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  • Asperger's Syndrome in Adults
  • Working To Come To Terms with Asperger's
  • Sex and Depression - The Real Story
  • The Loss of Joy: Anhedonia
  • All About Schizophrenia
  • Depression: Causes, Symptoms, and Treatment

Asperger Syndrome is an Autism Spectrum Disorder (or Pervasive Developmental Disorder) characterized by significant difficulties in social interaction along with restricted and repetitive patterns of behaviors and interests. Those with Asperger Syndrome, or AS, may exhibit a lack of empathy for their peers, clumsiness, and atypical use of language, though none of these symptoms are required for a diagnosis.1

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The pain of coming to terms with having Asperger's is still very real for me right now. There is a tremendous sense of grief. Grief for all that I suffered through to try to be "normal" and grief for how short of "normal" I always have been. There is also great relief to know that I am not crazy and that not everything can be traced back to an abusive past in the sense that some of what I experience is not choice/emotional but neurons/physical. The greatest challenge I face right now is trying to figure out which is which. This is not easy.

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One of the most common side effects of a number of antidepressant medications is loss of sex drive. I could forgive our friends at fine companies such as Eli Lilly, Bristol Meyers Squibb, and Pfizer if dry mouth, irritability, disrupted sleep patterns, loss of appetite, sloth, and social phobia were the sole issues related to the medications I take on a daily basis. However, it is the sex thing I find most challenging.

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Sadness

Anhedonia is the technical term for the inability to experience joy. When people are in the depths of depression, nothing touches them, not the most intensely pleasurable activities, not the most familiar comforts. They are emotionally frozen. In this state, people either have to get professional help or simply wait for weeks or months until the depression lifts by itself; nothing is going to make them feel better.

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Schizophrenia is a mental illness which affects one person in every hundred.

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Depression is perhaps the most common of all mental health problems, currently felt to affect one in every four adults to some degree. Depression is a problem with mood/feeling in which the mood is described as sad, feeling down in the dumps, being blue, or feeling low. While the depressed mood is present, evidence is also present which reflects the neurochemical or "brain chemistry" aspects of depression with the depressed individual experiencing poor concentration/attention, loss of energy, accelerated thought/worry, sleep/appetite disturbance, and other physical manifestations. When this diagnosis is present, the individual will exhibit at least five of the following symptoms during the depressive periods:

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Adolescents are social creatures, in the midst of learning their social skills, and are often more trusting of others their own age than of adults. This makes the group therapy setting an ideal choice when counseling becomes necessary for this age group. They are excellent at being able to learn from one another while observing and teaching appropriate skills as they grow.

However, adolescents cannot be treated as merely young adults in the group therapy setting. They come with their own dynamics which must be acknowledged and understood in order to work effectively with them.

Group Development

Group Appropriateness

The group is a natural setting for adolescents. They are taught in groups, live in groups, and often play in groups. Group therapy adolescents is an ideal choice, as social interaction is a key aspect of the developmental process, and as suggested by Bandura (1989) most social learning takes place by observing others and the results of their actions. Leader (1991) states that group therapy for adolescence provides the therapeutic environment where they can work through interpersonal problems and examine the four basic identity questions: Who am I? With whom do I identify? What do I believe in? and Where am I going? The activities in group therapy that adolescents can be exposed to that they don't have the opportunity to in individual therapy include the chances to learn cooperation and deal with issues such as cooperation, envy and aggression, while comparing how their thoughts and behaviors compare to those of their peers. Most adolescents are referred to treatment because of problems they are having in relationships with others in their lives such as parents, teachers and peers (Kymissis, 1996, p. 30). Adolescence is a time of rising psychosocial vulnerability where either psychopathology or self-actualization can occur (Gunther & Crandles, 1998) and thus social learning may be the best treatment for them.

Adolescent Participation

Adolescents are often reluctant to attend group therapy, though, for a number of reasons. They often are suspicious of anything recommended by their parents or other adults. They are also often fearful that if they enter a therapy group it means that they are crazy. Some fear that the therapist will interrogate them and tell them what to do. Others are frightened that they will encounter someone they know, and that they will be stigmatized (Gunther & Crandles, 1998). The younger the participant, the more likely they are to show less fear, and the greater likelihood that they will be more willing to enter group therapy with less reservations.

Group Membership

In the organization of therapy groups, the developmental characteristics, needs and abilities must be kept in mind. The major criteria the selection of the members of the groups include the ages, the diagnosis, the intelligence levels and the stage of development. Group of adolescents who are appropriately matched with respect to development form cohesion early and become therapy groups faster than groups organized only on the basis of biological age (Kymissis, 1996, p. 30). This is due to the fact that these adolescents share common goals and tasks, which are important in forming cohesive bonds.

Group Process Theories

Dies' Group Process Theory

There are 4 different levels of group therapy that may be utilized, as outlined by Maclennan and Dies (1992, p. 70). These different levels may be applied to, or adapted for, any population of adolescents from those who are healthy, those that are at risk for a social problem or mental illness, or those with serious long-term problems. These are:

  • Groups set up primarily for prevention, including behavioral health and mental health education and for program information and member diagnosis.
  • Groups concerned with specific problems and their resolution.
  • Groups related to general life adjustments demanding changes in a member's self-concept, self-management, and life-style.
  • Indirect counseling that arises out of other activities, such as playing, clubs, skills and craft groups, teaching and training settings, and work groups, and that emphasizes not only problem-solving but also the actual life experiences provided in the program.

They also define a number of different groups for us.

Groups for prevention may be held in many settings, including schools, youth service centers, and family agencies. They may be strictly informational, concerned with providing information on subjects timely to adolescents such at drug abuse, sex and sexually transmitted diseases. Or, they may be designed to help the youth improve their coping skills though such techniques as problem-solving, learning to say no, or the reframing of situations.

Program information groups are designed to give specific information about programs and to aid in the referral to other programs, and to make the best use of programs. These may often be found in clinics and treatment centers as well as hospitals, and often take the form of lectures, with the chance for questions and answers afterwards. These groups serve to reduce isolation, guilt and anxiety by allowing the participants to recognize that theirs is not a singular situation, that others are experiencing the same thing. It allows them to refocus their views of their problems, and clarify their feelings about what courses of action they want to take.

While the first two groups are larger, and are mostly concerned with providing information to the consumer, Diagnostic groups are smaller and provide the opportunity for the therapist to observe the clients more intimately in order to help formulate a diagnosis. This process is both helped and hindered by the group process. It is helped in that the therapist is able to see how the client acts in relation to peers. It is hindered in that the group may quickly begin to relate closely, form transferences, and become a cohesive whole. It is suggested that the adolescents, if they are in a diagnostic group, stay with the same therapist if they move into a treatment group, as they begin to form attachments to the therapist, and often do not tolerate transfers from one therapist to another well.

Problem-specific and life crisis groups are short-term groups that deal with a specific issue. The goal of these groups is to help the adolescent understand the consequences of the problem, and to explore alternatives in dealing with it, and their own attitudes and feelings towards it. Then, a course of action can be developed.

The final groups used with adolescents are life adjustment or change in life-style groups. These may be adolescents who are moving from one stage in their lives to another, teenagers needing or wanting to make more satisfactory adjustments in our lives, wanting to learn more about themselves, or to resolve serious long-term problems. The goals of these groups are to help members understand themselves, how they relate to others, what they want out of life, and how their own behavior and feelings intrude.

Gartner's Group Process Theory

Another group theory with adolescents parallels their separation-individuation process. This was proposed by Gartner (as cited in Gunther & Crandles, 1998), who defines the group as a system that moves in levels of differentiation from undifferentiated to differentiated. It begins with no interrelationships - it is a room full of strangers. As it matures and relationships deepen, individuals become interdependent. The four stages of this theory are safety, dependency, counterdependency, and independence. He also believes that this is not a simple linear set of stages. The group can move back and forth between them.

The safety stage is a point in which the adolescents are figuring out what behaviors are acceptable are unacceptable, what might embarrass them, and what would make them feel comfortable. They are recognizing similarities and differences in each other and seeking commonalities between each other. They may experience the "hot potato" syndrome where they feel anxiety about focusing on talking about themselves, and defer to others and the therapist. The therapists questions and attempts to engage the members are felt and intrusive and interrogative.

Dependency, the second stage, is where the members become dependent on the therapist and believe they will be cured by them. The members are passive and lack initiative in starting discussions. They continue to work on issues of safety and trust. Rather than focus on issues of substance, the group may revert to scapegoating other members and talking about tangential issues to fill time.

In the counterdependency stage, while still being dependent on the therapist, the members begin to fight their dependency. This results in conflict with the group leaders. The group members at this point may express transference of anger toward other adults onto the group leaders to a great degree at this point.

Finally, in the independent stage, the members will achieve autonomy, and have a sense of who they are and how they can continue in their lives. The group members will begin choosing the topics of discussion and leading the group independently. The group will begin giving constructive feedback to one another, with little therapist intervention. Instead of spending their energies protecting and defending themselves from one another, they can reveal their feelings and work through their problems.

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