The Mental Health Professional's Guide to Creating Safe Spaces in Children’s Group Therapy

Providing a Safer, More Productive Therapy Environment for Children's Support Groups

Therapists and counseling professionals who run children’s support groups should make the environment as safe and productive as possible. And the best way to do that is by establishing age-appropriate rules and consistently enforcing them. As therapists and counseling professionals who work with children already know—that’s harder than it sounds!

In therapy settings, children have likely been exposed to family issues like addiction, divorce, mental health disorders, death and other major life changes. These children are often expected to fill adult roles and duties that are otherwise unfulfilled by parents, and kids can feel like it’s their job to fix the family. On top of that, the family rules are often unenforced, and home life might be defined by crisis.

When the family home feels lawless and disordered, kids actually feel safer at school. When at school, rules, roles and leaders are clearly defined: children are given rules and consistently witness the teachers and administrators enforcing them. And that’s fundamental to adolescent development.

With that in mind, we’ll explain a few guidelines for therapists and counseling professionals who want to create a safe and productive environment in children’s support groups:

DO: Create therapy rules that tell children how to behave instead of how not to behave

When therapists and counseling professionals can clearly state a desired behavior, children respond well. In the Children’s Program at Hazelden Betty Ford, we use rules that are framed positively and broadly cover the group expectations:

• One person talks at a time
• You can pass
• Respect each other
• Put-ups only
• What we say here stays here

So, when creating rules for a children’s support group, keep it simple, keep it positive and keep it focused on how the kids can behave desirably.

DO: Give the children ownership of the therapy rules and consequences

Children follow rules that make sense to them. Counselors and therapists should frame the rules simply and have the kids discuss why the rules are important. This technique will give the children more ownership over the rules and will help them feel safer within the counseling setting.

Counselors and therapists can review the group rules on the very first day, asking the children why rules are important. They will likely respond eagerly, shouting "rules are important so things don’t get crazy" or "rules are to keep us safe!"

Counselors and therapists should reiterate that back to the children: we have rules to keep everyone safe and to make sure we all have a good time together.

DO: Make therapy rules relevant to the children’s lives

In therapy settings, kids should understand why the rules are relevant. Counselors can ask the children to read and describe the rules, and apply them to their lives. This again gives them ownership and helps them understand why the rules are important in the clinical setting and beyond.

Therapists and counseling professionals should spend time really discussing the rules in kid-friendly language, especially during the first therapy session. Then the children can come to understand why the rules are so important and why the rules are relevant to them.

DO: Review the therapy rules frequently

Therapists and counseling professionals should review the group rules before each session, and the rules should be displayed prominently for the kids to see.

This is especially true for therapy groups involving young or highly distractible kids. It’s unfair to expect a seven-, eight- or nine-year-old to attend a semi-regular therapy session and remember every rule from the first session. It’s better for therapists and counseling professionals to cover the rules before each session and whenever necessary moving forward.

In the Children’s Program, our mental health professionals review the rules on a daily basis. The therapy setting should be focused on processing difficult and emotional issues, not remembering rules from one day to the next.

DO: Enforce therapy rules with simple but clear consequences

Therapists and children’s counselors have to make the consequences clear for when a rule is violated, and the consequences should be kept simple and clear. In the Children’s Program, we have three consequences:

• Strike One—A Warning
• Strike Two—Ten Minute Time Out
• Strike Three—Parent Conference

We enforce the strike-three penalty when a child doesn’t return to group. It may sound harsh, but it’s clearly understood by kids.

Many children share a similar experience: during their time in school, one classmate consistently breaks the rules and the entire class gets punished. We assure the kids that this will not happen in our support group. One person will not be allowed to ruin the therapy session for everyone else. And the clear consequences make them less likely to be administered.

DO: Follow through on therapy rules from the beginning

The biggest mistake a therapist or counselor can make is refusing to enforce the consequences. If a rule is broken, the consequences should be enforced quickly or things may grow out of control.

It’s easier for mental health professionals to be strict at the beginning rather than backtrack toward the end. Being lenient and inconsistent is a recipe for disaster. By the time the counselor attempts to regain control and re-establish the rules of therapy, it won’t matter because the trust and credibility will be lost.

DON'T: Create too many therapy rules

There shouldn’t be more than five rules. Any more than that and the kids will struggle to remember them.

Some facilitators fall into a rule trap, where they create very specific rules for every issue that arises. Instead, create broad rules that can cover many different issues, like "Respect each other." Then, when a child pulls out a cell phone, for example, facilitators can tell the child that they aren’t respecting their treatment friends.

Don’t saturate the kids’ mental resources with a long list of specific rules. Keep it simple, and apply broad rules to specific instances.

DON'T: Reinforce bad behavior by processing the consequences with a child

Newly initiated children’s therapists or counseling professionals often make this mistake. After handing out a consequence for a broken rule, a child will react poorly. The facilitator may become overcome by anxiety or empathy, and attempt to console or explain the consequence to the child. Don’t.

A consequence is given calmly and without shaming, judgment or discussion. If the child doesn’t understand why they received the consequence, pull them aside after the session, but do not debate the rules in the moment.

If the therapist or counseling professional has regularly reviewed and displayed the rules, then the child is likely acting out to get attention. But counselors shouldn’t reward them with attention for breaking the rules. The entire adolescent cohort has emotional needs and issues, and everyone deserves attention.

DON'T: Take back a consequence!

It's natural, common and developmentally appropriate for young children to "test" facilitators. Kids want to know when parents or other adults will follow through on their word.

If a facilitator enforces a consequence and then takes it back, they will lose all credibility. It becomes clear that the adult is not in charge, and that rules don’t matter. It also violates trust: the sanctity and safety of the treatment environment is broken by inconsistency and poor follow-through.

Despite their protest, kids do not want to be in charge—and they shouldn’t be. But when a facilitator fails to enforce consequences, children will become annoyed that their needs aren’t met because a group member is unfairly breaking the rules. And they will lose trust in the facilitator to keep the space safe. Enforcing rules is non-negotiable.

Each day is a new beginning!

Consequences shouldn’t carry over from one therapy session to the next. Give children the chance to start with a clean slate each session. Don’t start the next session talking about broken rules or consequences from the last session, and don’t "save" a consequence for a future date. Consequences needs to happen quickly, or else the children may forget why they’re receiving consequences and it will become an ineffective affair.

If a child has received punishment, don’t take it to a parent at the end of the therapy session. If the broken rule was managed during the session, then it should be finished. Rehashing the issue will set the child up for repeated consequences or shame. Until the behavior has entered "strike-three" territory or breached safety standards, parent intervention is unnecessary.

Different techniques and mindsets: One-on-one children’s counseling vs. support group

Sometimes, the child’s background, family life or clinical circumstances can evoke in facilitators an apologetic sense of empathy, making it difficult to enforce rules or manage undesirable behavior. Counselors and therapists will be wary of hurting the kid’s feelings because they’ve already experienced undue stress, anxiety or heartbreak. And, after all, they’re just a kid.

But the support group environment is different from one-on-one children’s counseling. In one-on-one therapy, it’s appropriate to focus on one child and help them regulate their behavior or recognize the issue behind it. But this isn’t productive in the group environment.

Having high expectations of kids in a safe group environment should help foster resiliency in children. When children are treated like they are incapable of following rules, they will prove a facilitator correct. And the group experience will suffer for it. But they deserve an environment that allows them to play, learn and be safe without added anxiety or stress. That way, they can just be kids!