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Group therapy with adolescents who have learning disabilities and

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Article  in  Journal of Child and Adolescent Group Therapy · June 1994

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Journal of Child and AdolescentGroup Therapy,Vol. 4, No. 2,

Group Therapy with AdolescentsWho Have

Learning Disabilitiesand Social/Emotional
Problems
Faye Mishna, M.S.W.,C.S.W.,IJanice Kainran, M.S.W.' Sandra Little'
M.S.W.,C.S.W.,and ElizabethTarshis, Ed.D., C. Psych.

This paper presents groltp therapy with adolescentswho have learning

disabilitiesand sociallemotionalproblents. First,the paper reviewsthe literature
on prychosocial development ancl interventions offered to these adolescents.
Thire is agreement in the literature that group therapy is beneficial for
adolescents.I.earning disubled uclolescentsmeet the criteria Jbr receiving this
intervention.Despite this,review of the literature sulgeststhat this population
is not generally offered group therapy. Twct cuse examplesore presented. The
group approach described combines princiltles cleriveelJi'om prychodynamic
group theory with udjustmentsto occotn,nodutethe leaming disahilities.These
thut cutt he uddresseclin group with learning disabled
examplesilfustrate is.rrre,r
adolescents.
K D Y W O R D S : l c a r n i n g d i s a b i l i t i c s ;a d o l c s c c n t sg; r o u p t h c r a p y .

INTRODUCTION

A growing body of literaturesuggeststhat children and adolescents

who have learningdisabilitiesare at greater risk to experiencesocial and
emotionaldifficulties,with considerableproblemsrelatingto peers(Ameri-
kaner & Summerlin,1982;Offord et al., 1990;Pearl et al., 1986).A char-
a c t e r i sti cfe a tu re o f l e a rn i n g disabled adolescentsis their inability to
comprehendsocialcuesand use feedbackto adjusttheir behaviour.These
youth may become isolated,withdraw from peers and become or remain
lAddresscorrespondcnce
to Fayc Mishna, Integra,25 InrpcrialStreet,4th floor, Toronto,
OntarioM5P lCl, Canada.

tl7

I I 7$07.00/0O I 99'l I luman SciencesPress, Inc'

1053-0ti00/9.1i0(r00-0
118 Mishna, Kainran,Little, and Tarshls

dependentupon adults. Alternatively,they may show poor socialjudge-

ment, requiring coerciveadult involvement.
Grunebaum and Solomon (1980, 1982) underscorethe importance
a n d i nfl u e n ceo f p e e r re l a tionshipsupon socialdevelopm ent.In the lit-
e r a t ureo n l e a rn i n gd i sa b l edchildr enand adolescents, ther e is a pr epon-
deranceof articlesand studiesrelated to the topic of social competence.
The articles suggestthat this population'ssocial competenceand social
status is inferior to children and adolescentswho do not have learning
disabilities.Social status is defined as peer acceptanceand popularity.
Typically,learning disabledchildren and adolescentsare provided so-
cial skills training/teaching(Mclntosh et al., 1991) to improve their social
functioning.Most writersassumethat socialskillstrainingis the appropriate
interventionto enhancethe socialfunctioningof learningdisabledchildren
and adolescents (Feigin& Meisgeier,1987;Furman & Robbins,1985;Hops
& Finch, 1985;Jacksonet al., 1987;Perlntutter,1986;Schumaker& Ellis,
1982).They base this on the presumptionthat learningdisabledchildren
and adolescents have socialskillsdeficitsthat interferewith their ability to
learn theseskillsnaturally.The work with this populationbeganin the edu-
cation systemand was adjustedfrom purely academicremediationto inter-
ventionsthat target learningdisabledyouth'ssocialfunctioning.
There appearsto be consensus that teachingsocialskillsto this popu-
lation is the interventionof choice;however,there is inconclusiveevidence
of the efficacyof socialskillstrainingand/or teaching(Amerikaner& Sum-
.l9fJ5;
merlin, 1982;Furman & Robbins, Jacksonet al., 19t\7;Mclntosh et
a l . , 1 9 9 1 ';Ma h e a d y& S a i n ato,19[i6;Pear l et al., 1986;Per lmutter ,1986;
S c h u ma ke & r E l l i s, 1 9 8 2 ;S er afica,1986) .
There is agreementthat group therapy is beneficialfor adolescents,
especiallythose deficientin socialskills or sufferingfrom low self-esteem
(Azima & Dies, 1989;Berkovitz& Sugar,1976;Maclennan & Felsenfeld,
1968;Raubolt, 1983;Scheidlinger& Aronson, 1991).Berkovitzand Sugar
(1986)concurthat there are few contraindications for an adolescenttaking
part in group therapy.They write that a significantfactor in the decision
is the availabilityof an appropriategroup. Rutan and Stone(1984)contend
that group therapyis an optimal format as it "offers the hope of relatedness
i n t h e co n te xt o f a p p ro p riatelim its, an oppor tunity to gain autonomy
through intimacy,not at the expenseof intimacy" (p. 81).
There is very little in the literatureto suggestthat learningdisabled
adolescentsreceive group therapy. The documented group therapy with
learningdisabledadolescents is sparse.It tends either to take place in an
academicsetting (Coch6 & Fisher, 1989)or is not offered solely for learn-
ing disabledadolescents (Pickar,1988).There is agreement,however,that
while the cognitivedeficitsof these adolescentsmay have been primagr,
Group Therapy with AdolescentsWho Have Learnlng Disabilitles 119

social,interpersonaland emotional difficulties have likely becomeinter-

twined with their personalityand coping styles(Cohen, 1986;Kronick,
1980;Palombo& Feigon,1984; Rutter,1977;Searcy,1988).Severalauthors
(Hiebert,Wong, & Hunter,1982;Hooper & Willis, 1989;Hops & Finch,
1985;Jackson,1987;Pearl et al., 1986;Schumaker& Ellis, 1982)conclude
that a comprehensive view of the cognitive,emotional and social factors
affectingthe child or adolescentwould enhancetreatment,citing the im-
possibilityof isolatingfactors.
In this paperwe will describepsychodynamically informedgroup ther-
apy designedfor adolescents who havelearningdisabilitiesand relatedso-
cial/emotionalproblems.This is an atypical interventionwith this
population.We modifythe groupsaccordingto the specificproblemsand
needsof the learningdisabledadolescents.

LITERATURE REVIEW

Psychosocial
Development
and LearningDisabilities

Severalauthors(Amerikaner& Summerlin,1982;Kronick, 1980;Pearl

et al., 1986)discussthe concurrentemotionaland interpersonalproblems
that childrenandadolescents with learningdisabilities
frequentlyexhibit.This
populationis predisposedto problemswith self-esteem(Hiebert, Wong &
Hunter, 19821' Searcy,1988);and to depression, anxietyand poor motivation
(Bruck,1986;Licht & Kistner,1986;Pearl et al. 1986;Perlmutter,1986).
Further,learningdisabledadolescents often exhibitinadequateinterpersonal
skiflsresultingin lackof popularityandsocialrejection(Mclntoshet al., l99l1'
Maheady& Sainato,1986;Pearlet al., 1986;Wiener,L987);and to displaying
externallocusof control (Omizo & Omizo, 1987;Pickar,1986;Rosenthal,
1992).Investigators haveshownthat childrenand adolescents with learning
disabilitiescomprehendnonverbalcommunicationlessaccuratelythan non
learning-disabled youth (Axelrod,1982;Bryan,1977;Holder & Kirkpatrick,
1991;Jacksonet al., 1987).Offord, Boyle,& Racine(1990)found that chil-
dren who did poorly in schoolwere twiceas likely to havea psychiatricdis-
order comparedto childrenwho did not haveschooldifficulties.
Severalwritersnote that emotionalor behaviouralproblemsmay in-
itially be secondaryto cognitivedeficits.Due to maladaptivecopingover
time, theseproblemsbecomeembeddedin the adolescent's personality
structureand mannerof approaching the world (Bergman,1987;Feigin&
Meisgeier,1987;Palombo& Feigon,19841' Pickar,1986;Pine, 1985).
Maheadyand Sainato(1985)concludethat there is little supportfor
teachingnonverbalsensitivity. Theycite both the lack of empiricalevidence
120 Mishnu, Kaintrn, Little, and Tarshis

and how little lab approximateslife in this form of intervention.Mclntosh

et al. (1991)reviewedsocialskillstrainingprogramscarriedout with learn-
ing disabledstudentsbetweenthe agesof five and nineteen.The programs'
goalsincluded"elevationof peer acceptance or acquisitionof interpersonal
social skills" (p. a51). The authors note that ten of the fourteen studies
that used componentsof socialskills teaching/trainingreported positive in-
tervention effects.However, the authors expressconcern that despite the
positive effectsin controlled settings,the behaviourchangesfrequently did
"becausethe goal of most
not generalizeto natural settings.They state that
social skills intervention programs is to increasetarget students'social ac-
ceptanceand socialfunctioning,the finding that few interventionshavesuc-
cessfullyaccomplishedthis goal is causefor concern" (p. 458).
Some writers (Licht & Kistner, 1986;Perlmutter,1986;Schumakeret
al., 1986) critique social skills training with learningdisabledadolescents.
They write that teachinglearningdisabledadolescents socialskillswithin con-
trived circumstances, and without regard to the socialenvironmentand cues,
could be detrimental,especially if it is attenrptedwithout encouragingactive
participationin the learning process.This view is consistentwith the view
that underliesthe group therapyapproachto be presentedin this paper.Our
approachrecognizesthat learningdisabledadolescentsare frequently quite
dependentupon and compliantwith adults.In our view,teachingor training
suchchildrenhow to behavecan unintentionallyreinforcetheir dependence
upon adults.This may further diminish their nrotivation,senseof efficacy
and ability to initiatesocialrelationships without adult guidance.
After evaluatingand reviewingsocialskills training programs,writers
and investigatorsconcludethat current interventionsdo not foster gener-
alization of skills (Pearl et al., 19t16),are targetingthe wrong area (Per-
lmutter, 1986)or are linrited to one aspectof the learningdisabledchild
and adolescent's self (Amerikaner& Summerlin,1982).This has led vari-
ous authorsto suggestchangesto the current interventiontraining (Schu-
maker & Ellis, 1982); training to decode the environment (Perlmutter,
1986);adding content to the progrants(Furnran& Robbins,1985);includ-
ing a more comprehensive view of factorswhich contributeto socialcom-
petence(Hops & Finch, 1985)and increasingthe opportunitiesfor learning
disabledadolescents to practicein the naturalenvironment(Feigin& Meis*
geier, 1987;Jacksonet al., 1987).

AdolescentGroup Therapy

There is agreementthat group therapy is beneficialfor adolescents

(Azima & Dies, 1989;Berkovitz& Sugar, 1976;Maclennan & Felsenfeld,
Group Therapy with AdolescentsWho llave Lenrning Dlsabllities tzl

1968;Raubolt,1983;Sheidlinger& Aronson,L99L).Theseauthorsagree
that group therapyaidspeersin assistingand confrontingone another;pro-
vides a mirror to stimulatenew conceptsof self; enablesthe adolescent
membersto feel less isolated;and facilitatesincreasedself-esteemboth
through being acceptedby the group and by helping others.A group ex-
perienceallowsthe adolescents to expressrebellionand conflict,to become
more independentand to identifywith the leaders(Azima & Dies, 1989;
Azima & Richmond,1.989;Berkovitz& Sugar,1986;Maclennan & Fel-
senfeld,1968;Scheidlinger& Aronson, 1991).Peer support in therapy
groupsfacilitatesa working alliancedespitethe adolescent'sfrequent op-
positionto attendingthe group (Raubolt,1983).
These authors emphasizethat the developmentalstageadolescents
are irr-ryhich includesseparationfrom parents"-makesgroup particularly
effectivefor adolescents. The peergroup is central,importantand powerful
for adolescents; it facilitatesidentification,directionand aids in the task
of differentiation/separation.
A studyof curativefactorsin adolescentgrouppsychotherapy (Corder
et al., 1981)cited the mosthelpfulfactorsto be cohesion,universaliW, ca-
tharsisand interpersonallearning,with insightand direct interpretation
perceivedas the leasthelpful.Thesefindingswere similar to a previous
studywith adults(Yalom, 1975).

who haveLearningDisabilities
Group Therapywith Adolescents

There is a paucityof literatureon group therapywith adolescents

who havelearningdisabilities(Berg& Wages,1982;Coch6& Fisher,1989;
Pickar,1988).Berg & Wages(1982)reviewthe literatureon group coun-
sellingand guidanceactivitieswith learningdisabledadolescents. Theycon-
"in
tend that despiteambiguousresultsin a limited numberof studies, a
generalsense,a casecan be made for the use of group work with LD
studentssimilarto that madefor more traditionalpopulations"(p. 277).
Berg and Wageshighlightgroup'sapproximation to real life relation-
ships,which they believerepresentsan important benefit for learningdis-
abled adolescents. This proximitypermitsgroup membersto repeat issues
in the group,with one another,in the here-and-now. This is considered
central to group'spower and effectiveness. Issuesand conflictsthat arise,
such as self-esteem,behaviourcontrol, socializationproblems,motivation
and academicachievement,can be addressedwithin a group counselling
mode.A criticismof socialskillstrainingis that this real life facetis lacking,
as it is largelya didacticintervention.
122 M i s h n u , K u i t r t u n ,L i t t l e , a n d T a r s h i s

Coch6 and Fisher (1989) discussparticular difficultieslearning dis-

abled adolescentsencounterwhich interfere with their ability to talk about
their feelings.They recommend the provision of a peer group in which
there can be discussionof emotional issues.Pickar (1988) reviewsthe ra-
tionale for providing group therapy for adolescents, some of whom may
that "for a child who is forever
havelearningdisabilities.Pickaremphasizes
misperceivingthe socialcuesof others or has little sense of the impact of
his/herbehaviouron others,the group providesa supportivereality-testing
e n v i r on me n t w h e re su ch d i fficulties can be exposed,confr onted, and
worked on, with the group leader attenrptingto minimize the anxietythat
might typicatly result frorn fear of ridicule or rejection" (pp. 765-766).
There are numerousindicatorsto suggestthat group is the treatment
of choice for adolescents, especiallythose lacking in socialskills or confi-
dence (Scheidlinger& Aronson, 1991). Group therapy provides a peer
group that is essentialfor progressiveadolescentdevelopment.Relevant
peer group contactis often lackingfor youth who have learningdisabilities
and related social/enrotional problems.Despite the consensusthat group
psychotherapy with adolescents is stronglyindicated,it is not widely prac-
t i c e d a n d i s u n d e r r e p r e s e n t e di n t h e g e n e r a l t h e r a p e u t i c l i t e r a t u r e
(Scheidlingen, 1985;Siepker,1985).The lack of literatureon group therapy
with learning disabledadolescentssuggeststhat this interventionhas not
y i th this population( Pickar ,1988) .
b e e n u se d si g n i fi ca n tlw

PROGRAM DESCRIPTION

Integra is a Children'sMental Health Centre that serveschildrenand

a d o l e sce n tsw h o h a ve l e a rning disabilitiesand r elated social/emotiona l
problents.Adolescentsand their fanriliesnray receivea range of services
Gr oups ar e an integr al
, n ri l yand gr oup counselling.
i n c l u di n gi n d i vi d u a l fa
p a r t o f th e a d o l e sce n ts' tre a tm entand individualsmay par ticipatein sever al
differentgroupsover the courseof their involvementwith the agency.The
groupsoccur within the contextof an overall treatmentplan.
The cognitivedeficits that learningdisabledadolescentsexperience,
combined with their chronic academicand social failures,may interfere
with emotional and socialdevelopment.This understandingunderliesthe
model of group therapyused in the Integraprograms.The groupscombine
principles derived from psychodynamicgroup theory, with techniquesin
which the leadersactively facilitate group processto accommodatethe
teenagers'learningdisabilities.
The groups aim to improve the adolescents'social and emotional
functioning.Relationshipswithin the group provide the contextfor growth
Group Therapy with AdolescentsWho Have Learning Disabllities 123

and change. The goals and objectives for all the members include: (i)
greater ability to expressthemselvesand to verbalize theh feelings; (ii) in-
creased self-esteemand ability to take risks; (iii) increased social compe-
tence, which includes the ability to understand and relate to others, to
perceiveverbal and nonverbal cues and to be lesssocially isolated; and (iv)
greater ability to initiate social interaction,assumeresponsibility,and, in a
beginningway, deal with issuesof independence.
The group-as-a-wholetasks include finding commonalities and devel-
oping a sense of trust. In light of the absenceof appropriate social skills
among this population, the groups must deal with silly or inappropriate
behaviourswhich are exacerbatedby the learning disabilities.The leaders
help the adolescentsdeal with problematic interactions by encouraging
them to support and challengeone another. A key objective is to enable
the members to assumegreater responsibilityfor the group's functioning
over time, and thereby reduce their dependencyupon the leaders.
We make adjustmentsto accommodateparticular learning disabilities
and levels of social functioning. Iraders assessand respond to the needs
of individual group members. In doing so, a leader might clarify verbal
statements and nonverbal cues; monitor group discussionsto ensure that
members follow the conversationsand recall what others have said; offer
connectionsbetweeninappropriatebehavioursand underlyingfeelings;and
provide active direction and assistanceto enable membersto acknowledge
and talk to each other. Further adjustmentsdue to the adolescents'learning
disabilitiesand social isolation include having contact with parents while
the adolescentsare involved in groups, and encouraging members to so-
cialize with one another outside the group.
The groups can be understoodalong a continuum of social function-
ing. At one end are adolescentswho need help to make basic social con-
tacts;at the other end are adolescentswho displaysome socialcompetence
but need help to develop self-awareness and internalizedcoping strategies.
The extent to which leadersintervenein each group varies along this con-
tinuum. With memberswho need help in making basic social contacts,the
leaders actively direct, guide and provide structure for the group members.
With those who need help in developing self-awareness,the leaders offer
non-directive facilitation and interpretation. Parental involvement also var-
ies accordingto where the groups fall along the continuum of social com-
petence,decreasingas the adolescents'competenceincreases.For example,
in groups where socializationis just beginningand the adolescentsare less
able to speak for themselves,contact with parents can enhance the ado-
lescents' participation. Parents can suggestrelevant issuesfor the adoles-
cents to deal with in group, can encourage reluctant adolescentsto attend
group and can assistadolescentsto socialize outside the group.
t24 Mishrru,Kainran, Little, and Tarshls

In this paper, we will provide two case examples.These examples

highlight interactionsthat occur in group and demonstrateissuesthat can
be addressedin a group with adolescentswho have learning disabilities.
The trvo examplesexemplify different places along the continuum of so-
cial/emotionalcompetence.

Group Examllle #1

This example reflects a group that falls towards the end of the con-
tinuum where socializationis at an early stage.This was an 8-weekgroup,
which met weekly for | 1,12hour sessions.It was composedof seven ado-
lescentboys rangingin age from 13 to 16, all of whom had severelearning
disabilities.Their languageand conrmunicationdisabilitiescontributedto
their social isolation and dependenceupon their parents.The boys had
long historiesof being teasedand victimizedby peersdue to unusualman-
nerismsand behaviours.Most were withdrawnand afraid to initiate inter-
actionswith peers.Two femalesco-led the group.
In the sixth session,the leadersgavethe boystwo soft spongeplaying
balls during the group break. One boy, Martin, sat apart from the group
and tosseda ball into the air. The rest of the boys excitedlythrew the
secondball to one another,while Martirr watched.One boy, Alan, playfully
tried to grab Martin's ball, but Martin preventedhim. After severalat-
tempts,Alan walked away.At the end of group, Alan told the boys that
he had wanted to play with Martin. Another boy added that he too felt
disappointedthat Martin had not played with them. In response,Martin
declaredthat he did not want to play with the others.As it was time to
end, the leaderssuggestedthat they could continue this discussionin the
next group.
At the beginningof the following nreeting,Martin brought up the
previousweek's issueand told the group that he preferred to play by him-
self.Alan respondedby telling Martin that he thought that was a problem
and added that he wanted to play with Martin. A third boy, Charlie,sug-
gestedthat Alan wantedto be Martin's friend. He said he understoodMar-
tin becausein the past he too wanted to play alone,but that he now liked
playing with others and having friends.Alan agreed that he did want to
be Martin's friend to which Martin reiteratedthat he wanted to play alone.
During the break, Martin again tossedone ball up in the air and
Alan once more tried to engagehim by grabbingthe ball. Martin held the
ball tightly againsthis body. Alan playfully hit Martin with a cushion,to
which Martin respondedby laughingand dodging Alan. After the break,
Group Therapy wlth AdolescentsWho Have Learnlng Disabllitles 125

Martin declaredthat he still preferredplayingalone,but during the wrap-

up of the group, he admittedthat "break was exciting."

Discussion

As a result of these adolescents'language and communication diffi-

culties and fear of rejection, they required a great deal of active direction
from the leaders. The leaders encouraged the boys to speak loud enough
to be heard, to respond to others, to stop perseveratingand to speak di-
rectly to each other.
This example marked a dramatic shift in Martin's behaviour and in
the group members' abilities to reach out and interact with each other.
The group's challengeof one another allowed individual membersto reach
new levels of social interaction.
Martin is a gifted nonverbal learning disabled adolescentwho has a
severe social disability and displaysunusual physical and verbal manner-
isms. He stood out, even in this group of sociallydisabledpeers. Martin's
behaviour in the sixth sessionrepresentedthe way his behaviour alienates
him from peers in the group and in other contexts.Due to his intense
anxiety,dread of relating to others and his expectationof rejection,Martin
has developed maladaptive but effective ways to keep others away. For ex-
ample, Martin useshis superior vocabularyto insult and intimidate others,
in addition to odd behaviours,such as turning around in circles.Unfortu-
nately, these behavioursnot only kept others from talking to him, but also
set him up as a victim. Martin's use of his superior verbal skills to put
down and confuse others likely developed due to both his learning and
social deficits, and emotional issues.Despite his behaviour,the group did
not reject Martin, unlike the reaction he constantlyexperiencesin his life.
The leaders' feedback helped Martin to realize that his comments
and behaviours offended others. He learned to recognize that he had an
impact on the boys and that group members could hurt each other.
By raising the issueof the balls, Martin showed his emerging aware-
ness others and his ability to participate in the group. He had reflected
of
on the other members'feedbackabout the playing ball incident and wished
to resolve it. Martin's comment to the group that he preferred to play by
himself was his way of establishinghis needs in a nondestructiveway. It
was significantthat he modified his languageby speakingclearly and sim-
ply, using words that enabled him to communicateto the other boys.
The feedback he received from leaders over the course of the group
and the group's acceptanceof him allowed Martin to feel safe enough to
expresshis feelings.This example showed that Martin had become some-
 Mishnu, Kuimun, Little, and Tarshls

what aware of his impact on others and of their feelings.His desire not
to hurt them and to not be misunderstoodby them suggestedthe increasing
importance of group to Martin.
It was essentialthat the group members accept Martin for his pref-
erence to play alone. Once the others acceptedhim but still sought him
out, he showed a more active interest in their play. Thus, the group's ac-
ceptanceof his difference allowed Martin to risk joining in their play.
This group dealt with issuesof inclusionand trust. The exampleshows
the importanceof group membersfeeling acceptedbefore taking risks.This
was a group of boys who initially were not able to engagein spontaneous
social encounters.The boys needed the leadersto facilitate their interac-
tions to enhancetheir ability to relate to another.
Martin provideda significantchallengeto the other group members.
In response,they made dramaticshifts in their interactions.One boy took
a risk by initiating social contact and one boy displayedempathy for an-
other by recallingthat he too had similar feelings.The boys in the group
enactedtheir desiresto connect,play and have fun. They also expressed
their feelingsand needs.They understoodMartin's desire to play on his
own and could recall when they were like that. They identifiednew needs
and the changesthey had nrade in their desireto socializewith others.
By the end of the group, the boysestablished enoughcomfort to talk,
joke, roughhouse,plan a party and see each other outsidegroup. Several
monthsafter the group ended,most of the boyswere talking on the phone
and making plans to see one another.

Group Exanrple#2

The following describesa group that was at a more advancedpoint

along the continuum than the previousexample.This 17-weekgroup met
weekly for 1 712hour sessions.[t was composedof eight adolescentgirls,
ranging in age from 13 to 15. The group was for girls who were ready and
able to talk about their learningdisabilitiesand socialand emotionalissues.
They contracted to share their thoughts and feelings, give feedback and
try to support one another.The girls fell within the low-averageto mid-
averagerange of intelligence.Languagewas a significantarea of learning
disability for sevenof the girls, whereasone had a nonverbal learning dis-
ability. The girls were sociallyisolated,experiencedchronic conflict and/or
rejection from peers,with some strugglingto become less dependanton
their parents.Two femalesco-led the group.
In the fourth session,the group nremberswere discussingverbally
abusivephone callsfrom peers.Sonregirls sharedstoriesof being harassed
Group Therapy wlth AdolescentsWho llave learning Dlsabilities 127

and expressedthe pain they felt. Lana, who has a nonverbal learning dis-
"only friend in the world" would
ability, told the group her problem: her
phone her and after five minutes ask to speak to her younger sister.Typical
of these adolescents'situations,her sister was socially and academicallysuc-
cessful.Lana asked for advice to get her sister to stop talking to her friend.
Although the girls offered her advice,she was not comforted and continued
asking them what to do. Finally, the girls questioned whether the girl was
"friend", but the girls
indeed a good friend. lana initially defended her
pursued in their challenge. The leaders suggestedthat perhaps Lana ex-
cused the friend and blamed her sister out of fear of being alone. Lana
agreed and said that she was afraid shd would be lonely and friendless. In
responseto Lana expressingvulnerability, the other girls reached out and
told her that she could turn to them. Although it was difficult, Lana even-
tually was able to hear and think about the girls' feedback.
A significant issue in this group was the manner in which Lana ex-
pressedher issue by sitting forward in her chair and focused exclusivelyon
the leaders.She did not make eye contact with the group members.Not
long after she began talking, the girls stopped paying attention, became
restless,whisperedto one another and looked to the leadersfor direction.
Lana did not notice what was taking place, despite the obvious distracti-
bility of the group members.Eventually,one of the leadersstopped Lana
and askedthe group how they could help her talk to them rather than just
to the leaders.The girls immediatelytold Lana to try to look at them when
she spoke. She did so, but needed several reminders to continue talking
to the group. The leadersgave the first two remindersafter which the girls
spontaneouslyprompted her.

Discussion

In this group, Lana shared one problem and enacted another with
the group and received feedback about her relationshipsand behaviour.
The other group members challengedher to look at the problem differ-
ently, helping her to evaluate her friend's behaviour more objectively.In
the discussionthat followed, it emerged that Lana was afraid of being
alone. lraders linked this fear to her tendency to protect the friend and
blame her sister. As a result of the girls' feedback,Lana began to view her
situation differently. After Lana expressedloneliness,the girls felt empathy
and reached out to her, whereas previously they were frustrated with her
apparent obliviousnessto them.
Lana's behaviour in this group was due to severalfactors such as her
anxiety and lack of ability to socializeas a result of her learning disability.
128 Nlishnn, Kainran, Littlc, and Tnrshis

Dtte to lter poor.perceprtion of sor:ialcues,Lana wiis unawareol the group's

responseto her, The group rvasfrustratecland anxiousin responseto Lana.
T'heleaclers'interuentionslrelpeclthe group clealwitlr this difficult situation
and sltowerJthe menrberslrow to lre clirectr,vithL.ana.As tl'regroup r.rsecl
the interuentions, I-anareceivedfeeclbackon her behaviours.As well, Lana
was helped ro idelltify her f'eelingsand to talli to others in a way that en-
abled thenr to listen to her.'fhe group helped l,lna to becomeaware of
ofhers'responses to lter and to nrodifyinappropriatebehaviour.As a result,
L,anawas lessannoyingand was ultimatelynot rejectedcluringthis group.
A group mentberraiseda significantissueirr this group.The problems
talked about antl enactedby one menrberwcre applicatrleto the other girls
as wcll. J'he other mernbersexperiencecl the teedback,challengeand emo-
tional support provicleclfol'<tnegirl as helpful to them as well.
Memt,ersin ttris group learned aclaptiveways of dealing rvith their
trustratiorrs. Tlteirtook initiative,spokedirectlyand haclan impact on each
other. One girl shared trer irrsightalrout l-ana'sproblenr.Despite severe
a t t e n ti o na n d l a n g u a g ed i ffi c ulties,
anotlr ergir "lspont:ineously
told Lana to
'fhis
talk to thc qroup. girl's ability to fbllow and rnodelthcrleaders'intcr-
ventionswas a rrraj,rrstep for her.

SIJi\{Mr\IlY

In this papel',lve rcviewi'dit'lterventions offered tcl adolescents u'ith

l e a r tti n gd i si i b i l i ti csa n rl rcl atcd social/enr otional pr oblenr s.llascd r :n the
litc,raturercvierv,it is rensonableto concludethat group psychotl"rerapy is
n o t ofte re d si g n i fi ca n tl yfor adolescents who have lear r r ingdisabilitie s .
'l'hcre
is agreenrent,however,tlrat the social,interpersonaland enrotional
d i f f i c u l ti e so f th e sea cl o l e scents have likcly becor r r einter twinedwith thei r
personalityand coping stylesciespitethe prinrary factor having been cog-
nitive cleficits.Severalu,ritels point or.rtthat children with neurocognitive
deficits are ilt risk of conring into clrronic conflict with the environment
(Cohen, 198fi;l'alonrboct Feigon,l9fi4; Rutter, 1977).The Ontario Child
Health Study (Oftord et al., 199(f)found that chilclrenrvith languagedelay
were an'rongthe populationsmore at risk of clevelopinga psychiatricdis-
turbaitce.
The findings regardingthe ef icacy ol' social skills training/teaching
with learningdisabledyouth are inconclusive.Various studieshave found
that social skills training/teaching interventionsare linriteclto specificdo-
mainsand that the gainsdo not generalizeoutsideof the programsto natu-
r a l s e t t i n g s .D e s p i t e t h i s c r i t i q u e , m a n y w r i t e r s d o n o t q u e s t i o n t h e
Group Therapy wlth AdolescentsWho llave Learnlng Dlsabilltles 129

suitabilityof socialskillstraining/teaching as the interventionof choicewith

learningdisabled adolescents.
The literaturepoints to group therapyas a promisingtreatmentmo-
dality for learningdisabledadolescents with relatedsocial/emotional prob-
lems.The rationalefor group treatmentfor adolescents appliesequallyto
group treatmentof adolescents with learning Most obviously,
disabilities.
theseadolescents havedifficulty relatingto peers.Group therapyprovides
a peer group that is essentialfor developmentand is usuallylacking for
this clinical population.
Although modificationsor parametersmay be required due to their
cognitivedeficits and discrepancies, adolescentswith learning disabilities
and psychosocial problemsfit the criteria for group therapy.Despite this,
there is very little in the literature to suggestthat they receivethis form
of treatment.
In this paper,we have describedgroup therapyfor adolescents with
learningdisabilitiesand social/emotional problems. Through two examples,
we haveshownthe kinds of issuesthat group therapywith this population
can address.We illustratedhow modificationsare implementedaccording
to the level of socialcompetencedisplayedby group members.These ac-
commodations makegrouptherapyviablefor adolescents with learningdis-
abilities.

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