Psychologists take lead on public group therapy

The Richmond Mental Health Outpatient services, my work place for the past twelve years, offer a wide range of groups from one-year psychodynamic to ten-week panic disorder groups. Our group program for elderly depressed and anxious patients was featured in the Vancouver Sun

Although group therapy has been around for several decades, many people mistakenly associate it with “letting it all hang out” encounter groups. Group therapy has come a long ways since then, but it is still surprisingly difficult to access it in publicly funded mental health settings. As the need for effective mental health treatment continues to rise, Canada – and the rest of the world – could benefit from this very cost effective and humane form of healing.

This discussion is limited to two mental health problems on the increase, depression and anxiety. Depression and anxiety disorders make up the majority of all mental health problems. Overall, the economic burden of mental health problems has been estimated at $14.4 billion, making it the costliest of all health conditions in Canada (Stephens & Joubert, 2001). In Canada, 8% of people will become depressed in their lifetime, and 12% will suffer from an anxiety disorder. In any given year, 1.4 million Canadians suffer from diagnosable depression or anxiety (O’Donovan, 2004).

Family doctors are usually the first professionals we encourage a family member to talk to. This typically results in the person being prescribed medication and referred to a therapy program, if this exists in the community and the family doctor is aware of it. Although medications can be very effective in treating depression and anxiety, they are not suitable for those who experience significant side effects, or  who simply prefer a non-medication intervention, such as psychotherapy.

Cognitive Behavioural Therapy (CBT) is a form of therapy which is effective for many psychiatric disorders, including anxiety and depression (Hollon et al., 2006). Indeed Clinical Guidelines in Canada recommend CBT as a first-line treatment for both depression and anxiety due to the large body of evidence supporting the effectiveness of CBT (Butler et al., 2006). In recognition of these recommendations, the Provincial Health Services Authority (PHSA) and the BC Ministry of Health (MoH) have jointly developed a CBT framework to improve the quality and availability of CBT for mental health and addictions in BC. This CBT Framework includes several recommendations to support system wide improvements in the delivery of CBT services in BC.

A single therapist or two co-therapists can treat up to four times as many patients within the same number of hours compared to individual therapy. This is how effective group CBT is. Funding and resource limitations have made it impossible for CBT to be delivered in anything but a group format at the Richmond Hospital, the Royal Columbian Hospital (coordinated by psychologist Theo de Gagne) and Vancouver General Hospital.

But group CBT is not just about efficiency and cost-reduction. Group CBT is also a very human form of care with a focus on social support for individuals who feel isolated and stigmatized. We can all relate to the relief felt when realizing that someone truly understands our struggles and has perhaps gone through a similar ordeal. The group therapy process offers patients invaluable support, validation, opportunity to learn from others, and a sense of belonging.

Over the past fifteen years as a group therapist, I have been struck, but not surprised, by how much it means to human beings to have a sense of being “in the same boat”. Walking into, for example, a group for people with obsessive-compulsive disorder and seeing how the initial atmosphere of anxiety and shame changes toward the end of the first two-hour session to one of support, acceptance, and hope makes one almost feel that some not readily explicable group magic has taken place!

Despite the promise of group CBT, there is room for improvement with some unanswered questions yet to be addressed in the group therapy literature. After a comprehensive review of the field, CORRECT Groups, a Michael Smith Foundation Health Research funded research team (Dr. John Ogrodniczuk, a professor at UBC, as team leader and myself as a team member) established to promote collaborative, international research on group psychotherapy. The team identified the need to improve attendance in group therapy as one of its research priorities.

Poor attendance has been identified as one of the most common problems in therapy groups. In the context of group psychotherapy, poor attendance disrupts group solidarity and can precipitate poor attendance patterns among other group members. It can also hinder meaningful work for the rest of the group, often leaving other group members feeling insecure, worried, or angry (MacNair & Corazzini, 1994). Moreover, there is often increased reluctance to disclose private information when attendance among group members is unstable as patients do not wish to repeat their disclosures. At its extreme, poor compliance includes anywhere from 30-50% of patients who drop out of a group prematurely thus significantly limiting this delivery model’s cost-effectiveness. Thus, detecting which patients are at risk for poor treatment compliance is an important step towards improving the efficiency and effectiveness of group therapy.

Our team is pleased to recently having been awarded a Vancouver Coastal Health Team Grant 2010 to help us learn more about who is especially at risk for not completing a group, and what steps we as helpers can take to better support this person. We look forward to sharing our findings with our colleagues and the public.

References

Butler, A.C., Chapman, J.E., Forman, E.M. & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.

Hollon, S.D., Stewart, M.O. & Strunk, D. (2006). Cognitive behavior therapy has enduring effects in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285-315.

MacNair, R.R. & Corazzini, J.G. (1994). Client Factors Influencing Group Therapy Dropout. Psychotherapy, 31(2), 352-362. 

O’Donovan, C. (2004). Achieving and Sustaining Remission in Depression and Anxiety Disorders. The Canadian Journal of Psychiatry, 49, (suppl. 1), 5S – 9S.

Ogrodniczuk, J., Söchting, I., Piggott, N., & Piper, W. (2009). Integrated group therapy for a heterogeneous outpatient sample. The Journal of Nervous and Mental Disease, 197, 862-4 

Söchting, I., Wilson, C., & DeGagne, T. (2010). Group CBT: Capitalizing on Efficiency and Humanity. In J. Bennett-Levy & M. Lau, Oxford Guide to Low Intensity CBT Interventions. Oxford University Press

Stephens, T. & Joubert, N. (2001). The Economic Burden of Mental Health Problems in Canada. Chronic Diseases in Canada, 22(1), 18-23.

About the Author

Ingrid Söchting, Ph.D., R. Psych.

Dr. Ingrid Söchting is the Chief Psychologist at the Richmond Mental Health Outpatient Services located at the Richmond Hospital, B.C. and an assistant clinical professor in the Department of Psychiatry, UBC. She has developed a number of group therapy programs including CBT groups for OCD in adults and adolescents, panic disorder, post-traumatic stress disorder, and depression in adults and older adults. She supervises and teaches psychology interns and psychiatry residents and is co-director of the Richmond Psychotherapy Training Program (www.rhspsychiatry.com).  She is a clinician scientist and has an active group psychotherapy research program.

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