Class 5 Flashcards
Efficacy of group therapy is ??? as individual therapy
at least as good
Added benefits of group therapy
Cost-effective
Larger number of therapeutic relationships
Less human resources
Functions of the Group in Therapy
Normalizing Breaking isolation around experience Mutual accountability Developing trust Corrective or new relational experiences Reality testing
Group Therapy Indications
Anxiety disorders (GAD, SAD, Panic, PTSD)
Borderline Personality Disorder –- with individual
Substance Use Disorders
Bipolar I and II – adjunct to meds
Group Therapy Frame
Therapeutic modality Number of participants Composition of participants:homogeneous/heterogeneous - diagnoses, setting, gender, age, race, LGBTQ Closed vs. Rolling Timing, frequency and duration Facilitators Materials
Group Therapy Frame Generally….
8 – 12 participants 1 – 2 hours long 1 session a week, unless Day Hospital 2 facilitators Homogeneous vs. Heterogenous depending on the group
Supportive group
Provide support Sense of cohesion Can be peer-led Vulnerable populations Out of group contact encouraged Community-based Bereavement, cancer, community mental health, AA Homogeneity around an experience Objectives: Garner support around difficult experiences Focus is not long-term change
Psychoeducation & Skills group
Facilitator structures the group
Out of group contact generally discouraged
Rooted in behavioural therapies
CBT, DBT, MBCT, ACT, Stage I trauma groups
Facilitators prepare content and structure
Although there can be common ground, focus is on individual
Individual expected to apply content to their experience and practice skills
Homework between sessions
Objectives:
Learning new information to help understand difficulties
Learn new skills to manage symptoms
Process group
Work through relational patterns ex: personality disorder
Higher psychological-mindedness
Cross-talk
Out of group contact discouraged
Rooted in psychodynamic therapy
Early relationships influence adult relationships
Attachment wounds and disruptions set up a template for interpersonal difficulties
Patterns happen largely outside of our awareness
Facilitators respond organically, no predetermined material
Focus is on interpersonal relationships between patients
Focus is on the Here-and-Now
Group as a whole is the patient
Group as a microcosm for the world
Participants are the main agent of change
No homework
Objectives:
Learning new interpersonal patterns in vivo
Contra-indications to Group Therapy
Severe acting out Acute psychosis and paranoia Active suicidality Inability to tolerate Low motivation Severe incompatibility (e.g. deviant) Language barrier Antisocial Cognitively impaired
Caution if…
Previous lack of success in group therapy
Use of group to seek social contacts
If people are friends outside
Has unrealistic expectations for outcome of treatment
Unable to participate in group task
Low readiness for change
Group Therapeutic Factors Number 1 factor =
Cohesion
Group Therapist’s Role
Mainly facilitative
Ideally, the primary source of change is other group members
Facilitators are responsible for setting and maintaining the frame
Size of group, frequency, composition, materials, etc
Group norms to create safety
Guidelines for group
I-Statements, no advice
Non-judgement
Confidentiality
Accountability
Co-facilitator norms
Effective communication and respect
Different styles, but consistency and positive regard
Are the parents on the same page?
Process Groups - Stages
1.Norming
Building safety, cohesion, establishing roles
- Storming
Conflict, interpersonal patterns crop up - Performing
Advancement and growth, doing things differently
HOW to learn new interelational patterns
Mindfulness: building awareness around patterns
Mentalization: gaining insight on our impact on others
Do different: consciously doing something different.
Conflict as Opportunity
Working through conflict effectively can lead to greater connection and mutual understanding
Requires each person to acknowledge their contribution
Mutual acknowledgement of impact of behavior on the other
Joining in resolution
Day Hospital
Structured, intensive, multimodal therapeutic program for patients struggling with severe mental health issues
Multidisciplinary team
Day Hospital Objectives
Promote and develop functional capacities for recovery
Promote stabilization and coping skills among outpatients
Foster reintegration into the community
Prevent and shorten hospitalisation
Inclusion criteria Day Hospital
16.5 to 65 years old
Patient has external housing
Acute / sub-acute psychiatric illness
Requires support to regain function and reintegrate into the community
Requires support to manage symptoms
Willing to engage in a daily program
Aware of need for therapeutic improvement
Exclusion criteria Day Hospital
Lacks housing Requires 24-hour care or hospitalization Acutely suicidal or homicidal Acutely medically unstable Unable to attend program Substance use as primary problem Eating disorder as primary problem Severe cognitive deficits Absence of motivation
Prescribing Day Hospital
Multiple comorbidities Multiple treatment trials Loss of functioning Transition back towards work Transition back from ward to home Need for structure and intensive follow-up Need for socialization
Advantages of Day Hospital
Structure and routine Inbuilt behavioral activation Close observation Frequent social contact Diagnostic clarification Swift therapeutic gains over short period More rapid medication changes Patient retains autonomy and independence (vs. admission)
Group Interventions day hospital
DBT: managing emotions CBT Life Skills: self-care, life balance, nutrition, sleep, communication Mindfulness Community Meeting: process meeting Occupational Therapy: Focus on cognition, concentration, memory Physical Activity Creative Expression: with weekly prompts Leisure: focus on play
Individual Interventions day hospital
Individual Sessions
Medication Check-Ins
OT Check-In
Family Interventions day hospital
Family Meeting(s) Family Support Group
Termination & Discharge Planning day hospital
Re-define goals
Collaboratively choose next steps
Liaise with subsequent treating team
Shared Discharge Summary: to know what they accomplished
SMART Goals
Specific Measurable Achievable Realistic Timely
Empowerment
A multidimensional social process through which individuals and groups gain better understanding and control over their lives.
Individual Empowerment
Individual Central role in their trx
Self-define Needs Goals Ambitions
Relational Empowerment
Shared decision-making
Shared treatment plan
Equity in clinician-patient relationship
Empowerment leads to Good Outcomes
Increased: Adherence +++ Self-care Effective use of health services Motivation Independence Emotional well-being Decreased: Depressive symptoms, maintained 4 mo
