The document describes the work of the Latiff Community Mental Health Clinic for Children in Umm-Al-Fahm, Israel. The clinic provides individual psychotherapy, parent guidance, art therapy, and pharmacological treatment to Palestinian children ages 6-18 suffering from various psychological issues. Due to high demand, the clinic started initiating therapeutic groups for children and parents. The groups aim to help children through experiences of cohesion, catharsis, and interpersonal learning. Working with the Palestinian population presents unique challenges around cultural traditions, violence, and transitioning social norms. Research on the clinic's work provides early evidence that the groups help facilitate social changes like empowering women and altering family roles.

1. Therapeutic Groups for
Israeli-Palestinian
Children
Pioneering work,
primary experience

2. Latiff
Community
Mental Health Clinic
for Children
Umm-Al-Fahm, ISRAEL

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. 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. …The Globe

6. …The Middle East

7. …Israel

8. …Um Al Fahm
an Arabic town in the north

9. Our clients
 Palestinian children (ages 6 – 18),
Living in Northern Israel,
 Suffering of all kinds of
psychopathologies, as well as
psychosocial mishaps

10. Our staff
 3 psychologists
 4 social workers
 2 secretaries -
all of them Palestinians!

11. …and
 Director (psychiatrist) and supervising
personnel (psychologists)- all of them
Jewish!
(and not speaking Arabic)

12. Treatments were:
 Individual psychotherapy
 Parent’s guide
 Art therapy
 Pharmacological (psychiatric)

13. … and we had
 300 patients in waiting list!

14. So… we started initiating
therapeutic groups
 Groups for children according to age
groups
 Groups for children according to
diagnoses or classes of problems
 Groups for parents

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. .. 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. Principles of Group Work with Children
(Z. Shechtman – Group Counseling and Psychotherapy with
Children 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. Therapeutic factors in children’s groups
(Z. Shechtman – Group Counseling and Psychotherapy with
Children 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. Group therapist roles…
 Presence
 Self-Confidence
 Creativity
 Empathic understanding
 Genuiness
 Respect

20. Group therapist does…
 Initiates
 Encourages
 Directs
 Questions
 Informs
 Paraphrases
 Being patient (tolerant)
 and gives feedback

21. What is unique in working
with 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. 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. The war in Gaza Strip (December
27th 2008 – January 17n 2009)

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. Phenomena in working with
parents:
 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. 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. 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. Group leaders as social
change 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. Individual problems reflect
society 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. 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. 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. We say good-bye and thank
you…
 Our mission had not finished yet!