By the time kids get to treatment at Dakota Boys and Girls Ranch, they have likely been to many therapists, psychiatrists, and psychologists. They are fluent in everything related to therapy. They've learned about cognitive behavior modification, how to identify and challenge their thoughts, and many different coping skills — and none of it has been particularly helpful. In treatment, they receive more in-depth learning and have people around them 24 hours a day to coach them on how to use the things they've learned.
They also attend a variety of groups—with differing purposes, priorities, and formats. The beauty of group work, regardless of the type, is that the kids receive the same information at the same time. It allows them to build a connection, learn from each other, and keep each other accountable.
I love it when a child talks about something that happened that week, and other kids said, "Did you try this?" Or, "Yeah, that happened to me too, and it really helped when I..."
Group therapy is particularly valuable for teenagers, as it gives them the opportunity to open up about their struggles and successes and realize they are not alone in their journey.
If you are sitting with me in individual therapy, I can tell you that everyone with Post Traumatic Stress Disorder feels the same way, but you're like, "Whatever!" If you're in a group with five of your peers who feel like you, it makes you not weird. You aren't unique or have special problems that can't be solved. If you share this bond, then maybe, just maybe, you can heal because other people have these same feelings, and they've been able to heal.
Sharing experiences in a group setting helps validate our kids' feelings and provides them with new perspectives and coping strategies. Group therapy fosters empathy and allows them to learn from each other's insights and mistakes.
At the Ranch, we hold groups four days a week, after school, and after dinner. In addition to up to three different therapy groups per week, residents participate in Nursing group, Case Management group, Occupational Therapy group, Rec and Wellness group, and Spiritual Life/Moral Development group. While the format and purpose of each group are different, they are all about creating connections and shared experiences.
Cognitive Processing group, one of our therapy groups, specifically focuses on trauma treatment. The kids don't share their trauma narrative or go into detail about their trauma, but talk about the thoughts and beliefs shared by others who have experienced trauma. Like,
"It's my fault."
"I deserved what happened to me."
"If I had done X, Y wouldn't have happened."
In this group, we talk about how trauma has impacted their thoughts and how to challenge those thoughts. We also discuss themes like safety, control, self-esteem, and trust and how kids can rebuild those things in their lives. 
Another group we hold consistently is Cognitive Behavioral Therapy (CBT) group for depression. In addition to focusing on social skills and doing pleasant events even when you don't feel like it, CBT is about challenging negative or irrational thoughts. For instance, if a child answers a question wrong in class or thinks someone gave them a mean look, their thoughts might quickly escalate.
"I am stupid."
"I am worthless."
"I will end up alone."
"People can't be trusted."
In CBT group, we ask the kids to give examples of negative thoughts they've had during the week. The therapist then asks questions that challenge their negative thoughts or self-talk.
"What is the evidence that this is true?"
"Are you confusing a thought with a fact?"
"What would you tell a friend who was having that thought?"
"What is the worst that could happen?"
The goal is to have enough practice and reinforcement from their peers and staff outside of the group so they can catch themselves having a negative thought and challenge it on their own.
In Dialectical Behavior Therapy (DBT) group, kids learn all kinds of skills, from your "basic coping skills" (or crisis survival skills like distraction) to mindfulness, interpersonal effectiveness, and emotion regulation. Someone once told me that DBT distress tolerance skills (or the "basic" coping skills) are like an EpiPen. When you have an allergic reaction, you give yourself a shot with the EpiPen to prevent the initial reaction from getting worse. But you still must go to the hospital. The crisis survival skills get you through the initial reaction, but then you must use the more complicated skills (like emotion regulation) to heal at the next level. Our DBT and Acceptance and Commitment Therapy (ACT) groups focus on the more complicated skills that take it one step further to acceptance.
Acceptance is the foundation of change. We cannot change something we don't accept. If the walls in my office are painted a horrible puke green color, and I come in every day pretending they are yellow and saying how much I love the color, I'm never going to change it.
In the same way, kids come to the Ranch saying they don't need to be there. Fighting the reality of their circumstances prevents them from moving forward. They might spend all of their time being angry, refusing to go to school, refusing groups, refusing therapy, and fighting with staff. They do everything they can to prove they don't belong here.
It's almost irrelevant if they should be here or not. The reality is that they are here. The more they deny the reality of their experiences or circumstances, the harder it is for them to heal.
I tell the kids, "If you want to move forward and get discharged from a residential treatment facility, you must first accept that you are in one."
Group attendance and participation
It's not uncommon for kids to refuse to attend group because it's hard work.
All teenagers have times when they are afraid of feeling inadequate or of being judged. It's easy for them to fall into the comparison and competition trap that can arise in a group setting. It's no wonder that teenagers with trust and trauma issues might have a difficult time engaging and participating in group therapy.
At the Ranch, we reinforce the value of simply showing up at group and then shape it from there. Every week, each child gets a punch card. If they come to a group, they get a punch, even if they just sit and stare at the floor. If they participate in the group, they get another punch. If the group has homework and they come to the group having completed last week's homework, they get additional punches.
They collect these punches throughout the week, and at the end of the week, they can trade them in at "The Coping Store" for things that help them work through their emotions (journals, fidgets, and Squishmallows, egg-shaped cuddly toys that help some kids feel calmer and less anxious). Some items they can purchase with one week's worth of punches, and others they need to save up for. Earning punches for the coping store is a great motivator for kids to attend and participate in groups.
We also name a weekly "Group All Star." The group leaders get together to name the child who did the best in groups throughout the week. The Group Star gets to choose between an extra punch card with 20 punches and a one-on-one outing with the group leader of their choice.
Finally, we incorporate fun activities into groups to reinforce what the kids are learning. The art you see at the end of this article came from a group art project. We asked the kids to take some of the thoughts they struggle with and change their relationship to those thoughts by painting them in bright, fun colors. We tried other strategies to change our relationships to the thoughts as well, such as saying the words really fast or slow, saying them in a funny voice, or singing them to various tunes.
By the end of the group, the kids were laughing and having fun with these heavy thoughts instead of being weighed down by them.
Groups promote healing
Integrating groups into residential treatment promotes a sense of community, encourages personal growth, and provides support and connection among the residents. Harnessing the power of shared experiences and building community through groups can be incredibly helpful in promoting healing.
This article was originally published in Ranch Voice: Winter 2023.
Read more stories like this and explore other issues of Ranch Voice here.