RATIONALE
Adolescence is a time in life marked by conflicts, which lead to considerable anxiety and feelings of being separate and different, but when complicated by the onset of a psychosis, the conflicts are significantly greater and different. Onset of psychosis is also a form of severe trauma to the maturing identity of an adolescent and a young adult. Adolescents and young adults with psychotic disorders can benefit from having a place to openly explore a range of developmental and psychosis related concerns. Young people, being treated for their first episode of psychosis, need to know how to cope with the transition to adult life in terms of freedoms and responsibilities and how to adjust their young lives so as to minimize the impact of psychosis on their growth and development . A group of adolescents and young adults (15-24) can provide the opportunity to share common problems and to find ways to make responsible choices.
GOALS AND OBJECTIVES
The group is a place to gain support and understanding of the personal difficulties that each member is facing in dealing with conflicts and issues around treatment of psychosis. Participants will be encouraged to examine their values, behaviours, and relationships as it has an impact on their lives and is also relevant for symptom management. It will be up to the individual member to decide how much personal information he or she wishes to share with the group members.
The following are some general goals that help provide direction for individual members:
- To grow in self-acceptance and respect.
- To learn about psychosis in order to make treatment and other personal decisions based on the most up-to-date empirical findings about psychotic symptoms and their management.
- To explore ways of applying what is learned in the group to everyday situations encountered by young people.
- To provide and obtain support amongst peers who have similar experiences and concerns.
- To reduce the risk of future episodes of psychosis.
- To resume optimal functioning and positive approach to life as soon as possible.
TYPE OF GROUP
- This is a supportive group with an educational component for young clients between the ages of 15-24 who have experienced a first episode of psychosis.
- This group is not designed to treat persons who have been living with long-term mental illness. Instead, it is aimed at preventing further episodes of psychotic experience amongst those with recent onset.
- The group is time limited (8 weeks) and will consist of no more than six to ten members at a time.
- The group is led by two co-leaders who otherwise assume case management roles in the PEPP Program.
- The group meets weekly for two hours in the afternoon for eight weeks.
- It is preferred that prospective members not join the group unless they started with the first session.
- Membership is voluntary.
- A pre-requisite for joining this group is admission to the PEPP Program and completion of an individual screening and orientation to the group.
- Once the members have been assessed, there is a preliminary session designed to get acquainted with one another and to prepare the participants for a productive group experience. After this pre-group session, those participants who decide to participate in the group will be asked to make a commitment to attend all sessions for the eight-week period.
BASIC GROUND RULES
The group operates under the following rules:
- Members are expected to attend all the sessions and to participate at a level that is comfortable to them. Group members will, however, be reminded that making an effort to share and give feedback will most likely benefit them personally as well as others in the group.
- Members are asked to make an eight-week commitment, and if for some untoward reason the member cannot attend, he/she will contact one of the leaders so the information can be shared with all the members.
- Members must maintain the confidential disclosures of other group members.
- Members will come to group meetings drug and alcohol free.
- Members are asked to remain in the group room as much as possible. Juice, tea, coffee and snacks are provided at the scheduled break.
CRITERIA FOR INCLUSION
Persons with first episode psychosis treated in PEPP.
- Persons whose symptoms are sufficiently stabilized and are judged to be able to meet the cognitive demands of the group.
- Persons who can commit to two-hour weekly sessions for eight weeks.
GROUP SESSIONS AND THEMES
Each session is divided into two segments. The first hour is spent in exploring the theme of the session. The second hour is spent in providing information about a specific aspect of psychosis which is related to the theme. The group facilitators (leaders) will make use of a variety of media to convey educational material to members. The following is an outline of the themes and education provided in YES.
Session 1: Introduction (goals and expectations
- Acquaint group members with each other via 'ice breakers'
- Write a 'Dear Me' letter
- Review ground rules
- Discuss goals
- Intro to 'check out' exercise
Session 2: Self-Identity and What is Psychosis?
- Intro to 'check in' exercise
- Intro to theme
- Who am I exercise (profile)
- Discussion of profiles
- Film: 'Get Help Early'1 or 'First Break'2 (depending on group members)
- Check out exercise
Session 3: Peer Pressure and Drug and Alcohol Use
- Check in exercise
- Into to theme
- Film - 'The Truth About Drinking'3
- Film - 'Marijuana: Its Effects on Mind & Body'4
- Jeopardy game (facts about drugs and alcohol)
- Check out exercise
Session 4: Relationships and Medications
- Check in exercise
- Intro to theme
- Discussion - hassles with parents
- Small group work- psychological and physical side effects
- Review of medications
- Check out exercise
Session 5: Stigma and Strategies
- Check in exercise
- Intro to theme - what is stigma?
- Small group work - stigma at home, school work
- Film - 'One in Five'1
- Role playing situations - questions about illness, meds, etc.
- Check out exercise
Session 6: Social Skills and Recovery
- Check in exercise
- Intro to theme
- Identifying social deficits - 'depressed lady'
- Role play scenarios
- Check out exercise
Session 7: Return to School and Work and Early Warning Signs
- Check in exercise
- Review of skills necessary to return to work and school, i.e., attention
- Early warning signs - personal profile - printout of personal prodrome list check out exercise
Session 8: Review and Celebration
- Check in exercise
- P.S. to 'Dear Me' letter
- Discussion of any material from previous sessions
- Pizza and movie (according to group consensus with discretion)
The documentation for the client's participation in each session is stored in the client's file. The documentation is completed on a standardized form which provides a brief account of the member's contribution to the theme. It also provides for comments as to the client's needs and strengths. The client's case manager will be notified immediately when any group member demonstrates increasing symptomatology and/or expresses suicidal ideation. Group members are encouraged to maintain ongoing contacts with co-members.
1 EPPIC Program, Dr. Patrick McGorry, University of Melbourne, Melbourne, Australia
2 National Film Board of Canada
3 Canadian Learning Company, The Teen Files Series
4 Schlessinger Video Productions, Library Video Company
