Group Logistics
Group therapy is one of the most common modalities for managing major symptoms associated with mental disorders. In this regard, group psychotherapy can either be open or closed. However, choosing the method to organize the sessions will depend on the group’s objective. Since the treatment is intended for schizophrenic clients, consisting of a mixed group of adults currently using medications but not participating in therapy meetings, it will be vital to choose the closed group method (Hazell et al., 2016). This therapy session is mainly intended to address a specific diagnosis or clinical problem, where every client is working toward a common goal.
When selecting how to organize the group for schizophrenic patients, it is crucial to consider the group size and the time the sessions are scheduled to last. Group therapy usually comprises between two and 15 members (Ezhumalai et al., 2018). In this case, the group will consist of 12 members, and therapy sessions will last for around 16 weeks, each with at least two hours of counseling. In addition, selecting a method that provides a framework to work within a limited time would be appropriate. Thus, unlike open sessions, the closed group format will allow all clients to join the group at the same time (Ezhumalai et al., 2018). Therefore, this will enable them to learn from their experiences and adopt effective coping skills.
Schizophrenic clients seeking therapy may have reservations and questions about joining a group. Pre-group interviews create an opportunity to be acquainted with the group leader, find resources that could be more helpful, and assist the therapist in deciding if the group is the best match for their needs. In this case, pre-group screening may involve group or individual interviews. However, the method used during the initial meeting may be determined by the difficulties clients are experiencing. Social anxiety is a highly prevalent and disabling condition among clients with schizophrenia (Roy et al., 2018). Therefore, it is recommended that a therapist use an orientation method that will empower clients to express their expectations effectively. In this case, the individual interview can help a therapist talk to one client at a time and address all their concerns in detail before joining the group. Similarly, ground rules can help establish guidelines on how to relate within a group. Thus, since it is a group session, some standards may include not socializing outside of the group, maintaining confidentiality, and exhibiting appropriate behaviors in groups.
Ethical Considerations
In a closed group setting, clients with schizophrenia may no longer feel estranged from society or alone in their difficulties and instead view themselves as part of a community of individuals with shared experiences. In this case, the participants in the group therapy may benefit from the knowledge generated by other members and learn to manage their health conditions. Nevertheless, this type of group therapy can also bring unique ethical issues. In such scenarios, ethical considerations serve as principles for protecting clients from harm while undergoing a therapeutic process. Maintaining confidentiality is one code of conduct relevant to this type of group (Trachsel & grosse Holtforth, 2019). In this case, a therapist is required to take necessary steps to safeguard any identifying information and prevent any threats to data privacy. All personal information must be kept confidential, including contact information, client notes, intake forms, where they live, and what personal problems they are experiencing. This practice can help group leaders promote clients’ safety.
Obtaining informed consent is also essential in group therapy. This ethical standard requires all potential clients to be provided with relevant data to understand and decide whether they want to participate in closed group therapy (Trachsel & grosse Holtforth, 2019). This includes information about the benefits and risks of this type of therapy, its funding, and institutional approval. In addition, a group leader should not harm clients; therefore, they must consider all sources of injuries to clients and find concrete ways to mitigate them. These harms can either be physical or psychological or an invasion of privacy. Another ethical consideration is voluntary participation, which dictates that all clients are free to join the group without coercion (Trachsel & grosse Holtforth, 2019). Similarly, they can leave or withdraw from therapy at any point without consequences or repercussions. Lastly, it is important to maintain professional boundaries with the clients in the group (Trachsel & grosse Holtforth, 2019). As the therapeutic relationship develops, a client may form a strong attachment to the therapist. Therefore, it is crucial for professionals to maintain and re-establish boundaries as needed.
Leadership Role
Therapy sessions are led by counselors with specialized training to teach group members proven strategies for managing specific problems. For example, for schizophrenic clients, the professional may take a leadership role and work with the clients to devise scientifically tested coping strategies. In this case, collaboration will help negotiate goals and determine the pathway to reach them (Haram et al., 2019). Closed group therapy is recommended as a therapeutic strategy because it helps encourage coping, bonding, and sharing. Therefore, unlike the directive strategy, the non-directive counseling approach may help schizophrenic patients explore their thoughts and feelings (Erzin & Gülöksüz, 2021). In this case, unstructured groups can be vital because they allow clients to express their views and participate in the therapeutic process. However, a structured approach may be appropriate if the clients need to learn better problem-solving and daily coping skills. Nevertheless, a group leader should be prepared to provide more direction to group members when required.
In group therapy, members usually form relationships based on mutually shared expectations. In this case, drastic or abrupt changes in roles can lead to anxiety and unpredictability. A facilitator must take many roles in various group stages to be effective. Team development has a five-step process: forming, storming, norming, performing, and adjourning (Ezhumalai et al., 2018). In the first, second, third, fourth, and fifth stages, a facilitator may help the group set ground rules, deal with issues of control and power, find norms, function as a team, and find closure, respectively.
A group leader may use various techniques in cognitive behavioral therapy to help a team achieve desired outcomes. These strategies include role-playing, activity scheduling, journaling, guided discovery, and cognitive restructuring. In this case, role-playing can provide real-world scenarios to help clients improve their skill deficits. This can help reduce anxiety and give them the courage to manage their nervous feelings. Journaling is another technique that may help clients track their moods and thoughts. The approach can assist group members in recognizing triggers and learning ways to cope with them.
Activity schedules can help schizophrenic clients to establish healthy habits, such as walking or working on a project. This intervention can be critical for dealing with anxiety and depression (Gautam et al., 2020. Furthermore, guided discovery is a therapeutic dialogue designed to assist group members in finding their own solutions to their problems (Gautam et al., 2020). This can challenge and broaden clients’ thinking and enable them to choose a more helpful path. Lastly, cognitive restructuring can be used to explore a group’s dysfunctional thoughts and how to challenge them. In this case, clients will be able to reframe the unnecessary negative feelings they frequently experience and become more positive and productive.
References
Erzın, G., & Gülöksüz, S. (2021). Early interventions for clinical high-risk state for psychosis. Archives of Neuropsychiatry, 58(Suppl 1), S7–S11. Web.
Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(Suppl 4), S514–S521. Web.
Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(Suppl 2), S223–S229. Web.
Haram, A., Fosse, R., Jonsbu, E., & Hole, T. (2019). Impact of psychotherapy in psychosis: A retrospective case control study. Frontiers in Psychiatry, 10. Web.
Hazell, C. M., Hayward, M., Cavanagh, K., & Strauss, C. (2016). A systematic review and meta-analysis of low intensity CBT for psychosis. Clinical Psychology Review, 45, 183–192. Web.
Roy, M. A., Demers, M. F., & Achim, A. M. (2018). Social anxiety disorder in schizophrenia: A neglected, yet potentially important comorbidity. Journal of Psychiatry and Neuroscience, 43(4), 287–288. Web.
Trachsel, M., & grosse Holtforth, M. (2019). How to strengthen patients’ meaning response by an ethical informed consent in psychotherapy. Frontiers in Psychology, 10(1747), 1-6. Web.