The main goal of the recruitment phase of group treatment is to identify members who need both to accomplish the designated task of the group and who are able to work together toward that task accomplishment. Such identification requires sufficient clinical knowledge about each prospective group member. Several concrete steps facilitate the identification and recruitment process. First, group leaders must communicate clearly and broadly with all potential referral sources in an enthusiastic and welcoming manner. Referrals should be encouraged by conveying an eagerness and willingness to be helpful to colleagues and potential group members. Once a referral has been suggested, group leaders need to determine whether the child or adolescent has been fully evaluated. If a psychiatric evaluation or psychological assessment has been completed recently, the results of the evaluation should be reviewed carefully to assess compatibility with the designated group. If no recent evaluation has been done, group leaders either need to obtain in-depth clinical information about the prospective member from a clinician with ongoing knowledge about the member, or the leaders need to carry out a relevant evaluation. An in-depth, clinical understanding of each prospective group member is necessary to ensure appropriate group composition. Should the group leaders then determine that the prospective group member is inappropriate for the designated group, alternative treatment options or experiences should be suggested to the child or adolescent and his/her family. Should the group leaders conclude that the referral is appropriate, the leaders should meet with the group member’s parents to describe the group in detail, to plan for the child’s or adolescent’s course in the group treatment, and to answer parent questions. The leaders should then meet with the prospective group member to again describe the group, make certain that the member appears to fit admission criteria, and to answer the child’s or adolescent’s questions. At times, actually meeting with the prospective group member raises particular concerns about potential group membership. These concerns should be taken up with parents and referring clinicians to allow for confident admission decisions. If all are then agreed and comfortable, a date should be set for entrance into the group.

The question arises often about the relative merits of diagnostic homogeneity or heterogeneity in a group. This question should be resolved in relation to the proposed task of the group. A group designed to address specific, diagnosis-related issues would clearly demand diagnostic homogeneity. Thus, for example, a psychoeducational group for children with diabetes would, by definition, require that all members have diabetes. Similarly, a support group for HIV-affected youngsters would require that all members had direct experience with HIV infection. In contrast, a group with a developmental or psychotherapeutic task would thrive on diagnostic heterogeneity. Mirroring the diversity to be encountered in naturalistic environments, such group heterogeneity would bring differences in perspective, observational capacity, and interpersonal relatedness that would allow for spirited, mutually beneficial interactions among members and leaders. To illustrate, a social skills group would do best if members all displayed impaired social functioning but did so for widely different reasons. In such a group, a socially inhibited, depressed member might be able to give very age-appropriate social feedback to an idiosyncratic member on the autism spectrum, while an impulsive, acting-out member might be able to challenge the inhibited member toward more vigorous, instrumental interaction.

One important caution should always be considered in regard to diagnostic composition of the group. To the greatest extent possible given real-life contingencies, a group should not contain only one representative of any critical attribute or category. A solitary representative of any salient classification— racial, religious, ethnic, gender, or level of diagnostic severity— invites isolation and hinders significantly the potentially useful interventions implemented by the leaders. For example, a group for psychotic youngsters could be extremely beneficial, offering them evidence that they were not fully alone in their disorganization, and teaching them pragmatic coping strategies. Placement of a single psychotic child or adolescent into a group of more realistically functioning members, however, intensifies the psychotic member’s sense of isolation, highlights his/her impairment, deprives that member of appropriate group interventions, and frightens the group as a whole. In forming a group or admitting new members to an ongoing group, then, every effort should be made to include members who share important, relevant attributes with at least one other member.

Therapeutic groups for children and adolescents should be big enough to generate multiple, challenging interpersonal interactions and to allow for both dyadic, triadic, and whole-group activities. At the same time, the groups should be small enough
to permit a sense of intimacy and close personal attention. Groups composed of 4–6 members are ideal for most therapeutic tasks. While not overwhelming to individuals, groups of this size can continue to work productively even with occasional absences due to member illness, vacation, or other reasons.

As with the issue of diagnostic consistency, the question of same-sex versus mixed-sex groups is often debated and should be resolved in reference to the group’s task. Traditionally, therapeutic groups were offered to single sex populations. More currently, common practice has changed. For most tasks in groups of children and adolescents, mixed-sex groups prove to be most useful, since interacting with others of both sexes again parallels most closely real-life experience. Group members derive benefits directly applicable to the demands and challenges of daily life. There are, however, some groups that should remain single-sex groups. These are the groups designed to address sensitive issues related to sexuality, aggression, and/or sexual abuse. The need for comfort, trust, and empathy in such groups is difficult enough to satisfy but would be even more difficult in a mixed sex group.

In actual clinical life, age ranges are rarely absolute. Developmental and school grade levels tend to influence and sometimes extend the age range of a group. Still, a general age range of 2–3 years is most appropriate. It is important, too, that the span of years be contained within one developmental phase of life. This type of clustering allows for the necessary commonality of experience and capacity to benefit from group interventions.

A space should be dedicated to the group on a consistent, reliable basis. Two conditions are most important in identifying a group setting. First, the setting must be private for the duration of each group meeting. Intrusions by individuals not associated with the group are very destructive of the group process. Second, the setting must be furnished and equipped in a developmentally appropriate manner. While leaders should work hard to limit damage to the physical space, some wear and tear in the environment must be a realistic expectation in working with children and adolescents. It would be too difficult to carry out the work of the group if leaders were faced with constant worry about protecting a more adult-oriented room that contained objects or interior decorations of great value. If these conditions are met, groups can adapt to many different kinds of spaces of varying sizes.

When embarking on group treatment for children or adolescents, leaders are often tempted to amass a large collection of tempting, exciting, attractive play materials. In actuality, a big, tempting array is usually over stimulating to a group and leads to excessively active, disorganized interactions. A modest amount of developmentally appropriate materials facilitates much more productive group interaction. For adolescents, some decks of cards, a few advanced board games, and some limited art materials would likely be sufficient. Groups at this adolescent level tend to engage more in conversation than activity. Younger groups rely more heavily on activity as the vehicle of their clinical work. Thus, for elementary and middle schoolchildren, it would be best to provide decks of cards, a larger number of simpler board games, limited art materials, some building toys such as Legos, and something that allows the group to engage safely in an indoor large-motor activity, e.g., a soft, inflatable beach ball or a plastic indoor bowling set. Preschool groups do best with a small amount of building toys, some drawing materials, a few very simple board and card games, and materials that promote fantasy play such as a dollhouse or dress-ups. Whatever the age of the group, it would always be best to do with fewer rather than more materials.

In carrying out group treatment with children and adolescents, the challenge of group participation should always be remembered. Management of the self in relation to the group as a whole is daunting, in addition to the difficulty of the actual therapeutic work. In recognition of the challenges faced by group members, it is helpful to provide a snack as a tangible support to the group. In addition to its nurturing aspects, time spent eating together as a group promotes more intimate, relaxed interactions that often help with task accomplishment. The logistics of providing food in the group are important, as well. The exact food and accompanying drink to be provided should be very simple and should be decided by the group leaders. Accommodations should be made to any specific dietary requirements of group members. The group should be told that a set amount of snack will be offered to each member. Group protest should be expected no matter what the designated amount of snack is. Such protest should be understood as part of the group establishing and maintaining its trust in the group leadership. Leaders should adhere to the snack plans set forth at the outset of the group. The only useful exceptions to these snack plans involve either essential dietary restrictions on the part of individual members or special occasions. In regard to dietary restrictions, parental report sometimes indicates that a child cannot tolerate a food or drink for medical reasons. At other times, religious or cultural beliefs dictate acceptable vs. unacceptable food. These specific needs should be accommodated by the entire group, whenever possible. If group as a whole accommodations are impractical or impossible, the individual member should be cared for appropriately with a simple explanation offered to the group. In regard to special occasions, from time to time the group may observe a holiday if such observance is consistent with the task of the group. On these occasions, it is helpful to have the group plan together about food and drink, with the leaders retaining veto powers if the plans get too lavish to be practical.

Length of each meeting and lifespan of the group should both be considered. Regarding meeting length, 1–1½ hours is an optimal amount of time for a group meeting. Less than one hour deprives the group of sufficient time to enter fully into work on its task. Instead of concentrating on the work, both leaders and members feel the constant pressure of time and spend most of their energy hurrying to finish. More than 1½ hours is simply too exhausting. Many groups meet for 1¼ hours and find that duration to be very comfortable. In public school settings, the demands of the school day often dictate that groups must meet for only 20 minutes to ½ hour. Under such conditions, leaders should work hard to design group agendas that can be implemented realistically. Regarding group lifespan, professional preference and practical realities
of organizational life in many settings lead to decisions to offer time-limited groups. In such settings, constraints on professional availability, organizational resources, theoretical outlook, and regulations of third-party payers may all require a time-limited group. In other settings and under different conditions, long-term, open-ended groups are still offered, as they were more routinely in earlier years. It should be understood that time-limited versus long-term groups offer different possibilities for meaningful work and can accomplish different tasks. Time-limited groups are best for teaching specific, discrete skills, or imparting well specified information. They can also be very useful for individuals who could not tolerate the intensity of long-term interpersonal interaction. Brief groups may also lend themselves more readily to empirical research designs. In contrast, long-term, open-ended groups are best for facilitating more fundamental, broader changes in designated areas of personal functioning. To carry out formal, intensive psychotherapy in a group format, to engender genuine change in naturalistic social functioning, to provide support with some life-threatening situations, there is no substitute for a long-term, open-ended group experience.

A comfortable place for the group to go to on arrival at the clinic, school, or private therapy office should be designated. It should be communicated clearly that parents or substitute caregivers retain responsibility for behavior management in the arrival area. Exactly at the time for the group to begin, the leaders should go to the arrival area to greet the members and bring them to the group meeting room. Acceptable behavioral standards and full physical safety should be maintained as the group is escorted to the meeting room. In some behaviorally challenging groups, members may need to be escorted in subgroups if moving as a whole group is too stimulating. In public schools, this gathering of members may need to be modified to include bringing the group members from their classrooms. Once in the group meeting room, members should be guided to settle into their designated places, putting away any personal belongings as directed. Overall, the purpose of this period is to welcome the group members and help them settle back into being together.

The group should be seated so that everyone can see each other. In most groups, a circular, square, or rectangular seating arrangement on the floor or single chairs is appropriate. In some groups for more psychologically disorganized individuals, the informality and intimacy of such an arrangement might be overwhelming. Such groups should be seated around a table for more formality and support. The first purpose of talking time is to allow the leaders to make any necessary announcements regarding member absences, upcoming events, or other practical issues. The leaders may also use this time to lead the group in discussion of a particular occurrence or ongoing situation that requires the group’s consideration. The second purpose of talking time is to promote sustained, verbal interaction among the group members. Each member is encouraged to tell the group something of significance, if they choose to do so. In older, more mature groups, this part of talking time might be fairly informal. To the extent that the members can manage themselves, the leaders might be able to allow for free conversation. In younger, less mature groups, members’ participation in talking time has to be managed much more carefully by the leaders. A helpful model is to have each child/adolescent talk to the group about one or two topics of importance and then turn to the next child/adolescent and elicit a question or comment about what was just related. This model teaches group members about listening to one another, staying on topic, responding to someone else, and about distinguishing between questions and comments. In psychotherapy and clinical support groups, talking time may become quite lengthy as the group moves more deeply into its work. In social skill groups, leaders should limit talking time to approximately 10 minutes to allow for sufficient opportunities to engage the group members in fuller social interaction. Leaders should always be the ones to announce when talking time is completed.