Group Psycho-Therapy and the Psychiatric Social Worker By ERIKA CHANCE, B.A. Psychiatric Social Worker, Warlingham Park Hospital Although group treatment as a means of resolving the contribution she can make by participating personal difficulties has been practised for some in treatment groups, both to group therapy and to time, it has but recently received recognition in psychiatric social work. the psychiatric field. Since Pratt treated T.B. patients by these means in 1905, the advent of the THE FIELD shock therapies and the pressures of the late war The In-Patient have done much to focus attention on a technique (1) Group of psychotherapy which, it was hoped, would be This group has met once a week since November, time saving. 1946 for an hour's discussion of psychiatric pro- Psychiatry has for some years taken a wider view blems. A wide variety of techniques have been of its function in relation to the community than used, ranging from free discussion of problems that which would restrict it to the treatment of the raised by patients, to discussion illustrated by drama- mentally sick. Research into methods of group tic acting out of situations, to the didactic lecture therapy and sociometrics shows that the Mental discussion method. Health Service has a vital contribution to make in Of the three groups to be described, recruitment terms of guiding interpersonal relationships. Indeed, for this unit is least selective. Most patients attend it can have no less a than that of the Inter- on the invitation of their doctor, but some are goal " national Congress for Mental Health: The task brought by friends. of preparing the way for individuals to become The membership of the group is subject to constant citizens of the world.'' The formation of the groups change as patients attending are mostly on the described here and the specific way in which they road to recovery. There have, therefore, been large are linked are the product of a Mental Health variations in attendance, ranging from 7 to 16. Service which sets itself this goal. Male patients tend to be in the majority. The Group therapy may be defined as the re-orienta- place of this group is ancillary to the general treat- tion of the patient by means of specific relationships ment plan. Patients are also, as a rule, under between the individual and the group leader, the Insulin, E.C.T. or analytic treatment. individual and the group, and between individuals This group has failed to develop any social in the group. Two main divisions in group structure although there are a number of practical treatment techniques may be distinguished; dis- tasks for which patients could usefully take responsi- cussion therapy and activity therapy. In this bility, such as preparation of the meeting room, article, the writer will describe her experiences acting as secretary, etc. It differs in this respect in the past year in conducting group therapy strikingly from the Social Therapy Club. It is jointly with a psychiatrist for the following groups; the only one of the groups described in which (1) a discussion group for In-Patients, (2) a dis- movement is almost entirely absent and in which cussion group for Out-Patients and (3) a Social certain stereotyped features have developed. Men Therapy Club for Out-Patients. The psychiatric and women tend to sit at opposite sides of the social workers function in these groups will be room and, irrespective of the technique used, described and the writer will endeavour to assess the members contributions are nearly always MENTAL HEALTH directed to the leaders. Attendance is entirely in progress the psychiatrist and the writer interview voluntary and, by the very nature of the group, individual patients who have specific problems. patients come to it largely because they hope to At intervals they return to the tea room and join derive from their attendance some information in the conversation around the table. At the end which will enable them to leave the group of the meal patients assemble for the treatment permanently. group. Of the three groups described, recruitment here is (2) The Social Therapy Club for Out-Patients most selective. Only patients with average or good intelligence and with a real need for verbalizing This club was in January, 1947, under opened their problems are asked to attend. Attendance the leadership of the writer and of the psychiatrist ranges from 7 to 10 patients and at times patients in charge of the In-Patient group. are Meetings are asked to bring their husbands, wives, or other held once a week and a committee of members relatives to the when it is felt that decide of and club group they might questions programme manage- take in the discussion. ment. usefully part With the exception of one case all patients The programme includes discussions on questions attending this group also attend the club. They of interest as well as on general psychiatric problems, look the club as a field in which to dramatic and musical upon practice evenings, dancing, games, and understanding gained in the discussion. etc. A social is held six weeks to insight outings, every About half of these are former members which members invite friends and relatives. An patients of the discussion group for in-patients. invitation to the In-Patient group has become one The used in this group are similar of the traditional features of these social evenings. techniques to the methods used in the In-Patient group, but A quarterly concerned with magazine, largely the members' contributions tend to be more group articles on mental health is produced by the patients. centered. Patients state their personal problems Members take it in turn to bake for the canteen. spontaneously and, because they participate more Recruitment is selective. Patients attending for it is possible to bring into the group treatment and some of those actively, out-patient discharged discussion material which would be too from the Mental are invited to disturbing Hospital join by in the of the In-Patient the leaders. Information about each member setting group. This group shows no specific social structure, to enrolment is obtained from a prior psychiatric but members demonstrate their individual feeling interview and a social and psychiatric history. In for the group by assisting in the preparation of the course of his attendance the social patient's meals and of the meeting room and in helping to problems are noted. Intelligence is tested. The up after After an hour's discussion number of active members has remained at about tidy meetings. patients walk over to the club in groups of twos 30 the year and the bulk of the throughout and threes, often continuing the discussion on the has remained constant. The average membership way. attendance is 19. Men and women attend in In this of the the numbers. About 40 concluding description field, approximately equal per degree of interaction between the three therapeutic cent, of the members are former in-patients. groups should be stressed as an important factor It is the aim of this group to provide patients in treatment. To the in-patient who visits the Club with all the facilities which a good club may offer, on a social evening it is an encouraging experience an scope for self govern- including ever-increasing to meet former in-patients who look well and ment and The treatment aim of happy. responsibility. Members of the Out-Patient discussion group are the club is openly accepted by each patient in more conscious of the treatment purpose of the relation to the staff. sociometric tests Repeated club and to club aims in the minds show that do in fact full help keep although patients carry of other members. The three for all the mechanics of groups represent responsibility group stages of mental health and social adjustment. management their personal dependence is centered upon the leaders. It is felt that both these factors, the self governing, highly structured aspect of the THE PSYCHIATRIC SOCIAL WORKER'S club, and the extreme personal dependence on the FUNCTION leaders combine to give this group the family The joint leadership of any group presents a atmosphere of a living community; structured in that it taxes the leaders' capacity for to a realistic social problem enough provide background, co-operation and team work. The and flexible to allow psychiatric yet sufficiently therapeutic social worker and the have comple- situations to arise and to be con- psychiatrist naturally easily functions in the normal of a trolled and mentary working guided. Mental Health Service. These are usually per- formed separately in time and place. Joint work The Out-Patient Discussion (3) Group in group therapy requires detailed preparation This group has met once a week since January, of a treatment plan for each session and discussion 1947 at the Social Workers' Office. Prior to the which clarifies the role of each worker in the treat- discussion, tea is available in informal surroundings ment plan as a whole. It requires careful assess- for patients coming from work. While meals are ment of each patient's problem, of his relationship 10 MENTAL HEALTH to other members, and to the leaders, so that the The psychiatric social worker as an auxiliary to optimum use can be made of all therapeutic the psychiatrist can be of assistance in breaking resources. From the foregoing it will be seen down resistance in discussion therapy. The social that it is doubtful whether the advantages of group worker's contribution as a lay member of the group therapy lie in an economy of time.