A Structured Approach to Introducing Residents to Group Therapy Leadership

Abstract

To the editor: Group therapy is an effective aspect of treatment for psychiatric illness, allowing for efficient delivery of care within the context of an acute hospitalization. Brief hospitalizations have become the norm and created more pressure to acutely stabilize, refer, and discharge patients. Group-based modalities are a significant part of inpatient treatment, which psychiatrists are less likely to lead [1]. As inpatient units are common training sites, many residents feel group therapy is underemphasized and would prefer more time leading groups [2]. With fewer psychiatrists directly involved in group-based treatments, attendings that are comfortable educating residents in group therapy are few and far between. As trainees graduate, they too participate less frequently in group therapy, leading to perpetuation of the cycle [3]. Here, we propose an easyto-implement protocol to begin addressing this gap in group therapy training. The setting for this educational experience is a 4-week inpatient rotation during post-graduate year 1. At the start of the rotation, the resident is paired with a seasoned group therapist (an occupational therapist (OT) or licensed clinical social worker (LCSW)) who closely supervises the resident as a “group mentor.” In week 1, The LCSW/OT meets with the resident to discuss structure and concepts for groups. Residents read a short chapter on group dynamics and leadership [4], and are provided an evaluation form (available from the authors) which dually serves as a rubric that outlines the structure and characteristics of a successful group. This concrete explanation of the process was found to help residents feel more competent leading the group. During week 2, the resident observes the groupmentor lead a group. The mentor provides the resident a brief outline of the group so that they may follow along while observing. The trainee should focus on the structure of the group and the skills the leader uses to manage and direct learning. Afterwards, the resident and leader meet to debrief, discuss questions the resident has about the structure, techniques for handling unexpected or disruptive comments or behaviors, and potential or actualized adaptations to the plan. After observing the group, the resident creates an outline and materials for the group they will lead and discusses it with the group mentor. Residents are encouraged to be creative and the topic is left up to the resident with close supervision. The therapeutic aims and topics created have been remarkably unique and diverse, including groups about anger management, impact of social media use, and sleep hygiene bingo. During the final week, the resident leads the group. The group mentor is present and if needed serves as co-facilitator. Ideally, the attending also attends to maximize feedback. The LCSW/OT and attending will frequently participate (as opposed to passively observing), which can help keep the group on-task. Afterwards, the group mentor and attending provide constructive appraisal, for which the evaluation form can serve as a supplement to aid in the feedback process. In an IRB-exempt anonymous survey, we asked the 4 other trainees (excluding author ZH) to provide their preand postexperiences of the program. We received 3 responses, all of which were overwhelmingly positive. Feedback from one resident stated “I had a blast. It was a fantastic learning experience and really helped me to grow outside of my comfort zone”. This experience introduces residents firsthand to the structure, process, and types of activities performed in group therapy. This is useful for leading groups and for discussing group treatment options with patients and families. Furthermore, there are unique diagnostic experiences gained. For instance, observing patients within a peer-group social setting can clarify neurocognitive, personality, and social-emotional deficits and strengths. These insights can aid in clarifying diagnoses and allow trainees to better understand the needs and progress of patients beyond brief one-on-one encounters. As one * Hun Millard [email protected]