Mental Health Groups: Theories and Methods

• Constance Ballew

All over the world the issue of mental health is a rampantly growing problem. With budget cuts both statewide and federally since the 1980’s by President Ronald Reagan, our country has had to create more cost efficient ways to meet the needs of our mental health crisis. Because of these budget cuts the need for more mental health services has grown and our county has responded to the outcry from those with mental health issues. Tulare County has come up with a way to help meet these needs locally through the Mental Health Services Act (MHSA), which was voted for in November 2004 and became effective January 2005. From August 2009 to October 20011 MHSA has helped over 16,000 Tulare county residents with mental health issues. This is possible because of a 1% tax surcharge on those who make $1 million or more per year. Mental health groups in Tulare County treat a broad spectrum of problems. From Bipolar Disorder and depression to schizophrenia, there are support groups to help clients deal with the difficulties associated with mental illness (HHSA, 2012).

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In California the rate mental illness vary from county to county. Over all the rate of those with mental health issues in California are 16.3% that equals to about 4 million Californians. This percentage is a scarce comparison to that of all Americans who need mental health services. These figures which are 20-28% are alarming. Mental health affects everyone, even those who don’t have mental illness are affected by the mental health crisis in our county and country. Mental illness does not choose its victims by color, race, gender or age. Mental illness also does not prefer certain social or economic status. (Lund, 2001)

Before 1956 many patients were not open to the idea of group therapy, almost two thirds of the patients in fact. And of those who entered group therapy 15% dropped out within the first 5 weeks of therapy. It is also shown in the study done by DeSchill that patients who had already received individual counseling did not increase their likely hood of staying in group counseling over those who had not. (DeSchill, 2014)

The creation of mental health groups came from the need for more patients to be seen at a more economic and less time consuming. This is due to the introduction of Managed care into the mental health care system. Managed care has brought some limitations into treatment of mental illness as well as other groups. These are that managed care will pay for a certain amount of group sessions. There is a price cap on some of the sessions and therapist are often limited to the quantity and quality of care they provide group members.

The Goal of mental health groups is to help people cope with the disabilities they face in life. It is this such support that helps many people around the U.S. live their lives in more fruitful ways than they would if they did not had the support of the mental health support groups. Mental health support groups provide an end to isolation. The isolation that people suffer who have mental health issues is debilitating and leads to early death rates for the mentally ill. According to Marla Szalavitz, in a study done by researchers at University College London, 6,500 people over the age of 52 where studied. The most isolated of those had a 26% higher chance of earlier death than those who were not isolated. Mental health groups have a valuable role in the part of treating those with mental illness, not just mentally but also physically (Szalavitz, 2013).

The group members would be screened prior to entering the group. This is to ensure safety within the group and also to allow the maximum effectiveness for the group. The screening process would be done by a physician who would then refer the member to our group. This would help the therapist to focus on the members in the group who are able to do work and participate in their own change process.

The roles of the members in a group are important to study. Each member role help to establish a flow for the dynamic and solidifies norms. The challenges of the leaders in a mental health group can be somewhat different from a leader in other groups. This is because the dynamic could change more often than that of other groups due to the challenges that face those with mental illness.

The treatment models used to treat mental illness in group therapy according to Sara Battista, groups can be psychodynamic, cognitive behavioral psychotherapy and psychosocial. The purpose and goal of a mental health group is dependent on the type of model used. In psychosocial groups, the goal is to sustain a balance of norms in the clients life, change if it happens is slow and not expected with the psychosocial model of treatment. In a Cognitive behavioral model led group, the leader is an example for the group. The group is made of people with the same sorts of issues who seek the same goal. Psychodynamic groups focus on the role each member has had in their families or in society and now have in the group. (Battista, 2013)

In addition to the generalization of the treatments used to treat mental health issues, there are more in depth tools used in groups for the treatment of mental illness. Depression for people who have a mild or moderate level has been treated with cognitive behavioral along with interpersonal psychotherapies. While patients who have a disorder such as schizophrenia have been shown to benefit from cognitive behavioral psychotherapy. (Lehman et al, 2004)

Psychoanalytic groups or psychodynamic groups settings usually have anywhere from 5 to 10 people. In this type of setting there is a gender heterogeneity and the ages are usually within the same developmental stages. This is also a group which is cost effective and would benefit the members in financial hardship. The meetings are generally and 1 ½ long or longer depending on the group. This type of group would meet a couple of two to three time per a week. This model is used because of its effectiveness to deal with group issues such as resistance and transference. Because of the heterogeneity in the group, members are able to work out other emotional reactions they might have opposed to that of a homogeneous group. Group members use their interactions with each other to help them work out problems in their lives. There is a sense of self-awareness that is gained by this type of therapy in group and the individual is able to do work more efficiently than on his own (DeSchill, 1974).

Cognitive Behavioral Therapy used in group sessions is cost and time efficient. This type of therapy helps the group members to focus on life issues such as relationships, matters of their health and are aims to help correct dysfunctional issues with the clients. The goals for this type of group would be to help the group members realize that they can have more choices than the ones that have had in the past. Also to replace faulty behavior with healthy emotions and behaviors. This group would be a smaller group of about 5-10 people and also heterogeneous. This group would most likely meet about twice a week for about 2 hours to help promote the necessary change needed in the group (Cowdry, 2012).

Psychosocial group settings are settings in which the group members talk out their problems, this is an effective type of treatment for people who have various type of mental health disorders. The setting would also be gender heterogeneous and include different ethnic backgrounds. The cultural differences in the group may prove to be an issue of resistance but if the therapist is trained with a multicultural background it can be a learning experience for the rest of the group. This group much like the two previous types of groups I have mentioned would be smaller groups and would meet more frequently to help the process of change. (Cowdry, 2012)

The group duration is ongoing for those with more serious mental health issues and can be more time limited for those with anxiety or depression issues. Since the goals for the groups are different. The duration would also be different. Meaning that people with schizophrenia will need a group with a longer duration, maybe 2 years while someone suffering from anxiety and depression may only need 16-18. This is because for those with serious issues the goals are more about maintaining their lives and with anxiety or depression it is to help produce change.

The goals of each group would be depending on the degree of mental health issues in which the members have. For instance, the goals for group members who are more seriously mentally ill would more tailored to adapting or maintaining mental and physical health and not towards a cure or getting better. While the goals for groups that are for depression and anxiety are focused on cognitive and the behavioral changes for members. It is also focused on helping the group members see more positive ways to manage stress and coping skills to manage negative thoughts. (Corey et al, 2014).

Group rules for mental health members should be clear and easy to understand. They should set limits on behaviors and encourage the members to share. Rules should also help to ensure safety and confidentiality within the group. Rules would be as follows; please allow people to finish sharing before speaking. Respect others thoughts and feelings. Please keep what has been shared in group inside group. Please share any thoughts or concerns you may have in group.

The tools that can be used in the forming stage of the group can be activities used to create safety and trust. This would be for the first few sessions of the group. The next few sessions would be activities to confront resistance in the group so that the members can get through to the second stage of tuckmans model which is storming. Then a few team building exercises to help the group cohesion and encourage the norming stage. The next few sessions would be based on tools to increase performing within the members and the final stage and for the last few weeks group members and therapist would be focused on the ending of the group-termination. This final stage would be to help the member talk about any issues that they feel haven’t been addressed and also deal with the closing of the group. These last sessions will also be used to go over what has been learned by the group members, what they will do after group and help them with crisis plans.

There are some ways in which a group can be evaluated to see if it has been an effective form of treatment. One way is to ask the clients to complete a pre group and post group questionnaire. This would ask questions asking the group member to rate their feelings toward themselves, their mental illness, their current abilities to function inside and outside of the group and also would ask them how willing they are to join the group. The post group questionnaire would also ask the client to rate their feelings based on how they felt after receiving the treatment in group. Another way to evaluate the effectiveness of the group would be to ask the group members to share with each other how they feel in group during the first few sessions about the effectiveness. This would be charted. The therapist can also ask members to come to a meeting after termination of the group in which they are asked their thoughts and feelings again about their time in the group. This would also be charted. The comparisons used in the feeling checks before and after group can help the group leader determine the effectiveness of the group. A therapist can also evaluate the effectiveness of the group by research. The therapist can study how many people need more help, how many terminate early and for what reasons and also what changes need to be made to enhance the effectiveness (Corey et al, 2014).

In doing this research, I found that mental health groups are a vital part of treating those with mental health issues. At times people feel alone, with group such as mental health treatment groups, members don’t have to feel alone and can relate to each other.

References

Battista, S. (2013) New Trends in Mental Health Treatment, National Alliance on Mental Illness, Retrieved From http://www.nami.org/Template.cfm?Section=Top_Story&template=/contentmanagement/contentdisplay.cfm&ContentID=158934

Corey et al, (2014) Theories and Techniques of Group Counseling, Groups Process and Practice, Ninth Edition, Brooks/Cole, Cengage Learning

Cowdry, R (2012) Treatments and Services, National Alliance on Mental Illness, Retrieved From http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&Template=/ContentManagement/ContentDisplay.cfm&ContentID=10510

DeSchill, S (1974) Introduction to Psychoanalytic Group Psychotherapy Part 1, The Challenge for Group Psychotherapy, Retrieved From http://americanmentalhealthfoundation.org/books/introduction-to-psychoanalytic-group-psychotherapy-part-1/

Health and Human Services Agency (2012) Tulare County Mental Health Services Act, Five Year Report, HHSA, Retrieved From http://hhsawebdocs.tchhsa.org/questys.cmx.hhsawebdocs/File.ashx?id=2819&v=1&x=pdf

Lehman et al. (2004) Evidence-Based Mental Health Treatments and Services: Examples to Inform Public Policy, Millbank Memorial Fund Retrieved From http://www.milbank.org/uploads/documents/2004lehman/2004lehman.html

Lund, L. E. (2001) Mental Health Care in California Counties: Perceived Need and Barriers to Access, Center for Health Statistics, Retrieved From http://www.cdph.ca.gov/pubsforms/Pubs/OHIRmentalhealthCareCA2001.pdf

Szalavitz, M. (2013) Social Isolation, Not just feeling Lonely May Shorten Lives, Time, Retrieved from http://healthland.time.com/2013/03/26/social-isolation-not-just-feeling-lonely-may-shorten-lives/