For troubled teens, group therapy may be the problem and family
therapy the solution.
By
Ken Gordon, published on August 02, 2002 - last reviewed on May 22, 2006
Treating a delinquent teen alongside like-minded youths is the
norm, but it may exacerbate conduct disorders, according to José
Szapocznik, Ph.D., professor of psychiatry and behavioral sciences at the
University of Miami School of Medicine. "When kids are alone together,
they court each other's anti-social behavior. 'I smoke marijuana,' says
one kid. The other says, 'That's great: I know where to buy it.'"
There is no shortage of evidence that destructive behavior can be
socially reinforced, a phenomenon hardly confined to teens. (The
APA Monitor on Psychology recently documented
patients with anorexia and bulimia sharing starvation tips with one
another during treatment.)
Szapocznik thinks he has a better alternative for troubled teens:
In Evidence-Based Psychotherapies for Children and
Adolescents, a book published by Guilford
Publications, he argues for a short round of therapy in which the entire
family receives counseling once a week for eight to 12 weeks. This
targets the entire family, using the premise that the behavior of any one
member—in this case, the adolescent—can only be understood by examining
the context or family "system" in which it occurs.
When Szapocznik compared 317 adolescents in either brief, strategic
family therapy or in group outpatient treatment, he found that 27 percent
of youths with conduct disorder showed improvement with the
family-centered approach, but there was no improvement among those who
received conventional treatment. Almost half the adolescents in treatment
for marijuana abuse improved with brief strategic family therapy, as
opposed to 17 percent in group therapy. Teenagers in treatment for social
aggression proved the most resistant to either therapy, but even they
benefited more from the family-focused approach.
So why does group therapy remain the gold standard? "Group
counseling is driven by economics," says Szapocznik. "It has a better
return because several patients can be charged at the same time."
