On group programs.
By Dr Theresa Kidd
After facilitating at least one hundred groups over the years for autistic children, adolescents, adults, and families, it has been extremely refreshing to create and implement our neurodivergent-affirming programs this year. At The Kidd Clinic, the enthusiasm and careful thought and consideration that our team has poured into the development of each program has been wonderful to observe and be a part of. Our progressiveness has been grounded in personal/ lived experience, valuing all neurotypes, listening to what our clients are saying they need, continuously reading what the autistic community are wanting, and then interweaving this into what we have learned as therapists. We still have much to learn but the only way that we can do this is through consistently trying to get it right.
I have always loved group programs for many reasons, some of which I have listed below. Unfortunately many psychologists steer clear of them due to the time and energy required to cater for multiple clients (e.g., organising, advertising, facilitating, and trying to cater to individual psychological needs within a group setting) and because they are not well funded by Medicare (the rebate is much lower for groups then for individual sessions).
However:
Group treatment has shown to be at least as effective as individual treatment.
It can be an economical alternative to individual therapy, which is often expensive for parents and therefore difficult to access.
Group treatments provide the opportunity for young people (and parents!) to share their experiences and normalise their feelings of anxiety/isolation etc.
With significant social differences in mainstream/ non-autistic settings, the opportunity to form social connections and interact in a supportive environment can be highly beneficial, particularly for those who are often wanting social relationships but may have difficulty with to initiating and maintaining them.
PDA and group programs
I began studying Pathological Demand Avoidance (PDA) as a presentation thirteen years ago. At the time, I was running my PhD family-based, manualised, and modified cognitive behavioural therapy groups. While the results of this treatment showed a significant reduction in anxiety for adolescents compared to those in the wait list group, I noticed that similar to a young person in my own family, some adolescents were not able to attend or stay in the group as a result of their severe anxiety. There were some that could attend the group, but their participation was significantly limited due to their need for control. Sessions usually ended in the PDA young person feeling extremely distressed and not able to complete the program.
So why don’t manualised programs often work for PDA young people?
Attending a new setting is highly demanding - uncertainty is high, and control is low. Where is it? What will happen there? Who will be there? What will be expected of me? Will I know how to do it? The PDAer is often working from ‘self-protection’ mode and as such, revealing what they do not know places them in a vulnerable and out-of-control position.
The social performance is demanding (greetings and ‘having’ to respond, feeling a lack of control since others may know what is happening but the PDAer does not).
Manualised programs follow a particular format which means that certain activities and exercises need to be adhered to. This leaves little or no control for the PDAer.
Psychological programs are often focussed on fixing something such as anxiety/ depression or social skills. The PDAer is often doing what they can to keep others from seeing ‘their weaknesses.’ Having to talk about these can move them into fight/flight/freeze or fawn mode.
All the usual autistic characteristics are also at play – such as sensory processing difficulties/ overwhelm (groups can be noisy!), anxiety around social interaction, and emotion dysregulation.
As therapists, what can we do to assist PDA young people to attend groups successfully?
Build strong relationships through individual sessions with our PDA clients so that they have a safe person with them in group sessions.
Create a safe space at the clinic that the young person becomes familiar with (reduces uncertainty and increases a sense of control). We can do this by showing the young person around the space that the group will be held in, in advance.
Develop interest-based group programs (a focus on interest areas is usually less demanding for the PDAer and because they are knowledgeable about the topic, they are likely to feel more in control).
Include the young person in the development of the group program (increasing their sense of control).
Try to match similar-minded children/ adolescents together.
Have another space for the PDAer to move to if they begin to feel overwhelmed.
Find out what has or hasn’t worked in previous group attempts and make necessary adjustments.
Use PDA language/ approach in the sessions! Flexibility is key :)
Thank you to all the young people, parents, and The Kidd Clinic team for the development, facilitation, and evaluation of our group programs so far this year. As we have continued to receive many enquiries about our groups, we have begun a waitlist for future group programs. Please click here if you wish to register your interest in a group program.