Conclusion planning a service

Group psychotherapy encompasses a diverse range of methods and has been proved to be effective in many studies. For group psychotherapy to be effective, the group has to be the primary focus of therapy; patients need to be well selected; and therapists need to be adequately trained. Therapeutic competence is not a function of mastering the literature so much as the outcome of experience in the group situation itself. Courses introducing different group methods are now widely available throughout the United Kingdom, continental Europe, and the United States. Group training is also provided in many general training programmes and, along with clinical supervision, is offered in many health and other service agencies.

Long-term outpatient group therapy of 100 sessions or more is effective and economic in producing lasting benefits for patients with a wide range of medical and psychiatric symptoms, interpersonal problems, traumatic life experiences, and character and personality disorders. Inpatient group therapy is an effective resource in the context of acute units working with crisis, and in secure units working with long-term problems. Short-term group therapy in selected conditions requires careful composition and an active flexible therapeutic approach.

We have not tried to cover the range of group services and approaches for children. Schamess (l60) and Kymissis(!61) cover group work with children and adolescents respectively. Further readings are available in Dwivedi's handbook, (162) in Evans' text/163) in Melzak's forthcoming collection/164 and in the Special Edition of Group Analysis devoted to this subject.

Groups are often the treatment of choice for adults and children. The clinical arguments that recommend them, and the issues of selection, composition, focus, method, model, and approach, are the substance of this chapter.

The economic arguments for groups can be equally compelling. In just one study, for example, a follow-up questionnaire sent to 1000 former psychiatric patients who received different kinds of treatments had a 65 per cent return rate which showed significant self-assessed health status improvements 5 years after finishing therapy. The quality of improvement between individual and group therapy showed no significant difference, but the expenditure for the service was radically different. Cost savings were calculated as the reduction in medical consultations and hospital attendances, and lost workdays. For those treated with psychotherapy of any kind, the cost of treatment per patient was 25 per cent less than it was for those who did not receive psychotherapy. And the cost of group psychotherapy per patient was in turn some 33 per cent less than for individual psychotherapy. (165)

There are other advantages to institutions offering group therapy. If they are provided in the context of a comprehensive service, a number of groups will be available and the range of choice will allow successful placement for a wide range of patients. Choices also come into play for the therapists, who will have the benefit of electing patient or problem categories and of working with colleagues as co-therapists. They may receive clinical supervision on site or in the context of a course elsewhere, in either case benefiting from work with a group of colleagues.(166) Collaboration and interprofessional learning will be enhanced and in due course the responsibility of providing clinical supervision gives an outlet for more experienced clinicians. ^Z) The group and intergroup relations of the professionals providing the service can thus enjoy development which will serve them well within and beyond the context of the group work programme.

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