An effective strategy for intervention with children and adolescents affected by HIV and AIDS.
With John's deep sorrow and grief and inability to express it adaptively, the authors thought again about the children's therapeutic needs in group. What is planned and expected from group often turns itself over to what children expect and need. The program's wish for the children to verbally work out their conflicts was idealistic and unrealistic. Instead, the authors needed to use clinical skills creatively to re-establish safety for all the children and to help John cope with his sorrow and anger. It was obvious to the leaders that his anger regarding his mother's illness and death were escalated by the leader's pregnancy. Support needed to be provided to John and the group as a whole by understanding this psychologic struggle, and by providing a safe environment for him to establish a language to express his rage and develop more adaptive coping mechanisms. The example of John exemplifies many of the points made in this article. Although John's experiences only speak of one member's experience within a group, the power of the group is certain to be healing, not only for the individual but also for all of its members. While John's healing is made clear in the example, the other children also gained from these group experiences. They all had their anger and resentment of loss of a leader (and metaphorically of their mothers) expressed for them with a growing sense of safety in the demonstration of pain and anger. They witnessed concretely that their rage and sadness could be articulated and could not cause harm to others. Most interestingly, they all began to talk about their mothers and their early childhoods calmly, with a profound sense of connection with each other, even with silliness and age-appropriate fun. They began to use each other as sources of comfort in their sharing of their stories. The letters to and from John after his departure from group allowed the group members to continue their powerful bond. The current members remember John fondly. His angry outbursts and provocative behavior have been integrated into the story of the group. As children need to express rage they at times speak of John, using his ability to express this feeling as an example to the safety of the group. Again this type of work is not only powerful and intense, but needs to be unhurried. Children such as John and his comembers need time to experience their grief and heal their pain. Thus, groups are an effective strategy for work with HIV-affected children in helping them deal with the losses within their families and continue to grow into healthy adults.
Gossart-Walker
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Program for HIV-affected Children and Families, Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.
Moss
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D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology* / Q000628:therapy; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001601:Bereavement; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology; D003131:Combined Modality Therapy; D005260:Female; D006117:Grief; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011247:Pregnancy; D011615:Psychotherapy, Group; D011889:Rage; D012803:Sick Role; D012944:Social Support