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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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