Group Therapy for Depressed Single Mothers

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Institution

Date

Group Therapy for Depressed Single Mothers

Relevant Research

A research by Cairney, Boyle, Offord and Racine (2003) confirms what one would predict: single mothers experience depression at a higher rate compared to married mothers. According to Hill and Hilton (1999 as referenced in Atkins, 2010), single mothers are more likely to be depressed than single custodial fathers. Maternal depression not only affects the mother, but may also negatively impact on the well-being of the children in the household (Kersten-Alvarez, et al., 2011).

McLanahan (1984) asserts that the main cause of this higher rate of depression among single mothers is often related to the high rate of poverty facing single mothers. The lack of financial resources compounded by inadequate social support systems, a lack of education, low self-esteem, poor physical health, and the ever rising negative life experiences further worsen this problem (Atkins, 2010). Ironically, the very factor that increases the likelihood of depression (poverty) also increases the likelihood of single mother lacking adequate resources for treatment and medication (McDaniel & Lowenstein, 2013).

We selected the target population of single, depressed mothers because this demographic is an unserved population for which group therapy is highly effective (McDaniel & Lowenstein, 2013). In particular, the availability of social support group has been identifies to improve a single parent’s self-esteem and feelings of connectedness (Lipman, Kenny, Jack, Cameron, Secord & Byrne, 2010). Additionally, Kersten-Alvarez, et al. (2011) argues that an effective group experience can foster greater maternal responsiveness to their children’s needs.

We will use the group setting to empower and encourage single mothers to feel more in control of their lives, to provide support to each other, and identify their individual strengths. While we cannot solve the crippling problem of poverty, we can help our clients redefine themselves as valuable members of society who are deserving and capable of a better life for themselves and their children.

Group Description: Single Mothers Suffering from Depression

Recommended Size: 8-10 members

Diversity: The group includes women of various ethnicities, religions, ages, and social classes.

While there is diversity in the group population, it is anticipated that the group members will discover commonalities in their experiences as single mothers.

Type: Open, time-limited group

Potential group members will be interviewed to ensure that individuals are appropriate for the group. Conditions that would render a person inappropriate for a group include, but are not limited to, substance problems that would negatively impact on the work of the group, psychosis, or a comorbidity of borderline personality disorder.

There will be 7 weekly sessions for each group. If a member wants to terminate her membership before the maturity date, she is expected to come back for one more session to say good-bye to other members of the group. New members may be added to the group up to session 3.

We recognize that some clients may face financial obstacles for group therapy. As advocates for our clients, we will work with local social agencies and charitable foundations to source funding for our low income clients who do not have health insurance or are under-insured. Our goal is to ensure adequate funding for all clients who are unable to afford treatment.

Frequency: One 90 minute session per week

Special features: Childcare will be provided by high school and college student volunteers who have proper legal clearances paper. Light refreshments will be provided at group sessions.

Outreach: There are many potential referral sources. Women can be referred to local social service agencies such as Children, Youth and Families (CYF), the local woman’s shelter, Bethlehem Haven Women’s Shelter, Allegheny County Family Court Division, and the Birmingham Bridge Free Clinic. These agencies interact with single women who are at higher risk of suffering from depression due to their life circumstances. In addition, informational brochures can be provided to local primary care physicians, paediatrician offices, and OB/GYN medical practices for self-referral and/or physician referral.

Goal: The main purpose of this group is to provide encouragement and empowerment in a supportive atmosphere that implements the tools provided through recent research in the areas of positive psychology and cognitive behavioral therapy. Secondarily, psycho-education on the causes, incidence, and treatment of depression through written materials will be provided to the group to help members move beyond self-blame for their problems with depression.

Outline of Group Sessions

Session One

Introductions: The initial group session will begin with introductions, an explanation about the importance of confidentiality and the establishment of group norms. The leader conveys the expectation that members attend all 7 sessions, if possible. If a member terminates early, the member must attend one final session to say good-bye.

Icebreaker – Describe your most relaxing moment this week. This offers the women a chance to become comfortable in each other’s presence and share their experiences. If a member feels that there were no relaxing moments, then, she can identify a relaxing moment that she hopes to have in the upcoming week.

Aim: The first session is vital for gauging the expectations of both the members as well that of the group leaders.

Goals are set for the entire group and each individual.

Member start to form a trusting bond and sense of cohesiveness.

Rules of group – set by the group with prompts by leader

Review confidentiality in detail

Homework for next week – the VIA.org character strengths survey

Session Two (in-class exercise)

Check-in: Introduce new members who are joining the group at this meeting. Leader is warm and welcoming to the group. Confidentiality and group norms are reviewed.

Strength Activity: This activity is based on the Positive Psychology technique to refocus a client’s attention on what is positive about life and themselves.

1. Members share their top two character strengths from survey and their reaction to the strengths identified.

a. If a member disagrees with the strengths identified by the survey, ask the member what strength they possess.

3. Ask members if anyone can recall a time in which one or both of their character strengths were helpful to them.

4. Ask members to identify how their character strengths help them as a parent or in daily life generally.

5. What other strengths do you have that were not identified in this exercise? How do those strengths help you manage your life?

6. Leader: Watch for opportunities to engage two members of the group in a discussion about their strengths. Watch nonverbal cues and engage members who are not participating.

Psycho-Educational: Facilitate discussion about reason for the activity and the benefits of focusing on strengths and the things that go well.

Homework: For the next two weeks, keep a journal in which you list three things that went well each day for you and your children. Can be something big, but may be something that you notice, like a beautiful tree or flower, that you may have not noticed previously.

Goal: Starting to change focus from negative self-talk, blame and hopelessness to a place where the groupstarts to focus on their individual strengths and the strengths of the other group members.

Session Three – Management and Coping Tools against Depression

Check-in: 10 minute check-in; address any question that has been raised since the first session. Introduce any new member joining the group at this meeting. Review confidentiality and group norms, if there are new members.

Goal: The main goal of the session is to identify strategies and tools for managing stress among the single mothers.

1. Group starts by identifying the biggest stressors in their lives.

2. The group is asked if anyone has dealt with a stress that another member has identified. What worked? What did not work? Is it your fault if sometimes problem solving is unsuccessful? What strengths have helped you handle stressors in your life?

3. The purpose of the discussion is to foster improved self-esteem and a sense of better control over their lives, actions, and thoughts.

Homework: Continue recording examples of things that are going well each day.

Session Four – Balancing Various Spheres of Life

Check-in: 10 minute check-in; address any question that has arisen since the first session. Reminder about confidentiality. Congratulate the group on their continued participation and moving forward with their work in the group.

Goal: It is necessary for depressed single mothers to develop a sense of self-awareness which will provide them with insight on how to manage their overwhelming lifestyle and reduce their symptoms of depression. The right order can lead to positive changes and cause greater satisfaction in life.

Journals: We will ask for volunteers to share what they have recorded in their journals. We explain that the sharing of positive experiences may help others identify additional positive events in their lives.

CBT Technique: Thought records is a CBT technique that enables depressed single mothers to change their beliefs on a logical level. This exercise is designed to test the validity of the clients’ thoughts. Thought records can help the group identify their negative thought processes and start to change the way that their view themselves and their lives.

2. Homework: Continue the thought records throughout the coming week.

Session Five – Resources

Check-in: 10 minute check-in; address any question that has arisen since the first session. Remind about confidentiality.

Goals: To create a list of resources that the group members turn to for support.

1. Leader asks group members to identify the resources that they need for daily living. Members are asked to identify the resources that they have found helpful – social agencies, religious organizations, family, friends, etc.

2. Leader will record resources identified by group members. Leader will also have a resource packet for each group member that identifies social agencies, public housing information, financial assistance, pro bono legal clinics, medical clinics, parenting classes, etc.

Session Six – Perception

Check-in: 10 minute check-in; address any question that has been raised since the first session. Reminder about confidentiality.

Goal: To assist group members in identifying personal perceptions and biases through cognitive therapy.

1. Principle: Depression maybe caused by maladaptive, cognitive styles. To change maladaptive thinking, clients need better coping skills that involve quality problem solving. Cognitive therapy is effective approach to correct maladaptive thinking.

2. Method: In cognitive therapy, the leader will help the group to explore their biased perceptions of their lives and identify negative thinking patterns. It gives the women a chance to discover if they hold biased views regarding themselves. They can reflect on how they tend to respond to daily tasks and hurdles. Group members are encouraged to give honest and supportive feedback to each other.

3. Start preparing for termination of the group – Leader will ask members how they feel about the group ending. Make plans for a celebration at the last meeting.

Seventh Session – Termination

Check-in: 10 minute check-in; address any question that has arisen since the first session. Discussion about confidentiality continuing even after the group is over.

Goals: To evaluate the progress made by individual group members over the course of the sessions and to make sure that group know about additional resources if follow-up services are needed.

1. Evaluation of progress and saying good-bye is the final step. The leader will facilitate discussions about individual and group progress. Specifically, the leader will ask group members to identify what they will bring forward from their experience from the group. Leader asks group members how they will use what they learned if they encounter new challenges in their lives.

2. Review the mental health resources that have been previously identified for future use, if necessary.

3. Leader will ask members how they feel about the group ending. Leader will ask group members what they would like to say to the other members of the group. Leader will express admiration for the group’s work, perseverance, and honesty.

References

Cairney, J., Boyle, M., Offord, D. R., & Racine, Y. (2003). Stress, social support and depression in single and married mothers. Social Psychiatry and Psychiatric Epidemiology, 38 (8), 442-449.

Free, W., & Heminway, J. (2008). Stress: Portrait of a killer. New York: National Geographic Specials.

McLanahan, S. S. (1984). Working paper: Single Mothers and Psychological Well-Being: A Test of the Stress and Vulnerability Hypothesis. Retrieved February 24, 2014, from University of Wisconsim-Madison: http://www.ssc.wisc.edu/cde/cdewp/84-40.pdf

Peden, A., Rayens, M., & Hall, L. (2005). A community-based depression prevention intervention with low-income single mothers. American Psychiatric Nurses Association, 11 (1), 18-25.

Seligman, M. E., Rashid, T., & PParks, A. C. (2006). Positive Psychotherapy. American Psychologist, 774-788.