Decline or accept

Article published in: GROEPEN, tijdschrift voor groepsdynamica en groepspsychotherapie december 2011, year 6 nr. 4
Also on the website of the Latvian Supervision Association june 2013

Decline or accept?
An article about the influence of social media in (drama) group therapy for adolescents: threats and opportunities.
Gerian Dijkhuizen is a drama therapist, supervisor NVGP (Dutch association for group dynamics and group psychotherapy) and supervisor LVSC (National association for supervision and coaching) at a large psychiatric institute. She specializes in child- and youth psychiatry.
Marc Willemsen works as a drama therapist at the same institution and teaches drama therapy at the university of applied sciences in Utrecht. He is also active as a psycho-dramaturge at a private practice for psychodrama therapy.
Introduction and thesis.
Of all adolescents in the Netherlands, 99% has access to the internet. Nine out of ten uses the web on a daily basis (Central Agency for Statistics 2010). Nearly half feels uneasy when they have not been able to check their email and a third is late or is deprived of sleep because of instant messaging (MSN) on their computer (MeMo², 2008). Practically every adolescent uses a mobile phone. The majority always has his or her mobile phone within reach and only two third switches the phone off when the battery is low (Mijn Kind Online, 2010; MeMo², 2008).
During a group therapy session for girls with personality problems, two group members seem to have ‘found’ each other. When saying goodbye at the end of the session: ‘I’ll see you in the pub tonight, right?’. This is shouted abundantly to a girl who is standing just outside of the therapy room, busy switching her phone back on.
“Yes, give me your number,” the other girl shouts back without looking up, eyes locked and fingers hooked to her mobile phone. A number is called out and the recipient of the message saves the number in her phone.
A somewhat quieter girl observes the situation: Her eyes glance from one girl to the other and then to the therapist. The look in her eyes is reproachful. She makes a very obvious gesture at the therapist, as if demanding him to reprimand the two shouting girls.
The therapist is speechless
Social media on the internet and mobile phone (the article uses the term social media to summarize these two terms) have become a necessity of life in all its manifestations in the life of the average adolescent. Social media has invaded in several environments (the first environment is the family environment; second being school/ internship; and the third environment being spare time). According to Delfos, social media has its own status and indicates this as the fourth environment: the virtual environment. It is no surprise that we’ve come across with this so called fourth environment during (drama-) group therapy. This element fascinates us and frames the prelude to this article.
For instance: How do we cope with a group when group members not only have contact during group therapy, but can also find each other on social media websites such as Hyves and Facebook? Or when they tweet and text each other or use any type of instant messaging between sessions? It seems that because of the introduction and the frequent use of social media, a small and separate group is being formed outside of the therapy group. And not less important: How do group therapists deal with the important therapy rules such as ‘the secret of therapy’ and ‘preferably no contact about therapy outside of the therapy room’?
In terms of holding: How do we keep everybody within the group safe enough?
In short, there are many questions about the (possible) influence on adolescence and the use of social media during group therapy. How should a group therapist deal with such situations?
Context and aim article
We both work in the youth psychiatry sector of a large psychiatric institute and mainly deal with ambulant (drama-) group therapy for adolescents. Although we work with a younger target group also, this article focusses on the target group described earlier. First we will discuss the features of the adolescence phase and why it is so important for adolescents to learn how to manage and control self-presentation and self-revelation. Then we will look at literature research and we will demonstrate why social media is very attractive for adolescents and why it can be seen as an opportunity as well as a threat. We will use a vignette to illustrate how social media can ‘infiltrate’ during group therapy and how it can put the safe therapy environment under pressure. After that we will search for tools that will help a group therapist deal with such circumstances. During the conclusions we will formulate a standpoint and give recommendations on the changing therapist’s attitude when talking about the influence he can have when he’s dealing with social media in a group therapy. Furthermore we will describe a possible method that discusses issues with the use of media, and the effect it can have on the group and therapist.
Adolescence; a critical phase of training
Adolescence is a period in which a person is trying to become emotionally independent from their parents/caretakers and also a period of building a distinct self-image in comparison with other important people. It is the period of the development to a more adult identity (Kohnstamm, 2009). The adolescent needs learn and practice many new roles. On one hand, this is usually done by committing to a peer group, a group of peers who share certain types of important interests. On the other hand by forming tight friendships. However, trying to become part of a peer group and forming new friendships, the adolescent needs to acquire two different skills: self-presentation and self-revelation (Valkenburg & Peter, 2010).
Unfortunately, these skills do not invent themselves: They ask for a lot of practice. It shows that adolescents can easily express themselves in an intimate way, advice and social support
comes from their environment and that they are able// to have high-quality friendships. When adolescents experiment with self-presentation, they will obtain more self-confidence and will become more socially competent (Valkenburg & Peter, 2010).
The consequence is an upward spiral (Illustration 1).
Illustration 1.
Nevertheless, when adolescents do not have the ability to learn adequate self-presentation and self-revelation, it can have severe emotional and social consequences such as social exclusion, isolation, loneliness and depression.
It is also possible that adolescents do not get round to their task of development and get stuck in one or multiple environments (at home; school/internship and/ or spare time).
Force of attraction of social media for adolescents
Social media offers relatively easy settings to be constantly in contact with others. The revealing qualities of online communications give the opportunity to practice with self-presentation and self-revelation which avoids narcissism and shame. It makes it more interesting for adolescents and offers them important social opportunities. Because being able to practice with self-presentation(s) seems to be a stimulating influence on the level of self-confidence and social competence. It also seems that being able to experiment with self-revelation has a positive effect on the development of friendships and on existing friendships. To put it differently: there seems to be a positive online effect (Valkenburg & Peter, 2010).
Illustration 2.
There is an important side note that has to be made: the positive effect of online communication only benefits existing friendships and mainly works when one communicates with existing friends. And the positive effect on the lever of self-confidence only occurs when adolescents successfully know how to build an online profile that primarily receives positive feedback (Valkenburg & Peter, 2010).
Valkenburg & Peter conclude that especially lonely adolescents benefit from online communication and start to feel more competent (Valkenburg & Peter, 2008). However, when this vulnerable target group does not communicate online with non-existing friends, but with relatively unknown people (weak-tie-relationships), then literature seems less sceptical. It also seems that the positive effect described by Valkenburg & Peter cannot be applied to all social media (Van den Eijnden et al., 2008).
There are also risks involved. There is the risk of disorganization and exposing too much information as a consequence. Or problems of disorganization of others who use the internet such as cyber bullying. Van den Eijnden and others show with their research that ‘real-time’ communication (such as instant messaging and chatting) between adolescents leads to compulsive use of internet. This does not account for emailing (Van den Eijnden et al., 2008). Rosen indicates that compulsive use of social media can cause health risks: adolescents are more likely to develop mental as well as psychosomatic problems (Rosen, 2011).
Social media, some social media in particular, can be quite supportive for the adolescent’s ‘critical phase of training’. However, one should question if this also can be applied to the different vulnerable groups in our field.
Threats and chances for the therapy group and therapist.
A drama-group therapy can support adolescents with their ‘critical phase of training’. Within the protected environment of drama-group therapy and the safe dramatic reality (pretended play) adolescents can experiment with (new) roles, further explore roles and practice self-presentation and self-revelation with peers. The goal is to create an upwards spiral (illustration 1). But how protected is the environment of the drama-group therapy when (different) peers also meet each other via social media?
Liza enters the room with reluctance, when the drama-group therapy begins. She takes a seat at a table in the drama-therapy room. She takes a look round the room and asks the therapist with a soft voice and without looking at him, if it’s correct that Inge is not coming. The therapist confirms this and tells Liza that the evasive look in her eyes give him the
online communication
1. self-confidence
2. sociale competentie
3. development of friendships
4. kwaliteit vriendschappen
impression that something is bothering her. Liza stays silent. She hastily looks at her group members Paulien and Roos. She sighs. The therapist asks if his presumption that Liza finds it difficult to express herself about her feelings are right. Liza nods her head. Tears start to stream down her face. The therapist points out that he is curious why Liza finds it so difficult to share. She dries her eyes with a handkerchief, she carefully wipes the running mascara from under her eyes and says that she is afraid of Roos’ reaction. Roos is surprised and tries to encourage the therapist to ask Roos to share what she is feeling and what he is perceiving: Roos is curious and shows compassion. This seems to lower some of Liza’s barriers. Liza uses short and quick sentences to tell that she and Inge were talking via MSN messaging what they had discussed during a group session. She and Inge both agreed that Roos is disturbing group, is constantly trying to get the attention and that they both do not like her. Liza quickly ends her story by saying that this is not true: Inge slipped her tongue.
Let us focus on the group therapist’s role. What kind of attitude does he need to adopt towards what happens outside of the therapy sessions? That he needs to take some kind of action seems obvious. We cannot, especially with groups of adolescents, avoid this.
Phones are carried around all day, are switched on when therapy starts, and when a group has been in therapy for a while, in our experience, exchanging email addresses is very common.
This sometimes is combined with the so called pairing off. Two or more group members can find each other in a more critical setup towards group members or the group therapist. They can let this ‘tête-à-tête’ grow into a direct threat to the working climate of the group. It usually tells a lot about the informality of leadership and the vulnerability within the group. It is usually discussed within the group when pairing off takes place. In that respect pairing off is similar to when two or more group members meet via social media. This can generate visible or invisible exclusion within the therapy group.
However, expulsion is usually not as transparent as described in our vignette during the introduction. It also happens outside of the group, on the sidewalk, in the waiting room.
In our role as a group therapist the facilitating factor is something that interests us. Group therapist can be encouraging and affirmative in regard to group members in the (open and safe) climate that they try to create.
Berk speaks of a few basic conditions and identifies empathy, congruence and unconditional positive acceptation as a measurement in this context (Berk, 2005).
It seems as if time and resources have caught up with the group therapist and that he needs to facilitate. Because while during session he has that role which decides when the ‘here and now’ is discussed, social media can also facilitate contact between group members outside of group therapy.
Referring to the group therapist’s democratic style that Foulkes describes, it can lead to a discussion in the group about the need of exchanging of contacts outside of the sessions, for instance because group members feel the need to discuss the theme of the session further online.
Can the safety of the individual group members be guaranteed?
What happens when not everybody agrees with online sharing but goes along with it because the group want it so? Who protects ‘vulnerable group members’ against too much self-revelation?
Conclusions and recommendations.
This article advocates an active attitude for group therapist when it comes to dealing with and the influence of social media within group therapy.
The reason that our target group attends therapy is mainly to experiment staged play and role play, to be able to handle self-presentation and self-revelation better and try to improve self-confidence, social competence and the ability to start new friendships.
We know that with these goals that social media under certain circumstances can be of some kind of support, but that it also has risks involved for the more vulnerable group of adolescence that we work with. The more important question is how social media can be used during therapy so that they can benefit from the possible opportunities? Most of all because avoiding social media causes ‘proliferation’ and the risk that unsafe situations take place and more than is desirable, outside of the therapy sessions.
We should not ‘decline’ but where possible ‘accept’ and do this within the lines of our own responsibility as a group therapist.
That includes the willingness as a group therapist to move in the same direction as the group members who consider social media obvious during their daily communications. It seems inevitable.
But facilitating and having an emphatic attitude alone, does not cut it.
It is wise to discuss rules about the use of social media and try to be active during this process and take a critical look at the positive sides and the possible downfalls.
The group needs to be a place where a safe environment can lead to other roles and behaviour.
The setting, the group therapist’s responsibility, must create safety for each individual.
Going along with the possibilities of social media does not mean for us as group therapist to participate in social media.
However, it is possible that a (controlled) ‘chat site’ for group members and therapists is a possibility. To ask for advice from therapists and group members in between sessions. This naturally needs to occur on a ‘protected’ website. This can also offer a place to practice self-presentation and self-revelation, only if these chat sessions reappear in dosed fractions during the sessions so that nobody has so miss anything, that everything needs to be discussed again or that nobody needs to feel left out...
In this way a new instrument is created for therapists and the group.
The chance that we as group therapists do not know what to say, as described in the introduction and vignette, is lowered.
How can we train ‘media wisdom’ in practice?
A few recommendations:
 The therapist introduces the theme social media and how to deal with it during group therapy, as a theme in the early phase of group therapy or when a new member joins the group.
 The group discuss their own responsibilities, the group rules (no bullying, treat each other with respect etc.) when it comes to dealing with social media.
 An agreement is made with each individual group member to help, stimulate or to protect this.
 Joining the landscape of social media as a group therapist is of great influence on how group members deal with each other and deal with cyberspace (modelling).
An activity We asked a group of young females (with personality problems) the following question to introduce social media (in this case mobile phones) as a theme: ‘Although we usually expect you to switch off your phone, we now want to ask you to leave it on for the next half hour. Does it ring? Answer and take the call. Receive a text, take time to read it and respond to the message.’ The accompanying questions were:  What had you missed if you had not responded?  What effect has this interruption on the rest of the group?  What happens with you when you talk about yourself during a session but to an outsider? We were curious about what would happen with such an experiment and whether it would bother group members in the self-revelation and self-presentation. It also made us curious in what way it would affect us and whether the facts would (to some degree) support the reality. This session turned out to be very interesting! A lot happened in the group. A few notes:  The activity created commotion and curiosity and sometimes it became a race about who would receive the most calls.  One group member claimed not to have a phone on him.  The level of concentration was significantly different.  It generated suspicion: is it about the group?  Availability: three out of four girls put their phones under their pillows so they could
be reached in case of emergency.  The word ‘emergency’ lead to the defining of the term, which generated a lot of therapy material for a group member who thought that she needed to be available all the time. The activity created themes that were discussed elaborately and opened doors for some group members which seemed to be closed in previous session. It was easier to talk about themselves because of the use of phones. It was because of this activity that the themes self-presentation and self-revelation were current for the next three weeks
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