatment with children.
Rationale for children's groups:
Children's therapy groups have been recommended as an intervention for a diverse span of disorders. A computerized literature search of children's group therapy found twenty titles alone where group therapy was suggested for sexually abused children. Based on other titles, special needs children recommended for group therapy included: electively mute, diabetic, ethnic minorities, physically disabled, social isolates, psychiatrically hospitalized, primitively fixated, children with tics, emotional disturbed, obsessive compulsives, ego impaired, depressed, children of substance abusers, of divorce, in bereavement, social incompetents, and compulsive hair pullers. This modality apparently has a broad spectrum of social utility.
There are several rationales for offering group treatment (versus individual treatment or no treatment at all) to young children. Similar to individual treatment, the child in group treatment is offered an opportunity to use play, fantasy, and discussion as tools to organize their intrapsychic and extrapsychic experiences. Children's play offers the sensitive adult clues as to where the dilemmas lie. (Freud, S. 1922 and A. Freud, 1965). Children use the activity of play to master conflicts and to adaptively cope with trauma. They will highlight, through play, significant current conflicts in their lives. (Freud, A. 1965; Erikson, 1963).
Specifically, the child's group can be therapeutic as it invites children to create their own symbols. This symbolic play offers the therapist a route of entry into the child's internal world. The therapist can use the children's play symbols to speak in the children's language (Spinner & Pfeiffer, 1988). Furthermore, beyond the utility of the play for the therapists, such symbols offer a venue of growth for the children. Some of the benefits cited include: teaching of self-observational capacities (Spinner & Pfeiffer, 1988), self-examination (Bromfield & Pfeiffer, 1988), and, providing the order essential to rendering the self observable (Spinner & Pfeifer, 1988).
An individual child benefits through peer interaction and through this, has the opportunity to raise and explore highly charged questions. Children learn that topics and activities they thought were secret or shameful can be shared with others in the group. They may then discover that others have similar experiences. In this way, the group offers confirmation, affirmation, and acceptance to the child. The opportunity for positive peer relationships may ameliorate the effects of the dysfunctional family environs. (Sullivan, 1972; Grunebaum and Solomon, 1987).
In addition, the child has intense exposure with several peers, each of whom will have a different reaction to the child's behavior in the group. The group stimulates problematic interactions that emerge around peers (i.e., grabbing, hitting, silence, isolation, and name-calling). Without intervention, such behavior may place the child at risk for social isolation or scapegoating by the other children. Children will not always be needy or awkward and at the other end of the spectrum of social adjustment the children can serve as models, for each other, showing cleverness, coping, and adaptive learning. (Hargrave & Hargrave, 1983; Blotcky et al. 1980-81; Slavson, 1986).
In group treatment, the energy is diffused upon the therapist, the children, the room, and its objects. In individual treatment the energy is focussed entirely upon the therapist. The former may render the therapist a less frightening figure to the child. (Blotcky, et al. 1980-81; Slavson, 1986).
The child has the freedom to explore a variety of roles, and emotional states within the group. (Soo, 1985). Because the nature of the group is therapeutic, the child can do what would not be easily tolerated within the school or the home (i.e. crying, screaming, sulking, withdrawing, climbing on furniture). Thus, the group experience permits the child to express regressive, hostile or aggressive fantasies without facing punishment. (Slavson, 1986; Soo, 1985). The release offered within the group may enable some children to develop the inner controls necessary to tolerate the restrictions demanded in a more structured school setting and to compartmentalize their behavior. The freedom of expression offered in group enables the children to tolerate a more rigid external structure.
The experience children have in a therapy group differs from what they experience in their classrooms. In group, the child is offered a special opportunity to have consistent adult attention that the larger classroom setting may not provide a needy child. A child can also alternate between peer and adult interactions or solitude, as needed. In therapy, the children determine the ratio of distance/closeness that they will tolerate (Soo, 1985). Group treatment may be less stigmatizing for a young child than individual treatment. Children who are not in a therapeutic play group are curious and sometimes envious of these children's special time, in a room with few rules, and with supportive, non-judgmental adults. (As an example, see Lothstein, 1985 for a report of a school-based therapy group for black latency age males in an inner city school).
Placing a child in a therapy group offers some secondary gains for teachers. In a classroom, such children may present as disruptive--crying if their needs are not met immediately, hitting or grabbing if they must endure more frustration than they can handle, not listening, not participating in school activities, or following their own agenda despite what the teacher requires of them. This can become a source of stress for the teacher, and ultimately, a source of friction between teacher, child, and parents. When a child enters therapy, the teacher receives validation when other professionals agree this child requires special assistance. This support frees the teacher to respond to the child more empathically, as part of their burden has been relieved.
As is true with any psychological intervention with minors, group treatment with children also offers special challenges to the therapist. Parents play an important role in the success of this intervention by their willingness to allow the therapists access to their children. Parents may also reflect their ambivalence about outsiders being intimately aware of family problems and resist by forgetting to disclose information that would help the therapist understand the child's world. If the therapist is perceived as overly intrusive or overly authoritarian, the parent may try to terminate the child's treatment. Sometimes it is more the parent who requires treatment than the child. They may be willing to let the child be in group therapy, but unwilling to accept therapy themselves. Role of the therapist
The role of the therapist in childrens group is to reflect upon and articulate (in a straightforward non-judgmental manner) the range of the child's behavior and conflict; to use drama, fantasy, play, and games that will both engage the children and help them to organize their intrapsychic experiences. Then the children will have an experience with an adult who is reliable, consistent, and supportive.
In group, the therapist tells the children that the room is a special place, where they can work, play, use toys, and words to show their feelings. The therapist's role is explained as someone who will help the children to learn to use their words, to work, to play, and to keep the room safe. The therapist thus sets a few limits in the service of the children's safety (Hargrave and Hargrave, 1985). The therapist connects why the child is in the group with the child's specific problems (e.g., "you can learn to use your words to tell them what you want so you don't have to hit").
The literature available on children's therapy groups is predominantly based upon psychoanalytic principles of development. The typical article presents case vignettes or attempts to understand the stages of group development. Rigorous experimental methods are seldom utilized. There were no reports that compared the psycho-emotional development of children in group to those not in treatment, or to those in a non-therapeutic activity group. Many questions remain unresolved. For example, was it the therapeutic experience per se, or would all at-risk children be better served in small peer settings, regardless of whether the focus was therapeutic, recreational or educational? Was the underlying cause of the gains created through the enhancement of the parent's skill? Or, perhaps parents and teachers, because of the therapist's interpretations, softened inappropriate interpretations of the child's behavior. Alternately, did the therapy exert a synergistic effect which effected the interactional milieu of the parents, the teachers, and the child. Perhaps all children are being done a disservice and would be better served in a small group setting during early and middle childhood. Small therapy groups offer a growth enhancing opportunity for young children, but how and where the potency lies have not been resolved, or (perhaps) addressed.
The Group: Theory
The theoretical underpinning of the group to be presented is grounded on the understanding of individual, interpersonal, and group dynamics and the utilization of psychodynamic and developmental principles. The following excerpt explains the underlying principles that the therapists were grounded in:
...we are looking beneath the surface of the young child's play and interactions...for a deeper understanding of deprivations, vulnerabilities, fears, anxieties and conflicts...focus is to support ego functions, relative strengths and adaptive capacities...group process itself becomes an arena for extended evaluation and elucidation of a more complete understanding of a given child's developmental patterns...We use an attachment-individuation frame of reference...to organize our observations, develop hypotheses...and initiate strategies for intervention. (Shanok, et al. 1989).
Groups are ideally composed with a balance between "disturbed disturbers and .. disappearers [children] who don't disrupt but...fail to participate." (Shanok, et al, 1989).
The group consisted of children in grades 1-3. All had been in a pre-school group. (See Shanok et al. (1989) for a description of the pre-school program). The children were offered an after school group based upon a careful assessment of their needs, their estimated capacity to use the group, current areas of weaknesses, ongoing problems, and parental willingness for continued intervention. The child's unconscious processes were expressed and communicated through symbolic play, interactional and solitary play, interpersonal conflicts, the use of toys, and discussion. The group met once a week for one hour after school.
The Group: Case Vignettes
This group consists of members: Tiffany, a 7-year old African-American female in first grade, Raven, a 7.5 year old African-American female in second grade, Trudy, a 7.5 year old Caribbean-American female in second grade, Lizzy, an 8.5 year old Latina in third grade, and Sylvia, a 6.9 year old Latina in first grade.
Nosologically, the children represented several diverse diagnoses: dysthymia, adjustment disorder, and oppositional disorder. Teacher complaints usually dealt with the emotional fragility demonstrated by the children as it affected their social relationships.
Tiffany was a new member of this group. The other four were in their second year, having been in the group together previously. All five children were from financially struggling working class families. Both Sylvia and Lizzy lived in an intact two-parent family. Raven lived with both parents until recently, when her father left. The other children live with their mother and mother's relatives.
During the year reported on, the group was conducted with two volunteer female trainee-therapists. In the first 3 months of group, the trainees' child-work supervisor was present for on-site support, modeling, and training. She was pregnant and left the group after its third month to start her maternity leave.
The group met in an apartment within a northeastern housing project which straddled prosperous, gentrified, and poor neighborhoods. All the children were escorted to group, either by one of their therapists or a volunteer. Group commenced with a snack of graham crackers, peanut butter, and fruit. During the snack time, the children generated ideas about what they would do during the group, complained about the snack or about some annoyance, and/or demonstrated difficulties in sharing the snack. As they tired of the snack, the children drifted away from the table and played. Group ended with cleaning up, sharing news (which ranged from something that happened in group, something that happened at school, or to stories they spontaneously generated for the news time), and then a good-by song. Three of the children were picked up by their mothers; the other two were returned to their mother's accompanied by a volunteer or a therapist via cab or car. Raven and Tiffany will be presented as examples of the potentiality and potency of group treatment. Individual, interpersonal, interactional, and group dynamics will be discussed as necessary.
Raven is a 7.5 year old African-American female who was initially referred three years ago by the on-site mental health consultant at her pre-school who noted her school behavior as alternating between boisterous and active or withdrawn and sad. In group, a therapist observed that she varied in mood states and could be intrusive and aggressive with peers.
Until recently, Raven lived with her 38-year old father, her 33-year old mother, and her sister. Her mother is a teacher. Her father is a skilled blue-collar worker. The parents separated during the course of the group and the father moved out of the northeast regional area.
Raven is the older of two females. Her mother remembered Raven as an easy baby who met developmental milestones at the appropriate months.
Raven's mother reported that both maternal and paternal relatives have alcohol abuse problems, and that the father is a polydrug user. The mother is in psychotherapy and denied any substance abuse problems on her part.
Raven was in the school-aged group for two years. In group, Raven was consistently part of a trio of girls: Raven, Lizzy, and Trudy, who played together, they could negotiate turn taking, waiting, and sharing. However, Raven had trouble modulating her affect--she could become intensely sad and cry, then revert to excessive silliness and motoric activity. She could become very angry--yelling or weeping if another child touched materials she was using. Raven sought out the therapist's attention and nurturance (being held, being physically comforted when she cried) more frequently than the other girls, but could also obtain pleasure from peer interactions.
In the group, themes of emotional deprivation emerged especially during the snack time. Raven wanted more and more crackers and fruit, and she sometime grabbed as many as she could hold at one time. When she did this, Raven was gently told by one or another therapist that she could have as much of the snack as she wanted, but she must take one cracker, piece of fruit, etc. at a time. The therapist would reflect to her how hard it is sometimes to share. Her lack of modulation was apparent in her competitive friendship with Trudy. When she cried this year it was usually related to something that happened with Trudy: for example, once she had a play fight with Trudy--she hit Trudy on the behind, Trudy then hit her on her behind. When that happened, Raven opened her mouth as wide as it would go, let out several screams (to the extent that the veins begin to appear on her neck), and then began to weep. When Raven weeps, her body is racked with sobs and her cries sound as if a hole has been torn in her core sense of self that may be patched (and thus is liable to tear redux) but will never be whole and substantive. When she stops crying she can become silly and run around the room. Although she still becomes angry if anyone touches her stuff, she rarely cries unless the antagonist is Trudy. For example, if Tiffany touches her materials or tries to provoke her with name calling she becomes obviously angry (facial darkening, mouth contractions, arms folded, eyes bulging) but she will either share the materials, find a new activity, or try to verbally efface her.
Raven wanted more of the therapist's attention than others in the group. She would ask a therapist to pick her up and hold her, or would jump on a therapist's lap. However, she is neither a calm nor a cuddly child. While being held, various bodily parts are in frenzied movements--she will run her hands at a furious rate up and down the therapist's face or she will lean over backwards in a foolhardy fashion. Her frenzied movements while being held may reflect anxiety about adult rejection of these affectional needs, ambivalence over having these needs, or aggression toward maternal figures.
Although Raven wanted more physical contact with the therapists than any of the other children, over the course of the year she demonstrated increased social strengths, roles, and skills with peers. She alternated between engaging in peer interactions, symbolizing her needs, rehearsing new roles and returning to the therapists for regressive soothing/comforting. For example, one session, she sang and danced with the other girls, then competed with Lizzie in a game where they jumped into a therapist's arms and pretended to be frogs or kangaroos or creatures from the sky. Then, Raven played the mother in a game of "sleepover party" with Tiffany and Lizzie as the children. Then, she ran over to a therapist and asked to be held like a baby. During the news time, she (and Trudy) were the first to imitate or identify with the therapist's roles by grabbing pens and pads of paper and writing down everybody's news. During the news, she sometimes talks in the tone of an old-fashioned schoolmarm who tells the others if they behaved satisfactorily and sets limits about what can or cannot be told.
Furthermore, Raven shows leadership by suggesting play activities for the group and uses her verbal skills to approach each child and ask if they wanted to play such and such (as opposed to reactively screaming when her needs are not intuited for her).
This year Raven used words in symbolic and humorous ways. One day she sang a song called "Silly little girl....you think I like you but I hate you, hate you, hate you." This may reflect her ambivalent feelings toward her little sister. When her mother picks Raven up from group, she brings along the sister. She has also used words in a humorous way. Once, when she noticed a therapist had styled her hair in a different manner, she leapt onto the therapist's lap, ran her hands in her usual frenzied fashion through the therapist's hair, and sang out, "Thank goodness you're here and you didn't cut your hair..." The children respond to Raven's felicity with words by incorporating her words into their stories. For example, once Raven emphatically and gleefully chanted something like the following in the middle of her story, "...so I kicked him, I smacked him, etc." For weeks afterward, Lizzie and Trudy included this chorus in the stories they told.
Raven is using her time in group to explore various aspects of her identity, and is supported as she tries to find a balanced identity by treading back and forth along regressive and progressive lines. By the end of the group, she showed more flexibility, needed less time to recover from dysphoric mood states, and had a greater range of adaptive affects to draw upon. The group experience allows and supports Raven's experiencing of intense affect states. Group is different from school or home, where adults would either remand her for crying, or rush in to soothe her, thus invalidating the feeling or truncating the expression. In group, neither the adults nor the children judge her or tease her for showing her feelings. Because the group is accepting of her sorrow and turmoil, she is able to respond with empathy to another child's expressions of vulnerability. As an example, one day Lizzie cried in group. At the end of group, when we were sharing our news, Raven insisted, when one of the therapist's started to speak, that there be "no sad news." When asked, she replied that "sad news was anything that dealt with Lizzie's tears." The group setting gives her freedom to rehearse diverse roles and to experience fully all mood states. The full expression of the sorrow may liberate her energy to explore alternative methods of relating to peers and adults, even if it might be initially frustrating for her.
The therapists accept her regressions and encourage her engagement in alternative roles. They listen very intently to her and show her that they remember what she tells them. She may (to use Mahler's expression) use the therapists as a secure base, where she returns for refueling after engagement in more autonomous roles. (Mahler, et al, 1975). The therapists enable her to have a supportive, warm, consistent relationship with adults and serve as role models for relatedness with peers and adults.
Tiffany is a 7-year old African-American female who was initially referred two years ago by the mental health consultant at her pre-school because she took home possessions of classmates, cried frequently, and sought adult attention and approval. Tiffany lives with her three year old half-brother, her 29-year old mother, and her 70-year old grandmother. Her mother remembers Tiffany as a healthy baby with a good appetite who met the developmental milestones at the expected rates. When Tiffany was 2.4, her parents separated. Tiffany's mother left her for a few months to be cared for by her maternal grandmother. When she returned, Tiffany's mother re-married. In the new marriage, conflicts arose on how to discipline Tiffany and from the stepfather's jealousy of the mother/daughter relationship. Tiffany's mother and stepfather separated when Tiffany was 5 1/2 years of age.
Tiffany presented as shy, she was a newcomer to an established trio of girls. Yet, she also managed to be provocative of the group. For example, she became frustrated when the others danced on the couch and sang a song she did not know. So she blocked them, she sat on the couch, stuck her foot out, sucked her thumb, pouted, and refused to leave. For weeks, she had difficulties becoming integrated into the play situation, remaining on the periphery of group activity. She would play cooperatively with one or two other girls briefly, then, drift away and start her own solitary activity. Perhaps sustained play offered her more intimacy than she could handle initially.
Tiffany also took other children's toys, hid them, denied knowledge of their whereabouts, and refused to return them. When the other children asserted themselves, she pouted, whined, or cried that the other children were mean, that she did not want to come to group. When that happened, a therapist would reflect on how bad Tiffany feels when the other children gang up on her, or how difficult it sometimes is for Tiffany to be in group, without blaming her for playing victim, or reminding her of her own responsibility for creating the situation. The next time, Tiffany was able to engage in more prolonged play, and when she was provocative of other children, she was less likely to isolate herself by whining, crying, or teasing, and more able to rejoin the group and engage in activities.
When themes of separation were aroused within the group, she regressed to the level of a four-year old. Ending one activity to engage in another is difficult for her. Any event which symbolized separation evoked her anxiety, including the end of group for the week. She would refuse to engage in the good-by activity, refuse to clean up, attempted to take out new toys, or hide, refusing to leave the room. The therapist would try to reflect how difficult it is for Tiffany to leave, and to acknowledge her wish that things would go on and on. By the time the group ended, Tiffany had the capacity to accept and engage with the others in the group good-bye.
Tiffany's provocativeness is evoked in her interactions with Raven. In many ways, their overt behavior is similar, but the psychological dynamics are different. Tiffany screams like Raven, but with different feeling tones. Raven's screams are manifestations of frustration or emotional deprivation. Tiffany's screams are exuberant and liberating. Both children have mothers who, for different but unexpected reasons, must raise two young children without a father to consistently assist or relieve them. Both children witnessed the dissolution of conflicted, unhappy adult relationships. Both experienced this as a traumatic interpersonal loss where fathers first disappointed and then disappeared. Despite the conflicts, despite their disappointments, despite their shortcomings, their mothers remain.
Tiffany needed group therapy because her behavior sometimes created interpersonal conflicts with other children. She does not seem to consciously take their possessions. She just seems oblivious to the fact that they belong to another and will be missed, and that the other children would like her to get their permission first before using their things. The presence of other children elicits this behavior. The presence of therapists help her establish the link in-vivo between action and consequences. Her denial of responsibility, her acting the role of victim when confronted by a peer, her tendency to disrupt or to drift away from cooperative play, are all traits that over time and without modulation could create intensely painful situations of social conflict and isolation for her. These traits do not arise out of psychopathy, they underscore her anxiety. Adults have migrated in and then out of her life. She must wonder if she had any responsibility in their abandonment of her and her mother. This perceived responsibility places a tremendous onus on her--she must always be "good" and if she cannot be good, then she must deny that she had any role in the creation of a conflict. Group therapy gave her the experience of adults and peers who will always be there, every week, reliably, regardless of whether she was "good." Relationships are inevitably laden with conflicts, but are salvageable, may be reconstructed, and can endure. Group therapy offers a tremendous source of hope for such children.
Conclusion: Intervention before Exigency
Children such as Raven and Tiffany would not ordinarily come to the attention of child welfare associations. Raven is well-nourished, appropriately clothed and adequately housed. She is a good student who is liked by her classroom teachers. Her mother is concerned about her education and ensures her daily arrival at school and nightly completion of homework. Parental conflicts, substance abuse and financial problems overshadow them and deplete their available psychological resources so their children's socio-emotional development is neglected. Raven's mother is able to exert the energy necessary to bring her to people who can help Raven have access to a more functional, enriched emotional life.
Additionally, anyone would be hard pressed to imagine Tiffany as a child who suffers from any sort of deprivation. Indeed, she seems the very incarnation of an indulged Benetton child, with her stylish clothes, wondrous toys, private school, and status pets.
Group therapy is a preventive human service with value for those children not receiving the adult assistance required to make appropriate psycho-emotional developmental progress. Psychological intervention prevents children from becoming entrenched in a dysfunctional pattern of behavior.
Children who show such delays would not necessarily receive the kind of remediation required to make gains once they begin school. Elementary schools require children to increasingly tolerate their own delay of gratification and to subordinate their own agenda for those of the teachers. Children in school must share the attention of the teacher with many others. The role of the teacher is to educate. When the teacher speaks, all children must be attentive and not otherwise engaged in intrapsychic or external activities. A child presenting with social, emotional, or behavioral delays can find this experience more frustrating and difficult than children who present in school with age-adequate skills. Without intervention, such a child risks beginning a self-defeating and alienating cycle with both peers and adults. The expression of the behavioral problems will be recognized instead of the underlying issue of psycho- emotional developmental delays. This self-defeating and alienating cycle can become the main maladaptive way that children learn of relating to others.
Group therapy, by contrast, emphasizes the importance, uniqueness, and diversity of individuals that comprise the group. Group therapy offers options and models of relatedness that can be put to use immediately, or stored in memory, to be retrieved, used, and modified when the child is ready or motivated to access this knowledge.
Children learn through their group experience that differences between individuals add vitality to the group process and how the group can remain cohesive even if the individuals have different opinions or ways of doing things. Children are not forced to conform. They learn to recognize and appreciate diversity. Children learn to negotiate, to communicate, and to problem solve as conflicts naturally arise within play. The child sets the pace and the tone of the interactions. The rules in a group are few and are there to ensure the security of the child.
Finally, unlike the public school, the small group therapist has regular contact with each child's parent and works with them in a non-intrusive, non-judgmental fashion to enhance their parenting capacities and their understanding of their child.
What the children's group therapy offers is disentanglement for both parents and their offspring from the dysfunctional web of reacting to events, instead of addressing the issues. The therapist offers, to both the parent and the child, a non-threatening and consistent relationship with an authority figure. The group experience offers alternatives and an opportunity to discover and rehearse modes of being. The therapist offers to the parent a benign model of authority, who encourages or actively assists the parent to ameliorate their life, and enhances the parent's understanding of their child. Therapeutic children's groups prevent ossification of maladaptive behavior, and offer a milieu of reparation, growth, and hope for the distressed child.
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Sharon R. Kahn was a postdoctoral research fellow at Narcotic and Drug Research, Inc. The time needed to write this article was funded in part by Grant #5T32DA07233-08, awarded to the Behavioral Sciences Training Program at NDRI. I wish to acknowledge that some of the insights offered in this article were inspired in part through supervision with Rebecca Shahmoon Shanok, Ph.D and Susan Feiner, CSW, CMT. I wish to thank Estelle Zarowin for generously donating her time to discuss the content of this article. I appreciate the supportive presence and empathic resourcefulness of Maria Melendez as well. Finally, I also genuinely appreciate the support, companionship, cordiality, and esprit de corps tendered to me by my postdoctoral colleagues at NDRI. Dr. Kahn can be reached at the Postgraduate Center for Mental Health, Adult Analytic Clinic, 124 E. 28th St., New York, NY 10016.