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Latiff

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Latiff

  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!

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