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

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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.

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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

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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

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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

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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

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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

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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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