1 Running head: ADOLESCENT GIRLS AND ABUSE

Group Program Proposal: A Psychoeducational Group for Adolescent Girls and Abuse Lora Dawn Beazer University of Lethbridge

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Group Program Proposal: A Psychoeducational Group for Adolescent Girls and Abuse This paper is a proposal for a possible group that could take place with a non-dominant population, with a specific topic to be addressed. I have chosen to focus on young women, with dating violence/abuse issues to be presented. I have structured the groups mostly from a cognitive behavioral approach, and the group would be a psychoeducational, closed group. Statement and Rationale for Identifying Abuse with Adolescent Girls Violence against females is recognized by the World Health Organization (2011) as a major concern in public health. Likewise, Ellsberg, Jansen, Heise, Watts, and Garcia-Moreno (2008) state that in addition to being a breach of human rights, intimate partner violence is associated with serious public-health consequences that should be addressed in national and global health policies and programmes. (p. 1165) Abuse has many devastating effects for females in many aspects of life, however some of the more common correlates are health problems such as somatic symptoms (Eberhard-Gran, Shei & Eskild, 2007), self-esteem, selfworth, and physical health problems (McGarry, Simpson, & Hinchliff-Smith, 2011), PTDS (Tutty & Goard, 2002), social problems (Romito, Turan, and DeMarchi, 2005), injury and other health problems (Ellsberg et al., 2008), and suicidal thoughts and attempts (Devries, Watts, Yoshihama, Kiss, Schraiber, Deyessa, ... Garcia-Moreno, 2011). According to Bonomi, Thompson, Anderson, Reid, Carrell, Dimer, ... Rivara (2006), twenty five to fifty four percent of females will experience intimate partner violence in their adult lifetime. Women who experience domestic abuse at an earlier point in their life which remains unresolved, can experience a

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number of related emotional problems such as frustration, anger, helplessness, and low selfesteem (McGarry et al., 2011). However, most detrimentally is the concern raised by Romito et al. (2005) that violence and its consequences are still quite invisible in most health and social services. (p. 1723) Finally, and most importantly, Bonomi et al. (2006) suggest a focus on prevention in primary and secondary healthcare settings, such as routine inquiry, dialogue, and education for adolescents and adult women about partner violence in primary prevention programs. Group Sessions Based on the research, it is important for females to be educated about dating violence/abuse. During adolescence may be a beneficial time for this learning, as this is when dating has begun, and the education would be preventative for future relationships. The psychoeducational group being proposed is a six week set of sessions, each being an hour and a half in length. Session One Purpose This first session will mainly provide an orientation for the group members to the group process, what they can expect, discussion of confidentiality, discussion of group rules, opportunity to discuss any hesitations or fears, and explanation of homework logs.

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Rationale To begin this group, it will be important to have a solid group orientation including an ice breaker activity, to get the group verbalizing and begin to feel the group process. In order to create a sense of safety and trust, an explanation and discussion of the group rules and confidentiality is critical. An important component of CBT is homework, so the members will be introduced to their homework logs. The first homework assignment will address thoughts, feelings, and behaviors regarding relationships. Materials Needed Flip chart, marker, Healthy relationships handouts, colored paper, markers, homework logs, pens Instructional Procedure/Activities 20 minutes Welcome, introductions, name game Welcome the group and thank them for coming. Introduction of group facilitator. Each group member introduces herself by giving her name, something of interesting about her, and something that she likes to do. The name game. This game will serve as an ice breaker and also allows the group members to learn each others names. Each person thinks of an adjective that could describe her, that begins with the first letter of her name. For example, Caring Cathy. The group sits in a circle. The first person says their adjective and their name. The next person says the previous persons adjective and name, and then their own adjective and name. This continues around the whole circle, until the last person recites every persons adjective and name as well as their own.

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25 minutes Discussion of Confidentiality, group rules, goals, and expectations Group facilitator will review with the group what confidentiality means for the therapist, and for each of them as group members. Group facilitator will ask the girls to give ideas of what they would like to have as their group rules and will write down their ideas using a flip chart and marker. If needed, the facilitator will contribute and add to the list. Participants will be encouraged to address what things will help them to feel safe to disclose and open up in the group. The group facilitator will ask the girls to brainstorm ideas of goals they would like to accomplish over the next five sessions. The group facilitator will help the girls to draw themes from the brainstorming session to come up with three main goals. Group facilitator will outline what the group can expect each group. Each group will begin with a check in and review of their homework, and proceed with a learning component and/or activity, an opportunity to express what they learned from the session, and a homework assignment for each week. 20 minutes Learning activity The group facilitator will hand out and read over the Healthy Relationships Information Sheet (Appendix A). The group facilitator will then instruct the group to each take a turn and use one word to describe what a healthy relationship means to them. Each participant will then use colored paper and markers to create a drawing with or without the word on it, which they feel expresses the meaning of their chosen word.

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10 minutes Homework Assignments Participants will be given homework logs and pens Over the next week, participants answer the following questions (Thoughts, feelings, behaviors about intimate relationships): o What do I think I deserve and want out of a relationship? o What are my feelings about intimate relationships? o What have I learned about intimate relationships from others and how is this reflected in my own relationships? 15 minutes Take away messages and final questions Each participant will express what stood out to them the most, or what they will use from this session. Participants will have an opportunity to ask any final questions. Thank members for attending and close the group. Session Two Purpose This group will utilize a video to portray real adolescents talking about their own stories of abuse, to educate the group about dating violence. A collage activity will be used to have group members consider both healthy and unhealthy relationships. The homework assignment will have the group consider how media influences and portrays abuse.

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Rationale Psychoeducation and homework are both important aspects of CBT. Materials Needed Computer and screen for viewing youtube video, magazine, glue, scissors, paper, What is Abuse? hand outs Instructional Procedure/Activities 15 minutes Welcome and Check-Ins Welcome members back to the group. Invite members to discuss how their week went and any significant learning or events. 15 minutes Homework Review Review the homework assignment given last week. Each member will discuss one of the questions, either thought, feeling, or behavior, that they answered over the week and share why this was significant for them. 45 minutes Learning Activity Group facilitator will explain that we will be watching a video about youth, discussing their own real stories of dating violence. Play video: http://youtube.com/watch?v=F9Ctwk8R470

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Instruct the group members to create two collages using images that they will cut and paste from magazines. One collage will represent what a healthy relationship means to them, and the other will represent what an unhealthy/violent relationship means to them.

When complete, each group member will share their collages with a partner.

5 minutes Homework Assignment Group members will be given the handout What is Abuse? (Appendix B). They are instructed to read over the main types of abuse tactics. Over the week, they will pay attention to messages that they receive through media such as television and internet, and how abuse is supported through the media. 10 minutes Take-away messages and final questions Each participant will express what stood out to them the most, or what they will use from this session. Participants will have an opportunity to ask any final questions. Thank members for attending and close the group. Session Three Purpose This session will educate group members about the violence wheel, and how certain behaviors are used to gain power and control. The homework assignment will help members to explore their thoughts, feelings, and behaviors related to a potentially abusive person.

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Rationale The psychoeducational piece is an important aspect to CBT and the homework assignment has the group consider thoughts, feelings, and behaviors of abusive individuals. Materials Needed Violence Wheel hand outs, flip chart paper, markers, Dating Abuse hand outs Instructional Procedure/Activities 15 minutes Welcome and Check-Ins Welcome members back to the group. Invite members to discuss how their week went and any significant learning or events. 15 minutes Homework Review Review the homework assignment given last week. Each group member will share one type of abuse that they recognized in the media and how they feel this impacts those who view it. 45 minutes Learning Activity Group members will be provided with a Violence Wheel hand out (Appendix C). The group facilitator will educate the group about the violence wheel, and how under each heading are examples of different types of abuse, and how these types of behaviors are used to gain power and control.

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Group members will then use flip chart paper and markers to create their own violence wheel. Their violence wheel will include types of abuse that they have experienced, witnessed, or observed through media.

Group member will then share with a partner one area of the violence wheel with a partner, and how they feel that the behavior is used to gain power and control.

5 minutes Homework Assignment The group will be given the Dating Abuse hand out (Appendix D). Group members will be instructed to read the handout. After reading the seven warning signs that you are dating a person who is abusive and could be violent, they will pick one sign and write about why this behavior is wrong, how it would make them feel, and what they can do about it. 10 minutes Take-away messages and final questions Each participant will express what stood out to them the most, or what they will use from this session. Participants will have an opportunity to ask any final questions. Thank members for attending and close the group.

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Session Four Purpose In this session, the group will role play situations of abuse, acting out scenarios that could happen, and what they would do about it. The homework assignment will educate members about the cycle of violence, and ask them to associate feeling words with each phase of the cycle. Rationale Role play is an important learning activity in CBT. The homework assignment will have the group consider feelings with the cycle of violence. Materials Needed Flip chart, marker, Cycle of Violence hand outs Instructional Procedure/Activities 15 minutes Welcome and Check-Ins Welcome members back to the group. Invite members to discuss how their week went and any significant learning or events. 15 minutes Homework Review Review the homework assignment given last week. Group members will share the warning sign that was significant to them, and either the thought, feeling, or behavior that they wrote about in relation to it.

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45 minutes Learning Activity Group members will brain storm different situations that could happen to them that they would consider to be abusive in a dating relationship. The group facilitator will write their ideas on a flip chart. The group will then be divided into pairs. Each pair will choose one situation that they will use to create a role play. The role play will include one person playing the abusive boyfriend, and one the abused girlfriend. They will act out the scenario, and how they would respond to it. Each pair will then take turns demonstrating their role play to the group. The group as a whole will debrief their experience with the role play.

5 minutes Homework Assignment The group will be provided with the Cycle of Violence hand out (Appendix E). The group facilitator will go over the handout, explaining the cycle of violence. Over the week, group members will write down feeling words associated with each phase. 10 minutes Take-away messages and final questions Each participant will express what stood out to them the most, or what they will use from this session. Participants will have an opportunity to ask any final questions. Thank members for attending and close the group.

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Session Five Purpose This session will remind members that the group will be coming to a close next week. The homework assignment will have them consider what they have learned over the course and what they can continue to learn or work on. This weeks session activity will include becoming aware of available resources, and also creating coping cards associated with potential abusive situations and ideas for dealing with it. Rationale Psychoeducation is an important aspect of CBT. Coping cards are a learning tool utilized by CBT. Materials Needed Flip chart, marker, paper, pens, flip chart paper from last week with brainstormed ideas of potential abusive situations, 3x5 index cards Instructional Procedure/Activities 15 minutes Welcome and Check-Ins Welcome members back to the group. Invite members to discuss how their week went and any significant learning or events. Remind group members that next week will be the last session.

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15 minutes Homework Review Review the homework assignment given last week. Each group member will choose one phase of the cycle of violence and share with the group the feeling words that they associated with that phase. 45 minutes Learning Activity The group facilitator will ask the group to brainstorm and give ideas about what they could do and where they could go for help if they were experiencing abuse. The group facilitator will write their ideas on a flip chart, and will also provide paper and pens for the group members to write them down as well. The group facilitator may contribute to the brainstorming session to ensure that important resources such as speaking with a school counsellor are included. The group facilitator will ask each group member to put their list into their homework log, so that they will always have it. The group facilitator may also provide a list of resources along with telephone numbers and provide this to the group. The group facilitator will draw the groups attention to the flip chart paper that they created the previous week, which included potential situations of abuse. The group facilitator will ask each group member to choose one situation from the list, or another situation that they have thought of, that they consider likely to happen to them or someone they know. They will then create a coping card on a 3x5 index card, which will include the situation, and a list of ideas that they could use to cope with the situation. Group members will share with a partner their coping card.

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5 minutes Homework Assignment Group members will be asked to reflect on what they have learned over the last five sessions, what skills or knowledge they can take with them, as well as what they would like to continue to work on and learn in the future. 10 minutes Take-away messages and final questions Each participant will express what stood out to them the most, or what they will use from this session. Participants may also express how they feel about next week being their last session. Participants will have an opportunity to ask any final questions. Thank members for attending and close the group. Session Six Purpose This final group session will allow the group to process their entire experience of the group through the creation of a mural together, representing what they have learned. Each group member will also process learning and thoughts through a letter to them self. Rationale These activities will help group members to consider what they have learned, and what skills they will be able to take with them from the group to use in the future.

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Materials Needed Large rolling paper, finger paints, paper, pens, food Instructional Procedure/Activities 15 minutes Welcome and Check-Ins Welcome members back to the group and acknowledge that this is our last week together. Invite members to discuss how their week went and any significant learning or events. 15 minutes Homework Review Review the homework assignment given last week. Each group member will share what they feel is the most significant thing that they have learned from the group. 45 minutes Learning Activity Together the group will create a mural with large rolling paper and finger paint, that represents what they have learned over the course of the group. Each group member will be given a paper and pen and asked to write a letter to themselves, describing their goals, hopes, and dreams for their future dating relationships. The group will then share snacks together and are invited to share their letters with the group if they would like to.

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15 minutes Final good-byes and thank-yous Each participant will express what stood out to them the most, or what they will use from this session. Members are given the opportunity to say goodbye to their group and the group facilitator. Thank members for their participation in the group and close the group.

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References Bonomi, A.E., Thompson, R.S., Anderson, M., Robert, M.S., Reid, R.J., Carrel, D., ... Rivara, F.P. (2006). Intimate partner violence and womens physical, mental, and social functioning. American Journal of Preventive Medicine, 30(6), 458-466. Devries, K., Watts, C., Yoshihama, M., Kiss, L.,Schraiber, L.B., Deyessa, N., ... Garcia-Moreno, C. (2011). Violence against women is strongly associated with suicide attempts: Evidence from WHO multi-country study on womens health and domestic violence against women. Social Science & Medicine, 73, 79-86. Eberhard-Gran, M., Schei, B. & Eskil, A. (2007). Somatic symptoms and diseases are more common in women exposed to violence. Journal of General Internal Medicine, 22(12), 1668-1673. Ellsberg, M., Jansen, H.A., Watts, C.H., & Garcia-Moreno, C. (2008). Intimate partner violence and womens physical and mental health in the WHO multi-country study on womens health and domestic violence: An observational study. Lancet, 371, 1165-1172. McGarry, J., Simpson, C., & Hinchliff-Smith, K. (2011). The impact of domestic abuse for older women. Health and Social Care in the Community, 19(1), 3-14. Romito, P., Turan, J.M., & De Marchi, M. (2005). The impact of current and past interpersonal violence on womens mental health. Social Science & Medicine, 60, 1717-1727. Tutty, L.M., & Goard, C. (2002). Identifying, assessing, and treating male perpetrators and abused women. In R. Alaggia & C. Vine (Eds.), Cruel but not unusual: Violence in Canadian families (pp. 371-396). Waterloo, ON: Wilfrid Laurier University Press. World Health Organization. (2011). WHO Multi-country study on womens health and domestic violence against women. Retrieved from http://www.who.int/gender/violence/who_multicountry_study/summary_report/chapter4/ en/index.html

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Appendix A

Healthy Relationships
Information Sheet
PFVB1376

Healthy relationships are the foundation of safe and caring communities. Children who grow up with adults in a healthy relationship are more likely to thrive and flourish. People in healthy relationships live longer and are happier.

Information
For help in your community or for more information, please call the 24-hour Family Violence Info Line toll-free at 310-1818 or visit familyviolence.alberta.ca.

Ten characteristics of a healthy relationship:

1. The partners in the relationship value themselves and each other. They understand each others differences and they treat each other with respect and courtesy. 2. The partners are equal. They make decisions together. If they have children, they parent together. 3. When the partners disagree, they know that its okay to talk about their differences. They work it out together. They find ways for both partners to get what they need. 4. The partners listen to and respect each others viewpoints. They express their feelings and opinions. They do not make hurtful comments about the other person. 5. Each partner takes responsibility for themselves. They do not expect the other person to solve all their problems or always make them happy. 6. The partners each feel comfortable taking time alone if they need it. They feel okay about doing some things separately. 7. There is no fear in their relationship. Healthy relationships are built on love, respect, caring and happiness. 8. The partners do not try to restrict or control each other. They encourage and support each others growth. 9. Even when the partners are busy, they make time for one another and their relationship. 10. The partners have a circle of people who know them and support them as a couple. They spend time with others who have strong and healthy relationships.

Keep your relationship strong and healthy

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Maintaining a healthy relationship takes time, energy and care but it is well worth it. Healthy relationships make everyone in the family feel respected, happy and safe. Disagreements are a part of every relationship and sometimes people need extra help. Alberta Human Services has a help line that provides information on a range of relationship issues including how to keep your relationship healthy and strong, right through to addressing abuse in family violence situations. To access this 24-hour info line, call 310-1818 toll-free and tell the operator what kind of assistance or information you would like. Help is available in more than 170 languages. This information sheet is also available in Arabic, Chinese, Farsi, Plains Cree, Punjabi, Somali, Spanish, Swahili, Urdu, and Vietnamese at child.alberta.ca/home/832.cfm.
March 2011

Alberta Human Services is proud to lead Albertas Prevention of Family Violence and Bullying Initiative.

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Appendix B

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Appendix C

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Appendix D

Dating Abuse
Information Sheet
PFVB1105

What happens in a healthy dating relationship?

You enjoy the time you spend together You respect each others opinion You can disagree and know its okay to talk about your differences You feel good doing things apart from each other as well as together There is no fear in your relationship You do not try to restrict or control each other Its easy to be true to yourself when you are with the other person. You encourage each other to be great Being in a healthy dating relationship does not mean you always agree or that you are going to stay together for a long time. It just means you are respectful to each other while you are dating. But not all dating relationships are healthy. Is it a big problem? Well, one study found that 29 per cent of girls and 13 per cent of guys between 11 and 20 years old had experienced some form of dating abuse that was upsetting to them. 1

What is abuse?
Abuse is about power. Abuse is about control. Abuse is about one person trying to control or dominate another. Here are some control tactics that might be used. EMOTIONAL ABUSE TACTICS may include: Treating you with disrespect Name-calling, insulting, blaming, humiliating Interfering with or ridiculing your spiritual beliefs and practices Emotional roller coaster Being explosive or having wild mood swings Manipulating you emotionally, such as, If you love me then you will do as I want Isolation Being possessive, not wanting you to be with other people Trying to keep you away from your friends and family Dating can help you figure out what kind of people and activities you like and dont like, and whats important to you. But sometimes dating can turn into something that doesnt feel good. Sometimes people abuse their dating partner, or are even violent. If you or someone you know is in immediate danger, call 911. For help in your community or

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for more information, please call the 24-hour Family Violence Info Line toll-free at 310-1818 or visit www.familyviolence.alberta.ca. Alberta Children and Youth Services is proud to lead Albertas Prevention of Family Violence and Bullying Initiative.
Price, E. L., Byers, E. S., Sears, H. A., Whelan, J., & Saint-Pierre, M. (2000, January). Dating violence amongst New Brunswick adolescents: A summary of two studies. In Research Paper Series (2). Fredericton: The Muriel McQueen Fergusson Centre for Family Violence Research, University of New Brunswick. Retrieved from http://www.unbf.ca/arts/CFVR/documents/Dating-Violence.pdf
1

SEXUAL ABUSE TACTICS may include: Pressure to have sex Unwanted sexual touching and/or unsafe sexual practices Making fun of you if you do not want to do certain sexual things Forcing a person into degrading, humiliating or painful sexual acts INTIMIDATION TACTICS are actions meant to scare you. They may include: Behaviours that could harm you or people or possessions you care about, such as: Throwing things or breaking things Destroying your possessions Threats Threatening to harm you, people or pets you care about Threatening to spread rumours about you or get you in trouble Threatening to commit suicide if you do not do something they want Threatening gestures or facial expressions Stalking or harassment tactics, such as: Following you Parking close by and watching where you live or work Contacting you by phone, Internet or text message more than you feel comfortable with Contacting your friends or family to ask about you or spread false rumours about you PHYSICAL ABUSE TACTICS may include: Shoving, slapping, kicking, biting, punching, pinching, hair pulling, pushing or elbowing you Throwing things at you Threatening to harm you with an object or weapon
For more information on this topic, refer to the Dating Abuse Booklet; available online at www.familyviolence.alberta.ca or by phone at 310-1818, toll-free in Alberta. October 2008

Know the early warning signs:

Seven warning signs that you are dating a person who is abusive and could be violent. 1. Soon after you begin dating, your boyfriend or girlfriend pressures you to make the relationship very serious or to have sex. 2. Your boyfriend or girlfriend becomes

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extremely jealous and possessive. He or she thinks these destructive displays of emotion are signs of love. 3. Your boyfriend or girlfriend tries to control you and to make all decisions about what you do together. Your boyfriend or girlfriend does not take your views or desires seriously. 4. Your boyfriend or girlfriend tries to keep you from spending time with close friends or family. 5. Your boyfriend or girlfriend verbally and emotionally abuses you. He or she does things like yell at you, swear at you, manipulate you, spread false and degrading rumours about you, and try to make you feel guilty. 6. Your boyfriend or girlfriend threatens physical violence. 7. Your boyfriend or girlfriend has abused a previous girlfriend or boyfriend. He or she accepts and defends the use of violence by others. These are only some of the possible signs of abuse. Trust your instincts and get help if you feel your partner is abusive.

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Appendix E

Cycle of Violence

Incident

Any t ype of ab use occ urs ( p hysi cal/sexual /emoti onal )

Tension Building

Making-Up

Abus er starts to get a ngry Abus e may begi n Ther e i s a breakdow n of co mm uni cati on Vi cti m feel s the need to ke ep t he a buse r cal m Tensi o n becom es too m uc h Vi cti m feel s li ke they are ' wal ki ng on eg g s hel l s'

Calm

Abus er may apol ogi ze for a b use Abus er may pro mi se i t will never happe n agai n Abus er may bl ame t he vi cti m for causi ng t he ab us e Abus er may de ny ab use to ok pl ace or say i t was not as bad as t he vi cti m cl ai ms

Abus er acts l i ke the ab use never happe ned Physi cal abuse may not be taki ng p l ace Promi ses made d uri ng 'm aki ng - up ' may be met Vi cti m may hope t hat t he a b use i s over Abus er may gi ve gi fts to vi cti m

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The c ycl e can happe n hundreds of ti mes i n an ab usi ve rel ati ons hi p. Each s tage l asts a di fferent amo unt of ti me i n a rel ati ons hi p. The total cycl e can take a nyw he re from a few ho urs to a year or mo re to c ompl ete.

It i s i mportant to r emember t hat not all d omesti c vi ol ence rel ati ons hi ps fi t the cycl e. Ofte n, as ti me goes o n, t he 'maki ng - up' a nd 'cal m' stages di sappear.