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July 11 th , 2007

July 11 th , 2007. Group Psychotherapy in the Contemporary Psychiatric Ward. “ From Obstacles to Stepping Stones”. Background: Safety, Privacy and Dignity. Post of Group Therapy Development Officer 2001 Scottish Executive Audit : Safety, Privacy and Dignity

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July 11 th , 2007

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  1. July 11th, 2007 Group Psychotherapy in the Contemporary Psychiatric Ward

  2. “From Obstacles to Stepping Stones”

  3. Background: Safety, Privacy and Dignity. • Post of Group Therapy Development Officer • 2001 Scottish Executive Audit : Safety, Privacy and Dignity • Psychotherapy Dept consulted 2004 • Job description agreed and post appointed October 2005 • Post activated in Feb 2006.

  4. Key Elements of Post • “ ….to facilitate the development of group therapy and reflective practice……in the five acute admission wards, in the first instance.” • “To lead the development of this new clinical service via service provision, training, supervision and reflection in five teams.”

  5. “Rights, Relationships and Recovery” • “Recovery is often described as a long-term process or “journey” and is not simply the absence of symptoms. It is based on hope, involvement, participation, inclusion, meaning, • purpose, control and self-management and emphasises the importance of peer support, meaningful activity, employment, maintaining social networks and activities when distressed and having the chance to contribute, or giveback, in some way.” ( p18,RRR)

  6. “Rights, Relationships and Recovery.” • “Acute inpatient care is an area in which mental health nurses sometimes feel compromised in their ability to deliver rights, principles and recovery-focused care.” ( p24, RRR) • “…inpatient care is struggling against a culture of risk-averse, defensive practices……..serves to stifle some aspects of practice development and undermines efforts to meaningfully engage with service users and carers.” ( p24 RRR)

  7. The First Year

  8. Who?..What?...Why?...How? • “Who am I and what am I doing here?” • “Who are you and what do you do here?” • “What is your experience of here?” • “ Why are you / they doing that?” • “How might we improve your experience?”

  9. “Hello, my name is…….”

  10. “My Early Countertransference……..”

  11. Lost

  12. Afraid

  13. Bewildered…..and tired

  14. I think I was beginning to really understand the experience of both the service user and the staff member. • Many service users had told me of feeling lost, afraid and bored. • Many staff had described bewilderment, fatigue and frustration.

  15. A Paradigm Shift? • Countertansference • Resonance • Heinz Kohut’s emphasis on “ experience near” subjectivity and empathy. • A more systemic approach?

  16. Preliminary Work • Coping with Change, Loss and Location • Asking and listening • Discussions • Consultations • Training • Implementation • Psychotherapy Dept

  17. The Challenges…………………..

  18. Space

  19. “Busy…busy….busy….”

  20. Academia !!!

  21. The Debating Society

  22. The Fears : Fighting

  23. The Fears : Despair and Paranoia

  24. The fears : Distress and….

  25. …..and hugging.

  26. The Hopes • “There needs to be greater valuing of and support for the highly skilled nature of working with people with acute mental health problems.” ( p25, RRR) • Training • Support • Supervision / Reflective Practice • Protected time • Role extension

  27. Hopes • Nurses need to and want to.. “maximise time to build Relationships.....based onprinciples in legislation, safeguards and codes of conduct ( Rights)….to listen towhat people say….to see the whole person and not just his/her symptoms ( Respect)…..and to promote Recovery and inspire hope.” ( p14, RRR)

  28. Tell me what to do and how to think. • Staff were keen to have a theory Theories are not hardened truths, rather shared interactive constructions which emerge and have utility in certain situations • Theory helps therapist and the group contain and modify powerful and chaotic affects • Key concept in group analysis is a communications network • Yalom’s Therapeutic Factors, particularly:

  29. Yalom’s Therapeutic Factors • Instillation of Hope • Universality • Imparting Information • Altruism • The corrective recapitulaltion of the primary family group • Development of socialising techniques • Imitative behaviour • Interpersonal Learning • Group Cohesiveness • Catharsis • Existential Factors

  30. Setting Realistic Goals • Largely driven by patients • Context • Composition Difficulties • Previous Experience • Staff Hopes and Fears • Encouraging staff to be realistic

  31. Some numbers…. • Ward A has had 55 from a possible 73 groups • This equates to 75.3% • Average number of attendees per group was 4 • Highest number of attendees was 6 • Lowest number was 2, not technically a group but often time well spent. • Over six months 242 possible attendees ( from people assessed as able to attend) • Actual attendees was 175 • This equates to 72.31%

  32. “The Leap of Hope”

  33. More numbers….. • Ward B has had a more difficult start. • Of a possible 51 groups there have been 33 • This equates to 64.7% • Average number of attendees is 3.5 • Highest number of attendees is 6 • Lowest number of attendees 2 • Over 5 months possible attendees was 186 • Actual number of attendees 116

  34. Fresh numbers….. • Ward C recently commenced, on June 12th. • Of a possible 9 groups there have been 9 groups, this equals 100% • Possible number of attendees was 50 • Actual number of attendees was 43 • Average number of attendees per group was 4.6 • Highest number was 6 • Lowest number was 4

  35. Snapshots • “How come I’m allowed to talk now?” • “Can you hear my voices?” • “Is it o.k to talk about voices?” • “I’m not leaving…….” • “I never thought I would share that….” • “I don’t think I’ll be able to reveal anything about myself as I’m scared it won’t be confidential.” • “Oh God that’s just like me.” • “ “How would you like it?” • “What the xxxx would you know?” • “Thank you”

  36. Common Themes….. • Power and Control • The “Patient” experience • Medication, side-effects • Loss • Personal relationships • Ward Relationships • Facing the future

  37. Common Concerns…. • Managing diversity • Small numbers • Managing anxiety and silence • The Monopoliser • The Intruders • Staff rotas • Challenging themes

  38. Countertransference…… • Anxiety • Hope • Fear • Excitement • Paranoia • Numb • Frustration

  39. Presently……. • Groups, groups, groups…… • Yes, but…. • Training • Data • Collaborations • Supervision Groups • Reflective Practice Group • Presentations • Alternative and additional Groups

  40. Stepping Stones • Early patient and Staff Feedback • New wards coming on board • “Would you like to…..?” • “What do you think…..?” • Presentations

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