Mental Health Groups

[deleted640852]

I know this is a long-shot, but it doesn't hurt to ask.

I work in a short-term psychiatric facility and am in charge of running two groups during my shift. The problem is, I don't have many resources. The first group is a morning group. There really isn't much direction regarding what the group should be about. Usually, we are required to have the patients fill out a standard wellness sheet (goals for the day, report any suicidal/homicidal ideation, etc...), but after that, there's no other direction. The group is to last at least an hour. I used to have the patients go around the room, introduce themselves and then state goals for the day and any concerns/questions they may have. But, the short-term facility is slowly turning into a long-term facility. The group is getting shorter and shorter because patients are bored of the same thing day in and out.

The second group is usually supposed to be based on tools, such as Identifying Triggers, Anger Management, Patient Wellness, etc.

I truly have no direction other than some old worksheets that don't even have much direction or lesson plans attached to them.

Please help.

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[CheetahGirl]

I truly have no direction other than some old worksheets that don't even have much direction or lesson plans attached to them.

Please help.

It never hurts to ask and I'm glad you did.

The situation you are in is really unacceptable. Don't you have a supervisor that has a clue about what needs to be done? And what are your credentials? Are you an employed undergrad, medical student, psychology extern or what? Is this your job, part of some training placement or are you a volunteer? Also, you don't have any co-facilitators, either at the same level of training as you or senior to you? Please explain further.

I could go on and on about different types of group therapy (DBT, seeking safety, anger management, substance recovery, wellness, process groups, psychoeducation groups), suggestions for group topics, group process, how to handle problems among members in group therapy, angry/unsafe patient management but I am not your supervisor and this really needs to be addressed by him/her...so that the training/work can be followed from week to week and new problems/issues/victories can be addressed on an ongoing basis. (That said, you could also read Yalom's The theory and practice of group psychotherapy...it is considered the group therapy 'bible' by some - google it...there are several chapters offered via pdf).

I can clearly understand why patients are dropping out, and you hit the nail on the head...it is becoming a longer-term type group and patients find the same 'ole "bitch & moan about staff and fellow patients" groups to be non-therapeutic..and they are right.

Do me a huge favor and go ask your supervisor what is up with this? It is counterproductive and unfortunate, but often the case that the only therapy offered on inpatient psych units is the group therapy component, so the patients on your service are receiving an injustice by support staff without guidance and/or direction. Take this to the higher-up administration if your supervisor has no clue. ...unless you are the supervisor and then please explain how you got this job in the first place.

(BTW, not meaning to sound like a rant, but this is the very problem that I have heard from patients throughout training - usually not from the facilities I have trained at, but as a in 'horror stories' from other units. And it is extremely disadvantageous to be offered a psychotherapy group - assuming this is a psychotherapy group on a inpatient psychiatric unit - that is non-therapeutic. It undermines the work that some of us do well...and the patients leave these units jaded against mental health).

EDIT: Yes, and what erg923 says below.

 

[erg923]

Are you a licesned MH provider? If not, how is this not practicing psychology without a license?

 

[smalltownpsych]

Not good. I have seen this happen too many times. Why don't they just have a recreation group or social hour or watch Seinfeld and discuss group? Who the hell is in charge of this place? I would hope that no psychologists are working there because we aren't supposed to stand by and allow untrained, unlicensed people try to do psychotherapy. There is very clear evidence that a bad group can cause psychological harm even more so than bad individual psychotherapy. Likely because of the power of social pressure to effect people. That is what can make group very effective but also more risky. It is probably not really your fault as you don't know what you don't know, but there have to be people working there that are in charge who should know better and should be accountable.

 

[deleted640852]

I really appreciate everyone's input. I now feel better about the frustration I have been feeling. Personally, I only have an undergraduate degree in psychology. The position I hold does not even require an undergraduate degree. I am a Mental Health Technician (AKA: Psychiatric Technician). I have been wondering WHY this hospital has MHTs run groups. There is only one group during the day that Social Workers run (It's funny because they're Social Workers, but the hospital puts "Therapist" on their badge).
We are required to "program" the entire day. Keep the patients busy with groups lead by MHTs and have evidence that they're ran successfully with paperwork, etc.
I feel that the amount of work put on MHTs is not only too much, but out of our scope. We are not supported and are only punished if the groups do not happen. There is a large box with worksheets, but those only work for so long and are vague, to say the least.
This is a for-profit, private hospital and I am not surprised that there is a high turn-over rate.
Thank you for the suggestions.
Any questions I have asked at work have been shirked and have been met with a "Figure it out yourself! Just keep them busy!" attitude.

 

[CheetahGirl]

Wow, Pink_Squirrel. I'm livid. Not at you, of course, but again at the situation they have put you and the patients in at this facility. You are right...this is outside of the scope of what you should be doing. I wish I was someone who was authorized to give them a piece of my mind. I cannot believe this is a for-profit, (cheap-a$$) private hospital that does not provide better care for patients and staff. I will defer to others' opinions about what you should do, regarding administration and your employment position. But, start documenting everything (for your own benefit)...not private health information, but how many patients you have per group (on average from week to week), what topics you discussed, any problems or accomplishments, feedback from supervisors and patients. I would recommend keeping a 'work journal' or notebook. You never said what your career aspirations are, but this is technically "clinical work" that you are doing and whether you are pre-med or pre-doctoral psych, you can refer back to these experiences in interviews, essays, etc.

VERY IMPORTANT: Safety first - for you, staff & the patients. Please make sure you get aggressive patient management training AND you know where the safety call buttons are for staff. If they are not there, always make sure you are closest to the door (NOT on the opposite side of the room, with patients between you & the door). Move the chairs/tables are if you have to or request it. Never hand out pencils/pens or sharp objects (remember some patients could be actively suicidal). If art therapy is a topic...note and account for all writing/drawing utensils upon ending the group. Not to scare you, but you are on a psychiatric ward and patients may or may not be heavily sedated, but some could be agitated & lash out at any time. And never lay your hands on a patient...only talk things through and always get staff if you are worried about a situation or person. (I hope they at least provided you this vital safety information.)

Regarding what to do, attached is a good overview of group therapy from SAMSA...it is 2005 and on substance use, but the entire idea of types of groups (process vs. psychoeducation vs skills groups) are discussed, as well as some other good stuff. It may provide you some direction until someone at your facility 'wakes up and smells the coffee.' Read as much Irvin Yalom, MD, as you can. Google can be your friend, as far as ideas for day-to-day group therapy - search key words in the document attached to see what direction you want to go. Switch up the topics...don't circle back to a topic for at least several weeks (unless requested by the group). This keeps it interesting for you & the patients.

And lastly, be compassionate to the patients on the ward - not that you wouldn't, but don't look down on them no matter how disheveled they may look, sick they may be behaving, horrible they may be smelling (the topic of self-care is always helpful on inpt units), or bizarre they may be acting. You never know who could end up on a unit, for whatever reason, at any time, and you are there to help, not judge them. I have often been told by patients that I have run groups with that they have never felt judged by me (but have felt judged or belittled by other residents, psych externs, interns). It is a style you can develop now. Compassion and respect for other humans can go a long, long way.

That's all I can say...otherwise, I'm speechless. Best of luck!

 

[smalltownpsych]

Makes we wonder how they are billing for these groups. This type of unethical garbage makes my blood boil. I have seen it occur more frequently in settings where there are no psychologists because we tend to be sticklers about ethical practice since developing expertise in this is one of our core competencies. In my experience, most of the mid-level more generic therapists seem to be more likely to just go along with the system since they are just happy to have a job to get their hours. It's going to get worse too because the schools are flooding the market with new grads. At least that is what it seems like in the last few states where I have worked. I don't know what the actual statistics are, but am thinking that an enterprising psychologist to be who has an interest might want to start delving into this.