WK 3 Schizophrenia Analyzing Group Techniques

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Week 3 Foundations of Group Work and Types of Therapy

Silvia Hill

College of Nursing-PMHNP, Walden University

NRNP 6645: Psychotherapy with Multiple Modalities

Dr. Loraine Fleming

March 19, 2023

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According to Keepers et al., (2020) schizophrenia is one of the top 20 causes of disability

worldwide. There is a 0.7% lifetime prevalence of schizophrenia and the financial burden is

approximately $150 billion annually in the United States. People who suffer from this mental

illness have a shortened lifespan and mortality rates are twice as high than those who do not have

schizophrenia. The literature also mentions that the coincidences of other psychiatric disorders

or substance use disorders contribute to increase morbidity and mortality rates. Suicide rates are

about 4-10% and are higher among males early in the disease process.

Keepers et al., (2020) report new guidelines for treating patients with schizophrenia that

were introduced at a 2019 meeting hosted by the American Psychiatric Association (APA). The

guidelines focused on evidence-based pharmacological and non-pharmacological treatments for

the disease. The guidelines recommend cognitive-behavioral therapy for psychosis (CBTp)

psychoeducation for schizophrenia, community and supportive employment services for patients

with schizophrenia. In a study by Avasthi et al., (2020) evidence suggests CBTp can avert or

delay transition to psychosis and be cost effective. This report aims to examine the techniques

employed in the support group for patients presented in the video case Psychotherapy Group for

Schizophrenia.

Group therapy consists of a group of people gathering for treatment by one or more

healthcare providers. The group members diagnosed with the same condition allows the patient

to learn from each other and they become more comfortable indulging thoughts, feelings and

problems among peers (Sarkhel et al., 2020). The report mentions that support groups assist

patients who have already started treatment maintain new behaviors and reinforce new thought

processes and focuses on the management of symptoms of daily life.

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The group video consisted of four patients two men and two women. There are two

facilitators of the group Brooke and Robin. The seating arrangement is semi-circle in formation

and the session takes place in a room. Malhotra and Baker (2022) mention the seating should be

circular in formation. Brooke introduces her self and Robin and they ask the group to re-

introduce themselves to the group. They review the agenda and group norms and expectations.

This allows everyone to become familiar with each other again, allows the group members to

begin engaging and reminds everyone of the group rules.

According Sarkhel et al, (2020) psychoeducation encompasses patients with similar

ailments in this case schizophrenia the groups have 4-12 patients, the number of session varies.

And usually lasts about 40-60 minutes. The Universality of a group is when patients in the

group are aware of the other members that have similar feelings, thoughts and issues (Malhotra

and Baker 2022). The group was assigned homework from the last session where they identified

situations where they felt uncomfortable or negative with their illness and ways to cope.

Developing Socialization Techniques where according to Malhotra and Baker (2022) patients

learn the best way to interact with others. Sarkhel et al, (2020) also mention discussion of one’s

illness in terms that the patient will understand is essential components of therapy as Brooke

eluded when she mentioned components of the last session and how it relates to the homework.

Members of the group shared events of the week that were overwhelming or would

trigger a negative response and how they used what they learned in group to deal with the

situation. According to the literature Malhotra and Baker (2022), Self Understanding is the

ability of the patient to understand the hidden factors impacting their behavior. In Imparting

information the patients gain information and knowledge from the providers and group

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members as evidence of the breathing exercises that was introduced in the last session a group

member incorporated that exercise as part of her coping skills and other members of the group

shared how breathing was beneficial to them also (Malhotra and Baker 2022).

In a study by Avasthi det al., (2020) it was reported how CBTp is comparable to

cognitive behavioral therapy for depression and anxiety. The role of the facilitator is to validate

the symptoms of the patient, to educate and create an atmosphere of trust. The group members

look comfortable and relaxed considering their prognostic factors.

The group setting was not ideal, a bigger room so the patient had more leg room and

would not trigger any negative feelings and a larger space would allow the chairs to be placed in

a circle. Not much eye contact was displayed in the group but at least they realize the other

members are present. Ezhumalai et al., (2018) made great points about the techniques to follow

in regards to group therapy that was achieved in this case study. It appeared that both were

prepared prior to the group meeting one took notes while the other spoke and vis versa. They did

not interrupt eachother. There was guided group interactions, and they had specific objectives.

The flow from one week to the other show consistency is their plan. The relaxation teachniques,

breathing and encorporating those exercises in there daily lives.

There were too many distractions, the noise level was disturbing and the window at the

door was distracting as people were seen during the session. It was not private as many patients

may have issue with the confidentially aspect of the session. The introductions, agenda and

explanation of group norms is important and done well. I thought the facilitators were talking too

fast at the beginning it seemed rushed. The group was controlled, the facilitators had questions

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and addressed everyone in the room allowing them to share their experiences and feelings. The

most important aspect was acknowledging achievements and giving positive reinforcement.

In a report by Hallet (2018)

According to Walden University peer reviewed articles are evaluated by a group of

scholars who examine the papers’ methodology, literature and conclusions. The best sources are

within five years. Sources provided in Doc Sharing all fall under scholarly or peer reviewed

articles(Walden University, 2023).

References

Avasthi, A., Sahoo, S., & Grover, S. (2020). Clinical practice guidelines for cognitive behavioral

therapy for psychotic disorders. Indian Journal of Psychiatry, 62(8),

251. https://doi.org/10.4103/psychiatry.indianjpsychiatry_774_19

Bighelli, I., Huhn, M., Schneider-Thoma, J., Krause, M., Reitmeir, C., Wallis, S.,

Schwermann, F., Pitschel-Walz, G., Barbui, C., Furukawa, T. A., & Leucht, S. (2018).

Response rates in patients with schizophrenia and positive symptoms receiving cognitive

behavioural therapy: A systematic review and single-group meta-analysis. BMC

Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1964-8

Ezhumalai S, Muralidhar D, Dhanasekarapandian R, Nikketha BS. Group interventions. Indian J

Psychiatry. 2018 Feb;60(Suppl 4):S514-S521. doi:

10.4103/psychiatry.IndianJPsychiatry_42_18. PMID: 29540924; PMCID: PMC5844165.

George A. Keepers, M. D., Laura J. Fochtmann, M. D. . M. B. I., Joan M. Anzia, M. D., Sheldon

Benjamin, M. D., Jeffrey M. Lyness, M. D., Ramin Mojtabai, M. D., Mark Servis, M. D.,

Art Walaszek, M. D., Peter Buckley, M. D., Mark F. Lenzenweger, P. D., Alexander S.

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Young, M. D. . M. S. H. S., Amanda Degenhardt, M. D., & Seung-Hee Hong. (2020). The

American Psychiatric Association Practice Guideline for the Treatment of Patients With

Schizophrenia. American Journal of Psychiatry, 177(9), 868–872.

https://doi.org/10.1176/appi.ajp.2020.177901

Gerber, B. (2013, November 21). Psychotherapy group for schizophrenia Links to an external

site. [Video]. YouTube. https://www.youtube.com/watch?v=t8Dzus8WGqA

Hallett , N. (2018). Preventing and managing challenging behaviour. Nursing Standard

(2014+), 32(26), 51. doi:https://doi.org/10.7748/ns.2018.e10969

Malhotra A, Baker J. Group Therapy. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure

Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK549812/

Sarkhel, S., Singh, O., & Arora, M. (2020). Clinical practice guidelines for Psychoeducation in

psychiatric disorders general principles of Psychoeducation. Indian Journal of

Psychiatry, 62(8), 319. https://doi.org/10.4103/psychiatry.indianjpsychiatry_780_19

Walden University. (2023). Academic guides: Verify peer review: Home. Welcome – Walden

University Departments & Centers – Academic Guides at Walden

University. https://academicguides.waldenu.edu/library/verifypeerreview#s-lg-box-

20185792

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Week 3: Analyzing Group Techniques

College of Nursing-PMHNP, Walden University

NRNP 6645: Psychopathology and Diagnostic Reasoning

19/12/2021

Week 3: Analyzing Group Techniques

Schizophrenia is a derailing mental illness leading to substantial suffering to patients

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and extensive burden to families and caregivers (Soliman et al., 2018). Group therapy is one

of the most accepted ways to help individuals with schizophrenia. Group therapies are

gaining recognition based on the fact that any slight progress made by an individual is

manifested in the rest of the participants. The supportive environment created with peers and

therapists helps to facilitate healing as it stabilizes their emotional shortcomings. Even more,

the therapeutic methods and techniques assist participants to learn alternative methods to

cope with and reduce the symptoms of their psychological conditions such as sadness,

depression, and anxiety. This essay is based on the video Psychotherapy Group for

Schizophrenia to explore therapeutic techniques used for individuals with the condition and

the different approaches that can be applied to ensure better results for individual clients.

Group Therapy Techniques Demonstrated

It is worth acknowledging that the therapists did well by having a plan of everything

they intend to cover throughout the session. Also, it was important that they began by spelling

the ground rules and expectations from every group member. They applied relaxation

techniques, such as the deep breathing strategy, where participants are asked to take a deep

breath through the nose and exhale via the mouth. In their everyday experience with the disease,

patients can apply the deep breathing technique to help them calm down when they encounter

challenging situations. It is a strategy for coping and helps them manage affective symptoms.

Most of the techniques utilized by the therapist are evidence-based. Chien et al.

(2019) found the use of emotional regulation in psychoeducation group programs as

imperative in the psychosocial performance of patients with schizophrenia. For example, the

leaders started the session by greetings and allowed every member to introduce themselves.

Commencing the session in this manner helped to promote participation and encouraged the

participants to regulate their emotions. It was also a great way to break the ice and alleviate

any tension and further help to create rapport.

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In their study, Derksen et al. (2017) aimed to investigate the influence of empathy in

primary care sessions. The researchers found a notable connection between empathy, trust,

and patient satisfaction. Similarly, the therapists demonstrated their concern and value for the

participants by asking them, before commencing the session, to rate how they feel on a scale

of 1 to 10. From the responses, they are able to gauge the patients’ resilience in physical,

functional, and social well-being. These are all important domains in reflecting the patients’

quality of life and disease burden (Hofer et al., 2017). Hofer et al. (2017) found that utilizing

resilience-focused interventions enhance patients’ quality of life. The therapists guided the

participants in recapitulating lessons from the previous sessions by asking each of them to

reflect on their recent encounters and how they utilized the lessons to manage the situations.

Allowing group members to share their personal experiences is vital in encouraging group

learning and coherence. It reveals how individuals use interpersonal learning to tackle their

challenges.

What I Would Have Done Differently

From an evidence-based study by Soliman et al. (2018) to assess the effect of

psychoeducation therapy on schizophrenic patients, the intervention was statistically

effective in promoting the patients’ quality of life. Therefore, if I found myself in a situation

of leading the group, I would consider incorporating psychoeducation to assist the patients

understand their conditions better and gain better skills to manage their symptoms.

Moreover, I would tentatively yet directly point out the group members’ challenges,

misperceptions, and problematic behaviors. Being candid in this way would boost the

treatment progress by enabling the patients identify and comprehend their conditions and

tackle their symptoms accordingly.

Insight Gained

Based on the video, I realized that co-therapy becomes even more effective if the

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two professionals are able to cooperate and work harmoniously for the clients’ greater

good. In addition, I realized that it is important to keep notes of the session activities and

observations. Documenting is vital in evaluating the session’s effectiveness and planning

for future sessions. Using the records to plan for future objectives is critical in avoiding

possible repetition and omission of therapy stages (Shamoon et al., 2017).

Reflection on Leading a Group Session

While conducting group therapy sessions, one may encounter difficult clients who

provoke discomfort, anxiety, and emotional reactions from the therapist. If such a situation

arises, it calls upon the therapist to be alert and always try to manage their own reactivity,

compassion fatigue, and projections (Shamoon et al., 2017). Being that we cannot avoid

encounters with difficult clients, I would try as much as possible to handle them by utilizing

cautious confrontation to depress their moody or distractive tendencies. Trying to remain in

control of my emotions would help avoid aggravating the situation and promote goal

attainment. To elicit participation, I would assure every member of their confidentiality.

Besides, I would establish rules to promote respectful behavior from every member. Such

strategies ensure every member has the nerve to freely share their concerns without the fear

of judgment. Through the different phases of group therapy, I expect to see gradual

improvement in each members behaviors.

Generally, group therapy can be ideal in promoting positive support mechanism. The

main advantage is that even with the myriad advantages, it is comparatively affordable than

individual therapy sessions. Group therapy is also a proficient way to alleviate solitude

among participants. It subjects them to new behaviors displayed by their peers and gives

them a sense of safety. Notwithstanding these advantages, group therapy is associated with

drawbacks such as interference from difficult members and risk of conflicts.

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References

Chien, W. T., Cheng, H. Y., McMaster, T. W., Yip, A. L., & Wong, J. C. (2019).

Effectiveness of a mindfulness-based psychoeducation group programme for early-

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stage schizophrenia: An 18-month randomised controlled trial. Schizophrenia

Research, 212, 140-149. https://doi.org/10.1016/j.schres.2019.07.053

Derksen, F., Hartman, T. C. O., van Dijk, A., Plouvier, A., Bensing, J., & Lagro-Janssen, A.

(2017). Consequences of the presence and absence of empathy during consultations

in primary care: A focus group study with patients. Patient Education and

Counseling, 100(5), 987-993. http://dx.doi.org/10.1016/j.pec.2016.12.003

Gerber, B. (2013, November 21). Psychotherapy group for schizophrenia [Video]. YouTube.

Hofer, A., Mizuno, Y., Wartelsteiner, F., Fleischhacker, W. W., Frajo-Apor, B., Kemmler, G.,

Mimura, M., Pardeller, S., Sondermann, C., Suzuki, T., Welte, A., & Uchida, H.

(2017). Quality of life in schizophrenia and bipolar disorder: The impact of

symptomatic remission and resilience. European Psychiatry, 46, 42-47.

http://dx.doi.org/10.1016/j.eurpsy.2017.08.005

Shamoon, Z. A., Lappan, S., & Blow, A. J. (2017). Managing anxiety: A therapist

common factor. Contemporary Family Therapy, 39(1), 43-53. DOI

10.1007/s10591-016-9399-1

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