Live Healthy Counseling

Linda Monique Gali, MA, LMFT, CAAP

Groups

Unlocking the Inner You: Building Self-Esteem with your Companion Animal

8 Week Group for Increasing Self-esteem in Adolescent Females using Animal Assisted Psychotherapy

 

 

Abstract

Teenage girls are facing numerous challenges in our modern culture during the critical developmental stage of building identify and self-esteem.  Their challenge is to maneuver these years successfully, so they can gain a strong sense of who they are, learn what defines their worth and role in society, and how to live according to their values, in spite of outside pressures.  However, teen girls are experiencing a strong need for a sense of belonging and acceptance with peers and family.  Many teen girls may have difficulty mastering the aforementioned tasks, if they are having difficulty coping with family problems, are being sent messages by their peers and by boys about acceptable behavior and appearance,  have faced a history of trauma or abuse, or are receiving pressure to choose a job, career and succeed academically.  It is natural to experience low self-esteem as a result of these internal conflicts which may develop.  As such, this group, Unlocking the Inner You: Building Self-Esteem with your Companion Animal, is designed to provide peer support in a safe group environment, while utilizing the benefits of Animal Assisted Psychotherapy.  Teens are invited to bring their pet dog to group meetings which will serve as an ice-breaker, anxiety-reducer, soothing agent, and medium for projection of relational dynamics within the group environment.  The group theoretical approach is based in psychodynamic theory where change occurs through the developing relationships with peers and animals. In the group dynamic, roles may naturally occur such as leader, wallflower, caretaker, and challenger.  Members are invited to provide support to their peers and provide their insights about other members' group roles, experiences and personalities.  Through this group dynamic, members elicit new ways of thinking and behaving for each other by exploring transference and breaking through defense mechanisms.  In addition, facilitators will be observing the way members interact with the animals and the complex intersectional dynamics which are developing within humans and animals.  Animals will provide a medium for projection of self-esteem and identity development.  This group emphasizes acceptance of group members' shortcomings while magnifying strengths, especially while members share their thoughts and feelings about intimate past personal experiences, developing beliefs and values, and current conflicts.  The goal is for teenage girls to raise their self-esteem and promote self-acceptance and identity that will be carried into adulthood.

 

Core Objectives

  1. Develop an improved sense of self- esteem- adolescence is a time marked by attacks to self-esteem and identity conflict. Higher self-esteem is associated with improved life decisions, better coping skills, and healthier inter-personal relationships. Animals act as an object with which teens can make associations and explore analogies relating to self-esteem and identity.
  2. Develop stress management coping strategies- through assistance of animals and mindfulness based practices. The group will promote wellness through–stress management, realistic beliefs, self-worth, and healthy coping habits. Through engaging socially with peers and animals in the outdoors, teens will benefit from elevated mood, sunshine, and increased endorphins and oxytocin. Animals will provide enhancement of these factors.
  3. Make connections and develop social support- Pets will provide their teen owners with a medium to connect with their peers through lowering arousal while sharing a common bond. Studies show how animals can help create human-to-human friendships and social support, both of which are good for long-term health. Dog handlers are encouraged to communicate and bond with each other about topics important to teen life and self-esteem while in a spontaneous, stimulating and nature-based environment.
  4. Identify personal positive attributes and strengths- The group promotes the development of positive thinking and self-talk through exploring personal experiences and pressures which may hampering and realistic and healthy self-concept. Group members are encouraged to point out each other’s strengths.
  5. Recognize the power in personal choices- The group will engage members in interventions aimed at using creativity and introspective exploration of life domains which they can control and manage, leading to improved academic performance and relationships with self and others. Focus is on personal choices, enhanced sense of personal power, and capabilities increasing self-esteem

 

Assessing Level of Self-Esteem:

To assess a potential group members’ level of self-esteem the teenager will complete the Rosenberg Self-Esteem Scale at the beginning and end of group.  The scale was developed based on the data of 5,024 adolescents from American schools (Rosenberg, 1965).  This 10-item scale takes only a minute or so to fill in.  The Rosenberg Self-Esteem Scale is a 10-item self-report measure of global self-esteem. It consists of 10 statements related to overall feelings of self-worth or self-acceptance. The items are answered on a four-point scale ranging from strongly agree to strongly disagree. The SES has also been administered as an interview.  The scale ranges from 0-30. Scores between 15 and 25 are within normal range; scores below 15 suggest low self-esteem. Members of the group will be asked to fill out the paper version or online version if they are unable to be screened in person.  Eligible members must score 15 or lower to join.  This inventory will be used pre and post-group to measure change and group efficacy.

http://fetzer.org/sites/default/files/images/stories/pdf/selfmeasures/Self_Measures_for_Self-Esteem_ROSENBERG_SELF-ESTEEM.pdf

https://www.wwnorton.com/college/psych/psychsci/media/rosenberg.htm

 

Structure and Goals of the Group

Group Purpose and Target Population:

Adolescence is a time that is often characterized with low self-esteem and identity conflict, particularly for females. As such, this group is targeted for 15-19 year old females who are experiencing a lower level of self-esteem as identified by the Rosenberg Self-Esteem Inventory. The purpose of this group will be to provide these adolescents with a safe, caring environment in which to explore and process the concept of self-esteem, explore their own identity development, and build connections to peers with the assistance of animals.

Type of Group:

This group will be a closed group and include anywhere from 6-8 members. The group will run for 9 weeks and each session will run for an hour and a half. The group is structured using a process-based model and open discussion forum.  Each session will draw from a topic and include a worksheet. Interventions that will be used draw from a variety of therapeutic models including Ecotherapy, Animal Assisted Psychotherapy, Psychodynamic therapy, and including mindfulness based Cognitive Behavioral Therapy. 

Goals: 

The long term goal of the group is to increase member’s self-awareness and identify, increase positive coping skills, and to increase social support from peers through mutual respect for cultural diversity and unique life experiences.  Through the use of a natural outdoor environment, teens will be able to benefit from healing properties of being of the outdoors.  Each session is designed to enrich, empower, and develop each member’s sense of identity and self-esteem through specialized topics and activities (listed in curriculum.)

Fees:

Group members will not pay any fees to join this group, as it will occur on public city park property. Any fees that arise during the duration of the group (e.g., supplies required and fees to purchase) will be charged at the beginning of each session in the amount of $30.

Location and Set Up:

Group sessions will be held in the Huntington Beach Central Park adjacent to the dog park. Sessions will be held on Saturday mornings at 10:30am. Seating to form a circle will be set-up, as well as, tables, dog treats, water, snacks and materials as needed.

Drop Out Policy:

Participants will be asked to attend for at least three sessions before making the decision of whether to not to continue in the group. Participants will be asked to give at least one week’s notice prior to leaving the group.

 

Expectations for Group Members:

Group members will be expected to adhere to some basic group rules. Group members will be given the opportunity to expand and/or personalize these rules during the pre-group meeting to review the basic group rules that will be distributed and discussed with group members.

Prep and Debriefing Time for Facilitators:

Group Facilitators will meet 30 minutes before the start of each group session to review the lesson plan for that session and organize any material that will be used. The facilitators will then meet for 30 minutes after each session to debrief and complete documentation. Examples of the debriefing questions that will be used are: “What stood out for you the most in this session in regards to work done by members? What stood out for you the most in regards to strategies or interventions I (the co-facilitator) used? What do you perceive as one success of this group session? What was one thing that you think we could have done better?”

Facilitation Information:

This group will be co-facilitated by two female counselors. At the very minimum, group facilitators need to have taken a training course specific to group counseling and adhere to a code of ethic specific to group counselling. They will also engage in personal counselling if issues arise that would be better dealt with in an individual counseling setting. In the event that one facilitator is unable to attend a session, group members will be contacted via telephone and an additional session will be scheduled.

Learning Diversity:

There are a wide range of learning styles (e.g., auditory, visual, kinesthetic) and preferences on type of learning environment (e.g., individual activities versus partner activities). As such, this group will incorporate a wide range of activities that are aimed at meeting the needs of the different learning styles and preferences of the group members. Throughout the 9 week group there will be interventions that participants are asked to complete by themselves, with a partner, in small groups, and as a whole group. In addition, there will be some activities that involve nature and animals while moving around the outdoor environment.

Multicultural Diversity:

Part of engaging in ethical group counseling is being aware of, acknowledging, and incorporating discussions of multicultural diversity into group counseling sessions. Some specifics ways in which the co-facilitators will incorporate discussions of multicultural diversity into this group and remain attuned to how cultural diversity may be impacting group processes are:

-The pre-group session includes an exercise where members are asked to write down one word that describes what it means to them to feel supported or accepted. The facilitators will then read these words and facilitate a discussion of the different meanings/backgrounds that members attribute to what they need to feel supported and accepted.

-When discussing the basic group rules, these facilitators will incorporate a discussion of the different ways of behaving and rules that members have at home.

-Session one will include a discussion among members about the similarities and differences that the group members and facilitators bring with them into the group.

-Both facilitators will spend time during debrief and supervision sessions, reflecting on and discussing how their own cultural backgrounds may be impacting their understanding of group members and interventions they are selecting.

 

8 Week Curriculum

WHAT THE GROUP LEADER DOES/ WHAT THE PARTICIPANTS DO

 

Pre-group meeting- Getting to know you

Forming

5 MIN - Agenda

Overview: Leader will discuss the objectives and agenda for this group meeting (i.e., to review the purpose and nature of the group, talk about what members can expect from the group process, discuss members’ and facilitators’ rights and responsibilities, talk about confidentiality, and spend time answering any questions members might have). Participants are listening and asking questions.

10 MIN - Discussion of Roles

Leader will discuss the Roles of Group Members, Assisting Animals, and Facilitators: It will be important to discuss the role of group facilitators (e.g., highlight that it is different than that of a teacher) as well as the roles and expectations of group members (e.g., to participate in the group, to attend regularly, to have their cell phone turned off during the group, etc.) and animals (as an aid to interventions such as self-soothing.) This could be done through using a flip chart and asking members to identify (or write down) words that come to mind when they think of the terms “group facilitator”, "companion animal" and “group member”.  Members will find pairs and engage in ice breaker activity of learning something unique/interesting about their partner and their partner's animal which can be written down in workbook.  Members will share what they learned with the group. Participant are listening to information and participating in flip chart activity.

 

15 MIN- Education

Leader will discuss Commitment to the Group and its Work: Discuss what self-esteem is and provide a brief overview of the purpose of using Animal Assisted Psychotherapy and Psychodynamic Group Therapy to explore members’ self-esteem. Briefly overview the curriculum for the group and topics that will be covered each session.  Have the members break into facilitator selected pairs and share one past group experience that they have had, what they liked and what they did like about this experience. Then have each member write down one goal they have for this group on a blank piece of paper (they do not need to write down their name on this paper) and place it in a box that gets passed around.  Member will be asked to introduce themselves, their pet, pull a goal out of the box and read it to the group. Participants are listening for information and sharing in AB partners. Participants are writing down goals.

 

10 MIN- Group Rules

Leader will explore the Collective Process Inherent Group Work as well as Group Rules: One group facilitator will then read these goals, and help to facilitate a discussion of how each of these goals tie into what will take place in this self-esteem based group. Building off of this discussion, group facilitators will discuss confidentiality, the importance of attendance, respecting different opinions, understanding how culture plays a role in our transactions styles, discuss group rules, and the value of being open and honest throughout the group process. Leader will ask participants if there are any other group rules they would like to add? Participants are listening for information & responding to question.

 

10 MIN - How Change Occurs

Explore with the members how their interactions within the group can provide them with a safe space to practice new behaviors and ways of expressing themselves outside the group. One activity could be to ask members to put their heads down and close their eyes, then ask them to put up their hand if they “ever wished they had acted a different way or said something different to somebody?”, “if they ever felt that you did not know how to act or what to say in a social situation?”. The facilitators could then ask the members to think about how it felt to raise or not raise their hand to these questions. Afterwards, the facilitators would discuss how one purpose of this group is to practice new behaviors/ways of thinking and process what members are feeling right as it is happening for them in the group setting. Participant are listening for information, hand raising activity.

 

15 MIN - Discussion on Support

Leader will highlight the importance of Mutual Support and Acceptance: Ask the members to write down one word that comes to mind when thinking about being supported or accepted, and then ask them to place that piece of paper in a box. Based on these words, the group facilitators will facilitate a discussion of what it means to support and accept one another, through incorporating a discussion of similarities and differences that may underlie the words selected by members. Facilitate discussion around how member backgrounds could impact our response and how we can support one another’s cultural values. Participants will complete one word activity and participate in a discussion.

 

10 MIN - Informed Consent/ Risks and Benefits

Leader is discussing the Benefits and Risks of Engaging in the Group Interventions: The group facilitators will discuss the benefits that can arise from this group (e.g., increased understanding of self, feeling better about one’s self, and improved relationships with others) as well as the risks. This could be a good time for one (or both) of the facilitators to briefly self-disclose about having tried something that they did not think they would be good at, and what they learned from engaging in this activity anyways. The facilitators will then briefly discuss the different AAP interventions to be used and the risks/benefits that may arise from engaging in an activity, even though the member may have never engaged in this activity and/or feels hesitant in doing so. Participant will listen for information.

 

5-10 MIN Q & A

Leader is responding to questions in Question Period: At this point, leaders highlight to members that this pre-group meeting will be ending soon, and ask members to write down any questions that they have and place them in a box to be addressed at the start of the first official group session. Participants are asking questions.

 

5-10 MIN Wind Down Activity

To provide the members with a wind down activity we will have them select an animal in the group with they identify an emotion with (antsy, restless, happy, relaxed, sleepy, sad, lonely) and talk about a time they felt that way, and explain why they picked that animal to the member sitting to the left of them.

Total Time: 1 1⁄2 hours+ 30 minute debrief with co-facilitator.

 

Session 1- Building on Strengths and Values

Storming

 

10 min- Agenda and Snacks

30 minutes- Discussion

What is cultural identity? What is spirituality? How does culture and spirituality inform our values? What does the value mean to you? What are your personal values? How did you learn them?

30 minutes- Activity

Partner up with someone new. Meet and greet with your partner and their dog. Which animals have values of compassion, patience, staying connected to each other, living in the now, acceptance of differences, and respect for elders, responsibility, listening carefully, living lightly, sticking together, being forgiving, respecting nature, and being loyal? Talk to each other about some of your values from your family passed down?  Do you have any personal values that are developing?

10 minutes- Process Activity

 What does it mean to lead a value driven life? What does it mean to be internally motivated vs. externally motivated? How could motivation affect our self-esteem?

10 minutes- Wind down Activity

 

Session 2 - Exploring Self-Acceptance through Animal Acceptance

Storming

 

10 minutes- Check in, Agenda, and Snacks

20 minutes- Learning and Discussion

Pets are happy, loyal creatures. They are not judgmental and they don’t care what you wear or how you look. When you are feeling down or ill they are right by your side. They emit pure positive energy and unconditional love. They enjoy every moment with you as if it were truly the greatest gift. When you come home, your pets will greet you at the door and show you just how much they missed you (even if it were only an hour).

30 minutes- Activity

Explore your animal’s strengths and weaknesses which you accept unconditionally in them?  Do they get aggressive, do they poop in the wrong places, and are they socially anxious or overly friendly at times?  What are your strengths and weaknesses? How can you maximize your strengths?

30 minutes- Discussion

How does your pet show you unconditional love? Do you put conditions on accepting yourself? What do you find yourself most critical about?  When do you get angry at yourself?  What are the voices or tapes playing in your thoughts when you feel sad or anxious?  What do you think your animal that loves you unconditionally would say to you in those moments? What was that activity like for you? How was it difficult? How did giving yourself permission feel?

5 minutes- Wind down Activity

Homework

PRACTICE UNCONDITIONAL LOVE with yourself by identifying negative and positive self-talk and practicing self-compassion.

 

Session 3 - Identifying Positive and Negative coping

Norming

5 minutes- Agenda and Snacks

20 minutes- Learning

What is rumination? What is phishing? What is the right and wrong trap? How have you used these negative coping strategies in the past? What is the risk in relying on with using these types of thinking patterns?

40 minutes-Discussion

 Share with group a difficult experience you are having in your life and how you are coping with it. Group members offer support and insight about how they cope.

20 min- Activity

Identify how you know your animal is stressed.  Do they scratch, bite or chew incessantly?  Do they isolate or becomes depressed?  Identify ways to sooth your animal when they are in distress.  How can you help them calm down? Know they are safe and protected?  Make them comfortable with the situation? 

How can we positively sooth ourselves in times of distress?  How would you like to be soothed and supported by your parents or friends?  What can you do or say to have these needs met?

5 minutes- Wind down Activity

 

 

Session 4- Confidence, Mastery, and Self-efficacy

Norming

5 minutes- Agenda and Snacks

20 minutes- Learning

Talk about a time you really wanted something and were unable to have it?  Talk about a time when you were able to achieve a goal you set? What is a “confidence mindset”; what are “give-up thoughts” and “go to thoughts”?

30 minutes- Activity

Teaching dog a new trick - Lay the foundation for youth’s positive, respectful, and successful relationship with their therapy dog. Objectives of teaching the therapy dog a trick are to: Demonstrate the learning process, Inform the youths on the importance of appreciating each small progressive step that goes into building a finished product, Help the youths cope with the nonlinear learning process and problem solving that comes with teaching a new behavior to a different species.

30 minutes- Discussion

Discussion: How does teaching the dog to learn something new relate to your life? What is acceptance? How does it differ from resignation and feelings of failure? How was being positive, respectful, and attentive to your dog's needs important as you were teaching a new trick? Can you identify what can and can't be changed about learning something new?

5 minutes- Wind down Activity

 

 

Session 5- Learn and practice mindfulness strategies

Performing

20 min- Learning

Pets lead a simple life. They can sit back, enjoy a drive to the park with their owners and take in the breeze on the way. They truly live in the NOW with calmness and peace in most situations. They seize the day and don’t let worry run their life.

Pets also take advantage of the simple things in life, like naps. How many times do you catch your furry friend sleeping? Speaking of naps, have you noticed the refreshing stretches afterwards too? They will yawn and stretch as if to take in every oxygen cell around them. Afterwards, they are stimulated and ready to go.

To LIVE in the NOW is one of life’s most important lessons and while we humans are still trying to figure it all out and do the best we can to be conscious of it, pets already have it figure out. They live in the now effortlessly and bring a depth of peace and wellness one cannot truly even describe; it must be felt.

30 minutes- Discussion

 Have you ever been stuck thinking about the past or the worries about the future? What is mindfulness? How does it work? How could mindfulness strategies improve my self-esteem and sense of well-being?

10 minutes- Activity

 Mindfulness Exercise: Listening to your pet's heartbeat. Feeling their paw.  Peel orange.  Smell Mint. Find something you normally would not notice in the park and bring it back for discussion.

20 minutes- Discussion

Were you able to be present in the activities? Did you feel a reduced sense of stress? Could you see yourself using these strategies? Do you have places or activities that make you feel present (walking, sports, hobbies etc...)?

5 min- Wind Down Activity

Homework

Be fun and spontaneous with your dog.  Enjoy the present moment.

 

Session 6- Body Awareness, Relationships and Communication

Performing

5 minutes- Agenda and snacks

20 minutes- Learning

Body Awareness: What does our body tell us about how we are feeling?  What are the signs that you are feeling sad, happy, scared, frustrated, angry, worries, or confused?  How do we communicate these emotions to others? What is isolating, shutting down, exploding, and flooding?

30 minutes- Discussion

How does your animal express their emotions? How do they seek help and get their needs met? Does your animal ever shut down seem socially anxious? How does our pet communicate with us through nonverbal language?  What is our nonverbal language and what does it mean?  How can we identify our emotions through our nonverbal communication and body awareness?

30 min- Activity

Role Play: Get to know each other better while taking mindfulness walk. Learn more about your partner's life by practicing healthy verbal communication. Ask open-ended questions, use active listening, empathy, and provide support and switch.

5 minutes- Wind Down Activity

 

Session 7- Explore body image: Coping with negative feelings about our bodies

Performing

5 minutes- Agenda and Snacks

40 minutes- Discussion

What does it mean to self-love for a body’s abilities rather than perceived liabilities?  What would this look, feel, and be like for you? How did I come to define beauty? What experiences and messages contributed to my personal body opinions? What is the purpose of my body? How does nurturing the physical self, relate to the spiritual and emotional self? What are the costs of pursuing the thin-ideal? How does physical health relate to self-acceptance and self-care?

20 minutes - Activity

Mirror Exercise: The other exercise we asked you to do was to look in a mirror and list some of your positive qualities. How did you feel when you did this exercise?

20 minutes- Processing

Now that you have gone through this, members will share their lists with the group. Remember that thinking positively about our bodies requires practice and this is one exercise will give members practice in remembering all of the aspects of themselves they are happy with! What are at least three aspects of yourself that you are satisfied with, including at least two physical features?

Begin processing saying goodbye to group

 

5 minutes- Wind down activity

Homework: A thank you letter to my body. 10 gratitude messages to your body.

 

 

Session 8- Goals, personal responsibility and discuss identity:

Adjourning

5 minutes- Agenda and Snacks

20 minutes- Discussion

How have we shown responsibility for our pets in each session? e.g. making sure they are fed, have water, are not over or under stimulated or stressed?  How can we become responsible for ourselves?  e.g. hygiene, following routine, taking initiative, caring for our health, listening to our needs and asking for support, doing school work, chores, or being more kind and caring to others.

20 minutes- Activity

Exercise: Vision Plateau.  What is your maintenance goal for after this group is over? Connect goals to social network, values, history, and personal strengths. How does this all work together? How does having a sense of these build our self-concept, sense of self-esteem, and purpose?

40 minutes- Ceremony

Each member of the group picked a flag from the circle and gave it to another member of the group, saying why they were giving that particular flag to that particular person to receive recognition for positive changes and growth observed in other members.

5 minutes- Wind Down Activity and Certificates of Achievement