James W. Caron, Ed.D.
Connections Child and Adolescent Group Program
James W. Caron, Ed.D.
(781) 863-5555
connectionscagp@aol.com

120 School Street
Lexington, MA 02421
Map

Frequently Asked Questions

  1. What methods and approaches are used in the group program?
  2. How are groups composed?
  3. Who is appropriate for groups?
  4. Who is not appropriate for groups?
  5. How are goals set and monitored?
  6. How are parents involved in the group process?
  7. What is the format for the group sessions?
  8. Is therapy confidential, and what are the exceptions to confidentiality?
  1. Multidimensional approach combines theoretical and practical contributions from:
    1. social pragmatics (mechanics of social interaction and social use of language, often used in treatment of neurointegrative disorders which compromise social understanding)
    2. cognitive psychology and Cognitive Behavioral Therapy–CBT (relationship between cognitions, behavior and affect, often used in treatment of depression and anxiety)
    3. mind-body techniques (lowering arousal of the sympathetic nervous system, and increasing cortical regulation of the “emotional brain”, typically used to treat stress-related disorders and difficulties with modulating emotional responses)
    4. group process factors, such as summarized by Yalom (curative factors in group therapy)
    5. ongoing research on social development, relational aggression, teasing, bullying
    6. “biocognitivepsychosocial model”:  integrated approach as in “emotional intelligence” formulation

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  2. Groups are formed according to age and grade levels, which correspond roughly to developmental stages reflecting children’s increasing cognitive and executive capacities, awareness of their own and others’ emotional responses, and perspective taking.  Most groups are heterogeneous (intentionally combining children with different behavioral or emotional vulnerabilities, to provide balance and opportunities for learning or modeling) rather than homogeneous (in which all members are coping with the same issue, as in a “children of divorcing parents” group).

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  3. Children who experience difficulty in their social relationships for a variety of reasons:
    1. A. Children may already be diagnosed and be in treatment for a specific condition such as bipolar disorder, depression, anxiety, social anxiety, attention deficit-hyperactivity disorder, nonverbal learning disorder, high functioning Aspergers disorder (if it can be determined that the degree of severity is toward the mild end of the autism spectrum so that he/she can tolerate group process and benefit from the degree of structure we provide).  The group program addresses the social complications of these conditions, and is not a substitute for other treatments which target the condition itself (e.g. a child whose depression causes social withdrawal, decreased interest in peers, or limited range of social activities would continue to require individual or family therapy to treat his depression).
    2. B. Children who are affected by relational aggression, teasing, or bullying will learn strategies for coping with these difficulties and improving their repertoire of social tools.
    3. C. Children with learning disabilities affecting their capacity to process language and other social information rapidly may also benefit.
    4. Children whose social development has been disrupted by other circumstances, such as frequent moves, physical or mental illness in a parent or sibling, or divorce, may also be appropriate.

    We work collaboratively with other therapists who provide individual or family therapy.  When the referring problem is a diagnosed mental condition, the group addresses the social component of the child’s condition, but is not presented as a primary or sole treatment for the disorder itself.

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  4. Children with impaired reality testing or fragile ego structure who cannot tolerate the stress of multidirectional social interactions; children with severe neurobiological impairments (e.g. on the severe to moderate range of the autistic spectrum) who need a greater degree of structure and specialized methods; children with developmental disabilities who cannot manage the cognitive challenges of this type of group; children who are unable to accept the basic responsibilities of this group (confidentiality, safety, and working toward goals) after repeated efforts to address noncompliance.

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  5. Goals are set during the evaluation process (at least two sessions with parents and with the child, review of other information about the child’s needs and capacities, contact with other providers, etc.).  Each group member is expected to have one or more goals, which are monitored by group leaders during the course of the group.  After the therapist has worked with the child and observed social strengths and vulnerabilities, brief periodic individual sessions are conducted to provide individualized feedback to the group member, and to monitor progress toward goals.  A midyear review meeting with the child and parent is conducted to revise or add goals.  In most groups, members have some shared goals, as well as goals that are unique for each individual.

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  6. Parents are expected to participate in monthly parent meetings, held concurrently with the child meeting, on the last session of the month.  During parent meetings, we discuss current group themes, home activities to support newly learned skills, and upcoming themes for the coming month.  Parents also use the group as a forum for parenting questions or other issues of concern.Parents also participate in individual/family sessions, held every 5-6 weeks, to review progress and revise goals.  Additional sessions for parent support are available.

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  7. Basic model:
    1. “Check-in” to explore current problems or areas of growth, as well as to practice conversational strategies)—10 to 15 minutes
    2. Structured presentation of content/activity—30 to 40 minutes
    3. Snack and review of group session—10 to 15 minutes.

    The degree of structure varies with the age and needs of the group;  e.g. younger groups are more structured, but the content is presented in a simpler way, while high school groups tend to be more open-ended and member-directed (rather than leader-directed).  Content follows a general sequence, but more or less time may be devoted to each topic, depending on the needs of the group  (see page on  “Group Topics”).  Content is often incorporated into games or role-playing.  Some games are “therapeutic versions” of familiar games or TV shows, while others are our own board games, designed to strengthen problem-solving, communication, and cognitive restructuring skills, teamwork, etc.

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  8. As in individual psychotherapy, we have safeguards in place to protect the confidentiality of each member’s communications.  All group members agree not to discuss content of group discussions with anyone outside of the group, with the exception that each child can discuss his or her own comments with parents.In general, the law protects the confidentiality of all communications between a client and a psychotherapist. Information is not disclosed without written permission. However, there are number of exceptions to this rule. Exceptions include:
    1. Suspected child abuse or dependant adult or elder abuse. The therapist is required by law to report this to the appropriate authorities immediately.
    2. If a client is threatening serious bodily harm to another person/s. The therapist must notify the police and inform the intended victim.
    3. If a client intends to harm himself or herself. The therapist will make every effort to enlist his/her cooperation in ensuring safety. If the individual is unwilling or unable to contract for safety or accept other treatment recommendations, further measures may be taken without his/her permission in order to ensure safety.

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