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GROUP PROTOCOL: I DON’T BELONG HERE
I Don’t Belong
Here is a group designed to focus on the pre-contemplation stage within the
“Stages of Change” model through the use of motivational interviewing
interventions. This group will enhance the recipient of care’s intrinsic
motivation to change by exploring and resolving resistance. Motivational interviewing
acknowledges and emphasizes the notion that, the person who is resistant to
treatment needs to begin by expressing their perspective, both the positive and
negative aspects, in order to develop discrepancy as a way to support
change. Hence, this group will recognize
the uniqueness of each recipient of care by acknowledging their feelings and
experiences related to their current hospitalization. The group should build on the four principles
of MI: Express Empathy, Support
Self-Efficacy, Develop Discrepancy and Roll with Resistance within a
conversational model. The collaborative approach of motivational interviewing
(MI) and Stages of Change Module (SCM) will guide the Therapist, to help the
recipients’ of care (“ROC”) to consider the possibility of change, contemplate
the risks and benefits of change, and prepare for moving forward with the
identified change in their life.
The therapist is cautioned to remain aware of how avoidance can derail this
provide a “safe” environment
-To establish and continue to build therapeutic rapport
have the ROC express their feelings (both negative & positive) about being
in a psychiatric setting.
develop discrepancy between current behavior and healthy alternatives
of care will express their thoughts and feelings related to their
hospitalization within a psychiatric setting.
of care will acknowledge that their opinions have been heard as reported by
of care will be able to verbalize the pros and cons of the behavior that
preceded their hospitalization and consider the elements of each.
will be more receptive to the possibility of change.
of care should be identified by the treatment team as in the pre-contemplative
stage of change, in denial, or resistant to recovery based treatment.
of care should be organized enough to sit through the duration of the group
even if they chose not to speak.
of care should be alert to time, person and place.
The recipient of
care will be selected by their treatment team, given their assessment of being
in the pre-contemplative stage of change and referred to the group, “I Don’t
members have arrived, the group leader begins with introductory interventions
that get the group members to make small talk and share their names. Ice breaker exercises that allow the
recipients to get to know each other should be incorporated at this point.
portion of the group the leader should ask the group members how long they have
been in the hospital. Take note of those
recipients with a longer length of stay, as their experiences can be utilized
later in the group.
1 - Development
a go round share should explore why the group members feel that they should not
be here (in the hospital) with further exploration about the situation that
occurred prior to their hospitalization.
should follow to identify some of the ways that a hospital can help a person.
members have shared, the group leader should ask for one volunteer to share
their story the following week in order to further explore their experience.
-The take away
worksheet should then be given out to each member with instructions to complete
it and bring it to their next treatment team meeting.
-A brief review
of the worksheet should tie in what the members talked about during the
group. Ask each member to identify and
write down 3 reasons that they shouldn’t be in the hospital and 3 things that
might be helpful about their hospitalization.
should then ask the members to share something that they felt was valuable from
2 - Development
should then reflect back on the beliefs and perspectives that were expressed in
the previous group. New members should
be allowed to express their own feelings and the circumstances that led to
their hospitalization. Normalization and
universality are the goals for the facilitator without moving to discussing
white board, the facilitator should get the previous weeks member to complete a
“pros and cons” list of things related to their experience. Additional items should be pulled from the
other members of the group to enhance the list.
afterwards should developing discrepancy between the cons and the pros.
3 - Development
should then reflect back on the beliefs and perspectives that were expressed in
the previous 2 groups. New members
should be allowed to express their own feelings and the circumstances that led
to their hospitalization. Reflection and
empathy should be the goals of the facilitator.
example should be utilized in a role play.
If the recipient who gave the example is not present, another example
should be pulled from the group. The
leader should facilitate a role play where the ROC plays both him/herself and
the other people in their experience.
Utilizing other members of the group to play additional roles in the
experience is encouraged.
continues to build on the discrepancy between what happened and a more
therapeutic approach to what could happen.
should ask the members to discuss the worksheets that have been given out and
their experience of bringing them to their treatment teams. Their responses should be processed in a way
that encourages continued communication with their teams.
group interventions will be evaluated and subsequent
recommendations/modifications determined on the basis of multiple factors,
self-report during the discussion phase of the group, during treatment team
meetings, and in individual discussions (i.e., change in reported attitudes).
observation of the consumers’ level of functioning during and outside of groups
(i.e.: changes in observed behaviors).
changes in engagement or perspective connected with group participation and
engagement in their recovery reported to or observed by other staff.
I Don’t Belong
Reasons why you should not be in the hospital:
Things that are helpful while in the hospital:
this to your next Treatment Team and share with them your thoughts.