A SOLUTION FOCUSED SUPPORT GROUP
FOR CAREGIVERS OF STROKE SURVIVORS
A presentation for the Canadian Counselling and Psychotherapy
Association Conference, Calgary, Alberta. May 25, 2012.
Rhea Plosker, Athabasca University M.C. Student
Dr. Jeff Chang, R. Pysch
The Importance of Stroke Caregiver Support
•In 2002, over 2,000,000 Canadian family members and friends
were providing informal caregiving support for seniors
• In 2007, the number increased to over 2,750,000.
•20% of people over the age of 45 care for a senior
•Stroke is the leading cause of disability in Canada and the
stroke risk doubles every 10 years after age 55
•A stroke is a sudden loss of brain function. It is caused by the
interruption of flow of blood to the brain or the rupture of
blood vessels in the brain. The impacts of stroke vary widely
depending on what part of the brain was impacted.
A Canadian has a stroke every 10
minutes!!!!!!
300,000 Canadians are stroke
survivors. 75% of those people live
with some level of disability.
What do caregivers need?
•A review of 117 studies of caregivers of stroke survivors found
common themes of lived experience:
•Loss of self
•Changing roles and
relationships
•Pride
•Love
•Guilt
•Balancing care for the stroke
survivor with other life roles and
self-care
•Having no idea of what the future
holds
•Constructing a view of the future
•The review provided strong support for caregiver interventions based
on the transactional model of stress, treating coping challenges as an
imbalance between demands and available resources.
•Caregivers, particularly in today’s environment of scarce health care
resources, benefit from recognizing and maximizing their available
resources, as they have little control over demands placed upon them.
Moving Forward: A Therapeutic Group
Providence Healthcare, a Toronto rehabilitation
hospital, recognized the unique needs of
caregivers of stroke survivors and supported
developing a solution-focused caregiver support
group, called Moving Forward.
Moving Forward: A Caregiver Support
Group Was Created To
1. Create a slice of time and space in a
patient-centered world to focus on
caregivers and their needs
2. Provide opportunities for networking
and peer support from other caregivers
3. Deliver psychosocial interventions to
build coping strategies and a personal
toolkit of resources
“ Constructing a
view of the
future”
Why a solution-focused group?
Solution Focused Brief Therapy was founded in the 1980s by Insoo Kim Berg, Steve
de Shazer, with colleagues at the Brief Family Therapy Center in Milwaukee.
If I focus on the problem, the problem increases. If I focus on
the answer, the answer increases.
-Big Book of Alcoholics Anonymous
Typical medical model of
health interaction
• Focus on pathology including
symptoms, disabilities,and risks
• Focus on when the problem
occurs and how to treat it
• Health care provider is the expert
and sets goals
• Answers constrained by the
system
• Brief
Typical Solution Focused
interaction
• Focus on available resources,
strengths and “what’s better”
• Focus on exceptions when the
problem is absent or not as bad
• The person is the expert and sets
their own goals
• Answers based on attainable
goals
• Brief
Group Structure-What Worked
In keeping with Solution Focused Therapy’s focus on “what works”, the structure of
the group was modified quite significantly from the original plan, and will continue
to be modified, based on attendee input.
Group Focus and Structure
4 weeks
The original plan was for a 6 week group but this did
not align with hospital length of stay.
Combined inpatient
& outpatient groups
3-7 attendees, 2
hours
Semi-open group
All were welcomed to increase group size and prevent
caregivers from having to wait for a future group.
Caregiver-selected,
action oriented
topics
Caregivers preferred group-selected activities like
meditation, relaxation, goal-setting, brainstorming,
and action planning. A menu of potential topics was
prepared as a discussion starter.
We have not settled on an optimal approach to
recruitment, and would like more attendees.
The original plan for a closed group did not meet
caregivers’ needs. The group was restructured so
caregivers could attend one or all sessions.
The Power of Solution Focused Conversations
Reframing
Focuses on the people, not the
stroke.
“Please introduce yourself by
telling us your best quality and
the best quality of the loved one
you are caring for.”
Stubborn
Strong
Committed
Sense of
humour
Cooperative
Loyal
Accepting
Tolerant
Dedicated
Compassionate
Self-control
Deeply loving
Trying their best
Goal-Setting Questions
Articulate hope
“Let’s suppose that when we walk
out that door at the end of week 4,
or even today, this group has been
helpful to you in some way. What is
the first small thing you will notice
that would let you know it has
been helpful?”
Breathe better
Inspiration and
renewed mission
Advocacy ideas
New resources
Increased peace
Acceptance of
reality
Sense of
community
Balance between
my needs and
family needs
Challenges
Group Challenges
Immaturity of
Group
•The group has only been held twice, and facilitators
are not experienced solution focused practitioners. We
are all still learning from the caregivers attending.
Attendance
•Caregivers often have multiple conflicting demands on
their time.
Diversity of
attendees
• It can be difficult finding common ground between
spouses, children, and parents, young and older
caregivers, young and older stroke survivors, although
diversity proved to be a strength as well as a challenge.
Needs of
attendees
•Some attendees were not a good fit with solution
focused approaches and were hoping for “expert
opinions”.
Hospital
environment
•A flu outbreak on a unit resulted in the need to cancel
the final week of the second group as the caregivers
and social worker from the unit were unable to attend.
Doing What Works: The Wisdom of the Group
Chinese Proverb
Experience is a hard teacher because she gives the test first, the
lesson afterward.
•Meditate
•Find a mission
•Look forward-stroke is not the end
•Get out of bed and live life
•Love
•Get stronger
•Make a decision
•Pray and have faith
•Assume your normal routine
•Meet with friends
•Eat healthy meals
•Learn new skills
•Remember to breathe
•Learn more about stroke
•Focus on one day at a time
•Let things go
•Understand the fears of the
stroke survivor to help you cope
•Smile and hug
•Walk
•Use positive self-talk
•Plan, prioritize, organize
•Enjoy nature
•Rest
•Know your limits and work
within them
Acknowledgements and Thanks
Moving Forward: A Support Group for Caregivers of Stroke
Survivors was developed and delivered with the support,
guidance, and input of the Providence Healthcare social
work team, who dedicated a tremendous amount of time
in support of providing this service to caregivers. Special
acknowledgements to Joanne Avery, Mirela Tudosa
Cappella, Laura Derry, Anne Keown and Andrea Rodrigues,
who were so willing to dedicate their time to advise and
assist on developing materials, recruiting attendees and
co-facilitating the group sessions.
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