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