INPATIENT GROUP FACILITATION GUIDE: STAFF DEVELOPMENT …
[Pages:167]INPATIENT GROUP FACILITATION GUIDE: STAFF DEVELOPMENT AND PROCESSING,
CONNECTING BODY AND BRAIN
by
Susan D. Lee B.A., University of British Columbia, 1997
PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF EDUCATION IN COUNSELLING
UNIVERSITY OF NORTHERN BRITISH COLUMBIA April 2017
? Susan D. Lee, 2017
INPATIENT GROUP FACILITATION GUIDE
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Abstract The purpose of this project is to provide resources for staff development and inpatient group facilitation. The project begins with a literature review on the history and evolution of inpatient group therapy, therapeutic goals and expectations. The effects of patient transference, facilitator countertransference, attachment theory, and social engagement is examined with a focus on the body and brain connection and what it means to be traumainformed. Evidence-based theoretical approaches that provide safety and stabilization are described and integrated for group members and practitioners alike. Included is a description of the format of the guide, target audience, goals, and resources. Lastly, the resource guide itself contains a list of specialized staff training, short staff development sessions, and safety and stabilization techniques for acute care group therapy.
INPATIENT GROUP FACILITATION GUIDE
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TABLE OF CONTENTS
Abstract
ii
Table of Contents
iii
List of Table and Figures
vii
Acknowledgement
viii
Chapter 1: Introduction
1
Purpose and Rationale
2
Differences between inpatient and outpatient groups
3
Ongoing training and self-awareness for facilitators
5
Clarification of Terms
6
Personal Location
11
UHNBC: Adult psychiatric unit
11
Staffing, programming, and group structure
12
My facilitation experience
15
Complications
16
Summary of Chapter One
19
Chapter 2: Literature Review
20
History
20
Clinical efficacy
21
Outpatient Group Setting
22
Screening
23
Inpatient Group Setting
25
Goals of Inpatient Therapy
26
Safety and stabilization
27
Significance of cohesion
28
Facilitator self-disclosure and transparency
29
Transference and countertransference
30
Attachment Theory and Social Engagement
32
Secure
32
Preoccupied
33
Dismissive-avoidant
33
Fearful-avoidant
33
The Brain: Bottom-up or Top-down
36
Autonomic nervous system and polyvagal hierarchy
38
Window of tolerance
39
Corrective experiences
41
Trauma Informed Practice
42
Trauma and psychiatric patients
43
Three pillars of trauma-informed care
43
Problem of cohesion and single sessions
45
INPATIENT GROUP FACILITATION GUIDE
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Theoretical Approaches and Interventions
45
Here-and-now
46
Sensorimotor psychotherapy
48
Psychoeducational groups
49
Interpersonal approach
50
Process-oriented psychoeducational model (POP)
51
Training, Support, Personal Reflection and Awareness
53
Co-facilitation
54
Self-care
55
Summary of Chapter Two
57
Implications for groups
57
Implications for facilitators
58
Chapter 3: Project Description
59
Target Audience
59
Resource Guide Goals
59
Expectations of Group
60
Summary of Chapter Three
61
Chapter 4: Resource Guide
62
Part A: Twelve 30 Minute Sessions for Staff Development
62
The Power of Vulnerability
63
What's your attachment style?
64
Balanced life: POD
68
Understanding self-disclosure, ambiguity and blind spots
through the Johari Window
69
Six core strengths for healthy development
74
Awareness, expression and location
75
Listening to Shame
78
TIP Personal preparation plan
79
Addressing countertransference self-assessment
80
Hazards self-assessment
81
Building and maintaining support
82
Safety in groups
83
Issues of special concern
84
Part B: Safety and Stabilization Techniques
85
Do's and don'ts of trauma-informed inpatient group work
86
How to facilitate a large group daily check-in
87
How to facilitate a somatic and process-oriented
psychoeducational (POP) group
89
How to facilitate a reintegration (higher level) process group
92
How to facilitate a relaxation group
95
Part C: Training and Networking
97
Continuing Education and networking opportunities
97
Online Resources
98
INPATIENT GROUP FACILITATION GUIDE
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References
100
Appendix A: Belly Breathing
111
Appendix B: Mindful Breathing & Various Breathing Techniques
112
Appendix C: 33 Quick Ways to Ground
114
Appendix D: Learning the Language of the Body--Sensations
116
Appendix E: Movement and Connection with the Body
117
Appendix F: Movement and Checking-in with the Body
118
Appendix G: Redirecting onto a Positive or Productive Pathway
120
Appendix H: Containment Imagery Exercise
121
Appendix I: Visualization of a Safe Place
124
Appendix J: 4 Elements Exercise
125
Appendix K: S.M.A.R.T. Goals
128
Appendix L: Food and Anxiety
129
Appendix M: Sleep Hygiene
131
Appendix N: Skills and Strategies for Teaching Self-care
134
Appendix O: Feeling Cards
136
Appendix P: Feeling Wheel
137
Appendix Q: Self-care Wheel
138
Appendix R: The Grieving Wheel
139
Appendix S: The Medicine Wheel
140
Appendix T: Attachment Styles
141
Appendix U: Relationship Questionnaire (RQ)
143
Appendix V: Johari Window
145
INPATIENT GROUP FACILITATION GUIDE
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Appendix W: TIP Preparation Plan for Facilitators
150
Appendix X: Addressing Countertransference Self-assessment
151
Appendix Y: Hazards Self-assessment
153
Appendix Z: Building and Maintaining Support Self-assessment
155
INPATIENT GROUP FACILITATION GUIDE
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Table and Figures List
Table 1: Factors that affect group psychotherapy in outpatient
23
and inpatient settings
Figure 1: Dimensional model of adult attachment
34
Figure 2: Bottom-up: Development of brain states
37
Figure 3: Brain development stages and corresponding capabilities
37
Figure 4: Porges' view of the ANS
38
Figure 5: Three zones of arousal: A simple model for understanding
regulation of automatic arousal
40
Figure 6: Three pillars of trauma-informed care
44
INPATIENT GROUP FACILITATION GUIDE
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Acknowledgements Sincere thanks to my committee members for their guidance and contribution to this project. A special thank you goes to my supervisor Dr. John Sherry, I am very grateful for his direction, reassurance and challenge, and especially for shared laughter along the way.
Thanks to the remarkable psychiatrists, staff and patients at University Hospital of Northern British Columbia (UHNBC) whom I have had the pleasure to work closely with over the years and who inspired me to develop this resource guide.
Thank you to my boys Ayden and Adam and my husband Troy for loving me and giving me their gifts of time, space and encouragement to finish my Master's degree, and finally complete this project! And thank you to the special ladies who endeavor to keep me sane by supplying support and laughter, chocolate, wine or coffee as required. I am indeed blessed with precious people who share my pain, remind me I am not alone, and more importantly, that we all have something to offer; individuals that when together bear witness to the power of hope.
When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions,
or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand. ~ Henri Nouwen
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