Elisabeth Counselman Carpenter, LCSW
Note. This article has been broken into two parts. The first part (in this issue of TGP), provides an introduction to and literature review of concurrent group therapy. Part II, which will be included in the next issues of The Group Psychologist, describes the author’s exploratory study.
Parents of children with emotional, behavioral and learning issues, severe mental illness, or other problems that require treatment are particularly vulnerable. This population has been found to be at risk for high levels of stress (Levac, McKay, Merka, & Reddon-D’Arcy, 2008), increased social isolation (Levac et al., 2008), feelings of incompetence and guilt (Goodman, 2004), and the recipients of social stigma (Banach, Iudice, Conway & Couse, 2010; Gruber, Kajevic, Agius, & Martic-Biocina, 2006; Levac et al., 2008). In addition, parents of children with unusual needs (medical, emotional, behavioral or cognitive) are identified as having a greater risk for depression, anxiety, loneliness and feelings of hopelessness (Foreman, Willis & Goodenough, 2005; Levac. et al., 2008). While their children may be receiving treatment, this at-risk population of parents may not be receiving the services that are needed.
One form of parent groupwork that appears to be particularly under-utilized is concurrent parent group therapy. Concurrent group therapy, as identified by this author, is defined as the treatment modality in which some members of a family system participate in groupwork while other members of the family system participate in another group that is running at the same time, or participate in a group directly related to the group in which other members of the family system are participating. For concurrent parent group therapy, the parent group takes place while children are meeting in their particular form of group treatment. While concurrent refers to the timing of the groups, the types of group work do not necessarily need to coincide. For example, parents may participate in a psychoeducational or mutual aid group while children may participate in a support or psychodynamic group. Concurrent group therapy may also be known by the synonyms ‘parallel group therapy’ or ‘simultaneous group therapy’.
Recently, there has been more focus on how to stimulate the involvement of parents in their children’s treatment in a more holistic manner, which has been identified as a benefit to improving treatment outcomes (Ruffalo, Kuhn & Evans, 2006). This paper: presents current research on the types of interventions used with parents whose children are receiving treatment, with a particular focus on group therapy for parents; reviews the current literature on group work with parents whose children are receiving treatment; and presents the results of an exploratory study of the incidence of concurrent group therapy for parents whose children are receiving treatment.
Groupwork with parents. For parents whose children are receiving mental health services, group work can take place in many different forms, including support groups, mutual aid, problem-solving, psycho-educational, and therapeutic groups. Parent groupwork in multiple modalities has been shown to provide social support (Goodman 2004), provide psychoeducation, encourage advocacy (Levin, 1992), provide organizational opportunities (Levac et al., 2008), and can facilitate a healing experience as well as improve parenting skills (Pickett et al., 2008; Ruffalo et al., 2006). Groupwork with parents has also been found to improve a sense of parental competence, reduce family stress, and improve child-parent relationships (Levac et al., 2008; Ruffalo et al., 2006).
Concurrent group therapy. The term ‘concurrent group therapy’ does not appear to be commonly used in the group research literature as its own identified modality. In fact, very few results were returned using the electronic search engines (e.g. Google, PsycINfo) in regards to the words ‘parallel,’ ‘simultaneous,’ or ‘concurrent’ group therapy. For example, in one cited study, the modality used was identified by the researchers as one singular group, although it met criteria for concurrent group therapy with two separate parent and child groups meeting individually, yet simultaneously. Semantics and the lack of the use of the phrase ‘concurrent group therapy’ as its own separate modality may be one reason why initial search results were so lacking in the number of studies found.
Goh et al. (2007) acknowledge an overall lack of research in parent-child group work literature, stating that there is a lot of information on parent support groups, but not therapeutic group experiences that involve both parents and their children. Many articles and studies discussed parent groups, children’s groups, or a multi-family group, but not groups that involve children and parents separately in their own groups. Some studies initially claimed to look at a concurrent group process, but in fact the groups studied did not meet the criteria for concurrent group therapy.
The few examples of concurrent group therapy literature between parents and children involve diverse populations and types of group work. Some concurrent groups involve a ‘breakout model’, where part of the group session is spent together while the second part of the group is then separated out for children to be grouped with age-appropriate peers and a separate group for parents. One such group was analyzed by Berry and McCauley (2007) who studied the efficacy of the Intensive Reunification Program (IRP) that took place at a Midwestern child welfare agency. The IRP model involves home-based services for parents who have lost custody of their children and are now in the reunification process. In addition to other concrete services provided, the IRP had twice weekly evening meetings during which concurrent parent group therapy served as the primary modality. Following a community dinner and a group activity for all participants, parents and children met in concurrent, but separate groups for approximately an hour. Parents met as one large group while children were divided into age appropriate sub-groups. Qualitative and quantitative data gathered from staff and participants demonstrated improved parenting skills, social support and a much higher percentage of reunification than families not participating in concurrent group therapy (Berry & McCauley, 2007).
A British study by Dodd (2009) evaluated a support group for women and their pre-school children who were victims of domestic violence. The Young Children and Mothers Group served 10 mothers and their children with the goals of providing therapeutic play therapy for the children, a separate support-group environment for the mothers, followed by a Theraplay experience, which is a play therapy modality for both mothers and children designed to promote secure attachment (Dodd, 2009). Qualitative interviews with the mothers and group leaders indicated that the group experience positively influenced the mother-child interactions and improved the psychological well-being of the adult participants (Dodd, 2009). The interviews also indicated that some of the mothers felt the concurrent model of separating from their children during the group process allowed them to share things with one another that they would not have had their children been present.
Another successful implementation of the concurrent group therapy model was used with children diagnosed with selective mutism and their parents (Sharkey, McNicholas, Barry, Begley & Ahearn, 2008). The groups ran for an eight-week period, and for the parents focused on psychoeducation regarding selective mutism, behavioral management strategies, and support from other parents in a similar situation. The children’s group had a cognitive-behavioral focus designed specifically to reduce anxiety, while also working on building social skills. Findings indicated that children improved their ability to speak at school and in other external settings and in social situations while self-rating scales of parents indicated a decrease in their own anxiety. Six-month follow-up data indicated that results were maintained (Sharkey et al., 2008). However, the sample size was quite small, with only five children and seven parents participating in the study. The authors did not identify this modality as concurrent group therapy, nor do they give any specific reasons for using concurrent group therapy as the chosen modality.
An additional example of concurrent group therapy took place with parents whose children were receiving group cognitive behavioral therapy for severe anxiety (Monga, Young, & Owens, 2009). The children were aged five to seven years old and their group focused on developing CBT skills to manage their symptoms of anxiety. Fourteen children worked with the CBT group therapist while parents met in a separate group. The concurrent parent group focused on psychoeducation regarding childhood-onset anxiety disorders, behavioral management strategies for parents, support, and skill-building for the parents to help their children learn relaxation and desensitization skills. The concurrent group model of using CBT to treat anxiety was found to have a positive impact with parents reporting a better understanding of their children’s anxiety and improvement in their ability to manage their children’s behavior. Children reported an improved ability to recognize anxiety symptoms and verbalize anxiety and reported an overall decrease in anxiety (Monga et al., 2009).
An exploratory study of an eight week concurrent group therapy model for children of divorced parents was found by the authors to appear to have a positive impact (Rich, Molloy, Hart, Ginsbury & Mulvey, 2007). The children’s group focused on talk, play therapy and art designed to help process the divorce related transitions taking place in the children’s lives, while the parents’ group was psychoeducational and supportive in nature. However, formal data collection did not take place in this study, so the findings remain anecdotal (Rich et al., 2007).
Bereavement groups are probably the most widely known for using the concurrent group therapy model. In 2009, The Dougy Center, the National Center for Grieving Children and Families, located in Portland, Oregon served 450 children and 350 parents by offering approximately 26 bimonthly concurrent support groups for parents whose children and teenagers are also participated in age-appropriate bereavement groups (The Dougy Center, 2010). The Dougy Center identifies their group services as a peer support model, with the identified client as the child who is dealing with the death of a family member and concurrent services provided for the parents (The Dougy Center Mission Statement, 2010). Although this is a well-known national organization and has served as a model for other bereavement programs, it is unclear in their literature as to why the concurrent group model is used as their primary modality.
Another reported successful concurrent pre-bereavement group model took place in Worchester, England through the services of St. Richard’s Hospice. Their services were identified as a pre-death support group for families with a terminally ill parent (Popplestone-Helm & Helm, 2009). Although they used a concurrent group therapy model, the authors of the study identifies the modality as a ‘sub-grouping’ of adults and ‘sub-grouping’ of children. Children and parents in separate groups often participated in similar activities and then reconvened as a large group with representatives from each subgroup sharing feedback about the group experience (Popplestone-Helm & Helm, 2009). The concurrent group therapy modality was chosen particularly for this population to allow for the healthy, care-giving parents to participate in a support group with those also struggling with the imminent death of their partner. Data gathered through anonymous questionnaires indicated that the participants found the group experience to be helpful and healing (Popplestone-Helm & Helm, 2009).
One final reported successful model of concurrent group therapy took place for a group for chronically ill children and their parents. Known as the Terrific Tuesday Group, this model met for six to eight group sessions with a theoretically eclectic orientation and highly structured format (Curle, Bradford, Thompson, & Cawthron, 2005). Independent qualitative analysis using grounded theory demonstrated that parents found that the both parents and children felt the groups reduced isolation and empowered both populations to feel that things were not as ‘badly off’ as they had originally thought prior to group participation (Curle et al., 2005). Some of the parental feedback indicated that parents did not always feel like the parent group was a necessary part of the treatment process, which may have some implications for the general utilization of concurrent group therapy model. Again, the missing aspect to this research study is why the research team chose the concurrent group model as their modality.
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Sharkey, L., McNicholas, F., Barry, E., Begley, M., Ahearn, S. (2008) Group therapy for selective mutism: A parents’and children’s treatment group. Journal of Behavior Therapy and Experimental Psychiatry 39, 538-545.
The Dougy Center – The National Center for Grieving Children & Families, 2010, (n.d.).Mission & History.Retreived from http://www.dougy.org/about-us/mission-history
Beth Counselman Carpenter, MSW, LCSW is a licensed psychotherapist currently in private practice in Norwalk, CT. Beth holds an undergraduate degree in Sociology from the University of Richmond and a Masters in Clinical Social Work from New York University. Beth is currently a PhD candidate in clinical social work at Adelphi University.
Beth specializes in treating depression, bipolar disorder, anxiety, grief and bereavement, life change issues, LGBTQ issues and job concerns as well as postpartum depression, parenting and early childhood issues. She can be reached at firstname.lastname@example.org.