Art Therapy Group for Bereaved Adolescents

Population, Setting and Structure
Group Therapy has many benefits for adolescents because of the strong peer influence during this developmental stage. Groups provide adolescents with the opportunity to enhance their personal relationships, increase self-awareness, and try out new behaviors. A therapy group is composed of individuals who are interested in seeking solutions to life problems and requires a strong commitment. This group will be designed for adolescents who have common life experiences and common stresses, most specifically, the recent death of someone they know or loved. In a supportive atmosphere, group members explore their past experiences and learn ways of coping with current pressures and issues. Bereaved teens will be seen on a referral basis and the criteria will include any adolescent who has experienced the death of someone in their life. The client must come to therapy voluntarily, and also indicate an interest and commitment to the group art therapy process. The group will take place in a large conference room in the Visiting Nurses and Hospice office building. There will be enough space for each adolescent to work independently, as well as the space to work on larger group projects. The group of 6-8 members will meet for 12 sessions, for 2 hours each week.

Structure for each session will include:
1. Introductions and check-in (15 minutes)
2. Instructions regarding the art therapy directives (5 minutes)
3. Art making (60 minutes)
4. Group sharing of art work and group process. (40 minutes)

Purpose, Goals and Objectives
Group therapy provides an opportunity for members to articulate their most important current concerns. After a few sessions, a group dynamic begins to develop as group members share their feelings. This group dynamic has important benefits for everyone. The group members will be advised that they may choose how much they want to share about their artwork and related feelings, but they are expected to participate in the art task and listen to what other members share.

During the group meeting time, members take responsibility for their situation by talking about what is troubling them. Members are also encouraged to give feedback to others. Feedback includes expressing their own feelings about what someone says or does. Interaction between group members is highly encouraged and provides each person an opportunity to try out new ways of behaving; it also provides members with an opportunity for learning more about the way they interact with others. The first few sessions of a group usually focus on the establishment of trust. During this time, members usually work to establish a level of trust that allows them to talk personally and honestly. Group trust is enhanced when all members make a commitment to the group. Groups experience difficulty when a person either holds out from making this commitment or reneges on the contract. What makes the group therapy situation unique is that it is a closed and safe system. People who join groups are requested to keep the content of the group sessions confidential. What people talk about or disclose in groups must remain among the members of the group. It is not appropriate for a group member to disclose events of the group to an outside person.

Goals/Objectives within each Art Therapy Session:
1. Assist clients with the realization of their loss
2. Catharsis through the expression of emotions
3. Establish a safe environment and time to grieve
4. Educate about the normal grief process
5. Allow and support the exploration of each client's unique grief process

Goals / Objectives of the Art Therapy Group Process:
1. To build group cohesiveness, to instill a sense of belonging, and to reduce feelings of isolation
2. To foster empathy, group reflection and mutual support for group members
3. To create a safe, trusting, non-judgmental, consistent environment in order to facilitate and encourage the exploration of issues related to death and loss
4. To facilitate the different stages of grief
5. To assist individuals in acquiring and building new skills which allow for the safe expression of their thoughts and feelings related to the death loss
6. To provide art materials and directives to all for the expression of the individual's grief process
7. To facilitate honest visual and verbal expressions of thoughts and feelings
8. To encourage individual growth and increased self-esteem in art process and product, and provide opportunities for catharsis in the art process and product

Examples of Art Therapy Directives[during group therapy the art tasks will be tailored to needs]
(possible curative factors):
1. Free Drawing (Catharsis, Instillation of Hope, Universality, Imitative Behavior)
2. Draw a happy memory of something you and your loved one used to do together (Universality, The Corrective Recapitulation of the Primary Family Group, Group Cohesiveness)
3. Draw what it's like adjusting to the change and what you can do to cope (Imparting of Information, Catharsis, Interpersonal Learning)
4. Draw a memory from the week before you loved one died (Universality, Catharsis, Existential Factors)
5. Draw your family doing something together (Development of Socializing Techniques, Group Cohesiveness, The Corrective Recapitulation of the Primary Family Group)
6. Draw your support system (Interpersonal Learning, Altruism, Imitative Behavior)
7. Draw symbols of qualities to represent yourself (Instillation of Hope, Universality, Altruism)

Session 1 (Orientation and Hesitant Participation)
Establish aims, goals, boundaries and ground rules
Identify expectations and introduction of group members
Possible art directives: Free drawing, decorate your name, draw a place you like to be; create a collage of things you like to do (non-threatening media and allow for exploration of self-perception)
Instillation of Hope, Altruism and Universality are curative factors that are explored when adolescents can focus their attention on others and learn that they have similar experiences, thoughts, and/or feelings
Group discussion of the process and closure of the session

Sessions 2 and 3 (Hesitant Participation)
Reestablish aims, goals, boundaries and ground rules
Questions may arise: "Who am I? Why am I here? What do I do now? "How do I go on without them?"
Possible art directives: Free drawing, Life collages/symbols of self, Death/funeral masks or ceremonial pieces to remember the person who died
Development of Socializing Techniques, Instillation of Hope, Altruism, Universality are curative factors that continue to be explored as the group members learn more about each other and share with one another.
Group discussion and closure

Session 4 and 5 (Conflict / Dominance / Rebellion)
Reestablish and maintain aims, goals, boundaries and ground rules
Adolescents may rebel against being in group or refuse to follow directives in order to test limits, and adolescent may dominate as the leader and challenge authority.
Questions may arise: "Am I safe?" "How much do I share about my feelings?" "Can they be trusted?"
Possible art directives: Free drawing; Draw how you feel right now; Draw what it feels like to be with/without the person who died; Draw your ideal world; Draw the qualities you admired or disliked about the deceased.
Group discussion and closure

Session 6 and 7 (Cohesiveness, Closeness, Warm Feelings)
Reestablish aims, goals, boundaries and ground rules
Adolescents begin to feel as if they belong and are able to share and relate to others. Close contact with others allows for group cohesiveness to be experienced as a curative factor.
Imparting of information and Interpersonal learning are experienced as a curative factor with continued exploration and discussion of the grief process.
Possible art directives: Free drawings, mandalas, guided visualization on the process of grief followed by a reaction drawing, group mural on the theme of grief, loss, death, etc.
Group discussion and closure

Session 8 and 9 (Cohesiveness, Closeness, Warm Feelings)
Reestablish aims, goals, boundaries and ground rules
As the group members continue to build trust and safety, as well as develop relationships, group cohesiveness, universality and altruism continue to be experienced as curative factors.
Adolescents begin to repress conflict; catharsis is experienced through expressing negative feelings appropriately.
Possible art directives: Free drawing, Drawing in pairs, Drawing in Groups
Group discussion and closure

Session 10 and 11 (Cohesiveness, Closeness, Warm Feelings)
Reestablish aims, goals, boundaries and ground rules
Adolescents begin to treat each other like family so group cohesiveness and the corrective recapitulation of the primary family group are experienced as a curative factors.
Possible art directives: Free Drawing, Create remembrance book, Family drawing, Life-line, group collage
Group discussion (address ending of the group in the next couple weeks) and closure

Session 12 (Termination)
Reestablish aims, goals, boundaries and ground rules
Adolescents may feel pain around closure; process feelings of loss with the group.
Existential factors and Catharsis will be the curative factors of this session.
Possible art directives: Free drawing, Draw a gift for each group member, draw a symbol for yourself and for the person who died, Draw a large group mandala cut into pieces then brought back together
Group discussion, closure and termination