Get 20M+ Full-Text Papers For Less Than $1.50/day. Subscribe now for You or Your Team.

Learn More →

Expressive Group Therapy With At-Risk African American Adolescent Girls

Expressive Group Therapy With At-Risk African American Adolescent Girls Intemational foumal of Adolescence and Youth, 2008, Volume 14, pp. 135-159 0267-3843/08 $10 © 2008 A B Academic Publishers Printed in Great Britain Expressive Group Therapy With At-Risk African American Adolescent Girls Karly S. Stuart* and Ma. Teresa G. Tuason University of North Florida ABSTRACT In a study conducted by M.T. Tuason, A. Marcetic, S. Roberts, K. Stuart, and J. Rearick (in press), it was revealed that minority urban female adolescents 11 to 18 harbored more pain and anger and were at higher risk for ages deviant behaviors compared to children of other age groups within the same socioeconomic class. The current study is a group intervention and a systematic way to evaluate the outcome of expressive group therapy with African American female adolescents. Group members were drawn from the Refuge, an after-school program located in a southeastern city of the United and took part in expressive activities intended to expose them to new States, experiences and to increase their confidence in and awareness of their strengths and talents. Qualitative results revealed that expressive group therapy helped the adolescents with emotional exploration, increasing their self-esteem, and decreasing their anxiety. Moreover, qualitative results indicated that conflict among participants must be addressed in order to minimize attrition rates. EXPRESSIVE GROUP THERAPY WITH AT-RISK AFRICAN AMERICAN ADOLESCENT GIRLS Urban youth face many challenges, including gang violence, inadequate health care, high drop-out rates, and exposure to the premature death of family members and friends (Dryfoos, 1990; Halpern, 1990; Masten, Best, and Garmezy, 1990; Werner, 1990). A study conducted in Baltimore, Maryland, concluded that 24% of African American adolescents had observed a murder and 72% knew someone who had been shot (Cotten, Resnick, Brown, and Martin, 1994). This constant exposure to death has been associated *Correspondence address: e-mail: ksstuartl@yahoo.com 136 with depression, anxiety, and symptoms of post-traumatic stress disorder (Cooley-Quille, Boyd, Frantz, and Walsh, 2001; Edleson, 1999; Fitzpatrick and Boldizar, 1993). In families of lower socioeconomic status, parents are often forced to work multiple jobs; as a result, their adolescent children do not receive sufficient guidance and monitoring (Brook, Whiteman, Nomura, Gordon, and Cohen, 1988; Dishion and McMahon, 1998; Hawkins, Catalano, and Miller, 1992; Newcomb and Felix-Ortiz, 1992). Minority youth often have difficulties with academic performance, with 61% of African American students scoring below average on the middle school proficiency examination in comparison with 21% of Caucasian students and 56% of economically disadvantaged students scoring poorly on middle school math examinations as compared to 25% of middle and upper class adolescents (Education Trust, 2003a, 2003b, as cited by Day-Vines and Day-Hairston, 2005). Existing research evidences that organized after-school activities aid adolescents by increasing their willingness to learn and self­ confidence and encouraging stronger work ethic and positive peer associations (Quane and Rankin, 2006). Because African American youth are at increased risk of engaging in negative behaviors, and due to the absence of supervision for children from families of lower socio-economic status, expressive group therapy may be a viable intervention in addition to an after­ school program targeted to these youth. In the current study, expressive therapy was conducted to provide adolescents an outlet to express emotions and communicate needs while being exposed to expressive activities. Group experiences work particularly well with the adolescent minority population by allowing them to test unfamiliar waters while benefiting from the support of a peer group (Day-Vines and Day-Hairston, 2005). A group should be a safe environment for youth to establish closeness with one another, share fears and anxieties, gain insights, resolve conflicts, and express and process emotions (Yalom, 1995). Group therapy targeted to disadvantaged African American adolescents needs to incorporate Afrocentric principles in order to allow youth to establish a sense of pride and increase self-worth. Group members should be encouraged to use language and expression that is comfortable and familiar to them (Banks, Hogue, Timberlake, and Liddle, 1996). Minority youth benefit from intervention groups where they can learn to deal with emotional occurrences and how to process feelings without becoming aggressive (Banks et al., 1996). According to Atkinson, Morten, and Sue (1989), in groups, 137 African American adolescent females need to discuss their hopes for the future, ways to make a difference in the world, successful minority women, and their own emotional struggles, fears, and feelings associated with discrimination. Minority female adolescents value honesty, trust, respect, and a safe place to vent in their group experience (Locke and Kiselica, 1999). Intervention effectiveness has not been measured in previous studies; therefore, this study set out to qualitatively measure the effectiveness of a 10-session group intervention. study conducted by Tuason, Marcetic, Roberts, A previous and Rearick (in press) found that minority urban females Stuart, 11 to 18 were at heightened risk for deviant behaviors, ages emotionally burdened by life roles, and suffering from low self­ concept. These adolescents experienced hurt and anger and expressed these as chaotic demeanor. The adolescent girls did not that their needs were being met by the after-school program feel they attended and perceived staff treatment as unfair. They found the staff difficult to relate to and felt activities were centered on the younger population. In addition, according to the study's authors, no measures were in place to test the effectiveness of program's activities for this population. the after-school The current study's purpose was to conduct an expressive group therapy intervention with adolescent females attending the an after-school care program for minority youth located Refuge, in a city in the southeastern United States, and measure the such as psychodrama, effectiveness of this intervention. Activities and dance, as well as emotional processing sculpting, singing, took place. These techniques were aimed at initiating discussions and fear, feelings about concerning stressors, levels of anxiety and self-esteem, and assessment of psycho-emotional self-efficacy needs. The purpose of exposing these youth to expressive therapy them to gain new experiences, as well as confidence was to allow in and knowledge of their own strengths and talents. group therapy intervention was warranted The expressive because inner-city adolescents face many challenges including poverty and familial struggles (e.g., Dryfoos, 1990; Halpern, 1990; Masten et al., 1990; Werner, 1990). Due to these stressors, urban youth often perform below average in school, take part in delinquent activities, and lack self esteem (e.g., Connell, Halpern-Felsher, Clifford, Crichlow, and Usinger, 1995). They also may have a great deal of anger and aggression and frequently lack healthy means of coping with emotions (e.g., Edleson, 1999; Vanderschmidt, Lang, Knight-Williams, and Vanderschmidt, 1993). Group therapy has been shown to be very effective 138 with African American youth because it allows them a secure place to talk about their issues with their peers (Tucker, 1999). Much literature has focused on risk factors for minority individuals; however, understanding and implementing youth is also crucial (Durlak, 1998). preventive resources for these youth to discover their strengths For example, helping inner-city and the probability of increases their chances for future success better quality of life. Though preventive work has been shown to be effective, more evaluation of such programs is needed (Vera, 2000). Research in this area is scarce and much more data is needed on the effectiveness of preventive interventions such as expressive therapy groups with inner-city adolescents. Expressive therapy helps individuals cope with their issues by allowing them to express themselves artistically and reveal hidden conflict (Snyder, 1997), while group therapy involves processing emotions and conflicts and learning healthy coping styles (Corey and Corey,2006). Groups have been shown to benefit this population; however, specific data has not been gathered on methods in expressive group therapy that might be beneficial for female participants in particular. Moreover, much of the data gathered focuses on risk factors for this population rather than strengths and resources for future success. The current study provided quantitative and qualitative results that evaluated the effectiveness of expressive group therapy as an outlet for healthy expression and coping in urban female adolescents. In the current study, it was intended that expressive group therapy would be preventive and would provide minority adolescents a safe environment in which to communicate their concerns, label their emotions, and practice more adaptive methods for coping with feelings. The effectiveness of the expressive group was measured for each participant using pre­ test and post-test measures as well as post-session evaluation questionnaires and intervention evaluations. In group therapy, adolescents were shown different means of expressing emotions through healthy avenues, which in turn gave them a greater sense of control and empowerment. Social support was encouraged, and members were taught to be kind and respectful towards one another. Attention was drawn to their inner strengths and the youth engaged in self-esteem building activities such as clay sculpting. Leaders attempted to ask about the members' perspectives and allowed them to explain issues on their own terms. Feelings associated with discrimination were discussed, and leaders made changes if their methods were viewed as ineffective by participants. The participants were encouraged to 139 use psychodrama to talk about family struggles and dance to explore feelings about body image. African American heritage was valued, and participants took part in discussions about their culture and the meaning behind their feelings. Leaders modeled healthy ways of expressing emotion and the youth also used painting to help them identify and express emotions and learn coping mechanisms. Poetry was incorporated as well, to allow the participants to discuss hopes, dreams, and aspirations for themselves. The adolescents also received a tour of a college campus to increase their exposure to academic life. After taking part in the expressive group therapy sessions, it was hypothesized that the primary outcomes for participants would be increased ability to express authentic feelings, communicate their needs, and derive support from a group setting. These outcomes were analyzed using means from post-session evaluations. Moreover, it was hypothesized that secondary outcomes for participants would be an acceptable change in global self concept, a decrease in symptomatology, and an increase in interpersonal and affective strength. METHOD Participants Participants were African American female adolescent students age 11 to 15 attending the Refuge, a non-profit after-school care facility located in a poverty-stricken neighborhood in a southeastern city. The purpose of this facility was to provide children with a safe environment, assisting them with academics and exposing them to sports, computers, music, and other activities. The participants were from four of the poorest schools in the district and most dealt with family problems related to drugs, violence, crime, illness, and unemployment. The females who took part in the study were a purposive sample identified by staff at the after-school care facility. All participants have been given pseudonyms for purposes of maintaining confidentiality, as has the name of the after-school care program. Design and Procedure Group therapy sessions were proposed by the investigators after they were approached by the director of the Refuge program; 140 program staff had observed that female adolescents within the age range of 11 to 15 were having issues with anger, low self­ concept, and chaotic demeanor due to expectations that they fulfill multiple roles within family and school environments. Staff members also recognized that they were having difficulties relating to this group, recognizing the girls' needs, and connecting with them in a productive manner. The goals of the group therapy sessions were to alleviate feelings of stress/ anxiety, increase awareness of authentic feelings, gain understanding of emotions, improve coping mechanisms, increase self-efficacy and self-esteem, and gain awareness into appropriate communication styles and expression of needs. Parental consent was obtained for all participants, as well as the participants' assent to take part in the expressive group therapy intervention. The individuals participated in a 10-session group therapy intervention that involved process work as well as expressive therapy activities. The sessions were conducted at a local university and were held weekly for 1 hour. Sessions consisted of an expressive therapy activity for 30 minutes and a therapeutic processing of the activity or other pressing concerns for the remaining 30 minutes. Each of the 10 sessions had an activity that encouraged expression and exploration of a topic that was of relevance to the participants. Processing of the sessions encompassed discussions about the topic and any concerns they felt at that time. Participants' attendance depended on youths' presence at the Refuge program that day. The counseling sessions were conducted free of charge, and the students were transported to the university counseling lab by a Refuge staff member. The primary group leader was trained in group process and was a student in a counseling psychology master's program at a local university. The co-leader was a licensed clinical psychologist and an assistant professor at a local university. Together, both leaders conducted all 10 sessions. An African American psychology student was invited to attend sessions 4, 7, and 8 because the group leaders felt having an African American female in session would increase group members' comfort and be beneficial for the participants. In addition to having a structured activity and group process, a check-in (group members took turns expressing their needs and feelings at the beginning of each session) and check-out (group members expressed their feelings about that day's session) were conducted each session to ensure that the participants' needs were being met. Table 1 outlines the activities and processing conducted in each expressive group session. 141 TABLE 1 Session# Expressive Activity Processing 1 Pre-Test Goals, Expectations- What is group? 2 Ice Breaker Ground Rules Discussion, Role Activity Induction, Expectations of Group Members 3 Clay Sculpting/ Feelings, Perceptions of Self Self-Concept 4 Painting Emotional Exploration - Happiness, Pain, Anger, Anxiety 5 Psychodrama Family Environment - Family Roles 6 Dance Exploration of Body Image- Body Awareness 7 Poetry /University Life Dreams I Aspirations - Tour Career, Education 8 Heritage Show Meaning/Importance Heritage- and Tell Family and Meaning of Being African American 9 Post-Test Changes Made - Evaluation 10 Goodbye Achievements, Likes /Dislikes - Evaluation Measures Demographics. Each participant completed a demographics form with qualitative questions pertaining to gender, religion, ethnicity, and guardianship. Quantitative questions were asked regarding age, number of individuals living in the household, socioeconomic status, and satisfaction with the Refuge. Socioeconomic status and feelings about coming to the Refuge were measured using a Likert-type scale, where 1 signified poor and 10 indicated rich on the socioeconomic status portion of the demographic evaluation. Moreover, 1 designated no and 10 indicated yes on the scale that asked, "Do you like coming to the Refuge?" Open-ended questions were also asked about what the members liked and disliked about attending the Refuge. Demographic data was gathered for five participants, the sixth group member did not complete the demographic evaluation. All 142 participants were African American females. Three participants indicated that religion was not practiced within their families, and two group members stated that Baptist was the religion practiced within their families. Two group members reported that an aunt or uncle was caring for them, and two participants stated that a mother and/ or father were their guardians. One individual communicated that a sibling was her caretaker. Group members' ages ranged from 11 to 15 (M = 13.6, SD = 1.5). The mean score for number of individuals living in the household was 5.8 (SD = 1.6), and the mean score for socioeconomic status was 7.0 (SD = 1.9). The scores for feelings associated with attending the Refuge after-school care program exhibited a wide range (M = 6.2, SD = 4.1). Group session evaluation form. A post-session evaluation was given to participants after each of the sessions to assess expression of real feelings, ease of talking about self and problems, satisfaction with topics discussed, evaluation of the leaders' intervention, and level of session helpfulness. The questions to which the youth responded were meant to help them express their feelings and desires, what worked for them and did not work for them, and their overall feelings about the session. The questions were based on a Likert-type scale ranging from 1 to 10 with 1 indicating dissatisfaction and 10 signifying satisfaction. Questions included: (a) Expression of real feelings: 1 - I was not able to express my real feelings/10- I was able to express my real feelings; (b) Ease of talking about self and problems: 1 - I felt that it was very hard for me to talk about myself and my problems/10 -I felt that it was easy to talk about myself and my problems; (c) Satisfaction with topics talked about: 1 - We did not talk about what I needed to talk about/10 - We did talk about what I needed to talk about; (d) Evaluation of the leader's intervention: 1 - I did not like what the leader did/10 - I liked what the leader did; (e) Level of session helpfulness: 1- The session did not help me today /10 - The session helped me today. Open-ended questions were asked, including: What is the most important thing that happened in group today? How do you feel about what went on in group today? and What would you want for the next session to be helpful to you? Responses to each session evaluation handout were used when analyzing process outcomes for the expressive group therapy sessions. Questions were analyzed by calculating means and standard deviations for group sessions 2 through 8. The responses to the open-ended questions were evaluated using content qualitative analysis. 143 Group notes. Group notes were written following each session. These notes contained content of group discussion and the overall and individual processes that occurred within each session. The leader's and co-leader's impressions and thoughts regarding content and overall process were also documented within the group notes in order to best assist the participants. The group notes were analyzed using content qualitative analysis, themes and patterns were outlined, and group member quotes were incorporated to support leaders' impressions. Intervention evaluation. An intervention evaluation was conducted in sessions 7 and 8 in order to obtain feedback from group members with regard to changes made, likes/ dislikes about group, and feelings about the leader and co-leader. The questions asked were: What did you like/dislike about group? What activities did you like/ dislike? What personal changes were made after being part of the group? How is the group different from the Refuge? and What are your feelings/thoughts about the leader, co-leader, and visitor? Measuring change. Change was measured using both quantitative and qualitative analyses. It was hypothesized that means of availability for expression of feelings, ease of talking about self and problems, satisfaction with topics talked about, leader evaluation, and overall session helpfulness would increase from session 2 to session 8. Moreover, it was hypothesized that qualitative outcomes would indicate that group members enjoyed the activities conducted in group, experienced positive changes in their lives by attending group, and viewed the group as being extremely helpful overall. RESULTS The results were analyzed from both quantitative and qualitative measures evaluating the group intervention. Quantitative Analysis Quantitative analyses were used to compare means using a scale of 1-10 on variables included in the post-session evaluation scale. These variables included expression of real feelings, ease of talking about self and problems, satisfaction with topics 144 discussed, evaluations of leaders' intervention, and level of session helpfulness. The baseline measure used was session 2 and the post-test measure used was session 8. Overall ratings were compared for 35 points {the above five variables for seven sessions) and modifications from session to session were analyzed by looking at changes from baseline to post-test. The Likert-type scale evaluating the five variables ranged from 1-10 with 1 indicating dissatisfaction and 10 signifying satisfaction. Numerical evaluations using a scale of 1-10 were gathered for each participant in order to measure expression of real feelings, ease of talking about self and problems, satisfaction with topics discussed, evaluations of leaders' intervention, and level of session helpfulness. These were analyzed for seven sessions of the group: session 2 through session 8. Post-tests, including the Multidimensional Self-Concept Scale (Bracken, 1992), Symptom Checklist SCL-90-R (Derogatis, 1983), and Behavioral and Emotional Rating Scale (Epstein, 2004), were not administered due to few participants in the final session (N = 3). Figure 1 reveals the means of post-session evaluations per session. The mean scores seemed to increase for all five categories as therapy progressed; however, number of participants declined. The mean score for expression of feelings increased from session Figure 1. 145 2 to 3 (M = 9.6 to M = 10) and remained the same (M = 10) for the duration of the sessions. This outcome indicated that participants perceived that the expressive group therapy sessions aided them in expression of real feelings more in later sessions than in the first two sessions; however, the initial session seemed to help the participants express their emotions as well. This finding suggested that group members began to feel more comfortable in a group therapy setting and with the co-leaders. Also, it suggested that the members possibly saw increased value in expressing their genuine feelings to others as the group developed. Ease in talking about self and problems began low (M = 6.4) but steadily rose (M = 10) with the exception of session 5 (M = 9.8). This finding suggested that group members found it somewhat difficult to talk about themselves and their problems in the first session. The drop in the mean score in session 5 could be attributed to the topic of family and home life that was discussed. Participants might have felt somewhat uncomfortable sharing their feelings about this topic and possibly could have felt a sense of disloyalty to their families by discussing family problems. It seemed that participants found it easier to discuss their difficulties with school, each other, and family members as the sessions progressed. This finding might suggest that group members learned healthier ways of dealing with struggles and had their difficulties validated and normalized by other participants. Satisfaction with topics discussed was somewhat low in session 2 (M = 8.2) and declined in 3 (M = 7.8); however, mean score increased in session 4 (M = 10) and remained high (M = 10) throughout the eighth session. This finding could indicate that group members did not feel they were able to talk about what they needed to talk about in sessions 2 and 3, an outcome that could have resulted from the high levels of conflict between group members during these sessions. Moreover, session 3 took place in an alternate location as other university staff were occupying the counseling lab. This change could have caused group members to feel helpless and uncomfortable. The researchers attribute the rise in the scoring to participants becoming more at ease in discussing topics of importance to them as the sessions progressed because relationships among group members became healthier. The mean score of evaluations of the leaders' intervention began relatively high (M = 9.8) and remained high (M = 10) throughout the sessions. This result indicates that group members liked what the leaders did and felt comfortable with the leaders 146 TABLE2 Session# N Expression Ease of Satisfaction Leader Overall of Feelings Talking with Topic Evaluation Helpfulness M=9.8 M=lO 2 5 M= 9.6 M = 6.4 M = 8.2 SD = 0 SD = .89 SD = 3.8 SD = 4.02 SD = 4.5 M = 7.8 3 M = 9.8 M = 7.8 M = 10 4 M = 10 SD = 4.5 SD = 4.5 SD = 10 SD = 0.5 SD = 0 M=lO 4 M = 10 M=lO 3 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M=lO 5 5 M = 10 M = 9.8 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0.5 M=lO 6 M=lO M=lO 3 M=lO M=lO SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M = 10 M = 10 M=lO 7 2 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M = 10 M = 10 M=lO 8 3 M=lO M=lO SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 throughout the group sessions. Also, the members did not seem to dislike or be affected by the fact that the leaders were Filipino and Caucasian rather than African American. This disaffection was not indicated on the post-session evaluation handouts as well as in group members' discussion during the sessions of their feelings toward the leaders and thoughts concerning the leaders not being African American. Overall helpfulness mean scores were high for all sessions (M = 10) with the exception of session 3 (M = 7.8). This discovery suggested that group members felt that the sessions helped them overall. The drop in session 3 might have been due to the topic of that session, feelings, which might have caused participants to experience their hurt as part of the discussion. Table 2 summarizes sample sizes, means, and standard deviations for each session. Qualitative Analysis Results were analyzed qualitatively from the group notes, the leaders' impressions of each session, and open-ended questions on each post-session evaluation form. Participants were asked intervention evaluation questions in sessions 6 and 7, including what did and what did not help them in group, what activities were and were not enjoyable in group, and what changes they perceived in themselves after taking part in group. They also 147 responded to questions about how group was different from the Refuge, what they liked and disliked about each leader, and what they liked and disliked about the guest invited to attend. The qualitative results were analyzed using content analysis and quotes using pseudonyms were provided to substantiate the investigators' interpretations. Themes and patterns were identified by the leaders throughout the data evaluation process. Within the open-ended portion of the post-session evaluation, answers were reviewed to questions such as: What is the most important thing that happened in group today? How do you feel about what went on in group today? and What would you want for next session to be helpful? In the intervention evaluation, answers were examined to questions regarding what did and did not help in group, what activities were and were not enjoyable in group, and what changes were perceived after taking part in group. Answers to how the group differed from the Refuge, what was liked and/ or disliked about each leader, and what was liked and/ or disliked about the invited guest were also examined. Qualitative results from post-session evaluation scales indicated that the expressive group therapy sessions were very helpful for six out of six participants in terms of expressing their feelings, being exposed to what other participants were struggling with, and being able to convey emotions regarding family and home life. Shaniqua, age 11, stated, "The most important thing that happened in group today was that we talked about my feelings." Claudia, age 15, explained, "The most important thing that happened in group today was that we all acted out the other person's life. We got to act out another person about their feelings." Five out of six group participants indicated that expressive group therapy was helpful because it allowed them to communicate with one another in healthy ways. Group members seemed to feel that talking to other participants and the group leaders was beneficial for them. Tamica, age 15, said, "The most important thing that happened in group today was that I was able to talk and tell a story." Qualitative results from post-session evaluation scales pointed out that the expressive group therapy was helpful for the five out of six participants because it allowed them to have fun expressing themselves outwardly, feel accepted, and experience happiness. Monique, age 12, concluded, "I had fun. I feel loved and happy in group." Brianna, age 12, felt similarly, "I had fun. I feel good when I am in group." 148 Five out of six group members pointed out that much of the content and process work in the group depended on the group members present, as evidenced by qualitative evaluation of post­ session evaluation scales and intervention evaluation. During the group sessions in which conflict was minimal, the overall session evaluation ratings were higher and group members felt they were able to talk about their problems and what they needed to discuss; however, during the group sessions in which conflict was present, the overall session evaluation ratings were lower and participants indicated that it was very hard for them to talk about themselves and their problems. Much of this divergence was expressed when participants were asked about what they did not like in the group therapy sessions. Claudia, age 15, said, I don't like Samone because she is a white girl trapped in a black girl's body. She acts different, talks different, and dresses differently. made me mad because she did not pay me right for doing She her hair. I do not like Shaniqua because she'll switch out and talk behind your back. She tells other people what you say about them. I don't like Tamica because she tries to be a glam chick. I don't like Monique because she is an Indian giver. I bought her a bunch of stuff. She gave me a doll and she took it back. Tamica, age 15, stated, "I did not like group today. It would be helpful in the next session for everyone to be respectful and listen to others and just follow directions and if you are not told instructions, wait." Participants seemed to drive each other away from the Refuge as well as from the expressive group therapy intervention, as pointed out by qualitative findings from leaders' impressions. Many times during group, participants became hurt by one another and taunted each other. The group members did not state they were hurt but used verbal anger to express their feelings. The Refuge director informed group leaders that conflicts occurred outside of the group sessions as well, which might have contributed to group attendance and progress. Qualitative results from the intervention evaluations and leaders' impressions suggested that six out of six participants felt expressive and social activities such as acting, singing, discussion of dreams/hopes, touring a college campus, and communicating about family issues were most helpful. Six out of six participants did not appear to feel comfortable with the question/ answer type format that the group leaders incorporated at times. Four out of four participants seemed to enjoy coming to group in order to have new experiences aside from the Refuge. Claudia, age 15, explained, 149 I like acting out our families, clay sculpting, and talking about my hopes and dreams. I like that we get to leave the Refuge and we do something new in group every week; at the Refuge we do the same thing every day. Tamica, age 15, stated, I feel like group has made me better. I like coming to group because it's more fun than the Refuge, and I laugh a lot more in group. I like acting out how we feel and acting out each other. I like group because we listen to music, and we talk. I would not change anything. The leaders' impressions, post-session evaluations, and interven­ tion evaluations pointed out that four out of four participants enjoyed the leaders' interventions and felt very comfortable with the leaders despite the fact that they were not African American. These four seemed to value the leaders because they allowed them to be themselves and have fun. They also expressed that they enjoyed having an African American student visit the group sessions. Claudia, age 15, said, "I like the leader because she laughs a lot and has a nice personality. I think that the co-leader is okay too. I like having the guest because she is fun." Tamica, age 12, stated, "I like the leader because she is fun, and I like the co-leader too because she is a cute little lady. The guest is fun to have in group, too." The attrition rate for the group participants was extremely high. The group began with six members and dropped to three participants by the final session. The extraneous variables that could not be planned for included students not attending school on the day of the group session, students moving away from the Refuge, students lacking transportation to the after-school program, and students not attending the Refuge on the day of the group session. DISCUSSION Relevance of Current Research Numerous themes were revealed among group participants by analyzing the qualitative and quantitative findings. It was found that the needs of the participants were met by attending the group sessions. It should be pointed out that group members felt that therapy sessions were very helpful to them because they were allowed to express their feelings and gain love and acceptance. 150 Participants expressed that they enjoyed the sessions in which they were exposed to their peers' feelings and horne lives. These activities were seen as beneficial because they allowed group members to have their feelings and experiences validated and normalized. Group participants articulated feelings more as sessions progressed. The authors reason that this increase was due to the amplified level of comfort with the other group members and the group leaders as expressive therapy continued. Moreover, participants gained insight into their emotions and leamed that it is healthy to express feelings and to allow themselves to be vulnerable and authentic while in a safe environment. This finding is positive because past research indicates that many African American youth act out violently to express inner turmoil they are experiencing because they do not have healthy outlets for expression (Cartledge and Middleton, 1996). The group members gravitated towards activities that allowed them to be social and involve other group members. These activities included clay sculpting, acting out future hopes and dreams, imitating one another, and demonstrating horne life scenarios. This finding is consistent with other research. As noted in a study conducted by Sanders and Bradley (2005), African American girls might behave in ways that are labeled as resistant by societal norms. It is crucial for counselors to leam to listen to African American female adolescents, and appreciate the ways in which this population views their challenges and their environment (Sanders and Bradley). The participants viewed group sessions as beneficial because no unnecessary rules or restrictions were placed on them. The group members were allowed to be loud and perform scenarios creatively. The individuals felt empowered by being encouraged to laugh, have fun, and behave boisterously, which is something that participants are discouraged from doing at school and their after-school facility. Group members had some difficulty communicating their concems in the early sessions, which could be due to cultural values. There is a cultural expectation that African American individuals should handle their own problems and put forth an image of strength rather than one of vulnerability (Lee, 1996; Majors and Billson, 1992; Poussaint and Alexander, 2000). African American youth do not traditionally attend counseling, which should be alarming to counselors because many of these individuals deal with multiple stressors and could benefit greatly from processing emotions, leaming healthy coping styles, and adopting better conflict resolution skills (Muller, 2000). 151 The group members opened up more as sessions progressed and expressed themselves freely by discussing issues such as and uncertain future school problems, relationship difficulties, be more effective if group goals. Group sessions seemed to of importance to them. members were able to discuss topics Group leaders encouraged respect for the other members, which her concerns. This technique allowed each participant to voice when working with the minority female seemed effective adolescent population. Participants felt they were unable to talk about what they needed to talk about in the initial sessions; however, they were able to discuss their needs in the remaining five sessions. The researchers attribute this early discomfort to the stigma group and the cultural meaning of belonging to a therapy surrounding therapy. For instance, the girls asked if there was wrong with them. Past research reveals that African something be stigmatized if they American families fear their children will are seen by the community as having a mental health problem (Breland-Noble, Bell, and Nicolas, 2006). Group members gained in the other participants and co-leaders, viewed their needs trust and helped by therapy, looked as more valid, felt encouraged group intervention, and felt validated by forward to expressive the co-leaders as therapy progressed. Participants had a difficult time with ease of talking about and their problems in the session that discussed themselves familial problems. Group members possibly felt that they were being disloyal to their families by conversing about hardships and feelings regarding home life. Also, group participants could have been embarrassed to discuss current familial problems, which them in talking about themselves and their could have inhibited problems. Despite possible discomfort, many participants shared about fights that occurred in their home lives, which showed that they felt comfortable verbalizing personal issues with the leaders and other group members. The current finding is positive because study conducted by Breland-Noble et al. (2006) results from a pointed out that African American families engage ministers and faith based organizations to discuss familial problems. Moreover, African American families seem to rely heavily on one another as well as extended family for several dimensions of physical and emotional growth (Breland-Noble et al.). Group sessions appeared to be more helpful overall if conflict was minimal within the group. Because of the negative feelings many group members felt toward one another, individuals were distracted by the disagreements among their peers and could not 152 focus themselves on the group activity or be helped as extensively by the group process. Conflict in session 3 was particularly high; and this tension could have been exacerbated by the group's unexpected change in location due to other university staff occupying the original meeting space. This change could have caused the participants to feel helpless and irritated. Also, that group intervention began late because it took some time for the leaders to find another meeting place, which might have caused the adolescents to feel rushed and uneasy. Additionally, group members pushed each other away from the expressive group therapy sessions by fights with one another that happened outside of group. This finding is alarming because past research points out that healthy peer influences are crucial for inner-city adolescents' future success. Studies found that involvement with positive peer groups, achievement in school, and pro-social extracurricular groups increases children's chances of success and lessens the risk of behavioral struggles (Leffert et al., 1998; Mahoney and Cairns, 1997; Parker, Rubin, Price, and DeRosier, 1995; Steinberg, Elmen, and Mounts, 1989). In addition, Losel and Bliesener (1994) suggested factors such as intelligence level, coping mechanisms, outlets of positive influence, and a supportive home environment led to increased ability to deal with urban environmental stressors. It has been shown that empathy, supportiveness, and a nonjudgmental acceptance of the client fortify the relationship and the hope for an optimistic outcome (Houston, 1990). Group members seemed to value the co-leaders' approach throughout the progression of the intervention; however, the participants appeared to possess increased enjoyment and comfort with the leaders as therapy continued. The reasoning for this finding is that group members were initially unfamiliar with the group process and rules and norms of participating in a group intervention. In the remaining sessions, group members highly valued the leaders' interventions and methods, and they expressed that they liked the leaders despite the fact they were not African American. The group participants spoke of school teachers showing prejudice toward them and treating them unfairly. The adolescents perceived that the co-leaders possessed unconditional positive regard - a desire to understand their lives and listen to their challenges and their struggles with individuals of other races and to aid them in expressing their emotions. The participants could see that the leaders were trying to make the group experience fun for them and that the leaders cared for them. 153 Limitations Many of the things that are enumerated here as limitations are realizations the researchers had while conducting the group sessions. In a way, these limitations are things that we learned that would help future research doing group interventions for African American adolescents. In the current study, some limitations existed that hindered the group outcomes in various ways. Group members reported that they benefited from group because they were able to express their feelings, participate in fun activities, talk to one another, and get away from the Refuge; however, attrition rates were extremely high. To the authors, it seemed that the reasons for dropping out depended strongly on the relationships participants had with one another. Many of the group members drove each other away from the Refuge, which is a drop-in facility, because of disagreements that existed even before the group sessions occurred. Moreover, group members did not attend group if they were absent from school or had detention on the day of the group session. Another reason for the high attrition rate could be that many students lacked proper transportation to the after-school program and were forced to withdraw from the group therapy sessions. Due to the instability in many of the participants' lives, students moved away from the area where the Refuge is located. A similar study conducted by Ferguson (1998) found a 17% attrition rate due to relocation from pre-test to 3 month post-test in a pregnancy prevention program with inner-city female adolescents. The students who remained in the group were those who lived close to the Refuge, attended the after-school program on the day of the expressive therapy group, and who did not have continuous conflicts with others at the after-school program. The sample size was very small with only six participants beginning the group sessions and three participants by the end of them. Often, participants were different from session to session. Post-tests could have been administered and quantitative data including Multidimensional Self-Concept Scale (Bracken, 1992), the Symptom Checklist SCL-90-R (Derogatis, 1983), and the Behavioral and Emotional Rating Scale (Epstein, 2004) could have been analyzed for comparative purposes if the sample size had been larger and if the group's attendance had been more consistent. For future research, it is suggested that the initial sample size be larger than six in order to prevent discontinuation of quantitative analysis due to high attrition rates. No control group or random assignment was in place in the 154 current study because the participants were all female adolescents in the after-school program and all belonged to the sub-sample of the program that needed therapy. These youth were identified as at-risk for negative outcomes and were most unsatisfied with the after-school program (Tuason et al., in press). The current study could have benefited from incorporating random assignment in the control group and the group receiving treatment because it would have allowed for more meaningful comparisons, with the exception of the group intervention. Additionally, clinical comparisons could have been made if there was a wait-list control group with which to compare the treatment group. In future research, implementation of a wait­ list control group could be used in order to have a comparison group that is given usual care treatment (the Refuge after-school care) or postponed treatment. In this way, researchers could compare the changes in group members who received immediate treatment to those who did not receive therapy or obtained later treatment. Another limitation of the current study was that expressive interventions were not measured separately to test the effectiveness of each independently. Although the interventions were all considered expressive therapy activities, each was quite different. It might have been beneficial to measure the usefulness of each intervention separately rather than the effectiveness of the combined techniques. This analysis could have been done by measuring effectiveness of each intervention separately on the post-session evaluation and by getting input from the group members during the final session as to what intervention was most helpful and why. It is possible that in future research running two or more identical groups simultaneously could be beneficial by allowing researchers to pinpoint methods that work or, alternately, do not work with differing populations. Another possible group model would be to run several expressive group therapy sessions simultaneously within the same population. Using this model, one expressive therapy method could be used with each varying group (i.e., dance with one group, music with one group, etc.) in order to compare differing techniques' values. Practice effects could have occurred within the group because of identical post-session evaluations being conducted every session. Group members also might have rushed through the evaluations because they were given at the end of the group. It could have been useful to give these evaluations confidentially in order to receive more honest responses from members. 155 Evaluation of a baseline rating, midpoint rating, and endpoint rating by grouping post-session evaluations together accordingly might have been beneficial. Group members could have been asked to log behaviors in order to assess whether what they had learned in group had affected their conduct the following week. These reports might then be discussed in the next session. Finally, the leaders' involvement and helpfulness was measured together on the post-session evaluations for a combined efficacy evaluation. Although group members' thoughts and feelings with regards to each leader were measured on the intervention evaluation, it might have been more valuable to measure each leader's effectiveness on all post-session evaluations. This inquiry per session would have allowed participants to state what they liked and/ or disliked about the group leader and co­ leader separately, allowing both leaders to alter therapeutic style and techniques. It might also be useful to gain this perspective by having a third party evaluate participants' feelings of each leader. Implications for Future Research In future research, a contract could be signed by potential group members stating that they agree to remain in group therapy for a certain number of sessions. In addition, a contract might be signed with the agency stating that the agency director would ensure participants' attendance to the group intervention for a specified time. Moreover, the group intervention could be coordinated with the agency's schedule as well as the schools' schedules in order to have a planned number of sessions and specific dates for when the expressive group sessions would take place. Transportation could be provided in order to ensure individuals are able to attend group consistently. Also, group therapy could be held at the agency where the children are, which would decrease attrition rates; however, this would eliminate exposure to novel environments. Parental support is recommended in future research to make certain that participants will gain the most beneficial therapeutic experience from the group participation. An orientation could be conducted with parents and/ or caretakers in order to involve them in the group process and familiarize them with what will be taking place with their children. Perhaps, an initial group session might be held . with parents in order for them to hear what their adolescents are discussing, allowing them to better 156 assist their children outside of group. A study conducted by Hogue, Liddle, Becker, and Johnson-Leckrone (2002) suggested that adolescents who received counseling along with their families had improvement in self-concept and positive feelings associated with academics even though grades declined. These youth showed decreased desire to engage in unhealthy behavior and heightened closeness with the family unit. Participants also reported declining desire to participate in behaviors such as drug use and poor school conduct (Hogue et al., 2002). Future groups with inner-city female adolescents could invite an influential African American woman to speak with the group about hardships, goals, dreams, and her story of overcoming prejudice and obstacles. Future groups should also spend more time concentrating on participant feedback. For example, during each session it would be helpful to utilize 15-20 minutes at the end of the session to discuss what helped and did not help the group members in conjunction with a post-session evaluation handout. When working with inner-city female adolescents, conflict and attrition should be expected; however, leaders need to and respect group members. Leaders continually encourage must strive to empathically listen to participants and allow them to process feelings in ways that are helpful and comfortable to them. Moreover, group sessions might place increased focus on strengthening the relationships of the group participants. Conflict resolution skills might be incorporated to aid the participants in working through disagreements with other group members. Future researchers should allow group members to focus on dating relationships, feelings concerning friendships, issues with sexuality and sexual concerns, substance use apprehensions, familial struggles, feelings about prejudice and discrimination, and difficulties with academics. Direct question and answer formats must be minimized and open discussions by the group members should be amplified, especially utilizing activities that will make the discussions more dynamic. This population gravitates towards activities that get them involved, and directive formats possibly remind them of be conducted on educational institutions. Future research could the differences in minority groups led by minority leaders and non-minority leaders. Some research has been performed in this area; however, additional data is needed to uncover valid and reliable results that can be generalized to other studies. Much more research is needed with regard to inner-city group therapy as well as expressive group therapy. Although 157 attrition rates were high for the current study, expressive group therapy with inner-city female adolescents proved to be useful in allowing participants to express their feelings, communicate with one another in open ways, feel loved and validated, and discuss problems and concerns openly. Additionally, the group participants learned that they can have fun participating in activities that are safe, healthy, and beneficial. This study is one small step toward giving African American adolescent females an experience of support, empathy, and unconditional positive regard - a preventive effort, so that they will not act out their pain and anger to their own detriment. REFERENCES Atkinson, D.R., Morten, G. & Sue, D.W. (1989). A minority identity developmental model. In Counseling American minorities: A cross-cultural perspective (D.R. Atkinson, G. Morten & D.W. Sue, eds), pp. 11-47. Wm. C. Brown; Dubuque, lA. Banks, R., Hogue, A., Timberlake, T. & Liddle, H. (1996). An Afrocentric approach to group social skills training with inner-city African American adolescents. The Journal of Negro Education, 65(4), 414-423. Bracken, B. A. (1992). Multidimensional Self Concept Scale Examiner's Manual. Austin, TX: Pro-Ed, Inc. Breland-Noble, A.M., Bell, C. & Nicolas, G. (2006). Family-first: The development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Family Process, 45(2), 153-170. Brook, J.S., Whiteman, M., Nomura, C., Gordon, A.S. & Cohen, P. (1988). Personality, family, and ecological influences on adolescent drug use: A developmental analysis. In The family context of adolescent drug use R.H. Coombs (ed.), pp. 121-161. Haworth; New York. Cartledge, G. & Middleton, M. (1996). African Americans. In Cultural diversity and social skills instruction: Understanding ethnic and gender differences (G. Cartledge ed.) pp. 133-203. Research Press; Champaign, IL. Connell, J.P., Halpem-Felsher, B.L., Clifford, E., Crichlow, W. & Usinger, P. (1995). Hanging in there: Behavioral, psychological, and contextual factors affect in whether African American adolescents stay in high school. Journal of Adolescent Research, 10, 41-63. Cooley-Quille, M., Boyd, R.C., Frantz, E. & Walsh, J. (2001). Emotional and behavioral impact of exposure to community violence in inner city adolescents. Journal of Clinical Child Psychology, 30(2), 199-206. Corey, M. S. & Corey, G. (2006). Groups process and practice (7th ed.). Thomson Brooks/Cole; US. Cotten, N.U., Resnick, J., Brown, D.C. & Martin, S.L. (1994). Aggression and fighting behavior among African American adolescents: Individual and family factors. American Journal of Public Health, 84, 618-622. Day-Vines, N.L. & Day-Hairston, B.O. (2005). Culturally congruent strategies for addressing the behavioral needs of urban, African American male adolescents. Professional School Counseling, 8(3), 236-243. 158 Derogatis, L.R. (1983). Symptom Checklist-90-R Manual. NCS Assessments; Minnetonka, MN. Dishion, T.J. & McMahon, R.J. (1998). Parental monitoring and the prevention of child and adolescent problem behavior: A conceptual and empirical formulation. Clinical Child and Family Psychology, 1, 61-75. Dryfoos, J.G. (1990). Adolescents at risk: Prevalence and prevention. Oxford University Press; Oxford. Durlak, J.A. (1998). Primary prevention and mental health programs for children and adolescents are effective. Journal of Mental Health, 7(5), 463-470. Edleson, J.L. (1999). Children's witnessing of adult domestic violence. Journal of Interpersonal Violence, 14, 839-870. Epstein, M.H. (2004). Behavioral and Emotional Rating Scale Examiner's Manual. Pro-Ed; Austin, TX. Ferguson, S.L. (1998). Peer counseling in a culturally specific adolescent pregnancy prevention program. Journal of Health Care for the Poor and Underserved, 9(3}, 322-340. Fitzpatrick, K.M. & Boldizar, J.P. (1993). The prevalence and consequences of to exposure violence among African American youth. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 424-430. Halpern, R. (1990). Poverty and early childhood parenting: Toward a framework for intervention. American Journal of Orthopsychiatry, 60, 6-18. Hawkins, J.D., Catalano, R.F. & Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64- Hogue, A., Liddle, H.A., Becker, D. & Johnson-Leckrone, J. (2002). Family-based prevention counseling for high-risk young adolescents: Immediate outcomes. Journal of Community Psychology, 30(1}, 1-22. Houston, L.N. (1990). Psychological principles and the black experience. University Press of America; Lanham, MD. Lee, C.C. (1996). Saving the native son: Empowerment strategies for young Black males. ERIC Counseling and Student Services Clearinghouse; Greenboro, NC. Leffert, N., Benson, P.L., Scales, P.C., Sharma, A.R., Drake, D.R. & Blyth, D.A. (1998). Developmental assets: Measurement and prediction of risk behaviors among adolescents. Applied Developmental Science, 2, 209-230. Locke, D.C. & Kiselica, M. (1999). Pedagogy of possibilities: Teaching about racism in multicultural counseling courses. Journal of Counseling and Development, 77, 80-85. Losel, F. & Bliesener, T. (1994). Some high-risk adolescents do not develop conduct problems: A study of protective factors. International Journal of Behavioral Development, 17, 753-777. Mahoney, J.L. & Cairns, R.B. (1997). Do extracurricular activities protect against early school dropout? Developmental Psychology, 33, 241-253. Majors, R. & Billson, J.M. (1992). Cool pose: The dilemmas of Black manhood in America. Touchstone; New York. Masten, A.S., Best, K.M. & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcame adversity. Development and Psychopathology, 2, 425-444. Muller, L.E. (2000). A 12-session European American led counseling group for African American females. Professional School Counseling, 3(4), 264-270. Newcomb, M.D. & Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: Cross sectional and prospective findings. Journal of Personality and Social Psychology, 63, 280-296. 159 Parker, J.G., Rubin, K.H., Price, J.M. & DeRosier, M.E. (1995). Peer relationships, child development and adjustment: A developmental psychopathology perspective. In Developmental Psychopathololgy, Vol. 2: Risk, disorder, and adaptation (D. Cicchetti & D.J. Cohen eds), (pp. 96-161). Wiley; New York. Poussaint, A. & Alexander, A. (2000). Lay my burdm down: Suicide and the mental health crisis among African Americans. Beacon Press; Boston. Quane, J.M. & Rankin, B.H. (2006). Does it pay to participate? Neighborhood based organizations and the social development of urban adolescents. Children and Youth Services Review, 28(10), 1229-1250. Sanders, J.L. & Bradley, C. (2005). Multiple-lens paradigm: Evaluating African American girls and their development. Journal of Counseling and Development, 83(3), 299-305. Snyder, B.A. (1997). Expressive art therapy techniques: Healing the soul through creativity. Journal of Humanistic Education and Development, 36(2), 74-83. Steinberg, L., Elmen, J. & Mounts, N.S. (1989). Authoritative parenting, psychosocial maturity, and academic success among adolescents. Child Development, 60, 1424-1436. Tuason, M.T., Marcetic, A., Roberts, S., Stuart, K. & Rearick, J. (in press). A refuge: After-school care for African American children in poverty. Early Child Development and Care. Tucker, C. M. (1999). African American children: A self empowerment approach to modifying behavior problems and preventing academic failure. Allyn & Bacon; Boston. Vanderschmidt, H.F., Lang, J.M., Knight-Williams, V. & Vanderschmidt, G.F. (1993). Risks among inner city youth teens: The prevalence of sexual activity, violence, drugs, and smoking. Journal of Adolescent Health, 14, 282-288. Vera, E.M. (2000). A recommitment to prevention work in counseling psychology. The Counseling Psychologist, 28, 829-837. Werner, E.E. (1990). Protective factors and individual resilience. In Handbook of early childhood educatimt (S.J. Meisels & J.P. Shonkoff eds) pp. 225-256. Cambridge University Press; Cambridge, England. Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). Basic Books' New York. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Adolescence and Youth Taylor & Francis

Expressive Group Therapy With At-Risk African American Adolescent Girls

Loading next page...
 
/lp/taylor-francis/expressive-group-therapy-with-at-risk-african-american-adolescent-NdBJLuVMaA

References (48)

Publisher
Taylor & Francis
Copyright
Copyright Taylor & Francis Group, LLC
ISSN
2164-4527
eISSN
0267-3843
DOI
10.1080/02673843.2008.9747999
Publisher site
See Article on Publisher Site

Abstract

Intemational foumal of Adolescence and Youth, 2008, Volume 14, pp. 135-159 0267-3843/08 $10 © 2008 A B Academic Publishers Printed in Great Britain Expressive Group Therapy With At-Risk African American Adolescent Girls Karly S. Stuart* and Ma. Teresa G. Tuason University of North Florida ABSTRACT In a study conducted by M.T. Tuason, A. Marcetic, S. Roberts, K. Stuart, and J. Rearick (in press), it was revealed that minority urban female adolescents 11 to 18 harbored more pain and anger and were at higher risk for ages deviant behaviors compared to children of other age groups within the same socioeconomic class. The current study is a group intervention and a systematic way to evaluate the outcome of expressive group therapy with African American female adolescents. Group members were drawn from the Refuge, an after-school program located in a southeastern city of the United and took part in expressive activities intended to expose them to new States, experiences and to increase their confidence in and awareness of their strengths and talents. Qualitative results revealed that expressive group therapy helped the adolescents with emotional exploration, increasing their self-esteem, and decreasing their anxiety. Moreover, qualitative results indicated that conflict among participants must be addressed in order to minimize attrition rates. EXPRESSIVE GROUP THERAPY WITH AT-RISK AFRICAN AMERICAN ADOLESCENT GIRLS Urban youth face many challenges, including gang violence, inadequate health care, high drop-out rates, and exposure to the premature death of family members and friends (Dryfoos, 1990; Halpern, 1990; Masten, Best, and Garmezy, 1990; Werner, 1990). A study conducted in Baltimore, Maryland, concluded that 24% of African American adolescents had observed a murder and 72% knew someone who had been shot (Cotten, Resnick, Brown, and Martin, 1994). This constant exposure to death has been associated *Correspondence address: e-mail: ksstuartl@yahoo.com 136 with depression, anxiety, and symptoms of post-traumatic stress disorder (Cooley-Quille, Boyd, Frantz, and Walsh, 2001; Edleson, 1999; Fitzpatrick and Boldizar, 1993). In families of lower socioeconomic status, parents are often forced to work multiple jobs; as a result, their adolescent children do not receive sufficient guidance and monitoring (Brook, Whiteman, Nomura, Gordon, and Cohen, 1988; Dishion and McMahon, 1998; Hawkins, Catalano, and Miller, 1992; Newcomb and Felix-Ortiz, 1992). Minority youth often have difficulties with academic performance, with 61% of African American students scoring below average on the middle school proficiency examination in comparison with 21% of Caucasian students and 56% of economically disadvantaged students scoring poorly on middle school math examinations as compared to 25% of middle and upper class adolescents (Education Trust, 2003a, 2003b, as cited by Day-Vines and Day-Hairston, 2005). Existing research evidences that organized after-school activities aid adolescents by increasing their willingness to learn and self­ confidence and encouraging stronger work ethic and positive peer associations (Quane and Rankin, 2006). Because African American youth are at increased risk of engaging in negative behaviors, and due to the absence of supervision for children from families of lower socio-economic status, expressive group therapy may be a viable intervention in addition to an after­ school program targeted to these youth. In the current study, expressive therapy was conducted to provide adolescents an outlet to express emotions and communicate needs while being exposed to expressive activities. Group experiences work particularly well with the adolescent minority population by allowing them to test unfamiliar waters while benefiting from the support of a peer group (Day-Vines and Day-Hairston, 2005). A group should be a safe environment for youth to establish closeness with one another, share fears and anxieties, gain insights, resolve conflicts, and express and process emotions (Yalom, 1995). Group therapy targeted to disadvantaged African American adolescents needs to incorporate Afrocentric principles in order to allow youth to establish a sense of pride and increase self-worth. Group members should be encouraged to use language and expression that is comfortable and familiar to them (Banks, Hogue, Timberlake, and Liddle, 1996). Minority youth benefit from intervention groups where they can learn to deal with emotional occurrences and how to process feelings without becoming aggressive (Banks et al., 1996). According to Atkinson, Morten, and Sue (1989), in groups, 137 African American adolescent females need to discuss their hopes for the future, ways to make a difference in the world, successful minority women, and their own emotional struggles, fears, and feelings associated with discrimination. Minority female adolescents value honesty, trust, respect, and a safe place to vent in their group experience (Locke and Kiselica, 1999). Intervention effectiveness has not been measured in previous studies; therefore, this study set out to qualitatively measure the effectiveness of a 10-session group intervention. study conducted by Tuason, Marcetic, Roberts, A previous and Rearick (in press) found that minority urban females Stuart, 11 to 18 were at heightened risk for deviant behaviors, ages emotionally burdened by life roles, and suffering from low self­ concept. These adolescents experienced hurt and anger and expressed these as chaotic demeanor. The adolescent girls did not that their needs were being met by the after-school program feel they attended and perceived staff treatment as unfair. They found the staff difficult to relate to and felt activities were centered on the younger population. In addition, according to the study's authors, no measures were in place to test the effectiveness of program's activities for this population. the after-school The current study's purpose was to conduct an expressive group therapy intervention with adolescent females attending the an after-school care program for minority youth located Refuge, in a city in the southeastern United States, and measure the such as psychodrama, effectiveness of this intervention. Activities and dance, as well as emotional processing sculpting, singing, took place. These techniques were aimed at initiating discussions and fear, feelings about concerning stressors, levels of anxiety and self-esteem, and assessment of psycho-emotional self-efficacy needs. The purpose of exposing these youth to expressive therapy them to gain new experiences, as well as confidence was to allow in and knowledge of their own strengths and talents. group therapy intervention was warranted The expressive because inner-city adolescents face many challenges including poverty and familial struggles (e.g., Dryfoos, 1990; Halpern, 1990; Masten et al., 1990; Werner, 1990). Due to these stressors, urban youth often perform below average in school, take part in delinquent activities, and lack self esteem (e.g., Connell, Halpern-Felsher, Clifford, Crichlow, and Usinger, 1995). They also may have a great deal of anger and aggression and frequently lack healthy means of coping with emotions (e.g., Edleson, 1999; Vanderschmidt, Lang, Knight-Williams, and Vanderschmidt, 1993). Group therapy has been shown to be very effective 138 with African American youth because it allows them a secure place to talk about their issues with their peers (Tucker, 1999). Much literature has focused on risk factors for minority individuals; however, understanding and implementing youth is also crucial (Durlak, 1998). preventive resources for these youth to discover their strengths For example, helping inner-city and the probability of increases their chances for future success better quality of life. Though preventive work has been shown to be effective, more evaluation of such programs is needed (Vera, 2000). Research in this area is scarce and much more data is needed on the effectiveness of preventive interventions such as expressive therapy groups with inner-city adolescents. Expressive therapy helps individuals cope with their issues by allowing them to express themselves artistically and reveal hidden conflict (Snyder, 1997), while group therapy involves processing emotions and conflicts and learning healthy coping styles (Corey and Corey,2006). Groups have been shown to benefit this population; however, specific data has not been gathered on methods in expressive group therapy that might be beneficial for female participants in particular. Moreover, much of the data gathered focuses on risk factors for this population rather than strengths and resources for future success. The current study provided quantitative and qualitative results that evaluated the effectiveness of expressive group therapy as an outlet for healthy expression and coping in urban female adolescents. In the current study, it was intended that expressive group therapy would be preventive and would provide minority adolescents a safe environment in which to communicate their concerns, label their emotions, and practice more adaptive methods for coping with feelings. The effectiveness of the expressive group was measured for each participant using pre­ test and post-test measures as well as post-session evaluation questionnaires and intervention evaluations. In group therapy, adolescents were shown different means of expressing emotions through healthy avenues, which in turn gave them a greater sense of control and empowerment. Social support was encouraged, and members were taught to be kind and respectful towards one another. Attention was drawn to their inner strengths and the youth engaged in self-esteem building activities such as clay sculpting. Leaders attempted to ask about the members' perspectives and allowed them to explain issues on their own terms. Feelings associated with discrimination were discussed, and leaders made changes if their methods were viewed as ineffective by participants. The participants were encouraged to 139 use psychodrama to talk about family struggles and dance to explore feelings about body image. African American heritage was valued, and participants took part in discussions about their culture and the meaning behind their feelings. Leaders modeled healthy ways of expressing emotion and the youth also used painting to help them identify and express emotions and learn coping mechanisms. Poetry was incorporated as well, to allow the participants to discuss hopes, dreams, and aspirations for themselves. The adolescents also received a tour of a college campus to increase their exposure to academic life. After taking part in the expressive group therapy sessions, it was hypothesized that the primary outcomes for participants would be increased ability to express authentic feelings, communicate their needs, and derive support from a group setting. These outcomes were analyzed using means from post-session evaluations. Moreover, it was hypothesized that secondary outcomes for participants would be an acceptable change in global self concept, a decrease in symptomatology, and an increase in interpersonal and affective strength. METHOD Participants Participants were African American female adolescent students age 11 to 15 attending the Refuge, a non-profit after-school care facility located in a poverty-stricken neighborhood in a southeastern city. The purpose of this facility was to provide children with a safe environment, assisting them with academics and exposing them to sports, computers, music, and other activities. The participants were from four of the poorest schools in the district and most dealt with family problems related to drugs, violence, crime, illness, and unemployment. The females who took part in the study were a purposive sample identified by staff at the after-school care facility. All participants have been given pseudonyms for purposes of maintaining confidentiality, as has the name of the after-school care program. Design and Procedure Group therapy sessions were proposed by the investigators after they were approached by the director of the Refuge program; 140 program staff had observed that female adolescents within the age range of 11 to 15 were having issues with anger, low self­ concept, and chaotic demeanor due to expectations that they fulfill multiple roles within family and school environments. Staff members also recognized that they were having difficulties relating to this group, recognizing the girls' needs, and connecting with them in a productive manner. The goals of the group therapy sessions were to alleviate feelings of stress/ anxiety, increase awareness of authentic feelings, gain understanding of emotions, improve coping mechanisms, increase self-efficacy and self-esteem, and gain awareness into appropriate communication styles and expression of needs. Parental consent was obtained for all participants, as well as the participants' assent to take part in the expressive group therapy intervention. The individuals participated in a 10-session group therapy intervention that involved process work as well as expressive therapy activities. The sessions were conducted at a local university and were held weekly for 1 hour. Sessions consisted of an expressive therapy activity for 30 minutes and a therapeutic processing of the activity or other pressing concerns for the remaining 30 minutes. Each of the 10 sessions had an activity that encouraged expression and exploration of a topic that was of relevance to the participants. Processing of the sessions encompassed discussions about the topic and any concerns they felt at that time. Participants' attendance depended on youths' presence at the Refuge program that day. The counseling sessions were conducted free of charge, and the students were transported to the university counseling lab by a Refuge staff member. The primary group leader was trained in group process and was a student in a counseling psychology master's program at a local university. The co-leader was a licensed clinical psychologist and an assistant professor at a local university. Together, both leaders conducted all 10 sessions. An African American psychology student was invited to attend sessions 4, 7, and 8 because the group leaders felt having an African American female in session would increase group members' comfort and be beneficial for the participants. In addition to having a structured activity and group process, a check-in (group members took turns expressing their needs and feelings at the beginning of each session) and check-out (group members expressed their feelings about that day's session) were conducted each session to ensure that the participants' needs were being met. Table 1 outlines the activities and processing conducted in each expressive group session. 141 TABLE 1 Session# Expressive Activity Processing 1 Pre-Test Goals, Expectations- What is group? 2 Ice Breaker Ground Rules Discussion, Role Activity Induction, Expectations of Group Members 3 Clay Sculpting/ Feelings, Perceptions of Self Self-Concept 4 Painting Emotional Exploration - Happiness, Pain, Anger, Anxiety 5 Psychodrama Family Environment - Family Roles 6 Dance Exploration of Body Image- Body Awareness 7 Poetry /University Life Dreams I Aspirations - Tour Career, Education 8 Heritage Show Meaning/Importance Heritage- and Tell Family and Meaning of Being African American 9 Post-Test Changes Made - Evaluation 10 Goodbye Achievements, Likes /Dislikes - Evaluation Measures Demographics. Each participant completed a demographics form with qualitative questions pertaining to gender, religion, ethnicity, and guardianship. Quantitative questions were asked regarding age, number of individuals living in the household, socioeconomic status, and satisfaction with the Refuge. Socioeconomic status and feelings about coming to the Refuge were measured using a Likert-type scale, where 1 signified poor and 10 indicated rich on the socioeconomic status portion of the demographic evaluation. Moreover, 1 designated no and 10 indicated yes on the scale that asked, "Do you like coming to the Refuge?" Open-ended questions were also asked about what the members liked and disliked about attending the Refuge. Demographic data was gathered for five participants, the sixth group member did not complete the demographic evaluation. All 142 participants were African American females. Three participants indicated that religion was not practiced within their families, and two group members stated that Baptist was the religion practiced within their families. Two group members reported that an aunt or uncle was caring for them, and two participants stated that a mother and/ or father were their guardians. One individual communicated that a sibling was her caretaker. Group members' ages ranged from 11 to 15 (M = 13.6, SD = 1.5). The mean score for number of individuals living in the household was 5.8 (SD = 1.6), and the mean score for socioeconomic status was 7.0 (SD = 1.9). The scores for feelings associated with attending the Refuge after-school care program exhibited a wide range (M = 6.2, SD = 4.1). Group session evaluation form. A post-session evaluation was given to participants after each of the sessions to assess expression of real feelings, ease of talking about self and problems, satisfaction with topics discussed, evaluation of the leaders' intervention, and level of session helpfulness. The questions to which the youth responded were meant to help them express their feelings and desires, what worked for them and did not work for them, and their overall feelings about the session. The questions were based on a Likert-type scale ranging from 1 to 10 with 1 indicating dissatisfaction and 10 signifying satisfaction. Questions included: (a) Expression of real feelings: 1 - I was not able to express my real feelings/10- I was able to express my real feelings; (b) Ease of talking about self and problems: 1 - I felt that it was very hard for me to talk about myself and my problems/10 -I felt that it was easy to talk about myself and my problems; (c) Satisfaction with topics talked about: 1 - We did not talk about what I needed to talk about/10 - We did talk about what I needed to talk about; (d) Evaluation of the leader's intervention: 1 - I did not like what the leader did/10 - I liked what the leader did; (e) Level of session helpfulness: 1- The session did not help me today /10 - The session helped me today. Open-ended questions were asked, including: What is the most important thing that happened in group today? How do you feel about what went on in group today? and What would you want for the next session to be helpful to you? Responses to each session evaluation handout were used when analyzing process outcomes for the expressive group therapy sessions. Questions were analyzed by calculating means and standard deviations for group sessions 2 through 8. The responses to the open-ended questions were evaluated using content qualitative analysis. 143 Group notes. Group notes were written following each session. These notes contained content of group discussion and the overall and individual processes that occurred within each session. The leader's and co-leader's impressions and thoughts regarding content and overall process were also documented within the group notes in order to best assist the participants. The group notes were analyzed using content qualitative analysis, themes and patterns were outlined, and group member quotes were incorporated to support leaders' impressions. Intervention evaluation. An intervention evaluation was conducted in sessions 7 and 8 in order to obtain feedback from group members with regard to changes made, likes/ dislikes about group, and feelings about the leader and co-leader. The questions asked were: What did you like/dislike about group? What activities did you like/ dislike? What personal changes were made after being part of the group? How is the group different from the Refuge? and What are your feelings/thoughts about the leader, co-leader, and visitor? Measuring change. Change was measured using both quantitative and qualitative analyses. It was hypothesized that means of availability for expression of feelings, ease of talking about self and problems, satisfaction with topics talked about, leader evaluation, and overall session helpfulness would increase from session 2 to session 8. Moreover, it was hypothesized that qualitative outcomes would indicate that group members enjoyed the activities conducted in group, experienced positive changes in their lives by attending group, and viewed the group as being extremely helpful overall. RESULTS The results were analyzed from both quantitative and qualitative measures evaluating the group intervention. Quantitative Analysis Quantitative analyses were used to compare means using a scale of 1-10 on variables included in the post-session evaluation scale. These variables included expression of real feelings, ease of talking about self and problems, satisfaction with topics 144 discussed, evaluations of leaders' intervention, and level of session helpfulness. The baseline measure used was session 2 and the post-test measure used was session 8. Overall ratings were compared for 35 points {the above five variables for seven sessions) and modifications from session to session were analyzed by looking at changes from baseline to post-test. The Likert-type scale evaluating the five variables ranged from 1-10 with 1 indicating dissatisfaction and 10 signifying satisfaction. Numerical evaluations using a scale of 1-10 were gathered for each participant in order to measure expression of real feelings, ease of talking about self and problems, satisfaction with topics discussed, evaluations of leaders' intervention, and level of session helpfulness. These were analyzed for seven sessions of the group: session 2 through session 8. Post-tests, including the Multidimensional Self-Concept Scale (Bracken, 1992), Symptom Checklist SCL-90-R (Derogatis, 1983), and Behavioral and Emotional Rating Scale (Epstein, 2004), were not administered due to few participants in the final session (N = 3). Figure 1 reveals the means of post-session evaluations per session. The mean scores seemed to increase for all five categories as therapy progressed; however, number of participants declined. The mean score for expression of feelings increased from session Figure 1. 145 2 to 3 (M = 9.6 to M = 10) and remained the same (M = 10) for the duration of the sessions. This outcome indicated that participants perceived that the expressive group therapy sessions aided them in expression of real feelings more in later sessions than in the first two sessions; however, the initial session seemed to help the participants express their emotions as well. This finding suggested that group members began to feel more comfortable in a group therapy setting and with the co-leaders. Also, it suggested that the members possibly saw increased value in expressing their genuine feelings to others as the group developed. Ease in talking about self and problems began low (M = 6.4) but steadily rose (M = 10) with the exception of session 5 (M = 9.8). This finding suggested that group members found it somewhat difficult to talk about themselves and their problems in the first session. The drop in the mean score in session 5 could be attributed to the topic of family and home life that was discussed. Participants might have felt somewhat uncomfortable sharing their feelings about this topic and possibly could have felt a sense of disloyalty to their families by discussing family problems. It seemed that participants found it easier to discuss their difficulties with school, each other, and family members as the sessions progressed. This finding might suggest that group members learned healthier ways of dealing with struggles and had their difficulties validated and normalized by other participants. Satisfaction with topics discussed was somewhat low in session 2 (M = 8.2) and declined in 3 (M = 7.8); however, mean score increased in session 4 (M = 10) and remained high (M = 10) throughout the eighth session. This finding could indicate that group members did not feel they were able to talk about what they needed to talk about in sessions 2 and 3, an outcome that could have resulted from the high levels of conflict between group members during these sessions. Moreover, session 3 took place in an alternate location as other university staff were occupying the counseling lab. This change could have caused group members to feel helpless and uncomfortable. The researchers attribute the rise in the scoring to participants becoming more at ease in discussing topics of importance to them as the sessions progressed because relationships among group members became healthier. The mean score of evaluations of the leaders' intervention began relatively high (M = 9.8) and remained high (M = 10) throughout the sessions. This result indicates that group members liked what the leaders did and felt comfortable with the leaders 146 TABLE2 Session# N Expression Ease of Satisfaction Leader Overall of Feelings Talking with Topic Evaluation Helpfulness M=9.8 M=lO 2 5 M= 9.6 M = 6.4 M = 8.2 SD = 0 SD = .89 SD = 3.8 SD = 4.02 SD = 4.5 M = 7.8 3 M = 9.8 M = 7.8 M = 10 4 M = 10 SD = 4.5 SD = 4.5 SD = 10 SD = 0.5 SD = 0 M=lO 4 M = 10 M=lO 3 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M=lO 5 5 M = 10 M = 9.8 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0.5 M=lO 6 M=lO M=lO 3 M=lO M=lO SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M = 10 M = 10 M=lO 7 2 M = 10 M = 10 SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 M = 10 M = 10 M=lO 8 3 M=lO M=lO SD = 0 SD = 0 SD = 0 SD = 0 SD = 0 throughout the group sessions. Also, the members did not seem to dislike or be affected by the fact that the leaders were Filipino and Caucasian rather than African American. This disaffection was not indicated on the post-session evaluation handouts as well as in group members' discussion during the sessions of their feelings toward the leaders and thoughts concerning the leaders not being African American. Overall helpfulness mean scores were high for all sessions (M = 10) with the exception of session 3 (M = 7.8). This discovery suggested that group members felt that the sessions helped them overall. The drop in session 3 might have been due to the topic of that session, feelings, which might have caused participants to experience their hurt as part of the discussion. Table 2 summarizes sample sizes, means, and standard deviations for each session. Qualitative Analysis Results were analyzed qualitatively from the group notes, the leaders' impressions of each session, and open-ended questions on each post-session evaluation form. Participants were asked intervention evaluation questions in sessions 6 and 7, including what did and what did not help them in group, what activities were and were not enjoyable in group, and what changes they perceived in themselves after taking part in group. They also 147 responded to questions about how group was different from the Refuge, what they liked and disliked about each leader, and what they liked and disliked about the guest invited to attend. The qualitative results were analyzed using content analysis and quotes using pseudonyms were provided to substantiate the investigators' interpretations. Themes and patterns were identified by the leaders throughout the data evaluation process. Within the open-ended portion of the post-session evaluation, answers were reviewed to questions such as: What is the most important thing that happened in group today? How do you feel about what went on in group today? and What would you want for next session to be helpful? In the intervention evaluation, answers were examined to questions regarding what did and did not help in group, what activities were and were not enjoyable in group, and what changes were perceived after taking part in group. Answers to how the group differed from the Refuge, what was liked and/ or disliked about each leader, and what was liked and/ or disliked about the invited guest were also examined. Qualitative results from post-session evaluation scales indicated that the expressive group therapy sessions were very helpful for six out of six participants in terms of expressing their feelings, being exposed to what other participants were struggling with, and being able to convey emotions regarding family and home life. Shaniqua, age 11, stated, "The most important thing that happened in group today was that we talked about my feelings." Claudia, age 15, explained, "The most important thing that happened in group today was that we all acted out the other person's life. We got to act out another person about their feelings." Five out of six group participants indicated that expressive group therapy was helpful because it allowed them to communicate with one another in healthy ways. Group members seemed to feel that talking to other participants and the group leaders was beneficial for them. Tamica, age 15, said, "The most important thing that happened in group today was that I was able to talk and tell a story." Qualitative results from post-session evaluation scales pointed out that the expressive group therapy was helpful for the five out of six participants because it allowed them to have fun expressing themselves outwardly, feel accepted, and experience happiness. Monique, age 12, concluded, "I had fun. I feel loved and happy in group." Brianna, age 12, felt similarly, "I had fun. I feel good when I am in group." 148 Five out of six group members pointed out that much of the content and process work in the group depended on the group members present, as evidenced by qualitative evaluation of post­ session evaluation scales and intervention evaluation. During the group sessions in which conflict was minimal, the overall session evaluation ratings were higher and group members felt they were able to talk about their problems and what they needed to discuss; however, during the group sessions in which conflict was present, the overall session evaluation ratings were lower and participants indicated that it was very hard for them to talk about themselves and their problems. Much of this divergence was expressed when participants were asked about what they did not like in the group therapy sessions. Claudia, age 15, said, I don't like Samone because she is a white girl trapped in a black girl's body. She acts different, talks different, and dresses differently. made me mad because she did not pay me right for doing She her hair. I do not like Shaniqua because she'll switch out and talk behind your back. She tells other people what you say about them. I don't like Tamica because she tries to be a glam chick. I don't like Monique because she is an Indian giver. I bought her a bunch of stuff. She gave me a doll and she took it back. Tamica, age 15, stated, "I did not like group today. It would be helpful in the next session for everyone to be respectful and listen to others and just follow directions and if you are not told instructions, wait." Participants seemed to drive each other away from the Refuge as well as from the expressive group therapy intervention, as pointed out by qualitative findings from leaders' impressions. Many times during group, participants became hurt by one another and taunted each other. The group members did not state they were hurt but used verbal anger to express their feelings. The Refuge director informed group leaders that conflicts occurred outside of the group sessions as well, which might have contributed to group attendance and progress. Qualitative results from the intervention evaluations and leaders' impressions suggested that six out of six participants felt expressive and social activities such as acting, singing, discussion of dreams/hopes, touring a college campus, and communicating about family issues were most helpful. Six out of six participants did not appear to feel comfortable with the question/ answer type format that the group leaders incorporated at times. Four out of four participants seemed to enjoy coming to group in order to have new experiences aside from the Refuge. Claudia, age 15, explained, 149 I like acting out our families, clay sculpting, and talking about my hopes and dreams. I like that we get to leave the Refuge and we do something new in group every week; at the Refuge we do the same thing every day. Tamica, age 15, stated, I feel like group has made me better. I like coming to group because it's more fun than the Refuge, and I laugh a lot more in group. I like acting out how we feel and acting out each other. I like group because we listen to music, and we talk. I would not change anything. The leaders' impressions, post-session evaluations, and interven­ tion evaluations pointed out that four out of four participants enjoyed the leaders' interventions and felt very comfortable with the leaders despite the fact that they were not African American. These four seemed to value the leaders because they allowed them to be themselves and have fun. They also expressed that they enjoyed having an African American student visit the group sessions. Claudia, age 15, said, "I like the leader because she laughs a lot and has a nice personality. I think that the co-leader is okay too. I like having the guest because she is fun." Tamica, age 12, stated, "I like the leader because she is fun, and I like the co-leader too because she is a cute little lady. The guest is fun to have in group, too." The attrition rate for the group participants was extremely high. The group began with six members and dropped to three participants by the final session. The extraneous variables that could not be planned for included students not attending school on the day of the group session, students moving away from the Refuge, students lacking transportation to the after-school program, and students not attending the Refuge on the day of the group session. DISCUSSION Relevance of Current Research Numerous themes were revealed among group participants by analyzing the qualitative and quantitative findings. It was found that the needs of the participants were met by attending the group sessions. It should be pointed out that group members felt that therapy sessions were very helpful to them because they were allowed to express their feelings and gain love and acceptance. 150 Participants expressed that they enjoyed the sessions in which they were exposed to their peers' feelings and horne lives. These activities were seen as beneficial because they allowed group members to have their feelings and experiences validated and normalized. Group participants articulated feelings more as sessions progressed. The authors reason that this increase was due to the amplified level of comfort with the other group members and the group leaders as expressive therapy continued. Moreover, participants gained insight into their emotions and leamed that it is healthy to express feelings and to allow themselves to be vulnerable and authentic while in a safe environment. This finding is positive because past research indicates that many African American youth act out violently to express inner turmoil they are experiencing because they do not have healthy outlets for expression (Cartledge and Middleton, 1996). The group members gravitated towards activities that allowed them to be social and involve other group members. These activities included clay sculpting, acting out future hopes and dreams, imitating one another, and demonstrating horne life scenarios. This finding is consistent with other research. As noted in a study conducted by Sanders and Bradley (2005), African American girls might behave in ways that are labeled as resistant by societal norms. It is crucial for counselors to leam to listen to African American female adolescents, and appreciate the ways in which this population views their challenges and their environment (Sanders and Bradley). The participants viewed group sessions as beneficial because no unnecessary rules or restrictions were placed on them. The group members were allowed to be loud and perform scenarios creatively. The individuals felt empowered by being encouraged to laugh, have fun, and behave boisterously, which is something that participants are discouraged from doing at school and their after-school facility. Group members had some difficulty communicating their concems in the early sessions, which could be due to cultural values. There is a cultural expectation that African American individuals should handle their own problems and put forth an image of strength rather than one of vulnerability (Lee, 1996; Majors and Billson, 1992; Poussaint and Alexander, 2000). African American youth do not traditionally attend counseling, which should be alarming to counselors because many of these individuals deal with multiple stressors and could benefit greatly from processing emotions, leaming healthy coping styles, and adopting better conflict resolution skills (Muller, 2000). 151 The group members opened up more as sessions progressed and expressed themselves freely by discussing issues such as and uncertain future school problems, relationship difficulties, be more effective if group goals. Group sessions seemed to of importance to them. members were able to discuss topics Group leaders encouraged respect for the other members, which her concerns. This technique allowed each participant to voice when working with the minority female seemed effective adolescent population. Participants felt they were unable to talk about what they needed to talk about in the initial sessions; however, they were able to discuss their needs in the remaining five sessions. The researchers attribute this early discomfort to the stigma group and the cultural meaning of belonging to a therapy surrounding therapy. For instance, the girls asked if there was wrong with them. Past research reveals that African something be stigmatized if they American families fear their children will are seen by the community as having a mental health problem (Breland-Noble, Bell, and Nicolas, 2006). Group members gained in the other participants and co-leaders, viewed their needs trust and helped by therapy, looked as more valid, felt encouraged group intervention, and felt validated by forward to expressive the co-leaders as therapy progressed. Participants had a difficult time with ease of talking about and their problems in the session that discussed themselves familial problems. Group members possibly felt that they were being disloyal to their families by conversing about hardships and feelings regarding home life. Also, group participants could have been embarrassed to discuss current familial problems, which them in talking about themselves and their could have inhibited problems. Despite possible discomfort, many participants shared about fights that occurred in their home lives, which showed that they felt comfortable verbalizing personal issues with the leaders and other group members. The current finding is positive because study conducted by Breland-Noble et al. (2006) results from a pointed out that African American families engage ministers and faith based organizations to discuss familial problems. Moreover, African American families seem to rely heavily on one another as well as extended family for several dimensions of physical and emotional growth (Breland-Noble et al.). Group sessions appeared to be more helpful overall if conflict was minimal within the group. Because of the negative feelings many group members felt toward one another, individuals were distracted by the disagreements among their peers and could not 152 focus themselves on the group activity or be helped as extensively by the group process. Conflict in session 3 was particularly high; and this tension could have been exacerbated by the group's unexpected change in location due to other university staff occupying the original meeting space. This change could have caused the participants to feel helpless and irritated. Also, that group intervention began late because it took some time for the leaders to find another meeting place, which might have caused the adolescents to feel rushed and uneasy. Additionally, group members pushed each other away from the expressive group therapy sessions by fights with one another that happened outside of group. This finding is alarming because past research points out that healthy peer influences are crucial for inner-city adolescents' future success. Studies found that involvement with positive peer groups, achievement in school, and pro-social extracurricular groups increases children's chances of success and lessens the risk of behavioral struggles (Leffert et al., 1998; Mahoney and Cairns, 1997; Parker, Rubin, Price, and DeRosier, 1995; Steinberg, Elmen, and Mounts, 1989). In addition, Losel and Bliesener (1994) suggested factors such as intelligence level, coping mechanisms, outlets of positive influence, and a supportive home environment led to increased ability to deal with urban environmental stressors. It has been shown that empathy, supportiveness, and a nonjudgmental acceptance of the client fortify the relationship and the hope for an optimistic outcome (Houston, 1990). Group members seemed to value the co-leaders' approach throughout the progression of the intervention; however, the participants appeared to possess increased enjoyment and comfort with the leaders as therapy continued. The reasoning for this finding is that group members were initially unfamiliar with the group process and rules and norms of participating in a group intervention. In the remaining sessions, group members highly valued the leaders' interventions and methods, and they expressed that they liked the leaders despite the fact they were not African American. The group participants spoke of school teachers showing prejudice toward them and treating them unfairly. The adolescents perceived that the co-leaders possessed unconditional positive regard - a desire to understand their lives and listen to their challenges and their struggles with individuals of other races and to aid them in expressing their emotions. The participants could see that the leaders were trying to make the group experience fun for them and that the leaders cared for them. 153 Limitations Many of the things that are enumerated here as limitations are realizations the researchers had while conducting the group sessions. In a way, these limitations are things that we learned that would help future research doing group interventions for African American adolescents. In the current study, some limitations existed that hindered the group outcomes in various ways. Group members reported that they benefited from group because they were able to express their feelings, participate in fun activities, talk to one another, and get away from the Refuge; however, attrition rates were extremely high. To the authors, it seemed that the reasons for dropping out depended strongly on the relationships participants had with one another. Many of the group members drove each other away from the Refuge, which is a drop-in facility, because of disagreements that existed even before the group sessions occurred. Moreover, group members did not attend group if they were absent from school or had detention on the day of the group session. Another reason for the high attrition rate could be that many students lacked proper transportation to the after-school program and were forced to withdraw from the group therapy sessions. Due to the instability in many of the participants' lives, students moved away from the area where the Refuge is located. A similar study conducted by Ferguson (1998) found a 17% attrition rate due to relocation from pre-test to 3 month post-test in a pregnancy prevention program with inner-city female adolescents. The students who remained in the group were those who lived close to the Refuge, attended the after-school program on the day of the expressive therapy group, and who did not have continuous conflicts with others at the after-school program. The sample size was very small with only six participants beginning the group sessions and three participants by the end of them. Often, participants were different from session to session. Post-tests could have been administered and quantitative data including Multidimensional Self-Concept Scale (Bracken, 1992), the Symptom Checklist SCL-90-R (Derogatis, 1983), and the Behavioral and Emotional Rating Scale (Epstein, 2004) could have been analyzed for comparative purposes if the sample size had been larger and if the group's attendance had been more consistent. For future research, it is suggested that the initial sample size be larger than six in order to prevent discontinuation of quantitative analysis due to high attrition rates. No control group or random assignment was in place in the 154 current study because the participants were all female adolescents in the after-school program and all belonged to the sub-sample of the program that needed therapy. These youth were identified as at-risk for negative outcomes and were most unsatisfied with the after-school program (Tuason et al., in press). The current study could have benefited from incorporating random assignment in the control group and the group receiving treatment because it would have allowed for more meaningful comparisons, with the exception of the group intervention. Additionally, clinical comparisons could have been made if there was a wait-list control group with which to compare the treatment group. In future research, implementation of a wait­ list control group could be used in order to have a comparison group that is given usual care treatment (the Refuge after-school care) or postponed treatment. In this way, researchers could compare the changes in group members who received immediate treatment to those who did not receive therapy or obtained later treatment. Another limitation of the current study was that expressive interventions were not measured separately to test the effectiveness of each independently. Although the interventions were all considered expressive therapy activities, each was quite different. It might have been beneficial to measure the usefulness of each intervention separately rather than the effectiveness of the combined techniques. This analysis could have been done by measuring effectiveness of each intervention separately on the post-session evaluation and by getting input from the group members during the final session as to what intervention was most helpful and why. It is possible that in future research running two or more identical groups simultaneously could be beneficial by allowing researchers to pinpoint methods that work or, alternately, do not work with differing populations. Another possible group model would be to run several expressive group therapy sessions simultaneously within the same population. Using this model, one expressive therapy method could be used with each varying group (i.e., dance with one group, music with one group, etc.) in order to compare differing techniques' values. Practice effects could have occurred within the group because of identical post-session evaluations being conducted every session. Group members also might have rushed through the evaluations because they were given at the end of the group. It could have been useful to give these evaluations confidentially in order to receive more honest responses from members. 155 Evaluation of a baseline rating, midpoint rating, and endpoint rating by grouping post-session evaluations together accordingly might have been beneficial. Group members could have been asked to log behaviors in order to assess whether what they had learned in group had affected their conduct the following week. These reports might then be discussed in the next session. Finally, the leaders' involvement and helpfulness was measured together on the post-session evaluations for a combined efficacy evaluation. Although group members' thoughts and feelings with regards to each leader were measured on the intervention evaluation, it might have been more valuable to measure each leader's effectiveness on all post-session evaluations. This inquiry per session would have allowed participants to state what they liked and/ or disliked about the group leader and co­ leader separately, allowing both leaders to alter therapeutic style and techniques. It might also be useful to gain this perspective by having a third party evaluate participants' feelings of each leader. Implications for Future Research In future research, a contract could be signed by potential group members stating that they agree to remain in group therapy for a certain number of sessions. In addition, a contract might be signed with the agency stating that the agency director would ensure participants' attendance to the group intervention for a specified time. Moreover, the group intervention could be coordinated with the agency's schedule as well as the schools' schedules in order to have a planned number of sessions and specific dates for when the expressive group sessions would take place. Transportation could be provided in order to ensure individuals are able to attend group consistently. Also, group therapy could be held at the agency where the children are, which would decrease attrition rates; however, this would eliminate exposure to novel environments. Parental support is recommended in future research to make certain that participants will gain the most beneficial therapeutic experience from the group participation. An orientation could be conducted with parents and/ or caretakers in order to involve them in the group process and familiarize them with what will be taking place with their children. Perhaps, an initial group session might be held . with parents in order for them to hear what their adolescents are discussing, allowing them to better 156 assist their children outside of group. A study conducted by Hogue, Liddle, Becker, and Johnson-Leckrone (2002) suggested that adolescents who received counseling along with their families had improvement in self-concept and positive feelings associated with academics even though grades declined. These youth showed decreased desire to engage in unhealthy behavior and heightened closeness with the family unit. Participants also reported declining desire to participate in behaviors such as drug use and poor school conduct (Hogue et al., 2002). Future groups with inner-city female adolescents could invite an influential African American woman to speak with the group about hardships, goals, dreams, and her story of overcoming prejudice and obstacles. Future groups should also spend more time concentrating on participant feedback. For example, during each session it would be helpful to utilize 15-20 minutes at the end of the session to discuss what helped and did not help the group members in conjunction with a post-session evaluation handout. When working with inner-city female adolescents, conflict and attrition should be expected; however, leaders need to and respect group members. Leaders continually encourage must strive to empathically listen to participants and allow them to process feelings in ways that are helpful and comfortable to them. Moreover, group sessions might place increased focus on strengthening the relationships of the group participants. Conflict resolution skills might be incorporated to aid the participants in working through disagreements with other group members. Future researchers should allow group members to focus on dating relationships, feelings concerning friendships, issues with sexuality and sexual concerns, substance use apprehensions, familial struggles, feelings about prejudice and discrimination, and difficulties with academics. Direct question and answer formats must be minimized and open discussions by the group members should be amplified, especially utilizing activities that will make the discussions more dynamic. This population gravitates towards activities that get them involved, and directive formats possibly remind them of be conducted on educational institutions. Future research could the differences in minority groups led by minority leaders and non-minority leaders. Some research has been performed in this area; however, additional data is needed to uncover valid and reliable results that can be generalized to other studies. Much more research is needed with regard to inner-city group therapy as well as expressive group therapy. Although 157 attrition rates were high for the current study, expressive group therapy with inner-city female adolescents proved to be useful in allowing participants to express their feelings, communicate with one another in open ways, feel loved and validated, and discuss problems and concerns openly. Additionally, the group participants learned that they can have fun participating in activities that are safe, healthy, and beneficial. This study is one small step toward giving African American adolescent females an experience of support, empathy, and unconditional positive regard - a preventive effort, so that they will not act out their pain and anger to their own detriment. REFERENCES Atkinson, D.R., Morten, G. & Sue, D.W. (1989). A minority identity developmental model. In Counseling American minorities: A cross-cultural perspective (D.R. Atkinson, G. Morten & D.W. Sue, eds), pp. 11-47. Wm. C. Brown; Dubuque, lA. Banks, R., Hogue, A., Timberlake, T. & Liddle, H. (1996). An Afrocentric approach to group social skills training with inner-city African American adolescents. The Journal of Negro Education, 65(4), 414-423. Bracken, B. A. (1992). Multidimensional Self Concept Scale Examiner's Manual. Austin, TX: Pro-Ed, Inc. Breland-Noble, A.M., Bell, C. & Nicolas, G. (2006). Family-first: The development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Family Process, 45(2), 153-170. Brook, J.S., Whiteman, M., Nomura, C., Gordon, A.S. & Cohen, P. (1988). Personality, family, and ecological influences on adolescent drug use: A developmental analysis. In The family context of adolescent drug use R.H. Coombs (ed.), pp. 121-161. Haworth; New York. Cartledge, G. & Middleton, M. (1996). African Americans. In Cultural diversity and social skills instruction: Understanding ethnic and gender differences (G. Cartledge ed.) pp. 133-203. Research Press; Champaign, IL. Connell, J.P., Halpem-Felsher, B.L., Clifford, E., Crichlow, W. & Usinger, P. (1995). Hanging in there: Behavioral, psychological, and contextual factors affect in whether African American adolescents stay in high school. Journal of Adolescent Research, 10, 41-63. Cooley-Quille, M., Boyd, R.C., Frantz, E. & Walsh, J. (2001). Emotional and behavioral impact of exposure to community violence in inner city adolescents. Journal of Clinical Child Psychology, 30(2), 199-206. Corey, M. S. & Corey, G. (2006). Groups process and practice (7th ed.). Thomson Brooks/Cole; US. Cotten, N.U., Resnick, J., Brown, D.C. & Martin, S.L. (1994). Aggression and fighting behavior among African American adolescents: Individual and family factors. American Journal of Public Health, 84, 618-622. Day-Vines, N.L. & Day-Hairston, B.O. (2005). Culturally congruent strategies for addressing the behavioral needs of urban, African American male adolescents. Professional School Counseling, 8(3), 236-243. 158 Derogatis, L.R. (1983). Symptom Checklist-90-R Manual. NCS Assessments; Minnetonka, MN. Dishion, T.J. & McMahon, R.J. (1998). Parental monitoring and the prevention of child and adolescent problem behavior: A conceptual and empirical formulation. Clinical Child and Family Psychology, 1, 61-75. Dryfoos, J.G. (1990). Adolescents at risk: Prevalence and prevention. Oxford University Press; Oxford. Durlak, J.A. (1998). Primary prevention and mental health programs for children and adolescents are effective. Journal of Mental Health, 7(5), 463-470. Edleson, J.L. (1999). Children's witnessing of adult domestic violence. Journal of Interpersonal Violence, 14, 839-870. Epstein, M.H. (2004). Behavioral and Emotional Rating Scale Examiner's Manual. Pro-Ed; Austin, TX. Ferguson, S.L. (1998). Peer counseling in a culturally specific adolescent pregnancy prevention program. Journal of Health Care for the Poor and Underserved, 9(3}, 322-340. Fitzpatrick, K.M. & Boldizar, J.P. (1993). The prevalence and consequences of to exposure violence among African American youth. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 424-430. Halpern, R. (1990). Poverty and early childhood parenting: Toward a framework for intervention. American Journal of Orthopsychiatry, 60, 6-18. Hawkins, J.D., Catalano, R.F. & Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64- Hogue, A., Liddle, H.A., Becker, D. & Johnson-Leckrone, J. (2002). Family-based prevention counseling for high-risk young adolescents: Immediate outcomes. Journal of Community Psychology, 30(1}, 1-22. Houston, L.N. (1990). Psychological principles and the black experience. University Press of America; Lanham, MD. Lee, C.C. (1996). Saving the native son: Empowerment strategies for young Black males. ERIC Counseling and Student Services Clearinghouse; Greenboro, NC. Leffert, N., Benson, P.L., Scales, P.C., Sharma, A.R., Drake, D.R. & Blyth, D.A. (1998). Developmental assets: Measurement and prediction of risk behaviors among adolescents. Applied Developmental Science, 2, 209-230. Locke, D.C. & Kiselica, M. (1999). Pedagogy of possibilities: Teaching about racism in multicultural counseling courses. Journal of Counseling and Development, 77, 80-85. Losel, F. & Bliesener, T. (1994). Some high-risk adolescents do not develop conduct problems: A study of protective factors. International Journal of Behavioral Development, 17, 753-777. Mahoney, J.L. & Cairns, R.B. (1997). Do extracurricular activities protect against early school dropout? Developmental Psychology, 33, 241-253. Majors, R. & Billson, J.M. (1992). Cool pose: The dilemmas of Black manhood in America. Touchstone; New York. Masten, A.S., Best, K.M. & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcame adversity. Development and Psychopathology, 2, 425-444. Muller, L.E. (2000). A 12-session European American led counseling group for African American females. Professional School Counseling, 3(4), 264-270. Newcomb, M.D. & Felix-Ortiz, M. (1992). Multiple protective and risk factors for drug use and abuse: Cross sectional and prospective findings. Journal of Personality and Social Psychology, 63, 280-296. 159 Parker, J.G., Rubin, K.H., Price, J.M. & DeRosier, M.E. (1995). Peer relationships, child development and adjustment: A developmental psychopathology perspective. In Developmental Psychopathololgy, Vol. 2: Risk, disorder, and adaptation (D. Cicchetti & D.J. Cohen eds), (pp. 96-161). Wiley; New York. Poussaint, A. & Alexander, A. (2000). Lay my burdm down: Suicide and the mental health crisis among African Americans. Beacon Press; Boston. Quane, J.M. & Rankin, B.H. (2006). Does it pay to participate? Neighborhood based organizations and the social development of urban adolescents. Children and Youth Services Review, 28(10), 1229-1250. Sanders, J.L. & Bradley, C. (2005). Multiple-lens paradigm: Evaluating African American girls and their development. Journal of Counseling and Development, 83(3), 299-305. Snyder, B.A. (1997). Expressive art therapy techniques: Healing the soul through creativity. Journal of Humanistic Education and Development, 36(2), 74-83. Steinberg, L., Elmen, J. & Mounts, N.S. (1989). Authoritative parenting, psychosocial maturity, and academic success among adolescents. Child Development, 60, 1424-1436. Tuason, M.T., Marcetic, A., Roberts, S., Stuart, K. & Rearick, J. (in press). A refuge: After-school care for African American children in poverty. Early Child Development and Care. Tucker, C. M. (1999). African American children: A self empowerment approach to modifying behavior problems and preventing academic failure. Allyn & Bacon; Boston. Vanderschmidt, H.F., Lang, J.M., Knight-Williams, V. & Vanderschmidt, G.F. (1993). Risks among inner city youth teens: The prevalence of sexual activity, violence, drugs, and smoking. Journal of Adolescent Health, 14, 282-288. Vera, E.M. (2000). A recommitment to prevention work in counseling psychology. The Counseling Psychologist, 28, 829-837. Werner, E.E. (1990). Protective factors and individual resilience. In Handbook of early childhood educatimt (S.J. Meisels & J.P. Shonkoff eds) pp. 225-256. Cambridge University Press; Cambridge, England. Yalom, I.D. (1995). The theory and practice of group psychotherapy (4th ed.). Basic Books' New York.

Journal

International Journal of Adolescence and YouthTaylor & Francis

Published: Jan 1, 2008

There are no references for this article.