Research That Matters (January 17 - 20, 2008)

Purpose: Group therapy is the most popular modality used in the treatment of AOD problems and most studies report beneficial effects. However, some studies have reported that aggregating youth with conduct problems created environments in which youths exhibited negative behavior that was positively reinforced by other group members (i.e., "deviancy training"), producing iatrogenic effects. This presentation reports on an exploratory/developmental study funded by NIAAA (R21 AA015679-01) called Group Enhancement for Teens in Treatment (GET-IT), which examines the influence of group composition (i.e., proportion of adolescents with conduct disorders among group members), maladaptive group behavior (MGB) and its reinforcement (i.e., deviancy training), and group leader behaviors on AOD outcomes. In this study, we present data on the patterns, characteristics, and development of MGB and deviancy training within and across twelve groups, and discuss how group composition relates to MGB across these groups.

Methods: Data derive from a completed clinical trial involving 120 youths randomly assigned to 20, closed-ended groups using the Westchester Model Student Assistance Program protocol. In this new study, two evaluator teams reviewed audio tapes and verbatim transcripts of every group session to rate MGB and its reinforcement by other group members. This paper includes findings from a sample of 12 groups. We used descriptive analyses to explore the amount and type of maladaptive group behavior and its development over ten group sessions. To examine the relationship between the proportion of adolescents with conduct disorder in a group and the amount of disruptive behavior in the group, we used correlational analyses.

Results: There were 2284 observations of MGB over the 12 groups, consisting of 76 group sessions (mean = 30 incidents/session). The highest proportion of the behaviors (25%) were “distracting behaviors” (behaviors that interfere with, interrupt, or stop the session), followed by 20% that were “glorification or encouragement of tobacco, AOD use” and 7% each were “pejorative verbalizations to other group members” and “victimizing or disparaging others.” MGB showed a clear pattern of development across the groups, peaking around the middle group sessions. There was a significant and moderate correlation between the proportion of conduct disorder in groups and the exhibition of MGB in groups, r = .40, p < .001. When we examined behaviors that were also reinforced (deviancy training), the relationship strengthened, r = .44, p < .001.

Implications: In this study involving a randomized clinical trial, there was a considerable amount of maladaptive behavior in groups. Across the twelve groups, MGB presented a pattern of development over group sessions. In addition, the proportion of youths with conduct problems in a particular group significantly related to the amount of MGB exhibited in those groups. These findings help in the planning of AOD treatment groups and in what group workers may expect in groups consisting of students with AOD problems. We further discuss the implications of these findings for group work practice.