Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.



Published on

Published in: Health & Medicine, Technology
  • Be the first to comment

  • Be the first to like this


  1. 1. Therapeutic Groups forIsraeli-PalestinianChildren Pioneering work, primary experience
  2. 2. LatiffCommunityMental Health Clinicfor Children Umm-Al-Fahm, ISRAEL
  3. 3. Authors: Tsvi E. Gil, B. Sc., M. A., Graciela Karmon, M. D., and Latiff group work team Society for advancement of health services
  4. 4. Team members are… Mahmud Asla, Ph. D. Faten Egbaria, B. S. W. Ibrahim Igbariy, M. A. Kresteen Iskander, B, S. W., M. A. Mansur Mihdawi, B. S. W. Amany Saady, M. A.
  5. 5. …The Globe
  6. 6. …The Middle East
  7. 7. …Israel
  8. 8. …Um Al Fahman Arabic town in the north
  9. 9. Our clients Palestinian children (ages 6 – 18), Living in Northern Israel, Suffering of all kinds of psychopathologies, as well as psychosocial mishaps
  10. 10. Our staff 3 psychologists 4 social workers 2 secretaries - all of them Palestinians!
  11. 11. …and Director (psychiatrist) and supervising personnel (psychologists)- all of them Jewish! (and not speaking Arabic)
  12. 12. Treatments were: Individual psychotherapy Parent’s guide Art therapy Pharmacological (psychiatric)
  13. 13. … and we had 300 patients in waiting list!
  14. 14. So… we started initiatingtherapeutic groups Groups for children according to age groups Groups for children according to diagnoses or classes of problems Groups for parents
  15. 15. Obstacles for creating groups: Staff not trained in group work Staff sees group work as ‘second best’ Fear of failure Unrewarding previous experience Busy with ongoing treatments Anxiety in face of the unknown – uncertainty, lack of control, lack of knowledge, undefinability of goals (structured vs. open groups)
  16. 16. .. And target populations: Expect individual treatment, see group work as ‘second best’ Fear of disclosure and contagion Difficulties in gathering together at particular timing
  17. 17. Principles of Group Work with Children(Z. Shechtman – Group Counseling and Psychotherapy withChildren and Adolescents) Experiencing as a major mechanism of change (Greenberg) Exploration, Insight, Action (Hill) Vicarious learning, role flexibility, universality, altruism, family reenactment, interpersonal learning (Fuhriman & Burlingame) Self disclosure and mutual support (Spiegel & Classen)
  18. 18. Therapeutic factors in children’s groups (Z. Shechtman – Group Counseling and Psychotherapy withChildren and Adolescents) Group cohesion, catharsis, interpersonal learning (Fuhriman et al) Support, self-disclosure (Lieberman & Golant) Awareness, relationship, focus on others, problem definition (Kivlighan et al) Positive group climate (Riva & Haub)
  19. 19. Group therapist roles… Presence Self-Confidence Creativity Empathic understanding Genuiness Respect
  20. 20. Group therapist does… Initiates Encourages Directs Questions Informs Paraphrases Being patient (tolerant) and gives feedback
  21. 21. What is unique in workingwith Palestinian population? Holidays (olive harvest, Ramadan, pilgrimage, Muhammad birthday, Easter, Land Day, wedding). A large catchment area with poor level of public transportation, lack of resources for arrival Anger and violence in closer and distant surroundings
  22. 22. violence Violence inside the family Violence in the culture Accidents Violence in the Israeli society Violence between Israeli and Palestinians Violence anger and anxiety conflicts, distress, and misconducts
  23. 23. The war in Gaza Strip (December27th 2008 – January 17n 2009)
  24. 24. Phenomena in parent groups: Traditional and patriarchal families Minor paternal involvement in child upbringing, due to traditional familial values Involvement of the larger family Pseudo-adoption
  25. 25. Phenomena in working withparents: Idealization of childhood – jammed in traditional familial patterns Conflicts with sexuality, e.g. – value of virginity, rejection of homosexuality Men work and find it difficult to participate in parents group Manish roles of men (e.g., men do not touch or cry)
  26. 26. Palestinians – society in transition Laws, rules, and norms – change and are not clear-cut Influence of Israeli and global societies Influence of religious and fundamental values (Sunnis and Shiite) Vague boundaries between individuals and their family and community Conflict between women’s individual needs and their role in the family Individual is dependent on family and community Difficulties in contact with Israeli society Conflicts in national identity (Israeli, Arabic, Palestinians, Muslims)
  27. 27. Collectivist Society (M. Dwairy) Source of psychopathology – intra-psychic vs. interpersonal Aim of psychotherapy – strengthening the self vs. adaptation to societal values and requirements Adjustment to family and society vs. individuation and autonomy Treatment as individual parade vs. treatment as part of the community
  28. 28. Group leaders as socialchange agents Parent groups proved to contribute to alterations in family roles: men give up hierarchical superiority in favor of proven investments and achievements; women take inner locus of control Empowerment of women in their families
  29. 29. Individual problems reflectsociety conflicts: Identity in a transitional society Doubt and uncertainty in the community lead to conflicts and confusion in the individual Violence in the surrounding leads to fear and anxiety in the family and individual, leading to psychopathology Intrapsychic anxieties reflecting community fears: Palestinians in occupied territories, Rightists’ demonstrations
  30. 30. Research and findings Difficulties in harness staff to scientific missions Difficulties in eliciting valid reports from participants Difficulties in budgeting of research Evidence for significant underlying processes take place with participants
  31. 31. Literature cited Dwairy M. – Toward psycho-cultural approach in muddle eastern societies. Clinical psychology Review 19: 909-915, 1999. Dwairy M. – Foundations of psychosocial dynamic personality theory of collective people. Clinical Psychology Review 22: 343-360, 2002. Fuhriman S. G. & Burlingame G. M. – Consistency of matters: a comparative analysis of individual and group process variables. Counseling Psychologist 18: 6-63, 1990. Fuhriman A. et al – Validating a behavioral measure of catharsis, cohesion, and insight, in group therapy. Ann. Conf. Soc. Psychotherapy Res., Braga, Portugal, 1999. Greenberg L. S. – Emotion-Focused Therapy. Washington, D. C., American Psychological Association, 2002. Hill C. E. – Helping Skills: Facilitating exploration, insight, and action. Washington, D. C., American Psychological Association, 2nd. Ed., 2005. Kivilghan D. M., Multon K. D., & Brossat D. F. – Helpful impacts in group counseling: development of multidimensional rating system. Journal of Counseling Psychology 43: 347-355, 1996. Lieberman M. A. & Golant M., Leader behavior as perceived by cancer patients in professionally directed support groups and outcomes. Group Dynamics: Theory, Research, and Practice 6: 267-276, 2002. Riva M. T. & Haub A. L. – Group counseling in the schools. In J. L. de Lucia-Waack et al (eds.) – Handbook of Group Counseling and Psychotherapy. Thousand Oaks, Ca, Sage,, 2004, pp. 309-321. Schechtman Z. – Group Counseling and Psychotherapy With Children and Adolescents. Mahwah, N. J., and London, Lawrence Erlbaum, 2007. Spiegel D. & Classen C., Group Therapy for Cancer Patients. New-York: Basic Books, 2000.
  32. 32. We say good-bye and thankyou… Our mission had not finished yet!