Therapy Requirements, Possible Applications, and Indication




© Springer International Publishing Switzerland 2015
Volker Roder and Daniel R. Müller (eds.)INT-Integrated Neurocognitive Therapy for Schizophrenia Patients10.1007/978-3-319-13245-7_3


3. Therapy Requirements, Possible Applications, and Indication



D. R. Müller  and V. Roder 


(1)
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland

 



 

D. R. MüllerSenior Lecturer (Corresponding author)



 

V. RoderProfessor of Clinical Psychology (Corresponding author)




Additional material (CD-ROM) to this book can be downloaded from http://​extras.​springer.​com


The implementation of INT depends on various institutional conditions, which will be discussed in this chapter. In addition, the qualifications of the therapist team, characteristics and group composition of the patients have to be taken into account when planning an INT group. The chapter will conclude with a discussion from the point of view of differential indication of whether patients, on the basis of symptoms and treatment types, should be referred to INT or to other group interventions developed by our team. These include Integrated Psychological Therapy (IPT; Roder et al. 2008a, 2010) or the therapy programs targeting vocational, residential, and recreational domains (WAF; Roder et al. 2008b).


3.1 Setting Conditions


The general infrastructural requirements for implementing an INT group (room conditions, computers, materials) have already been addressed in Sect. 2.​1. The question now is which types of institutions are suitable for INT’s clinical implementation.


3.1.1 Types of Institutions


Hitherto, INT was implemented primarily in the context of outpatient and day-care treatment: outpatient clinics, day clinics, and (vocational) rehabilitation centers. Additionally, INT is also suitable as part of long-term treatment planning for the aftercare-treatment of patients currently treated in hospital. Such patients can already join the INT group before exiting the hospital and then continue to participate in the group after discharge. However, the requirements of group composition should be taken into account (Sect. 3.3). Additional considerations need to be made with respect to local and institutional treatment options as well as the implementation type of open or closed groups.


3.1.2 Intra-institutional and Inter-institutional Options


Within the boundaries of local psychiatric care, it is sometimes difficult to recruit enough patients so that the optimal group size of five to eight participants is reached within a limited time frame. The therapists must then resort to recruiting patients from other institutes – for example, patients from different outpatient clinics and day clinics. Also, registered doctors and rehabilitation centers within a region often lack the opportunity to offer comparable (group) interventions. Assuming there is close collaboration between institutions and practicing health care professionals within the regional area of psychiatric care, patients can be assigned to an INT group from within a large district. In our clinic in Bern, some participants travel a distance of up to 60 km to their group appointments. This entails great motivation and a high level of expectation, both on the part of the patient and the patient’s referrer.

Implementing intra-institutional and inter-institutional groups demands significant collaboration between the INT therapist team, the referrer (e.g. psychologists, psychiatrists, general practitioners) and the service providers. Given that it is likely that the patients do not know each other at the beginning of the treatment under such recruitment conditions, the therapists must be actively engaged in promoting a sustainable therapeutic relationship and group cohesion (Sect. 2.​5 “Motivation Building, Forming Relationships, and Group Processes”).


3.1.3 Intra-institutional Options


It is favorable for the psychotherapeutic treatment to establish INT as an intra-institutional option, for example, at an outpatient clinic or a day clinic. This ensures close interaction between the group therapists and the interdisciplinary team, and it permits integration of INT into the institution’s treatment and rehabilitation concept. The specific effects of treatment on patients’ everyday lives can then be further addressed between INT sessions. Since group members from the same institution are likely to know each other, building up group cohesion is substantially simplified. If any substantial prior differences exist among group members, these differences should be addressed outside the INT program.


3.1.4 Closed or Open Groups


The advantages of closed groups are obvious: each participant enters and leaves the group at the same time; each participant acquires the same amount of knowledge and coping strategies, which are practiced to the same extent. Thus, group cohesion tends to be stable. Closed groups are offered cyclically as a rule. When one group ends, the next begins. If a group has begun, subsequently referred patients are to be put on a waiting list for the following group. The closed group format is generally preferred over an open group format for patients who are able to meet for a sustained period of time.

In clinical reality however, closed groups can only be offered occasionally. This may be due to limited referral rates in small institutions or the stipulation that waitlists be avoided in order to guarantee each patient the same access to treatment within a short span of time. For these reasons, INT is also increasingly being offered as an open group. Entry and exit are possible at any time (although a certain degree of participant constancy has to be ensured for a period of time). Yet the high level of flexibility offered in an open group format has its disadvantages. It is more difficult to achieve group cohesion, and the participants are more diverse with respect to their stage of learning and insight. Also, it is harder to assess how each entry and exit affects group processes, as compared to the closed group format. As countermeasures, the therapist team might consider the adaptations to the recruitment process described in Chap. 2 (admission interview, trial session, group rules), increased session structuring compared to closed groups, or a circular repetition of therapy contents. For example, the topic of emotional perception from Module A can be recapitulated at the beginning of the introductions to social perception in Module B and to attribution in Module D. Open groups always place greater demands on the therapists when dealing with group dynamics and group processes, as compared to closed groups (Sect. 3.4).

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Sep 24, 2016 | Posted by in NEUROLOGY | Comments Off on Therapy Requirements, Possible Applications, and Indication

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