- Email: [email protected]
Video therapy: An alternative for the treatment of adolescents
The Arts in Psychotherapy,
Vol. 17, pp. 165-169.
VIDEO THERAPY:
0 Pergamon
Press plc, 1990. Printed in the U.S.A.
AN ALTERNATIVE
0197-4.556190 $3.00
FOR THE TREATMENT
+ .OO
OF
ADOLESCENTS
LOU FURMAN,
MFA. RDT*
The emphasis of many therapy groups since the 1960s has been on self-confrontation. A central component in this self-examination approach is feedback-a process in which group members respond to behaviors elicited during sessions. Also fundamental in the current approach are issues of transferences, the unconscious conveyance of past attitudes and emotions to persons in the present. Although feedback and transference are basic to many therapeutic designs, these elements operate differently in the multi-member setting of the group. Investigating these key mechanisms of the group and measuring the impact of video on the members’ functioning will give some indication as to the potential for such techniques when applied to adolescent clients. The feedback mechanism becomes productive only after a clear group dynamic is established. Video techniques enable group members to “galvanize a sense of identity and meaning” (Skafte, 1987, p. 389) because the video image presents members with visible evidence of the group. Not only do members have a clear visualization of the group, but their own image on the screen allows them to view themselves from an independent and external perspective. The distancing effect permits subjects of the feedback to literally interact with themselves (Fryrear & Stephens, 1988). With the inclusion of the opportunity to view and respond to one’s own behaviors, all group members now have the potential to fully participate in a process that previously had been limited to the ther-
The influence of television on young people has yet to be clearly determined, but that the medium is firmly entrenched in their culture cannot be denied. The familiarity of adolescents with television makes therapeutic approaches that utilize video techniques an attractive alternative to traditional methods. However, questions may be raised as to the validity of such approaches. Do video techniques help achieve therapeutic goals or detract from them? Do young people respond positively to the medium in a therapeutic setting? Which video techniques have potential for the most effective treatment? The group approach, considering the adolescent context, is an appropriate framework from which to explore these questions. Individual therapy under the watchful eye of an adult may prove less productive for the adolescent whose feelings toward adults are in a state of flux and who tends to turn to peers for support and feedback (MacLennan & Felsenfeld, 1968). Peer groups and peer related problems are the focus of this population. Adolescent deviant behaviors, such as delinquency, are often exhibited in a group subculture (Empey & Rabow, 1961). The social forum being the preferred vehicle for their interactions, group therapy would be the logical setting in which these young people’s problems could be explored, expressed, and worked out (Kraft, 1961). The questions raised as to the benefits of video techniques in the treatment of adolescents may be appropriately discussed, therefore, within the limits of group activity.
*Lou Furman is Director of Youth Drama, School of Music and Theatre Arts, Washington
165
State University,
Pullman,
WA.
166
LOU FURMAN
apist and others in the group. This broadening of the feedback mechanism has been identified as a “new self-reflexive loop of awareness” (Skafte, p. 389) in treatment. The opportunity for all to share in the feedback process does not ensure that behaviors viewed can be understood. A major determinant in the accurate interpretation of behavior is the clarity with which the feedback is presented (Stoller, 1968). Videotape replay is unique in its ability to clarify behaviors through repeated, detailed, and meaningful re-experiences of events (Alger, 1969; Berger, Sherman, Spalding, & Westlake, 1968; Skafte, 1987) by revealing dialogue initially obscured during a session (Stoller), and in presenting amorphous and complex interactions concretely (Alger; Skafte). The playback process reduces or even defeats denial systems faced with repeated confrontations of self-evident patterns of behavior (Berger et al., 1968; Danet 1968, 1969; Skafte)
The use of video enhances another aspect of the feedback process-the nonverbal response. The selfviewing aspect during the replay is in and of itself a form of feedback (Stoller, 1968). Another dimension of the nonverbal element may include the behavior that is the focus of the feedback. The interaction being explored itself may be nonverbal. Group members may find it difficult to describe or respond to nonverbal behaviors in a verbal mode. But videotape replay provides the potential for a nonverbal response to these numerous incidents of group interaction. The unique contribution of video technology to the feedback mechanism is underscored by the fact that the medium captures “the full significance of spontaneous, expressive behavior” (Paredes, Gottheil, Tausig, & Comelison, 1969, p. 288) immediately after the event or at any interval during the period of treatment. Feedback is no longer limited to recent behaviors or the vague recollections of past interactions. Any past group interactions that take on significance during the therapy may be replayed at any time and as often as necessary for group or therapist review. The discussion of video feedback takes on another significance when focused on the adolescent population. Young people are in the midst of a rebellious stage in which they are most likely to resist directions from any adult (Anderson & Stewart, 1983). Feedback based on video images provides a communication link through a nonthreatening other in the group. Most group members, regardless of age-but specif-
ically adolescents with a distrustful attitude toward adults-are more comfortable responding to the nonperson videocamera and image than they are to a group leader, a phenomenon observed in a number of studies (Alger, 1969; Berger et al. 1968; Mallery & Navas, 1982; Petitti, 1989; Skafte, 1987; Stoller, 1969). The common theme cited in these studies is the perceived objectivity of the video camera and image. In addition, comfort levels appear to increase when the adolescent has control over some or all of the video equipment. The overall result is a de-intensification of transference that may expedite the establishment of a working relationship between the therapist and group members. Transference reduction occurs further when the therapist is included in the group video process. The leader’s participation allows members to view the therapist more objectively than under other circumstances and creates a “democratic and equalitarian therapeutic relationship” (Alger, 1969, p. 430). The less authoritarian style may alter the focus of the relationship to form an alliance between therapist and client that fosters nontransference responses conducive to treatment. The therapist benefits from the objectivity as well, for the video image allows the leader to dissociate and divert from the “frequent preoccupation with mothering the family” (Berger, 1978). The positive influences of video techniques on the transference phenomenon should not be assumed unquestionably. Wachtel, Stein, and Baldinger (1979) suggest that the group as well as the therapist may be lured into a false sense that video playback viewing is largely transference-free. In actuality, the video equipment and process may be perceived by the group as “powerful extensions of the authority, omnipotence, and omniscience of the therapist” (p. 82). This impression would likely interfere with the reduction of transference interactions and the establishment of a working alliance. The above caution accepted for the moment, a basic rationale for using video therapy with most age groups has been forwarded. However, video techniques in therapy offer advantages to the adolescent that go beyond the general benefits cited thus far. Many conventional treatment methods, useful with adults, are less successful with adolescents. Literature dealing with young adults often refers to the need to modify traditional therapeutic treatment for adolescents because of their outgoing tendencies, impulsive behaviors, and difficulty in handling the anxiety that
VIDEO THERAPY accompanies intensive internalized explorations (Corder, Whiteside, McNeil, Brown, & Corder, 1981; Lorand & Schneer, 1962; Skafte, 1987). An alternative to traditional models is treatment that incorporates a video approach. Young people of today, reared in a world of television, are comfortable with activities that involve video (Marvit, Lind, & McLaughlin, 1974; Petitti, 1989; Wilmer, 1970). Comfort levels aside, the positive effect that video has on issues previously raised-feedback and transference -are equal or greater for young people than for other populations. Skafte (1987) suggests that adolescents’ favorable response to video feedback practices may be due in part to their underdevelo~d skills in self-obse~ation. The replay aspects of video feedback may help to augment and sharpen those skills. Although the theoretical foundation for the phenomenon may not be clear, research in the field indicates a definite link between enhanced participation of adolescents in treatment and the use of video feedback in therapy (Corder et al., 1981; Marvit et al., 1974; Wilmer, 1970). In one nine-month study, the treatment for 10 adolescent patients confined to a state mental hospital alternated between sessions in which videotaped excerpts of the previous meeting were reviewed preceding the session and meetings that did not include videotaped selections (Corder et al., 1981). The findings noted increased frequency of verbal feedback, intimacy levels, and frequency of peer interactions in group functioning for those sessions that included the video feedback. Transference issues discussed earlier are especially important for the adolescent because transference, although present in all therapeutic activity, occnrs in abundance in work with adolescents as they struggle with strong feelings of dependency on adult authority figures (Kraft, 1961). Countertransference is a strong factor in such situations as well. The therapist dealing with young people may easily slip into a parental role @aft). The de-intensified transference phenomenon associated with video therapy would be especially beneficial with this group of clients. The studies and arguments presented indicate that video can be a valuable ~era~utic tool when used in treatment of adolescents. The question remains, which video techniques would be most effective in reaching young people. Video feedback incorporated into traditional treatment has its advantages as cited. However, feedback in itself may be considered a passive activity, not totally in keeping with the “typically
WITH ADOLESCENTS restless” (Kraft, 1961, p. 36) demeanor of the adolescent. Active participation in treatment would result in a positive response from adolescents who would welcome some control over their destiny, power that is denied them by our society in their daily lives. They are given few meaningful adult responsibilities, are often restricted in their comings and goings, and have little or no authority in the adult world. People who believe that they cannot determine their own fates are unlikely to be able to cope with stresses, are less able to develop a clear measure of their own worth, and develop a fatalistic attitude of helplessness to alter their circumstances (Lefcourt, 1976)-characteristics that are found in many young people. The consequences are that the prime motivators for adolescents are “feelings of inferiority and despair” (MacLennan & Felsenfeld, p. 44). Such attitudes make it most difficult for anyone to initiate changes in his or her lifestyle, much less a young person floundering for identity between child and adult worlds. A viable option to change this perception is through “actionoriented therapies” (Lefcourt, p. 126). The video process offers several ways in which clients may take an active part in the treatment. The simplest method uncovered in researching the topic involves a stop-start switch that controls the video playback unit (Pascal, Cottrell, & Baugh, 1967). The treatment itself was traditional in nature, but each session was videotaped, and after each treatment the clients, five delinquent boys, viewed the tape and commented on the meeting. The stop-start switch was accessible to both therapist and group members. Anyone could stop the viewing of the tape at will to initiate discussion. The researchers concluded that the method allowed for insight and hindsight into behaviors of the group. They felt, in addition, that the self-confrontation method allowed for reinforcement of positive behaviors and helped reduce the deviant behaviors revealed in the review of the videotape. Access to the playback unit during the feedback process offers limited control to the adolescent, however. Locus of control would be best influenced if the client had input into the videotaping process itself. The young person’s desire to become an active participant in the recording of sessions is evident from the work of Mallery and Navas (1982) in which several of the preadolescent boys spontaneously chose to operate the camera. The boys used the video equipment to guide the group in such a way as to facilitate or redirect group focus on issues of interest
168
LOU FURMAN
to them. One boy, for example, moved the camera to include another member of the group who had chosen to remain out of the camera’s range. Operation of the camera by the group members may help break through the initial resistance of those adolescents who are uncomfortable with the video process. The progression toward group involvement can begin with work behind the camera (with its accompanying feelings of control and self-esteem as operating skills are developed) and move toward full participation on camera. Such a sequence was evident in the work of Petitti (1989). In that study, the subject was reluctant to be in front of the camera in the first sessions but gradually, through the process described above, he came to a position of leadership within the group. Increased locus of control under circumstances in which a group member is the camera operator will lead to other positive developments in the therapy. The sense of control is expanded as camera operators realize that they have the power to determine what the camera will record and, thus, the behaviors that will be the focus of the replay discussion. At another level, group members may come to question the choices made by the camera operator. Why, for example, did the boy cited in Mallery and Navas (1982) choose to focus on the group member who did not wish to be included in the picture? The additional opportunities to explore behaviors from several perspectives will most likely enhance the group therapeutic process. A further advantage of an in-group operator is that the process helps offset the concerns discussed earlier in which the therapist is perceived as all powerful. If group members are the camera operators, they control the equipment and take on responsibility for its operation. The adolescent shares an active role in the treatment that supports an atmosphere in which a working relationship can develop with the therapist. One further step remains in order to take full advantage of the opportunities offered by video technology for the adolescent population: control over the actual content of the sessions to be videotaped. The concept is not new or unusual, especially in the area of drama therapy in which clients regularly improvise or create scripted materials to express their concerns. These approaches to therapy are very effective. However, the possibility of videotaping and allowing clients to view and give feedback to their creations in a manner and with the benefits described earlier seem to combine and amplify the benefits of the two
approaches. A small number of studies have been conducted with adolescents as camera operators for their own videotaped improvisational and scripted dramas (Dequine, 1981; Dequine & Furman, 1988; Dequine & Pearson-Davis, 1983). Some researchers, such as Petitti (1989), imply that all interactions during the video therapy are dramas being played out. However, the emphasis here is on work that is developed by the adolescents for the purpose of performance in front of the camera. This technique allows the group members a high level of control over content and recording, almost to the exclusion of the therapist. In the Dequine and Pearson-Davis (1983) pilot study, seven adolescent students from a school associated with an institution for emotionally disturbed children were selected for videodrama classes over a nine-week period. The subjects developed their own improvised plays, which were videotaped, edited, and finally presented to an invited audience. The therapist provided a structure and facilitated the role playing process. The adolescent group members brainstormed and chose a theme for the drama, selected a setting, and defined characters to be portrayed, and then set up, improvised, and videotaped the first scene of the drama. The scene was played back, discussed, and redone if so desired by the group. The process continued until the drama was completed and edited for presentation. Dequine and Pearson-Davis (1983) measured staincreases in internal locus of tistically “significant control among participants” (p. 20). Anecdotal support for the process came from caseworkers’ comments and reports that six of the seven subjects had experienced breakthroughs in treatment over the course of the experiment period. Dequine and Pearson-Davis established a projective technique as an alternative treatment for adolescents that has numerous positive outcomes that include: (a) immediate feedback about decision-making skills, (b) centralization of locus of control, (c) high levels of self-expression, (d) acceptance of leadership roles in a group setting, (e) increased levels of self-esteem, and (f) effective closure processes (personal communication, 1988). The evidence presented in the above experiment suggests that an approach to video therapy in which group members control the equipment and the content of the videotape recording, especially if the content is active in nature, may be an extremely effective approach to adolescent treatment. Combining video techniques and drama therapy practices, Dequine and
VIDEO THERAPY Pearson-Davis developed a therapeutic approach for adolescents that considers their basic need to control their environment while offering them the opportunity to practice life coping skills. Other works cited earlier establish a firm support for the viability of video in therapeutic activities with adolescents. Limitations in the studies, such as the small number of subjects in most cases and the lack of measured statistical support in other investigations, suggest that further research should be conducted to ascertain the specific benefits of and appropriate situations for such treatment. The present lack of clearly defined guidelines for the application of video technology in adolescent treatment may be the cause for limited current use. Also, therapists may not feel comfortable with the video equipment or technology in their practices. They may believe it disruptive or that extensive video use might come at the expense of direct interactions among clients. Others may feel threatened by the inherent democratizing process that accompanies group participation in video activities. However, considering the clear benefits of a video strategy in dealing with an adolescent population, therapists would be doing a disservice to their young clients if they did not at least consider some form of video therapy as part of their treatment plan. References Alger, I. (1969). Therapeutic use of videotape playback. Journal of Nervous and Mental Disease, 148, 430436. Anderson, C. M., & Stewart, S. (1983). Mastering resistance. New York: Guilford Press. Berger, M. M. (Ed.). (1978). Videotape techniques in psychiatric training and treatment. New York: Brunner/Mazel. Berger, M. M., Sherman, B., Spalding, J., & Westlake, R. (1968). The use of videotape with psychotherapy groups in a community mental health service program. International Journal of Group Psychotherapy, 18, 504-5 15. Corder, B. F., Whiteside, R., McNeiil, M., Brown, T., & Corder, R. F. (1981). An experimental study of the effect of structured videotape feedback on adolescent group psychotherapy process. Journal of Youth and Adolescence, 10, 255-262. Danet, B. N. (1968). Self-confrontation in psychotherapy reviewed: Videotape playback as a clinical and research tool. American Journdl of Psychotherapy, 22, 245-257. Danet, B N. ( 1969). Videotape playback as a therapeutic device in group psychotherapy. In&b&al Journal of&Group Psychotherapy, 19, 433440. Dequine, E. R. (1981). Videotaped improvisational drama with emotionally disturbed adolescents: A pilot study. Unpublished manuscript.
WITH ADOLESCENTS
169
Dequine, E. R., & Pearson-Davis, S. (1983). Videotaped improvisational drama with emotionally disturbed adolescents: A pilot study. The Arts in Psychotherapy, 10, 15-21. Dequine, E. R., & Furman, L. (1988, November). Video - An effective strategy in drama therapy with young people. (Cassette recording No. 4. 300390) Los Angeles: National Association for Drama Therapy. Empey, L. T., & Rabow, J. (1961). The Provo experiment in delinquency rehabilitation. American Sociological Review, 26, 679-696. Fryrear, _I. L., & Stephens, B. C. (1988). Group psychotherapy using masks and video to facilitate intrapersonal communication. The Arts in Psychotherapy, 15. 227-234. Kraft, I. A. (1961). Some special considerations in adolescent group psychotherapy. International Journal of Group Psychotherapy, II, 196203. Lefcourt, H. M. (1976). Locus of control: Current trends in theory and research. New York: Wiley. Lorand, S., & Schneer, H. (1962). Adolescents: Psychoanalytic approach toproblems and therapy. New York: Paul B. Hoeber. MacLennan, B. W., & Felsenfeld, N. (1968). Group counseling and psychotherapy with adolescents. New York: Columbia University Press. Mallety, B., & Navas, M. (1982). Engagement of preadolescent boys in group therapy: Videotape as a tool. International Journal of Group Psychotherapy, 32, 453467. Marvit, R. C., Lind, J., & McLaughlin, D. G. (1974). Use of videotape to induce attitude change in delinquent adolescents. American Journal of Psychiatry, 131, 996-999. Paredes, A., Gottheil, E., Tausig, T. N., & Comelison, F. S. (1969). Behavioral changes as a function of repeated selfobservation. Journal of Nervous and Mental Disease, 148, 287-299. Pascal, G. R., Cottrell, T. B., & Baugh, J. R. (1967). A methodological note on the use of video tape in group psychotherapy with juvenile delinquents. International Journal of Group Psychotherapy, 17, 248-25 1. Petitti, G. J. (1989). Video as an externalizing object in drama therapy. The Arts in Psychotherapy, 16. 121-125. Skafte, D. (1987). Video in groups: Implications for a social theory of the self. International Journal of Group Psychotherapy, 37, 389402. Staller, F. H. (1968). Focused feedback with video tape: Extending the group’s function. In G. M. Gazda (Ed.), Innovations to group psychotherapy (pp. 207-255). Springfield, Ill: Charles C Thomas. Staller, F. H. (1969). Videotape feedback in the group setting. Journal of Nervous and Mental Disease, 148, 457466. Wachtel, A. B., Stein, A., & Baldinger, M. (1979). Dynamic implications of videotape recording and playback in analytic group psychotherapy: Paradoxical effect on transference resistance. International Journal of Group Psychotherapy, 29, 67-85. Wilmer, H. A. (1970). Use of the television monologue with adolescent psychiatric patients. American Journal of Psychiatry, 126, 1760-1766.
Vol. 17, pp. 165-169.
VIDEO THERAPY:
0 Pergamon
Press plc, 1990. Printed in the U.S.A.
AN ALTERNATIVE
0197-4.556190 $3.00
FOR THE TREATMENT
+ .OO
OF
ADOLESCENTS
LOU FURMAN,
MFA. RDT*
The emphasis of many therapy groups since the 1960s has been on self-confrontation. A central component in this self-examination approach is feedback-a process in which group members respond to behaviors elicited during sessions. Also fundamental in the current approach are issues of transferences, the unconscious conveyance of past attitudes and emotions to persons in the present. Although feedback and transference are basic to many therapeutic designs, these elements operate differently in the multi-member setting of the group. Investigating these key mechanisms of the group and measuring the impact of video on the members’ functioning will give some indication as to the potential for such techniques when applied to adolescent clients. The feedback mechanism becomes productive only after a clear group dynamic is established. Video techniques enable group members to “galvanize a sense of identity and meaning” (Skafte, 1987, p. 389) because the video image presents members with visible evidence of the group. Not only do members have a clear visualization of the group, but their own image on the screen allows them to view themselves from an independent and external perspective. The distancing effect permits subjects of the feedback to literally interact with themselves (Fryrear & Stephens, 1988). With the inclusion of the opportunity to view and respond to one’s own behaviors, all group members now have the potential to fully participate in a process that previously had been limited to the ther-
The influence of television on young people has yet to be clearly determined, but that the medium is firmly entrenched in their culture cannot be denied. The familiarity of adolescents with television makes therapeutic approaches that utilize video techniques an attractive alternative to traditional methods. However, questions may be raised as to the validity of such approaches. Do video techniques help achieve therapeutic goals or detract from them? Do young people respond positively to the medium in a therapeutic setting? Which video techniques have potential for the most effective treatment? The group approach, considering the adolescent context, is an appropriate framework from which to explore these questions. Individual therapy under the watchful eye of an adult may prove less productive for the adolescent whose feelings toward adults are in a state of flux and who tends to turn to peers for support and feedback (MacLennan & Felsenfeld, 1968). Peer groups and peer related problems are the focus of this population. Adolescent deviant behaviors, such as delinquency, are often exhibited in a group subculture (Empey & Rabow, 1961). The social forum being the preferred vehicle for their interactions, group therapy would be the logical setting in which these young people’s problems could be explored, expressed, and worked out (Kraft, 1961). The questions raised as to the benefits of video techniques in the treatment of adolescents may be appropriately discussed, therefore, within the limits of group activity.
*Lou Furman is Director of Youth Drama, School of Music and Theatre Arts, Washington
165
State University,
Pullman,
WA.
166
LOU FURMAN
apist and others in the group. This broadening of the feedback mechanism has been identified as a “new self-reflexive loop of awareness” (Skafte, p. 389) in treatment. The opportunity for all to share in the feedback process does not ensure that behaviors viewed can be understood. A major determinant in the accurate interpretation of behavior is the clarity with which the feedback is presented (Stoller, 1968). Videotape replay is unique in its ability to clarify behaviors through repeated, detailed, and meaningful re-experiences of events (Alger, 1969; Berger, Sherman, Spalding, & Westlake, 1968; Skafte, 1987) by revealing dialogue initially obscured during a session (Stoller), and in presenting amorphous and complex interactions concretely (Alger; Skafte). The playback process reduces or even defeats denial systems faced with repeated confrontations of self-evident patterns of behavior (Berger et al., 1968; Danet 1968, 1969; Skafte)
The use of video enhances another aspect of the feedback process-the nonverbal response. The selfviewing aspect during the replay is in and of itself a form of feedback (Stoller, 1968). Another dimension of the nonverbal element may include the behavior that is the focus of the feedback. The interaction being explored itself may be nonverbal. Group members may find it difficult to describe or respond to nonverbal behaviors in a verbal mode. But videotape replay provides the potential for a nonverbal response to these numerous incidents of group interaction. The unique contribution of video technology to the feedback mechanism is underscored by the fact that the medium captures “the full significance of spontaneous, expressive behavior” (Paredes, Gottheil, Tausig, & Comelison, 1969, p. 288) immediately after the event or at any interval during the period of treatment. Feedback is no longer limited to recent behaviors or the vague recollections of past interactions. Any past group interactions that take on significance during the therapy may be replayed at any time and as often as necessary for group or therapist review. The discussion of video feedback takes on another significance when focused on the adolescent population. Young people are in the midst of a rebellious stage in which they are most likely to resist directions from any adult (Anderson & Stewart, 1983). Feedback based on video images provides a communication link through a nonthreatening other in the group. Most group members, regardless of age-but specif-
ically adolescents with a distrustful attitude toward adults-are more comfortable responding to the nonperson videocamera and image than they are to a group leader, a phenomenon observed in a number of studies (Alger, 1969; Berger et al. 1968; Mallery & Navas, 1982; Petitti, 1989; Skafte, 1987; Stoller, 1969). The common theme cited in these studies is the perceived objectivity of the video camera and image. In addition, comfort levels appear to increase when the adolescent has control over some or all of the video equipment. The overall result is a de-intensification of transference that may expedite the establishment of a working relationship between the therapist and group members. Transference reduction occurs further when the therapist is included in the group video process. The leader’s participation allows members to view the therapist more objectively than under other circumstances and creates a “democratic and equalitarian therapeutic relationship” (Alger, 1969, p. 430). The less authoritarian style may alter the focus of the relationship to form an alliance between therapist and client that fosters nontransference responses conducive to treatment. The therapist benefits from the objectivity as well, for the video image allows the leader to dissociate and divert from the “frequent preoccupation with mothering the family” (Berger, 1978). The positive influences of video techniques on the transference phenomenon should not be assumed unquestionably. Wachtel, Stein, and Baldinger (1979) suggest that the group as well as the therapist may be lured into a false sense that video playback viewing is largely transference-free. In actuality, the video equipment and process may be perceived by the group as “powerful extensions of the authority, omnipotence, and omniscience of the therapist” (p. 82). This impression would likely interfere with the reduction of transference interactions and the establishment of a working alliance. The above caution accepted for the moment, a basic rationale for using video therapy with most age groups has been forwarded. However, video techniques in therapy offer advantages to the adolescent that go beyond the general benefits cited thus far. Many conventional treatment methods, useful with adults, are less successful with adolescents. Literature dealing with young adults often refers to the need to modify traditional therapeutic treatment for adolescents because of their outgoing tendencies, impulsive behaviors, and difficulty in handling the anxiety that
VIDEO THERAPY accompanies intensive internalized explorations (Corder, Whiteside, McNeil, Brown, & Corder, 1981; Lorand & Schneer, 1962; Skafte, 1987). An alternative to traditional models is treatment that incorporates a video approach. Young people of today, reared in a world of television, are comfortable with activities that involve video (Marvit, Lind, & McLaughlin, 1974; Petitti, 1989; Wilmer, 1970). Comfort levels aside, the positive effect that video has on issues previously raised-feedback and transference -are equal or greater for young people than for other populations. Skafte (1987) suggests that adolescents’ favorable response to video feedback practices may be due in part to their underdevelo~d skills in self-obse~ation. The replay aspects of video feedback may help to augment and sharpen those skills. Although the theoretical foundation for the phenomenon may not be clear, research in the field indicates a definite link between enhanced participation of adolescents in treatment and the use of video feedback in therapy (Corder et al., 1981; Marvit et al., 1974; Wilmer, 1970). In one nine-month study, the treatment for 10 adolescent patients confined to a state mental hospital alternated between sessions in which videotaped excerpts of the previous meeting were reviewed preceding the session and meetings that did not include videotaped selections (Corder et al., 1981). The findings noted increased frequency of verbal feedback, intimacy levels, and frequency of peer interactions in group functioning for those sessions that included the video feedback. Transference issues discussed earlier are especially important for the adolescent because transference, although present in all therapeutic activity, occnrs in abundance in work with adolescents as they struggle with strong feelings of dependency on adult authority figures (Kraft, 1961). Countertransference is a strong factor in such situations as well. The therapist dealing with young people may easily slip into a parental role @aft). The de-intensified transference phenomenon associated with video therapy would be especially beneficial with this group of clients. The studies and arguments presented indicate that video can be a valuable ~era~utic tool when used in treatment of adolescents. The question remains, which video techniques would be most effective in reaching young people. Video feedback incorporated into traditional treatment has its advantages as cited. However, feedback in itself may be considered a passive activity, not totally in keeping with the “typically
WITH ADOLESCENTS restless” (Kraft, 1961, p. 36) demeanor of the adolescent. Active participation in treatment would result in a positive response from adolescents who would welcome some control over their destiny, power that is denied them by our society in their daily lives. They are given few meaningful adult responsibilities, are often restricted in their comings and goings, and have little or no authority in the adult world. People who believe that they cannot determine their own fates are unlikely to be able to cope with stresses, are less able to develop a clear measure of their own worth, and develop a fatalistic attitude of helplessness to alter their circumstances (Lefcourt, 1976)-characteristics that are found in many young people. The consequences are that the prime motivators for adolescents are “feelings of inferiority and despair” (MacLennan & Felsenfeld, p. 44). Such attitudes make it most difficult for anyone to initiate changes in his or her lifestyle, much less a young person floundering for identity between child and adult worlds. A viable option to change this perception is through “actionoriented therapies” (Lefcourt, p. 126). The video process offers several ways in which clients may take an active part in the treatment. The simplest method uncovered in researching the topic involves a stop-start switch that controls the video playback unit (Pascal, Cottrell, & Baugh, 1967). The treatment itself was traditional in nature, but each session was videotaped, and after each treatment the clients, five delinquent boys, viewed the tape and commented on the meeting. The stop-start switch was accessible to both therapist and group members. Anyone could stop the viewing of the tape at will to initiate discussion. The researchers concluded that the method allowed for insight and hindsight into behaviors of the group. They felt, in addition, that the self-confrontation method allowed for reinforcement of positive behaviors and helped reduce the deviant behaviors revealed in the review of the videotape. Access to the playback unit during the feedback process offers limited control to the adolescent, however. Locus of control would be best influenced if the client had input into the videotaping process itself. The young person’s desire to become an active participant in the recording of sessions is evident from the work of Mallery and Navas (1982) in which several of the preadolescent boys spontaneously chose to operate the camera. The boys used the video equipment to guide the group in such a way as to facilitate or redirect group focus on issues of interest
168
LOU FURMAN
to them. One boy, for example, moved the camera to include another member of the group who had chosen to remain out of the camera’s range. Operation of the camera by the group members may help break through the initial resistance of those adolescents who are uncomfortable with the video process. The progression toward group involvement can begin with work behind the camera (with its accompanying feelings of control and self-esteem as operating skills are developed) and move toward full participation on camera. Such a sequence was evident in the work of Petitti (1989). In that study, the subject was reluctant to be in front of the camera in the first sessions but gradually, through the process described above, he came to a position of leadership within the group. Increased locus of control under circumstances in which a group member is the camera operator will lead to other positive developments in the therapy. The sense of control is expanded as camera operators realize that they have the power to determine what the camera will record and, thus, the behaviors that will be the focus of the replay discussion. At another level, group members may come to question the choices made by the camera operator. Why, for example, did the boy cited in Mallery and Navas (1982) choose to focus on the group member who did not wish to be included in the picture? The additional opportunities to explore behaviors from several perspectives will most likely enhance the group therapeutic process. A further advantage of an in-group operator is that the process helps offset the concerns discussed earlier in which the therapist is perceived as all powerful. If group members are the camera operators, they control the equipment and take on responsibility for its operation. The adolescent shares an active role in the treatment that supports an atmosphere in which a working relationship can develop with the therapist. One further step remains in order to take full advantage of the opportunities offered by video technology for the adolescent population: control over the actual content of the sessions to be videotaped. The concept is not new or unusual, especially in the area of drama therapy in which clients regularly improvise or create scripted materials to express their concerns. These approaches to therapy are very effective. However, the possibility of videotaping and allowing clients to view and give feedback to their creations in a manner and with the benefits described earlier seem to combine and amplify the benefits of the two
approaches. A small number of studies have been conducted with adolescents as camera operators for their own videotaped improvisational and scripted dramas (Dequine, 1981; Dequine & Furman, 1988; Dequine & Pearson-Davis, 1983). Some researchers, such as Petitti (1989), imply that all interactions during the video therapy are dramas being played out. However, the emphasis here is on work that is developed by the adolescents for the purpose of performance in front of the camera. This technique allows the group members a high level of control over content and recording, almost to the exclusion of the therapist. In the Dequine and Pearson-Davis (1983) pilot study, seven adolescent students from a school associated with an institution for emotionally disturbed children were selected for videodrama classes over a nine-week period. The subjects developed their own improvised plays, which were videotaped, edited, and finally presented to an invited audience. The therapist provided a structure and facilitated the role playing process. The adolescent group members brainstormed and chose a theme for the drama, selected a setting, and defined characters to be portrayed, and then set up, improvised, and videotaped the first scene of the drama. The scene was played back, discussed, and redone if so desired by the group. The process continued until the drama was completed and edited for presentation. Dequine and Pearson-Davis (1983) measured staincreases in internal locus of tistically “significant control among participants” (p. 20). Anecdotal support for the process came from caseworkers’ comments and reports that six of the seven subjects had experienced breakthroughs in treatment over the course of the experiment period. Dequine and Pearson-Davis established a projective technique as an alternative treatment for adolescents that has numerous positive outcomes that include: (a) immediate feedback about decision-making skills, (b) centralization of locus of control, (c) high levels of self-expression, (d) acceptance of leadership roles in a group setting, (e) increased levels of self-esteem, and (f) effective closure processes (personal communication, 1988). The evidence presented in the above experiment suggests that an approach to video therapy in which group members control the equipment and the content of the videotape recording, especially if the content is active in nature, may be an extremely effective approach to adolescent treatment. Combining video techniques and drama therapy practices, Dequine and
VIDEO THERAPY Pearson-Davis developed a therapeutic approach for adolescents that considers their basic need to control their environment while offering them the opportunity to practice life coping skills. Other works cited earlier establish a firm support for the viability of video in therapeutic activities with adolescents. Limitations in the studies, such as the small number of subjects in most cases and the lack of measured statistical support in other investigations, suggest that further research should be conducted to ascertain the specific benefits of and appropriate situations for such treatment. The present lack of clearly defined guidelines for the application of video technology in adolescent treatment may be the cause for limited current use. Also, therapists may not feel comfortable with the video equipment or technology in their practices. They may believe it disruptive or that extensive video use might come at the expense of direct interactions among clients. Others may feel threatened by the inherent democratizing process that accompanies group participation in video activities. However, considering the clear benefits of a video strategy in dealing with an adolescent population, therapists would be doing a disservice to their young clients if they did not at least consider some form of video therapy as part of their treatment plan. References Alger, I. (1969). Therapeutic use of videotape playback. Journal of Nervous and Mental Disease, 148, 430436. Anderson, C. M., & Stewart, S. (1983). Mastering resistance. New York: Guilford Press. Berger, M. M. (Ed.). (1978). Videotape techniques in psychiatric training and treatment. New York: Brunner/Mazel. Berger, M. M., Sherman, B., Spalding, J., & Westlake, R. (1968). The use of videotape with psychotherapy groups in a community mental health service program. International Journal of Group Psychotherapy, 18, 504-5 15. Corder, B. F., Whiteside, R., McNeiil, M., Brown, T., & Corder, R. F. (1981). An experimental study of the effect of structured videotape feedback on adolescent group psychotherapy process. Journal of Youth and Adolescence, 10, 255-262. Danet, B. N. (1968). Self-confrontation in psychotherapy reviewed: Videotape playback as a clinical and research tool. American Journdl of Psychotherapy, 22, 245-257. Danet, B N. ( 1969). Videotape playback as a therapeutic device in group psychotherapy. In&b&al Journal of&Group Psychotherapy, 19, 433440. Dequine, E. R. (1981). Videotaped improvisational drama with emotionally disturbed adolescents: A pilot study. Unpublished manuscript.
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Dequine, E. R., & Pearson-Davis, S. (1983). Videotaped improvisational drama with emotionally disturbed adolescents: A pilot study. The Arts in Psychotherapy, 10, 15-21. Dequine, E. R., & Furman, L. (1988, November). Video - An effective strategy in drama therapy with young people. (Cassette recording No. 4. 300390) Los Angeles: National Association for Drama Therapy. Empey, L. T., & Rabow, J. (1961). The Provo experiment in delinquency rehabilitation. American Sociological Review, 26, 679-696. Fryrear, _I. L., & Stephens, B. C. (1988). Group psychotherapy using masks and video to facilitate intrapersonal communication. The Arts in Psychotherapy, 15. 227-234. Kraft, I. A. (1961). Some special considerations in adolescent group psychotherapy. International Journal of Group Psychotherapy, II, 196203. Lefcourt, H. M. (1976). Locus of control: Current trends in theory and research. New York: Wiley. Lorand, S., & Schneer, H. (1962). Adolescents: Psychoanalytic approach toproblems and therapy. New York: Paul B. Hoeber. MacLennan, B. W., & Felsenfeld, N. (1968). Group counseling and psychotherapy with adolescents. New York: Columbia University Press. Mallety, B., & Navas, M. (1982). Engagement of preadolescent boys in group therapy: Videotape as a tool. International Journal of Group Psychotherapy, 32, 453467. Marvit, R. C., Lind, J., & McLaughlin, D. G. (1974). Use of videotape to induce attitude change in delinquent adolescents. American Journal of Psychiatry, 131, 996-999. Paredes, A., Gottheil, E., Tausig, T. N., & Comelison, F. S. (1969). Behavioral changes as a function of repeated selfobservation. Journal of Nervous and Mental Disease, 148, 287-299. Pascal, G. R., Cottrell, T. B., & Baugh, J. R. (1967). A methodological note on the use of video tape in group psychotherapy with juvenile delinquents. International Journal of Group Psychotherapy, 17, 248-25 1. Petitti, G. J. (1989). Video as an externalizing object in drama therapy. The Arts in Psychotherapy, 16. 121-125. Skafte, D. (1987). Video in groups: Implications for a social theory of the self. International Journal of Group Psychotherapy, 37, 389402. Staller, F. H. (1968). Focused feedback with video tape: Extending the group’s function. In G. M. Gazda (Ed.), Innovations to group psychotherapy (pp. 207-255). Springfield, Ill: Charles C Thomas. Staller, F. H. (1969). Videotape feedback in the group setting. Journal of Nervous and Mental Disease, 148, 457466. Wachtel, A. B., Stein, A., & Baldinger, M. (1979). Dynamic implications of videotape recording and playback in analytic group psychotherapy: Paradoxical effect on transference resistance. International Journal of Group Psychotherapy, 29, 67-85. Wilmer, H. A. (1970). Use of the television monologue with adolescent psychiatric patients. American Journal of Psychiatry, 126, 1760-1766.