IAPT Behind Closed Doors – ‘Group CBT’

I have had some interesting experiences with regard to group work.  Groups were divided into either Anxiety or Depression groups and it was often a difficult task to understand or to divide those suffering predominantly from anxiety and those suffering mostly from depression.  Added to this, groups were designed to deliver the most information to as many people as possible and were not tailored to individual need.  It was a “scattergun” approach, designed to keep the commissioners happy in terms of figures.  I think the worst example of this, was when a “Welcome Group” was planned which gave “due consideration in terms of numbers of people who could drop out” and asked 15 people to attend.  The room’s capacity in terms of seating was only 12, but in fact, 45 people attended and this would have been more if inclement weather had not prevented others from attending.  This was put down to a mistake with the figures and in the following week, only 3 attended the course.

Courses routinely had the obligatory people who presented with alcohol or drug problems and it was a regular occurrence that either one or the other would disrupt a group.  I once had a complaint made against me by a member of a group who felt that I had not been supportive to her situation and had been tearful and had had to go to the Ladies’ to recover.  I asked my colleague to accompany her.  I was rounded upon by the drunk in the room, who jeered and berated me for “making her cry” and that I should be ashamed of myself.  I told this inebriated person that he may not attend the next session and for this I was abused verbally.  I felt quite threatened, but was asked to explain my actions at a later date, when the complaint came in.  The situation was seen to be “one of those things” but my efforts to point out that anyone with either drug or alcohol problems should not have any place in a depression group, were largely ignored.  I had argued that anyone who had not made some kind of recovery from either drug or alcohol issues should not be permitted to attend a step 2 group, because they would not benefit and could possibly disrupt a group.

Anonymity protected – Dr Mike Scott

Developing Groupwork – An Exercise in Storytelling

Shifting the therapeutic focus from ‘classes’ to a shared narrative has greatly resonated with attendees at my ‘Delivering Group CBT’ workshops this year. My message has been if you are running a group make sure participants have the same story.

 

Social groups are formed by people having the same story e.g Labour Party supporters or Church groups. Therapeutic groups with diverging narratives are likely to run into difficulties.  Consider an anxiety group which includes a person with OCD, another group member with say generalised anxiety disorder , might well consider the OCD person as ‘weird’, become fearful that they will ‘catch’ the same disorder and drop out of treatment.  The therapists leading the group might well find that they are stretched too far in having to cater sufficiently for the person with OCD, yet simultanously keep other group members involved throughout.

Diagnosis is simply a way of ensuring people share the same story i.e the cognitive model of the particular disorder. There are free ‘storybooks’ for depression, the anxiety disorders and PTSD in the ‘Resources’ section of this site, which can form the content of group sessions.

Thus all members of a panic disorder group would be taught not to be ‘bullied’ by the panic attacks, but to gradually ‘dare’ go to places that they have historically avoided both within and outside the group session. The story-telling rationale ‘chunky CBT’ lends itself more to the use of  metaphor e.g ‘being bullied’, rather than talking class room style about say ‘the fight and flight response’.

Dr Mike Scott

Disseminating Group CBT – What You Need To Know

Clients often have similar stories, so it is a no-brainer to treat those with the same story in a group. But groups can go badly wrong – a colleague of mine was unavailable to lead a group because of illness, one of the group ‘stepped-in’ and ran the group at his flat, suggesting that he would be a much better group leader!

On September 6th I am giving a 1 Day Workshop on Delivering Group CBT to Bedford IAPT, one of many I have delivered to BABCP local Groups and IAPT. In 2013 when I gave the workshop in Copenhagen I discovered that  there Group CBT is the usual mode of service provision and therapists have to justify individual therapy, they found it surprising that in the UK we  did not operate that way. There are free group materials for depression, anxiety disorders and PTSD if you click the Resources button on this site, from Simply Effective Group Cognitive Behaviour Therapy (2011) London: Routledge. The Workshops have raised a whole host of questions that might be worth discussions in your locality and/or on this forum:

 

 

The learning objectives for the Delivering Group CBT workshop are for attendees to be able to answer most of the following questions by the end of the day:

  1. How do we ensure that we don’t play a numbers game with regards to groups?
  2. Why not admit all-comers?
  3. Aren’t classes a better use of resources than groups?
  4. How do we select the right people?
  5. Is group CBT really an answer to a Manager’s prayer?
  6. How do you identify and circumvent special problems in marketing group CBT?
  7. How can you integrate individual and group cbt?
  8. What is the structure of a session?
  9. What might the session by session content look like for depression and the anxiety disorders?
  10. How do you capitalise on group members assembling and/or departing?
  11. Do you have to specify groundrules?
  12. How do I handle clients with more than one disorder/difficulty in a group?
  13. How do you handle the difficult client?
  14. How do I know if the group is making a socially significant, real world difference?
  15. Which groups are best to start with?
  16. How do I manage group processes?
  17. How can I know whether I am managing group processes well?
  18. How does group cbt compare to individual cbt in terms of effectiveness?
  19. What if you are expected to run a group alone?
  20. How do you divide up the work between leader and co-leader?
  21. How should leader and co-leader debrief each other?
  22. Can you really do Socratic dialogue in a group?
  23. Are there advantages to a story telling/narrative approach in groups?
  24. What are useful materials?
  25. What can you do if your supervisor has no experience of group CBT?                                                    Dr Mike Scott