July 11th, 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
 Psychotherapy Dept consulted 2004
 Job description agreed and post appointed
October 2005
 Post activated in Feb 2006.
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Key Elements of Post
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“ ….to facilitate the development of group
therapy and reflective practice……in the
five acute admission wards, in the first
instance.”
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“To lead the development of this new
clinical service via service provision,
training, supervision and reflection in five
teams.”
“Rights, Relationships and Recovery”
 “Recovery is often described as a long-term
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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)
“Rights, Relationships and Recovery.”
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“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)
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“…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)
The First Year
Who?..What?...Why?...How?
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“Who am I and what am I doing here?”
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“Who are you and what do you do here?”
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“What is your experience of here?”
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“ Why are you / they doing that?”
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“How might we improve your experience?”
“Hello, my name is…….”
“My Early Countertransference……..”
Lost
Afraid
Bewildered…..and tired
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.
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A Paradigm Shift?
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Countertansference
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Resonance
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Heinz Kohut’s emphasis on “ experience
near” subjectivity and empathy.
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A more systemic approach?
Preliminary Work
Coping with Change, Loss and Location
 Asking and listening
 Discussions
 Consultations
 Training
 Implementation
 Psychotherapy Dept
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 The
Challenges…………………..
Space
“Busy…busy….busy….”
Academia !!!
The Debating Society
The Fears : Fighting
The Fears : Despair and Paranoia
The fears : Distress and….
…..and hugging.
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

Hopes
Nurses need to and want to.. “maximise
time to build Relationships.....based on
principles in legislation, safeguards and
codes of conduct ( Rights)….to listen to
what people say….to see the whole
person and not just his/her symptoms
( Respect)…..and to promote Recovery
and inspire hope.” ( p14, RRR)
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Tell me what to do and how to
think.
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Staff were keen to have a theory
Theories are not hardened truths, rather shared
interactive constructions which emerge and have utility in
certain situations
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Theory helps therapist and the group contain and modify
powerful and chaotic affects
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Key concept in group analysis is a communications
network
Yalom’s Therapeutic Factors, particularly:
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Yalom’s Therapeutic Factors
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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
Setting Realistic Goals
Largely driven by patients
 Context
 Composition Difficulties
 Previous Experience
 Staff Hopes and Fears
 Encouraging staff to be realistic
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Some numbers….
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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%
“The Leap of Hope”
More numbers…..
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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
Fresh numbers…..
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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
Snapshots
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“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”
Common Themes…..
Power and Control
 The “Patient” experience
 Medication, side-effects
 Loss
 Personal relationships
 Ward Relationships
 Facing the future
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Common Concerns….
Managing diversity
 Small numbers
 Managing anxiety and silence
 The Monopoliser
 The Intruders
 Staff rotas
 Challenging themes
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Countertransference……
Anxiety
 Hope
 Fear
 Excitement
 Paranoia
 Numb
 Frustration
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Presently…….
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Groups, groups, groups……
Yes, but….
Training
Data
Collaborations
Supervision Groups
Reflective Practice Group
Presentations
Alternative and additional Groups
Stepping Stones
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Early patient and Staff
Feedback
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New wards coming on
board
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“Would you like to…..?”
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“What do you think…..?”
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Presentations