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Group Work

Group programmes can significantly assist young people overcome the disruption to developmental pathways that can result from the onset of psychosis. Involvement in a peer group is essential to achieving many developmental tasks, and can provide a sense of belonging and acceptance, in addition to an environment in which it is possible to take risks and explore options.
 

Many young people feel alienated from their previous social contacts and networks after the onset of a psychotic episode. A long period of untreated psychosis can negatively impact on a person’s social networks and can lead to withdrawal from contact with others.

 
This social withdrawal may cause isolation and result in social anxiety which further inhibits the person from being able to fully integrate into their community. Therefore, instead of simply experiencing the short-term impact of an illness, people with ongoing symptoms may develop long-term, intractable social disabilities.

 

Consequently, interventions which focus on social recovery during the early phase or critical period of psychosis are vital.
 

Types of Groups

It is important to have a variety of styles groups as well as groups which address different issues:

  • Open, activity-based groups can be particularly helpful for people who are new to a service and may not wish to disclose personal details
  • Closed therapy groups can be beneficial for discussing and teaching coping strategies relating to issues such as social anxiety or coping with auditory hallucinations 
  • Psychoeducation groups can provide a useful format for people to discuss symptoms, medication, or experiences of psychosis, and may assist with treatment adherence and relapse prevention
  • Sports or activity groups can help maintain physical health and prevent weight gain

It is also extremely important to offer targeted groups for vocational and educational recovery and reintegration, given that this can be challenging, even in a first-episode population.  

Groups which consider the needs of family members and include psychoeducation and support can also be extremely valuable.

 

Setting up Groups

When setting up groups for young people experiencing a first psychotic episode, a number of factors need to be taken into account. 

Specifically:

  • Sedation and other side-effects resulting from some medications could limit a young person’s ability to attend or fully participate in groups
  • Cognitive difficulties relating to psychosis may mean that information or psychoeducation-based groups may need to avoid didactic presentation
  • Developmental issues may mean that the membership of a group may need to be carefully considered. For example, the needs and issues experienced by a 15 year old are likely to differ from those of a 21 year old
  • Cost and venue may also be important considerations, as young people who have been unwell may have limited incomes, and lengthy travel time might prohibit people with reduced motivation

 

Detailed descriptions of group interventions for early psychosis are provided in:

Woodhead, G. (2009) Therapeutic Group Work for Young People with First Episode Psychosis. In Gleeson, J.F.M., Killackey, E., & Krstev, H. Psychotherapies for the Psychoses: Theoretical, Cultural and Clinical Integration.  East Sussex: Routledge  

Malla, A.K., McLean T., & Norman, R.M.G. (2009) A Group Psychotherapeutic Intervention During Recovery from First-Episode Psychosis. In Jackson, H.J. & McGorry, P.D. The Recognition and Management of Early Psychosis: A Preventive Approach (2nd Ed.) Cambridge: Cambridge University Press.
 

 

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