For the fall semester of 2024 I wrote a research proposal for one of my classes. From there, I was invited to participate through a poster presentation of this paper in the Healing Through Counseling Relationships, Equity, Access, and Leadership (H.E.A.L.) Conference, presented by the American Mental Health Counselors Association (AMHCA). For those not interested in reading the entire paper, here is my poster project for you to review and have a summarized understanding of my ideas:
For those who are here via the QR code on my project, and/or are wanting to review the project in it's entirety, the rest of this is for you.
Abstract
This research will focus on investigating the comparative efficacy of group play therapy compared to group talk therapy in addressing academic and behavioral challenges among adolescents with significant Adverse Childhood Experiences (ACEs). This study will explore the impact of these therapeutic interventions to determine if group play therapy will have significant differences in positive outcomes compared to group talk therapy. While play therapy has shown success in treating trauma, this study will take a more in-depth look at play therapy in a group setting, opposed to talk therapy in a group setting.
This study will take place in a school-based setting involving adolescents who present with significant ACEs scores over a 16-week period. The students will be placed into equal groups: one half of the students will be divided into two groups of talk therapy (GTT), and the other half will be divided into two groups of play therapy (GPT), respective to their gender as a control for the gender divide.
To ensure a comprehensive understanding and holistic view of the impact of therapy on both quantitative and qualitative aspects, a mixed-methods design will be used. The suspected analyses would reveal significant improvement in post-session group play therapy outcomes, highlighting the effectiveness of group play therapy as a method of addressing the distinct aspects of ACE-related challenges.
Results will be collected through a review of both quantitative and qualitative data. Quantitative data will include collecting pre- and post-session grades, behavioral assessments, and any disciplinary and criminal documentation provided by the school system, collected as part of their normal documentation process. Qualitative methods - such as interviews and focus groups - will further capture the subjective narratives that quantitative measures alone may not fully encapsulate. Such findings will have implications for therapeutic choices in school-based interventions for adolescents with ACEs.
Introduction
Adolescents today, and across cultures and nationalities, are confronted with many challenges as they navigate the complex path of this critical stage of development. One specific challenge that has gained substantial attention within the field of psychology is referred to as Adverse Childhood Experiences (ACEs). These are described as, “potentially traumatic experiences that occur in childhood and adolescence.” ACEs encompass experiences such as physical, emotional, or sexual abuse, witnessing domestic violence, having a family member attempt or die by suicide, and growing up in a household marked by substance use, mental health issues, or instability resulting from parental separation, divorce, or incarceration (Jones et al., 2020). While these experiences are not new to today’s adolescents, the impact is still profound, often leading to short-term and long-term negative consequences. While both play therapy and traditional group talk therapy have shown promise in treating trauma individually, a comparative analysis is essential to ascertain the specific efficacy of play therapy in a group setting.
Numerous studies have consistently shown the significant influence of ACEs on the lives of adolescents. As indicated by the Centers for Disease Control and Prevention (CDC), ACEs can elevate the likelihood of mental and physical health issues, substance abuse, diminished academic achievement, emotional instability, behavioral challenges, impaired social and interpersonal relationships, and diminished employment prospects (2021). Despite the growing awareness of the long-term impact of ACEs, Ray et al. note that treatment studies of ACEs are rare, creating a gap in understanding which therapeutic modality is most effective in promoting positive outcomes in academic performance and behavior (2021).
This research will employ a rigorous methodology that includes collaboration with schools, informed consent procedures, ACE assessments, random assignments, and the collection of academic performance and disciplinary referral data. By collecting quantitative and qualitative data over a 16-week therapy period - including 6 months before therapy and 6 months after therapy - this study aims to provide valuable insights into the effectiveness of these two therapy modalities. Furthermore, this research adheres to strict ethical standards, ensuring the confidentiality and privacy of all participants. The hope is that the findings will contribute to the development of evidence-based interventions for this vulnerable population, enhancing their chances for academic success and improved behavior.
This study poses the research question: How does the efficacy of group play therapy (GPT) compared to traditional group talk therapy (GTT) in positively impacting adolescents with significant ACEs, specifically concerning academic performance and behavioral issues? The outcomes of this study hold significant implications for therapeutic choices within school-based interventions for adolescents with ACEs. By discerning the relative effectiveness of these two modalities, educators, clinicians, and policymakers can make informed decisions to optimize the well-being and academic success of this vulnerable population. It is hypothesized that group play therapy will lead to a significant improvement in academic performance, as well as a reduction in disciplinary referrals among adolescents with significant ACEs scores when compared to traditional group talk therapy.
Literature Review
Research is increasingly seeking to understand the profound effects of Adverse Childhood Experiences (ACEs) on adolescents and adults. These experiences encompass a spectrum of adversities, including neglect and abuse (e.g., emotional, financial, physical, sexual), exposure to violence in the home or community, familial instability, and mental health problems or substance use by close family members. Such experiences have the potential to significantly impact adolescents' lives in adverse ways. As per the CDC, the impact of toxic stress resulting from ACEs can modify brain development and influence the body's response to stress. ACEs have connections to persistent health issues, mental health disorders, and substance abuse in adulthood. At least five of the leading causes of death are correlated with ACEs and preventing them could potentially reduce adult depression cases by 44%. ACEs are further linked to approximately 1.9 million instances of heart disease and up to 2.5 million cases of overweight/obesity (CDC, 2021). The critical need to investigate strategies to alleviate the repercussions of ACEs on adolescents and improve academic performance and behavioral development is imperative.
This study will evaluate historical, prevalence, and diverse implications of ACEs so to establish a robust foundation for a comprehensive analysis of two therapeutic modalities: group play therapy and traditional group talk therapy. Through an analysis of the existing literature, we will address the specific needs of this particular population and identify research gaps in the current knowledge. This will lay the necessary groundwork for our upcoming comparative investigation, where we will compare the short-term and intermediate-term outcomes of group play therapy in contrast to traditional group talk therapy. Our hypothesis posits that group play therapy will yield significantly improved results in academic scores and behavioral development for adolescents with ACEs.
The importance of grasping the consequences of ACEs is becoming more evident, and this study aims to add to the expanding body of knowledge in this field. As the significance of understanding the lifelong impact of ACEs continues to grow, this study aspires to contribute new insights to the evolving body of knowledge in this critical field of study.
Established in 1984, the Behavioral Risk Factor Surveillance System (BRFSS) emerged as the foremost health-related telephone survey system in the United States. Its inception encompassed 15 states, and it has since expanded its reach to cover all 50 states, the District of Columbia, and three U.S. territories. Conducting over 400,000 adult interviews annually, the BRFSS stands as the world's most extensive and consistently administered health survey system, as reported by the CDC in the Behavioral Risk Factor Surveillance System (BRFSS) 2023.
In 1995, a CDC-Kaiser study, and in 1998, Felitte et al. released reports examining the systematic measurements of early-life adversity, providing documentation on the physical and mental health problems that arise from trauma in children. These reports were at the forefront of extensive research into the study of ACEs across a range of disciplines. In the initial CDC-Kaiser study, The Family Health History, and Health Appraisal Questionnaires were used to collect information on child abuse and neglect, household challenges, and other socio-behavioral factors (About the CDC-Kaiser ACE study, 2021). The CDC-Kaiser dataset collection is still ongoing today.
Out of the study of Adverse Childhood Experiences, came the ACE Pyramid, a representation of how ACEs are strongly related to development of risk factors for disease, and well-being throughout the child’s life (About the CDC-Kaiser ACE study, 2021).
Today, these studies have led to the proposal of an addition of Complex Trauma/C-PTSD (Complex Post Traumatic Stress Disorder) to The Diagnostic and Statistical Manual of Mental Disorders (DSM). While the DSM-5 updated the symptomology of PTSD, despite having the votes to add C-PTSD, the final decision was to leave it out. However, a study released in 2017 utilized the International Trauma Questionnaire (ITQ) and found C-PTSD to be more common than the commonly known sibling disorder PTSD (Karatzias et al., 2017). The refusal to add C-PTSD to the DSM-5 indicates that much more research is needed so that appropriate care and preventative measures can be provided. Dr. Bessel van der Kolk states that individuals undergoing psychiatric treatment often receive five or six distinct and unrelated diagnoses. Determining what is considered "wrong" with individuals is primarily influenced by the practitioner's mindset and what insurance companies are willing to cover, rather than being grounded in verifiable, objective facts. The implications of a psychiatric diagnosis are significant, as it guides the course of treatment, and receiving the incorrect treatment can lead to disastrous consequences. Additionally, a diagnostic label tends to persist throughout a person's life, profoundly shaping their self-perception (p. 138-139, 2015). The dismissal of C-PTSD to the DSM-5 was devastating, hindering therapists from giving a clear and accurate diagnosis to provide proper treatment for patients.
Methodology | Mixed Method Approach
For this study, we are employing a Mixed Methods Triangulation Design, utilizing the Convergence Model to ensure a comprehensive understanding of the research question. Combining quantitative and qualitative methods, this approach aims to overcome limitations of relying solely on assessments and provide a more holistic interpretation.
Quantitative Data Portion
In the quantitative component, we will evaluate measurable outcomes through standardized test scores, academic grades, behavioral assessments, and any available disciplinary and criminal documentation. The pre-study data collection will establish a baseline, enabling the assessment of short-term and intermediate-term impacts. The 16-week therapeutic interventions (group play therapy and group talk therapy) will be followed by post-study data collection at six-month intervals. Standardized tests, academic scores, and behavioral assessments will continue to be utilized so to maintain a consistent measure of evaluation.
Through statistical analyses, we seek to identify statistically significant improvements in test scores, grades, and behavioral outcomes, offering insights into the potential superiority of group play therapy over traditional group talk therapy in addressing ACE-related challenges among adolescents.
Qualitative Data Portion
The qualitative component complements quantitative data by exploring the nuanced experiences of participants. Qualitative methods, including semi-structured interviews, focus groups, and a structured family history will be employed to delve into participants' perceptions and voices. The participant selection criteria will consider characteristics or experiences related to ACEs.
By applying a dual-method approach, we aim to bridge the gap between numbers and narratives, offering a holistic perspective on the efficacy of group play therapy and group talk therapy in addressing the multifaceted dimensions of trauma and adversity among adolescents.
Mixed Methods Triangulation Design
The Convergence Model will guide the integration of quantitative and qualitative data, facilitating a comprehensive analysis. Comparative, contrasting, and validating strategies will be employed to synthesize findings from both methods, ensuring a robust and nuanced understanding of the research question.
Data Analysis
For consistent data analysis, standardized test scores will be one of the instruments used for data collection. The Scholastic Assessment Test (SAT), Preliminary SAT (PSAT), SAT Subject Tests, and the American College Testing (ACT) are commonly used in high schools across the United States.
There are no universal standards for grades and behavioral assessments; those vary on the specific needs, policies, and practices of each school and district. However, there are common approaches and tools that are often used to assess and address areas of concern. The Individualized Education Program (IEP) is a highly individualized legal document developed collaboratively by a team of educators, parents or guardians, and, when appropriate, the student to address both academic and behavioral performance for students with unique education needs. Combining different approaches provides a more comprehensive understanding of how students are progressing.
For behavioral analysis for this study, we will examine any available tools provided by the schools, such as records of disruptive behaviors – type and frequency – as well as interventions implemented, outcomes of interventions, and assessments from the school counselors on social-emotional well-being, mental health, and potential underlying factors contributing to behavioral challenges. We will also provide specific tools for documentation for control.
Behavioral checklists are a systematic method of observation and recording. These checklists often focus on specific behaviors, such as attention span, task completion, and social interactions. A Functional Behavior Assessment (FBA) is a comprehensive approach to understanding the functions or purposes of a student's behavior by gathering information about the antecedents, behaviors, and consequences to develop effective behavior intervention strategies. Behavior Rating Scales involve the use of direct observation from teachers and parents. Standardized forms are used to rate the frequency or severity of specific behaviors, including observations from the student being evaluated. Examples include the Behavior Assessment System for Children (BASC) or the Conners Rating Scales. Direct observations and evaluations can offer valuable insights into the context and stimuli that prompt specific behaviors.
For academic analysis for this study, in addition to standardized test scores, we will examine the available assessment tools and methods the schools use to evaluate student learning. These tools provide educators with insights into students' understanding of subject matter, progress, and areas where additional support may be needed. These tools may include diagnostic assessments of prior knowledge and skills, and formative and summative assessments of class assignments, projects, performances, and homework, to mid-term and final exams for current evaluation of strengths and areas for improvement.
States provide grading rubrics with specific criteria for performance levels. These rubrics act as a sort of checklist that students must achieve. These rubrics provide a standardized method for evaluating and providing feedback.
There is a wide variety of educational software and learning platforms used in high schools to enhance teaching and support student learning through addressing different subjects and educational needs in a safe learning environment online. Schools often integrate a combination of these tools to create a comprehensive and engaging digital learning environment. Some examples that may be included for academic assessment: Google Workspace for Education, Microsoft 365 Education, LinkedIn Learning, Schoology, I-Ready, and Canvas.
Per the example of Arias-Pujol & Anguera’s study (2017), tools used for gathering qualitative data will include, with consent by all participants, audio and video recordings with a closed-circuit television system, along with written notes from the therapists leading the groups. Software programs, such as GSEQ5, v.5.1 may be used to build the dataset for systematic observation (Bakeman and Quera, 2011). Based on the example study, participants would be informed as to the filming, and whereabouts of the cameras. Recordings could be transcribed for more in-depth analysis. Transcripts and notes will be organized through qualitative analysis software tools. These tools are designed to facilitate the coding, analysis, and interpretation of qualitative data. NVivo and MAXQDA (Capterra, 2023) will allow us to organize and analyze textual, audio, visual, transcripts, and documents for coding, text search, thematic analysis, and linking notes to specific parts of the transcript.
Analysis of Covariance (ANCOVA) may be used as a statistical technique to compare differences in post-intervention scores while considering the pre-existing baseline covariates. This tool may provide a more nuanced understanding of the impact group play therapy has on group talk therapy, considering potential pre-existing differences among participants.
Multivariate Analysis of Variance (MANOVA) can also be employed to evaluate whether there are statistically significant distinctions between the two therapy groups, taking into consideration the multiple dependent variables that require assessment, such as academic scores and behavioral evaluations. MANOVA would allow simultaneous analysis of all variables, considering the interrelationships among the dependent variables.
Addressing Criminal Behaviors for Data Analysis
It is imperative to acknowledge the potential influence of trauma on adolescents, which may manifest in various ways, including engagement in delinquent or criminal behaviors. As part of our comprehensive data analysis, we will closely examine any available criminal history among participants with trauma backgrounds. This may come from police reports and records that we are given permission to access, or information collected from the parents or guardians of the adolescent.
Therapeutic interventions, particularly group play therapy and group talk therapy, are anticipated to serve as pivotal components in mitigating the factors contributing to criminal behaviors. Our study aims to explore whether these interventions contribute to a decrease or cessation of such behaviors among adolescents with significant Adverse Childhood Events (ACEs). By incorporating criminal documentation alongside academic and behavioral assessments, we seek to provide a holistic understanding of the broader impact of therapeutic interventions on the lives of these adolescents.
Procedures
Pre-Study Data Collection
Prior to the commencement of the therapeutic interventions, a rigorous pre-study data collection process will be implemented to establish a comprehensive baseline for our research. This process involves gathering a range of essential information through various channels, ensuring a robust foundation for subsequent analyses.
Baseline Data Compilation: The initial step involves the compilation of baseline data, encompassing key metrics such as standardized test scores, academic grades, behavioral assessments, and comprehensive disciplinary and criminal documentation. This thorough examination of pre-existing data sets will provide a comprehensive snapshot of participants' academic and behavioral profiles.
Random Assignment to Therapeutic Groups: To ensure a fair and unbiased distribution of participants, a random assignment process will be employed. Participants will be randomly assigned to either the group play therapy or group talk therapy, with this randomization process serving as a crucial control measure. This approach aims to minimize potential biases and ensures that each therapeutic group is representative of the overall participant population.
By meticulously collecting pre-study data and employing random assignment procedures, our research endeavors to establish a solid foundation for assessing the short-term and intermediate-term impacts of group play therapy and group talk therapy. These procedures are integral to the methodological rigor of our study, contributing to the validity and reliability of the subsequent analyses.
16-Week Therapy Period: Nurturing Growth and Assessing Change
With the groundwork laid during the pre-study data collection phase, our 16-week therapy period marks a pivotal stage in the research, where the therapeutic interventions take center stage.
Implementation of Therapeutic Interventions: During this phase, both group play therapy and group talk therapy will be diligently implemented, guided by licensed and trained therapists. The 16-week duration allows for a comprehensive exploration of the therapeutic benefits, providing adolescents with a structured platform to engage in healing activities and therapeutic conversations tailored to each modality.
Periodic Assessments: Throughout the therapy period, participants will undergo periodic assessments, offering valuable insights into their academic performance, behavioral changes, and any recorded incidents. These assessments, conducted at weekly intervals, enable a dynamic evaluation of the therapeutic impact, allowing for real-time adjustments and capturing the evolving dynamics within each therapy group.
Holistic Evaluation: Our approach emphasizes a holistic evaluation encompassing both quantitative and qualitative dimensions. Academic progress will be tracked through standardized test scores and grades, while behavioral changes will be assessed through structured behavioral evaluations. Incidents, whether disciplinary or criminal, will be meticulously documented to provide a comprehensive understanding of the broader impact of the therapeutic interventions.
As we navigate this 16-week therapy period, the goal is not only to assess the immediate effects but also to lay the foundation for a sustainable positive trajectory beyond the study duration. By integrating both structured assessments and the voices of the participants, this phase promises to unveil valuable insights into the nuanced impacts of group play therapy and group talk therapy on adolescents with significant Adverse Childhood Experiences (ACEs).
Post-Study Data Collection: Tracking Long-Term Impact
Following the intensive 16-week therapy period, our research extends its focus to the post-study phase, where the sustained impact of group play therapy and group talk therapy becomes the central point of examination.
Time-Intervals for Evaluation: Post-study data will be meticulously evaluated at regular six-month intervals: six-month post-study for short-term evaluation and twelve-month post-study for intermediate-term evaluation. This will facilitate room for a longitudinal perspective of five-years post-study on the enduring effects of therapeutic interventions. This extended timeframe allows us to discern not only immediate outcomes but also the sustainability of positive changes over an extended period.
Quantitative Measures: Consistent with the pre-study phase, our quantitative measures include a comprehensive examination of standardized test scores, academic grades, behavioral assessments, and disciplinary and criminal documentation. This approach ensures a seamless comparison with baseline data, providing a comprehensive understanding of the evolution of academic and behavioral outcomes.
Data Analysis Summary: As detailed in the earlier sections, our data analysis involves a mixed-methods approach, utilizing statistical analyses such as ANCOVA and MANOVA to capture both quantitative and qualitative dimensions. This synthesis of numerical and narrative insights contributes to a more nuanced interpretation of the data, offering a holistic perspective on the comparative efficacy of group play therapy and group talk therapy.
In summary, the post-study data collection phase is integral to our research's overarching goal of not only assessing the immediate impact but also elucidating the enduring benefits of therapeutic interventions for adolescents with significant Adverse Childhood Experiences (ACEs).
Limitations and Considerations
Our sample size is too small for validity to be considered as an independent study. While the individual groups need to be kept small, this study would need to be conducted over multiple regions and demographics. The initial findings would not be valid enough for application and should not be generalized into broader populations until further data can be obtained and evaluated. A small sample-size would only be representative of the specific location that the study is conducted in.
The inclusion of covariates, such as baseline test scores, is to provide greater accuracy and validity of our comparisons. However, it needs to be understood that this covariate presents some limitations in that the post-intervention scores may not capture the full spectrum of factors that can influence students’ academic performance and behavioral development. There are variables that cannot be measured, such as socio-economic status, social support systems, and actual cognitive and behavioral functionality of each participant. This study is also limited to short-term and intermediate-term outcomes. A separate longitudinal study would be needed to fully capture the outcomes of this research. Readers should interpret our findings with this understanding.
Participants
Selection/Exclusion Criteria and Informed Consent
The participants for this study will encompass adolescents aged 13 to 19, selected from two diverse school settings—a rural school and an inner-city school. The rationale for this type of selection aims to capture a broad spectrum of experiences related to Adverse Childhood Experiences (ACEs) and ensures the generalizability of findings. The targeted population comprises adolescents with significant ACEs, reflecting a demographic vulnerable to the myriad challenges associated with ACEs during childhood.
To initiate the selection process, potential participants will be required to submit permission forms signed by their legal guardians before proceeding to receive the Adverse Childhood Experiences (ACEs) Questionnaire. Participants will be kept unaware of the specific study details until after completing the questionnaires to mitigate potential bias in test results for those eager to participate. Eligible participants must have a score of > 4 ACEs.
Upon selection, comprehensive consent forms will be obtained from both the participants and their legal guardians. The consent process will include detailed explanations of the study's purpose, procedures, and potential risks and benefits, emphasizing the voluntary nature of participation and the confidential handling of information.
Exclusion criteria involve (a) having less than 4 ACEs, (b) an inability to attend all therapy sessions, and (c) contraindications for group therapy. Students who do not meet the requirements for this study will be provided with consent forms to be signed and returned by their legal guardians for potential participation in further research on topics that may be more suitable for their circumstances. Those who may meet the requirements for number of ACEs but are unable to attend all 16 of the therapy sessions may be selected to participate as a control group for future data analysis.
Recruitment Process
For this study, we will begin by collaborating with the selected schools to review their recommendations for participants based on the tiered intervention system, and through recommendations from teachers and school counselors for students who may benefit from participating in this study. Once identified, invitations will be sent out to these selected students. Detailed information on the study will be limited so as not to skew the results through potential bias during the initial selection process.
Students expressing interest in participating in the study will be provided with a consent form for their legal guardians to fill out giving permission to take the Adverse Childhood Experiences (ACE) Questionnaire, clearly explaining that the ACE Questionnaire is not a diagnostic tool but is crucial for quantitative data collection and study control, and that this is voluntary but a necessary part of the recruitment for participation in the study.
Of the students who take the ACEs questionnaire, students with four or more ACEs will then be chosen, at random, while ensuring an equal distribution based on gender. Those students will then be sent home a second consent form to be signed by their legal guardians. These forms will outline the study's purpose, procedures, potential risks, and benefits; as well as, to emphasize the voluntary nature of participation, and the confidentiality of their information.
Group Allocation
Participants will be randomly placed into four equal groups, with each school having two groups for group talk therapy and two groups for group play therapy. To ensure a balanced representation, each therapy group will be further subdivided based on gender, resulting in four distinct groups for each school—two for males and two for females. The total participants for the initial study will be 96 adolescents: 48 males and 48 females.
Southeast Inner-City School (Group One) | |||
Group Play Therapy | Group Talk Therapy | ||
6 Males | 6 Females | 6 Males | 6 Females |
Southeast Inner-City School (Group Two) | |||
Group Play Therapy | Group Talk Therapy | ||
6 Males | 6 Females | 6 Males | 6 Females |
Southeast Rural Community School (Group One) | |||
Group Play Therapy | Group Talk Therapy | ||
6 Males | 6 Females | 6 Males | 6 Females |
Southeast Rural Community School (Group Two) | |||
Group Play Therapy | Group Talk Therapy | ||
6 Males | 6 Females | 6 Males | 6 Females |
Participants in both groups will benefit from the known advantages of group therapy. Risa Kerslake explains how participants and therapists will both receive benefit through the giving of support to one another, removing the isolation that so often comes with trauma experiences. “A big part of the group therapy experience is recognizing that others are struggling with very similar emotions and circumstances, so it’s helpful to have that support,” says Dr. Allison Chase. This alone can improve overall health through the release of dopamine into the body.
In group therapy, there is an atmosphere of safety and trust, something that adolescents with traumatic backgrounds often struggle to find in their daily lives. Both therapy groups will begin with icebreakers and warming-up activities to allow participants (including therapists) to introduce themselves to one another, lay the foundations to develop trust, and to build a safe space within the group. This will be done by establishing boundaries of confidentiality, respect for one another, the right to talk/not to talk, and to be heard and valued. Group therapy of any kind provides the opportunity for adolescents to move from “victim,” “witness,” and “damaged,” to focusing on their strengths to cope, resist and recover (Fellin et al., 2018).
Group therapy, in general, also provides resources for participants to learn and develop new skills to help them improve their mental health and decision-making abilities. Through the group, members can unpack their stories and what happened to them, share in an interpersonal process of comradery, role modeling and mentorship, coping, and learn how to live in hope beyond the trauma (Kerslake, 2021).
Group Talk Therapy: Nurturing Healing Conversations for Adolescents with ACEs
Within the realm of mental health interventions, group talk therapy emerges as a valuable and impactful therapeutic approach tailored to individuals, particularly adolescents, navigating the challenges of significant Adverse Childhood Experiences (ACEs). Also known as group counseling or psychotherapy, group talk therapy involves a trained therapist leading therapeutic conversations within a group setting. This method creates a supportive environment where individuals can openly provide a narrative of their experiences, emotions, and struggles while receiving valuable support, feedback, and guidance from both the therapist and group peers.
According to Yalom (2008), a pioneer in group psychotherapy, group talk therapy brings forth several primary benefits. Participants gain profound insights into their concerns by witnessing the experiences of others, fostering a sense of belonging and connection. The group dynamic, as identified by Yalom, becomes a catalyst for the development of interpersonal skills within a safe and empathetic space. For adolescents with ACEs, this realization that they are not alone in their struggles fosters a sense of community integral to the healing process (Yalom, 2008).
Additionally, group talk therapy serves as a platform for adolescents to hone essential communication, self-expression, and interpersonal skills—critical tools for navigating the challenges associated with ACEs (Soleimanpour et al., 2017). The shared experiences within the group contribute to the normalization of individual struggles, effectively reducing the stigma and isolation commonly linked to trauma. The group context further empowers therapists to address common themes and patterns, enabling the delivery of tailored interventions and insights beneficial for all participants (Soleimanpour et al., 2017).
As part of ongoing research, a deeper exploration of the distinct advantages of group talk therapy is poised to contribute valuable insights to the broader comparative analysis of therapeutic modalities for adolescents contending with significant ACEs.
Group Play Therapy: Unlocking the Healing Power of Play
Play therapy, as defined by The Association for Play Therapy (APT), is "the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development" (APT, n.d.). The essence of play, as an inherent, enjoyable, and effortless "language," forms the foundation of this therapeutic approach. Beyond traditional talk therapy, play therapy leverages a variety of activities, including dance and movement, to facilitate emotional expression, social interaction, and the development of problem-solving skills.
This therapeutic modality places a profound emphasis on non-verbal communication and symbolic expression, recognizing these as crucial elements in the healing process. As Koch (2016) aptly notes, play allows individuals to "develop the vitality within us and, most importantly, express our innermost thoughts and feelings."
Taking play therapy into a group setting amplifies its benefits, building on documented advantages of group therapy. A randomized controlled trial published in the Journal of Counseling and Development suggests that group play therapy may be particularly effective for adolescents facing challenges in verbal expression or articulating their emotions. This impact is notably more significant, as reported by parents, compared to observations by teachers (Blalock et al., 2019).
In our study, adolescents will engage in play therapy within small group settings, where sessions will encompass a diverse range of play-based activities. “Expressive arts enacted in the context of supportive relationships demonstrated how activating therapeutic powers of play, in the forms of self-expression, emotional catharsis, stress management, indirect teaching (learning through metaphor), improved self-esteem, and creative problem solving, diminished the effects of ACEs exposure,” (Pliske, 2020). Under the guidance of a licensed and trained therapist, participants will explore the unique advantages of play therapy within a group context, offering a dynamic alternative to traditional group talk therapy.
Conclusion: Unlocking Therapeutic Potential for Adolescents with ACEs
In conclusion, this research endeavors to bridge a critical gap in knowledge by investigating the comparative efficacy of group play therapy and traditional group talk therapy for adolescents grappling with significant Adverse Childhood Experiences (ACEs). Employing a mixed-methods approach, the study aims to offer a holistic evaluation, combining quantitative and qualitative data.
The urgency of this research is underscored by the enduring impact of ACEs on adolescents, manifesting in various health and socio-behavioral challenges. Our methodology involves robust data collection, encompassing pre- and post-session assessments such as academic grades, standardized test scores, behavioral evaluations, and disciplinary records. The qualitative component, incorporating interviews and focus groups, seeks to capture nuanced experiences that quantitative measures alone might overlook.
Through statistical analyses like ANCOVA and MANOVA, this research anticipates shedding light on the potential superiority of group play therapy in addressing the multifaceted challenges associated with ACEs compared to traditional group talk therapy. Acknowledging the limitations, including the relatively small sample size, emphasizes the need for further research to enhance generalizability.
The implications of our findings extend to educators, clinicians, and policymakers, providing evidence-based insights into therapeutic choices for adolescents with ACEs. With the aspiration to contribute to the development of more effective identification and interventions, this research aims to enhance the academic success and overall well-being of a vulnerable population, paving the way for a brighter and more resilient future.
References
Association for Play Therapy. (n.d.). Association overview. About APT. https://www.a4pt.org/page/aboutapt
Blalock, S. M., Lindo, N., & Ray, D. C. (2019). Individual and group child‐centered play therapy: Impact on social‐emotional competencies. Journal of Counseling and Development, 97(3), 238–249. https://doi.org/10.1002/jcad.12264
Capterra. (2023). Compare MAXQDA vs NVivo 2023. MAXQDA vs NVivo. https://www.capterra.com/qualitative-data-analysis-software/compare/174104-171501/MAXQDA-vs-NVivo
Centers for Disease Control and Prevention. (2021a, April 6). About the CDC-Kaiser Ace Study | violence prevention | injury center | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/aces/about.html
Centers for Disease Control and Prevention. (2021b, August 23). Adverse childhood experiences (aces). Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/aces/index.html
Chizimba, B. (2021). Assessing the knowledge and skills gap for Adverse Childhood Experiences (ACEs) and trauma-informed practice in children and young people’s services across the education, health, care and voluntary sector. Adoption & Fostering, 45(1), 105-111. https://doi.org/10.1177/0308575921995439
Dube, S. R. (2020). Twenty years and counting: The past, present, and future of Aces Research. Adverse Childhood Experiences, 3–16. https://doi.org/10.1016/b978-0-12-816065-7.00001-x
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Adverse childhood experiences study questionnaire. Adverse Childhood Experiences Study Questionnaire. https://doi.org/10.1037/t26957-000
Fellin, L. C., Callaghan, J. E., Alexander, J. H., Harrison-Breed, C., Mavrou, S., & Papathanasiou, M. (2018). Empowering young people who experienced domestic violence and abuse: The development of a group therapy intervention. Clinical Child Psychology and Psychiatry, 24(1), 170–189. https://doi.org/10.1177/1359104518794783
Jones, C. M., Merrick, M. T., & Houry, D. E. (2020). Identifying and preventing adverse childhood experiences. JAMA, 323(1), 25. https://doi.org/10.1001/jama.2019.18499
Karatzias, T., Cloitre, M., Maercker, A., Kazlauskas, E., Shevlin, M., Hyland, P., Bisson, J. I., Roberts, N. P., & Brewin, C. R. (2017). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European Journal of Psychotraumatology, 8(sup7). https://doi.org/10.1080/20008198.2017.1418103
Kerslake, R. (2021, June 25). Better together? 5 benefits of group therapy. Psych Central. https://psychcentral.com/lib/benefits-of-group-therapy#advantages
Koch, N. (2016, July 26). An introduction to dance/movement therapy. YouTube. https://www.youtube.com/watch?v=mhoEjbvIEw8&t=72s
National Center for Injury Prevention and Control, Division of Violence Prevention. (2021b, April 6). About the CDC-Kaiser ACE study. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/aces/about.html
National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. (2023, August 29). CDC - Behavioral Risk Factor Surveillance System (BRFSS). Centers for Disease Control and Prevention. https://www.cdc.gov/brfss/
Pliske, M. M. (2020). Changing the outcome of adverse childhood experiences: How interpersonal relationships, play, and the arts support posttraumatic growth. Scholarly Commons. https://repository.upenn.edu/entities/publication/c72450c8-e6ac-4a46-94f7-deb50c18ae48/full
Pliske, M. M., Stauffer, S. D., & Werner-Lin, A. (2021). Healing from adverse childhood experiences through therapeutic powers of play: “I can do it with my hands”. International Journal of Play Therapy, 30(4), 244–258. https://doi.org/10.1037/pla0000166
Portwood, S. G., Lawler, M. J., & Roberts, M. C. (2023). The past, present, and promise of adverse childhood experiences (ACES) science. Issues in Clinical Child Psychology, 3–11. https://doi.org/10.1007/978-3-031-32597-7_1
Ray, D. C., Burgin, E., Gutierrez, D., Ceballos, P., & Lindo, N. (2021). Child‐centered play therapy and adverse childhood experiences: A randomized controlled trial. Journal of Counseling & Development, 100(2), 134–145. https://doi.org/10.1002/jcad.12412
Soleimanpour, S., Geierstanger, S., & Brindis, C. D. (2017). Adverse childhood experiences and resilience: Addressing the unique needs of adolescents. Academic Pediatrics, 17(7), S108–S114. https://doi.org/10.1016/j.acap.2017.01.008
Yalom, I. D., & Leszcz, M. (2008). The theory and practice of group psychotherapy: Fourth edition (4th ed.). Basic Books.
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