1. Therapeutic Groups for
Israeli-Palestinian
Children
Pioneering work,
primary experience

2. Latiff
Community
Mental Health Clinic
for Children
Umm-Al-Fahm, ISRAEL

3. Authors:
 Tsvi E. Gil, B. Sc., M. A.,
 Graciela Karmon, M. D.,
 and Latiff group work team
 Society for advancement of health
services

4. Team members are…
 Mahmud Asla, Ph. D.
 Faten Egbaria, B. S. W.
 Ibrahim Igbariy, M. A.
 Kresteen Iskander, B, S. W., M. A.
 Mansur Mihdawi, B. S. W.
 Amany Saady, M. A.

5. …The Globe

6. …The Middle East

7. …Israel

8. …Um Al Fahm
an Arabic town in the north

9. Our clients
 Palestinian children (ages 6 – 18),
Living in Northern Israel,
 Suffering of all kinds of
psychopathologies, as well as
psychosocial mishaps

10. Our staff
 3 psychologists
 4 social workers
 2 secretaries -
all of them Palestinians!

11. …and
 Director (psychiatrist) and supervising
personnel (psychologists)- all of them
Jewish!
(and not speaking Arabic)

12. Treatments were:
 Individual psychotherapy
 Parent’s guide
 Art therapy
 Pharmacological (psychiatric)

13. … and we had
 300 patients in waiting list!

14. So… we started initiating
therapeutic groups
 Groups for children according to age
groups
 Groups for children according to
diagnoses or classes of problems
 Groups for parents

15. Obstacles for creating groups:
 Staff not trained in group work
 Staff sees group work as ‘second best’
 Fear of failure
 Unrewarding previous experience
 Busy with ongoing treatments
 Anxiety in face of the unknown – uncertainty,
lack of control, lack of knowledge,
undefinability of goals (structured vs. open
groups)

16. .. And target populations:
 Expect individual treatment, see group
work as ‘second best’
 Fear of disclosure and contagion
 Difficulties in gathering together at
particular timing

17. Principles of Group Work with Children
(Z. Shechtman – Group Counseling and Psychotherapy with
Children and Adolescents)
 Experiencing as a major mechanism of
change (Greenberg)
 Exploration, Insight, Action (Hill)
 Vicarious learning, role flexibility, universality,
altruism, family reenactment, interpersonal
learning (Fuhriman & Burlingame)
 Self disclosure and mutual support (Spiegel &
Classen)

18. Therapeutic factors in children’s groups
(Z. Shechtman – Group Counseling and Psychotherapy with
Children and Adolescents)
 Group cohesion, catharsis, interpersonal
learning (Fuhriman et al)
 Support, self-disclosure (Lieberman & Golant)
 Awareness, relationship, focus on others,
problem definition (Kivlighan et al)
 Positive group climate (Riva & Haub)

19. Group therapist roles…
 Presence
 Self-Confidence
 Creativity
 Empathic understanding
 Genuiness
 Respect

20. Group therapist does…
 Initiates
 Encourages
 Directs
 Questions
 Informs
 Paraphrases
 Being patient (tolerant)
 and gives feedback

21. What is unique in working
with Palestinian population?
 Holidays (olive harvest, Ramadan,
pilgrimage, Muhammad birthday,
Easter, Land Day, wedding).
 A large catchment area with poor level
of public transportation, lack of
resources for arrival
 Anger and violence in closer and
distant surroundings

22. violence
 Violence inside the family
 Violence in the culture
 Accidents
 Violence in the Israeli society
 Violence between Israeli and Palestinians
 Violence anger and anxiety
conflicts, distress, and misconducts

23. The war in Gaza Strip (December
27th 2008 – January 17n 2009)

24. Phenomena in parent groups:
 Traditional and patriarchal families
 Minor paternal involvement in child
upbringing, due to traditional familial
values
 Involvement of the larger family
 Pseudo-adoption

25. Phenomena in working with
parents:
 Idealization of childhood – jammed in
traditional familial patterns
 Conflicts with sexuality, e.g. – value of
virginity, rejection of homosexuality
 Men work and find it difficult to participate in
parents group
 Manish roles of men (e.g., men do not touch
or cry)

26. Palestinians – society in
transition
 Laws, rules, and norms – change and are not clear-cut
 Influence of Israeli and global societies
 Influence of religious and fundamental values (Sunnis and
Shiite)
 Vague boundaries between individuals and their family and
community
 Conflict between women’s individual needs and their role in the
family
 Individual is dependent on family and community
 Difficulties in contact with Israeli society
 Conflicts in national identity (Israeli, Arabic, Palestinians,
Muslims)

27. Collectivist Society (M. Dwairy)
 Source of psychopathology – intra-psychic vs.
interpersonal
 Aim of psychotherapy – strengthening the
self vs. adaptation to societal values and
requirements
 Adjustment to family and society vs.
individuation and autonomy
 Treatment as individual parade vs. treatment
as part of the community

28. Group leaders as social
change agents
 Parent groups proved to contribute to
alterations in family roles: men give up
hierarchical superiority in favor of
proven investments and achievements;
women take inner locus of control
 Empowerment of women in their
families

29. Individual problems reflect
society conflicts:
 Identity in a transitional society
 Doubt and uncertainty in the community lead
to conflicts and confusion in the individual
 Violence in the surrounding leads to fear and
anxiety in the family and individual, leading to
psychopathology
 Intrapsychic anxieties reflecting community
fears: Palestinians in occupied territories,
Rightists’ demonstrations

30. Research and findings
 Difficulties in harness staff to scientific
missions
 Difficulties in eliciting valid reports from
participants
 Difficulties in budgeting of research
 Evidence for significant underlying
processes take place with participants

31. Literature cited
 Dwairy M. – Toward psycho-cultural approach in muddle eastern societies. Clinical psychology Review 19: 909-915, 1999.
 Dwairy M. – Foundations of psychosocial dynamic personality theory of collective people. Clinical Psychology Review 22:
343-360, 2002.
 Fuhriman S. G. & Burlingame G. M. – Consistency of matters: a comparative analysis of individual and group process variables.
Counseling Psychologist 18: 6-63, 1990.
 Fuhriman A. et al – Validating a behavioral measure of catharsis, cohesion, and insight, in group therapy. Ann. Conf. Soc.
Psychotherapy Res., Braga, Portugal, 1999.
 Greenberg L. S. – Emotion-Focused Therapy. Washington, D. C., American Psychological Association, 2002.
 Hill C. E. – Helping Skills: Facilitating exploration, insight, and action. Washington, D. C., American Psychological Association, 2nd.
Ed., 2005.
 Kivilghan D. M., Multon K. D., & Brossat D. F. – Helpful impacts in group counseling: development of multidimensional rating
system. Journal of Counseling Psychology 43: 347-355, 1996.
 Lieberman M. A. & Golant M., Leader behavior as perceived by cancer patients in professionally directed support groups and
outcomes. Group Dynamics: Theory, Research, and Practice 6: 267-276, 2002.
 Riva M. T. & Haub A. L. – Group counseling in the schools. In J. L. de Lucia-Waack et al (eds.) – Handbook of Group Counseling
and Psychotherapy. Thousand Oaks, Ca, Sage,, 2004, pp. 309-321.
 Schechtman Z. – Group Counseling and Psychotherapy With Children and Adolescents. Mahwah, N. J., and London, Lawrence
Erlbaum, 2007.
 Spiegel D. & Classen C., Group Therapy for Cancer Patients. New-York: Basic Books, 2000.

32. We say good-bye and thank
you…
 Our mission had not finished yet!